Epilepsia最新文献

{"title":"Seizure outcomes following epilepsy surgery in pediatric and young adult patients with high-grade brain tumors: Results from a European survey.","authors":"Robert Lersch, Till Hartlieb, Tom Pieper, Manfred Kudernatsch, Wiebke Hofer, Carmen Barba, Renzo Guerrini, Flavio Giordano, Marianna Pommella, Susanne Schubert-Bast, Steffen Syrbe, Ricardo Rego, Jorge Pinheiro, Martha Feucht, Alexander Beck, Roland Coras, Ingmar Blumcke, Michael Alber, Moritz Tacke, Jan Rémi, Christian Vollmar, Mathias Kunz, Jay Shetty, Ailsa McLellan, Drahoslav Sokol, Jothy Kandasamy, Kerstin Alexandra Klotz, Victoria San Antonio-Arce, Andreas Schulze-Bonhage, Joshua Pepper, William B Lo, Alexis Arzimanoglou, Stefano Francione, Christian J Braun, Ingo Borggraefe","doi":"10.1111/epi.18323","DOIUrl":"https://doi.org/10.1111/epi.18323","url":null,"abstract":"<p><strong>Objective: </strong>Epilepsy surgery is a standard treatment for drug-resistant epilepsy, resulting in seizure freedom in a significant number of cases. Although frequently performed for low-grade brain tumors, it is rarely considered for high-grade tumors, despite the impact of chronic epilepsy on quality of life and cognition.</p><p><strong>Methods: </strong>This retrospective multicenter study across 43 European centers evaluated epilepsy surgery outcomes in children with high-grade brain tumors (World Health Organization grades III and IV). Two cohorts of patients younger than 25 years were studied: (1) those undergoing epilepsy surgery after tumor resection (n = 14) and (2) those initially suspected of low-grade lesions but diagnosed with high-grade brain tumors postsurgery (n = 11).</p><p><strong>Results: </strong>Eighty percent of patients achieved seizure freedom 1 year after last epilepsy surgery: 71% in Cohort 1 and 91% in Cohort 2. Eighty-four percent were free of disabling seizures (Engel IA-D) after a median follow-up period of 4.3 years (range = 1-15.9 years). No surgery-related deaths occurred. Thirty-two percent of children experienced persistent morbidity, including motor dysfunction, visual impairment, persistent seizures, cognitive deficits, and hydrocephalus.</p><p><strong>Significance: </strong>Epilepsy surgery is effective for medically refractory epilepsy in children with high-grade central nervous system tumors and should be considered early, as seizure freedom is achieved in the majority of patients. Despite involving numerous epilepsy centers, only 25 patients were recruited, indicating that this method is rarely considered for high-grade brain tumor patients with medically refractory epilepsy.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531291","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":"Assisted reproduction and the fetal malformation risk associated with antiseizure medication exposure in pregnancy.","authors":"Frank Vajda, Terence O'Brien, Janet Graham, Alison Hitchcock, Piero Perucca, Cecilie Lander, Mervyn Eadie","doi":"10.1111/epi.18335","DOIUrl":"https://doi.org/10.1111/epi.18335","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to explore the possible role of assisted reproduction treatment (ART) in the occurrence of fetal malformation in women with antiseizure medication (ASM)-treated epilepsy.</p><p><strong>Methods: </strong>Data collected in the Australian Pregnancy Register of Antiepileptic Drugs concerning the pregnancies of women with ASM-treated epilepsy were analyzed using standard simple statistical methods.</p><p><strong>Results: </strong>The malformed fetal occurrence rate tended to be higher in women with epilepsy (WWE) treated with ASMs than in those untreated in at least the earlier months of pregnancy, the risk being statistically significantly higher (p < .05) in relation to valproate monotherapy. The malformation risk was greater when the pregnancy had been initiated via ART (n = 152, malformation rate = 11.18%) than when ART was not involved (n = 2388, malformation rate = 6.49%, relative risk [RR] = 1.72, 95% confidence interval [CI] = 1.07-2.77) and also greater versus ASM-treated pregnancy not involving ART (n = 2191, malformation rate = 6.79%, RR = 1.64, 95% CI = 1.02-2.64). The anatomical sites affected by the malformations also differed, the heart and great vessels being more often involved when ART had been involved. Multivariate logistic regression analysis suggested that the heightened malformation risk associated with ART plus ASM exposure seemed to be related to use of hormones in ART more than to in vitro fertilization.</p><p><strong>Significance: </strong>WWE undertaking pregnancy through ART should be aware of the increased risk of fetal malformation beyond that related to ASM exposure. If this finding is supported in further studies, evaluations of fetal malformation risk rates associated with ASM exposure may need to be adjusted for possible overestimation because of confounder effects of ART, if ART was involved in the pregnancies studied.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523067","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":"Factors influencing seizure induction in patients with intracranial EEG recording.","authors":"Hina Dave, Morgan McCreary, Antonio Guerra, Michael R Sperling","doi":"10.1111/epi.18331","DOIUrl":"https://doi.org/10.1111/epi.18331","url":null,"abstract":"<p><strong>Objective: </strong>To shorten inpatient epilepsy monitoring unit (EMU) stays during epilepsy surgery evaluation, physicians utilize techniques to induce seizures including antiseizure medication (ASM) reduction, sleep deprivation, and chemical stimulation. We assessed the relative efficacy of these techniques.</p><p><strong>Methods: </strong>We reviewed data from patients admitted for intracranial video-EEG (electroencephalography) evaluation at a single center. Demographics, baseline seizure frequency, seizure type, sleep deprivation, reduction in ASM, chemical stimulation method, and seizures were recorded. Statistical analyses were performed in R with survival analyses.</p><p><strong>Results: </strong>A total of 209 patients were evaluated. We observed an increase in the risk of seizure occurrence of 1% for every increase of one seizure per week of baseline seizure frequency (confidence interval [CI] = 1.00-1.02, p = .009). Complete cessation of both sodium channel and non-sodium channel ASMs increase the rate of seizure occurrence (CI = 1.46-2.08, p < .0001 and CI = 1.28-1.80, p < .0001, respectively). A partial reduction in sodium channel drugs within 24 h of admission or previous seizure in the EMU increased seizure risk by 40% (CI = 1.18-1.72, p = .0002). For each seizure occurring during admission, the risk of seizure recurrence increased by 5% (CI = 1.03-1.08, p < .0001). Patients with temporal lobe epilepsy exhibited a 19% lower risk of seizures within the initial 24 h of admission than patients with extratemporal seizures (CI = .68-.97, p = .02). Neither chemical stimulation nor sleep deprivation impacted seizure risk.</p><p><strong>Significance: </strong>We found that ASM reduction was the only method that effectively induced seizures in hospitalized patients; sleep deprivation and chemical induction failed to do so. Prospective studies are needed to further understand these induction methods.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523078","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":"Magnetic resonance imaging findings in SCN1A-related epilepsies and Dravet syndrome: A systematic review.","authors":"Lydia Viviana Falsitta, Helen Cross, Camilla Lindan, Elizabeth George, P Ellen Grant, Sniya Sudhakar, Cesar Alves, Joseph Sullivan, Suresh Pujar, Felice D'Arco","doi":"10.1111/epi.18344","DOIUrl":"https://doi.org/10.1111/epi.18344","url":null,"abstract":"<p><p>We systematically reviewed the literature on neuroimaging findings in Dravet syndrome (DS) and SCN1A-related epilepsies to classify the reported structural abnormalities observed on magnetic resonance imaging (MRI). We searched PubMed and MEDLINE from January 2000 to June 2024 for studies describing brain MRI findings in DS and SCN1A-related epilepsies through specific keywords and MeSH (Medical Subject Headings) terms. Duplicates were removed, and titles and abstracts were screened. Studies with absent/marginal MRI focus and reviews were excluded. Images available were evaluated by two pediatric neuroradiologists in consensus. Manual reference checks were performed. For the selection process, we followed the latest PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Nineteen studies met the inclusion criteria, all of which had an observational design, including case reports (n = 3), case series (n = 7), and larger cohorts (n = 9). The most observed brain MRI findings were cortical/parenchymal atrophy, hippocampal sclerosis (HS), and malformations of cortical development. Less frequent abnormalities include callosal dysgenesis and postseizure changes on diffusion-weighted imaging. There was variability in the description across studies, as expected. This review represents a valuable reference database for current and future genetic therapy trials. DS, particularly when associated with SCN1A variants, involves a variety of neuroimaging abnormalities, including HS, diffuse brain atrophy, and malformations of cortical development. The spectrum of these findings probably reflects the interplay between genetic susceptibility, seizure duration/severity, medication effects, and timing of imaging. To date, high-quality studies on brain MRI findings are limited, and future research, with more standardized methodologies, a longitudinal design, and larger sample sizes, are needed to further uncover these relationships and improve our understanding of the disease.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523079","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":"Blocking the innate immune CD1d/NKT cell axis prevents the development of cortical hyperexcitability and posttraumatic epilepsy.","authors":"Xingjie Ping, Wenhui Xiong, Raj Priya, Jianyun Liu, Season K Wyatt-Johnson, Randy R Brutkiewicz, Xiaoming Jin","doi":"10.1111/epi.18332","DOIUrl":"https://doi.org/10.1111/epi.18332","url":null,"abstract":"<p><strong>Objective: </strong>Posttraumatic epilepsy (PTE) that develops after a traumatic brain injury (TBI) cannot be prevented by current treatments. Although neuroinflammation is involved in epileptogenesis, a potential role for cellular immunity in this process is largely unknown. Natural killer T (NKT) cells are innate-like T lymphocytes that recognize lipid antigens presented by the major histocompatibility complex class I-like CD1d molecule and play a crucial role in regulating immune responses. Herein we examined the role of the CD1d/NKT cell axis in PTE.</p><p><strong>Methods: </strong>We used an undercut surgery to induce TBI in wild-type (WT) and CD1d-deficient (CD1d knockout [KO], CD1d KO) or NKT cell-deficient (Traj18 KO) mice. A pentylenetetrazol (PTZ) test was used to determine seizure susceptibility in vivo, and field potential recordings were made from cortical slices in vitro. Continuous video and wireless EEG monitoring was undertaken of WT and CD1d KO mice between 5 and 8 weeks after brain injury. Because statins are known to impair antigen presentation by CD1d to NKT cells, we also treated WT mice with simvastatin for 10 days after injury and performed the PTZ test. Immunofluorescence and flow cytometry were used to determine changes in immune cells in brain tissue.</p><p><strong>Results: </strong>CD1d KO or Traj18 KO TBI mice had a significantly lower seizure susceptibility than WT mice on the PTZ test. CD1d KO mice had a significantly lower rate of detectable epileptiform activities during field potential recording. Video and EEG monitoring showed that CD1d KO TBI mice had a significantly lower frequency of spontaneous epileptic seizures. There was increased infiltration of immune cells, but reduced microgliosis in the brains of these mice. Simvastatin treatment significantly reduced seizure susceptibility in TBI mice.</p><p><strong>Significance: </strong>Neuroinflammation initiated by the CD1d/NKT cell axis is involved in the development of cortical hyperexcitability and PTE; early treatment with simvastatin following a TBI exerts a prophylactic effect on posttraumatic epileptogenesis by blocking this axis.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523068","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":"Operational definition of developmental and epileptic encephalopathies to underpin the design of therapeutic trials.","authors":"Ingrid E Scheffer, Jacqueline French, Kette D Valente, Stéphane Auvin, J Helen Cross, Nicola Specchio","doi":"10.1111/epi.18265","DOIUrl":"https://doi.org/10.1111/epi.18265","url":null,"abstract":"<p><p>Developmental and epileptic encephalopathies (DEEs) are the most severe group of epilepsies, characterized by drug-resistant seizures and developmental slowing or regression. DEEs encompass many epilepsy syndromes, although not all patients with a DEE can be classified into a specific syndrome. Our understanding of the etiologies of DEEs has been revolutionized with next-generation sequencing, with more than 900 genes implicated, in addition to structural causes. It is therefore now possible to consider precision medicine and novel therapeutic approaches for these devastating diseases with trials of repurposed and new drugs, including gene therapies. Trials are being designed to target either DEE diseases more broadly, specific DEE syndromes, or specific genetic DEEs. To serve this purpose, a clear operational definition of DEEs is needed to ensure that appropriate patients are selected for trials with precisely defined, targeted outcome measures. Herein we propose the operational definition of DEEs to set the stage for the development of DEE therapies.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515112","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":"Can artificial intelligence diagnose seizures based on patients' descriptions? A study of GPT-4.","authors":"Joseph Ford, Nathan Pevy, Richard Grunewald, Stephen Howell, Markus Reuber","doi":"10.1111/epi.18322","DOIUrl":"https://doi.org/10.1111/epi.18322","url":null,"abstract":"<p><strong>Objective: </strong>Generalist large language models (LLMs) have shown diagnostic potential in various medical contexts but have not been explored extensively in relation to epilepsy. This paper aims to test the performance of an LLM (OpenAI's GPT-4) on the differential diagnosis of epileptic and functional/dissociative seizures (FDS) based on patients' descriptions.</p><p><strong>Methods: </strong>GPT-4 was asked to diagnose 41 cases of epilepsy (n = 16) or FDS (n = 25) based on transcripts of patients describing their symptoms (median word count = 399). It was first asked to perform this task without additional training examples (zero-shot) before being asked to perform it having been given one, two, and three examples of each condition (one-, two, and three-shot). As a benchmark, three experienced neurologists performed this task without access to any additional clinical or demographic information (e.g., age, gender, socioeconomic status).</p><p><strong>Results: </strong>In the zero-shot condition, GPT-4's average balanced accuracy was 57% (κ = .15). Balanced accuracy improved in the one-shot condition (64%, κ = .27), but did not improve any further in the two-shot (62%, κ = .24) and three-shot (62%, κ = .23) conditions. Performance in all four conditions was worse than the mean balanced accuracy of the experienced neurologists (71%, κ = .42). However, in the subset of 18 cases that all three neurologists had \"diagnosed\" correctly (median word count = 684), GPT-4's balanced accuracy was 81% (κ = .66).</p><p><strong>Significance: </strong>Although its \"raw\" performance was poor, GPT-4 showed noticeable improvement having been given just one example of a patient describing epilepsy and FDS. Giving two and three examples did not further improve performance, but the finding that GPT-4 did much better in those cases correctly diagnosed by all three neurologists suggests that providing more extensive clinical data and more elaborate approaches (e.g., more refined prompt engineering, fine-tuning, or retrieval augmented generation) could unlock the full diagnostic potential of LLMs.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515107","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":"Brain ¹⁸F-fluorodeoxyglucose positron emission tomography: An efficient tool at the initial diagnosis of nonlesional late onset epilepsy.","authors":"Salomé Puisieux, Sébastien Heyer, Natacha Forthoffer, Matthieu Doyen, Louise Tyvaert, Antoine Verger","doi":"10.1111/epi.18328","DOIUrl":"https://doi.org/10.1111/epi.18328","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the diagnostic performance and prognostic value of brain ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) at the initial diagnosis of patients with nonlesional late onset epilepsy (NLLOE).</p><p><strong>Methods: </strong>In this cohort study at the University Hospital of Nancy, France, newly diagnosed NLLOE patients, >50 years old, were consecutively included from June 2017 to January 2021 and systematically underwent brain ¹⁸F-FDG PET. They were categorized into four presumed etiological NLLOE subtypes: neurodegenerative subtype (NDS; patients with a diagnosis of neurodegenerative disease), microvascular subtype (MVS; patients with ≥3 cardiovascular risk factors and ≥2 vascular lesions on magnetic resonance imaging), inflammatory subtype (IFS; patients meeting international criteria for encephalitis), and unlabeled subtype (ULS). A systematic patient follow-up (at least 2 years) allowed assessment of cognitive outcomes under antiseizure medication by comparing for each patient the proportion of preserved/altered scores between initial and second neuropsychological assessment. Brain ¹⁸F-FDG PET was analyzed using a combined visual and semiquantitative approach at the individual level.</p><p><strong>Results: </strong>Eighty-seven patients were included (NDS, n = 18; MVS, n = 22; IFS, n = 7; ULS, n = 40). A normal ¹⁸F-FDG PET was observed in 46% of patients, with the final diagnosis of 88% of these patients excluding a neurodegenerative or inflammatory disorder. ¹⁸F-FDG PET had a negative predictive value of 94% for a cognitive decline at follow-up, similar for the overall population (n = 71) and the ULS population (n = 32). Moreover, a PET hypometabolic pattern suggestive of a neurodegenerative disorder was indicative of cognitive decline at follow-up in 74% of cases.</p><p><strong>Significance: </strong>¹⁸F-FDG PET as part of the initial diagnosis of NLLOE patients may have a significant impact on both NLLOE diagnosis and cognitive prognosis. For almost half of NLLOE patients, a normal ¹⁸F-FDG PET could help to exclude neurodegenerative and inflammatory epilepsy etiologies as well as future cognitive decline.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499983","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":"Evaluating the accuracy of monitoring seizure cycles with seizure diaries.","authors":"Ashley Reynolds, Rachel E Stirling, Samuel Håkansson, Philippa Karoly, Alan Lai, David B Grayden, Mark J Cook, Ewan S Nurse, Andre Peterson","doi":"10.1111/epi.18309","DOIUrl":"https://doi.org/10.1111/epi.18309","url":null,"abstract":"<p><strong>Objective: </strong>Epileptic seizures occurring in cyclical patterns is increasingly recognized as a significant opportunity to advance epilepsy management. Current methods for detecting seizure cycles rely on intrusive techniques or specialized biomarkers, thereby limiting their accessibility. This study evaluates a non-invasive seizure cycle detection method using seizure diaries and compares its accuracy with cycles identified from intracranial electroencephalography (iEEG) seizures and interictal epileptiform discharges (IEDs).</p><p><strong>Methods: </strong>Using data from a previously published first in-human iEEG device trial (n = 10), we analyzed seizure cycles identified through diary reports, iEEG seizures, and IEDs. Cycle similarities across diary reports, iEEG seizures, and IEDs were evaluated at periods of 1 to 45 days using spectral coherence, accuracy, precision, recall, and the false-positive rate.</p><p><strong>Results: </strong>A spectral coherence analysis of the raw signals showed moderately similar periodic components between diary seizures/day and iEEG seizures/day (median = .43, IQR = .68). In contrast, there was low coherence between diary seizures/day and IEDs/day (median = .11, IQR = .18) and iEEG seizures/day and IEDs/day (median = .12, IQR = .19). Accuracy, precision, recall scores, and false-positive rates of iEEG seizure cycles from diary seizure cycles were significantly higher than chance across all participants (accuracy (mean ± standard deviation): .95 ± .02; precision: .56 ± .19; recall: .56 ± .19; false-positive rate: .02 ± .01). However, accuracy, precision, and recall scores of IED cycles from both diary and iEEG cycles did not perform above chance, on average. Recall scores were compared across good diary reporters, under-reporters, and over-reporters, with recall scores generally performing better in good reporters and under-reporters compared to over-reporters.</p><p><strong>Significance: </strong>These findings suggest that iEEG seizure cycles can be identified with diary reports, even in individuals who under- and over-report seizures. This approach offers an accessible alternative for monitoring seizure cycles compared to more invasive methods.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482534","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":"Enlarged perivascular space in the temporal lobe as a prognostic marker in temporal lobe epilepsy with hippocampal sclerosis.","authors":"Soomi Cho, Seungwon Song, Jungyon Yum, Eun Hwa Kim, Yun Ho Roh, Won-Joo Kim, Kyoung Heo, Han Kyu Na, Kyung Min Kim","doi":"10.1111/epi.18301","DOIUrl":"https://doi.org/10.1111/epi.18301","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to investigate the regional burden of enlarged perivascular spaces (EPVSs) in patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and explore its prognostic relevance.</p><p><strong>Methods: </strong>In this retrospective observational study, EPVSs in the temporal lobe (T-EPVS), centrum semiovale (CS-EPVS), basal ganglia (BG-EPVS), midbrain, and hippocampus were visually rated in 68 treatment-naïve patients with TLE-HS. Regional EPVS burden was dichotomized into high and low degrees (cutoff: >10 for BG-EPVS/T-EPVS; >20 for CS-EPVS). Cox proportional hazards models were used to determine the potential predictors of seizure freedom (SF; no seizure for >1 year) and delayed SF (SF achieved >6 months after initiating antiseizure medication [ASM]). Multivariate logistic regression using stepwise variable selection based on the Akaike information criterion was performed to investigate whether EPVS burden was associated with medical refractoriness (never achieving SF).</p><p><strong>Results: </strong>Of the 68 patients, 20 were classified into the refractory group (29.4%). The high T-EPVS group had an older epilepsy onset (37.3 ± 12.3 vs. 26.5 ± 13.0 years, p = .005), higher pretreatment seizure density (median = 12.0, interquartile range [IQR] = 5.0-20.0 vs. 4.0, IQR = 2.0-10.5, p = .008), and lower focal to bilateral tonic-clonic seizure prevalence (13.3% vs. 73.6%, p < .001) than the low T-EPVS group. High T-EPVS burden (odds ratio [OR] = 10.908, 95% confidence interval [CI] = 1.895-62.789) was an independent predictor of medial refractoriness, along with female sex (OR = 12.906, 95% CI = 2.214-75.220) and ASM treatment duration (OR = .985, 95% CI = .971-.999). The low T-EPVS group had higher probability of achieving delayed SF than the high T-EPVS group (p_Log-rank = .030, p_{Cox regression} = .038), whereas the probability of achieving SF was comparable between the two groups (p_Log-rank = .053, p_{Cox regression} = .146).</p><p><strong>Significance: </strong>Increased T-EPVS burden may serve as an imaging marker of unfavorable prognosis in patients with TLE-HS, underscoring the potential role of perivascular dysfunction in diminished ASM response.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476409","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}