Seizure-European Journal of Epilepsy最新文献

{"title":"Onchocerciasis-associated epilepsy: Charting a path forward","authors":"G Van Cutsem ,&nbsp;JN Siewe Fodjo ,&nbsp;A Hadermann ,&nbsp;L-J Amaral ,&nbsp;C Trevisan ,&nbsp;S Pion ,&nbsp;R Colebunders","doi":"10.1016/j.seizure.2024.04.018","DOIUrl":"10.1016/j.seizure.2024.04.018","url":null,"abstract":"<div><div>This narrative review intends to inform neurologists and public health professionals about Onchocerciasis-Associated Epilepsy (OAE), a neglected public health problem in many remote onchocerciasis-endemic areas. For epidemiological purposes, we define OAE as sudden-onset of convulsive and non-convulsive seizure types, including head nodding seizures (nodding syndrome) in a previously healthy child aged 3 to 18 years in the absence of any other obvious cause for epilepsy, all happening within an area with high ongoing <em>Onchocerca volvulus</em> transmission. Several OAE pathophysiological mechanisms have been proposed, but none has been proven yet. Recent population-based studies showed that strengthening onchocerciasis elimination programs was followed by a significant reduction in the incidence of OAE and nodding syndrome. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted, free access to anti-seizure medication to persons with epilepsy in these remote, impoverished areas. It is crucial todevelop policies and increase funding for the prevention and treatment of OAE to reduce the associated burden of disease, notably via the establishment of morbidity management and disability prevention programs (MMDP). Moreover, effective collaboration between onchocerciasis elimination and mental health programs is imperative to alleviate the burden of OAE. This synergy promises reciprocal advantages and underscores the need for a comprehensive approach to address this multifaceted challenge.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 105-114"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766218","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":"Poor neurodevelopment, nutritional and physical growth outcomes among children born to mothers with nodding syndrome","authors":"Mary Nyakato ,&nbsp;Shubaya Kasule Naggayi ,&nbsp;Pamela Rosemary Akun ,&nbsp;Sam Ononge ,&nbsp;Alfred Odong ,&nbsp;Erias Adams Baguma ,&nbsp;Hellen Nansiiro ,&nbsp;Dennis Kalibbala ,&nbsp;Simple Ouma ,&nbsp;Innocent Besigye ,&nbsp;Richard Idro","doi":"10.1016/j.seizure.2024.09.012","DOIUrl":"10.1016/j.seizure.2024.09.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Nodding syndrome (NS), a poorly understood severe neurological disorder develops in children. In Uganda, some NS cases have grown into child-bearing adults. Babies born to mothers with NS may be prone to impaired neurodevelopmental outcomes. Cognitive deficits in mothers with NS may further inhibit care offered to their children hence compromising neurocognitive development, physical growth, and behaviour.</div></div><div><h3>Objectives</h3><div>The study aimed to determine the neurodevelopmental, behavioural, nutritional, and physical growth outcomes of children whose mothers have nodding syndrome.</div></div><div><h3>Methods</h3><div>A comparative cross-sectional study was conducted between May 2021 and April 2022 in Northern Uganda. Children aged 0-5 years of mothers with NS were compared to those of mothers without NS, matched by age, gender and neighbouring residence. Neurodevelopment, behaviour, nutrition, and physical growth were assessed using standardized measures and t-tests employed for group comparisons of outcomes.</div></div><div><h3>Results</h3><div>Overall,106 children participated. Fifty-three (53) were offspring of mothers with NS and 53 of mothers without NS; having a mean age of 26.9 (2.22) and 27.5(2.12) months respectively. Children whose mothers have NS had significantly lower neurodevelopmental scores than those of NS-unaffected mothers in fine motor (37.5(12.1) vs 44.2(14.3), p = 0.011), receptive language (37.8(10.8) vs 43.9(12.9), p = 0.010), overall cognitive development (74.36(17.8) vs 83.34(19.6), p = 0.015), and attention (0.64(0.20) vs 0.76(0.15), p = 0.001). There were no differences in the behaviour scores. Children of mothers with NS also had significantly lower weight-for-age z scores (WAZ) (p = 0.003) and length/height-for-age z scores (LAZ/HAZ) (p = 0.001); with 19(35.9 %) of them stunted.</div></div><div><h3>Conclusion</h3><div>Children whose mothers have NS have poorer neurodevelopmental, nutritional, and physical growth outcomes. Interventions to improve outcomes in these children are warranted.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 129-133"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331056","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":"Long-term observation and mortality of children with nodding syndrome in western Uganda, 1994 – 2018","authors":"Christoph Kaiser ,&nbsp;Walter Kipp ,&nbsp;Nolbert Gumisiriza ,&nbsp;George Asaba","doi":"10.1016/j.seizure.2024.06.019","DOIUrl":"10.1016/j.seizure.2024.06.019","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess long-term mortality and causes of death in children with nodding syndrome, an epileptic disorder of sub-Sahara Africa.</div></div><div><h3>Methods</h3><div>Ten children with nodding syndrome were followed over 24 years. The mortality rate was determined as the number of deaths per 1000 person-years of observation. The standard mortality ratio (SMR) was calculated as the number of observed deaths divided by the number of expected deaths in the general population. Patients were started on phenobarbital and treatment response was monitored during the first 20 months of follow-up.</div></div><div><h3>Results</h3><div>During an observation period of 89.8 person-years, eight patients had died, one patient was found alive, and one patient had been lost to follow-up. This corresponded to a mortality rate of 89.1 deaths per 1000 person-years and a SMR of 21.4 (95 % CI 6.6–36.2). Five deaths were related to status epilepticus, in two cases occurring after inadvertent drug withdrawal. All patients responded on phenobarbital with a reduction of seizure frequency but only four reached a seizure-free period of at least 6 months.</div></div><div><h3>Conclusions</h3><div>This long-term follow-up demonstrated high mortality in patients with nodding syndrome. Anti-seizure treatment with phenobarbital was of moderate efficacy. Abrupt interruption of phenobarbital was found leading to seizure aggravation, status epilepticus, and death. Our findings point out the importance of securing continuity of treatment access once anti-seizure therapy is included in health services in resource-poor settings. More rigorous observations and controlled studies are needed to improve the therapeutic options for nodding syndrome.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 123-128"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499452","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":"Evolution into spike-and-wave activation in sleep in patients with self-limited focal epilepsies","authors":"Merve İriş,&nbsp;Miray Atacan Yaşgüçlükal,&nbsp;Cengiz Yalçınkaya,&nbsp;Veysi Demirbilek","doi":"10.1016/j.seizure.2026.01.006","DOIUrl":"10.1016/j.seizure.2026.01.006","url":null,"abstract":"<div><h3>Purposes</h3><div>Self-limited focal epilepsies of childhood (SeLFE), while predominantly considered benign, are known to potentially manifest with spike-and-wave activation in sleep (SWAS) in a minority of patients</div></div><div><h3>Methods</h3><div>The medical records of individuals diagnosed with one of the SeLFE syndromes according to the ILAE 2022 diagnostic criteria, who were followed in our center between 1989–2023, were retrospectively analyzed. At least two awake and sleep EEGs were performed during a minimum 2-year follow-up. SWAS is considered as spike and wave discharges occupying ≥50% of NREM sleep with symmetrical or mildly asymmetrical bilateral or unilateral hemispheric distribution.</div></div><div><h3>Results</h3><div>Among 144 patients with SeLFE, 57(39.6%) were diagnosed with self-limited epilepsy with centrotemporal spikes (SeLECTS); 65(45.1%) with self-limited epilepsy with autonomic seizures (SeLEAS); and 22 (15.3%) with childhood occipital visual epilepsy (COVE). The mean age of seizure onset was 7.6, 5.6, and 8.5 years, respectively. Twelve (8.3%) evolved into SWAS (5 from SeLECTS, 6 from SeLEAS, 1 from COVE). Time elapsed between onset of first seizure and evolution into SWAS ranged from 5.2 to 75 months (mean: 26.8±19.8), 6.2–42.8 months (mean: 20.1±14.7 for patients with SeLECTS; 5.2–75.0 months (mean: 32.7±24.5) with SeLEAS, and 25.0 months with COVE). All except two patients had also cognitive or behavioral regression and were diagnosed as epileptic encephalopathy with spike-wave activation in sleep(EE-SWAS) and one patient was diagnosed with Landau–Kleffner syndrome.</div></div><div><h3>Conclusions</h3><div>The most recent definition of ILAE highlights that SeLFEs are no longer recognized as “benign” epilepsies. Even with a low incidence rate, clinicians should always be cautious about the risk of SWAS development in these syndromes.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 34-38"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023818","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":"MRI techniques for detecting focal cortical dysplasia: A systematic review","authors":"Alastair Snell ,&nbsp;Jiaxin Du ,&nbsp;Viktor Vegh ,&nbsp;David Reutens","doi":"10.1016/j.seizure.2026.01.003","DOIUrl":"10.1016/j.seizure.2026.01.003","url":null,"abstract":"<div><h3>Background</h3><div>MRI is the cornerstone for detecting and characterising focal cortical dysplasia (FCD), a leading cause of drug-resistant epilepsy. Accurate identification of FCD is critical, as MRI-positive patients have markedly better surgical and clinical outcomes. However, lesion detection can be challenging, particularly in subtle or MRI-negative cases, and a range of MRI techniques has been developed to improve diagnostic performance.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Scopus, and Web of Science were searched up to April 2025. Diagnostic accuracy studies comparing MRI findings with histopathology or multidisciplinary consensus were retained. 68 studies satisfied eligibility; data extraction was performed, and risk of bias was assessed with QUADAS-2. Marked methodological and outcome heterogeneity precluded meta-analysis, so results were synthesised narratively.</div></div><div><h3>Results</h3><div>Conventional 1.5T/3T protocols incorporating 3D-T1 and FLAIR were reported to identify most type II lesions, with sensitivities of 50–91 %. At 7T, additional lesions, due partially to the characteristic “black-line” sign, were detected. Quantitative or specialised sequences and post-processing approaches enhanced detection in MRI-negative or type I/III cohorts. Across all patients, machine-learning classifiers yielded sensitivities of 74–93 % but exhibited wide-ranging specificities (34–100 %).</div></div><div><h3>Conclusions</h3><div>Based on these findings, a tiered diagnostic pathway is recommended: initial evaluation with standard MRI followed, when clinical suspicion persists, by high-field imaging and advanced quantitative or computational methods. Standard MRI detects most type II lesions, but advanced imaging and computational methods improve detection in MRI-negative or subtle cases; real-world implementation requires access, expertise, and standardised validation. Key limitations of the review were study heterogeneity, single-reviewer processes, and lack of consecutively case-sampled studies. The field would benefit from a multi-centre benchmark dataset of operated, histologically confirmed, seizure-free FCD patients, enabling fair head-to-head evaluation of detection methods.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 56-72"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047162","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":"Association of systemic inflammatory markers with post-stroke epilepsy after ischemic stroke: A competing risk analysis","authors":"Pannaporn Imemkamon ,&nbsp;Somjet Tosamran ,&nbsp;Sununtha Jankaew ,&nbsp;Nattawut Unwanatham ,&nbsp;Chusak Limotai","doi":"10.1016/j.seizure.2026.01.004","DOIUrl":"10.1016/j.seizure.2026.01.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Post-stroke epilepsy (PSE) is a serious long-term complication of ischemic stroke, yet early identification of patients at risk remains challenging. Systemic inflammatory biomarkers may reflect underlying epileptogenic processes. This study explored the association between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hemoglobin-to-lymphocyte ratio (HLR) and the subsequent development of PSE in a large, long-term cohort.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 1445 adult patients hospitalized for acute ischemic stroke between 2014 and 2017 at a university-affiliated center. Patients with prior epilepsy were excluded. Blood counts within 2 days of admission were used to calculate NLR, PLR, and HLR. PSE was defined as the occurrence of at least one unprovoked seizure beyond 7 days post-stroke. A competing risk model was used to assess associations, accounting for death as a competing event.</div></div><div><h3>Results</h3><div>Over a median follow-up of nearly 7 years, 43 patients (2.98 %) developed PSE. Median NLR was higher in the PSE group than in the non-PSE group (3.45 vs. 2.94; nominal <em>p</em> = 0.036). In multivariable competing risk analysis, continuous NLR was nominally associated with PSE (subdistribution hazard ratio [SHR] = 1.048, 95 % CI 1.002–1.100; <em>p</em> = 0.040). As an exploratory sensitivity analysis, NLR &gt; 7 was also associated with increased PSE incidence (SHR = 2.20, 95 % CI 1.11–4.35; <em>p</em> = 0.024). PLR and HLR did not show associations with PSE. The PSE group also experienced higher mortality and longer hospital stays.</div></div><div><h3>Conclusion</h3><div>NLR, an inexpensive and readily available inflammatory marker, was nominally associated with the development of PSE after ischemic stroke. These findings are exploratory and hypothesis-generating, supporting further investigation into the role of systemic inflammation in post-stroke epileptogenesis.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 11-18"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004809","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":"Prehospital management of convulsive status epilepticus in children: a knowledge, attitude and practice survey of UK ambulance service clinicians","authors":"Zakariya Vansoh ,&nbsp;Rachael Fothergill ,&nbsp;Fiona Bell ,&nbsp;Ria Osborne ,&nbsp;Andy Rosser ,&nbsp;Caitlin Wilson ,&nbsp;Jacqueline Stephen ,&nbsp;Richard F. Chin ,&nbsp;National Ambulance Research Steering Group","doi":"10.1016/j.seizure.2026.01.013","DOIUrl":"10.1016/j.seizure.2026.01.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Childhood convulsive status epilepticus (CSE) is a time-critical emergency (incidence 17-23/100,000/yr) requiring prompt treatment to reduce morbidity and mortality. Prehospital midazolam is as safe as diazepam, but more effective. However, legal and logistical barriers limit its use by paramedics. We performed a UK-wide survey of current practice, perceived barriers, and views on intramuscular midazolam (IMMDZ) to inform service development, gauge interest in a potential ambulance-based trial of emergency treatment of childhood CSE and identify opinions to consider in trial study design.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional JISC Knowledge-Attitude-Practice survey of personnel across all 13 UK NHS Ambulance Services (21 May–30 June 2025). The survey captured demographics, first-line antiseizure medication (ASM) choices, operational challenges, knowledge of IMMDZ usage, and support for research.</div></div><div><h3>Results</h3><div>153 respondents across all 13 ambulance services (4–26/service) participated; 146 (95%) were paramedics (100 were generalist). Diazepam (by the rectal or intravenous route) was first-line ASM in nine services; buccal midazolam in three, and IMMDZ in one. 89% reported that alternative ASMs should be available to generalist paramedics. 97% supported research on IMMDZ for emergency treatment of childhood CSE. If approved, 85% thought their Trust would likely support its clinical use. Potential barriers to use included dosing uncertainty (53%), risk of respiratory depression (46%), inappropriate use (37%), and reticence of administering intramuscular medication (24%).</div></div><div><h3>Conclusion</h3><div>There is a need to standardize paramedic treatment of seizures in children in the UK. NHS Ambulance clinicians are supportive of investigating IMMDZ as prehospital treatment for childhood CSE.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 73-76"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078185","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":"Nationwide registry-linked retrospective cohort study of Ganglioglioma in children and adults: Long-term follow-up of anti-seizure medication and mortality","authors":"Irena Grubor ,&nbsp;Maria Compagno Strandberg ,&nbsp;Johan Bengzon","doi":"10.1016/j.seizure.2026.01.002","DOIUrl":"10.1016/j.seizure.2026.01.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Gangliogliomas are highly epileptogenic tumors that are common in epilepsy surgery. The main aim of this study was to investigate whether the outcome of Anti-seizure medication (ASM) withdrawal differed between patients undergoing ganglioglioma surgery in an epilepsy surgery program compared with those who underwent surgery in other surgical programs. We also investigated which factors influence ASM discontinuation after ganglioglioma surgery.</div></div><div><h3>Method</h3><div>We achieved a nationwide Swedish coverage by retrieving and linking data from five registries, including 144 patients of all ages with surgically confirmed ganglioglioma (ICD-O-95051/95053) treated between 2005 and 2019. Cases required concordance across registries and unmatched records were excluded. Key variables included age at surgery, waiting time for surgery, and tumor location, along with demographic, surgical, and ASM-related data. ASM discontinuation was defined as a 14-month dispensing-free interval. Associations with ASM discontinuation were examined using nonparametric tests, Kaplan-Meier estimates and Cox regression.</div></div><div><h3>Results</h3><div>Most patients, 76%, had been prescribed ASM during the study period. Increasing age was found to be negatively associated with ASM withdrawal. Five years after surgery, 36% of adults and 59% of children had discontinued ASMs. There was no difference in ASM withdrawal in patients who had undergone surgery in an epilepsy surgery program compared with those who had not. Mortality was 15% overall.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that long-term ASM discontinuation after ganglioglioma surgery is negatively associated with increasing age. ASM discontinuation is the same for those undergoing surgery in an epilepsy surgery program as for those who do not. Future studies are needed to explore why older patients are less likely to discontinue ASM treatment after ganglioglioma surgery.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 4-10"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928434","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":"An e-Delphi approach to develop a patient-reported outcome measure to assess functional/dissociative seizures severity","authors":"Gregg Harry Rawlings ,&nbsp;Laura Whitaker ,&nbsp;Chris Gaskell ,&nbsp;Markus Reuber","doi":"10.1016/j.seizure.2025.12.015","DOIUrl":"10.1016/j.seizure.2025.12.015","url":null,"abstract":"<div><h3>Objectives</h3><div>Functional / dissociative seizures (FDS) are a debilitating condition for which there are no validated, reliable, or co-produced condition-specific severity measures. Such a measure would be of value for clinical and research applications. Here, we conduct a three-round electronic-Delphi survey with the aim of achieving consensus on questions that could be used to assess FDS severity as part of a patient reported outcome measure.</div></div><div><h3>Methods</h3><div>e-Delphi members consisted of individuals living with FND, professional experts in the condition (e.g., healthcare providers, researchers), and nonprofessional caregivers. Participants were recruited via international organisations linked with FND. The purpose and tasks of each round were iteratively developed and based on participants’ responses to the previous round.</div></div><div><h3>Results</h3><div>In total, 90 people participated in round one (54 individuals with FDS, 32 professionals and 4 nonprofessional cares). This reduced to 67 and 55 in rounds two and three, respectively. Overall, 136 candidate items proposed by the current authors or participants were initially considered for inclusion. The final measure consisted of three sections with 29 items assessing severity of FDS, six exploring frequency and duration of seizures, and a checklist of symptoms commonly associated with FDS. 90% of those in round three were “happy” with the proposed measure.</div></div><div><h3>Conclusions</h3><div>Notwithstanding the challenges of operationalising severity and the inter- and intra-individual variability of the condition, consensus on items to include was achieved by experts by experience or training. Future scale development will evaluate the proposed measure prior to its implementation in clinical and research practice.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 19-27"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012938","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":"Comparative efficacy of the classical ketogenic diet and modified Atkins diet in children with drug-resistant epilepsy: A systematic review and meta-analysis","authors":"Mohammad A. Sharaf ,&nbsp;Marwa Hosni Abdelhamed ,&nbsp;Marwa Salah ,&nbsp;Shaimaa Gad Ragheb Abdulbaki ,&nbsp;Heba G.A. Ali","doi":"10.1016/j.seizure.2026.01.014","DOIUrl":"10.1016/j.seizure.2026.01.014","url":null,"abstract":"<div><h3>Objectives</h3><div>Epilepsy is a common neurological disorder that can severely affect children's cognitive development and quality of life. While anti-seizure medications (ASM) are the first-line treatment, approximately 20–30% of pediatric patients experience drug-resistant epilepsy (DRE), necessitating alternative therapies. The classical ketogenic diet (CKD) and the modified Atkins diet (MAD) are two non-pharmacological interventions that have shown efficacy in reducing seizure frequency in children with DRE.</div></div><div><h3>Methods</h3><div>A meta-analysis included experimental and observational studies retrieved from relevant databases. It evaluated the efficacy of CKD and MAD in children with DRE. Data were extracted and analyzed using RevMan. A 3-month follow-up was used to measure all outcomes, whenever available; otherwise, the nearest reported time point was used.</div></div><div><h3>Results</h3><div>Eight studies were included in this meta-analysis. Both MAD and CKD were effective in treating drug-resistant epilepsy. CKD demonstrated a statistically significant advantage over MAD for achieving &gt;50% seizure reduction (OR = 0.55, 95% CI: 0.35–0.87; P = 0.01). However, no statistically significant differences were observed between CKD and MAD for complete seizure freedom (100% reduction; OR = 0.72, 95% CI: 0.43–1.19) or &gt;90% seizure reduction (OR = 0.87, 95% CI: 0.51–1.47). No statistically significant differences were found in lipid-related adverse effects or gastrointestinal symptoms, although MAD showed non-significant trends toward fewer cases of vomiting and constipation.</div></div><div><h3>Conclusion</h3><div>The CKD provides significant advantages in the management of drug-resistant epilepsy over the MAD, and CKD is more effective in reducing seizures at different levels.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 77-87"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078186","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}