Temporal lobe epilepsy is the most common type of epilepsy in clinic. In recent years, many studies have found that patients with temporal lobe epilepsy have different degrees of influence in executive function related fields. This influence may not only exist in a certain field of executive function, but may be affected in several fields, and may be related to the origin site of seizures. However, up to now, there is no unified standard for the composition of executive function, and it is widely accepted that the three core components of executive function are working memory, inhibitory control and cognitive flexibility/switching. In addition, the International League Against Epilepsy proposed a new definition in 2010, and epilepsy is a brain network disease. There is a close relationship between brain neural network and cognitive impairment. According to the cognitive field, the brain neural network can be divided into six types: default mode network, salience network, executive control network, dorsal attention network, somatic motor network and visual network. In recent years, there has been increasing evidence that four related internal brain networks are series in a range of cognitive processes. The executive dysfunction of temporal lobe epilepsy may be related to the changes of functional connectivity of neural network, and may be related to the left uncinate fasciculus. This article reviews the research progress related to executive function in temporal lobe epilepsy from working memory, inhibitory control and cognitive flexibility, and discusses the correlation between the changes of temporal lobe epilepsy neural network and executive function research.
We searched The Cochrane Library（Issue 3, 2005）, MEDLINE（1996-2005） ,CMCC（1996-2005）, VIP（1996-2005） ,CNKI（1996-2005） to summarize the available evidence of topiramate for an intractable epilepsy. After scanning all these articles, we identified 11 articles including meta-analysis, randomised controlled trials and systematic reviews to evaluate. Topiramate offered an alternative in the treament for intractable epilepsy, especially for partial epilepsy, and its efficacy was proven. Patients had good tolerance. And no intercross effects with the traditional anti-epileptic drugs were found. So topiramate had broad clinical value. The primary dosage of topiramate was 200mg/d. The sustaining dosage was 400-600mg/d. And we didn＇t recommend the dosage of more than 600mg/d.
ObjectiveTo provide the possibility to explain the relationship between genotype and phenotype, and to provide reference for the clinical treatment of Sleep-related hypermotor epilepsy (SHE). MethodsWe retrospectively analyzed the case data of the child (patient 1) diagnosed with SHE in the outpatient department of the Second Affiliated Hospital of Wenzhou Medical University in December 2017, and inquired about his family history and growth and development history. We learned that the father (patient 2) of the child had a history of epilepsy, and we also collected his medical history and growth and development history of patient 2. We carried out the basic physical examination for the two patients, and basic blood routine and blood biochemical indicators have also been done. In addition, electroencephalogram, Wechsler intelligence assessment and cranial magnetic resonance imaging were performed. After the diagnosis of patients 1 and 2, we treated them with antiepileptic drugs and make them long-term follow-up. What’more, we collected the peripheral blood of patient 1 and his father and mother, sequenced the gene, established phylogenetic tree for the mutation gene, and compared the homologous protein sequence to judge the conservation of the mutation. Moreover, in silico analysis was used to analyze the pathogenicity of the mutant gene. ResultsWe find a family with epilepsy, of whom patient 1 and his father are with epilepsy. Their clinical manifestations are atypical, and their seizures are all in sleep. After a long-term follow-up of two patients' drug treatments, it is found that patient 1 and patient 2 respond well to the drugs. Gene test shows that the mutations of DEPDC5 (c.484-1del c.484_485del) and KCNQ2 (c.1164A> T) are at the same site in both patient 1 and patient 2, and the mutation sites are first reported. What’more, the homologous protein alignment shows that the amino acids corresponding to the two mutant genes are highly conserved. ConclusionThis study mainly reports a family with sleep-related hypermotor epilepsy. Patients 1 and patient 2 have novel mutations of DEPDC5 and KCNQ2 genes. In the long-term follow-up of this study, it is found that the patients are effective the antiepileptic drugs.
ObjectiveThe purpose of this study was to better delineate the clinical spectrum of periventricular nodular heterotopia (PNH) in a large patient population to better understand social support in people with PNH and epilepsy in west China. Specifically, this study aimed to relate PNH subtypes to clinical or epileptic outcomes and epileptic discharges by analyzing anatomical features.
MethodsThe study included 70 patients with radiologically confirmed nodular heterotopias and epilepsy. We also recruited healthy controls from nearby urban and rural areas. People with PNH and epilepsy and healthy controls were gender-and age-matched. Two-sided Chi-square test and Fisher's exact t-test were used to assess associations between the distribution of PNHs and specific clinical features.
ResultsBased on imaging data, patients were subdivided into three groups: (a) classical (bilateral frontal and body, n=25), (b) bilateral asymmetrical or posterior (n=9) and (c) unilateral heterotopia (n=36). Most patients with classical heterotopia were females, but were mostly seizure-free. Patients with unilateral heterotopia were prone to develop refractory epilepsy.
ConclusionsEach group's distinctive genetic mutations, epileptic discharge patterns and overall clinical outcomes confirm that the proposed classification system is reliable. These findings could not only be an indicator of a more severe morphological and clinical phenotype, but could also have clinical implications with respect to the epilepsy management and optimization of therapeutic options.
Objectives
This study aims to examine the possible association between C-reactive protein (CRP) concentration and cognitive impairment in patients with post-stroke epilepsy.
Methods
Patients with post-stroke epilepsy admitted to Western China Hospital from January 2010 to June 2016 were consecutively enrolled in our study. CRP levels were assessed within one week of stroke onset, and then correlated with cognitive status assessed two years after stroke using the Six-Item Screener.
Results
Among the 96 patients with post-stroke epilepsy who included in our study, 24 patients were found to have cognitive impairment during the two years follow-up period. Our data showed a significant association between CRP levels and cognitive performance in these patients (31.5±36.2 vs. 11.9±19.4, P=0.029). In addition, this association persisted even after adjusting for potential confounders［OR=1.021, 95%CI (0.997, 1.206), P=0.037］.
Conclusions
Following ischemic stroke, higher CRP levels is associated with subsequent cognitive decline in patients with epilepsy. Association and prospective studies in larger sample size are needed in order to validate our findings, especially studies in which baseline CRP level and CRP level during follow-up are closely monitored.
ObjectiveTo explore the effect of family-school-hospital application in continuous nursing care for children with epilepsy. Methods120 children with epilepsy admitted to Children's Hospital Affiliated to Jiangnan University from January 2021 to October 2022 were randomly divided into two groups, each with 60 cases. The control group received routine care, while the experimental group received family-school-hospital continuous care. Compare the awareness of epilepsy knowledge, disease control effectiveness, medication compliance, negative emotions, physical and mental status, and quality of life before and after nursing between the families of two groups of children with epilepsy. ResultsAfter 2 months of nursing care, the scores of family members' knowledge of epilepsy in the experimental group were higher than the control group (P<0.05). The effect of disease control in the experimental group was better the control group (P<0.05). The drug compliance of the experimental group was higher than the control group (P<0.05). The quality of life score in the intervention group was higher than the control group (P<0.05). ConclusionThe application of family-school-hospital in the continuous care of children with epilepsy can improve their family members' awareness of epilepsy knowledge, effectively control the disease, improve medication compliance, improve negative emotions and physical and mental conditions, and thus improve the quality of life of children.
Epilepsy is a chronic brain dysfunction disease with complex and diverse causes, but 70%-80% of patients do not have obvious characteristic phenotypic symptoms. In order to provide precise treatment for epilepsy patients, research on the genetic pathogenic factors and pathogenesis of epilepsy has attracted much attention. Different types of epilepsy are constantly found to be closely related to mutations in specific genes, such as SCN1A, KCNA2, KCNT1, GABRA1, TSCs, CDKL5, and so on. Therefore, the development of broad-spectrum antiepileptic drugs is very difficult. However, plant-based drugs or functional ingredients derived from traditional medicinal herbs, such as cannabinol, aconitine, and dodecenal, will expand the development of safer and more effective anti epileptic drugs.
Epilepsy is one of the most common neurological diseases in children, about 2/3 can be seizure-free after anti-seizure medications (ASMs) treatment, but there are still some drug-resistant epilepsy (DRE) need surgical treatment, epilepsy surgery including excision surgery, dissociation surgery and palliative surgery, surgery can make 30%~40% DRE fully controlled. Clinicians usually choose to discontinue ASMs after seizure-free for 1 to 2 years after epilepsy surgery, but there has been controversy about whether to discontinue ASMs after surgery in children with epilepsy, how long to discontinue ASMs, the timing of ASMs withdrawal, and there is still a lack of unified guidelines. This article will comprehensively analyze and summarize the risk of recurrence after ASMs withdrawal in children with epilepsy.
ObjectiveTo screen and identify an ideal lead compound with potential inhibitory effects on N-methyl-D-aspartate receptor (NMDAR) from the ZINC15 drug database, promoting drug design and development to improve epilepsy treatment. Methods Potential NMDAR inhibitors were identified through a series of computer-aided structural and chemical virtual screening techniques (Discovery Studio). Structure-based virtual screening was used to predict and further filter candidate compounds based on physicochemical, pharmacological, and toxicological properties. The binding affinity and chemical bond distribution between selected compounds and NMDAR were then analyzed, and the stability of the ligand-NMDAR complex in a natural environment was evaluated. Results The study identified one novel natural compound from the ZINC15 database, with ZINC000096085903 showing low rodent carcinogenicity, no Ames mutagenicity, no developmental toxicity, and ideal physicochemical properties. This compound demonstrated high binding affinity and favorable interaction energy, with the ZINC000096085903-NMDAR complex exhibiting more favorable potential energy than the complex formed by NMDAR and the reference ligand ketamine. Furthermore, molecular dynamics simulation indicated that this complex remains stable in vivo and can inhibit NMDAR similarly to ketamine. Conclusion ZINC000096085903 is an ideal lead compound for NMDAR inhibition. With higher binding affinity and stability when bound to NMDAR, as well as slower metabolism, ZINC000096085903 showed significant potential for long-term epilepsy treatment.
To improve nursing interventions for patients with epilepsy and intellectual impairment. Epilepsy, as one of the common chronic neurological diseases, often coexists with intellectual impairment. This article reviews the treatment methods and related nursing measures for epilepsy patients with intellectual impairment, and proposes the application of comprehensive nursing concepts in clinical practice. The nursing of patients with epilepsy and intellectual impairment faces multiple challenges. Nursing activities provide personalized care needs, emphasize patient education, simplify medication treatment plans, and promote collaborative relationships between patients, nursing staff, and healthcare providers. Through evidence-based intervention, interdisciplinary collaboration, and innovative nursing models, nursing plays a crucial role in improving patient treatment outcomes and enhancing their quality of life.
