Epilepsia最新文献

{"title":"Tailoring antiseizure treatment with a wearable device: A proof-of-concept study in absence epilepsy.","authors":"Jaiver Macea, Christos Chatzichristos, Miguel Bhagubai, Maarten De Vos, Wim Van Paesschen","doi":"10.1111/epi.18384","DOIUrl":"https://doi.org/10.1111/epi.18384","url":null,"abstract":"<p><strong>Objective: </strong>Typical absence seizures are underreported. We aimed to improve patient care using a wearable electroencephalograph (wEEG) at home and assess a machine learning (ML) pipeline for absence detection.</p><p><strong>Methods: </strong>Patients with typical absences used a wEEG device 12-24 h 1 week after antiseizure medication (ASM) adjustments. Three-hertz generalized spike-wave discharges (SWDs) ≥ 3 s were used as absence surrogates. After manual inspection, we used the results to guide medical treatment. The outcomes were seizure freedom, number of consecutive measurements without relapse, and side effects. Afterward, we used the ML pipeline on the recordings, and a neurologist reviewed the output. Review time and diagnostic performance were compared with manual inspection.</p><p><strong>Results: </strong>Nineteen patients (12 female, median age = 24 years) were followed for a median of 5 months (range = 1-12). The median recording time for each session was 21.3 h (range = 10-24). Fifteen patients (79%) were seizure-free during the last measurement, including seven of 11 (63%) diagnosed with refractory epilepsy. Ten patients relapsed after a median of 1-2 recordings (range = 1-6) without 3-Hz SWDs. Side effects occurred in 21% of patients. Manual file inspection identified 806 3-Hz SWDs of ≥3 s. The ML pipeline reduced a neurologist's median review time for 24-h wEEG from 27 (range = 10-45) to 4.3 min (range = .1-10), with a sensitivity, precision, F1-score, and false positives per hour of .8, .95, .87, and .007, respectively.</p><p><strong>Significance: </strong>Home-based wEEG allows patient monitoring after ASM adjustments, improving absence seizure management. The ML-based pipeline performed well and was crucial in reducing review time.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673259","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":"Parallel transmit 7T MRI for adult epilepsy pre-surgical evaluation.","authors":"Krzysztof Klodowski, Minghao Zhang, Jian P Jen, Daniel J Scoffings, Robert Morris, Victoria Lupson, Franck Mauconduit, Aurélien Massire, Vincent Gras, Nicolas Boulant, Christopher T Rodgers, Thomas E Cope","doi":"10.1111/epi.18353","DOIUrl":"https://doi.org/10.1111/epi.18353","url":null,"abstract":"<p><strong>Objective: </strong>To implement parallel transmit (pTx) 7T magnetic resonance imaging (MRI) in the pre-surgical evaluation of 3T-negative patients with drug-resistant focal epilepsy, and to compare quality to conventional single transmit (specifically, circularly polarized [CP]) 7T MRI.</p><p><strong>Methods: </strong>We implemented a comparative protocol comprising both pTx and CP 7T MRI in consecutive adult candidates for epilepsy surgery who had negative or equivocal 3T MRI imaging. Here we report the outcomes from the first 31 patients. We acquired pTx and CP T₁, T₂, fluid-attenuated inversion recovery (FLAIR) and edge-enhancing gradient echo (EDGE) images, all in the same three-dimensional (3D) 0.8 mm isotropic space. Two-dimensional (2D) high-resolution T₂ and T₂*-weighted sequences were acquired only in CP mode due to current technological limitations. Two neuroradiologists, a neurologist, and a neurosurgeon made independent, blinded quality and preference ratings of pTx vs CP images. Quantitative methods were used to assess signal dropout.</p><p><strong>Results: </strong>7T revealed previously-unseen structural lesions in nine patients (29%), confirmed 3T-equivocal lesions in four patients (13%), and disproved 3T-equivocal lesions in four patients (13%). Lesions were better visualized on pTx than CP in 57% of cases, and never better visualized on CP. Clinical management was altered by 7T in 18 cases (58%). Nine cases were offered surgical resection and one laser interstitial thermal therapy (LITT). Three cases were removed from the surgical pathway because of bilateral or extensive lesions. Five cases were offered stereo-electroencephalography (sEEG) with better targeting (in three because the 7T lesion was deemed equivocal by the multi-disciplinary team (MDT), and in two because the lesion was extensive). Blinded comparison confirmed significantly better overall quality of pTx FLAIR images (F(2, 184) = 13.7, p = 2.88 × 10^-6), whereas pTx MP2RAGE images were subjectively non-inferior and had improved temporal lobe coverage with quantitatively less signal drop-out.</p><p><strong>Significance: </strong>pTx-7T is implementable in a clinical pathway, changed management in 58% of patients where 3T + FDG-PET had not enabled resection, and is superior to single transmit 7T MRI.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669429","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":"Toward molecular phenotyping of temporal lobe epilepsy by spatial omics.","authors":"Isabeau Vermeulen, Ronny Mohren, Micca Neusinger, Tobias A Dancker, Michiel Vandenbosch, Jan Beckervordersandforth, Benjamin Balluff, Rianna P Van der Hel, Olaf E M G Schijns, Govert Hoogland, Kim Rijkers, Berta Cillero-Pastor","doi":"10.1111/epi.18366","DOIUrl":"https://doi.org/10.1111/epi.18366","url":null,"abstract":"<p><strong>Objective: </strong>In temporal lobe epilepsy (TLE), detection of the epileptogenic zone predicts a good surgical outcome. When submitted to ¹⁸F-fluorodeoxyglucose positron emission tomography (PET), some patients display lateralized, focal hypometabolism in the temporal lobe (PET+), whereas others appear normometabolic (PET-). However, the mechanism behind this metabolic difference remains unclear. This study aimed to identify differential molecular mechanisms in these patient subtypes.</p><p><strong>Methods: </strong>Neocortical and hippocampal biopsies of TLE patients (n = 3 PET+, n = 3 PET-) and nonepileptic postmortem controls (n = 3) were analyzed for lipid distribution using mass spectrometry imaging (MSI). Laser capture microdissection of the neocortical gray matter and hippocampal cornu ammonis and dentate gyrus was guided by MSI-derived lipid profiles and histological annotations. Dissected areas were then subjected to liquid chromatography- tandem mass spectrometry-based label-free quantitative proteomic analysis.</p><p><strong>Results: </strong>MSI showed distinct lipid profiles, namely, phosphatidylserines were more abundant in PET+ samples in both the neocortex and hippocampus. Proteomic analysis showed significant differences between TLE and nonepileptic postmortem controls involving pathways in neuron excitability and neurotransmitter transporters, which were upregulated in TLE. Compared to PET-, all PET+ specimens displayed significantly dysregulated calcium signaling. Additionally, the neocortex of PET+ patients showed a shift from mitochondrial to cytosolic (cytoplasm of the cell) processes, whereas the hippocampus was characterized by a disruption of glycosylation and polyamine metabolism.</p><p><strong>Significance: </strong>The applied spatial omics approach demonstrated localized molecular differences between metabolic subtypes of TLE patients. These findings may further specify these TLE subtypes and provide leads for targeted treatment.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662878","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":"De novo TANC2 variants caused developmental and epileptic encephalopathy and epilepsy.","authors":"Sheng Luo, Wen-Jun Zhang, Mi Jiang, Rong-Na Ren, Lei Liu, Yu-Lan Li, Wen-Hui Liu, Peng-Yu Wang, Yu-Jie Gu, Li-Zhi Chen, Li-Ping Shen, Yang Tian, Xiao-Rong Liu, Yong-Hong Yi, Wei-Ping Liao, Peng Zhou","doi":"10.1111/epi.18358","DOIUrl":"https://doi.org/10.1111/epi.18358","url":null,"abstract":"<p><strong>Objective: </strong>The TANC2 gene encodes a scaffolding synaptic protein with essential roles in synaptic transmission. This study aims to explore the association between TANC2 and epilepsy and the mechanism underlying phenotypic variation.</p><p><strong>Methods: </strong>Trio-based exome sequencing was performed in patients with epilepsy from the China Epilepsy 1.0 cohort. The association between TANC2 and epilepsy was validated with a Drosophila model. The role of TANC2 in development was investigated by single-cell RNA sequencing in cerebral organoids and spatiotemporal expression across brain regions.</p><p><strong>Results: </strong>De novo TANC2 variants were identified in six unrelated cases, including four null and two missense variants. The six variants were classified as \"pathogenic\"/\"likely pathogenic,\" according to the American College of Medical Genetics and Genomics guidelines. Patients with null variants exhibited severe phenotypes, including three with epilepsy and neurodevelopmental disorders (NDDs) and one with developmental and epileptic encephalopathy (DEE). In contrast, the patients with missense variants presented with only epilepsy. Genotype-phenotype correlation analysis revealed that variants associated with epilepsy and NDD were mostly null variants, whereas the missense variants were associated with NDD or epilepsy. NDD-associated missense variants exhibited more severe damage effects, compared with the epilepsy-associated missense variants. Functional studies in Drosophila suggested that knockdown TANC2 led to increased susceptibility to seizure-like behavior. TANC2 expresses highly in the brain, with three peaks in early fetal, infancy, and adulthood, coinciding with the onset ages of patients. Specifically, TANC2 exhibited the highest expression in the early fetal stage, indicating its vital role in early development. Single-cell RNA sequencing revealed an extensive expression of TANC2 in neurons in 1-month-old cerebral organoids, suggesting its vital role in neurodevelopment.</p><p><strong>Significance: </strong>This study suggested TANC2 as a causative gene of epilepsy and DEE. The phenotypic spectrums of TANC2 potentially ranged from early lethality, DEE, epilepsy with NDD, NDD, to mild epilepsy, depending on the damaging effects caused by variants.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662875","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":"Seizure freedom and reducing the risk of sudden unexpected death in patients with focal epilepsy treated with cenobamate or other antiseizure medications","authors":"Michael R. Sperling,&nbsp;William E. Rosenfeld,&nbsp;John Watson,&nbsp;Pavel Klein","doi":"10.1111/epi.18307","DOIUrl":"10.1111/epi.18307","url":null,"abstract":"<p>People with epilepsy who have uncontrolled seizures are at increased risk of all-cause mortality, injuries, comorbidities, mood and psychosocial disorders, and diminished quality of life. For those with focal epilepsy, focal to bilateral tonic–clonic seizures (FBTCS) pose the greatest risk for sudden unexpected death in epilepsy (SUDEP), a leading cause of premature mortality in people with epilepsy. Cenobamate is a third-generation antiseizure medication with demonstrated efficacy in controlling focal seizures, including FBTCS, in people with drug-resistant epilepsy. Treatment with cenobamate in clinical trials was associated with a reduction in all-cause mortality to a rate statistically indistinguishable from that seen in the general population, and SUDEP rates were lower than expected. As FBTCS are associated with the highest risk of death, prevention of this seizure type is especially important, and physicians should continue to try new therapies to prevent these seizures. A shared decision-making model should be used when interacting with patients and their care providers to achieve and maintain seizure control and maximize treatment outcomes.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":"66 S1","pages":"4-14"},"PeriodicalIF":6.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656510","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":"Improving the tolerability of antiseizure medications: When and how to use cenobamate and other new antiseizure medications","authors":"Gregory L. Krauss,&nbsp;Josemir W. Sander,&nbsp;William E. Rosenfeld","doi":"10.1111/epi.18304","DOIUrl":"10.1111/epi.18304","url":null,"abstract":"<p>Despite the introduction of newer antiseizure medications (ASMs) with improved safety profiles over the past several years, rates of treatment-related intolerable adverse events (AEs) for people with epilepsy have not changed substantially. Tolerability issues can potentially jeopardize optimal dosing and effectiveness, regimen adherence, and treatment retention with these newer medications. Long-term clinical studies, open-label extension studies, and postmarketing studies allow flexible dosing and adjustment of concomitant ASMs, which can help clinicians reduce treatment-related AEs and thus improve the retention and tolerability of these treatments. With newer effective treatments (e.g., lacosamide, eslicarbazepine, perampanel, brivaracetam, and most recently, cenobamate), the risk of AEs may be minimized by proactively adjusting concomitant ASMs that have known pharmacokinetic and/or pharmacodynamic drug interactions. Additional tolerability considerations should be made for specific populations, for example, more determined reductions in concomitant ASMs may be required to improve treatment tolerability in older people, and individuals with more refractory seizures may require higher doses. Strategies to improve the tolerability of effective ASMs further, including earlier add-on therapy and transition to, or initial, monotherapy should be investigated. Ongoing clinical studies in children and people with generalized tonic–clonic seizures of the most recent ASM addition, cenobamate, will further inform the safety profile of cenobamate and its potential utility as a broad-spectrum treatment option.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":"66 S1","pages":"15-28"},"PeriodicalIF":6.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/epi.18304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656504","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":"Symptom network analysis of prefrontal seizures.","authors":"Christophe Gauld, Fabrice Bartolomei, Jean-Arthur Micoulaud-Franchi, Aileen McGonigal","doi":"10.1111/epi.18372","DOIUrl":"https://doi.org/10.1111/epi.18372","url":null,"abstract":"<p><strong>Objective: </strong>Prefrontal seizures pose significant challenges in accurately identifying the complex interactions between clinical manifestations and brain electrophysiological activities. This proof-of-concept study aims to propose a new approach to rigorously support electroclinical reasoning in the field of epilepsy.</p><p><strong>Methods: </strong>We analyzed stereoelectroencephalographic data from 42 patients with drug-resistant focal epilepsy, whose seizures involved prefrontal cortex at seizure onset. Semiological and brain activities features were scored by expert observers. We performed a symptom network analysis of semiological feature and a hybrid network analysis, coupling semiological features with network analysis of ictal brain activities. Centrality measures were used to identify the most influential features in the networks.</p><p><strong>Results: </strong>Our analysis identified impairment of consciousness as the most central feature in the semiological network. In the hybrid network, the anterior cingulate area (here incorporating Brodmann area [BA]-32 and/or rostral part of BA-24) emerged as the most central brain activity feature.</p><p><strong>Significance: </strong>By integrating semiological features with brain electrophysiological activities into hybrid networks, symptom network analysis offers an effective quantitative tool for examining the relationships between seizure semiology and brain activity correlates in prefrontal seizures. This study provides an opportunity to advance a novel approach to rigorously investigate the intricacies of electroclinical correlations, sustaining the development of dynamic models, on different series of focal epilepsies, larger cohorts, and semiological features automatically extracted by artificial intelligence, that better reflect the temporal and spatial complexities of seizure propagation in patients with complex seizures.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656485","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":"Cenobamate efficacy in specific populations","authors":"Pavel Klein","doi":"10.1111/epi.18303","DOIUrl":"10.1111/epi.18303","url":null,"abstract":"<p>Most people with epilepsy are able to achieve good seizure control with currently available medications. However, despite the development of more than 20 new antiseizure medications (ASMs) over the past 30 years, approximately one third of patients (both pediatric and adult) are treatment-resistant and at risk of increased morbidity and mortality, including sudden unexpected death in epilepsy. The management of epilepsy in these populations can be complex. Metabolic differences in older people and pediatric patients can alter drug metabolism, increasing the risk of adverse drug effects. Comorbid conditions, potential or existing polypharmacy, and age-related physiological changes need to be considered when treating these patients. Rare developmental epileptic encephalopathies such as Lennox–Gastaut syndrome and Dravet syndrome are typically diagnosed in childhood and have proven to be refractory to treatment and to have high mortality rates. Here, we provide an overview of ASM use in patients with refractory epilepsy, in older patients, and in pediatric patients, with a focus on the efficacy outcomes, safety, and tolerability observed with a newer ASM, cenobamate.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":"66 S1","pages":"29-37"},"PeriodicalIF":6.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/epi.18303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656488","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":"Epilepsy medication management: Addressing common treatment barriers to adopting cenobamate and other new antiseizure medications","authors":"William E. Rosenfeld","doi":"10.1111/epi.18305","DOIUrl":"10.1111/epi.18305","url":null,"abstract":"<p>Seizure freedom is an important therapeutic goal for people with epilepsy and is associated with improved quality of life and reduced morbidity and mortality. Yet despite the use of multiple antiseizure medications (ASMs; either as monotherapy or in combination), seizures persist in approximately one third of patients. Third-generation ASMs, such as lacosamide, eslicarbazepine, perampanel, and brivaracetam, have demonstrated good efficacy in terms of reductions in the frequency of focal seizures. The newest ASM, cenobamate, which is indicated for the treatment of focal seizures in adults, has demonstrated notable rates of seizure freedom for some patients with drug-resistant epilepsy. In long-term, open-label clinical studies of adjunctive cenobamate, between 18.4% and 36.3% of patients achieved seizure freedom for a consecutive ≥12-month duration, and 1-year retention rates ranged from 73% to 83%. This article reviews some of the potential treatment barriers encountered during the medication management of patients with epilepsy that may impede the use and optimization of newer ASMs like cenobamate. These include treatment complacency, inadequate trial of new adjunctive therapies (“last in, first out”), pitfalls of rational polytherapy, and restricting the use of newer drugs. Although treatment must always be tailored to the specific patient, clinicians should consider the potential benefits of newer therapies and continue to reassess and optimize ASM treatment to achieve the best outcomes for their patients.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":"66 S1","pages":"38-48"},"PeriodicalIF":6.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/epi.18305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656500","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":"Validation of a discrete electrographic seizure detection algorithm for extended-duration, reduced-channel wearable EEG.","authors":"Tyler J Newton, Mitchell A Frankel, Zoë Tosi, Avidor B Kazen, Vamshi K Muvvala, Tobias Loddenkemper, Mark C Spitz, Laura Strom, Daniel Friedman, Mark J Lehmkuhle","doi":"10.1111/epi.18365","DOIUrl":"https://doi.org/10.1111/epi.18365","url":null,"abstract":"<p><strong>Objective: </strong>Reduced-channel wearable electroencephalography (EEG) may overcome the accessibility and patient comfort limitations of traditional ambulatory electrographic seizure monitoring during extended-duration use. Automated algorithms are necessary for review of extended-duration reduced-channel EEG, yet current clinical support software is designed only for full-montage recordings.</p><p><strong>Methods: </strong>The performance of a novel automated seizure detection algorithm for reduced-channel EEG (Epitel) was evaluated in a clinical validation study involving 50 participants (31 with seizures) with diverse demographic and seizure representation.</p><p><strong>Results: </strong>The algorithm demonstrated an event-level sensitivity of 86.2% (95% confidence interval [CI] = 79.5%-93.2%) and a false detection rate of .162 per hour (95% CI = .116-.221), which is comparable to the performance of current clinical software for full-montage EEG. Performance varied by electrographic seizure type, with 91.4% sensitivity for focal evolving to generalized seizures, 86.7% for generalized seizures, and 77.3% for focal seizures. The algorithm maintained robust performance in both pediatric participants aged 6-21 years (83% sensitivity) and adults aged 22+ years (90% sensitivity), as well as in ambulatory (80%) and epilepsy monitoring unit (EMU) monitoring environments (87.5%). The false detection rate in ambulatory monitoring environments (.290 false positive [FP] detections/h), all of which involved pediatric participants, was notably higher than in the EMU (.136 FP/h), indicating an area with clear need for improvement for unrestricted at-home monitoring. The algorithm's supplemental Confidence metric, designed to engender trust in the algorithm, showed a strong correlation with detection precision.</p><p><strong>Significance: </strong>These results suggest that this algorithm can provide crucial support for review of extended-duration reduced-channel wearable EEG, enabling electrographic seizure monitoring with no restrictions on a person's daily life.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662883","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}