Pub Date : 2025-11-19DOI: 10.1016/j.yebeh.2025.110804
Chuanyong Qu , Zexiang Chen , Cuimi Luo , Lu Qin , Dongying Huang , Xiao Zhang , Ligen Fan , Jinou Zheng
Background
Intractable temporal lobe epilepsy (ITLE) remains a clinical challenge due to its resistance to standard treatments and its profound impact on cognitive function. Multimodal neuroimaging techniques offer potential biomarkers for diagnosis and treatment monitoring, yet comparative evaluations of their utility remain limited.
Methods
We conducted a longitudinal study comparing structural–functional coupling (SFC) and amplitude of low-frequency fluctuations (ALFF) between ITLE patients (pre- and post-treatment) and healthy controls. Regional features were extracted from resting-state functional Magnetic Resonance Imaging and diffusion tensor imaging, followed by machine learning-based classification and clustering analyses. Cognitive function was assessed via Montreal Cognitive Assessment (MoCA).
Results
Both SFC and ALFF were significantly altered in ITLE, with partial normalization after treatment. ALFF showed superior classification accuracy (92.45%) compared to SFC (81.13%), with abnormalities predominantly in the frontal lobe. In contrast, SFC alterations localized to the occipital lobe correlated more strongly with MoCA improvements. Subgroup clustering revealed that longitudinal changes in SFC better predicted cognitive recovery.
Conclusions
Our findings highlight the complementary value of ALFF and SFC in ITLE: ALFF excels in diagnostic differentiation, while SFC more effectively tracks cognitive outcomes. A multimodal framework incorporating both metrics may enhance personalized management strategies in ITLE.
{"title":"Multimodal imaging biomarkers in intractable temporal lobe Epilepsy: A comparative study of structural–functional coupling and ALFF","authors":"Chuanyong Qu , Zexiang Chen , Cuimi Luo , Lu Qin , Dongying Huang , Xiao Zhang , Ligen Fan , Jinou Zheng","doi":"10.1016/j.yebeh.2025.110804","DOIUrl":"10.1016/j.yebeh.2025.110804","url":null,"abstract":"<div><h3>Background</h3><div>Intractable temporal lobe epilepsy (ITLE) remains a clinical challenge due to its resistance to standard treatments and its profound impact on cognitive function. Multimodal neuroimaging techniques offer potential biomarkers for diagnosis and treatment monitoring, yet comparative evaluations of their utility remain limited.</div></div><div><h3>Methods</h3><div>We conducted a longitudinal study comparing structural–functional coupling (SFC) and amplitude of low-frequency fluctuations (ALFF) between ITLE patients (pre- and post-treatment) and healthy controls. Regional features were extracted from resting-state functional Magnetic Resonance Imaging and diffusion tensor imaging, followed by machine learning-based classification and clustering analyses. Cognitive function was assessed via Montreal Cognitive Assessment (MoCA).</div></div><div><h3>Results</h3><div>Both SFC and ALFF were significantly altered in ITLE, with partial normalization after treatment. ALFF showed superior classification accuracy (92.45%) compared to SFC (81.13%), with abnormalities predominantly in the frontal lobe. In contrast, SFC alterations localized to the occipital lobe correlated more strongly with MoCA improvements. Subgroup clustering revealed that longitudinal changes in SFC better predicted cognitive recovery.</div></div><div><h3>Conclusions</h3><div>Our findings highlight the complementary value of ALFF and SFC in ITLE: ALFF excels in diagnostic differentiation, while SFC more effectively tracks cognitive outcomes. A multimodal framework incorporating both metrics may enhance personalized management strategies in ITLE.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"174 ","pages":"Article 110804"},"PeriodicalIF":2.3,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563297","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 : 2025-11-17DOI: 10.1016/j.yebeh.2025.110740
Lucy Tarcha , Darcy A. Krueger , Hansel M. Greiner , Jesse Skoch , Francesco T. Mangano , Ravindra Arya , S. Katie Z. Ihnen
Introduction
Drug-refractory epilepsy (DRE) affects one-third of children with epilepsy and can be treated with surgery. The surgical target is determined by recording spontaneous seizures during stereoelectroencephalography (sEEG). In adults, induced seizures help define the surgical target and predict favorable outcomes. No studies focus on the safety, tolerability, and yield of electrical stimulation for the induction of seizures (ESIS) in children.
Methods
Stimulation at 1 Hz and 50 Hz was performed prospectively and comprehensively (all gray matter channels) during sEEG in children and young adults with DRE. Induced seizures were categorized as electroclinical habitual, clinical habitual (aura), subclinical and non-habitual. Primary safety outcome was rescue medication use. Tolerability was assessed by questionnaire. Yield was induced seizure rate.
Results
Sixty-seven patients (n = 30 female) participated during 70 admissions. Patients were 1–21 years old (mean ± SD, 11.1 ± 5.7). n = 10,135 stimulation trials were performed, requiring 175 ± 61 min per patient. One seizure required rescue medication. Tolerability ratings were favorable and improved from pre- to post-session. At least one induced seizure was obtained in 62/70 (89 %) sessions, representing 283/10,135 trials (2.8 %). Combined, habitual seizures and habitual auras accounted for 58 % of induced seizures; non-habitual seizures were uncommon (12 %). Of those with induced seizures, multiple seizure types occurred in 28/62 (45 %). Seizures were induced at 1 Hz and 50 Hz in 22/67 patients (33 %).
Significance
Seizure stimulation during sEEG is safe, well-tolerated, and high-yield in children at both 1 Hz and 50 Hz. These findings motivate a more systematic utilization of ESIS in pediatric patients.
{"title":"Electrical stimulation for the induction of seizures is safe, well-tolerated and high-yield in children with drug-resistant epilepsy","authors":"Lucy Tarcha , Darcy A. Krueger , Hansel M. Greiner , Jesse Skoch , Francesco T. Mangano , Ravindra Arya , S. Katie Z. Ihnen","doi":"10.1016/j.yebeh.2025.110740","DOIUrl":"10.1016/j.yebeh.2025.110740","url":null,"abstract":"<div><h3>Introduction</h3><div>Drug-refractory epilepsy (DRE) affects one-third of children with epilepsy and can be treated with surgery. The surgical target is determined by recording spontaneous seizures during stereoelectroencephalography (sEEG). In adults, induced seizures help define the surgical target and predict favorable outcomes. No studies focus on the safety, tolerability, and yield of electrical stimulation for the induction of seizures (ESIS) in children.</div></div><div><h3>Methods</h3><div>Stimulation at 1 Hz and 50 Hz was performed prospectively and comprehensively (all gray matter channels) during sEEG in children and young adults with DRE. Induced seizures were categorized as electroclinical habitual, clinical habitual (aura), subclinical and non-habitual. Primary safety outcome was rescue medication use. Tolerability was assessed by questionnaire. Yield was induced seizure rate.</div></div><div><h3>Results</h3><div>Sixty-seven patients (n = 30 female) participated during 70 admissions. Patients were 1–21 years old (mean ± SD, 11.1 ± 5.7). n = 10,135 stimulation trials were performed, requiring 175 ± 61 min per patient. One seizure required rescue medication. Tolerability ratings were favorable and improved from pre- to post-session. At least one induced seizure was obtained in 62/70 (89 %) sessions, representing 283/10,135 trials (2.8 %). Combined, habitual seizures and habitual auras accounted for 58 % of induced seizures; non-habitual seizures were uncommon (12 %). Of those with induced seizures, multiple seizure types occurred in 28/62 (45 %). Seizures were induced at 1 Hz and 50 Hz in 22/67 patients (33 %).</div></div><div><h3>Significance</h3><div>Seizure stimulation during sEEG is safe, well-tolerated, and high-yield in children at both 1 Hz and 50 Hz. These findings motivate a more systematic utilization of ESIS in pediatric patients.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"174 ","pages":"Article 110740"},"PeriodicalIF":2.3,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548727","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 : 2025-11-17DOI: 10.1016/j.yebeh.2025.110812
Sarah Prieto , Elaine T. Kiriakopoulos , Allyson Goldstein , Sarah Kaden , Geoffrey Tremont , Kunal Mankodiya , Elijah Castillo , Shehjar Sadhu , Dhaval Solanki , Jennifer D. Davis , Seth A. Margolis
This work elaborates the theoretical foundations of the RISE ABOVE program and presents a Multimodal Model of Internalized Stigma among people with epilepsy (PWE). The model integrates established behavioral science theories—including stress and coping, self-efficacy, learned helplessness, and cognitive-behavioral frameworks—to explain how stigma-related triggers, appraisals, and maladaptive cognitive–emotional–behavioral cycles culminate in self-reinforcing internalized stigma that may intersect with other stigmatized aspects of identity. In contrast to the psychoanalytic and post-rationalist perspectives proposed by Di Gennaro, Grammaldo, and Tomasini, our model offers concrete, evidence-informed pathways for intervention through conscious self-regulation and coping skill development. RISE ABOVE applies this framework through structured self-management exercises that enhance understanding of internalized stigma, strengthen stress management and psychological flexibility, and empower adaptive responses to stigma-related challenges. Prior findings demonstrate reductions in perceived stigma and improvements in psychosocial outcomes following RISE ABOVE completion, supporting the model’s utility for informing stigma-focused interventions.
{"title":"Toward a multimodal model of internalized epilepsy stigma","authors":"Sarah Prieto , Elaine T. Kiriakopoulos , Allyson Goldstein , Sarah Kaden , Geoffrey Tremont , Kunal Mankodiya , Elijah Castillo , Shehjar Sadhu , Dhaval Solanki , Jennifer D. Davis , Seth A. Margolis","doi":"10.1016/j.yebeh.2025.110812","DOIUrl":"10.1016/j.yebeh.2025.110812","url":null,"abstract":"<div><div>This work elaborates the theoretical foundations of the RISE ABOVE program and presents a Multimodal Model of Internalized Stigma among people with epilepsy (PWE). The model integrates established behavioral science theories—including stress and coping, self-efficacy, learned helplessness, and cognitive-behavioral frameworks—to explain how stigma-related triggers, appraisals, and maladaptive cognitive–emotional–behavioral cycles culminate in self-reinforcing internalized stigma that may intersect with other stigmatized aspects of identity. In contrast to the psychoanalytic and post-rationalist perspectives proposed by Di Gennaro, Grammaldo, and Tomasini, our model offers concrete, evidence-informed pathways for intervention through conscious self-regulation and coping skill development. RISE ABOVE applies this framework through structured self-management exercises that enhance understanding of internalized stigma, strengthen stress management and psychological flexibility, and empower adaptive responses to stigma-related challenges. Prior findings demonstrate reductions in perceived stigma and improvements in psychosocial outcomes following RISE ABOVE completion, supporting the model’s utility for informing stigma-focused interventions.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"174 ","pages":"Article 110812"},"PeriodicalIF":2.3,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548789","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 : 2025-11-16DOI: 10.1016/j.yebeh.2025.110810
Gleice Kelli Silva-Cardoso , Willian Lazarini-Lopes , Padmini Khandai , Patrick A. Forcelli , Prosper N’Gouemo
The genetically epilepsy-prone rat (GEPR) is a long-standing animal model for inherited epilepsy, with seizures triggered by high-intensity acoustic stimulation (audiogenic seizures), leading to generalized tonic-clonic seizures, which propagate through a well-characterized brainstem network and are known as brainstem seizures. Repeated exposure to acoustic stimuli can lead to the development of brainstem-triggered limbic seizures accompanied by cortical epileptiform activity, a process called audiogenic kindling (AK). Although the GEPR-3 strain has been in use for over 50 years, the influences of age and sex on the development of AK in GEPR-3s remain unknown; thus, this study aims to address this knowledge gap. Male and female GEPR-3s, aged 1, 2, 4, and 6 months, were exposed to acoustically evoked seizures once daily for 30 consecutive days. Seizure latency, duration, and severity were analyzed in relation to age and number of stimulations. The findings revealed that AK was age-dependent, with limbic motor seizures occurring exclusively in 4- and 6-month-old GEPR-3s, while younger GEPR-3s showed no limbic seizures. Female GEPR-3s developed AK more rapidly and experienced more severe seizures than males. Furthermore, as AK developed, brainstem seizures became more severe in the GEPR-3s. A subset of 4- and 6-month-old male and female GEPR-3s exhibited forelimb and hindlimb extensions or spontaneous limbic seizures. The results indicate that age and sex impact AK development in GEPR-3s, highlighting the need for further studies to understand their significance in advancing our understanding of epileptogenesis and developing more effective treatments.
{"title":"Influence of sex and age on the development of audiogenic kindling in the moderate seizure severity strain of the genetically epilepsy-prone rats","authors":"Gleice Kelli Silva-Cardoso , Willian Lazarini-Lopes , Padmini Khandai , Patrick A. Forcelli , Prosper N’Gouemo","doi":"10.1016/j.yebeh.2025.110810","DOIUrl":"10.1016/j.yebeh.2025.110810","url":null,"abstract":"<div><div>The genetically epilepsy-prone rat (GEPR) is a long-standing animal model for inherited epilepsy, with seizures triggered by high-intensity acoustic stimulation (audiogenic seizures), leading to generalized tonic-clonic seizures, which propagate through a well-characterized brainstem network and are known as brainstem seizures. Repeated exposure to acoustic stimuli can lead to the development of brainstem-triggered limbic seizures accompanied by cortical epileptiform activity, a process called audiogenic kindling (AK). Although the GEPR-3 strain has been in use for over 50 years, the influences of age and sex on the development of AK in GEPR-3s remain unknown; thus, this study aims to address this knowledge gap. Male and female GEPR-3s, aged 1, 2, 4, and 6 months, were exposed to acoustically evoked seizures once daily for 30 consecutive days. Seizure latency, duration, and severity were analyzed in relation to age and number of stimulations. The findings revealed that AK was age-dependent, with limbic motor seizures occurring exclusively in 4- and 6-month-old GEPR-3s, while younger GEPR-3s showed no limbic seizures. Female GEPR-3s developed AK more rapidly and experienced more severe seizures than males. Furthermore, as AK developed, brainstem seizures became more severe in the GEPR-3s. A subset of 4- and 6-month-old male and female GEPR-3s exhibited forelimb and hindlimb extensions or spontaneous limbic seizures. The results indicate that age and sex impact AK development in GEPR-3s, highlighting the need for further studies to understand their significance in advancing our understanding of epileptogenesis and developing more effective treatments.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"174 ","pages":"Article 110810"},"PeriodicalIF":2.3,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145539506","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 : 2025-11-07DOI: 10.1016/j.yebeh.2025.110797
C.J. Winchester
An examination of the work process of the artist Vincent Van Gogh from a cultural- and medical-historical perspective, this article looks at the role of temporal lobe epilepsy in shaping of the painter’s impulse to create, his methodology, and characteristics of his work product. All artists employ disparate methodologies to merge the landscapes of internal and external experience, and the drivers of an individual artist’s creativity are multi-fold. In the case of Van Gogh, synthetic aspects of the artistic process, data of personal history and the exigencies of an illness contribute to a dynamic interplay. Previous research has investigated how epileptic activity of right temporal and temporooccipital origin affects the prolongation of dream states. The global repercussions of non-convulsive seizures on self-world relations with respect to the artist and the act of aesthetic creation merit further study.
{"title":"Artistic imperative and epilepsy of Van Gogh","authors":"C.J. Winchester","doi":"10.1016/j.yebeh.2025.110797","DOIUrl":"10.1016/j.yebeh.2025.110797","url":null,"abstract":"<div><div>An examination of the work process of the artist Vincent Van Gogh from a cultural- and medical-historical perspective, this article looks at the role of temporal lobe epilepsy in shaping of the painter’s impulse to create, his methodology, and characteristics of his work product. All artists employ disparate methodologies to merge the landscapes of internal and external experience, and the drivers of an individual artist’s creativity are multi-fold. In the case of Van Gogh, synthetic aspects of the artistic process, data of personal history and the exigencies of an illness contribute to a dynamic interplay. Previous research has investigated how epileptic activity of right temporal and temporooccipital origin affects the prolongation of dream states. The global repercussions of non-convulsive seizures on self-world relations with respect to the artist and the act of aesthetic creation merit further study.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"174 ","pages":"Article 110797"},"PeriodicalIF":2.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476065","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 : 2025-11-07DOI: 10.1016/j.yebeh.2025.110800
Alena Javůrková , Jaroslava Raudenská , Tereza Březinová , Jana Zárubová , Jana Amlerová , Petr Marusič
Objective
Epilepsy treatment aims not only to control seizures but also to preserve patients’ cognitive abilities. EpiTrack® is a screening tool designed to monitor the influence of anti-seizure medications on executive functions and attention.
Methods
Czech version of EpiTrack® and selected neuropsychological tests, along with questionnaires measuring anxiety, depression, and health-related quality of life, were administered to consecutive epilepsy patients (n = 134) and matched by age, gender and premorbid intellect healthy controls (n = 121). Reliability and validity were assessed.
Results
Reliability was adequate, with acceptable internal consistency (Cronbach’s α = 0.75) and moderate test–retest reliability (rp = 0.59). Only 4 % of controls were classified as cognitive impaired, compared with 45 % of patients. Scores were sensitive to monthly seizure frequency, polytherapy, focal epilepsy, and were negatively correlated with premorbid intelligence, education, and activities of daily living (ps < 0.05). Multiple regression results suggested negative cognitive effects of anti-seizure medications (ps < 0.05) Principal component analysis yielded a two-factor solution (verbal and visuospatial) accounting for 58 % of the total variance in healthy controls, whereas in the patient group only one factor was extracted, accounting for 62 % of the variance, indicating a unified executive dysfunction profile. EpiTrack® scores correlated significantly with neuropsychological measures of attention and executive function in both healthy controls (rs = 0.37–0.65) and patients (rs = 0.35–0.72) (ps < 0.05), supporting convergent validity.
Conclusion
The Czech version of EpiTrack® demonstrated sufficient psychometric properties and is suitable for routine screening of executive function and attention in people with epilepsy.
{"title":"Tracking of executive functions and attention in people with epilepsy: Czech validation of EpiTrack®","authors":"Alena Javůrková , Jaroslava Raudenská , Tereza Březinová , Jana Zárubová , Jana Amlerová , Petr Marusič","doi":"10.1016/j.yebeh.2025.110800","DOIUrl":"10.1016/j.yebeh.2025.110800","url":null,"abstract":"<div><h3>Objective</h3><div> <!-->Epilepsy treatment aims not only to control seizures but also to preserve patients’ cognitive abilities. EpiTrack® is a screening tool designed to monitor the influence of anti-seizure medications on executive functions and attention.</div></div><div><h3>Methods</h3><div> <!-->Czech version of EpiTrack® and selected neuropsychological tests, along with questionnaires measuring anxiety, depression, and health-related quality of life, were administered to consecutive epilepsy patients (n = 134) and matched by age, gender and premorbid intellect healthy controls (n = 121). Reliability and validity were assessed.</div></div><div><h3>Results</h3><div> <!-->Reliability was adequate, with acceptable internal consistency (Cronbach’s α = 0.75) and moderate test–retest reliability (rp = 0.59). Only 4 % of controls were classified as cognitive impaired, compared with 45 % of patients. Scores were sensitive to monthly seizure frequency, polytherapy, focal epilepsy, and were negatively correlated with premorbid intelligence, education, and activities of daily living (ps < 0.05). Multiple regression results suggested negative cognitive effects of anti-seizure medications (ps < 0.05) Principal component analysis yielded a two-factor solution (verbal and visuospatial) accounting for 58 % of the total variance in healthy controls, whereas in the patient group only one factor was extracted, accounting for 62 % of the variance, indicating a unified executive dysfunction profile. EpiTrack® scores correlated significantly with neuropsychological measures of attention and executive function in both healthy controls (rs = 0.37–0.65) and patients (rs = 0.35–0.72) (ps < 0.05), supporting convergent validity.</div></div><div><h3>Conclusion</h3><div> <!-->The Czech version of EpiTrack® demonstrated sufficient psychometric properties and is suitable for routine screening of executive function and attention in people with epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"174 ","pages":"Article 110800"},"PeriodicalIF":2.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145448758","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 : 2025-11-04DOI: 10.1016/j.yebeh.2025.110806
M.M.L. van Arnhem , H.C. van Teeseling , L. van den Berg , K.P.J. Braun , F.E. Jansen
Developmental and/or Epileptic encephalopathy with spike-wave activation in sleep ((D)EE-SWAS) is an age related epilepsy syndrome that is associated with, often profound, cognitive deterioration in childhood. Although the EEG pattern in (D)EE-SWAS resolves, cognitive deficits persist during adulthood. Studies assessing objective cognitive outcomes after resolution of the EEG SWAS pattern are scarce. In this study we assessed intelligence quotient (IQ) scores after remission of SWAS in seventeen patients with a history of (D)EE-SWAS. In all patients with IQ data available before the onset of SWAS there was a profound decline in IQ during (D)EE-SWAS (mean decline –22.1 IQ points, sd 9.3). When we plotted change in IQ over time we observed two different developmental trajectories: in 8 children there was a further decrease of IQ after remission of SWAS (mean decrease of 8.1 IQ points, sd 4.8) and in 9 children an increase (mean increase of 15.9 IQ points, sd 11.0). The group with a decrease of IQ had a significantly earlier first assessment of SWAS. Our results reinforce the classification of (D)EE-SWAS as a true epileptic encephalopathy and suggest that an earlier onset of SWAS is related to poorer neurodevelopmental outcome.
{"title":"Intelligence outcomes in 17 patients with developmental and/or epileptic encephalopathy with spike-wave activation in sleep ((D)EE-SWAS) after remission of SWAS","authors":"M.M.L. van Arnhem , H.C. van Teeseling , L. van den Berg , K.P.J. Braun , F.E. Jansen","doi":"10.1016/j.yebeh.2025.110806","DOIUrl":"10.1016/j.yebeh.2025.110806","url":null,"abstract":"<div><div>Developmental and/or Epileptic encephalopathy with spike-wave activation in sleep ((D)EE-SWAS) is an age related epilepsy syndrome that is associated with, often profound, cognitive deterioration in childhood. Although the EEG pattern in (D)EE-SWAS resolves, cognitive deficits persist during adulthood. Studies assessing objective cognitive outcomes after resolution of the EEG SWAS pattern are scarce. In this study we assessed intelligence quotient (IQ) scores after remission of SWAS in seventeen patients with a history of (D)EE-SWAS. In all patients with IQ data available before the onset of SWAS there was a profound decline in IQ during (D)EE-SWAS (mean decline –22.1 IQ points, sd 9.3). When we plotted change in IQ over time we observed two different developmental trajectories: in 8 children there was a further decrease of IQ after remission of SWAS (mean decrease of 8.1 IQ points, sd 4.8) and in 9 children an increase (mean increase of 15.9 IQ points, sd 11.0). The group with a decrease of IQ had a significantly earlier first assessment of SWAS. Our results reinforce the classification of (D)EE-SWAS as a true epileptic encephalopathy and suggest that an earlier onset of SWAS is related to poorer neurodevelopmental outcome.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"173 ","pages":"Article 110806"},"PeriodicalIF":2.3,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451364","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 : 2025-11-04DOI: 10.1016/j.yebeh.2025.110794
Ahmed Ayaz , Syeda Amrah Hashmi , Muhammad Ibrahim , Sameer Sharma , Muhammad Asjad Abbas , Ifrah Zawar
Background
SeLECT score identifies patients at high risk of post-stroke epilepsy(PSE). This systematic review summarizes the effectiveness of SeLECT and its modified versions in predicting PSE risk.
Methods
A systematic search was done from inception to 21st July 2025. Studies using SeLECT score to predict the risk of PSE were included. Two authors independently screened and collected data. Due to the heterogeneity of the studies, a meta-analysis could not be done.
Results
Of 3079 articles, 15 were included. Over 10,000 S patients from eleven countries were studied. The original SeLECT score showed high predictive accuracy for PSE in cohorts from Switzerland, Austria, Germany, and Italy. In China, combining SeLECT with IL-1β increased the area under the curve(AUC) from 0.756 to 0.933. In Turkey, adding the severity of diabetes and leukoaraiosis to SeLECT raised AUC from 0.893 to 0.955. Japanese investigators proposed a modified SeLECT score by including cortical superficial siderosis, increasing the model’s accuracy(AUC = 0.84). SeLECT 2.0, SeLECT-ASyS, and SeLECT-EEG are modified versions of SeLECT, incorporating seizure type (status epilepticus vs. short seizure) and EEG findings to enhance PSE risk and mortality prediction. In multicenter cohorts, SeLECT 2.0 showed good discrimination (C-statistic = 0.78), while SeLECT-ASyS outperformed SeLECT in training (C = 0.68 vs. 0.58) and validation cohorts (C = 0.70 vs. 0.50). Among stroke patients without acute symptomatic seizures (ASyS), SeLECT-EEG improved time-to-PSE prediction (C = 0.75 vs. 0.71).
Conclusion
SeLECT is an easy-to-use tool that can predict PSE risk. Modification of SeLECT to include factors such as IL-1B, diabetes, leukoaraiosis, superficial siderosis, status epilepticus, ASyS, and EEG using an algorithmic approach should be investigated to increase the accuracy of predicting PSE risk.
背景:SeLECT评分可识别卒中后癫痫(PSE)高危患者。本系统综述总结了SeLECT及其修正版本在预测PSE风险方面的有效性。方法:系统检索自成立至2025年7月21日。纳入了使用SeLECT评分预测PSE风险的研究。两位作者独立筛选和收集数据。由于研究的异质性,不能进行meta分析。结果:3079篇文献中,纳入15篇。研究人员对来自11个国家的1万多名患者进行了研究。最初的SeLECT评分在来自瑞士、奥地利、德国和意大利的队列中显示出较高的PSE预测准确性。在中国,SeLECT与IL-1β联合使曲线下面积(AUC)从0.756增加到0.933。在土耳其,在SeLECT中加入糖尿病和白化病的严重程度将AUC从0.893提高到0.955。日本研究人员提出了一个改进的SeLECT评分,包括皮质浅表性铁沉着,提高了模型的准确性(AUC = 0.84)。SeLECT 2.0、SeLECT- asys和SeLECT-EEG是SeLECT的改进版本,结合了癫痫发作类型(癫痫持续状态vs.短暂发作)和脑电图结果,以提高PSE风险和死亡率预测。在多中心队列中,SeLECT 2.0具有良好的判别性(C-statistic = 0.78),而SeLECT- asys在训练队列(C = 0.68 vs. 0.58)和验证队列(C = 0.70 vs. 0.50)中优于SeLECT。在无急性症状性癫痫发作(ASyS)的脑卒中患者中,SeLECT-EEG改善了时间到pse的预测(C = 0.75 vs. 0.71)。结论:SeLECT是一种易于使用的预测PSE风险的工具。修改SeLECT以包括IL-1B、糖尿病、白质变、浅表性铁沉着、癫痫持续状态、ASyS和脑电图等因素,应采用算法方法进行研究,以提高预测PSE风险的准确性。
{"title":"To select or not to select: evaluating the effectiveness of SeLECT score in predicting the risk of post-stroke seizures: a systematic review","authors":"Ahmed Ayaz , Syeda Amrah Hashmi , Muhammad Ibrahim , Sameer Sharma , Muhammad Asjad Abbas , Ifrah Zawar","doi":"10.1016/j.yebeh.2025.110794","DOIUrl":"10.1016/j.yebeh.2025.110794","url":null,"abstract":"<div><h3>Background</h3><div>SeLECT score identifies patients at high risk of post-stroke epilepsy(PSE). This systematic review summarizes the effectiveness of SeLECT and its modified versions in predicting PSE risk.</div></div><div><h3>Methods</h3><div>A systematic search was done from inception to 21st July 2025. Studies using SeLECT score to predict the risk of PSE were included. Two authors independently screened and collected data. Due to the heterogeneity of the studies, a meta-analysis could not be done.</div></div><div><h3>Results</h3><div>Of 3079 articles, 15 were included. Over 10,000 S patients from eleven countries were studied. The original SeLECT score showed high predictive accuracy for PSE in cohorts from Switzerland, Austria, Germany, and Italy. In China, combining SeLECT with IL-1β increased the area under the curve(AUC) from 0.756 to 0.933. In Turkey, adding the severity of diabetes and leukoaraiosis to SeLECT raised AUC from 0.893 to 0.955. Japanese investigators proposed a modified SeLECT score by including cortical superficial siderosis, increasing the model’s accuracy(AUC = 0.84). SeLECT 2.0, SeLECT-ASyS, and SeLECT-EEG are modified versions of SeLECT, incorporating seizure type (status epilepticus vs. short seizure) and EEG findings to enhance PSE risk and mortality prediction. In multicenter cohorts, SeLECT 2.0 showed good discrimination (C-statistic = 0.78), while SeLECT-ASyS outperformed SeLECT in training (C = 0.68 vs. 0.58) and validation cohorts (C = 0.70 vs. 0.50). Among stroke patients without acute symptomatic seizures (ASyS), SeLECT-EEG improved time-to-PSE prediction (C = 0.75 vs. 0.71).</div></div><div><h3>Conclusion</h3><div>SeLECT is an easy-to-use tool that can predict PSE risk. Modification of SeLECT to include factors such as IL-1B, diabetes, leukoaraiosis, superficial siderosis, status epilepticus, ASyS, and EEG using an algorithmic approach should be investigated to increase the accuracy of predicting PSE risk.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"173 ","pages":"Article 110794"},"PeriodicalIF":2.3,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451348","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 : 2025-11-01Epub Date: 2025-09-07DOI: 10.1016/j.yebeh.2025.110687
Wanyue Fang, Shasha Zhang, Fang Zhang, Wenjun Wei, Shoushan Li
Objective: Explore the factors that promote and hinder emotional well-being(EWB) in adolescents with epilepsy(AWE), and provide theoretical evidence for promoting the improvement of EWB in AWEs.
Method: Using purposive sampling, semi-structured interviews were conducted with 16 AWEs aged 13-18 years, and data analysis was performed based on the PERMA model.
Results: Four subthemes of facilitating factors for EWB in AWEs were identified: positive emotions (positive experiences in daily life), engagement (stage-appropriate feasible goals), relationships (harmonious family relationships, supportive peer relationships, and understanding teachers), and accomplishment (stage-appropriate feasible goals). Four subthemes of barrier factors included: diminished positive emotional experiences (stigma associated with epilepsy), restricted engagement (limitations in physical activities), interpersonal conflicts (discordant social atmosphere), and difficult-to-achieve accomplishments (ineffective emotion regulation strategies and unmanageable academic pressure).
Conclusion: Both facilitating and obstructive factors influence EWB in AWEs. Healthcare professionals should focus on leisure activities, interpersonal dynamics, disease awareness, emotion regulation, and academic pressure when developing targeted interventions for patients and their caregivers. These measures aim to enhance patients' sense of meaning and EWB while alleviating epilepsy-related stress.
{"title":"The facilitators and barriers of emotional well-being in Chinese adolescents with epilepsy based on the PERMA model: A qualitative study.","authors":"Wanyue Fang, Shasha Zhang, Fang Zhang, Wenjun Wei, Shoushan Li","doi":"10.1016/j.yebeh.2025.110687","DOIUrl":"10.1016/j.yebeh.2025.110687","url":null,"abstract":"<p><strong>Objective: </strong>Explore the factors that promote and hinder emotional well-being(EWB) in adolescents with epilepsy(AWE), and provide theoretical evidence for promoting the improvement of EWB in AWEs.</p><p><strong>Method: </strong>Using purposive sampling, semi-structured interviews were conducted with 16 AWEs aged 13-18 years, and data analysis was performed based on the PERMA model.</p><p><strong>Results: </strong>Four subthemes of facilitating factors for EWB in AWEs were identified: positive emotions (positive experiences in daily life), engagement (stage-appropriate feasible goals), relationships (harmonious family relationships, supportive peer relationships, and understanding teachers), and accomplishment (stage-appropriate feasible goals). Four subthemes of barrier factors included: diminished positive emotional experiences (stigma associated with epilepsy), restricted engagement (limitations in physical activities), interpersonal conflicts (discordant social atmosphere), and difficult-to-achieve accomplishments (ineffective emotion regulation strategies and unmanageable academic pressure).</p><p><strong>Conclusion: </strong>Both facilitating and obstructive factors influence EWB in AWEs. Healthcare professionals should focus on leisure activities, interpersonal dynamics, disease awareness, emotion regulation, and academic pressure when developing targeted interventions for patients and their caregivers. These measures aim to enhance patients' sense of meaning and EWB while alleviating epilepsy-related stress.</p>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"172 ","pages":"110687"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008175","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}