Seizure-European Journal of Epilepsy最新文献

{"title":"Educational outcomes associated with prenatal exposure to antiseizure medications: A systematic literature review and meta-Analysis","authors":"Alexia Karain ,&nbsp;Lama A. Shakhshir ,&nbsp;Jill P. Pell ,&nbsp;Daniel F. Mackay ,&nbsp;Scott M Nelson ,&nbsp;Sarjit Singh ,&nbsp;Michael Fleming","doi":"10.1016/j.seizure.2025.08.016","DOIUrl":"10.1016/j.seizure.2025.08.016","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically review and meta-analyse evidence of the associations between prenatal exposure to antiseizure medications (ASMs) and educational outcomes in childhood, including educational difficulties, learning difficulties and academic performance.</div></div><div><h3>Methods</h3><div>We conducted a systematic review following the PICOS framework and PRISMA guidelines. MEDLINE (Ovid), CINAHL, PubMED, ERIC, and PsycINFO databases, along with Google Scholar, were searched from inception to 28 June 2024. Study quality was assessed using the Newcastle-Ottawa Scale and ROBINS-E. Relevant outcomes included record of special education needs, school-related behavioural problems, learning difficulties, and examination scores in core academic subjects. Pooled estimates were derived where appropriate and bias and heterogeneity assessed using funnel plots, Egger’s tests, and I² tests.</div></div><div><h3>Results</h3><div>Seventeen studies (12 cohort, 5 case-control) were included, encompassing 854,142 participants. Pooled estimates indicated that prenatal exposure to ASMs was associated with increased educational difficulties (RR 1.3, 95 % CI 1.01–1.69, <em>p</em> = 0.04), with sodium valproate showing the strongest association (RR 2.38, 95 % CI 1.25–4.53, <em>p</em> = 0.01). Carbamazepine and other first-generation ASMs showed no significant associations. Narrative findings suggested associations between newer-generation ASMs and educational difficulties, but limited data precluded quantitative synthesis. Studies assessing academic outcomes suggested lower academic performance among children exposed to sodium valproate or ASM polytherapy but could not undergo meta-analysis due to methodological heterogeneity.</div></div><div><h3>Conclusions</h3><div>Prenatal exposure to first-generation ASMs, especially sodium valproate, was associated with increased educational support needs. Newer-generation ASMs appear to have a more favourable risk profile, though evidence remains limited, underscoring the need for further high-quality research to inform clinical practice.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"132 ","pages":"Pages 37-45"},"PeriodicalIF":2.8,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994186","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":"A new loss-of-function variant in SCN1A is associated with early-onset complex febrile seizures","authors":"IE Christophersen ,&nbsp;J De Waele ,&nbsp;Aaberg KM ,&nbsp;Henning S ,&nbsp;PH Backe ,&nbsp;MA Kulseth ,&nbsp;IL Mero ,&nbsp;F Bosmans","doi":"10.1016/j.seizure.2025.08.010","DOIUrl":"10.1016/j.seizure.2025.08.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Pathogenic variants in the <em>SCN1A</em> gene are among the most common genetic causes of epilepsy and are predominantly linked to Generalized Epilepsy with Febrile Seizures Plus (GEFS+) or Dravet syndrome. We present a new variant in <em>SCN1A</em> in a child with treatment-resistant early-onset febrile seizures.</div></div><div><h3>Methods</h3><div>We performed genetic analysis in a child presenting with recurrent febrile seizures. Electrophysiological characterization of the identified variant was performed in <em>Xenopus laevis</em> oocytes and HEK293T cells.</div></div><div><h3>Results</h3><div>The child presented with complex febrile seizures at age 5 months, but by age 17 months the symptoms indicated an <em>SCN1A</em>-related epilepsy. Genetic analyses revealed a <em>de novo</em> missense variant in <em>SCN1A</em> (NM_001165963.1): c.998C&gt;<em>T</em>, p.(Ala333Val) classified as a variant of uncertain significance. The variant was absent from ∼800 000 individuals in the gnomAD database and is not reported in clinical databases. Compared to wildtype, Na_V1.1^A333V channel activation and channel availability shifted to depolarized potentials. Na⁺ influx was substantially reduced for Na_V1.1^A333V, indicative of loss-of-function.</div></div><div><h3>Significance</h3><div>We identified a Na_V1.1^A333V variant in a patient with recurrent complex febrile seizures, and functional characterization suggests a loss-of-function phenotype. Functional characterization of <em>SCN1A</em> missense variants may provide personalized diagnostic information in individuals with epilepsy, and improve treatment.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 378-381"},"PeriodicalIF":2.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864338","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":"Programming in Vagus nerve stimulation therapy: Consensus from a Nordic Delphi Panel","authors":"Oliver Henning ,&nbsp;Noemi Becser Andersen ,&nbsp;Fredrik Asztely ,&nbsp;Elinor Ben-Menachem ,&nbsp;Helena Gauffin ,&nbsp;Thorsten Gerstner ,&nbsp;Lisa Gordon ,&nbsp;Omar Hikmat ,&nbsp;Susanne Ingebrigtsen ,&nbsp;Sintia Kolbjer ,&nbsp;Hrisimir Kostov ,&nbsp;Salla Lamusuo ,&nbsp;Atle Lillebø ,&nbsp;Johan Lundgren ,&nbsp;Dragan Marjanovic ,&nbsp;Liisa Metsähonkala ,&nbsp;Kern Olofsson ,&nbsp;Reina Roivainen ,&nbsp;Anne Sabers ,&nbsp;Stein-Helge Tingvoll ,&nbsp;Jukka Peltola","doi":"10.1016/j.seizure.2025.08.014","DOIUrl":"10.1016/j.seizure.2025.08.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite VNS therapy being established broadly as a second line treatment for drug resistant epilepsy, there are currently no guidelines or recommendations giving sufficient and detailed guidance and suggestions to fully utilize the increasing array of parameter options.</div></div><div><h3>Methods</h3><div>A panel of 22 experts from the Nordic countries (6 were pediatric neurologists, 14 neurologists and 2 treating both pediatric and adult patients) was assembled to share their experience with VNS therapy using a 5-step Delphi approach. Agreement level ≥80% was considered strong consensus and 60 to79% was considered medium consensus.</div></div><div><h3>Results</h3><div>After the third round of the Delphi process there were 70 statements in different sections as: How to start the VNS after implantation (9 statements), How to do further adjustment after the initial phase (13 statements), How to use Autostimulation mode (14 statements), How to use scheduled programming (8 statements), Are there special settings for special seizure types/diagnosis (6 statements), How to use day-night programming (3 statements), What to know about Magnet mode (6 statements), How to manage side effects (3 statements), Considerations about gender/age and patient preferences (4 statements), and Practical programming (4 statements). In 46 statements (65.7%) the panel reached a strong consensus, in 11 (17.7%) a medium consensus, and in 13 (18.6%) no consensus was achieved.</div></div><div><h3>Conclusion</h3><div>The recommendations of the Delphi panel emphasize proactive deployment of available stimulation options including build up in duty cycle and the use of rapid cycling as well as increasing the output current if response with primary target current is insufficient. Additionally, the usage of Magnet mode and Autostimulation mode were encouraged. Guidance on how to use the newest stimulation options such as day-and-night and scheduled programming for improved feasibility and tolerability is provided.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 423-434"},"PeriodicalIF":2.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886992","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":"Effectiveness and safety of midazolam versus lorazepam for pediatric status epilepticus: A systematic review and meta-analysis","authors":"Suzana Ezzi ,&nbsp;Hassan K. Salamatullah ,&nbsp;Dhaii Alzahrani ,&nbsp;Amal Alshrif ,&nbsp;Dania E. Faidah ,&nbsp;Jamil M. Baljoon ,&nbsp;Alqassem Y. Hakami ,&nbsp;Kholoud Abdullah Babkair","doi":"10.1016/j.seizure.2025.08.013","DOIUrl":"10.1016/j.seizure.2025.08.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Status epilepticus is a life‐threatening pediatric emergency with high morbidity and mortality, where rapid benzodiazepine administration is critical. However, the optimal agent and route of administration remain subjects of ongoing evaluation, with direct head-to-head comparison between lorazepam and midazolam remaining limited.</div></div><div><h3>Methods</h3><div>An aggregate-level meta-analysis was conducted on randomized controlled trials (RCTs) comparing the efficacy of midazolam against lorazepam in managing pediatric status epilepticus. Primary outcomes included treatment success and failure rates, time to seizure cessation from drug administration, and safety outcomes (respiratory depression and need for intubation). Secondary outcomes included seizure recurrence, need for rescue medications, and two time intervals: from hospital arrival to drug administration, and from hospital arrival to seizure cessation. Pooled standardized mean difference (SMD) and risk ratios (RRs) were analyzed using a random-effects model. Risk of bias was assessed by the Cochrane risk-of-bias tool.</div></div><div><h3>Results</h3><div>Four RCTs were included in the analysis, encompassing a total of 326 patients. The two interventions were comparable in terms of seizure termination success (RR = 0.98, 95 % CI [0.92, 1.04], <em>p</em> = 0.45) and failure (RR = 0.91, 95 % CI [0.44, 1.89], <em>p</em> = 0.81). The mean time of seizure cessation following drug administration was similar for both medications (SMD = 0.01, 95 % CI [-0.27, 0.28], <em>p</em> = 0.95), although the intranasal midazolam subgroup exhibited a shorter duration (SMD = -0.02 [-0.38, 0.34], <em>p</em> = 0.90). A qualitative synthesis indicated that intranasal midazolam was associated with a shorter administration time and more rapid seizure control upon hospital arrival. Safety profiles were comparable.</div></div><div><h3>Conclusion</h3><div>In this meta-analysis, midazolam, irrespective of the route of administration, is shown to be non-inferior to lorazepam in the management of pediatric status epilepticus. Preliminary evidence indicates that intranasal midazolam may provide more rapid and practical administration, making it more favorable in certain clinical contexts. Further multicenter trials are needed to confirm these findings.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"132 ","pages":"Pages 4-12"},"PeriodicalIF":2.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903467","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":"Seizures in newborns: The missing evidence","authors":"C Spagnoli ,&nbsp;G Ramantani ,&nbsp;F Pisani","doi":"10.1016/j.seizure.2025.08.008","DOIUrl":"10.1016/j.seizure.2025.08.008","url":null,"abstract":"<div><div>Although frequent or prolonged acute symptomatic seizures in newborns can be associated with adverse neurodevelopmental outcomes, this correlation does not establish causality. Identifying reliable postneonatal outcome predictors among the many clinical, EEG and MRI variables reported in clinical studies thus remains challenging. Nevertheless, the cerebrovascular and metabolic effects of seizures are well documented and likely contribute to poor outcomes. Prolonged or frequent seizures, in particular, have shown the strongest association with mortality or disability. However, no consensus exists on what constitutes a high seizure burden in newborns, as clinically meaningful definitions are lacking. Experimental models and clinical studies in neonatal intensive care settings may help address these knowledge gaps. Moreover, additional variables beyond seizure duration and frequency may be required to develop predictive models that support evidence-based and clinically meaningful management changes. In this review, we critically examine these factors to contribute to this ongoing debate in neonatal neurology.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 443-453"},"PeriodicalIF":2.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895797","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":"Phenotypic variation in a family with GABRG2-related epilepsy caused by a novel missense variant","authors":"Takato Akiba ,&nbsp;Kaori Yamoto ,&nbsp;Takuya Hiraide ,&nbsp;Tsutomu Ogata ,&nbsp;Tokiko Fukuda ,&nbsp;Hirotomo Saitsu ,&nbsp;Katsumi Imai","doi":"10.1016/j.seizure.2025.08.012","DOIUrl":"10.1016/j.seizure.2025.08.012","url":null,"abstract":"<div><h3>Purpose</h3><div>The gamma-aminobutyric acid type A receptor subunit gamma-2 (<em>GABRG2</em>) gene is a well-known causative gene for genetic epilepsy with febrile seizures plus (GEFS+), exhibiting a broad phenotypic spectrum. This study aimed to describe the clinical variability among family members with a novel <em>GABRG2</em> variant.</div></div><div><h3>Methods</h3><div>We analyzed the clinical and genetic findings of three sisters and their father. Genetic testing using whole-exome sequencing was performed for patients 1 and 2 and their parents. Patient 3 was not genetically tested but is clinically suspected to have the same condition.</div></div><div><h3>Results</h3><div>A novel heterozygous missense variant in <em>GABRG2</em> (c.964G&gt;A; p.Ala322Thr) was identified in patient 1, patient 2, and their father. Patient 1 developed drug-resistant epilepsy requiring multiple anti-seizure medications (ASMs). Patient 2 exhibited milder epilepsy, controlled with a single ASM. Patient 3 has remained seizure-free under low-dose ASM. The father had febrile and afebrile seizures in childhood but has been seizure-free for over 10 years with ASMs. This intrafamilial phenotypic variability was observed despite all affected individuals carrying the same variant.</div></div><div><h3>Conclusion</h3><div>This report highlights the wide phenotypic spectrum of <em>GABRG2</em>-related epilepsy within a single family. Although the identified variant is located in the M2 segment of GABRG2, which is functionally important, the clinical presentations varied substantially. These findings suggest that additional genetic, structural, or epigenetic modifiers may contribute to the phenotypic heterogeneity in <em>GABRG2</em>-associated epilepsy, and underscore the limitations of genotype-based phenotype prediction.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 340-343"},"PeriodicalIF":2.8,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829009","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":"Modified atkins diet versus topiramate in young children with epileptic spasms refractory to steroids and vigabatrin: a randomised open-label trial","authors":"Rashmi Meena ,&nbsp;Sayoni Roy Chowdhury ,&nbsp;Aman Elwadhi ,&nbsp;Puneet Jain ,&nbsp;Sharmila B Mukherjee ,&nbsp;Suvasini Sharma","doi":"10.1016/j.seizure.2025.08.011","DOIUrl":"10.1016/j.seizure.2025.08.011","url":null,"abstract":"<div><h3>Background</h3><div>There is a paucity of evidence regarding the best treatment options for children with infantile epileptic spasm syndrome who have failed the first-line treatments, i.e. hormonal therapy and/or vigabatrin. The study aimed to compare the efficacy and tolerability of the Modified Atkins Diet (MAD) versus Topiramate in this population.</div></div><div><h3>Methods</h3><div>This was a randomized open-label trial that enrolled children with infantile epileptic spasm syndrome who had failed a trial of hormonal therapy and vigabatrin. Patients were randomly assigned to receive either MAD or Topiramate. Both groups were assessed at 12 weeks for spasm frequency through parental records, improvement in electroencephalographic findings as measured by the BASED (Burden of AmplitudeS and Epileptiform Discharges) score, adverse effects, and improvement in non-seizure domains. Intention-to-treat analysis was performed.</div></div><div><h3>Results</h3><div>A total of 80 children were recruited, with 40 children each in the MAD and topiramate arms. Children in the MAD arm showed a statistically significant improvement compared to the Topiramate arm at 12 weeks in terms of &gt;50% spasm reduction (27/40, 67.5% vs. 17/40, 42.5%, p- 0.02), &gt;90% spasm reduction (9/40, 22.5% vs. 2/40, 4.76%, p- 0.02), &gt; 1 point improvement in BASED score (16/40, 40% vs. 5/40, 12.5%, p- 0.005), and improvement in alertness (7/40, 17.5% vs. 1/40, 2,5%, p=0.026). Both interventions were well tolerated by the children, with mild side effects, including constipation, diarrhoea, and anorexia in the MAD arm, and anorexia and somnolence in the topiramate arm.</div></div><div><h3>Conclusion</h3><div>MAD proved to be more effective than Topiramate in managing epileptic spasms refractory to first-line treatment. However, further studies with larger sample sizes and longer follow-up periods are required to generalize the findings. (ClinicalTrials.gov, NCT05958160).</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 405-412"},"PeriodicalIF":2.8,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879028","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":"Trauma and health-related quality of life in patients with functional seizures","authors":"Jonah Fox,&nbsp;M. Junaid Humayun,&nbsp;Madelyn K. Bollig,&nbsp;Benjamin W. Hopkins,&nbsp;Murli Mishra","doi":"10.1016/j.seizure.2025.08.009","DOIUrl":"10.1016/j.seizure.2025.08.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the relationship between adverse life events and health-related quality of life in patients with functional seizures.</div></div><div><h3>Methods</h3><div>We recruited and consented patients with functional seizures who were admitted to the epilepsy monitoring unit and asked them to complete the Life Event Checklist for DSM-5 (LEC-5) and the 36-Item Short Form Health Survey (SF-36) to evaluate adverse life events and health-related quality of life, respectively. Additional variables were collected with a retrospective chart review. A multiple linear regression model was used to evaluate independent predictors of health-related quality of life.</div></div><div><h3>Results</h3><div>A total of 97 patients were included, and 98 % identified at least 1 adverse life event that was either witnessed or personally experienced. Health-related quality of life was poor compared to the general population. An increased number of types of witnessed or personally experienced adverse life events were associated with a worse mental component summary score and older age was associated with a worse physical component summary score. A longer duration of time with FS was associated with a better mental component summary score which may reflect some degree of adaptation or improved coping skills that developed over time.</div></div><div><h3>Conclusion</h3><div>Our study found that an increased burden of adverse life events in patients with functional seizures impacts health-related quality of life. These findings may have treatment and resource allocation implications.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 322-326"},"PeriodicalIF":2.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827337","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":"Involuntary movements in patients with impaired awareness: A comparative study of phenomenology and neurophysiological evaluation","authors":"Pedro Coelho ,&nbsp;Linda Azevedo Kauppila ,&nbsp;Ana Catarina Franco ,&nbsp;Carla Bentes ,&nbsp;Anabela Valadas ,&nbsp;Miguel Coelho ,&nbsp;Ana Rita Peralta","doi":"10.1016/j.seizure.2025.08.004","DOIUrl":"10.1016/j.seizure.2025.08.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Subtle involuntary movements in patients with impaired awareness may suggest non-convulsive status epilepticus (NCSE), but their diagnostic accuracy is unclear. Since electroencephalography (EEG) is not always available, clinicians often rely on motor signs for early diagnosis. We aimed to characterize these movements and evaluate interrater agreement and diagnostic accuracy among specialists.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study of 98 patients with suspected NCSE who underwent video-EEG between 2014 and 2019. Video samples of involuntary movements were reviewed by two epileptologists and two movement disorder specialists, blinded to clinical data. Movements were classified phenomenologically and categorized as epileptic or non-epileptic. Final NCSE diagnosis was determined using modified Salzburg Consensus Criteria. Interrater agreement and diagnostic metrics were calculated.</div></div><div><h3>Results</h3><div>NCSE was confirmed in 37 patients (37.8 %). Myoclonus (43.3 %), tremor (26.8 %), and clonus (19.6 %) were the most frequent phenomena. No significant differences in movement types were observed between NCSE and non-NCSE groups. Interrater agreement was fair overall (κ = 0.26), moderate only for tremor (κ = 0.577). Diagnostic sensitivity and specificity based on video alone were 54.1 % and 68.9 %, respectively. Movement disorder specialists were more sensitive (68.2 %) but less specific (62.2 %) than epileptologists (42.3 % sensitivity; 77.5 % specificity).</div></div><div><h3>Conclusion</h3><div>Motor phenomena alone do not reliably distinguish NCSE from other causes of impaired consciousness. Despite frequent use, these signs show limited diagnostic accuracy and low interrater reliability. Video-EEG remains essential, and future studies should refine clinical tools for early NCSE recognition.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"132 ","pages":"Pages 82-87"},"PeriodicalIF":2.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010670","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":"Short and long-term side effects of the Classic Ketogenic Diet in pediatric epilepsy treatment: A systematic review of clinical trials","authors":"Saman Sepehrar ,&nbsp;Tahere Sadeghi ,&nbsp;Eric Kossoff ,&nbsp;Maryam Nikoonia ,&nbsp;Mitra Zarei ,&nbsp;Mehran Beiraghi Toosi ,&nbsp;Saeedeh Talebi","doi":"10.1016/j.seizure.2025.08.005","DOIUrl":"10.1016/j.seizure.2025.08.005","url":null,"abstract":"<div><h3>Background/objective</h3><div>Classic Ketogenic Diet (CKD) is a well-known diet therapy with high fat and low carbohydrates which is used to treat children with medication-resistant epilepsy (MRE). As CKD is a restricted diet, it can cause side effects which are major reason for diet discontinuation. In this study, we aim to systematically identify and categorize these side effects by type and duration to optimize CKD use and increase adherence.</div></div><div><h3>Method</h3><div>This study followed PRISMA 2020 guidelines and is registered in Prospero (CRD42024566216). We searched PubMed, Scopus, Web of Science, and Google Scholar for English-language clinical trials on CKD side effects in children under 18 with MRE. The last search was conducted on January 8, 2025, with no time restrictions. Side effects from 26 clinical trials were extracted, categorized as short-term (≤3 months) or long-term (&gt;3 months), and prevalence estimated using reference populations for each side effect. We categorized side effects in nine groups: gastrointestinal (GI) issues, neurological complications, weight loss, dyslipidemia, infection, hyperuricemia, bone mineral density (BMD) decrease/osteoporosis and renal stones.</div></div><div><h3>Result</h3><div>In most patients, CKD does not have adverse side effects that cause diet termination and most side effects can be managed or treated to increase adherence. In the short-term, GI issues and neurological complications were most common side effects with prevalence of 49 % and 25 % respectively. In long-term GI issues still remain the most prevalent side effects with 44 % prevalence. Moreover, lower fat-to-carbohydrates ratios like 2.5:1 KD may reduce side effects but potentially compromise efficacy.</div></div><div><h3>Conclusion</h3><div>Most CKD side effects are treatable and transient and these results support tailored KD strategies to enhance adherence and improve epilepsy control.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"131 ","pages":"Pages 382-390"},"PeriodicalIF":2.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864424","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}