Epilepsy is a common neurological disorder affecting about 50 million people worldwide. Disparities in healthcare resources lead to geographical variation in its diagnosis, treatment, and management. In particular, the gap between plains and plateau regions in western China remains understudied. Assessing healthcare professionals’ expertise and delivering targeted training represent effective strategies to narrow this treatment gap. We compare epilepsy knowledge between physicians in more developed plains regions and less developed plateau regions of western China in order to inform targeted interventions to address regional disparities. In this cross-sectional study, physicians attending epilepsy training sessions in three cities representative of the western plains region of China (Chengdu) and of the western plateau region (Lhasa and Xichang) completed a questionnaire assessing knowledge in several modules of the disease, including its diagnosis, preoperative evaluation, drug and surgical treatments, and management during pregnancy. Of the 349 participants given questionnaires, 325 (93.1

Impaired inhibitory control places a serious burden on the lives and psyches of patients with frontal lobe epilepsy (FLE). Music may serve as an adjunctive therapy to increase inhibitory control function in adults. However, whether music improves inhibitory control function in patients with FLE and its mechanism of action remains to be explored. In this study, 21 FLE patients and 24 healthy controls were recruited to assess the effect of music on inhibitory control in FLE patients by EEG under the Go/NoGo task. The results showed that FLE patients had poor inhibitory control at baseline, and after the music intervention, FLE patients had significantly shorter task reaction time, higher accuracy. Meanwhile, a significant increase in wave amplitude difference between the N2 and P3 components was observed in the mid-frontal region. Also, music affected the connectivity between frontal and temporal lobes in FLE patients. Music may positively affect inhibitory control functions in FLE patients by modulating the amplitudes of N2 and P3 and the functional connectivity of frontal-temporal regions. This proposes a musical intervention to ameliorate cognitive impairment, and contributes to the understanding of the mechanism of action of musical interventions for the treatment of epilepsy with cognitive impairment.

Objective:Ubiquitin-specific peptidase 14 (USP14) may be a target for stroke treatment. Our study aims to explore the molecular mechanism of USP14 in the stroke process. Material and Methods:A stroke cell model was constructed using oxygen-glucose deprivation/reoxygenation (OGD/R)-induced SK-N-SH cells, and cell growth was assessed using cell counting kit 8 assay, EdU assay, and flow cytometry. Proinflammatory cytokine levels were tested through an enzyme-linked immunosorbent assay. The levels of USP14 and acyl-CoA synthetase long-chain family member 4 (ACSL4) were determined through Western blot and quantitative real-time polymerase chain reaction, whereas the interaction of USP14 and ACS14 was evaluated by co-immunoprecipitation assay. Results:OGD/R-induced SK-N-SH cell injury by enhancing ferroptosis and the knockdown of USP14 inhibited OGD/R-induced cell inflammation, apoptosis, and ferroptosis. Moreover, USP14 enhanced ACSL4 protein expression through deubiquitination. ACSL4 silencing mitigated neuron injury, and ACSL4 upregulation abolished USP14 knockdown-mediated inhibition of neuron injury. Conclusion:USP14 can enhance neuron injury through stabilizing ACSL4 protein expression.

OBJECTIVE:Sleep-related hypermotor epilepsy (SHE) is a relatively uncommon epilepsy syndrome, characterized by seizures closely related to the sleep cycle. This study aims to explore interictal electroencephalographic (EEG) characteristics in SHE. METHODS:We compared EEG data from 20 patients with SHE, 20 patients with focal epilepsy (FE), and 14 healthy controls, carefully matched for age, sex, education level, epilepsy duration, and drug-resistant epilepsy. RESULTS:Our findings revealed distinct patterns of power spectral density in SHE patients during wakefulness and N2 sleep compared to other groups, suggesting potential diagnostic value. During wakefulness, SHE patients showed enhanced frontal lobe power across all frequency bands, but decreased frontal lobe power in low-frequency bands during N2 sleep. Additionally, a positive correlation was found between frontal γ band power and epilepsy duration in SHE patients during N2 sleep but not during wakefulness. CONCLUSIONS:These findings suggest that interictal EEG abnormalities during wakefulness and N2 sleep might be used as potential biomarkers for the diagnosis of SHE. SIGNIFICANCE:This study is the first to simultaneously characterize EEG during sleep and wakefulness in SHE patients during interictal periods, with potential utility for diagnosis.

OBJECTIVE:Data on seizure and pregnancy outcomes in Asian women with epilepsy are limited. We used a Chinese pregnancy registry to assess the impact of seizures and antiseizure medications (ASMs) on pregnant women with epilepsy and their children. METHODS:This is an ongoing prospective multicenter study of pregnant women with epilepsy that has been running since 2012. Eligible participants were consecutively enrolled and had multiple follow-ups up to one year after delivery. We assessed ASM use and seizure frequency during pregnancy to establish potential effects on the mothers and infants and to identify relevant correlations. Descriptive analysis was used to estimate proportions. Logistic regression was used to identify the relevant risk factors and correlations. RESULTS:Of 1907 potentially eligible pregnancies, we included 1763 in 1483 women with known outcomes from January 2012 to February 2022. There were 1278 completed pregnancies, resulting in 1270 live births. Tonic-clonic seizures occurred in fewer than one-third of pregnancies in each trimester. Compared with baseline, seizure frequency remained relatively stable throughout approximately two-thirds of the pregnancies. The majority were on ASM, with levetiracetam (39%), oxcarbazepine (19%), and lamotrigine (17.5%) being the most commonly used. In contrast, only 14.2% of pregnancies were exposed to valproate (VPA). There was a declining trend in treatment adjustments over the course of the pregnancy, with most changes occurring in the first trimester. The incidence of major congenital malformation (MCM) was 4.4%, with cardiogenic and orofacial anomalies being the most common. VPA use (p < .001), lack of folic acid use (p = .009), positive family history of MCM (p = .006), and topiramate (TPM) use (p = .04) were the most important predictors of MCM. SIGNIFICANCE:Seizure control remained stable for the majority of women with epilepsy throughout pregnancy. Family history of MCM, VPA use, TPM use, and not taking folic acid were strong predictors of MCM in infants born to women with epilepsy.

Sleep-related hypermotor epilepsy (SHE) is associated with severe cognitive deficits. The condition involves impaired inhibitory control, and whether music therapy can be effective against it is unclear. Here we analyzed various pathophysiological markers of impaired inhibitory control and identified some that improved after music therapy. We assessed cognitive function in 41 patients with SHE in the Go/NoGo task and electroencephalographic activity before and after a single exposure to Mozart's K. 448. The same assessments were performed in two types of controls, 41 patients with nocturnal epilepsy and 40 healthy individuals. SHE showed significantly longer reaction time, lower accuracy, later onset of theta bursts in the mid-frontal region. Severity of them correlated positively with reaction time. During music exposure, theta activity synchronized with the rhythm. Music significantly shortened reaction time and increased accuracy in patients with SHE, while also shortening the interval until the onset of theta bursts. Our results suggest that SHE involves frontal network damage affecting inhibitory control, and that music therapy can mitigate this damage by facilitating onset of theta bursts. It also indicates that theta bursts may be useful for assessing therapeutic efficacy and for exploring ways to mitigate cognitive deficits in epilepsy patients with frontal network deficits.

Background The COVID-19 pandemic substantially increases the risk of severe psychological distress among people with epilepsy (PWE), especially those with monthly household income < 5000 RMB or with uncontrolled seizures. Patients with Kessler scores > 12 should consult a psychiatrist, especially during major disasters. This study was aimed to compare the frequency of psychological distress among Chinese PWE before and during the outbreak of the SARS-CoV-2 Omicron variant, and to identify risk factors for such distress. Methods In this prospective study, we collected sociodemographic data of PWE aged > 14 years, who were treated at our center during December 1 to 15, 2022. All participants completed the 6-item Kessler Psychological Distress Scale before the outbreak and again during the outbreak. Health visitors who were unrelated to those patients during the outbreak were included as a control. Multivariate logistic regression analysis was performed to identify risk factors of severe psychological distress and its exacerbation. Results Of the 223 PWE, 127 were tested positive for SARS-CoV-2, while 174 of 218 controls were positive for SARS-CoV-2. The neurological symptoms were similar between PWE and controls with SARS-CoV-2. The average Kessler score of PWE was significantly higher during the outbreak than before it (9.93 ± 3.98 vs. 8.52 ± 0.23, P < 0.001). The average score of controls during the outbreak (5.146 ± 0.35, P < 0.001) was significantly lower than that of the PWE. We identified three independent predictors for severe psychological distress in PWE during the outbreak, i.e., monthly household income < 5000 RMB (OR = 0.252, 95%CI 0.064–0.998, P = 0.048), severe psychological distress before the outbreak (OR = 0.067, 95%CI 0.026–0.174, P < 0.001), and seizure onset within 30 days before the assessment during the outbreak (OR = 0.356, 95%CI 0.157–0.805, P = 0.013). Of the three predictors, the last one was also an independent predictor for exacerbation of psychological distress during the outbreak (OR = 0.302, 95%CI 0.123–0.741, P = 0.009). Conclusions Our analysis suggests that the COVID-19 pandemic has substantially increased psychological distress of individuals with epilepsy, regardless of the viral infection or not. Various neurological symptoms similar to those of “long COVID” appeared for the first time among these individuals during the Omicron outbreak, highlighting the need for clinicians to screen carefully for this condition. Management of epilepsy during the pandemic or a similar major disaster should focus on the control of seizures and maintenance of mental health, especially among those with monthly household incomes below 5000 RMB, suffering uncontrolled seizures and having a history of severe psychological distress.

OBJECTIVE:The primary objective of this retrospective analysis was to evaluate the incidence and lateralization value of peri-ictal yawning (PY) in people with temporal lobe epilepsy (TLE). PY has only occasionally been reported as a manifestation of focal epilepsy. We aimed to determine whether PY could serve as an indicator to help lateralize seizure onset during epileptic seizures. METHODS:Among 236 consecutive TLE patients admitted for video-EEG monitoring, we analyzed the clinical characteristics, along with scalp video-EEG, magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), Wada test, and stereo EEG (SEEG) in patients with PY. RESULTS:Among the 236 patients, 26 (11.0%) exhibited PY, and 36 of 1018 recorded seizures (3.5%) were associated with PY. Of the 26 patients with PY, 19 (73.1%) had non-dominant TLE, while 7 (26.9%) had dominant TLE. The majority of these patients presented with staring, arrest, and automatisms during their seizures with accompanying vegetative signs. PY occurred either during the ictal or postictal phase in all patients. Exception for 10 seizures (10/36, 27.8%) at the early stage (less than 25% total duration), PY was primarily linked to the late ictal and postictal phases. Surgical intervention was performed in 12 patients, 9 of whom (75%) achieved seizure freedom (Engel class I), with 7 of these 9 (77.8%) having non-dominant TLE. SIGNIFICANCE:Yawning is a physiological phenomenon typically not associated with epilepsy. The present series suggests that PY is relatively uncommon in TLE, but may represent a rare vegetative sign, particularly in cases with non-dominant TLE. Further investigation with a larger cohort of surgically confirmed cases and using intracranial EEG is essential to deepen our understanding of this phenomenon. PLAIN LANGUAGE SUMMARY:Yawning is a typical physiological response that is generally not linked to epilepsy. However, it can occasionally indicate seizure activity, particularly in TLE. PY happens more often observed in non-dominant TLE and usually occurs in the later stages of a seizure or just after it. It may hold potential as a lateralizing marker in TLE.

Background There is a lack of further exploration of the epileptogenic network of specific types of epilepsy, such as unilateral hippocampal sclerosis (HS), and there is an urgent need to find exact evidence to confirm the consistency of its brain network changes.Methods We enrolled 22 mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) patients to compare the differences in brain activity between 22 healthy controls (HCs) and them. Resting-state electroencephalography (EEG) was also measured. Then, we calculated the power spectral density and phase locking values in and between these electrodes.Results The results showed the increased theta power was related to the high severity of epilepsy in the temporal, parietal, and central regions in mTLE-HS patients, and there were positive correlations between theta power in the contralateral temporal region and seizure frequency. Theta power in the ipsilateral parietal lobe is positively correlated with the number of anti-seizure medications (ASMs), but not with the usage of third-generation ASMs. Meanwhile, the temporal lobe of mTLE-HS patients had more connectivity with parietal lobe and central region.Conclusions Theta power is an important EEG indicator of mTLE-HS, positively correlates with epilepsy severity and seizure frequency, and has network properties that can be observed outside the lesion. Moreover, the usage of third-generation ASMs did not affect the risk of increased theta power. Lastly, the temporoparietal and temporal-central networks are likely to be causative pathways in epilepsy patients with cognitive impairment. This study provides a potential guideline for the treatment of mTLE-HS in clinical practice.

Objective: To study the relationship between depressive mood and parenting style of junior high school students. Methods: A total of 1966 junior high school students in Henan Province were selected by cluster sampling method from May 2022 to November 2022. The survey tools included the General Social Data Questionnaire, the Parenting Style Questionnaire (PBI) and the Childhood Depression Disorder Self-Rating Scale (DSRSC). Multivariate logistic regression analysis was used to evaluate the association between adolescent depression and parenting styles. Results: There were 1966 valid questionnaires, of which 1054 were female (53.6%) and 912 were male (46.4%). The age was 13.98±0.56 years. Among 1966 junior high school students, 465 junior high school students had depression. Depression of junior middle school students is negatively correlated with mother's care and father's care, positively correlated with mother's indifference and father's indifference, and positively correlated with mother's overprotection and father's overprotection. Conclusion: Parental care can reduce the risk of depression in junior middle school students, while parental apathy and overprotection can increase the risk of depression in junior middle school students. The depression detection rate of junior high school students is significantly different, highlighting different characteristics in gender, age, parenting style, etc. Educators should develop targeted education and intervention strategies according to the characteristics of junior high school students.

Introduction: Despite consistent reports of the association between problematic internet gaming (PIG) and nonsuicidal self-injury (NSSI), an increase in PIG does not necessarily lead to increased NSSI. This apparent paradox indicates the presence of other mediators and moderators in the PIG-NSSI association. This study aimed to investigate the role of anxiety as a potential moderating and mediating factor of the PIG-NSSI association in Chinese adolescents.Methods: A cross-sectional study was conducted among 10,479 Chinese adolescents (50.5% male; age range, 9-18 years). Standardized self-report questionnaires were used to assess the severity of PIG, anxiety, and NSSI. Spearman correlation and multiple linear regression were applied to examine the relationships among PIG, anxiety, and NSSI. Both moderating and mediating effects of anxiety were assessed using Hayes' methods.Results: PIG, anxiety symptoms, and NSSI significantly correlated with one another. Anxiety significantly moderated the relationship between PIG and NSSI [B = 0.002, standard error (SE) = 0.000, p < 0.001], and it partially mediated the PIG-NSSI association [B = 0.017, SE = 0.001, 95% confidence interval (CI) 0.014-0.021]. Social concern and concentration were the two dimensions of anxiety that exerted the strongest mediation effect (B = 0.017, SE = 0.002, 95% CI 0.014-0.020).Conclusions: Adolescents with PIG and high anxiety are likely to suffer more severe NSSI and may benefit from interventions to reduce anxiety symptoms.

BACKGROUND:Mozart's "Sonata for two pianos" (Köchel listing 448) has proven effective as music therapy for patients with epilepsy, but little is understood about the mechanism of which feature in it impacted therapeutic effect. This study explored whether tempo in that piece is important for its therapeutic effect.METHODS:We measured the effects of tempo in Mozart's sonata on clinical and electroencephalographic parameters of 147 patients with epilepsy who listened to the music at slow, original, or accelerated speed. As a control, patients listened to Haydn's Symphony no. 94 at original speed.RESULTS:Listening to Mozart's piece at original speed significantly reduced the number of interictal epileptic discharges. It decreased beta power in the frontal, parietal, and occipital regions, suggesting increased auditory attention and reduced visual attention. It also decreased functional connectivity among frontal, parietal, temporal, and occipital brain regions, also suggesting increased auditory attention and reduced visual attention. No such effects were observed after patients listened to the slow or fast version of Mozart's piece, or to Haydn's symphony at normal speed.CONCLUSIONS:These results suggest that Mozart's "Sonata for two pianos" may exert therapeutic effects by regulating attention when played at its original tempo, but not slower or faster. These findings may help guide the design and optimization of music therapy against epilepsy.

A 49-year-old man presented with a 2-year history of weakness and sensory disturbances in the bilateral lower extremities, vesicorectal dysfunction, and progressive gait disturbances. Brain MRI revealed multiple ischemic and hemorrhagic cortical/subcortical lesions with patchy enhancement involving the frontal and parietal lobes, suggesting the possibility of distal perforating arteries injury. Spine MRI revealed lesions of the cervical and thoracic spinal cord with associated enhancement. The diagnosis of malignant atrophic papulosis (Degos disease) with central nervous system involvement was prompted by the characteristic skin lesions.

ObjectiveMetabotropic glutamate receptor 5 (mGluR5) encephalitis is such a rare type of autoimmune encephalitis that its diagnosis remains a challenge.Case reportA 19-year-old female patient initially presented with anxiety and orthostatic leg tremors without cortical dysfunction. We found that this patient was positive for mGluR5 antibodies in both serum (1:1,000) and cerebrospinal fluid (1:32). After comprehensive intervention, the patient showed complete recovery at the 18-month follow-up.DiscussionThis report expands our knowledge of the possible presentations of mGluR5 encephalitis for early diagnosis, which makes it possible to prevent serious consequences and improve the prognosis.

Objectives To extend the symptomatic spectrum of acute neurologic syndrome associated with dopamine-2 receptor (D2R) antibodies. Methods A 13-year-old adolescent boy was admitted to the Neurology Department with abnormal jaw movements. The initial evaluation included laboratory examinations of blood, chest radiography, brain MRI, EEG, and neuropsychologic tests. Serum and CSF samples were collected for immunologic studies. The clinical outcome of the patient was followed up for 18 months after the first hospitalization. Results Paroxysmal jaw clonus, blepharospasm, and sialorrhea were observed in the patient with a history of Tourette syndrome and obsessive-compulsive disease and with an acute neurologic syndrome associated with D2R antibodies. The symptoms responded to IV methylprednisolone (IVMP), relapsed twice during prednisone reduction, and, finally, improved after the combined treatment of IVMP and IV immunoglobulin. Discussion Recognizing paroxysmal jaw clonus (possibly with blepharospasm and sialorrhea) and considering the relationship between these episodes and D2R antibodies will be helpful in the early diagnosis and treatment of immune neurologic syndromes.

BackgroundStrict quarantines can prevent the spread of the COVID-19 pandemic, but also increase the risk of mental illness. This study examined whether the people who have experienced repeated home quarantine performance more negative emotions such as anxiety, depression, and post-traumatic stress disorder (PTSD) in a Chinese population. MethodsWe collected data from 2,514 participants in Pi County, Chengdu City, and stratified them into two groups. Group 1 comprised 1,214 individuals who were quarantined only once in early 2020, while Group 2 comprised 1,300 individuals who were quarantined in early 2020 and again in late 2020. Both groups were from the same community. The GAD-7, PHQ-9, and PCL-C scales were used to assess symptoms of anxiety, depression, and PTSD between the two groups. ResultsAnalyses showed that total PHQ-9 scores were significantly higher in Group 2 than in Group 1 (p < 0.001) and the quarantine times and age are independent predictors of symptoms of depression (p < 0.001). The two groups did not differ significantly in total GAD-7 or PCL-C scores. ConclusionIncreasing quarantine times was associated with moderate to severe depression symptoms, but not with an increase in symptoms of anxiety or PTSD.