Is it really a seizure? The challenge of paroxysmal non-epileptic events in young infants Running title: Paroxysmal non-epileptic events in young infants

Objectives Many pediatric patients with epilepsy require treatment beyond the pediatric age. These patients require transition to an adult epilepsy center. Currently, many centers worldwide run epilepsy transition programs. However, a standardized protocol does not exist in Korea. The basic data required to establish a transition program are also unavailable. We aimed to assess the status and perceptions of patients and epilepsy care providers on transition. Methods To assess the status of epilepsy transition, we retrospectively collected data from patients with epilepsy older than 18 years who visited our pediatric epilepsy clinic between March 1990 and July 2019. To assess the perception of transition, we surveyed patients, parents, pediatric neurologists (PN), and adult epileptologists (AE). Results In a retrospective chart review, 39 of 267 (14.6%) patients visited the adult epilepsy clinic after consulting a pediatric neurologist, and three patients returned to the pediatric center. The average patient age at transition was 23.29 ± 5.10 years. A total of 94 patients or their guardians and 100 experts participated in the survey. About half of the patients or guardians (44.7%) did not want to transition and emotional dependence was the commonest reason. Most patients (52.1%) thought that the appropriate age of transition was above 20 years. PNs had greater concerns about patients' compliance than AEs. Regarding the age of transition, AEs believed that a younger age (18 years) was more appropriate than PNs (20 years). Significance This study describes difficulties in the transition from pediatric to adult epilepsy centers without appropriate support. There were differences in perspectives among patients, parents, and adult and pediatric epilepsy care providers. This study can assist in creating a standardized protocol in Korea.

Purpose: Studies have been conducted on the prevalence and infant mortality rate of congenital anomalies; however, studies on child mortality are rare. Therefore, we evaluated the characteristics of deaths associated with congenital anomalies among children born in Korea who died within 5 years of age.Methods: Birth-to-death cohort linked data of children under the age of 5 years from 2010 to 2013, and statistical data on the cause of death by age from 1999 to 2019, both provided by the Korea National Statistical Office's Microdata Integrated Service, were retrospectively investigated. We investigated the trends and characteristics of mortality associated with congenital anomalies.Results: Among 1,858,945 children, 6,510 children who died were under 5 years of age, and among them, 1,229 deaths were associated with congenital anomalies, while 5,281 deaths were due to other causes. Deaths associated with congenital anomalies accounted for 18.9% of all deaths. When comparing congenital anomalies by systems, anomalies of the cardiovascular system (52.6%) were the most common. The mortality rate associated with congenital anomalies and those of other causes showed similar declining trends in 21 years.Conclusion: The mortality rate of congenital anomalies during the first 5 years of life did not increase differently from the prevalence of congenital anomalies but rather decreased. Deaths associated with congenital anomalies accounted for 20.5% of all infant deaths and 12.1% of child deaths, since the major causes of death in infants and children are slightly different, continuous and careful monitoring is required.

Since pharmacologic agents are the mainstay of epilepsy treatment, drug compliance is one of the most important factors in seizure control. Outcomes of missing antiepileptic drug (AED) can be associated with higher seizure frequency, increased likelihood hospi-Purpose: Since pharmacologic agents are the mainstay of epilepsy treatment, drug compliance is one of the most important factors in seizure control. Once-daily levetiracetam (LEV) has been proven to have the same efficacy as that of an immediate-release (IR) formulation. A reduced number of doses may improve drug compliance and patient satisfaction. The aim of this study was to assess drug compliance and patient satisfaction when changing from IR to an extended-release (ER) formulation. Methods: Adolescent patients diagnosed with epilepsy who were taking LEV from 2018 to 2020 were included in this study. Compliance charts were reviewed retrospectively. We compared the frequency of seizure occurrence with the frequency of skipping doses and adverse effects before and after changing formulations. Changes in subjective compliance and satisfaction were also investigated. Results: Among 585 patients taking LEV, 44 were included in this study. The average age of the included patients was 16.4±2.0 years. There was no significant change in the average seizure frequency (P=0.491) after switching formulations. Objective compliance based on chart records significantly improved after switching formulations (P=0.021). Additionally, 26 of 44 patients mentioned how they felt about switching formulations, of whom 25 (96.2%) were satisfied with the ER formulation. Thirteen of 24 patients (54.2%) reported better compliance. Conclusion: Our study shows that the efficacy of LEV ER was similar to that of the IR formulation. The reduced number of medication doses improved patient satisfaction and medication compliance. LEV ER may be preferable in adolescent epilepsy patients.

Oxygenated water (OW) contains more oxygen than normal drinking water. It may induce oxygen enrichment in the blood and reduce oxidative stress. Hypoxia and oxidative stress could be involved in epilepsy. We aimed to examine the effects of OW-treated vs. control on four rodent models of epilepsy: (1) prenatal betamethasone priming with postnatal N-methyl-D-aspartate (NMDA)-triggered spasm, (2) no prenatal betamethasone, (3) repetitive kainate injection, and (4) intraperitoneal pilocarpine. We evaluated, in (1) and (2), the latency to onset and the total number of spasms; (3) the number of kainate injections required to induce epileptic seizures; (4) spontaneous recurrent seizures (SRS) (numbers and duration). In model (1), the OW-treated group showed significantly increased latency to onset and a decreased total number of spasms; in (2), OW completely inhibited spasms; in (3), the OW-treated group showed a significantly decreased number of injections required to induce epileptic seizures; and in (4), in the OW-treated group, the duration of a single SRS was significantly reduced. In summary, OW may increase the seizure threshold. Although the underlying mechanism remains unclear, OW may provide an adjunctive alternative for patients with refractory epilepsy.