Epilepsy ResearchPub Date : 2024-08-17DOI: 10.1016/j.eplepsyres.2024.107441
Deana Bonno , Lisa Vanatta , Eric Kossoff
{"title":"A side-by-side comparison of fine-tuning options for treatment of medically refractory epilepsy: Antiseizure medications, vagus nerve stimulation and ketogenic diet therapies","authors":"Deana Bonno , Lisa Vanatta , Eric Kossoff","doi":"10.1016/j.eplepsyres.2024.107441","DOIUrl":"10.1016/j.eplepsyres.2024.107441","url":null,"abstract":"<div><p>There are many treatment options available for patients with medically refractory epilepsy including antiseizure medications, surgery, devices and ketogenic diet therapy. Ketogenic diet therapy has been shown to be a safe and effective treatment option in adult and pediatric patients. In order to obtain maximal clinical effectiveness and tolerability of any treatment option, adjustments are often necessary. This article outlines the “fine-tuning” options available for antiseizure medications, vagus nerve stimulation and ketogenic diet therapies and demonstrates that ketogenic diet therapies offer a wider array of personalizing and fine-tuning options.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"206 ","pages":"Article 107441"},"PeriodicalIF":2.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094898","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}
Epilepsy ResearchPub Date : 2024-08-08DOI: 10.1016/j.eplepsyres.2024.107424
Brad K. Kamitaki , Shelly Maniar , Raaga Rambhatla , Kelly Gao , Joel C. Cantor , Hyunmi Choi , Michelle T. Bover Manderski
{"title":"Health insurance and transportation barriers impact access to epilepsy care in the United States","authors":"Brad K. Kamitaki , Shelly Maniar , Raaga Rambhatla , Kelly Gao , Joel C. Cantor , Hyunmi Choi , Michelle T. Bover Manderski","doi":"10.1016/j.eplepsyres.2024.107424","DOIUrl":"10.1016/j.eplepsyres.2024.107424","url":null,"abstract":"<div><h3>Purpose</h3><p>Inconsistent access to healthcare for people with epilepsy results in reduced adherence to antiseizure medications, increased seizure frequency, and fewer appropriate referrals for epilepsy surgery. Identifying and addressing factors that impede access to care should consequently improve patient outcomes. We hypothesized that health insurance and transportation affect access to outpatient neurology care for adults living with epilepsy in the United States (US).</p></div><div><h3>Methods</h3><p>We conducted a retrospective cross-sectional study of US adults with active epilepsy surveyed via the National Health Interview Survey (NHIS) in 2015 and 2017. We established whether patients reported seeing a neurologist in the past year and used multiple logistic regression to determine whether health insurance status and transportation access were associated with this outcome.</p></div><div><h3>Results</h3><p>We identified 735 respondents from 2015 and 2017, representing an estimated 2.98 million US adults with active epilepsy. After adjusting for socioeconomic and seizure-related co-variates, we found that a lack of health insurance coverage was associated with no epilepsy care in the past year (adjusted odds ratio [aOR] 0.22; 95 % confidence interval [CI]: 0.09 – 0.54). Delayed care due to inadequate transportation (aOR 0.42; 95 % CI: 0.19 – 0.93) also resulted in reduced patient access to a neurologist.</p></div><div><h3>Conclusion</h3><p>Due to the inherent nature of their condition, people with epilepsy are less likely to have employer-sponsored health insurance or consistent driving privileges. Yet, these factors also impact patient access to neurological care. We must address transportation and insurance barriers through long-term investment and partnership between community, healthcare, and government stakeholders.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"205 ","pages":"Article 107424"},"PeriodicalIF":2.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0920121124001396/pdfft?md5=97c63540da7eb99ec79217663fd736be&pid=1-s2.0-S0920121124001396-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912294","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}
Epilepsy ResearchPub Date : 2024-08-08DOI: 10.1016/j.eplepsyres.2024.107423
Bruna M. Schneider , Erica M. Krapf , Kathleen E. Hassara , Lisa D. Stanford , Dalin T. Pulsipher
{"title":"Differential contributions of performance-based and parental reports of executive functioning on memory in pediatric focal and generalized epilepsies","authors":"Bruna M. Schneider , Erica M. Krapf , Kathleen E. Hassara , Lisa D. Stanford , Dalin T. Pulsipher","doi":"10.1016/j.eplepsyres.2024.107423","DOIUrl":"10.1016/j.eplepsyres.2024.107423","url":null,"abstract":"<div><p>Children with epilepsy often experience deficits in both executive functioning (EF) and memory. However, how these two domains interact and relate to specific epilepsy types remains unclear. This study compared two groups of children: those with localization-related epilepsy (LRE) and those with genetic generalized epilepsy (GGE). We aimed to understand how performance-based and parent-reported EF differentially contribute to understanding memory function in each group.</p><p>We examined neuropsychological measures assessing memory and EF in 75 children with LRE and 91 with GGE. Multiple linear regressions explored the impact of EF on memory performance.</p><p>Performance-based EF scores accounted for greater variance in memory scores than parental EF reports. However, performance-based EF measures explained much more variance in visual memory for LRE than GGE and explained much more variance in verbal memory for the GGE group. Parental reports of EF contributed marginally to understanding variance.</p><p>These findings suggest differential relationships between EF and memory based on epilepsy type. Performance-based EF measures appear more reliable at understanding memory variance than did parent reports. Our results have potential clinical implications for tailoring neuropsychological assessment and intervention for children with different epilepsy types.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"205 ","pages":"Article 107423"},"PeriodicalIF":2.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912293","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}
Epilepsy ResearchPub Date : 2024-08-08DOI: 10.1016/j.eplepsyres.2024.107426
J. Austin Varner , Roozbeh Rezaie , Negar Noorizadeh , Frederick A. Boop , Stephen P. Fulton , Paul Klimo , Nir Shimony , James W. Wheless , Shalini Narayana
{"title":"Transcranial magnetic stimulation and magnetoencephalography are feasible alternatives to invasive methods in optimizing responsive neurostimulation device placement","authors":"J. Austin Varner , Roozbeh Rezaie , Negar Noorizadeh , Frederick A. Boop , Stephen P. Fulton , Paul Klimo , Nir Shimony , James W. Wheless , Shalini Narayana","doi":"10.1016/j.eplepsyres.2024.107426","DOIUrl":"10.1016/j.eplepsyres.2024.107426","url":null,"abstract":"<div><p>Responsive neurostimulation (RNS) is a treatment option for patients with refractory epilepsy when surgical resection is not possible due to overlap of the irritative zone and eloquent cortex. Presurgical evaluations for RNS placement typically rely on invasive methods. This study investigated the potential of transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG) to provide key presurgical information non-invasively. We hypothesized that these non-invasive methods may assist in optimizing RNS placement by providing useful information for seizure localization by MEG and eloquent cortex mapping by TMS. A retrospective chart review identified nine patients who underwent RNS placement (mean age = 20.4 years [<em>SD</em> = 5.6], two-thirds were female). Characterization of the irritative zone using MEG was successful in eight of nine patients. Non-invasive mapping of relevant eloquent cortex was attempted in all patients. TMS was successful in eight of nine patients, and MEG was successful in two of six patients. Importantly, patients mapped with non-invasive modalities experienced an average seizure reduction of 77 % at their most recent clinic visit, compared to 75 % seizure reduction in those with invasive evaluations, indicating appropriate RNS placement. These data demonstrate that TMS and MEG can provide key information for RNS and may be feasible alternatives to invasive methods for assisting in decision making regarding RNS placement. Non-invasive methods for determining RNS placement have a high rate of success when data from multiple non-invasive modalities converge and can inform more accurate placement of intracranial electrodes prior to RNS placement or mitigate their need.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"206 ","pages":"Article 107426"},"PeriodicalIF":2.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0920121124001414/pdfft?md5=b574e602655eca86054b0d15a28e797b&pid=1-s2.0-S0920121124001414-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916411","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}
Epilepsy ResearchPub Date : 2024-08-06DOI: 10.1016/j.eplepsyres.2024.107422
Kara B. Miecznikowski , James Leach , Leonid Rozhkov , Francesco T. Mangano , Jesse Skoch , Darcy A. Krueger , Paul S. Horn , Hansel M. Greiner
{"title":"Impact of seizure onset zone and intracranial electroencephalography ictal characteristics on epilepsy surgery outcomes in tuberous sclerosis complex","authors":"Kara B. Miecznikowski , James Leach , Leonid Rozhkov , Francesco T. Mangano , Jesse Skoch , Darcy A. Krueger , Paul S. Horn , Hansel M. Greiner","doi":"10.1016/j.eplepsyres.2024.107422","DOIUrl":"10.1016/j.eplepsyres.2024.107422","url":null,"abstract":"<div><p>Ninety percent of tuberous sclerosis complex (TSC) patients have seizures, with ∼50 % developing drug refractory epilepsy. Surgical intervention aims to remove the seizure onset zone (SOZ). This retrospective study investigated the relationship of SOZ size, ictal pattern, and extent of resection with surgical outcomes. TSC patients undergoing resective/ablative surgery with >1-year follow-up and adequate imaging were included. Preoperative iEEG data were reviewed to determine ictal pattern and SOZ location. For outcomes, an ILAE score of 1–3 was defined as good and 4–6 as poor. Forty-four patients were included (age 117.4 ± 110.8 months). Of these, 59.1 % achieved a good outcome, while 40.9 % had a poor outcome. Size of SOZ was a significant factor (p = 0.009), with the poor outcome group having a larger SOZ (11.9 ± 6.7 electrode contacts) than the good outcome group (7.3 ± 7.2). SOZ number was significant (p = 0.020); >1 SOZ was associated with poor outcome. These results demonstrate extent of SOZ as a predictor of seizure freedom following epilepsy surgery in a mostly pediatric TSC cohort. We hypothesize that these features represent biomarkers of focality of the epileptogenic zone and can be used to sharpen prognosis for epilepsy surgery outcomes in this cohort.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"205 ","pages":"Article 107422"},"PeriodicalIF":2.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912295","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":"Factors linked with perceived stigma amid people with Epilepsy -across sectional study","authors":"Archana Verma , Pooja Pathak , Ashutosh Kumar Mishra , Sachin Upadhya","doi":"10.1016/j.eplepsyres.2024.107428","DOIUrl":"10.1016/j.eplepsyres.2024.107428","url":null,"abstract":"<div><h3>Objectives</h3><p>People with epilepsy (PWE) continue to suffer from discrimination and often bear the negative attitudes surrounding this condition. The aim of the study was to assess the frequency of perceived stigma and factors associated with it among PWE in tertiary care centre.</p></div><div><h3>Material and methods</h3><p>A hospital-based, cross-sectional study was conducted using the Kilifi Stigma Scale of Epilepsy (KSSE) to assess the stigma associated with epilepsy and factors related to stigma.</p></div><div><h3>Results</h3><p>A total of 260 consecutive PWE were recruited, with a mean age of 28.12±9.96 years. The majority of subjects had primarily or secondarily generalized seizures (85 %), and most of PWE don’t know the cause of epilepsy (79.2 %) and feel that epilepsy is a contagious disease. Those with contagious beliefs felt more stigma (27.7 %). Stigma was perceived by 28.5 % of subjects using KSSE. Stigma was more perceived in those who had primarily or secondarily generalized seizures (23.9 %) and longer durations of anti-seizure medication (ASM) (24.4 %). Injury during a seizure was reported in 30 % of subjects and were more stigmatized (p<.01).</p></div><div><h3>Conclusion</h3><p>Perceived stigma in PWE was found to be correlated with contagious beliefs. There is a need for awareness and educational programs by healthcare professionals at different levels to support and encourage positive beliefs, dispel myths about epilepsy, and inform PWEs of the fact that it is not a contagious disease.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"205 ","pages":"Article 107428"},"PeriodicalIF":2.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906259","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}
Epilepsy ResearchPub Date : 2024-08-06DOI: 10.1016/j.eplepsyres.2024.107425
Paula Marques , Patrick B. Moloney , Caihong Ji , Quratulain Zulfiqar Ali , Archana Ramesh , David B. Goldstein , Karen Barboza , Ilakkiah Chandran , Marlene Rong , Arunan Selvarajah , Farah Qaiser , Victor S.T. Lira , Taufik A. Valiante , Carl W. Bazil , Hyunmi Choi , Orrin Devinsky , Chantal Depondt , Terence O’Brien , Piero Perucca , Arjune Sen , Danielle M. Andrade
{"title":"Do germline genetic variants influence surgical outcomes in drug-resistant epilepsy?","authors":"Paula Marques , Patrick B. Moloney , Caihong Ji , Quratulain Zulfiqar Ali , Archana Ramesh , David B. Goldstein , Karen Barboza , Ilakkiah Chandran , Marlene Rong , Arunan Selvarajah , Farah Qaiser , Victor S.T. Lira , Taufik A. Valiante , Carl W. Bazil , Hyunmi Choi , Orrin Devinsky , Chantal Depondt , Terence O’Brien , Piero Perucca , Arjune Sen , Danielle M. Andrade","doi":"10.1016/j.eplepsyres.2024.107425","DOIUrl":"10.1016/j.eplepsyres.2024.107425","url":null,"abstract":"<div><h3><u>Objective</u></h3><p>We retrospectively explored patients with drug-resistant epilepsy (DRE) who previously underwent presurgical evaluation to identify correlations between surgical outcomes and pathogenic variants in epilepsy genes.</p></div><div><h3><u>Methods</u></h3><p>Through an international collaboration, we evaluated adult DRE patients who were screened for surgical candidacy. Patients with pathogenic (P) or likely pathogenic (LP) germline variants in genes relevant to their epilepsy were included, regardless of whether the genetic diagnosis was made before or after the presurgical evaluation. Patients were divided into two groups: resective surgery (RS) and non-resective surgery candidates (NRSC), with the latter group further divided into: palliative surgery (vagus nerve stimulation, deep brain stimulation, responsive neurostimulation or corpus callosotomy) and no surgery. We compared surgical candidacy evaluations and postsurgical outcomes in patients with different genetic abnormalities.</p></div><div><h3><u>Results</u></h3><p>We identified 142 patients with P/LP variants. After presurgical evaluation, 36 patients underwent RS, while 106 patients were NRSC. Patients with variants in ion channel and synaptic transmission genes were more common in the NRSC group (48 %), compared with the RS group (14 %) (p<0.001). Most patients in the RS group had tuberous sclerosis complex. Almost half (17/36, 47 %) in the RS group had Engel class I or II outcomes. Patients with channelopathies were less likely to undergo a surgical procedure than patients with mTORopathies, but when deemed suitable for resection had better surgical outcomes (71 % versus 41 % with Engel I/II). Within the NRSC group, 40 underwent palliative surgery, with 26/40 (65 %) having ≥50 % seizure reduction after mean follow-up of 11 years. Favourable palliative surgery outcomes were observed across a diverse range of genetic epilepsies.</p></div><div><h3>Significance</h3><p>Genomic findings, including a channelopathy diagnosis, should not preclude presurgical evaluation or epilepsy surgery, and appropriately selected cases may have good surgical outcomes. Prospective registries of patients with monogenic epilepsies who undergo epilepsy surgery can provide additional insights on outcomes.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"206 ","pages":"Article 107425"},"PeriodicalIF":2.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142012636","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}
Epilepsy ResearchPub Date : 2024-08-06DOI: 10.1016/j.eplepsyres.2024.107427
Lidia Moura , Ioannis Karakis , David Howard
{"title":"Emergency department utilization among adults with epilepsy: A multi-state cross-sectional analysis, 2010–2019","authors":"Lidia Moura , Ioannis Karakis , David Howard","doi":"10.1016/j.eplepsyres.2024.107427","DOIUrl":"10.1016/j.eplepsyres.2024.107427","url":null,"abstract":"<div><h3>Objective</h3><p>We described patterns and trends in ED use among adults with epilepsy in the United States.</p></div><div><h3>Methods</h3><p>Utilizing inpatient and ED discharge data from seven states, we conducted a cross-sectional analysis to identify adult ED visits diagnosed with epilepsy or seizures from 2010 to 2019. Using ED visit counts and estimates of state-level epilepsy prevalence, we calculated ED visit rates overall and by payer, condition, and year.</p></div><div><h3>Results</h3><p>Our data captured 304,935 ED visits with epilepsy as a primary or secondary diagnosis in 2019. Across the seven states, visit rates ranged between 366 and 726 per 1000 and were higher than rates for adults without epilepsy in all states but one. ED visit rates were highest among Medicare and Medicaid beneficiaries (vs commercial or self-pay). Adults with epilepsy were more likely to be admitted as inpatients. Visits for nervous system disorders were 6.3–8.2 times higher among people with epilepsy, and visits for mental health conditions were 1.2–2.6 times higher. Increases in ED visit rates from 2010 to 2019 among people with epilepsy exceeded increases among adults without by 6.0–27.3 percentage points.</p></div><div><h3>Conclusion</h3><p>Adults with epilepsy visit the ED frequently and visit rates have been increasing over time. These results underscore the importance of identifying factors contributing to ED use and designing tailored interventions to improve ambulatory care quality.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"205 ","pages":"Article 107427"},"PeriodicalIF":2.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906258","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}
Epilepsy ResearchPub Date : 2024-08-06DOI: 10.1016/j.eplepsyres.2024.107429
Aimee Goel, Stefano Seri, Shakti Agrawal, Ratna Kumar, Annapurna Sudarsanam, Bryony Carr, Andrew Lawley, Lesley Macpherson, Adam J. Oates, Helen Williams, A. Richard Walsh, William B. Lo, Joshua Pepper
{"title":"The utility of Multicentre Epilepsy Lesion Detection (MELD) algorithm in identifying epileptic activity and predicting seizure freedom in MRI lesion-negative paediatric patients","authors":"Aimee Goel, Stefano Seri, Shakti Agrawal, Ratna Kumar, Annapurna Sudarsanam, Bryony Carr, Andrew Lawley, Lesley Macpherson, Adam J. Oates, Helen Williams, A. Richard Walsh, William B. Lo, Joshua Pepper","doi":"10.1016/j.eplepsyres.2024.107429","DOIUrl":"10.1016/j.eplepsyres.2024.107429","url":null,"abstract":"<div><h3>Aim</h3><p>Paediatric patients with drug-resistant focal epilepsy (DRFE) who have no clear focal lesion identified on conventional structural magnetic resonance imaging (MRI) are a particularly challenging cohort to treat and form an increasing part of epilepsy surgery programs. A recently developed deep-learning-based MRI lesion detection algorithm, the Multicentre Lesion Detection (MELD) algorithm, has been shown to aid detection of focal cortical dysplasia (FCD). We applied this algorithm retrospectively to a cohort of MRI-negative children with refractory focal epilepsy who underwent stereoelectroencephalography (SEEG) to determine its accuracy in identifying unseen epileptic lesions, seizure onset zones and clinical outcomes.</p></div><div><h3>Methods</h3><p>We retrospectively applied the MELD algorithm to a consecutive series of MRI-negative patients who underwent SEEG at our tertiary Paediatric Epilepsy Surgery centre. We assessed the extent to which the identified MELD cluster or lesion area corresponded with the clinical seizure hypothesis, the epileptic network, and the positron emission tomography (PET) focal hypometabolic area. In those who underwent resective surgery, we analysed whether the region of MELD abnormality corresponded with the surgical target and to what extent this was associated with seizure freedom.</p></div><div><h3>Results</h3><p>We identified 37 SEEG studies in 28 MRI-negative children in whom we could run the MELD algorithm. Of these, 14 (50 %) children had clusters identified on MELD. Nine (32 %) children had clusters concordant with seizure hypothesis, 6 (21 %) had clusters concordant with PET imaging, and 5 (18 %) children had at least one cluster concordant with SEEG electrode placement. Overall, 4 MELD clusters in 4 separate children correctly predicted either seizure onset zone or irritative zone based on SEEG stimulation data. Sixteen children (57 %) went on to have resective or lesional surgery. Of these, only one patient (4 %) had a MELD cluster which co-localised with the resection cavity and this child had an Engel 1 A outcome.</p></div><div><h3>Conclusions</h3><p>In our paediatric cohort of MRI-negative patients with drug-resistant focal epilepsy, the MELD algorithm identified abnormal clusters or lesions in half of cases, and identified one radiologically occult focal cortical dysplasia. Machine-learning-based lesion detection is a promising area of research with the potential to improve seizure outcomes in this challenging cohort of radiologically occult FCD cases. However, its application should be approached with caution, especially with regards to its specificity in detecting FCD lesions, and there is still work to be done before it adds to diagnostic utility.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"206 ","pages":"Article 107429"},"PeriodicalIF":2.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141990936","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}