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WONOEP appraisal: Targeted therapy development for early onset epilepsies. WONOEP 评估:针对早发性癫痫的靶向疗法开发。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-19 DOI: 10.1111/epi.18187
Pablo M Casillas-Espinosa, Jennifer C Wong, Wanda Grabon, Ana Gonzalez-Ramos, Massimo Mantegazza, Nihan Carcak Yilmaz, Manisha Patel, Kevin Staley, Raman Sankar, Terence J O'Brien, Özlem Akman, Ganna Balagura, Adam L Numis, Jeffrey L Noebels, Stéphanie Baulac, Stéphane Auvin, David C Henshall, Aristea S Galanopoulou

The early onset epilepsies encompass a heterogeneous group of disorders, some of which result in drug-resistant seizures, developmental delay, psychiatric comorbidities, and sudden death. Advancement in the widespread use of targeted gene panels as well as genome and exome sequencing has facilitated the identification of different causative genes in a subset of these patients. The ability to recognize the genetic basis of early onset epilepsies continues to improve, with de novo coding variants accounting for most of the genetic etiologies identified. Although current disease-specific and disease-modifying therapies remain limited, novel precision medicine approaches, such as small molecules, cell therapy, and other forms of genetic therapies for early onset epilepsies, have created excitement among researchers, clinicians, and caregivers. Here, we summarize the main findings of presentations and discussions on novel therapeutic strategies for targeted treatment of early onset epilepsies that occurred during the Workshop on Neurobiology of Epilepsy (WONOEP XVI, Talloires, France, July 2022). The presentations discussed the use of chloride transporter inhibitors for neonatal seizures, targeting orexinergic signaling for childhood absence epilepsy, targeting energy metabolism in Dravet syndrome, and the role of cannabinoid receptor type 2, reversible acetylcholinesterase inhibitors, cell therapies, and RNA-based therapies in early life epilepsies.

早发性癫痫包括一组异质性疾病,其中一些会导致耐药性癫痫发作、发育迟缓、精神并发症和猝死。随着靶向基因组以及基因组和外显子组测序技术的广泛应用,在这些患者中发现不同致病基因的工作取得了进展。识别早发性癫痫遗传基础的能力不断提高,新编码变异占已发现遗传病因的大多数。尽管目前针对特定疾病和改变疾病的疗法仍然有限,但小分子、细胞疗法和其他形式的早发性癫痫基因疗法等新型精准医疗方法在研究人员、临床医生和护理人员中引起了热烈反响。在此,我们总结了癫痫神经生物学研讨会(WONOEP XVI,法国塔卢瓦,2022 年 7 月)期间关于早发性癫痫靶向治疗的新型治疗策略的演讲和讨论的主要结果。发言讨论了氯化物转运体抑制剂在新生儿癫痫发作中的应用、针对儿童失神癫痫的奥曲肽能信号转导、针对Dravet综合征的能量代谢,以及大麻素受体2型、可逆性乙酰胆碱酯酶抑制剂、细胞疗法和基于RNA的疗法在早发性癫痫中的作用。
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引用次数: 0
Automatic responsiveness testing in epilepsy with wearable technology: The ARTiE Watch. 利用可穿戴技术自动测试癫痫患者的反应能力:ARTiE Watch。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-19 DOI: 10.1111/epi.18181
Lydia Wheeler, Vaclav Kremen, Cole Mersereau, Guillermo Ornelas, Taruna Yadav, Devon Cormier, Allyson Derry, Andrea Duque Lopez, Kevin McQuown, Vladimir Sladky, Christopher Benjamin, Joseph Giacino, Gregory Worrell, Hal Blumenfeld

Objective: An accurate evaluation of behavioral responsiveness during and after seizures in people with epilepsy is critical for diagnosis and management. Current methods for assessing behavioral responsiveness are characterized by substantial variation, subjectivity, and limited reliability and reproducibility in ambulatory and epilepsy monitoring unit settings. In this study, we aimed to develop and implement a novel mobile platform for deployment of automated responsiveness testing in epilepsy-the ARTiE Watch-to facilitate standardized, objective assessments of behavioral responsiveness during and after seizures.

Methods: We prospectively recruited patients admitted to the epilepsy monitoring units for diagnostic evaluation and long-term video-electroencephalographic monitoring at Mayo Clinic and Yale New Haven Hospital. Participants wore the ARTiE Watch, a smartwatch paired with custom smartphone software integrated with cloud infrastructure allowing for remote activation of standardized assessment on the participants' smartwatches. The assessment consisted of 18 command prompts that test behavioral responsiveness across motor, language, and memory domains. Upon visually identifying an electrographic seizure during EMU monitoring, the BrainRISE platform was used to deploy the ARTiE Watch behavioral testing sequence. Responsiveness scoring was conducted on smartwatch files.

Results: Eighteen of 56 participants had a total of 39 electrographic seizures assessed with the ARTiE Watch. The 18 subjects with ARTiE Watch-tested seizures had a total of 67 baseline (interictal) ARTiE Watch tests collected for analysis. The analysis showed distinct ARTiE Watch behavioral responsiveness phenotypes: (1) decreased responsiveness across all ARTiE Watch commands during seizure (ictal-postictal) periods compared (to baseline (p < .0001), (2) decreased responsiveness in bilateral tonic-clonic seizures compared to baseline (p < .0001) and compared to focal seizures (p < .0001), and (3) decreased responsiveness during focal impaired awareness seizures compared to baseline (p < .0001) and compared to focal aware seizures (p < .001).

Significance: ARTiE Watch behavioral testing deployed utilizing a mobile cloud-based platform is feasible and can provide standardized, objective behavioral responsiveness assessments during seizures.

目的:准确评估癫痫患者发作期间和发作后的行为反应性对于诊断和管理至关重要。目前评估行为反应性的方法存在很大的差异和主观性,而且在门诊和癫痫监测单位环境中的可靠性和可重复性有限。在这项研究中,我们旨在开发和实施一种新型移动平台,用于部署癫痫的自动反应性测试--ARTiE Watch,以促进对癫痫发作期间和发作后的行为反应性进行标准化的客观评估:我们前瞻性地招募了梅奥诊所和耶鲁纽黑文医院癫痫监测室的入院患者,对其进行诊断评估和长期视频脑电图监测。参与者佩戴ARTiE手表,这是一款智能手表,搭配与云基础设施集成的定制智能手机软件,可在参与者的智能手表上远程激活标准化评估。评估包括 18 个指令提示,用于测试运动、语言和记忆领域的行为反应能力。在 EMU 监测过程中目测到电图癫痫发作后,BrainRISE 平台将用于部署 ARTiE Watch 行为测试序列。响应性评分在智能手表文件上进行:56 名受试者中有 18 人使用 ARTiE Watch 共评估了 39 次电图癫痫发作。这 18 名接受 ARTiE Watch 测试的受试者共进行了 67 次基线(发作间期)ARTiE Watch 测试以进行分析。分析结果显示了明显的 ARTiE Watch 行为反应表型:(1) 与基线相比,癫痫发作(发作间期-发作后)期间所有 ARTiE Watch 命令的反应性均降低(p < .0001),(2) 与基线相比,双侧强直阵挛发作的反应性降低(p 有意义:利用移动云平台部署 ARTiE Watch 行为测试是可行的,可以在癫痫发作期间提供标准化、客观的行为反应评估。
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引用次数: 0
Epilepsia – November 2024 Announcements 癫痫杂志 - 2024 年 11 月公告
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-18 DOI: 10.1111/epi.18130
<p> <b>Pediatric Epilepsy Surgery: From basics to advancements</b> </p><p>7–10 November 2024</p><p>Cochin, India</p><p> <b>7th East Mediterranean Epilepsy Congress</b> </p><p>14–16 November 2024</p><p>Manama, Bahrain</p><p> <b>7th East Mediterranean Epilepsy Congress</b> </p><p>12–15 December 2024</p><p>Baghdad, Iraq</p><p> <b>14th ILAE School on Pre-Surgical Evaluation for Epilepsy and Epilepsy Surgery</b> </p><p>20–24 January 2025</p><p>Brno, Czech Republic</p><p> <b>15th Asian & Oceanian Epilepsy Congress</b> </p><p>20–23 February 2025</p><p>New Delhi, India</p><p> <b>18th Latin American Summer School on Epilepsy</b> </p><p>7–15 March 2025</p><p>São Paulo, Brazil</p><p> <b>7th ILAE School on EEG in the First Year of Life</b> </p><p>26–27 April 2025</p><p>Sanya City, Hainan, China</p><p> <b>5th African Epilepsy Congress</b> </p><p>1–31 May 2025</p><p>Africa</p><p> <b>XVIII Workshop on Neurobiology of Epilepsy (WONOEP 2025)</b> </p><p>25–29 August 2025</p><p>Portugal</p><p> <b>36th International Epilepsy Congress</b> </p><p>30 August–3 September 2025</p><p>Lisbon, Portugal</p><p> <b>16th European Epilepsy Congress</b> </p><p>5–9 September 2026</p><p>Athens, Greece</p><p> <b>HIV and Epilepsy</b> </p><p>5 November 2024</p><p> <b>Caribbean Nurses Epilepsy Web Conference</b> </p><p>18 November 2024</p><p> <b>ILAE e-Forum: Optimal timing for epilepsy surgery</b> </p><p>25 November 2024</p><p> <b>ILAE-YES Eastern Mediterranean Journal Club</b> </p><p>26 November 2024</p><p> <b>Services aux épileptiques dans les contextes à ressources limitées</b> </p><p>26 November 2024</p><p> <b>Epilepsy diagnosis when the routine ancillary tests are normal</b> </p><p>29 November 2024</p><p> <b>Barriers to Care Pathways</b> </p><p>3 December 2024</p><p> <b>Self Limiting Epilepsy</b> </p><p>6 December 2024</p><p> <b>2nd Annual Canadian Paediatric SEEG Conference</b>
小儿癫痫外科手术:2024 年 11 月 7-10 日印度科钦 2024 年 11 月 14-16 日巴林麦纳麦 2024 年 12 月 12-15 日伊拉克巴格达 2025 年 1 月 20-24 日捷克共和国布尔诺 2025 年 2 月 20-23 日印度新德里 2025 年 3 月 7-15 日巴西圣保罗 2025 年 3 月 7-15 日第 7 届 ILAE 癫痫术前评估和癫痫手术学校2025 年 2 月 20-23 日印度新德里 第 18 届拉丁美洲癫痫暑期学校 2025 年 3 月 7-15 日巴西圣保罗 第 7 届 ILAE 生命第一年脑电图学校 2025 年 4 月 26-27 日海南三亚市、2025 年 8 月 25-29 日葡萄牙第 36 届国际癫痫大会 2025 年 8 月 30 日至 9 月 3 日葡萄牙里斯本第 16 届欧洲癫痫大会 2026 年 9 月 5-9 日希腊雅典艾滋病毒与癫痫 2024 年 11 月 5 日加勒比护士癫痫网络会议 2024 年 11 月 18 日 ILAE 电子论坛:2024 年 11 月 25 日 ILAE-YES 东地中海期刊俱乐部 2024 年 11 月 26 日 资源有限情况下的癫痫服务 2024 年 11 月 26 日 常规辅助检查正常时的癫痫诊断 2024 年 11 月 29 日 护理路径的障碍 2024 年 12 月 3 日 自我限制性癫痫 2024 年 12 月 6 日 第二届加拿大儿科 SEEG 年度会议 2024 年 11 月 1-3 日伦敦、2024 年 11 月 1 日至 3 日加拿大安大略省伦敦 2024 年 11 月 6 日至 8 日澳大利亚塔斯马尼亚州霍巴特 2024 年 11 月 6 日至 8 日澳大利亚塔斯马尼亚州霍巴特 2024 年 11 月 7 日至 9 日突尼斯斯法克斯 2024 年 11 月 7 日至 9 日法语小儿癫痫培训 1 2024 年 11 月 7 日至 9 日突尼斯斯法克斯小儿癫痫手术:2024 年 11 月 7-10 日 印度科钦 第二期耐药性癫痫 (DRE) 药物治疗高级课程:2024 年 11 月 8-10 日西班牙马略卡岛帕尔马 2024 年 11 月 9 日英国伯明翰 41ra Conferencia Epilepsia del Caribe 2024 年 11 月 9 日圣胡安、波多黎各儿科癫痫培训 2024 年 11 月 21 日赞比亚第二届癫痫教学课程 2024 年 11 月 28-29 日乍得恩贾梅纳 3° Corso Pratico Residenziale 2024 年 11 月 29 日至 12 月 1 日意大利罗马 2024 年脑炎 2024 年 12 月 2-3 日英国伦敦 &amp;2024 年 12 月 6 日至 7 日利比亚的黎波里 AES 2024 年年会 2024 年 12 月 6 日至 10 日美国加利福尼亚州洛杉矶 IBRO/ILAE 癫痫学校 2024 年 12 月 9 日至 12 日刚果民主共和国金沙萨 寻找失去的时间 5 202 年 12 月 16 日至 18 日意大利罗马 2025 年 1 月 8 日至 10 日圣地亚哥拉丁美洲遗传癫痫第 1 次大会 2025 年 1 月 8 日至 10 日智利圣地亚哥、2025 年 3 月 20-22 日捷克共和国布拉格 2025 年 3 月 26-29 日奥地利萨尔茨堡 2025 年 3 月 26-29 日奥地利 AD/PD™ 2025 年 3 月 26-29 日德国和奥地利癫痫病学会及瑞士癫痫病联盟第 13 届三国会议
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引用次数: 0
Association of cognitive and structural correlates of brain aging and incident epilepsy. The Framingham Heart Study. 大脑老化的认知和结构相关性与癫痫发病的关系。弗雷明汉心脏研究。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-18 DOI: 10.1111/epi.18160
Maria Stefanidou, Jayandra J Himali, Rebecca Bernal, Claudia Satizabal, Orrin Devinsky, Jose R Romero, Alexa S Beiser, Sudha Seshadri, Daniel Friedman

Objectives: Late-onset epilepsy has the highest incidence among all age groups affected by epilepsy and often occurs in the absence of known clinical risk factors such as stroke and dementia. There is increasing evidence that brain changes contributing to epileptogenesis likely start years before disease onset, and we aim to relate cognitive and imaging correlates of subclinical brain injury to incident late-onset epilepsy in a large, community-based cohort.

Methods: We studied Offspring Cohort of the Framingham Heart Study participants 45 years or older, who were free of prevalent stroke, dementia, or epilepsy, and had neuropsychological (NP) evaluation and brain magnetic resonance imaging (MRI). Cognitive measures included Visual Reproduction Delayed Recall, Logical Memory Delayed Recall, Similarities, Trail Making Test B minus A (TrTB-TrTA; attention and executive function), and a global measure of cognition derived from principal component analysis. MRI measures included total cerebral brain volume, cortical gray matter volume (CGMV), white matter hyperintensity volume (WMHV), and hippocampal volume. Incident epilepsy was identified through a review of administrative data and medical records. Cox proportional hazards regression models were used for the analyses. All analyses were adjusted for age, sex, and educational level (cognition only).

Results: Among participants who underwent NP testing (n = 2349, 45.81% male), 31 incident epilepsy cases were identified during follow-up. Better performance on the TrTB-TrTA was associated with a lower risk of developing epilepsy (hazard ratio [HR] .25, 95% confidence interval [CI] .08-.73; p = .011). In the subgroup of participants with MRI (n = 2056, 46.01% male), 27 developed epilepsy. Higher WMHV was associated with higher epilepsy risk (HR 1.5, 95%CI 1.01-2.20; p = .042), but higher CGMV (HR .73, 95% CI .57-.93; p = .001) was associated with lower incidence of epilepsy.

Significance: Better performance on the (TrTB-TrTA), a measure of executive function and attention, and higher cortical volumes are associated with lower risk of developing epilepsy. Conversely, higher WMHV, a measure of occult vascular injury, increases the risk. Our study shows that non-invasive tests performed in mid-life may help identify people at risk for developing epilepsy later in life.

目的:在所有受癫痫影响的年龄组中,晚发性癫痫的发病率最高,而且往往在没有中风和痴呆等已知临床风险因素的情况下发生。越来越多的证据表明,导致癫痫发生的脑部变化可能在发病前数年就已开始,我们的目的是在一个大型社区队列中将亚临床脑损伤的认知和影像学相关因素与晚发性癫痫的发生联系起来:我们研究了弗雷明汉心脏研究后代队列中 45 岁或以上的参与者,他们没有流行性中风、痴呆或癫痫,并进行了神经心理学(NP)评估和脑磁共振成像(MRI)。认知测量包括视觉再现延迟回忆、逻辑记忆延迟回忆、相似性、路径制作测试 B 减 A(TrTB-TrTA;注意力和执行功能),以及通过主成分分析得出的整体认知测量。核磁共振成像测量包括大脑总体积、皮质灰质体积(CGMV)、白质高密度体积(WMHV)和海马体积。通过审查管理数据和医疗记录,确定了癫痫的发病情况。分析采用 Cox 比例危险回归模型。所有分析均已对年龄、性别和教育水平(仅认知水平)进行调整:在接受 NP 测试的参与者中(n = 2349,45.81% 为男性),随访期间发现了 31 例癫痫事件。TrTB-TrTA成绩越好,患癫痫的风险越低(危险比 [HR] .25,95% 置信区间 [CI] .08-.73;P = .011)。在有核磁共振成像的参与者亚组(n = 2056,46.01% 为男性)中,有 27 人罹患癫痫。较高的 WMHV 与较高的癫痫风险相关(HR 1.5,95%CI 1.01-2.20;p = .042),但较高的 CGMV(HR .73,95%CI .57-.93;p = .001)与较低的癫痫发病率相关:意义:在衡量执行功能和注意力的(TrTB-TrTA)测试中表现较好以及皮质体积较高与癫痫发病风险较低有关。相反,衡量隐性血管损伤的 WMHV 值越高,患病风险越大。我们的研究表明,在中年时进行的非侵入性测试可能有助于识别日后罹患癫痫的风险人群。
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引用次数: 0
High-dose folic acid use and cancer risk in women who have given birth: A register-based cohort study. 产妇服用高剂量叶酸与癌症风险:一项基于登记的队列研究。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-14 DOI: 10.1111/epi.18146
Håkon Magne Vegrim, Julie Werenberg Dreier, Jannicke Igland, Silje Alvestad, Nils Erik Gilhus, Mika Gissler, Maarit K Leinonen, Torbjörn Tomson, Helga Zoega, Jakob Christensen, Marte-Helene Bjørk

Objective: This study was undertaken to study whether high-dose folic acid (>1 mg daily) use is associated with an increased risk of cancer in all women who have given birth and in women with epilepsy. High-dose folic acid supplementation during pregnancy has been linked to increased cancer risk in children born to mothers with epilepsy.

Methods: We identified women with their first pregnancy in Denmark (1997-2017), Norway (2005-2017), and Sweden (2006-2017) using medical birth registers, linking individual data across nationwide health registers and statistical agencies. Exposure was defined as filled prescriptions for high-dose folic acid, considered time-varyingly. The primary outcome was the first malignant cancer diagnosis. Hazard ratios (HRs) of cancer after high-dose folic acid exposure were estimated using Cox proportional hazard models with 95% confidence intervals (CIs), adjusted for confounders including antiseizure medication (ASM) use, and stratified by maternal epilepsy diagnosis. A 6-month time lag was applied, as cancer is unlikely to develop immediately.

Results: With up to 21 years of follow-up, we identified 1 465 785 women who gave birth, including 64 485 (4.4%) exposed to high-dose folic acid. In the exposed group, 755 cancer cases were observed (208 per 100 000 person-years, 95% CI = 193.8-223.5), compared with 18 702 cases in the unexposed group (164 per 100 000 person-years, 95% CI = 161.5-166.2), yielding a 20% increased cancer risk overall (adjusted HR = 1.2, 95% CI = 1.1-1.2). This risk was attenuated after the 6-month lag analysis (adjusted HR = 1.1, 95% CI = 1.04-1.2). The risk for non-Hodgkin lymphoma was increased in all analyses (n = 28, adjusted HR = 2.0, 95% CI = 1.3-2.9). The association between high-dose folic acid use and overall cancer risk was similar in those with epilepsy regardless of ASM use (adjusted HR = 1.3, 95% CI = 1.0-1.8).

Significance: High-dose folic acid use was associated with increased overall cancer risk in women who have given birth, with a consistent association with non-Hodgkin lymphoma, including those with epilepsy, regardless of ASM use.

研究目的本研究旨在探讨服用大剂量叶酸(每天>1毫克)是否会增加所有产妇和癫痫妇女患癌症的风险。怀孕期间补充高剂量叶酸与癫痫母亲所生子女患癌风险增加有关:我们使用出生医学登记册对丹麦(1997-2017 年)、挪威(2005-2017 年)和瑞典(2006-2017 年)的首次怀孕妇女进行了识别,并将全国范围内的健康登记册和统计机构的个人数据联系起来。暴露被定义为已开具的高剂量叶酸处方,考虑时间变化。主要结果是首次恶性癌症诊断。使用带有 95% 置信区间 (CI) 的 Cox 比例危险模型估算了暴露于高剂量叶酸后癌症的危险比 (HRs),并对包括使用抗癫痫药物 (ASM) 在内的混杂因素进行了调整,同时根据孕产妇癫痫诊断进行了分层。由于癌症不可能立即发生,因此采用了6个月的时间滞后:在长达 21 年的随访中,我们发现了 1 465 785 名产妇,其中包括 64 485 名(4.4%)暴露于高剂量叶酸的产妇。在暴露组中,观察到 755 例癌症病例(每 10 万人年 208 例,95% CI = 193.8-223.5),而未暴露组中有 18 702 例(每 10 万人年 164 例,95% CI = 161.5-166.2),总体癌症风险增加了 20%(调整后 HR = 1.2,95% CI = 1.1-1.2)。经过 6 个月的滞后分析,这一风险有所降低(调整后 HR = 1.1,95% CI = 1.04-1.2)。在所有分析中,非霍奇金淋巴瘤的风险都有所增加(n = 28,调整后HR = 2.0,95% CI = 1.3-2.9)。在癫痫患者中,无论是否使用ASM,使用大剂量叶酸与总体癌症风险之间的关系相似(调整后HR = 1.3,95% CI = 1.0-1.8):使用大剂量叶酸与生育过的妇女患癌症的总体风险增加有关,与非霍奇金淋巴瘤的关系一致,包括癫痫患者,与使用ASM与否无关。
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引用次数: 0
Epilepsy-pregnancy registries: An update. 癫痫-怀孕登记:更新。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-14 DOI: 10.1111/epi.18180
Piero Perucca, Dina Battino, Rebecca Bromley, Lei Chen, John Craig, Sonia Hernandez-Diaz, Lewis B Holmes, Kiren G Koshy, Kimford J Meador, Ramshekhar N Menon, Terence J O'Brien, Page B Pennell, Dong Zhou, Torbjörn Tomson

This report is the first comprehensive update on the activities of existing epilepsy-pregnancy registries since 2010. The primary aim of these registries, which were initiated by independent international research groups some 25 years ago, has been to assess the risk of major congenital malformations (MCMs) in offspring exposed in utero to different antiseizure medications (ASMs). Progress reports are provided here from the five original registries (the International Registry of Antiepileptic Drugs and Pregnancy EURAP, the North American Antiepileptic Drug Pregnancy Registry, the UK and Ireland Epilepsy and Pregnancy Register, the Kerala Registry of Epilepsy and Pregnancy, and the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs) plus the more recently initiated West China Registry. Since their inception, the registries have published a wealth of data revealing important differences in risks across the most frequently used ASM treatments, thereby facilitating rational management of women with epilepsy who are of childbearing potential. Although the number of pregnancies enrolled in the different registries has more than doubled since the 2010 report, many questions remain. These include outcomes following prenatal exposure to most of the newer ASMs or different ASM combinations, as well as associations with specific MCMs rather than MCMs as a collective. All the registries, therefore, remain active and continue to enroll pregnancies. Administrative health care databases have been utilized more recently for the assessment of MCM risks and other adverse pregnancy outcomes associated with in utero exposure to ASMs. Although these can provide population-based complementary information, they cannot replace the specific epilepsy-pregnancy registries with their more detailed validated individual information. Given the multiple newer ASMs that are increasingly used and the continuing multiple knowledge gaps for the older ASMs, epilepsy-pregnancy registries will continue to play an important role in the future.

本报告是自 2010 年以来对现有癫痫-怀孕登记活动的首次全面更新。这些登记项目由独立的国际研究小组在大约 25 年前发起,其主要目的是评估子宫内暴露于不同抗癫痫药物 (ASM) 的后代发生重大先天畸形 (MCM) 的风险。本文提供了五个原始登记处(国际抗癫痫药物和妊娠登记处 EURAP、北美抗癫痫药物妊娠登记处、英国和爱尔兰癫痫和妊娠登记处、喀拉拉邦癫痫和妊娠登记处、拉乌尔-沃伦贝格澳大利亚抗癫痫药物妊娠登记处)以及最近启动的中国西部登记处的进展报告。自成立以来,这些登记处已公布了大量数据,揭示了最常用的 ASM 治疗在风险方面的重要差异,从而促进了对有生育能力的女性癫痫患者的合理管理。尽管自 2010 年报告发布以来,不同登记处登记的妊娠数量增加了一倍多,但许多问题依然存在。这些问题包括产前暴露于大多数较新的 ASM 或不同 ASM 组合后的结果,以及与特定 MCMs 而非 MCMs 整体的关联。因此,所有登记处都保持活跃,并继续登记孕妇。最近,人们开始利用行政医疗保健数据库来评估与子宫内接触 ASM 相关的含甲状腺激素风险和其他不良妊娠结局。虽然这些数据库可以提供基于人群的补充信息,但它们无法取代特定的癫痫-妊娠登记册及其更详细的经过验证的个体信息。鉴于越来越多地使用多种较新的 ASM,而对较老的 ASM 仍存在多种知识缺口,癫痫-怀孕登记册在未来将继续发挥重要作用。
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引用次数: 0
Expert level of detection of interictal discharges with a deep neural network. 利用深度神经网络对发作间期放电进行专家级检测。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-12 DOI: 10.1111/epi.18164
Marleen C Tjepkema-Cloostermans, Martijn R Tannemaat, Luuk Wieske, Anne-Fleur van Rootselaar, Bas C Stunnenberg, Hanneke M Keijzer, Johannes H T M Koelman, Selma C Tromp, Ioana Dunca, Baukje J van der Star, Myrthe E de Koning, Michel J A M van Putten

Objective: Deep learning methods have shown potential in automating the detection of interictal epileptiform discharges (IEDs) in electroencephalography (EEG). We compared IED detection using our previously trained deep neural network with a group of experts to assess its potential applicability.

Methods: First, we performed clinical validation on an internal data set. Seven experts reviewed all EEG studies. Performance agreement between experts and the network was compared at both the EEG and IED levels. All EEG recordings were also processed with Persyst. Subsequently, we performed external validation, with data from four centers, using a hybrid approach, where detections by the deep neural network were reviewed by an expert. In case of disagreement with the original report, the EEG recording was annotated independently by five experts.

Results: For internal validation we included 22 EEG studies with IEDs and 28 EEG studies from controls. At the EEG level, our network showed performance similar to that of the experts. For individual IED detection, the sensitivities between experts ranged from 20.7%-86.4%, whereas the sensitivity of our network was 82.5% (confidence interval [CI]: 77.7%-87.4%) at 99% specificity and a false detection rate (FDR) of <.2/min, outperforming Persyst, with 64.6% sensitivity (CI: 61.4%-67.9%) at 98% specificity. External validation in 174 EEG studies demonstrated that all 85 EEG recordings classified as normal in the original report were classified correctly, with an FDR of .10/min. Of the 89 EEG studies with IEDs according to the report, 56 were correctly classified (Cohen's κ = .62). Visual analysis of the remaining 33 EEG recordings showed high interobserver variability among the five experts (Fleiss' κ = .13).

Significance: Our deep neural network detects IEDs on par with clinical experts. The external validation in a hybrid approach showed substantial agreement with the original report. Disagreement was due mainly to high interobserver variability. Our deep neural network may support visual EEG analysis and assist in diagnostics, particularly when human resources are limited.

目的:深度学习方法在自动检测脑电图(EEG)中发作间期癫痫样放电(IED)方面已显示出潜力。我们比较了使用我们先前训练的深度神经网络和一组专家进行的 IED 检测,以评估其潜在的适用性:首先,我们在内部数据集上进行了临床验证。七位专家审查了所有脑电图研究。比较了专家和网络在 EEG 和 IED 水平上的性能一致性。所有脑电图记录也都用 Persyst 进行了处理。随后,我们利用来自四个中心的数据,采用混合方法进行了外部验证,由一名专家对深度神经网络的检测结果进行复核。如果与原始报告存在分歧,则由五位专家对脑电图记录进行独立注释:为了进行内部验证,我们纳入了 22 项 IED 脑电图研究和 28 项对照组脑电图研究。在脑电图层面,我们的网络显示出与专家相似的性能。对于单个 IED 的检测,专家们的灵敏度在 20.7%-86.4% 之间,而我们网络的灵敏度为 82.5%(置信区间 [CI]:77.7%-87.4%),特异性为 99%,误检率 (FDR) 为显著性:我们的深度神经网络在检测 IED 方面与临床专家不相上下。采用混合方法进行的外部验证显示,我们的结果与原始报告基本一致。不一致的主要原因是观察者之间的高变异性。我们的深度神经网络可支持视觉脑电图分析并协助诊断,尤其是在人力资源有限的情况下。
{"title":"Expert level of detection of interictal discharges with a deep neural network.","authors":"Marleen C Tjepkema-Cloostermans, Martijn R Tannemaat, Luuk Wieske, Anne-Fleur van Rootselaar, Bas C Stunnenberg, Hanneke M Keijzer, Johannes H T M Koelman, Selma C Tromp, Ioana Dunca, Baukje J van der Star, Myrthe E de Koning, Michel J A M van Putten","doi":"10.1111/epi.18164","DOIUrl":"https://doi.org/10.1111/epi.18164","url":null,"abstract":"<p><strong>Objective: </strong>Deep learning methods have shown potential in automating the detection of interictal epileptiform discharges (IEDs) in electroencephalography (EEG). We compared IED detection using our previously trained deep neural network with a group of experts to assess its potential applicability.</p><p><strong>Methods: </strong>First, we performed clinical validation on an internal data set. Seven experts reviewed all EEG studies. Performance agreement between experts and the network was compared at both the EEG and IED levels. All EEG recordings were also processed with Persyst. Subsequently, we performed external validation, with data from four centers, using a hybrid approach, where detections by the deep neural network were reviewed by an expert. In case of disagreement with the original report, the EEG recording was annotated independently by five experts.</p><p><strong>Results: </strong>For internal validation we included 22 EEG studies with IEDs and 28 EEG studies from controls. At the EEG level, our network showed performance similar to that of the experts. For individual IED detection, the sensitivities between experts ranged from 20.7%-86.4%, whereas the sensitivity of our network was 82.5% (confidence interval [CI]: 77.7%-87.4%) at 99% specificity and a false detection rate (FDR) of <.2/min, outperforming Persyst, with 64.6% sensitivity (CI: 61.4%-67.9%) at 98% specificity. External validation in 174 EEG studies demonstrated that all 85 EEG recordings classified as normal in the original report were classified correctly, with an FDR of .10/min. Of the 89 EEG studies with IEDs according to the report, 56 were correctly classified (Cohen's κ = .62). Visual analysis of the remaining 33 EEG recordings showed high interobserver variability among the five experts (Fleiss' κ = .13).</p><p><strong>Significance: </strong>Our deep neural network detects IEDs on par with clinical experts. The external validation in a hybrid approach showed substantial agreement with the original report. Disagreement was due mainly to high interobserver variability. Our deep neural network may support visual EEG analysis and assist in diagnostics, particularly when human resources are limited.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring multimodal biomarker candidates of post-traumatic epilepsy following moderate to severe traumatic brain injury: A systematic review and meta-analysis. 探索中重度脑外伤后创伤性癫痫的多模式生物标记候选物:系统综述和荟萃分析。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-12 DOI: 10.1111/epi.18131
Alexander A Bruckhaus, Tuba Asifriyaz, Kseniia Kriukova, Terence J O'Brien, Denes V Agoston, Richard J Staba, Nigel C Jones, Solomon L Moshé, Aristea S Galanopoulou, Dominique Duncan

This review systematically analyzes potential biomarker candidates for post-traumatic epilepsy (PTE) in humans who have experienced moderate to severe traumatic brain injury (TBI). Focusing on biomarkers across biofluid-based protein, genetic, neuroimaging, and neurophysiological categories, this review distinguishes between TBI patients who develop PTE and those who do not. The review adheres to established methodologies outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Data presentation follows the Meta-analyses of Observational Studies (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, Embase, and Web of Science were systematically searched and yielded 7538 records, of which 18 met inclusion criteria (moderate-severe TBI in humans, follow-up of at least 6 months, and no prior history of epilepsy). The review aggregates data from 15 cohort and 3 case-control studies (risk of bias was assessed using the Newcastle-Ottawa Scale). Statistically significant biomarkers were identified, with neurophysiological biomarkers showing the strongest effect size in a two-study meta-analysis. PTE, a severe long-term outcome of TBI affecting 2% to 53% of individuals with TBI, lacks validated biomarkers for forecasting development, crucial for designing preventive clinical trials. A multimodal approach, integrating biofluid-based protein, genetic, neuroimaging, and neurophysiological data, offers a promising strategy to enhance the predictability of PTE development and, potentially, its treatment. The study's protocol is registered in the International Prospective Register of Systematic Reviews PROSPERO (Registration ID: CRD42023470245).

本综述系统分析了中重度创伤性脑损伤(TBI)患者创伤后癫痫(PTE)的潜在候选生物标志物。本综述侧重于基于生物流体的蛋白质、基因、神经影像学和神经生理学类别的生物标志物,并对发生 PTE 的创伤性脑损伤患者和未发生 PTE 的创伤性脑损伤患者进行了区分。本综述遵循《科克伦干预措施系统综述手册》中概述的既定方法。数据展示遵循观察性研究元分析 (MOOSE) 和系统综述和元分析首选报告项目 (PRISMA) 指南。对 Medline、Embase 和 Web of Science 进行了系统检索,共获得 7538 条记录,其中 18 条符合纳入标准(人体中度严重创伤性脑损伤、随访至少 6 个月、既往无癫痫病史)。综述汇总了 15 项队列研究和 3 项病例对照研究的数据(偏倚风险采用纽卡斯尔-渥太华量表进行评估)。研究发现了具有统计学意义的生物标志物,其中神经电生理生物标志物在两项研究的荟萃分析中显示出最强的效应规模。PTE是创伤性脑损伤的一种长期严重后果,影响到2%到53%的创伤性脑损伤患者,但目前缺乏有效的生物标志物来预测PTE的发展,而这对设计预防性临床试验至关重要。将基于生物流体的蛋白质、遗传学、神经影像学和神经生理学数据整合在一起的多模式方法,为提高PTE发展的可预测性以及潜在的治疗提供了一种前景广阔的策略。该研究方案已在国际系统综述前瞻性注册中心 PROSPERO 注册(注册编号:CRD42023470245)。
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引用次数: 0
Cannabinoid-like compounds found in non-cannabis plants exhibit antiseizure activity in genetic mouse models of drug-resistant epilepsy. 非大麻植物中的大麻素类化合物在抗药性癫痫遗传小鼠模型中表现出抗癫痫活性。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-12 DOI: 10.1111/epi.18177
Ka Lai Yip, Michael Udoh, Laura A Sharman, Thomas Harman, Miguel Bedoya-Pérez, Lyndsey L Anderson, Samuel D Banister, Jonathon C Arnold

Objective: The cannabinoid cannabidiol has established antiseizure effects in drug-resistant epilepsies such as Dravet syndrome and Lennox-Gastaut syndrome. Amorfrutin 2, honokiol, and magnolol are structurally similar to cannabinoids (cannabis-like drugs) but derive from non-cannabis plants. We aimed to study the antiseizure potential of these compounds in various mouse seizure models. In addition, we aimed to characterize their molecular pharmacology at cannabinoid CB1 and CB2 receptors and at T-type calcium channels, which are known targets of the cannabinoids.

Methods: Brain and plasma pharmacokinetic profiles were determined. Antiseizure activity was assessed against hyperthermia-induced seizures in a Scn1a+/- mouse model of Dravet syndrome. We then elaborated on the most promising compounds in the maximal electroshock (MES) test in mice and the Gabrb3+/D120N mouse model of Lennox-Gastaut syndrome. Fluorescence-based assays were used to examine modulatory activity at cannabinoid CB1 and CB2 receptors and T-type calcium channel subtypes CaV3.1, CaV3.2, and CaV3.3 overexpressed in mammalian cells. Automated patch-clamp electrophysiology was then used to confirm inhibitory activity on CaV3.1, CaV3.2, and CaV3.3 channels.

Results: Magnolol and honokiol had high brain-to-plasma ratios (3.55 and 7.56, respectively), unlike amorfrutin 2 (0.06). Amorfrutin 2 and magnolol but not honokiol significantly increased the body temperature threshold at which Scn1a+/- mice had a generalized tonic-clonic seizure. Both amorfrutin 2 and magnolol significantly decreased the proportion of mice exhibiting hindlimb extension in the MES test. Furthermore, magnolol reduced the number and duration of atypical absence seizures in Gabrb3+/D120N mice. The three compounds inhibited all T-type calcium channel subtypes but were without specific activity at cannabinoid receptors.

Significance: We show for the first time that amorfrutin 2 and magnolol display novel antiseizure activity in mouse drug-resistant epilepsy models. Our results justify future drug discovery campaigns around these structural scaffolds that aim to develop novel antiseizure drugs for intractable epilepsies.

目的:大麻素大麻二酚对耐药性癫痫(如德拉维特综合症和伦诺克斯-加斯托综合症)具有抗癫痫作用。Amorfrutin 2、honokiol 和 magnolol 在结构上与大麻素(大麻样药物)相似,但却来自非大麻植物。我们的目的是研究这些化合物在各种小鼠癫痫模型中的抗癫痫潜力。此外,我们还旨在研究这些化合物在大麻素 CB1 和 CB2 受体以及 T 型钙通道(大麻素的已知靶点)上的分子药理学特征:方法:测定脑部和血浆药代动力学特征。在 Scn1a+/- 德雷维综合征小鼠模型中评估了对热疗诱导的癫痫发作的抗癫痫活性。然后,我们在小鼠最大电休克(MES)试验和Gabrb3+/D120N Lennox-Gastaut综合征小鼠模型中详细阐述了最有前景的化合物。我们使用基于荧光的检测方法来检查大麻素 CB1 和 CB2 受体以及哺乳动物细胞中过表达的 T 型钙通道亚型 CaV3.1、CaV3.2 和 CaV3.3 的调节活性。然后使用自动贴片钳电生理学来确认对 CaV3.1、CaV3.2 和 CaV3.3 通道的抑制活性:与阿莫鲁丁 2(0.06)不同,马格诺洛尔和霍诺喹具有较高的脑浆比(分别为 3.55 和 7.56)。Amorfrutin 2和magnolol能显著提高Scn1a+/-小鼠全身强直阵挛发作的体温阈值,但honokiol不能。在 MES 试验中,amorfrutin 2 和 magnolol 都能显著降低小鼠后肢伸展的比例。此外,magnolol还能减少Gabrb3+/D120N小鼠非典型失神发作的次数和持续时间。这三种化合物抑制所有 T 型钙通道亚型,但对大麻素受体没有特异性活性:我们首次发现,amorfrutin 2 和 magnolol 在小鼠耐药性癫痫模型中具有新型抗癫痫活性。我们的研究结果证明,未来围绕这些结构支架开展的药物发现活动是合理的,这些活动旨在开发治疗难治性癫痫的新型抗癫痫药物。
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引用次数: 0
Level 4 seizure monitoring unit admissions are associated with reduced long-term health care costs. 四级癫痫监护室的收治与长期医疗费用的降低有关。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-12 DOI: 10.1111/epi.18165
Colin B Josephson, Brendan Cord Lethebe, Elaine Pang, Fiona Clement, Nathalie Jetté, Jessie Hart Szostakiwskyj, Graham McLeod, Farnaz Sinaei, Guillermo Delgado-Garcia, Samuel Wiebe

Objective: This study was undertaken to determine whether admission to dedicated seizure monitoring units (SMUs) result in reduced health care use (HCU).

Methods: This was a retrospective open cohort study covering the years 2010-2018 of patients residing in Alberta, Canada, who were referred to the Calgary Comprehensive Epilepsy Program and admitted to a level 4 SMU. Patients were required to have ≥3 years pre- and postadmission follow-up. The outcome was the change in trajectory of composite HCU (primary care, specialist outpatient visits, emergency department visits, and hospitalizations) for the 3 years prior to and 3 years following SMU admission using the point of admission as the "index date." Secondary outcomes were HCU limited to specific settings. We excluded the first 30 days following the point of admission to mitigate the confounding admission would have on the postadmission HCU trajectory. We used adjusted restricted maximum likelihood linear and nonlinear effects models to determine trajectories expressed as Canadian dollars.

Results: A total of 315 of 600 (53%) patients met eligibility criteria. Mean age was 40 years (SD = 17.4), 176 (56%) were female, 220 (70%) had focal epilepsy, and 60 (19%) had functional seizures or physiologic seizure mimics without epilepsy as adjudicated by the attending physician at the point of discharge. Mean per person health care costs increased by CAD$341.28 (95% confidence interval [CI] = -25.17 to 707.74) for each successive 6-month interval prior to SMU admission (p = .07). Following admission, mean per person costs decreased by CAD$802.34 (95% CI = 699.62-905.06, p < .001) for each successive 6-month interval up to 3 years postdischarge. Similar trends were noted for primary and specialist care, emergency department, admitted care, and when nonlinear models were applied.

Significance: Admission to an SMU is associated with significant and enduring declines in HCU. Each 6-months following discharge overall HCU declined by a mean of CAD$802.34 and acute inpatient, emergency department, and outpatient physician interactions declined by 25%, 26%, and 18% respectively. Comprehensive epilepsy care not only reduces morbidity and mortality but also reduces cost.

研究目的本研究旨在确定入住专门的癫痫发作监测病房(SMU)是否会减少医疗服务(HCU)的使用:这是一项回顾性开放队列研究,研究对象是居住在加拿大阿尔伯塔省、转诊至卡尔加里综合癫痫项目并入住4级癫痫监测病房的患者,时间跨度为2010年至2018年。患者入院前和入院后的随访时间必须≥3年。结果是以入院时点为 "指数日期",SMU 入院前 3 年和入院后 3 年的综合 HCU(初级保健、专科门诊就诊、急诊就诊和住院)变化轨迹。次要结果为仅限于特定环境的 HCU。我们排除了入院后的前 30 天,以减少入院对入院后 HCU 轨迹的影响。我们使用调整后的限制性最大似然线性和非线性效应模型来确定以加元表示的轨迹:在 600 名患者中,共有 315 人(53%)符合资格标准。平均年龄为 40 岁(SD = 17.4),176 人(56%)为女性,220 人(70%)患有局灶性癫痫,60 人(19%)在出院时由主治医生判定为功能性癫痫发作或生理性癫痫发作模拟,但无癫痫。在入住SMU之前,每连续6个月的人均医疗费用平均增加341.28加元(95%置信区间[CI] = -25.17至707.74)(p = .07)。入院后,人均费用减少了802.34加元(95% CI = 699.62-905.06, p):入住 SMU 与 HCU 的显著和持久下降有关。出院后的 6 个月内,总的 HCU 平均下降了 802.34 加元,急性住院病人、急诊科和门诊病人与医生的互动分别下降了 25%、26% 和 18%。全面的癫痫护理不仅能降低发病率和死亡率,还能降低成本。
{"title":"Level 4 seizure monitoring unit admissions are associated with reduced long-term health care costs.","authors":"Colin B Josephson, Brendan Cord Lethebe, Elaine Pang, Fiona Clement, Nathalie Jetté, Jessie Hart Szostakiwskyj, Graham McLeod, Farnaz Sinaei, Guillermo Delgado-Garcia, Samuel Wiebe","doi":"10.1111/epi.18165","DOIUrl":"https://doi.org/10.1111/epi.18165","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to determine whether admission to dedicated seizure monitoring units (SMUs) result in reduced health care use (HCU).</p><p><strong>Methods: </strong>This was a retrospective open cohort study covering the years 2010-2018 of patients residing in Alberta, Canada, who were referred to the Calgary Comprehensive Epilepsy Program and admitted to a level 4 SMU. Patients were required to have ≥3 years pre- and postadmission follow-up. The outcome was the change in trajectory of composite HCU (primary care, specialist outpatient visits, emergency department visits, and hospitalizations) for the 3 years prior to and 3 years following SMU admission using the point of admission as the \"index date.\" Secondary outcomes were HCU limited to specific settings. We excluded the first 30 days following the point of admission to mitigate the confounding admission would have on the postadmission HCU trajectory. We used adjusted restricted maximum likelihood linear and nonlinear effects models to determine trajectories expressed as Canadian dollars.</p><p><strong>Results: </strong>A total of 315 of 600 (53%) patients met eligibility criteria. Mean age was 40 years (SD = 17.4), 176 (56%) were female, 220 (70%) had focal epilepsy, and 60 (19%) had functional seizures or physiologic seizure mimics without epilepsy as adjudicated by the attending physician at the point of discharge. Mean per person health care costs increased by CAD$341.28 (95% confidence interval [CI] = -25.17 to 707.74) for each successive 6-month interval prior to SMU admission (p = .07). Following admission, mean per person costs decreased by CAD$802.34 (95% CI = 699.62-905.06, p < .001) for each successive 6-month interval up to 3 years postdischarge. Similar trends were noted for primary and specialist care, emergency department, admitted care, and when nonlinear models were applied.</p><p><strong>Significance: </strong>Admission to an SMU is associated with significant and enduring declines in HCU. Each 6-months following discharge overall HCU declined by a mean of CAD$802.34 and acute inpatient, emergency department, and outpatient physician interactions declined by 25%, 26%, and 18% respectively. Comprehensive epilepsy care not only reduces morbidity and mortality but also reduces cost.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Epilepsia
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