Seizure-European Journal of Epilepsy最新文献

{"title":"Monitoring cognition in people with epilepsy and intellectual disability","authors":"Judit Catalán-Aguilar ,&nbsp;Juri-Alexander Witt ,&nbsp;Christoph Helmstaedter","doi":"10.1016/j.seizure.2025.06.021","DOIUrl":"10.1016/j.seizure.2025.06.021","url":null,"abstract":"<div><div>Monitoring cognition is essential in patients with epilepsy and intellectual disability (ID) to assess the course of the disease and its treatment. Patients with developmental or non-developmental ID are particularly vulnerable, as they more frequently experience severe medical conditions (such as seizures) and cognitive or psychiatric comorbidities than individuals with average intelligence. Given the difficulties in assessing patients with ID, this study aims to contextualise the current field of cognitive screening for patients with epilepsy and moderate or severe ID. To this purpose, this narrative review offers a critique of current approaches and provides a practical framework for individualised patient care. Furthermore, it highlights the challenges in assessing cognitive and behavioural changes in this population and focuses on the need for assessments that adapt to individual patient capabilities. It addresses the specific cognitive domains that should be evaluated and provides an overview of the tools employed, analysing the advantages and limitations of subjective and objective measures. Finally, it examines different procedures for assessing cognitive changes and considers future directions, such as the potential for new technologies, to improve exploration accuracy. In conclusion, objective screening tools to monitor intrasubject short-term changes in this population are necessary. The current approach is eclectic, which combines various age-adjusted and domain-specific tests. Future efforts should incorporate measures based on the WHO International Classification of Functioning, daily living activity scales, and surrogate markers for cognition (e.g., eye-tracking, AI-driven motion analysis, and wearables) to fill diagnostic gaps and improve the precision of cognitive monitoring in these patients.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 150-162"},"PeriodicalIF":2.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489761","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":"Adult epilepsy in a North Norwegian County – incidence, prevalence, clinical features, and mortality (2012-2022)","authors":"Susanne Gaarden Ingebrigtsen ,&nbsp;Thomas Karsten Kilvær ,&nbsp;Agnethe Eltoft","doi":"10.1016/j.seizure.2025.06.018","DOIUrl":"10.1016/j.seizure.2025.06.018","url":null,"abstract":"<div><div><strong>Background:</strong> Epilepsy affects 0.5–1 % of the population and remains a significant neurological disorder. This study examines the epidemiology and clinical characteristics of epilepsy among adults in Troms County, Northern Norway, from 2012 to 2022. We focus on incidence, prevalence, diagnostic approaches, treatment outcomes, use of advanced therapies, mortality rates, and epilepsy-related deaths, including Sudden Unexpected Death in Epilepsy (SUDEP). <strong>Methods</strong> We conducted a retrospective cohort study using electronic health records to identify adults with active epilepsy (ICD-10 code G40) from 2012 to 2022. Patients were included if they had experienced at least one seizure in the past five years or were actively receiving treatment. Data on demographics, diagnostic evaluations, antiseizure medication use, advanced therapies (vagus nerve stimulation, ketogenic diet), and mortality were analyzed. Factors associated with seizure control and mortality were assessed using multivariate logistic regression and Cox regression, respectively. <strong>Results</strong> Out of 1606 patient records, 1211 met the inclusion criteria, yielding a prevalence of 687 per 100,000 and an incidence of 43 per 100,000. Sixty percent of patients achieved seizure freedom. Age at diagnosis (OR 0.94, 95 % CI 0.91–0.97, <em>p</em> &lt; 0.001) and number of antiseizure medications (OR 0.60, 95 % CI 0.54–0.66, <em>p</em> &lt; 0.001) were negatively associated with seizure freedom. Only 2 % of patients received vagus nerve stimulation, and 0.4 % followed a ketogenic diet. Over 8407 person-years, 307 deaths occurred, corresponding to standardized mortality ratios of 2.76 for women and 2.70 for men. Sixteen deaths were epilepsy-related, including SUDEP. Key mortality risk factors included poor seizure control, male sex, advanced age, and abnormal EEG/MRI findings. <strong>Conclusions</strong> The epilepsy prevalence of 0.69 % aligns with Nordic data. The high proportion (39.5 %) of patients with uncontrolled seizures underscores the need for improved treatment strategies and expanded access to advanced therapies. We observed a nearly threefold increase in standardized mortality rates. Advanced age, male sex, poor seizure control, and abnormal EEG or MRI findings were significantly associated with increased mortality. These findings emphasize the need for individualized management strategies to improve long-term outcomes in epilepsy care.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 142-149"},"PeriodicalIF":2.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480754","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":"Barriers and enablers to antiseizure medication adherence in children with Epilepsy: A systematic review using meta-ethnography","authors":"Eric Amankona Abrefa Kyeremaa ,&nbsp;Sion Scott ,&nbsp;Caroline Smith ,&nbsp;Charlotte Lawthom ,&nbsp;Andy Stewart ,&nbsp;Majed Alorabi ,&nbsp;David Wright","doi":"10.1016/j.seizure.2025.06.016","DOIUrl":"10.1016/j.seizure.2025.06.016","url":null,"abstract":"<div><div>Adherence to antiseizure medications (ASMs) is essential for seizure control in children with epilepsy. However, multiple factors influence adherence, leading to varied treatment outcomes. The aim of this study is to explore the barriers and enablers to antiseizure medication adherence in children with epilepsy by synthesising qualitative studies. This systematic review and qualitative synthesis followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The critical appraisal skills programme (CASP) was used to assess the quality of the included studies. A comprehensive search was conducted in CINAHL, PubMed, SCOPUS, EMBASE, PsycINFO databases. Qualitative studies were extracted, analysed, and synthesised using meta-ethnography approach. Of the 20 studies identified, 18 were qualitative and remaining 2 were mixed method studies. Barriers included unpleasant medication taste, difficulty in swallowing, adverse effects, poor communication with healthcare providers, and stigma. Enablers included suitable taste of medication, easy to swallow, equity to healthcare, trust in ASMs, and access to mobile technology. Findings indicate that adherence barriers differ by age group. Younger children primarily face challenges related to medication formulation, while older children and adolescents experience barriers linked to stigma. This study provides deeper insight into the complex factors affecting ASM adherence in children with epilepsy. Addressing these barriers through individualized treatment approaches, caregiver education, improved healthcare communication, and accessible healthcare services could enhance adherence and improve health outcomes.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"130 ","pages":"Pages 115-134"},"PeriodicalIF":2.7,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534807","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":"Predicting seizure recurrence after status epilepticus: a multicenter exploratory machine learning approach","authors":"Francesco Pasini ,&nbsp;Manuel Quintana ,&nbsp;Marc Rodrigo-Gisbert ,&nbsp;Daniel Campos-Fernández ,&nbsp;Laura Abraira ,&nbsp;Elena Fonseca ,&nbsp;Samuel López-Maza ,&nbsp;Giada Giovannini ,&nbsp;Niccolò Orlandi ,&nbsp;Simona Lattanzi ,&nbsp;Simone Beretta ,&nbsp;Manuel Toledo ,&nbsp;Stefano Meletti ,&nbsp;Estevo Santamarina","doi":"10.1016/j.seizure.2025.06.019","DOIUrl":"10.1016/j.seizure.2025.06.019","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Tools to predict seizure recurrence after status epilepticus (SE) are lacking. In this multicenter cohort study, we explored the ability of different machine learning (ML) models to predict seizure recurrence following a first episode of SE in patients without a prior history of seizures (&lt;em&gt;de novo&lt;/em&gt; SE, dnSE).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Consecutive SE patients aged ≥16 years without a previous history of seizures admitted to Vall d’Hebron University Hospital (Barcelona, Spain) from 2011 to 2021 and Modena Academic Hospital (Baggiovara, Italy) from 2013 to 2022 were reviewed. Different machine learning techniques (k-Nearest Neighbors, Naïve Bayes, Artificial Neural Network, Support Vector Machines, Decision Tree, Random Forest) as well as the classic logistic regression model were built using clinical and neurophysiological variables and applied to develop predictive models of seizure recurrence. Seventy percent of the total sample was randomly selected to train the models; the remaining 30 % was used for validation. The area under the receiver operating characteristic curves (AUROC) with a 95 % confidence interval (95 % CI) was calculated to assess their predictive capability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 386 patients were included, of which 136 (35.2 %) had seizure recurrence within 2 years after the SE episode. Factors significantly associated with two-year seizure recurrence included progressive symptomatic SE etiology (&lt;em&gt;p&lt;/em&gt; &lt; 0.001), non-convulsive SE with coma (&lt;em&gt;p&lt;/em&gt; = 0.021), and out-of-hospital SE (&lt;em&gt;p&lt;/em&gt; = 0.033). Acute symptomatic SE etiology resulted a protective factor (&lt;em&gt;p&lt;/em&gt; &lt; 0.001). Among ML techniques, all were slightly superior to the logistic regression model in predicting two-year seizure recurrence, except for Artificial Neural Network. The Random Forest algorithm (AUROC 0.687, 95 %CI = 0.580 - 0.793) demonstrated the best predictive capability in the validation dataset, significantly outperforming the logistic regression model (AUROC 0.594, 95 %CI = 0.478 - 0.710).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In our study, the Random Forest algorithm showed the best predictive capability for two-year seizure recurrence after a dnSE in adult patients. Further studies and additional data are needed to improve its predictive performance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain language summary&lt;/h3&gt;&lt;div&gt;This multicenter international retrospective study found that over one-third (35.2 %) of patients who develop status epilepticus without a prior history of epilepsy will have a new seizure within two years after the event. By providing clinical and demographic variables, machine learning algorithms were built and their ability to predict seizure recurrence compared with that of classical statistical model. This is the first study to show that artificial intelligence - specifically, Random Forest algorithm - can outperform traditional statistical methods in predict","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 163-171"},"PeriodicalIF":2.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535509","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":"Pediatric refractory epilepsy related to tuberous sclerosis complex: A retrospective-cohort study of diagnosis and treatment","authors":"Rongbo Lin ,&nbsp;Zhao Liao ,&nbsp;Lingyu Kong ,&nbsp;Dian Jiang ,&nbsp;Cailei Zhao ,&nbsp;Xia Zhao ,&nbsp;Tian Yu ,&nbsp;Bixia Yuan ,&nbsp;Yuanzhen Ye ,&nbsp;Haifeng Wang ,&nbsp;Jianxiang Liao ,&nbsp;Jing Duan ,&nbsp;Zhanqi Hu","doi":"10.1016/j.seizure.2025.06.017","DOIUrl":"10.1016/j.seizure.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Tuberous sclerosis complex (TSC) patients often develop refractory epilepsy (RE). The present study evaluated numerous risk factors associated with TSC to determine risk factors of RE.</div></div><div><h3>Methods</h3><div>After enrollment, 315 pediatric patients with TSC-associated epilepsy were divided into control and RE groups. Multimodal data were used to characterize risk factors for RE, including clinical data, anti-seizure medication (ASM) or sirolimus use, family history, genotype, seizure types, neuroimaging and EEG findings, and developmental assessments.</div></div><div><h3>Results</h3><div>Infantile spasms, number of ASMs being taken, clustered seizures, family history, <em>TSC2</em> mutation, and presence of type II and Ⅲ lesions were positively correlated with RE. Age of onset, age of first hospital visit, and use of vigabatrin were negatively correlated with RE. MRI findings suggest lesion type is more important than lesion size and location in predicting RE. There were significant differences in spasms and delayed motor development or cognitive delay between the control and RE groups. Valproate was the most common ASM used, followed by vigabatrin and oxcarbazepine. Risk of RE was increased as much as 1.63-fold by the presence of type II lesions.</div></div><div><h3>Conclusions</h3><div>Age of onset, infantile spasms, type II lesions, <em>TSC2</em> mutation status, family history, and clustered seizures were identified as potential risk factors for the development of RE. ASM should be recommended for TSC patients even in cases with subclinical epileptiform EEG discharge. Using vigabatrin and sirolimus earlier in childhood may reduce the occurrence of RE.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 132-139"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365351","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":"Outcomes and responses to anti-seizure medications in status epilepticus: The significance of peri-ictal EEG and MRI abnormalities","authors":"Sung Eun Kim ,&nbsp;Ju Young Kim","doi":"10.1016/j.seizure.2025.06.015","DOIUrl":"10.1016/j.seizure.2025.06.015","url":null,"abstract":"<div><h3>Background</h3><div>Peri-ictal MRI (PMA) and EEG abnormalities (PEA) may predict the outcomes and responses to anti-seizure medications (ASMs) in patients with status epilepticus (SE).</div></div><div><h3>Methods</h3><div>The inclusion criteria were as follows: (1) patients with SE aged &gt;18 years, (2) peri‑ictal MRI including DWI and FLAIR, (3) peri‑ictal EEG, (4) well-documented medical records, and (5) recruitment between January 2016 and December 2023. Patients with hypoxic-ischemic encephalopathy as the etiology were excluded. Outcomes were classified as good (modified Rankin Scale 0–3) or poor (modified Rankin Scale 4–6) at discharge. Response to ASMs was defined as a failure if SE was not controlled with second-line ASMs at standard doses. PEA was defined as electro-clinical seizures, ictal-interictal continuum, or lateralized periodic discharges. PMA was defined as increased signal intensities in the cortex, thalamus, or hippocampus. A model was developed to predict poor outcomes using multivariate logistic regression with PMA, PEA, and response to second-line ASMs as dependent variables.</div></div><div><h3>Results</h3><div>A total of 114 patients were included. Poor outcomes were observed in 43.9 % (50/114), and 31 % (35/114) were refractory to second-line ASMs. A multivariate logistic regression predicting poor outcomes identified four variables that were independently associated with poor outcomes (<em>p</em> &lt; 0.0001, R²=0.46): PEA (OR 4.4, 95 % CI 1.68–11.31), PMA (OR 3.8, 95 % CI 1.22–12.1), failure of second-line ASMs (OR 3.7, 95 % CI 1.29–10.84) and status epilepticus severity score (OR 1.6, 95 % CI 1.16–2.13).</div></div><div><h3>Conclusions</h3><div>PMA, PEA and failure of second-line ASMs were robust predictors of poor outcomes in patients with SE.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"130 ","pages":"Pages 135-140"},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534808","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":"Response to letter by Alain Braillon entitled “autism and prenatal exposure to antiseizure medications: Still a long-standing blind spot?”","authors":"Isabella Christina Amaral de Lara ,&nbsp;Pedro Henrique de Souza Wagner ,&nbsp;Gustavo Tadeu Freitas Uchôa Matheus ,&nbsp;Lara Eduardo Campos ,&nbsp;Celso de Almeida Souza Miranda ,&nbsp;Maria Eduarda Cavalcanti Souza ,&nbsp;Francisco Cezar Aquino de Moraes ,&nbsp;Francinny Alves Kelly ,&nbsp;Lilianne Rodrigues Fernandes","doi":"10.1016/j.seizure.2025.06.009","DOIUrl":"10.1016/j.seizure.2025.06.009","url":null,"abstract":"","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 140-141"},"PeriodicalIF":2.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480755","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":"Systematic review of paediatric SUDEP and epilepsy-related deaths to inform a safety counselling checklist for clinical practice","authors":"Rohini Ranganath Rattihalli ,&nbsp;Sammy Ashby ,&nbsp;Lisa Burrows ,&nbsp;Rachel Howells ,&nbsp;Kezie Chukwudebelu ,&nbsp;Rohit Shankar","doi":"10.1016/j.seizure.2025.06.013","DOIUrl":"10.1016/j.seizure.2025.06.013","url":null,"abstract":"<div><h3>Background</h3><div>One in 200 children - in the UK have epilepsy. Approximately, 1 in 1,000 children with epilepsy die yearly from Sudden unexpected death in epilepsy (SUDEP), a leading cause of death in epilepsy. Various risk factors contributing to epilepsy mortality particularly SUDEP, some modifiable, have been identified. Structured discussion of risks results in behavioural change that reduces individual risk factors.</div></div><div><h3>Aim</h3><div>To investigate and collate risk factors for SUDEP and epilepsy mortality in children to propose a structured communication tool (“Checklist”) for person centred communication.</div></div><div><h3>Methods</h3><div>A Systematic review for children’s epilepsy mortality risk factors was conducted. The search strategy was developed by clinical and topic experts in conjunction with a clinical evidence specialist and an epilepsy charity. Database searches (MEDLINE, Embase, CINAHL, PsycINFO) were performed in 06/2022 and updated 02/2024, with results assessed independently by two reviewers. Terms covered paediatrics, epilepsy, epilepsy mortality and SUDEP. Results were synthesised into risk factor domain.</div></div><div><h3>Results</h3><div>Six papers encompassing three review articles (covering 33 original research articles), and three other original research articles were included. A further four articles specifically looking at different genetic epilepsies and SUDEP were also added. There was heterogeneity among papers. No RCTs, including papers in the review, were identified. Quality analysis of papers was not undertaken. Eleven key risk factors covering domains of seizure presentation, management, co-morbidity and genetics were identified.</div></div><div><h3>Conclusions</h3><div>A safety Checklist is proposed with identified risk factors for routine clinical–patient interaction to facilitate easier, structured, individualised and evidence-based communication.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 172-179"},"PeriodicalIF":2.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549056","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":"Thalamic stereoelectroencephalography in pediatric patients: Clinical practice and considerations","authors":"Nunthasiri Wittayanakorn ,&nbsp;Nathan T. Cohen ,&nbsp;Ersida Buraniqi ,&nbsp;Veronica D. Linan-Martinez ,&nbsp;Saige A. Teti ,&nbsp;Ban H. Shoukeir ,&nbsp;William D. Gaillard ,&nbsp;Chima O. Oluigbo","doi":"10.1016/j.seizure.2025.06.012","DOIUrl":"10.1016/j.seizure.2025.06.012","url":null,"abstract":"<div><h3>Objective</h3><div>Neuromodulation of cortical and subcortical structures is integral to pediatric epilepsy surgery. Subcortical and thalamic targets for neuromodulation continue to evolve. This paper reports the practical considerations and outcomes of pediatric thalamic stereoelectroencephalography (sEEG) at a single institution.</div></div><div><h3>Methods</h3><div>A retrospective study involved 16 patients with drug-resistant epilepsy who underwent sEEG with thalamic nuclei sampling at Children’s National Hospital (CNH) from July 2023 to Aug 2024. Electrodes targeted thalamic nuclei, including the anterior nucleus of thalamus (ANT), centromedian (CM), and/or pulvinar (PUL). Two pediatric epileptologists reviewed sEEG recordings at enhanced sensitivity to identify thalamic spread patterns. The definitive procedure after sEEG and the outcomes were reported for those who proceeded to surgery with at least six months of follow-up.</div></div><div><h3>Results</h3><div>Sixteen subjects underwent sEEG with thalamic nuclei sampling. Thirty-five thalamic electrodes were implanted, and four patients had multisite thalamic nuclei sampling. Most seizures reviewed (84 %) had early thalamic involvement (&lt;500 ms from seizure onset). A variety of early thalamic spread patterns were detected: spike wave, 30 % (<em>n</em> = 15/50); rhythmic slowing, 20 % (<em>n</em> = 10/50); and low voltage fast activity (LVFA), 16 % (<em>n</em> = 8/50). Among the fifteen patients exhibiting thalamic involvement, nine (60 %) demonstrated congruent ictal patterns originating from the neocortex, whereas 40 % exhibited discordant patterns. Furthermore, 60 % of patients (<em>n</em> = 9) exhibited consistent thalamic spread patterns, whereas 40 % demonstrated variable patterns across different nuclei within the same seizure or within the same nucleus across seizures. Eleven patients underwent surgery after the sEEG, and seizure outcomes of seven patients with a mean follow-up period of 7.9 months were reported. Only one patient experienced transient hemiparesis from an anterior insular hemorrhage.</div></div><div><h3>Conclusion</h3><div>Thalamic sEEG may serve as a valuable tool for selected patients with complex or extensive epileptic networks and may aid in the identification of neuromodulation targets when resection or ablation is not feasible.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 121-131"},"PeriodicalIF":2.7,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312741","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":"Developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep: A single tertiary center experience","authors":"Sibel Öz Yıldız ,&nbsp;Ceren Günbey ,&nbsp;Kader Karlı Oğuz ,&nbsp;Gökçen Konuşkan ,&nbsp;Göknur Haliloğlu ,&nbsp;Dilek Yalnızoğlu","doi":"10.1016/j.seizure.2025.06.010","DOIUrl":"10.1016/j.seizure.2025.06.010","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to analyze the clinical characteristics, etiology, neuroimaging, treatment, neurocognitive and EEG outcomes of patients with developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep (D/EE-SWAS).</div></div><div><h3>Methods</h3><div>Patients diagnosed with D/EE-SWAS, between 2014 and 2021, with a spike-wave index (SWI) ≥50 % in NREM sleep EEG, were analyzed retrospectively. Outcome measures included neurocognitive assessment, SWI, and seizure frequency.</div></div><div><h3>Results</h3><div>A total of 80 patients were included. Median age at initial admission was 43.5 (0.03–148) months, with seizures as the main symptom in 66 (82.5 %) patients. Median age at D/EE-SWAS onset and follow-up was 92.5 (21.3–193.6), and 86.9 (12–204) months, respectively. At diagnosis, 56 patients had seizures (focal: 13, generalized: 43). Unknown group (36; 45 %) constituted the most common etiology. There was a shift towards benzodiazepines, mostly as a combination therapy, in 58 (72.5 %). At the final visit, 38 (47.5 %) of the patients had favorable cognitive outcome which was correlated with older epilepsy onset (≥3 years), normal neurological examination, unknown etiology, seizure freedom during D/EE-SWAS, normal EEG background, fewer ASMs, shorter D/EE-SWAS duration, SWI response, decreased seizure frequency, and SWAS resolution. EEG recovery occurred in 48 (60 %) (median duration: 24 months), with 12(15 %) achieving complete resolution. Of the patients, 38 (47.5 %) were seizure-free at the end of the study period.</div></div><div><h3>Conclusions</h3><div>Baseline neurologic examination, age at onset of epilepsy/D/EE-SWAS, etiology, and number of ASMs at diagnosis had an impact on outcomes. Etiology and number of ASMs may serve as parameters to predict treatment response, and underscore the need for tailored approaches for D/EE-SWAS.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 203-211"},"PeriodicalIF":2.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653949","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}