Pub Date : 2026-02-01Epub Date: 2025-12-03DOI: 10.1016/j.yebeh.2025.110850
Lars Kullman
This review analyzes 155 papers published between 1966 and 2025 examining epilepsy in 108 famous persons (see Supplementary Material for complete list), using the PubMed “famous persons” MeSH term combined with epilepsy-related search terms. Vincent van Gogh (37 papers, 23.9 %) and Fyodor Dostoevsky (34 papers, 21.9 %) dominated the literature, together accounting for 45.8 % of all publications. Writers and artists received the most scholarly attention, with 72.3 % of papers published after 2000. Most papers discussed epilepsy generally without specifying type, while temporal lobe epilepsy was the most specified subtype. Notable biases were identified: 89.8 % male subjects and 44.0 % from 19th-20th centuries. The extreme concentration on Van Gogh and Dostoevsky, combined with significant gender and temporal biases, raises questions about publication bias and the perpetuation of medical mythology. While retrospective diagnosis remains methodologically challenging, this literature provides valuable insights into changing medical paradigms and societal attitudes toward epilepsy.
本综述使用PubMed“名人”MeSH术语结合癫痫相关搜索词，分析了1966年至2025年间发表的155篇论文，研究了108位名人的癫痫（完整列表见补充材料）。Vincent van Gogh（37篇，23.9%）和Fyodor Dostoevsky（34篇，21.9%）占据主导地位，共占总发表量的45.8%。作家和艺术家受到的学术关注最多，2000年以后发表的论文占72.3%。大多数文献对癫痫的讨论一般不明确类型，而颞叶癫痫是最明确的亚型。发现了显著的偏差：89.8%的受试者为男性，44.0%的受试者来自19 -20世纪。对梵高（Van Gogh）和陀思妥耶夫斯基（Dostoevsky）的极度关注，加上明显的性别和时间偏见，引发了有关出版偏见和医学神话永久化的问题。虽然回顾性诊断在方法上仍然具有挑战性，但这些文献为改变医学范式和社会对癫痫的态度提供了有价值的见解。
{"title":"Famous persons with epilepsy – Trends and patterns in the medical literature","authors":"Lars Kullman","doi":"10.1016/j.yebeh.2025.110850","DOIUrl":"10.1016/j.yebeh.2025.110850","url":null,"abstract":"<div><div>This review analyzes 155 papers published between 1966 and 2025 examining epilepsy in 108 famous persons (see <span><span>Supplementary Material</span></span> for complete list), using the PubMed “famous persons” MeSH term combined with epilepsy-related search terms. Vincent van Gogh (37 papers, 23.9 %) and Fyodor Dostoevsky (34 papers, 21.9 %) dominated the literature, together accounting for 45.8 % of all publications. Writers and artists received the most scholarly attention, with 72.3 % of papers published after 2000. Most papers discussed epilepsy generally without specifying type, while temporal lobe epilepsy was the most specified subtype. Notable biases were identified: 89.8 % male subjects and 44.0 % from 19th-20th centuries. The extreme concentration on Van Gogh and Dostoevsky, combined with significant gender and temporal biases, raises questions about publication bias and the perpetuation of medical mythology. While retrospective diagnosis remains methodologically challenging, this literature provides valuable insights into changing medical paradigms and societal attitudes toward epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110850"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-02DOI: 10.1016/j.yebeh.2025.110836
Je Ssy Low , Lance Watkins , Kevin Hampel , Laura Vilella , Rodrigo Rocamora , Paul Bassett , Rohit Shankar , Vicente Villanueva
Objective
Sudden Unexpected Death in Epilepsy (SUDEP) is a major cause of epilepsy-related mortality, yet discussions about SUDEP in clinical settings remain inconsistent. This study aimed to assess the perspectives, practices, and barriers related to SUDEP counselling for epilepsy professionals in Spain.
Methods
A cross-sectional online survey of 17 Likert style questions was disseminated via the Spanish Epilepsy Society between September 2023 and February 2024 to epilepsy professionals in Spain using a non-discriminatory exponential snowballing technique leading to non-probability sampling. The survey was a validated instrument previously employed in similar international studies. Questions revolved around SUDEP communication and counselling. Descriptive and comparative analyses were conducted.
Results
54 professionals responded, with the majority being adult neurologists-epileptologists. While most respondents acknowledged the importance of SUDEP counselling, none reported discussing it with all patients. SUDEP was typically discussed in response to risk changes (85 %) or patient enquiry (47 %). Only 9 % used structured communication tools, and 28 % had access to bereavement support services. Perceived low clinical risk (74 %), concern about patient distress (62 %), and limited consultation time (57 %) were the most common barriers. Comparative analysis revealed no statistically significant differences between adult neurologists and paediatric neurologists, though paediatricians reported more negative counselling experiences.
Conclusions
Despite strong recognition of its importance, SUDEP communication in Spain is infrequent and inconsistent. Key barriers include clinical judgment, time constraints, and limited resources. The findings underscore the need for national guideline, structured tools, and targeted training to support routine SUDEP counselling in Spanish clinical practice.
{"title":"Talking SUDEP: Gaps, confidence and training needs among Spanish epilepsy professionals","authors":"Je Ssy Low , Lance Watkins , Kevin Hampel , Laura Vilella , Rodrigo Rocamora , Paul Bassett , Rohit Shankar , Vicente Villanueva","doi":"10.1016/j.yebeh.2025.110836","DOIUrl":"10.1016/j.yebeh.2025.110836","url":null,"abstract":"<div><h3>Objective</h3><div>Sudden Unexpected Death in Epilepsy (SUDEP) is a major cause of epilepsy-related mortality, yet discussions about SUDEP in clinical settings remain inconsistent. This study aimed to assess the perspectives, practices, and barriers related to SUDEP counselling for epilepsy professionals in Spain.</div></div><div><h3>Methods</h3><div>A cross-sectional online survey of 17 Likert style questions was disseminated via the Spanish Epilepsy Society between September 2023 and February 2024 to epilepsy professionals in Spain using a non-discriminatory exponential snowballing technique leading to non-probability sampling. The survey was a validated instrument previously employed in similar international studies. Questions revolved around SUDEP communication and counselling. Descriptive and comparative analyses were conducted.</div></div><div><h3>Results</h3><div>54 professionals responded, with the majority being adult neurologists-epileptologists. While most respondents acknowledged the importance of SUDEP counselling, none reported discussing it with all patients. SUDEP was typically discussed in response to risk changes (85 %) or patient enquiry (47 %). Only 9 % used structured communication tools, and 28 % had access to bereavement support services. Perceived low clinical risk (74 %), concern about patient distress (62 %), and limited consultation time (57 %) were the most common barriers. Comparative analysis revealed no statistically significant differences between adult neurologists and paediatric neurologists, though paediatricians reported more negative counselling experiences.</div></div><div><h3>Conclusions</h3><div>Despite strong recognition of its importance, SUDEP communication in Spain is infrequent and inconsistent. Key barriers include clinical judgment, time constraints, and limited resources. The findings underscore the need for national guideline, structured tools, and targeted training to support routine SUDEP counselling in Spanish clinical practice.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110836"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-02DOI: 10.1016/j.yebeh.2025.110840
Drishti Shah , Peter Jacoby , Helen Doll , Hoan Do , J. Scott Andrews , Heather Romero , Gregor Gibson , Jenny Downs
Backgound.
To evaluate the psychometric properties of the Quality of Life Inventory −Disability (QI-Disability) for individuals with Dravet syndrome (DS) or Lennox-Gastaut syndrome (LGS), two rare developmental and epileptic encephalopathy conditions.
Methods
Cross-sectional data for individuals were drawn from the Adelphi DS & LGS Disease Specific Programme including the caregiver-reported QI-Disability and EQ-5D-5L, and physician-reported (7-point Likert scale) rating or quality of life. Factor structure of the QI-Disability was assessed using confirmatory factor analysis with goodness-of-fit statistics and internal consistency was assessed using Cronbach’s alpha. Convergent validity was assessed by evaluating relationships between QI-Disability, EQ-5D-5L scores, and physician QOL ratings.
Results
There were 154 patients with DS and 196 patients with LGS. The mean (SD) total QI-Disability score was 57.3 (SD 11.9) for DS and 58.9 (SD 13.8) for LGS. Fit statistics for the 6-factor QI-Disability model were mostly satisfactory; the factor loading for one item was unsatisfactory. Good internal consistency (alpha > 0.7) was found for all QI-Disability domains and for the total score in both LGS and DS groups. Convergent validity was demonstrated with correlations being as expected between QI-Disability and EQ-5D-5L scores, for example, strong correlations between the QI-Disability Physical Health and EQ-5D pain/discomfort dimension scores. There was a mean increase of approximately 3 points in the QI-Disability total score per unit category change in the physician-rated QOL scale.
Conclusions
QI-Disability had mostly satisfactory evidence of validity and reliability for DS and LGS and appears suitable for use in clinical practice and clinical trials.
{"title":"Psychometric validation of the quality of life Inventory − Disability (QI-Disability) among patients with Lennox-Gastaut syndrome and Dravet syndrome","authors":"Drishti Shah , Peter Jacoby , Helen Doll , Hoan Do , J. Scott Andrews , Heather Romero , Gregor Gibson , Jenny Downs","doi":"10.1016/j.yebeh.2025.110840","DOIUrl":"10.1016/j.yebeh.2025.110840","url":null,"abstract":"<div><div>Backgound.</div><div>To evaluate the psychometric properties of the Quality of Life Inventory −Disability (QI-Disability) for individuals with Dravet syndrome (DS) or Lennox-Gastaut syndrome (LGS), two rare developmental and epileptic encephalopathy conditions.</div></div><div><h3>Methods</h3><div>Cross-sectional data for individuals were drawn from the Adelphi DS & LGS Disease Specific Programme including the caregiver-reported QI-Disability and EQ-5D-5L, and physician-reported (7-point Likert scale) rating or quality of life. Factor structure of the QI-Disability was assessed using confirmatory factor analysis with goodness-of-fit statistics and internal consistency was assessed using Cronbach’s alpha. Convergent validity was assessed by evaluating relationships between QI-Disability, EQ-5D-5L scores, and physician QOL ratings.</div></div><div><h3>Results</h3><div>There were 154 patients with DS and 196 patients with LGS. The mean (SD) total QI-Disability score was 57.3 (SD 11.9) for DS and 58.9 (SD 13.8) for LGS. Fit statistics for the 6-factor QI-Disability model were mostly satisfactory; the factor loading for one item was unsatisfactory. Good internal consistency (alpha > 0.7) was found for all QI-Disability domains and for the total score in both LGS and DS groups. Convergent validity was demonstrated with correlations being as expected between QI-Disability and EQ-5D-5L scores, for example, strong correlations between the QI-Disability Physical Health and EQ-5D pain/discomfort dimension scores. There was a mean increase of approximately 3 points in the QI-Disability total score per unit category change in the physician-rated QOL scale.</div></div><div><h3>Conclusions</h3><div>QI-Disability had mostly satisfactory evidence of validity and reliability for DS and LGS and appears suitable for use in clinical practice and clinical trials.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110840"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-20DOI: 10.1016/j.yebeh.2025.110869
Seda Kılıç , Atiye Karakul , Duygu Sönmez Düzkaya
Background
Epilepsy is one of the most common chronic neurological disorders in childhood and can negatively affect children’s academic performance, social relationships, and emotional well-being. This study aimed to examine the school experiences of children aged 10–18 years.
Method
The research was conducted between August 2024 and May 2025 at the Mersin University Hospital Pediatric Neurology Outpatient Clinic. Twenty children with epilepsy, aged 10–18 years, were included. After transcription, interview data were coded, themes were generated, and relationships among codes and subcodes were analyzed using MAXQDA 22. Eight themes and 51 codes emerged: perceptions of ıllness, emotional responses to epilepsy, challenges in daily life, seizure symptoms, postictal experiences at school, peer relationships, academic performance and engagement, and social support at school.
Results
Children frequently reported emotional challenges such as sadness, fear, and anxiety regarding their condition. Daily life was significantly impacted by ’functional impairments’ (e.g., motor control issues), activity limitations (e.g., physical fatigue during sports), and participation restrictions (e.g., exclusion from social events and school absenteeism). During seizures, the most common symptoms were loss of consciousness and dizziness, followed by postictal states of fear, fatigue, and confusion. Regarding peer relationships, while some friendships remained unaffected, “concealment of epilepsy” emerged as a key subtheme, with some children hiding their condition to avoid exclusion. Academic engagement was often hindered by concentration difficulties and absenteeism related to medical appointments. Guidance counselors and peers were identified as primary sources of social support.
Conclusion
Children with epilepsy face significant emotional, social, and academic challenges in the school environment. Awareness-raising activities within schools and broader community education efforts, including the use of social media, are recommended to reduce stigma and support the well-being of these children.
{"title":"Between seizures and schooling: qualitative insights into the experiences of children with epilepsy","authors":"Seda Kılıç , Atiye Karakul , Duygu Sönmez Düzkaya","doi":"10.1016/j.yebeh.2025.110869","DOIUrl":"10.1016/j.yebeh.2025.110869","url":null,"abstract":"<div><h3>Background</h3><div>Epilepsy is one of the most common chronic neurological disorders in childhood and can negatively affect children’s academic performance, social relationships, and emotional well-being. This study aimed to examine the school experiences of children aged 10–18 years.</div></div><div><h3>Method</h3><div>The research was conducted between August 2024 and May 2025 at the Mersin University Hospital Pediatric Neurology Outpatient Clinic. Twenty children with epilepsy, aged 10–18 years, were included. After transcription, interview data were coded, themes were generated, and relationships among codes and subcodes were analyzed using MAXQDA 22. Eight themes and 51 codes emerged: perceptions of ıllness, emotional responses to epilepsy<strong>,</strong> challenges in daily life, seizure symptoms, postictal experiences at school, peer relationships, academic performance and engagement, and social support at school.</div></div><div><h3>Results</h3><div>Children frequently reported emotional challenges such as sadness, fear, and anxiety regarding their condition. Daily life was significantly impacted by ’functional impairments’ (e.g., motor control issues), activity limitations (e.g., physical fatigue during sports), and participation restrictions (e.g., exclusion from social events and school absenteeism). During seizures, the most common symptoms were loss of consciousness and dizziness, followed by postictal states of fear, fatigue, and confusion. Regarding peer relationships, while some friendships remained unaffected, “concealment of epilepsy” emerged as a key subtheme, with some children hiding their condition to avoid exclusion. Academic engagement was often hindered by concentration difficulties and absenteeism related to medical appointments. Guidance counselors and peers were identified as primary sources of social support.</div></div><div><h3>Conclusion</h3><div>Children with epilepsy face significant emotional, social, and academic challenges in the school environment. Awareness-raising activities within schools and broader community education efforts, including the use of social media, are recommended to reduce stigma and support the well-being of these children.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110869"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-11DOI: 10.1016/j.yebeh.2025.110856
Matti L Sillanpää , Vivian Reinhold , Leevi Toivonen , Peter R Camfield
Background
Transferring adolescents with epilepsy (AWE) to adult care is a complex process, yet there is limited data on its overall epidemiology and clinical implications.
Objective
This population-based study analyzes the long-term clinical trajectories and predictors of transfer among AWE within a robust Finnish healthcare system.
Methods
A cohort of 439 AWE was followed for a mean of 10.28 years. Transfer outcomes, care settings, and long-term seizure control were evaluated for patients reaching transfer age, focusing on predictors of public adult specialty care.
Results
Of 222 AWE reaching transfer age, 189 (85.1 %) were transferred to adult services, with 64 % entering university hospital care. Remission was achieved in 23 % during extended follow-up, while 27 % remained drug-resistant. Multivariable analysis identified developmental and epileptic encephalopathy, specific developmental disorders, and comorbidities such as asthma, allergies, and obesity as significant predictors for public adult specialty care. Notably, changing the transfer age from 16 to 18 years had no significant effect on transfer rates.
Conclusion
Transfer to adult specialty care affects the vast majority of AWE, imposing considerable demands on public health systems. These findings underscore the need for early identification of high-risk patients to inform resource planning and individualized care strategies.
{"title":"Transfer of Finnish adolescents with epilepsy to adult care: a population-based study","authors":"Matti L Sillanpää , Vivian Reinhold , Leevi Toivonen , Peter R Camfield","doi":"10.1016/j.yebeh.2025.110856","DOIUrl":"10.1016/j.yebeh.2025.110856","url":null,"abstract":"<div><h3>Background</h3><div>Transferring adolescents with epilepsy (AWE) to adult care is a complex process, yet there is limited data on its overall epidemiology and clinical implications.</div></div><div><h3>Objective</h3><div>This population-based study analyzes the long-term clinical trajectories and predictors of transfer among AWE within a robust Finnish healthcare system.</div></div><div><h3>Methods</h3><div>A cohort of 439 AWE was followed for a mean of 10.28 years. Transfer outcomes, care settings, and long-term seizure control were evaluated for patients reaching transfer age, focusing on predictors of public adult specialty care.</div></div><div><h3>Results</h3><div>Of 222 AWE reaching transfer age, 189 (85.1 %) were transferred to adult services, with 64 % entering university hospital care. Remission was achieved in 23 % during extended follow-up, while 27 % remained drug-resistant. Multivariable analysis identified developmental and epileptic encephalopathy, specific developmental disorders, and comorbidities such as asthma, allergies, and obesity as significant predictors for public adult specialty care. Notably, changing the transfer age from 16 to 18 years had no significant effect on transfer rates.</div></div><div><h3>Conclusion</h3><div>Transfer to adult specialty care affects the vast majority of AWE, imposing considerable demands on public health systems. These findings underscore the need for early identification of high-risk patients to inform resource planning and individualized care strategies.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110856"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-10DOI: 10.1016/j.yebeh.2025.110835
Yaroslav Winter , Raya Abou Dargham , Erik Ellwardt , Thilo Hammen , Christoph Massing , Sarah Gößling , Marina Flotats-Bastardas , Sergiu Groppa , Michael Zemlin , Christopher Meudt
Background
Quality of life is an important outcome measure for patients with epilepsy (PWE). However, data on health-related quality of life (HRQoL) in PWE treated with cenobamate (CNB), a new antiseizure medication (ASM) that achieves a high level of seizure freedom, is scarce. These data are especially important for evaluating the use of CNB in early therapy lines for focal-onset seizures.
Methods
The study population consisted of patients with focal-onset seizures that could not be controlled by fewer than three lifetime ASMs. They began treatment with CNB („CNB group“) or another ASM (controls). Both groups were matched at a ratio of 1:2 based on sex, age, and seizure frequency. HRQoL was evaluated using the Quality of Life in Epilepsy-10 (QOLIE-10), the EuroQol Visual Analogue Scale (EQVAS), and the EuroQol-5-Dimensions (EQ5D) questionnaire. The drug combinations were analyzed.
Results
Of the 231 study participants, 33.3 % were treated with CNB, 19.0 % with valproate, 17.3 % with lacosamide, 16.4 % with levetiracetam, and 13.9 % with topiramate. The percentage improvement in the EQ5D index score from baseline to the 12-month follow-up was higher for CNB (32.2 %) than for other ASMs (3.2 %–17.5 %, p < 0.05). Similar results were obtained for EQVAS (31 % vs. 3.2 %–17.5 %) and QOLIE-10 (46.9 % vs. 13.4 %–28.2 %), p < 0.05. CNB demonstrated superior seizure control and HrQoL when combined with low-dose clobazam and a trend for combination with SV2A modulators.
Conclusion
Our study provides evidence that CNB in early therapy lines for focal-onset seizures is associated with an increased HrQoL. Low-dose clobazam can wok synergistically with CNB. The combination with SV2A modulators showed a positive trend.
生活质量是衡量癫痫患者预后的重要指标。然而，关于使用cenobamate （CNB）治疗PWE的健康相关生活质量（HRQoL）的数据很少，CNB是一种新的抗癫痫药物（ASM），可实现高水平的癫痫发作自由。这些数据对于评估CNB在局灶性癫痫早期治疗中的应用尤其重要。方法研究人群包括局灶性癫痫发作患者，其终生asm不能控制在3次以下。他们开始用CNB（“CNB组”）或另一种ASM（对照组）治疗。两组根据性别、年龄和发作频率按1:2的比例配对。HRQoL采用癫痫生活质量-10 （QOLIE-10）、EuroQol视觉模拟量表（EQVAS）和EuroQol-5维量表（EQ5D）进行评估。并对其联合用药进行分析。在231名研究参与者中，33.3%的人接受CNB治疗，19.0%的人接受丙戊酸治疗，17.3%的人接受拉可沙胺治疗，16.4%的人接受左乙拉西坦治疗，13.9%的人接受托吡酯治疗。从基线到12个月的随访，CNB组EQ5D指数评分的改善百分比（32.2%）高于其他asm组（3.2% - 17.5%,p < 0.05）。EQVAS （31% vs. 3.2% - 17.5%）和QOLIE-10 （46.9% vs. 13.4% - 28.2%）的结果相似，p < 0.05。CNB与低剂量氯巴唑联用时表现出更好的癫痫发作控制和HrQoL，并有与SV2A调节剂联用的趋势。结论本研究为局灶性癫痫早期治疗线的CNB与HrQoL升高相关提供了证据。低剂量氯巴唑可与CNB协同作用。与SV2A调制器的组合表现出积极的趋势。
{"title":"Quality of life and synergistic combinations of antiseizure medication in patients treated with cenobamate in early therapy lines for focal-onset seizures","authors":"Yaroslav Winter , Raya Abou Dargham , Erik Ellwardt , Thilo Hammen , Christoph Massing , Sarah Gößling , Marina Flotats-Bastardas , Sergiu Groppa , Michael Zemlin , Christopher Meudt","doi":"10.1016/j.yebeh.2025.110835","DOIUrl":"10.1016/j.yebeh.2025.110835","url":null,"abstract":"<div><h3>Background</h3><div>Quality of life is an important outcome measure for patients with epilepsy (PWE). However, data on health-related quality of life (HRQoL) in PWE treated with cenobamate (CNB), a new antiseizure medication (ASM) that achieves a high level of seizure freedom, is scarce. These data are especially important for evaluating the use of CNB in early therapy lines for focal-onset seizures.</div></div><div><h3>Methods</h3><div>The study population consisted of patients with focal-onset seizures that could not be controlled by fewer than three lifetime ASMs. They began treatment with CNB („CNB group“) or another ASM (controls). Both groups were matched at a ratio of 1:2 based on sex, age, and seizure frequency. HRQoL was evaluated using the Quality of Life in Epilepsy-10 (QOLIE-10), the EuroQol Visual Analogue Scale (EQVAS), and the EuroQol-5-Dimensions (EQ5D) questionnaire. The drug combinations were analyzed.</div></div><div><h3>Results</h3><div>Of the 231 study participants, 33.3 % were treated with CNB, 19.0 % with valproate, 17.3 % with lacosamide, 16.4 % with levetiracetam, and 13.9 % with topiramate. The percentage improvement in the EQ5D index score from baseline to the 12-month follow-up was higher for CNB (32.2 %) than for other ASMs (3.2 %–17.5 %, p < 0.05). Similar results were obtained for EQVAS (31 % vs. 3.2 %–17.5 %) and QOLIE-10 (46.9 % vs. 13.4 %–28.2 %), p < 0.05. CNB demonstrated superior seizure control and HrQoL when combined with low-dose clobazam and a trend for combination with SV2A modulators.</div></div><div><h3>Conclusion</h3><div>Our study provides evidence that CNB in early therapy lines for focal-onset seizures is associated with an increased HrQoL. Low-dose clobazam can wok synergistically with CNB. The combination with SV2A modulators showed a positive trend.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110835"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-02DOI: 10.1016/j.yebeh.2025.110837
Vishva Natarajan , Ravi Sandhu , Charles Mazof , Nicole Odom , Jennifer Hong
Objective
To evaluate neuropsychiatric burden in the understudied population of patients with dual diagnoses of epileptic seizures (ES) and functional seizures (FS) who have received vagus nerve stimulation (VNS).
Methods
In this retrospective study, adults with dual diagnoses of ES and FS who underwent VNS at a tertiary care center between 2015 and 2024 were identified via ICD-10 codes and confirmed by video-electroencephalography (VEEG). Propensity score matching generated two control groups: (1) patients with ES only with VNS, and (2) patients with dual ES and FS without VNS. Longitudinal patient-reported outcomes, including seizure frequency, NDDI-E, and the QOLIE-31 Cognitive subscale, were analyzed using time-weighted averaging and nonparametric statistics.
Results
Eight patients with dual ES and FS who received VNS were matched to eight in each control group. The dual-diagnosis patients with VNS implants had significantly higher seizure frequency than those without VNS implants (median seizure frequency = 14.1 vs. 2.2, p = 0.001). Among patients with VNS implants, those with dual diagnoses had significantly greater depressive symptoms (median NDDI-E = 16.4 vs. 8.8, p = 0.015) compared to those with ES alone. Significant differences in cognitive quality of life were not observed.
Significance
Dual-diagnosis patients exhibited higher seizure reporting after VNS therapy compared to those without VNS and higher depressive burden compared to patients with ES alone, patterns that may reflect the underlying severity of FS-related comorbidity. These exploratory results support careful pre-implant counselling and highlight the need for prospective studies with baseline assessments to clarify outcomes in this complex population.
目的评估接受迷走神经刺激（VNS）治疗的癫痫性发作（ES）和功能性发作（FS）双重诊断患者的神经精神负担。方法回顾性研究2015年至2024年间在三级保健中心接受VNS治疗的ES和FS双重诊断的成人，通过ICD-10代码进行识别，并通过视频脑电图（VEEG）进行确认。倾向评分匹配产生两个对照组：(1)仅伴VNS的ES患者和(2)伴VNS的双ES和FS患者。纵向患者报告的结果，包括癫痫发作频率、NDDI-E和QOLIE-31认知量表，采用时间加权平均和非参数统计进行分析。结果8例接受VNS治疗的双ES和FS患者与对照组8例相匹配。双重诊断的VNS植入患者的癫痫发作频率明显高于未植入VNS的患者（中位癫痫发作频率= 14.1比2.2,p = 0.001）。在植入VNS的患者中，与单独植入ES的患者相比，双重诊断的患者抑郁症状明显加重（中位NDDI-E = 16.4 vs. 8.8, p = 0.015）。在认知生活质量方面未观察到显著差异。双重诊断的患者在接受VNS治疗后癫痫发作报告高于未接受VNS治疗的患者，抑郁负担高于单独接受ES治疗的患者，这些模式可能反映了fs相关合并症的潜在严重程度。这些探索性结果支持仔细的植入前咨询，并强调需要进行基线评估的前瞻性研究，以明确这一复杂人群的结果。
{"title":"Post-vagus nerve stimulation mood and cognitive burden in dual epileptic–functional seizure patients","authors":"Vishva Natarajan , Ravi Sandhu , Charles Mazof , Nicole Odom , Jennifer Hong","doi":"10.1016/j.yebeh.2025.110837","DOIUrl":"10.1016/j.yebeh.2025.110837","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate neuropsychiatric burden in the understudied population of patients with dual diagnoses of epileptic seizures (ES) and functional seizures (FS) who have received vagus nerve stimulation (VNS).</div></div><div><h3>Methods</h3><div>In this retrospective study, adults with dual diagnoses of ES and FS who underwent VNS at a tertiary care center between 2015 and 2024 were identified via ICD-10 codes and confirmed by video-electroencephalography (VEEG). Propensity score matching generated two control groups: (1) patients with ES only with VNS, and (2) patients with dual ES and FS without VNS. Longitudinal patient-reported outcomes, including seizure frequency, NDDI-E, and the QOLIE-31 Cognitive subscale, were analyzed using time-weighted averaging and nonparametric statistics.</div></div><div><h3>Results</h3><div>Eight patients with dual ES and FS who received VNS were matched to eight in each control group. The dual-diagnosis patients with VNS implants had significantly higher seizure frequency than those without VNS implants (median seizure frequency = 14.1 vs. 2.2, p = 0.001). Among patients with VNS implants, those with dual diagnoses had significantly greater depressive symptoms (median NDDI-E = 16.4 vs. 8.8, p = 0.015) compared to those with ES alone. Significant differences in cognitive quality of life were not observed.</div></div><div><h3>Significance</h3><div>Dual-diagnosis patients exhibited higher seizure reporting after VNS therapy compared to those without VNS and higher depressive burden compared to patients with ES alone, patterns that may reflect the underlying severity of FS-related comorbidity. These exploratory results support careful pre-implant counselling and highlight the need for prospective studies with baseline assessments to clarify outcomes in this complex population.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110837"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric comorbidity in pediatric epilepsy. Although the cognitive effects of epilepsy are well documented, the impact of ADHD as a comorbidity on neurocognitive outcomes remains unclear. This systematic review evaluates cognitive performance in pediatric patients with both epilepsy and ADHD. Following PRISMA 2020 guidelines, searches were conducted in MEDLINE, EMBASE, Cochrane Library and LILACS. Studies were included if they involved patients aged less than or equal to 18 years diagnosed with both epilepsy and ADHD. Fourteen studies met the inclusion criteria. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS), ROBINS-I and NIH/NHLBI tools. Results indicated that children with both epilepsy and ADHD exhibited more severe cognitive impairments than those with epilepsy only, ADHD only or healthy controls. These included lower Full-Scale and Verbal IQ scores and more frequent omission and commission errors, as well as increased reaction-time variability in attention tasks. Across studies, domains most affected included perceptual-motor function and executive function, as illustrated in a heat map summarizing the distribution and severity of cognitive impairments. These findings underscore that ADHD comorbidity in pediatric epilepsy is associated with exacerbated neurocognitive deficits, highlighting the need for early identification and tailored interventions to support cognitive development.
{"title":"Neurocognitive outcomes of ADHD as a comorbidity in pediatric epilepsy: a systematic review","authors":"Laura Zaffari Leal , Inácio Kehl , Natália Donati Polesello , Yolanda Aquino de Souza , Catarina Hauser Schmitz , Thiago Wendt Viola , Magda Lahorgue Nunes","doi":"10.1016/j.yebeh.2025.110852","DOIUrl":"10.1016/j.yebeh.2025.110852","url":null,"abstract":"<div><div>Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric comorbidity in pediatric epilepsy. Although the cognitive effects of epilepsy are well documented, the impact of ADHD as a comorbidity on neurocognitive outcomes remains unclear. This systematic review evaluates cognitive performance in pediatric patients with both epilepsy and ADHD. Following PRISMA 2020 guidelines, searches were conducted in MEDLINE, EMBASE, Cochrane Library and LILACS. Studies were included if they involved patients aged less than or equal to 18 years diagnosed with both epilepsy and ADHD. Fourteen studies met the inclusion criteria. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS), ROBINS-I and NIH/NHLBI tools. Results indicated that children with both epilepsy and ADHD exhibited more severe cognitive impairments than those with epilepsy only, ADHD only or healthy controls. These included lower Full-Scale and Verbal IQ scores and more frequent omission and commission errors, as well as increased reaction-time variability in attention tasks. Across studies, domains most affected included perceptual-motor function and executive function, as illustrated in a heat map summarizing the distribution and severity of cognitive impairments. These findings underscore that ADHD comorbidity in pediatric epilepsy is associated with exacerbated neurocognitive deficits, highlighting the need for early identification and tailored interventions to support cognitive development.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110852"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-11DOI: 10.1016/j.yebeh.2025.110855
Sabina Iqbal, Lei Liu, Gad A. Marshall, Rani A. Sarkis
Background
Compared to patients with well-controlled epilepsy, those with drug-resistant epilepsy often experience greater morbidity, mortality, and accelerated aging. Plasma biomarkers pTau217 and pTau181 align with cerebrospinal fluid tau values and amyloid PET imaging, correlating with Alzheimer’s disease (AD) pathology. These minimally invasive markers may help explore links between neurodegeneration and epilepsy. This study assessed plasma pTau217 and pTau181 levels in patients with drug-resistant (DR) and well-controlled (C) epilepsy to determine whether poor seizure control correlates with elevated biomarkers.
Methods
Adults aged 18–65 with focal epilepsy were prospectively recruited from the Brigham and Women’s Hospital Epilepsy Clinic. Clinical data, including time since last seizure, were obtained from electronic health records. Plasma pTau181 and pTau217 levels were measured and analyzed in relation to seizure control, MRI lesion presence, antiseizure medication use, and time since last seizure.
Results
Plasma was collected from 103 patients: 48 well-controlled (C, 31.3 % female) and 55 drug-resistant (DR, 50.9 % female). Mean ages were 38.7 ± 12.3 years (C) and 37.0 ± 11.6 years (DR). Log-transformed mean plasma levels were not significantly different: pTau181 (DR: 2.17 ± 0.99 vs. C: 2.33 ± 0.87, p = 0.35) and pTau217 (DR: 3.87 ± 0.97 vs. C: 4.10 ± 0.95, p = 0.23). No correlation was observed between plasma tau and time since last seizure: pTau181 (ρ = +0.001, p = 0.99), pTau217 (ρ = +0.13, p = 0.18). Tau levels did not differ based on use of synaptic vesicle protein 2A inhibitors or sodium channel blockers.
Discussion
Interictal plasma biomarkers of neurodegeneration are not elevated in adults with poorly controlled epilepsy and do not correlate with time since last seizure or specific antiseizure medications. Future studies should explore whether subpopulations exist with increased risk or early markers of accelerated aging.
背景：与控制良好的癫痫患者相比，耐药癫痫患者往往有更高的发病率、死亡率和加速衰老。血浆生物标志物pTau217和pTau181与脑脊液tau值和淀粉样蛋白PET成像一致，与阿尔茨海默病（AD）病理相关。这些微创标记可能有助于探索神经变性和癫痫之间的联系。本研究评估了耐药（DR）和控制良好(C)癫痫患者的血浆pTau217和pTau181水平，以确定癫痫发作控制不佳是否与生物标志物升高相关。方法前瞻性地从布莱根妇女医院癫痫诊所招募18-65岁局灶性癫痫患者。临床数据，包括上次癫痫发作的时间，都是从电子健康记录中获得的。测量和分析血浆pTau181和pTau217水平与癫痫发作控制、MRI病变存在、抗癫痫药物使用和上次癫痫发作时间的关系。结果103例患者采集血浆：对照组48例，女性31.3%；耐药组55例，女性50.9%。平均年龄38.7±12.3岁(C), 37.0±11.6岁（DR）。经对数变换后的平均血浆水平pTau181 （DR: 2.17±0.99 vs. C: 2.33±0.87,p = 0.35）和pTau217 （DR: 3.87±0.97 vs. C: 4.10±0.95,p = 0.23）无显著差异。血浆tau与上一次癫痫发作时间无相关性：pTau181 (ρ = +0.001, p = 0.99), pTau217 （ρ = +0.13, p = 0.18）。Tau水平没有因使用突触囊泡蛋白2A抑制剂或钠通道阻滞剂而不同。神经变性的血浆间期生物标志物在控制不良的成人癫痫患者中没有升高，并且与上次癫痫发作的时间或特定抗癫痫药物无关。未来的研究应该探索是否存在风险增加或加速衰老的早期标记的亚群。
{"title":"Plasma p-Tau217 and p-Tau181 levels in Well-Controlled versus Drug-Resistant focal epilepsy","authors":"Sabina Iqbal, Lei Liu, Gad A. Marshall, Rani A. Sarkis","doi":"10.1016/j.yebeh.2025.110855","DOIUrl":"10.1016/j.yebeh.2025.110855","url":null,"abstract":"<div><h3>Background</h3><div>Compared to patients with well-controlled epilepsy, those with drug-resistant epilepsy often experience greater morbidity, mortality, and accelerated aging. Plasma biomarkers pTau217 and pTau181 align with cerebrospinal fluid tau values and amyloid PET imaging, correlating with Alzheimer’s disease (AD) pathology. These minimally invasive markers may help explore links between neurodegeneration and epilepsy. This study assessed plasma pTau217 and pTau181 levels in patients with drug-resistant (DR) and well-controlled (C) epilepsy to determine whether poor seizure control correlates with elevated biomarkers.</div></div><div><h3>Methods</h3><div>Adults aged 18–65 with focal epilepsy were prospectively recruited from the Brigham and Women’s Hospital Epilepsy Clinic. Clinical data, including time since last seizure, were obtained from electronic health records. Plasma pTau181 and pTau217 levels were measured and analyzed in relation to seizure control, MRI lesion presence, antiseizure medication use, and time since last seizure.</div></div><div><h3>Results</h3><div>Plasma was collected from 103 patients: 48 well-controlled (C, 31.3 % female) and 55 drug-resistant (DR, 50.9 % female). Mean ages were 38.7 ± 12.3 years (C) and 37.0 ± 11.6 years (DR). Log-transformed mean plasma levels were not significantly different: pTau181 (DR: 2.17 ± 0.99 vs. C: 2.33 ± 0.87, p = 0.35) and pTau217 (DR: 3.87 ± 0.97 vs. C: 4.10 ± 0.95, p = 0.23). No correlation was observed between plasma tau and time since last seizure: pTau181 (ρ = +0.001, p = 0.99), pTau217 (ρ = +0.13, p = 0.18). Tau levels did not differ based on use of synaptic vesicle protein 2A inhibitors or sodium channel blockers.</div></div><div><h3>Discussion</h3><div>Interictal plasma biomarkers of neurodegeneration are not elevated in adults with poorly controlled epilepsy and do not correlate with time since last seizure or specific antiseizure medications. Future studies should explore whether subpopulations exist with increased risk or early markers of accelerated aging.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110855"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-11DOI: 10.1016/j.yebeh.2025.110829
Thomas A Lea , Athanasios Gaitatzis
Objective
The drivers of chronic disease in people with epilepsy with epilepsy (PWE) are unknown. We aimed to identify the role of health risk factors, polypharmacy, and medication usage in (PWE) according to age, sex, epilepsy types, epilepsy duration and resistance to treatment and their relevance to multimorbidity in epilepsy.
Methods
We analysed patient data from 330 PWE seen in a tertiary centre epilepsy clinic in Perth, Western Australia. The prevalence of biomedical and behavioural health risk factors (including hypertension, obesity or alcohol excess), polypharmacy, antiseizure (ASM) and general medication usage and their association with multimorbidity was investigated, as well as differences that existed across different age groups, sex, epilepsy types, epilepsy duration and resistance to treatment.
Results
Participants who had ≥1 health risk factor (37 % of participants) had a significantly greater number of comorbidities (p = 0.0008). The number of ASMs and general medications used were positively correlated with the number of comorbidities (p’s < 0.0001). Health risk factors were more commonly present in men (p = 0.0023), at older age (p < 0.0001) and in those with structural epilepsy (p = 0.0002). Polypharmacy was seen in 33 % of participants and was more commonly present in those of older age (p = 0.0003), in developmental and/or epileptic encephalopathy (DEE) (p = 0.0002) and in those with drug-resistant epilepsy (DRE) (p = 00006).
Conclusions
These findings indicate that health risk factors, polypharmacy and ASM usage are associated with chronic disease and multimorbidity in epilepsy. Routine screening and management of modifiable health risk factors and polypharmacy may reduce the chronic disease burden in PWE and its consequences.
{"title":"Health risk factors and polypharmacy in people with epilepsy and their association with multimorbidity: a single centre retrospective study","authors":"Thomas A Lea , Athanasios Gaitatzis","doi":"10.1016/j.yebeh.2025.110829","DOIUrl":"10.1016/j.yebeh.2025.110829","url":null,"abstract":"<div><h3>Objective</h3><div>The drivers of chronic disease in people with epilepsy with epilepsy (PWE) are unknown. We aimed to identify the role of health risk factors, polypharmacy, and medication usage in (PWE) according to age, sex, epilepsy types, epilepsy duration and resistance to treatment and their relevance to multimorbidity in epilepsy.</div></div><div><h3>Methods</h3><div>We analysed patient data from 330 PWE seen in a tertiary centre epilepsy clinic in Perth, Western Australia. The prevalence of biomedical and behavioural health risk factors (including hypertension, obesity or alcohol excess), polypharmacy, antiseizure (ASM) and general medication usage and their association with multimorbidity was investigated, as well as differences that existed across different age groups, sex, epilepsy types, epilepsy duration and resistance to treatment.</div></div><div><h3>Results</h3><div>Participants who had ≥1 health risk factor (37 % of participants) had a significantly greater number of comorbidities (p = 0.0008). The number of ASMs and general medications used were positively correlated with the number of comorbidities (p’s < 0.0001). Health risk factors were more commonly present in men (p = 0.0023), at older age (p < 0.0001) and in those with structural epilepsy (p = 0.0002). Polypharmacy was seen in 33 % of participants and was more commonly present in those of older age (p = 0.0003), in developmental and/or epileptic encephalopathy (DEE) (p = 0.0002) and in those with drug-resistant epilepsy (DRE) (p = 00006).</div></div><div><h3>Conclusions</h3><div>These findings indicate that health risk factors, polypharmacy and ASM usage are associated with chronic disease and multimorbidity in epilepsy. Routine screening and management of modifiable health risk factors and polypharmacy may reduce the chronic disease burden in PWE and its consequences.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"175 ","pages":"Article 110829"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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