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Why Do Seizures Sometimes Continue After Surgery?
Roughly one out of every two patients with drug-resistant temporal lobe epilepsy will not become completely seizure-free after temporal lobe surgery. The reasons for this remain unclear and are most likely due to multiple factors. Preoperative automated fiber quantification (AFQ), however, may predict postoperative seizure outcome in patients with temporal lobe epilepsy, according to a study published online ahead of print November 15, 2016, in Brain.
“We have identified three important factors that contribute to persistent postoperative seizures: diffusion abnormalities of the ipsilateral dorsal fornix outside the future margins of resection, diffusion abnormalities of the contralateral parahippocampal white matter bundle, and insufficient resection of the uncinate fasciculus,” said lead author Simon S. Keller, MSc, PhD, and colleagues. Dr. Keller is a Lecturer in Molecular and Clinical Pharmacology at the University of Liverpool in the United Kingdom. “These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures.” 
Sensitive Imaging Technology
MRI techniques such as quantitative volumetric imaging have provided limited insight into what causes recurrent seizures after temporal lobe surgery. AFQ is a diffusion tensor imaging (DTI) tractography technique that permits a comprehensive analysis of tissue characteristics along the length of white matter tract bundles. This technique may allow for a more sensitive measure of neuroanatomic white matter alterations in patients with neurologic disorders than whole-tract approaches.
Dr. Keller and colleagues conducted a comprehensive DTI study to evaluate the local tissue physical characteristics of preoperative temporal lobe white matter tracts by applying DTI and AFQ in patients with temporal lobe epilepsy who underwent surgical treatment and postoperative follow-up. The primary goal of their research was to identify preoperative diffusion markers of postoperative seizure outcome. Their secondary goal was to determine whether the extent of resection of the temporal lobe tract bundles was associated with seizure outcome.
Forty-three patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis and 44 healthy controls were included in the study. Patients underwent preoperative imaging, amygdalohippocampectomy, and postoperative assessment using the International League Against Epilepsy seizure outcome scale. The fimbria-fornix, parahippocampal, white matter bundle, and uncinate fasciculus were reconstructed from preoperative imaging. In addition, scalar diffusion metrics were calculated along the length of each tract.
Results revealed that 51.2% of patients had a completely seizure-free outcome, and 48.8% of patients had persistent postoperative seizures. More men were rendered seizure-free, relative to women. Compared to controls, both patient groups showed strong and significant diffusion abnormalities along the length of the uncinate bilaterally, the ipsilateral parahippocampal white matter bundle, and the ipsilateral fimbria-fornix in regions located within the medial temporal lobe.
However, only patients with persistent postoperative seizures showed evidence of significant pathology of tract sections located in the ipsilateral dorsal fornix and in the contralateral parahippocampal white matter bundle. Using receiver operating characteristic curves, diffusion characteristics of these regions could project individual patient outcomes with 84% sensitivity and 89% specificity.
Pathologic changes in the dorsal fornix were observed beyond the margins of resection. In addition, contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Diffusion characteristics of the ipsilateral uncinate could potentially classify patients from controls with a sensitivity of 98%.
By coregistering the preoperative fiber maps to postoperative surgical lacuna maps, Dr. Keller and colleagues observed that the extent of the surgical uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller surgical resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network.
“An important future step will be to perform a pragmatic prospective study of consecutive patients with consideration of these new findings,” said Dr. Keller and colleagues.
—Erica Tricarico
Suggested Reading
Keller SS, Glenn RG, Weber B, et al. Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy. Brain. 2016 Nov 15 [Epub ahead of print].
Roughly one out of every two patients with drug-resistant temporal lobe epilepsy will not become completely seizure-free after temporal lobe surgery. The reasons for this remain unclear and are most likely due to multiple factors. Preoperative automated fiber quantification (AFQ), however, may predict postoperative seizure outcome in patients with temporal lobe epilepsy, according to a study published online ahead of print November 15, 2016, in Brain.
“We have identified three important factors that contribute to persistent postoperative seizures: diffusion abnormalities of the ipsilateral dorsal fornix outside the future margins of resection, diffusion abnormalities of the contralateral parahippocampal white matter bundle, and insufficient resection of the uncinate fasciculus,” said lead author Simon S. Keller, MSc, PhD, and colleagues. Dr. Keller is a Lecturer in Molecular and Clinical Pharmacology at the University of Liverpool in the United Kingdom. “These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures.”
Sensitive Imaging Technology
MRI techniques such as quantitative volumetric imaging have provided limited insight into what causes recurrent seizures after temporal lobe surgery. AFQ is a diffusion tensor imaging (DTI) tractography technique that permits a comprehensive analysis of tissue characteristics along the length of white matter tract bundles. This technique may allow for a more sensitive measure of neuroanatomic white matter alterations in patients with neurologic disorders than whole-tract approaches.
Dr. Keller and colleagues conducted a comprehensive DTI study to evaluate the local tissue physical characteristics of preoperative temporal lobe white matter tracts by applying DTI and AFQ in patients with temporal lobe epilepsy who underwent surgical treatment and postoperative follow-up. The primary goal of their research was to identify preoperative diffusion markers of postoperative seizure outcome. Their secondary goal was to determine whether the extent of resection of the temporal lobe tract bundles was associated with seizure outcome.
Forty-three patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis and 44 healthy controls were included in the study. Patients underwent preoperative imaging, amygdalohippocampectomy, and postoperative assessment using the International League Against Epilepsy seizure outcome scale. The fimbria-fornix, parahippocampal, white matter bundle, and uncinate fasciculus were reconstructed from preoperative imaging. In addition, scalar diffusion metrics were calculated along the length of each tract.
Results revealed that 51.2% of patients had a completely seizure-free outcome, and 48.8% of patients had persistent postoperative seizures. More men were rendered seizure-free, relative to women. Compared to controls, both patient groups showed strong and significant diffusion abnormalities along the length of the uncinate bilaterally, the ipsilateral parahippocampal white matter bundle, and the ipsilateral fimbria-fornix in regions located within the medial temporal lobe.
However, only patients with persistent postoperative seizures showed evidence of significant pathology of tract sections located in the ipsilateral dorsal fornix and in the contralateral parahippocampal white matter bundle. Using receiver operating characteristic curves, diffusion characteristics of these regions could project individual patient outcomes with 84% sensitivity and 89% specificity.
Pathologic changes in the dorsal fornix were observed beyond the margins of resection. In addition, contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Diffusion characteristics of the ipsilateral uncinate could potentially classify patients from controls with a sensitivity of 98%.
By coregistering the preoperative fiber maps to postoperative surgical lacuna maps, Dr. Keller and colleagues observed that the extent of the surgical uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller surgical resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network.
“An important future step will be to perform a pragmatic prospective study of consecutive patients with consideration of these new findings,” said Dr. Keller and colleagues.
—Erica Tricarico
Suggested Reading
Keller SS, Glenn RG, Weber B, et al. Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy. Brain. 2016 Nov 15 [Epub ahead of print].
Roughly one out of every two patients with drug-resistant temporal lobe epilepsy will not become completely seizure-free after temporal lobe surgery. The reasons for this remain unclear and are most likely due to multiple factors. Preoperative automated fiber quantification (AFQ), however, may predict postoperative seizure outcome in patients with temporal lobe epilepsy, according to a study published online ahead of print November 15, 2016, in Brain.
“We have identified three important factors that contribute to persistent postoperative seizures: diffusion abnormalities of the ipsilateral dorsal fornix outside the future margins of resection, diffusion abnormalities of the contralateral parahippocampal white matter bundle, and insufficient resection of the uncinate fasciculus,” said lead author Simon S. Keller, MSc, PhD, and colleagues. Dr. Keller is a Lecturer in Molecular and Clinical Pharmacology at the University of Liverpool in the United Kingdom. “These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures.”
Sensitive Imaging Technology
MRI techniques such as quantitative volumetric imaging have provided limited insight into what causes recurrent seizures after temporal lobe surgery. AFQ is a diffusion tensor imaging (DTI) tractography technique that permits a comprehensive analysis of tissue characteristics along the length of white matter tract bundles. This technique may allow for a more sensitive measure of neuroanatomic white matter alterations in patients with neurologic disorders than whole-tract approaches.
Dr. Keller and colleagues conducted a comprehensive DTI study to evaluate the local tissue physical characteristics of preoperative temporal lobe white matter tracts by applying DTI and AFQ in patients with temporal lobe epilepsy who underwent surgical treatment and postoperative follow-up. The primary goal of their research was to identify preoperative diffusion markers of postoperative seizure outcome. Their secondary goal was to determine whether the extent of resection of the temporal lobe tract bundles was associated with seizure outcome.
Forty-three patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis and 44 healthy controls were included in the study. Patients underwent preoperative imaging, amygdalohippocampectomy, and postoperative assessment using the International League Against Epilepsy seizure outcome scale. The fimbria-fornix, parahippocampal, white matter bundle, and uncinate fasciculus were reconstructed from preoperative imaging. In addition, scalar diffusion metrics were calculated along the length of each tract.
Results revealed that 51.2% of patients had a completely seizure-free outcome, and 48.8% of patients had persistent postoperative seizures. More men were rendered seizure-free, relative to women. Compared to controls, both patient groups showed strong and significant diffusion abnormalities along the length of the uncinate bilaterally, the ipsilateral parahippocampal white matter bundle, and the ipsilateral fimbria-fornix in regions located within the medial temporal lobe.
However, only patients with persistent postoperative seizures showed evidence of significant pathology of tract sections located in the ipsilateral dorsal fornix and in the contralateral parahippocampal white matter bundle. Using receiver operating characteristic curves, diffusion characteristics of these regions could project individual patient outcomes with 84% sensitivity and 89% specificity.
Pathologic changes in the dorsal fornix were observed beyond the margins of resection. In addition, contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Diffusion characteristics of the ipsilateral uncinate could potentially classify patients from controls with a sensitivity of 98%.
By coregistering the preoperative fiber maps to postoperative surgical lacuna maps, Dr. Keller and colleagues observed that the extent of the surgical uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller surgical resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network.
“An important future step will be to perform a pragmatic prospective study of consecutive patients with consideration of these new findings,” said Dr. Keller and colleagues.
—Erica Tricarico
Suggested Reading
Keller SS, Glenn RG, Weber B, et al. Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy. Brain. 2016 Nov 15 [Epub ahead of print].
Which Factors Predict Response to Acute Migraine Treatment?
Demographic variables, headache features, comorbidity, and treatment factors may predict inadequate response to acute migraine treatment at two hours and at 24 hours, according to research published in the November issue of Headache. Similar factors may predict which patients with an adequate response at two hours will have an inadequate response at 24 hours.
The data suggest substantial unmet acute treatment needs at the population level, said Richard B. Lipton, MD, Edwin S. Lowe Chair in Neurology at the Albert Einstein College of Medicine in Bronx, New York, and colleagues. “A good response at two hours was associated with doing well at 24 hours. This [result] highlights the importance of initial response to treatment in overall patient outcomes.” 
An Analysis of AMPP Data
Much of the literature intended to identify predictors of response to migraine treatment focuses on outcomes of individual attacks. Study populations generally are limited, furthermore, to the select group of patients willing to participate in trials. A thorough evaluation of unmet acute treatment needs requires a more representative sample population, as well as information about long-term responses to multiple attacks, said Dr. Lipton.
He and his colleagues examined data from the American Migraine Prevalence and Prevention (AMPP) Study to identify factors that predict the success or failure of acute treatment at two hours and at 24 hours. The investigators focused on the 2006 AMPP survey, which included the Migraine Treatment Optimization Questionnaire (mTOQ). Eligible participants met criteria for episodic migraine, used acute pharmacologic treatment for migraine, and provided the necessary data for the researchers’ analysis.
In all, 14,520 people responded to the 2006 survey, 10,006 of whom met International Classification of Headache Disorders-3 beta criteria for migraine. Dr. Lipton’s group examined two questions from the mTOQ to assess pain-response outcomes following acute treatment. The first question asked whether the respondent was pain-free within two hours of treatment for most attacks. The second asked whether one dose of medication usually relieved the respondent’s headache and kept it away for at least 24 hours.
In all, 8,233 people responded to both questions. Patients who responded “never,” “rarely,” or “less than half the time” to the first or second question were considered to have an inadequate two-hour pain-free response or an inadequate 24-hour pain relief response, respectively. A response of “half the time or more” was defined as an adequate response. In addition, the researchers defined a 24-hour sustained pain-free response as an adequate response to both questions. Participants with an adequate two-hour response and an inadequate 24-hour response were considered to have recurrence. To identify outcome predictors, Dr. Lipton and colleagues conducted logistic regression analyses.
Most Participants Had Inadequate Response
Most participants (56.0%) reported inadequate two-hour pain-free response to usual acute treatment, and 53.6% of respondents reported inadequate 24-hour pain relief. Of the 44.0% of people with adequate two-hour pain-free response, 74.3% reported sustained pain relief at 24 hours.
The significant predictors of inadequate two-hour pain-free response were greater pain intensity, cutaneous allodynia, depression, higher BMI, and higher average monthly headache day frequency. Factors that protected against an inadequate two-hour pain-free response included using a preventive medication for migraine, female gender, and being married.
Factors that predicted inadequate 24-hour pain relief included greater feelings of depression, cutaneous allodynia, greater monthly headache day frequency, greater headache pain intensity, overuse of acute medication, lack of health insurance, being a smoker, and being unmarried. Predictors of inadequate 24-hour sustained pain-free response were greater monthly headache day frequency, cutaneous allodynia, meeting criteria for depression, acute medication overuse, and migraine symptom severity.
A Need for Treatment Optimization
Previous studies have found an association between high BMI and severe and progressive forms of migraine. This association “may reflect a proinflammatory state in obesity that renders treatment less effective,” said Dr. Lipton.
The authors’ finding of an association between depression and inadequate response is consistent with previous research suggesting that depression is a risk factor for headache progression. Preventive migraine medications were protective against this outcome, however.
A possible explanation for smokers’ higher likelihood of having inadequate 24-hour pain relief is that “smoking may alter drug metabolism and shorten the duration of action of selected acute treatments,” said Dr. Lipton. In addition, the association between monthly headache days and inadequate 24-hour pain relief “may reflect the fact that more frequent attacks may be associated with prolonged activation of neuronal networks involved in pain processing during attacks, which may lead to lowering the threshold for subsequent attacks.”
One limitation of the current study is its reliance on self-reported data, said the authors. The questionnaire that the researchers used is limited by recall bias, recency effects, and the risk that the preceding month did not represent the individual’s usual experience. Nonetheless, mTOQ items have demonstrated high reliability and validity. Other study limitations include the retrospective design, the high proportion of participants who used more than one acute treatment, and the fact that the data are 10 years old.
On the other hand, the study examined a large, representative sample of the US population. It also included various validated measures to diagnose migraine and to assess headache-related disability, allodynia, and depression.
“These results show that unmet needs remain, and the expansion of therapeutic options for episodic migraine is needed, as well as optimizing treatment by carefully designing comprehensive treatment plans with existing acute therapies with various doses, routes of administration, preventive and interventional treatment approaches, behavioral therapies, neuromodulators, and other empirically validated approaches to achieve optimized treatment,” Dr. Lipton concluded.
—Erik Greb
Suggested Reading
Lipton RB, Munjal S, Buse DC, et al. Predicting inadequate response to acute migraine medication: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2016;56(10):1635-1648.
Demographic variables, headache features, comorbidity, and treatment factors may predict inadequate response to acute migraine treatment at two hours and at 24 hours, according to research published in the November issue of Headache. Similar factors may predict which patients with an adequate response at two hours will have an inadequate response at 24 hours.
The data suggest substantial unmet acute treatment needs at the population level, said Richard B. Lipton, MD, Edwin S. Lowe Chair in Neurology at the Albert Einstein College of Medicine in Bronx, New York, and colleagues. “A good response at two hours was associated with doing well at 24 hours. This [result] highlights the importance of initial response to treatment in overall patient outcomes.”
An Analysis of AMPP Data
Much of the literature intended to identify predictors of response to migraine treatment focuses on outcomes of individual attacks. Study populations generally are limited, furthermore, to the select group of patients willing to participate in trials. A thorough evaluation of unmet acute treatment needs requires a more representative sample population, as well as information about long-term responses to multiple attacks, said Dr. Lipton.
He and his colleagues examined data from the American Migraine Prevalence and Prevention (AMPP) Study to identify factors that predict the success or failure of acute treatment at two hours and at 24 hours. The investigators focused on the 2006 AMPP survey, which included the Migraine Treatment Optimization Questionnaire (mTOQ). Eligible participants met criteria for episodic migraine, used acute pharmacologic treatment for migraine, and provided the necessary data for the researchers’ analysis.
In all, 14,520 people responded to the 2006 survey, 10,006 of whom met International Classification of Headache Disorders-3 beta criteria for migraine. Dr. Lipton’s group examined two questions from the mTOQ to assess pain-response outcomes following acute treatment. The first question asked whether the respondent was pain-free within two hours of treatment for most attacks. The second asked whether one dose of medication usually relieved the respondent’s headache and kept it away for at least 24 hours.
In all, 8,233 people responded to both questions. Patients who responded “never,” “rarely,” or “less than half the time” to the first or second question were considered to have an inadequate two-hour pain-free response or an inadequate 24-hour pain relief response, respectively. A response of “half the time or more” was defined as an adequate response. In addition, the researchers defined a 24-hour sustained pain-free response as an adequate response to both questions. Participants with an adequate two-hour response and an inadequate 24-hour response were considered to have recurrence. To identify outcome predictors, Dr. Lipton and colleagues conducted logistic regression analyses.
Most Participants Had Inadequate Response
Most participants (56.0%) reported inadequate two-hour pain-free response to usual acute treatment, and 53.6% of respondents reported inadequate 24-hour pain relief. Of the 44.0% of people with adequate two-hour pain-free response, 74.3% reported sustained pain relief at 24 hours.
The significant predictors of inadequate two-hour pain-free response were greater pain intensity, cutaneous allodynia, depression, higher BMI, and higher average monthly headache day frequency. Factors that protected against an inadequate two-hour pain-free response included using a preventive medication for migraine, female gender, and being married.
Factors that predicted inadequate 24-hour pain relief included greater feelings of depression, cutaneous allodynia, greater monthly headache day frequency, greater headache pain intensity, overuse of acute medication, lack of health insurance, being a smoker, and being unmarried. Predictors of inadequate 24-hour sustained pain-free response were greater monthly headache day frequency, cutaneous allodynia, meeting criteria for depression, acute medication overuse, and migraine symptom severity.
A Need for Treatment Optimization
Previous studies have found an association between high BMI and severe and progressive forms of migraine. This association “may reflect a proinflammatory state in obesity that renders treatment less effective,” said Dr. Lipton.
The authors’ finding of an association between depression and inadequate response is consistent with previous research suggesting that depression is a risk factor for headache progression. Preventive migraine medications were protective against this outcome, however.
A possible explanation for smokers’ higher likelihood of having inadequate 24-hour pain relief is that “smoking may alter drug metabolism and shorten the duration of action of selected acute treatments,” said Dr. Lipton. In addition, the association between monthly headache days and inadequate 24-hour pain relief “may reflect the fact that more frequent attacks may be associated with prolonged activation of neuronal networks involved in pain processing during attacks, which may lead to lowering the threshold for subsequent attacks.”
One limitation of the current study is its reliance on self-reported data, said the authors. The questionnaire that the researchers used is limited by recall bias, recency effects, and the risk that the preceding month did not represent the individual’s usual experience. Nonetheless, mTOQ items have demonstrated high reliability and validity. Other study limitations include the retrospective design, the high proportion of participants who used more than one acute treatment, and the fact that the data are 10 years old.
On the other hand, the study examined a large, representative sample of the US population. It also included various validated measures to diagnose migraine and to assess headache-related disability, allodynia, and depression.
“These results show that unmet needs remain, and the expansion of therapeutic options for episodic migraine is needed, as well as optimizing treatment by carefully designing comprehensive treatment plans with existing acute therapies with various doses, routes of administration, preventive and interventional treatment approaches, behavioral therapies, neuromodulators, and other empirically validated approaches to achieve optimized treatment,” Dr. Lipton concluded.
—Erik Greb
Suggested Reading
Lipton RB, Munjal S, Buse DC, et al. Predicting inadequate response to acute migraine medication: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2016;56(10):1635-1648.
Demographic variables, headache features, comorbidity, and treatment factors may predict inadequate response to acute migraine treatment at two hours and at 24 hours, according to research published in the November issue of Headache. Similar factors may predict which patients with an adequate response at two hours will have an inadequate response at 24 hours.
The data suggest substantial unmet acute treatment needs at the population level, said Richard B. Lipton, MD, Edwin S. Lowe Chair in Neurology at the Albert Einstein College of Medicine in Bronx, New York, and colleagues. “A good response at two hours was associated with doing well at 24 hours. This [result] highlights the importance of initial response to treatment in overall patient outcomes.”
An Analysis of AMPP Data
Much of the literature intended to identify predictors of response to migraine treatment focuses on outcomes of individual attacks. Study populations generally are limited, furthermore, to the select group of patients willing to participate in trials. A thorough evaluation of unmet acute treatment needs requires a more representative sample population, as well as information about long-term responses to multiple attacks, said Dr. Lipton.
He and his colleagues examined data from the American Migraine Prevalence and Prevention (AMPP) Study to identify factors that predict the success or failure of acute treatment at two hours and at 24 hours. The investigators focused on the 2006 AMPP survey, which included the Migraine Treatment Optimization Questionnaire (mTOQ). Eligible participants met criteria for episodic migraine, used acute pharmacologic treatment for migraine, and provided the necessary data for the researchers’ analysis.
In all, 14,520 people responded to the 2006 survey, 10,006 of whom met International Classification of Headache Disorders-3 beta criteria for migraine. Dr. Lipton’s group examined two questions from the mTOQ to assess pain-response outcomes following acute treatment. The first question asked whether the respondent was pain-free within two hours of treatment for most attacks. The second asked whether one dose of medication usually relieved the respondent’s headache and kept it away for at least 24 hours.
In all, 8,233 people responded to both questions. Patients who responded “never,” “rarely,” or “less than half the time” to the first or second question were considered to have an inadequate two-hour pain-free response or an inadequate 24-hour pain relief response, respectively. A response of “half the time or more” was defined as an adequate response. In addition, the researchers defined a 24-hour sustained pain-free response as an adequate response to both questions. Participants with an adequate two-hour response and an inadequate 24-hour response were considered to have recurrence. To identify outcome predictors, Dr. Lipton and colleagues conducted logistic regression analyses.
Most Participants Had Inadequate Response
Most participants (56.0%) reported inadequate two-hour pain-free response to usual acute treatment, and 53.6% of respondents reported inadequate 24-hour pain relief. Of the 44.0% of people with adequate two-hour pain-free response, 74.3% reported sustained pain relief at 24 hours.
The significant predictors of inadequate two-hour pain-free response were greater pain intensity, cutaneous allodynia, depression, higher BMI, and higher average monthly headache day frequency. Factors that protected against an inadequate two-hour pain-free response included using a preventive medication for migraine, female gender, and being married.
Factors that predicted inadequate 24-hour pain relief included greater feelings of depression, cutaneous allodynia, greater monthly headache day frequency, greater headache pain intensity, overuse of acute medication, lack of health insurance, being a smoker, and being unmarried. Predictors of inadequate 24-hour sustained pain-free response were greater monthly headache day frequency, cutaneous allodynia, meeting criteria for depression, acute medication overuse, and migraine symptom severity.
A Need for Treatment Optimization
Previous studies have found an association between high BMI and severe and progressive forms of migraine. This association “may reflect a proinflammatory state in obesity that renders treatment less effective,” said Dr. Lipton.
The authors’ finding of an association between depression and inadequate response is consistent with previous research suggesting that depression is a risk factor for headache progression. Preventive migraine medications were protective against this outcome, however.
A possible explanation for smokers’ higher likelihood of having inadequate 24-hour pain relief is that “smoking may alter drug metabolism and shorten the duration of action of selected acute treatments,” said Dr. Lipton. In addition, the association between monthly headache days and inadequate 24-hour pain relief “may reflect the fact that more frequent attacks may be associated with prolonged activation of neuronal networks involved in pain processing during attacks, which may lead to lowering the threshold for subsequent attacks.”
One limitation of the current study is its reliance on self-reported data, said the authors. The questionnaire that the researchers used is limited by recall bias, recency effects, and the risk that the preceding month did not represent the individual’s usual experience. Nonetheless, mTOQ items have demonstrated high reliability and validity. Other study limitations include the retrospective design, the high proportion of participants who used more than one acute treatment, and the fact that the data are 10 years old.
On the other hand, the study examined a large, representative sample of the US population. It also included various validated measures to diagnose migraine and to assess headache-related disability, allodynia, and depression.
“These results show that unmet needs remain, and the expansion of therapeutic options for episodic migraine is needed, as well as optimizing treatment by carefully designing comprehensive treatment plans with existing acute therapies with various doses, routes of administration, preventive and interventional treatment approaches, behavioral therapies, neuromodulators, and other empirically validated approaches to achieve optimized treatment,” Dr. Lipton concluded.
—Erik Greb
Suggested Reading
Lipton RB, Munjal S, Buse DC, et al. Predicting inadequate response to acute migraine medication: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2016;56(10):1635-1648.
Recovery From TBI and Better Sleep Go Hand in Hand
After a traumatic brain injury (TBI), people also experience major sleep problems, including changes in their sleep–wake cycle. A new study published online ahead of print December 21, 2016, in Neurology showed that recovering from these two conditions occurs in parallel.
“These results suggest that monitoring a person’s sleep–wake cycle may be a useful tool for assessing their recovery after TBI,” said study author Nadia Gosselin, PhD, an Assistant Professor in the Department of Psychology at the University of Montréal in Québec. “We found that when someone sustained a brain injury and had not recovered a certain level of consciousness to keep them awake and aware of their surroundings, they were not able to generate a good sleep–wake cycle. But as they recovered, their quality of sleep improved.” 
The study involved 30 people, ages 17 to 58, who had been hospitalized for moderate to severe TBI. Most of the patients were in a coma when they were admitted to the hospital, and all initially received care in an ICU. The injuries were caused by motor vehicle accidents for 20 people, falls for seven people, recreational or sports activities for two people and a blow to the head for one person. They were hospitalized for an average of 45 days, with monitoring for the study beginning an average of 21 days into the patient’s stay.
Each person was monitored daily for an average of 11 days for level of consciousness and thinking abilities using the Rancho Los Amigos scale, which ranges from 1 to 8. Each person also wore an activity monitor on the wrist so researchers could measure their sleep.
Researchers found that consciousness and thinking abilities improved hand in hand with measures of quality of sleep, showing a linear relationship.
One measure, the daytime activity ratio, reflects the percentage of activity that occurs during the day. Immediately after the injury, activity occurs throughout the day and night. The study showed that participants reached an acceptable sleep–wake cycle, with a daytime activity ratio of at least 80%, at the same point when they emerged from a minimally conscious state.
The participants still had inadequate sleep–wake cycles, at a score of 5 on the Rancho Los Amigos scale, where people are confused and give inappropriate responses to stimuli, but are able to follow simple commands. Sleep–wake cycles reached adequate levels at the same time that people reached a score of 6 on the Rancho Los Amigos scale, which is when people can give appropriate responses while still depending on outside input for direction. At that level, they can remember relearned tasks, but cannot remember new tasks.
The results were the same when researchers adjusted for the amount of time that had passed since the injury and the amount of medications they had received while they were in the ICU.
“It is possible that there are common underlying brain mechanisms involved in both recovery from TBI and improvement in sleep,” said Dr. Gosselin. “Still, more study needs to be done, and future research may want to examine how hospital lighting and noise also affect quality of sleep for those with TBI.”
Suggested Reading
Duclos C, Dumont M, Arbour C, et al. Parallel recovery of consciousness and sleep in acute traumatic brain injury. Neurology. 2016 Dec 21 [Epub ahead of print].
Soddu A, Bassetti CL. A good sleep for a fresh mind in patients with acute tramatic brain injury. Neurology. 2016 Dec 21 [Epub ahead of print].
After a traumatic brain injury (TBI), people also experience major sleep problems, including changes in their sleep–wake cycle. A new study published online ahead of print December 21, 2016, in Neurology showed that recovering from these two conditions occurs in parallel.
“These results suggest that monitoring a person’s sleep–wake cycle may be a useful tool for assessing their recovery after TBI,” said study author Nadia Gosselin, PhD, an Assistant Professor in the Department of Psychology at the University of Montréal in Québec. “We found that when someone sustained a brain injury and had not recovered a certain level of consciousness to keep them awake and aware of their surroundings, they were not able to generate a good sleep–wake cycle. But as they recovered, their quality of sleep improved.”
The study involved 30 people, ages 17 to 58, who had been hospitalized for moderate to severe TBI. Most of the patients were in a coma when they were admitted to the hospital, and all initially received care in an ICU. The injuries were caused by motor vehicle accidents for 20 people, falls for seven people, recreational or sports activities for two people and a blow to the head for one person. They were hospitalized for an average of 45 days, with monitoring for the study beginning an average of 21 days into the patient’s stay.
Each person was monitored daily for an average of 11 days for level of consciousness and thinking abilities using the Rancho Los Amigos scale, which ranges from 1 to 8. Each person also wore an activity monitor on the wrist so researchers could measure their sleep.
Researchers found that consciousness and thinking abilities improved hand in hand with measures of quality of sleep, showing a linear relationship.
One measure, the daytime activity ratio, reflects the percentage of activity that occurs during the day. Immediately after the injury, activity occurs throughout the day and night. The study showed that participants reached an acceptable sleep–wake cycle, with a daytime activity ratio of at least 80%, at the same point when they emerged from a minimally conscious state.
The participants still had inadequate sleep–wake cycles, at a score of 5 on the Rancho Los Amigos scale, where people are confused and give inappropriate responses to stimuli, but are able to follow simple commands. Sleep–wake cycles reached adequate levels at the same time that people reached a score of 6 on the Rancho Los Amigos scale, which is when people can give appropriate responses while still depending on outside input for direction. At that level, they can remember relearned tasks, but cannot remember new tasks.
The results were the same when researchers adjusted for the amount of time that had passed since the injury and the amount of medications they had received while they were in the ICU.
“It is possible that there are common underlying brain mechanisms involved in both recovery from TBI and improvement in sleep,” said Dr. Gosselin. “Still, more study needs to be done, and future research may want to examine how hospital lighting and noise also affect quality of sleep for those with TBI.”
Suggested Reading
Duclos C, Dumont M, Arbour C, et al. Parallel recovery of consciousness and sleep in acute traumatic brain injury. Neurology. 2016 Dec 21 [Epub ahead of print].
Soddu A, Bassetti CL. A good sleep for a fresh mind in patients with acute tramatic brain injury. Neurology. 2016 Dec 21 [Epub ahead of print].
After a traumatic brain injury (TBI), people also experience major sleep problems, including changes in their sleep–wake cycle. A new study published online ahead of print December 21, 2016, in Neurology showed that recovering from these two conditions occurs in parallel.
“These results suggest that monitoring a person’s sleep–wake cycle may be a useful tool for assessing their recovery after TBI,” said study author Nadia Gosselin, PhD, an Assistant Professor in the Department of Psychology at the University of Montréal in Québec. “We found that when someone sustained a brain injury and had not recovered a certain level of consciousness to keep them awake and aware of their surroundings, they were not able to generate a good sleep–wake cycle. But as they recovered, their quality of sleep improved.”
The study involved 30 people, ages 17 to 58, who had been hospitalized for moderate to severe TBI. Most of the patients were in a coma when they were admitted to the hospital, and all initially received care in an ICU. The injuries were caused by motor vehicle accidents for 20 people, falls for seven people, recreational or sports activities for two people and a blow to the head for one person. They were hospitalized for an average of 45 days, with monitoring for the study beginning an average of 21 days into the patient’s stay.
Each person was monitored daily for an average of 11 days for level of consciousness and thinking abilities using the Rancho Los Amigos scale, which ranges from 1 to 8. Each person also wore an activity monitor on the wrist so researchers could measure their sleep.
Researchers found that consciousness and thinking abilities improved hand in hand with measures of quality of sleep, showing a linear relationship.
One measure, the daytime activity ratio, reflects the percentage of activity that occurs during the day. Immediately after the injury, activity occurs throughout the day and night. The study showed that participants reached an acceptable sleep–wake cycle, with a daytime activity ratio of at least 80%, at the same point when they emerged from a minimally conscious state.
The participants still had inadequate sleep–wake cycles, at a score of 5 on the Rancho Los Amigos scale, where people are confused and give inappropriate responses to stimuli, but are able to follow simple commands. Sleep–wake cycles reached adequate levels at the same time that people reached a score of 6 on the Rancho Los Amigos scale, which is when people can give appropriate responses while still depending on outside input for direction. At that level, they can remember relearned tasks, but cannot remember new tasks.
The results were the same when researchers adjusted for the amount of time that had passed since the injury and the amount of medications they had received while they were in the ICU.
“It is possible that there are common underlying brain mechanisms involved in both recovery from TBI and improvement in sleep,” said Dr. Gosselin. “Still, more study needs to be done, and future research may want to examine how hospital lighting and noise also affect quality of sleep for those with TBI.”
Suggested Reading
Duclos C, Dumont M, Arbour C, et al. Parallel recovery of consciousness and sleep in acute traumatic brain injury. Neurology. 2016 Dec 21 [Epub ahead of print].
Soddu A, Bassetti CL. A good sleep for a fresh mind in patients with acute tramatic brain injury. Neurology. 2016 Dec 21 [Epub ahead of print].
Physicians and EHR time
Clinical question: How much time do ambulatory-care physicians spend on electronic health records (EHRs)?
Background: There is growing concern about physicians’ increased time and effort allocated to the EHR and decreased clinical face time and meaningful interaction with patients. Prior studies have shown that increased physician EHR task load is associated with increased physician stress and dissatisfaction.
Setting: Ambulatory-care practices.
Synopsis: Fifty-seven physicians from 16 practices in four U.S. states participated and were observed for more than 430 office hours. Additionally, 21 physicians completed a self-reported after-hours diary. During office hours, physicians spent 49.2% of their total time on the EHR and desk work and only 27% on face time with patients. While in the exam room, physicians spent 52.9% of the time on direct clinical face time and 37% on the EHR and desk work. Self-reported diaries showed an additional 1-2 hours of follow-up work on the EHR. These observations might not be generalizable to other practices. No formal statistical comparisons by physicians, practice, or EHR characteristics were done.
Bottom line: Ambulatory-care physicians appear to spend more time with EHR tasks and desk work than clinical face time with patients.
Citation: Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion studies in 4 specialties [published online ahead of print Sept. 6, 2016]. Ann Intern Med. 165(11):753-760.
Dr. Briones is an assistant professor at the University of Miami Miller School of Medicine and medical director of the hospitalist service at the University of Miami Hospital.
Clinical question: How much time do ambulatory-care physicians spend on electronic health records (EHRs)?
Background: There is growing concern about physicians’ increased time and effort allocated to the EHR and decreased clinical face time and meaningful interaction with patients. Prior studies have shown that increased physician EHR task load is associated with increased physician stress and dissatisfaction.
Setting: Ambulatory-care practices.
Synopsis: Fifty-seven physicians from 16 practices in four U.S. states participated and were observed for more than 430 office hours. Additionally, 21 physicians completed a self-reported after-hours diary. During office hours, physicians spent 49.2% of their total time on the EHR and desk work and only 27% on face time with patients. While in the exam room, physicians spent 52.9% of the time on direct clinical face time and 37% on the EHR and desk work. Self-reported diaries showed an additional 1-2 hours of follow-up work on the EHR. These observations might not be generalizable to other practices. No formal statistical comparisons by physicians, practice, or EHR characteristics were done.
Bottom line: Ambulatory-care physicians appear to spend more time with EHR tasks and desk work than clinical face time with patients.
Citation: Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion studies in 4 specialties [published online ahead of print Sept. 6, 2016]. Ann Intern Med. 165(11):753-760.
Dr. Briones is an assistant professor at the University of Miami Miller School of Medicine and medical director of the hospitalist service at the University of Miami Hospital.
Clinical question: How much time do ambulatory-care physicians spend on electronic health records (EHRs)?
Background: There is growing concern about physicians’ increased time and effort allocated to the EHR and decreased clinical face time and meaningful interaction with patients. Prior studies have shown that increased physician EHR task load is associated with increased physician stress and dissatisfaction.
Setting: Ambulatory-care practices.
Synopsis: Fifty-seven physicians from 16 practices in four U.S. states participated and were observed for more than 430 office hours. Additionally, 21 physicians completed a self-reported after-hours diary. During office hours, physicians spent 49.2% of their total time on the EHR and desk work and only 27% on face time with patients. While in the exam room, physicians spent 52.9% of the time on direct clinical face time and 37% on the EHR and desk work. Self-reported diaries showed an additional 1-2 hours of follow-up work on the EHR. These observations might not be generalizable to other practices. No formal statistical comparisons by physicians, practice, or EHR characteristics were done.
Bottom line: Ambulatory-care physicians appear to spend more time with EHR tasks and desk work than clinical face time with patients.
Citation: Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion studies in 4 specialties [published online ahead of print Sept. 6, 2016]. Ann Intern Med. 165(11):753-760.
Dr. Briones is an assistant professor at the University of Miami Miller School of Medicine and medical director of the hospitalist service at the University of Miami Hospital.
Self-management May Provide Some Relief for Patients with Intellectual Disabilities and Epilepsy
Self-management techniques may help patients with epilepsy and intellectual disabilities suggests a recent review of the medical literature. Michelle Dannenberg and associates found that, while the research on self-management intervention is very limited, 5 high quality pilot and randomized controlled feasibility studies did suggest that such interventions have the potential to improve patients’ knowledge base, reduce the frequency of seizures, and improve their quality of life.
Dannenberg M, Mengoni SE, Gates B et al. Self-management interventions for epilepsy in people with intellectual disabilities: A scoping review. Seizure.2016; 41:16-25.
Self-management techniques may help patients with epilepsy and intellectual disabilities suggests a recent review of the medical literature. Michelle Dannenberg and associates found that, while the research on self-management intervention is very limited, 5 high quality pilot and randomized controlled feasibility studies did suggest that such interventions have the potential to improve patients’ knowledge base, reduce the frequency of seizures, and improve their quality of life.
Dannenberg M, Mengoni SE, Gates B et al. Self-management interventions for epilepsy in people with intellectual disabilities: A scoping review. Seizure.2016; 41:16-25.
Self-management techniques may help patients with epilepsy and intellectual disabilities suggests a recent review of the medical literature. Michelle Dannenberg and associates found that, while the research on self-management intervention is very limited, 5 high quality pilot and randomized controlled feasibility studies did suggest that such interventions have the potential to improve patients’ knowledge base, reduce the frequency of seizures, and improve their quality of life.
Dannenberg M, Mengoni SE, Gates B et al. Self-management interventions for epilepsy in people with intellectual disabilities: A scoping review. Seizure.2016; 41:16-25.
SCN8A Mutations Linked to Epilepsy Variants and Developmental Delay
Pathogenic variants of the SCN8A gene may contribute to a variety of epilepsy types, as well as nonseizure neurodevelopmental disorders, according a recent genetic analysis. Five variants of the gene called sodium channel alpha subunit 8, which codes for the ion pore region of the voltage-gated sodium channel, were detected in the genetic sequencing data from 275 epilepsy panels performed by the Emory Genetics Laboratory. Four of the 5 affected individuals had epilepsy and developmental delay/intellectual disability. The fifth patient had a less severe form of epilepsy that did not impair their cognitive abilities.
Butler KM, da Silva C, Shafir Y et al. De novo and inherited SCN8A epilepsy mutations detected by gene panel analysis. Epilepsy Res. 2016;129:17-25.
Pathogenic variants of the SCN8A gene may contribute to a variety of epilepsy types, as well as nonseizure neurodevelopmental disorders, according a recent genetic analysis. Five variants of the gene called sodium channel alpha subunit 8, which codes for the ion pore region of the voltage-gated sodium channel, were detected in the genetic sequencing data from 275 epilepsy panels performed by the Emory Genetics Laboratory. Four of the 5 affected individuals had epilepsy and developmental delay/intellectual disability. The fifth patient had a less severe form of epilepsy that did not impair their cognitive abilities.
Butler KM, da Silva C, Shafir Y et al. De novo and inherited SCN8A epilepsy mutations detected by gene panel analysis. Epilepsy Res. 2016;129:17-25.
Pathogenic variants of the SCN8A gene may contribute to a variety of epilepsy types, as well as nonseizure neurodevelopmental disorders, according a recent genetic analysis. Five variants of the gene called sodium channel alpha subunit 8, which codes for the ion pore region of the voltage-gated sodium channel, were detected in the genetic sequencing data from 275 epilepsy panels performed by the Emory Genetics Laboratory. Four of the 5 affected individuals had epilepsy and developmental delay/intellectual disability. The fifth patient had a less severe form of epilepsy that did not impair their cognitive abilities.
Butler KM, da Silva C, Shafir Y et al. De novo and inherited SCN8A epilepsy mutations detected by gene panel analysis. Epilepsy Res. 2016;129:17-25.
When to Perform Invasive EEG on Surgical Candidates With Epilepsy
The precise indications for intracranial electroencephalography (IEEG) remain unresolved and vary among epilepsy surgical centers. The International League Against Epilepsy has issued recommendations on the diagnostic usefulness of IEEG that discuss the application of a variety of modalities and that provide a consensus among experts on its efficacy, safety, ease, and cost benefits. The goal of the guidelines is to reduce over- and underuse of IEEE while at the same time allowing flexibility among the epilepsy centers that perform the procedure.
Jayakar P, Gotman J, Harvey AS et al. Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques. Epilepsia. 2016;57(11):1735-1747.
The precise indications for intracranial electroencephalography (IEEG) remain unresolved and vary among epilepsy surgical centers. The International League Against Epilepsy has issued recommendations on the diagnostic usefulness of IEEG that discuss the application of a variety of modalities and that provide a consensus among experts on its efficacy, safety, ease, and cost benefits. The goal of the guidelines is to reduce over- and underuse of IEEE while at the same time allowing flexibility among the epilepsy centers that perform the procedure.
Jayakar P, Gotman J, Harvey AS et al. Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques. Epilepsia. 2016;57(11):1735-1747.
The precise indications for intracranial electroencephalography (IEEG) remain unresolved and vary among epilepsy surgical centers. The International League Against Epilepsy has issued recommendations on the diagnostic usefulness of IEEG that discuss the application of a variety of modalities and that provide a consensus among experts on its efficacy, safety, ease, and cost benefits. The goal of the guidelines is to reduce over- and underuse of IEEE while at the same time allowing flexibility among the epilepsy centers that perform the procedure.
Jayakar P, Gotman J, Harvey AS et al. Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques. Epilepsia. 2016;57(11):1735-1747.
Mortality Risk for Status Epilepticus Varies With Epilepsy Status
Status epilepticus (SE) significantly increases the all-cause mortality according to a review of more than 82,000 hospitalizations and emergency-department visits. Within this large group were 1,296 patients who presented with only SE, 2,136 patients who had post-epilepsy SE, and nearly 79,000 cases of epilepsy only, which served as controls. Angela M. Malek and associates found a mortality rate of 24.9% among SE only cases, compared with 20% in controls (hazard ratio 1.61) after adjustment for demographic and clinical confounding variables. Patients who presented with post-epilepsy SE had a mortality rate of 29.2% but a hazard ratio of only 1.16.
Malek AM, Wilson DA, Martz GU, et al. Mortality following status epilepticus in persons with and without epilepsy. Seizure. 2016;42:7-13.
Status epilepticus (SE) significantly increases the all-cause mortality according to a review of more than 82,000 hospitalizations and emergency-department visits. Within this large group were 1,296 patients who presented with only SE, 2,136 patients who had post-epilepsy SE, and nearly 79,000 cases of epilepsy only, which served as controls. Angela M. Malek and associates found a mortality rate of 24.9% among SE only cases, compared with 20% in controls (hazard ratio 1.61) after adjustment for demographic and clinical confounding variables. Patients who presented with post-epilepsy SE had a mortality rate of 29.2% but a hazard ratio of only 1.16.
Malek AM, Wilson DA, Martz GU, et al. Mortality following status epilepticus in persons with and without epilepsy. Seizure. 2016;42:7-13.
Status epilepticus (SE) significantly increases the all-cause mortality according to a review of more than 82,000 hospitalizations and emergency-department visits. Within this large group were 1,296 patients who presented with only SE, 2,136 patients who had post-epilepsy SE, and nearly 79,000 cases of epilepsy only, which served as controls. Angela M. Malek and associates found a mortality rate of 24.9% among SE only cases, compared with 20% in controls (hazard ratio 1.61) after adjustment for demographic and clinical confounding variables. Patients who presented with post-epilepsy SE had a mortality rate of 29.2% but a hazard ratio of only 1.16.
Malek AM, Wilson DA, Martz GU, et al. Mortality following status epilepticus in persons with and without epilepsy. Seizure. 2016;42:7-13.
Post-surgical Seizure Linked to Psychogenic Nonepileptic Seizures
Patients who continue to have seizures after epilepsy surgery should be evaluated for psychogenic nonepileptic seizures (PNES), based on a recent retrospective analysis of 1,105 patients. Among this cohort, 697 patients experienced postoperative seizures, and 27 of the 697 had documented PNES, according to Ali A. Asadi-Pooya and associates. Risk factors associated with post–epilepsy surgery PNES included an intelligence quotient (IQ) below 80 and a history of a psychiatric diagnosis.
Asadi-Pooya AA, Asadollahi M, Tinker J, et al. Post–epilepsy surgery psychogenic nonepileptic seizures. Epilepsia. 2016;57(10):1691-1696.
Patients who continue to have seizures after epilepsy surgery should be evaluated for psychogenic nonepileptic seizures (PNES), based on a recent retrospective analysis of 1,105 patients. Among this cohort, 697 patients experienced postoperative seizures, and 27 of the 697 had documented PNES, according to Ali A. Asadi-Pooya and associates. Risk factors associated with post–epilepsy surgery PNES included an intelligence quotient (IQ) below 80 and a history of a psychiatric diagnosis.
Asadi-Pooya AA, Asadollahi M, Tinker J, et al. Post–epilepsy surgery psychogenic nonepileptic seizures. Epilepsia. 2016;57(10):1691-1696.
Patients who continue to have seizures after epilepsy surgery should be evaluated for psychogenic nonepileptic seizures (PNES), based on a recent retrospective analysis of 1,105 patients. Among this cohort, 697 patients experienced postoperative seizures, and 27 of the 697 had documented PNES, according to Ali A. Asadi-Pooya and associates. Risk factors associated with post–epilepsy surgery PNES included an intelligence quotient (IQ) below 80 and a history of a psychiatric diagnosis.
Asadi-Pooya AA, Asadollahi M, Tinker J, et al. Post–epilepsy surgery psychogenic nonepileptic seizures. Epilepsia. 2016;57(10):1691-1696.
Do Epilepsy-related Mutations Make Patients Depressed?
Among relatives of patients with epilepsy, the prevalence of depression is greater among those who believe they have an increased risk of epilepsy because they may have inherited an epilepsy-related mutation. Shawn T. Sorge and his colleagues reached that conclusion after surveying 417 individuals in 104 families in which 4 persons per family had the disease on average. On the other hand, individuals with epilepsy seemed less troubled by the diagnosis: The likelihood of having depression was not related to any potential epilepsy-related mutation among persons who already have epilepsy.
Sorge ST, Hesdorffer DC, Phelan JC, et al. Depression and genetic causal attribution of epilepsy in multiplex epilepsy families. Epilepsia. 2016;57(10):1643-1650.
Among relatives of patients with epilepsy, the prevalence of depression is greater among those who believe they have an increased risk of epilepsy because they may have inherited an epilepsy-related mutation. Shawn T. Sorge and his colleagues reached that conclusion after surveying 417 individuals in 104 families in which 4 persons per family had the disease on average. On the other hand, individuals with epilepsy seemed less troubled by the diagnosis: The likelihood of having depression was not related to any potential epilepsy-related mutation among persons who already have epilepsy.
Sorge ST, Hesdorffer DC, Phelan JC, et al. Depression and genetic causal attribution of epilepsy in multiplex epilepsy families. Epilepsia. 2016;57(10):1643-1650.
Among relatives of patients with epilepsy, the prevalence of depression is greater among those who believe they have an increased risk of epilepsy because they may have inherited an epilepsy-related mutation. Shawn T. Sorge and his colleagues reached that conclusion after surveying 417 individuals in 104 families in which 4 persons per family had the disease on average. On the other hand, individuals with epilepsy seemed less troubled by the diagnosis: The likelihood of having depression was not related to any potential epilepsy-related mutation among persons who already have epilepsy.
Sorge ST, Hesdorffer DC, Phelan JC, et al. Depression and genetic causal attribution of epilepsy in multiplex epilepsy families. Epilepsia. 2016;57(10):1643-1650.