Epilepsia最新文献

{"title":"Real-world comparison of first-line antiseizure monotherapy and the role of age at treatment initiation in newly diagnosed childhood epilepsy: A cohort study from a tertiary center.","authors":"Ningshan Li, Huiting Zhang, Chaoran Yang, Xiaoying Qiao, Dezhi Cao, Lina Men, Guangjun Yu, Jianxiang Liao","doi":"10.1111/epi.18607","DOIUrl":"https://doi.org/10.1111/epi.18607","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to evaluate the real-world effectiveness and tolerability of first-line antiseizure medication (ASM) monotherapy in children with newly diagnosed epilepsy, focusing on comparative outcomes across developmental age groups and ASM types, and identifying clinical risk factors of treatment failure.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 10 years of electronic medical records from Shenzhen Children's Hospital. Children aged ≤18 years who initiated monotherapy with one of five ASMs (oxcarbazepine, valproate, levetiracetam, topiramate, or lamotrigine) were included. The primary outcome was treatment success, defined as sustained seizure and side effect freedom at the defined analytic endpoint. Outcomes based on the 2010 International League Against Epilepsy (ILAE) definition were also evaluated. Nineteen clinical variables across six domains were analyzed. Multivariable Cox regression and stabilized inverse probability of treatment weighting were used to adjust for confounding.</p><p><strong>Results: </strong>Among 7060 eligible patients with a median follow-up of 14.0 months, 47.9% achieved treatment success, and 48.3% met ILAE criteria. The median seizure- and side effect-free survival was 24.8 months (95% confidence interval [CI] = 23.3-26.5 months). Oxcarbazepine (32.3%), valproate (31.7%), and levetiracetam (22.5%) were the most commonly prescribed ASMs. Treatment success did not differ significantly across ASM types or age groups. Epileptic spasms (hazard ratio [HR] = 2.86, 95% CI = 1.98-4.09), generalized seizures (HR = 1.78, 95% CI = 1.49-2.13), seizures before reaching maintenance dose (HR = 1.52, 95% CI = 1.37-1.70), delayed treatment initiation (HR ~ 1.30), and neurodevelopmental delay (HR = 1.42, 95% CI = 1.26-1.60) were significant risk factors of treatment failure.</p><p><strong>Significance: </strong>First-line ASMs showed similar effectiveness in routine pediatric care. Childhood epilepsy treatment outcomes were more strongly influenced by seizure characteristics, neurodevelopmental comorbidities, and timing of initiation than by ASM choice or age. These findings support extrapolating ASM efficacy across pediatric age groups and highlight the value of real-world evidence in treatment decision-making.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820955","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":"Reliability and diagnostic accuracy of home video recording in differentiating sleep-related hypermotor epilepsy from disorders of arousal.","authors":"Laura Licchetta, Greta Mainieri, Giuseppe Loddo, Flavia Baccari, Giulia Bruschi, Lisa Taruffi, Lino Nobili, Paolo Tinuper, Luca Vignatelli, Federica Provini, Francesca Bisulli","doi":"10.1111/epi.18561","DOIUrl":"https://doi.org/10.1111/epi.18561","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the interobserver reliability (IR) and diagnostic accuracy of home video in distinguishing sleep-related hypermotor epilepsy (SHE) from disorders of arousal (DoA) among neurologists with varying levels of expertise. Additionally, it assesses the learning effect in nonexpert raters and extrapolates key diagnostic elements and confounding factors.</p><p><strong>Methods: </strong>We selected 24 home videos capturing sleep-related events recognized as typical from 12 patients with confirmed SHE and 12 with DoA. During a full-day video session, a panel of 18 experts in epileptology or in sleep medicine and 12 general neurologists and residents were asked to classify each video as \"SHE,\" \"DoA,\" or \"unknown,\" based on the semiology of the event. Baseline IR among all raters and among neurologists before and after experts' discussion was calculated using kappa statistics. The learning effect for nonexperts was assessed using McNemar test by comparing performance before and after training. A thematic analysis of raters' comments was conducted to extrapolate discriminatory features for diagnosis and to identify confounding factors.</p><p><strong>Results: </strong>The overall agreement was 75%, with a \"moderate\" IR (kappa = .56). Raw agreement among experts was 79%, with \"substantial\" IR (kappa = .62). Among general neurologists, raw agreement improved from 70% to 82% after training, corresponding to \"moderate\" IR (kappa = .47) and \"substantial\" IR (kappa = .65), respectively. Disagreement was higher for DoA cases. The thematic analysis identified abrupt onset and brief duration of episodes, ambulatory behavior, and irregular breathing as the main confounders.</p><p><strong>Significance: </strong>Home video is a reliable tool for distinguishing between SHE and DoA. IR is substantial when assessed by experts and among nonexperts after appropriate educational training. The use of home video as a diagnostic tool is feasible for clinicians with limited access to specialized diagnostic facilities, as well as for sleep and epilepsy specialists, aiding in the diagnostic process and in the follow-up assessment.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803876","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":"Folate transfer across the placenta during late pregnancy in women with epilepsy: A cross-sectional, two-center study.","authors":"Erez Berman, Gali Pariente, Natalia Erenburg, Roa'a Hamed, Cecilie Johannessen Landmark, Michal Kovo, Sara Eyal","doi":"10.1111/epi.18575","DOIUrl":"https://doi.org/10.1111/epi.18575","url":null,"abstract":"<p><strong>Objective: </strong>In women with epilepsy who are treated with antiseizure medications (ASMs), folate concentrations in maternal serum may not be a good indicator of fetal folate supply, because ASMs can interfere with folate handling by the placenta. We aimed to assess the transplacental folate transfer at birth in persons with epilepsy in comparison to controls with no known epilepsy and identify factors affecting it.</p><p><strong>Methods: </strong>This was a cross-sectional, two-center study, involving 22 pregnant women with epilepsy treated with ASMs, 10 nontreated pregnant women with epilepsy, and 19 control pregnant individuals with no known epilepsy. Maternal venous blood and umbilical cord blood samples were collected at delivery. Folate concentrations were measured using a validated chemiluminescence assay. ASM concentrations were analyzed in serum and umbilical cord blood.</p><p><strong>Results: </strong>Maternal and neonatal characteristics were generally comparable across the study groups, but cesarian sections were more frequent among controls (p < .001). Folate concentrations in maternal serum were lower than recommended levels in nine of 26 (35%) of women with epilepsy and eight of 19 (42%) controls. Median cord/maternal serum folate ratios were 1.51 (95% confidence interval [CI] = .92-6.35; n = 17) in women with epilepsy treated with ASMs and 2.02 (95% CI = 1.69-3.71; n = 19) in controls. In women with epilepsy, placental folate transfer was saturable (Cmax = 131.1 ng/mL, 95% CI = 96.4-190.5 ng/mL; Michaelis-Menten constant, Km = 32.6 ng/mL, 95% CI = 12.5-76.9 ng/mL; adjusted R² = .70). Predictability of cord values improved upon exclusion of preterm births (Cmax = 125.2 ng/mL, 95% CI = 97.4-164.7 ng/mL; Km =41.1 ng/mL, 95% CI = 22.4-71.1 ng/mL; adjusted R² = .78).</p><p><strong>Significance: </strong>Folate delivery to the fetus during late pregnancy is primarily explained by its concentrations in maternal circulation. In persons with epilepsy, it may be saturable. The frequent apparent folate deficiency observed in our cohort highlights the importance of folate supplementation and monitoring of its levels in maternal circulation throughout pregnancy.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803875","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":"Treatment of epilepsy using newer antiseizure medications: A retrospective cohort study of prescription patterns in Sweden 2013-2022.","authors":"Kristian Bolin, Patric Berling, Torbjörn Tomson","doi":"10.1111/epi.18576","DOIUrl":"https://doi.org/10.1111/epi.18576","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to analyze the choice of newly introduced antiseizure medications (ASMs; brivaracetam, cannabidiol, cenobamate, fenfluramine, and perampanel) by age and sex, and the use of these ASMs in relation to regulatory approval.</p><p><strong>Methods: </strong>Patients were identified with dispensation of any ASM subsequent to at least one health care contact due to epilepsy (International Classification of Diseases, 10th Revision: G40) during 2000-2022. Incidence rate ratios (IRRs) for starting a newly introduced ASM, retention rates, number of ASM treatments preceding the first dispensation of a new ASM and concurrent ASM treatments at first dispensed new ASM, and share of patients using new ASMs as adjunctive treatment were calculated.</p><p><strong>Results: </strong>Three percent of all patients identified with epilepsy treatment during the period 2013-2022 used at least one new ASM. IRRs for ever being dispensed a new ASM differed between age groups for all ASMs except cenobamate. The corresponding IRRs associated with sex were insignificantly different from 1, except for cannabidiol; men were more likely to start using cannabidiol. One-year retention rates were between 42% (cannabidiol, men) and 64% (brivaracetam, men). The majority (70%) of patients had used >2 ASMs prior to the first dispensation of a new ASM, and a majority (98%) of patients were treated with another ASM at first dispensation of a new ASM (≤90 days before). Similarly, 82% of the patients who started using a new ASM did so as an adjunctive treatment (ASMs dispensed ≤90 days before and ≥90 days after first new ASM).</p><p><strong>Significance: </strong>Our observations indicate that prescription patterns of the newer ASMs comply with the currently approved indications for the respective medications for a majority of patients (prevalence of brivaracetam as adjunctive treatment is somewhat lower). Retention on the dispensed medications are in line with what would be expected for adjunctive treatment of patients with drug-resistant epilepsies.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803877","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":"Suspected induction of epileptic negative myoclonus after lacosamide initiation.","authors":"Naohiro Yamamoto, Ichiro Kuki, Takeshi Inoue, Naoki Yamada, Shin Okazaki, Yayoi Shide-Moriguchi, Sayaka Yoshida","doi":"10.1111/epi.18595","DOIUrl":"https://doi.org/10.1111/epi.18595","url":null,"abstract":"<p><p>Older voltage-gated sodium channel (VGSC) blockers, such as carbamazepine and phenytoin, can increase interictal epileptiform abnormalities and induce new seizure types. However, we could find no reports for lacosamide (LCM), a newer VGSC blocker, behaving similarly in pediatric patients. We describe three pediatric patients who experienced epileptic negative myoclonus (ENM) following LCM administration. One patient had self-limited epilepsy with centrotemporal spikes; the others had focal epilepsy. In all cases, interictal electroencephalography (EEG) showed unilateral or bilateral independent spike-and-wave discharges in the central region before LCM initiation. Concomitant medications at the time of LCM initiation included levetiracetam (Case 1), levetiracetam and valproate (Case 2), and valproate (Case 3). After LCM initiation, all patients experienced brief unilateral upper extremity muscle tone loss during wakefulness. Electromyography confirmed momentary interruption of muscle activity, time-locked to the spike-and-wave discharges in the bilateral centrotemporal region. Hence, we determined that the movement was ENM. In addition, the interictal EEG worsened and showed bilateral synchronous spike-and-waves in all cases. ENM disappeared after the discontinuation of LCM. LCM can induce ENM, and the exacerbation seen in EEG due to LCM may have induced ENM. Patients should be monitored carefully for worsening of EEG findings or inducing other types of seizures.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069374","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":"Choice of antiseizure medications and associated outcomes in Medicare beneficiaries after acute ischemic stroke.","authors":"Julianne D Brooks, Rafaella Cazé de Medeiros, Shuo Sun, Madhav Sankaranarayanan, M Brandon Westover, Lee H Schwamm, Joseph P Newhouse, Sebastien Haneuse, Lidia M V R Moura","doi":"10.1111/epi.18594","DOIUrl":"10.1111/epi.18594","url":null,"abstract":"<p><strong>Objective: </strong>We examined choice of outpatient epilepsy-specific antiseizure medication (ESM) after a stroke discharge and outcomes in a sample of US older adults.</p><p><strong>Methods: </strong>In this matched cohort study, we analyzed a 20% sample of US Medicare beneficiaries aged 65 years and older hospitalized for acute ischemic stroke (AIS) between 2009 and 2021 who were discharged home. Individuals met insurance coverage criteria and were not taking ESM before hospitalization. We matched individuals on days from discharge to ESM initiation. Individuals who initiated ESMs other than levetiracetam within 30 days of discharge (n = 229) were matched to levetiracetam initiators (n = 687). We did not include antiseizure medications used for treatment of pain or psychiatric disorders such as gabapentin and benzodiazepines. We investigated the time to seizurelike events, emergency department (ED) visits, and readmissions using a semicompeting risk framework.</p><p><strong>Results: </strong>The matched cohort of 916 ESM initiators had a median age of 73 years (interquartile range = 69-81) and was 57% female and 71% non-Hispanic White. Using the semicompeting risk framework, those who received other ESM had a 37% lower hazard of seizurelike events compared to those receiving levetiracetam, given that death had not occurred (hazard ratio = .63, 95% confidence interval [CI] = .43-.91). Among other ESM initiators, the hazard of ED visits and hospital readmissions, given that death had not occurred, did not differ significantly from initiating levetiracetam (hazard ratios = 1.00 [95% CI = .80-1.25] and .98 [95% CI = .75-1.28], respectively).</p><p><strong>Significance: </strong>In a sample of US Medicare beneficiaries hospitalized for AIS and discharged home, initiating levetiracetam in the outpatient setting was associated with a higher risk of seizurelike events compared to other ESMs. However, there remains a possibility of residual confounding by indication, as individuals with greater risk of seizures may have been started on levetiracetam. We did not observe significant differences in the risk of ED visits or readmissions, suggesting comparable safety profiles in broader clinical outcomes.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793755","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":"Drug discovery and preclinical testing of drug candidates for developmental and epileptic encephalopathies.","authors":"Heidrun Potschka, Daniel Pérez-Pérez","doi":"10.1111/epi.18581","DOIUrl":"https://doi.org/10.1111/epi.18581","url":null,"abstract":"<p><p>Drug development for developmental and epileptic encephalopathies (DEEs) follows different strategies on one hand including disease-targeting precision medicine approaches considering the genetic variants and pathomechanisms in DEEs and on the other hand including therapeutic approaches with novel targets or second-generation drug candidates that may be of interest beyond selected DEEs. Although the first group of approaches can only be tested in dedicated DEE models, assessment in induced non-specific seizure and epilepsy models may provide valuable information if the mechanism of action implies a broader spectrum of efficacy. Data from such models can inform about general anti-seizure efficacy, efficacy against different seizure types including a possible broad-spectrum potential, dose range, and \"therapeutic\" plasma/brain concentrations. However, only dedicated DEE models will guide selection of the best candidates with a favorable efficacy and tolerability spectrum for specific DEEs. Several DEE models have already been used for preclinical testing of therapeutic approaches. Testing in these specific models can provide information about the effects on seizure generation; spread of seizure activity; epilepsy development; survival; behavioral, cognitive, and motor function; and about tolerability. On the other hand, we still face several limitations and challenges including lack of models for many DEEs, incomplete penetrance of the phenotype, high mortality, low throughput, limited knowledge concerning pharmacology and predictive validity, and species differences in development and disease course. In this review, we provide an overview of the preclinical efficacy data of approved orphan drugs in both model types and discuss the current state-of-knowledge concerning predictive validity. In conclusion, testing strategies need to be carefully tailored to the candidate drug or therapeutic approach. In this context, there is an urgent need for development of further specific DEE models and for a comprehensive characterization of the face and predictive validity of existing and future DEE models.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793756","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 crowdsourcing for ICU EEG annotation: A comparison with expert performance.","authors":"Wan-Yee Kong, Fábio A Nascimento, Aaron Struck, Erik Duhaime, Srishti Kapur, Edilberto Amorim, Gregory Kapinos, Andres Rodriguez, Brendan Thomas, Masoom Desai, Jong Woo Lee, M Brandon Westover, Jin Jing","doi":"10.1111/epi.18547","DOIUrl":"https://doi.org/10.1111/epi.18547","url":null,"abstract":"<p><strong>Objective: </strong>Detection of seizures and rhythmic or periodic patterns (SRPPs) on electroencephalography (EEG) is crucial for the diagnosis and management of patients with neurological critical illness. Although automated detection methods are advancing, they require large, high-quality, expert-annotated datasets for training. However, expert annotation is limited by the availability of trained neurophysiologists. Crowdsourcing, or soliciting contributions from a large group of people, may present a potential solution. This study evaluates the feasibility of crowdsourcing annotations of short epochs of EEG recordings by comparing the performance of experts and non-experts in identifying six SRPPs.</p><p><strong>Methods: </strong>We conducted an EEG scoring contest using a mobile app, involving expert and non-expert participants. Non-experts in our studies include physicians-MD, medical students-MS, nurse-practitioner-NP/physician-assistant-PA/pharmacists, NP-students/PA-students/pharmacy-students/other-healthcare-students, and others. Performance was assessed using pairwise agreement and Fleiss' kappa between experts, and accuracy comparisons between experts and the crowd using individual and weighted majority votes.</p><p><strong>Results: </strong>A total of 1542 participants (8 experts and 1534 non-experts) answered 478 834 questions across six SRPPs: seizures, generalized and lateralized periodic discharges (GPDs and LPDs), and generalized and lateralized rhythmic delta activity (GRDA LRDA), and \"Other.\" Using individual, non-weighted votes, the crowd's performance was inferior to experts for overall and across six SRPP identification. Using weighted majority votes, the crowd was non-inferior to experts for overall SRPP identification with accuracy of .70, 95% confidence interval [CI]: .69-.70 compared to expert's accuracy of .68, 95% CI: .68-.70. The crowd performed comparably or better than experts in identifying most SRPPs, except for LPDs and \"Other\". No individual expert outperformed the crowd on overall metrics.</p><p><strong>Significance: </strong>This proof-of-concept highlights the promise of crowd reviewers for obtaining expert-level annotations of SRPPs, which could potentially accelerate the development of large, diverse datasets for training automated detection algorithms. Challenges, such as varying calibration/test splits across crowd participants in the study and the absence of gold standard labels in the real-world settings, remain to be addressed.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793757","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":"Postneonatal epilepsy after acute provoked neonatal seizures: Incidence, predictors, and clinical burden in a multicenter cohort followed through early childhood.","authors":"Adam L Numis, Hannah C Glass, Janet S Soul, Courtney J Wusthoff, Shavonne L Massey, Giulia M Benedetti, Catherine J Chu, Cameron Thomas, Tayyba Anwar, Monica E Lemmon, Linda S Franck, Madison M Berl, Betsy Pilon, Stephanie M D Rau, Yi Li, Julie Sturza, Charles E McCulloch, Renée A Shellhaas","doi":"10.1111/epi.18590","DOIUrl":"https://doi.org/10.1111/epi.18590","url":null,"abstract":"<p><strong>Objective: </strong>Epilepsy is a known potential outcome following acute provoked neonatal seizures, but its onset, treatment patterns, and health care utilization through childhood remain poorly characterized. This study aimed to define the incidence and timing of postneonatal epilepsy, identify perinatal predictors, and describe the clinical burden of epilepsy among survivors of acute provoked neonatal seizures through early childhood.</p><p><strong>Methods: </strong>This prospective, multicenter cohort study followed neonates with acute provoked seizures from the Neonatal Seizure Registry (NSR-II) in an extended follow-up through early childhood (Developmental Functional Evaluation). Neonatal clinical and neuroimaging data were collected, and epilepsy outcomes (including semiology, treatments, and health care use) were assessed annually through at least 5 years via structured interviews and medical record review. Kaplan-Meier and Cox proportional hazards models evaluated epilepsy risk, with data censored at loss to follow-up.</p><p><strong>Results: </strong>Among 282 neonates evaluated for epilepsy in NSR-II, 183 (65%) continued into the extended follow-up study. Across the entire follow-up period through early childhood, 50 (18%) developed epilepsy, with a cumulative incidence of 21.6% (95% confidence interval [CI] = 16.7%-27.7%). Earlier epilepsy onset was associated with ≥3 days of neonatal seizures (hazard ratio [HR] = 2.8, 95% CI = 1.5-5.2), abnormal discharge neurological exam (HR = 2.4, 95% CI = 1.3-4.4), and deep gray/brainstem injury (HR = 2.4, 95% CI = 1.2-4.7). Prematurity (<37 weeks) was associated with later epilepsy onset (HR = 3.7, 95% CI = 2.0-6.8). Half (50%) of children with epilepsy developed intractable epilepsy, and 40% required intensive care unit admission. Despite this, only one child received vagus nerve stimulation, and none underwent other epilepsy surgeries.</p><p><strong>Significance: </strong>These findings highlight the early and persistent epilepsy risk after neonatal seizures. Preterm infants face increased risk later in childhood compared to infants born at term. Risk factor stratification may improve early surveillance, guide clinical decisions, and support family counseling. The underutilization of epilepsy surgery in this cohort suggests multifactorial barriers that warrant further investigation.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793760","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":"What matters most to people living with epilepsy? A rapid review of qualitative research relating to health outcomes.","authors":"James W Mitchell, John Doherty, Rachel Batchelor, Adam Noble, Anthony Marson","doi":"10.1111/epi.18570","DOIUrl":"https://doi.org/10.1111/epi.18570","url":null,"abstract":"<p><p>At present, the outcomes measured and reported in clinical trials for adults with epilepsy are heterogenous and have often not been selected in consultation with people living with epilepsy. As part of a wider project developing a core outcome set for clinical trials for adults with epilepsy (the EPSET Project), a rapid review of the published qualitative literature was performed. MEDLINE was searched using an established qualitative methodological search filter to identify studies discussing the views of adults with epilepsy and their representatives. Eligible articles included published free-text verbatim quotations from adults with epilepsy or their representatives discussing potential health outcomes. Data were coded and categorized in line with an established health outcome taxonomy. A total of 614 eligible articles were identified, of which 74 were included as they met the inclusion criteria. In total, the views of more than 2474 adults with epilepsy and 658 caregivers were included from six continents. Of the included studies, 77% used in-depth interviews and 12% used focus groups. A total of 140 individual health outcomes were identified in the included studies across nine outcome domains: seizure-related, cognitive-behavioral-neuropsychological, physical functioning-disability, emotional functioning, social role functioning, global quality of life, side effects and adverse events, fertility-pregnancy-offspring, and death. This is the first review of qualitative studies focusing on health outcomes for adults with epilepsy. The findings confirm that living with epilepsy represents more than living with seizures and highlight the impact of neuropsychiatric symptoms in these populations. Importantly, many outcomes identified from this review are not measured and reported in studies assessing the effectiveness and safety of treatments for epilepsy, supporting the development of a lived experience-informed core outcome set for future effectiveness studies. Furthermore, the findings could be used to inform clinical practice and noninterventional studies across broad geographic, societal, and cultural settings.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793773","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}