Epilepsy and Behavior Reports最新文献

{"title":"Electro-clinical correlation of rinch and peri-ictal vegetative symptoms","authors":"Divya Nagabushana ,&nbsp;Francesco Pucci ,&nbsp;Huan Huynh ,&nbsp;Julia Bodnya ,&nbsp;Anna Serafini","doi":"10.1016/j.ebr.2025.100831","DOIUrl":"10.1016/j.ebr.2025.100831","url":null,"abstract":"<div><div>Rhythmic ictal non-clonic hand (RINCH) movements and <em>peri</em>-ictal vegetative symptoms (PIVS) are rare semiological signs in temporal lobe epilepsy (TLE). RINCH refers to rhythmic, low-amplitude, complex hand movements that typically lateralize to the contralateral hemisphere, while PIVS includes manifestations such as ictal spitting and post-ictal coughing, more frequently associated with non-dominant TLE. We report a unique case of a 40-year-old woman with drug-resistant dominant TLE who exhibited both RINCH and PIVS as part of her habitual seizures. Non-invasive EEG and imaging localized the seizure onset to the left anterior temporal region. Stereoelectroencephalography (SEEG) confirmed seizure onset in the left mesial temporal pole with rapid propagation to the hippocampus, amygdala, and other limbic structures. Notably, RINCH was observed only in seizures that showed ictal spread to the superior temporal gyrus (STG) and superior temporal sulcus (STS), suggesting their role in mediating semi-automatic motor behaviors. Ictal spitting and other PIVS were linked to the spread to the entorhinal and parahippocampal regions. The patient underwent left anterior temporal lobectomy with histopathological confirmation of hippocampal sclerosis and has remained seizure-free at one-year follow-up. This case provides a rare anatomo-electro-clinical correlation of RINCH and PIVS using SEEG and emphasizes that while RINCH retains lateralizing value, PIVS may not. Our findings underscore the importance of invasive EEG in characterizing complex semiology and refining the epileptogenic zone in dominant TLE.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100831"},"PeriodicalIF":1.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Atkins Diet therapy during pregnancy for refractory idiopathic generalized epilepsy","authors":"Ryoichi Inoue ,&nbsp;Elizabeth Weinandy ,&nbsp;Sarita Maturu ,&nbsp;Nabil Khandker","doi":"10.1016/j.ebr.2025.100832","DOIUrl":"10.1016/j.ebr.2025.100832","url":null,"abstract":"<div><div>The management of refractory epilepsy in pregnancy is challenging, and diet therapy has been rarely reported. We report a case of a 25-year-old woman with refractory idiopathic generalized epilepsy who achieved prolonged seizure freedom with the Modified Atkins Diet (MAD) during pregnancy. Her epilepsy began at age 3, with seizures occurring every two months despite multiple antiseizure medications and vagus nerve stimulation. Three months before her first pregnancy, MAD was initiated with a carbohydrate limit of 30 g daily, resulting in immediate seizure freedom. During the pregnancy, carbohydrate intake was gradually increased to 60–70 g daily to support fetal growth. She remained seizure-free for 10 months before experiencing breakthrough seizures in the third trimester. Oligohydramnios was subsequently detected, and she underwent induction of labor with vaginal delivery at 37 weeks. After delivery, she discontinued MAD for breastfeeding and remained seizure-free for 13 months. In her second pregnancy without MAD, she experienced two breakthrough seizures in the second trimester. She later achieved 23 months of seizure freedom. Both children have met developmental milestones appropriately.</div><div>This case adds to the limited literature on diet therapy in pregnancy and is, to our knowledge, the first involving generalized epilepsy. The case suggests MAD may provide seizure control during pregnancy, even with possible sustained benefit after discontinuation. However, given the occurrence of oligohydramnios and limited safety data, larger studies are needed to clarify the efficacy, safety, and long-term outcomes of diet therapy during pregnancy.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100832"},"PeriodicalIF":1.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olfactory sensory phenomena as the main seizure type in a child with low-grade glioma: a case report","authors":"Takato Akiba,&nbsp;Shinpei Abe,&nbsp;Junya Fujimura,&nbsp;Hiromichi Shoji","doi":"10.1016/j.ebr.2025.100830","DOIUrl":"10.1016/j.ebr.2025.100830","url":null,"abstract":"<div><div>Olfactory sensory phenomena (OSP) are a rare and often underrecognized descriptor of seizures without observable clinical manifestations, particularly in children. We report a case involving a 7-year and 9-month-old boy who experienced OSP as the sole seizure manifestation for nearly a year, resulting in a delayed diagnosis. Symptoms were initially misattributed to gastroesophageal reflux but gradually progressed to include focal impaired consciousness seizures. Brain magnetic resonance imaging revealed a mass lesion involving the right optic nerve, hypothalamus, and medial temporal lobe, leading to the diagnosis of focal epilepsy owing to a structural etiology. Histopathological assessment confirmed a low-grade glioma (LGG). Because OSP persisted despite lacosamide therapy, perampanel (PER) was introduced based on prior reports of its efficacy in epilepsy associated with glioma; however, instead of reducing, the OSP frequency increased after PER initiation. This case highlights the diagnostic challenge posed by nonmotor seizures with subtle clinical presentations and underscores the importance of considering epilepsy in patients with recurrent, unexplained sensory symptoms such as abnormal smells or nausea. It also contributes to the limited literature on pediatric focal epilepsy associated with LGG, providing educational value for physicians less familiar with atypical seizure semiology.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100830"},"PeriodicalIF":1.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early detection of antiseizure medication inefficacy using an implantable continuous EEG system and a personalized model: a case study","authors":"A. Reynolds ,&nbsp;A. Lai ,&nbsp;D.B. Grayden ,&nbsp;M.J. Cook ,&nbsp;A. Peterson","doi":"10.1016/j.ebr.2025.100829","DOIUrl":"10.1016/j.ebr.2025.100829","url":null,"abstract":"<div><div>Evaluating anti-seizure medication (ASM) efficacy can be limited by inaccurate seizure diaries and periodic fluctuations in seizure frequency, known as seizure cycles. These limitations may prolong monitoring of ineffective treatments. This study explores implantable continuous EEG monitoring (iCEM™) with Epiminder’s Minder® system and timeseries modelling to improve efficacy assessments.</div><div>This retrospective case study examines a 49-year-old female with drug-resistant focal epilepsy with iCEM (Nov. 2019). The participant maintained a seizure diary and was followed-up for 3 years. ASMs were changed in Aug.-Oct. 2020. A personalised autoregressive model incorporating interictal epileptiform discharge cycles to project 3-monthly seizure rates was trained and validated on post-drug data then tested on four held-out datasets (two pre-drug and two post-drug). The Kruskal-Wallis test assessed model performance between drug periods (α = 0.05).</div><div>Only 37 % of seizures were reported. Post-drug, diary-reported seizures increased while detected seizures decreased, but both remained within normal seizure rate variability. ASM inefficacy was addressed after 3 years. The autoregressive model mean squared error post-drug was 0.17 and 0.13 seizures per day over 3-months², which were significantly different from pre-drug (0.49 and 0.58 seizures per day over 3-months², <span><math><mi>H</mi></math></span>=336.82, p = 2.44exp.^-89), suggesting the model could recognise when an altered drug regimen affected seizure rate and interictal epileptiform discharges.</div><div>Seizures identified using iCEM combined with an individualised model may be able to distinguish drug-induced changes in seizure rate from normal variability. This proof-of-concept study offers useful information towards the development of methods that can support early treatment assessments, potentially shortening the time to find an optimal therapy.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100829"},"PeriodicalIF":1.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to delivering optimal care in epilepsy surgery candidates during transition of care: a short case series","authors":"Quynh Vo ,&nbsp;Kathryn Lalor","doi":"10.1016/j.ebr.2025.100828","DOIUrl":"10.1016/j.ebr.2025.100828","url":null,"abstract":"<div><div>Transition of care is becoming an increasingly discussed topic and is a necessary process that all young adults requiring medical care should undergo. The lack of transition of care in epilepsy can often lead to poor outcomes for young adults. Youths with drug-resistant epilepsy (DRE) requiring surgical intervention often face a more difficult transition and clinicians have more complexities to consider. Here we present four unique cases of surgical candidates undergoing transition of care, and highlight common issues encountered by young adults and pediatric and adult clinicians during this time. Cases 1 to 3 focus on young adults transitioning care after completion of surgical intervention, in the middle of a surgical workup, and before the consideration of surgical interventions, respectively. These cases examine how transition of care can affect treatment options and outcome. Case 4 highlights the impact considering surgical intervention can have on the transition process. Each case presents unique challenges facing young adults and their epilepsy surgical team. By highlighting barriers to care, changes can be made to facilitate better epilepsy management.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100828"},"PeriodicalIF":1.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vagus nerve stimulation in KCNB1-related developmental and epileptic encephalopathy: A case of seizure reduction and review of literature","authors":"Taichi Sayanagi ,&nbsp;Kenzo Kosugi ,&nbsp;Eri Ogawa ,&nbsp;Toshiki Takenouchi ,&nbsp;Mamiko Yamada ,&nbsp;Kenjiro Kosaki ,&nbsp;Ichiro Sugiyama ,&nbsp;Masahiro Toda","doi":"10.1016/j.ebr.2025.100826","DOIUrl":"10.1016/j.ebr.2025.100826","url":null,"abstract":"<div><div>Developmental and epileptic encephalopathies (DEEs) are devastating syndromes characterized by early-onset, treatment-resistant seizures, and significant developmental delays. <em>KCNB1</em>-related DEE, arising from pathogenic variants in the <em>KCNB1</em> gene, presents with profound cognitive impairment and persistent seizures despite multiple antiseizure medications (ASMs). Vagus nerve stimulation (VNS) has emerged as a valuable adjunctive therapy for medically intractable epilepsy, yet its effectiveness in rare genetic DEEs remains unknown. We report the first case of VNS in a 5-year-old child with <em>KCNB1</em>-related DEE, achieving about 90% seizure reduction after one year. Prior treatments with multiple ASMs had minimal effect. After VNS implantation, optimized stimulation parameters combined with fenfluramine markedly improved seizure control. Although concurrent medication adjustments and transient seizure cessation during infection complicated interpretation, the sustained seizure improvement strongly suggests VNS’s efficacy in this genetic epilepsy.</div><div>This case illustrates VNS’s potential benefit and possible synergy with fenfluramine in <em>KCNB1</em>-related DEE. Further accumulation of case reports is necessary to confirm these findings.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100826"},"PeriodicalIF":1.5,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: Surgical disconnection for medically refractory epilepsy in ARID1B-related Coffin-Siris syndrome","authors":"Xiao-Lai Ye ,&nbsp;Cui-Jing Wang ,&nbsp;Min-Zhi Yin ,&nbsp;Ru-En Yao ,&nbsp;Ying Zhou ,&nbsp;Fo-Yang Fan ,&nbsp;Qin-Chuan Liang","doi":"10.1016/j.ebr.2025.100825","DOIUrl":"10.1016/j.ebr.2025.100825","url":null,"abstract":"<div><div>Coffin–Siris syndrome is a rare multiple congenital anomaly syndrome. We report a case of medically refractory epilepsy developing in a pediatric patient with ARID1B-related Coffin–Siris syndrome, with pachygyria and polymicrogyria in right frontal lobe. Following presurgical evaluations, surgical disconnection of the epileptogenic zone was performed. Postoperative follow-up at 18 months demonstrated complete seizure freedom, with concomitant improvements in speech development and motor strength. This expands the phenotypes associated with ARID1B-related Coffin–Siris syndrome and underscores the importance of early genetic testing for DEEs, along with timely surgical evaluation and treatment for genetic epilepsies where applicable.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100825"},"PeriodicalIF":1.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significant seizure frequency reduction in a patient with refractory bitemporal epilepsy following transition from high-frequency to low-frequency responsive neurostimulation","authors":"Stacey Kim ,&nbsp;Christel Benny ,&nbsp;Alan Salim ,&nbsp;Charles Liu ,&nbsp;Brian Lee ,&nbsp;Hari Prasad Kunhi Veedu","doi":"10.1016/j.ebr.2025.100822","DOIUrl":"10.1016/j.ebr.2025.100822","url":null,"abstract":"<div><div>While many patients treated with Responsive Neurostimulation (RNS) experience a significant reduction in seizures, poor responders to traditional high frequency stimulation (HFS) may experience a meaningful reduction in seizure frequency when switched to low frequency stimulation (LFS). This case report presents a patient who developed post-traumatic pharmacoresistant bitemporal epilepsy and underwent unsuccessful treatments, including antiseizure polytherapy and implantation of a vagus nerve stimulator (VNS). Due to ongoing seizures, the patient underwent RNS System implantation with bilateral hippocampal depth electrodes. Prior to RNS implantation, the patient experienced a median frequency of 6.5 seizures per month. At traditional HFS settings applied for 30 months, the patient experienced a 31 % reduction from baseline. After switching to LFS for 8 months, the patient experienced an 85 % reduction. HFS delivered 6.02 min per day, compared to 113.77 min per day with LFS. This patient experienced a substantial and meaningful reduction in seizure frequency after switching to LFS, suggesting that LFS may be an effective alternative for RNS patients who do not have a satisfactory seizure reduction to traditional HFS. Furthermore, this case report highlights the importance of collaboration between academic medical centers with public safety net hospitals in delivering advanced epilepsy care to people in underserved communities.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100822"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emptying the fridge syndrome: a case of nocturnal food craving associated with peak perampanel concentration","authors":"Paola Vassallo ,&nbsp;Josemir W. Sander","doi":"10.1016/j.ebr.2025.100821","DOIUrl":"10.1016/j.ebr.2025.100821","url":null,"abstract":"<div><div>Perampanel, a non-competitive AMPA receptor antagonist, is widely used in treating focal and generalised epilepsy. We report the case of a 26-year-old man with pharmaco-resistant focal epilepsy who developed nocturnal compulsive food-seeking behaviour after off-label titration of perampanel to 24 mg/day. Symptoms resolved entirely after dose reduction, supporting a possible causal relationship. Pharmacokinetic data showed a 26 % increase in serum levels between near-trough and peak, potentially explaining the timing of nocturnal symptoms. This case underscores the importance of recognising atypical behavioural adverse events. Direct questioning is essential, as individuals may not spontaneously report such symptoms due to stigma or fear of losing seizure control.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100821"},"PeriodicalIF":1.5,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EPIDEP: Prevalence of undiagnosed depression in an epilepsy outpatient clinic","authors":"Alejandro Fernández-Cabrera ,&nbsp;Paula Santamaría-Montero ,&nbsp;Jesús García-de Soto ,&nbsp;Antía Figueira-Gómez ,&nbsp;Martín Rodríguez-Botana ,&nbsp;Benigno Pérez-Regojo ,&nbsp;Robustiano Pego-Reigosa","doi":"10.1016/j.ebr.2025.100819","DOIUrl":"10.1016/j.ebr.2025.100819","url":null,"abstract":"<div><div>Epilepsy and depression frequently coexist, with depressive symptoms affecting up to 50 % of patients, particularly those with drug-resistant epilepsy (DRE). Underdetection of depression in general neurology settings can worsen seizure control, treatment adherence, and overall prognosis. This study aimed to characterize the prevalence of undiagnosed depression in epilepsy outpatients and to evaluate the Neurological Disorders Depression Inventory for Epilepsy (NDDIE) as a screening tool, as well as the impact of early SSRI treatment. In a single-center, observational, non-interventional, prospective design, 82 consenting adults (mean age 50.8 ± 23 years; 59.8 % female) with diagnosed epilepsy (focal, idiopathic generalized, or unknown onset) and no prior psychiatric history or antidepressant use were enrolled over one year. Participants completed the NDDIE at baseline; those screening positive (score &gt; 13) began SSRI therapy and were referred to psychiatry for diagnostic confirmation. Repeat NDDIE assessments occurred at three months. Of 82 patients, 35 (42.7 %) screened positive on NDDIE and 24 (29.3 % overall) were confirmed depressed by psychiatry (κ = 0.71). Baseline mean NDDIE was 12.17 ± 5.46, decreasing to 10.78 ± 4.36 at three months across all participants (Δ = 1.39; p &lt; 0.05). In treated patients (n = 35), NDDIE fell from 17.83 ± 2.74 to 14.74 ± 3.48 (Δ = 3.09; p &lt; 0.001). Patients with DRE (n = 10) had higher baseline scores than non-DRE (19.40 ± 1.96 vs 11.00 ± 5.40; p &lt; 0.05) and those on ≥ 2 anti-seizure medications (ASM) scored higher than monotherapy (17.52 ± 4.08 vs 9.82 ± 4.20; p &lt; 0.001). Patients &gt; 60 years had lower scores than younger patients (10.68 ± 4.58 vs 13.23 ± 5.82; p &lt; 0.05). No sex or epilepsy type differences were significant. Depression is common and underdiagnosed in epilepsy outpatients, especially among those with DRE or on multiple ASMs. The NDDIE demonstrates good agreement with psychiatric diagnosis and detects clinically meaningful improvements following early SSRI treatment. Systematic depression screening using NDDIE in neurology clinics is recommended to identify and treat comorbid depression, potentially improving quality of life and seizure outcomes.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100819"},"PeriodicalIF":1.5,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}