Epilepsia最新文献

{"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}

{"title":"The epilepsy-autism phenotype associated with developmental and epileptic encephalopathies: New mechanism-based therapeutic options.","authors":"Nicola Specchio, Valentina Di Micco, Eleonora Aronica, Stéphane Auvin, Simona Balestrini, Andreas Brunklaus, Elena Gardella, Mirte Scheper, Maurizio Taglialatela, Marina Trivisano, Paolo Curatolo","doi":"10.1111/epi.18209","DOIUrl":"https://doi.org/10.1111/epi.18209","url":null,"abstract":"<p><p>Epilepsy and autism often co-occur in genetic developmental and epileptic encephalopathies (DEEs), but their underlying neurobiological processes remain poorly understood, complicating treatment. Advances in molecular genetics and understanding the neurodevelopmental pathogenesis of the epilepsy-autism phenotype may lead to mechanism-based treatments for children with DEEs and autism. Several genes, including the newly reported PPFIA3, MYCBP2, DHX9, TMEM63B, and RELN, are linked to various neurodevelopmental and epileptic disorders, intellectual disabilities, and autistic features. These findings underscore the clinical heterogeneity of genetic DEEs and suggest diverse neurobiological mechanisms influenced by genetic, epigenetic, and environmental factors. Mechanisms linking epilepsy and autism include γ-aminobutyric acidergic (GABAergic) signaling dysregulation, synaptic plasticity, disrupted functional connectivity, and neuroinflammatory responses. GABA system abnormalities, critical for inhibitory neurotransmission, contribute to both conditions. Dysregulation of the mechanistic target of rapamycin (mTOR) pathway and neuroinflammation are also pivotal, affecting seizure generation, drug resistance, and neuropsychiatric comorbidities. Abnormal synaptic function and connectivity further underscore the epilepsy-autism phenotype. New treatment options targeting specific mechanisms linked to the epilepsy-autism phenotype are emerging. Genetic variants in potassium channel genes like KCNQ2 and KCNT1 are frequent causes of early onset DEEs. Personalized treatments like retigabine and quinidine have been explored with heterogeneous responses. Efforts are ongoing to develop more effective KCNQ activators and KCNT1 blockers. SCN1A genetic variants, particularly in Dravet syndrome, show potential for treatment of autistic symptoms with low-dose clonazepam, fenfluramine, and cannabidiol, although human trials have yet to consistently replicate animal model successes. Early intervention before the age of 3 years, particularly in SCN1A- and tuberous sclerosis complex-related DEEs, is crucial. Additionally, targeting the mTOR pathway shows promise for seizure control and managing epilepsy-associated comorbidities. Understanding the distinct autism spectrum disorder phenotype in DEEs and implementing early behavioral interventions are essential for improving outcomes. Despite genetic advances, significant challenges persist in diagnosing and treating DEE-associated epilepsy-autism phenotypes. Future clinical trials should adopt precision health approaches to improve neurodevelopmental outcomes.</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":"143476038","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":"Pharmacokinetic variability and use of therapeutic drug monitoring of cannabidiol in patients with refractory epilepsy.","authors":"Cecilie Johannessen Landmark, Johan Sætre, André Gottås, Martha Wolden, Tao Angell-Petersen McQuade, Signe Flood Kjeldsen, Anne Våtevik, Erik Sætre, Torleiv Svendsen, Margrete Larsen Burns, Elisabeth Leere Øiestad, Svein I Johannessen","doi":"10.1111/epi.18284","DOIUrl":"https://doi.org/10.1111/epi.18284","url":null,"abstract":"<p><strong>Objective: </strong>Cannabidiol (CBD) (Epidyolex) is a new antiseizure medication (ASM) for rare and severe epileptic syndromes. We aimed to investigate the pharmacokinetic variability of CBD to elucidate relationships between doses, serum concentrations, metabolites, and biochemical markers of toxicity by using therapeutic drug monitoring (TDM) data.</p><p><strong>Methods: </strong>Data on serum concentrations of all ASMs, CBD, and the active metabolite 7-hydroxy-cannabidiol (7-OH-CBD) were collected (January 2022 to June 2023) at the Section for Clinical Pharmacology, National Centre for Epilepsy, Oslo University Hospital.</p><p><strong>Results: </strong>Data from 52 patients were included: 122 serum concentration measurements (1-7 per patient); 48% female, mean age 23 (range 3-55) years. At maintenance (n = 34), the mean daily dose was 535 (SD 224) mg, that is, 10.03 (standard deviation [SD] .49) mg/kg/day, serum concentration .26 (SD .14) for CBD and .13 (SD .10) μmol/L for 7-OH-CBD. Reference ranges of .15-.50 μmol/L for CBD and .04-.25 μmol/L for 7-OH-CBD are proposed, which included 80% of measurements. There was a linear correlation between CBD dose to concentration and CBD to CBD-7-OH concentrations (r² = .39 and .38) (p < .05). The hepatic marker alanine aminotransferase (ALT) increased on average 37%, demonstrating a moderate effect on liver function. Intra-individual coefficients of variation (CVs) were 32% (SD 17) for CBD and 48% (SD 24) for 7-OH-CBD (n = 15, ≥3 measurements). Twenty different ASMs were used: clobazam (n = 24), valproate (n = 17), and stiripentol (n = 8) were most common. The mean concentration ratio of desmethyl-clobazam/clobazam increased by 140% (7.29-17.5; p < .05) but was variable, pointing to enzyme inhibition by CBD.</p><p><strong>Significance: </strong>This observational study with TDM data revealed extensive pharmacokinetic variability of CBD in patients with refractory epilepsy. The results demonstrate the need for close follow-up and use of TDM, including biochemical markers of toxicity, for individualized treatment with CBD.</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":"143476411","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":"Voluntary running wheel activity reduces seizure burden and affords neuroprotection in a mouse model of acquired epilepsy.","authors":"Valentina Kebede, Rossella Di Sapia, Nicole Tonesi, Massimo Rizzi, Silvia Balosso, Daniele Spallaci, Ilaria Craparotta, Laura Pasetto, Valentina Bonetto, Gerardo Marsella, Luca Porcu, Giorgio Rosati, Alessandro Ieraci, Annamaria Vezzani","doi":"10.1111/epi.18313","DOIUrl":"https://doi.org/10.1111/epi.18313","url":null,"abstract":"<p><strong>Objective: </strong>Physical exercise may improve neurological deficits and neuronal damage after acute brain injuries and decrease established seizures. We investigated whether voluntary running wheel (RW) activity affects epileptogenesis in a mouse model of acquired epilepsy compared to sedentary mice.</p><p><strong>Methods: </strong>Epilepsy was induced by intra-amygdala kainate causing status epilepticus (SE) in adult male mice. Sham mice were implanted with electrodes and injected with saline, and matched to experimental mice. In the RW-1 protocol, SE mice were trained to run for 5 weeks before SE induction and for 6 weeks thereafter. In the RW-2 protocol, mice began using RWs 24 h post-SE for 10 weeks. At the end of each protocol, electrocorticography (ECoG) was recorded for 2 weeks (24/7) in the absence of RWs. Matched sedentary mice were kept in home cages without RWs, subjected to SE, and had ECoG monitored. At the end of experiment, all mice were processed for assessing hippocampal neuronal cell loss (Nissl staining), hilar mossy cells (GLUR2/3 staining), and blood-brain barrier (BBB) damage (serum matrix metalloproteinase-9 [MMP-9] by enzyme-linked immunosorbent assay). Neuroinflammation (reverse-transcriptase quantitative polymerase chain reaction) and albumin level (western blot) were also measured in the hippocampus of RW1 mice 72 h post-SE, together with serum MMP-9.</p><p><strong>Results: </strong>RW activity in SE mice reduced the incidence of epilepsy (RW-1 by 38%; RW-2 by 54%, p < .05) and the total time spent in seizures (RW-1, p < .05; RW-2, p < .01) compared to sedentary mice. RW-1 SE mice showed reduced average seizure duration (p < .01), whereas RW-2 SE mice showed reduced number of seizures (p < .01). Reduction in seizure duration was associated with prevention of GluR2/3-positive mossy cell loss, which occurs in sedentary SE mice (p < .01 vs sham mice). Seizure duration in epileptic mice was negatively correlated with the number of hilar mossy cells (p < .01). Preventive RW-1 activity reduced SE duration and severity (p < .05) vs sedentary mice. Aberrant neurogenesis was reduced in the dentate gyrus of SE mice subjected to RWs (p < .01) vs sedentary mice. Serum MMP-9 and brain albumin levels were reduced in SE mice exposed to running activity (p < .05) compared to sedentary mice.</p><p><strong>Significance: </strong>Physical exercise reduced seizure burden and neuropathology in mice, offering a strategy to improve disease outcomes after acute brain injury.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466635","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":"Perioperative clinical and radiological predictors of late post-traumatic seizures in surgically treated patients with depressed skull fractures: A prospective observational study.","authors":"Hervé Monka Lekuya, Jelle Vandersteene, David Patrick Kateete, Fredrick Makumbi, Stephen Cose, Jean-Pierre Okito Kalala, Moses Galukande, Edward Baert","doi":"10.1111/epi.18300","DOIUrl":"https://doi.org/10.1111/epi.18300","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify perioperative clinical and radiological factors that predict the risk of developing late posttraumatic seizures (PTS) within 24 months of injury among surgically managed traumatic brain injury (TBI) patients with depressed skull fracture (DSF).</p><p><strong>Methods: </strong>A prospective cohort study was conducted at Mulago Hospital, Uganda, involving mild-to-moderate TBI patients with DSF, followed up perioperatively and at outpatient clinics, and additionally via phone interviews for up to 24 months. The study monitored the incidence and recurrence of late PTS.</p><p><strong>Results: </strong>The cohort included 171 patients with DSF, with a median age of 24 years (interquartile range = 15-31), 89.5% of whom were male, and 49.73% were assault victims. Approximately 73.1% had mild TBI, and 25% had a history of immediate or early PTS. The frontal bone was most commonly involved (46.2%). Over 24 months, nine patients (5.3%) experienced their first late PTS within 6 months, and a total of 20 reported late PTS by the end of follow-up (277.17 person-years, with 37 lost to follow-up). Incidence rate of late PTS was higher among those with a history of immediate and early PTS (.1319 vs. .0527, p = .0449). Multivariate analysis identified the absence of basal cisterns, midline shift (MLS) ≥ 5 mm, and dural tear as significant predictors of late PTS, with increased risks of sevenfold, fourfold, and >2.5-fold, respectively. Furthermore, abnormal basal cisterns were associated with a higher risk of late PTS recurrence.</p><p><strong>Significance: </strong>A history of immediate or early PTS and abnormal radiological findings such as absent basal cisterns, MLS ≥ 5 mm, and dural tear are strong predictors of late PTS in DSF patients. The risk of developing late PTS gradually increases over time. We recommend aggressive management of increased intracranial pressure during the acute phase of TBI and systematic antiseizure prophylaxis to potentially mitigate the risk of late PTS. We also emphasize the importance of implementing long-term management and surveillance strategies for high-risk patients.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467400","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":"Focal to bilateral tonic-clonic seizures in newly diagnosed focal epilepsy.","authors":"Shruti Agashe, Gregory D Cascino, Orrin Devinsky, Sarah Barnard, Barry Gidal, Bassel Abou-Khalil, Manisha G Holmes, Jonah Fox, Pavel Klein, Jacob Pellinen, Jacqueline A French","doi":"10.1111/epi.18324","DOIUrl":"https://doi.org/10.1111/epi.18324","url":null,"abstract":"<p><p>Presence of focal to bilateral tonic-clonic seizures (FBTCS) in focal epilepsy is associated with increased morbidity and mortality. Risk factors for FBTCS are poorly understood, and little is known regarding FBTCS recurrence after treatment initiation. This study aimed to investigate factors related to FBTCS in newly diagnosed focal epilepsy and their recurrence after starting antiseizure medications (ASMs) in the Human Epilepsy Project (HEP) cohort. HEP was an international, prospective cohort study that enrolled people with newly diagnosed focal epilepsy within 4 months of treatment initiation and followed them for up to 6 years. Baseline characteristics, treatment choices, and seizure outcomes were collected. Descriptive and inferential statistical analysis was conducted to assess the differences between study participants who had FBTCS and those who never experienced FBTCS. A total of 443 participants were included in this analysis; 77% (n = 342) had FBTCS at some point prior to or within the study period. In participants with FBTCS, regardless of initial seizure type, diagnosis was mostly made after FBTCS (335/342, 98%). After treatment initiation, FBTCS did not recur in 57% (n = 194/342) of cases. A higher number of total pretreatment seizures (median = 16 vs. 11, p = .048, Mann-Whitney U-test), predominantly focal aware seizures (FAS) or focal impaired awareness seizures (FIAS; median = 15 vs. 10, p = .049, Mann Whitney U-test), was associated with no recurrence in FBTCS after treatment initiation. Of 108 participants without FBTCS prior to treatment, only seven (6%) developed FBTCS after treatment initiation. There was no significant difference in choice of initial ASM class (levetiracetam vs. sodium channel blockers) between participants who experienced FBTCS and those who did not. This study highlights the significance of FBTCS among individuals with newly diagnosed focal epilepsy. The majority of participants who experienced FBTCS were diagnosed with epilepsy after experiencing their first FBTCS despite preceding FAS/FIAS. The more frequent FAS/FIAS in participants whose FBTCS resolved may be a characteristic of their epilepsy.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457341","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":"Cytomegalic parvalbumin neurons in fetal cases of hemimegalencephaly.","authors":"Antoinette-Bernabe Gelot, Tangra Ondina Draia-Nicolau, Rémi Mathieu, Lucas Silvagnoli, Françoise Watrin, Carlos Cardoso, Jean-Bernard Manent, Antoine de Chevigny, Alfonso Represa","doi":"10.1111/epi.18325","DOIUrl":"https://doi.org/10.1111/epi.18325","url":null,"abstract":"<p><strong>Objective: </strong>Mutations in genes of the mTOR pathway have been identified as a major cause of hemimegalencephaly (HMG), focal cortical dysplasia type II, and tuberous sclerosis, cortical malformations associated with epilepsy. These conditions are characterized at the cellular level by increased size of pyramidal neurons that grow with dysmorphic features and in some cases by the presence of giant balloon cells. Our previous research in tuberous sclerosis has shown that parvalbumin (Pvalb) and calbindin immunoreactive cells in cortical and subcortical tuberal lesions show cytomegalic features, suggesting the involvement of GABAergic cells in mTOR-related pathologies. In the present report, we propose to deepen our understanding of the role of interneurons in mTOR-related cortical malformations by analyzing the maturation of Pvalb neurons in fetal samples of HMG.</p><p><strong>Methods: </strong>We performed immunohistochemical staining of cortical samples from individuals with HMG from 21 gestational weeks to 10 postnatal months. The study focused on Pvalb cells, and pS6 counterstaining was performed to assess the activation of the mTOR pathway. To investigate the pathomechanisms behind the cytomegalic features, we examined mTOR pathway gene expression in Pvalb interneurons and cortical projection neurons using a single-cell transcriptomic atlas of the human neocortex.</p><p><strong>Results: </strong>Our results revealed cytomegalic features in Pvalb interneurons, indicating abnormal development in HMG patients compared to controls. This phenotype progressively worsened over time, suggesting ongoing developmental abnormalities associated with mTOR dysregulation, which may underlie the pathology of cortical malformations in HMG. Our transcriptomic data revealed similar expression patterns of mTOR and its upstream regulators in both Pvalb and glutamatergic neurons during development, suggesting that mTOR pathway disorders may induce similar phenotypes in both cell types.</p><p><strong>Significance: </strong>The present data suggest that Pvalb interneurons are involved in the development of mTOR-related cortical dysplasia and that they may be a contributor to the clinical phenotype of these patients.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457340","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}