Uncovering the neurobehavioural comorbidities of epilepsy over the lifespan

Department of Neurology, University of California at Irvine, Irvine, CA, USA.
The Lancet (Impact Factor: 45.22). 09/2012; 380(9848):1180-92. DOI: 10.1016/S0140-6736(12)61455-X
Source: PubMed

ABSTRACT Epilepsy is a common neurological disorder that is complicated by psychiatric, cognitive, and social comorbidities that have become a major target of concern and investigation in view of their adverse effect on the course and quality of life. In this report we define the specific psychiatric, cognitive, and social comorbidities of paediatric and adult epilepsy, their epidemiology, and real life effects; examine the relation between epilepsy syndromes and the risk of neurobehavioural comorbidities; address the lifespan effect of epilepsy on brain neurodevelopment and brain ageing and the risk of neurobehavioural comorbidities; consider the overarching effect of broader brain disorders on both epilepsy and neurobehavioural comorbidities; examine directions of causality and the contribution of selected epilepsy-related characteristics; and outline clinic-friendly screening approaches for these problems and recommended pharmacological, behavioural, and educational interventions.

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Available from: Jack Lin, Dec 18, 2013
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    • "Generally, comorbidities are associated with poor health outcomes. It is now widely appreciated that comorbidities impact the quality of life in pediatric epilepsy and are evident at or prior to the onset of epilepsy (Lin et al., 2012). "
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    ABSTRACT: Objective Children with epilepsy may have comorbidities that result in significant disability. Epidemiological information for pediatric patients with epilepsy in Taiwan is scant. This research estimates the prevalence and common neuro-psychiatric comorbidities of children with epilepsy in Taiwan. Methods Patients aged less than 20 years old who had received a diagnosis of epilepsy and suffered from epileptic seizures in 2005 were identified in the NHIRD based on ICD-9-CM and prescription records for the use of at least one AED. We used cases of epileptic seizure to survey outpatient service data, and identify common neuro-psychiatric comorbidities. The crude prevalence rate and the age- and sex-specific prevalence were estimated. We also examined the effects of urbanization. Results The estimated prevalence of epilepsy was 0.33% in the pediatric population, with 0.29% for girls and 0.36% for boys. The most common neuropsychiatric comorbidities were learning disability and developmental delay, cerebral palsy, and mental retardation. Epilepsy was more prevalent in boys than in girls, especially among infants, preschool children, and those living in rural areas. In addition, boys with epilepsy had a higher rate of neurological comorbidities. The prevalence of psychiatric comorbidities was lower than that reported in previous studies performed in other countries, especially among children with epilepsy living in rural areas. Conclusion This research provides the largest nationwide, population-based study of childhood epilepsy to estimate the prevalence and the associated neuropsychiatric comorbidities of pediatric epilepsy in Taiwan. Potential rural-urban disparity basing on prevalence and associated neuropsychiatric comorbidities cannot be ignored in Taiwan.
    Epilepsy Research 10/2014; 108(8). DOI:10.1016/j.eplepsyres.2014.07.004 · 2.19 Impact Factor
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    • "Accordingly, whereas scientific efforts previously concentrated on the mechanisms underlying seizures and development of drugs with better efficacy, research has increasingly reflected the recognition that epilepsy is often accompanied by cognitive, psychiatric, linguistic, and social comorbidities [2] [3]. In 2000 and 2007, the NINDS-sponsored Curing Epilepsy conferences in partnership with nongovernmental organizations and other federal agencies assessed the state of epilepsy research and identified needs and new directions. "
    Epilepsy & Behavior 09/2014; 38. DOI:10.1016/j.yebeh.2014.06.035 · 2.06 Impact Factor
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    • "Neurological diseases with onset during critical stages of brain maturation may threaten this orderly neurodevelopmental process. An especially pertinent model in this regard is childhood epilepsy, which is very common and known to affect cognition and behavior with persisting adverse effects on lifespan achievement even if the seizures remit and treatment is stopped [Lin et al., 2012a]. The degree to which childhood epilepsies exert a significant effect on network brain organization and subsequent cognition remains uncertain. "
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    ABSTRACT: Recent neuroimaging and behavioral studies have revealed that children with new onset epilepsy already exhibit brain structural abnormalities and cognitive impairment. How the organization of large-scale brain structural networks is altered near the time of seizure onset and whether network changes are related to cognitive performances remain unclear. Recent studies also suggest that regional brain volume covariance reflects synchronized brain developmental changes. Here, we test the hypothesis that epilepsy during early-life is associated with abnormalities in brain network organization and cognition. We used graph theory to study structural brain networks based on regional volume covariance in 39 children with new-onset seizures and 28 healthy controls. Children with new-onset epilepsy showed a suboptimal topological structural organization with enhanced network segregation and reduced global integration compared with controls. At the regional level, structural reorganization was evident with redistributed nodes from the posterior to more anterior head regions. The epileptic brain network was more vulnerable to targeted but not random attacks. Finally, a subgroup of children with epilepsy, namely those with lower IQ and poorer executive function, had a reduced balance between network segregation and integration. Taken together, the findings suggest that the neurodevelopmental impact of new onset childhood epilepsies alters large-scale brain networks, resulting in greater vulnerability to network failure and cognitive impairment. Hum Brain Mapp, 2014. © 2014 Wiley Periodicals, Inc.
    Human Brain Mapping 08/2014; 35(8). DOI:10.1002/hbm.22428 · 6.92 Impact Factor
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