Pub Date : 2026-04-01Epub Date: 2026-02-02DOI: 10.1016/j.yebeh.2026.110898
Xinru Yan, Jian He, Min Cheng, Siqi Hong, Li Jiang, Wei Han
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.
{"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, Jian He, Min Cheng, Siqi Hong, Li Jiang, 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}
Pub Date : 2026-04-01Epub Date: 2026-02-03DOI: 10.1016/j.yebeh.2026.110899
Giancarlo Di Gennaro , Liliana G. Grammaldo , Andrea Tomasini
This letter responds to Prieto et al.’s discussion of our article Rethinking epilepsy stigma: the uncanny, the emotional, and the structural. We clarify that our original framework was primarily theoretical, aiming to illuminate the multifaceted mechanisms sustaining internalized epilepsy stigma, including the “uncanny” experience of seizures, ambivalent emotional responses, and structural inequities. We highlight how third-generation psychotherapeutic approaches, emphasizing psychological flexibility, mindfulness, and emotional acceptance, complement cognitive-behavioral strategies by enhancing individuals’ capacity to relate adaptively to stigma-related distress. We propose that integrating behavioural, emotional, and structural perspectives offers a multidimensional framework to better understand and address internalized epilepsy stigma, guiding interventions that promote psychological well-being, social inclusion, and empowerment for people living with epilepsy.
{"title":"Toward a multidimensional understanding of internalized epilepsy stigma","authors":"Giancarlo Di Gennaro , Liliana G. Grammaldo , Andrea Tomasini","doi":"10.1016/j.yebeh.2026.110899","DOIUrl":"10.1016/j.yebeh.2026.110899","url":null,"abstract":"<div><div>This letter responds to Prieto et al.’s discussion of our article Rethinking epilepsy stigma: the uncanny, the emotional, and the structural. We clarify that our original framework was primarily theoretical, aiming to illuminate the multifaceted mechanisms sustaining internalized epilepsy stigma, including the “uncanny” experience of seizures, ambivalent emotional responses, and structural inequities. We highlight how third-generation psychotherapeutic approaches, emphasizing psychological flexibility, mindfulness, and emotional acceptance, complement cognitive-behavioral strategies by enhancing individuals’ capacity to relate adaptively to stigma-related distress. We propose that integrating behavioural, emotional, and structural perspectives offers a multidimensional framework to better understand and address internalized epilepsy stigma, guiding interventions that promote psychological well-being, social inclusion, and empowerment for people living with epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"177 ","pages":"Article 110899"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098596","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 : 2026-04-01Epub Date: 2026-02-02DOI: 10.1016/j.yebeh.2026.110888
Cang Lyu, Chunyan Fang
Objective
To evaluate the levels of serum inflammatory cytokines in children with simple febrile seizures (SFS) and to explore their correlations with clinical variables such as seizure history and duration.
Methods
Clinical data of 60 consecutive children with SFS admitted to the hospital between January 2021 and April 2025 were retrospectively analyzed and designated as the SFS group. These patients were categorized into two subgroups: those experiencing their first seizure episode (premiere seizure, PS; n = 37) and those with multiple seizure episodes (repeated seizures, RS; n = 23). Additionally, a control group was established, consisting of 60 febrile pediatric inpatients without seizures who were treated at the same hospital during the same period. During case collection, basic clinical information was recorded, including age, sex, body temperature, WBC count, CRP, SFS history, family history of epilepsy, duration of fever, duration of seizure episodes, and length of hospitalization. Serum levels of tumor necrosis factor(TNF)-α, interleukin-1β (IL-1β), IL-6, IL-4, and IL-10 were measured using enzyme-linked immunosorbent assay.
Results
Serum levels of TNF-α, IL-1β, IL-6, IL-4, and IL-10 were significantly higher in children with FS compared to those in the control group, with statistically significant differences (P < 0.05). TNF-α, IL-1β, IL-6, IL-4, and IL-10 levels were significantly higher in the RS group compared to the PS group, with statistical significance (P < 0.05). In children with seizure durations of ≥5 min, TNF-α, IL-1β, IL-6, IL-4, and IL-10 levels were significantly higher compared to those whose seizure episodes lasted <5 min (P < 0.05). The area under the curve for the combined differentiation of FS using all measured serum inflammatory factors was significantly higher than that of any individual factor alone (P < 0.05).
Conclusion
Levels of TNF-α, IL-1β, IL-6, IL-4, and IL-10 were markedly elevated in children with SFS. These inflammatory factors may be involved in the pathological process of SFS and are associated with seizure duration and recurrence risk, warranting further investigation as potential indicators for risk stratification.
目的评价单纯热性惊厥（SFS）患儿血清炎症因子水平，并探讨其与癫痫发作史、持续时间等临床变量的相关性。方法回顾性分析2021年1月至2025年4月连续收治的60例SFS患儿的临床资料，并将其定为SFS组。这些患者被分为两组：第一次发作的患者（首发发作，PS, n = 37）和多次发作的患者（反复发作，RS, n = 23）。此外，建立了一个对照组，由60名在同一时期在同一家医院接受治疗的无癫痫发作的发热儿科住院患者组成。收集病例时记录患者的基本临床信息，包括年龄、性别、体温、白细胞计数、CRP、SFS史、癫痫家族史、发热持续时间、癫痫发作持续时间、住院时间等。采用酶联免疫吸附法检测血清肿瘤坏死因子(TNF)-α、白细胞介素-1β (IL-1β)、IL-6、IL-4、IL-10水平。结果FS患儿血清TNF-α、IL-1β、IL-6、IL-4、IL-10水平显著高于对照组，差异有统计学意义（P < 0.05）。RS组TNF-α、IL-1β、IL-6、IL-4、IL-10水平均显著高于PS组，差异均有统计学意义（P < 0.05）。发作时间≥5min患儿的TNF-α、IL-1β、IL-6、IL-4、IL-10水平显著高于发作时间≥5min患儿（P < 0.05）。所有血清炎症因子联合分化FS的曲线下面积明显高于单独使用任何单个因子（P < 0.05）。结论SFS患儿血清TNF-α、IL-1β、IL-6、IL-4、IL-10水平明显升高。这些炎症因子可能参与了SFS的病理过程，并与癫痫发作时间和复发风险相关，值得进一步研究，作为风险分层的潜在指标。
{"title":"The changes in serum inflammatory factor levels in children with simple febrile seizures and their clinical significance","authors":"Cang Lyu, Chunyan Fang","doi":"10.1016/j.yebeh.2026.110888","DOIUrl":"10.1016/j.yebeh.2026.110888","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the levels of serum inflammatory cytokines in children with simple febrile seizures (SFS) and to explore their correlations with clinical variables such as seizure history and duration.</div></div><div><h3>Methods</h3><div>Clinical data of 60 consecutive children with SFS admitted to the hospital between January 2021 and April 2025 were retrospectively analyzed and designated as the SFS group. These patients were categorized into two subgroups: those experiencing their first seizure episode (premiere seizure, PS; n = 37) and those with multiple seizure episodes (repeated seizures, RS; n = 23). Additionally, a control group was established, consisting of 60 febrile pediatric inpatients without seizures who were treated at the same hospital during the same period. During case collection, basic clinical information was recorded, including age, sex, body temperature, WBC count, CRP, SFS history, family history of epilepsy, duration of fever, duration of seizure episodes, and length of hospitalization. Serum levels of tumor necrosis factor(TNF)-α, interleukin-1β (IL-1β), IL-6, IL-4, and IL-10 were measured using enzyme-linked immunosorbent assay.</div></div><div><h3>Results</h3><div>Serum levels of TNF-α, IL-1β, IL-6, IL-4, and IL-10 were significantly higher in children with FS compared to those in the control group, with statistically significant differences (<em>P</em> < 0.05). TNF-α, IL-1β, IL-6, IL-4, and IL-10 levels were significantly higher in the RS group compared to the PS group, with statistical significance (<em>P</em> < 0.05). In children with seizure durations of ≥5 min, TNF-α, IL-1β, IL-6, IL-4, and IL-10 levels were significantly higher compared to those whose seizure episodes lasted <5 min (<em>P</em> < 0.05). The area under the curve for the combined differentiation of FS using all measured serum inflammatory factors was significantly higher than that of any individual factor alone (<em>P</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Levels of TNF-α, IL-1β, IL-6, IL-4, and IL-10 were markedly elevated in children with SFS. These inflammatory factors may be involved in the pathological process of SFS and are associated with seizure duration and recurrence risk, warranting further investigation as potential indicators for risk stratification.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"177 ","pages":"Article 110888"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098593","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 : 2026-04-01DOI: 10.1016/j.yebeh.2026.111025
Andrea Tomasini, Enrico M Salamone, Liliana G Grammaldo, Alfredo D'Aniello, Giancarlo Di Gennaro
Empirical evidence confirms both the pervasiveness and the significant impact of stigma among people with epilepsy (PWE). Despite being one of the most extensively studied neurological disorders, epilepsy continues to carry a disproportionate social burden across cultures and historical periods. Stigma is not only a psychological consequence but also a chronic social determinant of health that negatively affects quality of life, social participation, and long-term outcomes. Recent research highlights the multidimensional nature of epilepsy-related stigma, including internalized, enacted, and intersectional forms, and its interaction with emotional, relational, and structural factors. While seizure control remains a central goal of clinical care, it rarely eliminates the social and psychological consequences of stigma. We propose conceptualizing epilepsy-related stigma as a "social comorbidity": a chronic, co-evolving social condition that exacerbates disability, constrains life opportunities, and requires targeted interventions beyond conventional biomedical treatment. Addressing stigma effectively demands integrated strategies that combine psychosocial support, community engagement, policy reform, and public education, aiming to facilitate genuine social recovery and inclusion for PWE. Recognizing stigma as a social comorbidity reframes epilepsy care and research, emphasizing that clinical gains alone are insufficient without addressing the enduring social and relational consequences of the disorder.
{"title":"Stigma as social comorbidity in epilepsy.","authors":"Andrea Tomasini, Enrico M Salamone, Liliana G Grammaldo, Alfredo D'Aniello, Giancarlo Di Gennaro","doi":"10.1016/j.yebeh.2026.111025","DOIUrl":"https://doi.org/10.1016/j.yebeh.2026.111025","url":null,"abstract":"<p><p>Empirical evidence confirms both the pervasiveness and the significant impact of stigma among people with epilepsy (PWE). Despite being one of the most extensively studied neurological disorders, epilepsy continues to carry a disproportionate social burden across cultures and historical periods. Stigma is not only a psychological consequence but also a chronic social determinant of health that negatively affects quality of life, social participation, and long-term outcomes. Recent research highlights the multidimensional nature of epilepsy-related stigma, including internalized, enacted, and intersectional forms, and its interaction with emotional, relational, and structural factors. While seizure control remains a central goal of clinical care, it rarely eliminates the social and psychological consequences of stigma. We propose conceptualizing epilepsy-related stigma as a \"social comorbidity\": a chronic, co-evolving social condition that exacerbates disability, constrains life opportunities, and requires targeted interventions beyond conventional biomedical treatment. Addressing stigma effectively demands integrated strategies that combine psychosocial support, community engagement, policy reform, and public education, aiming to facilitate genuine social recovery and inclusion for PWE. Recognizing stigma as a social comorbidity reframes epilepsy care and research, emphasizing that clinical gains alone are insufficient without addressing the enduring social and relational consequences of the disorder.</p>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":" ","pages":"111025"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608511","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 : 2026-04-01Epub Date: 2026-02-03DOI: 10.1016/j.yebeh.2026.110900
Kairui Li , Hui Song , Chenxiao Zhao , Chunmei Hu , Pan Hu , Qinghua Luo , Zheng Xiao
Objective
This feasibility study aimed to evaluate the feasibility, acceptability, and preliminary effects of a simplified, app-based mindfulness intervention for people with epilepsy (PWE) in mainland China.
Methods
Ten adults with epilepsy completed a 6-week, self-guided mindfulness program (15 min/day, 6 days/week) delivered via a WeChat mini-program. Feasibility was measured by program completion rates and an acceptability questionnaire. Exploratory pre-post assessments included quality of life (QOLIE-31), anxiety (GAD-7), depression (NDDI-E), trait mindfulness (MAAS), and seizure frequency. Data were analyzed using Wilcoxon signed-rank tests, effect size estimators (Cliff’s δ, Hodges–Lehmann), Bayes factors, minimal clinically important difference (MCID) thresholds and descriptive statistics were employed.
Results
The intervention demonstrated high feasibility, with a mean program completion rate of 110.1% and positive user feedback. Exploratory analyses noted improvements in quality of life (QOLIE-31 median difference = +9.12) and anxiety (GAD-7 median difference = −5.50). No inferential testing was performed for seizure frequency, but a descriptive median reduction of 1.17 seizures per 4 weeks was observed, with 50% of participants achieving a ≥ 50% reduction.
Conclusions
A brief, app-based mindfulness intervention is feasible and acceptable for PWE in mainland China. This finding supports the rationale for a future randomized controlled trial to rigorously evaluate its efficacy within a stepped-care model.
{"title":"App-based self-guided mindfulness training for adults with epilepsy: a six-week single-arm feasibility study","authors":"Kairui Li , Hui Song , Chenxiao Zhao , Chunmei Hu , Pan Hu , Qinghua Luo , Zheng Xiao","doi":"10.1016/j.yebeh.2026.110900","DOIUrl":"10.1016/j.yebeh.2026.110900","url":null,"abstract":"<div><h3>Objective</h3><div>This feasibility study aimed to evaluate the feasibility, acceptability, and preliminary effects of a simplified, app-based mindfulness intervention for people with epilepsy (PWE) in mainland China.</div></div><div><h3>Methods</h3><div>Ten adults with epilepsy completed a 6-week, self-guided mindfulness program (15 min/day, 6 days/week) delivered via a WeChat mini-program. Feasibility was measured by program completion rates and an acceptability questionnaire. Exploratory pre-post assessments included quality of life (QOLIE-31), anxiety (GAD-7), depression (NDDI-E), trait mindfulness (MAAS), and seizure frequency. Data were analyzed using Wilcoxon signed-rank tests, effect size estimators (Cliff’s δ, Hodges–Lehmann), Bayes factors, minimal clinically important difference (MCID) thresholds and descriptive statistics were employed.</div></div><div><h3>Results</h3><div>The intervention demonstrated high feasibility, with a mean program completion rate of 110.1% and positive user feedback. Exploratory analyses noted improvements in quality of life (QOLIE-31 median difference = +9.12) and anxiety (GAD-7 median difference = −5.50). No inferential testing was performed for seizure frequency, but a descriptive median reduction of 1.17 seizures per 4 weeks was observed, with 50% of participants achieving a ≥ 50% reduction.</div></div><div><h3>Conclusions</h3><div>A brief, app-based mindfulness intervention is feasible and acceptable for PWE in mainland China. This finding supports the rationale for a future randomized controlled trial to rigorously evaluate its efficacy within a stepped-care model.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"177 ","pages":"Article 110900"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098594","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 : 2026-04-01Epub Date: 2026-02-03DOI: 10.1016/j.yebeh.2026.110929
Ignazio Leale , Fabio Tiziano Orlando , Vincenzo Di Stefano , Salvatore Maria Lima , Manuel Gómez-López , Filippo Brighina , Giuseppe Battaglia
People with Epilepsy exhibit low levels of physical activity compared with the general population, despite evidence suggesting potential benefits for seizure control, physical fitness and psychosocial well-being. Persistent barriers such as fear of seizures, limited access to supervised programs, transportation difficulties, and time constraints contribute to sedentary behaviour. Telecoaching (TC), which delivers structured exercise programs through digital technologies, may help overcome these barriers. This systematic review aimed to evaluate the feasibility and potential effects of TC-based training physical activity interventions in individuals with epilepsy, focusing on adherence, QoL, physical fitness and psychological outcomes. A systematic search of PubMed, Web of Science, and Scopus identified 1086 records, of which 7 studies involving 342 participants met the inclusion criteria. Interventions included remotely delivered aerobic, resistance, flexibility, and combined exercise programs. Study quality ranged from “fair” to “good”. TC-based interventions were generally safe and feasible, with no major adverse events reported. Evidence suggest potential benefits for physical fitness and psychosocial outcomes, particularly in paediatric populations, although the limited number and heterogeneity of studies preclude definitive conclusions, especially regarding seizure-related outcomes. Future research should focus on standardized TC programs, long-term follow-up, and adequately powered randomized trials to confirm effectiveness and sustainability.
与一般人群相比，癫痫患者的身体活动水平较低，尽管有证据表明，这对癫痫发作控制、身体健康和社会心理健康有潜在益处。长期存在的障碍，如害怕癫痫发作、参与监督项目的机会有限、交通困难和时间限制，都会导致久坐行为。远程教学（TC）通过数字技术提供结构化的锻炼计划，可能有助于克服这些障碍。本系统综述旨在评估基于tc的训练体力活动干预在癫痫患者中的可行性和潜在效果，重点关注依从性、生活质量、身体健康和心理结局。系统检索PubMed、Web of Science和Scopus共1086条记录，其中7项研究共342名参与者符合纳入标准。干预措施包括远程提供有氧、抗阻、柔韧性和联合运动项目。研究质量从“一般”到“良好”。基于tc的干预措施总体上是安全可行的，没有重大不良事件的报告。有证据表明对身体健康和社会心理结局有潜在的益处，特别是在儿科人群中，尽管研究数量有限且异质性妨碍了明确的结论，特别是关于癫痫相关的结局。未来的研究应集中在标准化的TC项目、长期随访和充分有力的随机试验上，以确认有效性和可持续性。
{"title":"Telecoaching Interventions for People with Epilepsy: Enhancing Physical Activity and Quality of Life through Digital Health. A Systematic Review","authors":"Ignazio Leale , Fabio Tiziano Orlando , Vincenzo Di Stefano , Salvatore Maria Lima , Manuel Gómez-López , Filippo Brighina , Giuseppe Battaglia","doi":"10.1016/j.yebeh.2026.110929","DOIUrl":"10.1016/j.yebeh.2026.110929","url":null,"abstract":"<div><div>People with Epilepsy exhibit low levels of physical activity compared with the general population, despite evidence suggesting potential benefits for seizure control, physical fitness and psychosocial well-being. Persistent barriers such as fear of seizures, limited access to supervised programs, transportation difficulties, and time constraints contribute to sedentary behaviour. Telecoaching (TC), which delivers structured exercise programs through digital technologies, may help overcome these barriers. This systematic review aimed to evaluate the feasibility and potential effects of TC-based training physical activity interventions in individuals with epilepsy, focusing on adherence, QoL, physical fitness and psychological outcomes. A systematic search of PubMed, Web of Science, and Scopus identified 1086 records, of which 7 studies involving 342 participants met the inclusion criteria. Interventions included remotely delivered aerobic, resistance, flexibility, and combined exercise programs. Study quality ranged from “fair” to “good”. TC-based interventions were generally safe and feasible, with no major adverse events reported. Evidence suggest potential benefits for physical fitness and psychosocial outcomes, particularly in paediatric populations, although the limited number and heterogeneity of studies preclude definitive conclusions, especially regarding seizure-related outcomes. Future research should focus on standardized TC programs, long-term follow-up, and adequately powered randomized trials to confirm effectiveness and sustainability.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"177 ","pages":"Article 110929"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098552","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 : 2026-04-01Epub Date: 2026-02-03DOI: 10.1016/j.yebeh.2026.110895
Karin Revajová , Michal Fusek , Irena Doležalová , Martin Pail , Pavlína Danhofer , Patrícia Všianská , Eva Feketeová , Ondřej Strýček
Objective
Functional/dissociative seizures are seizures that mimic epileptic seizures in their presentation and are often mistaken for them. Clinical recognition of these seizures presents a challenge and misdiagnosis can lead to inappropriate treatment, increasing the risk of complications. To address this, we conducted a study involving 45 young neurology residents from the Czech Republic and Slovakia who had no specialized training in epilepsy or functional neurological disorders. Our goal was to determine whether a brief training in selected semiological features of functional/dissociative seizures (FDS) would efficiently teach them to differentiate between FDS and epileptic seizures (ES) in a clinical setting.
Methods
A set of 10 clinical signs characteristic of FDS was selected based on Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures (Baslet et al., 2021). Initially, participants identified epileptic seizures and FDS in 30 video recordings without any prior instruction. Subsequently, they received a 15-minute educational session focused on selected semiological features of FDS. Then the same 30 seizure videos were shown again to assess their recognition abilities. No EEG recordings were shown.
Results
Following this educational intervention, participants’ accuracy in distinguishing FDS from ES significantly improved from 77% before training to 89% after training (p < 0.001). Importantly, recognition of epileptic seizures remained stable at 54% before and 53% after the training.
Conclusion
We demonstrated the effectiveness of a concise, targeted education on FDS semiological signs for clinical practice.
目的：功能性/解离性癫痫发作是一种表现类似癫痫发作的癫痫发作，常被误认为是癫痫发作。这些癫痫发作的临床识别是一个挑战，误诊可能导致不适当的治疗，增加并发症的风险。为了解决这个问题，我们进行了一项研究，涉及来自捷克共和国和斯洛伐克的45名年轻的神经内科住院医生，他们没有接受过癫痫或功能性神经系统疾病的专门培训。我们的目的是确定对功能性/解离性发作（FDS）的选定符号学特征进行简短的培训，是否能有效地教会他们在临床环境中区分FDS和癫痫发作（ES）。方法根据《心因性非癫痫性发作临床评估循证实践》（Baslet et al., 2021），选取FDS的10个临床体征特征。最初，参与者在没有任何事先指示的情况下，通过30个视频记录识别癫痫发作和FDS。随后，他们接受了15分钟的教育课程，重点是FDS的选定符号学特征。然后再次播放同样的30个癫痫发作视频，以评估他们的识别能力。未见脑电图记录。结果经过教育干预后，参与者区分FDS和ES的准确率显著提高，从培训前的77%提高到培训后的89% （p <； 0.001）。重要的是，训练前和训练后癫痫发作的识别率分别稳定在54%和53%。结论我们证明了简明、有针对性的FDS符号学标志教育对临床实践的有效性。
{"title":"Effectiveness of brief semiological training in distinguishing functional/dissociative seizures from epileptic seizures","authors":"Karin Revajová , Michal Fusek , Irena Doležalová , Martin Pail , Pavlína Danhofer , Patrícia Všianská , Eva Feketeová , Ondřej Strýček","doi":"10.1016/j.yebeh.2026.110895","DOIUrl":"10.1016/j.yebeh.2026.110895","url":null,"abstract":"<div><h3>Objective</h3><div>Functional/dissociative seizures are seizures that mimic epileptic seizures in their presentation and are often mistaken for them. Clinical recognition of these seizures presents a challenge and misdiagnosis can lead to inappropriate treatment, increasing the risk of complications. To address this, we conducted a study involving 45 young neurology residents from the Czech Republic and Slovakia who had no specialized training in epilepsy or functional neurological disorders. Our goal was to determine whether a brief training in selected semiological features of functional/dissociative seizures (FDS) would efficiently teach them to differentiate between FDS and epileptic seizures (ES) in a clinical setting.</div></div><div><h3>Methods</h3><div>A set of 10 clinical signs characteristic of FDS was selected based on Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures (Baslet et al., 2021). Initially, participants identified epileptic seizures and FDS in 30 video recordings without any prior instruction. Subsequently, they received a 15-minute educational session focused on selected semiological features of FDS. Then the same 30 seizure videos were shown again to assess their recognition abilities. No EEG recordings were shown.</div></div><div><h3>Results</h3><div>Following this educational intervention, participants’ accuracy in distinguishing FDS from ES significantly improved from 77% before training to 89% after training (p < 0.001). Importantly, recognition of epileptic seizures remained stable at 54% before and 53% after the training.</div></div><div><h3>Conclusion</h3><div>We demonstrated the effectiveness of a concise, targeted education on FDS semiological signs for clinical practice.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"177 ","pages":"Article 110895"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098595","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 : 2026-03-01Epub Date: 2026-01-23DOI: 10.1016/j.yebeh.2025.110859
Dana Buršíková Brabcová, Ivana Mašková, Jiří Kohout, Kateřina Lohrová
Epilepsy-related stigma—especially stigma enacted by peers—can have profoundly negative consequences for children living with the disease. Despite the availability of educational interventions aimed at reducing epilepsy-related stigma in children, relatively few studies systematically evaluate multiple intervention formats using follow-up assessments. The present study therefore sought to evaluate the efficacy of three educational interventions among primary school pupils: (1) the Action Zone! board game, (2) the Campi the Seahorse educational video, and (3) a read-aloud story based on the Campi the Seahorse video. A total of 406 primary school pupils aged 9–12 years participated in the study. Immediately before the intervention and again six months later, participants completed a multiple-choice test assessing epilepsy-related knowledge and the Stigma Scale of Epilepsy. Results indicated that all three intervention formats significantly improved epilepsy-related knowledge and reduced stigmatizing beliefs and attitudes toward epilepsy at the six-month follow-up compared with baseline. The Action Zone! board game produced a very large increase in knowledge (d = 1.29) and a moderate reduction in stigmatizing beliefs and attitudes (d = 0.50). In contrast, the Campi the Seahorse video yielded a small improvement in knowledge (d = 0.33), while the story-based intervention showed a small-to-moderate effect (d = 0.42). Both Campi the Seahorse interventions led to small reductions in stigmatizing beliefs and attitudes (d = 0.19 for video, d = 0.21 for story). These findings suggest that even brief, one-time interventions can meaningfully reduce epilepsy-related stigma in this age group.
与癫痫相关的耻辱感——尤其是来自同伴的耻辱感——会对患有这种疾病的儿童产生深远的负面影响。尽管有旨在减少儿童癫痫相关耻辱的教育干预措施，但相对较少的研究使用随访评估系统地评估多种干预形式。因此，本研究试图评估三种教育干预措施在小学生中的效果：(1)行动区！(2) Campi the Seahorse教育视频，(3)基于Campi the Seahorse视频的朗读故事。共有406名9-12岁的小学生参与了这项研究。在干预之前和六个月后，参与者完成了一项评估癫痫相关知识和癫痫病耻感量表的多项选择测试。结果表明，在六个月的随访中，与基线相比，所有三种干预形式均显著改善了癫痫相关知识，减少了对癫痫的污名化信念和态度。行动区！棋类游戏极大地提高了知识水平（d = 1.29），并适度减少了偏见信念和态度（d = 0.50）。相比之下，Campi the Seahorse视频在知识方面产生了微小的改善（d = 0.33），而基于故事的干预则显示出小到中等的效果（d = 0.42）。Campi the Seahorse的两项干预措施都导致了污名化信念和态度的小幅减少（视频= 0.19，故事= 0.21）。这些发现表明，即使是短暂的一次性干预也能有效地减少这一年龄组中与癫痫相关的耻辱感。
{"title":"Exploring multiple education interventions to reduce epilepsy-related stigma in primary school pupils: game, video, and story","authors":"Dana Buršíková Brabcová, Ivana Mašková, Jiří Kohout, Kateřina Lohrová","doi":"10.1016/j.yebeh.2025.110859","DOIUrl":"10.1016/j.yebeh.2025.110859","url":null,"abstract":"<div><div>Epilepsy-related stigma—especially stigma enacted by peers—can have profoundly negative consequences for children living with the disease. Despite the availability of educational interventions aimed at reducing epilepsy-related stigma in children, relatively few studies systematically evaluate multiple intervention formats using follow-up assessments. The present study therefore sought to evaluate the efficacy of three educational interventions among primary school pupils: (1) the <em>Action Zone!</em> board game, (2) the <em>Campi the Seahorse</em> educational video, and (3) a read-aloud story based on the <em>Campi the Seahorse</em> video. A total of 406 primary school pupils aged 9–12 years participated in the study. Immediately before the intervention and again six months later, participants completed a multiple-choice test assessing epilepsy-related knowledge and the Stigma Scale of Epilepsy. Results indicated that all three intervention formats significantly improved epilepsy-related knowledge and reduced stigmatizing beliefs and attitudes toward epilepsy at the six-month follow-up compared with baseline. The <em>Action Zone!</em> board game produced a very large increase in knowledge (<em>d</em> = 1.29) and a moderate reduction in stigmatizing beliefs and attitudes (<em>d</em> = 0.50). In contrast, the <em>Campi the Seahorse</em> video yielded a small improvement in knowledge (<em>d</em> = 0.33), while the story-based intervention showed a small-to-moderate effect (<em>d</em> = 0.42). Both <em>Campi the Seahorse</em> interventions led to small reductions in stigmatizing beliefs and attitudes (<em>d</em> = 0.19 for video, <em>d</em> = 0.21 for story). These findings suggest that even brief, one-time interventions can meaningfully reduce epilepsy-related stigma in this age group.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"176 ","pages":"Article 110859"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035130","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 : 2026-03-01Epub Date: 2026-01-22DOI: 10.1016/j.yebeh.2025.110873
Chunyan Huang , Yujun Gao , Ruoshi Liu , Dongbin Li
Objective
Depression is the most common comorbidity in epilepsy. Currently, the diagnosis of comorbid depression in epilepsy primarily relies on medical history and scales. However, this approach is highly subjective and heavily dependent on the physician’s experience, and prone to missed or misdiagnosis. The primary objective of this study was to evaluate the effectiveness of network homogeneity (NH) measurements analyzed via support vector machine (SVM) in diagnosing MRI-negative temporal lobe epilepsy with depression (MRI-negative TLED).
Methods
The study included a total of 217 participants, comprising 90 healthy controls, 45 patients with MRI-negative temporal lobe epilepsy (MRI-negative TLE) and 82 patients with MRI-negative TLED. All subjects underwent resting-state fMRI scans for data collection. For analytical purposes, NH were computed and combined with SVM techniques for comprehensive data analysis.
Results
Compared to healthy control individuals, MRI-negative TLED patients demonstrated significantly increased NH values in the right mid-cingulum, right precuneus and right supramarginal, accompanied by decreased NH in the bilateral inferior temporal gyrus, left parahippocampal gyrus (PHG) and the right medial superior frontal gyrus (mSFG). Compared to MRI-negative TLE patients, MRI-negative TLED patients demonstrated significantly decreased NH values in the left parahippocampal gyrus (PHG) and the left mid temporal pole (MTP). SVM was used to differentiate patients with MRI-negative TLED from healthy control individuals based on rs-fMRI data, and the decreased NH in the left PHG showed highe diagnostic accuracy (71.56%).
Significance
According to the results, decreased NH values in the left PHG could serve as neuroimaging marker for MRI-negative TLED, offering objective guidance for its diagnosis.
{"title":"An rs-fMRI based neural marker for MRI-negative temporal lobe epilepsy with depression","authors":"Chunyan Huang , Yujun Gao , Ruoshi Liu , Dongbin Li","doi":"10.1016/j.yebeh.2025.110873","DOIUrl":"10.1016/j.yebeh.2025.110873","url":null,"abstract":"<div><h3>Objective</h3><div>Depression is the most common comorbidity in epilepsy. Currently, the diagnosis of comorbid depression in epilepsy primarily relies on medical history and scales. However, this approach is highly subjective and heavily dependent on the physician’s experience, and prone to missed or misdiagnosis. The primary objective of this study was to evaluate the effectiveness of network homogeneity (NH) measurements analyzed via support vector machine (SVM) in diagnosing MRI-negative temporal lobe epilepsy with depression (MRI-negative TLED).</div></div><div><h3>Methods</h3><div>The study included a total of 217 participants, comprising 90 healthy controls, 45 patients with MRI-negative temporal lobe epilepsy (MRI-negative TLE) and 82 patients with MRI-negative TLED. All subjects underwent resting-state fMRI scans for data collection. For analytical purposes, NH were computed and combined with SVM techniques for comprehensive data analysis.</div></div><div><h3>Results</h3><div>Compared to healthy control individuals, MRI-negative TLED patients demonstrated significantly increased NH values in the right mid-cingulum, right precuneus and right supramarginal, accompanied by decreased NH in the bilateral inferior temporal gyrus, left parahippocampal gyrus (PHG) and the right medial superior frontal gyrus (mSFG). Compared to MRI-negative TLE patients, MRI-negative TLED patients demonstrated significantly decreased NH values in the left parahippocampal gyrus (PHG) and the left mid temporal<!--> <!-->pole (MTP). SVM was used to differentiate patients with MRI-negative TLED from healthy control individuals based on rs-fMRI data, and the decreased NH in the left PHG showed highe diagnostic accuracy (71.56%).</div></div><div><h3>Significance</h3><div>According to the results, decreased NH values in the left PHG could serve as neuroimaging marker for MRI-negative TLED, offering objective guidance for its diagnosis.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"176 ","pages":"Article 110873"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035129","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 : 2026-03-01Epub Date: 2026-01-17DOI: 10.1016/j.yebeh.2026.110902
Pyae Aung, Smriti Bose, Asha Patel, Salini Sumangala, Daniel White, Barbara Wysota, Shanika Samarasekera
Objectives
To assess the effectiveness of adjunctive Cenobamate (CNB) in reducing seizure frequency and influencing concomitant antiseizure medication (ASM) use for adults with refractory epilepsy on the VNS pathway. To assess whether addition of CNB leads to deferral of VNS insertion or deactivation in those with a VNS in situ.
Methods
This retrospective cohort study evaluated adult patients on the epilepsy surgery pathway who were both awaiting and had already undergone VNS insertion (the latter conducted over two years prior to study onset and not requiring imminent battery replacement over a 36-month period. Seizure frequency, changes in concomitant ASMs and decisions regarding VNS were ascertained from electronic records at baseline (T1), 12-month (T2) and 36-month (T3) post initiation of Cenobamate.
Results
65 patients (29 male) were assessed, 42 patients (64.6 %) had a VNS in situ, the remainder were awaiting VNS. 64 patients had a minimum duration of epilepsy of 10 years. 18 patients (28 %) were classified as LGS spectrum.
At T2, 40 patients (61.5 %) attained significant seizure reduction of at least 50 % (p < 0.0001). There was no significant difference between the LGS spectrum and non LGS cohorts. 9 of 23 patients awaiting VNS elected not to undergo insertion in light of seizure reduction. 22 (52 %) of the 42 VNS patients attained significant seizure reduction, of whom 3 (8 %) attained seizure freedom. 2 patients requested VNS deactivation. At T3, 13 patients of 23 deferred VNS insertion on account of seizure control with Cenobamate.
Conclusions
Adjunctive CNB has the potential to influence decision making in people with epilepsy. VNS deferral and/or deactivation as a result of significant seizure reduction with CNB has a significant economic impact.
{"title":"Does adjunctive Cenobamate lead to a reduction in the use of vagal nerve stimulation? A long-term observational study of patients on the epilepsy surgery pathway","authors":"Pyae Aung, Smriti Bose, Asha Patel, Salini Sumangala, Daniel White, Barbara Wysota, Shanika Samarasekera","doi":"10.1016/j.yebeh.2026.110902","DOIUrl":"10.1016/j.yebeh.2026.110902","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the effectiveness of adjunctive Cenobamate (CNB) in reducing seizure frequency and influencing concomitant antiseizure medication (ASM) use for adults with refractory epilepsy on the VNS pathway. To assess whether addition of CNB leads to deferral of VNS insertion or deactivation in those with a VNS in situ.</div></div><div><h3>Methods</h3><div>This retrospective cohort study evaluated adult patients on the epilepsy surgery pathway who were both awaiting and had already undergone VNS insertion (the latter conducted over two years prior to study onset and not requiring imminent battery replacement over a 36-month period. Seizure frequency, changes in concomitant ASMs and decisions regarding VNS were ascertained from electronic records at baseline (T1), 12-month (T2) and 36-month (T3) post initiation of Cenobamate.</div></div><div><h3>Results</h3><div>65 patients (29 male) were assessed, 42 patients (64.6 %) had a VNS in situ, the remainder were awaiting VNS. 64 patients had a minimum duration of epilepsy of 10 years. 18 patients (28 %) were classified as LGS spectrum.</div><div>At T2, 40 patients (61.5 %) attained significant seizure reduction of at least 50 % (p < 0.0001). There was no significant difference between the LGS spectrum and non LGS cohorts. 9 of 23 patients awaiting VNS elected not to undergo insertion in light of seizure reduction. 22 (52 %) of the 42 VNS patients attained significant seizure reduction, of whom 3 (8 %) attained seizure freedom. 2 patients requested VNS deactivation. At T3, 13 patients of 23 deferred VNS insertion on account of seizure control with Cenobamate.</div></div><div><h3>Conclusions</h3><div>Adjunctive CNB has the potential to influence decision making in people with epilepsy. VNS deferral and/or deactivation as a result of significant seizure reduction with CNB has a significant economic impact.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"176 ","pages":"Article 110902"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974351","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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