Epilepsy & Behavior最新文献

{"title":"Seizure-type-specific treatment responses in Lennox-Gastaut Syndrome: A comprehensive review of pharmacological, neuromodulatory, dietary, and surgical therapies","authors":"Debopam Samanta ,&nbsp;Sunil Naik","doi":"10.1016/j.yebeh.2025.110472","DOIUrl":"10.1016/j.yebeh.2025.110472","url":null,"abstract":"<div><div>Lennox-Gastaut Syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, presenting significant challenges for treatment. This comprehensive review examines seizure-type-specific response patterns to various therapeutic interventions in LGS. We conducted an extensive literature review of randomized controlled trials, observational studies, and real-world evidence, covering research up to February 2025. Our analysis shows that atonic seizures respond particularly well to corpus callosotomy (CC) and Vagus Nerve Stimulation (VNS), with CC demonstrating superior efficacy. Generalized tonic-clonic seizures (GTCS) show favorable responses to antiseizure medications (ASMs) such as felbamate, lamotrigine, topiramate, fenfluramine, lacosamide, and perampanel. Myoclonic seizures tend to respond better to clonazepam, topiramate, zonisamide, brivaracetam, and perampanel, but may show limited responsiveness to neuromodulation and CC. Atypical absence seizures may respond to valproate, topiramate, and rufinamide, but show poor responses to brivaracetam and perampanel. The ketogenic diet and resective epilepsy surgery demonstrate broad efficacy across seizure types, although specific data for each type remain limited. VNS is most effective for atonic and tonic seizures, with less consistent responses in GTCS and focal seizures. Emerging neuromodulation techniques, including deep brain stimulation (DBS) and responsive neurostimulation (RNS), show promise, particularly for tonic and GTCS, but further investigation is needed. This review underscores the importance of tailoring treatment to predominant seizure types and calls for more rigorous, seizure-type-specific outcome reporting in future clinical trials, along with the need for long-term studies. The findings advocate for a precision, network-based approach to treatment, where therapeutic decisions are guided by individual seizure patterns and supported by evidence-based, seizure-type-specific efficacy data.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"170 ","pages":"Article 110472"},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychogenic non-epileptic seizures and the role of the right hemisphere","authors":"Styliani Gousia ,&nbsp;Panayiotis Patrikelis ,&nbsp;Lambros Messinis ,&nbsp;Mary H. Kosmidis ,&nbsp;Vasileios Kimiskidis","doi":"10.1016/j.yebeh.2025.110465","DOIUrl":"10.1016/j.yebeh.2025.110465","url":null,"abstract":"<div><div>Psychogenic non-epileptic seizures (PNES) constitute a puzzling clinical condition often linked to psychological trauma, whose underlying neuropsychopathology remains unclear. Aberrant sensorimotor-cognitive integration normally mediated by the right ventral prefrontal cortex (vPFC) may account for a series of involuntary behavioral patterns. The right hemisphere (RH) plays a crucial role in rapidly detecting emotions and unconscious emotional processing. Difficulties in recognizing and processing emotions, along with impaired behavioral inhibition represent a salient feature among PNES patients. RH’s dominance in unconscious emotional processing is supported by findings both in normality and neuropathology, including historical studies of hysteria, which pointed to left body side manifestations and abnormal responses in patients with right brain damage. Yet, subsequent studies have occasionally challenged this idea. Post ictal or interictal unilateral neglect in seizures arising from the RH may provide further insights. PNES seen in the light of trauma and emotional suppression, along with the somatization assumption of unconscious psychological conflicts sound consistent with the notion of RH as a mediator of self-awareness and the sense of bodily self. In our view, the affection of autonomic-arousal and visceral-emotional functioning, multimodal afferent and efferent affective processing, trauma-dissociation and aberrant conscious behavior may represent neuropsychopathological breakdowns through which RH mediates PNES.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"170 ","pages":"Article 110465"},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epilepsy Research Institute UK Sudden Unexpected Death in Epilepsy (SUDEP) workshop: Identifying the pre-clinical and clinical priorities for SUDEP research","authors":"Hannah Pickard ,&nbsp;Sammy Ashby ,&nbsp;David Sibree ,&nbsp;Martin Elliott ,&nbsp;Amol Bhandare ,&nbsp;Rob. C. Wykes ,&nbsp;Arjune Sen","doi":"10.1016/j.yebeh.2025.110473","DOIUrl":"10.1016/j.yebeh.2025.110473","url":null,"abstract":"<div><div>The Epilepsy Research Institute’s Mortality, Morbidity and Risk Theme workshop on Sudden Unexpected Death in Epilepsy (SUDEP) brought together a diverse group of stakeholders, including basic science researchers, clinicians and clinical researchers, charity partners, bereaved individuals and people with epilepsy to identify important gaps in pre-clinical and clinical SUDEP research. Collectively, the SUDEP workshop highlighted recommendations for future research to address several identified gaps and the need to develop infrastructures that utilise data-driven approaches to reduce SUDEP risk. National and global cross-institution collaborations will be fundamental in driving these research efforts forward.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"171 ","pages":"Article 110473"},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of emergency department physician perspectives on people with functional seizures","authors":"Mackenzi Moore,&nbsp;Meagan Watson,&nbsp;Laura Strom","doi":"10.1016/j.yebeh.2025.110494","DOIUrl":"10.1016/j.yebeh.2025.110494","url":null,"abstract":"<div><h3>Background and objectives</h3><div>People with Functional Seizures (PwFS) often face stigma and mismanagement in the emergency department (ED), which may include misdiagnosis, unnecessary treatment, and delayed care [<span><span>1</span></span>]. Negative biases among providers may contribute to these challenges, affecting patient outcomes. This study examines explicit and implicit stigma toward functional seizures (FS) among ED physicians to identify factors that reduce bias and inform strategies for improving care.</div></div><div><h3>Methods</h3><div>40 ED physicians were recruited via email to complete a 15-minute Qualtrics survey. This survey asked participants about their perspectives of PwFS. Questions were based on a previously validated stigma questionnaire, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC). This was followed by an Implicit Association Test (IAT), which assessed participant’s subconscious biases towards FS compared with other behavioral health disorders. Of the 40 participants, 25 completed the IAT.</div></div><div><h3>Results</h3><div>Responses reflected mixed implicit and explicit attitudes. Explicitly, while participants acknowledged negative reactions toward PwFS, they rejected beliefs that PwFS lack effort and supported advocacy, indicating generally positive explicit attitudes.<!--> <!-->Implicitly, 56% of IAT respondents demonstrated negative bias towards FS, though average scores did not significantly differ from neutrality. Lower implicit bias was observed among those treating both pediatric and adult patients and those with moderate FS patient exposure.</div></div><div><h3>Discussion</h3><div>These findings reflect a complex picture of provider attitudes, with explicit support for PwFS coexisting alongside some indications of implicit bias. Variability in implicit responses by patient exposure and clinical scope suggests that provider experiences may influence underlying attitudes towards FS.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"170 ","pages":"Article 110494"},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-dose diazepam as a long-term treatment strategy for epileptic encephalopathy and developmental epileptic encephalopathy spike-and-wave activation in sleep: A tertiary center’s experience","authors":"Nasrin Hamed ,&nbsp;Efrat Zohar Dayan ,&nbsp;Gali Heimer ,&nbsp;Bruria Ben Zeev ,&nbsp;Michal Tzadok","doi":"10.1016/j.yebeh.2025.110482","DOIUrl":"10.1016/j.yebeh.2025.110482","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the efficacy, safety, developmental and behavioral outcomes associated with 12-month high-dose diazepam (HDD) treatment for epileptic encephalopathy (EE) and developmental epileptic encephalopathy (DEE) spike-and-wave activation in sleep (SWAS).</div></div><div><h3>Methods</h3><div>A single-center prospective study involving twenty patients (mean age 6.1 years, 60 % males) who received two equal doses of oral HDD 1 mg/kg/day (maximum 40 mg), once daily, with a 24-hour interval between doses. Treatment was evaluated by EEG at regular intervals. Patients who exhibited positive responses were subjected to a carefully managed tapering schedule adjusted based on their tolerability. Cognitive changes and adverse events (AEs) were recorded.</div></div><div><h3>Results</h3><div>The average duration of SWAS before HDD treatment was 2.5 years (range: three months to eight years). Ten patients (50 %) showed EEG improvement after one month, with decreasing response rates over time: 25 % at three months and 20 % at 12 months. Additionally, all patients who remained in remission at 12 months were diagnosed with EE-SWAS. AEs occurred in 60 % of patients, including drowsiness (30 %) and behavioral issues (25 %). Four patients (20 %) discontinued treatment due to intolerable AEs.</div></div><div><h3>Conclusions</h3><div>HDD demonstrated promising short-term efficacy in reducing epileptiform activity in children with SWAS, though its long-term effectiveness was modest, with responses declining over time. The treatment was generally well-tolerated. However, the occurrence of AEs underscores the importance of vigilant monitoring and tailored management to maximize its therapeutic potential.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"171 ","pages":"Article 110482"},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and feasibility testing of an implementation evaluation tool: Recommendations from the managing epilepsy well (MEW) network research collaborative","authors":"Martha Sajatovic ,&nbsp;Ross Shegog ,&nbsp;Elaine Kiriakopoulos ,&nbsp;Clara Adeniyi ,&nbsp;Jessie Black ,&nbsp;Barbara C. Jobst ,&nbsp;Erica K. Johnson ,&nbsp;Robin McGee ,&nbsp;Tanya M. Spruill ,&nbsp;Cam Escoffery","doi":"10.1016/j.yebeh.2025.110488","DOIUrl":"10.1016/j.yebeh.2025.110488","url":null,"abstract":"<div><h3>Aims</h3><div>The Managing Epilepsy Well (MEW) Network has led the development, testing and scale-up of epilepsy self-management (ESM). The MEW Integrated Database (MEW DB) is a pooled repository of archival studies that facilitates aggregate analysis. This report describes an implementation evaluation tool for ESM adopters.</div></div><div><h3>Methods</h3><div>Publicly available materials on program implementation, adoption and sustainability as well as readiness surveys used by the MEW Network were reviewed, as were content domains and format styles relevant to ESM implementation. Requirements for data Tiers included: 1) survey Tier should be short (≤6 items) and completed quickly (&lt; 3 min), 2) question and response format should be consistent, 3) data elements are relevant to ESM adopters and 4) the tool should be applicable across ESM programs. Iterative review, discussion and item-ranking yielded a final set of 3 distinct data element Tiers.</div></div><div><h3>Results</h3><div>Implementation data elements assess the characteristics of organization that may be a potential ESM adopter (Tier 1), organizational readiness to ESM implementation (Tier 2) and perceptions of ESM program effects or impact by adopters at the individual and program levels (Tier 3). There are 18 data elements, 6 elements in each Tier. Organizational characteristics reflect health disparities among people with epilepsy and common comorbidities. Implementation readiness barriers include motivational factors, training and resources. Implementation experience/outcomes include perceived ESM duration, credibility, impact, likability and effectiveness.</div></div><div><h3>Conclusions</h3><div>A brief and practical implementation evaluation tool for ESM has potential value and important clinical and policy implications in advancing care for people with epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"171 ","pages":"Article 110488"},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotional processing in epilepsy: Investigating alexithymia and its associated factors","authors":"Katerina Poprelka ,&nbsp;Theodoros Fasilis ,&nbsp;Panayiotis Patrikelis ,&nbsp;Maria Stefanatou ,&nbsp;Evniki Ntinopoulou ,&nbsp;Anastasia Verentzioti ,&nbsp;Athanasia Alexoudi ,&nbsp;Lampis C. Stavrinou ,&nbsp;Stefanos Korfias ,&nbsp;Stylianos Gatzonis","doi":"10.1016/j.yebeh.2025.110469","DOIUrl":"10.1016/j.yebeh.2025.110469","url":null,"abstract":"<div><h3>Background</h3><div>Alexithymia refers to the difficulty in identifying and expressing emotions. Although it is frequently observed in patients with epilepsy (PWE), its relationship with the neurological condition remains poorly understood. This review aims to synthesize existing findings on the relationship between alexithymia and sociodemographic, psychological, and epilepsy-related factors in PWE, offering a comprehensive analysis of how these variables interact to influence alexithymia levels within this population.</div></div><div><h3>Methods</h3><div>The PRISMA guidelines were followed, and a comprehensive search of electronic databases (PubMed, Science Direct) was conducted to identify original research articles published till the end of January 2025 in English. Two reviewers conducted the screening independently. Study quality was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies.</div></div><div><h3>Results</h3><div>Six studies were included in the review involving 832 PWE. The average TAS-20 score across studies indicates moderate levels of alexithymia across studied populations. Psychological factors such as depression, anxiety, emotional dysregulation, stigma, and suicidal ideation are closely related to alexithymia, while the link between alexithymia, sociodemographic, and epilepsy-related characteristics remains less clear.</div></div><div><h3>Conclusion</h3><div>Alexithymia is prevalent in PWE, highlighting emotional processing difficulties as a critical yet often overlooked aspect of the condition. The relationship between alexithymia and various sociodemographic, psychological, and epilepsy-related factors is complex and multifaceted. Future research is essential to understand these associations better and to develop targeted interventions that address the emotional and psychological needs of PWE.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"170 ","pages":"Article 110469"},"PeriodicalIF":2.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors and prevalence of acute symptomatic seizures among patients with acute traumatic brain injuries","authors":"Konstantin Kohlhase ,&nbsp;Adam Strzelczyk ,&nbsp;Laurent M. Willems ,&nbsp;Luis Mandelka ,&nbsp;Sarah C. Reitz ,&nbsp;Marcus Czabanka ,&nbsp;Moritz Funke ,&nbsp;Christian Grefkes ,&nbsp;Ingo Marzi ,&nbsp;Cora Schindler ,&nbsp;Ferdinand O. Bohmann","doi":"10.1016/j.yebeh.2025.110487","DOIUrl":"10.1016/j.yebeh.2025.110487","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic brain injuries (TBI) significantly contribute to hospital admissions in Europe. Acute symptomatic seizures (ASz), occurring within seven days post-TBI, increase morbidity and mortality. This study analyzes the frequency, risk factors, and short-term outcomes of ASz in patients with acute TBI.</div></div><div><h3>Material and methods</h3><div>This retrospective study included 212 patients with acute TBI admitted to the University Hospital Frankfurt/Germany between 2018 and 2021. Data were collected on demographics, injury characteristics, clinical course, and outcomes. ASz were defined as clinically or electroencephalographically detected seizures within seven days post-TBI. Logistic regression was used to identify predictors of ASz and non-convulsive status epilepticus (NCSE).</div></div><div><h3>Results</h3><div>ASz occurred in 17.9 % (n = 38) of patients, with a mean latency of 2.4 ± 1.9 days post-TBI. Status epilepticus developed in 47.4 % (n = 18) of these patients, predominantly as NCSE (n = 15). Predictors of ASz included older age (OR = 1.034, p = 0.012), higher Glasgow Coma Scale (GCS) at 24 h (OR = 1.133, p = 0.021), severe TBI (OR = 5.085, p = 0.018), and pneumonia (OR = 5.828, p = 0.007). For NCSE, significant predictors were older age (OR = 1.059, p = 0.021), pneumonia (OR = 6.766, p = 0.012), and urinary tract infection (OR = 7.38, p = 0.012). Patients with ASz had a significantly worse modified Rankin Scale (mRS) score at discharge (OR = 5.01, CI: 1.93–13.0, p &lt; 0.001)).</div></div><div><h3>Conclusion</h3><div>ASz are a frequent and serious complication of TBI, particularly in severe cases and older patients. Early identification of high-risk patients using predictive factors such as age, GCS, and pneumonia may result in earlier treatment and improved outcomes. The findings highlight the importance of dedicated epilepsy monitoring in acute TBI care.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"170 ","pages":"Article 110487"},"PeriodicalIF":2.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing sleep disturbance and daytime sleepiness in people with epilepsy: A United Kingdom survey of four categories of healthcare professional","authors":"Guy Leschziner ,&nbsp;Elisa Bruno ,&nbsp;Marta Torres Arlandis","doi":"10.1016/j.yebeh.2025.110483","DOIUrl":"10.1016/j.yebeh.2025.110483","url":null,"abstract":"<div><div>Sleep disorders are more common in People With Epilepsy (PWE) than in healthy populations and affect one-third of PWE. Identifying and treating sleep disorders in PWE significantly improves health outcomes, leading to better quality of life and seizure control. Systematic sleep screenings of PWE and their bed partners are therefore highly recommended as addressing sleep disorders offers a potential disease-modifying strategy. However, evidence shows that sleep disorders in epilepsy are largely under-recognised, under-diagnosed and untreated in clinical practice. There is a lack of understanding of how healthcare practitioners (HCPs) perceive the burden of sleep disturbance and how they screen for sleep disturbances in PWE. This study aimed to assess how different categories of HCPs perceive the burden of sleep disturbance in PWE in the UK, and to determine which tools they use to measure sleep disturbance and sleep quality in clinical practice. A total of 100 HCPs (general practitioners, general neurologists, epileptologists, epilepsy specialist nurses) completed a 30-minute online questionnaire about their clinical practice and how they screen and manage sleep disorders in PWE. Our findings confirmed that sleep disturbance is common in PWE. HCPs considered sleep disturbance a burden in PWE with the majority taking it into consideration when prescribing antiseizure medications. However, there was variable awareness and/or utilisation of the different sleep questionnaires, suggesting the need for education on these tools and on the management and recognition of sleep disturbance in PWE and innovative ways to administer sleep questionnaires to minimise the time/administrative burden on HCPs.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"170 ","pages":"Article 110483"},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of fatigue among adults with epilepsy: Should we focus solely on antiseizure medication effects?","authors":"Kristijonas Puteikis ,&nbsp;Benas Matuzevičius ,&nbsp;Rūta Mameniškienė","doi":"10.1016/j.yebeh.2025.110480","DOIUrl":"10.1016/j.yebeh.2025.110480","url":null,"abstract":"<div><h3>Introduction</h3><div>Fatigue is a frequent, albeit underexplored symptom among people with epilepsy (PWE). We aimed to investigate factors associated with fatigue among PWE with a special focus on antiseizure medication (ASM) use.</div></div><div><h3>Methods</h3><div>We conducted an anonymous cross-sectional survey among adult outpatients asking them to complete instruments assessing fatigue (the Fatigue Severity Scale, FSS), symptoms of anxiety (Generalized Anxiety Disorder-7, GAD-7), depression (Neurological Disorders Depression Inventory for Epilepsy, NDDI-E) as well as provide data on adverse ASM effects (Liverpool Adverse Events Profile, LAEP), medication type, number, adherence and self-reported treatment efficacy. Independent-samples <em>t</em>-test and Mann-Whitney <em>U</em> test (two groups) or analysis of variance and Kruskal-Wallis tests (more than two groups) were used for between-group comparisons. Correlation and linear multiple regression analysis was done in search of factors associated with fatigue. Multiple imputation was used for sensitivity analysis to account for missing data.</div></div><div><h3>Results</h3><div>The study sample comprised 232 PWE (130 (56.0 %) female, average age 39.1 ± 14.7 years) with 190 (81.9 %) PWE having completed the FSS and 40.5 % among them reporting clinically significant fatigue (FSS score ≥ 4). Higher FSS scores were associated with female sex (t = –2.086, p = 0.038), higher seizure frequency (r = 0.183, p = 0.020), missing at least one dose of ASMs in the past month (t = 2.491, p = 0.014), symptoms of anxiety (GAD-7, r = 0.510, p &lt; 0.001), depression (NDDI-E, r = 0.453, p &lt; 0.001) and adverse ASM profile (LAEP, r = 0.565, p &lt; 0.001). The FSS score was inversely related to self-reported efficacy of epilepsy treatment (r = –0.277, p &lt; 0.001) and independent of the ASM count, duration of use, recent changes in ASM regimen, frequency of non-adherence or the use of concomitant medications (p &gt; 0.05). FSS scores also did not differ across subgroups based on specific ASM use. Adverse ASM effects (LAEP), symptoms of anxiety (GAD-7) and the subjectively perceived efficacy of current treatment were independent factors associated with results of the FSS in a multiple regression model (F(3, 130) = 27.310, p &lt; 0.001, <span><math><msubsup><mi>R</mi><mrow><mi>adj</mi></mrow><mn>2</mn></msubsup></math></span> = 0.372).</div></div><div><h3>Conclusion</h3><div>Our data suggests that fatigue among PWE is mostly associated with symptoms of anxiety, adverse ASM effects and self-reported treatment efficacy. Regardless of the type and count of ASMs, special attention to self-reported tolerability and efficacy, alongside psychological symptomatology, could help to reduce fatigue among PWE when adjusting treatment.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"170 ","pages":"Article 110480"},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}