Background: The parental role is crucial in the management of children with epilepsy before, during, and after the seizures. It is crucial to ascertain the sufficient knowledge, attitude, and proper practice of the caregivers about epilepsy; however, caregivers with high self-efficacy are more able to achieve caregiving tasks of epilepsy children at the best level.

Purpose: To assess the effect of an educational intervention on the knowledge, attitude, reported practice and self-efficacy of caregivers of children with epilepsy.

Methods: A pretest-posttest quasi-experimental design was used to carry out the study, in which a convenient sample of 60 caregivers for epilepsy children was chosen from the outpatient clinics of Al-Ahrar Zagazig Teaching Hospital. The candidates were asked to fill up a questionnaire as a pretest, and then were exposed to a tailored educational intervention about epilepsy before being reassessed again using the same questionnaire.

Results: Most of caregivers were married females, and mainly mothers. Although caregivers generally had low level of knowledge, attitudes, reported practices, and self-efficacy about epilepsy before the educational intervention, they improved significantly after the educational intervention. The educational program was a significant independent positive predictor of caregivers' scores of knowledge, attitudes, practice and self-efficacy.

Discussion: The study findings demonstrate significant improvements in the knowledge, attitude, and reported practice as well as the self-efficacy scores of caregivers of children with epilepsy following the implementation of the educational intervention, which reflects the importance of providing educational intervention to improve the knowledge, attitude, practice, and self-efficacy of epilepsy children caregivers.

Epilepsy is a chronic neurological disorder that causes spontaneous recurrence of unprovoked seizures. The incidence rate is known to be bimodal with peaks in children and older people. Older people have been found to be particularly susceptible to threats posed by the coronavirus disease 2019 (COVID-19). In this article, we discuss the vulnerability of older patients with epilepsy and the importance of comprehensive support for this population during the COVID-19 crisis. Epilepsy clinicians need to understand their situations in order to provide proper care for older patients with epilepsy.

Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2. COVID-19 was initially detected in Wuhan, China in late 2019, and has rapidly spread worldwide. As the battle against COVID-19 becomes more and more long-term, it has become important to consider how to perform epilepsy surgery in the environment with the COVID-19 crisis. In this review article, we propose strategies for institutions that perform epilepsy surgery. First, we discuss the importance of coordinating neurosurgical team and inter-hospital collaboration as a hospital-based initiative. Next, we describe three surgical activities: preoperative evaluation, perioperative management, and during operation. We also discuss management of outpatients as a postoperative strategy. Finally, we mention the importance of psycho-logical support for medical staff, patients, and caregivers. By utilizing these strategies, we should make the best efforts to provide the necessary surgical treatment to patients with epilepsy, even in the COVID-19 era.

The purpose of this review is to describe the impact of COVID-19 on women with epilepsy and how the issues are managed. From a review of relevant literature, we discuss special considerations for women with epilepsy during the COVID-19 crisis, which include menstruation, pregnancy, and living environment. We also propose comprehensive management including menstruation/pregnancy, medications, and mental stress. Through this review, the serious impact of COVID-19 on women with epilepsy is revealed. Epileptologists must understand these burdens in order to provide comprehensive support for women with epilepsy.

We report on a tuberous sclerosis (TSC) patient with intractable epilepsy and chronic renal failure. In spite of having the characteristic features of TSC (cutaneous manifestations, multiple cystic lesions in the kidneys, and intractable epilepsy with a history of brain surgery), he had been over-looked for a long period of time in an inpatient facility for handicapped persons. He was under management by several physicians, including neurologists for adult patients, without a well-organized transition plan or efficient support from pediatric neurologists. Genetic testing revealed that the patient had a novel causative gene anomaly on the TSC1 gene. Before receiving adequate treatment for epilepsy, he had had daily tonic seizures and focal seizures. After prescription of levetiracetam (LEV) by a child neurologist/epileptologist, his seizures were reduced dramatically. He also had episodes of eating difficulty, which were diagnosed as non-convulsive status epilepticus by EEG monitoring. With the use of LEV infusion and an increase in daily dose of LEV, these episodes also disappeared. TSC is a multisystemic disease and presents various challenges to physicians due to its wide phenotypic variability. Careful transition of a TSC patient from the care of a child neurologist to the care of a general medical practitioner in an adult setting is a critical issue. This case is an important example showing the difficulty of transition to adulthood in a patient with TSC and epilepsy.

Although epilepsy is a known complication in Coffin-Siris syndrome, its clinical symptoms and effective treatment methods have not been thoroughly investigated so far. Here, we present the case of a female with a 594-kb interstitial deletion at 6q25.3, involving partially ARID1B, with developmental delay, short stature, and intractable epilepsy. At 4 years of age, she developed epilepsy with clonic seizures in the right half of her body. Treatment with carbamazepine, levetiracetam, or topiramate was ineffective. The frequency of epileptic seizures gradually worsened. At the peak of her seizures, she had focal onset clonic seizures 3-4 times a month, and neck atonic seizures lasting for several seconds more than 10 times a day. After administration of sodium valproate, her epileptic seizures decreased to 0-1 times a year. In conclusion, gathering genetic information in Coffin-Siris syndrome allows improvement of epilepsy treatment and outcomes in these patients.

Subacute encephalopathy with seizures in chronic alcoholism (SESA) often presents with confusion, seizures, and focal neurological deficits. We herein report a case of SESA with thalamic lesion on MRI taken after status epilepticus in a patient having a typical alcohol withdrawal seizure. A 58-year-old woman with a history of chronic alcoholism was admitted for motor onset seizures, status epilepticus, and confusion thought to be secondary to an alcohol withdrawal seizure. After starting levetiracetam, her mental status and left hemiparesis were resolved, and she was dis-charged from the hospital. She resumed drinking and discontinued her medication. Two months after discharge, she experienced recurrent epileptic seizures and was readmitted due to psychiatric symptoms. SESA is a rare clinical syndrome for which an accurate diagnosis is critical, since MRI examination and continuous EEG monitoring are recommended for suspicious cases. Patients may also require long-term treatment with antiepileptic drugs to prevent recurrence.

Lateralized periodic discharges (LPDs) have been known to be one of the ictal electroencephalography (EEG) activities in non-convulsive status epilepticus (NCSE). Cyclic seizures represent a special form of status epilepticus in which seizures recur at regular intervals. We treated a patient who suffered from NCSE with LPDs which developed under hyponatremia. The patient showed cyclic seizures with automatisms during NCSE. The cyclic seizures were associated with high-frequency rhythmic discharges on EEG, and the NCSE was associated with LPDs. Our patient showed that cyclic seizures with motor symptoms can occur on the background of NCSE with LPDs. The rhythm of LPDs abruptly changed at the initiation and the ending of the seizures, implying the possibility of replacement of one pacemaker by another pacemaker, which triggers seizures associated with the ictal high-frequency rhythmic activities. We discuss the pathophysiology underlying the evolution of these two types of seizures.

We examined immune system dysfunction in a pair of twins with intractable epilepsy and different developmental outcomes; twin A showed severe developmental delay whereas twin B showed moderate developmental delay. We profiled the intracellular cytokines of peripheral blood mono-nuclear cells collected from the twins. Compared to twin B, twin A had a higher percentage of in-terleukin (IL)-1β–, IL-1 receptor antagonist–, and tumor necrosis factor-α–positive CD14+ mono-cytes and lower levels of these cytokines in the plasma. Twin A had more interferon (IFN)-γ–positive cells and lower plasma cytokine level of IFN-γ than twin B. Furthermore, twin A showed higher level of IL-1β than twin B. We found no correlation between the ratio of positive cells and the plasma level of any given cytokine in the affected patients. The twin presenting with a severe developmental delay showed higher level of IL-1β cytokine than the twin with a moderate delay.

Purpose: Somnolence is a major adverse effect associated with levetiracetam (LEV) administration in epilepsy treatment, and it can prompt patients to discontinue the drug. This study aimed to assess the efficacy of LEV and evaluate the incidence and risk factors of somnolence caused by LEV administration.

Methods: Medical records of patients with epilepsy treated with LEV between October 2010 and June 2018 were retrospectively analyzed to evaluate drug efficacy. We also analyzed the corresponding incidence of somnolence and its associated factors.

Results: Ninety-five patients were included in the study. Of these, 55 (58.9%) showed more than 50% seizure reduction. There was no significant difference in efficacy between the monotherapy (n=38) and adjunctive therapy (n=57) groups. Twenty-nine patients (30.5%) experienced somnolence, and nine patients (9.5%) discontinued LEV. In total, nine patients (23.7%) treated with LEV as monotherapy and 20 patients (35.1%) treated with LEV as adjunctive therapy experienced somnolence, with no significant difference between the two groups. Regarding concomitant antiepileptic drug use, only valproic acid (VPA) significantly induced somnolence. Multiple logistic regression analysis showed that LEV as adjunctive therapy to VPA was a risk factor for somnolence (odds ratio, 3.95; 95% confidence interval, 1.43-11.36; p=0.0079).

Discussion: Our data showed that the efficacy of LEV and the incidence of somnolence due to LEV therapy were comparable to those reported previously. Incidence of somnolence increased when patients were treated with LEV as adjunctive therapy to VPA. Discontinuation of LEV due to somnolence might be decreased by avoiding adjunctive treatment with VPA.