Attention-deficit/hyperactivity disorder in children with epilepsy: A systematic review and meta-analysis of prevalence and risk factors.

OBJECTIVE: To evaluate the prevalence of and risk factors for attention-deficit/hyperactivity disorder (ADHD) in children with epilepsy (CWE). METHODS: We conducted a systematic search in PubMed and Embase for the meta-analysis. The pooled prevalence of ADHD was calculated using a random-effects model; subgroup analyses were performed to explore heterogeneity. We collected raw data from articles reporting potential risk factors, which were included in the subsequent risk factor analysis. RESULTS: Forty-six articles met the inclusion criteria for the meta-analysis, which showed a pooled ADHD prevalence of 30.7% in CWE, with a predominance of the inattentive subtype of ADHD; the heterogeneity of prevalence was related to population source/study setting (clinic based, community based, or database based) and method of ADHD diagnosis (with or without clinical review). Risk factors for ADHD in epilepsy included younger age, intellectual/developmental disabilities, a family history of epilepsy, earlier epilepsy onset, absence epilepsy, more frequent seizures, and polytherapy; In contrast, risk factors such as sex, generalized epilepsy or seizures, epilepsy etiology, and electroencephalogram abnormalities were not significantly associated with the occurrence of ADHD. SIGNIFICANCE: The prevalence of ADHD in CWE is high and several potential risk factors are associated with it. This study contributes to a better understanding of ADHD in epilepsy for screening and treatment. PLAIN LANGUAGE SUMMARY: This systematic review summarizes the prevalence of attention-deficit/hyperactivity disorder (ADHD) occurring in children with epilepsy and analyses the risk factors for comorbid ADHD in epilepsy. By reviewing 46 articles, we concluded that the overall prevalence of ADHD in children with epilepsy was 30.7% and that intellectual/developmental disabilities were the most significant risk factor for combined ADHD in children with epilepsy. This study provides a wealth of information on comorbid ADHD in epilepsy, which will help clinicians identify and treat potential ADHD in children with epilepsy in a timely manner.

Atypical absence seizures and gene variants: A gene-based review of etiology, electro-clinical features, and associated epilepsy syndrome.

Atypical absence seizures are generalized non-convulsive seizures that often occur in children with cognitive impairment. They are common in refractory epilepsy and have been recognized as one of the hallmarks of developmental epileptic encephalopathies. Notably, pathogenic variants associated with AAS, such as GABRG2, GABRG3, SLC6A1, CACNB4, SCN8A, and SYNGAP1, are also linked to developmental epileptic encephalopathies. Atypical absences differ from typical absences in that they are frequently drug-resistant and the prognosis is dependent on the etiology or related epileptic syndromes. To improve clinicians' understanding of atypical absences and provide novel perspectives for clinical treatment, we have reviewed the electro-clinical characteristics, etiologies, treatment, and prognosis of atypical absences, with a focus on the etiology of advancements in gene variants, shedding light on potential avenues for improved clinical management.

Dravet syndrome: Advances in etiology, clinical presentation, and treatment.

Dravet syndrome (DS) is a form of genetic refractory epilepsy. More than 80 % of DS patients carry pathogenic SCN1A mutations, and this percentage is actually higher due to false-negative results in gene testing. Potential genotype-phenotype correlations may exist but require further confirmation. "SCN1A mutation-mediated dysfunction of NaV1.1 affects GABAergic inhibitory interneurons" is currently the most accepted pathogenesis. Besides SCN1A, there are other genes associated with DS-like phenotypes, among which GABAA-receptor subunit genes have recently received more attention. Most DS patients experience prolonged, hemiclonic or tonic-clonic seizures triggered by fever during the first year of life, followed by the gradual onset of other seizure types, including myoclonic, atypical absence, and focal seizures. Over time, seizures tend to become less frequent and severe but generalized tonic-clonic seizures remain. DS also has many comorbidities, including motor, cognitive, behavior, and sleep impairments, which cause poor quality of life and impact the long-term course. The electroencephalography and neuroimaging of DS lack specificity, but the evolution of electroencephalography may help to identify DS. Current treatments for DS are symptomatic and difficult to control seizures. The combination of valproic acid, clobazam and stiripentol is a commonly used clinical treatment option, fenfluramine and cannabidiol have been used as second- and third-line drugs, respectively. Later therapeutic options include other anti-seizure medications, the ketogenic diet, and vagus nerve stimulation, whereas sodium channel blockers should be avoided in DS. Furthermore, several promising drugs including soticlestat are in development, and genetic therapies are beginning to emerge, representing future treatment directions.

Effects of cefuroxime axetil combined with Xingpi Yanger granules on the serum gastrin, motilin, and somatostatin levels in children with upper respiratory tract infection accompanied by diarrhea: results of a randomized trial.

BACKGROUND: The purpose of the study was to investigate the effects of cefuroxime axetil combined with Xingpi Yanger granules on the treatment of upper respiratory tract infection accompanied by diarrhea and on serum gastrin (GAS), motilin (MOT), and somatostatin (SS) levels in children. METHODS: In total, 124 children with upper respiratory tract infection accompanied by diarrhea admitted to the department of pediatrics in our hospital from May 2019 to May 2020 were selected and divided into a study group (n=62) and a reference group (n=62), according to admission number. The reference group children received routine treatment, while the children in the study group were treated with cefuroxime axetil combined with Xingpi Yanger granules. After treatment, each clinical index of the children in both groups was detected to evaluate the clinical efficacy of the different treatment methods. RESULTS: There were no significant differences in gender ratio, average age, mean body temperature, mean duration of diarrhea, average weight, or place of residence between the 2 groups (P>0.05); the total clinical effective rate after treatment in the study group was significantly higher than that in the reference group (P<0.05); the dehydration correction time, antipyretic time, antidiarrheal time, and total treatment time in the study group were all significantly lower than those in the reference group (P<0.001); the serum GAS and MOT levels at T1, T2, and T3 in the study group were significantly lower than those in the reference group (P<0.001), whereas the SS levels at T1, T2, and T3 in the study group were significantly higher than those in the reference group (P<0.001); and the incidence of adverse reactions of the children in the study group was significantly lower than that in the reference group (P<0.05). CONCLUSIONS: Cefuroxime axetil combined with Xingpi Yanger granules can significantly lower serum GAS, MOT, and SS levels and shorten treatment time in children with upper respiratory tract infection accompanied by diarrhea, with significant clinical efficacy and high safety, and is thus worthy of application and promotion. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100049234.

Rapid cycling bipolar disorder is associated with antithyroid antibodies, instead of thyroid dysfunction.

BACKGROUND: Conclusions regarding the association between antithyroid antibodies or thyroid dysfunction and rapid cycling bipolar disorder (RCBD) have been conflicting. Previous studies suggest that the impact of antithyroid antibodies on mental wellbeing seems to be independent of thyroid function. Here, we investigated their independent association with RCBD in a large, well-defined population of bipolar disorder (BD). METHODS: Fast serum levels of free thyroxine (FT4), free triiodothyronine (FT3), thyroid Stimulating Hormone (TSH), TPO-abs and Tg-abs were simultaneously measured in 352 patients with BD. Clinical features of BD were collected through semi-structural interview conducted by trained interviewers with background of psychiatric education. RESULTS: Neither hypothyroidism nor hyperthyroidism was significantly associated with RCBD. Both TPO-abs and Tg-abs were significantly related to RCBD, even after controlling for gender, age, marriage status, education, antidepressants treatment, comorbidity of thyroid diseases, and thyroid function (serum levels of FT3, FT4 and TSH). Although TPO-abs and Tg-abs were highly correlated with each other, binary logistic regression with forward LR selected TPO-abs, instead of Tg-abs, to be associated with RCBD. TPO-abs was significantly, independently of Tg-abs, associated with hyperthyroidism, while Tg-abs was marginally significantly related to hypothyroidism at the presence of TPO-abs. CONCLUSION: TPO-abs might be treated as a biomarker of RCBD. Further exploring the underlying mechanism might help understand the nature of RCBD and find out new treatment target for it.

The association between low-grade inflammation and the clinical features of bipolar disorder in Han Chinese population.

Variety of evidence suggests that low-grade inflammation may be involved in the pathophysiology of bipolar disorder (BD). However, the conclusion regarding the relationship between inflammation and BD has been inconsistent. In this study, we aimed to survey the prevalence of low-grade inflammation in a large Han Chinese population with BD and assess its impact on the clinical features of BD. 430 eligible cases were drawn from patients who were admitted or had ever been admitted for BD to the inpatient service of the psychiatric department of the Third Hospital of Sun Yat-sen University. Subjects with current active physical diseases or white blood count (WBC) >19.0 × 109/L (2 times the upper reference) were excluded. Serum C-reactive protein (CRP) levels and WBC were measured with fast blood sample. Low-grade inflammation was defined as CRP>3 mg/L or WBC > 9.5 × 109/L(the upper reference). Clinical features of BD were collected through semi-structural interview conducted by trained interviewers with background of psychiatric education. If defined as CRP>3 mg/L, the prevalence of low-grade inflammation among BD was 10.1% (41/404), it was positively associated with BMI (p = 0.012), comorbidity of glycolipid metabolic diseases(p = 0.018). After adjusting for BMI, it was found to be positively related to recent suicide attempt (p = 0.03), initiation with (hypo)manic episode(p = 0.047), leaden paralysis (p = 0.037) and family history of mental disorders(p = 0.012), while the association between comorbidity of glycolipid metabolic diseases and low-grade inflammation disappeared (p = 0.330). If defined as WBC > 9.5 × 109/L, the prevalence of low-grade inflammation was 8.1% (33/409), it was positively associated with psychotic features (p = 0.011) and adverse life events before the onset of illness(p < 0.001), but was not significantly influenced by BMI (p = 0.077). A much lower prevalence of low-grade inflammation in BD is found among Han Chinese population than among western population. Low-grade inflammation of different definition impacts differentially on the clinical features of BD.

Physicochemical characterization of novel aqueous two-phase system: gemini surfactant 12-2-12/NaBr/H2O.

A novel aqueous two-phase system (ATPS) only containing Gemini surfactant ethanediyl-1,2-bis(dodecyldimethylammonium bromide) and an inorganic salt sodium bromide was designed, and the physicochemical properties of the ATPS were investigated systematically. The results have shown that the coexisting two phases, one surfactant-rich and the other salt-rich, are stable and the phase behavior, volume ratio, and extraction efficiency of ATPS are strongly influenced by contents of surfactant and salt. The novel ATPS here investigated have potential application in partitioning and analysis of biomaterials. Compared with other complicated surfactant-based ATPS, the surfactant concentration for the formation of ATPS is much lower, which implies that the studied system is potentially more economical for purification and separation of biomaterials. Meanwhile, the surfactant can be recycled by altering salt concentration in ATPS. Lyotropic liquid crystal was found in the bottom phase besides micelles under different conditions. The salting-out effect may be the driving force of ATPS formation for the studied "living polymer"/salt system. However, the coexistence of micelles with different microstructures is the necessary condition of phase separation. The current studies not only present a new ATPS for partitioning and analysis of biomaterials but also have a great significance on rational use of Gemini surfactants.