Epilepsy & Behavior最新文献

{"title":"Post-traumatic epilepsy: Insights from human cortical contused tissue","authors":"Lina V. Becerra-Hernández ,&nbsp;Carlos A. González-Acosta ,&nbsp;Efraín Buriticá-Ramírez","doi":"10.1016/j.yebeh.2024.110252","DOIUrl":"10.1016/j.yebeh.2024.110252","url":null,"abstract":"<div><div>Traumatic brain injury is a significant risk factor for the development of post-traumatic epilepsy (PTE), posing a major clinical challenge. This review discusses the critical role of GABAergic interneurons and reactive astrogliosis in the pathophysiology of post-traumatic epilepsy, integrating findings from our research group within the traumatic brain injury context with recent literature to highlight the impact of excitation-inhibition imbalance. We analyzed alterations in interneuron populations, specifically subtypes expressing the calcium-binding proteins parvalbumin, calretinin, and calbindin, and their association with an increased risk of epileptogenesis after TBI. Furthermore, we detail the role of reactive astrogliosis, elucidating how dysregulated astrocytic functions, including impaired glutamate homeostasis and aberrant calcium signaling, contribute to an environment conducive to seizure activity. Increased expression of glial fibrillary acidic protein and crystallin alpha-B in reactive astrocytes identified in contused human tissue suggests their involvement in exacerbating epileptogenic circuits. Our findings emphasize the intricate interactions between GABAergic interneurons and astrocytes, underscoring the need for a comprehensive understanding of the mechanisms underlying post-traumatic epilepsy. By bridging our group’s data with existing evidence, this review establishes a foundation for future studies aimed at validating systemic biomarkers and developing targeted therapies to prevent or mitigate epilepsy progression following TBI. These insights are essential for addressing the complexities of drug-resistant epilepsy in affected patients.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110252"},"PeriodicalIF":2.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002232","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}

{"title":"Clinical characteristics and outcomes of adults with multifocal epilepsy","authors":"Alex M. Dudley ,&nbsp;Daniel J. Costello","doi":"10.1016/j.yebeh.2024.110250","DOIUrl":"10.1016/j.yebeh.2024.110250","url":null,"abstract":"<div><h3>Objective</h3><div>Multifocal epilepsy is an important subtype of epilepsy, but it is sometimes difficult to recognise in general clinical practice. Distinguishing (uni)focal from multifocal drug resistant epilepsy is important when considering surgical resection. The presence of multiple discrete autonomous epileptogenic zones may limit surgical options to neuromodulation or palliative resection. We describe the clinical characteristics and outcomes of a cohort of patients with multifocal epilepsy diagnosed by video-EEG monitoring.</div></div><div><h3>Methods</h3><div>Patients with probable and possible multifocal epilepsy were identified from an Epilepsy Monitoring Unit database during a 9-year period. Clinical characteristics and long term outcomes are described.</div></div><div><h3>Results</h3><div>We identified 30 patients- 19 with possible and 11 with probable multifocal epilepsy based on clinical assessment and video-EEG findings. The aetiology of epilepsy was structural or of unknown cause in the majority. Prior to video-EEG monitoring, clinical assessment including ascertainment of seizure semiology or routine EEG suggested multifocal epilepsy in only 13.3% of patients. Over 95% had ongoing drug resistant seizures at last follow up. One patient died from sudden unexpected death in epilepsy over the 9-year study interval.</div></div><div><h3>Significance</h3><div>This study highlights that multifocal epilepsy is often not recognised or diagnosed in the outpatient setting. Typically it is a diagnosis made after video-EEG monitoring. In our experience multifocal epilepsy is usually drug-resistant and often highly refractory. Recognising patients with multifocal epilepsy as a more treatment-resistant subgroup within focal epilepsy is important for counselling and management considerations.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110250"},"PeriodicalIF":2.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002427","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}

{"title":"Trends in anti-seizure medication spending by Medicare Part D and Medicaid from 2012 to 2022","authors":"Jiping Zhou ,&nbsp;Maysaa M. Basha ,&nbsp;Abdulmohsen Ghuloum ,&nbsp;Wesley Kohls ,&nbsp;Jason Liu ,&nbsp;Yeonju Kim ,&nbsp;Deepti Zutshi","doi":"10.1016/j.yebeh.2024.110254","DOIUrl":"10.1016/j.yebeh.2024.110254","url":null,"abstract":"<div><h3>Objectives</h3><div>The rising cost of anti-seizure medications (ASMs) in the United States (US) is a major concern for patients, healthcare providers, insurance payors, and policymakers. We aim to describe and analyze the spending trends on ASMs in the Medicare Part D (MPD) and Medicaid population in the US.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on the databases of MPD and Medicaid Spending by Drug from 2012 to 2022, which was published by the Centers for Medicare and Medicaid Services (CMS). The total expenditures (adjusted for inflation to 2022 dollars), number of claims, and cost-per-claim (CPC) for individual ASMs were summarized on an annual basis. Stratifications of ASMs were made by ASM generations and brand versus generic manufacturers.</div></div><div><h3>Results</h3><div>Expenditure on ASM by both MPD and Medicaid more than doubled between 2012 and 2022, soaring from $2.8 billion to $5.7 billion. The ASMs total annual claim number increased from 32.2 to 43.2 million. In 2012, second-generation ASMs comprised the largest percentage of total spending of MPD (51%) and Medicaid (57%), but third-generation ASMs took over the lead in 2022 (44% of MPD and 68% of Medicaid). The total spending by MPD and Medicaid on brand-name ASMs increased significantly from 2012 to 2022, likely contributed by almost tripling of CPC of brand-name ASMs in 2022. There was no significant change in CPC for generic ASMs from 2012 to 2022.</div></div><div><h3>Significance</h3><div>The expenditure by MPD and Medicaid on ASMs has doubled in the past decade. The rise in spending was disproportionately comprised of newer third-generation and brand-name ASMs. Further monitoring of the spending trend and efforts on drug price negotiation may play a role curbing the rising cost of ASMs. The methods to control drug spending remain unclear and drug pricing negotiation and other policy reforms should be considered.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110254"},"PeriodicalIF":2.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002224","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}

{"title":"Characteristics of patients diagnosed with psychogenic non-epileptic seizures (PNES) who request reinstatement of their driving privileges","authors":"Robert Trobliger ,&nbsp;Talia Simpson ,&nbsp;Kaleb Lancman ,&nbsp;Lenka Kramska ,&nbsp;Selim Benbadis","doi":"10.1016/j.yebeh.2025.110265","DOIUrl":"10.1016/j.yebeh.2025.110265","url":null,"abstract":"<div><div>Rationale: Patients who experience seizures, including PNES, are usually advised to discontinue driving, or have their driving privileges revoked until a determined period of seizure-freedom is achieved. In this retrospective study, patients with PNES who requested driving privileges or reported having resumed driving were compared to those who did not on measures of depression, anxiety, PTSD, and cognitive flexibility/motor speed.</div></div><div><h3>Methods</h3><div>Diagnosis<!--> <!-->of<!--> <!-->PNES<!--> <!-->was<!--> <!-->confirmed<!--> <!-->with<!--> <!-->video-EEG.<!--> <!-->Demographic<!--> <!-->and clinical data<!--> <!-->and requests for reinstatement of driving privileges (requiring 6 or more months seizure freedom) and reports of decisions to resume driving were noted. Tests of motor speed and hand eye coordination and self-report questionnaires of depression, anxiety and PTSD administered as part of neuropsychological assessment were analyzed.</div></div><div><h3>Results</h3><div>A total of 403 patients with PNES evaluated in 2010–2020 were identified. Of those, 365 patients were eligible for inclusion, and of those, 60 applied for driving privileges or reported that they resumed driving. When the two groups were compared, the group that applied for driving privileges or decided to resume driving was significantly less depressed (p = 0.001) when tested than the group that did not. Furthermore, a significant difference was seen in measures of motor performance between those who requested to resume driving and those who did not (DKEFS T1, p = 0.006, DKEFS T2, p = 0.001, DKEFS T3, p = 0.002, DKEFS T4, p = 0.001; GPT dominant, p = 0.05, GPT non-dominant, p = 0.003).</div></div><div><h3>Conclusion</h3><div>Driving a motor vehicle is a useful measure of improvement for PNES because patients with seizures are required to discontinue driving until seizure-freedom is achieved. This study revealed that lower levels of depression and better fine motor functioning were associated with reported seizure-freedom and driving resumption. Depression is commonly associated with diminished performance (slower motor response times and impaired fine motor movements) on tests of motor functioning, both of which may result in less interest in pursuing permission to resume driving. These findings suggest that mood symptoms (and associated performance on measures of motor speed and coordination) may have prognostic significance in patients diagnosed with PNES. This also suggests that timely treatment of depression in newly diagnosed patients with PNES may be indicated.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110265"},"PeriodicalIF":2.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to evaluation and characteristics of patients evaluated at epilepsy centers within an integrated health care delivery system","authors":"Josiah Ambrose ,&nbsp;Nausheen Mahmood ,&nbsp;Cynthia I. Campbell ,&nbsp;Abigail Eaton","doi":"10.1016/j.yebeh.2024.110256","DOIUrl":"10.1016/j.yebeh.2024.110256","url":null,"abstract":"<div><h3>Objective</h3><div>Rapid patient referral to epilepsy centers may facilitate subsequent disease-modifying surgical and non-surgical treatments. Delays of 15–18 years have been reported from time of epilepsy diagnosis to surgical evaluation in some settings, though patterns for timely guideline-concordant referrals within integrated care models are not well known and could inform strategies for optimizing guideline-concordant access.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of 1088 patients undergoing epilepsy center evaluation from January 1, 2008 through June 30, 2023 in a Northern California integrated healthcare delivery system (IDS) with a Level 4 Epilepsy Center. Using electronic health record (EHR) data, we summarized time from diagnosis and other major care time points until first visit at the epilepsy center. A multivariate linear model was used to evaluate the relationship of select demographic, socioeconomic, and clinical characteristics with the time to first epilepsy center visit.</div></div><div><h3>Results</h3><div>The mean times to epilepsy center visit from first prescription of an anti-seizure medication (ASM), diagnosis of epilepsy or seizures, and first visit with a general neurologist, were 3.9 years (SD = 4.5), 3.2 years (SD = 3.2) and 2.7 years (SD = 3.2), respectively, for the full cohort of patients prescribed any number of ASMs. Comparable time frames were seen for patients prescribed two or more ASMs at the time of first visit. Significantly longer time to epilepsy center visit was seen in patients with multiple ASMs prescribed, a concordant diagnosis of developmental delay, and those age 40 and above. Longer times to epilepsy center visit were not seen among patients with psychiatric comorbidities, public health insurance coverage, and among patients in traditionally underserved groups.</div></div><div><h3>Conclusions</h3><div>Patients evaluated at an epilepsy clinic within an IDS system did so within less than four years of diagnosis and initial treatment, with few disparities by demographics or comorbidities. Future studies can identify specific health system features that are key to shorter time frames to test transferable strategies to reduce time to epilepsy centers.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110256"},"PeriodicalIF":2.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002166","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}

{"title":"The management of people with epilepsy in a city wide care home service, the impact of a GP with Special Interest in epilepsy, and Enhanced Health in Care Homes Framework","authors":"I Minshall ,&nbsp;A Neligan","doi":"10.1016/j.yebeh.2024.110239","DOIUrl":"10.1016/j.yebeh.2024.110239","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of epilepsy increases with age, especially in people diagnosed with dementia. Seizures in an elderly population are likely to have a focal onset, for which sodium channel blockers are the drug of choice. This study reviews the clinical needs and care of people with epilepsy (PWE) in a city wide care home service and assessing the impact of a GP with Special Interest in epilepsy (GPwSIe).</div></div><div><h3>Method</h3><div>The clinical notes of PWE, or with a documented single seizure, who had at any time been under the care of the service, which included a GPwSIe, providing care to all nursing and residential homes in Chester were reviewed from June 2020 to December 2022.</div></div><div><h3>Results</h3><div>In the 102 people in the study, thirty eight (37%) had clinical input from a GPwSIe with 82% having positive outcomes. No referrals were required to secondary care.</div></div><div><h3>Conclusion</h3><div>This first comprehensive study of epilepsy in UK care homes has revealed a significant workload. A dedicated care home service, which included a GPwSIe, can meet that clinical need, prevent secondary care referral, and facilitate education for colleagues and carers. National Institute of Health and Care Excellence (NICE) guidelines for management of seizures, likely to have a focal onset, and in a population who might not be suitable for standard investigation, could be simplified for this group of people. The service is a good example of how the Enhanced Care Home Framework can facilitate improved care.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110239"},"PeriodicalIF":2.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002239","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}

{"title":"Exploring the experience of stigma among children and adolescents with epilepsy in China: A qualitative study","authors":"Jing Zhao ,&nbsp;Shuangzi Li ,&nbsp;Ni Zhang ,&nbsp;Junqi Zeng ,&nbsp;Cui Cui ,&nbsp;Ting Wang ,&nbsp;Qing Xia ,&nbsp;Yuan Xie","doi":"10.1016/j.yebeh.2025.110264","DOIUrl":"10.1016/j.yebeh.2025.110264","url":null,"abstract":"<div><h3>Objective</h3><div>Epilepsy-related stigma negatively affects the lives of children and adolescents. This study aims to explore the experience of stigma among children and adolescents with epilepsy in China.</div></div><div><h3>Methods</h3><div>This study used purposive sampling to select children and adolescents aged 10–18 diagnosed with epilepsy. A total of sixteen participants with epilepsy engaged in semi-structured interviews. The interviews were audio-recorded, transcribed and translated. The data were then analyzed using a thematic analysis approach to identify themes and subthemes.</div></div><div><h3>Results</h3><div>The study identified four themes in the stigma experiences of children and adolescents with epilepsy: (1) The triggers of stigma, which include epilepsy stereotypes, seizure manifestations, and their unpredictability; (2) Concerns and uncertainties encompassing ASMs, academic pressure, future concerns, and transition uncertainties; (3) The impact of stigma on daily life including sleep and physical activity; and (4) Strategies and resources for addressing stigma, highlighting the importance of education and peer support.</div></div><div><h3>Conclusion</h3><div>Our findings provide a better understanding of the experience of epilepsy-related stigma among children and adolescents in China. The experiences of stigma described reveal the complex causes and the profound negative impact on their lives. However, it’s important to note that children and adolescents can also have positive experiences when confronted with stigma. Psychosocial outcomes can be improved through comprehensive education and peer support. Our findings can inform further research into evidence-based strategies for stigma reduction interventions that promote well-being.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110264"},"PeriodicalIF":2.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001710","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}

{"title":"Effects of Klotho in epilepsy: An umbrella review of observational and mendelian randomization studies","authors":"Si-Chun Gu ,&nbsp;Tao-Tao Lv ,&nbsp;Jing Peng ,&nbsp;Wei Zhang ,&nbsp;Qing Ye ,&nbsp;Yong Hao","doi":"10.1016/j.yebeh.2024.110231","DOIUrl":"10.1016/j.yebeh.2024.110231","url":null,"abstract":"<div><h3>Background</h3><div>Klotho is a geroprotective protein which has been recognized for its anti-aging properties. Pre-clinical evidence suggested that boosting Klotho might hold therapeutic potential in ageing and disease. Epilepsy is a neurological disorder characterized by its recurrent seizures. The complex interplay between Klotho and epilepsy has not been elucidated. The main objective was to investigate the role of Klotho in epilepsy with combination of observational and mendelian randomization (MR) studies.</div></div><div><h3>Methods</h3><div>The observational data set comprised 13,766 adults who were aged 20–80 years from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016. We used weighted multivariable-adjusted logistic regression models to examine the association between Klotho and epilepsy. We also applied MR to discern if a causal link is present between Klotho and epilepsy.</div></div><div><h3>Results</h3><div>In NHANES study, the incidence of epilepsy tended to decline with an increase of Klotho levels after covariate adjustments. Klotho was identified to have causal effects on epilepsy. MR analyses revealed that higher transformed Klotho (by rank-based inverse normal transformation) levels were correlated with a higher likelihood of developing generalized epilepsy, lesion-negative focal epilepsy, and focal epilepsy, indicating that higher Klotho concentrations were associated with reduced risks of epilepsy. The sensitivity analyses upheld these consistent relationships.</div></div><div><h3>Conclusions</h3><div>Our research, encompassing comprehensive NHANSE analysis and MR methods, revealed that an increase in Klotho levels was associated with a reduced risk of epilepsy, suggesting that increasing or restoring Klotho might play a protective role and offer new anti-aging therapeutic potential in epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110231"},"PeriodicalIF":2.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002568","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}

{"title":"“Clinical outcomes and healthcare costs in status epilepticus: A multivariable analysis from a tertiary center in a resource-limited setting”","authors":"Mohsen Farjoud Kouhanjani ,&nbsp;Mohammad Shafie’ei ,&nbsp;Bita Hashemi ,&nbsp;Mohsen Farazdaghi ,&nbsp;Ali A. Asadi-Pooya","doi":"10.1016/j.yebeh.2024.110259","DOIUrl":"10.1016/j.yebeh.2024.110259","url":null,"abstract":"<div><h3>Background</h3><div>As a debilitating and severe repercussion, the clinical and economic impact of Status epilepticus (SE) has not been thoroughly explored in various regions around the world, especially those with limited resources. Therefore, we aimed to identify the predictors of mortality and healthcare costs associated with SE in one tertiary care center with limited resources.</div></div><div><h3>Methods</h3><div>This retrospective single-center cohort study, carried out at Namazi Hospital, Shiraz, Iran, included 130 SE cases from March 21, 2021, to March 20, 2022. Patient data were extracted from medical records, including demographics, clinical presentations, hospital course, treatment modalities, and costs. Multivariable regression models were used to identify factors associated with mortality and hospital stay costs.</div></div><div><h3>Results</h3><div>Patients were aged 1 month to 92 years (mean 20.36 years, median 7), with a male predominance of 59.23 %. Pre-existing epilepsy was found to be associated with lower mortality (p &lt; 0.05), while cardiovascular complications (p &lt; 0.05) and cerebrovascular disease (p &lt; 0.001) were significantly associated with increased mortality risks. In addition, Intensive Care Unit (ICU) admission, necessitated by complex treatment regimens, was linked to significantly higher healthcare costs (p &lt; 0.001). Older age and the use of sedatives were also associated with higher costs, while psychiatric disorders were linked to lower costs.</div></div><div><h3>Conclusion</h3><div>SE imposes a substantial clinical and economic burden in resource-limited settings, as limited availability of ICU beds is common. Thus, screening SE cases based on clinical characteristics (e.g., comorbidities) is paramount. Therefore, targeted strategies are essential for optimizing care and reducing costs.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110259"},"PeriodicalIF":2.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002384","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}

{"title":"Diagnostic features of functional/ dissociative seizures in the first presentation of transient loss of consciousness","authors":"Alistair Wardrope ,&nbsp;Stephen J Howell ,&nbsp;Markus Reuber","doi":"10.1016/j.yebeh.2025.110263","DOIUrl":"10.1016/j.yebeh.2025.110263","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous studies have identified features in patient’s history and seizure descriptions supporting a clinical diagnosis of functional / dissociative seizures (FDS). However, most studies involved patients with chronic seizure disorders. This study explores the value of reported features for a clinical diagnosis of FDS in an adult population with a first presentation of transient loss of consciousness (TLoC).</div></div><div><h3>Methods</h3><div>We prospectively recruited patients newly presenting with TLoC to an Emergency Department (ED), Acute Medical Unit (AMU; admitting ward for general medical patients), first seizure or syncope clinic. We invited participants to complete an online questionnaire, either at home or at time of initial assessment. Two expert raters determined cause of participants’ TLOC after 6-month follow-up. We also reviewed clinical records at this timepoint to extract relevant information for assessment of putative diagnostic features (13 categorical variables and 6 interval or continuous variables), and validation of two previously-developed diagnostic classifiers.</div></div><div><h3>Results</h3><div>We included 178 patients in final analysis (134 syncope, 32 epilepsy, 12 FDS). 3 categorical variables were significantly more common in FDS: fluctuating course or waxing/waning movements (<em>p</em> = 0.0037), asynchronous limb movements (<em>p</em> = 0.0024), and preserved ictal awareness or responsiveness (<em>p</em> = 0.0013). Three interval/continuous variables supported diagnosis of FDS: younger age at onset (area under receiver-operating characteristic curve [AUC] = 0.865 (0.771–0.960)); total non-ictal symptoms reported on structured review of systems (AUC = 0.834 (0.730–0.928)); and total peri-ictal symptoms self-reported on structured questionnaire (AUC = 0.864 (0.781–0.948)).</div></div><div><h3>Conclusions</h3><div>Our study does not find support for some clinical features previously reported as diagnostic of FDS in adult patients with a first presentation of TLoC. Features suggestive of preserved ictal responsiveness (reported by witnesses) and awareness (in the form of total number of self-reported peri-ictal symptoms) support FDS diagnoses.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110263"},"PeriodicalIF":2.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002567","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}