Epilepsy Research最新文献

{"title":"Validation of hemispherectomy outcome prediction scale in treatment of medically intractable epilepsy","authors":"Ashley M. Howell,&nbsp;Shelly Wang,&nbsp;John Ragheb,&nbsp;Julia Decker,&nbsp;Erik C. Brown","doi":"10.1016/j.eplepsyres.2024.107477","DOIUrl":"10.1016/j.eplepsyres.2024.107477","url":null,"abstract":"<div><div>The Hemispherectomy Outcome Prediction Scale (HOPS) was developed to aid both clinicians and patients in determining the chance of success after hemispheric surgery for medically refractory epilepsy. The original study generating HOPS had a multi-institutional, large cohort format yielding near perfect patient stratification. Evidence suggests that methodologies utilized to create such predictive models, including cross-validation as well as stratification utilizing the same data employed for model generation, may be at risk of an undesirable modeling phenomenon known as overfitting. We posed the question of whether overfitting may be influencing HOPS results and aimed for preliminary evidence of external validation with parameters from patients at our institution not included in the original HOPS study. We found HOPS to stratify our limited post-operative cohort adequately. However, the likelihood of complete seizure freedom among the patients predicted by HOPS to be at greatest chance of success was ∼75 %, about 20 points lower than in the original HOPS cohort. This reduction in absolute chance of success predicted by HOPS may represent some degree of overfitting. It will be informative to aim for external validation of HOPS utilizing patient cohorts entirely separate from those used for model generation. External validation of HOPS and similar models could optimize realistic prediction of success after intervention.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107477"},"PeriodicalIF":2.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644216","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":"MicroRNAs as potential biomarkers of response to modified Atkins diet in treatment of adults with drug-resistant epilepsy: A proof-of-concept study","authors":"Raquel Samões ,&nbsp;Ana Cavalheiro ,&nbsp;Cristina Santos ,&nbsp;Joana Lopes ,&nbsp;Catarina Teixeira ,&nbsp;Maria Manuel Tavares ,&nbsp;Cláudia Carvalho ,&nbsp;Carolina Lemos ,&nbsp;Paulo Pinho e Costa ,&nbsp;Sara Cavaco ,&nbsp;João Chaves ,&nbsp;Bárbara Leal","doi":"10.1016/j.eplepsyres.2024.107478","DOIUrl":"10.1016/j.eplepsyres.2024.107478","url":null,"abstract":"<div><h3>Background</h3><div>Accurate predictors of response to modified Atkins diet (MAD) are needed. MicroRNAs are potential biomarkers in epilepsy. This study aimed to explore the value of circulating miR-146a, miR-155, miR-22, miR-21 and miR-134 levels in predicting response to MAD.</div></div><div><h3>Methods</h3><div>Patients who completed 3 months of MAD were selected from a prospective cohort of adults with DRE followed in a specialized MAD outpatient clinic. Patients were classified as responders if any reduction in seizure frequency at follow-up, calculated through seizure-calendars). The &gt;50 % seizure reduction cut-off was also explored. Qualitative benefits in seizures and cognition were analysed. Blood samples were collected prior to initiate MAD and microRNAs were quantified by qRT-PCR.</div></div><div><h3>Results</h3><div>Thirty-nine patients were included (56 %males, mean age=33.1±8.5yo, 62 %focal epilepsies, 59 %structural aetiology): 20(51 %) were responders [mean reduction in seizure frequency=54 %(17–100 %); 10 had ≥50 % reduction]; 25(64 %) reported qualitative benefit in seizures and 21(54 %) reported cognitive benefits. At pre-treatment baseline, a panel combining serum levels of all studied microRNAs predicted seizure reduction (AUC=0.839, p&lt;0.0001), qualitative benefit in seizures (AUC=0.683, p=0.048) and in cognition (AUC=0.751, p&lt;0.01) at 3months. miR-146a was the only significant microRNA when evaluated in isolation. There was no statistical correlation in the biomarkers when a ≥50 % seizure reduction was compared to &lt;50 %.</div></div><div><h3>Conclusions</h3><div>A panel combining pre-treatment serum levels of miR-146a, miR-155, miR-134, miR-21 and miR-22 predicted any reduction in seizures with MAD in adults with DRE at 3months. This panel may be a promising biomarker and a useful tool in the selection of patients.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107478"},"PeriodicalIF":2.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616803","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":"Necessary for seizure forecasting outcome metrics: Seizure frequency and benchmark model","authors":"Chi-Yuan Chang ,&nbsp;Boyu Zhang ,&nbsp;Robert Moss ,&nbsp;Rosalind Picard ,&nbsp;M. Brandon Westover ,&nbsp;Daniel Goldenholz","doi":"10.1016/j.eplepsyres.2024.107474","DOIUrl":"10.1016/j.eplepsyres.2024.107474","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to illustrate the connection between seizure frequency (SF) and performance metrics in seizure forecasting, and to compare the effectiveness of a moving average (MA) model versus the commonly used permutation benchmark.</div></div><div><h3>Methods</h3><div>Metrics of calibration and discrimination were computed for each dataset, comparing MA and permutation performance across SF values. Three datasets were used: (1) self-reported seizure diaries from 3994 Seizure Tracker patients, (2) automatically detected and sometimes manually reported or edited generalized tonic-clonic seizures from 2350 Empatica Embrace 2 and Mate App users, and (3) simulated datasets with varying SFs.</div></div><div><h3>Results</h3><div>Most metrics were found to depend on SF. The MA model outperformed or matched the permutation model in all cases. These more advanced metrics show that comparison to permutation will falsely elevate poor forecasting models.</div></div><div><h3>Conclusions</h3><div>The findings highlight SF's role in seizure forecasting accuracy and the MA model's suitability as a benchmark. This study underscores the need for considering patient SF in forecasting studies and suggests the MA model may provide a better standard for evaluating future seizure forecasting models.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107474"},"PeriodicalIF":2.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616826","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":"Prevalence, clinical characteristics and outcomes of seizures in neurofibromatosis type 1: A systematic review and single arm meta-analysis","authors":"Fan Wu ,&nbsp;Xinna Ji ,&nbsp;Mengxiao Shen ,&nbsp;Peidi Cheng ,&nbsp;Yanyan Gao ,&nbsp;Wanting Liu ,&nbsp;Jinxiao Chen ,&nbsp;Shuo Feng ,&nbsp;Huanhuan Wu ,&nbsp;Fei Di ,&nbsp;Yunlin Li ,&nbsp;Jianhua Wang ,&nbsp;Xue Zhang ,&nbsp;Qian Chen","doi":"10.1016/j.eplepsyres.2024.107476","DOIUrl":"10.1016/j.eplepsyres.2024.107476","url":null,"abstract":"<div><h3>Background</h3><div>Neurofibromatosis type 1 (NF1) is a common neurocutaneous syndrome that predisposes patients to seizures. We aimed to estimate the prevalence, clinical characteristics and outcomes of seizures in NF1 patients, and analyze prognostic factors of seizures.</div></div><div><h3>Methods</h3><div>Systematic searches were conducted in the PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and grey literature databases from inception to April 2024. We identified observational studies that included NF1 patients with seizures. Clinical characteristics of seizures were summarized and meta-analyses of prevalence and outcomes were conducted. We assessed publication bias using funnel plots and conducted sensitivity analysis to assess stability and reliability. Individual patient data were analyzed to evaluate prognostic factors.</div></div><div><h3>Results</h3><div>Fourteen studies were identified from 1021 records. A total of 337 patients with seizures from 4946 NF1 patients were included. Meta-analysis indicated the overall prevalence of seizures in NF1 patients was 8.1 % (95 % CI= 5.9–10.3 %). The first seizure usually occurs in childhood, with a median age range of 3.5–12.0 years. Focal seizures (54.2 %) and generalized tonic-clonic seizures (16.8 %) were the most common types. The seizure freedom rate was 68.5 % (95 % CI= 57.5–79.5 %), mostly with one or two antiseizure medications. Cortical malformation/hippocampus sclerosis emerged as an independent risk factor for persistent seizures (OR=5.19, 95 %CI=1.27–21.18, P=0.02).</div></div><div><h3>Conclusion</h3><div>Though NF1 patients face a higher risk of seizures than the general population, the majority achieve seizure freedom. Patients with cortical malformation or hippocampus sclerosis were at a higher risk of persistent seizures.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107476"},"PeriodicalIF":2.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616931","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":"A universal method for seizure onset zone localization in focal epilepsy using standard deviation of spike amplitude","authors":"Xiang Ji ,&nbsp;Yuanyuan Dang ,&nbsp;Ming Song ,&nbsp;Aijun Liu ,&nbsp;Hulin Zhao ,&nbsp;Tianzi Jiang","doi":"10.1016/j.eplepsyres.2024.107475","DOIUrl":"10.1016/j.eplepsyres.2024.107475","url":null,"abstract":"<div><h3>Background</h3><div>Precisely localizing the seizure onset zone (SOZ) is critical for focal epilepsy surgery. Existing methods mainly focus on high-frequency activities in stereo-electroencephalography, but often fail when seizures are not driven by high-frequency activities. Recognized as biomarkers of epileptic seizures, ictal spikes in SOZ induce epileptiform discharges in other brain regions. Based on this understanding, we aim to develop a universal algorithm to localize SOZ and investigate how ictal spikes within the SOZ induce seizures.</div></div><div><h3>Methods</h3><div>We proposed a novel metric called standard deviation of spike amplitude (SDSA) and utilized channel-averaged SDSA to describe seizure processes and detect seizures. By integrating SDSA values in specific intervals, the score for each channel located within SOZ was calculated. Channels with high SOZ scores were clustered as SOZ. The localization accuracy was asserted using area under the receiver operating characteristic (ROC) curve. Further, we analyzed early ictal signals from SOZ channels and investigated factors influencing their duration to reveal the seizure inducing conditions.</div></div><div><h3>Results</h3><div>We analyzed data from 15 patients with focal epilepsy. The channel-averaged SDSA successfully detected all 28 seizures without false alarms. Using SDSA integration, we achieved precise SOZ localization with an average area under ROC curve (AUC) of 0.96, significantly outperforming previous methods based on high-frequency activities. Further, we discovered that energy of ictal spikes in SOZ was concentrated at a specific frequency distributed in [6, 12 Hz]. Additionally, we found that the higher the energy per second in this frequency band, the faster ictal spikes could induce seizures.</div></div><div><h3>Conclusion</h3><div>The SDSA metric offered precise SOZ localization with robustness and low computational cost, making it suitable for clinical practice. By studying the propagation patterns of ictal spikes between the SOZ and non-SOZ, we suggest that ictal spikes from SOZ need to accumulate energy at a specific central frequency to induce epileptic spikes in non-SOZ, which may have significant implications for understanding the seizure onset pattern.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107475"},"PeriodicalIF":2.0,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593409","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":"Parameter analysis in stereoelectroencephalography-guided radiofrequency thermocoagulation: A common basis for objective comparison between protocols","authors":"Luca Zanuttini ,&nbsp;Federico Mason ,&nbsp;Lorenzo Ferri ,&nbsp;Elena Pasini ,&nbsp;Lidia Di Vito ,&nbsp;Roberto Mai ,&nbsp;Laura Tassi ,&nbsp;Laura Castana ,&nbsp;Gianfranco Vornetti ,&nbsp;Lorenzo Muccioli ,&nbsp;Luigi Cirillo ,&nbsp;Francesca Bisulli ,&nbsp;Roberto Michelucci ,&nbsp;Raffaele Lodi ,&nbsp;Francesco Cardinale ,&nbsp;Matteo Martinoni","doi":"10.1016/j.eplepsyres.2024.107472","DOIUrl":"10.1016/j.eplepsyres.2024.107472","url":null,"abstract":"<div><h3>Objective</h3><div>Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) is an invasive procedure based on stereotactic lesioning of cortical targets in the brain using bipolar current through electrode contacts within the SEEG implant. To date, several RF-TC protocols have been described in the literature; however, a consensus has yet to be reached. This work aims to analyze the electrical parameters during RF-TC processes, offering a method to objectively describe and compare different SEEG-guided RF-TC protocols.</div></div><div><h3>Methods</h3><div>The study included patients who underwent RF-TC procedures at the IRCCS Istituto delle Scienze Neurologiche di Bologna from February 2022 to May 2023. During each procedure, modifications of the following parameters were measured: voltage, current, impedance, and electric power. An ad-hoc algorithm was implemented to detect abrupt impedance raises, which reflects the occurrence of the thermocoagulation. A two-sample t-test was used to compare parameter curves in RF-TC of different brain structures.</div></div><div><h3>Results</h3><div>A total of ninety-two RF-TC procedures were performed in eight patients according to a standardized protocol. During each procedure, impedance levels started at about <span><math><mrow><mn>700</mn><mi>Ω</mi></mrow></math></span> and rose up to <span><math><mrow><mn>1300</mn><mi>Ω</mi></mrow></math></span>, displaying an erratic pattern characterized by one or multiple raises. All measured parameters exhibited similar trends until the first peak, after which changes were influenced by the frequency of impedance raises. No significant correlations were observed between parameter modifications in distinct anatomical sites of RF-TC.</div></div><div><h3>Significance</h3><div>The systematic analysis of electrical parameters may represent a reliable tool to compare different RF-TC protocols, paving the way for identifying optimal configurations for SEEG-guided RF-TC procedures in the future.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107472"},"PeriodicalIF":2.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578071","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":"Beyond seizure freedom: Reduction in anti-seizure medication after epilepsy surgery","authors":"Rohan Jha ,&nbsp;Melissa M.J. Chua ,&nbsp;David D. Liu ,&nbsp;R. Mark Richardson ,&nbsp;Steven Tobochnik ,&nbsp;John D. Rolston","doi":"10.1016/j.eplepsyres.2024.107473","DOIUrl":"10.1016/j.eplepsyres.2024.107473","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients considering therapeutic epilepsy surgery often seek to decrease the number of anti-seizure medications (ASMs) they need. Predicting such reductions remains challenging. Although predictors of seizure freedom after epilepsy surgery are well-established, long-term outcomes remain modest and factors associated with ASM reduction, even in the absence of seizure freedom, may improve surgical planning to align with patient goals.</div></div><div><h3>Methods</h3><div>We studied a large multi-institutional cohort of patients who underwent epilepsy surgery between 2001 and 2022, with a minimum of two years follow-up. Preoperative features, including duration of epilepsy, epilepsy etiology, non-invasive investigation data, and total number of ASMs prescribed immediately prior to surgery were extracted for each patient. Primary endpoints included likelihood of ASM reduction and ASM freedom at multiple post-operative time points up to 15 years and stratified by seizure control.</div></div><div><h3>Results</h3><div>A total of 250 patients were followed for a median of 6.0 (range 2, 22) years after intracranial EEG (iEEG) surgery. Significant ASM reduction was only observed in those who underwent subsequent resection, whereas those undergoing neuromodulation saw their ASM usage maintained. Engel I outcomes were the strongest driver of ASM reduction. In patients with persistent seizures, patients with lateralized seizure onset zones (SOZs) also achieved sustained ASM reduction over time. Similarly, an increased number of preoperative ASMs also corresponded to a higher likelihood of ASM reduction across all follow-up periods. Other preoperative factors, including seizure etiology, did not independently influence ASM reduction.</div></div><div><h3>Conclusions</h3><div>Even patients with persistent seizures after epilepsy surgery can observe meaningful ASM reduction during long-term follow-up. ASM reduction may be a relevant secondary outcome measure for epilepsy surgery.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107473"},"PeriodicalIF":2.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553760","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":"Repetitive transcranial magnetic stimulation in murine models of epilepsy: A systematic review of methodological aspects and outcomes","authors":"Vasilis-Spyridon Tseriotis ,&nbsp;Vasilios K. Kimiskidis ,&nbsp;David-Dimitris Chlorogiannis ,&nbsp;Marianthi Arnaoutoglou ,&nbsp;Dimitrios Kouvelas ,&nbsp;Georgios Konstantis ,&nbsp;Sofia Karachrysafi ,&nbsp;Faye Malliou ,&nbsp;Paraskevas Mavropoulos ,&nbsp;Marina Manani ,&nbsp;Stavroula Koukou ,&nbsp;Chryssa Pourzitaki","doi":"10.1016/j.eplepsyres.2024.107468","DOIUrl":"10.1016/j.eplepsyres.2024.107468","url":null,"abstract":"<div><h3>Objectives</h3><div>Clinical studies of repetitive transcranial magnetic stimulation (rTMS) do not provide consistent efficacy results, possibly due to variability in methodological parameters. Our aim is to systematically review preclinical rTMS protocols in murine models of epilepsy, offering insights from might facilitate the optimization of clinical trials.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, SCOPUS and Web of Science from inception until December 2023, including English-written and peer-reviewed studies with clinical or electroencephalographic (EEG) outcomes.</div></div><div><h3>Results</h3><div>Among 480 search results, in the 23 eligible studies both mice and rats were used. Epilepsy induction methods included injections of pentylenetetrazole, kainic acid, picrotoxin and lithium-pilocarpine, electrical kindling (amygdala/ventral hippocampus), electroconvulsive shock and genetic models of absence and temporal lobe epilepsy. For motor threshold (MT) definition electromyography with motor evoked potentials and single-pulse TMS were used. Stimulation intensity ranged between 40 % and 200 % of MT or 0.125–2.5 T. High-frequency rTMS (≥5 Hz) demonstrated either no effect on seizure suppression or a rather facilitatory effect, promoting ictogenesis, with the exception of 20-Hz-rTMS coupling with lorazepam for status epilepticus cessation. Low-frequency rTMS (&lt;5 Hz), primarily at 0.5 and 1 Hz, exerted an inhibitory effect on both clinical and EEG parameters on various epilepsy models in most studies and also significantly ameliorated performance in behavioral tests.</div></div><div><h3>Conclusions</h3><div>rTMS holds potential for effective neuromodulation, that is critically dependent on stimulation frequency and epilepsy type. Translational knowledge gained from preclinical protocols may inform and optimize rTMS application for epilepsy management in future clinical trials.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107468"},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544487","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":"Differential electrographic seizure patterns in malformations of cortical development, early life brain injury, and later life brain injury","authors":"Melody T. Trudgen,&nbsp;Brenna R. McKaig,&nbsp;Rishabh Jain,&nbsp;Wesley T. Kerr,&nbsp;James F. Castellano","doi":"10.1016/j.eplepsyres.2024.107470","DOIUrl":"10.1016/j.eplepsyres.2024.107470","url":null,"abstract":"<div><div>Structural epilepsy is a chronic neurologic condition that may be caused by in utero malformations of cortical development (MCD) or post-natal brain injuries resulting in encephalomalacia. We hypothesized that the timing of epileptogenic insult would lead to distinct electrographic seizure patterns. Specifically, we predicted that later life insults would lead to longer duration seizures with higher proportion of focal: focal to bilateral tonic-clonic (FBTC) seizures and low rates of bihemispheric onset seizures, as compared to early life insults. We performed a retrospective chart review of 70 adult patients – 33 with epilepsy secondary to brain injury (9 with injury occurring before 16 years and 24 with injury occurring at or after 16 years) with resultant encephalomalacia on MR imaging and 37 with epilepsy secondary to MCD – admitted to the University of Pittsburgh Epilepsy Monitoring Unit for presurgical evaluation. There were no significant differences in duration of epilepsy or number of trialed seizure medications between the groups. We examined scalp EEG data for all patients, as well as intracranial EEG data in a subset. We analyzed seizure duration, seizure frequency, and seizure type (focal, FBTC, and bihemispheric onset) in three cohorts: MCD patients, patients with brain injury occurring in early life (&lt;16 years old), and patients with brain injury occurring in later life (≥16 years old). Patients with later life brain injury had significantly longer and less frequent seizures as compared to MCD cohorts. There were no differences between MCD and early life brain injury cohorts. Seizure duration findings were corroborated in a subset of patients who additionally underwent intracranial EEG monitoring. Additionally, later life brain injury patients had significantly different seizure types as compared to MCD cohorts, with high rates of FBTC and low rates of bihemispheric onset. Again, there was no significant differences in seizure type between early life brain injury and MCD cohorts. These novel findings indicate the relevance of timing of epileptogenic insult on the electrophysiological characteristics of structural epilepsies.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107470"},"PeriodicalIF":2.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497439","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":"Effects of sleeve gastrectomy and Roux-en-Y gastric bypass on pharmacokinetics of lamotrigine and valproate: A cohort study","authors":"Georgios Schoretsanitis ,&nbsp;Magnus Strømmen ,&nbsp;Hege-Merete Krabseth ,&nbsp;Olav Spigset ,&nbsp;Arne Helland","doi":"10.1016/j.eplepsyres.2024.107469","DOIUrl":"10.1016/j.eplepsyres.2024.107469","url":null,"abstract":"<div><h3>Background</h3><div>Bariatric surgeries may affect the pharmacokinetics of medications through alterations of the gastrointestinal physiology. Pharmacokinetic changes of first-line antiseizure medications such as lamotrigine and valproate following bariatric treatment have received little research attention so far.</div></div><div><h3>Methods</h3><div>In our prospective case study we included lamotrigine- or valproate-treated patients undergoing bariatric surgery at hospitals in Central Norway. Lamotrigine and valproate concentrations were assessed using serial blood samples over a dose interval, before and one, six and twelve months following surgery. Primary outcomes included changes in area under the time-concentration curve (AUC) with secondary outcomes comprising full pharmacokinetic profiling.</div></div><div><h3>Results</h3><div>Six lamotrigine-treated obese patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 3) and sleeve gastrectomy (SG) (n = 3), as well as two valproate-treated patients (one undergoing RYGB and one SG) were included. Largest changes for dose-adjusted AUC values after surgery were seen in RYGB-treated patients on lamotrigine (average increases of 38 % one month and 32 % 12 months postoperatively). In the patients on valproate, AUC values were decreased by 22 % after 6 months and by 30 % after 12 months. The interindividual variation was high. Formal statistical testing was not done due to few cases.</div></div><div><h3>Conclusion</h3><div>Postoperative pharmacokinetic changes for lamotrigine and valproate were modest, but for lamotrigine changes may be larger in patients undergoing RYGB than in those undergoing SG. Given the substantial interindividual variation, therapeutic drug monitoring should be used to capture pharmacokinetic changes and guide dose adjustments after bariatric surgery.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107469"},"PeriodicalIF":2.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544514","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}