Pub Date : 2025-02-19DOI: 10.1016/j.yebeh.2025.110313
Victor Rodrigues Santos , Lilian G. Jerow , Candi L. LaSarge
Tuberous sclerosis complex (TSC) is typically associated with epilepsy, but patients also present with a myriad of comorbid neuropsychiatric disorders. TSC is caused by mutations in the tuberous sclerosis complex genes 1 or 2 (TSC1, TSC2). This TSC1/2 complex serves as a negative regulator of the mammalian target of rapamycin (mTOR) signaling pathway, which plays a crucial role in regulating neuronal function, including cell proliferation, survival, growth, and protein synthesis. Mutations result in hyperactivation of the pathway. Animal models with mutations in Tsc1 or Tsc2 consistently exhibit epilepsy and behavioral phenotypes. Additionally, abnormal neuronal populations can impact the broader network, leading to deficits in learning and memory, anxiety-like behaviors, deficits in social behaviors, and perseverative and repetitive behaviors. This review aims to synthesize the existing animal literature linking TSC models to epileptogenesis and behavioral impairments, with insights on how modifications in TSC signaling influence both the structure and function of neurons and behavior. Understanding these relationships may provide valuable insights into potential therapeutic targets for managing epilepsy and neuropsychiatric disorders associated with TSC dysregulation.
{"title":"Behavioral analyses in rodent models of tuberous sclerosis complex","authors":"Victor Rodrigues Santos , Lilian G. Jerow , Candi L. LaSarge","doi":"10.1016/j.yebeh.2025.110313","DOIUrl":"10.1016/j.yebeh.2025.110313","url":null,"abstract":"<div><div>Tuberous sclerosis complex (TSC) is typically associated with epilepsy, but patients also present with a myriad of comorbid neuropsychiatric disorders. TSC is caused by mutations in the tuberous sclerosis complex genes 1 or 2 (<em>TSC1</em>, <em>TSC2</em>). This TSC1/2 complex serves as a negative regulator of the mammalian target of rapamycin (mTOR) signaling pathway, which plays a crucial role in regulating neuronal function, including cell proliferation, survival, growth, and protein synthesis. Mutations result in hyperactivation of the pathway. Animal models with mutations in <em>Tsc1</em> or <em>Tsc2</em> consistently exhibit epilepsy and behavioral phenotypes. Additionally, abnormal neuronal populations can impact the broader network, leading to deficits in learning and memory, anxiety-like behaviors, deficits in social behaviors, and perseverative and repetitive behaviors. This review aims to synthesize the existing animal literature linking TSC models to epileptogenesis and behavioral impairments, with insights on how modifications in TSC signaling influence both the structure and function of neurons and behavior. Understanding these relationships may provide valuable insights into potential therapeutic targets for managing epilepsy and neuropsychiatric disorders associated with TSC dysregulation.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"165 ","pages":"Article 110313"},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437138","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 : 2025-02-19DOI: 10.1016/j.yebeh.2024.110248
Su-Hyun Han , Hye Jeong Lee , Jung-Kyeom Kim , Hyesung Lee , Seo-Young Lee
Purpose
This study aims to investigate trends in birth and cesarean section (CS) rates among women with epilepsy (WWE) in Korea.
Methods
We conducted a nationwide, population-based, repeated cross-sectional study using data from the Korean National Health Insurance Service database. We evaluated the annual childbirth rate and proportion of CS among all deliveries for WWE and the entire female population aged 15–49 years from 2004 to 2019.
Results
The annual childbirth rates declined more sharply for WWE than those for the general population, with an average annual percent change (AAPC) of −3.5 % for WWE compared to −1.3 % for general women. The CS rate was higher in WWE (51.2 %) than in general population (38.9 %), with increasing trends observed in both groups (AAPC = 2.2 % for WWE vs. AAPC = 1.8 % for general women). Among WWE under monotherapy, without emergency room visits related to epilepsy, and without both central nervous system and psychiatric diseases, the CS rates were 47.8%, 50.6%, and 48.3%, respectively. After adjusting for age and obstetric comorbidities, factors associated with increased CS risk included the use of four or more antiseizure medications (adjusted odds ratio (aOR) 1.74 [1.06–2.87]), emergency room visits (aOR 5.64 [2.83–11.24]), and an Epilepsy-Specific Comorbidity Index of ≥2 (aOR 1.45 [1.05–2.01]).
Conclusions
The annual decline in childbirth and increase in CS rates were more prominent in WWE. While epilepsy severity and comorbidities were associated with CS deliveries, the persistently high CS rates in WWE even under favorable maternal conditions suggest the potential for unnecessary CS procedures.
{"title":"Trends of childbirth and cesarean section among women with epilepsy in Korea","authors":"Su-Hyun Han , Hye Jeong Lee , Jung-Kyeom Kim , Hyesung Lee , Seo-Young Lee","doi":"10.1016/j.yebeh.2024.110248","DOIUrl":"10.1016/j.yebeh.2024.110248","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to investigate trends in birth and cesarean section (CS) rates among women with epilepsy (WWE) in Korea.</div></div><div><h3>Methods</h3><div>We conducted a nationwide, population-based, repeated cross-sectional study using data from the Korean National Health Insurance Service database. We evaluated the annual childbirth rate and proportion of CS among all deliveries for WWE and the entire female population aged 15–49 years from 2004 to 2019.</div></div><div><h3>Results</h3><div>The annual childbirth rates declined more sharply for WWE than those for the general population, with an average annual percent change (AAPC) of −3.5 % for WWE compared to −1.3 % for general women. The CS rate was higher in WWE (51.2 %) than in general population (38.9 %), with increasing trends observed in both groups (AAPC = 2.2 % for WWE vs. AAPC = 1.8 % for general women). Among WWE under monotherapy, without emergency room visits related to epilepsy, and without both central nervous system and psychiatric diseases, the CS rates were 47.8%, 50.6%, and 48.3%, respectively. After adjusting for age and obstetric comorbidities, factors associated with increased CS risk included the use of four or more antiseizure medications (adjusted odds ratio (aOR) 1.74 [1.06–2.87]), emergency room visits (aOR 5.64 [2.83–11.24]), and an Epilepsy-Specific Comorbidity Index of ≥2 (aOR 1.45 [1.05–2.01]).</div></div><div><h3>Conclusions</h3><div>The annual decline in childbirth and increase in CS rates were more prominent in WWE. While epilepsy severity and comorbidities were associated with CS deliveries, the persistently high CS rates in WWE even under favorable maternal conditions suggest the potential for unnecessary CS procedures.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110248"},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437698","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 : 2025-02-18DOI: 10.1016/j.yebeh.2025.110322
Kristien Verhaert , Karolien Persyn , An De Cock , Lieve Troch , Lieven Lagae
Objectives
Cognitive and behavioral comorbidity is frequent in childhood epilepsy and impacts on prognosis and QOL. Comorbidity often precedes seizure onset. Early screening is recommended but no consensus exists on the screening method. The current pilot study investigated the feasibility and validity of a newly developed screening method in children with recently diagnosed epilepsy.
Methods
An online screening method was developed using a combination of existing and validated screening instruments (i.e. 2 standardised questionnaires and 2 psychometric tests), selected to detect the most common comorbid problems in childhood epilepsies. Feasibility was studied using patient and parent questionnaires and drop-out rates. Validity was studied by comparing the screening results to an in-depth diagnostic assessment. Descriptive statistics were used to analyse results.
Results
Out of twenty referred children, 13 entered the study, of whom 1 dropped out (retention rate 93 %). Of those, ten were girls. Most patients were aged 9–12 year (38 %) or 12–15-year (38 %). Eighty-three percent of tested children proved to have cognitive or behavioral comorbidity. Screening results corresponded with diagnostic assessment results in most cases (9 true positives, one true negative), there was 1 false positive and 1 false negative screening result. Sensitivity of the screening amounts to 90 % (CI 73–107).
Conclusions
The current pilot study shows promising results with regards to feasibility and validity of the tested screening method for cognitive and behavioral comorbidity in childhood epilepsy. This warrants further investigation of the method.
{"title":"Screening of cognitive and behavioral comorbidity in children with recently diagnosed epilepsy: A pilot study exploring the feasibility and validity of a newly composed online screening tool","authors":"Kristien Verhaert , Karolien Persyn , An De Cock , Lieve Troch , Lieven Lagae","doi":"10.1016/j.yebeh.2025.110322","DOIUrl":"10.1016/j.yebeh.2025.110322","url":null,"abstract":"<div><h3>Objectives</h3><div>Cognitive and behavioral comorbidity is frequent in childhood epilepsy and impacts on prognosis and QOL. Comorbidity often precedes seizure onset. Early screening is recommended but no consensus exists on the screening method. The current pilot study investigated the feasibility and validity of a newly developed screening method in children with recently diagnosed epilepsy.</div></div><div><h3>Methods</h3><div>An online screening method was developed using a combination of existing and validated screening instruments (i.e. 2 standardised questionnaires and 2 psychometric tests), selected to detect the most common comorbid problems in childhood epilepsies. Feasibility was studied using patient and parent questionnaires and drop-out rates. Validity was studied by comparing the screening results to an in-depth diagnostic assessment. Descriptive statistics were used to analyse results.</div></div><div><h3>Results</h3><div>Out of twenty referred children, 13 entered the study, of whom 1 dropped out (retention rate 93 %). Of those, ten were girls. Most patients were aged 9–12 year (38 %) or 12–15-year (38 %). Eighty-three percent of tested children proved to have cognitive or behavioral comorbidity. Screening results corresponded with diagnostic assessment results in most cases (9 true positives, one true negative), there was 1 false positive and 1 false negative screening result. Sensitivity of the screening amounts to 90 % (CI 73–107).</div></div><div><h3>Conclusions</h3><div>The current pilot study shows promising results with regards to feasibility and validity of the tested screening method for cognitive and behavioral comorbidity in childhood epilepsy. This warrants further investigation of the method.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"165 ","pages":"Article 110322"},"PeriodicalIF":2.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.yebeh.2025.110305
Alexandra Eid , Christina Kallik , Radwa Aly , Ya-Huei Li , Noor Taweh , Anumeha Sheth
Background and objective
Catamenial seizure exacerbation (CSE) is challenging to track given unreliable patient reports. This highlights the need for improved recognition of CSE. In this study, we discuss the feasibility of using the Seizure Cycle app for that purpose.
Design/methods
Eligible participants logged menstrual cycles and seizure data in the app for 6 months. CSE was defined based on criteria by Herzog et al [1], as two-fold increase in average daily seizure frequency (ADSF) during menstrual (C1) and ovulatory (C2) phases during ovulatory cycles, and the entire luteal phase during anovulatory cycles (C3). Feasibility was assessed by the proportion of participants who completed 4-month and 6-month documentation.
Results
Among 8 participants, 5 (62.5 %) shared > 4-month data and 4 (50 %) shared 6-month data. Among the 6 participants who shared at least one month of data, CSE type C3 was identified based on number of seizures in one participant who had variable cycle length and was presumed to have anovulatory cycles. This was not confirmed with calculation of ADSF.
Conclusions
Seizure Cycle app can serve as a feasible tool to improve diagnosis of this underrecognized condition. Despite the small sample size, CSE was potentially identified in one participant, although use of ADSF did not confirm this classification. Clearer definition of the C3 pattern may be useful. Future work will prioritize app automation to streamline data collection, facilitating larger and more robust datasets. These advancements will ultimately support the systematic assessment of therapeutic interventions to improve the diagnosis and treatment of CSE.
{"title":"Seizure Cycle app: A feasibility study","authors":"Alexandra Eid , Christina Kallik , Radwa Aly , Ya-Huei Li , Noor Taweh , Anumeha Sheth","doi":"10.1016/j.yebeh.2025.110305","DOIUrl":"10.1016/j.yebeh.2025.110305","url":null,"abstract":"<div><h3>Background and objective</h3><div>Catamenial seizure exacerbation (CSE) is challenging to track given unreliable patient reports. This highlights the need for improved recognition of CSE. In this study, we discuss the feasibility of using the <em>Seizure Cycle</em> app for that purpose.</div></div><div><h3>Design/methods</h3><div>Eligible participants logged menstrual cycles and seizure data in the app for 6 months. CSE was defined based on criteria by Herzog et al <span><span>[1]</span></span>, as two-fold increase in average daily seizure frequency (ADSF) during menstrual (C1) and ovulatory (C2) phases during ovulatory cycles, and the entire luteal phase during anovulatory cycles (C3). Feasibility was assessed by the proportion of participants who completed 4-month and 6-month documentation.</div></div><div><h3>Results</h3><div>Among 8 participants, 5 (62.5 %) shared > 4-month data and 4 (50 %) shared 6-month data. Among the 6 participants who shared at least one month of data, CSE type C3 was identified based on number of seizures in one participant who had variable cycle length and was presumed to have anovulatory cycles. This was not confirmed with calculation of ADSF.</div></div><div><h3>Conclusions</h3><div><em>Seizure Cycle</em> app can serve as a feasible tool to improve diagnosis of this underrecognized condition. Despite the small sample size, CSE was potentially identified in one participant, although use of ADSF did not confirm this classification. Clearer definition of the C3 pattern may be useful. Future work will prioritize app automation to streamline data collection, facilitating larger and more robust datasets. These advancements will ultimately support the systematic assessment of therapeutic interventions to improve the diagnosis and treatment of CSE.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110305"},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386444","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 : 2025-02-11DOI: 10.1016/j.yebeh.2025.110290
Ping-Tao Tseng , Bing-Yan Zeng , Chih-Wei Hsu , Chih-Sung Liang , Andre F. Carvalho , Andre R. Brunoni , Brendon Stubbs , Kuan-Pin Su , Yu-Kang Tu , Yi-Cheng Wu , Tien-Yu Chen , Dian-Jeng Li , Pao-Yen Lin , Yen-Wen Chen , Mein-Woei Suen , Chun-Hung Chang , Jiann-Jy Chen , Yow-Ling Shiue , Bing-Syuan Zeng , Cheng-Ta Li
The noninvasive brain and nerve stimulation (NIBNS) treatments had been widely applied in numerous psychiatric diseases. They exerted preferable efficacy and had been considered as an alternative or add-on treatment to the traditional pharmacotherapy. However, the risk of complication of seizure had seized the clinicians so that they feared about this potential complication. Actually, the NIBNS techniques have emerged as an alternative adjunctive treatment method for patients with epilepsy. However, the results of randomized controlled trials (RCTs) investigating the ability of NIBNS to reduce the frequency of seizures have been inconclusive. The aim of the current network meta-analysis (NMA) was to compare the efficacy and acceptability of various NIBNS techniques for reducing the frequency of seizures in patients with epilepsy. This frequentist model-based NMA included RCTs of NIBNS techniques for patients with epilepsy. The primary outcomes were seizure frequency change and acceptability (i.e., dropout rate). This NMA of 20 RCTs indicated that only 2-mA cathodal short-duration transcranial direct current stimulation (hc-sd-c-tDCS) was associated with significantly greater reduction in seizure frequency and significantly greater improvement in quality of life than the sham/control. Further, none of the investigated NIBNS techniques had significantly increased seizure frequency compared with the sham/control. In addition, all the investigated NIBNS techniques were associated with similar acceptability with the sham/control. Our results indicated that none of the investigated NIBNS techniques was associated with an increased risk of epileptic seizure.
{"title":"The non-invasive brain or nerve stimulation treatment did not increase seizure frequency in patients with epilepsy: A network meta-analysis","authors":"Ping-Tao Tseng , Bing-Yan Zeng , Chih-Wei Hsu , Chih-Sung Liang , Andre F. Carvalho , Andre R. Brunoni , Brendon Stubbs , Kuan-Pin Su , Yu-Kang Tu , Yi-Cheng Wu , Tien-Yu Chen , Dian-Jeng Li , Pao-Yen Lin , Yen-Wen Chen , Mein-Woei Suen , Chun-Hung Chang , Jiann-Jy Chen , Yow-Ling Shiue , Bing-Syuan Zeng , Cheng-Ta Li","doi":"10.1016/j.yebeh.2025.110290","DOIUrl":"10.1016/j.yebeh.2025.110290","url":null,"abstract":"<div><div>The noninvasive brain and nerve stimulation (NIBNS) treatments had been widely applied in numerous psychiatric diseases. They exerted preferable efficacy and had been considered as an alternative or add-on treatment to the traditional pharmacotherapy. However, the risk of complication of seizure had seized the clinicians so that they feared about this potential complication. Actually, the NIBNS techniques have emerged as an alternative adjunctive treatment method for patients with epilepsy. However, the results of randomized controlled trials (RCTs) investigating the ability of NIBNS to reduce the frequency of seizures have been inconclusive. The aim of the current network <em>meta</em>-analysis (NMA) was to compare the efficacy and acceptability of various NIBNS techniques for reducing the frequency of seizures in patients with epilepsy. This frequentist model-based NMA included RCTs of NIBNS techniques for patients with epilepsy. The primary outcomes were seizure frequency change and acceptability (i.e., dropout rate). This NMA of 20 RCTs indicated that only 2-mA cathodal short-duration transcranial direct current stimulation (hc-sd-c-tDCS) was associated with significantly greater reduction in seizure frequency and significantly greater improvement in quality of life than the sham/control. Further, none of the investigated NIBNS techniques had significantly increased seizure frequency compared with the sham/control. In addition, all the investigated NIBNS techniques were associated with similar acceptability with the sham/control. Our results indicated that none of the investigated NIBNS techniques was associated with an increased risk of epileptic seizure.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110290"},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143379223","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 : 2025-02-08DOI: 10.1016/j.yebeh.2025.110288
Panagiota-Eleni Tsalouchidou , Zafeirenia Vlakou , Maria Angeli , Lampros Kousoulos , Marianna Bregianni , Anna Keramida , Vasiliki Kotsali-Peteinelli , Klearchos Ntemiris , Maria Gogou
Background
Early-career professionals in epilepsy face unique challenges that can impact their professional growth and capacity to provide high-quality care. This study explores the demographic and professional characteristics, access to resources, barriers, and training needs of young professionals in epilepsy in Greece, to identify key areas for support and improvement.
Methods
A cross-sectional survey was conducted among early-career professionals in epilepsy in Greece, including neurologists, pediatricians, residents, nurses, and allied health professionals. Participants completed a structured questionnaire addressing demographics, professional experiences, training needs, and perceived challenges. Data were analyzed using descriptive statistics, and results were visualized through graphs and tables.
Results
The survey included 58 participants, the majority being female (74.1 %) and aged 30–35 years (56.9 %). Most participants were employed in public or university hospitals (81.04 %), with 49.12 % reporting no specialized training in epilepsy but expressing a strong intention to pursue it. Financial constraints (41.4 %) and work-related challenges (31.0 %) were the primary barriers to attending educational activities. Key training priorities included clinical neurophysiology (71.9 %), neuroimaging (68.4 %), and genetics (66.7 %). Preferences for conference topics focused on hands-on EEG (81 %) and neuroimaging (77.6 %) courses, followed by pharmacological management (67.2 %), diagnostic approaches (63.8 %), epilepsy surgery (63.8 %), and precision medicine (55.2 %).
Conclusion
The findings highlight the barriers and training needs among early-career epilepsy professionals in Greece. Addressing these challenges through targeted educational initiatives, mentorship programs, and financial support mechanisms could foster professional development and enhance the quality of epilepsy care. These results also provide a foundation for the establishment of initiatives such as the Young Epilepsy Section in Greece to support the next generation of epilepsy specialists.
{"title":"Early career in epilepsy in Greece","authors":"Panagiota-Eleni Tsalouchidou , Zafeirenia Vlakou , Maria Angeli , Lampros Kousoulos , Marianna Bregianni , Anna Keramida , Vasiliki Kotsali-Peteinelli , Klearchos Ntemiris , Maria Gogou","doi":"10.1016/j.yebeh.2025.110288","DOIUrl":"10.1016/j.yebeh.2025.110288","url":null,"abstract":"<div><h3>Background</h3><div>Early-career professionals in epilepsy face unique challenges that can impact their professional growth and capacity to provide high-quality care. This study explores the demographic and professional characteristics, access to resources, barriers, and training needs of young professionals in epilepsy in Greece, to identify key areas for support and improvement.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted among early-career professionals in epilepsy in Greece, including neurologists, pediatricians, residents, nurses, and allied health professionals. Participants completed a structured questionnaire addressing demographics, professional experiences, training needs, and perceived challenges. Data were analyzed using descriptive statistics, and results were visualized through graphs and tables.</div></div><div><h3>Results</h3><div>The survey included 58 participants, the majority being female (74.1 %) and aged 30–35 years (56.9 %). Most participants were employed in public or university hospitals (81.04 %), with 49.12 % reporting no specialized training in epilepsy but expressing a strong intention to pursue it. Financial constraints (41.4 %) and work-related challenges (31.0 %) were the primary barriers to attending educational activities. Key training priorities included clinical neurophysiology (71.9 %), neuroimaging (68.4 %), and genetics (66.7 %). Preferences for conference topics focused on hands-on EEG (81 %) and neuroimaging (77.6 %) courses, followed by pharmacological management (67.2 %), diagnostic approaches (63.8 %), epilepsy surgery (63.8 %), and precision medicine (55.2 %).</div></div><div><h3>Conclusion</h3><div>The findings highlight the barriers and training needs among early-career epilepsy professionals in Greece. Addressing these challenges through targeted educational initiatives, mentorship programs, and financial support mechanisms could foster professional development and enhance the quality of epilepsy care. These results also provide a foundation for the establishment of initiatives such as the Young Epilepsy Section in Greece to support the next generation of epilepsy specialists.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110288"},"PeriodicalIF":2.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-08DOI: 10.1016/j.yebeh.2025.110301
Yanmei Li , Xueyi Rao , Chunsong Yang , Rong Luo , Dezhi Cao , Jing Gan
Objectives
This systematic review with meta-analysis (PROSPERO: CRD42022377532) was performed to comprehensively assess the prevalence of anxiety, depression, and posttraumatic stress disorder (PTSD) in caregivers of children with epilepsy.
Methods
A search was performed on June 2024, in 4 databases (PubMed, Embase, Web of Science, and PsycInfo) for original research reporting on caregivers of children with epilepsy, with no language restrictions. Two reviewers independently screened and extracted data. The methodological quality was assessed using the Healthcare Research and Quality of America (AHRQ) standardized appraisal tool. Random-effects models were used to calculate the pooled prevalence of anxiety, depression, and PTSD. The subgroup analysis was further conducted to identify possible sources of heterogeneity. All studies were reviewed by PRISMA guidelines.
Results
A total of 2,588 records were screened and 38 studies with 6,593 participants across 18 countries were included for analysis: 25 studies provided prevalence estimates for anxiety, 33 for depression, and 5 for PTSD. Eleven studies were rated as high quality according to the AHRQ scale, 24 as moderate quality, and 3 as low quality. The pooled prevalence of anxiety was 34 % (95 %CI 0.28–0.41) with considerable heterogeneity (I2 = 96.18 %), 31 % for depression (95 %CI 0.24–0.37) with substantial heterogeneity (I2 = 97.60 %), and 21 % for PTSD (95 %CI 0.17–0.26) with moderate heterogeneity (I2 = 55.02 %). Significant heterogeneity was observed, particularly concerning anxiety and depression, which could be attributed to variations in screening methods. However, no statistical differences were found between subgroups based on gender, region, year of publication, type of seizure, economic development level of countries. In the gender subgroup analysis for PTSD, females had a higher prevalence (24 %) than males (6 %). In the sensitive analysis of PTSD, the prevalence was 23 % with low heterogeneity (I2 = 22.94 %) by excluding one study.
Conclusion
We systematically analyzed the prevalence of anxiety, depression, and PTSD in caregivers of children with epilepsy. Our findings highlight the high mental health burden among caregivers, with prevalence rates notably higher than those in the general population. These results emphasize the urgent need for early identification, interventions, and comprehensive support to improve the well-being and quality of life of these caregivers.
{"title":"Prevalence of anxiety, depression, and posttraumatic stress disorder in caregivers of children with epilepsy: A meta-analysis","authors":"Yanmei Li , Xueyi Rao , Chunsong Yang , Rong Luo , Dezhi Cao , Jing Gan","doi":"10.1016/j.yebeh.2025.110301","DOIUrl":"10.1016/j.yebeh.2025.110301","url":null,"abstract":"<div><h3>Objectives</h3><div>This systematic review with <em>meta</em>-analysis (PROSPERO: CRD42022377532) was performed to comprehensively assess the prevalence of anxiety, depression, and posttraumatic stress disorder (PTSD) in caregivers of children with epilepsy.</div></div><div><h3>Methods</h3><div>A search was performed on June 2024, in 4 databases (PubMed, Embase, Web of Science, and PsycInfo) for original research reporting on caregivers of children with epilepsy, with no language restrictions. Two reviewers independently screened and extracted data. The methodological quality was assessed using the Healthcare Research and Quality of America (AHRQ) standardized appraisal tool. Random-effects models were used to calculate the pooled prevalence of anxiety, depression, and PTSD. The subgroup analysis was further conducted to identify possible sources of heterogeneity. All studies were reviewed by PRISMA guidelines.</div></div><div><h3>Results</h3><div>A total of 2,588 records were screened and 38 studies with 6,593 participants across 18 countries were included for analysis: 25 studies provided prevalence estimates for anxiety, 33 for depression, and 5 for PTSD. Eleven studies were rated as high quality according to the AHRQ scale, 24 as moderate quality, and 3 as low quality. The pooled prevalence of anxiety was 34 % (95 %CI 0.28–0.41) with considerable heterogeneity (I<sup>2</sup> = 96.18 %), 31 % for depression (95 %CI 0.24–0.37) with substantial heterogeneity (I<sup>2</sup> = 97.60 %), and 21 % for PTSD (95 %CI 0.17–0.26) with moderate heterogeneity (I<sup>2</sup> = 55.02 %). Significant heterogeneity was observed, particularly concerning anxiety and depression, which could be attributed to variations in screening methods. However, no statistical differences were found between subgroups based on gender, region, year of publication, type of seizure, economic development level of countries. In the gender subgroup analysis for PTSD, females had a higher prevalence (24 %) than males (6 %). In the sensitive analysis of PTSD, the prevalence was 23 % with low heterogeneity (I<sup>2</sup> = 22.94 %) by excluding one study.</div></div><div><h3>Conclusion</h3><div>We systematically analyzed the prevalence of anxiety, depression, and PTSD in caregivers of children with epilepsy. Our findings highlight the high mental health burden among caregivers, with prevalence rates notably higher than those in the general population. These results emphasize the urgent need for early identification, interventions, and comprehensive support to improve the well-being and quality of life of these caregivers.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110301"},"PeriodicalIF":2.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350467","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 : 2025-02-08DOI: 10.1016/j.yebeh.2025.110293
Jacob Pellinen , Stefan Sillau , Chris Morrison , Paul Maruff , Terence J. O’Brien , Patricia Penovich , Jacqueline French , Kelly G. Knupp , Sarah Barnard , Manisha Holmes , Manu Hegde , Andres M. Kanner , Kimford J. Meador , the Human Epilepsy Project Investigators
<div><h3>Objective</h3><div>Seizures can impact cognition both acutely and chronically. However, among those without significant comorbidities and broadly average cognition at epilepsy onset, the relationship between cognitive function at the time of diagnosis and long-term seizure control has been relatively unexplored. This analysis investigated associations between participant characteristics including specific aspects of cognitive performance at the time of focal epilepsy diagnosis and antiseizure medication (ASM) treatment resistance.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of Human Epilepsy Project (HEP) data, which enrolled people with newly diagnosed focal epilepsy and broadly average cognition (estimated IQ ≥ 70) from June 29, 2012, to September 1, 2019. Participants analyzed in this study were between 18 and 60 years old, and scored within an acceptable range (i.e., Standard Score of ≥80) on measures estimating premorbid cognitive ability were offered the Cogstate Brief Battery (CBB). Participant characteristics were analyzed, including the presence of any anxiety disorders or depression, and summary CBB scores. HEP participants who were classified by the study as treatment resistant if they had experienced failure to achieve seizure freedom after two adequate trials of ASMs. Treatment resistance was modeled using multiple logistic regression to assess for independent associations between attention and working memory after correcting for the presence of the other potentially explanatory variables.</div></div><div><h3>Results</h3><div>200 HEP participants had comprehensive enrollment records including CBB results and complete seizure outcome data for analysis in this study. After correcting for potentially confounding variables, there were no independent associations between cognitive measures on the CBB at the time of enrollment and subsequent development of ASM treatment resistance. Specifically, z-scores for reaction time on the CBB (an average of the CBB Identification and Detection tests) were not associated with treatment resistance (p = 0.51) and z-scores for memory performance (an average of the CBB One Card Learning test and One Back tests) were not associated with treatment resistance (p = 0.24). There were no significant independent associations between age or the presence of depression or anxiety disorders at the time of CBB testing and treatment resistance. However, there was an independent association between employment status and treatment resistance, with those who were employed or students (>18 years old) at the time of enrollment and CBB testing having 0.35 times lower odds of treatment resistance (95 %CI 0.15–0.81, p = 0.01).</div></div><div><h3>Significance</h3><div>The findings from this study suggest that in otherwise healthy people with new onset focal epilepsy who have broadly average intelligence, attention and working memory as measured by the CBB at the time of diagnosis is not ass
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Pub Date : 2025-02-08DOI: 10.1016/j.yebeh.2025.110303
Esin Kavuran , Cemal Özalp , Emrah Ay
{"title":"Corrigendum to “The impact of a walking program on self-management, anxiety, stress, depression, quality of life, and seizure frequency in patients with epilepsy: A mixed methods approach using the COM-B behaviour change model” [Epilepsy Behav. 162 (2025) 110149]","authors":"Esin Kavuran , Cemal Özalp , Emrah Ay","doi":"10.1016/j.yebeh.2025.110303","DOIUrl":"10.1016/j.yebeh.2025.110303","url":null,"abstract":"","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110303"},"PeriodicalIF":2.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350472","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}
Postictal depression is a common comorbidity in epilepsy, yet effective treatments remain limited. While ketamine is well-known for its antidepressant properties, its role in postictal depression has not been thoroughly investigated. In this study, we utilized a pilocarpine-induced status epilepticus (SE) mouse model and found that depression-like behavior does not appear within a day after SE but develops within one week and persists for over two weeks. We also observed a significant reduction in hippocampal LRP4 expression one day after SE. However, despite partial recovery over the next seven days, LRP4 levels remained markedly lower through day 14, correlating with the onset and persistence of postictal depression. These findings suggest that SE-induced modulation of LRP4 expression plays distinct roles at different stages of postictal depression. Furthermore, treatment with (2R, 6R)-hydroxynorketamine ((2R, 6R)-HNK), a ketamine metabolite that lacks dissociative and addictive properties while retaining strong antidepressant-like effects, significantly alleviated depressive-like behaviors and reduced LRP4 expression in hippocampal astrocytes within one day of administration. This treatment continued to alleviate depressive-like behaviors for up to seven days, while notably increasing Lrp4 levels within one week. To further investigate the role of LRP4, we generated astrocyte-specific LRP4 overexpression mice by stereotactically injecting an Lrp4 OE adenovirus with the gfaABC1D promoter, driving astrocyte-specific expression, into the molecular layer (ML) of the hippocampus. LRP4 overexpression in hippocampal astrocytes accelerated the onset of depressive-like behaviors and abolished the antidepressant effects of (2R, 6R)-HNK. These findings indicate that (2R, 6R)-HNK alleviates postictal depression induced by pilocarpine through stage-specific modulation of LRP4 expression in hippocampal astrocytes. This research provides novel insights into potential therapeutic targets for managing postictal depression.
{"title":"(2R, 6R)-hydroxynorketamine alleviates postictal depression induced by pilocarpine through modulating LRP4 expression in hippocampal astrocytes","authors":"Meiying Zhang , Liting Zheng , Jixing Chen , Zheng Yu","doi":"10.1016/j.yebeh.2025.110294","DOIUrl":"10.1016/j.yebeh.2025.110294","url":null,"abstract":"<div><div>Postictal depression is a common comorbidity in epilepsy, yet effective treatments remain limited. While ketamine is well-known for its antidepressant properties, its role in postictal depression has not been thoroughly investigated. In this study, we utilized a pilocarpine-induced status epilepticus (SE) mouse model and found that depression-like behavior does not appear within a day after SE but develops within one week and persists for over two weeks. We also observed a significant reduction in hippocampal LRP4 expression one day after SE. However, despite partial recovery over the next seven days, LRP4 levels remained markedly lower through day 14, correlating with the onset and persistence of postictal depression. These findings suggest that SE-induced modulation of LRP4 expression plays distinct roles at different stages of postictal depression. Furthermore, treatment with (2R, 6R)-hydroxynorketamine ((2R, 6R)-HNK), a ketamine metabolite that lacks dissociative and addictive properties while retaining strong antidepressant-like effects, significantly alleviated depressive-like behaviors and reduced LRP4 expression in hippocampal astrocytes within one day of administration. This treatment continued to alleviate depressive-like behaviors for up to seven days, while notably increasing Lrp4 levels within one week. To further investigate the role of LRP4, we generated astrocyte-specific LRP4 overexpression mice by stereotactically injecting an <em>Lrp4</em> OE adenovirus with the gfaABC1D promoter, driving astrocyte-specific expression, into the molecular layer (ML) of the hippocampus. LRP4 overexpression in hippocampal astrocytes accelerated the onset of depressive-like behaviors and abolished the antidepressant effects of (2R, 6R)-HNK. These findings indicate that (2R, 6R)-HNK alleviates postictal depression induced by pilocarpine through stage-specific modulation of LRP4 expression in hippocampal astrocytes. This research provides novel insights into potential therapeutic targets for managing postictal depression.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"164 ","pages":"Article 110294"},"PeriodicalIF":2.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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