Severe psychomotor developmental delay resulting from early postnatal (within 3 months) seizures can be diagnosed as Early-Infantile Developmental and Epileptic encephalopathies (EIDEE). Its primary etiologies include structural, hereditary, metabolic and etc. The main pathogenesis may be related to the inhibition of normal physiological activity of the brain by abnormal electrical activity and the damage of the brain neural network. Ohtahara syndrome and Early Myoclonic Encephalopathy (EME) are typical types of EIDEE. The principle of treatment is to improve the cognitive and developmental function by controlling frequent seizures. When the seizure is difficult to control with drugs, surgical evaluation should be performed as soon as possible, and surgical treatment is the first choice for patients suitable for surgery. The types of surgery can be divided into excision surgery, dissociation surgery, neuromodulation surgery and etc. The current status of surgical treatment of EIDEE was described, and the curative effect of surgical treatment was explored, so as to help clinicians choose appropriate treatment methods.
ObjectiveThe purpose of this study was to find a new method for the treatment of drug-resistant epilepsy, and to study the efficacy and safety of Bacteroidesfragilis (BF839) in the adjunctive treatment of refractory epilepsy, as well as the improvement of comorbidity.MethodsA prospective, single-arm, open pilot clinical study was designed for the additive treatment of drug-resistant epilepsy using BacteroidesFragilis 839 (BF839). 47 patients with refractory epilepsy, who were admitted to the epilepsy outpatient clinic of the Second Affiliated Hospital of Guangzhou Medical University from April 2019 to October 2019, were enrolled and treated with BF839 adjunct treatment. The primary efficacy endpoint was median percent reduction from baseline in monthly (28-day) seizure frequency for the 16-week treatment period. Other efficacy analysis included response rate(proportion of patients with ≥ 50% seizure reduction) in the 16 weeks period, the proportion of patients seizure free and the retention rate after12 months intervention, and the observance of the side effects and comorbidities.ResultsThe median reduction percent of all seizure types was −53.5% (P=0.002). The response rate was 61.1% (22/36). 8.5% (4/47) patients seizure free at 12 months. The retention rate at 12 months was 57.4% (27/47). The side effects were diarrhea 4.3% (2/47) and constipation 4.3% (2/47). 48.9% (23/47) of the patients reported improvement in comorbidities, with cognitive improvement of 21.2% (10/47).ConclusionBF839 can be used as an effective additive therapy to treat drug-resistant epilepsy. It is safe and beneficial to the improvement of comorbidities. This is the first time in the world that a single intestinal strain has been reported to be effective in treating drug-resistant epilepsy. This research has important implications.
The correlation between gut microbes and epilepsy is a hot research topic. This review aims to summarize the effects of Ketogenic diet (KD) on gut microbes and the preclinical and clinical progress of the use of Fecal microbiota transplants (FMT) and Probiotics in the intervention of epilepsy to provide clinical reference. Gut microbes mediates the antiepileptic effect of KD. Many studies have found that bactericides decreased in epileptic patients, and KD can increase bactericides abundance, which may be one of its effective mechanisms. Both FMT and probiotics showed antiepileptic effects on epileptic model mice with different pathogenesis, suggesting that gut microbes is an important target for epilepsy treatment. Preliminary clinical studies of small samples suggest that the use of probiotics can effectively treat refractory epilepsy and autoimmune-associated epilepsy, and can improve comorbidities. No serious and long-term side effects of probiotics have been found in epileptic patients. In the future, more high-quality studies are needed to further clarify its efficacy and mechanisms, which could lead to new strategies for epilepsy treatment and refresh our understanding of the causes of epilepsy.
ObjectiveTo retrospectively analyze patients taking Bacteroides fragilis (BF839) alone for their "possible autoimmune-related epilepsy" to find new treatments for epilepsy. Methods15 newly diagnosed patients who were not treated with standard Anti-seizure medications were diagnosed with "possible autoimmune-related epilepsy" and were given oral BF839 to initiate treatment. Seizure changes, self-reported improvement of comorbidities, EEG, adverse reactions and other information were reviewed. ResultsDuring the follow-up period of 14~33 months, 73.33% (11/15) patients achieved 1-year remission during the follow-up period, 7 patients had a remission time of more than 24 months, and 4 patients had a remission time of more than 30 months. 73.33% (11/15) of the patients reported that their comorbidities improved, and the EEG improvement rate was 57.14% (4/7). No patients withdrew due to adverse reactions, and the 12-month retention rate was 73.33% (11/15).ConclusionIt is the first report that the early application of intestinal flora preparation alone can effectively treat “possible autoimmune-related epilepsy”, and it can also be used as a diagnostic treatment tool due to its lower adverse reactions and improvement of comorbidities. This is not only of great significance to significantly improve the early diagnosis rate and remission rate of autoimmune-related epilepsy, and to prevent patients from developing refractory epilepsy, but also refreshes our understanding of the etiology of epilepsy.
Adenoid hypertrophy in children with epilepsy is rarely reported. This paper analyzes the clinical characteristics and incidence of adenoid hypertrophy in children with epilepsy.Methods The clinical data in children with epilepsy from December 2014 to April 2020 in Shenzhen Children's hospital were analyzed retrospectively.Results There were 449 cases diagnosed with adenoid hypertrophy (2.74%) in 16387 children with epilepsy. Among 449 cases of adenoid hypertrophy, 276 males (61.47%) and 173 females (38.53%). The age distribution was: 28 days to 1 year old, 8 cases (2%); 1-3 years old, 78 cases (17%); 3-6 years old 167 cases (37%); 6-12 years old, 153 cases (34%); 12-18 years old, 43 cases (10%). In 40 patients the IgG antibody were positive for EB capsid antigen in 25 (62.5%). In 56 cases of EB virus DNA were detected by fluorescence quantitative PCR, 25 (44.64%) positive, and 21/44 cases (47.72%) were positive by general nucleic acid detection of enteroviruses. The neutrophil reduction rate in peripheral blood was 42.19% in 673 tests, lymphocyteincreased in 292 (43.38%), platelet count increased in 307 (45.61%), abnormal in platelet hematocrit in 311 (46.21%); the mean volume of RBC was decreased in319 (47.39%) tests. The content of \begin{document}${\rm{HCO}_3^-} $\end{document} was reduced in 20/55 cases (36.36%). 25-hydroxy vitamin D was 33 (44.5%) decreased in 74 cases. The blood glucose was measured in 146 cases, 60 (41.09%) increased, total cholesterol was 31 (40.78%) increased in 76 cases, serum C peptide was 12 (29.26%) increased in 41 cases.Conclusion Adenoid hypertrophy in children with epilepsy may be related to infection, inflammation or immune disorder, which may cause nutritional, metabolic or internal environment disorders. Therefore, there is need of nursing and health education, transferring to specialized centers for diagnosis and treatment.