Diego Morita

Even a single seizure negatively impacts pediatric health-related quality of life.

Purpose:  Both a single seizure and chronic recurrent seizures (epilepsy) occur commonly in childhood. Although several studies have documented the impact of pediatric epilepsy on psychosocial functioning, such as health‐related quality of life (HRQOL), no studies have examined the impact of a single seizure on HRQOL. The primary objectives of this study were: (1) to compare parent–proxy HRQOL in children with a single seizure and newly diagnosed untreated epilepsy to normative data and (2) to examine differences in parent–proxy HRQOL between children with single seizure and newly diagnosed untreated epilepsy.

Quality improvement in neurology: Epilepsy Update Quality Measurement Set.

Epilepsy is a common, debilitating, and costly disease. It is estimated that 2.2 million people in the United States are diagnosed with epilepsy, and 150,000 new cases of epilepsy are diagnosed in the United States annually.1 However, epilepsy prevalence might be underestimated due to numerous social issues that accompany a diagnosis of epilepsy.2 People with epilepsy have poorer overall health status, impaired intellectual and physical functioning, and a greater risk for accidents and injuries.1–3 It is estimated that the annual direct medical cost of epilepsy in the United States is

Development and validation of the Pediatric Epilepsy Side Effects Questionnaire

9.6 billion, and this estimate does not include indirect costs from losses in quality of life or productivity.1

One-Month Adherence in Children With New-Onset Epilepsy: White-Coat Compliance Does Not Occur

Objective: To develop and validate a measure of antiepileptic drug (AED) side effects in children with a variety of seizure types, treatments, and therapy durations. Methods: Content for an initial 44-item measure was developed using the previously published Hague Scale and expert opinion from recognized pediatric epileptologists (n = 12) and caregivers of children with epilepsy (n = 21). The measure was completed by caregivers during routine clinic visits. Demographic and medical data were collected through chart reviews. Factor analysis was conducted and internal consistency, test-retest reliability, and construct validity were assessed. Results: Questionnaires were analyzed from 495 children with epilepsy (Mage = 10.1 years; range 2–21 years; 42% female; 14% African American; 32% new onset vs 68% chronic epilepsy). The final questionnaire, the Pediatric Epilepsy Side Effects Questionnaire (PESQ), is a 19-item measure with 5 subscales (i.e., cognitive, motor, behavioral, general neurological, and weight) that accounts for 99% of the variance. Internal consistency coefficients and test-retest reliabilities ranged from 0.72 to 0.93 and 0.74 to 0.97, respectively. Construct validity was demonstrated by increasing side effects as the number of drugs increased. Participants on valproic acid had significantly higher scores on the Weight Scale compared to those on carbamazepine. Conclusions: The PESQ is a reliable and valid measure of AED side effects in children across the epilepsy spectrum that can be used in both clinical and research settings.

Ictal MEG onset source localization compared to intracranial EEG and outcome: improved epilepsy presurgical evaluation in pediatrics.

OBJECTIVES. Adherence to antiepileptic drug therapy plays an important role in the effectiveness of pharmacologic treatment of epilepsy. The purpose of this study was to use an objective measure of adherence to (1) document patterns of adherence for the first month of therapy for children with new-onset epilepsy, (2) examine differences in adherence by demographic and epilepsy variables, and (3) determine whether treatment adherence improves for a short time before a clinic visit (eg, “white-coat compliance”). METHODS. Participants included 35 children with new-onset epilepsy (mean age: 7.2 years; 34% female; 66% white) and their caregivers. Children had a diagnosis of partial (60%), generalized (29%), or unclassified (11%) epilepsy. Adherence to treatment was electronically monitored with Medication Event Monitoring System TrackCap, starting with the first antiepileptic drug dose. Adherence was calculated across a 1-month period and for the 1, 3, and 5 days before and 3 days after the clinic appointment. RESULTS. Adherence for the first month of treatment in children with new-onset epilepsy was 79.4%. One-month adherence was higher in children of married parents and those with higher socioeconomic status but did not correlate with childs gender, age, epilepsy type, prescribed medication, seizure frequency, or length of time since seizure onset. Adherence across the entire 1-month period was not different from adherence for the 1, 3, or 5 days before or 3 days after the clinic visit. CONCLUSIONS. Poor adherence seen for children with new-onset epilepsy during the first month of antiepileptic drug therapy is a cause for concern. Several demographic variables influence adherence to treatment, whereas the proximity to a clinic visit does not. Additional studies are needed to document whether this trend continues longitudinally and determine the clinical impact of poor adherence.

Development and reliability of a correction factor for parent-reported adherence to pediatric antiepileptic drug therapy.

PURPOSE Magnetoencephalography (MEG) has been shown a useful diagnostic tool for presurgical evaluation of pediatric medically intractable partial epilepsy as MEG source localization has been shown to improve the likelihood of seizure onset zone (SOZ) sampling during subsequent evaluation with intracranial EEG (ICEEG). We investigated whether ictal MEG onset source localization further improves results of interictal MEG in defining the SOZ. METHODS We identified 20 pediatric patients with one habitual seizure during MEG recordings between October 2007 and April 2011. MEG was recorded with sampling rates of 600Hz and 4000Hz for 10 and 2min respectively. Continuous head localization (CHL) was applied. Source localization analyses were applied using multiple algorithms, both at the beginning of ictal onset and for interictal MEG discharges. Ictal MEG onsets were identified by visual inspection and power spectrum using short-time Fourier transform (STFT). Source localizations were compared with ICEEG, surgical procedure and outcome. KEY FINDINGS Eight patients met all inclusion criteria. Five of the 8 patients (63%) had concordant ictal MEG onset source localization and interictal MEG discharge source localizations in the same lobe, but the source of ictal MEG onset was closer to the SOZ defined by ICEEG. SIGNIFICANCE Although the capture of seizures during MEG recording is challenging, the source localization for ictal MEG onset proved to be a useful tool for presurgical evaluation in our pediatric population with medically intractable epilepsy.

Functional magnetic resonance imaging reveals changes in language localization in children with benign childhood epilepsy with centrotemporal spikes.

Purpose:  Study aims were (1) to document and examine associations between parent‐report and electronic monitoring (EM) of pediatric antiepileptic drug (AED) adherence, (2) to determine the sensitivity and specificity of parent‐reported adherence, and (3) to develop a correction factor for parent‐reported adherence.

Valproate in children with newly diagnosed idiopathic generalized epilepsy.

In children with benign childhood epilepsy with centrotemporal spikes, centrotemporal spikes may cause language dysfunction via disruption of underlying functional neuroanatomy. Fifteen patients with benign childhood epilepsy with centrotemporal spikes and 15 healthy controls completed 3 functional magnetic resonance imaging (MRI) language paradigms; standardized cognitive and language assessments were also performed. For all paradigms, children with benign childhood epilepsy with centrotemporal spikes showed specific regional differences in activation compared to controls. Children with benign childhood epilepsy with centrotemporal spikes also differed from controls on neuropsychological testing. They did not differ in general intelligence, but children with benign childhood epilepsy with centrotemporal spikes scored significantly lower than controls on tests of language, visuomotor integration, and processing speed. These results extend previous findings of lower language and cognitive skills in patients with benign childhood epilepsy with centrotemporal spikes, and suggest epilepsy-related remodeling of language networks that may underlie these observed differences.

Impact of frequency and lateralization of interictal discharges on neuropsychological and fine motor status in children with benign epilepsy with centrotemporal spikes

Holland KD, Monahan S, Morita D, Vartzelis G, Glauser TA. Valproate in children with newly diagnosed idiopathic generalized epilepsy. 
Acta Neurol Scand: 2010: 121: 149–153.
© 2009 The Authors Journal compilation

Quality improvement in neurology: Child neurology quality measure set: Executive summary

Despite a positive prognosis for seizure remission, children with benign epilepsy with centrotemporal spikes (BECTS) have been reported to exhibit subtle neuropsychological difficulties. We examined the relationship between patterns of centrotemporal spikes (the typical electroencephalography [EEG] finding in BECTS) and neuropsychological and motor outcomes in children with new‐onset BECTS. Thirty‐four patients with new‐onset BECTS (not taking antiepileptic medication) and 48 typically developing children participated in the study. In BECTS patients, centrotemporal spikes (CTS) were evaluated in the first hour awake and first 2 h of sleep in a 24‐h EEG recording and left or right‐sided origin was noted. General intellectual function, language, visuospatial skill, processing speed, and fine motor skill were assessed in all participants. We found no significant difference between BECTS patients and controls on measures of general intellectual function, or visuospatial or language testing. There were significant differences in processing speed index and nondominant hand fine motor scores between groups. Significant negative relationships were observed between rates of left‐sided CTS and right hand fine motor scores. This suggests that psychomotor and fine motor speed are affected in BECTS, but the extent of affected domains may be more limited than previously suggested, especially in untreated patients early in the course of their epilepsy.