{"title":"Self-limited familial focal epilepsy caused by ANK2 variants: A potentially under-recognized condition.","authors":"Po-Hsi Lin, Chen-Jui Ho, Chih-Hsiang Lin, Ya-Yuan Hou, Cheng-Han Chan, Meng-Han Tsai","doi":"10.1002/epi4.70003","DOIUrl":"https://doi.org/10.1002/epi4.70003","url":null,"abstract":"<p><p>The Ankyrin 2 (ANK2) gene encodes the ankyrin-B protein (ANKB), which is involved in the organization and stability of membrane ion channels, transporters, and receptors in cardiomyocytes and neurons. Variants in ANK2 genes are initially reported in long QT syndrome and autism. Animal models with ANK2 deletion have exhibited seizures and been anecdotally associated with epilepsy in case reports. Hereby, we reported a Taiwanese family with the ANK2 pathogenic variant (chr4:114276707, c.6933del, p.T2312Lfs*2) that affects the giant ankyrin-B isoform. The family members presented with young-onset self-limited focal epilepsy, and achieved seizure-free in adulthood with antiseizure medications. Interestingly, the electrocardiogram revealed no obvious cardiac phenotype. We further reviewed reported ANK2-related epilepsies. Most variants are de novo and loss-of-function variants. Most patients had young epilepsy or neonatal seizures. Notably, most cases of ANK2-related epilepsy are self-limited and pharmaco-responsive, which suggests that it is likely to be underdiagnosed. With the increased availability of whole exome sequencing, the diagnosis of ANK2-related epilepsies may increase. The co-existence of QT prolongation on electrocardiogram, autism, and a positive family history of cardiac arrhythmia or sudden death may provide important clues in the clinical diagnosis of ANK2-related epilepsy. Furthermore, a correct genetic diagnosis of ANK2-related epilepsy will initiate close cardiac surveillance to avoid the potential sudden death risk of this disorder. PLAIN LANGUAGE SUMMARY: ANK2 has long been regarded as an arrhythmic gene. This study reported the first familial ANK2-related epilepsy, highlighting the role of ANK2 in epileptogenesis. Most reported ANK2-related epilepsies are self-limited and pharmaco-responsive, suggesting that they are likely to be underdiagnosed. Literature review of the phenotype and genotype of ANK2 showed that LOF ANK2 variants tend to have CNS phenotypes, whereas missense variants are arrhythmic. Early detection of ANK2 variants in epilepsy patients is worthwhile considering the potential sudden death risk of this disorder.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440285","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}
Epilepsia OpenPub Date : 2025-02-17DOI: 10.1002/epi4.70010
Lucia Fusco
{"title":"Predictive value of electrographic neonatal seizures for later epilepsy: A call for a broader perspective.","authors":"Lucia Fusco","doi":"10.1002/epi4.70010","DOIUrl":"https://doi.org/10.1002/epi4.70010","url":null,"abstract":"<p><p>This is a letter to the editor commenting on a recently published study on electrographic seizures as predictors of epilepsy in neonates with encephalopathy. The letter highlights potential overemphasis on electrographic neonatal seizures, underscores the importance of severely abnormal EEG backgrounds and advanced neuroimaging, and suggests incorporating genetic analyses for a more comprehensive understanding.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440281","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}
Epilepsia OpenPub Date : 2025-02-17DOI: 10.1002/epi4.13140
Kenza El Marzouki, Bridley K Jenkins, Tamy Moraes Tsujimoto, Huijun Jiang, Emma B Cardwell, Martin Arhin, Unwana Eyo, Cristian Gonzalez-Rodriguez, Stephanie Peck, Feng-Chang Lin, Senyene E Hunter
{"title":"Disparities in the utilization of genetic testing for non-acquired infantile epileptic spasms syndrome in a single healthcare center in North Carolina.","authors":"Kenza El Marzouki, Bridley K Jenkins, Tamy Moraes Tsujimoto, Huijun Jiang, Emma B Cardwell, Martin Arhin, Unwana Eyo, Cristian Gonzalez-Rodriguez, Stephanie Peck, Feng-Chang Lin, Senyene E Hunter","doi":"10.1002/epi4.13140","DOIUrl":"https://doi.org/10.1002/epi4.13140","url":null,"abstract":"<p><strong>Objective: </strong>To investigate disparities in the utilization of genetic sequencing among children with Infantile Epileptic Spasms Syndrome (IESS), a severe early-onset epilepsy where timely diagnosis and treatment are crucial for improving neurodevelopmental outcomes, previous studies have highlighted disparities in the evaluation and management of IESS. Genetic sequencing has emerged as a crucial tool in diagnosing unexplained epilepsies, offering precise etiological insights that can guide management. Despite guidelines recommending genetic sequencing for all unexplained epilepsies, little is known about how demographic and clinical factors influence the utilization of genetic sequencing in children with IESS.</p><p><strong>Methods: </strong>Retrospective cross-sectional cohort study, of 121 children diagnosed with IESS (2015-2020) within a single healthcare system. The primary outcome was the association between the utilization of genetic sequencing and demographic factors (race, ethnicity, language, rurality, and insurance status). Secondary outcomes included the utilization of genetic sequencing and its association with healthcare providers or clinical characteristics.</p><p><strong>Results: </strong>Genetic sequencing was performed in 64% (n = 74) of the patients with IESS. Race was significantly associated with the utilization of genetic sequencing, with non-Hispanic Black/African American children having significantly lower odds of undergoing genetic testing (OR = 0.19, 95% CI = 0.04-0.74, p = 0.02). No significant associations were found between language, rurality, or insurance status and the utilization of genetic sequencing. Notably, a low number of patients were from small towns and rural areas (7%). Clinical measures of seizure severity, including the presence of additional seizure types (p = 0.039) and the use of interventions in addition to standard IESS treatments (p = 0.01), were associated with higher rates of genetic sequencing.</p><p><strong>Significance: </strong>Non-Hispanic Black/African American children with IESS were less likely to undergo genetic sequencing. These findings underscore the need for evidence-based solutions addressing genetic sequencing utilization that may disproportionately impact children with IESS from medically underserved groups.</p><p><strong>Plain language summary: </strong>This study looked at how genetic testing is used in children with Infantile Epileptic Spasms Syndrome (IESS), a serious type of epilepsy. The results showed that Black/African American children were much less likely to receive genetic testing compared to children of other racial groups, even though this testing is important for diagnosing and treating IESS. The study also found that only 7% of children in the study came from small towns or rural areas, suggesting that children in these areas may not have the same access to healthcare. These findings show the need for more research to understand and address gaps i","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440329","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}
Epilepsia OpenPub Date : 2025-02-12DOI: 10.1002/epi4.13019
Ruth Walsh, Colin P Doherty, Elisabeth Doran
{"title":"The use of steroids in adult epilepsy: A systematic review.","authors":"Ruth Walsh, Colin P Doherty, Elisabeth Doran","doi":"10.1002/epi4.13019","DOIUrl":"https://doi.org/10.1002/epi4.13019","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to systematically review the clinical studies investigating the use of steroids in adult epilepsy.</p><p><strong>Methods: </strong>This systematic review utilized Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to examine literature on the use of steroids in adult epilepsy. Three databases, Embase, PubMed and Medline, were searched and clinical studies fitting the inclusion and exclusion criteria were included for review.</p><p><strong>Results: </strong>There were 4333 articles retrieved after duplicates were removed and 16 met the inclusion criteria. Three of these studied corticosteroid use in seronegative autoimmune epilepsies. There was one study that examined the use of corticosteroids in adult-onset Rasmussen's Encephalitis. There were three studies which described the use of neurosteroids in various forms of adult epilepsy. The remaining 9 studies were pertaining to the use of corticosteroids in refractory status epilepticus.</p><p><strong>Significance: </strong>Steroids show favorable outcomes in many forms of adult epilepsy. Yet, there is a paucity of data supporting implementation of this treatment in practice. High-level evidence such as Randomized-Controlled Trials investigating the use of corticosteroids in adult epilepsy are required, particularly those examining seronegative autoimmune epilepsy and refractory status epilepticus given the prevalence of these conditions and lack of treatment options.</p><p><strong>Plain language summary: </strong>Epilepsy, characterized by repeated seizures often without a known cause, is initially treated with anti-seizure medications. However, about one third of patients do not become seizure-free with medication. Steroids, known for their anti-inflammatory effect, are now being trialed as a seizure treatment for difficult to control seizures because uncontrolled seizures are thought to cause inflammation in the brain. However, the use of steroids as a treatment for uncontrolled seizures has not been researched widely. This article reviews studies exploring the use of steroids in adult epilepsy and finds that there is some evidence that steroids may be able to improve seizures in some cases. Yet, further research is needed to better understand the effect and benefits of steroids in managing epilepsy.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398575","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":"HMGB1 blood levels and neurological outcomes after traumatic brain injury: Insights from an exploratory study.","authors":"Irma Wati Ngadimon, Devi Mohan, Mohd Farooq Shaikh, Ching Soong Khoo, Hui Jan Tan, Yu Mey Lee, Nor Syazwani Chamhuri, Farizal Fadzil, Nursyazwana Zolkafli, Alina Arulsamy, Jegan Thanabalan, Angel Aledo-Serrano, Wing Loong Cheong","doi":"10.1002/epi4.70001","DOIUrl":"https://doi.org/10.1002/epi4.70001","url":null,"abstract":"<p><strong>Objective: </strong>Posttraumatic epilepsy (PTE) and cognitive impairment are severe complications following traumatic brain injury (TBI). Neuroinflammation likely contributes, but the role of specific inflammatory mediators requires clarification. High-mobility group box 1 (HMGB1) is an inflammatory cytokine released after brain injury that may be involved. This prospective longitudinal study investigated whether serum HMGB1 levels are associated with PTE development and cognitive decline over 12 months post-TBI.</p><p><strong>Methods: </strong>Serum samples were collected from 41 TBI patients, including mild and moderate to severe, at baseline, 6, and 12 months following TBI. HMGB1 was quantified by ELISA alongside interleukin-1β (IL-1β) and tumor necrosis factor (TNF). Cognitive assessments using validated neuropsychological assessments were performed at 6 and 12 months. The occurrence of PTE was also tracked.</p><p><strong>Results: </strong>HMGB1 remained elevated at 12 months post-TBI only in the subgroup (n = 6) that developed PTE (p = 0.026). PTE was associated with moderate to severe TBI cases. Higher HMGB1 levels at 12 months correlated with a greater decline in Addenbrooke's Cognitive Examination scores (p < 0.05). Reductions in HMGB1 (p < 0.05), IL-1β (p < 0.05) and TNF (p < 0.001) levels from 6 to 12 months correlated with improvements in cognitive scores. Multivariate regression analysis confirmed that HMGB1 level changes were independently associated with cognitive trajectory post-TBI (p = 0.003).</p><p><strong>Significance: </strong>The study highlights the importance of understanding the interactions between HMGB1 and inflammatory markers in posttraumatic neuroinflammatory responses. Targeting HMGB1 and associated markers may offer a promising strategy for managing chronic neuroinflammation and mitigating cognitive deficits in TBI patients, emphasizing the potential for targeted therapeutic interventions in this context.</p><p><strong>Plain language summary: </strong>This study examines how a protein called HMGB1 may contribute to epilepsy and cognitive deficits after traumatic brain injury (TBI). Patients with higher HMGB1 levels were more likely to develop epilepsy and experience significant cognitive decline within a year. Reducing HMGB1 and related inflammation was associated with better cognitive function and overall brain health. These findings suggest that HMGB1 could be a valuable marker and a potential target for treatments to prevent epilepsy and improve brain recovery after TBI.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398621","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}
Epilepsia OpenPub Date : 2025-02-12DOI: 10.1002/epi4.13115
Sophie Adler, Felice D'Arco, Kshitij Mankad, Martin Kyncl, Alexis Arzimanoglou, Petr Marusic
{"title":"Harmonization of MRI sequences across ERN EpiCARE centers.","authors":"Sophie Adler, Felice D'Arco, Kshitij Mankad, Martin Kyncl, Alexis Arzimanoglou, Petr Marusic","doi":"10.1002/epi4.13115","DOIUrl":"https://doi.org/10.1002/epi4.13115","url":null,"abstract":"<p><p>Neuroimaging investigations are fundamental in the diagnosis of patients with epilepsy. The International League Against Epilepsy (ILAE) harmonized neuroimaging of epilepsy structural sequences (HARNESS-MRI) protocol was intended as a generalizable structural MRI protocol. The European Reference Network for Rare and Complex Epilepsies, EpiCARE, includes 50 centers, across 26 countries, with expertise in epilepsy. We investigated adherence to the HARNESS-MRI protocol across EpiCARE. A survey on the clinical use of imaging and postprocessing methods in epilepsy patients was distributed among the centers. A descriptive analysis was performed, and results were compared to existing guidelines, as well as a previous survey in 2016. 79% of centers were adhering to the HARNESS-MRI protocol in all epilepsy patients. All centers were acquiring 3D T1-weighted sequences, 90% were acquiring 3D FLAIR and 87% were acquiring high in-plane 2D coronal T2 MRI sequences in all epilepsy patients. In comparison, in 2016, only 50% of centers were following MRI recommendations at the time. Across European expert epilepsy centers, there has been increased harmonization of MRI sequences since the introduction of the HARNESS-MRI protocol. This standardization supports optimal radiological review at individual centers as well as enabling harmonization of multicenter datasets for research. PLAIN LANGUAGE SUMMARY: Neuroimaging investigations are a fundamental component of epilepsy diagnosis. The International League Against Epilepsy (ILAE) has created guidelines about what MRI images to obtain in all epilepsy patients. In this study, we assessed the adherence of expert European epilepsy centers to these guidelines and found that 79% are acquiring the minimum set of MRI scans in all epilepsy patients. Standardization of MRI imaging serves to improve epilepsy diagnosis across Europe.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406489","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":"Practical experience and challenges in nutritional management of glucose transporter 1 deficiency syndrome: Provider survey results.","authors":"Diana Lehner-Gulotta, Robyn Blackford, Stacey Bessone, Wesley Lowman, Nicole Haggerty, Chu-Yi Huang, Erika T Axeen","doi":"10.1002/epi4.13135","DOIUrl":"https://doi.org/10.1002/epi4.13135","url":null,"abstract":"<p><p>Ketogenic diets (KDs) are recommended as precision therapy for glucose transporter 1 deficiency syndrome (GLUT-1 DS) but there are no recommendations for optimal implementation in this population. We administered an online survey targeting clinicians with experience implementing KDs in GLUT-1 DS, focusing on diet selection, initiation, and management. Respondents were primarily experienced registered dietitian nutritionists (RDNs) from 34 centers in 10 countries. Most reported a preference for carbohydrate counting or ratios under 3:1. KD-related laboratory monitoring (including blood ketones) and vitamin/mineral supplementation did not differ for GLUT-1 DS patients compared to the epilepsy population. Routine use of exogenous ketones was not endorsed for improved ketosis, whereas MCT oil is a commonly used supplement. Respondents overwhelmingly endorsed discussing and implementing gastrostomy feedings to support continued dietary therapy when medically indicated. Most but not all providers (80%) were familiar with the 2020 consensus guidelines. Our survey demonstrates practice variability among experienced dietitians, particularly in diet type and ratio. Identified challenges carry clinical significance, as the diet is a precision therapy in GLUT1-DS. Further research is needed to examine the outcomes of different approaches to KDs in GLUT-1 DS before consensus about the most effective interventions can be reached. PLAIN LANGUAGE SUMMARY: Glucose transporter deficiency syndrome is a genetic condition caused by an inability to move sugar (glucose) into the brain, which is needed for proper brain function. Ketogenic diets (low in carbohydrate and high in fat) are the established treatment to help control symptoms. Although the diet is effective, it can be challenging. To understand these challenges, we surveyed experts in ketogenic diet management and found significant variability regarding specifics of how the diet is managed. More research is needed before one approach can be endorsed as most effective.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364150","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}
Epilepsia OpenPub Date : 2025-02-07DOI: 10.1002/epi4.13134
Sha Xu, Qianwen Zhu, Jinqi Zhou, Lingqi Ye, Hongyi Ye, Chunhong Shen, Zhe Zheng, Hongjie Jiang, Shan Wang, Yao Ding, Cong Chen, Yi Guo, Zhongjin Wang, Shuang Wang
{"title":"Ictal scalp EEG patterns are shaped by seizure etiology in temporal lobe epilepsy.","authors":"Sha Xu, Qianwen Zhu, Jinqi Zhou, Lingqi Ye, Hongyi Ye, Chunhong Shen, Zhe Zheng, Hongjie Jiang, Shan Wang, Yao Ding, Cong Chen, Yi Guo, Zhongjin Wang, Shuang Wang","doi":"10.1002/epi4.13134","DOIUrl":"https://doi.org/10.1002/epi4.13134","url":null,"abstract":"<p><strong>Objective: </strong>To investigate how etiology and seizure localization influence ictal scalp electroencephalographic (EEG) patterns in temporal lobe epilepsy (TLE).</p><p><strong>Methods: </strong>We retrospectively analyzed ictal EEG features from 504 focal seizures recorded in 189 TLE patients with various etiologies who underwent resective surgery.</p><p><strong>Results: </strong>For seizure onset patterns (SOPs), α/β onset was more common in the low-grade tumor group (38.4%) than in the hippocampal sclerosis (HS) group (14.1%, p < 0.001). The ictal EEG duration was shorter in the tumor group compared to the focal cortical dysplasia (FCD), HS, and non-specific groups (p < 0.05). Among mesial TLE patients, SOPs varied depending on the etiology. Within both the tumor and non-specific groups, SOPs and the spreading time to the contralateral hemisphere differed between mesial and neocortical origins. Ictal pattern (87.7%) and ictal theta activity (83.9%) correctly lateralized the seizure in most cases.</p><p><strong>Significance: </strong>The ictal scalp pattern in TLE is influenced by both etiology and seizure localization. TLE associated with low-grade tumors exhibits distinct ictal EEG characteristics. Furthermore, ictal pattern and ictal theta activity are equally effective in lateralizing seizures, regardless of etiology.</p><p><strong>Plain language summary: </strong>This research examined how brain activity during seizures in people with temporal lobe epilepsy can be different based on what caused the epilepsy and where in the brain the seizure starts. We found that seizures caused by brain tumors have unique patterns in the brain's electrical activity. Additionally, we discovered that specific patterns and types of brain waves can help determine which side of the brain the seizure is occurring on, regardless of its cause.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364180","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}