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    Assessment of Prognostic Factors and Validity of Scoring Models in Childhood Autoimmune Encephalitis
    (AVES, 2023) Kanmaz, Seda; Yilmaz, Sanem; Toprak, Dilara Ece; Atas, Yavuz; Ince, Tugce; Simsek, Erdem; Dokurel, Ipek
    Objective: The aim of this study is to evaluate the prognostic factors in a single-center pediatric cohort with autoimmune encephalitis. Materials and Methods: The study group consisted of 23 pediatric autoimmune encephalitis patients (seropositive autoimmune encephalitis: 15, seronegative autoimmune encephalitis: 8). Five group prognostic parameters were evaluated: clinical manifestations, electroenc ephalography features, magnetic resonance imaging characteristics, biomarkers, and treatment modalities. Three scoring models were applied: the Antibody Prevalence in Epilepsy and Response to Immunotherapy in Epilepsy for predicting autoimmune-related epilepsy in the whole cohort and the anti-N-methyl-d-aspartate receptor Encephalitis 1-Year Functional Status score for overall outcome in patients with anti-N-methyl-d-aspartate receptor encephalitis. Results: The initial clinical spectrum of the disease was similar in the seronegative and seropositive groups. Almost half of the patients (48%) recovered without any complications with first-line immunotherapy. The patients with movement disorders in the acute phase of the disease needed more likely second-line immunotherapy (P =.039). The presence of status epilepticus at admission was significantly associated with adverse outcomes and the development of autoimmune-related epilepsy (P =.019). Autoimmune-related epilepsy was defined in an equal proportion of patients (91.5%) with 2 immune epilepsy scores (Antibody Prevalence in Epilepsy and Response to Immunotherapy in Epilepsy). The N-methyl-d-aspartate receptor Encephalitis 1-Year Functional Status score and the modified Rankin score assessed for the first-year prognosis were strongly correlated among the patients with anti-N-methyl-d-aspartate receptor encephalitis (P =.03, Spearmen's rho = 0.751). Conclusions: The presence of status epilepticus was the most important prognostic factor in the patients with the adverse outcome. The studied scoring models (Anti-N-methyl-d-aspartate receptor Encephalitis 1-Year Functional Status, Antibody Prevalence in Epilepsy, and Response to Immunotherapy in Epilepsy) have also been proven to be applicable to the pediatric age group for predicting overall outcome and autoimmune-related epilepsy.
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    The Prophylaxis of Febrile Convulsions in Childhood: Secular Trends in the Last Decade (2007-2008 versus 2017-2018)
    (Galenos Publ House, 2023) Kanmaz, Seda; Atas, Yavuz; Toprak, Dilara Ece; Hoscoskun, Elif; Olculu, Cemile Busra; Ince, Tugce; Yilmaz, Ozlem
    Aim: To analyze trends in the prophylaxis of febrile convulsions (FC) in childhood by comparing two cohorts from the previous two decades (2007-2008 versus 2017-2018).Materials and Methods: The cohort consisted of 272 children with FC who were followed up during the 2007-2008 (n=105) and 2017-2018 (n=167) periods in Ege University Faculty of Medicine Children's Hospital. The following clinical parameters were analyzed: demographic data, FC types, prophylaxis types, selected anti-seizure medications (ASM), recurrence risk factors, and electroencephalography (EEG) characteristics.Results: We defined two secular trends for the prophylaxis of FC in children in the last decade: (1) a reduced rate of FC prophylaxis (22.1%) in the period of 2017-2018 compared with a rate of 63.8% in 2007-2008, p<0.01, (2) no impact of recurrence risk factors for the initiation of prophylaxis for complex FC in the last decade (p=0.028). The mean number of previous seizures at the initiation of the ASM prophylaxis increased from 2.8 +/- 1.13 to 3.4 +/- 2.00 for simple FC and from 1.9 +/- 0.24 to 3.1 +/- 0.31 for complex FC (p<0.01) in the period of 2017-2018.Conclusion: Prophylaxis rates were determined to be lower in the last decade in children with FC. There was no impact of recurrence risk factors for the initiation of prophylaxis in children with simple or complex FC.
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    Trends in the choice of antiseizure medications in juvenile myoclonic epilepsy: A retrospective multi-center study from Turkey between 2010 and 2020
    (W B Saunders Co Ltd, 2022) Kilic, Betul; Serdaroglu, Esra; Polat, Burcin Gonullu; Ince, Tugce; Esenulku, Gulnur; Topcu, Yasemin; Serdaroglu, Ayse
    Purpose:Valproic acid (VPA) is frequently used and effective in juvenile myoclonic epilepsy (JME). Recently, levetiracetam (LEV) has been suggested as a monotherapy in JME. This study aimed to evaluate antiseizure medication (ASM) use in patients with JME. Methods: Treatment choices in a total of 257 patients (age range 8-18 years, 152 girls, 105 boys) with JME diagnosed and treated between 2010 and 2020 were evaluated retrospectively. Seizure remission was defined as complete seizure control for at least 12 months. Results: Across the study period and entire patient group, VPA was most commonly chosen as the initial ASM (50.9%), followed by LEV (44.4%), and lamotrigine (4.7%). VPA was also the most frequent first choice in the subgroup of boys (73.3%), while LEV was the commonest first choice in girls (57.9%). The sex difference regarding the ASM of the first choice was statistically significant (p<0.001). While VPA was the most frequent initial ASM in the first 5 years of the study period (2010-2015,n = 66, 64%), LEV had taken over as the most popular first ASM in the last 5 years (n = 83, 53.9%, p = 0.005). The most frequent reasons for discontinuation were inefficacy for LEV and adverse effects for VPA (p= 0.001). During follow-up, 237 patients (92.2%) were seizure-free for at least 12 months, and 159 (61.9%) were also in electmgraphic remission. Seizure remission occurred earlier than electroencephalographic remission (p<0.001). Conclusion: This study revealed that LEV has become the most frequently chosen initial ASM in the treatment of JME. Although LEV appears to have a better adverse effect profile, VPA seems more likely to be effective in achieving seizure control.