Epilepsy Currents最新文献

{"title":"Mobilizing a New Era in Lennox-Gastaut Syndrome Treatment and Prevention.","authors":"Aaron E L Warren, Anup D Patel, J Helen Cross, Dave F Clarke, Linda J Dalic, Zachary M Grinspan, Gabrielle Conecker, Juliet K Knowles","doi":"10.1177/15357597251321926","DOIUrl":"10.1177/15357597251321926","url":null,"abstract":"<p><p>This review summarizes content presented at the Pediatric State of the Art Symposium held during the American Epilepsy Society's annual meeting in December 2024. The symposium focused on Lennox-Gastaut syndrome (LGS), a severe developmental and epileptic encephalopathy that emerges in childhood. Despite its diverse etiologies, LGS is defined by a convergent constellation of electroclinical features: multiple seizure types including tonic seizures, slow spike-wave and generalized paroxysmal fast activity on EEG, and intellectual disability. LGS is almost always refractory to available therapies and accounts for substantial costs-in healthcare spending and in quality of life for affected individuals, their families, and caregivers. The symposium highlighted recent breakthroughs in research, clinical care, and outcome measurement that have positioned the clinical, scientific, and patient advocacy communities to usher in a new, more hopeful era of treatment and prevention.</p>","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"236-243"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Therapeutic Seizure Monitoring: A Closed-Loop Device for Direct Delivery of Antiseizure Therapeutics.","authors":"Sara Eyal","doi":"10.1177/15357597251320190","DOIUrl":"10.1177/15357597251320190","url":null,"abstract":"","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"190-191"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Merritt-Putnam Symposium | Developmental and Epileptic Encephalopathies-Current Concepts and Novel Approaches.","authors":"Rodney C Scott, Jenny Hsieh, Amy McTague, J Matthew Mahoney, Catherine A Christian-Hinman","doi":"10.1177/15357597251320142","DOIUrl":"10.1177/15357597251320142","url":null,"abstract":"<p><p>Developmental and epileptic encephalopathies (DEEs) are among the most severe and difficult to treat epilepsies. Two broad strategies for understanding the etiology and impacts of DEEs include genetic and complex adaptive systems approaches. This review, inspired by the 2024 Merritt-Putnam Symposium, describes current perspectives of DEE, identifies limitations of current views, and discusses potential novel ways forward. First, we discuss the rationale for a reevaluation of the role of seizures in the pathogenesis of cognitive and behavioral impairments in DEE. Second, we discuss newly emerging methods employing neural organoids to study brain development and DEE in vitro. Third, we present recent precision therapy approaches for the clinical treatment of DEE. Lastly, we discuss computational systems approaches to understanding the genetic landscape of DEE. The severe and multifaceted impacts of DEE and associated comorbidities underscore the necessity of novel interdisciplinary approaches to produce an improved understanding of etiology and more effective treatment strategies.</p>","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"229-235"},"PeriodicalIF":5.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Stumbling Blocks to Stepping Stones: Progress in Treating Temporal Lobe Epilepsy With Stem Cell Transplantation.","authors":"Janice R Naegele","doi":"10.1177/15357597251318571","DOIUrl":"10.1177/15357597251318571","url":null,"abstract":"<p><p>The last three decades of scientific research provided a wealth of data on the brain origins, development, and functional roles of GABAergic interneurons and new insights into GABAergic interneuron dysfunction in different types of epilepsy. A stumbling block in treating GABAergic interneuron dysfunction in acquired temporal lobe epilepsy (TLE) has been the incapacity of the adult human brain to replace interneurons through adult neurogenesis. Recent advances in the field of stem cell biology led to the development of pluripotent stem cells (iPSCs), and this technology has been used in combination with effective differentiation protocols for generating GABAergic neurons from human iPSCs. Neuroscientists have now established that transplanting human iPSC-derived GABAergic interneurons into the hippocampus in rodent models of TLE can suppress spontaneous recurrent seizures. Basic research studies in mice further showed that interneuron transplants prevent some of the neuropathological hallmarks of TLE that contribute to hyperexcitability and epileptogenesis by forming new inhibitory synaptic connections within the host hippocampus and preventing neuropathological changes from developing. These basic scientific findings paved the way for a recent clinical trial testing human neuron transplantation in patients with severe TLE that is having promising early results.</p>","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"179-183"},"PeriodicalIF":5.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Therapy Opportunities for Progressive Myoclonus in Epilepsy.","authors":"Cameron S Metcalf","doi":"10.1177/15357597251315143","DOIUrl":"10.1177/15357597251315143","url":null,"abstract":"","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"139-141"},"PeriodicalIF":5.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleeping With the Enemy: Drug-Resistant Epilepsy and Sleep.","authors":"Charuta Joshi","doi":"10.1177/15357597251320139","DOIUrl":"10.1177/15357597251320139","url":null,"abstract":"","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"170-172"},"PeriodicalIF":5.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Illuminating LGI1 Seizure Mechanisms Using Novel Optical Techniques.","authors":"Carl E Stafstrom","doi":"10.1177/15357597251320748","DOIUrl":"10.1177/15357597251320748","url":null,"abstract":"","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"195-197"},"PeriodicalIF":5.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After In Utero Exposure to Antiseizure Medication.","authors":"Alison M Pack, Maryam Oskoui, Shawniqua Williams Roberson, Diane K Donley, Jacqueline French, Elizabeth E Gerard, David Gloss, Wendy R Miller, Heidi M Munger Clary, Sarah S Osmundson, Brandy McFadden, Kaitlyn Parratt, Page B Pennell, George Saade, Don B Smith, Kelly Sullivan, Sanjeev V Thomas, Torbjörn Tomson, Mary Dolan O'Brien, Kylie Botchway-Doe, Heather M Silsbee, Mark R Keezer","doi":"10.1177/15357597241258514","DOIUrl":"10.1177/15357597241258514","url":null,"abstract":"<p><p>This practice guideline provides updated evidence-based conclusions and recommendations regarding the effects of antiseizure medications (ASMs) and folic acid supplementation on the prevalence of major congenital malformations (MCMs), adverse perinatal outcomes, and neuro-developmental outcomes in children born to people with epilepsy of childbearing potential (PWECP). A multidisciplinary panel conducted a systematic review and developed practice recommendations following the process outlined in the 2017 edition of the American Academy of Neurology Clinical Practice Guideline Process Manual. The systematic review includes studies through August 2022. Recommendations are supported by structured rationales that integrate evidence from the systematic review, related evidence, principles of care, and inferences from evidence. The following are some of the major recommendations. When treating PWECP, clinicians should recommend ASMs and doses that optimize both seizure control and fetal outcomes should pregnancy occur, at the earliest possible opportunity preconceptionally. Clinicians must minimize the occurrence of convulsive seizures in PWECP during pregnancy to minimize potential risks to the birth parent and to the fetus. Once a PWECP is already pregnant, clinicians should exercise caution in attempting to remove or replace an ASM that is effective in controlling generalized tonic-clonic or focal-to-bilateral tonic-clonic seizures. Clinicians must consider using lamotrigine, levetiracetam, or oxcarbazepine in PWECP when appropriate based on the patient's epilepsy syndrome, likelihood of achieving seizure control, and comorbidities, to minimize the risk of MCMs. Clinicians must avoid the use of valproic acid in PWECP to minimize the risk of MCMs or neural tube defects (NTDs), if clinically feasible. Clinicians should avoid the use of valproic acid or topiramate in PWECP to minimize the risk of offspring being born small for gestational age, if clinically feasible. To reduce the risk of poor neurodevelopmental outcomes, including autism spectrum disorder and lower IQ, in children born to PWECP, clinicians must avoid the use of valproic acid in PWECP, if clinically feasible. Clinicians should prescribe at least 0.4 mg of folic acid supplementation daily preconceptionally and during pregnancy to any PWECP treated with an ASM to decrease the risk of NTDs and possibly improve neurodevelopmental outcomes in the offspring.</p>","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"15357597241258514"},"PeriodicalIF":5.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"In the Name of the Father: Risk to the Offspring From Paternal Exposure to Valproate During Conception\".","authors":"Ioannis Karakis","doi":"10.1177/15357597251317286","DOIUrl":"10.1177/15357597251317286","url":null,"abstract":"","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"116-118"},"PeriodicalIF":5.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Clinical Practice Guidelines: Considerations for Epileptologists.","authors":"Camilo Gutierrez, Shawniqua Williams Roberson, Behnaz Esmaeili, Vineet Punia, Emily L Johnson","doi":"10.1177/15357597251318536","DOIUrl":"10.1177/15357597251318536","url":null,"abstract":"<p><p>Over 5000 epilepsy-related articles are indexed annually, posing a challenge for clinicians to stay updated on all relevant research. Clinical Practice Guidelines (CPGs) are vital tools for translating evidence into practice and promoting equitable, high-quality care while addressing practice variations. This review examines CPG applicability for epileptologists, emphasizing the nuances between primary and specialty care, addressing disparities, and comparing guideline usage in the United States and internationally. CPGs are utilized differently across specialties. General practitioners often manage initial epilepsy cases guided by first-seizure and new-onset epilepsy guidelines. Specialists, dealing with complex cases like treatment-resistant epilepsy, face challenges as guidelines may lag behind emerging therapies. Yet, evidence shows specialists heavily rely on CPGs to ensure optimal care. The use of race in medical algorithms highlights disparities, with examples like race-based adjustments in glomerular filtration rate calculations raising equity concerns. While frameworks exist to reduce biases, ongoing monitoring and inclusive approaches are critical. Globally, CPG implementation varies. The UK's centralized system integrates cost-effectiveness analyses, while the United States adopts a decentralized approach prioritizing clinical efficacy. Emerging technologies, such as electronic medical records and clinical decision support systems, improve CPG adoption and patient outcomes. Success stories like the \"Get with the Guidelines\" stroke program illustrate the potential of structured CPG frameworks. However, challenges persist, such as inconsistencies in epilepsy guidelines for acute seizure management. Ultimately, bridging the gap between evidence and practice requires rigorous, inclusive guideline development, effective communication, and proactive implementation strategies tailored to diverse healthcare systems.</p>","PeriodicalId":11742,"journal":{"name":"Epilepsy Currents","volume":" ","pages":"207-213"},"PeriodicalIF":5.8,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}