Epilepsy Research最新文献

{"title":"Investigation of in-vivo GABA+ and Glutamate levels in patients with drug resistant unilateral temporal lobe epilepsy using MEGA-PRESS and correlates with clinical semiology","authors":"N. Pradhan ,&nbsp;Manoj Kumar ,&nbsp;M. Sandhya ,&nbsp;P. Bairwa ,&nbsp;PV Prathyusha ,&nbsp;K. Raghavendra ,&nbsp;LG Viswanathan ,&nbsp;A. Asranna ,&nbsp;RC Mundlamuri ,&nbsp;DK Deelchand ,&nbsp;Jitender Saini ,&nbsp;Rose Dawn Bharath ,&nbsp;Sanjib Sinha","doi":"10.1016/j.eplepsyres.2025.107625","DOIUrl":"10.1016/j.eplepsyres.2025.107625","url":null,"abstract":"<div><h3>Background</h3><div>In this study, we used in vivo MEGA-PRESS spectroscopy to investigate GABA and Glu levels in patients with drug-resistant unilateral temporal lobe epilepsy (TLE) and also look for correlation between neurometabolites and clinical semiology assessed by other modalities.</div></div><div><h3>Materials and methods</h3><div>Twenty-five patients with TLE underwent MRS data acquisition on a 3.0 T MRI. Bilateral single-voxel MEGA-PRESS data was acquired from mesial temporal lobes, and data was post-processed using MRSpa and LC-Model for computing neurometabolites concentration. Tissue segmentation from spectroscopic voxel was performed for tissue metabolite and CSF correction. Statistical analysis was performed to analyze differences in neurometabolic between affected and normal-sides and clinical correlations.</div></div><div><h3>Results</h3><div>GABA, Glu, NAA, Cr, and Cho neurometabolites were computed. The group-wise statistical comparison revealed a significantly reduced NAA level from the affected compared to normal-side of the hippocampus (p-value=0.039). We observed reduced GABA (p-value=0.07) values and hippocampal volume (p-value&lt;0.001) were observed from the affected side. A significant negative correlation was noted between affected-side hippocampal volume and NAA concentration (rho=-0.497, p-value=0.05). Glu/NAA ratios from both affected (rho=-0.692, p-value=0.012) and normal-sides (rho=-0.608, p-value=0.016) of the hippocampus were negatively correlated with age. Concordance between neurometabolites with video-EEG for lateralization demonstrates correct classification percentage for GABA was 86.7 %, indicating that there is an 86.7 % chance that GABA will be able to lateralize the unaffected side as detected by VEEG.</div></div><div><h3>Conclusion</h3><div>A novel exploratory study demonstrates an alternation of <em>in-vivo</em> GABA and Glu levels and hippocampal volume. This study may provide a direction for utilizing MEGA-PRES as a presurgical tool for assessing <em>in-vivo</em> neurometabolic profiles and add to the knowledge of the role of GABA and Glu in epilepsy and its interplay.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"218 ","pages":"Article 107625"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739530","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":"Real world observational study investigating clinical effectiveness and safety of lacosamide in epilepsy: ULTIMATE study","authors":"Sanjay Bhaumik ,&nbsp;S.C. Nemichandra ,&nbsp;Divyam Sharma ,&nbsp;Malini Gopinath ,&nbsp;Yakshdeep Dave ,&nbsp;Zahraan Qureshi ,&nbsp;Krishnaprasad Korukonda ,&nbsp;Girish Kulkarni","doi":"10.1016/j.eplepsyres.2025.107657","DOIUrl":"10.1016/j.eplepsyres.2025.107657","url":null,"abstract":"<div><h3>Objective</h3><div>Primary generalized tonic-clonic seizures (pGTCS) are often misdiagnosed and remain challenging to manage due to limited treatment options. Lacosamide (LCM), approved for focal-onset seizures and adjunctive pGTCS therapy, was evaluated for real-world effectiveness in Indian patients.</div></div><div><h3>Methods</h3><div>This real-world, multicenter, retrospective, observational, and non-interventional study was conducted across 124 centers in India following approval from a centralized institutional ethics committee. Data were analysed using descriptive and analytical statistical methods for continuous and categorical variables, utilizing SPSS version 29.0.1.0.</div></div><div><h3>Results</h3><div>The Full Analysis Set (FAS) included 685 patients (245 females, 35.77 %; 440 males, 64.23 %) with a mean age of 43.30 ± 11.87 years. Among them, 301 (43.94 %) had pGTCS and 384 (56.06 %) had FoS. Concomitant ASMs for pGTCS included LEV (68.44 %), VPA (21.93 %), and CBZ (13.62 %), while for FoS, LEV (47.14 %) was most common, followed by VPA (16.15 %) and CBZ (14.58 %).</div><div>At week 12, mean seizure frequency in pGTCS reduced from 3 to 1 (p &lt; 0.0001), with 52.16 % achieving seizure freedom and a 66.78 % responder rate. LCM with LEV showed a two-fold higher responder rate than with other ASMs (OR: 2.3582, p = 0.0037). In FoS, 47.66 % achieved seizure freedom, with a 58.85 % responder rate. Moreover, when prescribed as monotherapy in FoS, LCM showed a 62.96 % responder rate. LCM was generally well tolerated across both groups, with no unexpected safety concerns observed during the study period.</div></div><div><h3>Conclusion</h3><div>This study demonstrated the effectiveness of LCM therapy in reducing seizure frequency and improving seizure control in Indian patients with epilepsy. LCM was well tolerated and remains potential therapeutic option either as monotherapy or as an adjuvant therapy in the management of FoS.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"218 ","pages":"Article 107657"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018501","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":"Comment on \"Seizure outcome and anti-seizure medication use in post-stroke epilepsy: A retrospective cohort study\"","authors":"Rachana Mehta,&nbsp;Ranjana Sah","doi":"10.1016/j.eplepsyres.2025.107672","DOIUrl":"10.1016/j.eplepsyres.2025.107672","url":null,"abstract":"","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"218 ","pages":"Article 107672"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244010","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":"Bridging surface and depth: A systematic review of seizure patterns in simultaneous scalp and stereo-EEG","authors":"Cristiana Santos ,&nbsp;Daniel Filipe Borges ,&nbsp;Joana Isabel Soares","doi":"10.1016/j.eplepsyres.2025.107666","DOIUrl":"10.1016/j.eplepsyres.2025.107666","url":null,"abstract":"<div><h3>Background</h3><div>Drug-resistant epilepsy often requires invasive monitoring. Although simultaneous scalp EEG and stereo EEG are increasingly used together, their added value for preoperative evaluation and surgical planning remains uncertain and warrants systematic investigation.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus and Web of Science for English- or Portuguese-language studies in which patients with drug-resistant epilepsy were simultaneously monitored with scEEG and SEEG. Reports lacking primary data, systematic reviews, conference abstracts, case reports and studies limited to scEEG with electrocorticography were excluded. Two reviewers independently screened all records, extracted data and assessed methodological quality. The protocol was registered in PROSPERO (CRD42024590432) and conducted in accordance with PRISMA-P guidelines.</div></div><div><h3>Results</h3><div>From 9750 records, 16 articles underwent full-text analysis, and eight retrospective observational studies met the inclusion criteria. These eight studies - evenly split between the United States and Europe - included 250 patients. Data on diagnostic yield and postoperative outcomes were inconsistent. Key findings included (i) detailed mapping of seizure onset and propagation across cortical and subcortical regions, (ii) typical latency intervals between scEEG and SEEG detection, and (iii) concordance rates in localizing the epileptogenic zone.</div></div><div><h3>Conclusions</h3><div>Simultaneous scEEG-SEEG provides complementary cortical and mesial findings that sharpen the delineation of the epileptogenic zone and allow for targeted surgery. SEEG captures the deep generators, while scEEG provides the broader context for electrode placement. Current evidence is limited to small, methodologically heterogeneous series. Standardized protocols, larger multicenter cohorts and multimodal co-registration are needed to confirm the diagnostic gain and anchor this two-layered approach in routine clinical care.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"218 ","pages":"Article 107666"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108995","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":"Analysis of risk factors for recurrence after the withdrawal of ASMs in 135 children with epilepsy.","authors":"Yuchen Gao, Xuan Li, Zenghua Yong, Baoqiang Yuan, Yunlong Dou","doi":"10.1016/j.eplepsyres.2025.107638","DOIUrl":"10.1016/j.eplepsyres.2025.107638","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors for seizure recurrence following anti-seizure medication (ASM) withdrawal in children with epilepsy who achieved sustained seizure freedom.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 135 children with epilepsy from a single tertiary center (2022--2023) meeting withdrawal criteria (aged <16 years, seizure-free ≥2 years on stable ASMs, followed ≥1 year after withdrawal). Participants were grouped by postwithdrawal seizure relapse status: recurrent (n = 42) and nonrecurrent (n = 93). Thirteen risk factors were compared via chi-square tests. Variables significantly associated (P < 0.05) with recurrence in univariate analysis were entered into multivariate logistic regression to identify independent predictors (reported as ORs with 95 % CIs). The analyses were performed with SPSS 19.0.</p><p><strong>Results: </strong>The overall recurrence rate was 31.11 % (42/135), with 80.95 % of recurrences occurring during ASM tapering or within the first year after withdrawal. Univariate analysis revealed significant differences between the recurrence and nonrecurrence groups regarding prewithdrawal EEG abnormalities (P = 0.006), ASM polytherapy (P = 0.003), time to seizure freedom > 1 year (P = 0.037), pretreatment epilepsy duration > 1 year (P = 0.011), presence of comorbidities (P < 0.001), and multiple seizure types (P = 0.020). Multivariate logistic regression confirmed three independent risk factors for recurrence: (1) abnormal EEG before withdrawal (OR=9.268, 95 % CI: 2.255-38.092, P = 0.002), (2) ASM polytherapy (OR=3.205, 95 % CI: 1.159-8.866, P = 0.025), and (3) pretreatment epilepsy duration > 1 year (OR=5.363, 95 % CI: 1.781-16.150, P = 0.003).</p><p><strong>Conclusion: </strong>Abnormal EEG before withdrawal, polytherapy, and pretreatment duration > 1 year predicted recurrence. Enzyme-induction patterns showed exploratory associations requiring further validation.</p>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"218 ","pages":"107638"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811960","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":"Turning data analytics into an organisational asset: A landscape population analysis of 5720 people with epilepsy attending outpatient care in Ireland","authors":"Derek Corrigan ,&nbsp;Colin P. Doherty ,&nbsp;Tim Jacquemard ,&nbsp;Norman Delanty ,&nbsp;Máire White ,&nbsp;Mary Fitzsimons","doi":"10.1016/j.eplepsyres.2025.107613","DOIUrl":"10.1016/j.eplepsyres.2025.107613","url":null,"abstract":"<div><h3>Introduction</h3><div>The National Clinical Programme for Epilepsy (NCPE) in Ireland identified analytics applied to Electronic Patient Record (EPR) data as an organisational asset for driving continuous service improvement. This study describes the diagnostic, therapeutic and prognostic characteristics of a population of people with epilepsy (PwE) currently taking anti-epileptic drugs. This is an epidemiological question of interest to clinicians, PwE and their families, along with those involved in heath policy, and health service planning, implementation, monitoring and evaluation.</div></div><div><h3>Material and methods</h3><div>A de-identified data extract of 5720 PwE was taken from the Irish epilepsy EPR. Phenotypical characteristics were aggregated and visualised using data analytics. A set of landscape analyses fully describe this subpopulation in terms of epilepsy types, seizure types, seizure frequencies, aetiologies, comorbidities and numbers of anti-epileptic-drugs taken.</div></div><div><h3>Results</h3><div>A multi-disciplinary team of epilepsy healthcare providers and stakeholders reviewed the analytics results from which they identified a number of policy issues that required improvement relating to current epilepsy service delivery including:<ul><li><span>•</span><span><div>Equity of care relating to less refractory and older people with epilepsy.</div></span></li></ul></div><div><ul><li><span>•</span><span><div>Further review of patient cohorts taking greater than 4 AEDs with a view to describing underlying aetiologies of patients with complex epilepsy that may be poorly controlled.</div></span></li></ul><ul><li><span>•</span><span><div>Closer integration of other clinical disciplines that reflects diverse needs of PwE e.g. mental health and geriatric services.</div></span></li></ul></div><div><ul><li><span>•</span><span><div>Development of national capacity for genetic testing and preventative strategies for epilepsy.</div></span></li></ul></div></div><div><h3>Significance</h3><div>This study demonstrates how interrogation and analysis of large volumes of patient data can be applied to a real-world epilepsy EPR that is used in frontline epilepsy clinical care. This analytics approach was supported by a multi-disciplinary review of outputs to support a data-driven approach that interprets analytics with a view to improving actual clinical care.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"217 ","pages":"Article 107613"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489919","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":"Efficacy and tolerability of magnesium sulfate in children with infantile epileptic spasms syndrome: A systematic review and meta-analysis","authors":"Indar Kumar Sharawat ,&nbsp;Ananthanarayanan Kasinathan ,&nbsp;Pragnya Panda ,&nbsp;Lesa Dawman ,&nbsp;Juhi Tiwari ,&nbsp;RC Pavan Kumar ,&nbsp;Prateek Kumar Panda","doi":"10.1016/j.eplepsyres.2025.107628","DOIUrl":"10.1016/j.eplepsyres.2025.107628","url":null,"abstract":"<div><h3>Background</h3><div>Several trials and clinical studies have explored the efficacy and safety of magnesium sulfate (MgSO₄) in children with infantile epileptic spasms syndrome (IESS). However, no systematic review has been conducted to synthesize the available evidence.</div></div><div><h3>Methods</h3><div>This systematic review aimed to assess the efficacy and safety of MgSO₄ in children with IESS. The primary outcomes included the proportion of patients achieving spasm freedom, a favorable response in the number of spasms (defined as at least a 50 % reduction in daily spasms), resolution of hypsarrhythmia, improvement in developmental quotient, and the nature and frequency of adverse events. Additionally, we compared these variables between the ACTH+MgSO₄ combination therapy and ACTH monotherapy at various time points. We included all controlled and uncontrolled trials, as well as prospective and retrospective cohort studies.</div></div><div><h3>Results</h3><div>A total of four studies involving 1334 IESS patients were identified. The proportion of patients achieving a favorable response in daily spasm frequency, spasm freedom, hypsarrhythmia resolution, and EEG normalization was higher in the adrenocorticotropic hormone (ACTH)+MgSO₄ group than in the ACTH monotherapy group (RR=1.22, 95 % CI: 1.09–1.36, I²=0 %, p = 0.0004; RR=1.44, 95 % CI: 1.24–1.67, I²=29 %, p &lt; 0.00001; RR=1.27, 95 % CI: 1.15–1.41, I²=0 %, p &lt; 0.00001; and RR=1.46, 95 % CI: 1.06–2.02, I²=0 %, p = 0.02, respectively). The proportion of patients experiencing treatment-emergent adverse events and serious adverse events was comparable between the ACTH+MgSO₄ and ACTH monotherapy groups (RR=0.55, 95 % CI: 0.28–1.07, I²=49 %, p = 0.08; and RR=1.15, 95 % CI: 0.74–1.79, I²=0 %, p = 0.54, respectively). However, the frequency of hypertension was significantly lower in the ACTH+MgSO₄ group compared to the ACTH monotherapy group (RR=0.11, 95 % CI: 0.03–0.34, I²=0 %, p = 0.0002).</div></div><div><h3>Conclusions</h3><div>The combination of ACTH and MgSO₄ is more effective than ACTH monotherapy in achieving seizure control in children with IESS. Additionally, it is associated with a reduced risk of certain adverse events, such as hypertension.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"217 ","pages":"Article 107628"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653410","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":"Depressive symptoms in Chinese patients with epilepsy: Prevalence and clinical correlates","authors":"Yuwei Han ,&nbsp;Shun Gong ,&nbsp;Shimei Sun,&nbsp;Dan Yang,&nbsp;Bingying Zhang,&nbsp;Dandan Gao,&nbsp;Guanqian Yuan,&nbsp;Xiaoming Li,&nbsp;Guangzhi Hao,&nbsp;Guobiao Liang","doi":"10.1016/j.eplepsyres.2025.107624","DOIUrl":"10.1016/j.eplepsyres.2025.107624","url":null,"abstract":"<div><h3>Objective</h3><div>Depressive symptoms were a prevalent comorbidity among patients with epilepsy, significantly impacting their quality of life and treatment outcomes. This study aims to investigate the prevalence and clinical correlates of depressive symptoms in Chinese patients with epilepsy.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional study was conducted at the Department of Neurosurgery, General Hospital of Northern Theater Command, from January 2018 to June 2023. Patients diagnosed with epilepsy aged 16 years or older were included, excluding those with severe illnesses, substance abuse disorders, or severe cognitive impairments. Demographic and epilepsy-related information was collected using a standardized clinical data collection form. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Statistical analyses were performed using SPSS version 27.0.</div></div><div><h3>Results</h3><div>The study included 513 patients with epilepsy, with a mean age of 37.48 years (SD= 15.09). Among these, 65.9 % were male, and 62.6 % were aged 40 years or older. The majority of patients were single (50.9 %) and had formal education (57.1 %). The mean age of epilepsy onset was 21.96 years (SD = 12.83), and the mean duration of illness was 11.02 years (SD= 13.64). Generalized tonic-clonic seizures were the most common type (62.0 %), and 32.7 % of patients experienced very frequent seizures. Polytherapy was used by 63.5 % of patients. Depressive symptoms were present in 137 patients, representing a prevalence of 26.7 % (95 % CI: 20.51–31.89). The severity of depressive symptoms was categorized as mild in 62.0 %, mild to moderate in 18.2 %, moderate in 10.2 %, and severe in 9.5 %. The prevalence of depressive symptoms was higher among females, separated/widowed individuals, those with lower educational attainment, and unemployed patients. Significant associations were found between depressive symptoms and seizure frequency, duration of seizures, and polytherapy. Multivariate analysis identified seizure frequency, duration of seizures, and polytherapy as independent predictors of depressive symptoms.</div></div><div><h3>Conclusions</h3><div>Depressive symptoms were highly prevalent among Chinese patients with epilepsy, with significant associations found between depressive symptoms and several sociodemographic and clinical characteristics. Routine screening for depressive symptoms and tailored interventions are crucial for improving the quality of life and treatment outcomes in this population. Future research should focus on longitudinal studies to explore causal relationships and develop targeted interventions.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"217 ","pages":"Article 107624"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653411","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":"Childhood-onset epilepsy: Longitudinal seizure outcomes in a large single-center cohort","authors":"Hyun-Jin Kim,&nbsp;Min-Jee Kim,&nbsp;Eon Ah Kim,&nbsp;Ohcheol Kwon,&nbsp;Yun Sung Nam,&nbsp;Mi-Sun Yum ,&nbsp;Tae-Sung Ko","doi":"10.1016/j.eplepsyres.2025.107622","DOIUrl":"10.1016/j.eplepsyres.2025.107622","url":null,"abstract":"<div><h3>Objectives</h3><div>Epilepsy is the most common serious neurological disorder in children; however, previous long-term studies are often limited by small sample sizes or methodological variability. This study aimed to assess the epidemiology, seizure outcomes, and prognostic factors of childhood-onset epilepsy over &gt; 10 years of follow-up at a single tertiary center.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the medical records of 4248 patients diagnosed with epilepsy before age 19 between 1995 and 2017 at Asan Medical Center Children’s Hospital. All patients underwent at least one electroencephalogram (EEG) and received anti-seizure medications (ASMs) for &gt; 2 years.</div></div><div><h3>Results</h3><div>During a mean follow-up of 11.0 years, 43 patients (1.0 %) died. The median age at seizure onset was 7.2 years. Etiologies included unknown (52.5 %), structural (29.3 %), genetic/metabolic (23.4 %), and infectious/autoimmune (4.5 %). Focal epilepsy was the most common (63.4 %). Neurocognitive and psychological comorbidities were observed in 32.7 % and 20.6 % of patients, respectively. Seizure freedom for ≥ 2 years was achieved in 81.2 %, and terminal remission in 63.1 %. However, relapse occurred in 38.0 %, and 28.6 % developed intractable epilepsy. Prognostic factors included status epilepticus, intellectual disability, pretreatment seizure frequency, etiology, epilepsy syndromes, and EEG abnormalities.</div></div><div><h3>Conclusions</h3><div>This study reaffirms known risk factors while providing comprehensive insights into seizure trajectories, relapse patterns, and treatment responses in a large cohort. It highlights the clinical relevance of the 2-year seizure-free definition and underscores the need for early interventions in high-risk subgroups. Despite diagnostic advances, several cases remain etiologically unresolved, reinforcing the importance of expanding access to molecular and imaging tools in pediatric epilepsy care.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"217 ","pages":"Article 107622"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604321","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":"Machine learning models for predicting therapeutic response in drug-resistant epilepsy: A bivariate diagnostic meta-analysis","authors":"Anderson Matheus Pereira da Silva ,&nbsp;Victor Arthur Ohannesian ,&nbsp;Luciano Falcão ,&nbsp;Filipe Virgilio Ribeiro ,&nbsp;Isabelle Rodrigues Menezes ,&nbsp;Mariana Leticia de Bastos Maximiano ,&nbsp;Mariana Lee Han ,&nbsp;Lucas Silva Cabeça ,&nbsp;Pedro Lucas Machado Magalhães ,&nbsp;Gustavo Sousa Noleto ,&nbsp;Maria Bernadete de Sousa Maia ,&nbsp;Eryvelton de Souza Franco","doi":"10.1016/j.eplepsyres.2025.107623","DOIUrl":"10.1016/j.eplepsyres.2025.107623","url":null,"abstract":"<div><h3>Background</h3><div>Epilepsy affects approximately 6.4 per 1000 individuals worldwide. Despite advances in antiseizure medications (ASMs), nearly one-third of patients remain refractory to treatment, meeting criteria for drug-resistant epilepsy (DRE). This meta-analysis evaluated the performance of machine learning (ML) models in predicting therapeutic response in DRE based on ILAE-defined outcomes.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted in accordance with PRISMA-DTA guidelines. Studies applying ML algorithms to predict treatment response in DRE were included. Eligible designs comprised retrospective or prospective observational studies. Outcomes included seizure remission (ILAE Class 1), ≥ 50 % reduction in seizure frequency, treatment failure, and diagnostic accuracy metrics. A bivariate random-effects model was used to pool sensitivity, specificity, and diagnostic odds ratio (DOR). Heterogeneity was assessed (I², χ²), and subgroup and meta-regression analyses were performed. Likelihood ratios, area under the curve (AUC), and Bayesian post-test probabilities were estimated. Publication bias was evaluated with Deeks’ test.</div></div><div><h3>Results</h3><div>Eight studies (n = 1887) met inclusion criteria (Kappa=0.98). Pooled sensitivity and specificity were both 0.84 (95 % CI: 0.76–0.89 and 0.77–0.89, respectively), with an AUC of 0.91. DOR was 27; LR+ , 5.2; LR−, 0.19. Heterogeneity was high (χ²=22.7; p &lt; 0.001). Sensitivity was lower in prospective studies, prognostic models, and ASMs users, and higher with long-term follow-up. Meta-regression identified model type, study design, ASM exposure, and sample adequacy as key moderators.</div></div><div><h3>Conclusion</h3><div>ML models demonstrate high diagnostic accuracy in predicting therapeutic response in DRE. Findings support their potential clinical utility, provided external validation and methodological standardisation.</div></div><div><h3>Registration PROSPERO protocol number</h3><div>CRD 42024628323</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"217 ","pages":"Article 107623"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595496","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}