Recently, the development of digital EEG technology has enabled us to visualize EEG activities of wider frequency bands in addition to conventional 'Berger bands'. We could record the low frequency activities below 1 Hz and also the high frequency activities above 200 Hz, and utilize such novel information as DC shift (infra-slow) and high frequency oscillations (HFO). Both activities have been found in epileptogenic areas, and have received much attention as new surrogate biomarkers of epileptic focus. However, the definition and methods of recoding/analysis have not been well established so that it would be difficult to compare previous reports from various institutes. We have conducted the multi-institutional collaborative study about wide-band EEG analysis of ictal electrocorticogram, and have been trying to make a tentative standard method of recording and analysis. In this review, we explain our method by means of the wide-band EEG analysis software.
There are some obstacles with establishing a comprehensive communication system between patients, primary-care physicians and epilepsy specialists (Epi-Net) in the current Japanese epilepsy care system. To build this system in the western medical service area of Shizuoka, we have introduced the "Epilepsy Passport" as of December 2014. This tool allows the patient's medical information about freedom from seizures and current medications to be shared among Epi-Net members. We have already issued 244 Epi passports. The age distribution was mostly in the working-age population. Many of the patients were referred from primary-care but not from hospitals non-specializing in epilepsy. To build a realistic network, close and direct communications between primary-care and specialists should be taken into consideration more.
To evaluate the characteristics of patients with cryptogenic West syndrome who exhibited favorable long-term cognitive outcomes (10 patients), we retrospectively investigated the patients' information, their responses to initial treatments and during subsequent clinical courses, including epileptic seizures, findings of electroencephalography and cognitive developments. These outcomes were compared with those of patients exhibiting moderately delayed (5 patients) and severely delayed cognitive outcome (10 patients). The differences in short treatment lag between favorable and severely delayed group was statistically significant. All the patients in the favorable outcome group responded to initial treatment or ACTH therapy and showed normal development after 6 months of the initial treatment. Although development was delayed in a few cases not long after initial treatment, they caught up with the normal range up to that point. These seemed highly likely prognostic characteristics of patients with favorable cognitive outcomes. On the other hand, there were some cases where delayed initial treatment could not make up for favorable outcome even though they sustained response to the treatment and absence of EEG abnormalities after initial treatment. In order to achieve a favorable cognitive outcome, it is necessary to not disturb the formation of neuronal networks during this period of early infancy.
The aim of this study was to examine the social benefits of different treatment options for patients with epilepsy and their families. We evaluated the willingness to pay (WTP) of patients and their families and analyzed factors related to WTP for two treatment options: 1) continue current therapy and 2) switch to new therapy that can achieve ideal condition without seizures. A web survey was conducted, and a total of 932 valid responses were obtained from patients receiving antiepileptic drugs and their families. The results showed that, with an acceptance rate of 50%, the WTP of option 1 was 1,448 yen/month in addition to current self-payment while that of option 2 was 3,791 yen/month in addition to current self-payment, and the difference between the two options was 2,343 yen/month. Factors affecting WTP include type of respondents (families), employment status of patients, household income, and the frequency of the most severe seizures. The results of this study confirmed that social benefits of epilepsy treatment were greatly influenced not only by seizures but also by living environment.
The aim of this study was to examine the differences in perceptions between patients and their families regarding epilepsy treatment. Social benefits of epilepsy treatment were evaluated using willingness to pay (WTP). A web survey was conducted, and a total of 932 valid responses were obtained from respondents, including 382 patients and 548 family members. As for the median WTP for continuing current epilepsy treatment, families' answer (2,000 yen/month) was significantly higher than patients' answer (1,000 yen/month) (P<0.01). The median WTP in addition to current self-payment for new therapy that can achieve ideal condition without seizures was significantly higher in families' answer (5,000 yen/month) than in patients' answer (2,000 yen/month) (P<0.01). Although there was a difference in perception between patients and families, the results of this study confirmed that both demanded better treatment and considered social awareness and support to be important in the daily lives of patients with epilepsy.
The aim of this study was to comparatively examine the social benefits of epilepsy treatment and degree of satisfaction with current treatment in patients and families according to the differences in clinical symptoms of patients with epilepsy. Social benefits were evaluated using willingness to pay (WTP). A web survey was conducted, and a total of 932 valid responses were obtained from patients receiving antiepileptic drugs and their families. The average WTP in addition to current self-payment for new therapy that can achieve ideal condition without seizures was the highest at 26,214 yen/month in patients with daily seizures followed by 23,438 yen/month in those with weekly seizures, 22,553 yen/month in those with depression, and 19,645 in those whose age at first seizure onset was 20 to 39 years. The degree of satisfaction with current treatment was relatively low among patients with frequent seizures and/or multiple complications.
Myoclonic encephalopathy in non-progressive disorders (MEND) is characterized by recurrent myoclonic status (MS). Other initial seizure types, except for myoclonus, might also occur at onset. Prognosis is typically unfavorable with severe psychomotor developmental delay. Case 1: A 31-year-old man presented with severe psychomotor developmental delay. His seizures began at 1 year of age. Since the age of 8 years, he had recurrent MS. Case 2: A 39-year-old man presented with severe psychomotor developmental delay. At the age of 1 year, he experienced epileptic seizures. At 6 years, he had recurrent MS. Ictal electroencephalography (I-EEG) of cases 1 and 2 revealed rhythmic alpha activities. Case 3: A 5-year-old boy experienced epileptic seizures and deterioration since 4 years of age. At 5 years, he had MS. I-EEG revealed diffuse bilateral slow spike-wave discharge. Cerebral spinal fluid examination was positive for N-methyl-D-aspartate receptor antibody. Steroid pulse therapy was effective in this case. All the cases had common clinical features of MEND and one case might have a pathology associated with autoimmunity.
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