Seizure-European Journal of Epilepsy最新文献

{"title":"Parents' experiences of caring for a child with epilepsy: a systematic review of qualitative research and thematic synthesis","authors":"Amy Breed ,&nbsp;Bridget Hanley ,&nbsp;Candice Walton ,&nbsp;Craig D. Murray","doi":"10.1016/j.seizure.2025.10.025","DOIUrl":"10.1016/j.seizure.2025.10.025","url":null,"abstract":"<div><h3>Purpose</h3><div>Previous research highlights the impact of chronic health conditions on parents of children with health conditions, including epilepsy, however thus far there has not been a qualitative synthesis of the parental experience of caring for a child with epilepsy. This review aims to synthesise the available literature to gain greater insight into how parents experience their child’s condition and to identify gaps in current healthcare provision.</div></div><div><h3>Methods: a</h3><div>systematic literature search of five electronic databases identified 14 papers which included data regarding the parental experience of caring for a child with epilepsy. A thematic analysis method was used to synthesise these papers.</div></div><div><h3>Results</h3><div>Four main themes were identified: 1) prolonged uncertainty, 2) a 24-7 condition, 3) a multitude of losses and 4) facing societal stigma.</div></div><div><h3>Conclusions</h3><div>The synthesis identified that parents face a range of experiences and emotions whilst caring for their child with epilepsy. Recommendations for how healthcare and third sector services can support parents further to help them cope with their experience are provided.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 232-241"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460509","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 intersection of epilepsy and assisted reproduction: A review of therapeutic approaches and considerations","authors":"Banafsheh Mohammadi ,&nbsp;Jafar Mehvari ,&nbsp;Navid Naghibi ,&nbsp;Nasim Tabrizi","doi":"10.1016/j.seizure.2025.10.019","DOIUrl":"10.1016/j.seizure.2025.10.019","url":null,"abstract":"<div><h3>Objective</h3><div>Women with epilepsy (WWE) have unique reproductive problems due to interactions among seizures, antiseizure medications (ASMs), and endocrine changes. These interactions can cause infertility, menstrual dysfunction, and an increased risk for reproductive endocrine disorders. Assisted reproductive technologies (ART), offer a hope for WWE seeking pregnancy but raise questions about seizure control, drug interactions, and pregnancy outcomes. This review aims to discuss the challenges associated with the use of ART in WWE.</div></div><div><h3>Methods</h3><div>A narrative review was conducted through PubMed, MEDLINE, and ISI Web of Science. Inclusion criteria were original research, cohort studies, case series, randomized trials, and systematic reviews incorporating ART outcomes, ASM interactions, and hormonal therapies in WWE. Animal studies and abstracts without full text available were excluded.</div></div><div><h3>Results</h3><div>The data about the use, most appropriate protocols and success rate of ART in WWE is scarce. Current findings suggest that ART is effective in WWE, with live birth rates comparable to those of women without epilepsy. Most WWE with well-controlled epilepsy have seizure stability during ART, but sporadic cases of seizure worsening, have been reported. ART hormonal treatments can interact with ASMs, necessitating therapeutic drug level monitoring and dose adjustment, especially for lamotrigine. Enzyme-inducing ASMs can reduce the efficacy of hormonal treatments, requiring augmented doses of progesterone for luteal support. WWE remain at higher risk of pregnancy complication, but ART does not yet appear to contribute to these risks when appropriately managed.</div></div><div><h3>Conclusion</h3><div>Based on the limited current studies, ART might be an acceptable and safe fertility treatment for WWE, provided that seizure control is optimized and ASM-hormone interactions are carefully managed. ASM choice, therapeutic drug monitoring, and multidisciplinary care need to be tailored to maximize reproductive and neurological outcomes. Frozen embryo transfer protocols and progestin-only contraception may also enhance safety. Continued research and clinical monitoring are needed to further develop management strategies and long-term outcomes in WWE undergoing ART.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 219-223"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460483","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 of nurse led intervention on quality of life, cost effectiveness and drug management in patients with epilepsy: Systematic review of randomized control trials","authors":"Pushpa ,&nbsp;Mamta ,&nbsp;Uma Phalswal ,&nbsp;Raman Kalia","doi":"10.1016/j.seizure.2025.10.006","DOIUrl":"10.1016/j.seizure.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Epilepsy is a long-term neurological condition marked by recurring seizures and is among the most prevalent neurological disorders. The presence of stigma and negative societal views regarding epilepsy further exacerbates the condition. A wide treatment gap and a lack of medical professionals are major contributors; however, efforts to enhance care delivery and improve patient satisfaction have also emphasized the involvement of epilepsy specialist nurses. Nevertheless, the effectiveness of nurse-led interventions in improving the quality of life for individuals living with epilepsy remains uncertain.</div></div><div><h3>Objective</h3><div>To evaluate the effectiveness of nurse-led interventions on quality of life, cost-efficiency, and medication management among patients with epilepsy.</div></div><div><h3>Design</h3><div>Randomized controlled trials studies were selected only.</div></div><div><h3>Data sources</h3><div>A thorough literature search was carried out in PubMed Central, EBSCO host, Medline, and Scopus in January 2025 to locate peer-reviewed published studies. Two reviewers independently extracted and evaluated the data using a standardized assessment tool.</div></div><div><h3>Results</h3><div>Seven randomized controlled trials met the eligibility criteria and were included in this review. These studies detailed nurse-led interventions administered through both face-to-face interactions and telephone-based approaches. The interventions varied in their outcomes and the measurement instruments employed, with several studies noting participant attrition. Overall, the majority of studies indicated that nurse-led interventions led to improvements in quality of life, cost-effectiveness, and medication management among individuals with epilepsy.</div></div><div><h3>Conclusion</h3><div>The evidence indicates that nurse-led interventions are effective in managing care for individuals with epilepsy. This review highlights intervention strategies that may guide future clinical practice and research aimed at enhancing quality of life, cost-efficiency, and medication management for people living with epilepsy. Further investigations should focus on identifying the key components of successful nurse-led interventions, assessing their impact on quality of life and cost-effectiveness, and exploring their integration into routine clinical care.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 80-87"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326147","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":"Pediatric frontal lobe epilepsy (FLE): Semiological distinctions from adult-onset FLE","authors":"Dr Sujit A. Jagtap ,&nbsp;Dr Zubin A. Shah ,&nbsp;Dr Nilesh Kurwale ,&nbsp;Dr. Sandeep Patil ,&nbsp;Dr Aniruddha Joshi ,&nbsp;Dr. Yogeshwari Deshmukh ,&nbsp;Dr Sujit Nilegaonkar","doi":"10.1016/j.seizure.2025.10.002","DOIUrl":"10.1016/j.seizure.2025.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize seizure semiology, electroclinical features, and lesion localization in pediatric frontal lobe epilepsy (FLE), and to assess the applicability of the Bonini classification system, with comparison to adult-onset FLE.</div></div><div><h3>Methods</h3><div>We retrospectively analysed clinical, video-EEG, and neuroimaging data from 61 children with FLE who underwent presurgical evaluation between January 2015 and June 2023. Seizure semiology was categorised using Bonini’s system. Imaging findings were correlated with semiological features.</div></div><div><h3>Results</h3><div>The majority of patients had daily seizures (67.2 %) and clustering (88.5 %). Auras were rare (9.8 %), and focal to bilateral tonic-clonic seizures (FBTCS) occurred in only 3.2 %. Motor manifestations dominated the clinical picture, with Group 1 semiology (elementary motor signs) present in 59 % of cases, a frequency significantly higher than reported in adults. Emotional behaviours (Group 4) and integrated gestural behaviours (Group 3) were infrequent. Epileptic spasms occurred in children up to 5 years and were associated with focal lesions. Over half of the patients initially had normal MRIs, with subsequent detection of focal cortical dysplasia in 78.6 % of cases following advanced imaging techniques. There was no clear correlation between lesion location and seizure semiology. Fifty-three patients underwent surgery with 81 % seizure-free outcome after a median follow-up of 36 months.</div></div><div><h3>Significance</h3><div>Pediatric FLE exhibits distinct clinical patterns compared to adult FLE, including higher rates of motor-dominant semiology and lower incidence of auras and FBTCS. Bonini classification is applicable but may require pediatric-specific modifications. Accurate imaging interpretation is essential for identifying subtle dysplastic lesions in children.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 68-72"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318894","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 in the context of forensic psychiatry: The relationship between epilepsy, violence and criminal responsibility","authors":"Barış Kılıç Demir ,&nbsp;Selma Çilem Kızılpınar ,&nbsp;Elif Banu Söker","doi":"10.1016/j.seizure.2025.09.017","DOIUrl":"10.1016/j.seizure.2025.09.017","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to describe the sociodemographic, clinical, and criminal characteristics of forensic psychiatry patients with epilepsy and to examine the relationship between epilepsy and seizures, criminal responsibility, and violence.</div></div><div><h3>Materials and Methods</h3><div>The study included 1235 patients who had completed inpatient treatment in a high-security forensic psychiatry unit. Within the total sample, 48 individuals diagnosed with epilepsy were assessed in terms of sociodemographic, clinical, and criminal variables, and their characteristics were compared to those of the overall sample.</div></div><div><h3>Results</h3><div>The prevalence of epilepsy was 3.79% (n=48). No significant difference was found between the groups of forensic psychiatry patients with a diagnosis of epilepsy and forensic psychiatry patients without a diagnosis of epilepsy in terms of self-destructive behaviour, suicide attempt, history of imprisonment, non-documented offense, and index offense severity (respectively p=0.598, p=0.840, p=0.907, p=0.479, p=0.343). The epilepsy group had a higher rate of non-violent offences, and no patients had committed severe violent offences. There were two patients (4.1%) in whom the index offence was associated with epilepsy and seizures.</div></div><div><h3>Conclusion</h3><div>The prevalence of epilepsy in the forensic psychiatry patient group was higher than in the general population. The predominance of non-violent offenses among the epilepsy group, the absence of any serious violent offense in this group, and the minority in other violence-related indicators provides important evidence against stigmatisation based on exaggerated associations between epilepsy and violence. The high comorbidity rates of epilepsy and intellectual disability underscore the need for developing special treatment programmes and approaches.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 1-7"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145271025","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 proposal for a machine-learning algorithm for the prediction of seizure recurrence risk at 2 years after discontinuation of anti-seizure medications","authors":"Margherita Contento ,&nbsp;Bruno Bertaccini ,&nbsp;Martina Biggi ,&nbsp;Matteo Magliani ,&nbsp;Ylenia Failli ,&nbsp;Marco Paganini ,&nbsp;Luca Massacesi ,&nbsp;Eleonora Rosati","doi":"10.1016/j.seizure.2025.09.020","DOIUrl":"10.1016/j.seizure.2025.09.020","url":null,"abstract":"<div><h3>Background</h3><div>This article presents a novel method to create a scale for predicting the risk of seizure recurrence 2 years after discontinuation of anti-seizure medications (ASMs). The approach enables the development of a straightforward, easily calculable score scale with a clear-cut threshold to effectively identify high-risk patients.</div></div><div><h3>Methods</h3><div>Clinical and demographic features of epileptic patients who had discontinued their ASMs were incorporated into a customized R algorithm. This algorithm evaluated each covariate and its corresponding weight to determine the combination of weighted scores creating the scale with the highest accuracy for predicting seizure recurrence risk. Moreover, the algorithm generated a threshold that differentiates between low- and high-risk patients.</div></div><div><h3>Results</h3><div>In our dataset, the 10 covariates whose combination was associated with the scale with the maximized Youden index (0.51) selected by the algorithm were: “duration of epilepsy”, “duration of the seizure-free period on therapy”, “duration of ASM tapering”, “development delay”, “age at ASM withdrawal over 50 years”, “gender”, “age at ASM withdrawal over 40 years”, “structural etiology of epilepsy”, “failure of previous ASM discontinuations”, “age at seizure onset”; The sensitivity and specificity of the scale were 0.87 and 0.64 respectively. Scale scores above 5 identify high-risk patients.</div></div><div><h3>Conclusions</h3><div>This work does not aim to propose a definitive scale to predict the risk of seizure recurrence 2 years after discontinuation of ASMs. Rather, it introduces a data-driven tool to support the development of a scale with a clear-cut threshold, easily applicable in the clinical practice and understandable to patients.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 73-79"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318728","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":"History of Lennox–Gastaut Syndrome: An electro-clinical voyage in search of an epileptic syndrome","authors":"Philippe Gélisse ,&nbsp;Arielle Crespel ,&nbsp;Pierre Genton ,&nbsp;Charlotte Dravet","doi":"10.1016/j.seizure.2025.11.001","DOIUrl":"10.1016/j.seizure.2025.11.001","url":null,"abstract":"<div><div>Lennox<strong>–</strong>Gastaut syndrome (LGS), one of the most severe childhood epileptic encephalopathies, was described stepwise in the United States and France. Gibbs (1938) and Gibbs <em>et al</em>. (1939) identified a characteristically slow spike-and-wave pattern, which they called the ‘<em>petit mal variant,</em>’ as opposed to typical spike-and-waves at 3 Hz observed in ‘<em>petit mal.</em>’ Shortly after participating in the description of this pattern, William G. Lennox reported children with 1) diffuse slow spike-and-waves, 2) mental deficiency, and 3) three seizure types with—myoclonic jerks—a variant of petit mal absences described as brief episodes of immobility—and drops of the head on the chest or of the whole body on the ground. Henri Gastaut arranged three symposia over six years in Marseille to discuss the entity conceptualized by Lennox. Charlotte Dravet’s medical dissertation (1965) was the basis of a paper published in <em>Epilepsia</em> by Gastaut <em>et al.</em> (1966), enriched with 50 new cases. Gastaut <em>et al</em>. proposed describing this epileptic syndrome under the name ‘<em>Lennox syndrome.</em>’ They preferred this designation over ‘<em>petit mal variant</em>’ because of the term's exclusive electroencephalographic significance that cannot be employed to designate a clinical syndrome. Furthermore, Henri Gastaut wanted to use the term ‘<em>Lennox syndrome</em>’ in the same manner as ‘<em>West syndrome</em>’ was used to describe infantile myoclonic encephalopathy with hypsarrhythmia. Margaret Lennox–Buchthal, daughter of William Lennox, co-chaired the second meeting dedicated to the concept developed by her father, held in Marseille in September 1966 and suggested that the syndrome be called the LGS in honor of her father’s first description, later confirmed and completed by the Marseille school. Nowadays, the clinical and EEG characteristics of the LGS are well-defined. The Marseille school stressed the importance of sleep electroencephalographic recording to highlight bilateral fast epileptic rhythms and axial tonic seizures. The eponym LGS should be restricted to a relatively homogeneous entity, clinical expression, and prognosis, with multiple possible etiologies.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 251-260"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507467","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":"Efficacy and safety of cannabidiol in children with developmental and epileptic encephalopathies: A systematic review","authors":"Anna Saranti ,&nbsp;Pinelopi Dragoumi ,&nbsp;Konstantinos Pavlogiannis ,&nbsp;Evangelos Pavlou ,&nbsp;Dimitrios Zafeiriou","doi":"10.1016/j.seizure.2025.10.001","DOIUrl":"10.1016/j.seizure.2025.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Developmental and epileptic encephalopathies (DEEs) constitute rare epileptic conditions characterized by treatment-resistant seizures, neurodevelopmental delay, and various comorbidities. None of the currently available drugs have proven effective in suppressing epileptiform activity in those conditions.</div></div><div><h3>Objectives</h3><div>We aimed to assess the efficacy and safety of cannabidiol in children with DEEs through a systematic review.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Cochrane Central Register of Controlled Trials, trial registries, and reference lists of included studies. We conducted the last search on March 9, 2024. All study types investigating pharmaceutical cannabidiol in children with DEEs were considered eligible, with no language or date restrictions. Risk of bias was assessed using RoB2 and ROBINS-I V2.</div></div><div><h3>Results</h3><div>Of the 722 records identified, 14 met the inclusion criteria. The included studies varied in design and involved a total of 682 children. Cannabidiol was administered to a maximum dose of 50mg/kg/day. Almost all studies reported positive outcomes with cannabidiol, leading to a reduction of a 50% or above in seizure frequency in at least 20% of patients included in 11 studies. Adverse events were relatively common across studies and included somnolence, loss of appetite, diarrhea, fatigue, and increased serum aminotransferases. Most of them were mild to moderate and reversible.</div></div><div><h3>Conclusions</h3><div>Cannabidiol is generally well tolerated and has been shown to effectively reduce seizure frequency in children with DEEs whose seizures are refractory to concomitant antiepileptic medications. Future research should explore the long-term effects of cannabidiol on seizure control, developmental outcomes, and quality of life in this population.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 114-127"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364361","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":"Efficacy and safety of vigabatrin as preventive therapy for children with tuberous sclerosis complex: A systematic review and meta-analysis","authors":"Nagita Devi ,&nbsp;Pooja Soni ,&nbsp;Priyanka Madaan ,&nbsp;Indrasish Ray Chaudhuri ,&nbsp;Vaishakh Anand ,&nbsp;Dipika Bansal ,&nbsp;Jitendra Kumar Sahu ,&nbsp;Kollencheri Puthenveettil Vinayan ,&nbsp;Sheffali Gulati","doi":"10.1016/j.seizure.2025.10.008","DOIUrl":"10.1016/j.seizure.2025.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Tuberous sclerosis complex (TSC) is associated with early-onset epilepsy, often leading to drug-resistant epilepsy (DRE) and developmental impairment. Preventive therapy with vigabatrin (VGB) has been proposed as a strategy to modify disease progression, but its efficacy and safety remain uncertain. This systematic review and meta-analysis aimed to evaluate the impact of preventive VGB therapy on seizure occurrence [including infantile epileptic spasms syndrome (IESS) and DRE], neurocognitive outcomes, and adverse events in infants with TSC.</div></div><div><h3>Methods</h3><div>We performed a systematic search of MEDLINE, EMBASE, Scopus, and Web of Science. Studies were eligible if they enrolled infants with TSC without prior seizures and compared preventive VGB to standard treatment. Risk of bias was assessed using the ROB 2.0 tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Meta-analyses were performed using a random-effects model, with results expressed as risk ratios (RR) or standardized mean differences (SMD) and 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Three studies with 149 children were included. There was reduced occurrence of seizures (including IESS and DRE) in the preventive therapy group (39/68 vs 64/81). However, the risk ratios were not statistically significant for occurrence of seizures (RR: 0.72; 95 % CI: 0.47–1.10), IESS (RR: 0.23; 95 % CI: 0.04–1.25), and DRE (RR: 0.74; 95 % CI: 0.49–1.12). Neurocognitive outcomes did not differ significantly between the two groups (SMD: 0.35; 95 % CI: -0.21– 0.91). Preventive vigabatrin was generally well-tolerated, with few adverse events and rare treatment discontinuation reported.</div></div><div><h3>Conclusion</h3><div>Preventive vigabatrin therapy may prevent the development of epilepsy, including IESS and DRE, in children with TSC, with an acceptable safety profile. Although statistical significance was not achieved, the favorable trend highlights the potential clinical benefits of early intervention with VGB. Larger, high-quality randomized trials are warranted to confirm these findings and explore the long-term neurodevelopmental outcomes.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 137-143"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364362","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":"Cardiac safety of low-dose ACTH therapy in infantile spasms: Evidence from electrocardiography and advanced echocardiography","authors":"Borakay Dilek ,&nbsp;Saylan Cevik Berna ,&nbsp;Unver Olcay ,&nbsp;Doganci Demet Deniz ,&nbsp;Gunes Sager Safiye ,&nbsp;Turkdogan Dilsad","doi":"10.1016/j.seizure.2025.10.020","DOIUrl":"10.1016/j.seizure.2025.10.020","url":null,"abstract":"<div><h3>Objective</h3><div>Infantile epileptic spasms syndrome (IESS) is a catastrophic epileptic encephalopathy of infancy. While adrenocorticotropic hormone (ACTH) remains the most effective first-line therapy, its cardiac safety profile, particularly at low doses, has not been systematically evaluated. This study aimed to investigate the effects of low-dose ACTH therapy on cardiac conduction and function using electrocardiography (ECG) and advanced echocardiography.</div></div><div><h3>Methods</h3><div>This prospective controlled study included 24 infants with IESS and 24 age- and sex-matched healthy controls. All patients received low-dose ACTH (Synacthen® Depot, intramuscular; 0.5 mg/kg if &lt; 10 kg, 1 mg/kg if ≥ 10 kg; 18 injections over 8 weeks). Serial 12-lead ECGs and echocardiographic assessments, including M-mode, Doppler, tissue Doppler imaging (TDI), and speckle-tracking strain, were performed at baseline and at 2, 4, and 6 months. Controls underwent single baseline assessments.</div></div><div><h3>Results</h3><div>No patient developed overt arrhythmia or hypertension during treatment. However, ECG analysis revealed progressive prolongation of PR, QRS, QT, QTc, Tp–Te, and Tp–Te-related ratios (p &lt; 0.001). Echocardiography demonstrated significant increases in LVEDD, LVESD, LV mass, and MPI, with impaired diastolic relaxation and progressive deterioration of longitudinal and circumferential strain (p &lt; 0.05). Subgroup analyses showed no significant differences among genetic, hypoxic-ischemic, and hypoxia-related etiologies.</div></div><div><h3>Conclusion</h3><div>Even short-term, low-dose ACTH therapy is associated with subclinical conduction abnormalities and myocardial dysfunction in IESS patients. Routine cardiac monitoring, including advanced imaging modalities, should be integrated into ACTH protocols. Multidisciplinary management and larger multicenter studies are warranted to clarify the long-term cardiovascular implications of ACTH therapy in IESS.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 268-274"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520657","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}