Epilepsia最新文献

{"title":"Differences in patterns of outpatient epilepsy-specific medication initiation after acute ischemic stroke in the Medicare population.","authors":"Maria A Donahue, Julianne D Brooks, John Hsu, Mary Price, Deborah Blacker, Lee H Schwamm, Joseph P Newhouse, M Brandon Westover, Sebastien Haneuse, Lidia M V R Moura","doi":"10.1111/epi.18396","DOIUrl":"https://doi.org/10.1111/epi.18396","url":null,"abstract":"<p><strong>Objective: </strong>Acute ischemic stroke (AIS) is a leading hospitalization cause and significantly contributes to seizures among older adults. We examined outpatient epilepsy-specific medication (ESM) initiation patterns after AIS discharge in adults 65 years and older, trends over time (by stratifying the analysis from 2013 to 2021), and racial/ethnic differences.</p><p><strong>Methods: </strong>We analyzed nationwide administrative claims data for a 20% sample of US Medicare beneficiaries (enrolled in Traditional Medicare Parts A, B, and D for at least 12 months before admission) aged ≥65 years and hospitalized for AIS between 2013 and 2021. We estimated the cumulative incidence of ESM initiation within 90 days after AIS discharge, with mortality as a competing risk and censoring person time if individuals experienced an inpatient readmission. We described drug type and stratified our analysis by race, ethnicity, US geographic region, hospital region, and year of discharge.</p><p><strong>Results: </strong>Of 128 174 community-dwelling beneficiaries after AIS discharge, 2435 (1.9%, 95% confidence interval [CI] = 1.8%-2.0%) initiated ESM within the 90-day follow-up period and levetiracetam was the most common medication across all years (81%). Mean age was 79 years (range = 65-110), 56% were female, 81% were non-Hispanic White, 10% were Black/African American, 5% were Hispanic, and 3% were Asian. The cumulative incidence of ESM initiation at 90 days in the overall sample was 1.4% (95% CI = 1.3%-1.4%); it was 1.8% (95% CI = 1.6%-2.1%) for Black/African American, 1.9% (95% CI = 1.6%-2.3%) for Hispanic, and 1.2% (95% CI = 1.2%-1.3%) for non-Hispanic White beneficiaries. The 90-day cumulative incidence also varied by US Census division, from 1.0% (95% CI = .8-1.3; West North Central) to 1.5% (95% CI = 1.3%-1.8%; East South Central). We observed an increase in ESM 90-day initiation over time, from 1.2% (95% CI = 1.0%-1.5%) in 2013 to 1.7% (95% CI = 1.5%-1.9%) in 2021. ESM initiation was 1.6% (95% CI = 1.4%-1.8%) in the 65-70-year age group and decreased in older age groups.</p><p><strong>Significance: </strong>Black/African American and Hispanic beneficiaries had a higher 90-day incidence of post-AIS ESM initiation than non-Hispanic Whites. ESM initiation decreased in older age groups.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779567","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":"Protective effect of CACNA1A deficiency in oligogenic refractory epilepsy with CACNA1A-CELSR2 digenic mutations.","authors":"Chu-Qiao Liu, Mei-Zhen Sun, Yong-Miao Lin, Xi-Xing Zhang, Rui-Na Huang, Ming-Feng He, Sheng Luo, Si-Yuan Luo, Tao Huang, Nan Jiang, Jie Luo, Jia-Xin Zhang, Pei-Run Chen, Xi Dai, Tian-Ai Han, Wei-Ping Liao, Rong-Chao Peng, Jing-Da Qiao","doi":"10.1111/epi.18390","DOIUrl":"https://doi.org/10.1111/epi.18390","url":null,"abstract":"<p><strong>Objective: </strong>The vast majority of refractory epilepsy cases have a complex oligogenic/polygenic origin, which presents a challenge to precision medicine in individual patients. Nonetheless, the high workload and lack of effective guidelines have limited the number of in-depth animal studies.</p><p><strong>Methods: </strong>Whole-exon sequencing identified a case with refractory epilepsy caused by a combination of two rare and de novo heterozygous variants in CACNA1A and CELSR2, respectively. Polygenic mutation flies were established and logistic regression were applied to study the gene-gene interaction and quantify the seizure-risk weight of epilepsy-associated genes in a polygenic background. In addition, calcium imaging, pharmacology, and transgenic rescue experiments were used to explore the mechanism and the precision medicine strategy for this model.</p><p><strong>Results: </strong>Seizure-like activity was mitigated in the Cacna1a-Celsr2 digenic knockdown flies, whereas it was aggravated in the Cacna1a knockin-Celsr2 knockdown flies, and all relevant monogenic mutation flies showed seizures. Logistic regression suggested that the Cacna1a deficiency provided a protective effect against seizures in Celsr2 knockdown flies. The severe seizures from Cacna1a knockin-Celsr2 knockdown, the genotype mimicking that of the patient, can be completely rescued by inhibiting the calcium channel via genetic (Cacna1a knockdown) or pharmacologic (pregabalin) treatment during a limited period of development. Calcium imaging results suggested a synaptic cleft balance mechanism for the protective effect of CACNA1A deficiency in the polygenic background.</p><p><strong>Significance: </strong>CACNA1A presented multiple effects on epileptogenesis in diverse genetic backgrounds and provided an effective preclinical approach to clarify the net impact of polygenic variants for designing a precisive medicine strategy against refractory epilepsy.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784365","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":"Clinical trials of prevention of acquired epilepsy: New proof-of-concept approach to restart trials.","authors":"Pavel Klein, Matthias Koepp, Alexander Rotenberg, Mustafa Q Hameed, Wolfgang Löscher","doi":"10.1111/epi.18394","DOIUrl":"10.1111/epi.18394","url":null,"abstract":"<p><p>Approximately 20% of epilepsy is caused by acute central nervous system insults such as traumatic brain injury (TBI), stroke, and infection. There is a latent period of weeks to years between the insult and epilepsy onset, which offers an opportunity to prevent epilepsy. No preventive treatments exist. Their development is a major unmet need in neurology. For logistical reasons, epilepsy acquired after TBI, posttraumatic epilepsy (PTE), is most suitable for epilepsy prevention studies. In the past 20 years, preclinical PTE research has flourished, offering potential treatments to prevent PTE, but clinical development has been dormant. The major barrier in the development of PTE preventive treatment is the lack of a viable proof of concept (POC) trial design. PTE trials use the first late unprovoked posttraumatic seizure as an outcome measure, which necessitates a long (~2-year) follow-up and makes POC studies nonfeasible. A reliable biomarker of early PTE detection would allow shorter follow-up duration and facilitate POC studies, but such a biomarker is not yet available. Biomarker, POC, and randomized clinical trial studies have virtually identical designs in terms of patient inclusion and follow-up. Done sequentially, the studies would take a generation to complete. We propose a novel trial design for studies of PTE prevention that combines discovery of biomarker(s) of early PTE detection with POC study and uses an adaptive study POC-phase 3 continuation design approach to incorporate POC study into phase 3 study following an interim futility analysis after 6 months of treatment of the first 25% of the cohort, the POC population. This approach would establish a POC model for treatment of PTE prevention, shorten development of PTE prevention treatment, and reopen the door to clinical trials to prevent epilepsy.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784358","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":"Achieving epilepsy care for all: Ecosystem-based transformation.","authors":"Susanna Gallani, Bernice Martin Lee, Lidia M V R Moura","doi":"10.1111/epi.18400","DOIUrl":"https://doi.org/10.1111/epi.18400","url":null,"abstract":"<p><p>Epilepsy exemplifies many of the systemic challenges of modern health care-fragmented care delivery, inequitable access, financial strain, and so on. The current \"system of systems\" (SoS) structure of U.S. health care fosters siloed operations among its member systems (e.g., insurers, health care institutions, providers, researchers, pharmaceutical companies, and technology vendors), failing to address interconnected issues like care continuity, clinician burnout, and appropriate resource allocation. This article proposes embracing a health care ecosystem approach as a solution, emphasizing interdependence, collaboration, and equity. Section 1 examines the shortcomings of the current care model, with a focus on its financial challenges and the systemic inefficiencies it perpetuates. Section 2 explains the concept of a health care ecosystem and its potential to drive equity through organic coordination and collective accountability. It highlights the role of key member systems-patients, advocacy groups, professional organizations, health care providers, payers, purchasers, policymakers, researchers, and industry leaders-in achieving equity in brain health care. Finally, Section 3 presents a roadmap for transitioning from SoS to ecosystem, outlining multiple actionable strategies, such as enhancing advocacy and data sharing by professional organizations, adopting integrated and multidisciplinary care models by health care providers, and prioritizing affordability and collaboration by industry leaders. Policymakers and federal research organizations can support the transition by incentivizing collaboration, expanding funding for health services research, and supporting data-driven decision-making. Advocacy groups can amplify collective voices and help prioritize improvement opportunities. Using epilepsy care as an example condition, this article argues that coordinated, multi-sector, and multi-level efforts can successfully and efficiently address systemic challenges, improve outcomes, and reduce inequities. It offers a replicable framework for achieving sustainable, scalable, and equitable care for chronic neurological conditions.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779513","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":"Assessment of antiseizure medication adherence based on postmortem toxicology and claimed prescriptions in cases of sudden unexpected death in epilepsy.","authors":"Marie Kroman Palsøe, Carl Johann Hansen, Christian Torp-Pedersen, Kristian Linnet, Marius Kløvgaard, Jacob Tfelt-Hansen, Jytte Banner","doi":"10.1111/epi.18354","DOIUrl":"https://doi.org/10.1111/epi.18354","url":null,"abstract":"<p><strong>Objective: </strong>Individuals with epilepsy are at a higher risk of dying suddenly and without explanation, known as sudden unexpected death in epilepsy (SUDEP). Seizures are a risk factor for SUDEP, and nonadherence to antiseizure medication (ASM) increases this risk. We aimed to assess adherence to ASMs at the time of death among young SUDEP cases by comparing prescription claims with postmortem toxicology at an individual level.</p><p><strong>Methods: </strong>We identified all forensically autopsied SUDEP cases by assessing autopsy reports, toxicology reports, and Danish health registries from a previously identified nationwide population of sudden unexplained deaths in Denmark. We included cases aged 1-35 and 36-49 years between 2000-2019 and 2007-2019, respectively. We assessed adherence to ASMs by examining discrepancies or consistencies between any register-based claimed prescriptions and postmortem toxicology findings, resulting in four possible outcomes: evidence of adherence, nonadherence, nontreatment or undertreatment, and nonprescribed medication.</p><p><strong>Results: </strong>Of 477 sudden unexplained deaths, 84 (18%) were identified as SUDEP. Among the SUDEP cases, 73 (87%) claimed ASMs before death and 67 (80%) had ingested ASM according to postmortem findings. Evidence of nonadherence was found in 16 (19%) SUDEP cases, constituting 22% (n = 16/73) of SUDEP cases who claimed ASM before death. Adherence was observed in 53 SUDEP cases (63%), comprising 73% (n = 53/73) of SUDEP cases who claimed ASM before death. Nonadherent SUDEP cases tended toward a higher prevalence of psychiatric diseases when compared with the remaining SUDEP cases.</p><p><strong>Significance: </strong>By uniquely matching register-based prescription data with postmortem toxicology findings, we ascertained that 73% of SUDEP cases adhered to their claimed ASM, underscoring the necessity for continued vigilance in seizure management. However, improving medication adherence may possess preventive potential for SUDEP, as 22% exhibited nonadherence to their claimed ASM.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763273","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":"Deep brain stimulation of the centromedian nucleus for drug-resistant epilepsy in children: Quality-of-life and functional outcomes from the CHILD-DBS registry.","authors":"Karim Mithani, Farbod Niazi, Hrishikesh Suresh, Yousof Alrumayyan, Eriberto R Rayco, Ayako Ochi, Hiroshi Otsubo, Elizabeth Kerr, Sara Breitbart, Andrea LeBlanc-Millar, Nisha Gadgil, Jeffrey S Raskin, Alexander G Weil, Aristides Hadjinicolaou, Christian Iorio-Morin, Shelly Weiss, Puneet Jain, Lauren Sham, Elizabeth Donner, Alfonso Fasano, Carolina Gorodetsky, George M Ibrahim","doi":"10.1111/epi.18393","DOIUrl":"https://doi.org/10.1111/epi.18393","url":null,"abstract":"<p><strong>Objective: </strong>Deep brain stimulation of the centromedian nucleus of the thalamus (CM-DBS) is an investigational, off-label treatment for drug-resistant epilepsy (DRE) in children. Although emerging evidence supports its safety and efficacy for select indications, the effect of CM-DBS on quality of life and functional outcomes such as school attendance has not been studied. Here, we analyzed data from the prospective CHILD-DBS (Child & Youth Comprehensive Longitudinal Database for Deep Brain Stimulation) to examine the impact of CM-DBS on patient- and caregiver-reported outcomes.</p><p><strong>Methods: </strong>Twenty-two children and youth underwent bilateral CM-DBS. Caregiver-child dyads completed surveys related to seizure frequency, seizure severity, quality of life, and school attendance at baseline, 6 months, and 1 year postsurgery. Simulated volumes of tissue activation were analyzed to identify optimal stimulation targets associated with treatment outcome.</p><p><strong>Results: </strong>Of 22 children, 10 experienced ≥50% reduction in seizure frequency (mean reduction = 66.7 ± 17.3%), one exhibited a modest benefit (37.5% reduction), and the remaining 11 experienced no change. The majority (73% of patients) exhibited a clinically important reduction in seizure severity, including six children who did not demonstrate any change in seizure frequency. Only those who experienced a reduction in seizure frequency demonstrated significant improvements in general health and overall quality of life. Furthermore, we observed an increase in school attendance across participants 1 year after CM-DBS.</p><p><strong>Significance: </strong>CM-DBS can lead to reduction in seizure burden concurrent with improvements in quality of life and relevant functional outcomes in children with DRE. These findings further our understanding of the impact of CM-DBS on meaningful outcomes for children and caregivers.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751693","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":"Reduction of generalized tonic-clonic seizures following vagus nerve stimulation therapy: CORE-VNS Study 24-month follow-up.","authors":"Ana Suller Marti, Ryan Verner, Mark Keezer, Andrea Andrade, Martin Veilleux, Kenneth Myers, Gaia Giannicola, Kathryn Nichol, Jorge G Burneo","doi":"10.1111/epi.18371","DOIUrl":"https://doi.org/10.1111/epi.18371","url":null,"abstract":"<p><strong>Objective: </strong>Generalized tonic-clonic seizures (GTCS) are considered to be among the most devastating seizures due to increased health risks. Use of device-based therapies, such as vagus nerve stimulation (VNS), is common for those resistant to antiseizure medications and important for those in whom resective surgery is not feasible. Our objective is to investigate whether adjunctive VNS can reduce the frequency of GTCS.</p><p><strong>Methods: </strong>Participants were enrolled in an international, multicenter, prospective observational study (CORE-VNS) on seizure and nonseizure outcomes following the implantation of VNS. Participants with GTCS at baseline were selected for analysis. Baseline seizure frequency data and patient-reported outcome measures were collected at 3, 6, 12, 24, and 36 months. This interim analysis compared baseline data to VNS therapy outcomes through 24 months.</p><p><strong>Results: </strong>A total of 115 participants met the inclusion criteria. Following 12 months of VNS, participants experienced a median GTCS reduction of 73.9%, with 37% of participants reporting seizure freedom from GTCS for the 3 months prior to the 12-month follow-up. This outcome remained stable at 24 months, with a median GTCS reduction of 77% and 42.6% of participants reporting seizure freedom for the 3 months prior to the 24-month visit. After 12 months of VNS, the number of participants reporting the postictal severity of their most debilitating seizure as \"severe\" or \"very severe\" dropped from 52.8% to 25.3% (21/83). After 24 months of VNS, the percentage of participants reporting these levels of postictal severity was 26.3% (20/76). The participants' drug load did not change significantly during the follow-up. Adverse events were typical of those previously documented in patients with drug-resistant epilepsy (DRE) using VNS.</p><p><strong>Significance: </strong>Adjunctive VNS therapy was effective in reducing GTCS frequency in study participants. The sustained and consistent nature of the response further supports VNS as a long-term effective therapy in patients with DRE who have GTCS.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751697","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":"Antiseizure potential of the triple T-type calcium channel blocker ACT-709478 (apinocaltamide) in rodent models.","authors":"Melanie Kessler, Hélène Roellinger, Corinne Roucard, Michel Alexander Steiner, Catherine Roch","doi":"10.1111/epi.18386","DOIUrl":"https://doi.org/10.1111/epi.18386","url":null,"abstract":"<p><strong>Objective: </strong>T-type Ca²⁺ channels in the brain contribute to the generation of spike-and-wave discharges (SWDs). Absence seizures are defined by the occurrence of SWDs and are associated with impairment of consciousness. ACT-709478 is a selective and highly potent blocker of the low-voltage-activated T-type Ca²⁺ channels, Ca_v3.1, Ca_v3.2, and Ca_v3.3, with no relevant activity on other targets. Our aim was to investigate the efficacy of ACT-709478 in reducing absence-like and other types of seizures in rodents.</p><p><strong>Methods: </strong>We studied the effect of oral ACT-709478 on SWDs in two models of absence-like epilepsy, Wistar Albino Glaxo from Rijswijk (WAG/Rij) rats and Genetic Absence Epilepsy Rats from Strasbourg (GAERS), and compared it to first-line monotherapy. We also assessed the potential of ACT-709478 to reduce generalized convulsive seizures in audiogenic seizure-sensitive (AGS) mice and in the maximal electroshock threshold test (MEST) in mice, as well as in one model of focal onset seizures, the amygdala kindling rat model. We tested combinations of ACT-709478 with the broadly used first-line medication valproate in AGS mice.</p><p><strong>Results: </strong>ACT-709478 suppressed SWDs in WAG/Rij rats and GAERS with efficacy equivalent to or superior to that of first-line monotherapy. ACT-709478 also reduced the severity of generalized convulsive seizures in the AGS mouse model and the MEST in mice, albeit at higher concentration. ACT-709478 had synergistic effects against generalized convulsive seizures, when combined with valproate, and had no effect on focal onset seizures.</p><p><strong>Significance: </strong>Based on its efficacy profile in rodent models, ACT-709478 represents a promising drug candidate for the treatment of absence epilepsy such as childhood absence epilepsy or syndromes featuring SWDs. It could possibly also be beneficial for epileptic syndromes presenting with additional seizure types.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751688","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":"Assessing the diagnostic performance of investigations in pediatric myoclonic epilepsies: A retrospective cohort study.","authors":"Sophie Brulé, Blandine Dozières-Puyravel, Hala Nasser, Monique Elmaleh-Bergès, François-Xavier Mauvais, Stéphane Auvin","doi":"10.1111/epi.18383","DOIUrl":"https://doi.org/10.1111/epi.18383","url":null,"abstract":"<p><strong>Objective: </strong>The primary purpose was to assess the diagnostic performance of investigations in children with myoclonic epilepsy. The secondary objectives were to examine the definitive syndromic diagnoses and report the outcomes of pediatric myoclonic epilepsies.</p><p><strong>Methods: </strong>We conducted a retrospective monocentric study from a pediatric center for rare epilepsies. We included pediatric patients investigated for myoclonic epilepsy at our center from 2009 to 2022. Data were collected from their medical records.</p><p><strong>Results: </strong>Forty-one children were included; 32 (78%) underwent untargeted etiological investigations, including brain magnetic resonance imaging and diverse laboratory tests to rule out an underlying etiology for progressive myoclonus epilepsy (PME). These investigations led to an etiological diagnosis of epilepsy for two patients, exclusively based on genetic investigations. At the final follow-up, an underlying etiology for epilepsy was established for nine patients (22%). The definitive syndromic diagnoses were diverse, comprising myoclonic epilepsy in infancy, epilepsy with myoclonic absences, Rasmussen syndrome, and PME. Some patients were diagnosed with nonsyndromic developmental and epileptic encephalopathy or unclassified nonsyndromic myoclonic epilepsy. Developmental delay or regression at the initial evaluation was found to be significantly associated with an unfavorable neurological outcome, the total number of antiseizure medications (ASMs) prescribed, and the unlikelihood of achieving ASM freedom. No patients with an abnormal head circumference or born of a consanguineous union were in the favorable neurological outcome group, although this finding did not reach statistical significance.</p><p><strong>Significance: </strong>Except for the need to promptly identify diseases for which precision medicine treatments are available, a first-line genetic approach seems reasonable to investigate children diagnosed with epileptic myoclonus.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735884","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":"Intestinal dysbiosis alters acute seizure burden and antiseizure medicine activity in Theiler's virus model of encephalitis.","authors":"Inga Erickson, Stephanie Davidson, Hanna Choi, Seongheon Rho, Michelle Guignet, Kristen Peagler, Kenneth Thummel, Aaron Ericsson, Melissa Barker-Haliski","doi":"10.1111/epi.18395","DOIUrl":"https://doi.org/10.1111/epi.18395","url":null,"abstract":"<p><strong>Objective: </strong>Brain infection with Theiler's murine encephalomyelitis virus (TMEV) in C57BL/6J mice produces an etiologically relevant model of acquired seizures. Dietary changes can modify seizure presentation following TMEV brain infection and influence intestinal microbiome diversity and composition. Intestinal dysbiosis may thus similarly affect seizure burden and antiseizure medicine (ASM) activity in this model, independent of pharmacokinetic effects. We thus sought to define the influence of antibiotic (ABX)-induced gut dysbiosis on acute seizure presentation, anticonvulsant activity of carbamazepine (CBZ), and CBZ pharmacokinetics with TMEV infection.</p><p><strong>Methods: </strong>Male C57BL/6J mice (4-5 weeks old) received oral ABX or saline (SAL) once daily beginning on arrival through day 7 after TMEV infection (postinfection [p.i.]). Mice were infected with TMEV or phosphate-buffered saline on day 0. Mice received intraperitoneal (20 mg/kg) CBZ or vehicle (VEH) twice daily on days 3-7 p.i. and were assessed for handling-induced seizures 30 min after treatment. Plasma was collected on day 7 p.i. at 15 and 60 min after CBZ administration for bioanalysis.</p><p><strong>Results: </strong>TMEV infection induced acute seizures, but ABX-induced gut dysbiosis altered seizure presentation. There were 75% SAL-VEH, 35% SAL-CBZ, 35% ABX-VEH, and 72% ABX-CBZ mice with seizures during the 7-day monitoring period. There was a significant pretreatment × ASM interaction (p = .0001), with differences in seizure burden in SAL- versus ABX-pretreated mice (p = .004). CBZ significantly increased latency to seizure presentation, an effect absent in ABX-CBZ mice. Plasma CBZ concentrations did not differ between SAL and ABX pretreatment groups, suggesting that ABX did not influence CBZ pharmacokinetics.</p><p><strong>Significance: </strong>ABX-induced gut dysbiosis markedly altered acute disease trajectory with TMEV-induced encephalitis, reflecting a novel contribution of the gut microbiome to seizure presentation. ABX-induced gut dysbiosis also significantly changed acute seizure control by CBZ, but did not influence plasma CBZ concentrations. The gut-brain axis is thus an underrecognized contributor to TMEV infection-induced seizures, ASM activity, and disease burden.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735885","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}