Epilepsia最新文献

{"title":"Long-term outcomes of stereotactic radiofrequency ablation in hypothalamic hamartomas: A single-center experience.","authors":"Peter Christoph Reinacher, Julia Jacobs, Mukesch Johannes Shah, Theo Demerath, Kathrin Wagner, Victoria San Antonio-Arce, Horst Urbach, Volker Arnd Coenen, Andreas Schulze-Bonhage, Kerstin Alexandra Klotz","doi":"10.1111/epi.18660","DOIUrl":"https://doi.org/10.1111/epi.18660","url":null,"abstract":"<p><strong>Objective: </strong>Hypothalamic hamartomas (HHs) lead to refractory epilepsy, and minimally invasive surgical approaches are standard of care for affected patients. Stereotactic radiofrequency thermocoagulation (SRT) is one of the treatment methods recognized to achieve seizure freedom. This study reports surgical outcome from a single center reporting an ablation technique using fewer trajectories than previously reported and assesses the effect of coagulated volume on long-term seizure freedom.</p><p><strong>Methods: </strong>Retrospective analysis was made of all patients who underwent SRT at the University of Freiburg between 2016 and 2024 with a follow-up of ≥12 months. Statistical analysis was made of outcome dependent on type of hamartoma, seizure type, coagulation volume (based on magnetic resonance imaging evaluation), and epilepsy duration.</p><p><strong>Results: </strong>Forty-three patients received SRT; 35 (22 children) had >12 months of follow-up, with a median of 38 months. Nine patients had two SRTs, and two patients had three SRTs. Twelve months after their last SRT, 60% of patients were seizure-free, 88.6% were free of bilateral tonic-clonic seizures, and 77.1% were free of gelastic seizures (last follow-up: 54.3% seizure-free, 88.6% free of bilateral tonic-clonic seizures, 74.3% free of gelastic seizures). There was a significant reduction of antiseizure medication (ASM) postsurgically, with an average number of ASMs of two prior to surgery and one after surgery. After 12 months, 14.3% of patients experienced ongoing but mostly mild surgical complications, with hypothalamic dysfunction being the most common. Coagulation volumes were higher in larger HHs, but no correlation was observed between coagulated volume and seizure freedom or complication rates.</p><p><strong>Significance: </strong>SRT is a minimally invasive method to successfully treat refractory seizures in patients with HH. Disconnection seems to be more important for successful treatment than volume reduction. Even large HHs can be successfully treated with small coagulation volumes.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198779","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":"Anti-γ-aminobutyric acid B receptor autoimmune encephalitis: Clinical presentation and diagnostic insights.","authors":"Naveen K Paramasivan, Jennifer A McCombe, Andrea Stabile, James P Fryer, Abhigyan Datta, Mohamed Rezk, Nihar Upadhyay, Jeffrey W Britton, Eoin P Flanagan, Andrew McKeon, John R Mills, Sean J Pittock, Anastasia Zekeridou, Divyanshu Dubey","doi":"10.1111/epi.18654","DOIUrl":"https://doi.org/10.1111/epi.18654","url":null,"abstract":"<p><strong>Objectives: </strong>γ-Aminobutyric acid B receptor (GABA_BR)-IgG (immunoglobulin G) is an intermediate-risk paraneoplastic autoantibody often associated with seizures. We aimed to assess the clinical and oncological features of GABA_BR-IgG autoimmune encephalitis (AE) and evaluate the performance of antibody testing.</p><p><strong>Methods: </strong>Patients testing positive for GABA_BR-IgG in serum/cerebrospinal fluid (CSF) at Mayo Clinic Neuroimmunology Laboratory were identified. Archived sera were retested by cell-based assay (CBA) at 1:100 and 1:200 dilutions. A live-cell flow cytometry-based assay (LCFBA) was developed and validated using archived sera and CSF. True positivity included patients with classic presentations of GABA_BR-IgG AE or oncological explanations for antibody presence.</p><p><strong>Results: </strong>Eighty-six patients (median age 63 years; 43 female) presented with classic presentations of GABA_BR-IgG AE: encephalopathy with prominent seizures (n = 55), status epilepticus (n = 23), and rapidly progressive dementia (n = 8). In addition, 44 patients (33%) had a false-positive result for GABA_BR-IgG characterized by non-specific symptoms/alternate diagnoses. Malignancy was identified in 78% of true-positive patients, predominantly small cell lung carcinoma (SCLC). Testing serum at 1:100 dilution on CBA and using tissue immunofluorescence assay (IFA) in serum and CSF improved the identification of true-positive patients (p < 0.001). CBA at 1:100 dilution performed better than conventional CBA (at 1:10 dilution, p < 0.001) and tissue IFA (p = 0.031). An in-house LCFBA showed 100% sensitivity and specificity in CSF, performing similarly to conventional CBA (p = 0.125) in CSF, but better than tissue IFA (p = 0.031). Furthermore, serum LCFBA performed better than conventional CBA (p = 0.022) and tissue IFA (p = 0.006). LCFBA had the highest diagnostic accuracy and was closely followed by CBA at 1:100 dilution.</p><p><strong>Significance: </strong>GABA_BR-IgG AE often presents as encephalopathy with seizures or status epilepticus in the context of an underlying SCLC. Multimodal evaluation using tissue IFA and fixed CBA at higher dilutions improves detection of true cases. LCFBA performs very well as a diagnostic test with very high sensitivity and specificity.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198803","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":"Automated detection of bottom-of-sulcus dysplasia on magnetic resonance imaging-positron emission tomography in patients with drug-resistant focal epilepsy.","authors":"Emma Macdonald-Laurs, Aaron E L Warren, Remika Mito, Sila Genc, Bonnie Alexander, Sarah Barton, Joseph Yuan-Mou Yang, Peter Francis, Heath R Pardoe, Graeme Jackson, A Simon Harvey","doi":"10.1111/epi.18628","DOIUrl":"https://doi.org/10.1111/epi.18628","url":null,"abstract":"<p><strong>Objective: </strong>Bottom-of-sulcus dysplasia (BOSD) is a diagnostically challenging subtype of focal cortical dysplasia, 60% being missed on magnetic resonance imaging (MRI). Automated MRI-based detection methods have been developed for focal cortical dysplasia, but not BOSD specifically, and few methods incorporate fluorodeoxyglucose positron emission tomography (FDG-PET) alongside MRI features. We report the development and performance of an automated BOSD detector using combined MRI + PET.</p><p><strong>Methods: </strong>The training set comprised 54 patients with focal epilepsy and BOSD. The test sets comprised 17 subsequently diagnosed patients with BOSD from the same center, and 12 published patients from a different center. Across training and test sets, 81% of patients had normal initial MRIs and most BOSDs were <1.5 cm³. In the training set, 12 features from T1-MRI, fluid-attenuated inversion recovery-MRI, and FDG-PET were evaluated to determine which features best distinguished dysplastic from normal-appearing cortex. Using the Multi-centre Epilepsy Lesion Detection group's machine-learning detection method with the addition of FDG-PET, neural network classifiers were then trained and tested on MRI + PET, MRI-only, and PET-only features. The proportion of patients whose BOSD was overlapped by the top output cluster, and the top five output clusters, were determined.</p><p><strong>Results: </strong>Cortical and subcortical hypometabolism on FDG-PET was superior in discriminating dysplastic from normal-appearing cortex compared to MRI features. When the BOSD detector was trained on MRI + PET features, 87% BOSDs were overlapped by one of the top five clusters (69% top cluster) in the training set, 94% in the prospective test set (88% top cluster), and 75% in the published test set (58% top cluster). Cluster overlap was generally lower when the detector was trained and tested on PET-only or MRI-only features.</p><p><strong>Significance: </strong>Detection of BOSD is possible using established MRI-based automated detection methods, supplemented with FDG-PET features and trained on a BOSD-specific cohort. In clinically appropriate patients with seemingly negative MRI, the detector could suggest MRI regions to scrutinize for possible BOSD.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198806","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":"Atenolol rescues premature mortality in genetic mouse models of sudden unexpected death in epilepsy.","authors":"Ming S Soh, Amanda Hu, Alibek Kuanyshbek, Erlina S Mohamed Syazwan, Hian M Lee, Chaseley E McKenzie, A Marie Phillips, Lauren E Bleakley, Christopher Semsarian, Ingrid E Scheffer, Samuel F Berkovic, Christopher A Reid","doi":"10.1111/epi.18642","DOIUrl":"https://doi.org/10.1111/epi.18642","url":null,"abstract":"<p><strong>Objective: </strong>Sudden unexpected death in epilepsy (SUDEP) is the leading cause of premature mortality in epilepsy. Genetic studies have identified that loss-of-function (LOF) KCNH2 variants are enriched in SUDEP patients, suggesting that they may act as a risk factor. KCNH2 encodes the K_V11.1 channel, with LOF pathogenic variants a cause of long-QT syndrome (LQTS), increasing the risk of arrhythmia and sudden cardiac death. Here, we engineered preclinical rodent models that combine epilepsy-causing pathogenic variants with heterozygous Kcnh2 knockout mice to explore the impact of reduced K_V11.1 channel function on mortality.</p><p><strong>Methods: </strong>Both the Gabrg2^R43Q/+ and Hcn1^M294L/+ genetic mouse models of monogenic epilepsy were crossed with Kcnh2^+/- mice. All genotypes were video-recorded post-weaning and time to death was measured. Additional mice underwent surgery to enable simultaneous electrocorticography and electrocardiography recordings. Atenolol was delivered in drinking water to a subset of mice.</p><p><strong>Results: </strong>Both single mutant Gabrg2^R43Q/+ and Hcn1^M294L/+ mice displayed spontaneous seizures recapitulating the human phenotypes. Single mutant Kcnh2^+/- mice exhibited an LQTS phenotype. Double mutant mice (Gabrg2^R43Q/+/Kcnh2^+/- and Hcn1^M294L/+/Kcnh2^+/-) had both seizure and prolonged QT interval phenotypes that were similar to their respective single mutant mice. Survival analysis revealed that Gabrg2^R43Q/+/Kcnh2^+/- and Hcn1^M294L/+/Kcnh2^+/- mice experienced a disproportionately higher rate of seizure-related death when compared to wild-type and their respective single mutant littermates. Oral administration of the cardiac-selective β-blocker atenolol significantly improved survival in Gabrg2^R43Q/+/Kcnh2^+/-, Hcn1^M294L/+, and Hcn1^M294L/+/Kcnh2^+/- mice. Atenolol attenuated the sympathetic cardiac response to non-terminal seizures.</p><p><strong>Significance: </strong>The data support the premise that LOF KCNH2 variants can contribute to SUDEP risk in a subset of epilepsy patients. Our findings also highlight the potential use of β-blockers as a prevention strategy in SUDEP.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130424","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 epileptic heart: Let's not forget to look at the atria!","authors":"Guilherme L Fialho, Ramsés Miotto, Katia Lin","doi":"10.1111/epi.18650","DOIUrl":"https://doi.org/10.1111/epi.18650","url":null,"abstract":"","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124536","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":"Beyond the spike: Functional (dissociative) seizures as a key to holistic attitudes in seizure disorders.","authors":"Mahinda Yogarajah, Barbara Dworetzky, Josemir W Sander, Angel Aledo-Serrano","doi":"10.1111/epi.18651","DOIUrl":"https://doi.org/10.1111/epi.18651","url":null,"abstract":"<p><p>Epileptologists can improve outcomes through follow-up and coordination of care for patients with functional seizures. Epileptic and functional seizures share some mechanistic overlap involving interoceptive, emotional, and stress dysregulation, and disorders of agency and perception. Similar psychiatric and neurological comorbidities occur at comparable rates in both functional and epileptic seizure populations. A holistic, biopsychosocial approach benefits all seizure patients and reflects modern models of epilepsy care.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124488","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":"Availability and affordability of cannabinoids for epilepsy treatment across different geographic settings-A survey from the ILAE Plant-Based Therapy Task Force.","authors":"Kollencheri Puthenveettil Vinayan, Ali Akbar Asadi-Pooya, Aruna Setumadhava Jyotsna, Nithya N Kumar, Siegward-M Elsas, Cecilie Johannessen Landmark, Motlalepula Matsabisa, Boulenouar Mesraoua, Finbar O'Callaghan, Elizabeth Thiele, Chunbo Zhang, Kate Riney","doi":"10.1111/epi.18622","DOIUrl":"https://doi.org/10.1111/epi.18622","url":null,"abstract":"","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124493","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 – September 2025 Announcements","authors":"","doi":"10.1111/epi.18634","DOIUrl":"10.1111/epi.18634","url":null,"abstract":"&lt;p&gt;\u0000 Neuroimaging in Epilepsy\u0000 &lt;/p&gt;&lt;p&gt;25–26 September 2025&lt;/p&gt;&lt;p&gt;Cairo, Egypt&lt;/p&gt;&lt;p&gt;\u0000 Genetic Basis of Developmental and Epileptic Encephalopathies Workshop for the Eastern Mediterranean Epilepsy Health Care Providers\u0000 &lt;/p&gt;&lt;p&gt;1–2 October 2025&lt;/p&gt;&lt;p&gt;Sfax, Tunisia&lt;/p&gt;&lt;p&gt;\u0000 Visiting Teacher Program – Tunisia\u0000 &lt;/p&gt;&lt;p&gt;6–8 November 2025&lt;/p&gt;&lt;p&gt;Sfax, Tunisia&lt;/p&gt;&lt;p&gt;\u0000 Visiting Teacher Program\u0000 &lt;/p&gt;&lt;p&gt;13–15 November 2025&lt;/p&gt;&lt;p&gt;Rabat, Morocco&lt;/p&gt;&lt;p&gt;\u0000 Epilepsy in the Elderly: At the Crossroads of Brain Aging, Neurodegeneration, and Functional Networks\u0000 &lt;/p&gt;&lt;p&gt;21–22 November 2025&lt;/p&gt;&lt;p&gt;Marrakech, Morocco&lt;/p&gt;&lt;p&gt;\u0000 15th ILAE School on Pre-Surgical Evaluation for Epilepsy and Epilepsy Surgery\u0000 &lt;/p&gt;&lt;p&gt;19–23 January 2026&lt;/p&gt;&lt;p&gt;Brno, Czech Republic&lt;/p&gt;&lt;p&gt;\u0000 19th Latin American Summer School on Epilepsy\u0000 &lt;/p&gt;&lt;p&gt;23–28 February 2026&lt;/p&gt;&lt;p&gt;Guadalajara, Mexico&lt;/p&gt;&lt;p&gt;\u0000 8th ILAE School on EEG in the First Year of Life\u0000 &lt;/p&gt;&lt;p&gt;30 March–2 April 2026&lt;/p&gt;&lt;p&gt;Cambridge, UK&lt;/p&gt;&lt;p&gt;\u0000 5th International Summer School of Neuropsychology\u0000 &lt;/p&gt;&lt;p&gt;19–24 April 2026&lt;/p&gt;&lt;p&gt;Picardy, France&lt;/p&gt;&lt;p&gt;\u0000 XIV Congreso Latinoamericano de Epilepsia\u0000 &lt;/p&gt;&lt;p&gt;16–18 May 2026&lt;/p&gt;&lt;p&gt;Lima, Peru&lt;/p&gt;&lt;p&gt;\u0000 1° Curso Latinoamericano de EEG Pediátrico\u0000 &lt;/p&gt;&lt;p&gt;6–9 August 2026&lt;/p&gt;&lt;p&gt;TBC&lt;/p&gt;&lt;p&gt;\u0000 16th European Epilepsy Congress\u0000 &lt;/p&gt;&lt;p&gt;5–9 September 2026&lt;/p&gt;&lt;p&gt;Athens, Greece&lt;/p&gt;&lt;p&gt;\u0000 16th Asian &amp; Oceanian Epilepsy Congress\u0000 &lt;/p&gt;&lt;p&gt;19–22 November 2026&lt;/p&gt;&lt;p&gt;Kuala Lumpur, Malaysia&lt;/p&gt;&lt;p&gt;\u0000 37th International Epilepsy Congress\u0000 &lt;/p&gt;&lt;p&gt;28 August–1 September 2027&lt;/p&gt;&lt;p&gt;Amsterdam, Netherlands&lt;/p&gt;&lt;p&gt;\u0000 Diagnostic differentiel des epilepsies de l'enfant\u0000 &lt;/p&gt;&lt;p&gt;9 September 2025&lt;/p&gt;&lt;p&gt;\u0000 VNS and Epilepsy\u0000 &lt;/p&gt;&lt;p&gt;11 September 2025&lt;/p&gt;&lt;p&gt;\u0000 How to interpret genetic data: Germline and somatic mutations of GATOR1 genes and focal epilepsy\u0000 &lt;/p&gt;&lt;p&gt;25 September 2025&lt;/p&gt;&lt;p&gt;\u0000 EEG in Absence Epilepsy\u0000 &lt;/p&gt;&lt;p&gt;26 September 2025&lt;/p&gt;&lt;p&gt;\u0000 Rassmusen Encephalitis: A Case Series on Epilepsia Partialis Continua in a LMIC\u0000 &lt;/p&gt;&lt;p&gt;7 October 2025&lt;/p&gt;&lt;p&gt;\u0000 How to manage ketogenic diet therapies for refractory status epilepticus\u0000 &lt;/p&gt;&lt;p&gt;16 October 2025&lt;/p&gt;&lt;p&gt;\u0000 How to use AI in clinical EEG interpretation\u0000 &lt;/p&gt;&lt;p&gt;23 October 2025&lt;/p&gt;&lt;p&gt;\u0000 ILAE e-Forum: The role of digital technologies in the management of epilepsy\u0000 &lt;/p&gt;&lt;p&gt;4 November 2025&lt;/p&gt;&lt;p&gt;\u0000 How to interpret genetic data in SCN1A-related disorders\u0000 &lt;/p&gt;&lt;p&gt;27 November 2025&lt;/p&gt;&lt;p&gt;\u0000 ILAE e-Forum: EEG: When, why and how?\u0000 &lt;/p&gt;&lt;p&gt;12 December 2025&lt;/p&gt;&lt;p&gt;\u0000 5th International Congress ","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":"66 9","pages":"3581-3583"},"PeriodicalIF":6.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/epi.18634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129137","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":"Artificial intelligence-driven closed-loop devices in sudden unexpected death in epilepsy prediction and prevention: Insights from persons with epilepsy and caregivers.","authors":"João Ferreira, Miguel França, Mariana Cardoso Regalo, Mariana Rei, Ricardo Peixoto, José Ángel Aibar, Torie Robinson, Ricardo Matias, Fabrice Duprat, Massimo Mantegazza, Onur Parlak, Philippe Ryvlin, Sándor Beniczky, Lígia Lopes, Emilio Perucca, João Claro, Carlos Conde","doi":"10.1111/epi.18647","DOIUrl":"https://doi.org/10.1111/epi.18647","url":null,"abstract":"<p><strong>Objective: </strong>The absence of strategies for predicting and preventing sudden unexpected death in epilepsy (SUDEP) is intertwined with the lack of studies measuring users' attitudes toward potential innovative interventions. The NEUROSENSE Project (http://www.neurosense-project.eu) aims to evaluate novel SUDEP-predictive neuroendocrine biomarkers in interstitial fluid. The ultimate aim is to develop an artificial intelligence-driven closed loop device (AI-CLD) prototype that can recognize life-threatening seizures and prevent SUDEP through automatic intervention. The current study introduces the potential use of AI-CLDs in SUDEP prediction and prevention, while assessing person with epilepsy (PWE) and caregiver (CG) attitudes toward AI-CLD adoption and implementation.</p><p><strong>Methods: </strong>A qualitative study was conducted through three focus groups involving PWEs and CGs. Participants were recruited through the NEUROSENSE Patient Advisory Board, with discussions facilitated through a semistructured interview guide. The study followed grounded theory and qualitative content analysis methods. Data were collected between October 2024 and February 2025, with all sessions transcribed and analyzed.</p><p><strong>Results: </strong>Three main areas emerged from the analysis: expectations of AI-CLDs for SUDEP prediction and prevention, decision-making processes involving AI use in health care, and barriers and facilitators to AI-CLD adoption. PWEs and CGs generally expressed positive attitudes toward AI-CLDs, supporting automatic data sharing with health care providers and real-time alerts. However, concerns about AI accuracy, overreliance on automation, and the need for control over interventions were raised. Both groups preferred wearable devices over implanted solutions, emphasizing comfort and discretion as critical factors for adoption.</p><p><strong>Significance: </strong>This study highlights the potential of AI-CLDs in improving the prediction and prevention of SUDEP, showing promise for enhancing patient safety through real-time monitoring and interventions. The findings underscore the importance of user-centered design in device development, emphasizing comfort, control over interventions, and integration into daily life. This research provides insights useful for future development aiming to improve PWE and CG confidence in using AI technologies for epilepsy care and risk management.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124508","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":"Targeting interictal low-entropy zones during epilepsy surgery predicts successful outcomes in pediatric drug-resistant epilepsy.","authors":"Navaneethakrishna Makaram, Matthew Pesce, Melissa Tsuboyama, Jeffrey Bolton, Joseph Harmon, Christos Papadelis, Scellig Stone, Phillip Pearl, Alexander Rotenberg, Ellen P Grant, Eleonora Tamilia","doi":"10.1111/epi.18636","DOIUrl":"10.1111/epi.18636","url":null,"abstract":"<p><strong>Objective: </strong>Approximately 40% of children undergoing epilepsy surgery have postoperative seizures, underscoring the need for enhanced estimators of the epileptogenic zone (EZ). We hypothesize that visually imperceptible low-entropy activity in the interictal periods, even in the absence of conventional spikes, is a robust signature of the EZ. To test this, we mapped interictal \"low-entropy zones\" using intracranial electroencephalography (iEEG) in children with drug-resistant epilepsy (DRE) and assessed their value for postsurgical outcome prediction when targeted during surgery, along with their stability over prolonged periods.</p><p><strong>Methods: </strong>We analyzed iEEG data of 75 DRE children, including brief (5 min) data from patients with known Engel outcome (N = 59; used for outcome prediction) plus prolonged data from a separate recent cohort (N = 16; used for stability assessment). We estimated each contact's entropy across various frequencies (delta to fast-ripple), pinpointed low-entropy zones, and assessed whether their removal predicts outcome (3-fold cross-validation). In addition, the predictive value of entropy during non-epileptiform (spike-free) epochs was also assessed. Furthermore, established interictal estimators (spikes-on-ripple, fast ripples) were tested for outcome prediction. Using the prolonged dataset, we tested whether entropy distribution over brief epochs was similar to prolonged (3 h) data.</p><p><strong>Results: </strong>High overlap between low-entropy zones and resection correlated with low Engel class (p < 0.0001, R = -0.54, N = 59), also during non-epileptiform epochs (R = -0.52). Low-entropy-zone removal predicted outcomes with F1 score of 87% (p < 0.0001, N = 51; Engel I vs III-IV) outperforming spikes-on-ripple (F1 score = 82%, p = 0.002) or fast ripples (F1 score = 80%, p = 0.01). Low-entropy zones retained high predictive value when non-epileptiform epochs were used (F1 score = 89%, N = 44). Entropy distribution over brief epochs was strongly correlated with prolonged data (R > 0.8, p < 0.0001), and its relationship with seizure-onset zone did not differ (brief vs prolonged data: p > 0.6).</p><p><strong>Significance: </strong>Surgically targeting low-entropy zones accurately predicts the postoperative seizure outcomes of children with DRE. Mapping low-entropy activity using brief iEEG segments shows consistency with using prolonged data and could enhance surgical planning in pediatric DRE.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091353","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}