Epilepsia最新文献

{"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}

{"title":"Epilepsia – July 2025 announcements","authors":"","doi":"10.1111/epi.18530","DOIUrl":"https://doi.org/10.1111/epi.18530","url":null,"abstract":"&lt;p&gt;\u0000 \u0000 &lt;b&gt;15th ILAE School for Neuropathology and Neuroimaging in Epilepsy&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;31 July–3 August 2025&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Campinas, São Paulo, Brazil&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;XVIII Workshop on Neurobiology of Epilepsy (WONOEP 2025)&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;25–29 August 2025&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Portugal&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;36th International Epilepsy Congress&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;30 August–3 September 2025&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Lisbon, Portugal&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;Neuroimaging in Epilepsy&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;25–26 September 2025&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Cairo, Egypt&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;Genetic Basis of Developmental and Epileptic Encephalopathies Workshop for the Eastern Mediterranean Epilepsy Health Care Providers&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;1–2 October 2025&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Sfax, Tunisia&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;Visiting Teacher Program&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;23–25 October 2025&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Rabat, Morocco&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;Visiting Teacher Program – Tunisia&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;6–8 November 2025&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Sfax, Tunisia&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;Epilepsy in the Elderly: At the Crossroads of Brain Aging, Neurodegeneration, and Functional Networks&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;21–22 November 2025&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Marrakech, Morocco&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;15th ILAE School on Pre-Surgical Evaluation for Epilepsy and Epilepsy Surgery&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;19–23 January 2026&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Brno, Czech Republic&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;5th International Summer School of Neuropsychology&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;19–24 April 2026&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Picardy, France&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;16th European Epilepsy Congress&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;5–9 September 2026&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Athens, Greece&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;Classification of Epilepsy&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;1 July 2025&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;How to address regulatory rules about new orphan drugs/pharmaceutical product&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;10 July 2025&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;AOEC Webinar Series: ASEPA Didactic Lectures: Part 1&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;3 July 2025&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;AOEC Webinar Series: ASEPA Didactic Lectures: Part 2&lt;/b&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;10 July 2025&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;b&gt;How to address regulatory rules about new orphan drugs/pharmaceutical product&lt;/b&gt;\u0000 ","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":"66 7","pages":"2602-2604"},"PeriodicalIF":6.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/epi.18530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiseizure medication reduction in long-term video-electroencephalographic monitoring for presurgical evaluation: A multicenter safety and efficacy analysis.","authors":"Renate van Griethuysen, Charlotte J J van Asch, Willem M Otte, Herm Lamberink, Josemir W Sander, Mireille D Bourez-Swart, Lotte de Jong, Albert J Colon, Kees P J Braun","doi":"10.1111/epi.18572","DOIUrl":"https://doi.org/10.1111/epi.18572","url":null,"abstract":"<p><strong>Objective: </strong>In people with refractory focal epilepsy, long-term video-electroencephalographic monitoring (LT-VEEG) is a valuable tool for surgical evaluation. Antiseizure medication (ASM) is often tapered during LT-VEEG. ASM reduction may increase the risk of complications such as status epilepticus, and efficacy has not been established. We characterized contributing factors to successful and safe LT-VEEG within a large multicenter dataset.</p><p><strong>Methods: </strong>Adults and children were included from eight tertiary epilepsy centers in Europe for whom LT-VEEG was part of the preoperative assessment for epilepsy surgery from May 2017 until January 2022. We collected demographics, baseline seizure frequency, ASM use and reductions or complete discontinuation, outcome (successful LT-VEEG), and complications during ASM withdrawal/LT-VEEG. We performed multivariate regression analysis to determine factors contributing to risks of complications and successful LT-VEEG.</p><p><strong>Results: </strong>We included 843 people. LT-VEEG was successful in 70%. ASM was tapered in 756 persons (90%). Five hundred forty-four persons started reduction of ASM before LT-VEEG, of whom 72% reduced it at home. Baseline seizure frequency had a strong influence on ASM withdrawal policy. In people with a lower baseline seizure frequency, ASM was more likely to be tapered, and the reduction was more often initiated before the start of the LT-VEEG. The extent of ASM dose reduction was identified as a critical factor contributing to a successful LT-VEEG. ASM reduction increased the chance of complications; 10% had a complication compared to 1% without reduction. Starting ASM reduction before LT-VEEG did not increase the risk of complications.</p><p><strong>Significance: </strong>ASM reduction contributes to a successful LT-VEEG in people with a lower baseline seizure frequency and is relatively safe, taking specific factors into account. The risk of adverse events is higher when ASM is reduced, regardless of timing or setting (outpatient vs. in-hospital).</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":"144706771","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":"Long-term survival after adult epilepsy surgery: Mortality and predictors in a large cohort.","authors":"Giorgio Fiore, Jane de Tisi, Aidan O'Keeffe, Anna Miserocchi, Andrew W McEvoy, Josemir W Sander, John S Duncan","doi":"10.1111/epi.18564","DOIUrl":"https://doi.org/10.1111/epi.18564","url":null,"abstract":"<p><strong>Objective: </strong>Long-term survival data in adults undergoing surgery for drug-resistant focal epilepsy remain limited. We examined mortality patterns and predictors in a large cohort followed for over 30 years.</p><p><strong>Methods: </strong>Adults who underwent epilepsy surgery (1990-2022) were analyzed. Prospectively collected clinical, surgical, and outcome data were included. We estimated the cumulative incidence of mortality and standardized mortality ratios (SMRs) for the cohort. Predictors of epilepsy-related and non-epilepsy-related deaths were identified using Fine-Gray and cause-specific hazard models.</p><p><strong>Results: </strong>A total of 1062 individuals contributed 14 279 person-years of follow-up (median, 13 years). The overall mortality rate was 6.16 per 1000 person-years, with 2.52 per 1000 person-years due to epilepsy-related deaths, including 0.84 per 1000 person-years from sudden unexpected death in epilepsy (SUDEP). Epilepsy-related deaths were more frequent within the first 15 years post-surgery (p = 0.006). The overall SMR was 1.12 (95% confidence interval [CI]: 0.90-1.38), and 0.65 (95% CI: 0.46-0.89) among individuals followed for more than 15 years. Independent predictors of epilepsy-related mortality were older age at surgery, cortical malformations, and poor post-operative seizure control (International League Against Epilepsy [ILAE] outcome class ≥4). Non-epilepsy-related mortality was driven primarily by older age at surgery.</p><p><strong>Significance: </strong>Epilepsy surgery is associated with reduced premature mortality and increasingly normalized long-term survival. Age at surgery, post-operative seizure control, and pathological findings are key determinants of survival, highlighting opportunities to improve surgical outcomes further.</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":"144706772","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":"Resection of the temporal piriform cortex in mesial temporal lobe epilepsy: Association with seizure freedom in a retrospective cohort study.","authors":"Shan Wang, Chenmin He, Xiao Chen, Hongyi Ye, Lingli Hu, Yuyu Yang, Sha Xu, Cong Chen, Yao Ding, Hongjie Jiang, Zhe Zheng, Meiping Ding, Junming Zhu, Shuang Wang","doi":"10.1111/epi.18573","DOIUrl":"https://doi.org/10.1111/epi.18573","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the association between temporal piriform cortex (tPC) resection and long-term postoperative outcomes in temporal lobe epilepsy (TLE).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients with TLE undergoing surgery between 2012 and 2022, with a minimum follow-up of 2 years. The extent of resection, including the tPC, hippocampal head/body, and amygdala, was assessed using magnetic resonance imaging scans. These measurements, along with demographic data and other presurgical evaluations, were analyzed for their associations with Engel class postoperative outcomes and antiseizure medications (ASMs) withdrawal across different TLE subtypes.</p><p><strong>Results: </strong>Among 216 included patients, 158 had mesial TLE (MTLE). At the final follow-up, 131 MTLE and 35 neocortical TLE (NTLE) patients were seizure-free. Multivariable logistic regression revealed that unresected tPC significantly predicted seizure recurrence (p < .001, odds ratio [OR] = 4.415, 95% confidence interval [CI] = 2.032-9.594), along with older age at surgery (p = .018, OR = 1.034, 95% CI = 1.006-1.063) and nonspecific pathology (p = .017, OR = 3.899, 95% CI = 1.278-11.894). In NTLE, tPC resection did not significantly affect outcomes. However, in MTLE, unresected tPC was strongly associated with poorer seizure outcomes at both 2-year (p = .012, OR = 3.362, 95% CI = 1.311-8.621) and 5-year (p = .014, OR = 5.750, 95% CI = 1.423-23.242) follow-ups. Among seizure-free MTLE patients, those with tPC resection had higher rates of ASMs reduction and withdrawal after 5 years (p < .05). In hippocampal sclerosis (HS) patients, unresected tPC correlated with seizure recurrence (p < .05), whereas no such association was observed in non-HS cases.</p><p><strong>Significance: </strong>Our findings suggest that tPC involvement in the epileptogenic zone varies by TLE subtype, with tPC resection strongly linked to favorable outcomes in MTLE, particularly in HS patients. These results reinforce the understanding of the hippocampus-amygdala-piriform complex as crucial to the epileptogenic zone in MTLE.</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":"144706773","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":"The transcriptomic signature of DEPDC5 KO induced mTOR hyperactivation in human neurons and its response to rapamycin treatment.","authors":"Mattson S O Jones, Silvia Lindlar, Johannes Ludwig, Regina Waltes, Afsheen Kumar, Sophie V Brauchitsch, Andrea Rossi, Evelyn Ullrich, Stefan Momma, Christine M Freitag, Jasmin K Hefendehl, Karl Martin Klein, Felix Rosenow, Denise Haslinger, Andreas G Chiocchetti","doi":"10.1111/epi.18549","DOIUrl":"https://doi.org/10.1111/epi.18549","url":null,"abstract":"<p><strong>Objective: </strong>Mutations of the DEP Domain Containing 5 gene (DEPDC5), a mechanistic Target of Rapamycin (mTOR) inhibitor involved in amino acid sensing, are associated with neurological diseases such as epilepsy and/or autism spectrum disorder (ASD). Loss of DEPDC5 impacts early neuronal development via mTOR hyperactivity. Although, in the mTOR-hyperactivity-associated syndrome tuberous sclerosis, mTOR inhibitors have proven to be beneficial in treating epilepsy, ASD-associated symptoms are ameliorated only partially. Similarly, the mTOR inhibitor rapamycin (RAPA) only partially rescues phenotypes induced by loss of DEPDC5 in animal models, suggesting some pathological mechanisms independent of mTOR.</p><p><strong>Methods: </strong>We dissected these mechanisms by identifying the DEPDC5-associated gene networks and how they are targeted by RAPA in an isogenic primary human neural progenitor (phNPC) DEPDC5 knock-out cell model.</p><p><strong>Results: </strong>We confirm that loss of DEPDC5 leads to hyperactivation of mTOR, paralleled by altered expression of mTOR-associated genes. These effects were partially (up to 33% of genes) attenuated by RAPA treatment applying a clinically comparable concentration. We did not observe an association of the differentially expressed genes with ASD or epilepsy risk genes in general. However, we identified a significant association with gene networks known to be differentially regulated in cortex samples of individuals with ASD, which were still significantly deregulated after RAPA treatment. Furthermore, genes not rescued in differentiated neurons were specifically associated with synaptic pruning and early cortical development. The observed increase in neuronal markers was confirmed morphologically. RAPA treatment recovered the increased differentiation but not the morphological changes.</p><p><strong>Significance: </strong>These new insights on the human gene network of DEPDC5 show evidence for pathological mechanisms that are not attenuated by the currently administered RAPA concentrations or that are independent of mTOR. These mechanisms should be considered as potential targets for future therapies.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697851","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":"Left atrial remodeling in epilepsy: A comparative echocardiographic study of left atrial emptying fraction and left atrial volumetric index in patients with epilepsy.","authors":"Selcen Duran, Yalcin Boduroglu","doi":"10.1111/epi.18577","DOIUrl":"https://doi.org/10.1111/epi.18577","url":null,"abstract":"<p><strong>Objective: </strong>Patients with epilepsy (PWE) are at increased risk for cardiac abnormalities, including arrhythmias, structural changes, and sudden unexpected death in epilepsy (SUDEP). Although previous studies have examined ventricular dysfunction, left atrial (LA) structural and mechanical changes remain underexplored. This study aimed to evaluate LA remodeling in PWE using echocardiographic markers-LA volume index (LAVI), LA emptying fraction (LAEF), and E/e' ratio-as well as to examine their associations with SUDEP-7 scores.</p><p><strong>Methods: </strong>This prospective, cross-sectional study included 58 PWE and 49 healthy controls. Participants underwent transthoracic echocardiography at least 24 h after a seizure. LAEF and LAVI were calculated using the biplane area-length method. PWE were further stratified into two groups: medically controlled epilepsy (MCE) and drug-resistant epilepsy (DRE). The risk of SUDEP was assessed using the SUDEP-7 inventory.</p><p><strong>Results: </strong>PWE exhibited significantly higher maximum LAVI (p = .047), lower total LAEF (p = .001), and reduced LA active emptying fraction (p = .001), alongside increased LA passive emptying fraction (p = .028) when compared to the control group. However, no significant differences were noted in the E/e' ratio. Furthermore, maximum LAVI demonstrated a positive correlation with SUDEP-7 scores (r = .265, p = .044). Patients with DRE exhibited significantly higher SUDEP-7 scores and longer disease duration in comparison to MCE.</p><p><strong>Significance: </strong>This study reveals that reduced LAEF and elevated LAVI may serve as early, underrecognized markers of LA remodeling in chronic epilepsy-changes that are not captured by conventional diastolic indices such as the E/e' ratio. Given their strong association with SUDEP-7 scores, LAEF and LAVI show promise as novel echocardiographic biomarkers for identifying individuals at high risk for cardiovascular events and SUDEP.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689646","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":"The impact of revised definitions on the epidemiology of status epilepticus: A population-based study.","authors":"Meike Menche, Clara Jünemann, Jens-Peter Reese, Martin Jünemann, Michael Teepker, Christoph Best, Christian Roth, Ingrid Sünkeler, Elisabeth Pryss, Felix Rosenow, Adam Strzelczyk, Leona Möller, Lena Habermehl, Panagiota-Eleni Tsalouchidou, Ole Simon, Andre Kemmling, Christopher Nimsky, Lars Timmermann, Katja Menzler, Susanne Knake","doi":"10.1111/epi.18535","DOIUrl":"https://doi.org/10.1111/epi.18535","url":null,"abstract":"<p><strong>Objective: </strong>Status epilepticus (SE) represents one of the most common neurological emergencies. The International League Against Epilepsy (ILAE) redefined SE duration thresholds from 30 to 5 min for convulsive SE in 2015. We conducted a prospective population-based study to determine SE incidence and outcomes under the revised criteria and compared findings with historical data using the 30-min definition.</p><p><strong>Methods: </strong>A prospective, population-based cohort study was conducted over a period of 18 months to determine the incidence of SE in Germany, replicating the methodology of a first study conducted in this region in 1999. The study included all adults residing within the 35-postcode area, with participation from all regional hospitals and emergency departments. SE cases were prospectively identified and reported. To ensure comparability with the historical data, the analysis focused on the Primary Service Area (PS-Area)-the direct catchment region of the University Hospital Marburg.</p><p><strong>Results: </strong>A total of 180 adults with SE (96 men, mean age 66.47 years, SD ± 18.5 years, range: 20-94 years). The crude annual incidence in the PS-Area increased from 15.8/100 000 (95% confidence interval [CI] 11.2-21.6) in 1999 to 29.4/100 000 adults (95% CI 20.5-40.0). It was higher in men than in women (30.9 vs 28.1/100 000, p = .11) and in patients ≥60 years (68.5 vs 13.5/100 000; p < .0001). The calculated age- and gender-adjusted incidence was 32.5/100 000 in the PS-Area. The case-fatality rate was 5.77% (95% CI 1.2%-12.7%) and the crude annual cause-specific mortality rate per 100 000 is 1.70 (95% CI 0.21-4.73). In 53% SE was the first seizure episode; only 47% had a history of epilepsy. When extrapolating these findings to the entire German population, there were at least 20 000 cases of SE with 1000 associated deaths annually.</p><p><strong>Significance: </strong>These findings provide new epidemiologic evidence that the incidence of SE has increased by ~12% with the adoption of the ILAE 2015 definition, underscoring the impact of updated diagnostic criteria on epidemiological estimates.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674197","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":"Phase 1 study of ABI-009 (nab-rapamycin) for surgically refractory epilepsy (RaSuRE).","authors":"Koko Hall, Russell Saneto, Stephanie Randle, Mark S Wainwright, Patricia Berry, Sarah Leary, Ghayda Mirzaa, Jason Lockrow, Hannah Goldstein, Jeffrey Ojemann, Rosita Thiessen, Hope Willis, Erin Sullivan, Renee Rivers, Jani Klein, Jason Hauptman","doi":"10.1111/epi.18555","DOIUrl":"https://doi.org/10.1111/epi.18555","url":null,"abstract":"<p><strong>Objective: </strong>Seizures that are refractory to medical and surgical therapy increase the risk of morbidity and mortality in children with epilepsy. Novel therapeutic trials for this population remain sparse and suboptimal. This Phase 1 study evaluates the (1) safety, tolerability, and (2) preliminary efficacy of ABI-009 (nab-rapamycin) in children with medically and surgically refractory epilepsy.</p><p><strong>Methods: </strong>Children with medically intractable epilepsy and a history of resective surgery who experienced >8 seizures during the 30-day baseline were included. Participants maintained their existing antiseizure medication regimens throughout the study. ABI-009 was administered over 3 weeks using a 3 + 3 dose-escalation design, with dosing cohorts of 5, 10, and 20 mg/m². Treatment was then discontinued, and participants were observed for a 90-day follow-up period. Data were collected on seizure frequency, seizure type, adverse events, medical and laboratory assessments, the Quality of Life in Childhood Epilepsy (QOLCE), and the Nisonger Child Behavior Rating Form (NCBRF).</p><p><strong>Results: </strong>Twelve participants received ABI-009 and completed all study visits. Seizure etiologies included tuberous sclerosis complex, focal cortical dysplasia, and hemimegalencephaly, although Mammalian target of rapamycin involvement was not required for inclusion. No doses were missed, and dose escalation progressed through all levels. The maximum tolerated dose was 20 mg/m². All 12 participants experienced at least one treatment-emergent adverse event (TEAE), with the majority being mild (80%). No participants withdrew from the study voluntarily or by necessity secondary to TEAEs, and there were no serious adverse events. The median change in the weekly seizure rate was a 37.6% reduction from baseline to treatment completion. The treatment response rate (≥25% seizure reduction) was 66.7%, and two participants achieved seizure freedom by follow-up.</p><p><strong>Significance: </strong>ABI-009 was deemed safe and tolerable in a pediatric cohort with medically and surgically refractory epilepsy, establishing a maximum tolerated dose of 20 mg/m² and showing early signs of efficacy.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667340","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":"Motor-associated thalamic nuclei are reduced in juvenile myoclonic epilepsy.","authors":"Aaron F Struck, Camille Garcia-Ramos, Vivek Prabhakaran, Veena Nair, Anusha Adluru, Santiago Philibert Rosas, Dace Almane, Nagesh Adluru, Jana E Jones, Bruce P Hermann","doi":"10.1111/epi.18571","DOIUrl":"https://doi.org/10.1111/epi.18571","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to determine the thalamic nuclei that are different between juvenile myoclonic epilepsy (JME) and healthy controls from the Juvenile Myoclonic Epilepsy Connectome Project and then to determine their relationship with other subcortical gray matter volumes, disease covariates, and motor performance.</p><p><strong>Methods: </strong>Sixty-two patients with JME and 41 age-matched controls (mean age = 20 years) were examined using T1-weighted images. Thalamic nuclei volumes were compared after normalization to total intracranial volume. The relationship between thalamic nuclei volumes and age, duration of epilepsy, number of antiseizure medications, and age at onset were examined using linear models with relative assessment of regressors. Correlation with other subcortical volumes was undertaken to identify a potential network effect. Nuclei volumes were related to a task of speeded fine-motor dexterity.</p><p><strong>Results: </strong>Ventral motor-associated thalamic nuclei (ventral anterior, ventral lateral anterior, and ventral lateral posterior) as well as one intralaminar nucleus (parafascicular) volumes were reduced in JME. These thalamic nuclei volume reductions were correlated with cerebellar and ventral diencephalon volume reductions. The reduction in thalamic volumes was associated with age (which differed from controls) in only the ventral thalamic nuclei. Duration of epilepsy also had an effect. JME was associated with decreased dominant and nondominant hand speeded dexterity, with greater deficits relative to reduction of thalamic nuclei volume than in controls. The findings suggest a baseline decrease in ventral thalamic volume with an inability to make efficiency gains because of disordered adolescent synaptic pruning.</p><p><strong>Significance: </strong>Motor-related ventral thalamic nuclei appear to be a core factor in JME pathogenesis. These motor-associated nuclei have known connections with premotor cortex, basal ganglion, and cerebellar pathways that are related to motor control. Their dysregulation may account for the myoclonus seen in JME and interictal motor effects. Further longitudinal investigation and comparison with other cohorts are needed. Targeted neuromodulation of JME may be possible.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667339","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}