Journal of epilepsy research最新文献

{"title":"Deep Brain Stimulation Therapy for Drug-Resistant Epilepsy: Present and Future Perspectives.","authors":"Young-Min Shon, Hea Ree Park, Seunghoon Lee","doi":"10.14581/jer.25004","DOIUrl":"10.14581/jer.25004","url":null,"abstract":"<p><p>Drug-resistant epilepsy (DRE) remains a formidable clinical challenge, affecting nearly 30-40% of patients despite optimized pharmacotherapy. In patients for whom resective surgery is contraindicated or poses unacceptable risks, neuromodulatory therapies-most notably deep brain stimulation (DBS)-have emerged as viable and reversible treatment options. This narrative review critically examines the current applications of DBS for DRE, with a focus on major targets including the anterior thalamic nucleus, centromedian nucleus, hippocampus, and emerging targets such as the pulvinar. We provide an in-depth discussion of the therapeutic mechanisms underlying DBS-from local cellular inhibition and desynchronization to widespread network modulation and neuroplasticity induction-and review the latest advances in sensing technologies, patient-specific connectivity mapping, and closed loop stimulation paradigms. In addition to integrating data from randomized controlled trials, long-term observational studies, and advanced imaging investigations, we discuss limitations, persistent challenges, and future research directions that will guide clinical decision-making and optimize therapeutic outcomes.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"15 1","pages":"33-41"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stigmas in Epilepsy: Systematic Review and Meta-Analysis.","authors":"Matheus Henrique Leite E Silva, João Vitor Sabadine Lima, Iza Paula da Silva Lopes, Ana Carolina Valgas da Silva, Isabela Magalhães Lucchi, Gabriela Padovani Oliveira, Luam Anacleto Mandonça Vieira, Guilherme Octávio Martins Bruno, Elisa de Paula França Resende","doi":"10.14581/jer.25003","DOIUrl":"10.14581/jer.25003","url":null,"abstract":"<p><p>Recent research has disclosed significant associations between stigma suffered by people living with epilepsy (PWE) and psychiatric conditions, especially major depression. These results have practical implication when coupled with the precise regional-and-local prevalences of stigma in its heterogeneous manifestations among PWE. Here we review current research involving stigma in PWE to assess its prevalence and explore psychopathological associations. A systematic review was conducted in PubMed and Scopus to identify clinical trials objectively evaluating prevalence of any type of stigma, enacted and perceived, in PWE, published from database inception to 31 May 2024. A random effects meta-analysis was undertaken, with 6,072 participants, to obtain the meta-prevalence of stigma among PWE. Subgroup analysis moderated by major continent was delineated. A report was obtained from clinical documentation review and adjoined to the evidence generated. From the 105 records identified, 22 studies were eligible for inclusion. The meta-analysis revealed an overall stigma prevalence of 35% (29%; 41%), and subgroups, Africa or Asia (mostly); arbitrarily defined after analysis of geographical study distributions; indicated a prevalence of 40% (34%; 46%) and 28% (21%; 37%), respectively. Significant difference was identified (<i>p</i>=0.03). The case reported exemplifies how stigma may impair development, especially in children and adolescents. Stigmas among PWE are prevalent. More than one in three PWE has already experienced some form of stigma and there is potential to undermine quality of life and associate with psychiatric disorders. PWE may benefit from tailored screening and management approaches to decrease stigma burden.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"15 1","pages":"23-32"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Epilepsy: A Systemic Review.","authors":"Almuntasar Al-Breiki, Said Al-Sinani, Ahmed Elsharaawy, Mohamed Usama, Tariq Al-Saadi","doi":"10.14581/jer.25002","DOIUrl":"10.14581/jer.25002","url":null,"abstract":"<p><p>Diagnosing and managing epilepsy is difficult for doctors. Surgery can help some patients, but it often takes a long time to get there. This research looks at scientific studies to see if artificial intelligence and machine learning (ML) can be used to improve epilepsy treatment. In-depth research was conducted across PubMed, Google Scholar, Scopus, Wiley, Web of Science, and Microsoft Academia. This search focused on studies exploring the use of ML for diagnosing epilepsy, predicting treatment response, and predicting outcomes of epilepsy surgery. The search was limited to original English-language articles published between 2015 and 2022. This review examined 36 studies on using ML to predict epilepsy. The studies fell into four categories: general diagnosis (27), treatment outcome (3), identifying surgical candidates (2), and predicting surgical results (4). Researchers employed a diverse set of data, including symptoms and brain scans, alongside machine learning algorithms like support vector machines and convolutional neural networks, to construct their models. Some models achieved impressive results with areas under the curve reaching up to 0.99, but most studies were limited by small sample sizes and a lack of independent validation. ML shows potential for epilepsy treatment based on initial studies, but real-world use is restricted due to small sample sizes and the need for more validation from other studies. Large collaborative research efforts and data on long-term outcomes are essential before ML can be widely adopted by doctors and make a positive difference for epilepsy patients.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"15 1","pages":"2-22"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brivaracetam, Another Useful Antiseizure Medication.","authors":"Dong Wook Kim","doi":"10.14581/jer.25001","DOIUrl":"10.14581/jer.25001","url":null,"abstract":"","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"15 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Ketamine Needs Caution in NMDA-R Encephalitis Related Status Epilepticus.","authors":"Samhita Panda, Krishna Kanth Ravi, Rohit Kushwah, Sameer Taywade, Sarbesh Tiwari","doi":"10.14581/jer.25008","DOIUrl":"10.14581/jer.25008","url":null,"abstract":"<p><p>Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is characterised by the antibodies decreasing the NMDAR surface density and synaptic localization by selective antibody-mediated capping and internalization of surface NMDAR. Ketamine is a NMDAR antagonist which can produce dose-dependent, self-limiting side effects such as hypersalivation, hyperreflexia, transient clonus, dizziness, nausea, vomiting, tachycardia, hypertension, and detrusor muscle overactivity. A 22-year-old girl presented with recent onset behavioral change, progressive movement disorder and later lapsed into super refractory status epilepticus (SRSE). She was treated with at least four antiseizure medications, immunomodulation as well as anesthetic drugs with only partial relief in status. Ketamine was added for SRSE and led to a significant worsening of clinical symptoms with abatement after stopping. She finally responded to thiopentone infusion. Ketamine has been found to be beneficial in SRSE in encephalitis including anti-NMDAR encephalitis. This is seemingly counterintuitive given how the action of the drug mimics the pathophysiology of the disease. This report highlights the risk of paroxysmal sympathetic hyperactivity and aggravation of clinical and electrographic features of anti-NMDAR encephalitis with ketamine. Hence, ketamine and similar medications acting on the NMDAR should be used with caution in anti-NMDAR encephalitis.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"15 1","pages":"76-79"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Medicinal Cannabis for Epilepsy in the Australian Community 2023-2024: A Cross-Sectional Survey.","authors":"Douglas A D Skene, Iain S McGregor, Lisa Todd, Anastasia Suraev","doi":"10.14581/jer.25006","DOIUrl":"10.14581/jer.25006","url":null,"abstract":"<p><strong>Background and purpose: </strong>Epilepsy is a common indication for medicinal cannabis (MC) prescription in Australia. Despite legal MC products being available for 8 years, some individuals continue to rely on illicit cannabis. Here, we conducted a survey of Australian persons/people with epilepsy (PWE) and caregivers of a PWE to assess whether the current legal framework supports PWE and/or their caregivers to access prescribed MC.</p><p><strong>Methods: </strong>The cross-sectional survey consisted of five sections examining sociodemographics, medical history, history of MC use, attitudes towards MC, and barriers to accessing MC.</p><p><strong>Results: </strong>Of the 126 respondents included in these analyses, 102 were PWE (mean age, 40.9±12.3 years) and 24 were caregivers of a PWE (mean age of PWE, 14.1±8.9 years). Among PWE, 27.5% (28/102) had only used illicit MC products, 27.5% (28/102) had transitioned to prescribed MC products, and 16.7% (17/102) used both. Most caregivers 70.8% (17/24) had only accessed prescribed MC products. Most respondents 77.0% (97/126) reported using MC as an adjunct to conventional anti-seizure medications. Caregivers were more likely to administer prescribed high-cannabidiol products to children using oral routes of administration (<i>p</i><0.001). In contrast, PWE often used inhaled cannabis (<i>p</i><0.001). Overall, 67.0% (83/124) of respondents reported that MC \"improved\" or \"greatly improved\" their epilepsy, irrespective of MC type. The main barrier to accessing prescribed MC was \"cost\" (69.0%, 87/126), while tetrahydrocannabinol (THC)-related driving restrictions were also a significant concern for PWE.</p><p><strong>Conclusions: </strong>The current regulatory framework in Australia supports MC access for PWE and their caregivers, primarily through cannabis clinics. However, cost remains a significant concern. The prevalent use of Δ9-THC-containing and inhaled MC products, either illicit or prescribed, highlights the urgent need to further investigate their safety and efficacy in epilepsy.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"15 1","pages":"56-69"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult-Onset Febrile Infection-Related Epilepsy Syndrome Treated with Short-Term Anakinra.","authors":"Tyler Heinrich, Vishal Pandya","doi":"10.14581/jer.25007","DOIUrl":"10.14581/jer.25007","url":null,"abstract":"<p><p>In this case report, we discuss the oldest patient, at 47-year-old, on record to receive anakinra in treatment for febrile infection-related epilepsy syndrome (FIRES). Additionally, our patient was treated with a shorter course compared to that seen in the current literature. FIRES is rarely seen in adults and remains an area of investigation for best treatment practices due to the refractory and often devastating clinical course. Anakinra is a recombinant interleukin-1 receptor antagonist that effectively targets central nervous system inflammation implicated in the pathogenesis of FIRES. The current literature regarding anakinra use in FIRES mostly represents the pediatric population with dose schedules continued into the chronic phase of the disease. There is a dearth of information regarding the response to anakinra in adult FIRES patients as well as the appropriate treatment duration. This patient presented in focal status epilepticus after 1 week of febrile illness. Focal status epilepticus remained refractory despite these of multiple anti-seizure medications, anesthetics, and steroids. An extensive workup yielded no clear underlying etiology to account for his presentation. Anakinra was started 9 days after seizure onset and continued for 2 weeks. After anakinra initiation, sedative medications were fully weaned within 8 days and all epileptiform activity on electroencephalogram resolved within 2 weeks. The patient eventually returned to his prior cognitive baseline and achieved approximately 1 year of seizure freedom. These outcomes support the use of anakinra in treating adults with FIRES. Further studies with a focus on determining the underlying mechanism that accounts for variability in patient response to anakinra are essential. Such studies may aid in the development of ideal dosing and therapy duration of anakinra in FIRES.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"15 1","pages":"70-75"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brivaracetam: Pharmacology, Clinical Efficacy, and Safety in Epilepsy.","authors":"Heewon Hwang, Won-Joo Kim","doi":"10.14581/jer.25005","DOIUrl":"10.14581/jer.25005","url":null,"abstract":"<p><p>Brivaracetam, a high-affinity synaptic vesicle 2A (SV2A) ligand and propyl analog of levetiracetam, has been approved as an adjunctive and monotherapy option for focal onset seizures in various age groups. This review synthesizes data from both clinical trials and real-world studies to evaluate brivaracetam's efficacy, safety, and tolerability profile. Notably, brivaracetam's rapid penetration across the blood-brain barrier, selective SV2A binding, and favorable pharmacokinetic properties contribute to its robust seizure control capabilities, setting it apart from other antiseizure medications. Studies have shown that brivaracetam consistently achieves significant seizure frequency reductions and high responder rates, demonstrating strong efficacy and an overall favorable safety profile. Importantly, brivaracetam also demonstrates effectiveness in special populations, including older individuals and patients with post-stroke epilepsy, maintaining good tolerability and favorable outcomes and achieving high rates of seizure freedom. Future research should further investigate brivaracetam's utility in broader patient groups to better understand its long-term safety and expand its therapeutic reach. With its unique pharmacological properties, clinical flexibility, and promising safety profile, brivaracetam stands as a valuable addition to current epilepsy treatment options, addressing several unmet needs in seizure management.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"15 1","pages":"42-55"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Perampanel in the Treatment of Lance-Adams Syndrome.","authors":"Vishal Pandya, Khalil S Husari","doi":"10.14581/jer.24016","DOIUrl":"10.14581/jer.24016","url":null,"abstract":"<p><p>Lance Adams syndrome (LAS) is characterized by chronic action or intention myoclonus resulting from cerebral hypoxia. Perampanel, a non-competitive antagonist of aamino-3-hydroxy-5methyl-4 isooxazoleproprionic acid glutamate receptor, has demonstrated some efficacy in myoclonic epilepsy and other types of myoclonus. We report significant benefit in a patient with LAS treated with add on perampanel and provide a review of the relevant literature. In our case, a male patient in his 30s was found pulseless with unknown down time. The patient developed post anoxic myoclonus within 1 week from cardiac arrest. Patient continued to suffer from intractable myoclonus despite being treated with brivaracetam, valproic acid, and clonazepam. Perampanel was added to his medication regimen and up-titrated to 12 mg daily over 1-2 weeks. This resulted in significant improvement in frequency and severity of myoclonus for about 6 months. Growing evidence exists for perampanel as an adjunctive treatment in patients with post hypoxic myoclonus or LAS. A review of the available literature, comprised of case reports and case series, and suggests a potential role for perampanel in patients with LAS. Further study is warranted including controlled trials of perampanel use in post hypoxic myoclonus.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"14 2","pages":"97-101"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Perampanel for First-Episode Seizures versus Usual Care on Clinical Outcome and Safety Profile Aspects of the Thai Experience.","authors":"Panu Boontoterm, Siraruj Sakoolnamarka, Karanarak Urasyanandana, Pusit Fuengfoo","doi":"10.14581/jer.24014","DOIUrl":"10.14581/jer.24014","url":null,"abstract":"<p><strong>Background and purpose: </strong>Epilepsy increases poor outcomes in patients with post-traumatic brain injury and brain tumor-related epilepsy, for whom early seizure control is essential. Perampanel (PER) was a known third-generation antiepileptic drug for treatment all types of seizures. The objective of the study is to compare clinical outcomes and safety of PER administration as monotherapy.</p><p><strong>Methods: </strong>A prospective study of all 84 patients assigned to PER monotherapy (PER group, n=36) and other first-line antiepileptic drugs (n=48). Clinical outcomes parameters were measured by the prevalence of patients with a diminish in seizure frequency at 50% in 28 days. From November 1, 2020 to April 30, 2024, comparing the PER group with usual care. Clinical outcomes included adherence rate and seizure-free proportion at 28 days and 6 months. Adverse drug reactions were recorded in both groups.</p><p><strong>Results: </strong>There was no difference in demographic data and incidence of adverse drug reactions between two groups. Median PER dosage was 4 mg (range, 2-12 mg). Compared to other antiepileptic drugs, the PER group had a prevalence of 50% responder rate at 28 days and 6 months significantly were 75%, 81%, 65%, and 51% respectively. Common adverse drug reactions were somnolence and dizziness.</p><p><strong>Conclusions: </strong>PER administration as monotherapy demonstrated good efficacy and less adverse drug reactions. Low dosages helped to decrease adverse drug reactions and improved retention rate.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"14 2","pages":"81-93"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}