Epilepsia最新文献

{"title":"Common network related to hyperkinetic seizures revealed by functional lesion network mapping.","authors":"Bowen Yang, Chen Yao, Jinping Xu, Ningfei Li, Wenhan Hu, Xiu Wang, Baotian Zhao, Jiajie Mo, Zhong Zheng, Xiaoqiu Shao, Jianguo Zhang, Andreas Horn, Chao Zhang, Kai Zhang","doi":"10.1111/epi.18603","DOIUrl":"https://doi.org/10.1111/epi.18603","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to determine whether the anatomically heterogeneous lesions that cause hyperkinetic seizures (HKS) are connected to a common functional network.</p><p><strong>Methods: </strong>We identified patients from the Beijing Tiantan-Fengtai Epilepsy Center with HKs as the primary ictal semiology. These included patients had focal seizure-onset zone, here referred to as a \"lesion.\" The network of brain regions functionally connected to each lesion was identified using whole-brain functional connectivity from a functional magnetic resonance imaging (fMRI) dataset of healthy participants (n = 1000). Network maps were overlapped to identify regions functionally connected to most lesions. Specificity was evaluated using a case-control design. Therapeutic relevance was assessed using a cohort that underwent deep brain stimulation to the anterior nucleus of the thalamus to improve seizure control.</p><p><strong>Results: </strong>Lesion locations for patients with HKS (n = 50) and patients without HKS (n = 47 for automatisms; n = 53 for elementary motor signs) were included. Based on the lesion brain network, the most sensitive and specific region with HKS was the anterior cingulate cortex (ACC) (>90% overlap). Reversed connectivity patterns between the ACC and the whole brain encompassed most lesion locations that caused HKS (47/50, 94%). In addition, the functional connectivity between ACC and deep brain stimulation sites was associated with improved seizure control (r = .49, p < .01) in 27 patients with drug-resistant epilepsy.</p><p><strong>Significance: </strong>These findings indicated that HKS might be a symptom of brain network disruption that resulted from lesions in various brain regions commonly connected to ACC, emphasizing the ACC as a potential target for therapeutic intervention in HKS.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006025","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":"How accurate are witnesses of first suspected seizures in recalling semiology at clinically relevant timepoints? A UK experimental study with a pilot intervention.","authors":"Adam J Noble, Steven Lane, Paul New, Harriet Cope, Chloe Foley, Holly Lynn Williams, Laszlo Sztriha, Graham Powell, Markus Reuber, Anthony G Marson","doi":"10.1111/epi.18624","DOIUrl":"https://doi.org/10.1111/epi.18624","url":null,"abstract":"<p><strong>Objective: </strong>A key diagnostic challenge at \"first seizure\" clinic appointments is determining whether the reported event was epileptic. Witness accounts are often critical, yet such appointments typically occur weeks after the event. Guidelines recommend review within 2 weeks. Wait times are however often longer, with a median of 7 weeks in countries such as the UK. The accuracy of witness recall at these clinically relevant intervals and whether their confidence predicts accuracy have never been determined. This study addressed these fundamental questions. It also piloted a potential intervention: whether asking witnesses a set of systematic questions immediately after viewing a suspected seizure improves recall at follow-up, compared to the usual free recall approach used by first responders.</p><p><strong>Methods: </strong>In this UK-based experimental study, adults (≥18 years old) viewed a video of an epileptic seizure and were randomized into four conditions: A (immediate free recall + 2-week follow-up), B (immediate free recall + 7-week follow-up), C (immediate systematic questions + 2-week follow-up), and D (immediate systematic questions + 7-week follow-up). The primary outcome was accuracy on 15 standardized questions addressing key semiological features, scored against consensus ratings from five neurologists.</p><p><strong>Results: </strong>Of a representative sample of 304 participants, 295 (97%) fully viewed the video, and 94.7% completed follow-up. At 2 weeks, participants answered 54.4% of questions correctly-only 3.9% (95% confidence interval [CI] = .52-7.3) more than those at 7 weeks. Confidence was poorly correlated with accuracy. Immediate systematic questioning improved later recall by 6.7% (95% CI = 3.3-10.0). A definitive trial of this intervention would require 926 participants.</p><p><strong>Significance: </strong>This is the first evidence on the accuracy of witness recall at clinically relevant intervals. Recall is modest even within recommended timeframes and declines only slightly by 7 weeks. Witness confidence does not predict accuracy. Immediate structured questioning may enhance later recall and thus support seizure diagnoses.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006050","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":"A critical review of high-frequency activity for functional mapping in SEEG.","authors":"Parveen Sagar, Matt Hudson, Genevieve Rayner, Terence J O'Brien, Joshua Laing, Andrew Neal","doi":"10.1111/epi.18619","DOIUrl":"https://doi.org/10.1111/epi.18619","url":null,"abstract":"<p><p>Mapping functional brain networks is a critical component of stereo-electroencephalography (SEEG) evaluations. Although direct cortical stimulation (DCS) is the clinical gold standard, it has important limitations-particularly in mapping distributed, complex functions such as language and memory, where deficits may still occur despite preservation of DCS-positive sites, impacting quality of life. More broadly, there is increasing emphasis on preserving cognitive function in epilepsy surgery. The growing use of minimally invasive treatments-such as laser interstitial thermal therapy and radiofrequency thermocoagulation-reflects this shift. This trend highlights a need for adjunctive mapping techniques that provide anatomically precise and clinically relevant information about cortical functions, complementing existing mapping methods. Task-induced high-frequency activity (HFA), broadly defined as neural activity above 30 Hz, reflects localized cortical processing and has emerged as a physiologically plausible signal for functional mapping. As an activation-based technique, HFA may complement DCS by providing additional information about cortical function to inform surgical planning and outcome prediction. Despite growing interest, clinical uptake of HFA mapping in SEEG remains limited. This likely reflects methodological heterogeneity across published studies, lack of standardized analysis pipelines, and limited validation through outcome-linked research. Together, these challenges create uncertainty around the clinical utility of HFA. In this narrative review, we describe the neurophysiological basis of HFA, review key mapping findings across functional domains, outline practical requirements for clinical implementation, and examine major barriers to clinical translation. In doing so, we aim to provide clarity on the current evidence base and identify opportunities for future research that may support the integration of HFA mapping into clinical workflows.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999939","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":"Incidence, mortality, and management of status epilepticus from 2012 to 2022: An 11-year nationwide study.","authors":"Quentin Calonge, Aurélie Hanin, Edouard Januel, Octave Guinebretiere, Thomas Nedelec, Francois Le Gac, Mario Chavez, Sophie Tezenas du Montcel, Vincent Navarro","doi":"10.1111/epi.18627","DOIUrl":"10.1111/epi.18627","url":null,"abstract":"<p><strong>Objective: </strong>Recent data on status epilepticus (SE) incidence and mortality remain limited, despite the 2015 revision of its definition by the International League Against Epilepsy. The impact of the COVID-19 pandemic also remains unclear. We assessed trends in SE incidence, mortality, and management from 2012 to 2022 and examined the pandemic's impact.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the French National Health Data System, including all patients with a first hospitalization coded for SE (International Statistical Classification of Diseases, 10th Revision) from 2012 to 2022. Patients were stratified by intensive care unit (ICU) admission and mechanical ventilation (MV) duration. Annual age-standardized incidence rates were analyzed using Poisson regression. ICU admission rates, in-hospital mortality, and 1-year mortality were compared to 2019 (reference), adjusting for demographics, causes, and comorbidities. Interrupted time series analysis assessed changes during the pandemic.</p><p><strong>Results: </strong>We identified 118 050 patients hospitalized for first SE. From 2012 to 2019, the incidence of SE hospitalization decreased annually by 1.9%, from 18.0 to 15.6 per 100 000 (incidence rate ratio [IRR] = .981, 95% confidence interval [CI] = .978-.984). ICU hospitalizations declined similarly (from 10.4 to 9.59 per 100 000, IRR = .989, 95% CI = .986-.993), except among patients without MV. In-hospital mortality was 22.9% and 1-year mortality was 36.0% in 2019, stable compared to 2012. The highest mortality occurred in patients requiring prolonged MV or not admitted to ICU. During the COVID-19 years (2020-2022), SE hospitalizations dropped significantly (IRR = .897, 95% CI = .831-.969), ICU admission rates decreased, and mortality among non-ICU patients rose.</p><p><strong>Significance: </strong>SE hospitalizations declined over the past decade, without a parallel reduction in mortality. The COVID-19 pandemic further disrupted SE care, with fewer hospitalizations, reduced ICU admissions, and increased mortality among non-ICU patients. Further research is needed to elucidate the factors driving declining incidence and excess mortality.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947411","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":"Deciphering SCN2A: A comprehensive review of rodent models of Scn2a dysfunction.","authors":"Katelin E J Scott, Maria Fernanda Hermosillo Arrieta, Aislinn J Williams","doi":"10.1111/epi.18615","DOIUrl":"10.1111/epi.18615","url":null,"abstract":"<p><p>SCN2A encodes for the alpha subunit of the voltage-gated sodium channel Na_V1.2, which is involved in action potential initiation and backpropagation in excitatory neurons. Currently, it is one of the highest monogenetic risk factors for both epilepsy and autism spectrum disorder. However, SCN2A-related disorders manifest in a broad clinical neuropsychiatric spectrum, including distinct neurological and psychiatric disorders. This clinical heterogeneity presents challenges for mechanistic understanding and treatment development. SCN2A mutations are generally classified as either gain-of-function (GOF) or loss-of-function (LOF); however, many mutations do not perfectly align to this binary framework. SCN2A dysfunction alters neuronal excitability, channel kinetics, and synaptic transmission in various ways, resulting in multiple electrophysiological effects and both seizure and behavioral phenotypes that are influenced by developmental stage, brain region, genetic background, and sex. Although early lethality in GOF models limits behavioral characterization, LOF models broadly show patterns of learning impairments, altered sociability, and disrupted sensory processing. Still, behavioral and seizure phenotypes are often inconsistent even across models with similar or identical variants, suggesting that genetic modifiers, such as potassium channels, play a role in shaping disease outcomes. Overall, these findings suggest that SCN2A-related disorders involve complex gene-gene and gene-environment interactions, rather than only channel biophysics. Current therapeutic strategies include Clustered Regularly Interspaced Short Palindromic Repeat-mediated transcriptional activation (CRISPRa), antisense oligonucleotides, and deep brain stimulation; however, they are limited due to variant specificity or age of intervention. This review highlights areas of convergence and conflict across models, emphasizing knowledge gaps, such as the limited availability of data on early development. Ultimately, it emphasizes the importance of investigating models across different developmental stages, using diverse genetic background strains, among other approaches, to encourage therapeutic innovation and enhance care for patients. We hope this work contributes to the emerging unifying framework that looks beyond the GOF and LOF binary in SCN2A-related disorders.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947348","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":"Functional/dissociative seizures: Proposal for a new diagnostic label and definition by the ILAE task force.","authors":"Coraline Hingray, Stoyan Popkirov, Kasia Kozlowska, Chrisma Pretorius, Mercedes Sarudiansky, Wissam El-Hage, Dong Zhou, Deniz Ertan, W Curt LaFrance, Markus Reuber","doi":"10.1111/epi.18574","DOIUrl":"https://doi.org/10.1111/epi.18574","url":null,"abstract":"<p><p>The acceptability and validity of the term \"psychogenic nonepileptic seizures\" (PNES) have been questioned. Currently, numerous alternative terms, such as \"conversion,\" \"dissociative,\" \"functional,\" \"attacks,\" and \"events,\" are used in both medical literature and clinical practice, leading to confusion among professionals and patients. The lack of a uniform diagnostic label is likely to impede research funding and service development. The International League Against Epilepsy (ILAE) Psychiatry Commission charged its task force focusing on these seizures to propose a more uniform and integrative terminology. Members of the previous ILAE PNES Task Force (2017-2021) helped to organize two workshops to try to build a consensus for a new terminology. These meetings involved experts by experience, clinicians, and researchers, including representatives of the Functional Neurological Disorders Society (an international professional organization), FND Hope (an international patient advocacy organization), and the American Epilepsy Society. The current task force (2021-2025) continued this work by reviewing the existing literature and debating the nomenclature and classification of seizures commonly labeled as PNES. The present proposal paper synthesizes the findings of this process. Based on our critical consideration of the literature, academic insights, and clinical experience, and noting the current international medical and psychiatric classification systems, the ILAE task force proposes the new term \"functional/dissociative seizures\" (FDS). This proposal paper explores the pros and cons of each component of the label \"functional,\" \"dissociative,\" and \"seizure\" from different perspectives, taking account of patient and health care professional acceptability, diagnostic and semiological considerations, underlying illness mechanisms, treatment provision, and health-economic, sociocultural, and linguistic factors. The dual characterization and use of a slash offer clinicians flexibility to adopt either \"functional\" or \"dissociative,\" or both, in their practice depending on the patient's profile, their own preferences, and the cultural/linguistic context. The abbreviation \"FDS\" is recommend for use in scientific writings.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947456","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":"Presence of interictal epileptiform EEG discharges implies increased risk of recurrence after the first unprovoked seizure: Report of the International League Against Epilepsy and International Federation of Clinical Neurophysiology.","authors":"Betül Baykan, John Dunne, Samuel Wiebe, Louis Maillard, Sandor Beniczky, Michalis Koutroumanidis, Margitta Seeck","doi":"10.1111/epi.18591","DOIUrl":"https://doi.org/10.1111/epi.18591","url":null,"abstract":"<p><strong>Objective: </strong>A joint International Federation of Clinical Neurophysiology-International League Against Epilepsy (IFCN-ILAE) Taskforce was created to explore the published evidence for initial EEG recordings in the evaluation of patients who experienced their first unprovoked seizure, and to determine the diagnostic value of EEG in supporting the diagnosis of epilepsy.</p><p><strong>Methods: </strong>We conducted a systematic literature review, with two independent authors screening each study. We extracted seizure recurrence data among patients with EEG showing interictal epileptiform discharges (IEDs) vs those with normal or nonspecific-abnormal EEG results. Random-effects meta-analyses of seizure recurrence in relation to IEDs was conducted in the included studies, calculating odds ratios (OR) with confidence intervals (CIs) and diagnostic accuracy.</p><p><strong>Results: </strong>A total of 4847 patients from 22 studies with variable follow-up durations were analyzed. The random-effects pooled binary estimate of seizure recurrence was 47% (95% CI 40%-55%). The overall proportion with seizure recurrence was higher in patients with IEDs (60%, 95% CI 53%-68%) compared to those without (40%, 95% CI 33%-48%, p < .001). Random-effects meta-analysis showed that the presence of IEDs was associated with seizure recurrence (OR 2.32, 95% CI 1.69-3.17, p < .001). Subgroup analyses of adults and children showed that this difference remained significant in both groups: OR in children of 3.24 (95% CI 2.19-4.79) and in adults of 1.55 (95% CI 1.08-2.21). In eight studies (n = 1209, 923 children) patients remained untreated before the second seizure; the pooled probability of seizure recurrence in those with IED in these studies was no different than in studies in which some patients were treated.</p><p><strong>Significance: </strong>In conclusion, the presence of IEDs in EEG recordings obtained after the first unprovoked seizure can help clinicians to confirm the clinical diagnosis of epilepsy after a first unprovoked seizure, according to the revised ILAE definition. These results support the relevance of IED detection on EEG as a predictor of seizure recurrence after a first unprovoked seizure. However, its prognostic value is influenced by age and other clinical factors.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947418","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":"Exploratory study of peripheral immune changes associated with diffusion MRI multi-compartment model in temporal lobe epilepsy.","authors":"Jerzy P Szaflarski, Rodolphe Nenert, Huixian Hong, Christina Mueller, Ayushe A Sharma, Hongwei Qin, Etty N Benveniste","doi":"10.1111/epi.18612","DOIUrl":"https://doi.org/10.1111/epi.18612","url":null,"abstract":"<p><strong>Objective: </strong>Studies in temporal lobe epilepsy (TLE) have shown that focal inflammation is a key contributor to seizure initiation and maintenance. However, most in vivo studies to date have focused on positron emission tomography (PET) findings. In this exploratory study, we assessed the relationship between multicompartment Neurite Orientation Dispersion and Density Imaging (NODDI) measures (FISO [extracellular/free water], FICVF [neurite density], and ODI [neurite dispersion]) and peripheral immune cells and inflammatory biomarkers. We hypothesized that these biomarkers would be associated with NODDI abnormalities in the affected temporal lobe (aTL).</p><p><strong>Methods: </strong>Eighteen patients with TLE and 18 age-matched healthy participants underwent 3 Tesla magnetic resonance imaging (MRI) high angular resolution diffusion imaging. TLE participants also provided peripheral blood samples. We generated NODDI parameter maps (FISO, FICVF, and ODI) and compared the groups using voxelwise two-sample t tests with corrections for multiple comparisons (p < .05), focusing on temporal regions. In TLE patients only, NODDI values extracted from significant clusters correlated with peripheral inflammatory biomarkers.</p><p><strong>Results: </strong>ODI increases in the aTL significantly correlated with pro-inflammatory cytokines such as interleukin (IL)-1α and IL-2. FICVF was lower in the aTL, and this decrease correlated with IL-27 and CD3⁺, CD8⁺, and Th17 T-cell responses. FISO was increased in the aTL, and this increase correlated with CXCL10 expression and immune cells such as CD3⁺, CD8⁺, and Th1 T cells. In addition, FISO was increased in other areas of the affected and unaffected temporal lobes, but this increase was not correlated with any of the biomarkers tested.</p><p><strong>Significance: </strong>Group differences indicate a significant relationship between NODDI biomarkers of injury/neuroinflammation and peripheral immune cells and pro-inflammatory biomarkers in aTL. These novel in vivo findings support further the development of NODDI as a promising non-invasive technique for visualizing neuroinflammation. Further validation of NODDI may enable clinicians to use this approach for monitoring disease progression and treatment response in epilepsy, potentially leading to more personalized treatment strategies.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947321","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":"Association between enlarged perivascular space (ePVS) density and stereo-electroencephalography (SEEG) biomarkers of epileptogenicity.","authors":"Jacob Bunyamin, Benjamin Sinclair, Thanomporn Wittayacharoenpong, Parveen Sagar, William Pham, Zhibin Chen, Noam Bosak, Joshua Laing, Matthew Gutman, Martin Hunn, Patrick Kwan, Terence J O'Brien, Meng Law, Andrew Neal","doi":"10.1111/epi.18614","DOIUrl":"https://doi.org/10.1111/epi.18614","url":null,"abstract":"<p><strong>Objective: </strong>We aim to explore the association between enlarged perivascular space (ePVS) density and stereo-electroencephalography (SEEG) biomarkers of epileptogenicity.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive SEEG patients from an Australian site. We automatically segmented ePVSs from 3T pre-SEEG T1-weighted magnetic resonance imaging (MRI) scans and calculated ePVS (1) hemispheric, (2) sub-lobar, and (3) contact-level density. We defined the epileptogenic zone (EZ) SEEG contacts as those identified as the primary EZ and then selected for radiofrequency thermocoagulation (RF-TC). We classified contacts generating the top 10% of interictal epileptogenicity biomarkers (spikes, fast ripples, and cross-rates of high-frequency oscillations [HFO]*spikes). We assessed the relationship at each level for the whole cohort and its subgroups: MRI-negative-only, different voxel sizes (.9 mm³/1.0 mm³), contact locations (mesial temporal/neocortical), and seizure-free patients.</p><p><strong>Results: </strong>From 53 RF-TC patients, ePVS density was not associated with the EZ at the hemispheric (p = .995), sub-lobar (p = .090), or contact (p = .999) level in the whole cohort. In the MRI-negative-only subgroup and 1.0 mm³ isotropic subgroup, ePVS density was inversely associated with EZ (odds ratio [OR] .76, 95% confidence interval [CI]: .61-.93, p = .009 and OR .83, 95% CI: .69-.99, p = .036, respectively). There was no association between ePVSs and the interictal epileptogenic biomarkers at all levels in the whole cohort. At the subgroup level, mesial temporal ePVS density was inversely associated with the top 10% of fast ripples (OR .09, 95% CI: .04-.24, p < .001) and cross-rates of HFO*spikes (OR .22, 95%CI: .11-.44, p < .001), whereas in the neocortex, ePVSs were positively associated with fast ripples (OR 1.10, 95% CI: 1.01-1.18, p = .018), which may be driven by the interictal biomarker organization rather than epileptogenicity.</p><p><strong>Significance: </strong>ePVS density may not be a consistent biomarker of SEEG-defined epileptogenicity. The relationship between reduced ePVS and epileptogenicity in MRI-negative cases warrants further study, as this may shed light on underlying pathobiology and EZ biomarkers. Different imaging techniques may be able to capture the relationship between the glymphatic system disruption and epileptogenicity.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947285","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":"Neurologic impairment and brain microstructural-functional alterations in infantile spasms: A multimodal magnetic resonance imaging study.","authors":"Yuchun Huang, Shumin Xu, Xiaoyu Wang, Tong Mo, Yan Hu, Xianlei Meng, Diangang Fang, Dongfang Zou, Li Chen, Hongwu Zeng","doi":"10.1111/epi.18620","DOIUrl":"https://doi.org/10.1111/epi.18620","url":null,"abstract":"<p><strong>Objective: </strong>Infantile spasms (IS) are associated with significant neurodevelopmental impairments, yet the underlying brain microstructural and functional alterations remain poorly understood. This study aimed to investigate gray and white matter abnormalities in IS patients and their correlations with neurological dysfunction using advanced neuroimaging techniques.</p><p><strong>Methods: </strong>Thirty-four IS patients (21 males, age = 2.8-64.4 months) and 32 age- and sex-matched healthy controls (HC) underwent high-resolution magnetic resonance imaging. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) were employed to analyze gray matter volume (GMV) and cortical thickness, respectively. Diffusion tensor imaging (DTI) assessed white matter integrity. Cognitive and motor functions were evaluated using the Bayley Scales of Infant Development-II.</p><p><strong>Results: </strong>IS patients exhibited significantly lower Mental Development Index (MDI; 50 vs. 99, p < .001) and Physical Development Index (50 vs. 106, p < .001) compared to HC. VBM revealed reduced GMV in bilateral inferior temporal gyri (BA20/37), left middle occipital gyrus (BA19), right precentral gyrus (BA6), posterior cingulate gyrus, and parahippocampal regions (p < .001). Cortical thinning (by SBM) was observed in the right parahippocampal gyrus, supramarginal gyrus, and left middle temporal gyrus. DTI demonstrated decreased fractional anisotropy in corticospinal tracts and hippocampal-cingulum pathways (p < .05). GMV in the left middle occipital gyrus correlated positively with MDI scores (r = .42, p = .02).</p><p><strong>Significance: </strong>IS patients exhibit widespread microstructural abnormalities in brain regions critical for visual, auditory-language, motor, and limbic functions. These structural deficits, particularly in the occipital and temporal cortices, may underlie the neurodevelopmental impairments observed in IS. The findings highlight the importance of early neuroimaging to identify anatomical correlates of dysfunction and guide targeted interventions.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947405","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}