Objectives. The combination of epilepsy, intellectual disability, and other psychiatric comorbidities disorders represents an extreme burden on their families and lay caregivers. The study aimed to investigate previously missing data on the burden and level of stress lay caregivers of patients with epilepsy and mental/intellectual disability and possible changes during the COVID-19 pandemic. Methods. The unicentric pilot study in lay caregivers of dispensed patients with epilepsy and concurrent mental/intellectual disability in an Epilepsy Center focused on lay caregivers burden. Caregiver burden was subjectively assessed for a period before and during the COVID-19 pandemic using the Caregiver Burden Scale. The Chi-Square Test was used for statistical evaluation at a significance level of 0.05. Results. Since the beginning of the COVID-19 pandemic, 526 patients were dispensed with the principal diagnosis of G40.* in the selected center; 46 lay caregivers were included in the study (9 males, and 37 females; the patient’s average age was 52.1 years). Due to the limitation of respite services, 25 (54.3%) caregivers reported worsening economic situations, and 31 (67.4%) reported increased stress levels. Increased caregiver burden during the COVID-19 pandemic was verified for walking (15 cases, p = 0.001), dressing, and bathing (12 cases, p = 0.010) activities. Conclusion. The obtained results confirmed the high dependency rate of patients and identified several factors (impaired mobility, falls, aggression, fear of COVID-19 disease) that increase the level of burden and stress in their caregivers due to the inability to use respite care and common tools for external assistance in care. Worsening socioeconomic situation and increased use of antidepressants by caregivers have been identified. The analysis also confirmed differences in the availability of respite care by place of residence at the national level.
- MeSH
- bolesti hlavy klasifikace MeSH
- cluster headache * diagnóza klasifikace MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- trigeminální autonomní cefalalgie diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- zprávy MeSH
BACKGROUND: Migraine and epilepsy are two paroxysmal chronic neurological disorders affecting a high number of individuals and being responsible for a high individual and socioeconomic burden. The link between these disorders has been of interest for decades and innovations concerning diagnosing and treatment enable new insights into their relationship. FINDINGS: Although appearing to be distinct at first glance, both diseases exhibit a noteworthy comorbidity, shared pathophysiological pathways, and significant overlaps in characteristics like clinical manifestation or prophylactic treatment. This review aims to explore the intricate relationship between these two conditions, shedding light on shared pathophysiological foundations, genetic interdependencies, common and distinct clinical features, clinically overlapping syndromes, and therapeutic similarities. There are several shared pathophysiological mechanisms, like CSD, the likely underlying cause of migraine aura, or neurotransmitters, mainly Glutamate and GABA, which represent important roles in triggering migraine attacks and seizures. The genetic interrelations between the two disorders can be observed by taking a closer look at the group of familial hemiplegic migraines, which are caused by mutations in genes like CACNA1A, ATP1A2, or SCN1A. The intricate relationship is further underlined by the high number of shared clinical features, which can be observed over the entire course of migraine attacks and epileptic seizures. While the variety of the clinical manifestation of an epileptic seizure is naturally higher than that of a migraine attack, a distinction can indeed be difficult in some cases, e.g. in occipital lobe epilepsy. Moreover, triggering factors like sleep deprivation or alcohol consumption play an important role in both diseases. In the period after the seizure or migraine attack, symptoms like speech difficulties, tiredness, and yawning occur. While the actual attack of the disease usually lasts for a limited time, research indicates that individuals suffering from migraine and/or epilepsy are highly affected in their daily life, especially regarding cognitive and social aspects, a burden that is even worsened using antiseizure medication. This medication allows us to reveal further connections, as certain antiepileptics are proven to have beneficial effects on the frequency and severity of migraine and have been used as a preventive drug for both diseases over many years. CONCLUSION: Migraine and epilepsy show a high number of similarities in their mechanisms and clinical presentation. A deeper understanding of the intricate relationship will positively advance patient-oriented research and clinical work.
- MeSH
- antikonvulziva terapeutické užití MeSH
- epilepsie * etiologie genetika MeSH
- komorbidita MeSH
- lidé MeSH
- migréna s aurou * genetika MeSH
- migréna * diagnóza genetika epidemiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVE: Focal cortical dysplasia (FCD), hippocampal sclerosis (HS), nonspecific gliosis (NG), and normal tissue (NT) comprise the majority of histopathological results of surgically treated drug-resistant epilepsy patients. Epileptic spikes, high-frequency oscillations (HFOs), and connectivity measures are valuable biomarkers of epileptogenicity. The question remains whether they could also be utilized for preresective differentiation of the underlying brain pathology. This study explored spikes and HFOs together with functional connectivity in various epileptogenic pathologies. METHODS: Interictal awake stereoelectroencephalographic recordings of 33 patients with focal drug-resistant epilepsy with seizure-free postoperative outcomes were analyzed (15 FCD, 8 HS, 6 NT, and 4 NG). Interictal spikes and HFOs were automatically identified in the channels contained in the overlap of seizure onset zone and resected tissue. Functional connectivity measures (relative entropy, linear correlation, cross-correlation, and phase consistency) were computed for neighboring electrode pairs. RESULTS: Statistically significant differences were found between the individual pathologies in HFO rates, spikes, and their characteristics, together with functional connectivity measures, with the highest values in the case of HS and NG/NT. A model to predict brain pathology based on all interictal measures achieved up to 84.0% prediction accuracy. SIGNIFICANCE: The electrophysiological profile of the various epileptogenic lesions in epilepsy surgery patients was analyzed. Based on this profile, a predictive model was developed. This model offers excellent potential to identify the nature of the underlying lesion prior to resection. If validated, this model may be particularly valuable for counseling patients, as depending on the lesion type, different outcomes are achieved after epilepsy surgery.
- MeSH
- elektroencefalografie metody MeSH
- epilepsie * diagnóza chirurgie MeSH
- lidé MeSH
- mozek diagnostické zobrazování chirurgie MeSH
- refrakterní epilepsie * diagnostické zobrazování chirurgie MeSH
- stereotaktické techniky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
The phenomenon of déjà vu (DV) has intrigued scientists for decades, yet its neurophysiological underpinnings remain elusive. Brain regions have been identified in which morphometry differs between healthy individuals according to the frequency of their DV experiences. This study built upon these findings by assessing if and how neural activity in these and other brain regions also differ with respect to DV experience. Resting-state fMRI was performed on 68 healthy volunteers, 44 of whom reported DV experiences (DV group) and 24 who did not (NDV group). Using multivariate analyses, we then assessed the (fractional) amplitude of low-frequency fluctuations (fALFF/ALFF), a metric that is believed to index brain tissue excitability, for five discrete frequency bands within sets of brain regions implicated in DV and those comprising the default mode network (DMN). Analyses revealed significantly lower values of fALFF/ALFF for specific frequency bands in the DV relative to the NDV group, particularly within mesiotemporal structures, bilateral putamina, right caudatum, bilateral superior frontal cortices, left lateral parietal cortex, dorsal and ventral medial prefrontal cortex, and the posterior cingulate cortex. The pattern of differences in fALFF/ALFF measures between the brains of individuals who have experienced DV and those who have not provides new neurophysiological insights into this phenomenon, including the potential role of the DMN. We suggest that the erroneous feeling of familiarity arises from a temporary disruption of cortico-subcortical circuitry together with the upregulation of cortical excitability.
- MeSH
- emoce MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- mapování mozku metody MeSH
- mozek diagnostické zobrazování MeSH
- mozkové vlny * fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Anti-NMDA encefalitida je významným zástupcem autoimunitních encefalitid (AIE), na které se v dnešní době v rámci diferenciální diagostiky stále častěji pomýšlí. Mezi základní klinické projevy AIE patří subakutní rozvoj poruchy paměti, epileptické záchvaty a psychiatrické symptomy. V rámci diagnostiky je důležité potvrzení pozitivity protilátek, u anti-NMDA encefalitidy se jedná o protilátky proti N-metyl-D-aspartát receptorům. Existují i případy pozitivity anti-NMDA protilátek nejasného klinického významu, v literatuře se objevuje vzácná asociace anti-NMDA protilátek a Creutzfeldt-Jakobovy nemoci, jak je tomu i v naší kazuistice.
Anti-NMDA encephalitis is one of many types of autoimunne encephalitis (AIE), about which we are thinking during diagnostic process even more in these days. Typical symptoms of AIE are loss of memory, epileptic seizures and psychiatric symptoms. During diagnostic process is important to find positivity of antibodies, in the case of anti-NMDA encephalitis there are antibodies against N-methyl-D-aspartate receptors, which are placed on almost all neurons in the brain and spinal cord. Early diagnosis and treatment of this disease is an important prognostic factor. However there are some cases, in which there is no association between anti-NMDA antibodies and autoimunne encephalitis, as we can see in the following case report.
- MeSH
- chybná diagnóza MeSH
- Creutzfeldtova-Jakobova nemoc * diagnóza MeSH
- cyklofosfamid aplikace a dávkování MeSH
- encefalitida s protilátkami proti NMDA receptorům * diagnóza MeSH
- fatální výsledek MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- pitva MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Cíl: Cílem studie bylo zjistit, jakým způsobem ovlivňuje epileptochirurgická léčba kvalitu života u pacientů operovaných pro farmakorezistentní epilepsii. Metodika: Pacienti operovaní pro farmakorezistentní epilepsii vyplnili dotazník se zaměřením na kvalitu života (Quality of Life in Epilepsy Inventory-89, QOLIE-89) před a po operaci. QOLIE-89 hodnotí 17 podoblastí kvality života, je možné rovněž hodnotit celkovou kvalitu života pomocí celkového skóre. Statisticky jsme vyhodnotili, zda došlo po operaci ke změně kvality života. Následně jsme výsledky QOLIE-89 korelovali s demografickými daty pacientů, včetně hodnoty IQ a psychiatrických/ somatických komorbidit. Výsledky: Do studie jsme zařadili celkem 95 pacientů po resekčním epileptochirurgickém výkonu, kteří správně a kompletně vyplnili dotazník před a minimálně jeden rok po operaci. Ke statisticky významnému zlepšení dochází v následujících podoblastech: vnímání zdraví (p < 0,001), změna zdraví (p < 0,001), celkové zdraví (p < 0,001), práce/řízení motorového vozidla/sociální fungovaní (p < 0,001), obava ze záchvatu (p < 0,001), ztráta odvahy v souvislosti se zdravotním stavem (p = 0,049), účinky léků (p = 0,002) a celková kvalita života (p = 0,001). Po operaci bylo zjištěno i statisticky významné zlepšení celkového skóre (p = 0,008). Nebyla zjištěna statisticky významná korelace celkového skóre s demografickými údaji. Závěr: Na základě naší dotazníkové studie můžeme konstatovat, že epileptochirurgická léčba vede u většiny pacientů nejen k eliminaci záchvatů, ale výrazně rovněž přispívá ke zlepšení kvality života.
Objective: The aim of the study was to ascertain in what way epilepsy surgery treatment affects the quality of life of patientsoperated on for pharmacoresistant epilepsy. Method: Patients operated on for pharmacoresistant epilepsy completed a quality of life questionnaire (Quality of Life in EpilepsyInventory-89; QOLIE-89) before and after the surgery. QOLIE-89 evaluates the quality of life in 17 subscales, including the assessmentof overall quality of life using the total score. We statistically evaluated whether a change in the quality of life had occurredafter the surgery. Subsequently, the QOLIE-89 results were correlated with patient demographic data, including their IQ scoresand psychiatric/somatic comorbidities. Results: The study included a total of 95 patients after resection epilepsy surgery who fully and correctly completed the questionnaireprior to and at least one year after the surgery. A statistically significant improvement occurred in the following subscales:health perceptions (p < 0.001), change in health (p < 0.001), general health (p < 0.001), work/driving/social function (p < 0.001), seizure worry (p < 0.001), health discouragement (p = 0.049), medication effects (p = 0.002), and overall quality of life (p = 0.001).Following surgery, a statistically significant improvement in the total score (p = 0.008) was found. No statistically significant correlationwas observed between the total score and demographic data. Conclusion: Based on our questionnaire study it can be concluded that, in the majority of patients, epilepsy surgery treatmentnot only leads to elimination of seizures, but also significantly contributes to improved quality of life.
