Epilepsia Open最新文献

{"title":"Genetic etiologies with a large NGS panel in a monocentric cohort of 1000 patients with pediatric onset epilepsies.","authors":"Giulia Barcia, Nicole Chemaly, Stéphanie Gobin-Limballe, Emma Losito, Mélodie Aubart, Eugénie Sarda, Zahra Assouline, Pauline Plante-Bordeneuve, Marie Hully, Remi Barrois, Christine Barnerias, Doxa Sareidaki, Delphine Coste Zeitoun, Monika Eisermann, Cécile Fourrage, Sylvain Hanein, Marlène Rio, Nathalie Boddaert, Isabelle Desguerre, Anna Kaminska, Julie Steffann, Rima Nabbout","doi":"10.1002/epi4.70057","DOIUrl":"https://doi.org/10.1002/epi4.70057","url":null,"abstract":"<p><strong>Objective: </strong>Genetic testing is now included in the diagnostic assessment of childhood onset epilepsies. We evaluated the yield of a targeted next generation sequencing (TNGS) panel dedicated to pediatric epilepsies.</p><p><strong>Methods: </strong>We tested by TNGS panel 1000 consecutive patients presenting with childhood onset epilepsies and including mainly patients with early onset epilepsies (under 2 years, 61%).</p><p><strong>Results: </strong>Causal variants were identified in 31% of patients, spanning 78 different genes. Patients with benign familial neonatal/infantile epilepsy (BFN/IS) exhibited the highest rate of positive findings (82%). Developmental and epileptic encephalopathies (DEEs) had a global diagnostic yield of 37%, with epilepsy of infancy with migrating focal seizures (EIMFSI) and Dravet syndrome (DS) presenting the highest yield in this group (78%) and early infantile DEE (EIDEE) laying next with a yield of 43%. The lowest rates of genetic diagnosis were observed in infantile epileptic spasms syndrome (IESS, 17%), epilepsy with myoclonic-atonic seizures (EMAtS, 19%), and DEE-SWAS (14%). Patients with GEFS+ had a yield of 16%. Among patients with developmental encephalopathies and refractory seizures with onset after 2 years, TNGS yielded a 33% diagnostic rate. Atypical absences yielded 16%, focal epilepsy yielded 18%, and generalized epilepsies with refractory seizures yielded 13%. These groups exhibited a high genetic heterogeneity.</p><p><strong>Significance: </strong>TNGS is an effective first-step genetic screening in patients with high diagnostic yields (BFN/IS, EIMFS, DS, EIDEE) and for epilepsy syndromes associated with one or a few major genes (BFN/IS, EIMFS, DS, GEFS+, DEE-SWAS). Whole exome or genome sequencing (WES/WGS) should be considered as a second step in these groups with a probably relevant Mendelian inheritance. WES/WGS could be proposed as first-tier analysis in patients with IESS, EMAtS, generalized or focal epilepsies refractory to ASMs, and developmental encephalopathies with seizure onset after 2 years. However, the lower diagnostic yield obtained in these groups may suggest a complex inheritance.</p><p><strong>Plain language summary: </strong>This study emphasizes the importance of accurately identifying different types of epilepsy and epilepsy syndromes to improve genetic testing strategies. We suggest that a targeted gene panel can be a good first step for some genetic conditions, such as benign familial neonatal/infantile epilepsy, Dravet syndrome, and epilepsy of infancy with migrating focal seizures.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004912","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":"Personalized multichannel transcranial direct current electrical stimulation (tDCS) in drug-resistant epilepsy: A SEEG based open-labeled study.","authors":"Fabrice Bartolomei, Maëva Daoud, Megane Delourme, Sophie Tardoski, Julia Makhalova, Eya Bourguiba, Samuel Medina Villalon, Stanislas Lagarde, Fabrice Wendling, Giulio Ruffini, Ricardo Salvador, Francesca Pizzo, Bernard Giusiano","doi":"10.1002/epi4.70055","DOIUrl":"https://doi.org/10.1002/epi4.70055","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of personalized multichannel tDCS on seizure frequency, severity, quality of life, and psychiatric comorbidities in patients with drug-resistant focal epilepsy. Secondary goals include assessing the safety and feasibility of this approach.</p><p><strong>Methods: </strong>This open-label pilot study involved 16 patients with drug-resistant focal epilepsy. Patients underwent 3 cycles of personalized multichannel tDCS over 6 months, targeting the EZ defined by stereoelectroencephalography (SEEG). Each cycle consisted of five consecutive days of tDCS, with two daily sessions of 20 min each. The primary endpoint was a reduction in seizure frequency, with secondary endpoints addressing quality of life (QOLIE-31 scores), seizure severity (NHS3 scores), and psychiatric comorbidities (NDDI-E and GAD-7 scales).</p><p><strong>Results: </strong>Across all participants, a statistically significant 20% reduction in seizure frequency was observed (p = 0.044). Six patients (37%) were identified as responders (≥50% seizure reduction), with one achieving seizure freedom. The mean seizure reduction among responders was 68%. Significant improvements were noted in overall quality of life (QOLIE-31, p = 0.009), with greater benefits for patients with poorer baseline scores. No overall significant changes were observed in depression, anxiety, and seizure severity scores, though individual variability was noted. The treatment was well tolerated, with mild adverse events, primarily skin-related.</p><p><strong>Significance: </strong>Personalized multichannel tDCS shows promise as a noninvasive therapeutic option for drug-resistant focal epilepsy, with benefits in seizure reduction and quality of life. Although results were variable, the method's safety and feasibility support further exploration through randomized controlled trials to refine protocols, better select potential responders' patients, and validate findings.</p><p><strong>Plain language summary: </strong>This study tested a personalized brain stimulation technique called tDCS in people with difficult-to-treat epilepsy. The treatment led to fewer seizures in some patients and improved their quality of life. The approach was safe and caused only mild side effects. These results suggest that this type of noninvasive brain stimulation may be a helpful new option for people who do not benefit from medication or surgery.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960499","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":"Exploring proposed recommendations for immediate-use seizure medication: Treating both cluster and prolonged seizures with diazepam nasal spray.","authors":"Michael Chez, Pavel Klein, Danielle Becker, Jurriaan M Peters, Enrique Carrazana, Adrian L Rabinowicz","doi":"10.1002/epi4.70054","DOIUrl":"https://doi.org/10.1002/epi4.70054","url":null,"abstract":"<p><p>The Seizure Termination Project developed expert consensus recommendations for outpatient management of seizure clusters and prolonged seizures to prevent progression to a higher-level emergency. The consensus recommendations described therapeutic scenarios for seizure clusters (acute cluster treatment [ACT]) to prevent further seizures in a cluster and treatment to stop ongoing seizures that were expected to be prolonged (rapid and early seizure termination [REST]). Here, we review ACT and REST as categories and explore their practical application by examining patient-level data for diazepam nasal spray. ACT and REST criteria were examined using data from the long-term safety study that evaluated diazepam nasal spray for seizure clusters. To explore the effectiveness and duration of treatment for ACT, the proportion of seizure clusters for which second doses were administered within 24 h was used as a proxy. REST was investigated using the time from administration to seizure cluster termination; timing for the termination of prolonged seizures (5-15 min for the purposes of this analysis) in clusters also was examined. In the long-term safety study of diazepam nasal spray, a single dose demonstrated effectiveness at terminating a substantial majority of seizure clusters (3368/3853 [87.4%]) across 24 h, demonstrating its use as ACT. The majority of seizure clusters (2169/3225 [67.3%]) were recognized and treated quickly, within 5 min from onset, demonstrating its utility as REST. Notably, effectiveness was maintained in seizures treated after they had become prolonged. These findings from the large dataset of the long-term safety study of diazepam nasal spray demonstrate that it is of benefit in immediate use for both termination of an acute seizure and prolonged seizures within seizure clusters, thus supporting the recent expert consensus recommendations. Early use of a single rescue treatment can meet the need for ACT and REST, simplifying patient care. PLAIN LANGUAGE SUMMARY: An expert group defined 2 groups of seizure medicines for patients and caregivers to use. \"ACT\" medicines are for acute cluster treatment to prevent more seizures in a cluster. \"REST\" medicines for rapid and early seizure treatment stop prolonged seizures. Diazepam nasal spray for seizure clusters was looked at to see if it could fit in both categories. Study data showed that for most seizure clusters only 1 dose of diazepam nasal spray was used over 24 h (fitting ACT), and seizures were treated and ended quickly (fitting REST). One medicine for REST and ACT may make treatment simpler.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959783","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":"Knowledge, attitudes, and practices of epilepsy patients regarding the ketogenic diet therapy: A cross-sectional study","authors":"Xiuping Zhang,&nbsp;Meizhen Sun,&nbsp;Guofang Xue,&nbsp;Yongxiong Zhao,&nbsp;Taotao Du,&nbsp;Xueying Guan,&nbsp;Yong Xu","doi":"10.1002/epi4.70048","DOIUrl":"10.1002/epi4.70048","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The therapeutic ketogenic diet is typically used in epilepsy treatments, yet there has been insufficient understanding regarding the knowledge, attitudes, and practices (KAP) of epilepsy patients concerning this dietary therapy. This study aims to investigate the KAP of epilepsy patients regarding ketogenic diet therapy, with the goal of identifying gaps in knowledge and attitudes that may impact clinical outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Method&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A cross-sectional study was conducted between November 2023 and December 2023 at three epilepsy centers in Shanxi Province: the First Hospital of Shanxi Medical University, the Second Hospital of Shanxi Medical University, and Taiyuan Epilepsy Hospital. Data, including demographic characteristics and KAP scores, were collected via online questionnaires, yielding a total of 612 valid responses, with 320 (52.29%) males.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The mean KAP scores were calculated as follows: knowledge score 4.99 ± 6.72 (possible range: 0–24), attitude score 24.82 ± 2.34 (possible range: 8–40), and practice score 29.48 ± 8.49 (possible range: 9–45). Multivariate analysis revealed that the attitude score (OR = 1.443, 95% CI: [1.296–1.607], &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and an epilepsy duration of 5–10 years (OR = 3.086, 95% CI: [1.716–5.548], &lt;i&gt;p&lt;/i&gt; &lt; 0.001) were independently associated with positive practice. Additionally, Structural Equation Modeling indicated that knowledge (&lt;i&gt;β&lt;/i&gt; = 0.034, &lt;i&gt;p&lt;/i&gt; = 0.012) and attitude (&lt;i&gt;β&lt;/i&gt; = 0.583, &lt;i&gt;p&lt;/i&gt; = 0.010) directly influenced practice, while knowledge also directly affected attitude (&lt;i&gt;β&lt;/i&gt; = 0.565, &lt;i&gt;p&lt;/i&gt; = 0.013), with an indirect effect on practice through attitude (&lt;i&gt;β&lt;/i&gt; = 0.329, &lt;i&gt;p&lt;/i&gt; = 0.009).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Significance&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The study found insufficient knowledge, suboptimal attitudes, and negative practices toward the ketogenic diet among epilepsy patients. This underscores the need for targeted educational interventions to enhance patient engagement and optimize clinical outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Plain Language Summary&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study looked at how much epilepsy patients know about, feel about, and use the ketogenic diet as a treatment. We found that patients generally know little about the diet, have mixed feelings, and do not use it much. Better understanding and positive attitudes were linked to better use of the diet. The result","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"866-879"},"PeriodicalIF":2.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building a dashboard to inform policy and clinical practice using the Irish epilepsy electronic patient record: Towards a learning health system","authors":"Ian A. J. Darragh,&nbsp;Laura Brady,&nbsp;Norman Delanty,&nbsp;Colin Doherty,&nbsp;David Lewis-Smith,&nbsp;Kathleen E. Bennett","doi":"10.1002/epi4.70052","DOIUrl":"10.1002/epi4.70052","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Ireland lags heavily in capacity and stakeholder interest for the development of learning health system tools. However, Ireland possesses a rich repository of electronic patient records for epilepsy patients stored at the National Epilepsy Centre at Beaumont Hospital. The objective of the current study was to develop a prototype dashboard from anonymized electronic records of Irish epilepsy patients to demonstrate the potential for the development of learning health systems in Ireland.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A cross-sectional extract of electronic patient records was extracted from the Irish National Epilepsy Centre. Extracted data were then used to construct a prototype clinical dashboard based on iterative feedback provided by relevant stakeholders. As proof-of-concept, a mock analysis was performed using the EpiData Dashboard to identify the number of women of childbearing age (16–45 years) who are currently prescribed sodium valproate.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A prototype clinical dashboard called the EpiData Dashboard was produced with four distinct tabs (homepage, patient demographic information, patient diagnosis information and patient medication information) based on stakeholder feedback.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Significance&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The EpiData Dashboard enables group-level analysis of information contained within epilepsy electronic patient records in a straightforward and accessible way. The development of the EpiData Dashboard demonstrates that the capacity to develop learning health system tools in Ireland can be informative for policy and epilepsy clinical care. This demonstration can drive stakeholder engagement to develop more enhanced and integrated tools to improve the capacity of epilepsy care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Plain Language Summary&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Electronic patient records are useful for storing and sharing patient data between clinicians and represent data repositories that can be leveraged to enhance healthcare policy and clinical care. Ireland lacks in leveraging electronic patient resources. The current study produced a prototype analysis tool using electronic patient records from a national epilepsy center. The efficacy of this prototype dashboard is exemplified through a demonstrative analysis that identifies females of childbearing age (16–45 years) currently taking sodium valproate. The results and reporting of the current st","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"930-941"},"PeriodicalIF":2.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiseizure medication choice in diffuse glioma: A single-center population-based experience","authors":"Leena Ollila,&nbsp;Reina Roivainen","doi":"10.1002/epi4.70007","DOIUrl":"10.1002/epi4.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Several antiseizure medications (ASMs) can be considered as first-line treatment for glioma-associated epilepsy (GAE). We aimed to find out, if there are subgroups of glioma patients which may benefit from different first-line ASMs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All diffuse glioma (grade 2–4) patients, who were in contact with Helsinki University Hospital Neurology or Oncology Departments during 2013–2015, were recognized from medical records. Follow-up data was retrospectively collected of all GAE patients living in Helsinki for 5 years from diagnosis of glioma, or until death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 121 patients with GAE fulfilling inclusion criteria were identified. Forty-nine (40.5%) had grade 2 glioma, 18 (14.9%) had grade 3 glioma, and 54 (44.6%) had grade 4 glioma. The most common first ASM was oxcarbazepine (39.2%), followed by levetiracetam (22.5%), carbamazepine (19.3%), phenytoin (10.8%) and valproic acid (8.3%). The first ASM was retained in use in 70 (57.9%) patients until the end of follow-up. Among patients with low-grade glioma, oxcarbazepine was favored, whereas grade 4 glioma patients more often received levetiracetam as first ASM. At the end of follow-up, the retention rate of levetiracetam as first ASM was higher than retention rate of other ASMs in grade 4 glioma patients (<i>p</i> 0.002). Patients who initiated valproic acid as first ASM underwent more ASM changes than patients who initiated other first-line ASM (<i>p</i> 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>Levetiracetam seems to be a favorable first-line treatment for GAE, especially for patients with grade 4 glioma. For grade 2–3 glioma patients, oxcarbazepine may be a reasonable option.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Plain Language Summary</h3>\u0000 \u0000 <p>Grade 2–4 gliomas are central nervous system tumors originating from glial cells, and epilepsy is common in glioma patients. We found that levetiracetam was favored as first antiseizure medication for patients with malignant, grade 4, glioma. For patients with slower-growing tumors, grade 2–3 gliomas, oxcarbazepine may be a reasonable choice for first antiseizure medication. The findings highlight the need for individual assessment in the use of antiseizure medications in glioma patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"705-716"},"PeriodicalIF":2.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of length of stay on diagnostic yield in the epilepsy monitoring unit: A multi-center retrospective 12-year Veterans Health Administration study","authors":"Maximillian S. Feygin,&nbsp;Autumn Smith,&nbsp;Sruthi Gopinath Karicheri,&nbsp;Khadar Haroun,&nbsp;Omar Khan,&nbsp;Maria R. Lopez,&nbsp;Stephan Eisenschenk,&nbsp;John Jones,&nbsp;Stephanie Reeder,&nbsp;Alan R. Towne,&nbsp;Christopher Ransom,&nbsp;Karen Medin,&nbsp;James Chen,&nbsp;Tung Tran,&nbsp;Nina I. Garga,&nbsp;Noemi Rincon-Flores,&nbsp;Marissa Kellogg,&nbsp;Steven Tobochnik,&nbsp;Zulfi Haneef,&nbsp;the Veterans Epilepsy Learning, Collaborative Research, and Operations (VELCRO) investigators","doi":"10.1002/epi4.70047","DOIUrl":"10.1002/epi4.70047","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Epilepsy Monitoring Units (EMUs) in Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) are critical for the diagnosis and management of seizure disorders. Whether a shorter length of stay (LOS) in the EMU due to scheduling impacts diagnostic yield is unclear.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Data from 7074 EMU visits across 15 VHA EMUs (2012–2024) were analyzed. Based on usual admission schedules, EMUs were divided into “fixed” (typically Monday–Friday) or “flexible” subgroups. Diagnostic outcomes were classified as epileptic seizures (ES), psychogenic non-epileptic seizures (PNES), other non-epileptic events, and inconclusive. Diagnostic rates were compared between fixed and flexible sites using cumulative distribution functions and other statistical tests. Readmission data for initially inconclusive cases were also examined.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Diagnostic outcomes showed the following distribution: 23% ES, 19% PNES, 11% other non-epileptic events, and 47% inconclusive. Similar distributions were seen between fixed and flexible sites, although a higher proportion of diagnostic admissions were completed earlier in fixed sites and over a longer average LOS at flexible sites. Admissions diagnostic of ES had longer LOS than all other outcomes (4.5 vs. 3.8 days, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Repeat EMU admissions were performed in 10% of patients and were more likely to be diagnostic of ES than PNES or other non-epileptic events.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Significance&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;About half of EMU admissions within VHA were non-diagnostic with respect to the patients' typical clinical events. ES and PNES were observed at approximately similar rates, although the diagnosis of ES required a longer LOS. Fixed sites did not appear inferior to flexible sites for reaching diagnostic conclusions in our analysis. The higher proportion of earlier diagnoses at fixed sites observed was likely a statistical effect of their predefined shorter admission lengths. Further investigations of EMU resource utilization based on individual goals of monitoring are necessary to better examine and improve efficiency.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Plain Language Summary&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Epilepsy Monitoring Units (EMUs) are specialized hospital units used to diagnose and characterize seizures. This study looked at over 7000 admissions across 15 Veterans Health Administration EMUs to see whether ","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"894-905"},"PeriodicalIF":2.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calpastatin, a calpain specific inhibitor, reduce seizures in a mouse model of temporal lobe epilepsy","authors":"Philip M. Lam,&nbsp;Mala V. Rao,&nbsp;Ralph A. Nixon,&nbsp;Marco I. González","doi":"10.1002/epi4.70030","DOIUrl":"10.1002/epi4.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Epilepsy is a chronic condition characterized by unpredictable and recurrent spontaneous seizures. In a previous study, we reported that pharmacological inhibition of calpain prevented epileptogenesis in the rat pilocarpine model. In this study, we demonstrate that transgenic overexpression of calpastatin, the endogenous inhibitor of calpain, reduces calpain activation and lessens seizure burden in the mouse intrahippocampal kainate model. Blockade of calpain activation was evidenced by a reduction in the generation of spectrin breakdown products, a hallmark of calpain activation. CAST overexpression was associated with a significant reduction in seizure burden, further supporting the idea that blocking calpain overactivation prevents epilepsy. Moreover, a reduction in seizure burden was accompanied by a decrease in inflammatory markers but not cell death. Together, these observations corroborate the role of calpain overactivation in epileptogenesis and provide further support for the use of calpain inhibitors as a viable strategy to prevent epilepsy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Plain Language Summary</h3>\u0000 \u0000 <p>The mechanisms by which brain alterations lead to spontaneous seizures are not well understood. Acquired epilepsy often follows brain trauma. After a brain injury, the activation of the protease calpain has been associated with the development of spontaneous seizures. Our observations indicate that transgenic overexpression of calpastatin, an endogenous inhibitor of calpain, impacts epileptogenesis and reduces seizure burden. This suggests that inhibiting calpain could be a viable strategy to prevent epilepsy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"957-964"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility and limitations of homemade videos in differentiating functional seizures from other paroxysmal events: An Italian cohort study","authors":"Sara Gasparini,&nbsp;Giorgia Giussani,&nbsp;Elisa Bianchi,&nbsp;Adriana Magaudda,&nbsp;Angelo Labate,&nbsp;Angela Laganà,&nbsp;Chiara Martellino,&nbsp;Marina Casazza,&nbsp;Giuseppe Didato,&nbsp;Valentina Chiesa,&nbsp;Maria Paola Canevini,&nbsp;Vincenzo Belcastro,&nbsp;Tommaso Bocci,&nbsp;Elisabetta Domina,&nbsp;Angela La Neve,&nbsp;Stefano Meletti,&nbsp;Marco Poloni,&nbsp;Ettore Salsano,&nbsp;Vittorio Velucci,&nbsp;Stefano Martini,&nbsp;Valentina Bova,&nbsp;Anna Mammì,&nbsp;Angelo Pascarella,&nbsp;Vittoria Cianci,&nbsp;Edoardo Ferlazzo,&nbsp;Umberto Aguglia,&nbsp;Giuseppe Erba","doi":"10.1002/epi4.70050","DOIUrl":"10.1002/epi4.70050","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The gold standard for distinguishing epileptic seizures (ES) from non-epileptic events is video-EEG monitoring. In some cases, video alone might suffice, leading to increased utilization of home videos, to support the diagnosis. This study aimed to assess the feasibility of such practice and its accuracy compared to video-EEG, to identify key signs and symptoms of functional seizure (FS) and to establish if self-reported questionnaires would improve diagnostic accuracy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;All consecutive patients ≥14 years presenting to six Italian epilepsy centers with either recurrent paroxysmal events of uncertain nature or with confirmed ES were enrolled. Subjects had to record home videos of the events and to respond to ad-hoc questionnaires. De-identified data were randomly assigned to pairs of evaluators blinded to the gold standard diagnosis, one epileptologist and one neurologist, to predict the correct diagnosis in two steps: Step 1 (home video alone) and Step 2 (patient's and witness' questionnaires).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Ninety-four videos (48 ES; 45 FS; 1 other), obtained from 36 patients, were independently evaluated by the 16 reviewers, providing a total of 188 assessments. Diagnostic accuracy for the whole group was 55.3% among epileptologists and 48.9% among neurologists (&lt;i&gt;p&lt;/i&gt; = 0.6892) but was significantly higher in the FS subgroup (71.1%) compared to ES (41.7%) (&lt;i&gt;p&lt;/i&gt; = 0.0043).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Significance&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Diagnostic accuracy was moderate, without significant differences between epileptologists and neurologists, while it was higher for FS compared to ES. The addition of questionnaires did not improve accuracy. Eye closure for FS and abrupt ending for ES emerged as the only diagnostic signs. Thus, homemade videos have a role in differentiating these disorders.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Plain Language Summary&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study aimed to assess if home videos can distinguish epileptic seizures from functional seizures. Patients over 14 years from six Italian centers recorded videos of their episodes and answered questionnaires. Data were evaluated by epileptologists and neurologists. Results showed moderate diagnostic accuracy, with higher accuracy for functional seizures compared to epileptic seizures. Key diagnostic signs included eye closure for functional seizures and abrupt endings for epileptic seizure","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"918-929"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac structural and molecular alterations in rodent models of temporal lobe epilepsy","authors":"Zining Liu,&nbsp;Shobi Sivathamboo,&nbsp;Peravina Thergarajan,&nbsp;Flavia M. Gomes,&nbsp;Idrish Ali,&nbsp;Kim L. Powell,&nbsp;Piero Perucca,&nbsp;Nigel C. Jones,&nbsp;Terence J. O'Brien,&nbsp;Pablo Casillas-Espinosa","doi":"10.1002/epi4.70032","DOIUrl":"10.1002/epi4.70032","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Cardiac structural and molecular changes are prevalent in people with chronic epilepsy, possibly contributing to an increased risk of premature mortality. However, understanding of the underlying pathophysiological mechanisms is limited. Here, we investigated the subacute and chronic changes in cardiac structure and ion channel/exchanger expression in different rodent models of temporal lobe epilepsy (TLE).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Two models of TLE were used: the kainic acid-induced post-status epilepticus (KASE) model in Wistar rats and the electrical self-sustained status epilepticus (SSSE) model in C57BL/6J mice. Heart tissue was collected at subacute (7 days post-SE) and chronic (12–16 weeks post-SE) timepoints from both models. Histological analysis for cardiac fibrosis and qPCR of ion channel/exchanger mRNA expression was performed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Increased cardiac fibrosis was found in the KASE rats at the subacute (&lt;i&gt;p&lt;/i&gt; = 0.016) and chronic (&lt;i&gt;p&lt;/i&gt; = 0.003) timepoints compared with sham rats. In chronically epileptic KASE rats, mRNA expression analyses showed that Na&lt;sub&gt;V&lt;/sub&gt;1.5 and NCX1 were reduced in the septum (&lt;i&gt;p&lt;/i&gt; = 0.026 and &lt;i&gt;p&lt;/i&gt; = 0.020, respectively) compared with shams. In SSSE mice, Na&lt;sub&gt;V&lt;/sub&gt;1.5 was decreased in the right atrium (&lt;i&gt;p&lt;/i&gt; = 0.039), and Ca&lt;sub&gt;V&lt;/sub&gt;3.2 and NCX1 were increased in the left ventricle subacutely (&lt;i&gt;p&lt;/i&gt; = 0.033 and &lt;i&gt;p&lt;/i&gt; = 0.003, respectively), and Na&lt;sub&gt;V&lt;/sub&gt;1.5 was increased in the septum at the chronic timepoint (&lt;i&gt;p&lt;/i&gt; = 0.008), compared with the non-epileptic sham group.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Significance&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Cardiac alterations at structural and molecular levels were found in both experimental rodent epilepsy models, subacutely post-SE and during the chronically epileptic timepoint. The presence of similar cardiac changes across the models, despite being different species and having different modes of epilepsy indication, suggests that these changes are a direct or indirect result of the seizures.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Plain Language Summary&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Epilepsy may lead to heart problems, which could raise the risk of early death, but the exact causes are unclear. This study examined heart changes in two rodent models of epilepsy. In rats, heart scarring and stiffness (fibrosis) increased both shortly after seizures and during chronic epilepsy, and the ab","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"809-821"},"PeriodicalIF":2.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}