Epilepsy Research最新文献

{"title":"Associating clinical outcomes and number of antiseizure medications in refractory status epilepticus","authors":"Jacob Smearman ,&nbsp;Brittany Cunningham ,&nbsp;Melissa Fowler ,&nbsp;Enyinna Nwachuku","doi":"10.1016/j.eplepsyres.2025.107547","DOIUrl":"10.1016/j.eplepsyres.2025.107547","url":null,"abstract":"<div><h3>Background/objective</h3><div>Prior studies have not directly evaluated the association between number of antiseizure medications (ASMs) and neurological outcomes. The objective of this study was to evaluate the association between the number of ASMs administered to patients in refractory SE and modified Rankin Scale (mRS) score at discharge.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort analysis of adults with SE from 2020 to 2023. Exclusion criteria included pregnancy, post-arrest myoclonus, and ≤ 2 non-benzodiazepine ASMs during admission. Patients were grouped by number of non-benzodiazepine ASMs received during admission (2, 3, or ≥4 ASMs). The primary outcome was mRS score at discharge.</div></div><div><h3>Results</h3><div>The study included 287 patients (2 ASMs: 86, 3 ASMs: 82, ≥4 ASMs: 119), predominantly white (52.6 %) non-Hispanic (92.0 %) males (57.8 %) aged 55 – 60 years. Most patients had a history of epilepsy (73.9 %) and presented with convulsive SE (66.9 %). Patients receiving ≥ 4 ASMs had a higher median mRS score (4 vs. 1 vs. 1, p = 0.0001) and higher level of care at discharge (p = 0.0001) than comparators. Hospital and intensive care unit lengths of stay were longer in the ≥ 4 ASM group (12.2 and 6.0 days, respectively) than in comparator groups (2 ASMs: 5.5 and 2.2 days; 3 ASMs: 5.8 and 2.8 days; p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The results of this study suggest that patients requiring ≥ 4 ASMs for treatment of SE have worse neurological outcomes. These results may inform treatment preferences for refractory SE and provide data for risk-benefit discussions.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"213 ","pages":"Article 107547"},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enteral topiramate treatment in refractory status epilepticus","authors":"Selda Keskin-Güler ,&nbsp;Ömer Karadaş ,&nbsp;Murat Mert Atmaca ,&nbsp;Sibel Üstün Özek ,&nbsp;Gulshan Yunisova ,&nbsp;Eser Buluş ,&nbsp;Fulya Eren ,&nbsp;Melek Colak Atmaca ,&nbsp;Aylin Reyhani ,&nbsp;Candan Gürses","doi":"10.1016/j.eplepsyres.2025.107551","DOIUrl":"10.1016/j.eplepsyres.2025.107551","url":null,"abstract":"<div><h3>Objective</h3><div>Refractory status epilepticus (RSE) is defined as persistent seizure activity despite first- and second-line antiepileptic medications (ASMs). Although benzodiazepines and a range of iv ASMs are available, mortality is 3–4 times higher than in those without RSE. Topiramate (TPM), a broad-spectrum ASM, may have neuroprotective, anti-inflammatory, and mitigating effects on neuronal injury. We aimed to investigate the efficacy of TPM and mortality in RSE.</div></div><div><h3>Methods</h3><div>This retrospective, multicentre study was conducted on RSE ≥ 18 years of age in six different universities and state hospitals in Ankara and Istanbul, Turkey. Demographic data, seizure classification and etiology were analyzed. TPM was loaded and a maintenance dose was scheduled. The outcomes, prognoses, comorbidities were analysed. The effectiveness of TPM and mortality rates of the patients were also analyzed.</div></div><div><h3>Results</h3><div>The study includes 60 patients with a mean age of 51.6 (±20, 20–84) years, 46.7 % were women. The patients were classified as having convulsive SE or nonconvulsive SE. TPM was performed as median third order ASM. The loading dose varied between 200 and 500 mg bid. The dose was subsequently reduced and maintained at 100–200 mg/day. There were 6 patients in whom TPM could not be continued due to adverse effects. TPM was considered successful in 22 patients, possibly successful in 23 patients and unsuccessful in 15 patients. Thirty-three patients were discharged from hospital, 8 were transferred to a rehabilitation center, 4 were transferred to a palliative care center and 13 died. There was no effect of age, gender, whether intubation was performed or not, etiologic classification, SE type (convulsive or nonconvulsive), duration of TPM administration, TPM loading dose on TPM success. Patients with RSE who were successfully treated with TPM had shorter hospital stays. The mortality predicting variables were determined as older age, not having epilepsy, failure to terminate RSE and acute symptomatic etiology.</div></div><div><h3>Significance</h3><div>This observational, multicenter study indicates that enteral TPM therapy is well tolerated, has a favorable safety profile, and is effective in patients with RSE. This is the first study in the literature to end SE with both high and low dose oral TPM treatment.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"213 ","pages":"Article 107551"},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between ghrelin, epilepsy-related inflammatory biomarkers (IL-1β, IL-1R1, HMGB1), and drug-resistant epilepsy in children","authors":"Betül Diler Durgut ,&nbsp;Beril Dilber ,&nbsp;Tülay Kamaşak ,&nbsp;Hüseyin Yaman ,&nbsp;Ömer Faruk Saz ,&nbsp;Cevriye Ceyda Kolaylı ,&nbsp;Pınar Özkan Kart ,&nbsp;Sevim Şahin ,&nbsp;Ali Cansu","doi":"10.1016/j.eplepsyres.2025.107553","DOIUrl":"10.1016/j.eplepsyres.2025.107553","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to investigate the relationship between ghrelin levels and severity of inflammation in children with epilepsy by evaluating the differences in total ghrelin, High Mobility Group Box 1 (HMGB1), Interleukin-1 Receptor Type 1 (IL1R1), and Interleukin-1 Beta (IL1-β) levels in patients with drug-resistant and non-drug-resistant epilepsy and comparing these parameters with those of healthy controls.</div></div><div><h3>Methods</h3><div>We measured total ghrelin, HMGB1, IL1R1, and IL1-β levels—known to play roles in epileptogenesis—in patients with severe (n: 28), mild (n:29) epilepsy, and 31 healthy controls. The severe epilepsy group included patients with treatment-resistant epilepsy, while the mild epilepsy group consisted of patients whose seizures could be controlled with monotherapy.</div></div><div><h3>Results</h3><div>Total ghrelin levels, along with HMGB1, IL1R1, and IL1-β, were significantly elevated in children with epilepsy compared to healthy controls. This increase was more pronounced in the drug-resistant epilepsy group, suggesting a potential role for ghrelin in drug-resistant epilepsy. While no direct correlation was found between ghrelin and the inflammatory markers, we observed that ghrelin levels rose significantly when levels of IL1R1, IL1-β, and HMGB1 surpassed their respective cut-off values in epilepsy patients. The biomarkers IL1R1 and IL1-β had the strongest discriminative potential in distinguishing patients with severe epilepsy from healthy controls. Although ghrelin was not as powerful a diagnostic marker as IL1R1 or IL1-β, it still showed moderate diagnostic value.</div></div><div><h3>Conclusion</h3><div>Ghrelin could serve as a biomarker reflecting both inflammation and drug resistance in epilepsy. It may be associated with inflammatory responses in epilepsy and could play a potential role in the pathophysiology of the disease.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"213 ","pages":"Article 107553"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombin mediates seizures following cortical injury-induced status epilepticus","authors":"Tanveer Singh ,&nbsp;Arnav Mehra ,&nbsp;Tamal Batabyal ,&nbsp;Suchitra Joshi ,&nbsp;Jaideep Kapur","doi":"10.1016/j.eplepsyres.2025.107549","DOIUrl":"10.1016/j.eplepsyres.2025.107549","url":null,"abstract":"<div><div>The neurobiological mechanisms underlying acute seizures, status epilepticus (SE), and cerebral edema following cortical insult are unknown. Currently, benzodiazepines are first-line therapy for SE, and mechanistic insight could lead to improved treatment for cortical-injury-related seizures. Cobalt was implanted in the supplementary motor cortex (M2). Homocysteine was administered sixteen hours later, which converted focal seizures to SE. Seizures were monitored by video-EEG. Blood-brain barrier (BBB) damage was assessed using Evans blue staining and Western blotting. Cerebral edema was evaluated using MRI and a wet-dry method of measuring brain water content. We also assessed if diazepam and thrombin inhibitor α-naphthylsulphonylglycyl-4-amidinophenylalanine piperidine (α-NAPAP) administered individually or together treated seizures and protected animals from edema and mortality. Blood proteins thrombin and albumin were present in the brain parenchyma, primarily in the ipsilateral hemisphere, of animals in SE. Evans blue staining revealed a wider spread of albumin in post-SE animals compared to those in early SE. The seizures rapidly became diazepam-resistant, and the drug did not reduce death due to cerebral edema. Thrombin inhibitor α-NAPAP reduced cerebral edema and prevented seizures. A combination of diazepam and α-NAPAP treatment suppressed seizures, lowered edema, and improved survival. Thrombin extravasation triggers seizures and edema following neocortical injury, and it is a therapeutic target. A combination of benzodiazepines and anti-thrombin agents could terminate SE and reduce mortality.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"213 ","pages":"Article 107549"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of oral anti-seizure medication via nasogastric tube to treat IV-diazepam resistant status epilepticus in a setting with limited resources: An observational study","authors":"Fitri Octaviana ,&nbsp;Adrian Ridski Harsono ,&nbsp;Winnugroho Wiratman ,&nbsp;Luh Ari Indrawati ,&nbsp;Astri Budikayanti","doi":"10.1016/j.eplepsyres.2025.107544","DOIUrl":"10.1016/j.eplepsyres.2025.107544","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the availability of new antiseizure medications (ASM), status epilepticus (SE) is still associated with a high mortality rate. One third of cases present with benzodiazepine resistance. The availability of intravenous ASMs in Indonesia is limited, meaning that the use of oral ASMs to treat SE is unavoidable. This study aimed to determine whether oral formulations of levetiracetam, topiramate, and valproic acid could successfully terminate diazepam-resistant SE.</div></div><div><h3>Methods</h3><div>This prospective cohort study was conducted at Dr. Cipto Mangunkusumo National Hospital between June 2021 and March 2023. Patients with SE aged over 18 years, who achieved clinically apparent seizure cessation with second-line oral ASMs following diazepam, were enrolled. Plasma levels of ASMs were assessed 24 h after the last seizure. Demography, clinical characteristics, and the percentage of successful seizure termination was recorded, as well as duration of seizure termination.</div></div><div><h3>Results</h3><div>Of the 53 participants, 33, 15, and 5 subjects were administered levetiracetam, topiramate, and valproic acid respectively. Of these, 26 (79 %), 15 (100 %), and 4 (80 %) achieved seizure termination. The median dose required to terminate clinically apparent seizures for oral formulations of levetiracetam, topiramate, and valproic acid were 23 mg/kg, 6 mg/kg, and 20 mg/kg. Seizure termination duration was significantly longer in the topiramate group. Median plasma levels (µg/ml) for levetiracetam, topiramate, and valproic acid among subjects who achieved seizure termination with one second-line ASM were 18.3, 9.5, and 43.2. The 30-day mortality rate among subjects administered levetiracetam, topiramate, and valproic acid, was 15 %, 53 %, and 40 %, respectively.</div></div><div><h3>Conclusion</h3><div>Oral ASMs can be a viable option for the treatment of diazepam-resistant SE in settings with limited resources, where intravenous formulations are not attainable.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"212 ","pages":"Article 107544"},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of seizure video recordings in the diagnosis of referred drug-resistant epilepsy: A stepwise approach","authors":"Duy Duan Nguyen ,&nbsp;Thi Kim Anh Tran ,&nbsp;Thi Phuoc Yen Tran ,&nbsp;Quoc Nguyen Bao Pham ,&nbsp;Toan Dinh Nguyen","doi":"10.1016/j.eplepsyres.2025.107530","DOIUrl":"10.1016/j.eplepsyres.2025.107530","url":null,"abstract":"<div><h3>Background</h3><div>Patient-recorded videos offer a practical alternative for diagnosing epilepsy and psychogenic nonepileptic seizures (PNES), yet their diagnostic value across sequential clinical questions remains underexplored.</div></div><div><h3>Objective</h3><div>To assess the diagnostic utility of patient-recorded seizure videos in distinguishing epilepsy from PNES, classifying seizure types, and localizing and lateralizing epileptic foci, as well as their impact on physician confidence and interrater reliability.</div></div><div><h3>Methods</h3><div>In this prospective two-phase study, 40 patients referred for drug-resistant epilepsy evaluation were screened, 30 of whom met the inclusion criteria. Diagnoses were made by one neurologist and confirmed by an independent neurologist via clinical data, electroencephalography, neuroimaging, and patient-recorded videos. Three neurologists independently reviewed cases across four diagnostic steps: (1) epilepsy vs. PNES, (2) focal vs. generalized epilepsy, (3) seizure localization: temporal vs. extratemporal, and (4) seizure lateralization: right vs. left. Diagnostic accuracy, physician confidence, and interrater reliability were analyzed before and after video integration.</div></div><div><h3>Results</h3><div>Diagnostic accuracy achieved excellent results before and after watching videos in Step 1 (91.67–95 %) and Step 2 (95.93–100 %). After the videos were reviewed, the accuracies in Steps 3 and 4 were good, reaching 83.87 % and 81.48 %, respectively. Videos significantly increased physician confidence across all steps. Interrater reliability improved for Steps 1 and 2–0.67 and 1.00, respectively. Those of seizure localization and lateralization slightly decreased, accompanied by increased accuracy, reflecting a trend toward inconsistent alterations to correct diagnoses among physicians.</div></div><div><h3>Conclusion</h3><div>The accuracy of epilepsy diagnosis in steps 1 and 2 is excellent, and that in steps 3 and 4 is good. Their integration with v-EEG and other diagnostic modalities, such as neuroimaging and invasive techniques, can enhance diagnostic workflows by providing complementary semiological information. Further studies with larger cohorts are warranted to confirm these findings and optimize their application in clinical practice.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"211 ","pages":"Article 107530"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Significant reduction of seizure frequency in patients with drug-resistant epilepsy by vagus nerve stimulation: Systematic review and meta-analysis” [Epilepsy Res. 210 (2025) 107510]","authors":"Malaisamy Muniyandi ,&nbsp;Karthick Chelvanayagam ,&nbsp;Sahil Abdul Salam ,&nbsp;Sathishkumar Vadamalai ,&nbsp;Kavitha Rajsekar ,&nbsp;Rajeswari Ramachandran","doi":"10.1016/j.eplepsyres.2025.107519","DOIUrl":"10.1016/j.eplepsyres.2025.107519","url":null,"abstract":"","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"211 ","pages":"Article 107519"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Long-term outcome and predictors of vagus nerve stimulation for drug-resistant epilepsy: Real-world evidence from the Korean National Hospital Consortium” [Epilepsy Res. 210 (2025) 107511 0920-1211]","authors":"Seo-Young Lee ,&nbsp;Hyesung Lee ,&nbsp;Jae-Wook Cho ,&nbsp;Kyung Wook Kang ,&nbsp;Jong-Geun Seo ,&nbsp;Jon Soo Kim ,&nbsp;Joon-Won Kang ,&nbsp;Daeyoung Kim ,&nbsp;Young-Soo Kim ,&nbsp;Sun Ah Choi ,&nbsp;Jeonghoon Park ,&nbsp;Ji Hoon Phi ,&nbsp;Sang Ook Nam ,&nbsp;Won Seop Kim ,&nbsp;Jae-Moon Kim ,&nbsp;Ki Joong Kim ,&nbsp;Korean National Hospital Consortium for VNS Outcome Study","doi":"10.1016/j.eplepsyres.2025.107522","DOIUrl":"10.1016/j.eplepsyres.2025.107522","url":null,"abstract":"","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"211 ","pages":"Article 107522"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracellular bromide enhances GABAA receptor function in the immature, but not the adolescent rat pilocarpine epilepsy model","authors":"Heiner Kolp ,&nbsp;Jana K. Hackert ,&nbsp;Marco Heerdegen ,&nbsp;Christa Unger ,&nbsp;Tina Sellmann ,&nbsp;Katrin Porath ,&nbsp;Valentin Neubert ,&nbsp;Marco Weiergräber ,&nbsp;Timo Kirschstein ,&nbsp;Rüdiger Köhling","doi":"10.1016/j.eplepsyres.2025.107535","DOIUrl":"10.1016/j.eplepsyres.2025.107535","url":null,"abstract":"<div><h3>Objective</h3><div>To study the effects of extracellular bromide in a novel immature rat pilocarpine model compared to the standard adolescent rat model.</div></div><div><h3>Methods</h3><div>We employed an immature rat model of repetitive pilocarpine-induced status epilepticus (340 mg/kg on postnatal days 9, 11 and 15). The electrophysiological characterization of the Schaffer collateral CA1-synapse and of CA1 pyramidal neurons was performed in 30–70 day-old animals. To explore the effects of bromide, 20 mM NaCl in the bath solution was replaced by 20 mM NaBr. We compared our findings in the immature model with data from the standard adolescent model of a single pilocarpine-induced status epilepticus (340 mg/kg on postnatal day 30) obtained from 40−90 day-old animals.</div></div><div><h3>Results</h3><div>In the immature, but not in the adolescent model, extracellular bromide (20 mM) enhanced the GABA_A-receptor component of the inhibitory postsynaptic potential, hyperpolarized the GABA_A-receptor reversal potential and reduced intrinsic excitability. However, bromide left high-frequency stimulation-induced long-term potentiation unaltered – in both the immature and the adolescent model.</div></div><div><h3>Significance</h3><div>The immature model, but not the commonly used adolescent pilocarpine model, showed a persistent bromide-enhanced GABA_A-receptor function leading to reduced intrinsic excitability. Hence, we suggest that immature animal models are needed to explore novel therapeutic strategies for epilepsies acquired during infancy.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"211 ","pages":"Article 107535"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inductive reasoning with large language models: A simulated randomized controlled trial for epilepsy","authors":"Daniel M. Goldenholz ,&nbsp;Shira R. Goldenholz ,&nbsp;Sara Habib ,&nbsp;M. Brandon Westover","doi":"10.1016/j.eplepsyres.2025.107532","DOIUrl":"10.1016/j.eplepsyres.2025.107532","url":null,"abstract":"<div><h3>Introduction</h3><div>To investigate the potential of using artificial intelligence (AI), specifically large language models (LLMs), for synthesizing information in a simulated randomized clinical trial (RCT) for an anti-seizure medication, cenobamate, demonstrating the feasibility of inductive reasoning via medical chart review.</div></div><div><h3>Methods</h3><div>An LLM-generated simulated RCT was conducted, featuring a placebo arm and a full-strength drug arm with a cohort of 240 patients divided 1:1. Seizure counts were simulated using a realistic seizure diary simulator. The study utilized LLMs to generate clinical notes with four neurologist writing styles and random extraneous details. A secondary LLM pipeline synthesized data from these notes. The efficacy and safety of cenobamate in seizure control were evaluated by both an LLM-based pipeline and a human reader.</div></div><div><h3>Results</h3><div>The AI analysis closely mirrored human analysis, demonstrating the drug's efficacy with marginal differences (&lt;3 %) in identifying both drug efficacy and reported symptoms. The AI successfully identified the number of seizures, symptom reports, and treatment efficacy, with statistical analysis comparing the 50 %-responder rate and median percentage change between the placebo and drug arms, as well as side effect rates in each arm.</div></div><div><h3>Discussion</h3><div>This study highlights the potential of AI to accurately analyze noisy clinical notes to inductively produce clinical knowledge. Here, treatment effect sizes and symptom frequencies derived from unstructured simulated notes were inferred despite many distractors. The findings emphasize the relevance of AI in future clinical research, offering a scalable and efficient alternative to traditional labor-intensive data mining.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"211 ","pages":"Article 107532"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}