Epilepsia最新文献

{"title":"Topiramate for the treatment of neonatal seizures and beyond.","authors":"Wolfgang Löscher, Janet S Soul","doi":"10.1111/epi.18563","DOIUrl":"https://doi.org/10.1111/epi.18563","url":null,"abstract":"<p><p>Acute symptomatic neonatal seizures are one of the most common neurological disorders in newborns admitted to neonatal intensive care units and require prompt treatment. Up to 50% of neonatal seizures are refractory to first-line medications such as phenobarbital (PB), and another 30% fail second-line therapy. Furthermore, antiseizure medications (ASMs) such as PB have short-term adverse effects and may exert long-term detrimental effects on neurodevelopment. Thus, the development of more effective and safer ASMs is an urgent medical need. Because of its multimodal mechanisms of action and neuroprotective activity as well as promising preclinical and clinical findings, topiramate (TPM) is currently among the most attractive ASMs for the treatment of PB-refractory neonatal seizures. However, parenteral TPM is not clinically available, which restricts its use in most newborns with acute seizures. In this review, we critically discuss the current knowledge about TPM as a treatment for neonatal seizures and associated conditions. We describe both preclinical and clinical data and highlight that the neuroprotective activity of this drug, not shared by most other ASMs, may enhance the efficacy of therapeutic hypothermia to decrease adverse neurodevelopment after neonatal brain injury. In addition, we describe two novel intravenous formulations of TPM currently being developed for clinical use. One formulation uses the highly tolerable U.S. Food and Drug Administration (FDA)-approved excipient meglumine for the preparation of an aqueous TPM solution, so is particularly suitable for neonates. We recommend prospective randomized controlled clinical trials designed to test the safety and efficacy of intravenous TPM for neonatal seizures. TPM doses in such trials should be based on the maintenance of effective plasma levels not achieved in most previous clinical studies with enteral administration of TPM suspensions. Furthermore, the potentially beneficial neuroprotective effects of TPM on adverse outcomes associated with neonatal seizures and their etiologies should be examined in such trials.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Untangling the tangled relationship between cognitive and psychological comorbidities in epilepsy: Bidirectionality and mediation.","authors":"Bruce P Hermann, Aaron F Struck, Qirui Zhang, Sam S Javidi, Joseph I Tracy","doi":"10.1111/epi.18589","DOIUrl":"https://doi.org/10.1111/epi.18589","url":null,"abstract":"<p><strong>Objective: </strong>Cognitive and psychological abnormalities are known to be frequently occurring complications of the epilepsies, but their patterns of co-occurrence, directions of effect, underlying mechanism(s), and causal pathways remain uncertain. The intent of this investigation was to advance understanding of these issues in patients with temporal lobe epilepsy (TLE).</p><p><strong>Methods: </strong>A total of 121 patients with TLE were administered a comprehensive neuropsychological battery, and symptoms of diverse psychological syndromes were assessed with a standardized psychological inventory. The cognitive and psychological data were reduced by factor analysis (FA) to broad- and narrowband indicators that were then examined by partial least squares structural equation modeling (PLS-SEM) to inform the presence, strength, direction, and mediators of cognitive-psychological relationships.</p><p><strong>Results: </strong>FA identified overarching metrics of cognition (g) and psychopathology (p) as well as their correlation and underlying factors wherein g contained three indicators (language/memory, perceptual/nonverbal reasoning, information/processing speed) and p contained two indicators (externalizing, internalizing). PLS-SEM demonstrated direct, bidirectional associations between internalizing psychopathology and language/memory, indicating these factors express a strong interdependency. Mediation modeling showed an index of functional brain reserve served to explain this selective, shared influence, as well the relationship between the broader concepts of p and g, indicating origin in a common psychological/cognitive mechanism.</p><p><strong>Significance: </strong>Neuropsychological and psychological comorbidities of TLE are represented by both broadband and narrowband indicators of clinical and theoretical relevance. These indicators exhibit multidimensionality, multimorbidity, and bidirectionality that point to a shared neurobiological core best expressed and explained by the mediating influence of brain functional reserve.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct spike-and-wave EEG profiles reveal susceptibility to fleeting/almost loss of consciousness (so-called blips) in generalized epilepsy.","authors":"Edgar Matringe, Aya Khalaf, Romain Granchamp, Juan R Vidal, Marcela Perrone-Bertolotti, Hal Blumenfeld, Laurent Vercueil","doi":"10.1111/epi.18557","DOIUrl":"https://doi.org/10.1111/epi.18557","url":null,"abstract":"<p><strong>Objective: </strong>To characterize electroencephalographic (EEG) profiles of short spike-and-wave bursts (SWBs) in patients with idiopathic generalized epilepsy reporting sensations of fleeting/almost loss of consciousness, described as \"a blip on the screen\"-a phenomenon first termed \"blips\" by J.W. Lance.</p><p><strong>Methods: </strong>Among 176 consecutive patients, 19 were included based on a diagnosis of idiopathic generalized epilepsy and the presence of SWBs on EEG recordings. Patients were classified as \"blippers\" (yes) or \"non-blippers\" (no) based on their response to whether they had ever experienced \"blip\"-like sensations. A total of 624 SWBs extracted from EEG traces were compared between groups. The analysis focused on the spike (10-125 Hz) and wave (2.5-4 Hz) frequency band components across predefined spatial regions of interests.</p><p><strong>Results: </strong>SWBs were significantly longer in blippers than in non-blippers (median: 1.2 s, interquartile range [IQR]: (Q1-Q3): 753-1796 vs 0.9 s, 599-1541; p < .001, r = .14). EEG analyses revealed two distinct spatial profiles, with higher fractional change in wave amplitude over anterior frontal (39.73, 12.56-81.27 vs 17.34, 5.18-56.95; p < .01, r = .13), frontal (46.94, 20.55-100.28 vs 31.08, 9.51-88.81; p < .05, r = .10), and occipital (25.25, 11.51-50.97 vs 14.99, 4.94-43.80; p < .01, r = .13) regions, but not parietal (p > .05). Similarly, spikes showed increased amplitude in anterior frontal (5.32, 2.50-15.27 vs 4.20, 2.58-7.60; p < .05, r = .09) and central (3.95, 2.81-6.20 vs 3.07, 1.82-5.08; p < .01, r = .14) regions, with lower occipital power in blippers (1.93, 1.36-3.19 vs 2.53, 1.52-4.33; p < .05, r = -.10). Overall, spike and wave amplitudes were higher in blippers, particularly at SWB onset. All p-values were false discover rate (FDR)-corrected and analyses were conducted at the SWB level.</p><p><strong>Significance: </strong>Distinct EEG profiles of SWBs may be associated with self-reported blip experiences.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world use of cenobamate in pediatric focal epilepsies and developmental epileptic encephalopathies: A multicenter retrospective series.","authors":"Víctor Soto-Insuga, Adrián Valls Carbó, Anna Gretel Pinzón-Acevedo, Elena González-Alguacil, Juan José García Peñas, Andrea Sariego Jamardo, Gemma Aznar-Laín, Salvador Ibáñez-Micó, Helena Alarcón Martínez, Raquel Buenache, Saray Rekarte, Andrea Parejo Olivera, Ezequiel Tuero-Montiel, Jana DomínguezCarral, María López, Ainhoa García Ribes, María Jesús Martínez González, Eva Arias, Adrián García Ron, Susana Boronat, Eulalia Turón Viñas, Dolors Casellas, Virginia Navarro, David Conejo, Elena Miravet, Irene Sánchez-Miranda Román, Antonio Gil Nagel-Rein, María Muñoz Cabeza, Patricia Smeyers, Ángel Aledo-Serrano","doi":"10.1111/epi.18586","DOIUrl":"https://doi.org/10.1111/epi.18586","url":null,"abstract":"<p><strong>Objective: </strong>Cenobamate (CNB) is an anti-seizure medication approved for focal-onset seizures in adults, with growing evidence supporting its use in pediatric drug-resistant epilepsy (DRE). This study evaluates the efficacy, retention, and safety of CNB in children and adolescents, including those with developmental and epileptic encephalopathies (DEEs).</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter study of 169 pediatric patients (0-18 years) with DRE treated with CNB across centers in Spain. Seizure response (≥50% reduction) and seizure freedom (no seizures in the previous month) were assessed at 3, 6, and 12 months.</p><p><strong>Results: </strong>At 12 months, CNB showed a retention rate of 89.2%, with 83.9% of patients achieving seizure response and 19.6% reaching seizure freedom. Response rates were 73.4% at 3 months and 77.1% at 6 months, with seizure freedom increasing from 11.8% at 3 months to 21.1% at 6 months. Outcomes were comparable between DEEs and focal epilepsies, indicating broad-spectrum efficacy. Seizure worsening occurred in 4.7% of patients, all with DEEs. After adjusting for seizure type, those patients with focal seizures had higher odds of achieving seizure response (odds ratio [OR] 95% confidence interval [95% CI] 5.46, 1.27-23.52; p = 0.02) and seizure freedom (OR 95% CI 5.32, 1.57-17.97; p < 0.01). Median CNB doses (mg/kg/day) were 1.78 (range 0.37-12.5), 2.5 (range 0.67-12.5), and 3.19 (range 0.96-9.09) at 3, 6, and 12 months, respectively. Adverse events occurred in 44.9% of patients, most commonly somnolence (42.3%) and dizziness (22.4%), which improved with slower titration.</p><p><strong>Significance: </strong>CNB appears effective and well-tolerated in pediatric DRE, including DEE, with high retention and sustained efficacy over time. Adverse events were generally manageable with dose adjustments, and slow, weight-based titration improved tolerability. Prospective studies are warranted to confirm these findings.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epileptogenesis in meningioma: Theories, putative biomarkers, and postoperative risk.","authors":"William H Cook, Conor S Gillespie, Ali Bakhsh, Anthony G Marson, Michael D Jenkinson, Adel E Helmy","doi":"10.1111/epi.18559","DOIUrl":"https://doi.org/10.1111/epi.18559","url":null,"abstract":"<p><p>Cranial meningioma are the most common type of primary brain tumor, and focal onset, tumor-related seizures affect a significant proportion of patients. Seizures affect 30% of symptomatic preoperative patients and a further 12% of postoperative patients. Although most patients may be cured of their oncological disease by surgery, seizures confer disability, reduced quality-of-life, delayed return to driving and work, and increase the risk of sudden death. Tumor-associated seizures are also more likely to be resistant to antiseizure medications (ASMs). ASMs are limited to treating the symptoms of epilepsy-seizures-but have no disease-modifying effect on the mechanisms that cause or maintain seizure susceptibility. There is a need to be able to predict who is at risk of developing postoperative seizures for targeted prevention or closer monitoring of those at greater risk. Mechanisms underpinning brain tumor-related seizures are most likely multifactorial and related to morphological, biochemical, and metabolic causes. Brain tumors likely cause cortical hyperexcitability due to irritation caused by mass effect, brain invasion, and peritumoral brain edema. Inflammatory mediators are involved in epileptogenesis in animal models and human seizure syndromes and there are experimental data to support the development of inflammatory mediators as biomarkers for epileptogenesis. Meningioma-associated seizures are incompletely understood and consequently unpredictable with current knowledge. In this review, we discuss the proposed mechanisms of epileptogenesis in brain tumors and putative neuroinflammatory mechanisms for meningioma-associated seizures. Ultimately, we evaluate the potential of neuroinflammatory biomarkers of epileptogenesis in meningioma and the current challenges with extrapolating from current literature, which primarily consider epilepsy and intrinsic brain tumors. A prospective randomized controlled trial (STOP'EM: ISRCTN14381346) is open in the UK and will determine the role of two weeks of prophylactic levetiracetam in seizure-naïve patients undergoing meningioma surgery and provide an opportunity to obtain serial blood measurements from patients to assist with biomarker discovery.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focal hypermetabolism in suspected non-convulsive status epilepticus.","authors":"Jeroen Gijs, Annelies Geebels, Greet Vanderlinden, Koen Van Laere, Ahmed Radwan, Anke Wouters, Patrick Dupont, Aline Delva, Wim Vandenberghe, Wim Van Paesschen, Karolien Goffin","doi":"10.1111/epi.18567","DOIUrl":"https://doi.org/10.1111/epi.18567","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) as a biomarker in suspected non-convulsive status epilepticus (NCSE) by characterizing electroclinical-metabolic correlations and quantifying focal hypermetabolism.</p><p><strong>Methods: </strong>We included adult patients with rhythmic and periodic patterns (RPPs) undergoing ¹⁸F-FDG PET for suspected NCSE. Two neurologists reviewed patient electroencephalography (EEG) recordings (0-30 min post-injection) using 2021 American Clinical Neurophysiology Society (ACNS) criteria. ¹⁸F-FDG PET images were blindly assessed by two nuclear medicine specialists for the presence and lobar location of focal hypermetabolism. Structural magnetic resonance imaging (MRI) studies enabled PET co-registration and segmentation. Patients with available MRI scans were compared to external age/sex-matched and in-house validation healthy control datasets. We calculated intra-subject standardized uptake value (SUV) z-scores within the gray matter and then compared this approach to SUV ratio (SUVR) methods (using either the cerebellum or the pons as reference region) using consensus visual assessment as the reference standard. For hypermetabolic volume quantification, we chose the lowest threshold with 100% specificity (z ≥ 3.0) to eliminate false-positive volumes, which yielded 62% sensitivity. Resulting volumes were correlated with lateralized periodic discharge (LPD) main modifiers (frequency, prevalence, evolution, plus-factors).</p><p><strong>Results: </strong>Of 24 adult patients (median age 62 years, 15 female), 17 (71%) had LPDs. Qualitatively, focal hypermetabolism was present in 92% of patients (n = 22), with strong concordance between visual PET findings and EEG lateralization in patients with LPDs. Twenty-three patients underwent MRI and were compared to external age/sex-matched (n = 23) and in-house validation (n = 22) healthy control datasets. Our technique outperformed traditional SUVR methods (AUC = 0.92 vs 0.55-0.64, p < .001) in detecting focal hypermetabolism. In patients with LPDs, hypermetabolic volumes ranged from 0 to 21.4 mL, with substantial volumes (>10 mL) observed across all discharge frequencies.</p><p><strong>Significance: </strong>¹⁸F-FDG-PET revealed focal hypermetabolism in most suspected NCSE cases, including in cases with equivocal EEG patterns. In patients with LPDs, the extent of focal hypermetabolism was highly variable across different frequencies.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in delivery type, breastfeeding initiation, and length of postpartum hospitalization in patients with epilepsy.","authors":"Kelly Rios-Papachristos, Sarah Lindsay, Ya-Huei Li, Stephen Thompson, Anumeha Sheth","doi":"10.1111/epi.18578","DOIUrl":"https://doi.org/10.1111/epi.18578","url":null,"abstract":"<p><strong>Objective: </strong>Patients with epilepsy (PWE) account for .3%-.5% of all births annually. PWE have higher obstetric health care utilization and lower rates of breastfeeding initiation, whereas data on cesarean delivery rates are mixed. The aim of this study was to examine the association of epilepsy with maternal outcomes, including the rate of cesarean delivery, rate of breastfeeding initiation, and length of postpartum hospitalization, in individuals delivering a singleton infant in a multihospital health care system on the East Coast.</p><p><strong>Methods: </strong>We included patients aged 18-45 years who delivered a singleton infant between September 1, 2018 and May 31, 2023. We compared the following among PWE and patients without epilepsy (PWoE): cesarean deliveries, length of postpartum hospitalization, breastfeeding initiation, inductions of labor versus spontaneous labor, unlabored primary cesarean deliveries, preterm deliveries (gestational age < 37 weeks), neonatal disposition, postpartum hemorrhage, placental abruption, and preeclampsia. Antiseizure medications (ASMs) listed at the time of delivery hospitalization were also extracted. A sensitivity analysis of PWE who either used or did not use ASMs at the time of delivery evaluated whether ASM use affected the primary outcomes. Comparable subpopulations identified with propensity score matching (PSM) examined the effect of epilepsy on maternal outcomes. A multivariate logistic regression identified predictors of prolonged postpartum hospitalization.</p><p><strong>Results: </strong>Of 33 764 deliveries, 199 (.59%) were to PWE. PWE had a higher proportion of cesarean delivery (36.1% vs. 28.2%), preterm delivery (15.0% vs. 8.4%), neonates requiring intensive care (9.9% vs. 5.4%), and prolonged postpartum hospitalization (33.3% vs. 22.1%) compared to PWoE (p ≤ .021) after PSM. A total of 54.8% (n = 109) of PWE used ASMs at the time of delivery compared to PWoE (n = 473, 1.4%). Epilepsy was associated with a higher risk of prolonged postpartum hospitalization (odds ratio = 1.8, 95% confidence interval = 1.0-3.1).</p><p><strong>Significance: </strong>PWE had worse maternal outcomes than PWoE, and epilepsy itself was a risk factor for prolonged postpartum hospitalization. ASM use in PWE at the time of delivery was lower than expected.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in epilepsy surgery in Italy before and after the COVID-19 pandemic: A nationwide study.","authors":"Giuseppe Didato, Federico Vigevano, Laura Tassi, Renzo Guerrini, Marco de Curtis, Luca De Palma, Giancarlo Di Gennaro, Lino Nobili, Matteo Martinoni, Stefano Meletti, Domenica Battaglia, Elisabetta Cesaroni, Roberta Vittorini, Laura Grisotto, Giuseppe d'Orsi, Robertino Dilena, Valeria Pingue, Antonio Nardone, Federica Ranzato, Claudio Zucca, Paolo Bonanni, Pietro Mattioli, Gianpiero Tamburrini, Michela Quintiliani, Michele Luzi, Roberto Trignani, Francesca Torta, Giovanni Morana, Matteo Pugnaghi, Anna Elisabetta Vaudano, Francesca Bisulli, Elena Pasini, Alessandro Consales, Giulia Nobile, Vincenzo Esposito, Pier Paolo Quarato, Elena Freri, Carlo Efisio Marras, Flavio Giordano, Veronica Pelliccia, Laura Castana, Nicola Specchio, Umberto Costantino, Mauro Pluderi, Michele Rizzi, Diana Polo, Stefania Zambrano, Alberto Danieli, Flavio Villani, Carmen Barba","doi":"10.1111/epi.18558","DOIUrl":"https://doi.org/10.1111/epi.18558","url":null,"abstract":"<p><strong>Objective: </strong>To study the current practice of epilepsy surgery in Italy and the relative impact of coronavirus disease 2019 (COVID-19) pandemic on it.</p><p><strong>Methods: </strong>We launched a survey through the Italian National Virtual Epilepsy Institute, to identify centers with epilepsy surgery programs and collect data on the current preoperative and surgical practices. We reported changes in surgical volumes and complications and seizure outcomes between 2018 and 2022, that is, before and after the COVID-19 pandemic in Italy.</p><p><strong>Results: </strong>A total of 21 of the 26 surveyed centers (80.7%) responded. Eleven centers (52.4%) reported having an established epilepsy surgery program, with most performing complex procedures, such as multilobar, disconnective, and hemispheric interventions. However, only a few carry out minimally invasive surgeries. Presurgical evaluation protocols vary across centers, but in keeping with international standards. Globally, 618 surgeries were performed in children and 621 in adults (total 1239) between 2018 and 2022. The most frequent type of surgery was unilobar extratemporal lobectomy for children (38.7%, p < 0.0001) and unilobar temporal lobectomy for adults (63.3%, p < 0.0001). Hemispheric surgeries were more frequent in children than in adults (11.5% vs 2.1%, p = 0.001), whereas interventions in unrevealing magnetic resonance (MRI) cases were more frequent in adults than in children (p = 0.030). At the onset of COVID-19outbreak in Italy (March 2020), we observed a significant decrease in the total number of operations compared to 2019, especially for hemispheric interventions (p = 0.027). Surgical volumes resumed in 2021, particularly for temporal lobe epilepsies and in adult cohorts. Surgical complications increased significantly in 2020 (Incidence Rate Ratio [IRR] = 13.13), whereas seizure outcome did not change significantly between 2018 and 2022.</p><p><strong>Significance: </strong>Advanced pre- and postsurgical evaluation protocols are currently implemented across Italy, with a great variability between centers. Starting in 2021, epilepsy surgery volumes have regained their pre-pandemic levels, albeit with a slight loss of complexity, whereas seizure outcome has remained stable.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical stimulation of stem cell-derived human neural networks for evaluating anti-seizure medications.","authors":"Joshua Nicholls, Jinchao Gu, Zhibin Chen, Zikou Liu, Ana Antonic-Baker, Muhammad Shahid Javaid, Eliza Moore, Hailin Zhu, Afaf Altalhi, David K Wright, Huseyin Sumer, Terence J O'Brien, Patrick Kwan, Ben Rollo","doi":"10.1111/epi.18560","DOIUrl":"https://doi.org/10.1111/epi.18560","url":null,"abstract":"<p><strong>Objective: </strong>Current preclinical epilepsy drug screening relies on animal models that poorly reflect human neurophysiology, leading to high failure rates in clinical translation. We aimed to establish a human in vitro model using human-induced pluripotent stem cell (hiPSC)-derived cortical neurons cultured on multielectrode arrays (MEAs), capable of generating precisely controlled after-discharges (ADs) through electrical stimulation. We optimized stimulation parameters to evoke epileptiform-like hypersynchronous events and validated the model using six approved antiseizure medications (ASMs).</p><p><strong>Methods: </strong>hiPSCs were rapidly differentiated into NGN2 cortical neurons and co-cultured with astrocytes on a 12-electrode, 24-well MEA. Network activity was tracked weekly. Upon maturation, biphasic voltage stimuli (400-2000 mV, 10 pulses at 100 Hz, 100 μs phase width) were applied in 100 ms trains to induce ADs. Stimulation intensity was increased until a maximum spike count per burst was reached. The timing of the stimulating inter-burst interval (IBI) was shortened from 10 to 1 s. We tested six ASMs with distinct mechanisms of action for their ability to attenuate induced ADs, as measured by the area under the curve (AUC) of spikes within bursts.</p><p><strong>Results: </strong>A ±1000 mV stimulus was sufficient to evoke robust ADs; higher voltages caused network instability without enhancing response strength. The maximum hypersynchronous bursting rate was observed with 2 s IBIs, whereas attempts to induce more frequent events using 1 s IBIs led to desynchronization and a reduction in burst frequency below baseline. Phenytoin, perampanel, clonazepam, and lamotrigine significantly reduced AUC within 5 min in a concentration-dependent manner. Vigabatrin and levetiracetam required longer pre-incubations: AUC was reduced after 6 h for levetiracetam and at 24 h for vigabatrin.</p><p><strong>Significance: </strong>We present a novel hiPSC-derived, electrically induced in vitro model for screening ASM candidates. This approach captures human-relevant epileptiform dynamics, allows fine control over stimulation parameters, and enables testing of diverse drug mechanisms. Its compatibility with high-throughput platforms makes it a promising tool for ASM discovery and personalized treatment strategies.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone-based interventions for the diagnosis of epileptic seizures: A systematic review and meta-analysis.","authors":"Carlos Alva-Diaz, Wendy Nieto-Gutierrez, Ethel Rodriguez-López, Carlos Quispe-Vicuña, María E Cáceres-Távara, Luz M Moyano, Kevin Pacheco-Barrios, Jorge G Burneo","doi":"10.1111/epi.18483","DOIUrl":"https://doi.org/10.1111/epi.18483","url":null,"abstract":"<p><strong>Objective: </strong>The main objective of this study was to assess the utility of smartphone-based interventions for epilepsy diagnosis.</p><p><strong>Methods: </strong>A systematic review was performed to evaluate the use of smartphone devices to diagnose epileptic seizures compared with encephalogram (EEG), using the MEDLINE, Scopus, Web of Science, and Embase databases. We plotted pooled sensitivity and specificity estimates on forest plots and on receiver operating characteristics curves. We evaluated evidence certainty using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. Also, we constructed a Fagan nomogram to guide clinical decision-making.</p><p><strong>Results: </strong>We identified 10 studies that evaluated different smartphone-based interventions to diagnose epileptic seizures, including a mobile app of a clinical survey, smartphone-based studies assessing EEG recording, heart rate variability recording and classifier, and video of the epileptic seizure using a smartphone. However, we only performed a quantitative analysis for the smartphone videos and Smartphone Brain Scanner-2. We found that smartphone videos had sensitivity of 77% (95% confidence interval [CI] = 60%-88%) and specificity of 91% (95% CI = 88%-93%) to diagnostic epileptic seizure, with an area under the curve of .91. On the other hand, Smartphone Brain Scanner-2 had sensitivity of 44% (95% CI = 34%-55%) and specificity of 94% (95% CI = 89%-96%). The Epilepsy Diagnosis Aid app had good sensitivity of 76% (95% CI = 66%-84%) and specificity 100% (95% CI = .83%-1.00%); in addition, the RRBLE6:9123 device had sensitivity of 86%.</p><p><strong>Significance: </strong>Our systematic review and meta-analysis demonstrate high specificity with the use of smartphone videos compared with studies assessing EEG. Smartphone-based interventions show promise for diagnosing epilepsy; however, further research is needed to assess the utility of other tools like symptom survey apps and heart rate variability recorders.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}