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EEG microstate-derived dynamic network biomarkers for lateralization and structural etiology in temporal lobe epilepsy. 脑电图微状态衍生的动态网络生物标志物在颞叶癫痫的侧化和结构病因。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-26 DOI: 10.1002/epi.70121
Kailing Huang, Wenhao Li, Yunhui Wang, Xiang Huang, Yuming Li, Yingying Zhang, Qiuxing Lin, Peiwen Liu, Danyang Cao, Wei Li, Dong Zhou, Dongmei An

Objective: Temporal lobe epilepsy (TLE) is the most common focal epilepsy but remains highly heterogeneous across hemispheric and structural etiology. This study aimed to characterize microstate-based network dynamics in TLE and evaluate their diagnostic value for seizure lateralization and structural etiology using machine learning.

Methods: Resting-state electroencephalography (EEG) recordings from 150 patients with unilateral TLE (71 right, 79 left) and 65 healthy controls (HCs) were analyzed. EEG signals were segmented into canonical microstates (A, B, C, D), and microstate-specific spatial, and temporal dynamic functional connectivity (dFC) variability metrics were extracted using phase lag index analysis. After two-step feature selection, the appropriate number of features were derived and input into Random Forest, XGBoost, and Support Vector Machine (SVM) classifiers to distinguish: TLE vs HCs, left vs right TLE, and magnetic resonance imaging (MRI)-negative (MRI-neg) vs hippocampal sclerosis (HS) TLE subtypes (TLE-HS). Model performance was evaluated on independent hold-out validation set using receiver operating characteristic analyses.

Results: Compared with HCs, patients with TLE exhibited increased duration and occurrence of microstate D and reduced expression microstate B, reflecting maladaptive attentional overactivation and visual suppression. Spatial variability was globally decreased, most prominently in left TLE. SVM achieved excellent performance for TLE detection (area under the curve [AUC] = .98) and lateralization (AUC = .97), whereas classification between MRI-neg TLE and TLE-HS was limited (AUC = .58).

Significance: EEG microstate-derived dFC metrics provide reliable, non-invasive biomarkers for identifying and lateralizing TLE using short duration resting-state EEG recordings. This framework advances understanding of TLE heterogeneity and supports the development of individualized electrophysiological tools for precision diagnosis.

目的:颞叶癫痫(TLE)是最常见的局灶性癫痫,但在半球和结构病因上仍然高度异质性。本研究旨在描述TLE中基于微状态的网络动力学特征,并利用机器学习评估其对癫痫发作侧化和结构病因的诊断价值。方法:分析150例单侧TLE患者(71例右侧,79例左侧)和65例健康对照(hc)的静息状态脑电图(EEG)记录。将EEG信号分割为典型微状态(A、B、C、D),并利用相位滞后指数分析提取微状态的时空动态功能连通性(dFC)变异性指标。经过两步特征选择后,导出适当数量的特征并输入到随机森林、XGBoost和支持向量机(SVM)分类器中,以区分TLE与hc、左TLE与右TLE,以及磁共振成像(MRI)阴性(MRI-neg)与海马硬化(HS) TLE亚型(TLE-HS)。利用接收机工作特性分析,在独立的保留验证集上评估模型的性能。结果:与hc相比,TLE患者微状态D持续时间和发生率增加,微状态B表达减少,反映了不适应的注意过度激活和视觉抑制。空间变异性在全球范围内下降,最显著的是左TLE。SVM在TLE检测中取得了优异的性能(曲线下面积[AUC] =)。98)和侧化(AUC =。97),而MRI-neg TLE和TLE- hs之间的分类有限(AUC = 0.58)。意义:脑电图微状态衍生的dFC指标提供了可靠的、无创的生物标志物,可以通过短时间静息状态脑电图记录来识别和侧化TLE。该框架促进了对TLE异质性的理解,并支持个体化电生理工具的发展,以进行精确诊断。
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引用次数: 0
Lactate receptor HCAR1 in neonatal hypoxic-ischemic seizures. 乳酸受体HCAR1在新生儿缺氧缺血性发作中的作用。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-26 DOI: 10.1002/epi.70172
Jennifer Burnsed, Angelina June, Maria Marlicz, Emmy Zucker, Ellie Kain-Kuzniewski, Hannah Mulhern, Leanne Maharaj, John Williamson, Chengsan Sun, Suchitra Joshi, Huayu Sun, Jaideep Kapur

Hydroxycarboxylic acid receptor 1 (HCAR1) is a G-protein-coupled lactate receptor expressed in the brain and plays a role in neuronal excitability and repair after injury. Hypoxic-ischemic encephalopathy (HIE) is the most common cause of brain injury and seizures in term neonates. The goal of this study was to describe HCAR1 expression and function in the neonatal brain and understand its role in HIE-associated seizures. HCAR1 expression was measured using quantitative reverse transcriptase polymerase chain reaction in postnatal day (p)10-50 mice. Neuronal properties and spontaneous excitatory postsynaptic currents (sEPSCs) were measured in hippocampal principal neurons from HCAR1 knockout and wild-type mice when exposed to lactate. p10 HCAR1 knockout and wild-type mice were exposed to hypoxia-ischemia (HI) and underwent electroencephalography to compare seizure burden. HCAR1 was expressed at p10 at similar levels to adults. Lactate decreased amplitudes and sEPSC frequency in wild-type but not HCAR1 knockout mice. After HI, HCAR1 knockout mice had higher seizure burden and behavioral seizure scores than wild-type mice. HCAR1 is expressed on neurons and plays a role in neuronal excitability and seizures in the neonatal brain.

羟羧酸受体1 (Hydroxycarboxylic acid receptor 1, HCAR1)是一种在大脑中表达的g蛋白偶联乳酸受体,在神经元兴奋性和损伤后修复中起作用。缺氧缺血性脑病(HIE)是足月新生儿脑损伤和癫痫发作的最常见原因。本研究的目的是描述HCAR1在新生儿大脑中的表达和功能,并了解其在hie相关癫痫发作中的作用。用定量逆转录酶聚合酶链反应测定出生后10-50天小鼠的HCAR1表达。我们测量了HCAR1基因敲除小鼠和野生型小鼠海马主神经元在暴露于乳酸时的神经元特性和自发兴奋性突触后电流(sEPSCs)。将p10 HCAR1基因敲除小鼠和野生型小鼠暴露于缺氧缺血(HI)后,通过脑电图比较癫痫发作负担。HCAR1在p10的表达水平与成人相似。乳酸降低了野生型小鼠的振幅和sEPSC频率,但没有降低HCAR1基因敲除小鼠的频率。HI后,HCAR1基因敲除小鼠的癫痫发作负担和行为癫痫发作评分高于野生型小鼠。HCAR1在神经元上表达,在新生儿大脑的神经元兴奋性和癫痫发作中起作用。
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引用次数: 0
Graded extent of hippocampal resection is related to neuropsychological outcomes in temporal lobe epilepsy surgery. 海马切除术的分级程度与颞叶癫痫手术的神经心理学结果有关。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-26 DOI: 10.1002/epi.70162
Eliza M Reedy, Emma Robinson, Thandar Aung, Catherine Liégeois-Chauvel, Danielle R Carns, Natalie Sherry, Luke C Henry, Bradford Z Mahon, Arka N Mallela, Jorge A Gonzalez-Martinez

Objective: Surgical resection for epilepsy seeks to maximize seizure freedom while minimizing new neurocognitive impairments. Tailored resections guided by anatomoelectroclinical (AEC) hypotheses offer the possibility of sparing parts of the hippocampus. The relationship between the extent of hippocampal resection and postoperative neurocognitive outcomes in this context has not been studied and has important implications for clinical practice. We test this relationship in a series of left and right tailored anterior temporal lobectomy (ATL) surgeries.

Methods: We conducted a retrospective analysis of 34 adult patients with drug-resistant temporal lobe epilepsy (18 left, 16 right) who underwent tailored ATL based on individualized AEC hypotheses at the University of Pittsburgh Medical Center. All patients completed standardized pre- and postoperative neuropsychological testing, and 85.3% underwent preoperative stereoelectroencephalography to guide resection. Surgical extent was tailored through a multidisciplinary process integrating AEC correlations and intraoperative electrophysiology. Preoperative and postoperative hippocampal volumes were measured and correlated with changes in verbal and visual memory, as well as language performance.

Results: Greater extent of resection of the left hippocampus was significantly associated with worse postoperative outcomes in both verbal and visual recall. Extent of resection of the right hippocampus was not related to reductions in performance across any domain, with some indication of improvements in performance after right ATL surgery at the group level. Seizure outcomes (66.6% Engel I at 2 years) were consistent with the existing literature and did not vary with hippocampal resection extent.

Significance: These findings highlight the critical role of the left hippocampus in supporting both verbal and visual memory and underscore the importance of preserving hippocampal tissue during left ATL when feasible. Our results support the utility of AEC-guided tailored resections as a strategy to balance seizure control with cognitive preservation.

目的:手术切除癫痫寻求最大限度的癫痫发作自由,同时尽量减少新的神经认知障碍。由解剖-临床电(AEC)假说指导的量身定制的切除提供了保留海马部分的可能性。在这种情况下,海马切除程度与术后神经认知结果之间的关系尚未得到研究,但对临床实践具有重要意义。我们在一系列左、右裁剪的颞叶前切除术(ATL)手术中检验了这种关系。方法:我们对34例成人耐药颞叶癫痫患者(18例左,16例右)进行了回顾性分析,这些患者在匹兹堡大学医学中心接受了基于个体化AEC假设的量身定制的ATL。所有患者均完成了标准化的术前和术后神经心理测试,85.3%的患者术前进行了立体脑电图检查以指导手术。通过综合AEC相关性和术中电生理的多学科过程来定制手术范围。测量术前和术后海马体积,并将其与言语和视觉记忆以及语言表现的变化相关联。结果:左侧海马体切除的程度越大,术后言语和视觉回忆的结果就越差。右侧海马体的切除程度与任何领域的表现下降无关,在组水平上有一些迹象表明右侧ATL手术后表现有所改善。癫痫发作结局(2年时66.6%的Engel I)与现有文献一致,且不随海马切除程度而变化。意义:这些发现强调了左侧海马体在支持语言和视觉记忆中的关键作用,并强调了在可行的情况下保留左侧ATL期间海马体组织的重要性。我们的研究结果支持aec指导下的定制切除作为平衡癫痫发作控制与认知保存的策略的效用。
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引用次数: 0
Mapping intraoperative interictal epileptiform discharges using high-resolution, thin-film cortical arrays. 利用高分辨率薄膜皮质阵列绘制术中间断性癫痫样放电。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-26 DOI: 10.1002/epi.70135
Katrina J Barth, Iakov Rachinskiy, Suseendrakumar Duraivel, James Sun, Chia-Han Chiang, Charles Wang, Shervin Rahimpour, Michael M Haglund, Matthew Vestal, Stephen C Harward, Sasha Devore, Daniel Friedman, Bijan Pesaran, Saurabh R Sinha, Derek G Southwell, Birgit Frauscher, Gregory B Cogan, Justin Blanco, Jonathan Viventi

Objective: Interictal epileptiform discharges (IEDs) are transients observed on the electroencephalogram (EEG) of patients with epilepsy. IEDs have traditionally been recorded from scalp or intracranial EEG macrocontacts, which coarsely sample neural activity. Here, we investigated the use of flexible, high-resolution microelectrocorticographic (μECoG) arrays for measuring IEDs with greater spatiotemporal precision to test whether there exist microscale patterns of IED activity that may be missed on standard intracranial EEG.

Methods: We used liquid crystal polymer thin-film μECoG arrays with both high resolution (.76-1.72-mm spacing, 200-μm diameter) and large cortical coverage (144-1596 mm2) to record from seven patients undergoing surgical treatment of epilepsy. We identified IEDs by a combination of expert review and automated detection. We quantified the spatial extent of IEDs, mapped patterns of repeated IED activity, and quantified IED propagation direction using multilinear fit models. We also compared IED detection rates and propagation measurements between μECoG arrays and simulated macroarrays (10-mm spacing, 2.3-mm diameter).

Results: We demonstrated successful use of μECoG arrays to map intraoperative microscale patterns of IEDs. The majority of patients (5/7) exhibited elevated IED activity that was highly localized (subcentimeter localization). Across all patients, 40% of detected IEDs were observed within a 4-mm radius of cortex. μECoG arrays also mapped the direction of IED propagation. An average of 39% (range = 4.2%-96.5%, SD = ±36.8%) of the IED events captured by the μECoG arrays were not detectable by simulated macrocontacts.

Significance: These intraoperative data demonstrate that μECoG arrays can map the microscale spatiotemporal activity of IEDs. These patterns of IEDs may be poorly captured by standard, macroscale recording devices. Our findings support the use of high-resolution, large area coverage μECoG arrays for the presurgical and intraoperative mapping of epileptic cortex.

目的:癫痫样间期放电(IEDs)是癫痫患者脑电图(EEG)上观察到的短暂性放电。传统上,简易爆炸装置是通过头皮或颅内脑电图大接触来记录的,这是对神经活动的粗略采样。在这里,我们研究了使用灵活的、高分辨率的微皮质电图(μECoG)阵列以更高的时空精度测量IED,以测试是否存在标准颅内脑电图可能遗漏的IED活动的微尺度模式。方法:采用高分辨率(间隔0.76 ~ 1.72 mm,直径200 μm)、大皮质覆盖(144 ~ 1596 mm2)的液晶聚合物薄膜μECoG阵列记录7例癫痫手术患者的脑电图。我们通过专家审查和自动检测相结合的方式来识别简易爆炸装置。我们量化了IED的空间范围,绘制了重复IED活动的模式,并使用多线性拟合模型量化了IED的传播方向。我们还比较了μECoG阵列和模拟宏阵列(10-mm间距,2.3-mm直径)之间的IED检出率和传播测量结果。结果:我们成功地使用μECoG阵列来绘制术中ied的微尺度模式。大多数患者(5/7)表现出高度定位(亚厘米定位)的IED活性升高。在所有患者中,40%检测到的ied发生在皮质半径4毫米范围内。μECoG阵列还绘制了IED的传播方向。μECoG阵列捕获的IED事件中,平均有39%(范围= 4.2% ~ 96.5%,SD =±36.8%)不能被模拟的宏观接触检测到。意义:这些术中数据表明μECoG阵列可以映射ied的微观时空活动。标准的宏观记录设备可能很难捕捉到这些简易爆炸装置的形态。我们的研究结果支持使用高分辨率,大面积覆盖μECoG阵列进行术前和术中癫痫皮质的测绘。
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引用次数: 0
One year of seizure freedom reduces premature death in people with epilepsy in rural China: A 10-year cohort study. 一年的癫痫发作自由减少了中国农村癫痫患者的过早死亡:一项10年队列研究。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-24 DOI: 10.1002/epi.70173
Xiaowen Zhou, Yan Ge, Bin Yang, Guoxing Zhu, Patrick Kwan, Wenzhi Wang, Josemir W Sander, Ding Ding

Objective: Epilepsy carries an increased risk of premature mortality. Although seizure freedom may reduce deaths, most population-based evidence originates from high-income countries. Data from low-income settings, such as rural China, remain scarce. We update mortality patterns and evaluate their associations with achieving 1-year seizure freedom among rural populations in China.

Methods: People with epilepsy living in rural Henan, China, were enrolled between 2010 and 2011 and followed up at three subsequent time points over 10 years. We collected demographic and clinical data, including survival outcomes. Seizure freedom was defined as a 12-month seizure-free interval recorded in any follow-up period. Causes of death were assessed using a structured verbal autopsy questionnaire and adjudicated by a multidisciplinary panel. We estimated mortality rates, standardized mortality ratios (SMRs), and cause-specific distributions, and used regression models to identify mortality predictors and associations with seizure freedom.

Results: Among the 610 participants enrolled (57.5% male), 67 had died over 10-year follow-up, yielding an all-cause mortality rate of 13.5/1000 person-years (95% confidence interval [CI] = 10.5-17.2) and an age- and sex-adjusted SMR of 2.4 (95% CI = 2.3-2.5). Epilepsy-related deaths accounted for 48% of deaths, with sudden unexpected death in epilepsy being predominant (33%). People who had ever achieved 12-month seizure freedom (n = 317) had significantly lower SMRs than those who never did (n = 293). Ever achieving seizure freedom was independently associated with a lower risk of all-cause mortality (odds ratio [OR] = .30, 95% CI = .17-.52) and epilepsy-related death (OR = .29, 95% CI = .12-.63). This protective effect was most pronounced in women, older adults, those with seizure onset during adulthood, and those without comorbidities.

Significance: Mortality in this cohort remains more than twice that of the general population, with sudden death accounting for one third of cases. Achieving 1-year seizure freedom even once during follow-up substantially reduced mortality risk and altered cause-of-death distributions. This finding underscores seizure control as a practical and encouraging treatment goal in resource-limited settings.

目的:癫痫会增加过早死亡的风险。虽然癫痫发作自由可能减少死亡,但大多数基于人群的证据来自高收入国家。来自中国农村等低收入地区的数据仍然很少。我们更新了死亡率模式,并评估了它们与中国农村人口实现1年癫痫发作自由的关系。方法:选取2010 - 2011年间居住在中国河南农村的癫痫患者,并在随后的10年时间点进行随访。我们收集了人口统计学和临床数据,包括生存结果。癫痫发作自由被定义为在任何随访期间记录的12个月无癫痫发作间隔。死因评估采用结构化的死因推断问卷,并由多学科小组裁决。我们估计了死亡率、标准化死亡率(SMRs)和病因特异性分布,并使用回归模型确定死亡率预测因子及其与癫痫发作自由度的关联。结果:在纳入的610名参与者中(57.5%为男性),67人在10年随访期间死亡,全因死亡率为13.5/1000人年(95%置信区间[CI] = 10.5-17.2),年龄和性别调整后的SMR为2.4 (95% CI = 2.3-2.5)。癫痫相关死亡占死亡人数的48%,癫痫猝死占主导地位(33%)。曾经实现12个月癫痫发作自由的患者(n = 317)的smr显著低于从未实现过的患者(n = 293)。实现癫痫发作自由与全因死亡率(比值比[OR] = 0.30, 95% CI = 0.17 - 0.52)和癫痫相关死亡(OR = 0.29, 95% CI = 0.12 - 0.63)的风险降低独立相关。这种保护作用在女性、老年人、成年期癫痫发作者和无合并症者中最为明显。意义:该队列的死亡率仍然是一般人群的两倍多,其中猝死占病例的三分之一。在随访期间实现1年的癫痫发作自由,即使只有一次,也大大降低了死亡风险并改变了死因分布。这一发现强调了在资源有限的情况下,癫痫控制是一个实用和令人鼓舞的治疗目标。
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引用次数: 0
Stiripentol: Unpublished results from the first phase 2 clinical trial in Lennox-Gastaut syndrome conducted in the early 1990s. Stiripentol: 20世纪90年代初进行的lenox - gastaut综合征的第一期2期临床试验未发表的结果。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-23 DOI: 10.1002/epi.70155
Stéphane Auvin, Benjamin Serraz, Jérémie Lespinasse, Laurent Chancharme

Objective: This study was undertaken to present the results of an exploratory phase 2 trial of stiripentol in Lennox-Gastaut syndrome (LGS).

Methods: This exploratory single-blind, single-arm, nonrandomized sequential-period phase 2 study was conducted at four centers in France between January 1989 and August 1993. Eligible patients were aged 2-20 years with LGS and experienced at least one seizure per week despite optimized therapy. After a 1-month baseline period under a stable treatment regimen, patients received placebo for 1 month followed by stiripentol for 2 months.

Results: Sixteen patients with LGS were enrolled, and efficacy was assessable in 14. The median [Q1-Q3] overall seizure frequency decreased from 31 [16-89] at baseline to 14 [8-21] after the first month of stiripentol (p = .044) and further to 4 [0-18] after the second month (p = .044). The reduction was consistent across seizure types. Eight patients (57%) were responders (≥50% reduction in overall seizure frequency) at the end of stiripentol treatment, including five (36%) who achieved complete seizure freedom and two with a ≥75% reduction in seizure frequency. All patients reported at least one adverse event during stiripentol treatment, most commonly somnolence, decreased appetite, and vomiting. These effects may be related to the high stiripentol doses administered (median = 91 mg/kg/day in the second month). Despite their frequency, no serious adverse events were reported during the stiripentol treatment period, and no clinically meaningful changes in hematological parameters or liver enzyme levels were observed.

Significance: Although this study was conducted before standardized clinical trial designs for LGS were established, a more comprehensive evaluation of stiripentol could have provided further insight into its potential benefits in this severe developmental and epileptic encephalopathy.

目的:本研究旨在介绍一项用于lenox - gastaut综合征(LGS)的stiripentol 2期探索性试验的结果。方法:这项探索性的单盲、单臂、非随机顺序期2期研究于1989年1月至1993年8月在法国的4个中心进行。符合条件的患者年龄为2-20岁,患有LGS,尽管优化了治疗,但每周至少发生一次癫痫发作。在稳定的治疗方案下,基线期1个月后,患者接受安慰剂治疗1个月,随后接受斯特里彭托尔治疗2个月。结果:16例LGS患者入组,14例疗效可评估。中位[Q1-Q3]总发作频率从基线时的31次[16-89次]降至施曲哌醇第一个月后的14次[8-21次](p = 0.044),第二个月后进一步降至4次[0-18次](p = 0.044)。这种减少在不同类型的癫痫发作中是一致的。8名患者(57%)在斯特里苯妥醇治疗结束时出现应答(总发作频率降低≥50%),其中5名患者(36%)实现完全发作自由,2名患者发作频率降低≥75%。所有患者报告在施曲妥醇治疗期间至少有一个不良事件,最常见的是嗜睡、食欲下降和呕吐。这些影响可能与施打高剂量(第二个月中位数= 91 mg/kg/天)有关。尽管发生频率较高,但在施曲哌醇治疗期间未见严重不良事件的报道,血液学参数和肝酶水平未见有临床意义的变化。意义:虽然这项研究是在LGS标准化临床试验设计建立之前进行的,但对斯曲妥醇进行更全面的评估可以进一步了解其对这种严重发育性和癫痫性脑病的潜在益处。
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引用次数: 0
Persons with epilepsy and their caregivers understand the definition of ictal impairment of consciousness. 癫痫患者及其护理人员了解意识严重损害的定义。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-18 DOI: 10.1002/epi.70154
Kaley J Marcinski Nascimento, Fábio A Nascimento, Torie Robinson, Birgit Frauscher, Eugen Trinka, Sándor Beniczky

The term consciousness has been reintroduced in the updated seizure classification. Concerns have been raised that "ictal impaired consciousness" may be misunderstood by persons with epilepsy (PWEs) and their caregivers, particularly that English-speaking individuals might equate it with complete loss of consciousness. We conducted an online survey distributed via epilepsy organizations and social media to assess whether English-speaking PWEs and caregivers could understand and apply a simple medical definition of consciousness: "In medical terms, consciousness means being able to remember things and respond to what is happening around you. During a seizure, consciousness is considered affected if the person cannot remember what happened and if they are unable to respond normally when people try to interact with them." The survey was completed by 253 respondents (148 caregivers, 105 PWEs). Almost all participants (97%) found the definition clear, 90% reported they could apply it to their seizures, and 99% demonstrated comprehension by correctly interpreting an example question. No significant differences were observed between PWEs and caregivers, across education levels, or by seizure characteristics. These findings indicate that PWEs and caregivers can readily understand and apply the concept of ictal impairment of consciousness when given a concise, patient-friendly definition.

在最新的癫痫分类中重新引入了“意识”一词。人们担心“严重意识受损”可能被癫痫患者及其护理人员误解,特别是讲英语的患者可能将其等同于完全丧失意识。我们通过癫痫组织和社交媒体进行了一项在线调查,以评估说英语的pwe和护理人员是否能够理解和应用意识的简单医学定义:“在医学术语中,意识意味着能够记住事物并对周围发生的事情做出反应。在癫痫发作期间,如果患者不记得发生了什么,并且当人们试图与他们互动时,如果他们无法正常反应,则认为意识受到了影响。”该调查由253名受访者完成(148名护理人员,105名pwe)。几乎所有的参与者(97%)都发现这个定义很清楚,90%的人报告说他们可以把它应用到他们的癫痫发作中,99%的人通过正确地解释一个示例问题表现出理解能力。pwe和护理人员之间、教育水平或癫痫发作特征没有显著差异。这些发现表明,pwe和护理人员可以很容易地理解和应用意识障碍的概念,当给出一个简洁的,病人友好的定义。
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引用次数: 0
Seizure-type-specific disruption of hypercapnic cardioventilatory responses in epilepsy models. 癫痫模型中高碳酸血症性心血管呼吸反应的癫痫型特异性中断。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-17 DOI: 10.1002/epi.70123
Ayse S Dereli, Auriane Apaire, Enrique Germany Morrison, Abigail Niyibizi, Elena Acedo Reina, Elise Collard, Antoine Nonclercq, Riem El Tahry

Objective: Sudden unexpected death in epilepsy (SUDEP) is linked to respiratory and autonomic failure with post-ictal periods of prolonged hypercapnia indicative of impaired central chemoreception. Yet how interictal hypercapnic cardioventilatory responses vary by seizure phenotype is unclear. We aimed to determine whether central chemoreception and autonomic regulation differ across epilepsy phenotypes during a standardized CO2 challenge. We hypothesized that rats with chronic generalized tonic-clonic seizures would show impaired hypercapnic cardioventilatory and autonomic responses compared with rats with generalized absence seizures and healthy controls.

Methods: We measured breathing frequency (fB), heart rate (HR), and heart rate variability (HRV) before, during, and after a 1 h 10% CO2 exposure in three groups of male rats: kainic acid (KA; tonic-clonic), genetic absence epilepsy rat from Strasbourg (GAERS; absence), and Wistar controls.

Results: Controls showed increased fB and decreased HR during hypercapnia. KA rats exhibited blunted fB and HR responses; GAERS displayed preserved fB elevation with faster post-challenge normalization and intermediate HR changes. Coupling of fB and HR collapsed during CO2 in both epilepsy groups and re-emerged in recovery. In KA rats, Stage 3-4 seizure burden positively correlated with HR during hypercapnia. HRV reactivity to hypercapnia was robust in controls, attenuated in GAERS, and largely absent in KA, whereas interictal baseline HRV did not differ among the groups.

Significance: These data support seizure-type-specific disruption of chemoreflex-autonomic integration. Extending clinical hypercapnic ventilatory response (HCVR) testing, a hypercapnic cardioventilatory response (HCCVR), that is, a combined fB, HR, and HRV readout, may help to refine SUDEP risk stratification beyond seizure frequency and type.

目的:癫痫猝死(SUDEP)与呼吸和自主神经衰竭有关,并伴有癫痫发作后长时间的高碳酸血症,表明中枢化学接受功能受损。然而,间期高碳酸血症性心血管反应如何随发作表型而变化尚不清楚。我们的目的是确定在标准化二氧化碳挑战期间,不同癫痫表型的中枢化学接受和自主调节是否存在差异。我们假设慢性全身性强直-阵挛发作的大鼠与全身性癫痫发作和健康对照的大鼠相比,高碳酸血症性心血管和自主神经反应受损。方法:我们测量了三组雄性大鼠在10% CO2暴露前、期间和之后的呼吸频率(fB)、心率(HR)和心率变异性(HRV): kainic acid (KA;强力性阵挛)、Strasbourg遗传缺失癫痫大鼠(GAERS;缺席)和Wistar对照。结果:对照组在高碳酸血症期间fB升高,HR降低。KA大鼠fB和HR反应迟钝;GAERS显示fB升高保持不变,刺激后正常化速度较快,HR变化中等。在两组癫痫患者中,fB和HR的偶联在CO2期间消失,并在恢复时重新出现。KA大鼠3-4期癫痫发作负担与高碳酸血症HR呈正相关。HRV对高碳酸血症的反应性在对照组中很强劲,在GAERS中减弱,在KA中基本不存在,而各组间基线HRV没有差异。意义:这些数据支持癫痫类型特异性化学反射-自主神经整合的破坏。扩展临床高碳酸血症通气反应(HCVR)测试,高碳酸血症心血管反应(HCCVR),即fB, HR和HRV的综合读数,可能有助于细化SUDEP的风险分层,而不是癫痫发作频率和类型。
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引用次数: 0
Impact of antiseizure medication taper on electroencephalographic dynamics in focal epilepsy: A stereoelectroencephalographic study. 抗癫痫药物用量对局灶性癫痫患者脑电图动态的影响:一项立体脑电图研究。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-16 DOI: 10.1002/epi.70149
Guoping Ren, Sana Hannan, Katharina Schiller, John Thomas, Matthew Moye, Tamir Avigdor, Kassem Jaber, Xiaoyan Wei, Hongyi Ye, Alyssa Ho, Nina J Ghosn, Erin C Conrad, Derek Southwell, Jeffery Hall, Xiaoqiu Shao, Qun Wang, Rodney Radtke, Jean Gotman, Birgit Frauscher

Objective: Tapering of the antiseizure medication dosage in the epilepsy monitoring unit can provoke seizures, but its effects on seizure dynamics remain poorly characterized. This study addresses three questions: (1) Does antiseizure medication tapering influence spatiotemporal dynamics of seizures? (2) Does the tapering rate affect these dynamics? (3) Does tapering have a similar effect on interictal epileptic discharges as it does on seizures?

Methods: Patients with drug-resistant epilepsy undergoing stereoelectroencephalographic (stereo-EEG) presurgical evaluations at Duke University Medical Center (n = 104) and the Montreal Neurological Institute and Hospital (n = 80) were screened. We included patients in whom the antiseizure medication dosage was tapered from the highest daily dosage (high dosage) to ≤ 50% (low dosage) during stereo-EEG monitoring, and at least one seizure from the same focus was recorded in both conditions. Using an intrapatient design, we compared seizure onset-zone, onset pattern, and propagation dynamics between the two conditions. Given the intrinsic seizure variability, comparisons were made between same-dosage and cross-dosage seizure pairs. We further assessed effects of tapering rates and examined the characteristics of interictal epileptiform discharges.

Results: Among 30 patients, the proportion of channels in the seizure onset zone did not differ between high-dosage and low-dosage conditions (7.25% vs. 8.95%, p = .50, d = -.04). Similarly, no differences were observed in the overlap ratio of seizure-onset regions (62% vs. 64%, p = .72, d = -.01), or the cross-correlation of seizure-onset patterns (.36 vs. .35, p = .54, d = .04) when comparing same-dosage versus cross-dosage seizure pairs. Conversely, seizures at low dosage involved more channels (40.71% vs. 81.49%, p = .001, d = -.39) and lasted longer (33.36 s vs. 74.30 s, p < .01, d = -.47). Tapering rate did not affect seizure dynamics. The mean interictal epileptiform discharge rate and number of propagation channels also remained unchanged.

Significance: Despite seizure exacerbation during antiseizure medication tapering, seizure-onset location remained stable. This supports the robustness of seizure-based localization even under reduced medication levels and rapid tapering regimens.

目的:在癫痫监测单位逐渐减少抗癫痫药物剂量可引起癫痫发作,但其对癫痫发作动态的影响尚不清楚。本研究解决了三个问题:(1)抗癫痫药物减量是否影响癫痫发作的时空动态?(2)锥形速率是否影响这些动态?(3)逐渐减量对癫痫发作间期放电的影响是否与对癫痫发作的影响相似?方法:筛选在杜克大学医学中心(n = 104)和蒙特利尔神经学研究所和医院(n = 80)接受立体脑电图(stereo-EEG)术前评估的耐药性癫痫患者。我们纳入了在立体脑电图监测期间抗癫痫药物剂量从最高日剂量(高剂量)逐渐减少到≤50%(低剂量),并且在两种情况下至少记录一次来自同一病灶的癫痫发作的患者。采用患者内部设计,我们比较了两种情况下的癫痫发作区、发作模式和传播动态。考虑到固有的发作变异性,在相同剂量和交叉剂量的发作对之间进行了比较。我们进一步评估了减量率的影响,并检查了癫痫样放电的特征。结果:30例患者中,高剂量组与低剂量组发作区通道比例无显著差异(7.25% vs 8.95%, p =;50, d = - 0.04)。同样,在癫痫发作区域的重叠比例上也没有观察到差异(62%对64%,p =。72, d = - 0.01),或癫痫发作模式的交叉相关(p < 0.05)。36 . a35, p =。54, d =。04)当比较相同剂量与交叉剂量的癫痫发作对时。相反,低剂量组癫痫发作涉及更多通道(40.71% vs. 81.49%, p =。0.001, d = - 0.39)且持续时间更长(33.36 s vs. 74.30 s, p意义:尽管抗癫痫药物减量期间癫痫发作加剧,但癫痫发作部位保持稳定。这支持基于癫痫的定位的稳健性,即使在减少药物水平和快速减量方案。
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引用次数: 0
Extreme cryptogenic new onset refractory status epilepticus/febrile infection-related epilepsy syndrome: Evidence of profound neuroinflammation and neuronal injury. 极端隐源性新发难治性癫痫持续状态/发热感染相关癫痫综合征:深度神经炎症和神经元损伤的证据。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-16 DOI: 10.1002/epi.70157
Lorenzo Muccioli, Lorenzo Ferri, Lidia Di Vito, Elena Pasini, Barbara Mostacci, Carlo Alberto Castioni, Francesca Bisulli
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引用次数: 0
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Epilepsia
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