Xiaoting Hao

Background: Epilepsy is a common neurological disorder affecting about 50 million people worldwide. Disparities in healthcare resources lead to geographical variation in its diagnosis, treatment, and management. In particular, the gap between plains and plateau regions in western China remains understudied. Assessing healthcare professionals’ expertise and delivering targeted training represent effective strategies to narrow this treatment gap. We compare epilepsy knowledge between physicians in more developed plains regions and less developed plateau regions of western China in order to inform targeted interventions to address regional disparities. Methods: In this cross-sectional study, physicians attending epilepsy training sessions in three cities representative of the western plains region of China (Chengdu) and of the western plateau region (Lhasa and Xichang) completed a questionnaire assessing knowledge in several modules of the disease, including its diagnosis, preoperative evaluation, drug and surgical treatments, and management during pregnancy. Results: Of the 349 participants given questionnaires, 325 (93.1%) were included in the final analysis. Physicians from the plateau region scored significantly lower than physicians from the plains region on knowledge about epilepsy diagnosis (Number of questions with discrepancies / Total number of questions in this module, i.e., 7/7, P < 0.05), definition of drug-resistant epilepsy (2/2 questions P < 0.05), preoperative evaluation and surgical treatments (7/14 questions P < 0.05), status epilepticus (2/2 questions P < 0.05), epilepsy comorbidities (2/2 questions P < 0.05), and epilepsy management during pregnancy (3/3 questions P < 0.05). However, no significant differences were found between neurology specialists in plateau regions and those in plain regions across all six epilepsy knowledge modules and the overall score (0.542 < P < 0.829). Conclusions: Significant gaps persist in epilepsy care knowledge among physicians in western plateau of China, particularly in diagnosis, treatment, and specialized management. Both plateau and plains regions lack awareness of advanced preoperative evaluation techniques. Targeted training and capacity-building interventions are needed, with effectiveness evaluated through longitudinal studies. Graphical

Objective: This study was undertaken to assess whether periconceptional folic acid (FA) supplementation affects seizures, maternal, and fetal outcomes in Chinese women with epilepsy. Methods: We included pregnant women with epilepsy enrolled in the West China Pregnancy Registry of Epilepsy between 2012 and 2021. Detailed data on maternal health, FA intake, antiseizure medications (ASMs), pregnancy, and perinatal outcomes were obtained during regular visits to neurology clinics. Primary outcomes were seizure control status and adverse maternal and fetal outcomes. To adjust for potential confounders, subgroup and sensitivity analyses were performed. Results: We included 1638 pregnancies of 1405 women with epilepsy. A total of 1299 (79.3%) pregnancies in 1173 women used FA supplements during periconception, and 1351 (82.5%) pregnancies were exposed to ASMs. The recurrence rate of convulsive seizures was significantly higher among non‐FA users compared with FA users throughout pregnancy. Low FA dose, delayed initiation, and short use duration were associated with an increased risk of seizures during pregnancy. Most pregnancies (78.8%) in the non‐FA group were lost compared to 13% in the FA group ( p < .001). Non‐FA users had 3.5‐fold and 7.5‐fold increased risks of spontaneous and elective abortions compared with FA users. The protective effect was more prevalent among those using ASMs. Pregnancies exposed to low‐dose FA had higher rates of adverse maternal–fetal outcomes than those receiving medium‐ to high‐dose FA supplements. Significance: Periconceptional FA intake by women with epilepsy was associated with an approximately 66% decreased risk of abortion and improved seizure control during pregnancy. Low‐dose FA may be insufficient to prevent adverse maternal–fetal outcomes in this population. Further studies are warranted to confirm these findings.

Objective: Data on seizure and pregnancy outcomes in Asian women with epilepsy are limited. We used a Chinese pregnancy registry to assess the impact of seizures and antiseizure medications (ASMs) on pregnant women with epilepsy and their children. Methods: This is an ongoing prospective multicenter study of pregnant women with epilepsy that has been running since 2012. Eligible participants were consecutively enrolled and had multiple follow‐ups up to one year after delivery. We assessed ASM use and seizure frequency during pregnancy to establish potential effects on the mothers and infants and to identify relevant correlations. Descriptive analysis was used to estimate proportions. Logistic regression was used to identify the relevant risk factors and correlations. Results: Of 1907 potentially eligible pregnancies, we included 1763 in 1483 women with known outcomes from January 2012 to February 2022. There were 1278 completed pregnancies, resulting in 1270 live births. Tonic–clonic seizures occurred in fewer than one‐third of pregnancies in each trimester. Compared with baseline, seizure frequency remained relatively stable throughout approximately two‐thirds of the pregnancies. The majority were on ASM, with levetiracetam (39%), oxcarbazepine (19%), and lamotrigine (17.5%) being the most commonly used. In contrast, only 14.2% of pregnancies were exposed to valproate (VPA). There was a declining trend in treatment adjustments over the course of the pregnancy, with most changes occurring in the first trimester. The incidence of major congenital malformation (MCM) was 4.4%, with cardiogenic and orofacial anomalies being the most common. VPA use ( p < .001), lack of folic acid use ( p = .009), positive family history of MCM ( p = .006), and topiramate (TPM) use ( p = .04) were the most important predictors of MCM. Significance: Seizure control remained stable for the majority of women with epilepsy throughout pregnancy. Family history of MCM, VPA use, TPM use, and not taking folic acid were strong predictors of MCM in infants born to women with epilepsy.

Objective: The primary objective of this retrospective analysis was to evaluate the incidence and lateralization value of peri‐ictal yawning (PY) in people with temporal lobe epilepsy (TLE). PY has only occasionally been reported as a manifestation of focal epilepsy. We aimed to determine whether PY could serve as an indicator to help lateralize seizure onset during epileptic seizures.Methods: Among 236 consecutive TLE patients admitted for video‐EEG monitoring, we analyzed the clinical characteristics, along with scalp video‐EEG, magnetic resonance imaging (MRI), fluorodeoxyglucose‐positron emission tomography (FDG‐PET), Wada test, and stereo EEG (SEEG) in patients with PY.Results: Among the 236 patients, 26 (11.0%) exhibited PY, and 36 of 1018 recorded seizures (3.5%) were associated with PY. Of the 26 patients with PY, 19 (73.1%) had non‐dominant TLE, while 7 (26.9%) had dominant TLE. The majority of these patients presented with staring, arrest, and automatisms during their seizures with accompanying vegetative signs. PY occurred either during the ictal or postictal phase in all patients. Exception for 10 seizures (10/36, 27.8%) at the early stage (less than 25% total duration), PY was primarily linked to the late ictal and postictal phases. Surgical intervention was performed in 12 patients, 9 of whom (75%) achieved seizure freedom (Engel class I), with 7 of these 9 (77.8%) having non‐dominant TLE.Significance: Yawning is a physiological phenomenon typically not associated with epilepsy. The present series suggests that PY is relatively uncommon in TLE, but may represent a rare vegetative sign, particularly in cases with non‐dominant TLE. Further investigation with a larger cohort of surgically confirmed cases and using intracranial EEG is essential to deepen our understanding of this phenomenon.Plain Language Summary: Yawning is a typical physiological response that is generally not linked to epilepsy. However, it can occasionally indicate seizure activity, particularly in TLE. PY happens more often observed in non‐dominant TLE and usually occurs in the later stages of a seizure or just after it. It may hold potential as a lateralizing marker in TLE.

Background: There is a lack of further exploration of the epileptogenic network of specific types of epilepsy, such as unilateral hippocampal sclerosis (HS), and there is an urgent need to find exact evidence to confirm the consistency of its brain network changes. Methods: We enrolled 22 mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) patients to compare the differences in brain activity between 22 healthy controls (HCs) and them. Resting-state electroencephalography (EEG) was also measured. Then, we calculated the power spectral density and phase locking values in and between these electrodes. Results: The results showed the increased theta power was related to the high severity of epilepsy in the temporal, parietal, and central regions in mTLE-HS patients, and there were positive correlations between theta power in the contralateral temporal region and seizure frequency. Theta power in the ipsilateral parietal lobe is positively correlated with the number of anti-seizure medications (ASMs), but not with the usage of third-generation ASMs. Meanwhile, the temporal lobe of mTLE-HS patients had more connectivity with parietal lobe and central region. Conclusions: Theta power is an important EEG indicator of mTLE-HS, positively correlates with epilepsy severity and seizure frequency, and has network properties that can be observed outside the lesion. Moreover, the usage of third-generation ASMs did not affect the risk of increased theta power. Lastly, the temporoparietal and temporal-central networks are likely to be causative pathways in epilepsy patients with cognitive impairment. This study provides a potential guideline for the treatment of mTLE-HS in clinical practice.

Background: The COVID-19 pandemic substantially increases the risk of severe psychological distress among people with epilepsy (PWE), especially those with monthly household income < 5000 RMB or with uncontrolled seizures. Patients with Kessler scores > 12 should consult a psychiatrist, especially during major disasters. This study was aimed to compare the frequency of psychological distress among Chinese PWE before and during the outbreak of the SARS-CoV-2 Omicron variant, and to identify risk factors for such distress. Methods: In this prospective study, we collected sociodemographic data of PWE aged > 14 years, who were treated at our center during December 1 to 15, 2022. All participants completed the 6-item Kessler Psychological Distress Scale before the outbreak and again during the outbreak. Health visitors who were unrelated to those patients during the outbreak were included as a control. Multivariate logistic regression analysis was performed to identify risk factors of severe psychological distress and its exacerbation. Results: Of the 223 PWE, 127 were tested positive for SARS-CoV-2, while 174 of 218 controls were positive for SARS-CoV-2. The neurological symptoms were similar between PWE and controls with SARS-CoV-2. The average Kessler score of PWE was significantly higher during the outbreak than before it (9.93 ± 3.98 vs. 8.52 ± 0.23, P < 0.001). The average score of controls during the outbreak (5.146 ± 0.35, P < 0.001) was significantly lower than that of the PWE. We identified three independent predictors for severe psychological distress in PWE during the outbreak, i.e., monthly household income < 5000 RMB (OR = 0.252, 95%CI 0.064–0.998, P = 0.048), severe psychological distress before the outbreak (OR = 0.067, 95%CI 0.026–0.174, P < 0.001), and seizure onset within 30 days before the assessment during the outbreak (OR = 0.356, 95%CI 0.157–0.805, P = 0.013). Of the three predictors, the last one was also an independent predictor for exacerbation of psychological distress during the outbreak (OR = 0.302, 95%CI 0.123–0.741, P = 0.009). Conclusions: Our analysis suggests that the COVID-19 pandemic has substantially increased psychological distress of individuals with epilepsy, regardless of the viral infection or not. Various neurological symptoms similar to those of “long COVID” appeared for the first time among these individuals during the Omicron outbreak, highlighting the need for clinicians to screen carefully for this condition. Management of epilepsy during the pandemic or a similar major disaster should focus on the control of seizures and maintenance of mental health, especially among those with monthly household incomes below 5000 RMB, suffering uncontrolled seizures and having a history of severe psychological distress.

A 49-year-old man presented with a 2-year history of weakness and sensory disturbances in the bilateral lower extremities, vesicorectal dysfunction, and progressive gait disturbances. Brain MRI revealed multiple ischemic and hemorrhagic cortical/subcortical lesions with patchy enhancement involving the frontal and parietal lobes, suggesting the possibility of distal perforating arteries injury. Spine MRI revealed lesions of the cervical and thoracic spinal cord with associated enhancement. The diagnosis of malignant atrophic papulosis (Degos disease) with central nervous system involvement was prompted by the characteristic skin lesions.

Objective: Metabotropic glutamate receptor 5 (mGluR5) encephalitis is such a rare type of autoimmune encephalitis that its diagnosis remains a challenge.Case report: A 19-year-old female patient initially presented with anxiety and orthostatic leg tremors without cortical dysfunction. We found that this patient was positive for mGluR5 antibodies in both serum (1:1,000) and cerebrospinal fluid (1:32). After comprehensive intervention, the patient showed complete recovery at the 18-month follow-up.Discussion: This report expands our knowledge of the possible presentations of mGluR5 encephalitis for early diagnosis, which makes it possible to prevent serious consequences and improve the prognosis.