Epilepsy Research最新文献

{"title":"Seizure and cognitive outcomes of cortical long bursting responsive neurostimulation in intractable focal epilepsy","authors":"Surya Suresh ,&nbsp;Yosefa Modiano ,&nbsp;Ganne Chaitanya ,&nbsp;Vladimir Vashin ,&nbsp;Jeston Chin ,&nbsp;Sandipan Pati","doi":"10.1016/j.eplepsyres.2025.107555","DOIUrl":"10.1016/j.eplepsyres.2025.107555","url":null,"abstract":"<div><div>Responsive Neurostimulation (RNS) is an established therapy for drug-resistant epilepsies (DRE), yet conventional high-frequency stimulation delivered in short bursts (SB; 100 ms) may fail to achieve significant seizure reduction. This retrospective study evaluated the efficacy of cortical high-frequency long-burst (LB; 5000 ms) RNS therapy in 13 DRE patients who experienced less than a 50 % reduction in seizures with SB therapy. After initiating LB therapy, 55 % of patients achieved a seizure reduction of more than 50 %, with a median follow-up of 13 months. Although the number of stimulation therapies delivered per day did not significantly differ between the SB and LB paradigms, the LB RNS delivered a substantially higher charge per hour (mean 18 mC/hr vs. 0.7 mC/hr) to the epileptogenic cortex. Importantly, despite the increased charge, no cognitive decline was observed, likely due to the precise timing of the stimulation in response to epileptiform activity. These findings suggest that LB RNS may be a viable alternative for patients who do not respond to conventional RNS therapy, offering improved seizure control without compromising cognitive function. However, the increased charge raises concerns about battery life, emphasizing the need for further research on different stimulation frequencies in LB RNS. This study highlights the potential of tailored stimulation paradigms to optimize outcomes in drug-resistant epilepsy.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"214 ","pages":"Article 107555"},"PeriodicalIF":2.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143842689","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":"Evaluation and clinical characteristics of anxiety, depression, and sleep quality among adult patients with seizure clusters","authors":"Lan Mou ,&nbsp;Yuwen Zhang ,&nbsp;Chenshi Liu ,&nbsp;Ming-Ming Zhang ,&nbsp;Ting-Ting Liu ,&nbsp;Jun Liu ,&nbsp;Qi Wang ,&nbsp;Jie Liu","doi":"10.1016/j.eplepsyres.2025.107552","DOIUrl":"10.1016/j.eplepsyres.2025.107552","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to examine the clinical characteristics among seizure clusters (SCs) in adult patients with epilepsy, measure anxiety and depression symptoms, sleep quality and analyze risk factors related to these conditions while assessing their social burden.</div></div><div><h3>Methods</h3><div>The Generalized Anxiety Disorder-7 (GAD-7), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Pittsburgh Sleep Quality Index (PSQI), and the Social Support Rating Scale (SSRS) were among the structured questionnaires utilized in Sichuan Provincial People's Hospital. Multivariate logistic regression analysis was conducted on the related differential indicators.</div></div><div><h3>Results</h3><div>A total of 330 adult patients with epilepsy were included. Statistically significant differences (p &lt; 0.05) were found between the patients with SCs and without groups in terms of age at first onset, etiology, semiology distribution, imaging and EEG results, therapy, and prognosis. SC patients had significantly higher GAD-7, NDDI-E, and PSQI average total scores than in the Non-Seizure Cluster (NSC) group. (p &lt; 0.001), and the distribution of related factors varying by age and daily seizure frequency. Patients with SCs had shown lower objective support, including material support, social networks, and group relationships than the control group</div></div><div><h3>Significance</h3><div>SCs are a type of clinical emergency. Patients with SCs are more susceptible to anxiety, depression, poor sleep quality and social burden, requiring proactive intervention and mental health management.</div><div>This study is registered with the Chinese Clinical Trials Registry (identifier: ChiCTR2400088157).</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"213 ","pages":"Article 107552"},"PeriodicalIF":2.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824128","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":"Treatment modifications of antiseizure medications in children due to adverse drug reactions: The parents’ perspective","authors":"Esther Meise ,&nbsp;Thilo Bertsche ,&nbsp;Sarah Jeschke ,&nbsp;Astrid Bertsche ,&nbsp;Martina P. Neininger","doi":"10.1016/j.eplepsyres.2025.107548","DOIUrl":"10.1016/j.eplepsyres.2025.107548","url":null,"abstract":"<div><h3>Background</h3><div>Adverse drug reactions (ADRs) occur frequently in the treatment with antiseizure medication (ASM). We investigated the influence of experienced ADRs on desired or actual treatment modifications in paediatric patients from the parents’ perspective.</div></div><div><h3>Methods</h3><div>We interviewed 104 parents of children with an epilepsy diagnosis in routine paediatric care at a German university hospital. The questionnaire comprised questions about current and previous experiences with ASM regarding ADRs leading to desired or actual treatment modifications.</div></div><div><h3>Results</h3><div>Of 94 parents of children with current ASM, 11/94 (12 %) desired treatment modifications because of ADRs. Of 66 parents of children with previous ASM treatment, 51/66 (77 %) reported a total of 72 actual ADR-related modifications in the past. The most frequently mentioned ADRs leading to desired or actual treatment modifications were fatigue (current: 7/94 [7 %]; previous: 23/72 [32 %]), behavioural changes (current: 6/94 [6 %]; previous: 28/72 [39 %]), and negative changes in cognitive processes (current: 3/94 [3 %]; previous: 12/72 [17 %]). In total, parents attributed ADR-related desired or actual treatment modifications to 14 different ASMs. Behavioural changes leading to desired or actual modifications were mentioned for 10/14 (71 %) ASMs, fatigue for 9/14 (64 %) ASMs, and negative changes in cognitive processes for 8/14 (57 %) ASMs.</div></div><div><h3>Conclusion</h3><div>One-in-ten parents desired to modify current ASM treatment due to ADRs, and almost two thirds reported actual ADR-related modifications of previous ASMs. As the same ADRs were reported for different ASMs, those ADRs may not be preventable through ASM variation. Thus, coping strategies are needed, particularly for the occurrence of common neurological and psychiatric ADRs.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"213 ","pages":"Article 107548"},"PeriodicalIF":2.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799263","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":"UGT polymorphisms and epileptic seizure control in pregnant women treated with Lamotrigine","authors":"Nadja Skadkær Hansen ,&nbsp;Inger Öhman ,&nbsp;Lena Ekström ,&nbsp;Vaiva Petrenaite","doi":"10.1016/j.eplepsyres.2025.107554","DOIUrl":"10.1016/j.eplepsyres.2025.107554","url":null,"abstract":"<div><h3>Objective</h3><div>We investigated whether polymorphisms of selected uridine-diphospho-glucuronosyl-tranferases (UGT) involved in Lamotrigine (LTG) metabolism are associated with seizure control during pregnancy and post-partum in women with epilepsy treated with LTG.</div></div><div><h3>Methods</h3><div>Single nucleotide polymorphisms for UGT1A4 * 2 (P24T, c.70 C&gt;A), UGT1A4 * 3 (L48V c.142 T &gt; G) and UGT2B7 * 2 (H268Y, c.802 C&gt;T), were determined in 47 pregnancies in 40 non-smoking women with LTG-treated epilepsy. Retrospectively collected data included seizure type and frequency, LTG dosage and LTG plasma level changes during pregnancy and PP. We evaluated the effect of UGT genotype on seizure control throughout pregnancy and post-partum (T1-PP).</div></div><div><h3>Results</h3><div>In 47 pregnancies, seizure control was achieved in 60 % in T1-PP. Occurrence of seizures T1-PP was not directly associated with UGT genotype, but with having pre-pregnant seizures within the past 6 months (OR 8.33 (95 % CI 1.53–45.41, <em>p = 0.01</em>) and 12 months (OR 5.25, 95 % CI 1.47–18.77, <em>p = 0.02</em>) preceding pregnancy.</div></div><div><h3>Conclusion</h3><div>We did not observe any proximate effect of UGT genotypes on seizure control during pregnancy and post-partum in women treated with LTG, but seizures within the year preceding pregnancy had a significant impact.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"213 ","pages":"Article 107554"},"PeriodicalIF":2.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824127","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":"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":"Impact of the economic crisis in Sri Lanka on health and healthcare related to epilepsy","authors":"Jithangi Wanigasinghe ,&nbsp;Carukshi Arambepola ,&nbsp;Poorna A. de Silva ,&nbsp;Dilara Abeygunaratne ,&nbsp;Dulara M. Elapatha ,&nbsp;Saamir Mohideen ,&nbsp;Saraji Wijesekara ,&nbsp;Thashi Chang","doi":"10.1016/j.eplepsyres.2025.107550","DOIUrl":"10.1016/j.eplepsyres.2025.107550","url":null,"abstract":"<div><h3>Background</h3><div>The economic crisis in Sri Lanka in 2022–23, has had a significant impact on its healthcare system, particularly with epilepsy, a condition demanding continuous care, facing heightened vulnerability amidst this turmoil.</div></div><div><h3>Objectives</h3><div>To assess the health impact of the economic crisis on people with epilepsy (PWE), their caregivers and healthcare providers and on the delivery of epilepsy-related healthcare services</div></div><div><h3>Method</h3><div>A hospital-based cross-sectional study was conducted from June to August 2022 in the most populated province in Sri Lanka. The sample included 405 patients and their caregivers. A separate cross-sectional survey among all neurologists practicing in the national healthcare system was concurrently performed. Health outcomes were assessed by recall for before and after the economic crisis. Epilepsy control scales, mental well-being scales and questionnaires were used to measure health outcomes. Impact on healthcare services was evaluated through 1). a country-wide survey on availability of anti-seizure medication (ASM) and 2). neurologists’ views on effects on healthcare services during the crisis.</div></div><div><h3>Results</h3><div>Significant shifts in health outcomes such as increase in frequency of average number of seizures experienced (p &lt; 0.001), number of emergency admissions(p &lt; 0.01) and greater number of breakthrough seizures(p &lt; 0.001) was reported. Psychological distress was reported by all three categories (PWEs, caregivers and care providers). Healthcare services were affected due to shortage of ASMs and other first-line medications. Healthcare providers reported management challenges, including medication shortages and increased patient burdens.</div></div><div><h3>Significance</h3><div>The adverse impacts of the economic crisis in Sri Lanka extend to both health and epilepsy-related healthcare services. This study underscores the imperative for immediate collaborative efforts to address these challenges.</div></div><div><h3>Funding</h3><div>Self-funded by the authors.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"214 ","pages":"Article 107550"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838676","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}