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The purpose of the current study was to investigate whether taking valproic acid (VPA) was protective against coronavirus disease 2019 (COVID-19) infection or severity in patients with epilepsy.This was a questionnaire study of 150 people who were taking VPA in monotherapy or polytherapy (since the start of the pandemic or longer) and also 150 people who were not taking VPA (since the start of the pandemic), registered in our epilepsy database. The data compared rates of the seropositivity and severity of infection of COVID-19 between the 2 groups. The latter was assessed, by proxy, vis-à-vis rates of hospital admission and intensive care unit admission.Two hundred forty-one patients were studied, including 130 (53.9%) male and 111 (46.1%) female patients. The mean age of the patients was 30.7 ± 11.4 years. The infection rate and severity of COVID-19 did not significantly differ among patients who were taking VPA and those who were not taking VPA (P = 0.587) and (P = 0.648), respectively.In this pilot study, no support was found for the hypothesis of a protective effect of VPA against the infectivity rate of COVID-19. Neither was there any indication of a disease-modulating effect of VPA in people with active COVID-19 infection. Larger, randomized controlled trials would be warranted to substantiate our conclusion.

PURPOSE OF REVIEW We review data on injuries and traffic accidents affecting people with epilepsy with emphasis on the overall risk of injuries, specific types of injuries, and risk factors. RECENT FINDINGS Population-based studies of incident epilepsy cohorts indicate that the risk of physical injuries in people with epilepsy in general is increased only modestly. The risk is higher in selected populations that attend epilepsy clinics or referral centers. Soft tissue injuries, dislocations, and fractures are the most common injures, whereas the greatest increase in risk is reported for more uncommon injuries such as drowning. People with epilepsy are at a two-fold to four-fold increased risk for fatal injuries. Comorbidities contribute to fatal as well as nonfatal injuries. The other major risk factor is poorly controlled major convulsive seizures (generalized as well as focal to bilateral tonic-clonic seizures). Serious transport accidents associated with increased risks for people with epilepsy include pedestrian, bicycle, as well as car accidents. SUMMARY Individualized information on the risk of physical injuries and accidents should be part of counseling of patients with epilepsy. Improved seizure control is likely the most effective way to reduce risks, but work place and home adjustments should also be considered.

Knowledge of normal patterns is essential for correct EEG interpretation. The overinterpretation of EEG (i.e., ascribing abnormality to EEG patterns that are not associated with disease) is a common problem and can contribute to misdiagnosis and mismanagement. Here, the authors concisely review normal patterns that might be improperly interpreted as abnormal. These include posterior slow waves of youth, central theta, K complexes, asymmetric sleep spindles, hypnagogic and hypnopompic hypersynchrony, arousal patterns, rhythmic midtemporal theta of drowsiness, and the wicket rhythm. Recognition of these patterns will lead to greater accuracy in EEG interpretation and help avoid incorrect management.

To assess whether epilepsy surgery is associated with a reduction in mortality rate and if postoperative seizure frequency and severity affect mortality.A total of 1,110 patients were evaluated (1,006 surgically and 104 nonsurgically treated) for a total follow-up of 8,126.62 person-years from 1986 to 2013. Deaths were ascertained through database and Social Security Death Index query. Patients were grouped by surgery type and seizure status; standardized mortality ratio and deaths per 1,000 person-years were calculated. Survival analysis and Cox proportional hazard regression were performed.Eighty-nine deaths were observed. Surgically treated patients had a lower mortality rate (8.6 per 1,000 person-years [95% confidence interval (CI) 6.58-11.15]) than nonsurgically treated patients (25.3 per 1,000 person-years [14.50-41.17]; p0.001). Seizure-free patients had a lower mortality rate (5.2 per 1,000 person-years [95% CI 2.67-9.02]) than non-seizure-free patients (10.4 per 1,000 person-years [95% CI 7.67-13.89] p = 0.03). More frequent postoperative tonic-clonic seizures (2 per year) were associated with increased mortality (p = 0.006) whereas complex partial seizure frequency was not related to death rate. Mortality was similar in temporal and extratemporal epilepsy patients (p = 0.7).Brain surgery is associated with a reduction in mortality rate in drug-resistant epilepsy, both when seizures are abolished and when it results in significant palliation of tonic-clonic seizure frequency. These observations provide further rationale for earlier consideration of epilepsy surgery.

People with epilepsy may die unexpectedly without a clear structural or pathologic cause. This condition is called sudden unexpected death in epilepsy (SUDEP), and it accounts for a large proportion of deaths among people with epilepsy. SUDEP incidence rates vary with the cohort studied, ranging from 0.35 per 1,000 person-years of follow-up in population-based studies to 9.3 per 1,000 person-years in patients with refractory epilepsy. Although many studies have been performed, the causes of SUDEP are not understood. However, even without precise knowledge of the underlying pathogenic mechanism(s), SUDEP prevention could start with the identification of the most prominent risk factors. SUDEP seems to occur more commonly during sleep and it preferentially affects young adults with medically intractable epilepsy (especially tonic-clonic seizures), individuals who also have neurologic comorbidity, and patients receiving antiepileptic drug polytherapy. This article reviews the clinical features associated with SUDEP and suggests preventive measures for this condition.

Editors' Note: Commenting on “A reappraisal of mortality after epilepsy surgery,” Dr. Kinney asks whether time of operation affected mortality. Sperling et al., authors of the study, could not perform a valid statistical analysis because of the small number of patients with true early intervention. However, following additional analysis, they argue that once intractability is apparent, surgery should be offered as soon as possible. In response to “Myasthenia gravis exacerbation after discontinuing mycophenolate: A single-center cohort study,” Dimachkie et al. argue that the best way to investigate the hypothesis that mycophenolate mofetil (MMF) plays a role in the maintenance of myasthenia gravis (MG) remission …

I congratulate Xiao et al.1 on their recent article. Modern functional studies provide an exciting method to study the impact of epilepsy upon cognition. However, the concluding statements of Xiao et al. do not seem to be substantiated by the presented data. Simply put: an association does not prove causation. It …