Epilepsy & Behavior最新文献

Rationale: Resistance to anti-seizure medications (ASMs) remains a major challenge in managing super refractory status epilepticus (SRSE), including new-onset refractory status epilepticus (NORSE). Vagus Nerve Stimulation (VNS) has emerged as a potential adjunctive therapy, but clinical evidence in SRSE is limited.

Methods: We retrospectively identified patients who underwent VNS implantation for SRSE during hospitalization within a large tertiary hospital system in New York City (July 2018 - June 2024). Electronic medical records were reviewed for demographic, clinical features, neuroimaging, EEG findings, medications, VNS parameters, and short- and long-term functional outcomes.

Results: Fifteen patients (14 female; age 16-77 years) underwent VNS implantation for SRSE, including 8 with NORSE (6 cryptogenic; 2 with a later-identified etiology) and 7 non-NORSE patients. Compared to non-NORSE patients, NORSE patients received more ASMs (median 5 vs. 4) and anesthetic infusions (3 vs 2) for longer duration (14.5 vs. 11 days) before implantation. All but one patient was successfully weaned off anesthetics without SE recurrence; VNS output at weaning was higher in NORSE patients (0.88 vs. 0.50 mA). No complications were observed related to VNS implantation or titration. Despite longer hospitalization (86.5 vs 47 days) and similar ASM burden (4) and functional status at discharge (GOS-E 3), NORSE patients showed a trend toward better long-term functional outcomes (GOS-E 7 vs 1, p = 0.31), despite developing post-NORSE epilepsy. In exploratory analyses, earlier implantation showed non-significant trends toward shorter hospitalization (47 vs. 116 days, p = 0.09) and higher discharge GOS-E (4 vs. 2.5, p = 0.06).

Conclusions: Our findings suggest that VNS is likely a safe addition to the established treatment for SRSE. However, given the retrospective and uncontrolled design, efficacy of VNS cannot be determined. Prospective controlled studies are needed to assess clinical benefit and to define optimal implantation timing, titration strategies, and short-and long-term outcomes, including post-NORSE epilepsy.

Forced thinking is a rare ictal phenomenon characterized by the sudden intrusion of involuntary thoughts at seizure onset. Historically classified as a psychic aura and variably associated with frontal or temporal lobe epilepsy, its semiologic definition and localizing value remain debated, largely due to the scarcity of systematic studies. We conducted a retrospective review of a tertiary epilepsy center database (2005-2025) to identify patients with drug-resistant focal epilepsy presenting with forced thinking auras. Detailed semiologic analysis was performed using medical records, video-EEG data, and structured patient interviews. Presurgical evaluation findings, including scalp EEG, neuroimaging, and, when available, stereoelectroencephalography (SEEG), were reviewed to determine the epileptogenic zone. In parallel, we analyzed a large SEEG cortical stimulation database (329 patients, ∼2500 stimulations) to identify stimulation-induced forced thinking phenomena. Eight patients met the inclusion criteria. Forced thinking was consistently described as a brief, intrusive mental event occurring at seizure onset, most often with verbal content. In seven of eight patients, seizures involved the temporal lobe, predominantly the dominant (left) hemisphere; none had a purely frontal epileptogenic zone. The cohort showed a marked male predominance (7 of 8 patients). In the SEEG stimulation cohort, forced thinking was observed in only 2 patients (0.6%), all induced by temporal stimulation, with none by frontal stimulation. Forced thinking is a rare but well-defined ictal cognitive phenomenon. Our findings indicate that it is not a specific marker of frontal lobe epilepsy but rather reflects involvement of dominant temporal networks related to language and internal thought generation.

Objective: To evaluate the efficacy and tolerability of lacosamide (LCM) adjunctive therapy in a nationwide pediatric epilepsy cohort, including drug-refractory epilepsies (DREs).

Methods: A retrospective nationwide Turkish cohort study included 334 pediatric epilepsy patients (aged 1-18 years) treated with LCM adjunctive therapy. The population was divided into the two cohorts: (I) DREs with developmental and epileptic encephalopaties (DEEs); early-onset DEEs (group A) and late-onset DEEs (group B), and (II) DRE without DEEs: focal/generalized electroclinical syndromes (group C) and well-defined epilepsy syndromes (group D). The effectiveness of LCM adjunctive therapy was assessed by seizure outcome (seizure freedom, ≥50% reduction, <50% reduction, no change, or worsening) and EEG outcome (no change, <50% improvement, >50% improvement, complete improvement, or worsening). Tolerability was evaluated via drug retention rate and treatment-emergent adverse events (TEAEs).

Results: The mean duration of LCM adjunctive therapy was 24.63 ± 20.09 months in the cohort (mean age:13.28 ± 4.71 years; 53.8% male). The mean daily effective dose was 6.95 ± 2.25 mg/kg/day, and the time to effectiveness was 2.09 months. Etiological distribution differed across cohorts (p < 0.001), with structural etiology most frequent in groups C (47.1%) and A (34.4%), genetic in group A (22.9%), metabolic in groups A and B (6.3%), and immune/infectious in group D (13.6%). LCM adjunctive therapy provided sustained long-term seizure control in pediatric patients with DRE, with overall seizure control rates of 56.9% at 12 months and 55.6% at 24 months and a consistent responder rate (>50% seizure reduction) of 20.7% (n = 69/334). Cumulative EEG improvement was observed in 33.8% of patients receiving LCM adjunctive therapy, while complete EEG recovery rate was achieved in 6.3%. Similar seizure control rates was identified for DRE with DEEs (28.9%) and DRE without DEEs (35%). Drug retention was 73.9% at 12 months and 67.7% at 24 months, while TEAEs occurred in 20.7%, most commonly somnolence (10.4).

Conclusions: LCM adjunctive therapy was associated with favorable electro-clinical outcomes and good tolerability across a broad spectrum of DREs with DEEs or without DEEs in childhood.

Introduction: Mesial temporal lobe epilepsy (MTLE) is the most common focal epilepsy, frequently associated with hippocampal sclerosis and cognitive dysfunction extending beyond episodic memory. Verbal fluency, a multidomain task integrating executive and temporal-semantic processes, is particularly sensitive to temporal pathology. This study examined Arabic letter and category fluency in patients with MTLE, generalized epilepsy (GE), and healthy controls (HC), with a focus on semantic categories differing in episodic content.

Methods: A cross-sectional study was conducted at King Saud University Medical City. Participants (N = 135; age 18-59) completed four Arabic letter fluency tasks (Ain, Sheen, Qaf, Dal) and three category tasks (countries, fruits, four-legged animals). Among the participants, 43 had MTLE, 45 had GE, and 47 were HC. Assessments were conducted remotely via telephone using standardized administration procedures. Quantitative measures (total words, z-scores) and qualitative indices (clustering, switching, perseverations, intrusions) were analyzed. Multiple linear regressions controlled for age, sex, education, epilepsy type, and antiseizure medication (ASM) burden.

Results: Both epilepsy groups produced significantly fewer words than HC for total phonemic but not total semantic fluency. The "countries" category however, classified as episodically enriched, was selectively impaired in MTLE (p = 0.034), while static categories (fruits, four-legged animals) were preserved. MTLE participants exhibited markedly more perseverations across all semantic categories and increased intrusions exclusively in "countries." Fluency performance declined across time intervals in all groups. Polytherapy with ≥3 ASMs predicted lower fluency scores, whereas laterality of MTLE did not.

Conclusion: MTLE selectively disrupts episodically enriched semantic fluency, supporting a hippocampal role in binding episodic and semantic memory. These findings highlight the diagnostic potential of category-specific fluency-such as "countries"-as a marker of hippocampal dysfunction and underscore the value of culturally adapted Arabic fluency norms.