Yuto Arai

Background: Sleep deprivation has notable effects on neurobehavioural functioning in children. However, the link between sleep duration and the risk of developing epilepsy in early childhood remains uncertain. The aim of this study was to explore the association between sleep duration at 12 and 18 months and the risk of epilepsy at 2 and 3 years of age. Methods: Data from the Japan Environment and Children’s Study (JECS), a largescale birth cohort, were analysed. We assessed the risk of epilepsy at 2 and 3 years of age among children sleeping under 11 hours per night, the minimum recommended by the American Academy of Sleep Medicine for 1–2 year olds. Results: Overall, 86 441 children were retrospectively analysed. Of these, 8786 (10.2%) and 12 850 (14.9%) slept for less than 11 hours at 12 months and 18 months, respectively. Multivariate logistic regression showed that a sleep duration of less than 11 hours at 12 months remained significantly associated with epilepsy incidence at 2 and 3 years (adjusted OR (aOR) 2.02, 95% CI 1.01 to 4.01, p=0.045; aOR 1.98, 95% CI 1.15 to 3.41, p=0.013). Furthermore, a sleep duration of less than 11 hours at 12 and 18 months was significantly associated with epilepsy incidence at 3 years (aOR 2.77, 95% CI 1.28 to 6.01, p=0.010). Conclusions: Insufficient sleep in infancy may be linked to epilepsy later in childhood. These findings highlight the importance of sleep interventions during early life to improve long-term neurological health.

Objective: For patients with infantile epileptic spasms syndrome (IESS) who have achieved remission of epileptic spasms (ES), indicators of how well the electroencephalographic (EEG) state should be maintained during follow‐up are not available. We hypothesized that the time course of the Burden of Amplitudes and Epileptiform Discharges (BASED) score after ES remission is associated with ES relapse. This study aimed to investigate the association between ES relapse and BASED scores at the time of initial ES remission and during the subsequent follow‐up period. Methods: We collected clinical and digital EEG data at four hospitals from patients with IESS who achieved initial ES remission. The BASED score was evaluated using EEGs obtained before remission, during remission, and after remission. The scoring was performed independently by the three reviewers, who were blinded to each other's scores. We analyzed the associations between clinical factors, BASED score, maximum BASED score, and ES relapse. Results: Data were collected from 44 patients aged 4–8 months at disease onset, which included 33 nonrelapsed and 11 relapsed patients. We assessed the BASED score of 262 EEGs. Structural etiology ( p = .002) and the development of seizure other than ES ( p = .04) were positively associated with ES relapse. Whereas BASED score before and at remission was not associated with relapse, a maximum BASED score of ≥3 during the postremission period was significantly associated with relapse ( p < .001, odds ratio = 100). In multivariate analysis, only maximum BASED score ≥3 during this period remained significantly associated with relapse ( p = .001, odds ratio = 76). The interrater reliability of the BASED score was high, with a quadratically weighted kappa coefficient of .93. Significance: A maximum BASED score of ≥3 during postremission indicates a risk for ES relapse in patients with IESS.

Objective: The employment outcomes of childhood-onset drug-resistant epilepsy (DRE) has not been studied enough. The aim of this retrospective cohort study is to investigate the employment outcomes of childhood-onset DRE in June 2022 and identify the risk factors associated with non-employment.Materials and methods: The sample consisted of 65 participants ≥18 years of age with a history of childhood-onset DRE. Fifty participants (77%) were salaried employees and 15 participants (23%) were non-employed. Clinical and psychosocial information were evaluated for calculating the relative risk (RR) of non-employment.Results: Regarding medical factors, lower IQ [RR, 0.645; 95% confidence interval (CI), 0.443–0.938; p = 0.022] was positively associated with employment. In contrast, age at follow-up (RR, 1.046; 95% CI, 1.009–1.085; p = 0.014); number of ASMs at follow-up (RR, 1.517; 95% CI, 1.081–2.129; p = 0.016); use of medications such as phenobarbital (RR, 3.111; 95% CI, 1.383–6.997; p = 0.006), levetiracetam (RR, 2.471; 95% CI, 1.056–5.782; p = 0.037), and topiramate (RR, 3.576; 95% CI, 1.644–7.780; p = 0.001) were negatively associated with employment. Regarding psychosocial factor, initial workplace at employment support facilities (RR, 0.241; 95% CI, 0.113–0.513; p < 0.001) was positively associated with employment. In contrast, complication of psychiatric disorder symptoms (RR, 6.833; 95% CI, 2.141–21.810; p = 0.001) was negatively associated with employment. Regarding educational factor, graduating schools of special needs education (RR, 0.148; 95% CI, 0.061–0.360; p < 0.001) was positively associated with employment.Conclusions: Specific medical, psychosocial, and educational factors may influence the employment outcomes of childhood-onset DRE. Paying attention to ASMs’ side effects, adequately preventing the complications of psychiatric disorder symptoms, and providing an environment suitable for each patient condition would promote a fine working status for people with childhood-onset DRE.