Epilepsy is one of the most common neurological diseases, and symptomatic epilepsy patients are the main group of epilepsy patients, and their etiologies mainly include structural, infectious, metabolic and autoimmune, and the seizures caused by each etiology may have different degrees of impact on the quality of life of patients. The purpose of this article is to review the research on the quality of life of patients with symptomatic epilepsy caused by structural and infectious etiologies, including cerebrovascular diseases, neurodegenerative diseases, brain tumors, traumatic brain injuries and neurocysticercosis, in order to help clinicians understand the quality of life of patients with symptomatic epilepsy and benefit patients in clinical practice.
Epilepsy is one of the most common neurological disorders, and surgical intervention is usually used for drug-resistant focal epilepsy. Cortical electrical stimulation is widely used in preoperative evaluation of epilepsy to explore the anatomical-clinical electrical correlations between epileptogenic and functional networks through electrical stimulation, and the functional brain maps produced by cortical electrical stimulation depict areas of the functional cortex at an individual level, identifying the functional cortex with greater precision, as well as helping to establish epilepsy network, enabling more precise localization of seizure zones and providing a more accurate localization for surgical resection. Electrical cortical stimulation has become a standard technique for the preoperative assessment of brain region function in brain surgery. It is an indispensable part of preoperative evaluation.The main types of functional mapping by electrical stimulation include stereoelectroencephalography (SEEG) and subdural electrode (SDE), SEEG-guided cortical electrical stimulation is gradually becoming more mainstream compared to subdural electrodes, and is increasingly valuable and important as a preoperative evaluation of epilepsy. It is increasingly demonstrating its value and importance because it avoids craniotomy, takes less time for surgery, has fewer associated complications and infections, and can explore deep lesions, increasing the understanding of human functional neuroanatomy and enabling more precise localization of seizure zones.This article reviews the history of the development of cortical electrical stimulation technology, the intrinsic mechanisms, the value of the application of SEEG, and also provides a comprehensive comparison between SEEG and SDE, despite the irreplaceable advantages of SEEG, attention should be paid to the unresolved clinical and scientific issues of SEEG, and the establishment of a consensus-based clinical guideline, as the application of this technology will be more widely used in both clinical and scientific work.
ObjectivesTo systematically review the influence of antiepileptic drugs on bone mineral density and bone metabolism in adults.MethodsPubMed, EMbase, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect studies on the influence on antiepileptic drugs on the bone mineral density and bone metabolism in adults from inception to April 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 studies were included. The results of meta-analysis showed that: VPA could decline the bone mineral density of lumbar spine (SMD=–0.39, 95%CI –0.65 to –0.13, P=0.003); CBZ (SMD=–0.71, 95%CI –1.08 to –0.33, P=0.000 2) and VPA (SMD=–0.3, 95%CI –0.58 to –0.02, P=0.03) could decline the bone mineral density of femoral neck; CBZ could decline the bone mineral density of total hip (SMD=–0.47, 95%CI –0.84 to –0.10, P=0.01). Serum 25-hydroxy vitamin D3 was decreased in OXC group (SMD=–0.67, 95%CI –1.28 to –0.05, P=0.03); serum calcium was decreased in CBZ (SMD=–0.49, 95%CI –0.78 to –0.20, P=0.000 8), LEV (SMD=–0.83, 95%CI –1.15 to –0.51, P<0.000 01) and OXC (SMD=–0.48, 95%CI –0.90 to –0.05, P=0.03) group; serum phosphorus was decreased in LEV group (SMD=–11.36, 95%CI –12.97 to –9.76, P<0.000 01). Serum alkaline phosphatase was increased significantly in LEV (SMD=6.79, 95%CI 5.78 to 7.80, P<0.000 01) and CBZ (SMD=1.90, 95%CI 1.35 to 2.44, P<0.000 01) group.ConclusionsCurrent evidence shows that treatment with antiepileptic drugs may be associated with an decreasing bone mineral density and influence bone metabolism in epileptic adults. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
Objective To investigate the clinical effect and safety study of agomelatine combined with eszopiclone in the treatment of epilepsy complicated by insomnia. Methods 69 epilepsy complicated by insomnia patients were collected in the outpatient of the Department of Neurology, the First Affiliated Hospital of Shanxi Medical University from December 2021 to October 2022. Patients were randomly divided into control group (34 cases) and observation group (35 cases) Patients in control group were given eszopiclone, 1.5 ~ 3 mg (3 ~ 5 times/week). Patients in observation group were given agomelatine 25 mg (1 time/day) and eszopiclone 1.5 ~ 3 mg (3 ~ 5 times/week). Patients in both groups maintained their original anti-seizure medications treatment regimen for 12 weeks during the study. Pittsburgh sleep quality index (PSQI), Insomnia severity scale (ISI), Patient health questionnaire-9 (PHQ-9) and Generalized anxiety disorder-7 (GAD-7) were used to compare differences in subjective sleep quality, insomnia severity, depression and anxiety symptoms before treatment and at the end of 4 and 12 weeks of treatment. The change of seizure frequency before and after treatment was statistically evaluated to assess epilepsy control. The adverse effects after medication were recorded in both groups. Results After 4 weeks and 12 weeks of treatment, the scores of PSQI, ISI, PHQ-9 and GAD-7 of both groups were significantly lower than those before treatment, and the scores of PSQI, ISI, PHQ-9 and GAD-7 in the combined group at the 4th week and 12 weeks after treatment were significantly lower than those in the single-drug group (P<0.05). The incidence of adverse reactions was 13.33% in the single-agent group and 15.63% in the combined group. Conclusions Agomelatine combined with eszopiclone improve subjective sleep quality, insomnia severity, depression and anxiety symptoms of patients more significantly.
Ketogenic diet (KD) is one of the effective treatments for refractory epilepsy (RE) and is recommended when anti-seizure medications (ASMs) are ineffective or less effective, inoperable or ineffective. The efficacy of the medium-chain triglyceride (MCT) ketogenic diet is as good as the classical KD (CKD), which has been demonstrated in several retrospective, prospective, and randomized studies, and MCT is more ketogenic than long-chain triglycerides, so MCTD allows more carbohydrate and protein foods, which makes MCTD more palatable than CKD more palatable. Research advances in the mechanisms and clinical efficacy associated with MCTD in the treatment of refractory epilepsy are reviewed.