Epilepsy & Behavior最新文献

Introduction: The objective of this study was to assess feasibility of a remotely delivered physical activity intervention in adults with epilepsy.

Methods: Adults with epilepsy and at least one seizure in the prior six months were randomized 2:1 to either a physical activity intervention or a healthy living education control arm. The intervention group received a 12-week program led by a trained health coach aimed to progressively increase daily steps while the control group received biweekly telephone education on healthy living. Sustainability was assessed at 12 weeks post-intervention. Daily steps and activity intensity were continuously measured by a Garmin Forerunner 45.

Results: A total of 21 participants were randomized (15 intervention; 6 control), and 17 completed the full study (14; 3). There was high retention (93%), attendance (80%), and acceptability in the intervention group. While the proportion of the intervention group who strictly adhered to their daily step goal was low (26.67%; 95% CI 0.076 - 0.581), there was a significant increase in mean daily steps (3495 (95% CI 2,170-4,821) to 5591(4,271-6,911), p < 0.001) and mean daily moderate-to-vigorous intensity activity minutes (17.98 (5.55-30.41) to 30.11 (17.93-42.28), p < 0.001) in the intervention group compared to the control group. Both measures remained elevated at follow-up (4,758 (3,437-6,079) and 35.26 (23.03-47.49), respectively) while the control group showed no statistically significant changes over time.

Conclusion: A remotely delivered daily steps-based physical activity intervention is feasible for people with epilepsy and shows promising immediate and sustainable effects on physical activity behaviors.

Objective: Alexithymia, characterized by difficulties in identifying and describing emotions, has been increasingly recognized in neurological disorders. This study aimed to evaluate alexithymia in adult patients with epilepsy (PWE) compared with HCs and to examine its association with affective symptoms and epilepsy-related clinical variables.

Methods: In this cross-sectional case-control study, adult PWE and HCs were assessed using the Toronto Alexithymia Scale-20, Beck Depression and Beck Anxiety Inventory. Clinical epilepsy variables, including seizure type, seizure control status, age at epilepsy onset, duration of epilepsy, antiseizure medications, EEG findings, and MRI abnormalities, were recorded. Group comparisons were performed according to alexithymia status. Multivariable binary logistic regression analysis was conducted to identify factors independently associated with alexithymia.

Results: PWE exhibited significantly higher alexithymia, anxiety, and depression scores compared with HCs (all p < 0.05). Within the epilepsy group, patients with alexithymia had significantly higher anxiety and depression scores in univariate analyses. However, no significant associations were observed between alexithymia and epilepsy-related clinical characteristics. In multivariable logistic regression analysis including anxiety score, depression score, age at epilepsy onset, and duration of epilepsy, none of these variables independently predicted the presence of alexithymia.

Significance: Alexithymia is more prevalent in PWE and is associated with increased affective symptom burden; however, it appears to be independent of epilepsy-related clinical variables and is not fully explained by anxiety or depressive severity. These findings support the conceptualization of alexithymia as a distinct affective construct in epilepsy and highlight the importance of its direct assessment in routine clinical practice.

Background and purpose: Although numerous studies have examined teachers' knowledge and attitudes toward epilepsy, research focusing on their practical emergency seizure management remains limited. This study examined the effectiveness of Visually Enhanced Mental Simulation (VEMS) in improving seizure-response skills and attitudes among pre-service teachers.

Methods: A single-group pretest-posttest quasi-experimental design was conducted with 45 final-year teacher candidates from a public university in Türkiye between 13 and 31 May 2024. Participants received theoretical instruction followed by a structured VEMS-based scenario and guided debriefing. Seizure-response performance was evaluated using the Epileptic Seizure First Response Evaluation Form, and attitudes were assessed using the Social Attitudes Toward Childhood Epilepsies Scale.

Results: Post-intervention performance scores were significantly higher than pre-intervention scores (117.56 ± 9.57 vs. 79.56 ± 23.93, p < 0.001). Attitude scores also improved (p < 0.001), reflecting more positive perceptions of epilepsy.

Conclusions: VEMS-based training improved teacher candidates' practical seizure-response skills and attitudes toward epilepsy. Integrating experiential, simulation-based approaches into teacher education may enhance knowledge and foster greater confidence, competence, and preparedness for epilepsy-related emergencies in school settings.

Background: Sleep EEG (S-EEG) is commonly used to increase diagnostic yield after a first suspected seizure, yet its scheduling is usually standardized and does not account for individual circadian preference. We investigated whether aligning S-EEG timing to individual chronotype improves sleep parameters and IED detection compared with standard morning recordings in a pilot prospective study.

Methods: In this prospective observational two-phase study, patients aged ≥ 18 years undergoing diagnostic work-up for a first suspected unprovoked seizure underwent S-EEG after partial sleep deprivation. In Phase I, all recordings were performed at 8:00 AM. In Phase II, recording time was adapted to chronotype assessed by the Morningness-Eveningness Questionnaire (early chronotypes at 2:00 PM, late chronotypes at 8:00 AM). Sleep architecture and IED detection were compared between phases.

Results: Eighty-eight patients (age range 18-84 years; 60.3% male) were included. Groups were comparable in demographic and clinical variables. Total sleep time and N2 sleep were significantly longer with standard morning scheduling than with chronotype-based scheduling. IEDs were more frequent in chronotype-aligned recordings (32.6% vs. 25.0%), without a statistically significant difference (p = 0.44). The absolute difference in detection rate was 7.6% (95% CI - 11.0% to 26.4%). Neither chronotype nor sleep-related symptoms (insomnia, excessive daytime sleepiness, restless legs syndrome) were significantly associated with IED detection.

Conclusions: Chronotype-based scheduling of S-EEG alone did not significantly improve sleep duration or IED detection under routine clinical conditions. Sleep duration during recordings was short overall, which may have limited the ability to detect circadian effects. These findings suggest that optimization of S-EEG diagnostics may require integrated strategies beyond scheduling alone, including longer recordings or tailored sleep facilitation, rather than chronotype-based timing in isolation.

Background: Hippocampal atrophy is a defining structural feature of mesial temporal lobe epilepsy (mTLE), yet the magnitude of volume loss and the extent of contralateral involvement vary across magnetic resonance imaging (MRI) studies, limiting quantitative interpretation in clinical practice. We conducted a systematic review and meta-analysis to quantify hippocampal volume reduction in adults with mTLE and assess the consistency of contralateral changes.

Methods: Following PRISMA 2020 guidelines, we searched six bibliographic databases and different trial registries. Eligible studies included adults with unilateral mTLE who underwent pre-surgical structural MRI with quantitative hippocampal volumetry, as well as healthy controls. Two reviewers independently assessed risk of bias using ROBINS-E. Random-effects meta-analyses pooled mean differences in absolute hippocampal volume (mm³; controls minus patients) for hippocampi ipsilateral and contralateral to the seizure focus.

Results: Twenty-eight studies met the inclusion criteria; 23 contributed to the meta-analysis (803 patients, 613 controls). Ipsilateral hippocampal volume was significantly reduced (mean difference 985.2 mm³, 95% CI 759.7-1210.7; p < 0.001; I² = 98%). Contralateral volume was also reduced (22 studies; mean difference 198.8 mm³, 95% CI 124.4-273.3; p < 0.001; I² = 85%). Funnel plot inspection and Egger testing showed no evidence of small-study effects. ROBINS-E indicated low to moderate risk of bias overall.

Conclusions: Adult mTLE shows marked ipsilateral hippocampal atrophy with a smaller, consistent contralateral reduction, consistent with partial bilateral structural involvement. Pooled estimates provide clinically interpretable reference values for quantitative MRI in presurgical evaluation, though substantial heterogeneity warrants caution.

Background: Self-management is important for effective care for people living with epilepsy. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based program that improves health outcomes and lifestyle behaviors in chronic diseases such as diabetes, hypertension, heart disease, stroke, and arthritis. We describe initial results from a program evaluation of the CDSMP in adults with epilepsy.

Methods: The Epilepsy Foundation of America (EFA) recruited adults with epilepsy to participate in the CDSMP through its nationwide community network. The program included 6 workshops held weekly online or by phone and led by trained facilitators. At program outset and at 1 and 6 months after completion, participants reported on measures of epilepsy self-management (Epilepsy Self-Management Scale, ESMS), self-efficacy (Self-Efficacy for Managing Chronic Disease, SEMCD), depression (Patient Health Questionnaire-8, PHQ-8), and self-rated health. Participants and EFA sites delivering the program in their communities provided qualitative feedback.

Results: Across 8 EFA sites, 99 adults with epilepsy completed the CDMSP. Evaluation measure scores at 1 and 6 months after program completion showed improvement in epilepsy self-management, self-efficacy, and depression, but no change in self-rated health. Feedback from staff, facilitators, and participants suggested the program was well-received and recommended strategies to strengthen planning, recruitment, and delivery.

Conclusion: The CDSMP can be implemented in a community-based network for adults living with epilepsy. Initial participant outcomes suggest that program completion is associated with improvements in epilepsy self-management, self-efficacy, and depression. The CDSMP is a beneficial addition to community-based resources that promote disease self-management in adults with epilepsy.

Background: The Intersectoral Global Action Plan (IGAP) for Epilepsy and other Neurological Disorders aims to improve access to quality care, including diagnosis, treatment, and support services for people with epilepsy (PWE). Adolescents with epilepsy (AWE) comprise a highly vulnerable group, with limited access to treatment, higher seizure-related risks, and poor quality of life. However, there are hardly any systematic descriptions of the community perspectives on how the care and treatment of epilepsy can be improved in this group.

Purpose: The study aimed to establish the primary ideas within the community of proposed interventions that can improve the care and treatment of AWE in Uganda.

Methods: A qualitative study, using semi structured focus group and in-depth interview guides, explored the perspectives of 128 participants enrolled from Wakiso district, Uganda. Sample included AWE (n = 22); Caregivers of AWE (n = 22); Health workers (n = 24); Teachers (n = 19); Local leaders (n = 14); Religious leaders (n = 6); Traditional healers (n = 5); Village health team members (n = 10) and other community members (n = 6). Using Dedoose software, thematic analysis ascertained commonly occurring themes about perceptions and recommendations for epilepsy care.

Results: All community groups emphasized the profound stigmatization of AWE/PWE. Four major themes summarized the proposed areas to impact care and well-being: education of AWE/PWE and their families; development of a broad epilepsy community sensitization campaign, restoration and strengthening of the epilepsy healthcare infrastructure, and government commitment to epilepsy health service provision.

Conclusions: The community recommendations prioritized as key in improving the care for PWE/AWE in Uganda, aligns with the IGAP. Their adoption is critical in ensuring effective management of epilepsy in Uganda.

Objective: Bilateral tonic-clonic seizures (BTCS) and functional/dissociative seizures (FDS) can present with similar motor manifestations, complicating differential diagnosis based on visual examination alone. This retrospective study applied optical flow analysis of video electroencephalography (VEEG) recordings from BTCS and FDS patients to quantitatively compare upper limb rhythmic clonic movements for possible differentiation.

Methods: Optical flow was calculated within a region of interest covering one upper limb using the Farnebäck method, and principal component analysis was applied to extract a one-dimensional motion waveform (principal component 1, PC1) for each event. Primary outcome measures were (1) temporal change in PC1 interpeak interval as assessed by Kendall's τ, (2) logarithmic regression line slope of PC1 amplitude with time (amplitude decay slope, ADS), and (3) integrated absolute PC1 amplitude (|PC1|). Metrics were compared between patient groups by Mann-Whitney U test.

Results: The VEEG records of 27 BTCS and 15 FDS patients were analyzed. Kendall's τ was significantly higher in the BTCS group, indicating progressively longer clonic intervals over time (p < 0.001), while ADS was more negative in BTCS, reflecting greater attenuation of movement amplitude (p < 0.05). Integrated |PC1| was also significantly higher in the BTCS group (p < 0.001). Scatter plots of these primary metrics suggested multivariate separation between BTCS and FDS.

Conclusion: Optical flow analysis enabled quantitative extraction of upper limb clonic movement temporal structure and amplitude from VEEG. These quantitative metrics of seizure-related motor activity may provide complementary support in the differential diagnosis of BTCS and FDS.