Epilepsia Open最新文献

{"title":"Late-onset asystole associated with vagal nerve stimulation.","authors":"Divya Nagabushana, Huan Huynh, Mark D McCauley, Anna Serafini","doi":"10.1002/epi4.70061","DOIUrl":"https://doi.org/10.1002/epi4.70061","url":null,"abstract":"<p><p>Vagal nerve stimulation (VNS) is a form of neuromodulation that is an established adjunct in the management of drug-resistant epilepsy. The common side effects of VNS are cough, dysphonia, or shortness of breath, which are often mild and do not require discontinuation of therapy. However, serious adverse effects such as bradyarrhythmia and asystole can occur rarely in patients who have had VNS implanted several years ago due to certain technical issues, patient-related risk factors, and unknown causes that necessitate the deactivation of VNS. We describe the late onset of bradyarrhythmia in a 32-year-old patient with drug-resistant epilepsy 2 years after the implantation of VNS and the subsequent management. We also review similar cases in the literature to understand their mechanism of asystole and the antecedent risk factors. In conclusion, when selecting a patient for VNS, all the possible risk factors for adverse cardiac events should be considered. Initial EKG Holter prior to implantation and periodic monitoring is recommended for patients on VNS. PLAIN LANGUAGE SUMMARY: Vagal nerve stimulation (VNS) is a treatment used alongside medication for people with epilepsy who do not respond to drugs. It usually causes mild side effects such as cough or voice changes. Rarely, it can lead to serious heart problems such as slow heartbeat or heart stoppage, even years after the device is implanted. This report describes such a case in a 32-year-old patient and reviews similar cases to understand the risks. The authors recommend checking heart health with tests like an electrocardiogram before starting VNS and doing regular follow-up checks to help prevent serious complications.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketogenic diet therapy for epilepsy during pregnancy and lactation: An international survey exploring clinician perspectives.","authors":"Kelly Faltersack, Tanya J W McDonald, Valentina De Giorgis, Bobbie Barron, Mackenzie C Cervenka, Anita Devlin, Laura A Healy, Magnhild Kverneland, Elles van der Louw, Mengyang Lu, Martina P Zanaboni, Marisa Armeno, Elizabeth A Felton","doi":"10.1002/epi4.70067","DOIUrl":"https://doi.org/10.1002/epi4.70067","url":null,"abstract":"<p><strong>Objective: </strong>Ketogenic diet therapies (KDTs) are increasingly used as a treatment for people with epilepsy of childbearing potential (PWECP) and glucose transporter type 1 deficiency syndrome (Glut1DS). The aim of this study was to collect information on clinical experience with KDT during pregnancy and lactation in these populations.</p><p><strong>Methods: </strong>Between December 2023 and June 2024, an online survey was widely circulated to healthcare professionals (HCPs) working with PWECP and people with Glut1DS of childbearing potential on KDT. The survey explored KDT use during pregnancy and lactation. Only HCPs working with patients who expressed interest in KDT and who were planning to become pregnant or were already pregnant were invited to complete the survey.</p><p><strong>Results: </strong>Thirty-five HCPs had counseled patients about whether to follow KDT during pregnancy. Sixty percent of HCPs did not recommend KDT during pregnancy. Key concerns included a lack of expertise with KDT use during pregnancy, insufficient data on the safety of KDT use during pregnancy, and uncertainty about the impact on fetal development. Among the HCPs (40%) who recommended KDT during pregnancy, there was no consensus regarding the version of KDT or optimal macronutrient composition. Even fewer HCPs (n = 5) had provided counseling on diet adaptation during lactation. Low Glycemic Index Treatment and the modified Atkins diet were most recommended. Blood ketone monitoring was unanimously recommended during lactation.</p><p><strong>Significance: </strong>Based on the survey results, HCPs have variable opinions about the safety, management, ideal diet, and levels of ketosis for people with epilepsy (PWE) and Glut1DS on KDT during pregnancy and lactation. There was consensus about monitoring ketosis levels and ensuring micronutrient supplementation. Patient enrollment in pregnancy registries that capture KDT use is crucial to support future research and expand knowledge about the safety of KDT so HCPs and PWE or Glut1DS can make informed decisions about their treatment.</p><p><strong>Plain language summary: </strong>Most healthcare providers (HCPs) did not advise ketogenic diet therapy (KDT) for epilepsy during pregnancy, though some noted exceptions for glucose transporter type 1 deficiency syndrome. Their main concerns were not having enough information about safety for the parent and fetus and their own lack of experience using KDT during pregnancy. The 40% of HCPs who supported the use of KDT during pregnancy stressed the need for personalized care and close monitoring to reduce risks. Few HCPs have used KDT during lactation. Experts advised using more flexible versions of KDT during lactation. More research is needed.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resting-state functional connectivity changes with microburst vagus nerve stimulation therapy.","authors":"Jane B Allendorfer, Rodolphe Nenert, Elhum Shamshiri, Giovanni Ranuzzi, Jason Begnaud, Ryan Verner, Jerzy P Szaflarski","doi":"10.1002/epi4.70059","DOIUrl":"https://doi.org/10.1002/epi4.70059","url":null,"abstract":"<p><strong>Objective: </strong>Microburst vagus nerve stimulation (μVNS) may reduce seizure frequency in drug-resistant epilepsy (DRE) via targeted thalamic plasticity. We prospectively investigated the role of thalamic resting-state functional connectivity (rsFC) in μVNS effects and hypothesized a relationship between thalamic rsFC and long-term seizure frequency changes.</p><p><strong>Methods: </strong>Eighteen patients with focal (Foc) and 10 with generalized (Gen) DRE underwent 3T resting-state fMRI at 2 weeks post-implantation and before starting (baseline) and after 6 months of μVNS. Resting-state fMRI analyses were performed using in-house Matlab scripts. Nonparametric permutation tests assessed baseline group differences in rsFC between automated anatomical atlas (AAL) brain regions and longitudinal rsFC changes. Spearman correlations were performed between baseline thalamus rsFC and percent change in seizures after 12 months of μVNS (PCHG-12).</p><p><strong>Results: </strong>Gen had stronger baseline rsFC between AAL regions compared with Foc. Gen showed significant baseline-to-6-month rsFC changes, including a decrease between the left thalamus and left superior parietal lobule. Foc showed significant rsFC changes, including increases between the left thalamus and four regions: right middle cingulum (Lthal-Rmidcing), right angular gyrus (Lthal-Rangular), left angular gyrus (Lthal-Langular), and left precuneus (Lthal-Lprecuneus), and increases between the right thalamus and left angular gyrus (Rthal-Langular). Foc showed negative correlations between PCHG-12 and baseline rsFC for Lthal-Rmidcing (ρ = -0.61; p = 0.007), Lthal-Rangular (ρ = -0.51; p = 0.032), and Rthal-Langular (ρ = -0.52; p = 0.028).</p><p><strong>Significance: </strong>Baseline thalamic rsFC is correlated with long-term seizure frequency reduction with μVNS in focal DRE. RsFC may be a potential biomarker for μVNS response in focal-onset seizure patients; this relationship may be different in DRE with generalized seizures.</p><p><strong>Plain language summary: </strong>We investigated how stimulating the vagus nerve in a specific manner may reduce seizure frequency in people with drug-resistant epilepsy through its actions on how a part of the brain called the thalamus is functionally connected to other brain regions. People with focal seizures showed a different pattern of changes in thalamus functional connectivity than those with generalized seizures after 6 months of stimulation. People with focal seizures also showed that stronger functional connectivity between the thalamus and other brain regions at baseline was related to a greater decrease in seizure frequency after 12 months of stimulation.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision therapies for genetic epilepsies in 2025: Promises and pitfalls.","authors":"Shuyu Wang, Emilio Perucca, Samuel F Berkovic, Piero Perucca","doi":"10.1002/epi4.70065","DOIUrl":"https://doi.org/10.1002/epi4.70065","url":null,"abstract":"<p><p>By targeting the underlying etiology, precision therapies offer an exciting paradigm shift to improve the stagnant outcomes of drug-resistant epilepsies, including developmental and epileptic encephalopathies. Unlike conventional antiseizure medications (ASMs) which only treat the symptoms (seizures) but have no effect on the underlying disease, precision therapies have the potential to suppress not only the seizures but also disabling comorbidities, including cognitive and behavioral abnormalities, which share the same causative mechanisms. Monogenic epilepsies are an attractive target for precision therapies because of their well-defined molecular mechanisms which can be tested in vitro and can be counteracted by specific drugs. Unfortunately, however, for the vast majority of proposed precision therapies, the evidence for their clinical efficacy is either non-existent or limited to uncontrolled observational accounts. Everolimus is the sole precision therapy with a seizure-related indication with class I evidence of efficacy, highlighting the practical and ethical challenges in obtaining high-level evidence. Here, we review the evidence landscape for candidate precision therapies, including repurposed and innovative treatments currently in development, discuss lessons learned from their use, and highlight strategies to improve their application and evaluation in the clinical setting. PLAIN LANGUAGE SUMMARY: Precision therapies offer a new approach to treat drug-resistant monogenic epilepsies, that is, epilepsies caused by a defect in a single gene. Unlike traditional antiseizure medications, precision therapies target the cause of the disease and have the potential to improve not only seizure control but also concomitant conditions such as cognitive and behavioral disorders. To date, the evidence derived from the clinical use of most proposed precision therapies is limited. This review explores current evidence and strategies to advance their development.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 perampanel as add-on therapy in Dravet syndrome: A prospective real-world study.","authors":"Han Wang, Hong Chen, Xin Ding, Xueyan Cao, Jiahui Mai, Huafang Zou, Dongfang Zou, Yanwei Zhu, Jianxiang Liao, Dezhi Cao","doi":"10.1002/epi4.70058","DOIUrl":"https://doi.org/10.1002/epi4.70058","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the efficacy and tolerability of perampanel (PER) on Dravet syndrome in China by a prospective real-world study.</p><p><strong>Methods: </strong>We prospectively enrolled children with Dravet syndrome from the neurology clinic of Shenzhen Children's Hospital from September 2020 to October 2021. The average monthly seizure frequency within 2 months before enrollment was recorded as the baseline. PER was administered after enrollment. The response rate (the rate of seizure reduction ≥50% compared to the baseline) was regarded as the major index. The adverse events and retention rates were regarded as the minor index. All indexes were calculated after 3 and 6 months' follow-up, respectively. The outcome-predictive value of various clinical factors was analyzed.</p><p><strong>Results: </strong>A total of 21 children were enrolled, including 15 boys and 6 girls, with a median age of 4 years and 8 months (1 year and 3 months to 15 years and 6 months). Averagely, 2.57 ASMs had been administrated and failed to control seizures before enrollment. The response rates were 52.4% (11/21) and 47.6% (10/21) after 3 and 6 months of PER administration, respectively. Adverse events were observed in 8 patients (38.1%), including irritability (3/8, 37.5%), fatigue (3/8, 37.5%), unstable walking (2/8, 25%), somnolence (2/8, 25%), and sluggish response (2/8, 25%); most of them were mild and temporary. The retention rate was 90.5% (19/21) at 6 months' follow-up. Two patients discontinued PER due to failure of seizure control, and no patients discontinued due to adverse events.</p><p><strong>Significance: </strong>This study provides a comprehensive analysis of PER's effectiveness and tolerability in treating DS, highlighting its importance as an additional treatment option. It broadens the range of anti-seizure medications (ASMs) that may be effective for patients with DS.</p><p><strong>Plain language summary: </strong>In the neurology clinic of Shenzhen Children's Hospital, 21 children with Dravet syndrome were administered perampanel. Perampanel, as a novel anti-seizure medication approved for focal and generalized epilepsies as add-on therapy, showed sufficient efficacy and a satisfactory safety and tolerability profile in this study.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambient technology in epilepsy clinical practice.","authors":"Haania Kakwan, Justin F Rousseau, Lidia M Moura, Irfan S Sheikh","doi":"10.1002/epi4.70066","DOIUrl":"https://doi.org/10.1002/epi4.70066","url":null,"abstract":"<p><p>The utilization of large language model-based artificial intelligence (AI) in the field of neurology has gained attention as a viable tool to enhance and assist providers with processes ranging from scheduling patients to providing preliminary interpretations of testing results, pending orders, and documenting encounters. Epileptologists could benefit from these technologies by utilizing ambient AI models, recent applications of which offer promising solutions for automating clinical documentation. While the potential benefits of using these tools are significant and include reduced physician burnout and improved patient experience, the deployment of these technologies also raises critical concerns, such as potential biases in model training and the risk of errors being inserted into the electronic health record (EHR), among other yet to be realized unintended consequences. The accuracy of clinical documentation is essential in epilepsy care, where detailed seizure histories and accurate medication records are critical to patient safety. Another concern may be paradoxically increased physician burnout as increased expectations of providers are created. This article examines the challenges, risks, and practical considerations in applying documentation tools that utilize ambient intelligence (AmI) for outpatient epilepsy clinic encounters, highlighting key examples from clinical practice and underscoring the importance of human oversight. Although AmI models may enhance clinical documentation efficiency as measured by time to close a note and reduced rates of burnout in providers, their role in clinical environments must be carefully regulated, with further studies needed to validate this claim, provide ongoing monitoring of performance, and establish safeguards for patient safety. Collaborative efforts among clinicians, clinical informatics professionals, AI developers, and regulatory bodies are pressingly needed to ensure the safe deployment of AmI into clinical care settings. PLAIN LANGUAGE SUMMARY: Ambient artificial intelligence technology takes advantage of sensors embedded in the environment to automate tasks without the need for human input. It has the potential to streamline numerous tasks within outpatient epilepsy clinics and reduce the workload of providers as well as improve patient care. This technology has already been brought to the market as a tool for clinical documentation. The current challenges and limitations associated with its implementation require careful human oversight, which we show with examples. Further research, regulations, and ongoing monitoring are necessary to ensure ambient artificial intelligence benefits both patients and healthcare providers while minimizing risks.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An interview with Thomas Foutz, 2025 Epilepsia open prize winner for basic science research.","authors":"Merab Kokaia, Piero Perucca","doi":"10.1002/epi4.70041","DOIUrl":"https://doi.org/10.1002/epi4.70041","url":null,"abstract":"","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An interview with Ondřej Strýček, 2025 Epilepsia Open prize winner for clinical research.","authors":"Merab Kokaia, Piero Perucca","doi":"10.1002/epi4.70040","DOIUrl":"https://doi.org/10.1002/epi4.70040","url":null,"abstract":"","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The landscape of epilepsy surgery in older adults: Challenges and opportunities.","authors":"Vineet Punia","doi":"10.1002/epi4.70062","DOIUrl":"https://doi.org/10.1002/epi4.70062","url":null,"abstract":"<p><p>The prevalence of epilepsy increases with age, and with the aging population, the number of drug-resistant epilepsy (DRE) cases is expected to rise. However, epilepsy surgery remains underutilized and is typically offered to younger adults. Despite historical hesitancy due to concerns over risks and outcomes, evidence over the last two decades shows that epilepsy surgery in older adults (≥50 years) can achieve seizure freedom. Seizure outcomes in older adults are comparable to those in younger adults, with some studies indicating even higher seizure freedom rates in patients over 60. However, concerns persist regarding surgical risks, cognitive decline, and postoperative complications. Older adults undergoing epilepsy surgery have a higher comorbidity burden, which may be associated with lower seizure freedom rates and an increased likelihood of non-home discharge post-surgery. Additionally, frailty can influence post-surgical disposition, although its impact on seizure outcome remains unclear. Surgical complications are more common in older adults, with a higher incidence of language disturbances, infarctions, and subdural hygromas-an issue exclusively observed in this population. Cognitive outcomes remain heterogeneous, with older adults at greater risk of verbal memory decline, particularly after dominant hemisphere resections. However, studies indicate that quality of life improves after surgery, particularly in patients with seizure freedom. Minimally invasive procedures such as laser interstitial thermal therapy (LITT) and neuromodulation techniques like vagus nerve stimulation (VNS) and responsive neurostimulation (RNS) offer promising alternatives for those who are not ideal candidates for resective surgery. Future research will help refine patient selection, address the impact of frailty, and explore long-term outcomes. Despite the risks, age alone should not preclude epilepsy surgery, and individualized decision-making remains key to optimizing outcomes. PLAIN LANGUAGE SUMMARY: In our rapidly aging world, an increasing number of older adults will have drug-resistant epilepsy. Epilepsy surgery can be a safe and effective option for adults over 50, and in many cases, they do just as well as younger patients in becoming seizure-free. While there is a slightly higher risk of complications, these risks should be weighed against the potential benefits. Older adults often have other health issues that may affect recovery. Memory and thinking changes can happen, especially with age, but outcomes vary. Age alone should not prevent someone from being considered for surgery. Each case deserves careful, personalized evaluation.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medications used for seizure-emergency management in the UK community: A clinical practice research datalink retrospective database study.","authors":"Yuanjun Ma, Chao Lu, Peggy Hastie, Ana Paula Bartmann, Cédric Laloyaux, Simon Borghs","doi":"10.1002/epi4.70035","DOIUrl":"https://doi.org/10.1002/epi4.70035","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Assess the prevalence, characteristics, and healthcare resource utilization (HCRU) of patients prescribed certain benzodiazepines for seizure-emergency management in the United Kingdom.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Retrospective cohort study using Clinical Practice Research Datalink (CPRD-Aurum) and Hospital Episode Statistics (HES) data that included patients with ≥1 recorded seizure-emergency medication prescription between 2016 and 2020. Patient characteristics were described for the whole sample. Inpatient, outpatient, and Accident and Emergency (A&E) encounters during 2019 were described. The 2019 prevalence of seizure-emergency medication prescription among patients with epilepsy was calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 2019, 6.7% (9336/139667) of CPRD-Aurum patients with epilepsy were prescribed seizure-emergency medication. Between 2016 and 2020, 26 534 patients with seizure-emergency medication were identified (mean/median age: 41.5/41.0 years [71.8% were adults]; 50.3% male). In this sample, the most prescribed seizure-emergency medication was buccal midazolam (60.6% of patients). Rectal diazepam was prescribed for 19.0%; oral benzodiazepines for 20.3%. Of the oral benzodiazepines prescribed for seizure-emergency management, oral diazepam was most common (97.5%). Buccal midazolam was prescribed both to children and adults (44.2%/55.8%); rectal diazepam and oral benzodiazepines mainly to adults (93.3%/99.5%). Among 11 594 patients with HES linkage in 2019, 25.1% experienced ≥1 epilepsy-specific inpatient hospitalization (median hospitalization days in patients with ≥1 hospitalization = 2.9 [IQR 12.0]); 35.7% had ≥1 neurology-specific outpatient visit (median visits in patients with ≥1 visit = 2.6 [3.4]); 8.7% had ≥1 epilepsy-related emergency attendance (median attendances in patients with ≥1 attendance = 3.0 [4.0]); 7.8% arrived in A&E by ambulance due to epilepsy (median arrivals in patients with ≥1 arrival = 2.2 [3.4]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Significance: &lt;/strong&gt;In 2019, 6.7% of patients with epilepsy were prescribed seizure-emergency medication. Nevertheless, patients continue to encounter challenges to manage seizure-related emergencies, as shown by high HCRU, suggesting that it may be time for a new treatment paradigm. The recently proposed concept of Rapid and Early Seizure Termination (REST) warrants further investigation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;In people with epilepsy, some seizures last too long and will not stop on their own, or may happen one after another, becoming emergencies that need medical attention; seizure-emergency medications are given to stop the seizure and prevent other medical problems. We looked at the share of people with epilepsy who had a seizure-emergency medication prescription in a UK database, and this group's use of health services. In 2019, 7% of people with epilepsy were prescribed a seizure-emergency medication. Use of health services was ","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}