Seizure-European Journal of Epilepsy最新文献

{"title":"Seizure recurrence proportion under antiseizure medication in people living with epilepsy and prolonged seizure remission: A systematic review","authors":"Tae-Won Yang ,&nbsp;Young-Soo Kim ,&nbsp;Do-Hyung Kim ,&nbsp;Minjung Kim ,&nbsp;Minjun Kim ,&nbsp;Jung Sook Yeom ,&nbsp;Oh-Young Kwon","doi":"10.1016/j.seizure.2024.11.006","DOIUrl":"10.1016/j.seizure.2024.11.006","url":null,"abstract":"<div><h3>Background and purpose</h3><div>People living with epilepsy (PLWE) may wish to discontinue antiseizure medications (ASMs) after long-term remission. However, fear of relapse may lead to continued ASM use. Previous studies have focused on seizure relapse in PLWE who discontinued ASMs after long-term seizure remission (PLWE off ASM), with limited data on those who continued ASMs (PLWE on ASM).</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of studies from five databases. We included studies with adult PLWE on ASM with long-term follow-up, using a common-effect model for analysis.</div></div><div><h3>Results</h3><div>Seven datasets from six studies were reviewed. Three of the six studies appeared to include some children and adolescents. Significant differences in seizure recurrence proportions (SRP) were found between PLWE whose seizures were controlled on one ASM (PLWE on one ASM) and those whose seizures were controlled on multiple ASMs (PLWE on multiple ASMs) over one to five years of follow-up. After two years, the SRP was 0.1416 for PLWE on one ASM and 0.2479 for PLWE on multiple ASMs. The relative risk (RR) of seizure recurrence for PLWE off ASM compared to PLWE on ASM was 1.9912 after two years, with the RR decreasing over time.</div></div><div><h3>Discussion</h3><div>Among PLWE on ASM, PLWE on one ASM have a lower chance of seizure recurrence than PLWE on multiple ASMs. PLWE off ASM have twice the risk of recurrence compared to PLWE on ASM after two years. This information aids PLWE in making informed decisions about ASM continuation or discontinuation.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"124 ","pages":"Pages 25-34"},"PeriodicalIF":2.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743291","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":"Parent-Reported mental health in nearest age siblings of children with Dravet Syndrome in Sweden","authors":"Colin Reilly ,&nbsp;Björn Bjurulf ,&nbsp;Tove Hallböök","doi":"10.1016/j.seizure.2024.11.004","DOIUrl":"10.1016/j.seizure.2024.11.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess parent-reported mental health in nearest age siblings of children with Dravet Syndrome (DS).</div></div><div><h3>Methods</h3><div>In this observational study parents of 31 children (age 3–16 years; 18 males and 13 females) of nearest age siblings of children with DS completed the SDQ (Strength and Difficulties Questionnaire). Mental health level was determined using validated norms; abnormal ≥ 90 percentile/borderline ≥80 percentile. At risk status was considered borderline/abnormal. Data were analysed using descriptives and linear regression. Significance level was <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Only five siblings (16 %) had elevated scores on the SDQ total score. However, 32 % of siblings had difficulties on the Emotional subscale and 26 % on the Peer subscale. Only one child (3 %) had an elevated score on the Prosocial subscale which indicates strengths. Regression analysis did not find any significant associations with the SDQ total score.</div></div><div><h3>Conclusions</h3><div>Siblings of children with DS would not appear to have a higher risk of mental health problems but specific supports may be needed regarding emotional problems. More research is needed to better understand the sibling experience in children with DS and other Developmental and Epileptic Encephalopathies.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 113-115"},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631280","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":"Whole-course power evolution in childhood absence epilepsy: A multi-frequency magnetoencephalography study","authors":"Minghao Li ,&nbsp;Xinyi Zhou ,&nbsp;Yingfan Wang,&nbsp;Jing Lu,&nbsp;Yinjie Zhu,&nbsp;Peilin Jiang,&nbsp;Ke Hu,&nbsp;Xiaoshan Wang","doi":"10.1016/j.seizure.2024.11.008","DOIUrl":"10.1016/j.seizure.2024.11.008","url":null,"abstract":"<div><h3>Objective</h3><div>This study explores the whole-course neuromagnetic activity changes in childhood absence epilepsy (CAE) using multifrequency magnetoencephalogram (MEG) analysis. We aim to uncover the underlying neurophysiological mechanisms and identify functional signal targets with potential clinical applications.</div></div><div><h3>Methods</h3><div>We recruited 37 drug-naive children with CAE and collected magnetoencephalography (MEG) data from 62 seizures and interictal periods using a CTF-275 channel MEG system. The seizure course was segmented with temporal unification and subjected to dynamic frequency band analysis. Minimum norm estimation combined with Welch's method was employed for spectral power calculation, followed by correlation analysis between power and seizure duration.</div></div><div><h3>Results</h3><div>Whole-brain magnetic source power changes in 2–60 Hz largely paralleled the progression of spike and wave discharges (SWDs), while power in 60–90 Hz was suppressed during seizures. Alpha band (8–12 Hz) activity showed a prompt loss of occipital dominance at seizure onset, with concurrent elevation in frontal alpha activity. This frontal alpha dominance persisted throughout the ictal period and reverted to occipital dominance at termination. Beta and gamma1 band (15–59 Hz) activity characteristically declined before SWDs cessation. The power of SWDs during ictal period was negatively correlated with seizure duration.</div></div><div><h3>Conclusion</h3><div>Spectral power analysis of neuromagnetic signals throughout CAE process identifies specific frequency-dependent characteristic changes, among which, the distribution of alpha band (8–12 Hz) activity is closely related to absence manifestations, beta band (15–29 Hz) power decline induces seizure termination. Additionally, ictal SWDs power can serve as a neuroimaging indicator of epilepsy severity.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"124 ","pages":"Pages 9-17"},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721247","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":"Visual acuity in the context of retinal neuroaxonal loss in people with epilepsy","authors":"Luisa Delazer ,&nbsp;Joachim Havla ,&nbsp;Soheyl Noachtar ,&nbsp;Elisabeth Kaufmann","doi":"10.1016/j.seizure.2024.10.019","DOIUrl":"10.1016/j.seizure.2024.10.019","url":null,"abstract":"<div><h3>Objective</h3><div>Recent studies reported a significant retinal neuroaxonal loss in people with epilepsy (PWE). However, the impact of these structural alterations on visual function, i.e., visual acuity is yet unknown.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, 70 PWE and 76 healthy controls (HC), all aged 18–55 years, underwent an assessment of visual acuity with 100 % high contrast (HCVA) and 2.5 % low contrast (LCVA) Sloan letter charts. Thickness of the global peripapillary retinal nerve fiber layer (G-pRNFL) and volume of the ganglion cell inner plexiform layer (GCIP) were assessed with spectral-domain optical coherence tomography (OCT). For the statistical analyses, the epilepsy group was subdivided into PWE with sodium channel blocking (SCB)-drug intake (<em>n</em> = 52) and PWE without SCB-drug intake (<em>n</em> = 18), since an effect of SCB-drugs on visual perception has been reported previously.</div></div><div><h3>Results</h3><div>The overall PWE cohort presented significantly lower structural retinal measures, i.e., G-pRNFL thickness (97.57 ± 9.06 µm) and GCIP volume (1.99 ± 0.13 mm³) than HC (101.31 ± 8.28 µm, <em>p</em> = .01; 2.10 ± 0.15 mm³, <em>p</em> &lt; .001). Subgroup analyses revealed that PWE who were treated with SCB-drugs had a significantly reduced G-pRNFL thickness (96.61 ± 9.70 µm, <em>p</em> = .01) and GCIP volume (1.98 ± 0.14mm³, <em>p</em> &lt; .001) compared to HC, while PWE without SCB-drugs (100.36 ± 6.32 µm, 2.01 ± 0.13 mm³) did not differ from HC or PWE with SCB-drugs. In visual acuity tests (HCVA and LCVA), the overall PWE cohort (52.28 ± 8.56; 31.71 ± 8.49) scored significantly lower than HC (56.57 ± 4.74, <em>p</em> = .001; 35.13 ± 5.50, <em>p</em> = .04). In subgroup analyses only PWE with SCB-drugs presented significantly lower HCVA (51.25 ± 9.35, <em>p</em> = .003) and LCVA (30.04 ± 8.93, <em>p</em> = .03) scores compared to HC, while visual acuity scores did not differ between PWE without SCB-drugs (55.25 ± 4.75, 36.53 ± 4.50) and HC. PWE with SCB-drugs had significantly lower LCVA scores than PWE without SCB-drugs (<em>p</em> = .03). Importantly, no association was found between visual acuity scores and structural parameters, neither in the overall sample, nor in any of the subgroups.</div></div><div><h3>Significance</h3><div>Retinal neuroaxonal loss in PWE was not associated with reduced visual acuity under high and low contrast. Instead, our findings reinforce SCB-drug intake as an important factor for reduced visual acuity under high and low contrast.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 116-122"},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631288","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":"Ictal tachycardia in children with epilepsy","authors":"Victoria San Antonio-Arce ,&nbsp;Anne-Kathrin König ,&nbsp;Kerstin Alexandra Klotz ,&nbsp;Jan Schönberger ,&nbsp;Andreas Schulze-Bonhage ,&nbsp;Julia Jacobs-Le Van","doi":"10.1016/j.seizure.2024.11.007","DOIUrl":"10.1016/j.seizure.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Changes in heart rate (HR) may provide an extracerebral indicator of seizure onset. The purpose of this study is to assess the frequency and timing of presentation of ictal tachycardia in a larger series of children with epilepsy grouped in different age groups as well as the influence of seizure characteristics.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 732 seizures of 195 patients aged 0 to 14 (median 6.91) years with epilepsy of any cause. Patients were grouped according to the age in groups (1) &lt;1 year (<em>n</em> = 18); (2) 1–2 years (<em>n</em> = 26); (3) 2–6 years (<em>n</em> = 43); (4) 6–10 years (<em>n</em> = 44); and (5) 10–14 years (<em>n</em> = 64). HR was assessed visually during the seizures and compared with HR 1 min before seizure onset. The time from seizure onset to ictal tachycardia, defined as an increase in HR by at least 33 %, was described. Ictal tachycardia was considered early if occurring in the first 10 s.</div></div><div><h3>Results</h3><div>Ictal tachycardia occurred in at least one seizure in 70.3 % of patients and in 51.1 % of seizures. It was more frequent and earlier in focal seizures and in seizures occurring in sleep. &gt;30 % of patients had ictal tachycardia in all of their seizures, this being more frequent in the age groups 6–10 and 10–14 years.</div></div><div><h3>Conclusions</h3><div>Children older than 6 years especially with focal seizures during sleep could be ideal candidates for warning devices or stimulation therapies triggered by tachycardia detection. Future studies should aim to assess the implications in relation to the risk of SUDEP.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 128-132"},"PeriodicalIF":2.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649497","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":"Safety profile of abdominal magnetic resonance imaging (MRI) performed for renal disease surveillance in tuberous sclerosis complex patients with vagus nerve stimulation","authors":"Ethan Sage ,&nbsp;Asim F. Choudhri ,&nbsp;Jorge A. Lee-Diaz ,&nbsp;John Bissler ,&nbsp;James W. Wheless","doi":"10.1016/j.seizure.2024.11.005","DOIUrl":"10.1016/j.seizure.2024.11.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Individuals with tuberous sclerosis complex (TSC) often present with refractory epilepsy and may be undergoing treatment with vagus nerve stimulation (VNS) to control seizures. Surveillance magnetic resonance imaging (MRI) is necessary to monitor for the renal angiomyolipomas associated with TSC; however, MRI of the abdomen is not approved for patients withVNS therapy. We have many TSC patients with refractory epilelpsy who benefitted from VNS therapy, so we developed an MRI protocol that allows MRI of the abdomen to be performed in these patients to permit safe imaging of their kidneys. Here we report our results using this protocol.</div></div><div><h3>Methods</h3><div>We performed a retrospective review for all TSC patients seen from 01/01/1997 to 10/01/2022 at a single center to determine VNS implantation status. Patients with VNS implants and abdomen imaging performed according to the protocol for kidney surveillance were included.</div></div><div><h3>Results</h3><div>Sixteen patients with 48 total MRIs of the abdomen were found: 34 (71 %) scans were conducted under sedation and 14 (29 %) without sedation. None of the patients reported any adverse effects (pain or discomfort). No instances of VNS dysfunction were noted when re-interrogating the device immediately after completion of the imaging studies or at later neurology follow-up appointments. All MRI scans were of good quality for interpretation.</div></div><div><h3>Conclusion</h3><div>Abdominal MRIs performed in typical VNS exclusion zones were not associated with adverse events or VNS dysfunction. We believe this protocol is safe and permits the best method for monitoring renal disease in TSC patients with VNS.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 148-151"},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689437","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":"Corpus callosotomy for refractory epileptic spasms: Systematic review and meta-analysis","authors":"Robyn Whitney ,&nbsp;Hiroshi Otsubo ,&nbsp;Jessie Cunningham ,&nbsp;Kevin C. Jones ,&nbsp;Rajesh RamachandranNair ,&nbsp;Maryam Nabavi Nouri ,&nbsp;Elizabeth J Donner ,&nbsp;George M Ibrahim ,&nbsp;Ravindra Arya ,&nbsp;Puneet Jain","doi":"10.1016/j.seizure.2024.11.001","DOIUrl":"10.1016/j.seizure.2024.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>We systematically reviewed the existing literature on the efficacy of corpus callosotomy (CC) in children and adults with refractory epileptic spasms (ES) and analyzed clinical determinants of seizure outcomes.</div></div><div><h3>Methods</h3><div>The Preferred Report Items for Systematic Reviews and Meta-Analysis Guidelines (PRISMA) were followed. We systematically searched MEDLINE, EMBASE and Cochrane databases up to December 2023 for original research articles on using CC to treat refractory ES. The primary outcome measure was the proportion of study participants who achieved seizure freedom following initial CC at the last follow-up. Meta-regression using mixed-effects models was performed to obtain clinical determinants of seizure outcomes.</div></div><div><h3>Results</h3><div>A total of 12 studies were included (253 individuals). Initial complete total CC was most common (<em>n</em> = 218/253, 86%), followed by anterior CC (<em>n</em> = 29/253, 12%) and other forms of CC (i.e., anterior to posterior, posterior, staged total) (<em>n</em> = 6/253, 2%). The pooled proportion of patients achieving spasm freedom following CC was 0.31 (95% CI: 0.22, 0.42) (mean follow-up 47 months). Meta-regression showed that structural etiology and mean age at the time of CC were significant moderators of the pooled effect. For every 1% increase in the proportion of structural etiology, the proportion of spasm-free outcome was found to reduce by 0.45 (95% CI: -0.86, -0.03, <em>p</em> &lt; 0.0001). In addition, increasing the mean age by 1 month led to a reduction in the proportion of spasms-free patients by 0.003 (95% CI: -0.005, -0.0006, <em>p</em> = 0.01). Sixty-two individuals (24%) from seven studies underwent further surgery for residual ES; 34 became spasm free (55%).</div></div><div><h3>Conclusions</h3><div>Corpus callosotomy may be an effective treatment option in selected individuals with refractory epileptic spasms. Structural aetiologies and increased age at the time of corpus callosotomy are important clinical determinants. In some cases, CC may lead to further epilepsy surgery.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 159-167"},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693797","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":"Critical care EEG monitoring in children with abusive head trauma: A retrospective study of seizure burden and predictors of neurological outcomes","authors":"Jakob Bie Granild-Jensen ,&nbsp;Kian Yousefi Kousha ,&nbsp;Ayako Ochi ,&nbsp;Hiroshi Otsubo ,&nbsp;Rajesh RamchandranNair ,&nbsp;Karen Choong ,&nbsp;Burke Baird ,&nbsp;Emma Cory ,&nbsp;Shelly Weiss ,&nbsp;Cecil Hahn ,&nbsp;Elizabeth J Donner ,&nbsp;Robyn Whitney ,&nbsp;Kevin C Jones ,&nbsp;Puneet Jain","doi":"10.1016/j.seizure.2024.11.002","DOIUrl":"10.1016/j.seizure.2024.11.002","url":null,"abstract":"<div><h3>Objectives</h3><div>Abusive Head Trauma (AHT) remains an important cause of acute seizures, morbidity, and mortality in children. We aimed to assess the clinical and electrographic seizure burden in children with AHT and to explore predictors of morbidity and mortality.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of all children admitted with AHT who underwent continuous electroencephalographic monitoring (cEEG) between January 1st, 2015, and April 15th, 2021. Their clinical, EEG and imaging variables were extracted and summarized.</div></div><div><h3>Results</h3><div>A total of 31 children (17 female) were included. The median age was 3 months (IQR 1.75–5). Forty-five percent of cases presented in the winter season (<em>p</em> = 0.024). In 25 cases out of 31, cEEG detected electrographic seizures, with 6 of these children not manifesting clinical seizures. A shorter time to first recorded seizure during cEEG was a significant predictor of in-hospital mortality (<em>p</em> = 0.012) and the maximum 1-hour seizure count was higher in children with worse cerebral outcomes (<em>p</em> = 0.008). A normal EEG background activity during cEEG was associated with favorable neurological outcomes (<em>p</em> = 0.008). The hospital mortality rate was 23 %.</div></div><div><h3>Conclusion</h3><div>Almost 20 % of children with AHT had seizures recognized exclusively by cEEG. Normal cEEG background activity predicted a better outcome, while a shorter time to the first recorded seizure was associated with a higher in-hospital mortality. Corroborating prior reports, we found a significant clustering of cases during the winter. These results could enhance AHT prevention strategies and case prognostication.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 142-147"},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662360","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":"Epilepsy-surgery for fronto-basal lesions: Management, outcome, and review of literature","authors":"Alexander Grote ,&nbsp;Daniel Delev ,&nbsp;Hendrik Hoffmann ,&nbsp;Christian Elger ,&nbsp;Marec von Lehe","doi":"10.1016/j.seizure.2024.11.003","DOIUrl":"10.1016/j.seizure.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>In this study, we isolated a cohort of patients who have refractory epilepsy who underwent surgery with frontobasal focus. This work aimed to develop prognostic factors associated with a better seizure outcome and identify risk factors determining postoperative morbidity.</div></div><div><h3>Methods</h3><div>We identified all patients with frontobasal epilepsy who underwent surgery due to refractory epilepsy at the University Hospital Bonn over 22 years. Although this is a retrospective study, all data sets were collected prospectively. We evaluated both surgical and functional outcomes.</div></div><div><h3>Results</h3><div>In total, 32 patients were identified for inclusion in this study. With a long and stable postoperative seizure outcome averaging 109 months, we were able to show that patients with frontobasal epilepsy can achieve a better outcome (53 % seizure-free, ILAE1) than patients with frontal epilepsy. In contrast to other brain regions, the resection size (isolated or extended) did not influence the outcome. Low-grade tumors, on the other hand, were associated with a better seizure outcome, and gliosis or non-specific histological findings with a worse seizure outcome. Stereo-EEG with depth electrodes is more suitable for invasive diagnostics at the frontal base than strip or grid electrodes. Patients who did not become seizure-free after surgery and underwent a second surgery did not profit significantly concerning seizure outcome.</div></div><div><h3>Conclusion</h3><div>Patients with frontobasal epilepsy who are operated on early in the course of the disease, are MRI-positive, and have a tumor as an epileptogenic pathology have the best chance of seizure freedom.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 104-112"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631272","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":"Computed tomography of the head with and without contrast in imaging focal and unknown epilepsy – A prospective observational study","authors":"Jasmine Parihar ,&nbsp;Mamta Bhushan Singh ,&nbsp;Ajay Garg ,&nbsp;Leve Joseph Devarajan ,&nbsp;Rohit Bhatia ,&nbsp;Anuj Prabhakar ,&nbsp;Shailesh Gaikwad ,&nbsp;MV Padma Srivastava ,&nbsp;Vinay Goyal ,&nbsp;Garima Shukla ,&nbsp;Vishnu VY ,&nbsp;Maroof Ahmad Khan","doi":"10.1016/j.seizure.2024.10.020","DOIUrl":"10.1016/j.seizure.2024.10.020","url":null,"abstract":"<div><h3>Purpose</h3><div>Brain imaging is needed when investigating epilepsy. Imaging options available include MRI and CT scan which may be non-contrast (NCCT) or contrast-enhanced (CECT). The specific clinical question and probable epilepsy substrate in the epidemiological context and socioeconomic milieu are important in determining the choice of imaging. In patients with well-controlled focal or unknown epilepsy who are unlikely to be surgical candidates, is CECT essential or can NCCT be an acceptable choice?</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted at a tertiary care centre in India. Consecutive patients with focal or unknown epilepsy who were relatively well-controlled on medical treatment underwent NCCT followed by CECT brain. Three neuroradiologists independently reported the images. Proportion of abnormalities missed on NCCT and picked only on CECT were determined. How often abnormalities picked on CECT changed patient management was also analysed.</div></div><div><h3>Results</h3><div>Two hundred and nineteen patients with focal (87 %) or unknown (13 %) epilepsy underwent NCCT followed by CECT brain. Most had epilepsy for &gt;3 months and an annual seizure frequency of 2–10 seizures. There was a nearly perfect inter-observer agreement between 3 neuroradiologists in reporting the NCCT and CECT as 'normal' or 'abnormal' with kappa (κ) values of 0.9 and 1.0 respectively. The sensitivity of NCCT compared to CECT in detecting an abnormality was 97 % (CI 92.6 - 99.5 %) and the specificity was 99 % (CI 94.9 - 99.9 %). There was no significant difference in the proportion of NCCTs and CECTs found abnormal (50.22 % vs 51.14 %, <em>p</em> = 0.91). A solitary calcified granuloma was the most common abnormality reported on NCCT as well as CECT, 21.0 % and 19.1 % respectively. New findings picked on CECT alone, did not change management in any patient.</div></div><div><h3>Conclusion</h3><div>When imaging focal or unknown epilepsy, an NCCT performs as well as a CECT, especially in regions where calcified lesions contribute a significant etiological burden. The role of imaging in epilepsy varies between patients and a universal recommendation of an MRI or a CECT in all patients is neither cost-efficient nor evidence-based. In drug responsive focal or unknown epilepsy of longstanding duration, CT scans are either normal or have calcified lesions that are easily picked on NCCT.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 123-127"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639925","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}