首页 > 最新文献

Epilepsia最新文献

英文 中文
Users´ perspectives and preferences on using wearables in epilepsy: A critical review.
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-28 DOI: 10.1111/epi.18280
Levente Hadady, Torie Robinson, Elisa Bruno, Mark P Richardson, Sándor Beniczky

Seizure detection devices (SDDs) offer promising technological advancements in epilepsy management, providing real-time seizure monitoring and alerts for patients and caregivers. This critical review explores user perspectives and experiences with SDDs to better understand factors influencing their adoption and sustained use. An electronic literature search identified 34 relevant studies addressing common themes such as usability, motivation, comfort, accuracy, barriers, and the financial burden of these devices. Usability emerged as the most frequently discussed factor, with patients and caregivers also emphasizing the importance of ease of use, long battery life, and waterproof design. Although validated devices showed high user satisfaction, technical challenges, false negatives, and false positives need much improvement. Motivation to use SDDs was driven by enhanced safety, symptom tracking, and health care professional recommendations. Comfort and wearability were also critical aspects, with users favoring lightweight, breathable, and discreet designs for long-term wear. Users reported the devices as "comfortable" and preferring wrist or arm-worn devices for the long term. Accuracy-particularly minimizing false positives and false negatives-was a priority for users. Barriers to adoption included device cost, limited insurance reimbursement, discomfort, and concerns about data privacy. Despite these challenges, many users were willing to use SDDs. Recommendations from health care professionals significantly increased user motivation. This review highlights the need for SDD designs that address user concerns regarding usability, comfort, looks, and accuracy, while also reducing financial and technical barriers. Enhancing clinical involvement and tailoring devices to specific patient needs may be crucial to promoting wider SDD adoption. Further research is needed to evaluate the impact of SDDs on quality of life and to explore ways to mitigate challenges in long-term use.

癫痫发作检测设备(SDD)为癫痫管理提供了前景广阔的技术进步,可为患者和护理人员提供实时癫痫发作监测和警报。这篇重要综述探讨了用户对 SDD 的看法和体验,以更好地了解影响其采用和持续使用的因素。通过电子文献检索发现了 34 项相关研究,涉及这些设备的可用性、动机、舒适性、准确性、障碍和经济负担等共同主题。可用性是最常被讨论的因素,患者和护理人员也强调了易用性、长电池寿命和防水设计的重要性。尽管经过验证的设备显示出较高的用户满意度,但在技术挑战、假阴性和假阳性方面仍需大力改进。使用 SDD 的动机主要来自于安全性的提高、症状跟踪和医疗保健专业人员的建议。舒适度和可佩戴性也是至关重要的方面,用户倾向于长期佩戴轻便、透气和隐蔽的设计。用户认为这些设备 "舒适",更喜欢长期佩戴在手腕或手臂上。准确性--尤其是尽量减少误报和误报--是用户优先考虑的问题。采用设备的障碍包括设备成本、有限的保险报销、不适感以及对数据隐私的担忧。尽管存在这些挑战,许多用户还是愿意使用 SDD。医疗保健专业人员的推荐大大提高了用户的积极性。本综述强调了 SDD 设计的必要性,即要解决用户对可用性、舒适度、外观和准确性的担忧,同时还要减少经济和技术障碍。加强临床参与并根据患者的具体需求定制设备可能是促进 SDD 更广泛应用的关键。还需要进一步开展研究,评估 SDD 对生活质量的影响,并探索如何减轻长期使用 SDD 所带来的挑战。
{"title":"Users´ perspectives and preferences on using wearables in epilepsy: A critical review.","authors":"Levente Hadady, Torie Robinson, Elisa Bruno, Mark P Richardson, Sándor Beniczky","doi":"10.1111/epi.18280","DOIUrl":"https://doi.org/10.1111/epi.18280","url":null,"abstract":"<p><p>Seizure detection devices (SDDs) offer promising technological advancements in epilepsy management, providing real-time seizure monitoring and alerts for patients and caregivers. This critical review explores user perspectives and experiences with SDDs to better understand factors influencing their adoption and sustained use. An electronic literature search identified 34 relevant studies addressing common themes such as usability, motivation, comfort, accuracy, barriers, and the financial burden of these devices. Usability emerged as the most frequently discussed factor, with patients and caregivers also emphasizing the importance of ease of use, long battery life, and waterproof design. Although validated devices showed high user satisfaction, technical challenges, false negatives, and false positives need much improvement. Motivation to use SDDs was driven by enhanced safety, symptom tracking, and health care professional recommendations. Comfort and wearability were also critical aspects, with users favoring lightweight, breathable, and discreet designs for long-term wear. Users reported the devices as \"comfortable\" and preferring wrist or arm-worn devices for the long term. Accuracy-particularly minimizing false positives and false negatives-was a priority for users. Barriers to adoption included device cost, limited insurance reimbursement, discomfort, and concerns about data privacy. Despite these challenges, many users were willing to use SDDs. Recommendations from health care professionals significantly increased user motivation. This review highlights the need for SDD designs that address user concerns regarding usability, comfort, looks, and accuracy, while also reducing financial and technical barriers. Enhancing clinical involvement and tailoring devices to specific patient needs may be crucial to promoting wider SDD adoption. Further research is needed to evaluate the impact of SDDs on quality of life and to explore ways to mitigate challenges in long-term use.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051966","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
Durable suppression of seizures in a preclinical model of KCNT1 genetic epilepsy with divalent small interfering RNA.
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-27 DOI: 10.1111/epi.18278
Benjamin J Andreone, Jennifer Lin, Jenna Tocci, Matthew Rook, Amr Omer, Lauren M Carito, Chunhua Yang, Hryhoriy Zhoba, Christopher DeJesus, Mariam Traore, Phensinee Haruehanroengra, Alex Prinzen, Gregory Miglis, Matthew Deninger, Mingwei Li, Taylor Lynch, Bryce Howat, Kelly A Rogers, Corrie L Gallant-Behm, Garth A Kinberger, Guillermo Yudowski, Qingmin Chen, Aimee L Jackson, Stefan I McDonough

Objective: Gain-of-function variants in the KCNT1 gene, which encodes a sodium-activated potassium ion channel, drive severe early onset developmental epileptic encephalopathies including epilepsy of infancy with migrating focal seizures and sleep-related hypermotor epilepsy. No therapy provides more than sporadic or incremental improvement. Here, we report suppression of seizures in a genetic mouse model of KCNT1 epilepsy by reducing Kcnt1 transcript with divalent small interfering RNA (siRNA), an emerging variant of oligonucleotide technology developed for the central nervous system.

Methods: The ATL-201 molecule is two identical synthetic double-stranded siRNAs, covalently linked, with 100% nucleotide base pair match to sequence present in both human KCNT1 and mouse Kcnt1 that does not contain any known pathogenic variant. ATL-201 activity was tested in cortical neurons cultured from wild-type mice and in mice homozygous for Kcnt1-Y777H, the mouse ortholog to the human pathogenic KCNT1-Y796H missense variant. Seizures and nest-building behavior were measured in freely behaving Kcnt1-Y777H mice. The number and duration of seizures were measured by electrocorticography in mice dosed with ATL-201 or phosphate-buffered saline in a 6-month durability study and in a 2-month dose-efficacy study.

Results: In vitro, ATL-201 reduced KCNT1 transcript from whole-cell lysate and eliminated potassium currents from KCNT1 channels in heterologous expression. ATL-201 also eliminated sodium-activated potassium currents recorded from individual cortical neurons. In vivo, ATL-201 suppressed seizures in Kcnt1-Y777H homozygous mice in a dose-dependent manner with near-complete suppression from 2 weeks to at least 4 months. Kcnt1-Y777H mice had defects in nest building, whereas in ATL-201-treated mice nest building was equivalent to wild-type mice.

Significance: Patients with KCNT1-driven epilepsy experience up to hundreds of seizures per day and have severe impairment in cognitive, motor, and language development and high mortality. The dose-dependent efficacy and long durability of ATL-201 in mice show promise for ATL-201 as a disease-modifying treatment of KCNT1 epilepsy.

{"title":"Durable suppression of seizures in a preclinical model of KCNT1 genetic epilepsy with divalent small interfering RNA.","authors":"Benjamin J Andreone, Jennifer Lin, Jenna Tocci, Matthew Rook, Amr Omer, Lauren M Carito, Chunhua Yang, Hryhoriy Zhoba, Christopher DeJesus, Mariam Traore, Phensinee Haruehanroengra, Alex Prinzen, Gregory Miglis, Matthew Deninger, Mingwei Li, Taylor Lynch, Bryce Howat, Kelly A Rogers, Corrie L Gallant-Behm, Garth A Kinberger, Guillermo Yudowski, Qingmin Chen, Aimee L Jackson, Stefan I McDonough","doi":"10.1111/epi.18278","DOIUrl":"https://doi.org/10.1111/epi.18278","url":null,"abstract":"<p><strong>Objective: </strong>Gain-of-function variants in the KCNT1 gene, which encodes a sodium-activated potassium ion channel, drive severe early onset developmental epileptic encephalopathies including epilepsy of infancy with migrating focal seizures and sleep-related hypermotor epilepsy. No therapy provides more than sporadic or incremental improvement. Here, we report suppression of seizures in a genetic mouse model of KCNT1 epilepsy by reducing Kcnt1 transcript with divalent small interfering RNA (siRNA), an emerging variant of oligonucleotide technology developed for the central nervous system.</p><p><strong>Methods: </strong>The ATL-201 molecule is two identical synthetic double-stranded siRNAs, covalently linked, with 100% nucleotide base pair match to sequence present in both human KCNT1 and mouse Kcnt1 that does not contain any known pathogenic variant. ATL-201 activity was tested in cortical neurons cultured from wild-type mice and in mice homozygous for Kcnt1-Y777H, the mouse ortholog to the human pathogenic KCNT1-Y796H missense variant. Seizures and nest-building behavior were measured in freely behaving Kcnt1-Y777H mice. The number and duration of seizures were measured by electrocorticography in mice dosed with ATL-201 or phosphate-buffered saline in a 6-month durability study and in a 2-month dose-efficacy study.</p><p><strong>Results: </strong>In vitro, ATL-201 reduced KCNT1 transcript from whole-cell lysate and eliminated potassium currents from KCNT1 channels in heterologous expression. ATL-201 also eliminated sodium-activated potassium currents recorded from individual cortical neurons. In vivo, ATL-201 suppressed seizures in Kcnt1-Y777H homozygous mice in a dose-dependent manner with near-complete suppression from 2 weeks to at least 4 months. Kcnt1-Y777H mice had defects in nest building, whereas in ATL-201-treated mice nest building was equivalent to wild-type mice.</p><p><strong>Significance: </strong>Patients with KCNT1-driven epilepsy experience up to hundreds of seizures per day and have severe impairment in cognitive, motor, and language development and high mortality. The dose-dependent efficacy and long durability of ATL-201 in mice show promise for ATL-201 as a disease-modifying treatment of KCNT1 epilepsy.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051961","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
Valproate discontinuation in girls and women of childbearing age with epilepsy: An Italian multicenter retrospective study on prescribing patterns and outcomes.
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-27 DOI: 10.1111/epi.18281
Roberta Esposto, Giovanni Falcicchio, Elena Zambrelli, Emanuele Cerulli Irelli, Giulia Monti, Federica Ranzato, Loretta Giuliano, Angela La Neve, Carlo Adrea Galimberti, Laura Maria Beatrice Belotti, Katherine Turner, Cecilia Catania, Diana Polo, Valeria Todaro, Francesca Bisulli, Barbara Mostacci

Objective: This study aimed to identify prescribing behaviors in women of childbearing potential (WOCP) with epilepsy already taking valproate (VPA), and to investigate the relationship between VPA maintenance, substitution, reduction, or withdrawal as part of polytherapy, and seizure worsening or relapse.

Methods: We retrospectively reviewed the prescription behaviors and seizure outcomes in WOCP (16-50 years of age) with epilepsy, referred to eight Italian epilepsy centers, who were taking VPA for at least 1 year between 2014 and 2019.

Results: Among 750 women (~12% of all WOCP), 528 (70.4%) maintained VPA unchanged throughout the observation period, 103 (13.7%) replaced VPA with another antiseizure medication (ASM), 90 (12%) reduced VPA, and 29 (3.9%) discontinued VPA in polytherapy. Focal epilepsy was most strongly associated with VPA withdrawal (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.38-6.38), whereas generalized epilepsy was most associated with its non-withdrawal (reduction/switch/maintenance) (OR .31, 95% CI .14-.68). Intellectual disability, higher seizure frequency, and higher VPA doses were linked to VPA continuation. VPA withdrawal from polytherapy was associated with a higher risk of tonic-clonic seizure worsening (OR 2.91, 95% CI 1.09-7.77) compared to non-withdrawal.

Significance: VPA was rarely withdrawn or substituted in WOCP with epilepsy, in secondary and tertiary care settings following European regulatory restrictions. This likely reflects a population with severe epilepsies where VPA is difficult to replace; whereas women with milder epilepsies likely discontinued VPA earlier, as evidenced by its low overall prescription frequency. Withdrawal of VPA from a polytherapy regimen was associated with a threefold increased risk of seizure exacerbation.

{"title":"Valproate discontinuation in girls and women of childbearing age with epilepsy: An Italian multicenter retrospective study on prescribing patterns and outcomes.","authors":"Roberta Esposto, Giovanni Falcicchio, Elena Zambrelli, Emanuele Cerulli Irelli, Giulia Monti, Federica Ranzato, Loretta Giuliano, Angela La Neve, Carlo Adrea Galimberti, Laura Maria Beatrice Belotti, Katherine Turner, Cecilia Catania, Diana Polo, Valeria Todaro, Francesca Bisulli, Barbara Mostacci","doi":"10.1111/epi.18281","DOIUrl":"https://doi.org/10.1111/epi.18281","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify prescribing behaviors in women of childbearing potential (WOCP) with epilepsy already taking valproate (VPA), and to investigate the relationship between VPA maintenance, substitution, reduction, or withdrawal as part of polytherapy, and seizure worsening or relapse.</p><p><strong>Methods: </strong>We retrospectively reviewed the prescription behaviors and seizure outcomes in WOCP (16-50 years of age) with epilepsy, referred to eight Italian epilepsy centers, who were taking VPA for at least 1 year between 2014 and 2019.</p><p><strong>Results: </strong>Among 750 women (~12% of all WOCP), 528 (70.4%) maintained VPA unchanged throughout the observation period, 103 (13.7%) replaced VPA with another antiseizure medication (ASM), 90 (12%) reduced VPA, and 29 (3.9%) discontinued VPA in polytherapy. Focal epilepsy was most strongly associated with VPA withdrawal (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.38-6.38), whereas generalized epilepsy was most associated with its non-withdrawal (reduction/switch/maintenance) (OR .31, 95% CI .14-.68). Intellectual disability, higher seizure frequency, and higher VPA doses were linked to VPA continuation. VPA withdrawal from polytherapy was associated with a higher risk of tonic-clonic seizure worsening (OR 2.91, 95% CI 1.09-7.77) compared to non-withdrawal.</p><p><strong>Significance: </strong>VPA was rarely withdrawn or substituted in WOCP with epilepsy, in secondary and tertiary care settings following European regulatory restrictions. This likely reflects a population with severe epilepsies where VPA is difficult to replace; whereas women with milder epilepsies likely discontinued VPA earlier, as evidenced by its low overall prescription frequency. Withdrawal of VPA from a polytherapy regimen was associated with a threefold increased risk of seizure exacerbation.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046029","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
Integrated care for mental health in epilepsy: A systematic review and meta-synthesis by the International League Against Epilepsy Integrated Mental Health Care Pathways Task Force.
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-27 DOI: 10.1111/epi.18252
Milena Gandy, Wendy Wu, Thomas Woldhuis, Sophie D Bennett, Gaston Baslet, Gerardo Araujo-Filho, Avani C Modi, Markus Reuber, Venus Tang, M Providence Umuziga, Heidi M Munger Clary

Mental health (MH) comorbidities are prevalent among people with epilepsy (PWE), but many experience challenges accessing care. To address this, suggestions have been made to integrate MH care into epilepsy care settings, yet the current approaches, benefits, and implementation determinants to MH care integration are unclear. This review aims to synthesize existing integrated MH care models for PWE to inform the development and planning of future initiatives. We searched Embase, Medline, PsycINFO, and Cochrane for articles that described any activity within a health care setting that addressed MH as routine care for PWE. Year of publication was restricted to 2000 onward. At least two authors reviewed articles and extracted data. Barriers, facilitators, and future recommendations were identified through thematic synthesis using NVivo. Study quality was assessed for articles reporting clinical outcomes. Following review of 7520 abstracts and 596 full-text articles, 65 met eligibility criteria and were included. Most (k = 43, 66%) described routine MH screening, with 11 reporting on uptake and acceptability, which was generally high. Interventions included psychological interventions (k = 23, 35%), psychoeducation (k = 9, 14%), and pharmacotherapy (k = 6, 9%). Thirteen articles (20%) reported on changes in MH outcomes, all of which indicated some improvements in MH, but 33% were rated as poor quality. Thirty-four (52%) articles reported on barriers and facilitators, and 34 (37%) articles provided recommendations for future initiatives. Overall, diverse approaches to integrated MH care for PWE were identified, with promising uptake, acceptability, and impacts on MH outcomes. Qualitative analysis informed a proposed framework for future integrated MH care initiatives. The framework outlines fundamental components of care activities, such as MH screening, psychoeducation, and care pathways, as well as key facilitators for their establishment (e.g., policies, infrastructure, staffing) and effective delivery (e.g., staff incentives, acceptability, evaluation).

{"title":"Integrated care for mental health in epilepsy: A systematic review and meta-synthesis by the International League Against Epilepsy Integrated Mental Health Care Pathways Task Force.","authors":"Milena Gandy, Wendy Wu, Thomas Woldhuis, Sophie D Bennett, Gaston Baslet, Gerardo Araujo-Filho, Avani C Modi, Markus Reuber, Venus Tang, M Providence Umuziga, Heidi M Munger Clary","doi":"10.1111/epi.18252","DOIUrl":"https://doi.org/10.1111/epi.18252","url":null,"abstract":"<p><p>Mental health (MH) comorbidities are prevalent among people with epilepsy (PWE), but many experience challenges accessing care. To address this, suggestions have been made to integrate MH care into epilepsy care settings, yet the current approaches, benefits, and implementation determinants to MH care integration are unclear. This review aims to synthesize existing integrated MH care models for PWE to inform the development and planning of future initiatives. We searched Embase, Medline, PsycINFO, and Cochrane for articles that described any activity within a health care setting that addressed MH as routine care for PWE. Year of publication was restricted to 2000 onward. At least two authors reviewed articles and extracted data. Barriers, facilitators, and future recommendations were identified through thematic synthesis using NVivo. Study quality was assessed for articles reporting clinical outcomes. Following review of 7520 abstracts and 596 full-text articles, 65 met eligibility criteria and were included. Most (k = 43, 66%) described routine MH screening, with 11 reporting on uptake and acceptability, which was generally high. Interventions included psychological interventions (k = 23, 35%), psychoeducation (k = 9, 14%), and pharmacotherapy (k = 6, 9%). Thirteen articles (20%) reported on changes in MH outcomes, all of which indicated some improvements in MH, but 33% were rated as poor quality. Thirty-four (52%) articles reported on barriers and facilitators, and 34 (37%) articles provided recommendations for future initiatives. Overall, diverse approaches to integrated MH care for PWE were identified, with promising uptake, acceptability, and impacts on MH outcomes. Qualitative analysis informed a proposed framework for future integrated MH care initiatives. The framework outlines fundamental components of care activities, such as MH screening, psychoeducation, and care pathways, as well as key facilitators for their establishment (e.g., policies, infrastructure, staffing) and effective delivery (e.g., staff incentives, acceptability, evaluation).</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046027","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
Stereoelectroencephalographic exploration and surgical outcome in Lennox-Gastaut syndrome.
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-27 DOI: 10.1111/epi.18283
Soomi Cho, Julia Makhalova, Samuel Medina Villalon, Nathalie Villeneuve, Agnes Trébuchon, Manel Krouma, Didier Scavarda, Anne Lépine, Mathieu Milh, Romain Carron, Francesca Bonini, Géraldine Daquin, Sandrine Aubert, Stanislas Lagarde, Francesca Pizzo, Fabrice Bartolomei

Objective: Lennox-Gastaut syndrome (LGS) is typically characterized by drug-resistant epilepsy and subsequent cognitive deterioration. Surgery is a rare but viable option for the control of seizures in a subset of patients with LGS. This study aimed to describe the organization of the epileptogenic zone network (EZN) in patients with LGS using stereoelectroencephalography (SEEG) and to report the outcome of post-SEEG treatment.

Methods: A quantitative SEEG signal analysis was conducted in 14 consecutive patients with LGS, in whom a potentially localized EZN was suggested based on a comprehensive noninvasive evaluation. The EZN and the irritative zone network were identified using relevant biomarkers during ictal (epileptogenicity index and connectivity epileptogenicity index) and interictal (spikes and high-frequency oscillations) recordings. The applied post-SEEG treatments were assessed, including SEEG-guided radiofrequency thermocoagulation (RF-TC), surgery, and neurostimulation.

Results: The seizure onset patterns showed some specificity by seizure type, with 84% of tonic seizures involving low-voltage fast activity. The EZN of patients with LGS was often, but not always, complex and extensive, involving two or more lobes (79%) and both hemispheres (64%). The lateral neocortical structures, particularly the lateral premotor and dorsolateral prefrontal cortices, were identified as being most frequently involved in the EZN. Among the explored subcortical structures, only the pulvinar, central-lateral thalamic nucleus, and hypothalamic hamartoma belonged to the EZN. Twelve patients (86%) underwent SEEG-guided RF-TC, with 50% experiencing a >50% reduction in baseline seizure frequency. Four patients (29%) underwent curative surgery for significant involvement of a lesion in the EZN, and one case achieved an Engel class I outcome.

Significance: This is the first quantitative SEEG study in patients with LGS to demonstrate the utility of SEEG in identifying patients who may benefit from surgery and to perform SEEG-guided RF-TC. Nevertheless, the indications for SEEG should be carefully assessed, as localized EZN is uncommon in LGS.

{"title":"Stereoelectroencephalographic exploration and surgical outcome in Lennox-Gastaut syndrome.","authors":"Soomi Cho, Julia Makhalova, Samuel Medina Villalon, Nathalie Villeneuve, Agnes Trébuchon, Manel Krouma, Didier Scavarda, Anne Lépine, Mathieu Milh, Romain Carron, Francesca Bonini, Géraldine Daquin, Sandrine Aubert, Stanislas Lagarde, Francesca Pizzo, Fabrice Bartolomei","doi":"10.1111/epi.18283","DOIUrl":"https://doi.org/10.1111/epi.18283","url":null,"abstract":"<p><strong>Objective: </strong>Lennox-Gastaut syndrome (LGS) is typically characterized by drug-resistant epilepsy and subsequent cognitive deterioration. Surgery is a rare but viable option for the control of seizures in a subset of patients with LGS. This study aimed to describe the organization of the epileptogenic zone network (EZN) in patients with LGS using stereoelectroencephalography (SEEG) and to report the outcome of post-SEEG treatment.</p><p><strong>Methods: </strong>A quantitative SEEG signal analysis was conducted in 14 consecutive patients with LGS, in whom a potentially localized EZN was suggested based on a comprehensive noninvasive evaluation. The EZN and the irritative zone network were identified using relevant biomarkers during ictal (epileptogenicity index and connectivity epileptogenicity index) and interictal (spikes and high-frequency oscillations) recordings. The applied post-SEEG treatments were assessed, including SEEG-guided radiofrequency thermocoagulation (RF-TC), surgery, and neurostimulation.</p><p><strong>Results: </strong>The seizure onset patterns showed some specificity by seizure type, with 84% of tonic seizures involving low-voltage fast activity. The EZN of patients with LGS was often, but not always, complex and extensive, involving two or more lobes (79%) and both hemispheres (64%). The lateral neocortical structures, particularly the lateral premotor and dorsolateral prefrontal cortices, were identified as being most frequently involved in the EZN. Among the explored subcortical structures, only the pulvinar, central-lateral thalamic nucleus, and hypothalamic hamartoma belonged to the EZN. Twelve patients (86%) underwent SEEG-guided RF-TC, with 50% experiencing a >50% reduction in baseline seizure frequency. Four patients (29%) underwent curative surgery for significant involvement of a lesion in the EZN, and one case achieved an Engel class I outcome.</p><p><strong>Significance: </strong>This is the first quantitative SEEG study in patients with LGS to demonstrate the utility of SEEG in identifying patients who may benefit from surgery and to perform SEEG-guided RF-TC. Nevertheless, the indications for SEEG should be carefully assessed, as localized EZN is uncommon in LGS.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051963","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
Job loss and reemployment of newly diagnosed people with epilepsy: A nationwide cohort study.
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-23 DOI: 10.1111/epi.18262
Su-Hyun Han, Sang Min Park, Sujin Yum, Hye-Jin Moon, Hyesung Lee, Seo-Young Lee, Sang-Ahm Lee

Objective: Epilepsy has negative socioeconomic impacts on those affected, resulting not only from actual disability but also from social stigma. However, longitudinal studies examining occupational consequences following an epilepsy diagnosis are limited. We aimed to investigate the occupational outcomes of newly diagnosed epilepsy among Korean employees.

Methods: We conducted a nationwide population-based retrospective cohort study using the Korean National Health Insurance Service database. We included newly diagnosed people with epilepsy (PWE) aged 25 to 54 years, identified by diagnostic codes and antiseizure medication (ASM) prescriptions, who were employed at diagnosis between 2004 and 2018. The employment status of PWE was determined based on their enrollment in the employer-provided health insurance scheme. We analyzed the rates of job loss and reemployment, associated factors, and income changes following diagnosis.

Results: Among the 13 122 newly diagnosed PWE, the overall first-year job loss rate across the study period was 21.7%, which was 1.62-2.54 times higher than that of the general population for each year. The excesses of job loss among PWE in safe occupations were comparable to those in safety-sensitive occupations. Central nervous system illness (adjusted hazard ratio [aHR] = 1.12), psychiatric disease (aHR = 1.19), ≥2 emergency room visits or hospitalizations (aHR = 3.00), and ≥4 ASM attempts (aHR = 1.26) increased the risk of job loss. Among individuals who lost their job during the first year, 22.4% were reemployed within 1 year, with similar risk factors hindering reemployment. The income distribution of regained jobs showed a downward shift compared to previous jobs.

Significance: Newly diagnosed PWE were at risk of job loss, irrespective of the occupational hazards related to seizures. Poor disease control and comorbidities partially contributed to unemployment. Alongside active seizure management, guidance for suitable occupations and the implementation of tailored restrictions based on occupational risk stratification are imperative to improve the job security of PWE.

{"title":"Job loss and reemployment of newly diagnosed people with epilepsy: A nationwide cohort study.","authors":"Su-Hyun Han, Sang Min Park, Sujin Yum, Hye-Jin Moon, Hyesung Lee, Seo-Young Lee, Sang-Ahm Lee","doi":"10.1111/epi.18262","DOIUrl":"https://doi.org/10.1111/epi.18262","url":null,"abstract":"<p><strong>Objective: </strong>Epilepsy has negative socioeconomic impacts on those affected, resulting not only from actual disability but also from social stigma. However, longitudinal studies examining occupational consequences following an epilepsy diagnosis are limited. We aimed to investigate the occupational outcomes of newly diagnosed epilepsy among Korean employees.</p><p><strong>Methods: </strong>We conducted a nationwide population-based retrospective cohort study using the Korean National Health Insurance Service database. We included newly diagnosed people with epilepsy (PWE) aged 25 to 54 years, identified by diagnostic codes and antiseizure medication (ASM) prescriptions, who were employed at diagnosis between 2004 and 2018. The employment status of PWE was determined based on their enrollment in the employer-provided health insurance scheme. We analyzed the rates of job loss and reemployment, associated factors, and income changes following diagnosis.</p><p><strong>Results: </strong>Among the 13 122 newly diagnosed PWE, the overall first-year job loss rate across the study period was 21.7%, which was 1.62-2.54 times higher than that of the general population for each year. The excesses of job loss among PWE in safe occupations were comparable to those in safety-sensitive occupations. Central nervous system illness (adjusted hazard ratio [aHR] = 1.12), psychiatric disease (aHR = 1.19), ≥2 emergency room visits or hospitalizations (aHR = 3.00), and ≥4 ASM attempts (aHR = 1.26) increased the risk of job loss. Among individuals who lost their job during the first year, 22.4% were reemployed within 1 year, with similar risk factors hindering reemployment. The income distribution of regained jobs showed a downward shift compared to previous jobs.</p><p><strong>Significance: </strong>Newly diagnosed PWE were at risk of job loss, irrespective of the occupational hazards related to seizures. Poor disease control and comorbidities partially contributed to unemployment. Alongside active seizure management, guidance for suitable occupations and the implementation of tailored restrictions based on occupational risk stratification are imperative to improve the job security of PWE.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032719","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
Antiseizure medication use in acute symptomatic seizures: A narrative review. 抗癫痫药物在急性症状性癫痫发作中的应用:叙述性回顾。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-22 DOI: 10.1111/epi.18275
Ruta Yardi, Rani Priyanka Vasireddy, Marian Galovic, Vineet Punia

Acute symptomatic seizures, occurring shortly after a central nervous system insult, constitute nearly half of all seizure cases. However, there is a conspicuous absence of clear, comprehensive, and cohesive guidelines for the management of these seizures with antiseizure medications, especially their duration of use. This lack of consensus on the optimal duration of therapy leads to prolonged treatments that may carry adverse consequences. The primary objective of this narrative review is to present the existing evidence-based literature on the management of acute symptomatic seizures within the context of the underlying pathologies that trigger them. We explore the risk of developing epilepsy for each specific etiology and identify the factors that influence this risk. Finally, to facilitate decision-making regarding treatment duration, we categorize acute seizures based on the temporal characteristics of hyperexcitability as acute, subacute, and prolonged. Such a rubric may offer clarity in an area where consensus and guidelines are lacking.

在中枢神经系统损伤后不久发生的急性症状性癫痫发作,占所有癫痫发作病例的近一半。然而,目前明显缺乏明确、全面和有凝聚力的抗癫痫药物治疗这些癫痫发作的指南,特别是它们的使用时间。对最佳治疗时间缺乏共识导致治疗时间延长,可能带来不良后果。这篇叙述性综述的主要目的是在引发急性症状性癫痫发作的潜在病理背景下,介绍现有的基于证据的急性症状性癫痫发作管理文献。我们探讨发展癫痫的风险为每个特定的病因,并确定影响这种风险的因素。最后,为了便于决策治疗时间,我们根据高兴奋性的时间特征将急性发作分为急性、亚急性和延长。这样的准则可能在缺乏共识和指导方针的领域提供清晰度。
{"title":"Antiseizure medication use in acute symptomatic seizures: A narrative review.","authors":"Ruta Yardi, Rani Priyanka Vasireddy, Marian Galovic, Vineet Punia","doi":"10.1111/epi.18275","DOIUrl":"https://doi.org/10.1111/epi.18275","url":null,"abstract":"<p><p>Acute symptomatic seizures, occurring shortly after a central nervous system insult, constitute nearly half of all seizure cases. However, there is a conspicuous absence of clear, comprehensive, and cohesive guidelines for the management of these seizures with antiseizure medications, especially their duration of use. This lack of consensus on the optimal duration of therapy leads to prolonged treatments that may carry adverse consequences. The primary objective of this narrative review is to present the existing evidence-based literature on the management of acute symptomatic seizures within the context of the underlying pathologies that trigger them. We explore the risk of developing epilepsy for each specific etiology and identify the factors that influence this risk. Finally, to facilitate decision-making regarding treatment duration, we categorize acute seizures based on the temporal characteristics of hyperexcitability as acute, subacute, and prolonged. Such a rubric may offer clarity in an area where consensus and guidelines are lacking.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002178","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
Which is the most cost-effective antiseizure medication for initial monotherapy for focal epilepsy? 对于局灶性癫痫的初始单药治疗,哪种抗癫痫药物最具成本效益?
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-22 DOI: 10.1111/epi.18269
Yani Hu, Shunan Chen, Fengqian Mao, Suhong Wang, Jie Chen, Wei Hu, Lingyan Yu, Haibin Dai

Objective: An increasing number of antiseizure medications (ASMs) are approved for monotherapy for focal epilepsy, but direct comparisons of the lifetime cost-effectiveness of all existing treatment strategies are lacking. This study aims to compare the cost-effectiveness of new ASMs and traditional ASMs as first-line monotherapy for newly diagnosed focal epilepsy.

Method: We used a Markov model to evaluate the lifetime cost-effectiveness of 10 ASMs in the treatment of focal epilepsy, with lacosamide (LCM) as a control, from the perspective of society in the United States. Effectiveness, cost data, and health state utilities were obtained from published literature. The cycle of the model is 6 months. Willingness to pay was defined as $150 000 per quality-adjusted life year (QALY). One-way and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty, and several scenario analyses were also conducted.

Results: The base case analysis showed that carbamazepine (CBZ) was the least costly ASM and more effective than valproic acid (VPA), levetiracetam (LEV), gabapentin (GBP), topiramate (TPM), and lamotrigine (LTG) from an American social perspective. In contrast, oxcarbazepine (OXC), phenytoin (PHT), phenobarbitone (PHB), LCM, and zonisamide (ZNS) were more effective than CBZ, with incremental cost-effectiveness ratios of $334 703.50, $325 610.99, $3 037 148.62, $1 178 954.91, and $108 153 360.85/QALY, respectively. The traditional ASMs were ranked as CBZ, PHT, VPA, and PHB; the new ASMs were ranked as OXC, LEV, LCM, LTG, TPM, GBP, and ZNS. When generic drugs are used, PHT, OXC, and CBZ remain the three most cost-effective options.

Significance: In terms of cost-effectiveness, CBZ monotherapy is the best option for newly diagnosed focal epilepsy, followed by OXC, PHT, VPA, LEV, PHB, LCM, LTG, TPM, GBP, and ZNS. Most traditional ASMs are more cost-effective than new ASMs; OXC is an exception.

目的:越来越多的抗癫痫药物(asm)被批准用于局灶性癫痫的单一治疗,但缺乏对所有现有治疗策略的终生成本效益的直接比较。本研究旨在比较新型抗痉挛药和传统抗痉挛药作为一线单药治疗新诊断局灶性癫痫的成本-效果。方法:从美国社会的角度,以拉科沙胺(lacosamide, LCM)为对照,采用马尔可夫模型评价10种asm治疗局灶性癫痫的终生成本-效果。有效性、成本数据和健康状态效用从已发表的文献中获得。模型周期为6个月。支付意愿定义为每个质量调整生命年(QALY) 15万美元。对参数的不确定性进行了单向和概率敏感性分析,并进行了几种情景分析。结果:从美国社会的角度来看,卡马西平(CBZ)是最便宜的ASM,并且比丙戊酸(VPA)、左乙拉西坦(LEV)、加巴喷丁(GBP)、托吡酯(TPM)和拉莫三嗪(LTG)更有效。相比而言,奥卡西平(OXC)、苯妥英(PHT)、苯巴比妥(PHB)、LCM和唑尼沙胺(ZNS)比CBZ更有效,其增量成本-效果比分别为334 703.50美元、325 610.99美元、3 037 148.62美元、1 178 954.91美元和108 153 360.85美元/QALY。传统asm依次为CBZ、PHT、VPA、PHB;新的asm分别为OXC、LEV、LCM、LTG、TPM、GBP和ZNS。当使用仿制药时,PHT、OXC和CBZ仍然是三个最具成本效益的选择。意义:就成本-效果而言,CBZ单药治疗是新诊断局灶性癫痫的最佳选择,其次是OXC、PHT、VPA、LEV、PHB、LCM、LTG、TPM、GBP和ZNS。大多数传统asm比新型asm更具成本效益;OXC是个例外。
{"title":"Which is the most cost-effective antiseizure medication for initial monotherapy for focal epilepsy?","authors":"Yani Hu, Shunan Chen, Fengqian Mao, Suhong Wang, Jie Chen, Wei Hu, Lingyan Yu, Haibin Dai","doi":"10.1111/epi.18269","DOIUrl":"https://doi.org/10.1111/epi.18269","url":null,"abstract":"<p><strong>Objective: </strong>An increasing number of antiseizure medications (ASMs) are approved for monotherapy for focal epilepsy, but direct comparisons of the lifetime cost-effectiveness of all existing treatment strategies are lacking. This study aims to compare the cost-effectiveness of new ASMs and traditional ASMs as first-line monotherapy for newly diagnosed focal epilepsy.</p><p><strong>Method: </strong>We used a Markov model to evaluate the lifetime cost-effectiveness of 10 ASMs in the treatment of focal epilepsy, with lacosamide (LCM) as a control, from the perspective of society in the United States. Effectiveness, cost data, and health state utilities were obtained from published literature. The cycle of the model is 6 months. Willingness to pay was defined as $150 000 per quality-adjusted life year (QALY). One-way and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty, and several scenario analyses were also conducted.</p><p><strong>Results: </strong>The base case analysis showed that carbamazepine (CBZ) was the least costly ASM and more effective than valproic acid (VPA), levetiracetam (LEV), gabapentin (GBP), topiramate (TPM), and lamotrigine (LTG) from an American social perspective. In contrast, oxcarbazepine (OXC), phenytoin (PHT), phenobarbitone (PHB), LCM, and zonisamide (ZNS) were more effective than CBZ, with incremental cost-effectiveness ratios of $334 703.50, $325 610.99, $3 037 148.62, $1 178 954.91, and $108 153 360.85/QALY, respectively. The traditional ASMs were ranked as CBZ, PHT, VPA, and PHB; the new ASMs were ranked as OXC, LEV, LCM, LTG, TPM, GBP, and ZNS. When generic drugs are used, PHT, OXC, and CBZ remain the three most cost-effective options.</p><p><strong>Significance: </strong>In terms of cost-effectiveness, CBZ monotherapy is the best option for newly diagnosed focal epilepsy, followed by OXC, PHT, VPA, LEV, PHB, LCM, LTG, TPM, GBP, and ZNS. Most traditional ASMs are more cost-effective than new ASMs; OXC is an exception.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002238","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
The impact of radiofrequency thermocoagulation on brain connectivity in drug-resistant epilepsy: Insights from stereo-electroencephalography and cortico-cortical evoked potentials. 射频热凝对耐药癫痫患者脑连通性的影响:来自立体脑电图和皮质-皮质诱发电位的见解。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-20 DOI: 10.1111/epi.18270
Justyna Gula, Rutger J Slegers, Raf H M Van Hoof, Balu Krishnan, Massimo Mischi, Vivianne H J M van Kranen-Mastenbroek, Ilse E C W Van Straaten, Danny Hilkman, Louis Wagner, Albert Colon, Olaf E M G Schijns, Borbála Hunyadi, Jacobus F A Jansen, Simon Tousseyn

Objective: To investigate whether local lesions created by stereo-electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) affect distant brain connectivity and excitability in patients with focal, drug-resistant epilepsy (DRE).

Methods: Ten patients with focal DRE underwent SEEG implantation and subsequently 1 Hz bipolar repetitive electrical stimulation (RES) for 30 s before and after RFTC. Root mean square (RMS) of cortico-cortical evoked potentials (CCEPs) was calculated for 15 ms to 300 ms post-stimulation with baseline correction. Contact pairs were categorized as both coagulated, hybrid, or both non-coagulated. The data were divided into nine categories based on the stimulating and recording contact pair combinations. RMS of CCEPs was compared before and after (<12 h) RFTC using a two-sample t test (Hochberg corrected, p < 0.05) for each patient. Boost score, indicating power increase during seizures before RFTC relative to baseline, was analyzed in 4 s windows with 1 s overlap during seizure duration.

Results: RFTC altered connectivity across all categories. Of interest, decreases and increases in RMS were observed in connections between non-coagulated contacts distant from coagulation site (range: 1.09-85 mm, median = 17.7 mm, interquartile range [IQR] 10.1-32.3). Contact pairs involved in significantly altered non-coagulated connections showed a higher boost score correlation in the theta, beta, and gamma bands, as well as a stronger maximum correlation with coagulated sites in the delta band than contacts for which connectivity did not change after RFTC.

Significance: This study highlights how local lesions alter distant brain connectivity, providing insights for future research on epilepsy network changes and seizure outcomes following RFTC.

目的:探讨立体脑电图(SEEG)引导下射频热凝(RFTC)局部病变对局灶性耐药癫痫(DRE)患者远端脑连通性和兴奋性的影响。方法:10例局灶性DRE患者在RFTC前后分别行SEEG植入和1 Hz双极重复电刺激(RES) 30 s。经基线校正后,计算刺激后15 ~ 300 ms皮质-皮质诱发电位(CCEPs)的均方根(RMS)。接触对被分类为既凝固,杂交,或既不凝固。根据刺激和记录接触对组合将数据分为9类。结果:RFTC改变了所有类别的连通性。令人感兴趣的是,在远离凝血部位的非凝血接触者之间的连接中,RMS下降或上升(范围:1.09-85 mm,中位数= 17.7 mm,四分位数间距[IQR] 10.1-32.3)。非凝固性连接发生显著改变的接触对在theta、beta和gamma波段表现出更高的提升得分相关性,而在delta波段与凝固性位点的最大相关性强于连接未发生改变的接触对。意义:本研究强调了局部病变如何改变远端大脑连通性,为RFTC后癫痫网络变化和癫痫结局的未来研究提供了见解。
{"title":"The impact of radiofrequency thermocoagulation on brain connectivity in drug-resistant epilepsy: Insights from stereo-electroencephalography and cortico-cortical evoked potentials.","authors":"Justyna Gula, Rutger J Slegers, Raf H M Van Hoof, Balu Krishnan, Massimo Mischi, Vivianne H J M van Kranen-Mastenbroek, Ilse E C W Van Straaten, Danny Hilkman, Louis Wagner, Albert Colon, Olaf E M G Schijns, Borbála Hunyadi, Jacobus F A Jansen, Simon Tousseyn","doi":"10.1111/epi.18270","DOIUrl":"https://doi.org/10.1111/epi.18270","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether local lesions created by stereo-electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) affect distant brain connectivity and excitability in patients with focal, drug-resistant epilepsy (DRE).</p><p><strong>Methods: </strong>Ten patients with focal DRE underwent SEEG implantation and subsequently 1 Hz bipolar repetitive electrical stimulation (RES) for 30 s before and after RFTC. Root mean square (RMS) of cortico-cortical evoked potentials (CCEPs) was calculated for 15 ms to 300 ms post-stimulation with baseline correction. Contact pairs were categorized as both coagulated, hybrid, or both non-coagulated. The data were divided into nine categories based on the stimulating and recording contact pair combinations. RMS of CCEPs was compared before and after (<12 h) RFTC using a two-sample t test (Hochberg corrected, p < 0.05) for each patient. Boost score, indicating power increase during seizures before RFTC relative to baseline, was analyzed in 4 s windows with 1 s overlap during seizure duration.</p><p><strong>Results: </strong>RFTC altered connectivity across all categories. Of interest, decreases and increases in RMS were observed in connections between non-coagulated contacts distant from coagulation site (range: 1.09-85 mm, median = 17.7 mm, interquartile range [IQR] 10.1-32.3). Contact pairs involved in significantly altered non-coagulated connections showed a higher boost score correlation in the theta, beta, and gamma bands, as well as a stronger maximum correlation with coagulated sites in the delta band than contacts for which connectivity did not change after RFTC.</p><p><strong>Significance: </strong>This study highlights how local lesions alter distant brain connectivity, providing insights for future research on epilepsy network changes and seizure outcomes following RFTC.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002213","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
New onset refractory status epilepticus: Long-term outcomes beyond seizures. 新发难治性癫痫持续状态:癫痫发作以外的长期结局。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-18 DOI: 10.1111/epi.18267
Poul H Espino, Krista Eschbach, Leah J Blank, Mackenzie C Cervenka, Eyal Muscal, Raquel Farias-Moeller, Emily J Gilmore, Margaret T Gopaul, Hiba A Haider, Aurelie Hanin, Lawrence J Hirsch, Marissa A Kellogg, Gerhard Kluger, Soon-Tae Lee, Alexandria E Melendez-Zaidi, Vincent Navarro, Audrey C Oliger, Elena Pasini, Gitta Reuner, Cynthia M Sharpe, Zubeda B Sheikh, Leon Steigleder, Claude Steriade, Coral M Stredny, Adam Strzelczyk, Olga Taraschenko, Andreas van Baalen, Sarah A Vinette, Ronny Wickström, Nora W Wong, Jiyeoun Yoo, Teneille E Gofton

We propose and prioritize important outcome domains that should be considered for future research investigating long-term outcomes (LTO) after new onset refractory status epilepticus (NORSE). The study was led by the international NORSE Institute LTO Working Group. First, literature describing the LTO of NORSE survivors was identified using a PubMed search and summarized to identify knowledge gaps. Subsequently, a consensus-building process was performed to prioritize and rank important LTO domains for further research. The prioritization of LTO domains was qualitative, enabling the expert panel to generate ideas, share opinions, and provide reasons for the rankings. A second round took place to allow expansion and agreement regarding specific details for each domain. Outcomes were classified into eight main domains: (1) Function: Neuropsychological, Neurological (other than seizures), and Psychiatric (mood and behavior); (2) Quality of Life; (3) Epilepsy; (4) Nonneurological (medical); (5) Social; (6) Caregiver Burden; (7) Long-Term Mortality; and (8) Health Care System Impact. In addition, the working group suggested obtaining outcome measures for each domain at 6 months and 1 year after discharge and annually thereafter until stability has been reached. There are no currently established time frames set for when LTO in NORSE begin or plateau, and previously there existed no consensus regarding which LTO should be considered. This consensus process identifies and recommends NORSE LTO domains that should be considered in future research studies to provide more consistent results that can be compared between studies. Survivors of NORSE should be evaluated serially and at fixed points over time to maximize our understanding of the recovery trajectory for all LTO domains. Establishing reliable and standardized data describing LTO (beyond seizures) after NORSE will support discussions with families during the acute stages, prognostication, the development of targeted management strategies for survivors, and future comparative research globally helping to identify biomarkers that may predict LTO.

我们提出并优先考虑未来研究新发难治性癫痫持续状态(NORSE)后长期结局(LTO)应考虑的重要结局领域。这项研究是由国际挪威研究所LTO工作组领导的。首先,通过PubMed检索确定描述挪威幸存者LTO的文献,并对其进行总结以确定知识空白。随后,进行了一个建立共识的过程,以确定重要的LTO领域的优先次序和排名,以供进一步研究。LTO域的优先级是定性的,使专家小组能够产生想法,分享意见,并提供排名的原因。第二轮是为了允许扩展和就每个领域的具体细节达成协议。结果分为八个主要领域:(1)功能:神经心理学、神经学(不包括癫痫发作)和精神病学(情绪和行为);(2)生活质量;(3)癫痫;(4)非神经学(医学);(5)社会;(6)照顾者负担;(7)长期死亡率;(8)卫生保健系统影响。此外,工作组建议在出院后6个月和1年以及此后每年获得每个领域的结果测量,直到达到稳定为止。对于挪威的LTO何时开始或趋于平稳,目前还没有确定的时间框架,以前也没有就应该考虑哪一种LTO达成共识。这一共识过程确定并推荐了在未来的研究中应该考虑的北欧LTO域,以提供更一致的结果,可以在研究之间进行比较。NORSE的幸存者应该随着时间的推移在固定的时间点进行连续评估,以最大限度地了解所有LTO域的恢复轨迹。建立可靠和标准化的数据,描述NORSE后的LTO(癫痫发作后),将支持在急性期与家属讨论,预测,为幸存者制定有针对性的管理策略,以及未来全球范围内的比较研究,帮助确定可能预测LTO的生物标志物。
{"title":"New onset refractory status epilepticus: Long-term outcomes beyond seizures.","authors":"Poul H Espino, Krista Eschbach, Leah J Blank, Mackenzie C Cervenka, Eyal Muscal, Raquel Farias-Moeller, Emily J Gilmore, Margaret T Gopaul, Hiba A Haider, Aurelie Hanin, Lawrence J Hirsch, Marissa A Kellogg, Gerhard Kluger, Soon-Tae Lee, Alexandria E Melendez-Zaidi, Vincent Navarro, Audrey C Oliger, Elena Pasini, Gitta Reuner, Cynthia M Sharpe, Zubeda B Sheikh, Leon Steigleder, Claude Steriade, Coral M Stredny, Adam Strzelczyk, Olga Taraschenko, Andreas van Baalen, Sarah A Vinette, Ronny Wickström, Nora W Wong, Jiyeoun Yoo, Teneille E Gofton","doi":"10.1111/epi.18267","DOIUrl":"https://doi.org/10.1111/epi.18267","url":null,"abstract":"<p><p>We propose and prioritize important outcome domains that should be considered for future research investigating long-term outcomes (LTO) after new onset refractory status epilepticus (NORSE). The study was led by the international NORSE Institute LTO Working Group. First, literature describing the LTO of NORSE survivors was identified using a PubMed search and summarized to identify knowledge gaps. Subsequently, a consensus-building process was performed to prioritize and rank important LTO domains for further research. The prioritization of LTO domains was qualitative, enabling the expert panel to generate ideas, share opinions, and provide reasons for the rankings. A second round took place to allow expansion and agreement regarding specific details for each domain. Outcomes were classified into eight main domains: (1) Function: Neuropsychological, Neurological (other than seizures), and Psychiatric (mood and behavior); (2) Quality of Life; (3) Epilepsy; (4) Nonneurological (medical); (5) Social; (6) Caregiver Burden; (7) Long-Term Mortality; and (8) Health Care System Impact. In addition, the working group suggested obtaining outcome measures for each domain at 6 months and 1 year after discharge and annually thereafter until stability has been reached. There are no currently established time frames set for when LTO in NORSE begin or plateau, and previously there existed no consensus regarding which LTO should be considered. This consensus process identifies and recommends NORSE LTO domains that should be considered in future research studies to provide more consistent results that can be compared between studies. Survivors of NORSE should be evaluated serially and at fixed points over time to maximize our understanding of the recovery trajectory for all LTO domains. Establishing reliable and standardized data describing LTO (beyond seizures) after NORSE will support discussions with families during the acute stages, prognostication, the development of targeted management strategies for survivors, and future comparative research globally helping to identify biomarkers that may predict LTO.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002193","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
期刊
Epilepsia
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1