Seizure-European Journal of Epilepsy最新文献

{"title":"Aging and Late-Onset Epilepsy: An urgent call for action!","authors":"Christoph Helmstaedter , Hermann Stefan , Friedhelm Schmitt , Markus Reuber","doi":"10.1016/j.seizure.2025.02.017","DOIUrl":"10.1016/j.seizure.2025.02.017","url":null,"abstract":"","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"128 ","pages":"Pages 1-3"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587871","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":"Neuropsychology of late-onset epilepsies","authors":"C. Helmstaedter ,&nbsp;C. Tailby ,&nbsp;J-A. Witt","doi":"10.1016/j.seizure.2024.03.010","DOIUrl":"10.1016/j.seizure.2024.03.010","url":null,"abstract":"<div><div>In an increasingly ageing society, patients ageing with epilepsy and those with late-onset epilepsies (LOE) represent a challenge for epilepsy care and treatment. Senescence itself bears risks of pathologies which in the form of acute focal damage (e.g. stroke) or slowly progressive degenerative damage can cause seizures and substantial cognitive impairment. There is converging evidence from studies in LOE that cognitive impairments are present from epilepsy onset before treatment is initiated and may even precede the emergence of seizures. This suggests that these impairments (like the seizures) are expressions of the underlying disease. Indeed, both seizures and cognitive impairments can be early indicators of disease conditions which lead to mental decline. Cognitive decline over time poses the challenge of disentangling the interrelation between seizures, treatment effects and underlying disease. This issue must be considered as some of the etiologies for causing neuropsychological decline can be addressed. Medication and active epilepsy can contribute to impairments and their impact may be reversible. Dementia is rare if seizures are what has brought the person to attention, and if this is not accompanied by other slowly developing features (such as cognitive of psychiatric changes). From a neuropsychological point of view choosing the right screening tools or assessments, obtaining the history and timeline of impairments in relation to epilepsy, and most importantly longitudinally following the patients regardless of whether epilepsy is ultimately controlled or not appear essential.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"128 ","pages":"Pages 16-19"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140330268","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":"Functional imaging in late-onset epilepsy: A focused review","authors":"Isha Puntambekar ,&nbsp;Fenglai Xiao ,&nbsp;Robert Shortman ,&nbsp;Matthias Koepp","doi":"10.1016/j.seizure.2024.06.024","DOIUrl":"10.1016/j.seizure.2024.06.024","url":null,"abstract":"<div><h3>Introduction</h3><div>About 25 % of new-onset epilepsies are diagnosed after age 65. Late-onset epilepsy (LOE) is predicted to become a major healthcare problem in the next 15 years as the global population increases and ages. Neurodegenerative disorders account for 10–20 % of LOE, while over 20 % of these patients have an unknown etiology. Established diagnostic tools such as FDG-PET and novel biomarkers of neurodegeneration including amyloid and tau PET hold a lot of promise in diagnosing and ruling out neurodegenerative disorders in these patients.</div></div><div><h3>Methods</h3><div>We conducted a literature search to identify articles involving LOE populations and using one or more functional neuroimaging techniques.</div></div><div><h3>Results</h3><div>A total of 5 studies were identified through Boolean searching and snowballing. These were highly heterogenous with respect to operational definitions of LOE, analyses and interpretation pipelines.</div></div><div><h3>Conclusion</h3><div>While there is some evidence for feasibility and usefulness of FDG- and Amyloid PET in LOE, methodological heterogeneities in the available literature preclude any notable conclusions. Future research in this field will benefit from a consensus on epilepsy-specific analysis and interpretation guidelines for amyloid and tau PET.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"128 ","pages":"Pages 59-63"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591852","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":"EEG and semiology in the elderly: A systematic review","authors":"Meritam Larsen Pirgit ,&nbsp;Sándor Beniczky","doi":"10.1016/j.seizure.2024.09.003","DOIUrl":"10.1016/j.seizure.2024.09.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The prevalence and incidence of epileptic seizures and epilepsy increases among the elderly. Epileptic seizures in older people remain often unreported and undiagnosed, contributing to incorrect or delayed treatment. The goal of our review paper is to increase awareness of seizures in the elderly, to improve the diagnostic process in this growing population.</div></div><div><h3>Methods</h3><div>We present a systematic review of the literature on EEG findings and seizure semiology among the elderly according to the PRISMA statement. One hundred and two original studies were included and findings were divided in four groups: EEG among elderly without seizures, EEG among elderly with seizures or epilepsy, semiology, and status epilepticus.</div></div><div><h3>Conclusions</h3><div>EEG abnormalities are found in approximately half of the geriatric population referred to routine EEG. Slowing (both focal and diffuse) is the most common finding among seniors with and without seizures. Interictal epileptiform discharges (IEDs) are likewise seen among healthy seniors, which reduces their specificity as biomarker for epilepsy. Focal onset seizures prevail among the aged. Generalized seizures are uncommon, starting usually earlier in life but exacerbating in later years. Motor phenomena are less frequently seen than among younger individuals. Seizures are mainly characterized by impairment of awareness, disturbed cognition and confusion, both ictally and postictally. Unresponsiveness may occur during non-epileptic events too, which further challenges seizure recognition. Epilepsy and dementia are bi-directionally related: dementia carries an increased risk of developing epilepsy and vice versa. Up to 45 % of the aged with new onset seizures present with status epilepticus (SE). SE among the elderly is more often focal motor; non-convulsive status epilepticus (NSCE) constitutes 10–25 %.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"128 ","pages":"Pages 90-121"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256060","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":"Demographics and care of epilepsy in older adults in Germany","authors":"Adam Strzelczyk ,&nbsp;Nils G. Margraf ,&nbsp;Sonya C. Faber ,&nbsp;Nina Fulgeri ,&nbsp;Andreas Schulze-Bonhage","doi":"10.1016/j.seizure.2025.02.003","DOIUrl":"10.1016/j.seizure.2025.02.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Epilepsy is one of the most frequent chronic neurological disorders worldwide and is increasingly significant in individuals aged over 65 years due to rising life expectancy and comorbidities. This study aims to improve epilepsy care by examining demographic changes and treatment parameters in patients aged 65 and older in Germany.</div></div><div><h3>Methods</h3><div>Data from the IQVIA™ LRx and Disease Analyzer (DA) databases (2018–2022) were analyzed for epilepsy patients 65+. The LRx database provided prescription data, while DA offered diagnostic and demographic information. Multivariable logistic regression analysis was conducted to evaluate the association between age, sex, region, physician specialty and pre-defined outcomes, i.e., therapy delay and adherence.</div></div><div><h3>Results</h3><div>In 2022, the DA database estimated epilepsy prevalence at 0.64 % (65–74: 0.91 %; 75+: 1.32 %), and LRx at 0.67 % (65–74: 0.97 %; 75+: 1.75 %). Regional differences in prevalence, incidence, and treatment were observed, with geographic gradients visualized. Most patients (63 %) received anti-seizure medication (ASM) on diagnosis day, but neurologists prescribed ASMs later than GPs, especially in those over 75. Age 75+ was associated with significantly lower odds of therapy delay (adjusted odds ratio; AOR = 0.79, p 0.004), and male gender with a slightly reduced risk of delay (AOR = 0.91, p 0.003). Treatment by neurologists was associated with a higher adherence (AOR = 1.85, <em>p</em> &lt; 0.001) but greater therapy delays (AOR = 1.19, <em>p</em> &lt; 0.001) compared with GPs. Third-line therapies improved adherence across all ages (AOR = 2.09, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>The study highlights a higher prevalence of epilepsy in older adults than previously estimated and significant differences in treatment timing and adherence between GPs and neurologists. Further research is needed to explore regional treatment disparities and improve care for elderly epilepsy patients.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"128 ","pages":"Pages 4-15"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574388","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 in older patients—A focused review","authors":"Stephan Seiler ,&nbsp;Christian Enzinger","doi":"10.1016/j.seizure.2024.11.015","DOIUrl":"10.1016/j.seizure.2024.11.015","url":null,"abstract":"<div><div>MRI has considerably increased our pathophysiological knowledge of age-related brain abnormalities. Brain abnormalities regularly seen on MRI of older adults are atrophy, and changes related to small vessel disease (SVD). SVD-related changes include white matter hyperintensities (WMH), lacunes, microbleeds, microinfarcts and perivascular spaces. While atrophy, WMH and lacunes are recognized as important contributors to cognitive decline and dementia, relationships are less clear for microbleeds, microinfarcts and perivascular spaces. Vascular risk factors are considered critical in the development of these changes and being potentially modifiable have become increasingly interesting to researchers and clinicians alike. Managing vascular risk early, particularly hypertension, is a key factor in slowing down the evolution of age-related brain abnormalities and decelerate their detrimental cognitive consequences. Cognition and visible brain abnormalities have a complex relationship, which reaches far beyond what we can understand using standard MRI. Remote effects of lesions and associated- as well as independent network changes likely explain much of the different cognitive trajectories observed with aging. Because of the versatility of MRI in the diagnostic of various diseases, including epilepsy, incident signs of brain aging will be encountered ever more frequently on standard MRI of older adults. To facilitate understanding and ultimately reporting these changes to patients, this review will give a brief overview of MRI findings encountered on MRI of older people. We will discuss their pathology, risk factors, and relationships with cognition. Special emphasis will be given to more recent developments, including remote effects of lesions, and effects on the structural brain network. Relationships between MRI findings in older people and epilepsy will be discussed as well.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"128 ","pages":"Pages 140-145"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808019","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":"The impact and adherence of ketogenic dietary therapies for Dravet syndrome: A systematic review and meta-analysis","authors":"Yan Li,&nbsp;Sisi Dai,&nbsp;Qingqing Deng,&nbsp;Zhanli Liu","doi":"10.1016/j.seizure.2025.05.001","DOIUrl":"10.1016/j.seizure.2025.05.001","url":null,"abstract":"<div><div>This systematic review and meta-analysis evaluated the efficacy, safety, and adherence of ketogenic dietary therapies (KDTs) in patients with Dravet syndrome (DS). This study found that KDTs were effective in reducing seizure frequency, especially in the short term, with pooled efficacy rates of 73.4% at 3 months, 59.0% at 6 months, 44.4% at 12 months, and 51.0% for interventions that lasted longer than 1 year. However, long-term adherence to KDTs still remains challenging, as evidenced by the sharp decline in adherence rates from 90.6% at 3 months to 43.8% at 12 months. With the majority of side effects being minor and temporary, KDTs have a typically good safety profile. The study highlights the need for comprehensive support strategies to optimize treatment outcomes and suggests that future research should focus on well-designed randomized controlled trials and innovative approaches to enhance the efficacy and acceptability of KDTs in DS patients.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"130 ","pages":"Pages 16-24"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906415","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":"Autoimmune-associated epilepsy – a challenging concept","authors":"Nico Melzer ,&nbsp;Felix Rosenow","doi":"10.1016/j.seizure.2024.05.017","DOIUrl":"10.1016/j.seizure.2024.05.017","url":null,"abstract":"<div><div>The current International League Against Epilepsy (ILAE) definition and classification guidelines for the first time introduced the category of immune-mediated focal epilepsy in addition to structural, genetic, infectious, and metabolic aetiologies. Moreover, the ILAE Autoimmunity and Inflammation Taskforce recently provided a conceptual framework for the distinction between acute “provoked” seizures in the acute phase of autoimmune encephalitis from chronic “unprovoked” seizures due to autoimmune-associated epilepsy. The first category predominately applies to those autoimmune encephalitis patients with autoantibodies against cell surface neural antigens, in whom autoantibodies are assumed to exert a direct ictogenic effect without overt structural damage. These patients do not exhibit enduring predisposition to seizures after the “acute phase” encephalitis, and thus do not fulfil the definition of epilepsy. The second category applies to those autoimmune encephalitis patients with autoantibodies against intracellular neural antigens and Rasmussen's encephalitis, in whom T cells are assumed to cause epileptogenic effects through immune-inflammation and overt structural damage. These patients do exhibit enduring predisposition to seizures after the “acute phase” of encephalitis and thus fulfil the definition of epilepsy. AAE may result from both, ongoing brain autoimmunity and associated structural brain damage according to the current ILAE definition and classification guideline. We here discuss the difficulties of this concept and suggest an unbiased translationally validated and data-driven approach to predict in an individual encephalitis patient the propensity to develop (or not) AAE and the cognitive and behavioural outcome.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"128 ","pages":"Pages 20-23"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293901","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":"Fluid biomarkers unveil signatures of pathological aging","authors":"Niels Hansen ,&nbsp;Jens Wiltfang","doi":"10.1016/j.seizure.2024.05.019","DOIUrl":"10.1016/j.seizure.2024.05.019","url":null,"abstract":"<div><div>Aging is a multifaceted and highly varied process in the brain. Identifying aging biomarkers is one means of distinguishing pathological from physiological aging. The aim of this narrative review is to focus on two new developments in the field of fluid biomarkers and draw attention to this excellent tool for the early detection of potential brain pathologies that delay, alter, or enable physiological aging to become pathological. Pathological aging can lower the threshold for the development of specific diseases such as late-onset epilepsy. Fluid biomarkers can reveal pathological levels at an early stage and thus indicate disease processes in the brain that begin before symptoms develop; they thus differ from physiological aging.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"128 ","pages":"Pages 24-28"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318714","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":"Late-onset epilepsy clinic: From clinical diagnostics to biomarkers","authors":"Vineet Punia,&nbsp;Sakhi Bhansali,&nbsp;Carolyn Tsai","doi":"10.1016/j.seizure.2024.06.026","DOIUrl":"10.1016/j.seizure.2024.06.026","url":null,"abstract":"<div><div>The unique patho-clinical entity of late-onset epilepsy (LOE), distinguished by its distinct natural history, from its onset to the prognosis it portends, necessitates specialized care. We lack a universally accepted definition, but LOE is typically identified as epilepsy onset after the age of 60 or 65. Unlike epilepsy in younger individuals, LOE is almost by default focal in origin, secondary to acquired etiologies, and presents unique diagnostic and management challenges due to its atypical semiology, higher comorbidity burden, frailty, and increased risks of subsequent stroke and dementia. LOE clinics have been established to address these challenges, providing a multidisciplinary approach to optimize outcomes in patients with new-onset seizures beyond the fifth decade of life. LOE clinics are essential for comprehensive care, offering not only seizure management but also monitoring and addressing associated comorbidities. The care model involves collaboration among neurologists, primary care providers, cardiologists, mental health professionals, and social workers to manage LOE patients' complex needs effectively. The prevalence of cognitive dysfunction in LOE patients underscores the need for regular cognitive assessments and interventions. Biomarker research, particularly involving amyloid beta, offers promising avenues for early diagnosis and a better understanding of the interplay between LOE and Alzheimer's disease. Establishing LOE clinics in major referral centers can enhance provider expertise, improve patient outcomes, and facilitate research to advance diagnostic and therapeutic strategies. In conclusion, LOE clinics play a critical role in addressing the multifaceted needs of older adults with epilepsy, tailored to local resources and challenges, thus enhancing epilepsy care in an aging global population.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"128 ","pages":"Pages 68-73"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471986","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}