Seizure-European Journal of Epilepsy最新文献

{"title":"Pricing dynamics of anti-seizure medications in the U.S.","authors":"Pradeep Javarayee , Tengizi Mtchedlidze , Wanda Snell , Vibha Mahesha , Jennifer Meylor , Shamshad Shahrukh , Shannon Pollock , Jeetendra Sah , Yilu Dong , Hema Patel","doi":"10.1016/j.seizure.2024.09.010","DOIUrl":"10.1016/j.seizure.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><p>The median cost of anti-seizure medications (ASM) in the United States (U.S.) nearly doubled per person between 2006 and 2021. This increase, combined with shifts in ASM usage and the impact of the COVID-19 pandemic on drug supply chains amid rising inflation, underscored the urgent need to scrutinize ASM pricing dynamics. This study aimed to analyze the complex dynamics of ASM pricing in the U.S. over the past decade (2013–2023); this included how the entry of generic ASMs influenced the pricing of brand-name counterparts and what impacted price variations across different ASM formulations (e.g., significant inflation, the COVID-19 pandemic).</p></div><div><h3>Methods</h3><p>This study utilized National Average Drug Acquisition Cost (NADAC) data from November 2013 to July 2023. We adjusted ASM prices for inflation using the Consumer Price Index for Medicinal Drugs - Seasonally Adjusted (CPI-MDS). Statistical analyses included fixed effects regressions and multivariable regression analysis to evaluate the impact of inflation, the number of medication labelers, and the COVID-19 pandemic on ASM prices.</p></div><div><h3>Results</h3><p>Our study analyzed 23 ASMs approved by the U.S. Food and Drug Administration (FDA), which encompassed 223 oral formulations:112 brand-name and 111 generics. From 2013–2016 to 2020–2023, accounting for standard deviations (SD), the average price of brand-name ASMs increased from $8.71 (SD 5.9) to $15.43 (SD 10.7), while generic ASMs saw a slight decrease from $1.39 (SD 1.8) to $1.26 (SD 1.6). Consequently, the price gap between brand-name and generic ASMs surged from 1452.39 % to 3399.26 %. The proportion of matched brand-name and generic ASMs with a price difference of 1000 %–9999 % increased from 32.88 % (2013–2016) to 41.43 % (2020–2023), while those exceeding 10,000 % rose from 16.44 % to 20 % in the same period. Generic immediate-release (IR) formulations were significantly less expensive than extended-release (ER) or delayed-release (DR) counterparts, with cost differences reaching up to 7751.20 %. The number of medication labelers was inversely related to generic ASM prices, which decreased by 5.45 % (<em>p</em> = 0.001) with each additional generic labeler, while brand-name ASM prices increased by 2.46 % (<em>p</em> < 0.001) with each additional generic labeler. The COVID-19 pandemic led to a 24.4 % increase in brand-name ASM prices and a 23.1 % decrease in generic ASM prices.</p></div><div><h3>Conclusions</h3><p>The findings reveal an expanding price disparity between brand-name and generic oral ASMs. An inverse relationship was observed between the number of medication labelers and generic ASM prices, with additional labelers driving down generic prices. However, introducing more generic labelers led to a significant increase in brand-name ASM prices. Furthermore, following patent expirations, brand-name ASM prices rose—a trend explained by the \"generics paradox,\" where, contrary","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 26-33"},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271444","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":"Seizure outcome in surgically treated pediatric gangliogliomas and dysembryoplastic neuroepitheliomas according to imaging and resection strategies","authors":"Julia Shawarba ,&nbsp;Karl Roessler ,&nbsp;Matthias Tomschik ,&nbsp;Jonathan Wais ,&nbsp;Fabian Winter ,&nbsp;Florian Mayer ,&nbsp;Gregor Kasprian ,&nbsp;Christine Haberler ,&nbsp;Tatjana Traub-Weidinger ,&nbsp;Martin Niederle ,&nbsp;Thomas Czech ,&nbsp;Johannes Herta ,&nbsp;Christian Dorfer ,&nbsp;Martha Feucht","doi":"10.1016/j.seizure.2024.09.002","DOIUrl":"10.1016/j.seizure.2024.09.002","url":null,"abstract":"<div><h3>Purpose</h3><p>Imaging and resection strategies for pediatric gangliogliomas (GG) and dysembryoplastic neuroepitheliomas (DNET) presenting with epilepsy were retrospectively analyzed in a consecutive institutional series of surgically treated patients.</p></div><div><h3>Methods</h3><p>Twenty-two children (median 8 years, 3–18 years) presented with seizures for 30 months median (14–55.2 months) due to a histologically verified GG/DNET.</p></div><div><h3>Results</h3><p>There were 20 GG and 2 DNT, 68 % located temporal, 32 % extra-temporal. Seizure history was significantly longer in temporal cases (38 versus 14 months median, <em>p</em> &lt; 0.01). MRI contrast enhancement was present in 50 % and methionine (MET) positron emission tomography (PET) uptake in 70 % (standard uptake values (SUVs) 2.92 mean, from 1.6 to 6.4). 27 % had glucose PET hypometabolism. Primarily, in temporal GG, ECoG (electrocorticography) -guided lesionectomies were performed in 87 % and antero-mesial temporal lobe resections (AMTLR) in 13 %, whereas in extra-temporal GG/DNETs, lesionectomies were performed in 100 %. ILAE Class 1 seizure outcome was primarily achieved in 73 % of the temporal cases, and was increased to 93 % by performing six repeat surgeries using AMTLR. Extratemporal patients experienced ILAE Class 1 seizure outcomes in 86 % without additional surgeries, although harboring significantly more residual tumor (<em>p</em> &lt; 0.005, mean follow-up 28 months).</p></div><div><h3>Conclusion</h3><p>In children, MET PET imaging for suspected GG is proposed preoperatively showing a high diagnostic sensitivity and an option to delineate the lesions for navigated resection, whereas MRI contrast behavior was of no differential diagnostic use. As a surgical strategy we propose primarily lesionectomies for extratemporal but AMTLR for temporal GG respecting eloquent brain areas.</p></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 19-25"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1059131124002504/pdfft?md5=5e1697d81f8f45d3237a713349375b78&pid=1-s2.0-S1059131124002504-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Mood, psychosis and suicidal behavior in epilepsy\".","authors":"Hrvoje Hećimović","doi":"10.1016/j.seizure.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.seizure.2024.09.007","url":null,"abstract":"<p><p>Epilepsy is a chronic neurological disorder that has complex relations with social, vocational and psychological functioning. Multiple studies showed that frequency of mood disorders in patients with epilepsy is increased and include depression, anxiety and psychosis. We present data from a neurobiological prospective having clinical relevance for epilepsy and comorbidities, including studies in people with late onset epilepsies. Better understanding of neurobiological mechanisms, anatomical, functional, neuroendocrine and molecular basis of psychiatric comorbidities in persons with epilepsy, can advance therapeutic responses. Epilepsy patients have a significantly higher prevalence of depressive symptoms. Many studies showed that depressive symptoms reduce their quality of life. Psychosis in epilepsy is a rare but severe disorder that usually occurs in patients with early onset of seizures, less localised ictal EEG recordings and seizure clustering. Suicide behavior presents an important problem in managing people with epilepsy. Suicidal ideation is not uncommon, and patients also have an increased risk for suicidal attempt or completed suicide. Psychiatric comorbidities present a significant problem and ask for a multidisciplinary approach to optimize treatment of people with epilepsy.</p>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299518","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":"Epidemiology of self-limited epilepsy with centrotemporal spikes (SeLECTS): A population study using primary care records","authors":"Arron S. Lacey ,&nbsp;Carys B. Jones ,&nbsp;Seung Gwan Ryoo ,&nbsp;Jacqueline Stephen ,&nbsp;Christopher J. Weir ,&nbsp;William Owen Pickrell ,&nbsp;Richard F. Chin","doi":"10.1016/j.seizure.2024.09.008","DOIUrl":"10.1016/j.seizure.2024.09.008","url":null,"abstract":"<div><h3>Background and objective</h3><div>Information on self-limited epilepsy with centrotemporal spikes (SeLECTS) epidemiology is limited. We aimed to determine the incidence of SeLECTS in children, its association with socioeconomic deprivation and the prevalence of neurodevelopmental comorbidities.</div></div><div><h3>Method</h3><div>We performed a retrospective cohort study (2004–2017) using anonymised, linked, routinely collected, primary care and demographic data for children in Wales. We used primary care diagnosis codes to identify children (aged 0–16 years) with SeLECTS and other epilepsies and to record antiseizure medication (ASM) prescriptions and neurodevelopmental comorbidities. We used a mixed effects Poisson regression model to determine temporal trends of SeLECTS incidence and its association with socioeconomic deprivation.</div></div><div><h3>Results</h3><div>We identified 6,732 children with epilepsy, 186 (3%) with SeLECTS. In 2017, epilepsy and SeLECTS prevalence was 0.55% and 0.02% respectively with corresponding crude incidence of 51.2/100,000/year and 1.1/100,000/year. The incidence of epilepsy in children decreased with decreasing deprivation with an adjusted incidence rate ratio (AIRR) of 0.72 (95% CI 0.64–0.82) in the least deprived compared with the most deprived quintile. The corresponding AIRR for children with SeLECTS was 1.35 (95% CI 0.46–1.99). 34% of children with epilepsy, 18% of children with SeLECTS and 3% of all children in Wales had a neurodevelopmental disorder and or school problems. Half of children with SeLECTS were treated with ASM.</div></div><div><h3>Conclusions</h3><div>We identified a lower than previously reported incidence of SeLECTS, which may be due to under-recording of SeLECTS. There was no change in the incidence of SeLECTS over time, whilst the incidence of childhood epilepsy overall was decreasing. There was no significant association between incidence of SeLECTS and deprivation but the modest sample size needs to be considered. Children with SeLECTS should be screened for neurodevelopmental and or learning comorbidities. Treatment for SeLECTS remains debatable.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 52-57"},"PeriodicalIF":2.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incidence of sudden unexpected death in epilepsy (SUDEP) in the Republic of Ireland","authors":"Yvonne Langan ,&nbsp;Ena Lynn","doi":"10.1016/j.seizure.2024.09.006","DOIUrl":"10.1016/j.seizure.2024.09.006","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of sudden unexpected death in epilepsy (SUDEP) in Ireland has previously been studied in only a small geographical area. Our aim was to calculate an incidence rate for the whole of the Republic of Ireland in 2019.</div></div><div><h3>Methods</h3><div>All deaths referred to the coroner in 2019 were examined. Those with a history of possible epilepsy were noted and subjected to a more detailed assessment. Cases fulfilling the definition of definite SUDEP were identified. The incidence of SUDEP was calculated using the population of the Republic of Ireland in 2019 and the known prevalence of epilepsy in Ireland.</div></div><div><h3>Results</h3><div>Thirty-three cases of definite SUDEP were identified in the Republic of Ireland in 2019. The estimated incidence of SUDEP in the epilepsy population as a whole was 0.7/1000(0.46 – 0.94) person years. This may be a conservative estimate. More men than women were identified, and most individuals were found dead at home. SUDEP was mentioned on the death certificate in only 52 % of cases.</div></div><div><h3>Conclusion</h3><div>This is the first nationwide study of SUDEP incidence in Ireland and provides an incidence rate in keeping with other populations. This work demonstrates that the interrogation of coronial records is a useful way to monitor epilepsy mortality albeit with certain limitations.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 34-38"},"PeriodicalIF":2.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142310797","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 dietary fiber intake with epileptic seizures in U.S. adults: A Population-base study of 13,277 participants","authors":"Yi-Bin Zhang ,&nbsp;Ye Xu ,&nbsp;Shu-Fa Zheng ,&nbsp;Yuan-Xiang Lin ,&nbsp;De-Zhi Kang ,&nbsp;Pei-Sen Yao","doi":"10.1016/j.seizure.2024.09.005","DOIUrl":"10.1016/j.seizure.2024.09.005","url":null,"abstract":"<div><h3>Objective</h3><p>Epilepsy, a neurological disorder, is identified by the presence of recurrent seizures. We aimed to detect dietary fiber intake and its association with epilepsy prevalence in U.S. adults.</p></div><div><h3>Methods</h3><p>This cross-sectional study obtained data from the 2013–2018 National Health and Nutrition Examination Survey database. Univariate and multivariate logistic regression models were employed to estimate the association between dietary fiber intake and epilepsy prevalence. The restricted cubic spline (RCS) model was also applied to investigate the dose-response relationships between dietary fiber intake and epileptic seizure events(ESEs).</p></div><div><h3>Results</h3><p>Our final sample included 13,277 NHANES participants, with the average prevalence of ESEs being 1.09 % (145/13277). After adjusting for all confounding factors, the third quartile of dietary fiber intake levels remained significantly associated with a decreased risk of ESEs[odds ratios (OR) 0.54,95 % confidence interval (CI) 0.33–0.88, <em>P</em> = 0.014)] compared to the first quartile. Higher fiber intake indicated a stable negative association with ESEs in the multivariate logistic regression analysis, weighted generalized additive model. A nonlinear dose-response relationship was observed between dietary fiber intake levels and decreased ESEs risk (<em>P</em> for overall=0.017, <em>P</em> for nonlinear=0.155). Interaction tests showed no significant effect of demographic and disease status on the association between dietary fiber intake and ESEs.</p></div><div><h3>Conclusion</h3><p>In this cross-sectional study, people with a high dietary fiber intake were at a reduced risk of ESEs. However, further prospective studies are needed to investigate the effect of dietary fiber intake in epilepsy events and to determine causality.</p></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 1-9"},"PeriodicalIF":2.7,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168878","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":"Evaluation of burden of SCN1A pathogenicity in North Indian children with Dravet syndrome","authors":"Sandeep Negi ,&nbsp;Prateek Bhatia ,&nbsp;Anupriya Kaur ,&nbsp;Jhumki Das ,&nbsp;Tanvi Bhatia ,&nbsp;Ritu Aggarwal ,&nbsp;Naveen Sankhyan ,&nbsp;Pratibha Singhi ,&nbsp;Jitendra Kumar Sahu","doi":"10.1016/j.seizure.2024.09.004","DOIUrl":"10.1016/j.seizure.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Dravet syndrome is an infantile-onset developmental and epileptic encephalopathy with limited data on the frequency of <em>SCN1A</em> in Indian children. The study aimed to identify and characterize the burden of <em>SCN1A</em> pathogenic variants associated with the Dravet syndrome phenotype through genetic testing in the North Indian population.</p></div><div><h3>Method</h3><p>In this prospective, cross-sectional study from March 2015 to February 2019, we enrolled 52 children with Dravet syndrome phenotype who underwent genetic testing for <em>SCN1A</em> gene pathogenicity. We assessed variant effect using multiple algorithms, and genetic test results were reported based on recommendations from the American College of Medical Genetics and Genomics guidelines. Additionally, we performed multiplex-ligation dependent probe amplification (MLPA) to detect copy number variations of the <em>SCN1A</em> gene in children without identified genetic pathogenicity (<em>n</em> = 22) and analysed the results using Coffalyser.net.</p></div><div><h3>Results</h3><p>Of the 52 probands studied, pathogenic variants in the <em>SCN1A</em> gene were identified in 30 children. Among these variants, 11 truncating variants (3 frame-shift variants, 3 intronic variants in splice site regions, and 5 nonsense variants) in 12 unrelated probands, and 17 missense variants in 18 unrelated probands were found. The genetic yield of <em>SCN1A</em> pathogenicity in our cohort (<em>n</em> = 52) was 58 %. Additionally, two of the identified variants were novel. Furthermore, MLPA analysis of the <em>SCN1A</em> gene in 22 children without pathogenic variants yielded no results.</p></div><div><h3>Conclusion</h3><p>This work represents a genetic analysis of a Dravet syndrome cohort, revealing a 58 % burden of <em>SCN1A</em> variants in children with the Dravet syndrome phenotype from the North Indian population.</p></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 10-18"},"PeriodicalIF":2.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142242253","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":"Current practices in the diagnosis and treatment of Rasmussen syndrome: Results of an international survey","authors":"Coral M. Stredny ,&nbsp;Claude Steriade ,&nbsp;Maria T Papadopoulou ,&nbsp;Suresh Pujar ,&nbsp;Marios Kaliakatsos ,&nbsp;Stuart Tomko ,&nbsp;Ronny Wickström ,&nbsp;Christopher Cortina ,&nbsp;Bo Zhang ,&nbsp;Christian G. Bien","doi":"10.1016/j.seizure.2024.09.001","DOIUrl":"10.1016/j.seizure.2024.09.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Rasmussen syndrome (RS) is marked by progressive unihemispheric atrophy, resulting in hemiparesis, refractory epilepsy, and cognitive/language decline. Detailed diagnostic and treatment algorithms are currently lacking. We aimed to survey medical providers on their current practices in the diagnosis and treatment of RS.</div></div><div><h3>Methods</h3><div>A steering committee was formed to create the survey, which was disseminated to the international medical community. One hundred twelve surveys were completed. Descriptive statistics, as well as comparisons by level of experience, patient age group cared for, and geographic region using Fisher's exact test, were conducted.</div></div><div><h3>Results</h3><div>Analysis of cerebrospinal fluid (82 %) and serum (78 %) for autoimmune encephalitis (AE) are completed by most, while approximately one-third obtain genetic and metabolic studies in all patients (36 % and 38 %, respectively). Providers in US and Europe more readily pursue serum AE antibody panels (85 % and 85 %, respectively, versus 67 %, <em>p</em> = 0.019) and genetic testing (56 % and 47 %, respectively, versus 14 %, <em>p</em> &lt; 0.001) than the rest of the world. Thirty-six percent proceed to biopsy in patients otherwise meeting diagnostic criteria, and US providers are more likely to suggest this than others (73 % versus 14–41 %, <em>p</em> &lt; 0.001). Opinions differed on the prioritization of hemispherectomy/hemispherotomy versus immunotherapy in 14 clinical scenarios with various neurologic deficit severity provided. Preferred immunotherapy regimens also varied, with US providers more often choosing IVIG as first-line (67 %) compared to others (28 %-32 %, <em>p</em> = 0.030). Surgical standard of care was identified as functional hemispherectomy or hemispherotomy by 90 %.</div></div><div><h3>Conclusion</h3><div>The survey highlights trends but also significant variations in clinical practice that can serve as targets for future research and expert consensus guidelines.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 153-164"},"PeriodicalIF":2.7,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445747","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":"Brivaracetam use in children with epilepsy: A retrospective multicenter study","authors":"Z Špilárová ,&nbsp;S Sládková ,&nbsp;A Bělohlávková ,&nbsp;K Česká ,&nbsp;P Hanáková ,&nbsp;O Horák ,&nbsp;A Jahodová ,&nbsp;L Knedlíková ,&nbsp;S Kolář ,&nbsp;M Ebel ,&nbsp;M Kudr ,&nbsp;H Ošlejšková ,&nbsp;M Ryzí ,&nbsp;K Španělová ,&nbsp;K Štěrbová ,&nbsp;A Koubová ,&nbsp;P Kršek ,&nbsp;P Danhofer","doi":"10.1016/j.seizure.2024.08.022","DOIUrl":"10.1016/j.seizure.2024.08.022","url":null,"abstract":"<div><h3>Purpose</h3><div>This retrospective multicenter study aimed to assess the efficacy and safety of brivaracetam (BRV) in pediatric epilepsy.</div></div><div><h3>Methods</h3><div>Our cohort consisted of 93 children (mean age 11.5 ± 7.5 years) with a wide spectrum of pediatric epilepsy, including epileptic encephalopathy and generalized epilepsy. Of these, 61 (60.4%) were diagnosed with focal epilepsy, 19 (15.8%) with generalized epilepsy, and 16 (15.8%) with combined epilepsy, while 8 patients (7.9%) had an unknown epilepsy type. The cohort included rare epilepsy syndromes: 8 patients with Lennox-Gastaut syndrome, 3 with Dravet syndrome, and 1 with Rasmussen syndrome. Patients had a history of various antiseizure medications (ASMs) (6.42 ± 3.15), and on average, were being treated with more than two (2.57 ± 1.16) drugs at the time of BRV deployment.</div></div><div><h3>Results</h3><div>Retention rates were high, with 80.6% of patients adhering to treatment at 3 months, 66.7% at 6 months, and 45.2% at 12 months. In 29 patients (30.1%), BRV was added in an overnight switch from levetiracetam (LEV), resulting in a reduction of behavioral adverse effects (AEs) in 5 patients (17.2%). The response rate was 25.8% at 3 months, 16.1% at 6 months, and 17.2% at 12 months, with no responders in the epileptic encephalopathy group. Therapy tolerance was notable, with 70 patients (75.3%) reporting no AEs. Transient AEs occurred in 10 patients (10.7%), and in 13 cases (14.0%), the AEs warranted dose adjustment or discontinuation of BRV.</div></div><div><h3>Conclusion</h3><div>Approximately one-fifth of pediatric patients with drug-resistant epilepsy responded to BRV, with the best response observed in patients with focal seizures. However, the impact on patients with epileptic encephalopathy was limited.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"121 ","pages":"Pages 243-252"},"PeriodicalIF":2.7,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299519","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":"Artificial intelligence and telemedicine in epilepsy and EEG: A narrative review","authors":"Mohammad Alkhaldi ,&nbsp;Layla Abu Joudeh ,&nbsp;Yaman B. Ahmed ,&nbsp;Khalil S. Husari","doi":"10.1016/j.seizure.2024.08.024","DOIUrl":"10.1016/j.seizure.2024.08.024","url":null,"abstract":"<div><p>The emergence of telemedicine and artificial intelligence (AI) has set the stage for a possible revolution in the future of medicine and neurology including the diagnosis and management of epilepsy. Telemedicine, with its proven efficacy during the COVID-19 pandemic, offers the advantage of bridging the gap between patients in resource-limited areas and specialized care, where in one study telemedicine reduced the epilepsy treatment gap from 43 % to 9 %. AI innovations promise a transformation in epilepsy care by possibly enhancing the accuracy of electroencephalogram (EEG) interpretation and seizure prediction through machine and deep learning. In one study, abnormal EEG recordings were classified into different categories using a convolutional neural networks (CNN) model showing a specificity of 90 % and an accuracy of 88.3 %. Other models constructed to predict seizures have also achieved a sensitivity of 96.8 % and specificity of 95.5 %. Various machine learning (ML) models highlight the potential AI holds in identifying interictal biomarkers and localizing seizure onset zones aiding in epilepsy treatment decision and outcome prediction. An ML model highlighted in this review localized seizure onset zone with an accuracy reaching 73 % and predicted surgical outcomes with an accuracy reaching 79 % compared to the 43 % accuracy of clinicians. However, limitations and challenges hinder the application of such technologies to reach their full potential in epilepsy care. Limitations include access to compatible devices, integration into clinical workflows, data bias, and availability of sufficient data. Extensive validated research is needed to guide future clinical practice with the implementation of technology-enhanced epilepsy care. This narrative review article will explore the use of AI and telemedicine in EEG and epilepsy care, examining their individual and combined impacts in shaping the future of epilepsy care and discussing the challenges and limitations faced in their usage.</p></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"121 ","pages":"Pages 204-210"},"PeriodicalIF":2.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096881","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}