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Worldwide around 70 million people have epilepsy, and every year, more than 1 out of 1000 cases of epilepsy result in Sudden Unexpected Death in Epilepsy (SUDEP). Video – EEG is the standard clinical method for monitoring epilepsy and seizures. However, wearable systems are required to monitor epileptic activity in daily living due to the complexity of using EEG outside the laboratory. Also, to prevent SUDEP, early prediction of seizure onset is required. In this work, we propose a machine learning model to detect ictal and preictal conditions using an Empatica E4 smartwatch. The Empatica E4 records real-time photoplethysmography, electrodermal activity, accelerometry, and temperature. Clinical data were recorded from 11 patients with epilepsy (PWE) for 19 seizure onsets. Features from all the modalities were extracted by taking segments of the signal during the seizure (ictal), pre-seizure, and inter-ictal (non-seizure) conditions. These features were used on support vector machine (SVM-RBF), decision tree (DTC), and logistic regression (LRC)-based supervised training for ictal vs. non-ictal and pre-ictal vs. inter-ictal conditions. The highest accuracy of 99.40% was recorded for DTC-based seizure detection classifier during 10-fold cross-validation. Also, the highest accuracy of 95.42% was recorded for DTC-based pre-seizure onset detection classifier during 10-fold cross-validation. [ABSTRACT FROM AUTHOR]

Background Knowledge, attitudes, and practice (KAP) questionnaire-based surveys have captured negative attitudes towards marriage involving people with epilepsy (PWE). The attitudes may vary according to the nature of the question posed, whether personal or generic, in addition to many other covariates. Methods We carried out meta-proportion and -regression analyses of epilepsy-related KAP surveys published between 1970 and 2016 in the medical literature analysis retrieval system online (MEDLINE) database. Results The pooled estimate of the proportion of those responding positively to the marriage question was 0.45 (95% confidence interval ( 95% CI): 0.35 to 0.54; I 2 res  = 99.89%). The pooled proportion of positive responders to a personal question (0.40; 95% CI: 0.35 to 0.46) was significantly lower than those responding positively to a generic question (0.64; 95% CI: 0.57 to 0.70) (P = 0.001). When modeled individually in regression analyses, only the continent of origin of the survey (P = 0.001; tau 2 : 0.06; I 2 res : 99.8%; adjusted R 2 : 11.4%) and subject population type (P = 0.02; tau 2 : 0.07; I 2 res : 99.9%; adjusted R 2 : 4.2%) were associated with the pooled estimate of positive responders to the question on marriage. Conclusions Personal questions probing the possibility of marriage of self or family members to someone with epilepsy bring about negative attitudes more often than generic questions inquiring the marriage-worthiness of PWE. [ABSTRACT FROM AUTHOR]

Introduction Matrimony remains a challenging psychosocial problem confronting people with epilepsy (PWE). People with epilepsy are less likely to marry; however, their marital prospects are most seriously compromised in arranged marriages. Aims The aim of this study was to document marital prospects and outcomes in PWE going through arranged marriage and to propose optimal practices for counseling PWE contemplating arranged marriage. Methods A MEDLINE search and literature review were conducted, followed by a cross-disciplinary meeting of experts to generate consensus. Results People with epilepsy experience high levels of felt and enacted stigma in arranged marriages, but the repercussions are heavily biased against women. Hiding epilepsy is common during marital negotiations but may be associated with poor medication adherence, reduced physician visits, and poor marital outcome. Although divorce rates are generally insubstantial in PWE, divorce rates appear to be higher in PWE undergoing arranged marriages. In these marriages, hiding epilepsy during marital negotiations is a risk factor for divorce. Conclusions In communities in which arranged marriages are common, physicians caring for PWE are best-equipped to counsel them about their marital prospects. Marital plans and aspirations should be discussed with the family of the person with epilepsy in a timely and proactive manner. The benefits of disclosing epilepsy during marital negotiations should be underscored. [ABSTRACT FROM AUTHOR]

• A community sample with epilepsy was screened for psychiatric comorbidities followed by a psychiatrist's confirmation. • Psychiatric diagnoses were confirmed in 52%, with depression in 32% and anxiety in 15%. • The NDDI-E and GAD-7, both returned low yields in this population from impoverished communities in India. • The psychiatric diagnosis was associated with lower education, later onset and higher frequency of seizures, and, clobazam. Psychiatric disorders are frequent among people with epilepsy but often under-recognized. The diagnosis and treatment of these disorders in low- and low-middle-income countries (LMICs) are challenging. This cross-sectional survey included people recruited during a community epilepsy screening program involving 59,509 individuals from poor communities in Ludhiana in Northwest India. Adults (age ≥18 years) with confirmed epilepsy on antiseizure medications were screened for depression and anxiety using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7) twice over two years of follow-up. They were later interviewed for symptoms using the Brief Psychiatric Rating Scale, which was then confirmed by assessments by an experienced psychiatrist. Of the 240 people with confirmed epilepsy, 167 (70%) were adults, of whom, 116 (70%) eventually participated in the study. The NDDI-E with a cut-off of 15 identified depression in 14 (12%) of 116 people after one year of follow-up and 17 (15%) at two years. The GAD-7 using a cut-off of 6 identified 22 (19%) at one year and 32 (28%) with anxiety at two years. The area under the curves for NDDI-E was estimated as 0.62 (95% CI, 0.51–0.73; SE: 0.06; p = 0.04) and for GAD-7 as 0.62 (95% CI, 0.46–0.78; SE: 0.08; p = 0.12). Brief Psychiatric Rating Scale identified 63 (54%) people with psychiatric symptoms, for whom, a psychiatric diagnosis was confirmed in 60 (52%). A psychiatric diagnosis was associated with education below high school [Odds Ratio (OR): 2.59, 95% CI, 1.12–5.1; p = 0.03], later age of seizure onset (OR, 1.05, 95% CI: 1.0–1.10; p = 0.04), seizure frequency of at least one/year at enrolment (OR, 2.36, 95% CI: 1.0–5.58; p = 0.05) and the use of clobazam (OR, 5.09, 95% CI, 1.40–18.42; p = 0.01). Depression and anxiety are common in people with epilepsy. Our findings underscore the low yields of screening instruments, NDDI-E and GAD-7, and comparatively better professionally-administered diagnostic assessments in resource-limited settings in LMICs. Moreover, previously established cut-offs do not apply to the community studied. [ABSTRACT FROM AUTHOR]

Summary: Background: People with epilepsy may experience an altered pattern of mortality due to cancer. We determined cancer mortality in two distinct populations with epilepsy: (i) an institutionalised cohort with severe epilepsy (SEC) and (ii) another cohort with presumed milder epilepsy (MEC). Methods: Mortality data from 1977 until 2003 were obtained for the two cohorts (SEC, n =1358 and MEC, n =4494). Standardised mortality ratios (SMRs) for all causes, all cancers and specific cancer sites were calculated. Findings: The SMR for all cancers was significantly elevated in the SEC (SMR: 1.42; 95%CI: 1.18–1.69) but not in the MEC (SMR: 0.93; 95%CI: 0.84–1.03). The SMR for brain and CNS neoplasms was significantly elevated in the MEC; most cancer deaths in younger ages (<45 years) in this cohort were due to brain and CNS neoplasms. There was also a deficit in deaths due to lung cancer (SMR: 0.68; 95%CI: 0.54–0.84) in this cohort. In the SEC, SMRs for oesophageal (SMR: 2.81, 95%CI: 1.35–5.17), liver (SMR: 4.12, 95%CI: 1.12–10.56) and gall bladder (SMR: 7.32, 95%CI: 1.51–21.38) cancers and non-Hodgkin''s lymphoma (SMR: 2.67, 95%CI: 0.98–5.80) were elevated. Conclusions: The modest excess of all cancer deaths and large excesses of deaths due to cancers at certain sites in the SEC and the lack thereof in the MEC suggests dissimilarity in the risk factor profile of the two populations. These risk factors, whether life style attributes or antiepileptic drugs, need to be identified. [Copyright &y& Elsevier]

The classification of epilepsy is essential for people with epilepsy and their families, healthcare providers, physicians and researchers. The International League Against Epilepsy proposed updated seizure and epilepsy classifications in 2017, while another four-dimensional epilepsy classification was updated in 2019. An Integrated Epilepsy Classification system was proposed in 2020. Existing classifications, however, lack consideration of important pragmatic factors relevant to the day-to-day life of people with epilepsy and stakeholders. Despite promising developments, consideration of comorbidities in brain development, genetic causes, and environmental triggers of epilepsy remains largely user-dependent in existing classifications. Demographics of epilepsy have changed over time, while existing classification schemes exhibit caveats. A pragmatic classification scheme should incorporate these factors to provide a nuanced classification. Validation across disparate contexts will ensure widespread applicability and ease of use. A team-based approach may simplify communication between healthcare personnel, while an individual-centred perspective may empower people with epilepsy. Together, incorporating these elements into a modern but pragmatic classification scheme may ensure optimal care for people with epilepsy by emphasising cohesiveness among its myriad users. Technological advancements such as 7T MRI, next-generation sequencing, and artificial intelligence may affect future classification efforts. • Existing epilepsy classifications exhibit shortcomings. • Pragmatic classifications scheme are necessary to streamline communication. • 7T MRI, next-generation sequencing, and AI will affect future classifications. [ABSTRACT FROM AUTHOR]

Community-based, public care programs are a requisite to close the epilepsy treatment gap in disadvantaged communities in low- and middle-income countries (LMICs). Potential beneficiaries may, however, choose not to engage in these programs. The aim of the study was to describe factors associated with and mortality consequences of nonacceptance of a public epilepsy care initiative. In this cross-sectional study, we contacted 207 (36%) people out of 575 who screened positive for epilepsy during a population-based survey of 59,509 people. They were invited for neurological evaluation and care provision (including antiseizure medications (ASMs)) but chose not to engage. Structured questionnaires and qualitative interviews were conducted to determine reason for their nonengagement. Factors associated with nonengagement were evaluated by univariate and multivariate analysis. We conducted verbal autopsies for those who had died. Ten (5%) of the 207 individuals died since the initial screening; six with epilepsy-related causes. Of those who could be contacted (n = 48), 40 (19%) were confirmed to have epilepsy. Nonengaging individuals were likely to be older (odds ratio (OR): 1.02; 95% confidence interval (CI), 1.01, 1.11), locals (OR: 4.32; 95% CI, 1.55, 12.03), and earn less than US$ 78/month (OR: 3.6; 95% CI, 1.62, 8.06). Reasons for not engaging included a belief that epilepsy is inconsequential, loss of daily wages owing to healthcare facility visit and physical infirmity. Nonacceptance of a community-based public epilepsy care initiative is associated with high premature mortality, mostly attributed to epilepsy-related causes. Older age, ethnic status, and economic deprivation are factors associated with nonacceptance, though the underlying reasons may be varied. • Nonengagement in epilepsy public programs is common in resource-limited settings. • This might be due to economic reasons or beliefs about epilepsy and its treatment. • People with epilepsy in resource-limited communities are at risk of early death. [ABSTRACT FROM AUTHOR]

The Global Burden of Epilepsy Report estimates that there are 13 million disability adjusted life years due to epilepsy each year. Estimates of years lived with disability attributed to uncontrolled and untreated epilepsies are particularly raised in comparison to controlled epilepsies in countries with low sociodemographic indices. There are 50 million people with epilepsy in the world and of these, 125,000 die each year, and over 80% of these deaths occur in low- and middle-income countries. Overall, a global decline in the number of epilepsy-related deaths has been seen between 1990 and 2016. The least improvements have been, however, recorded in countries with low sociodemographic indices. These countries include 13 African countries, which have recorded an increase in number of epilepsy deaths over the 26 years. The huge burden of untreated and uncontrolled epilepsy and of epilepsy-related deaths in low- and middle-income countries calls for urgent efforts to improve access to epilepsy management. • Over 80% of epilepsy deaths occur in low- and middle-income countries. • Overall, epilepsy mortality has declined but the least improvements are from low-SDI countries. • The gap in DALYs between high and low-SDI countries is largely accounted for by premature mortality. [ABSTRACT FROM AUTHOR]

• Success of an epilepsy survey rely on available screening tool in local languages. • An epilepsy-screening questionnaire was developed by modifying previous tools. • Translations into Hausa, Igbo and Yoruba were performed using set guidelines. • Three versions of the epilepsy screening can reliably suggest or exclude epilepsy. • A validated questionnaire is now available for epilepsy screening in Nigeria. We describe the development, translation and validation of epilepsy-screening questionnaires in the three most popular Nigerian languages: Hausa, Igbo and Yoruba. A 9-item epilepsy-screening questionnaire was developed by modifying previously validated English language questionnaires. Separate multilingual experts forward- and back-translated them to the three target languages. Translations were discussed with fieldworkers and community members for ethnolinguistic acceptability and comprehension. We used an unmatched affected-case versus unaffected-control design for the pilot study. Cases were people with epilepsy attending the tertiary hospitals where these languages are spoken. The controls were relatives of cases or people attending for other medical conditions. An affirmative response to any of the nine questions amounted to a positive screen for epilepsy. We recruited 153 (75 cases and 78 controls) people for the Hausa version, 106 (45 cases and 61 controls) for Igbo and 153 (66 cases and 87 controls) for the Yoruba. The sensitivity and specificity of the questionnaire were: Hausa (97.3% and 88.5%), Igbo (91.1% and 88.5%) and Yoruba (93.9% and 86.7%). The three versions reliably indicated epilepsy with positive predictive values of 85.9% (Hausa), 85.4% (Igbo) and 87.3% (Yoruba) and reliably excluded epilepsy with negative predictive values of 97.1% (Hausa), 93.1% (Igbo) and 95.1% (Yoruba). Positive likelihood ratios were all greater than one. Validated epilepsy screening questionnaires are now available for the three languages to be used for community-based epilepsy survey in Nigeria. The translation and validation process are discussed to facilitate usage and development for other languages in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

• Errors are common among medication order provided by non-specialist and specialist. • Errors are common among Primary care and AYUSH Physicians orders'. • Audit of Physician orders' at a larger level might reduce these errors. To enumerate and classify errors in physicians' orders of antiseizure medications (ASMs) to people with epilepsy presenting to neurology clinic. This cross-sectional study was conducted in the neurology clinic of a teaching hospital catering to a predominantly rural population. People in whom a diagnosis of epilepsy was confirmed and who presented for the first time with a prior prescription for antiseizure medication/s were included. Their immediate previous prescriptions were assessed for errors, enumerated and classified according to WHO guidelines for prescription writing. Hundred prescriptions of 334 patients screened were analyzed. The number of ASMs prescribed to a participant was 2 ± 0.6 (mean ± SD). We identified a mean of 5 ± 4 (median: 3; range: 1–7) errors in each order. These included superscription errors, e.g., missing information on seizure control and frequency (n = 90, 90%), generic name (n = 62, 62%), patient identifiers (n = 57, 57%), prescribers' identifiers (n = 29, 29%) and diagnosis or indication for prescribing the medication/s (n = 55, 55%). The most common inscription and subscription errors were dosing errors (22%) and pharmaceutical form errors (20%) followed by omission (13%), duplication (13%), substitution (12%), commission (9%) and frequency errors (8%). Errors were more common among prescriptions provided by primary-care and Ayurvedic, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) physicians compared to specialists (P < 0.05). Errors are common among medication orders provided by non-specialist and specialist physicians. Primary care and AYUSH are more liable to make errors underscoring the need to educate them in basic epilepsy treatment. [ABSTRACT FROM AUTHOR]