Epilepsy Research最新文献

{"title":"Autoimmune-associated epilepsy or acute symptomatic seizures? A case series of recurrent seizures in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)","authors":"Alexander J Jonokuchi ,&nbsp;Ilya Kister ,&nbsp;Angie H. Kim ,&nbsp;Claude Steriade","doi":"10.1016/j.eplepsyres.2026.107740","DOIUrl":"10.1016/j.eplepsyres.2026.107740","url":null,"abstract":"<div><div>Acute symptomatic seizures are a well recognized symptom of myelin oligodendrocyte antibody-associated disease (MOGAD), but long-term seizure outcomes and risk of epilepsy are understudied. In a retrospective cohort of 135 consecutive patients meeting consensus criteria for MOGAD without a prior diagnosis of epilepsy or concurrent NMDA-R Ab positivity, 19 developed seizures after MOGAD onset (16 %). Of these 19 patients, 7 patients (37 % of those with seizures, and 5 % of the total cohort). experienced one or more seizure recurrence during MOGAD remission (i.e. outside of an acute attack). Five of the 7 patients with recurrent seizures remained on antiseizure medication (ASM) (four on monotherapy and one on two ASMs) at last follow-up (median duration of follow up: 92 months). We discuss phenotypes of recurrent seizures in patients with MOGAD in the context of the conceptual framework of acute symptomatic seizures versus autoimmune encephalitis associated epilepsy (AEAE).</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"221 ","pages":"Article 107740"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075797","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":"Healthcare resource utilization in adults with focal onset seizures before and after initiating cenobamate: A US database analysis","authors":"Alessandro Lovera ,&nbsp;Elena Alvarez-Baron ,&nbsp;Rafia Bosan ,&nbsp;Caroline Clare Benoist ,&nbsp;Paola Lipone ,&nbsp;Maria Teresa Rosignoli ,&nbsp;Alessandro Comandini ,&nbsp;Enrica Salvatori ,&nbsp;Hsiu-Ching Chang ,&nbsp;Queenie Paltanwale ,&nbsp;Efe Eworuke ,&nbsp;John Paul Leach ,&nbsp;Agnese Cattaneo","doi":"10.1016/j.eplepsyres.2026.107739","DOIUrl":"10.1016/j.eplepsyres.2026.107739","url":null,"abstract":"<div><h3>Background</h3><div>Antiseizure medications (ASMs) are the mainstay of treatment for patients with epilepsy, though over one third remain uncontrolled after treatment with at least two ASMs. Cenobamate is an ASM indicated for the treatment of adults with focal onset seizures (FOS) in the United States. In Europe cenobamate is approved for the adjunctive treatment of FOS in adult patients with epilepsy who have not been adequately controlled despite at least 2 previous ASMs. Real-world data helps to better describe the impact of cenobamate long-term effectiveness and tolerability/safety balance. Evidence reflecting a reduction of the impact of epilepsy on the daily lives of patients would be important when assessing and eventually predicting the benefit of treatments.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted using the IQVIA PharMetrics Plus database among adult patients with both a claim for cenobamate between April 1, 2020, to April 30, 2023, and a diagnosis of FOS prior to the first cenobamate dispensing date (identified in the baseline period). Demographic characteristics were captured on the index date and clinical characteristics were captured in the 6 months baseline period; treatment patterns and healthcare resource utilization (HCRU) were assessed across 3 epochs forming 3 non-mutually exclusive cohorts: Cohort A, 6 months follow-up; Cohort B, 12 months follow-up; Cohort C, 18 months follow-up. Designated treatment regimen was defined by recorded ASMs prescribed in the 90 days following cenobamate dispensing (treatment regimen evaluation window), and patients were classified as ‘monotherapy’, ‘stable polytherapy’, or ‘changing treatment regimen’.</div></div><div><h3>Results</h3><div>Among the 1132 patients included in Cohort A, approximately half (45.1 %) had stable polytherapy, 1.5 % had monotherapy, and 53.5 % had a changing treatment regimen following initiation of cenobamate. Similar distribution of designation was present among the 800 patients in Cohort B and 554 patients in Cohort C. A lower proportion of patients required hospitalization and emergency department visits in the 6 months after cenobamate initiation compared to the 6-month pre-index period (Cohort A: 15.4 % vs. 21.9 % and 24.9 % vs. 30.9 % respectively). Lower HCRU reduction rates (%) per patient per month were found at 6, 12 and 18 months of follow-up.</div></div><div><h3>Conclusion</h3><div>Epilepsy-related hospitalizations and Emergency Room visits (indicators of seizures) were reduced in adult FOS patients with epilepsy 6, 12 and 18 months after initiating cenobamate as monotherapy or stable polytherapy, leading to reduced HCRUs and epilepsy costs.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"221 ","pages":"Article 107739"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026045","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":"Inflammation-mediated function enhancement of KNa channels promotes network hyperactivity in the peripheral cortex following TBI","authors":"Lei Sun ,&nbsp;Ru Liu ,&nbsp;Xiong Han ,&nbsp;Na Wang ,&nbsp;Ting Zhao ,&nbsp;Yanan Chen ,&nbsp;Jianping Wu ,&nbsp;Junfan Chen ,&nbsp;Qun Wang","doi":"10.1016/j.eplepsyres.2026.107751","DOIUrl":"10.1016/j.eplepsyres.2026.107751","url":null,"abstract":"<div><h3>Background</h3><div>Post-traumatic epilepsy (PTE) is a common complication of traumatic brain injury (TBI). Studies have indicated that functional abnormalities of the sodium-activated potassium (K_Na) channels are closely related to infantile “refractory epilepsy”. However, whether and how the K_Na channels are involved in the occurrence of PTE remains unknown.</div></div><div><h3>Methods</h3><div>We used adult male C57BL/6 J mice to establish a controlled cortical impact (CCI) mice model with different severity levels. We implanted intracranial electrodes 7 days after injury to observe the spontaneous seizures in the moderately injured mice.vEEG was continuously recorded for 7 days (24 h/day). Then, a multi - electrode array (MEA) was performed 14 days after TBI to evaluate the network activity in the peripheral cortex of TBI lesions.Seven days after injury, we detected the expression of K_Na channels around the injury site and the activation of glial cells through immunofluorescence staining. Finally, primary neuron cultures were used to verify whether or not the inflammatory factor upregulated K_Na channels and affected neuronal excitability by activating the NF-κB pathway.</div></div><div><h3>Results</h3><div>Through continuous vEEG monitoring, we observed abnormal electrographic discharges in the moderate TBI group (9 %, 2/22). MEA recording confirmed hyperactive network around the lesion, supporting that peripheral cortex may be the potential epileptogenic focus. Our findings revealed that expression of K_Na channels was elevated in neuronal membranes in the peripheral cortex. Reactive astrocytes and activated microglia were observed in the injured ipsilateral cortex of the moderate and severe TBI mice. In primary neurons, we found that K_Na currents were markedly increased after TNF-α stimulation. When the NF-κB signaling pathway was inhibited by SN50, the K_Na currents were correspondingly decreased.</div></div><div><h3>Conclusions</h3><div>Our results suggest that network hyperactivity in the perilesional neocortex may be the origin of abnormal epileptiform discharge. Activation of glial cells around the lesion releases inflammatory factors that initiate the NF-κB signaling pathway and modulate the K_Na channels, which may be a potential mechanism for the occurrence of PTE. This research had important implications for clarifying the origin of epileptic foci of TBI and identifying immune-based biomarkers to improve the prognosis of PTE.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"221 ","pages":"Article 107751"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146136995","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":"CHD2-related disorders: A conceptual disease model informed by caregiver experience","authors":"Christina SanInocencio ,&nbsp;Stephanie Prince ,&nbsp;Ilakkiah Chandran ,&nbsp;Elijah W. Simon ,&nbsp;Laura Marks","doi":"10.1016/j.eplepsyres.2026.107735","DOIUrl":"10.1016/j.eplepsyres.2026.107735","url":null,"abstract":"<div><h3>Background</h3><div>CHD2-related disorders (CHD2-RDs) are ultra-rare neurodevelopmental conditions caused by pathogenic variants in the <em>CHD2</em> gene, which plays a crucial role in chromatin remodeling during brain development. These disorders present with a complex phenotype that includes refractory epilepsy, intellectual disability, autism spectrum disorder, speech and motor delays, and behavioral challenges. Despite emerging clinical descriptions, limited research has captured the lived experience of affected families or organized this complexity into a patient-centered disease model.</div></div><div><h3>Methods</h3><div>To develop a conceptual disease model (CDM) for CHD2-RDs, we conducted a systematic literature review alongside in-depth qualitative interviews with 15 caregivers of individuals with CHD2. Thematic saturation was reached, and findings were analyzed using inductive and deductive coding. Reflexive and AI-supported analytic techniques were employed to ensure trustworthiness. Caregiver quotes were integrated to illustrate how symptoms translate into real-world impact.</div></div><div><h3>Results</h3><div>The resulting CDM identifies three core domains: patient symptoms, patient impacts, and caregiver impacts. Symptom domains include seizures, cognitive impairment, communication difficulties, behavioral issues, sensory sensitivities, motor delays, and other comorbidities (e.g., GI, endocrine, vision). These symptoms disrupt sleep, development, socialization, and autonomy. Caregivers reported sleep loss, mental health strain, career disruption, and social isolation. Emergent themes, such as reliance on routine, diagnostic odyssey, and fears about the future, further contextualize the burden of CHD2-RDs.</div></div><div><h3>Conclusion</h3><div>This is the first caregiver-informed CDM for CHD2-RDs and provides a foundational tool for future research, clinical care, and regulatory engagement. It can inform the development of meaningful outcome measures, trial readiness, and patient-centered endpoints. The model highlights the need for integrated support and underscores the critical role of caregiver insight in understanding and addressing rare neurodevelopmental disorders.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"221 ","pages":"Article 107735"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100168","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":"Clinical and hematologic predictors of early intensive care unit admission in seizure patients presenting to the emergency room","authors":"Eun Seok Park ,&nbsp;Hyo Min Shin ,&nbsp;Sung-Woo Kim ,&nbsp;Won-Joo Kim ,&nbsp;Heewon Hwang","doi":"10.1016/j.eplepsyres.2026.107752","DOIUrl":"10.1016/j.eplepsyres.2026.107752","url":null,"abstract":"<div><h3>Objective</h3><div>History of hypertension is a common comorbidity among patients with epilepsy, yet its role in acute seizure outcomes remains unclear. This study investigated whether history of hypertension and routine hematologic markers could predict intensive care unit (ICU) admission among patients with seizures presenting to the emergency room (ER).</div></div><div><h3>Methods</h3><div>Ninety patients with confirmed seizures were retrospectively analysed. Demographic characteristics, comorbidities, and laboratory findings were compared between patients admitted to the ICU and those who were not. Multivariate logistic regression analysis identified independent predictors of ICU admission. In addition, all 20 ICU-admitted cases during the study period were further examined to characterize their clinical patterns.</div></div><div><h3>Results</h3><div>Twenty patients (22.2 %) required direct ICU admission. History of hypertension was more frequent in the ICU group (45.0 % vs. 17.1 %, <em>p</em> = 0.009) and independently predicted ICU admission (OR 4.07, 95 % CI 1.05–15.80, <em>p</em> = 0.042). Elevated white blood cell counts (OR 1.27, 95 % CI 1.10–1.48, <em>p</em> = 0.002) and reduced red blood cell counts (OR 0.17, 95 % CI 0.05–0.59, <em>p</em> = 0.006) were also significant predictors.</div></div><div><h3>Conclusion</h3><div>History of hypertension, leukocytosis, and anemia may indicate a higher risk of clinical deterioration in patients with seizures. These routinely available measures could assist early triage and management decisions in the ER. Prospective studies are warranted to confirm their prognostic utility.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"221 ","pages":"Article 107752"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131558","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":"Seizure recurrences after temporal lobe epilepsy surgery in childhood and adolescence: predictive factors, patterns of recurrence, and long-term outcomes","authors":"Ming-Chen Tsai ,&nbsp;Keith Starnes ,&nbsp;Anthony L. Fine ,&nbsp;Katherine C. Nickels ,&nbsp;Elaine C. Wirrell ,&nbsp;Jamie J. Van Gompel ,&nbsp;Kai J. Miller ,&nbsp;Lily C. Wong-Kisiel","doi":"10.1016/j.eplepsyres.2026.107732","DOIUrl":"10.1016/j.eplepsyres.2026.107732","url":null,"abstract":"<div><h3>Background</h3><div>Temporal lobe epilepsy (TLE) is the leading cause of drug-resistant focal epilepsy. Surgery is effective, yet many patients experience postoperative seizure recurrence.</div></div><div><h3>Objective</h3><div>To identify predictors of recurrence and characterize recurrence patterns, treatment responses, and long-term outcomes using a 16-year surgical database.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed children and adolescents (0–19 years) with TLE who underwent resective or destructive temporal lobe surgery at Mayo Clinic, Rochester (2008–2024). All patients underwent scalp EEG phase I monitoring and 1.5 T or 3 T MRI, with invasive monitoring and advanced imaging studies utilized in selected patients when clinically indicated. Patients with prior epilepsy surgery, &lt;1-year follow-up, or without research authorization were excluded. Data were analyzed using descriptive statistics, survival analysis, and Cox proportional hazard models. Seizure recurrence was categorized as acute post-operative seizures (APOS, ≤1 week post-surgery), early recurrence (&gt;1 week–2 years), and late recurrence (&gt;2 years). Delayed seizure freedom was defined as ≥1 year seizure-free before last follow-up after recurrence.</div></div><div><h3>Results</h3><div>Among 61 patients, 34 (55.7 %) had recurrence over a median follow-up of 49 months. Median time to first recurrence was 48 months. Four patients (6.5 %) had APOS; all developed early recurrence. APOS predicted early recurrence (HR = 6.02, 95 % CI = 1.64–22.04, p = 0.006). Delayed seizure freedom was achieved with medication trials in 19 % (5/26) of early and 75 % (6/8) of late recurrences. At last follow-up, 68 % (42/61) were seizure free: 44 % (27/61) since the first surgery and 24 % (15/61) after recurrence.</div></div><div><h3>Conclusion</h3><div>Temporal lobe epilepsy surgery provides durable seizure control in two-thirds of pediatric and adolescent patients. APOS may predict early recurrence, which is often less medically responsive and may warrant repeat surgery.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"221 ","pages":"Article 107732"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146006812","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":"Examination of psychological resilience and self-esteem in adolescents having siblings with epilepsy","authors":"Buşra Kantarcı ,&nbsp;Fatma Kurudirek","doi":"10.1016/j.eplepsyres.2026.107741","DOIUrl":"10.1016/j.eplepsyres.2026.107741","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to examine the relationship between psychological resilience and self-esteem among healthy adolescents who have siblings diagnosed with epilepsy.</div></div><div><h3>Methods</h3><div>This descriptive and cross-sectional study was conducted between May and November 2024 at Muş State Hospital. The sample consisted of 126 healthy adolescents aged 12–18 years who had siblings diagnosed with epilepsy and were receiving follow-up care at the pediatric neurology outpatient clinic. Data were collected using a Personal Information Form, the Rosenberg Self-Esteem Scale (RSES), and the Child and Youth Resilience Measure (CYRM).</div></div><div><h3>Results</h3><div>The mean CYRM score was 41.32 ± 9.87, indicating moderate psychological resilience, and the mean RSES score was 2.11 ± 1.75, indicating moderate self-esteem. Psychological resilience scores were significantly higher among girls and adolescents from higher-income families, as well as those whose parents had higher educational levels and professional occupations. Self-esteem levels were higher among adolescents whose parents were university graduates or civil servants and lower among those from low-income families. Emotional responses during siblings’ seizures were also associated with both outcomes; adolescents reporting compassion or sadness demonstrated higher psychological resilience and self-esteem than those reporting pity. A moderate negative correlation was found between CYRM and RSES scores, reflecting the inverse scoring structure of the RSES, in which lower scores indicate higher self-esteem.</div></div><div><h3>Conclusion</h3><div>Adolescents who have siblings with epilepsy exhibit moderate levels of psychological resilience and self-esteem compared with normative adolescent samples. Sociodemographic characteristics and emotional responses to seizures play an important role in shaping these outcomes, highlighting the need for psychosocial support strategies to strengthen resilience and self-esteem.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"221 ","pages":"Article 107741"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124302","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":"Antiseizure medication discontinuation in pediatric epilepsy: Real-world insights","authors":"Deniz Menderes ,&nbsp;Salih Akbaş ,&nbsp;Esra Serdaroğlu ,&nbsp;Tuğba Hırfanoğlu ,&nbsp;Ayşe Serdaroğlu ,&nbsp;Ebru Arhan","doi":"10.1016/j.eplepsyres.2026.107742","DOIUrl":"10.1016/j.eplepsyres.2026.107742","url":null,"abstract":"<div><h3>Objective</h3><div>This retrospective study aimed to precisely characterize the factors necessitating antiseizure medication (ASM) discontinuation in pediatric epilepsy patients and to delineate drug-specific adverse event patterns based on monotherapy and polytherapy regimens.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from patients under 18 years of age, followed at a single Pediatric Neurology Clinic between January 2015 and September 2024. Discontinuation was defined as the cessation of a medication due to inadequate efficacy or intolerable adverse effects. Patient demographics, epilepsy classification, ASM regimen, treatment duration, and detailed reasons for discontinuation were collected for analysis.</div></div><div><h3>Results</h3><div>Out of 4578 pediatric epilepsy patients screened, ASM discontinuation was recorded in 169 cases (4 %). The discontinuation rate was higher in polytherapy (68/1373, 5 %) than in monotherapy (101/3205, 3 %). The most frequent compelling reasons for cessation were seizure persistence or worsening (48/169, 28 %) and psychiatric adverse effects (40/169, 24 %). Levetiracetam was overwhelmingly associated with psychiatric complaints (25/34, 74 %), while carbamazepine demonstrated a powerful correlation with the emergence of continuous spikes and waves during sleep (CSWS) like sleep-activated epileptiform EEG pattern (28/42, 67 %), leading to its withdrawal. The mean time to discontinuation was 8 ± 6 months.</div></div><div><h3>Conclusion</h3><div>Our real-world data confirms that persistent seizures and drug-induced psychiatric adverse effects are the dominant causes of ASM discontinuation in children. The particular correlations between levetiracetam and psychiatric issues, and carbamazepine and CSWS-like sleep-activated EEG pattern, highlight the critical necessity for highly individualized ASM selection and close clinical and electroencephalographic monitoring in pediatric practice.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"221 ","pages":"Article 107742"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075798","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":"Antiseizure medication effects on sleep architecture in epilepsy: Glymphatic insights and implications for cognitive decline","authors":"Justyna Swierz ,&nbsp;Michael Doherty ,&nbsp;Sung Ji ,&nbsp;Jeffrey Iliff ,&nbsp;Yeilim Cho","doi":"10.1016/j.eplepsyres.2025.107730","DOIUrl":"10.1016/j.eplepsyres.2025.107730","url":null,"abstract":"<div><div>Disruptions in sleep architecture may contribute to cognitive decline in people with epilepsy (PWE), potentially through impaired glymphatic clearance. In this narrative review, we explore how antiseizure medications (ASMs) influence key sleep stages, particularly slow-wave sleep (SWS) and rapid eye movement (REM) sleep, and consider how these changes may intersect with glymphatic function and cognitive outcomes. SWS supports glymphatic clearance of interstitial waste, including neurotoxic solutes such as amyloid-β and tau. Some ASMs appear to enhance SWS, while others suppress it, suggesting the possibility of differential long-term cognitive effects. We propose that sleep disruption may represent an important but underappreciated factor linking epilepsy and neurocognitive decline. While sleep impairment in epilepsy is often attributed to seizures or interictal activity, ASM-induced alterations in sleep architecture may also play a role. However, this relationship remains largely theoretical and requires further experimental study. We also review the use of diffusion tensor image analysis along the perivascular space (DTI-ALPS) as an emerging imaging method to approximate glymphatic activity. Although DTI-ALPS provides a non-invasive proxy for perivascular water diffusivity, it does not directly measure glymphatic clearance and may be affected by factors such as partial volume effects. Its role in epilepsy research remains exploratory and should be interpreted cautiously. To date, no study has directly examined the combined effects of ASMs, sleep structure, and glymphatic function in a single cohort. We outline opportunities for future research integrating neuroimaging, sleep assessment, and cognitive testing to better understand how sleep-targeted strategies might preserve brain health in epilepsy.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"220 ","pages":"Article 107730"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938883","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":"Elevated thalamic blood flow in self-limited epilepsy with centrotemporal spikes","authors":"Niki Iasinovschi ,&nbsp;Elizabeth Tong ,&nbsp;Lucia Bicknell ,&nbsp;Fiona Mitchell Baumer","doi":"10.1016/j.eplepsyres.2025.107716","DOIUrl":"10.1016/j.eplepsyres.2025.107716","url":null,"abstract":"<div><div>Children with self-limited epilepsy syndrome with centrotemporal spikes (SeLECTS) exhibit altered thalamocortical connectivity, but whether thalamic function itself is abnormal remains unclear. We investigated whether thalamic blood flow, a marker of metabolism, differs between children with SeLECTS and controls, and examined the effects of spike distribution and antiseizure medications (ASMs) on thalamic perfusion. In this retrospective cohort study, we identified consecutive children with SeLECTS who underwent magnetic resonance imaging (MRI) for epilepsy evaluation (n = 44) and age- and sex-matched children who underwent MRI for non-epilepsy indications (n = 35). We quantified thalamic blood flow via manual segmentation of cerebral blood flow (CBF) sequences obtained from arterial spin labeling MRI. Clinical variables including sedation use during MRI, daily ASM use, and spike distribution (unilateral or bilateral) were extracted from medical records. Children with SeLECTS demonstrated elevated thalamic blood flow compared to controls, with the most pronounced differences in specific subgroups. Children with unilateral spikes showed the highest CBF, particularly in the thalamus contralateral to spike activity. ASM use significantly modulated thalamic blood flow: children taking oxcarbazepine showed the highest CBF, while those on levetiracetam had CBF similar to controls. Unmedicated children showed intermediate elevations. These findings demonstrate that elevated thalamic blood flow may be intrinsic to SeLECTS pathophysiology, with different ASMs producing distinct neurobiological effects. The differential medication effects may relate to their clinical efficacy and provide neurobiological rationale for treatment selection in this common childhood epilepsy syndrome.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"220 ","pages":"Article 107716"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693019","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}