Qi Zhang

Objective: To evaluate whether add‐on memantine would exacerbate seizures in people with epilepsy. Methods: This was a prospective cohort study. People with epilepsy diagnosed with cognitive impairment were consecutively invited. Those who agreed were followed up for at least 24 weeks. Participants were required to be adherent to their antiseizure medication regimens, which had remained unchanged for at least 24 weeks before recruitment. Participants were prescribed memantine and categorized according to their treatment decisions (memantine group vs. non‐memantine group). Primary outcome measures were the occurrence of new‐onset bilateral tonic–clonic seizure, new‐onset status epilepticus, and increased seizure frequency (≥ 25%). The incidence of other adverse events (AEs) and 24‐week retention rate were secondary outcome measures. Results: Two hundred and eleven participants were enrolled (median age, 63; male, 65%). Among them, one hundred and one (48%) started memantine. Baseline seizure characteristics were comparable between the two groups. During follow‐up, no new‐onset bilateral tonic–clonic seizure was recorded; there was one status epilepticus in the non‐memantine group. Increased seizure frequency was reported by 12 (6%) participants (memantine vs. non‐memantine, seven vs. five). Other AEs in the memantine group included headache (7%), dizziness (5%), fatigue (4%), drowsiness (2%), and anorexia (2%). The 24‐week retention rate was 91%. Interpretation: Adjunctive memantine was well tolerated in people with epilepsy regarding seizure control and other AEs. Previous warnings might have been disproportionate. Large‐scale, randomized trials are required to confirm this and further elucidate its efficacy profiles in epilepsy.

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.

Background and purpose: The aim was to investigate the neurological complications associated with coronavirus disease 19 (COVID‐19) during the 2022 Omicron wave.Methods and analysis: The medical records of a cohort of people admitted to neurological wards of three participating tertiary centres in Sichuan from 12 December 2022 to 12 January 2023 were reviewed. Demographics and clinical data were obtained and analysed with an interest in COVID‐19‐related new‐onset or worse neurological symptoms. The current data were also compared in two centres with similar data from the same period 12 months earlier.Results: In all, 790 people were enrolled, of whom 436 were positive for COVID‐19. Ninety‐nine had new onset COVID‐related neurological problems, or their known neurological condition deteriorated during the wave. There was a significant difference in demographics from the findings amongst admissions 12 months earlier as there was an increase in the average age, the incidence of encephalitis and encephalopathy, and mortality rates. One hundred and one received COVID‐specific antivirals, intravenous glucocorticoids and intravenous immunoglobulin therapy. No differences were seen between these and those who did not use them.Conclusion: New‐onset neurological conditions, particularly encephalitis and encephalopathy, increased significantly during this period. Deterioration of existing neurological conditions, such as seizure exacerbation, was also observed. A large‐scale treatment trial of people with COVID‐19 infection presenting with neurological disorders is still needed.

Background: The optimal management of epilepsy includes engaging patients through education on knowledge of the disease, its treatment and diet control. Methods: This was a cross-sectional survey-based cohort study, aimed to investigate the awareness of epilepsy in Chinese patients and to understand their dietary habits. Participants were consecutively enrolled from epileptic patients treated in a single epilepsy center from October 1, 2019 to February 29, 2020. A self-reported questionnaire (Cronbach’s α = 0.758) consisting of 3 parts was sent to 407 patients with epilepsy. The questionnaire included items on demographic information, epilepsy features, awareness of epilepsy treatment and dietary habits. Results: About half of the patients (53.8%, 219/407) thought epilepsy was curable and only 80% knew that the first choice of treatment is medication. While 58.6% of the patients with low educational level preferred the use of antiepileptic drugs (p = 0.014), 52.7% believed that the medication should not be stopped immediately after seizure control (p = 0.026), especially after surgery (40.5%, p = 0.011). Patients with lower household monthly incomes had less awareness of the use of antiepileptic drugs than patients with higher incomes: only 39.2 and 49.8% of patients with lower incomes thought that the drugs could be stopped after epilepsy surgery or seizure control, respectively, compared to 51.6 and 66.1% with higher incomes. Alcohol (86.2%), caffeine (56.8%) and strong tea (49.1%) were top three foods considered by the patients to be avoided to prevent seizures. Approximately 30.2% of patients identified at least one food that made them susceptible to seizures. Conclusions: Patient education on epilepsy, antiepileptic drugs and diet for management of seizures should be provided especially to patients with less education, lower income or inaccurate beliefs of epilepsy in Western China.

Summary: Objective: This study was undertaken to investigate the COVID‐19 vaccine uptake rate and possible postvaccination effects in adults with epilepsy.Methods: We invited adults with epilepsy attending three centers in China from July 24 to August 31, 2021 to participate in this study. We also asked age‐ and sex‐matched controls among people attending for other chronic neuropsychiatric conditions and healthy controls accompanying people with illness attending the hospitals to participate. We excluded people who, under the national guidelines, had evident contradictions to vaccination. Participants were interviewed face‐to‐face using questionnaires. Vaccine uptake and postvaccine adverse events among the people with epilepsy were compared with those with neuropsychiatric conditions and controls. We also compared the willingness and reasons for hesitancy among unvaccinated participants.Results: We enrolled 981 people, of whom 491 had epilepsy, 217 had other neuropsychiatric conditions, and 273 were controls. Forty‐two percent of those with epilepsy had had the first dose of a vaccine, compared with 93% of controls and 84% of the people with neuropsychiatric conditions (p < .0001). The majority (93.8%) of those immunized had inactivated vaccines. Among the unvaccinated people with epilepsy, 59.6% were willing to have the vaccine. Their main reasons for hesitation were potential adverse effects (53.3%) and concerns about losing seizure control (47.0%). The incidence of adverse events in the epilepsy group was similar to controls. Nineteen people with epilepsy reported an increase in seizure frequency. No episode of status epilepticus or prolonged seizures was reported. Two controls had their first‐ever seizure, which was unlikely related to the vaccine.Significance: The vaccine uptake rate in people with epilepsy was lower than in their same‐age controls. The postvaccination effect was no higher than in controls. We found no evidence suggesting worsening seizures after vaccination. Measurement and education focused on increasing the vaccination rate in epilepsy are warranted.

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The coronavirus disease 2019 caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has become a pandemic with people infected in almost all countries. The most efficient solution to end this pandemic is a safe and efficient vaccine. Classic platforms are used to develop vaccines including live‐attenuated vaccine, inactivated vaccine, protein subunit vaccine, and viral vector. Nucleic acid vaccine uses next‐generation platforms for their development. Vaccines are now rushing to the market. Eleven candidates are in advance development. These comprise inactivated vaccines, viral vector vaccine, nucleic acid vaccine, and the protein subunit vaccine platform, which are now quite advanced in trials in various geographic and ethnic populations. The reported severe adverse effects raised the worries about their safety. It becomes critical to know whether these vaccines will cause neurologic disorders like previously recognized vaccine‐related demyelinating diseases, fever‐induced seizure, and other possible deficits. We reviewed the most promising COVID‐2 vaccines with a particular interest in mechanism(s) and adverse effect(s). We exemplify potential neurological problems these vaccines could cause by looking at previous studies. The current evidence indicated a minor risk of the acute neurological disorders after the application. The observation of the long‐time effect is still needed.

T-cell immunoglobulin and mucin domain-containing molecule 3 (Tim-3) plays an important role in regulating T cells in hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC). However, few researches have reported the association of Tim-3 genetic variants with susceptibility and progression of HBV infection. In this study, we focused on the association of Tim-3 polymorphisms with HBV infection, HBsAg seroclearance and hepatocellular carcinoma. A total of 800 subjects were involved in this study. Four groups were studied here, including HBV, HBsAg seroclearance, HBV-associated HCC and healthy controls. Three single-nucleotide polymorphisms (SNPs) of Tim-3, rs246871, rs25855 and rs31223 were genotyped to analyze the association of Tim-3 polymorphisms with susceptibility and disease progression of HBV infection. Our study found that rs31223 and rs246871 were associated with disease progression of HBV infection, while none of the three SNPs was relevant to HBV susceptibility. The minor allele “C” of rs31223 was found to be associated with an increased probability of HBsAg seroclearance (P = 0.033) and genotype “CC” of rs246871 to be associated with an increased probability of HBV-associated HCC (P = 0.007). In accordance, haplotypic analysis of the three polymorphisms also showed that the haplotype block CGC* and TGC* were significantly associated with HBsAg seroclearance (P<0.05) while haplotype block CAT*, CGT*, TAC* and TGT* were significantly associated with HBV-associated HCC (all P<0.05). Genetic variants of Tim-3 have an important impact on disease progression of HBV infection. With specific Tim-3 polymorphisms, patients infected with HBV could be potential candidates of HCC and HBsAg seroclearance.