Epilepsia Open最新文献

{"title":"Cerebrospinal fluid metabolites as potential biomarkers for epilepsy: Insights from genome-wide association studies.","authors":"Zhenxiang Zhao, Na Xing, Lin Hou","doi":"10.1002/epi4.13101","DOIUrl":"https://doi.org/10.1002/epi4.13101","url":null,"abstract":"<p><strong>Objectives: </strong>While metabolic imbalances have been observed in individuals with epilepsy, the direct involvement of specific metabolites in the development of the condition remains underexplored. A comprehensive analysis of the causality between cerebrospinal fluid metabolites (CSF) and epilepsy is pivotal in discovering innovative therapeutic interventions and prophylactic approaches.</p><p><strong>Methods: </strong>Summary data from genome-wide association studies (GWAS) of CSF metabolites and epilepsy subtypes were obtained separately. A total of 338 CSF metabolites were investigated as exposures, and 11 epilepsy phenotypes were examined as the outcomes. A two sample Mendelian randomization (MR) approach was utilized to explore the causal influence of these metabolites on epilepsy. Causality was primarily estimated through inverse variance weighted (IVW) analysis, complemented by a range of sensitivity analyses to ensure result stability. Additionally, reverse MR analysis was performed to explore the possibility of bidirectional causality.</p><p><strong>Results: </strong>The IVW method, reinforced by sensitivity analyses, pinpointed 17 CSF metabolites with causal implications for six epilepsy phenotypes. After False Discovery Rate (FDR) multiple testing correction, two metabolites (Methylmalonate and Gamma-glutamyl-alpha-lysine) were found to have robust causal links to epilepsy (p < 0.05 and FDR<0.05). The other 15 metabolites exhibited suggestive evidence of a causal association (p < 0.05 and FDR>0.05).</p><p><strong>Significance: </strong>This study highlights CSF metabolites that could serve as valuable biomarkers and may be critical in developing targeted treatments and preventing epilepsy.</p><p><strong>Plain language summary: </strong>This study explores how certain chemicals in the brain fluid might influence the development of epilepsy, aiming to find new ways to treat or prevent it. Researchers looked at the relationship between 338 cerebrospinal fluid metabolites and 11 types of epilepsy using genetic data. They found that 17 of these chemicals could potentially cause six types of epilepsy. Two of these chemicals were strongly linked to epilepsy, suggesting they could be important for creating specific treatments or prevention strategies.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645964","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":"A multicenter, cross-sectional analysis to assess the safety and usage pattern of brivaracetam in the management of partial-onset seizure with BAEs-BREEZE study: A post-hoc analysis.","authors":"Arvind Sharma, Krishnaprasad Korukonda, Amit Haldar, Usha Kant Misra, R V Anand, Yakshdeep Dave, Girish Kulkarni","doi":"10.1002/epi4.13065","DOIUrl":"https://doi.org/10.1002/epi4.13065","url":null,"abstract":"<p><strong>Objective: </strong>Brivaracetam (BRV), a third-generation anti-seizure medication (ASM) offers strong conformational receptor domain binding, faster blood brain barrier (BBB) permeability and better tolerability making it potential therapeutic option as an initial line or initial line add-on strategy for focal onset seizure (FoS). The following study was planned to further understand the role and relevance of BRV in the real world settings of India.</p><p><strong>Method: </strong>This was a multicentric, cross-sectional, and non-interventional study conducted in patients with FoS across India. The study was approved by central independent ethics committee. Descriptive and analytical statistics employed using SPSS version 29.0.1.0.</p><p><strong>Results: </strong>Per protocol (PP) analysis included 8479 eligible patients from 1069 sites, gender; 5771 (68.06%) male and 2708 (31.94%) female with mean age 41.21 ± 12.74 years. Total 8019 (94.57%) patients had FoS and 460 (5.43%) patients had focal to bilateral tonic-clonic seizures (FBTCs). In FoS, 4105 (51.19%) patients switched from LEV to BRV whereas 3914 (48.81%) switched from other ASMs to BRV. BAEs accounted for 2059 (50.16%) patients in LEV to BRV switch versus 133 (3.39%) in other ASM to BRV switch. Post switch, LEV-associated BAEs reduced irrespective of being used as monotherapy 85.65% (p < 0.001) or as an adjuvant therapy 83.71% (p < 0.001) at BRV dosage of 50 to 100 mg BID. This RWE showed the utility of BRV as mono component as an initial add-on strategy in FoS cases.</p><p><strong>Significance: </strong>BRV remains a pertinent therapeutic choice for FoS for the treatment naïve and/or BAE cases. Exposure of LEV leads to considerable BAEs compared to patients without LEV exposure. Patients who switched to BRV due to LEV-induced BAEs significantly improved tolerability with BRV irrespective being used as monotherapy or as adjuvant therapy.</p><p><strong>Plain language summary: </strong>Current study was planned to understand the clinical role and relevance of third-generation anti-seizure medication (ASM), brivaracetam (BRV) in the real world settings of India. Outcome of the study highlighted that BRV is an emerging, potential and safe ASM treatment option for epilepsy in Indian context. Many patients with epilepsy who are not able to tolerate the other ASM including levetiracetam (LEV) primarily due to behavioral side effects improves tolerability post switch to BRV, additionally results are consistent either BRV being used as an adjuvant therapy or as monotherapy therapy.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617241","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":"Defining neonatal status epilepticus: A scoping review from the ILAE neonatal task force.","authors":"Magda L Nunes, Elissa G Yozawitz, Courtney J Wusthoff, Renée A Shellhaas, Efraín Olivas-Peña, Jo M Wilmshurst, Ronit M Pressler, Chahnez C Triki, Hans Hartmann, Terrie Inder, Geraldine B Boylan, Kette Valente, Solomon L Moshe, Eli M Mizrahi, Nicholas S Abend","doi":"10.1002/epi4.13090","DOIUrl":"https://doi.org/10.1002/epi4.13090","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To review the available literature concerning the definition of neonatal status epilepticus (SE) and/or seizure burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The International League Against Epilepsy Neonatal Task Force performed a scoping review of the definitions of neonatal SE. Following a systematic literature review, articles were screened and data were abstracted regarding: (1) article characteristics (author identification, publication year, journal name, digital object identifier, title, objective, and study design); (2) cohort characteristics (sample size, gestational age, seizure etiology); (3) definition of SE and/or seizure burden; and (4) the method used to identify and classify SE, including routine EEG (EEG), continuous EEG monitoring (cEEG), amplitude-integrated EEG (aEEG), or clinical features.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The scoping review yielded 44 articles containing a definition of neonatal SE. Studies mainly included infants with hypoxic-ischemic encephalopathy or neonates considered at risk for seizures. SE identification and classification most often relied on cEEG. The majority of studies based the definition of SE on seizure duration, including summed duration of seizures comprising ≥50% of any 1-h epoch, recurrent seizures for &gt;50% of the total recording time, or either electrographic seizures lasting &gt;30 min and/or repeated electrographic seizures totaling &gt;50% in any 1-h period. Seizure burden was reported in 20 studies, and the most commonly used approach assessed total seizure burden, defined as total duration of EEG seizures in minutes. Sixteen studies assessed the relationship between seizure burden and outcomes, and most identified a significant association between higher seizure burden and unfavorable outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Significance: &lt;/strong&gt;This scoping review demonstrates a substantial variation in neonatal SE definitions across the literature. The most common definitions were based around a 30-min seizure duration criterion, but evidence was insufficient to support that 30 min was a cutoff defining prolonged seizures or that seizures exceeding this burden were more likely to be pharmacoresistant or associated with worse outcomes. As a next step, the Neonatal Task Force intends to develop a standardized approach to assessing and describing neonatal seizure burden and defining neonatal SE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Prolonged seizures are a neurologic emergency, if untreated, can lead to permanent injury or death. In adults and children, seizures lasting longer than 30 min are believed to cause brain damage. However, it is not clear if this definition can be applied to neonates. The International League Against Epilepsy Neonatal Taskforce performed a scoping literature review which identified 44 articles containing a definition of neonatal status epilepticus. In this article, the authors reviewed the current used definitions for prolonged seizures in neona","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617375","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":"Anxiety and depression in people with epilepsy during and one year after the COVID-19 pandemic.","authors":"Iris E Martínez-Juárez, Jimena Gonzalez-Salido, Jimena Colado-Martinez, Irving Fuentes-Calvo, Santiago Philibert-Rosas, E Rodrigo Velásquez-Coria, Salvador Martínez-Medina, Mijail A Rivas-Cruz, Eithel Valenzuela-Mendivil, Karen E Guzmán-Sánchez, Elizabeth M Ruiz-Peñaflor, Arnold R Thomson-Cerna, Emilia M González-Villagómez, Jimena Armenta-Báez, Andrea Santos-Peyret, Aurelio Jara-Prado, Adriana Ochoa-Morales, Daniel Crail-Meléndez, Ángel Ruiz-Chow, Mario A Sebastián-Díaz","doi":"10.1002/epi4.13097","DOIUrl":"https://doi.org/10.1002/epi4.13097","url":null,"abstract":"<p><strong>Objective: </strong>Compare the prevalence and severity of anxiety and depression among people with epilepsy (PWE) evaluated by telemedicine during the initial stages of the COVID-19 pandemic and follow up on their status 15 months later.</p><p><strong>Methods: </strong>We conducted a prospective, observational, and analytical study at the Epilepsy Clinic of the National Institute of Neurology and Neurosurgery (NINN) in Mexico City during the COVID-19 pandemic. HADS-A and HADS-D instruments were administered to adult patients diagnosed with epilepsy, initially through telemedicine and later through in-person visits or phone calls after one year.</p><p><strong>Results: </strong>A sample of 115 patients was obtained, with 62.5% being women. The mean age of the patients was 33.6 years (± 12), and the mean age of epilepsy onset was 16.82 years (± 13.82). The majority of patients had focal epilepsy (78.3%), and only 42% reported being seizure-free. The results from the HADS-A scale showed that 48.69% of the patients had anxiety. On the HADS-D scale, 29.56% of the patients were found to have depression. At follow-up, the HADS-A results indicated that 50.64% of the patients had anxiety, and the HADS-D results showed that 36.36% had depression. An analysis of associations between sociodemographic or clinical variables and the presence of anxiety and/or depression in PWE revealed no statistically significant results, except for the clinical variable of patients taking anxiolytic or antidepressant medications during the assessment. These patients had lower HADS-A and HADS-D scores, with a statistically significant p-value of 0.0001.</p><p><strong>Significance: </strong>Comparing these findings with a previously published paper by our group showed a significant increase in both depression and anxiety, which were already prevalent in the earlier study. In conclusion, PWE exhibited high levels of anxiety and depression during and one year after the pandemic, despite receiving appropriate treatment. These symptoms, present before the pandemic, have been further exacerbated and continue to persist.</p><p><strong>Plain language summary: </strong>This study examined anxiety and depression in patients with epilepsy (PWE) during the COVID-19 pandemic at the National Institute of Neurology and Neurosurgery in Mexico. Using the HADS-A and HADS-D scales, 115 patients were assessed over a year. Results showed that 48.69% had anxiety and 29.56% had depression, with both increasing to 50.64% and 36.36%, respectively, after one year. The only significant finding was that patients on anxiolytic or antidepressant medication had lower scores for anxiety and depression. The study concludes that anxiety and depression in PWE worsened during the pandemic and persisted despite treatment.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617364","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":"Clinical efficacy of low-dose Perampanel correlates with neurophysiological changes in familial adult myoclonus epilepsy 2.","authors":"Antonietta Coppola, Claudia Cuccurullo, Gianmaria Senerchia, Marica Rubino, Liana Veneziano, Francesco Brancati, Luigi Baratto, Valentina Virginia Iuzzolino, Leonilda Bilo, Pasquale Striano, Raffaele Dubbioso","doi":"10.1002/epi4.13100","DOIUrl":"https://doi.org/10.1002/epi4.13100","url":null,"abstract":"<p><p>Familial adult myoclonus epilepsy (FAME) management relies on antiseizure medications (ASMs), which inadequately address myoclonus and cortical tremor. This study evaluates Perampanel (PER), an AMPA-receptor antagonist, for treating FAME symptoms. Fifteen FAME2 patients participated in an observational prospective study. They received up to 6 mg daily of PER and underwent Unified-Myoclonus-Rating-Scale (UMRS) before and after treatment. Neurophysiological evaluations, including somatosensory evoked potentials (SEPs) and transcranial magnetic stimulation (TMS), assessed PER's impact on cortical glutamatergic excitatory and GABAergic inhibitory circuits. PER treatment significantly reduced UMRS total scores (p = 0.001) and action-myoclonus subscores (p = 0.002), irrespective of disease duration, age at onset, or testing time (p >0.05). Patients with more severe baseline myoclonus demonstrated significant improvements. Neurophysiological assessments revealed a PER-induced decrease in sensorimotor hyperexcitability, characterized by diminished N33 amplitudes, attenuated glutamatergic facilitation, and enhanced GABAergic inhibition in the motor cortex. In conclusion, low-dose PER is well tolerated and effective in alleviating myoclonus in FAME2 patients, supported by its modulatory effects on glutamatergic and GABAergic neuronal circuits. Plain Language Summary: This study investigated the effects of low-dose perampanel in individuals with Familial Adult Myoclonus Epilepsy2 (FAME2), a hereditary condition characterized by epilepsy and tremors. Perampanel, an antiepileptic drug, blocks AMPA receptors in the brain, reducing excessive neural activity that causes seizures and abnormal movements. The results showed significant symptom improvement, which correlated with changes in brain activity as measured by neurophysiological tests. This study suggests that perampanel helps regulate abnormal brain signals and may help managing FAME2 symptoms.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617370","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":"ECG-based epileptic seizure prediction: Challenges of current data-driven models.","authors":"Sotirios Kalousios, Jens Müller, Hongliu Yang, Matthias Eberlein, Ortrud Uckermann, Gabriele Schackert, Witold H Polanski, Georg Leonhardt","doi":"10.1002/epi4.13073","DOIUrl":"https://doi.org/10.1002/epi4.13073","url":null,"abstract":"<p><strong>Objective: </strong>Up to a third of patients with epilepsy fail to achieve satisfactory seizure control. A reliable method of predicting seizures would alleviate psychological and physical impact. Dysregulation in heart rate variability (HRV) has been found to precede epileptic seizures and may serve as an extracerebral predictive biomarker. This study aims to identify the preictal HRV dynamics and unveil the factors impeding the clinical application of ECG-based seizure prediction.</p><p><strong>Methods: </strong>Thirty-nine adult patients (eight women; median age: 38, [IQR = 31, 56.5]) with 252 seizures were included. Each patient had more than three recorded epileptic seizures, each at least 2 hours apart. For each seizure, one hour of ECG prior to seizure onset was analyzed and 97 HRV features were extracted from overlapping three-minute windows with 10s stride. Two separate patient-specific experiments were performed using a support vector machine (SVM). Firstly, the separability of training data was examined in a non-causal trial. Secondly, the prediction was attempted in pseudo-prospective conditions. Finally, visualized HRV data, clinical metadata, and results were correlated.</p><p><strong>Results: </strong>The mean receiver operating characteristic (ROC) area under the curve (AUC) for the non-causal experiment was 0.823 (±0.12), with 208 (82.5%) seizures achieving an improvement over chance (IoC) classification score (p < 0.05, Hanley & McNeil test). In pseudo-prospective classification, the ROC-AUC was 0.569 (±0.17), and 86 (49.4%) seizures were classified with IoC. Off-sample optimized SVMs failed to improve performance. Major limiting factors identified include non-stationarity, variable preictal duration and dynamics. The latter is expressed as both inter-seizure onset zone (SOZ) and intra-SOZ variability.</p><p><strong>Significance: </strong>The pseudo-prospective preictal classification achieving IoC in approximately half of tested seizures suggests the presence of genuine preictal HRV dynamics, but the overall performance does not warrant clinical application at present. The limiting factors identified are often overlooked in non-causal study designs. While current deterministic prediction methods prove inadequate, probabilistic approaches may offer a promising alternative.</p><p><strong>Plain language summary: </strong>Many patients with epilepsy suffer from uncontrollable seizures and would greatly benefit from a reliable seizure prediction method. Currently, no such system is available to meet this need. Previous studies suggest that changes in the electrocardiogram (ECG) precede seizures by several minutes. In our work, we evaluated whether variations in heart rate could be used to predict epileptic seizures. Our findings indicate that we are still far from achieving results suitable for clinical application and highlight several limiting factors of present seizure prediction approaches.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617378","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":"Multicentric study of adherence to antiseizure medications among adults with epilepsy attended in neurology departments in Burkina Faso.","authors":"Alfred Anselme Dabilgou, Alassane Dravé, Julie Marie Adeline Wendlamita Kyelem, Adama Kaboré, Christian Napon, Athanase Millogo, Kapouné Karfo, Jean Kaboré","doi":"10.1002/epi4.13092","DOIUrl":"https://doi.org/10.1002/epi4.13092","url":null,"abstract":"<p><strong>Objective: </strong>To study the adherence of antiseizures medication in neurology in the city of Ouagadougou.</p><p><strong>Patients and methods: </strong>We conducted a multicentric cross-sectional study on adherence to antiseizure medications among adult patients with epilepsy followed by outpatient neurology consultations. The patients were recruited from November 22, 2021 to February 22, 2022 in four departments of neurology. Adherence to antiseizure medications (ASM) was measured using the Morisky Medication Adhesion Scale (MMAS). Logistic regression analysis was used to investigate factors associated with adherence.</p><p><strong>Results: </strong>One hundred and seven patients with a mean age of 38.92 ± 16.06 years were included in the study. Most of the patients were men (52.34%). Twenty-eight patients complied well with ASM (26.17%). The main causes of nonadherence to treatment were forgetfulness and lack of financial means. Factors associated with nonadherence were rural residence (p = 0.023), celibacy or divorce (p = 0.002), low level of education (p = 0.028), perception of stigma (p = 0.026), duration of epilepsy <5 years (p = 0.009).</p><p><strong>Conclusions: </strong>Adherence to ASM is low in Burkina Faso. The main causes of nonadherence were forgetting and insufficiency of financial resources. Rural residence, celibacy, or divorce, low level of education, perception of stigmatization, and short duration of epilepsy were associated with non-adherence.</p><p><strong>Plain language summary: </strong>Studies on adherence to antiseizure medications are rare in Africa while patients do not have access to adequate treatment. The aim of our study was to evaluate the adherence to antiseizure medications among patients with epilepsy followed by the neurology departments in the city of Ouagadougou. Forgetfulness and financial insufficiency were the main causes of treatment interruption. Our study showed that most of the patients were non adherent. Several factors such as place of residence, level of education, and duration of epilepsy influence the level of compliance.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617397","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":"Peri-ictal yawning: A potential lateralizing sign in temporal lobe epilepsy.","authors":"Xiaoping Du, Yi Yao, Jiani Chen, Xiaoping Yang, Lei Zhang, Yingying Tang, Xiaoting Hao, Dong Zhou, Shizhong Lian, Fengpeng Wang, Xiaobin Zhang, Meizhen Sun, Junhong Guo","doi":"10.1002/epi4.13095","DOIUrl":"https://doi.org/10.1002/epi4.13095","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this retrospective analysis was to evaluate the incidence and lateralization value of peri-ictal yawning (PY) in people with temporal lobe epilepsy (TLE). PY has only occasionally been reported as a manifestation of focal epilepsy. We aimed to determine whether PY could serve as an indicator to help lateralize seizure onset during epileptic seizures.</p><p><strong>Methods: </strong>Among 236 consecutive TLE patients admitted for video-EEG monitoring, we analyzed the clinical characteristics, along with scalp video-EEG, magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), Wada test, and stereo EEG (SEEG) in patients with PY.</p><p><strong>Results: </strong>Among the 236 patients, 26 (11.0%) exhibited PY, and 36 of 1018 recorded seizures (3.5%) were associated with PY. Of the 26 patients with PY, 19 (73.1%) had non-dominant TLE, while 7 (26.9%) had dominant TLE. The majority of these patients presented with staring, arrest, and automatisms during their seizures with accompanying vegetative signs. PY occurred either during the ictal or postictal phase in all patients. Exception for 10 seizures (10/36, 27.8%) at the early stage (less than 25% total duration), PY was primarily linked to the late ictal and postictal phases. Surgical intervention was performed in 12 patients, 9 of whom (75%) achieved seizure freedom (Engel class I), with 7 of these 9 (77.8%) having non-dominant TLE.</p><p><strong>Significance: </strong>Yawning is a physiological phenomenon typically not associated with epilepsy. The present series suggests that PY is relatively uncommon in TLE, but may represent a rare vegetative sign, particularly in cases with non-dominant TLE. Further investigation with a larger cohort of surgically confirmed cases and using intracranial EEG is essential to deepen our understanding of this phenomenon.</p><p><strong>Plain language summary: </strong>Yawning is a typical physiological response that is generally not linked to epilepsy. However, it can occasionally indicate seizure activity, particularly in TLE. PY happens more often observed in non-dominant TLE and usually occurs in the later stages of a seizure or just after it. It may hold potential as a lateralizing marker in TLE.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617413","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":"Mortality in older adults with epilepsy: An understudied entity.","authors":"Syeda Amrah Hashmi, Rithvik Gundlapalli, Ifrah Zawar","doi":"10.1002/epi4.13098","DOIUrl":"https://doi.org/10.1002/epi4.13098","url":null,"abstract":"<p><p>Despite the recognition of Sudden Unexpected Death in Epilepsy (SUDEP) and other risks of premature mortality in people with epilepsy (PWE), mortality in older PWE remains an understudied entity. This review provides a comprehensive overview of the multifaceted causes of premature mortality in older adults with epilepsy and emphasizes the need for targeted interventions to reduce mortality and enhance the quality of life in this vulnerable population. It underscores the heightened prevalence of epilepsy among older adults and the interplay of intrinsic and extrinsic factors contributing to their mortality. Further, this paper delves into the nuances of diagnosing SUDEP in older adults and the underestimation of its incidence due to misclassification and lack of standardized protocols. Factors such as frailty, comorbidities, and the bidirectional relationship between epilepsy and conditions such as dementia and stroke further compound the mortality risks. Key factors, including status epilepticus, comorbid conditions (such as cardiovascular diseases, cerebrovascular events, and neurodegenerative disorders), and external causes like accidents, falls, and suicide, are discussed. It also examines the implications of anti-seizure medications, particularly polypharmacy, and their adverse effects on this population. Future directions include implementing enhanced diagnostic protocols, developing treatment plans, and integrating real-time monitoring technologies to reduce the risk of sudden death and multifaceted premature mortality in this patient population. Increasing awareness among healthcare providers and families about the risks and management of epilepsy in older adults, along with fostering collaborative research efforts, is essential to improve mortality outcomes. PLAIN LANGUAGE SUMMARY: There is a heightened risk of mortality in older people with epilepsy due to many causes unique to their population. Despite the risk, Sudden Unexpected Death in Epilepsy and early mortality in older adults with epilepsy are underestimated. Unique contributing factors include comorbid conditions like dementia, stroke, and frailty, adverse effects from polypharmacy, and increased risks of cardiovascular complications and external injuries such as falls and suicide. A careful consideration of all these factors can help mitigate the mortality in older adults with epilepsy.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617391","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":"Epilepsy care pathway: The Finnish model.","authors":"Reetta Kälviäinen, Zakarya Hadj-Allal, Jarkko Kirjavainen, Reina Roivainen, Tarja Linnankivi, Jukka Peltola, Kai Eriksson, Salla Lamusuo, Tuire Lähdesmäki, Johanna Annunen, Päivi Vieira, Virpi Tarkiainen, Leena Jutila, Anni Saarela, Leena Kämppi, Liisa Metsähonkala, Eija Gaily, Niina Lähde, Jaana Antinmaa, Sini Erme, Anna-Leena Pirttisalo, Jari Virolainen, Milla Ylijoki, Laura Kela, Jonna Komulainen-Ebrahim, Paula Sorjonen","doi":"10.1002/epi4.13093","DOIUrl":"https://doi.org/10.1002/epi4.13093","url":null,"abstract":"<p><strong>Objective: </strong>Integrated care pathways are essential for consistent, effective epilepsy care, offering equal access and quality regardless of socioeconomic status. They must align with the WHO Global Action Plan on Epilepsy, ensuring best practices and cost-effective management. We describe the Finnish national epilepsy care pathway, which includes multiple levels of care, from initial diagnosis to long-term care for all types of epilepsy, with a specific focus on rare and complex cases integrated with the European Reference Network (ERN) for Rare and Complex Epilepsies EpiCARE.</p><p><strong>Methods: </strong>In 2017, the Finnish government nominated Kuopio University Hospital to coordinate diagnostics and care for severe epilepsy in Finland. A national multidisciplinary consensus panel, including specialists from both adult and pediatric neurology departments across all five Finnish university hospitals and from the patient organization, was established. The resulting pathway was adopted into the current Finnish evidence-based current care guidelines for epilepsy.</p><p><strong>Results: </strong>The Finnish epilepsy care pathway focuses on timely referrals, continuity of care and enhanced communication between healthcare providers at different levels of care. Patient involvement is assured with an individualized digital application offering secure online messaging, a seizure calendar, and remote visits. The pathway enhances virtual consultations and includes regular national diagnostic multidisciplinary meetings for severe epilepsies before selected cases are consulted in ERN EpiCARE meetings.</p><p><strong>Significance: </strong>This Finnish model for epilepsy care provides a streamlined, multidisciplinary approach to diagnosis and treatment and combines modern digital tools, data sharing, and peer support. This pathway can serve to model how integrated healthcare systems can effectively manage complex conditions.</p><p><strong>Plain language summary: </strong>We describe the Finnish national epilepsy care pathway, which includes multiple levels of care, from initial diagnosis to long-term care for all types of epilepsy, with a specific focus on rare and complex cases integrated with the European Reference Network (ERN) for Rare and Complex Epilepsies EpiCARE. Finnish model for epilepsy care provides a streamlined, multidisciplinary approach to diagnosis and long-term treatment of epilepsy. The pathway enhances virtual consultations and includes national and European-level diagnostic multidisciplinary meetings for severe epilepsies. To improve outcomes, we emphasize the use of modern digital tools, data sharing, and peer support.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617383","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}