Mark Robert Keezer

Mark Robert Keezer
Université de Montréal | UdeM · Neurosciences

MDCM PhD

About

154
Publications
18,227
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3,322
Citations
Introduction

Publications

Publications (154)
Article
OBJECTIVE This article reviews the comorbidities of epilepsy and identifies tools to incorporate comorbidity awareness into clinical practice. LATEST DEVELOPMENTS The comorbidities of epilepsy are broadly defined, including conditions that may cause but also be a consequence of epilepsy. These can be divided into somatic and psychiatric conditions...
Article
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Objective Tuberous sclerosis complex (TSC) is a monogenetic disorder associated with sustained mechanistic target of rapamycin (mTOR) activation, leading to heterogeneous clinical manifestations. Epilepsy and renal angiomyolipoma are the most important causes of morbidity in adult people with TSC (pwTSC). mTOR is a key player in inflammation, which...
Preprint
Background: Acute symptomatic seizures (ASyS) increase the risk of epilepsy and mortality after a stroke. The impact of the timing and type of ASyS remains unclear. Methods: This multicenter cohort study included data from nine centers between 2002 and 2018, with final analysis in February 2024. The study included 4,552 adults (2,005 female; median...
Article
Importance How epilepsy may promote cardiovascular disease remains poorly understood. Objective To estimate the odds of new-onset cardiovascular events (CVEs) over 6 years in older people with vs without epilepsy, exploring how enzyme-inducing antiseizure medications (EIASMs) and traditional cardiovascular risk factors mediate these odds. Design,...
Article
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Older adults constitute a large proportion of people with epilepsy (PWE) due to the changing demographics worldwide and epilepsy's natural history. Aging‐related pathophysiological changes lower the tolerance and increase our vulnerability to stressors, which manifests as frailty. Frailty is closely associated with adverse health outcomes. This nar...
Article
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Objectives To report the current elastography methods used to quantify back muscles’ biomechanical characteristics in patients with musculoskeletal disorders (MSKd) and inform on their reliability, validity, and responsiveness. Methods MEDLINE, Embase, CINAHL, Cochrane library and grey literature were consulted. Predefined criteria allowed for stu...
Article
In the last decades, epilepsy has shifted from being a condition defined purely by seizures to one also characterised by its comorbidities. This conceptualisation of epilepsy as an index disease to a set of comorbidities has been helpful but now faces challenges. Epilepsy is not always “the root of the problem”, nor is it inherently a homogeneous d...
Article
Objective This study aims to develop and internally validate a clinical risk score to predict incident renal angiomyolipoma (AML) and pulmonary lymphangioleiomyomatosis (LAM) in people with tuberous sclerosis complex (TSC). Study design Data from 2420 participants in the TSC Alliance Natural History Database were leveraged for these analyses. Logi...
Article
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Background In addition to other stroke-related deficits, the risk of seizures may impact driving ability after stroke. Methods We analysed data from a multicentre international cohort, including 4452 adults with acute ischaemic stroke and no prior seizures. We calculated the Chance of Occurrence of Seizure in the next Year (COSY) according to the...
Article
This practice guideline provides updated evidence-based conclusions and recommendations regarding the effects of antiseizure medications (ASMs) and folic acid supplementation on the prevalence of major congenital malformations (MCMs), adverse perinatal outcomes, and neurodevelopmental outcomes in children born to people with epilepsy of childbearin...
Article
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Objective Despite the general safety and efficacy of epilepsy surgery, there is evidence that epilepsy surgery remains underutilized. Although there are an increasing number of studies reporting epilepsy surgery in older adults, there is no consensus on whether epilepsy surgery is efficacious or safe for this population. Our objective was to system...
Article
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Background Few studies have compared different measures of frailty for predicting adverse outcomes. It remains unknown which frailty measurement approach best predicts healthcare utilization such as hospitalization and mortality. Aims This study aims to compare three approaches to measuring frailty—grip strength, frailty phenotype, and frailty ind...
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Introduction Hypothalamic hamartomas (HHs) are deep-seated congenital lesions that typically lead to pharmacoresistant epilepsy and a catastrophic encephalopathic syndrome characterised by severe neuropsychological impairment and decline in quality of life. A variety of surgical approaches and technologies are available for the treatment of HH-rela...
Article
We evaluated the effectiveness and tolerability of brivaracetam (BRV), an adjunctive antiseizure medication, as a treatment for focal epilepsy in adults. In this prospective study, we enrolled 51 participants from 3 sites across Canada. At 6 months, 68% (26/38) of participants were still taking BRV, among whom 35% (8/23) attained seizure freedom an...
Article
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Purpose There is limited knowledge on the reliability of risk of bias (ROB) tools for assessing internal validity in systematic reviews of exposure and frequency studies. We aimed to identify and then compare the inter-rater reliability (IRR) of six commonly used tools for frequency (Loney scale, Gyorkos checklist, American Academy of Neurology [AA...
Article
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Background: Computational analysis of routine electroencephalogram (rEEG) could improve the accuracy of epilepsy diagnosis. We aim to systematically assess the diagnostic performances of computed biomarkers for epilepsy in individuals undergoing rEEG. Methods: We searched MEDLINE, EMBASE, EBM reviews, IEEE Explore and the grey literature for studi...
Article
A bibliometric analysis (BA) is a knowledge synthesis methodology aimed at quantitively summarizing large amounts of bibliometric data. We aimed to summarize the performance of BAs in the health sciences. We searched Scopus for BAs in the health sciences published prior to May 10th, 2023. All identified studies were included. We performed a BA on t...
Article
Objective: To evaluate the impact of text mining (TM) on the sensitivity and specificity of title and abstract screening strategies for systematic reviews (SR). Study design and setting: Twenty reviewers each evaluated a 500 citation set. We compared five screening methods: conventional double screen (CDS), single screen (SS), double screen with...
Article
Background and objectives: Late-onset epilepsy is a heterogenous entity associated with specific aetiologies and an elevated risk of premature mortality. Specific multimorbid-socioeconomic profiles and their unique prognostic trajectories have not been described. We sought to determine if specific clusters of late onset epilepsy exist, and whether...
Article
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On June 24, 2022, Dobbs vs Jackson Women’s Health Organization was decided by the Supreme Court effectively overturning the former precedent of Roe v. Wade. This ruling has direct consequences for the care of persons with epilepsy of childbearing potential. Now more than ever we need to provide informed and comprehensive care to our patients with e...
Article
Objective: The literature on sudden unexpected death in epilepsy (SUDEP) has been evolving at a staggering rate. We conducted a bibliometric analysis of the SUDEP literature with the aim of presenting its structure, performance, and trends. Methods: The Scopus database was searched in April 2023 for documents explicitly detailing SUDEP in their...
Article
Tuberous sclerosis complex (TSC) is a multisystem disorder caused by loss-of-function mutations in TSC1/2 proteins. This results in constitutive mTOR activation and predisposes to the development of benign tumours, with renal angiomyolipomas (AMLs) and tuber-related drug-resistant epilepsy (DRE) being major causes of morbidity and mortality in adul...
Poster
We conducted a scoping review on non-medical cannabis (NMC) use in people with epilepsy (PWE), focusing on their experience, habits, and beliefs regarding NMC. Evidence on NMC use in PWE is sparse and heterogeneous. Lifetime prevalence of NMC use varied from 0.69% to 76.8%. Children and adults took NMC differently. Most PWE perceived NMC as benefic...
Article
Importance: Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. Objective: To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. D...
Article
Full-text available
Objective The use of medical cannabis among people with epilepsy (PWE) has been garnering increasing interest. In this scoping review, we aimed to summarize the literature on recreational/non-medical cannabis (NMC) use in PWE, focusing on the experience, habits, and beliefs of PWE regarding NMC. Methods Four databases (OVID Medline, OVID Embase, O...
Article
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Objective There are no clinical guidelines dedicated to the treatment of epilepsy in older adults. We investigated physician opinion and practice regarding the treatment of people with epilepsy aged 65 years or older. We also sought to study how our opinion and practice varied between geriatricians, general neurologists, and epilepsy neurologists (...
Article
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Introduction The diagnosis of epilepsy frequently relies on the visual interpretation of the electroencephalogram (EEG) by a neurologist. The hallmark of epilepsy on EEG is the interictal epileptiform discharge (IED). This marker lacks sensitivity: it is only captured in a small percentage of 30 min routine EEGs in patients with epilepsy. In the pa...
Article
Rationale Frailty is an important aspect of biological aging, referring to the increased vulnerability of individuals with frailty to physical and psychological stressors. While older adults with epilepsy are an important and distinct clinical group, there are no data on frailty in this population. We hypothesize that frailty will correlate with th...
Preprint
Full-text available
PURPOSE There is currently no recommended risk of bias (ROB) tools to assess the internal validity of systematic reviews involving exposure or frequency studies. We aimed to first identify and secondly compare the inter-rater reliability (IRR) of six commonly used tools for frequency (Loney scale, Gyorkos checklist, American Academy of Neurology [A...
Article
Background and objectives: There is a paucity of data on the frequency and prognosis of infratentorial brain injury among patients suspected of death by neurologic criteria (DNC), which likely contributes to scientific uncertainty regarding the role of isolated brainstem death in DNC determination. Our aim was to synthesize the prevalence, charact...
Preprint
Full-text available
Background The diagnosis of epilepsy frequently relies on the visual interpretation of the electroencephalogram (EEG) by a neurologist. The hallmark of epilepsy on EEG is the interictal epileptiform discharge (IED). This marker lacks sensitivity: it is only captured in a small percentage of 30-minute routine EEGs in patients with epilepsy. In the p...
Article
Background: Ischemic stroke (IS) may be the first sign of an occult cancer, due to an underlying paraneoplastic prothrombotic state. Predictors of occult cancer in acute IS, however, remain unclear. We performed a single-center study to identify clinical features that may distinguish cancer-associated IS from IS without recent cancer. Methods: We r...
Article
Background: People with acute ischemic stroke (IS) have a higher prevalence of occult malignancy. Consensus is lacking, however, on the extent of cancer screening tests that should be offered in this population. We performed a single-center study to review curent cancer screening practices in acute IS. Methods: We reviewed consecutive admissions fo...
Article
Objective Our study describes adults in Canada between 2009 and 2013 receiving at least one antiseizure medication (ASM) at the end of a hospitalization for newly-diagnosed epilepsy, with a focus on the type of ASM prescribed, changes in drug prescriptions after one year, and how this differs between younger and older adults. Methods Canada-wide d...
Article
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Objective Summarize the current evidence on efficacy and tolerability of vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) through a systematic review and meta‐analysis. Methods We followed the Preferred Reporting Items of Systematic reviews and Meta‐Analyses reporting standards and searched Ovid Me...
Article
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Objective A recent FDA warning concerning an arrhythmogenic potential of lamotrigine created concern in the neurological community. This warning was based on in vitro studies, but no clinically relevant risk was considered. This rapid systematic review aims to elucidate the risk of lamotrigine on sudden death or electrocardiogram abnormalities. Me...
Article
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Objective We aimed to assess the reliability and validity of single‐item global ratings (GR) of satisfaction with epilepsy surgery. Methods We recruited 240 patients from four centers in Canada and Sweden who underwent epilepsy surgery ≥1 year earlier. Participants completed a validated questionnaire on satisfaction with epilepsy surgery (the ESSQ...
Article
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Objectives There are few data on adults living with tuberous sclerosis complex (TSC), with most studies focusing on pediatric populations. The objective of our study was to examine a large national cohort of adults with TSC, and to describe the clinical characteristics of these adults and the nature of the multidisciplinary care that they receive....
Article
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Frailty is often described as being an increased vulnerability to the effects of stressors. There is little research investing how frailty may act as either a mediator or participate in interactions in the associations between risk factors and chronic disease. We will present novel analyses of the Canadian Longitudinal Study on Aging, focusing on t...
Article
Acute Central Nervous System (CNS) Graft Versus Host Disease (GvHD) is a rare form of GvHD, only described in case reports. Knowledge about this condition is extrapolated from chronic CNS GvHD cases occurring mostly after hematopoietic stem cell transplantation. GvHD following solid organ transplantation is an unexpected complication. GvHD after li...
Article
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Background Not all research findings are translated to clinical practice. Reasons for lack of applicability are varied, and multiple frameworks and criteria exist to appraise the general applicability of epidemiological and clinical research. In this two-part study, we identify, map, and synthesize frameworks and criteria; we develop a framework to...
Article
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Background: We aimed to evaluate heart rate variability (HRV) changes in insulo-opercular epilepsy (IOE) and after insulo-opercular surgery. Methods: We analyzed 5-min resting HRV of IOE patients before and after surgery. Patients' SUDEP-7 risk inventory scores were also calculated. Results were compared with age- and sex-matched patients with t...
Article
Background: Drug-resistant epilepsy (DRE) can affect up to one third of individuals with epilepsy. We conducted a systematic review and meta-analysis of vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) in patients with DRE to summarize the current evidence on efficacy and tolerability for these neur...
Article
Importance Enzyme-inducing antiseizure medications (eiASMs) have been hypothesized to be associated with long-term risks of cardiovascular disease. Objective To quantify and model the putative hazard of cardiovascular disease secondary to eiASM use. Design, Setting, and Participants This cohort study covered January 1990 to March 2019 (median [IQ...
Article
Research on frailty has expanded in the last decade, but direct evidence supporting its implementation in clinical practice may be limited. This mapping review synthesizes the contexts-of-use and overall clinical applicability of recent pre-COVID frailty research. We sampled 476 articles from articles published on frailty in PubMed and EMBASE in 20...
Article
Full-text available
Purpose: Indocyanine green fluorescence angiography (ICG-FA) is a validated non-invasive imaging technique used to assess tissue vascularization and guide intraoperative decisions in many surgical fields including plastic surgery, neurosurgery, and general surgery. While this technology is well-established in adult surgery, it remains sparsely used...
Article
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Objective To identify risk factors for acute symptomatic seizures and post-stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. Methods We assessed the risk factors for post-stroke seizures using logistic or Cox regression in a multicenter study including adults from eight European referral centers with ne...
Article
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Objective This study was undertaken to investigate the distribution of social, lifestyle/behavior, and chronic disease risk factors for cardiovascular disease (CVD) in people with epilepsy as compared to the general population. We also measured the cross‐sectional association between epilepsy and CVD in older adults, with and without adjustments fo...
Article
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Objective The 19‐item Epilepsy Surgery Satisfaction Questionnaire (ESSQ‐19) is a validated and reliable post hoc means of assessing patient satisfaction with epilepsy surgery. Prediction models building on these data can be used to counsel patients. Methods The ESSQ‐19 was derived and validated on 229 patients recruited from Canada and Sweden. We...
Article
Epidemiological estimates indicate that individuals with epilepsy are more likely to experience headaches, including migraine, than individuals without epilepsy. Headaches can be temporally unrelated to seizures, or can occur before, during or after an episode; seizures and migraine attacks are mostly not temporally linked. The pathophysiological l...
Article
Objective Ictal semiology interpretation for differentiating psychogenic nonepileptic seizures (PNESs) and epileptic seizures (ESs) is important for the institution of appropriate treatment. Our objective was to assess the ability of different health care professionals (HCPs) or students to distinguish PNES from ES based on video-recorded seizure s...
Article
Background Deficit-accumulation frailty indices (FIs) are widely used to characterize frailty. FIs vary in number and composition of items; the impact of this variation on reliability and clinical applicability is unknown. Methods We simulated 12,000 studies using a set of 70 candidate deficits in 12,080 community-dwelling participants 65 years an...
Article
This protocol for a Cochrane Review is out of date and has been withdrawn in order to adhere to Cochrane policy. The editorial group responsible for this previously published document have withdrawn it from publication.
Article
Background Prehospital delays are a major obstacle to timely reperfusion therapy in acute ischemic stroke. Stroke sign recognition, however, remains poor in the community. We present an analysis of repeated surveys to assess the impact of Face, Arm, Speech, Time (FAST) public awareness campaigns on stroke knowledge. Methods Four cross-sectional su...
Article
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Objective: Although the prevalence of comorbid epilepsy and dementia is expected to increase, the impact is not well understood. Our objectives were to examine risk factors associated with incident dementia and the impact of frailty and dementia on mortality in older adults with epilepsy. Methods: The CALIBER scientific platform was used. People...
Article
Background: Stroke survivors may be at higher risk of incident cancer, although the magnitude and the period at risk remain unclear. We conducted a retrospective cohort study to compare the risk of cancer in stroke survivors to that of the general population. Methods: The Canadian Longitudinal Study on Aging is a large population-based cohort of...
Article
Objective In order to evaluate the incidence and prevalence of drug-resistant epilepsy (DRE) as well as its predictors and correlates, we conducted a systematic review and meta-analysis of observational studies. Methods Our protocol was registered with PROSPERO and the PRISMA and MOOSE reporting standards were followed. We searched MEDLINE, Embase...
Conference Paper
Background: Cancer promotes thromboembolism through inflammation and hypercoagulability, and an ischemic stroke may be the first sign of an occult malignancy. Stroke survivors may be at higher risk of incident cancer diagnosis, although the magnitude and the period at risk remain unclear. We conducted a retrospective cohort study to compare the ris...
Article
Full-text available
The International League Against Epilepsy (ILAE) / American Epilepsy Society (AES) Task Force on the cardiac effects of lamotrigine was convened in response to a recent addition to the lamotrigine label by the US Food and Drug Administration (FDA).1 Lamotrigine is the nonproprietary name for a medicine that is sold under its generic name and severa...
Article
Background: Intervention time in response to seizures (IT) and adverse events (AE) have emerged as key elements in epilepsy monitoring unit (EMU) management. We performed an audit of our EMU, focusing on IT and AEs. Methods: We performed a retrospective study on all clinical seizures of admissions over a one year period at our Canadian academic te...
Article
Background The optimal approach for cancer screening after an ischemic stroke remains unclear. Aims We sought to summarize the existing evidence regarding the frequency and predictors of cancer after an ischemic stroke. Summary of review We searched seven databases from January 1980 to September 2019 for articles reporting malignant tumors and my...
Article
Background A widely held dictum in aging research is that heterogeneity in health increases with age, but the basis for this claim has not been fully investigated. We examined heterogeneity at different ages across health characteristics to describe variation and trends; we investigated the comparative importance of between‐age versus within‐age he...
Article
Full-text available
Objective Adult drug‐resistant epilepsy (DRE) is associated with significant morbidity. Infiltration of immune cells is observed in DRE epileptic foci; however, the relation between DRE and the peripheral immune cell compartment remains only partially understood. We aimed to investigate differences in immune cell populations, cytokines, and neurode...
Article
Objective A web-based intervention was developed to support epilepsy self-management. A mixed methods study was undertaken to evaluate the intervention’s extent of utilization, acceptability and preliminary effects, and to assess user perception of it. Methods First, a pilot parallel-group randomized controlled trial was conducted with a convenien...
Article
Full-text available
Objective No validated tools exist to assess satisfaction with epilepsy surgery. We aimed to develop and validate a new measure of patient satisfaction with epilepsy surgery, the 19‐item Epilepsy Surgery Satisfaction Questionnaire (ESSQ‐19). Methods An initial 31‐item measure was developed based on literature review, patient focus groups, thematic...