Epilepsia Open最新文献

{"title":"New insights into epileptic spasm generation and treatment from the TTX animal model.","authors":"John W Swann, Carlos J Ballester-Rosado, Chih-Hong Lee","doi":"10.1002/epi4.70042","DOIUrl":"https://doi.org/10.1002/epi4.70042","url":null,"abstract":"<p><p>Currently, we have an incomplete understanding of the mechanisms underlying infantile epileptic spasms syndrome (IESS). However, over the past decade, significant efforts have been made to develop IESS animal models to provide much-needed mechanistic information for therapy development. Our laboratory has focused on the TTX model and in this paper, we review some of our findings. To induce spasms, tetrodotoxin (TTX) is infused into the neocortex of infant rats. TTX produces a lesion at its infusion site and thus mimics IESS resulting from acquired structural brain abnormalities. Subsequent electrophysiological studies showed that the epileptic spasms originate from neocortical layer V pyramidal cells. Importantly, experimental maneuvers that increase the excitability of these cells produce focal seizures in non-epileptic control animals but never produce them in TTX-infused epileptic rats; instead, epileptic spasms are produced in epileptic rats, indicating a significant transformation in the operations of neocortical networks. At the molecular level, studies showed that the expression of insulin-like growth factor 1 was markedly reduced in the cortex and this corresponded with a loss of presynaptic GABAergic nerve terminals. Very similar observations were made in surgically resected tissue from IESS patients with a history of perinatal strokes. Other experiments in conditional knockout mice indicated that IGF-1 plays a critical role in the maturation of neocortical inhibitory connectivity. This finding led to our hypothesis that the loss of IGF-1 in epileptic animals impairs inhibitory interneuron synaptogenesis and is responsible for spasms. To test this idea, we treated epileptic rats with the IGF-1-derived tripeptide (1-3)IGF-1, which was shown to act through IGF-1's receptor. (1-3)IGF-1 rescued inhibitory interneuron connectivity, restored IGF-1 levels, and abolished spasms. Thus, (1-3)IGF-1 or its analogs are potential novel treatments for IESS following perinatal brain injury. We conclude by discussing our findings in the broader context of the often-debated final common pathway hypothesis for IESS. PLAIN LANGUAGE SUMMARY: We review findings from the TTX animal model of infantile epileptic spasms syndrome, which show that these seizures come from an area of the brain called the neocortex. In this area, the amount of an important growth factor called IGF-1 is reduced, as is the number of inhibitory synapses that play an important role in preventing seizures. Other results indicate that the loss of IGF-1 prevents the normal development of these inhibitory synapses. Treatment of epileptic animals with (1-3)IGF-1 restored IGF-1 levels and inhibitory synapses and abolished spasms. Thus, (1-3)IGF-1 or an analog is a potential new therapy for epileptic spasms.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988744","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":"Epilepsia Open – April 2025 Announcements","authors":"","doi":"10.1002/epi4.70025","DOIUrl":"https://doi.org/10.1002/epi4.70025","url":null,"abstract":"&lt;p&gt;\u0000 7th ILAE School on EEG in the First Year of Life\u0000 &lt;/p&gt;&lt;p&gt;26 - 27 April 2025&lt;/p&gt;&lt;p&gt;Sanya City, Hainan, China&lt;/p&gt;&lt;p&gt;\u0000 ILAE School on Neuroimaging 2025\u0000 &lt;/p&gt;&lt;p&gt;15 - 17 May 2025&lt;/p&gt;&lt;p&gt;Potsdam, Germany&lt;/p&gt;&lt;p&gt;\u0000 5th African Epilepsy Congress\u0000 &lt;/p&gt;&lt;p&gt;16 - 18 May 2025&lt;/p&gt;&lt;p&gt;Lusaka, Zambia&lt;/p&gt;&lt;p&gt;\u0000 Curso-taller internacional de electroencefalografia básica y avanzada\u0000 &lt;/p&gt;&lt;p&gt;23 - 24 May 2025&lt;/p&gt;&lt;p&gt;En línea&lt;/p&gt;&lt;p&gt;\u0000 15th ILAE School for Neuropathology and Neuroimaging in Epilepsy\u0000 &lt;/p&gt;&lt;p&gt;31 July - 3 August 2025&lt;/p&gt;&lt;p&gt;Campinas, São Paulo, Brazil&lt;/p&gt;&lt;p&gt;\u0000 XVIII Workshop on Neurobiology of Epilepsy (WONOEP 2025)\u0000 &lt;/p&gt;&lt;p&gt;25 - 29 August 2025&lt;/p&gt;&lt;p&gt;Portugal&lt;/p&gt;&lt;p&gt;\u0000 36th International Epilepsy Congress\u0000 &lt;/p&gt;&lt;p&gt;30 August - 3 September 2025&lt;/p&gt;&lt;p&gt;Lisbon, Portugal&lt;/p&gt;&lt;p&gt;\u0000 15th ILAE School on Pre-Surgical Evaluation for Epilepsy and Epilepsy Surgery\u0000 &lt;/p&gt;&lt;p&gt;19 - 23 January 2026&lt;/p&gt;&lt;p&gt;Brno, Czech Republic&lt;/p&gt;&lt;p&gt;\u0000 16th European Epilepsy Congress\u0000 &lt;/p&gt;&lt;p&gt;5 - 9 September 2026&lt;/p&gt;&lt;p&gt;Athens, Greece&lt;/p&gt;&lt;p&gt;\u0000 Epilepsy and Stroke\u0000 &lt;/p&gt;&lt;p&gt;1 April 2025&lt;/p&gt;&lt;p&gt;\u0000 Crises occipitales et pariétales\u0000 &lt;/p&gt;&lt;p&gt;8 April 2025&lt;/p&gt;&lt;p&gt;\u0000 Focal Ictogenesis: When and why does interictal activity transition into ictal activity?\u0000 &lt;/p&gt;&lt;p&gt;10 April 2025&lt;/p&gt;&lt;p&gt;\u0000 ILAE e-Forum: Diagnosis and classification of Developmental and Epileptic Encephalopathies (DEE)\u0000 &lt;/p&gt;&lt;p&gt;22 April 2025&lt;/p&gt;&lt;p&gt;\u0000 Thalamo-cortical Network: How does coupling between focus and thalamus change before seizures?\u0000 &lt;/p&gt;&lt;p&gt;24 April 2025&lt;/p&gt;&lt;p&gt;\u0000 ILAE Eastern Mediterranean Webinar\u0000 &lt;/p&gt;&lt;p&gt;24 April 2025&lt;/p&gt;&lt;p&gt;\u0000 Neurodevelopment\u0000 &lt;/p&gt;&lt;p&gt;1 May 2025&lt;/p&gt;&lt;p&gt;\u0000 SUDEP: What are the mechanisms and risk factors?\u0000 &lt;/p&gt;&lt;p&gt;13 May 2025&lt;/p&gt;&lt;p&gt;\u0000 Neurodegeneration: When and how do neurodegenerative diseases lead to seizures?\u0000 &lt;/p&gt;&lt;p&gt;20 May 2025&lt;/p&gt;&lt;p&gt;\u0000 Understanding Functional Seizures in Children\u0000 &lt;/p&gt;&lt;p&gt;17 June 2025&lt;/p&gt;&lt;p&gt;\u0000 AD/PD™ 2025 International Conference on Alzheimer's and Parkinson's Diseases and related neurological disorders\u0000 &lt;/p&gt;&lt;p&gt;1 - 5 April 2025&lt;/p&gt;&lt;p&gt;Vienna, Austria &amp; Online&lt;/p&gt;&lt;p&gt;\u0000 International Congress on Structural Epilepsy &amp; Symptomatic Seizures 2025\u0000 &lt;/p&gt;&lt;p&gt;2 - 4 April 2025&lt;/p&gt;&lt;p&gt;Gothenburg, Sweden&lt;/p&gt;&lt;p&gt;\u0000 EPIPED Course: Treatment Strategies in Pediatric Epilepsies\u0000 &lt;/p&gt;&lt;p&gt;23 - 26 April 2025&lt;/p&gt;&lt;p&gt;Girona, Spain&lt;/p&gt;&lt;p&gt;\u0000 12th International Residential Course on Drug Resistant Epilepsies\u0000 &lt;/p&gt;&lt;p&gt;11 - 27 May 2025&lt;/p&gt;&lt;p&gt;Tagliacozzo, Italy&lt;/p&gt;&lt;p&gt;\u0000 International Conference for Technology and Analysis of Seizures (ICTALS 2025)\u0000 ","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 2","pages":"658-660"},"PeriodicalIF":2.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861604","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":"A pilot study on the programming protocol of vagus nerve stimulation in children with drug-resistant epilepsy: High pulse amplitude or high duty cycle","authors":"Yuying Pan,&nbsp;Han Xie,&nbsp;Jiayi Ma,&nbsp;Taoyun Ji,&nbsp;Qingzhu Liu,&nbsp;Lixin Cai,&nbsp;Yuwu Jiang,&nbsp;Kai Zhang,&nbsp;Jianguo Zhang,&nbsp;Ye Wu","doi":"10.1002/epi4.70043","DOIUrl":"10.1002/epi4.70043","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;To compare the efficacy and safety of vagus nerve stimulation using different modes in patients with drug-resistant epilepsy (DRE).&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;Children with DRE who underwent vagus nerve stimulator implantation between March 2019 and December 2022 were prospectively enrolled at the Peking University First Hospital. Ninety-four children were randomly divided into the high pulse amplitude [pulse amplitude was gradually increased to maximum tolerance value (≤2.8 mA) and duty cycle was maintained at 10%] and high duty cycle groups [pulse amplitude was maintained at 1.5 mA and duty cycle was subsequently increased to maximum tolerance value (≤37%)]. At the 55-week follow-up, the responder rate, seizure-free rate, and adverse effects were compared between the two groups.&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 children with DRE were included (47 patients each in the high pulse amplitude group and the high duty cycle group). For epileptic seizures, the responder rate of the high pulse amplitude group was 53.2% (25/47), while that of the high duty cycle group was 38.3% (18/47). High pulse amplitude had a higher responder rate of focal seizures (60.7% in the high pulse amplitude group vs. 29.2% in the high duty cycle group; chi-squared test, &lt;i&gt;p&lt;/i&gt; = 0.023). Among children with a ≥ 75% reduction in epileptic spasms, the high duty cycle group had a higher responder rate than the high pulse amplitude group (54.5% vs. 16.7%; Fisher's exact test, &lt;i&gt;p&lt;/i&gt; = 0.022). In addition, in the high duty cycle group, the responder rate in children with epileptic spasms was higher than that in children without epileptic spasms (59.1% vs. 20.0%; chi-square test, &lt;i&gt;p&lt;/i&gt; = 0.011). Among children with implantation age &lt;6 years, the responder rate of the high pulse amplitude group was higher (chi-square test, &lt;i&gt;p&lt;/i&gt; = 0.024). The incidence of adverse effects in the two groups was not statistically different.&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 overall responder rates in the two modes were similar. The high pulse amplitude mode may be more effective for focal seizures, whereas the high duty cycle mode may be more effective for epileptic spasms. Patients aged &lt;6 years with DRE and VNS implantation may require a higher pulse amplitude to achieve better efficacy.&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 compared the anti-seizure ","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"831-841"},"PeriodicalIF":2.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063190","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":"Facilitators and barriers to neurologist referral of patients for epilepsy surgery evaluation","authors":"Chloé E. Hill,&nbsp;Daniel Hochster,&nbsp;Jessica E. Baker,&nbsp;Alison L. Herman,&nbsp;Nishad Shaheid,&nbsp;Susanna S. O'Kula,&nbsp;Jack M. Parent,&nbsp;Darin B. Zahuranec,&nbsp;Lesli E. Skolarus","doi":"10.1002/epi4.70045","DOIUrl":"10.1002/epi4.70045","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 surgery offers a potential cure for drug-resistant epilepsy (DRE), yet surgery is underutilized. An estimated 5% of patients with DRE undergo long-term EEG monitoring (LTM) annually, the requisite first step of evaluation for surgical candidacy. Much of the variation in LTM referral may be attributable to individual neurologist practice rather than patient characteristics. We explored neurologist behaviors and practices in epilepsy surgery referral to guide future interventions to expand patient access to surgery.&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;This qualitative interview study recruited neurologists who treated adults with epilepsy. Interviews were grounded in the Theoretical Domains Framework (TDF) of behavior change to identify facilitators and barriers to neurologist referral for epilepsy surgery evaluation. Transcripts of semi-structured interviews were analyzed with deductive coding guided by the TDF domains as well as emergent coding of subcodes/themes.&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;Of 40 invited neurologists, 13 (33%) participated. Median time since medical school graduation was 14 years (range 5–45); four had no subspecialty training, and nine completed epilepsy/neurophysiology fellowships; nine practiced in community settings. Referral rates for presurgical evaluation ranged from less than 1 annually to 1 monthly. The most important TDF domains identified as facilitators of neurologist referral were knowledge, skills, optimism, and beliefs about capabilities. Domains identified as barriers of neurologist referral included reinforcement and environmental context and resources, both at the intersection of referring provider and epilepsy center and with regard to perceived patient burden. Social influences and social/professional role and identity operated as facilitators or barriers.&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;Looking toward future interventions to improve rates of presurgical evaluation, attention should be focused on the most pertinent and most modifiable domains. Neurologists' skills and their perception of their capabilities operate as facilitators; thus, disseminating effective communication approaches to patient discussions may support increased neurologist referral. To address environmental context &amp; resource barriers specifically, inter-institutional communication, presurgical evaluation pathway coordination, and resources/support for patients could be targeted to improve neurologist referral.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"855-865"},"PeriodicalIF":2.8,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991425","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":"Intestinal microbiome alterations in pediatric epilepsy: Implications for seizures and therapeutic approaches.","authors":"Teresa Ravizza, Greta Volpedo, Antonella Riva, Pasquale Striano, Annamaria Vezzani","doi":"10.1002/epi4.70037","DOIUrl":"https://doi.org/10.1002/epi4.70037","url":null,"abstract":"<p><p>The intestinal microbiome plays a pivotal role in maintaining host health through its involvement in gastrointestinal, immune, and central nervous system (CNS) functions. Recent evidence underscores the bidirectional communication between the microbiota, the gut, and the brain and the impact of this axis on neurological diseases, including epilepsy. In pediatric patients, alterations in gut microbiota composition-called intestinal dysbiosis-have been linked to seizure susceptibility. Preclinical models revealed that gut dysbiosis may exacerbate seizures, while microbiome-targeted therapies, including fecal microbiota transplantation, pre/pro-biotics, and ketogenic diets, show promise in reducing seizures. Focusing on clinical and preclinical studies, this review examines the role of the gut microbiota in pediatric epilepsy with the aim of exploring its implications for seizure control and management of epilepsy. We also discuss mechanisms that may underlie mutual gut-brain communication and emerging therapeutic strategies targeting the gut microbiome as a novel approach to improve outcomes in pediatric epilepsy. PLAIN LANGUAGE SUMMARY: Reciprocal communication between the brain and the gut appears to be dysfunctional in pediatric epilepsy. The composition of bacteria in the intestine -known as microbiota- and the gastrointestinal functions are altered in children with drug-resistant epilepsy and animal models of pediatric epilepsies. Microbiota-targeted interventions, such as ketogenic diets, pre-/post-biotics administration, and fecal microbiota transplantation, improve both gastrointestinal dysfunctions and seizures in pediatric epilepsy. These findings suggest that the gut and its microbiota represent potential therapeutic targets for reducing drug-resistant seizures in pediatric epilepsy.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between neuromagnetic networks and cognitive impairment in self-limited epilepsy with centrotemporal spikes","authors":"Jing Lu,&nbsp;Peilin Jiang,&nbsp;Yingfan Wang,&nbsp;Minghao Li,&nbsp;Yinjie Zhu,&nbsp;Ke Hu,&nbsp;Xinyi Zhou,&nbsp;Xiaoshan Wang","doi":"10.1002/epi4.70044","DOIUrl":"10.1002/epi4.70044","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;This was an exploratory study designed to examine the alterations in neuromagnetic networks within brain regions involved in cognitive functions in children with self-limited epilepsy with centrotemporal spikes (SeLECTS). Additionally, it sought to explore the relationship between these neural network differences and cognitive impairment.&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;Magnetoencephalography (MEG) data were collected from 63 drug-naïve children diagnosed with SeLECTS and 30 healthy controls (HC). Functional connectivity (FC) across 26 cognitive-related brain regions, as defined by Desikan-Killiany, was assessed using corrected amplitude envelope correlation (AEC-c) analysis. The cognitive function of the children was evaluated using the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV). Spearman's correlation analysis was then performed to assess the relationship between AEC-c values and WISC-IV indices.&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;Children with SeLECTS showed reduced FC in the delta band between the left rostral middle frontal (rMFG.L) and the left rostral anterior cingulate (rACC.L), as well as in the gamma2 band between the left superior frontal (SFG.L) and the rACC on both sides, compared to HC (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). On the other hand, several FC networks were enhanced, including those between the left rMFG and the right rACC, the left rMFG and the left caudal middle frontal (CMF.L), and between the right caudal middle frontal (CMF.R) and the right supramarginal (SMG.R), specifically in the gamma1 band (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). A correlation analysis revealed a positive association between the AEC-c values between the left rMFG and the right rACC and the Verbal Comprehension Index (VCI) scores (R = 0.4228, &lt;i&gt;p&lt;/i&gt; &lt; 0.05).&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 findings of this study revealed that children with SeLECTS exhibited significant differences in the FC networks in brain regions associated with cognition, especially within the delta and gamma frequency bands, when compared to HC. We also found that these differences in FC networks are significantly correlated with verbal comprehension ability, which may contribute to the understanding of the mechanisms underlying the weaknesses in cognitive function in children with SeLECTS. Furthermore, our findings may provide hypotheses for future work dedicated to further exploring the mechanisms associated with brain network alterations in cognitive impairment in children with SeLECTS.&lt;/p&gt;","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"842-854"},"PeriodicalIF":2.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985245","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":"Noninvasive brain stimulation as focal epilepsy treatment in the hospital, clinic, and home","authors":"Karimul Islam,&nbsp;Keith Starnes,&nbsp;Kelsey M. Smith,&nbsp;Thomas Richner,&nbsp;Nicholas Gregg,&nbsp;Alejandro A. Rabinstein,&nbsp;Gregory A. Worrell,&nbsp;Brian N. Lundstrom","doi":"10.1002/epi4.70033","DOIUrl":"10.1002/epi4.70033","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;Noninvasive brain stimulation (NIBS) provides a treatment option for patients not eligible for surgical intervention or who seek low-risk approaches and may be used in the hospital, clinic, and at home. Our objective is to summarize our single-center experience with multiple NIBS approaches for the treatment of focal epilepsy.&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 retrospective chart review identified drug-resistant focal epilepsy patients who received NIBS as an epilepsy treatment at Mayo Clinic in Rochester, MN. Patients were typically treated as follows: (1) for TMS, 1 Hz stimulation was applied for five consecutive days in the neuromodulation clinic, (2) for outpatient tDCS, stimulation was applied for five consecutive days in the clinic, followed by optional treatment at home, and (3) for inpatient tDCS, stimulation was applied for three consecutive days. We analyzed continuous EEG data for the inpatient tDCS cohort and available HD-EEG data for outpatient cohorts to quantify changes in interictal epileptiform discharges (IEDs) as a result of stimulation. Outcomes were assessed at 1 month for TMS and outpatient tDCS and 1 week for inpatient tDCS.&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;Twenty-four patients were treated with TMS (&lt;i&gt;n&lt;/i&gt; = 10) and tDCS (&lt;i&gt;n&lt;/i&gt; = 14, 9 as outpatients). The median age was 40 years (range 15–73). The median seizure reduction following stimulation was 50%. Fourteen patients (58%) were responders to treatment (TMS = 4/10, tDCS Outpatient = 7/9, tDCS Inpatient = 3/5). Five outpatient tDCS participants elected to continue treatment at home. Four TMS and four outpatient tDCS patients underwent high-density EEG before and after 5 days of therapy. Following stimulation, IED rate was reduced in 4/5 inpatient tDCS patients, 4/4 outpatient tDCS patients, and 4/4 TMS patients. Two patients experienced an increase in seizure frequency (1 following TMS and 1 following outpatient tDCS), which returned to baseline 4–6 weeks after stimulation treatments were discontinued.&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;TMS and tDCS are potential treatment approaches for drug-resistant focal epilepsy patients in the hospital, clinic, and home. They have a favorable safety profile and can lead to a reduction in IED rates and seizures. These results suggest further studies are needed to examine NIBS as a treatment for epilepsy.&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 ","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"787-795"},"PeriodicalIF":2.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963546","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 hippocampectomy on seizure freedom in temporal encephaloceles: A systematic review and individual participant data meta-analysis","authors":"Panagiota-Eleni Tsalouchidou,&nbsp;Alexandros Matsingos,&nbsp;Wiebke Hahn,&nbsp;Katja Menzler,&nbsp;Susanne Knake","doi":"10.1002/epi4.70036","DOIUrl":"10.1002/epi4.70036","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;Temporal encephaloceles (TEs) are increasingly recognized as a cause of MRI-negative temporal lobe epilepsy (TLE). The optimal surgical approach for TE-related refractory epilepsy remains unclear, particularly regarding the necessity of excluding mesiotemporal structures such as the hippocampus, which may lead to worse neuropsychological outcomes. This study evaluates the impact of hippocampectomy on achieving seizure freedom in patients with TE-related epilepsy through a systematic review and individual participant data (IPD) meta-analysis.&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 systematic literature review was conducted across Medline, Google Scholar, Embase, and Web of Science, identifying studies reporting surgical outcomes in TE-related epilepsy. Studies were included if they provided at least 12 months of follow-up and reported seizure outcomes using Engel or ILAE classification. The primary outcome was postsurgical seizure freedom (Engel Class IA or ILAE Class 1). A mixed-effects logistic regression model was used to compare outcomes between patients who underwent hippocampectomy and those who did not. Heterogeneity was assessed using &lt;i&gt;τ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; and &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; statistics.&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 meta-analysis included 23 studies with a total of 155 surgically treated patients. The primary analysis did not identify a statistically significant difference in seizure freedom between patients who underwent hippocampectomy and those who did not (Risk Ratio [RR] = 0.66, 95% Confidence Interval [CI]: 0.29–1.52, &lt;i&gt;p&lt;/i&gt; = 0.329). Other covariates, including sex, duration of epilepsy, presence of additional epileptogenic lesions, and the use of invasive presurgical evaluation, were not significant predictors of seizure freedom. The &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; statistic indicated moderate heterogeneity (54.68%).&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;This IPD meta-analysis suggests that hippocompectomy does not significantly impact seizure freedom in patients with TE-related epilepsy and should not be part of a universal approach when determining the optimal surgical strategy. These results reinforce the need for an individualized approach, considering patient-specific factors to optimize surgical decision-making in TE-related epilepsy.&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;Temporal encephaloceles (TEs) can cause drug-resistant epi","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"796-808"},"PeriodicalIF":2.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959794","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":"Genetic epilepsies with myoclonic seizures: Mechanisms and syndromes.","authors":"Antonietta Coppola, Marica Rubino, Antonella Riva, Pasquale Striano","doi":"10.1002/epi4.70039","DOIUrl":"https://doi.org/10.1002/epi4.70039","url":null,"abstract":"<p><p>Genetic epilepsy with myoclonic seizures encompasses a heterogeneous spectrum of conditions, ranging from benign and self-limiting forms to severe, progressive disorders. While their causes are diverse, a significant proportion stems from genetic abnormalities. Advances in genetic research over the past decade have uncovered novel mechanisms underlying these disorders, including single-gene mutations, copy number variations (CNVs), and non-coding repeat expansions. These findings not only deepen our understanding of their pathophysiology but also highlight potential avenues for precision medicine. This review provides a comprehensive overview of myoclonic epilepsies linked to pathogenic gene variants, exploring genetic mechanisms and discussing their clinical implications. PLAIN LANGUAGE SUMMARY: In this work, we describe genetic epilepsies mainly characterized by myoclonic seizures, their genetic defects and disease mechanisms, and considerations of precision medicine treatment.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976673","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":"Perampanel monotherapy in pediatric epilepsy: Emphasizing the need for comprehensive safety evaluation","authors":"Gabriel Christian de Farias Morais,&nbsp;Guilherme Bastos Alves,&nbsp;Shahina Akter,&nbsp;Shopnil Akash,&nbsp;Md. Aktaruzzaman,&nbsp;Md. Sakib Al Hasan,&nbsp;Umberto Laino Fulco,&nbsp;Edilson Dantas da Silva Junior,&nbsp;Jonas Ivan Nobre Oliveira","doi":"10.1002/epi4.70031","DOIUrl":"10.1002/epi4.70031","url":null,"abstract":"&lt;p&gt;We read with great interest the recent article by Gu et al. titled “Clinical efficacy and safety of perampanel monotherapy as primary anti-seizure medication in the treatment of pediatric epilepsy: A single-center, prospective, observational study”.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The study highlighted the high efficacy and safety of perampanel (PER; a noncompetitive antagonist of the (AMPA) - α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid - glutamate receptor) monotherapy in pediatric patients aged 4–18 years with epilepsy, demonstrating seizure freedom rates exceeding 70% at various observation points and a retention rate of 71.58% at 12 months. Notably, the overall adverse event rate was 38.71%, with irritability and dizziness being the most common adverse effects. These findings underscore the potential of PER as an effective therapeutic option for pediatric epilepsy, offering favorable seizure control with a relatively lower maintenance dose for patients who respond well and adhere to long-term treatment.&lt;/p&gt;&lt;p&gt;While the study provides valuable insights into the clinical benefits of PER monotherapy in children, we believe that a more comprehensive evaluation of its safety profile is crucial, especially considering the vulnerable pediatric population. The limited scope of adverse effects reported, primarily mild to moderate, may not fully capture the potential risks associated with PER, particularly in long-term use. To address this gap, we examined existing data from established drug databases and scientific literature to evaluate the toxicological and safety considerations of PER.&lt;/p&gt;&lt;p&gt;Utilizing information from databases such as &lt;i&gt;ChemBL&lt;/i&gt; (https://www.ebi.ac.uk/chembl/), &lt;i&gt;PubChem&lt;/i&gt; (https://pubchem.ncbi.nlm.nih.gov/), &lt;i&gt;DrugBank&lt;/i&gt; (https://go.drugbank.com/), and reports from &lt;i&gt;PreADMET&lt;/i&gt; (https://preadmet.webservice.bmdrc.org/), &lt;i&gt;FAFDrugs4&lt;/i&gt; (https://fafdrugs4.rpbs.univ-paris-diderot.fr/), &lt;i&gt;ADMETSAR&lt;/i&gt; (http://lmmd.ecust.edu.cn/admetsar2), &lt;i&gt;MolInspiration&lt;/i&gt; (https://www.molinspiration.com/cgi-bin/properties), &lt;i&gt;pkCSM&lt;/i&gt; (https://biosig.lab.uq.edu.au/pkcsm/prediction), &lt;i&gt;SwissADME&lt;/i&gt; (http://www.swissadme.ch/), ADMETlab 2.0 (https://admetmesh.scbdd.com/), and &lt;i&gt;ADMET-AI&lt;/i&gt; (https://admet.ai.greenstonebio.com/) web servers, we gathered insights into the structural, physicochemical, and toxicological properties of PER (details in &lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;). Several concerns regarding potential adverse effects emerged from this analysis (Figure 1) and are discussed below.&lt;/p&gt;&lt;p&gt;First, PER exhibits physicochemical properties that may predispose it to non-specific binding and adverse drug reactions. Specifically, it has a calculated LogP (oil/water partition coefficient) of 3.374 and a topological polar surface area (TPSA) of 58.68 Å&lt;sup&gt;2&lt;/sup&gt;. According to established drug design principles, compounds with LogP values greater than 3 and TPSA less than 75 Å&lt;sup&gt;2&lt;/sup&gt; are associated with a higher likelihood o","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 3","pages":"971-975"},"PeriodicalIF":2.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802920","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}