Epilepsy & Behavior最新文献

{"title":"Low levels of mindfulness in the Epilepsy Monitoring Unit","authors":"Sreya Rahman ,&nbsp;Kush Maheshwari ,&nbsp;Ana Rivera ,&nbsp;Victoria Chang ,&nbsp;Mirza Usman Baig ,&nbsp;Bruno Moscoso ,&nbsp;Ana Chavez ,&nbsp;Erik D. Anderson ,&nbsp;Atul Maheshwari","doi":"10.1016/j.yebeh.2026.110956","DOIUrl":"10.1016/j.yebeh.2026.110956","url":null,"abstract":"<div><h3>Objectives</h3><div>Recent studies have shown that mindfulness therapy and attention tasks may benefit patients with seizure disorders. However, there is limited research on levels of mindfulness and electroencephalogram (EEG) power during a mindfulness task in these patients. This study evaluated levels of mindfulness in patients admitted to the Epilepsy Monitoring Unit (EMU) and its relationship with EEG power during a mindfulness task.</div></div><div><h3>Methods</h3><div>71 Epilepsy Monitoring Unit (EMU) patients completed a validated mindfulness questionnaire (the Five-Facet Mindfulness Questionnaire) and consented to participate in a standard 10-minute mindfulness task while scalp EEG was being recorded. Participants were then asked 6 questions about their experience with mindfulness and any prior or current diagnoses of Attention Deficit Hyperactivity Disorder (ADHD). Mindfulness scores were analyzed based on EMU diagnosis and also compared to historical healthy controls.</div></div><div><h3>Results</h3><div>Overall mindfulness scores of EMU patients were lower than those reported in historical healthy control samples. Patients with epilepsy and patients with functional seizures both exhibited lower scores in the “Acting with Awareness” and “Describing” facets of mindfulness relative to these controls. Within the EMU cohort, no significant differences were found in the total and sub-domain mindfulness scores between patients with epilepsy and patients with functional seizures. Relative alpha power (8–9 Hz) was significantly greater in the right frontocentral region (F4) in the high-mindfulness group compared with the low-mindfulness group.</div></div><div><h3>Conclusions</h3><div>Overall mindfulness levels of EMU patients were lower than described in historical healthy controls, and higher mindfulness levels were associated with greater alpha power within the frontoparietal attention network during a mindfulness task.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"178 ","pages":"Article 110956"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270116","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":"Use of fenfluramine in MECP2-related Rett syndrome: Findings from a retrospective multicenter pediatric case series","authors":"Silvia Boeri ,&nbsp;Erica Cognolato ,&nbsp;Davide Simonetta ,&nbsp;Giulio Ratta ,&nbsp;Maria Federica Pelizza ,&nbsp;Giulia Stevanato ,&nbsp;Domenica Battaglia ,&nbsp;Michela Quintiliani ,&nbsp;Martina Quartana ,&nbsp;Renata Pitino ,&nbsp;Giulia Prato ,&nbsp;Irene Bagnasco","doi":"10.1016/j.yebeh.2026.110920","DOIUrl":"10.1016/j.yebeh.2026.110920","url":null,"abstract":"<div><h3>Introduction</h3><div>Rett syndrome (RTT) is a severe neurodevelopmental disorder mainly affecting females. The patients could experience many comorbidities, including gastrointestinal, breathing, cardiovascular disorders, and seizures, which are often drug-resistant. Many antiseizure medications (ASMs) can be utilized as monotherapy or in combination. Fenfluramine (FFA), has a unique mechanism of action that targets the serotonergic system and sigma-1 receptors, has shown benefit in other epileptic encephalopathies, but data on RTT are lacking.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the charts of four pediatric patients (mean age 11 years, ± 2.6, min, 9 years old, max 14 years old) with MECP2-related RTT and drug-resistant epilepsy, treated with FFA between 2019 and 2025 (mean treatment duration: 10.5 months ± 2.4, min. 9 months, max 13 months − treatment duration was calculated from treatment initiation until study completion, which was uniformly defined as March 2025 (time of first manuscript draft) or until drug discontinuation. Clinical data, seizure outcomes, behavioral changes, and adverse effects were collected through medical records and caregiver interviews.</div></div><div><h3>Results</h3><div>Three out of four patients experienced a significant reduction in seizure frequency, with &gt; 50% reduction in two cases. Tonic-clonic seizures decreased in all responders. One patient did not show improvement and discontinued FFA. Adverse events (apathy and psychomotor slowing) were reported in one case but resolved after temporary discontinuation. EEGs in responders demonstrated partial improvement with a reduction in interictal abnormalities. No cardiac adverse events were observed. Improvement in alertness and interaction, and reduced irritability were reported in two patients.</div></div><div><h3>Discussion</h3><div>FFA appears effective and generally well-tolerated in patients with RTT and drug-resistant epilepsy, particularly for generalized tonic-clonic seizures. Cognitive and behavioral improvements reported by caregivers may be attributable to a combination of serotonergic receptor modulation and reduced seizure burden. Despite polytherapy, side effects were minimal. These findings align with existing literature on FFA use in other developmental epileptic encephalopathies. Prospective studies on larger cohorts with long-term monitoring are needed to validate efficacy, safety, and cognitive-behavioral outcomes.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"178 ","pages":"Article 110920"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270118","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":"Effect of adjunctive perampanel on daytime sleepiness and quality of life in adults with focal–onset seizures: Post hoc analyses of the AMPA study","authors":"Claudio Liguori ,&nbsp;Giovanni Assenza ,&nbsp;Martina Chiacchiaretta ,&nbsp;Anna Patten ,&nbsp;Ricardo Sáinz-Fuertes ,&nbsp;Anna Lisa Gentile","doi":"10.1016/j.yebeh.2026.110962","DOIUrl":"10.1016/j.yebeh.2026.110962","url":null,"abstract":"<div><h3>Objective</h3><div>Assess the relationship between subjective daytime sleepiness and therapeutic effect of adjunctive perampanel in a post hoc analysis of AMPA (NCT04257604), a prospective, observational study in Italy.</div></div><div><h3>Methods</h3><div>AMPA included people with epilepsy (PWE) aged ≥ 12 years with insufficiently controlled focal-onset seizures, with/without focal to bilateral tonic-clonic seizures, on 1–3 baseline anti-seizure medications, who were prescribed adjunctive perampanel. Full Analysis Set (FAS) included PWE (≥ 18 years) who received ≥ 1 perampanel dose, with baseline Epworth Sleepiness Scale (ESS) scores. ESS was administered at baseline and each study visit for ≤ 12 months. Excessive daytime sleepiness was defined as ESS ≥‍ 11 points. Quality of life (QoL) was assessed using QOLIE-31-P.</div></div><div><h3>Results</h3><div>FAS included 202 PWE. Mean (SD) ESS was 6.3 (4.5) at baseline (N = 202) and 6.2 (4.4) at end of treatment (EoT; n = 177); 29 PWE reported ≥‍ 4–point decreases from baseline ESS at EoT, while 31 reported ≥‍ 4–point increases. Median percent reductions in seizure frequency/28 days from baseline were 85.6% in improved ESS group and 77.6% in worsened ESS group (n = 14 each). At EoT, 14 PWE with no excessive daytime sleepiness reported a mean (SD) QOLIE-31-P score change of + 7.9 (12.9) points while 11 PWE with excessive daytime sleepiness had a mean (SD) change of −3.4 (18.6). Overall incidence of treatment–emergent adverse events was 56.9%; most commonly, dizziness/vertigo (22.8%) and somnolence (8.4%).</div></div><div><h3>Conclusion</h3><div>In the FAS, adjunctive perampanel did not worsen daytime sleepiness for ≤ 12 months. In a small subset of patients, seizure frequency was reduced, regardless of ESS changes, and mean QoL at EoT was improved for those without excessive daytime sleepiness but declined for those with excessive daytime sleepiness. No new safety signals emerged.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"178 ","pages":"Article 110962"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270158","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":"Social cognition and psychological measures in adults with Epilepsy: An exploratory study using Theory of Mind tasks","authors":"Ulufer Celebi ,&nbsp;Bilge Piri Cinar ,&nbsp;Nursena Ceylan ,&nbsp;Pınar Yigit ,&nbsp;Beste Dagdeviren Boz ,&nbsp;Sena Destan Bunul ,&nbsp;Atıl Mantar ,&nbsp;H.Tugrul Atasoy","doi":"10.1016/j.yebeh.2026.110958","DOIUrl":"10.1016/j.yebeh.2026.110958","url":null,"abstract":"<div><h3>Purpose</h3><div>This study explores the relationship between social cognition, psychological well-being, and self-compassion in patients with epilepsy, aiming to generate hypotheses for future research on the role of social cognition in epilepsy.</div></div><div><h3>Methods</h3><div>Including 38 patients with epilepsy and 21 healthy controls, the research assessed psychological well-being using the Flourishing Scale, self-compassion with the Self-Compassion Scale, and social cognition through the Reading the Mind in the Eyes Test (RMET), Facial Emotion Recognition Test (FERT), and Faux-Pas Test.</div></div><div><h3>Results</h3><div>Compared to healthy controls, patients with epilepsy (PWE) performed significantly lower on all social cognition tasks, including FERT (53.09 ± 5.94 vs. 50.07 ± 4.50, p = 0.032), RMET (23.19 ± 3.98 vs. 20.05 ± 4.82, p = 0.014), and the Faux-Pas Test (19.57 ± 4.27 vs. 15.18 ± 6.90, p = 0.11), with effect sizes ranging from d = 0.60 to d = 0.72, indicating small-to-moderate group differences. PWE with generalized seizures performed lower on the Over-Identification and Isolation subdimensions of the Self-Compassion Scale than those with focal seizures, whereas no significant differences in social cognitive performance were observed across seizure types. Patients experiencing fewer than one seizure per month performed higher on the Faux-Pas Test. Correlation analyses revealed that education positively correlated with FERT, and lower perceived Isolation emerged as a strong predictor of better FERT and Faux-Pas performance, independent of demographic or clinical factors. RMET performance was significantly associated with epilepsy diagnosis but was not predicted by psychological variables.</div></div><div><h3>Conclusion</h3><div>Lower perceived isolation emerged as a strong and independent predictor of better social cognitive performance, with patients experiencing fewer than one seizure per month also exhibiting higher Faux-Pas Test scores, suggesting that both psychological well-being and seizure frequency are important determinants of social cognition in PWE. Findings may inform the development of psychosocial interventions aimed at reducing isolation and supporting self-compassion in people with epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"178 ","pages":"Article 110958"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303561","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":"In good paws: A qualitative investigation into patients’ and caregivers’ experiences with seizure dogs","authors":"Valérie Johannavan Hezik-Wester ,&nbsp;Saskia de Groot ,&nbsp;Job van Exel ,&nbsp;Hester van de Bovenkamp ,&nbsp;Bert de Graaff","doi":"10.1016/j.yebeh.2026.110954","DOIUrl":"10.1016/j.yebeh.2026.110954","url":null,"abstract":"<div><h3>Objective</h3><div>The EPISODE trial demonstrated that seizure dogs can reduce seizure frequency and improve quality of life in patients with severe refractory epilepsy. This qualitative study explored patients’ and caregivers’ lived experiences with seizure dog partnerships near the end of the trial’s 36-month follow-up to understand their perceived impact in daily life.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with seventeen patients in the EPISODE trial and their caregivers. At the time of the interview, all patients had a seizure dog, either certified or in the final phase of training towards certification. Transcripts were analysed thematically.</div></div><div><h3>Results</h3><div>Patients described substantial emotional, social, and practical burdens associated with epilepsy and elaborated on how the introduction of a seizure dog shaped their subsequent experiences. Seizure dogs were described as fulfilling multiple roles, including first responder, emotional support companion, potential seizure predictor, source of public attention and a responsibility. Patients experienced benefits related to emotional stability, daily functioning, social participation, and seizure frequency. Challenges concerned training and care demands, unsolicited public attention, increased visibility of the condition, and unmet expectations, particularly regarding alerting behaviour. Caregivers reported reassurance from the dog’s presence and reduced need for supervision, while maintaining vigilance. While a sense of safety and independence formed common ground in patients’ and caregivers’ accounts, the perceived impact on daily life varied widely.</div></div><div><h3>Conclusion</h3><div>This study identifies perceived outcomes of seizure dog partnerships relevant to patients and caregivers, elucidates reasons for variation in experiences, and provides patient-centred insights to support realistic expectations and inform broader discussions on the potential of seizure dogs in epilepsy care.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"178 ","pages":"Article 110954"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282871","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":"Ramadan fasting and seizure activity in adults with epilepsy: A systematic review and meta-analysis","authors":"Ismail A. Ibrahim ,&nbsp;Sally Shaaban ,&nbsp;Mandy Elewa ,&nbsp;Muhammad Samir Haziq bin Abd Rahman ,&nbsp;Lobna Ahmed Mohamed ,&nbsp;Ahmed M. Talaia ,&nbsp;Yasein Fadel Awadalla ,&nbsp;Ching Soong Khoo","doi":"10.1016/j.yebeh.2026.110931","DOIUrl":"10.1016/j.yebeh.2026.110931","url":null,"abstract":"<div><h3>Purpose</h3><div>Ramadan fasting in Muslims entails abstaining from food and fluids from dawn to sunset, which can influence sleep patterns, medication timing, and food intake. Building on evidence that ketogenic diets and intermittent fasting may improve seizure control, we aim to analyze the link between intermittent Ramadan fasting in adults with epilepsy and seizure activity.</div></div><div><h3>Method</h3><div>We systematically searched PubMed, Scopus, Web of Science, Cochrane Library, and Embase between 2000 and January 2025 for articles that appeared between these dates. The terms used for searching included fasting in Ramadan with epilepsy or seizures. The seizure frequency and seizure status of the participants are the outcomes that we analyzed. Two reviewers independently screened and extracted data, with a third resolving any differences that arose between them. Meta-analysis was done using the random-effects model with statistical heterogeneity using the I² statistic.</div></div><div><h3>Results</h3><div>Of the 1485 articles, only eight were found to be relevant, and 4 of these included 564 patients who met the inclusion criteria. The analysis of the pooled data demonstrated that 61.1% of patients remained seizure-free throughout Ramadan (95% CI: 38.8%–83.4%), with considerable heterogeneity (I² = 87.7%). Seizure risk was higher in patients on polytherapy with poor baseline seizure control, increased fasting times, or high potassium levels. In contrast, extended seizure-free intervals and increased sleep duration pre-Ramadan were good predictors of safe fasting, and each seizure-free week increased the chance of remaining seizure-free by 10%, as did each extra hour of sleep by 30%. Seizure frequency increases were caused by interruption of daily rhythms, psychological tension, tiredness, and extended fasting.</div></div><div><h3>Conclusion</h3><div>While many patients remained seizure-free during Ramadan, high study variability highlights the need for standardized research. With proper medical supervision, fasting may be safely practiced for selected epilepsy patients.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"178 ","pages":"Article 110931"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146219063","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":"Evaluating executive functions in children and adolescents with epilepsy using the EpiTRACK tool: A 5-year longitudinal follow-up study","authors":"Thalía Motos Flores ,&nbsp;Mª Lourdes Abarca ,&nbsp;Alia Ramírez-Camacho ,&nbsp;Inés Medina Rivera ,&nbsp;Anna López-Sala ,&nbsp;Laia Nou-Fontanet ,&nbsp;Oliver Valero Coppin ,&nbsp;Alexis Arzimanoglou ,&nbsp;Andrea Palacio-Navarro","doi":"10.1016/j.yebeh.2026.110959","DOIUrl":"10.1016/j.yebeh.2026.110959","url":null,"abstract":"<div><div>Executive functions (EF) play a crucial role in the cognitive, emotional, and social development of children and adolescents, and they can be significantly impaired in those with epilepsy. Despite their clinical relevance, few longitudinal studies have examined the progression of EF from the onset of the disorder. The present study aimed to investigate the trajectory of EF over a 5-year period in a cohort of 44 paediatric patients with new-onset epilepsy, and to explore the influence of factors such as age, gender, age at seizure onset, clinical status, epilepsy syndrome type and epileptic focus. A longitudinal design was employed, with repeated assessments using the EpiTrack and EpiTrack Junior as the primary tools to assess executive performance over time. Results revealed a significant longitudinal improvement in EF, particularly among older adolescents. However, girls obtained lower scores. These findings suggest that neurocognitive maturation and ex-related differences influence the development of EF. Overall, the results provide relevant valuable empirical evidence for designing early intervention programs and highlight the need for individualized, long-term neuropsychological follow-up in this population.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"178 ","pages":"Article 110959"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282900","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":"Intracranial EEG findings and outcomes in MRI-negative epilepsy with temporal lobe semiology and scalp EEG features","authors":"Vishal Pandya ,&nbsp;Julie K. Janecek ,&nbsp;Joshua J. LaRocque ,&nbsp;Serena Thompson ,&nbsp;Patrick Bauer ,&nbsp;Aditya Vuppala ,&nbsp;Christopher Anderson ,&nbsp;Ika Noviawaty ,&nbsp;Jeffrey R. Binder ,&nbsp;Kunal Gupta ,&nbsp;Sean Lew ,&nbsp;Wade Mueller ,&nbsp;Cathleen Greene ,&nbsp;Anthony Oleksy ,&nbsp;Sara J. Swanson ,&nbsp;Chad Carlson ,&nbsp;Manoj Raghavan","doi":"10.1016/j.yebeh.2026.110963","DOIUrl":"10.1016/j.yebeh.2026.110963","url":null,"abstract":"<div><div>We sought to correlate seizure and cognitive outcomes with seizure onset zones (SOZs) determined from intracranial EEG (iEEG) in patients with MRI-negative drug-resistant focal epilepsy with scalp EEG and semiological features of temporal lobe epilepsy (TLE). We identified 66 patient cases with these imaging, EEG, and semiological characteristics evaluated at the Medical College of Wisconsin from 2002 to 2024. Ictal iEEG data were available for 61 patients. Of these, 25 (41%) had unilateral SOZs in the anteromedial temporal lobe (Group A). In 36 (59%) patients SOZs were in the mid to posterior temporal neocortex, adjacent/closely connected regions (temporal-plus), entirely extratemporal, or involved both temporal lobes (Group B). In all, 45 patients underwent resective surgery, with a significantly higher proportion of patients in Group A (84%) undergoing resection compared to Group B (58%) (p = 0.049). Overall, 40 (88%) had an Engel I outcome at last follow up (11.5 years +/- 5.91). Seizure-outcomes were transiently superior in Group A at year-1 post-surgery (p = 0.048), but there was no significant difference at year-2 or at last follow up between the two groups. Postoperative neuropsychological data were available for 28 patients (14 each in Group A and B) and notable only for an improvement in processing speed index (PSI) in Group A and a decline in Group B (p = 0.015). Our results indicate that with carefully planned iEEG studies to guide tailored resections, excellent long-term post-surgical outcomes can be achieved in most MRI-negative epilepsy patients with temporal lobe semiology and scalp EEG features.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"178 ","pages":"Article 110963"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257849","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":"Interplay between olfactory inputs and seizure regulation: Mechanisms and evidence","authors":"Jinji Li ,&nbsp;Xuan Liu ,&nbsp;Xinxin Liu,&nbsp;Yilei Zhou,&nbsp;Li Wang","doi":"10.1016/j.yebeh.2026.110897","DOIUrl":"10.1016/j.yebeh.2026.110897","url":null,"abstract":"<div><div>Olfactory stimuli represent a long-standing paradox in epilepsy: identical odors can provoke seizures in some individuals yet suppress them in others. Despite extensive anecdotal and experimental evidence, the mechanisms underlying this duality remain poorly defined. Here we synthesize anatomical, physiological, and clinical data linking olfaction to epileptogenic networks, highlighting the piriform cortex (PC) as a low-threshold hub coupling olfactory bulb (OB) inputs to limbic circuits. We propose an integrative framework in which olfactory influences arise through four interacting levels: (i) circuit competition via defensive and brainstem reflexes, (ii) respiration-locked gating of olfactory–limbic coupling, (iii) state-dependent bias from stress and neuromodulatory tone, and (iv) molecular actions on receptors and ion channels. This framework reconciles the apparent paradox by demonstrating how context and network state determine whether olfactory inputs suppress or facilitate seizures. We argue that the olfactory system offers a unique experimental window into ictogenesis and a tractable platform for probing, and potentially harnessing, state-dependent seizure modulation.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"177 ","pages":"Article 110897"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098551","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":"Efficacy differences between tocilizumab and ketogenic diet during acute phase of febrile Infection-Related epilepsy syndrome in children: A retrospective cohort study","authors":"Xinru Yan,&nbsp;Jian He,&nbsp;Min Cheng,&nbsp;Siqi Hong,&nbsp;Li Jiang,&nbsp;Wei Han","doi":"10.1016/j.yebeh.2026.110898","DOIUrl":"10.1016/j.yebeh.2026.110898","url":null,"abstract":"<div><div>Febrile infection-related epilepsy syndrome (FIRES) is a rare and devastating subtype of new-onset refractory status epilepticus (NORSE), characterized by rapid progression, high mortality, and poor response to conventional antiseizure therapies. The underlying pathophysiology remains elusive, and no standardized treatment has been established. This retrospective study evaluated 36 pediatric patients diagnosed with FIRES at the Children’s Hospital of Chongqing Medical University from January 2019 to December 2024. Patients received first-line immunotherapy alone (n = 17), combined with tocilizumab (n = 8), or with ketogenic diet (KD) (n = 11). Compared to other groups, the tocilizumab cohort showed more rapid seizure control within the first week, improved EEG background activity, and earlier normalization of the neutrophil-to-lymphocyte ratio (NLR), an inflammatory biomarker. At three months, KD demonstrated superior EEG improvement, suggesting a delayed but sustained therapeutic effect. These findings suggest that early initiation of tocilizumab as a second-line therapy following first-line immunotherapy may effectively reduce seizure burden and improve clinical outcomes in children with FIRES.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"177 ","pages":"Article 110898"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098592","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}