CONFERENCE AES2023 HIGHLIGHTS

New research was presented at AES 2023, the annual meeting of the American Epilepsy Society, from December 1-5. The features below highlight some of the studies presented during the conference.

HRQOL in Focal Epilepsy Impacted by Depression & Employment

While previous research has examined HRQOL in focal epilepsy, determinants of HRQOL in these patients have not been assessed comprehensively, according to Joyce Matsumoto, MD. Dr. Matsumoto and colleagues conducted a systematic literature review that included 25 studies to address this issue. They identified a range of HRQOL determinants, including mood, epilepsy-related factors, and cognition. The review revealed that temporal lobe epilepsy was the most common subset of focal epilepsy studied. Researchers found depression was associated with reduced HRQOL 86% of the time in 14 studies. Eight studies examined anxiety, and seven found significant associations with lower HRQOL. Five studies assessed employment, and all found it to be an important consideration for HRQOL. Regarding factors related to epilepsy, 14 studies assessed seizure burden but only reached significance when dichotomized into seizure freedom versus no seizure freedom; however, it did so in every study that used this categorization (n=4). “Comprehensive understanding of the modifiable determinants of HRQOL is relevant to patient health and well-being and can inform everyday clinical care [and] interventional and observational studies,” Dr. Matsumoto and colleagues wrote.

Testing Identifies Genetic Link in Nearly Half of Adults With Epilepsy

Genetic testing in children with early-onset epilepsies has become the standard of care. A study by Yi Li, MD, PhD, and colleagues aimed to determine whether physicians should offer such testing to adults with epilepsy who never received it. The researchers identified 286 patients aged 16 and older who underwent genetic testing, including whole exome sequencing (WES), panel testing, and microarray testing. The average age of seizure onset was 12, although 21.4% of patients had their first seizure as infants. In total, 41% had at least one genetic variant related to epilepsy, and 2% had unrelated variants. WES resulted in the greatest percentage of positive results (48% vs 34% for panel testing and 21% for microarray testing). Among 22 patients who had panel testing with either a variant of unknown significance or negative result who then had WES, nine (41%) were found to have pathogenic variants for epilepsy. Patients with a history of developmental delay and seizures at a younger age were most likely to have a positive result. “Interestingly, those with a family history of epilepsy were not more likely to test positive for a genetic link, meaning doctors should not rule out testing in children or adults if there is no family history,” Dr. Li said in a press release.

Eating Disorders Affect Nearly 10% of Adolescents With Epilepsy

Eating disorders have been associated with chronic medical conditions in previous research, but the link between such disorders and epilepsy has yet to be assessed. To examine this, Itay Tokatly Latzer, MD, and colleagues compared intellectually intact adolescents with epilepsy and comorbid eating disorders (n=146) with two age-matched control groups of intellectually intact adolescents with epilepsy and no eating disorder (n=146) and those with only an eating disorder (n=146). The rate of eating disorders in adolescents with epilepsy was 8.4% overall, 13.1% in girls, and 3.5% in boys. The researchers reported a significant increase in the annual number of adolescents with epilepsy who had comorbid eating disorders between 2013 and 2022 (P<0.001). Risk factors for eating disorders included psychogenic nonepileptic seizures (P<0.001) and lower zBMI percentiles (P<0.001). The study team identified three distinct eating disorder patterns associated with different seizure types: non-provoked seizures (epilepsy) preceded anorexia nervosarestrictive type (P=0.01), provoked seizures followed atypical anorexia (P=0.01), and psychogenic nonepileptic seizures preceded bulimia nervosa (P=0.001). “Adolescents with epilepsy may feel a loss of control because they don’t know when they’ll have a seizure,” Dr. Tokatly Latzer said in a press release. “Controlling what they eat or don’t eat can presumably make them feel they have regained some control.”

Disparities Impact Receipt of Surgery in Pediatric Epilepsy

In previous research, Sandi K. Lam, MD, MBA, and colleagues found that survival was significantly higher for pediatric patients with drug-resistant epilepsy (DRE) who underwent cranial surgery. For a follow-up study, Dr. Lam and colleagues examined factors associated with receiving surgical treatment, including vagus nerve stimulation (VNS) or cranial epilepsy surgery, among 18,292 pediatric patients with DRE. Most (n=10,240) were treated with antiseizure medications alone; 5,019 received antiseizure medications and VNS, and 3,033 were treated with antiseizure medications and cranial epilepsy surgery. The researchers reported significant differences across groups in age, geographic region, race/ ethnicity, diagnosis, and insurance type. Those who underwent surgery were two years older than those who were treated with antiseizure medications alone. Patients who received antiseizure medications only were less likely to be White (51.78%), have focal/partial epilepsy (8.74%), and have private health insurance (35.82%). “For the first time, we measured the impact of treatments for [DRE] in children and found that surgical care is associated with longer survival, and yet there are disparities in who gets this care,” Dr. Lam said in a press release. “Further research is needed to understand and inform the development.