Faculty of Medicine

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Incidence, risk factors and management practices in post-viral encephalitis epilepsy: A long-term, nationwide population-based study and review of literature
(Elsevier BV, 2026-03)
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Adjami, Bekim
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Boshkovski, Bojan
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Babunovska, Marija
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Objective: We investigated the incidence, risk factors, and management of post-viral encephalitis epilepsy (PEE) in a nationwide cohort in North Macedonia. Additionally, we conducted a comprehensive literature search on PEE. Methods: Data were obtained from the electronic National Health System (eNHS), encompassing all patients diagnosed with viral encephalitis (VE) in 2016. Patients with pre-existing epilepsy diagnoses were excluded. Clinical, neuroimaging, and EEG data were collected and analyzed, and participants were followed for seven years. Results: Of 1660,584 individuals registered in the eNHS in 2016, 68 were confirmed to have VE (incidence: 4.1/100,000). Among these, six patients died during hospitalization, and the remaining 62 were included in the study cohort. Acute symptomatic seizures (ASyS) occurred in 39 % of patients, with focal to bilateral tonic-clonic seizures (FBTCS) being the most common seizure type. Over the seven-year follow-up period, 11 patients (18 %) developed PEE, with 73 % of cases diagnosed within the first year. Significant risk factors for PEE included ASyS, younger age, and epileptiform abnormalities on EEG. By the end of the follow-up, seven patients with PEE (64 %) remained on antiseizure medications (ASMs). Conclusions: Our results confirm ASyS and highlight acute electro-clinical findings and young age as risk factors for PEE. There is a need for evidence-based clinical pathways and care protocols for patients at risk.
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Cases of Guillain-Barre Sundrome associated with COVID-19
(SHMSHM / AAMD, 2022)
Dalipi, Teuta
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Stojkovska, Frosina
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Mitrevska Velkov, Jasmina
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Babunovska, Marija
A novel member of human RNA coronavirus, which is an enveloped betacoronavirus, has been termed severe acute respiratory syndrome coronavirus-2 (SARS COV-2). The illness caused by SARS COV-2 is referred to as the coronavirus disease 2019 (COVID-19). It is a highly contagious disease that has resulted in a global pandemic. The clinical spectrum of COVID-19 ranges from asymptomatic illness to acute respiratory distress syndrome, septic shock, multi-organ dysfunction, and death. The most common symptoms include fever, fatigue, dry cough, dyspnea, and diarrhea. Neurological manifestations have also been reported. However, the data on the association of Guillain-Barré syndrome (GBS) with COVID-19 are scarce. We report two case of a COVID-19-positive patients who presents clinical features of GBS. In both cases clinical examination showed generalized weakness mostly in lower extremitis and hyporeflexia. The cerebrospinal fluid (CSF) analysis showed albuminocytological dissociation. The neurological condition was different in both patients they both recived kortikosteroids in first case it has good results but in second cases Intravenous immunoglobulin (IVIG) was administered. A thoracolumbar spine magnetic resonance imaging was obtained to rule out other causes, which was normal. COVID-19 is believed to cause a dysregulated immune system, which likely plays an important role in the neuropathogenesis of GBS.
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Risk factors associated with new-onset epilepsy in young adults: Population-based study
(Elsevier BV, 2021-10-19)
Babunovska, Marija
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Boskovski, Bojan
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Kuzmanovski, I
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Risk factors for childhood and late-onset epilepsy are thoroughly described in existing literature, while they are less defined and ambiguous for young adults. We aimed to evaluate the prevalence of various risk factors associated with new-onset epilepsy in adults aged 20-49 years. We included all incident cases in North Macedonia between 2015 and 2018.
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Prevalence of various risk factors associated with new-onset epilepsy after the age of 50: a retrospective population-based study
(Wiley, 2022-02-01)
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Babunovska, Marija
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Boskovski, Bojan
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Kuzmanovski, I
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Population-based studies of epilepsy risk factors are rare. We aimed to evaluate the prevalence of various risk factors associated with new-onset epilepsy after the age of 50 years. We included all incident cases in North Macedonia between 2015 and 2018. Study participants were ascertained from the national healthcare platform. We performed a retrospective analysis of Electronic Health Records of 2,367 patients (1,017 females and 1,350 males) whose epileptic seizures started after the age of 50 years. Patients were stratified into 10-year age groups. The most common risk factor for new-onset epilepsy in our cohort was stroke, which was associated with new-onset epilepsy in 20% of patients aged 50-59 years and almost 50% of patients aged 70-79 years. The second most frequent risk factor was neoplasm in patients aged 50-69 years and dementia in patients older than 70 years. The other pre-existing conditions included: metabolic disorders, traumatic brain injury, and postencephalitic and inflammatory diseases. Chronic alcoholism was the most common metabolic risk factor associated with new-onset epilepsy and accounted for 84% of cases in this subgroup. Only metabolic disorders were significantly more frequent in males than in females (p<0.00001). We did not identify any epilepsy risk factor in 967 patients (41%). Systemic vascular risk factors were frequent in our cohort: 1,574 patients had hypertension (66%) and 449 patients had diabetes (19%), and 339 had both conditions (14%). We found that structural lesions were the most prevalent risk factor associated with new-onset epilepsy in middle-aged and elderly patients. Recognition of possibly modifiable factors associated with late-onset epilepsy could have a positive impact on reducing the risk of developing epilepsy.
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Levetiracetam-Induced Seizure Aggravation in Patients With Focal Cortical Dysplasia
(Lippincott, Williams & Wilkins, 2018)
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Babunovska, Marija
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Boshkovski, Bojan
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Aleksovska, Katina
The choice of antiepileptic drug is typically based on seizure type, and there is no evidence for superior effectiveness or potential deterioration of particular antiepileptic drug in specific etiologic subgroups. The aim of the study was to identify etiological factor(s) associated with increased risk of seizure aggravation with levetiracetam (LEV).
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Patients' attitude toward AED withdrawal: A survey among individuals who had been seizure-free for over 2 years
(Elsevier BV, 2020)
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Babunovska, Marija
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Kuzmanovski, I
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Boskovski, Bojan
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Sazdova-Burneska, Slobodanka
The study aimed to evaluate the attitudes of seizure-free patients toward the antiepileptic drug (AED) withdrawal and to highlight the factors that affect their perspectives.
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Incidence and prevalence of epilepsy in the Republic of North Macedonia: Data from nationwide integrated health care platform
(Elsevier BV, 2021-03-04)
Babunovska, Marija
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Boskovski, Bojan
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Kuzmanovski, I
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This study aimed to evaluate the incidence and period prevalence of epilepsy in the Republic of North Macedonia, an upper-middle-income country with universal access to healthcare, based on a nationwide healthcare platform (NHP).

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