Epilepsy Research最新文献_第3页

Elevated thalamic blood flow in self-limited epilepsy with centrotemporal spikes 伴有中央颞叶尖峰的自限性癫痫患者丘脑血流量升高

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-12-02 DOI: 10.1016/j.eplepsyres.2025.107716

Niki Iasinovschi , Elizabeth Tong , Lucia Bicknell , Fiona Mitchell Baumer

Children with self-limited epilepsy syndrome with centrotemporal spikes (SeLECTS) exhibit altered thalamocortical connectivity, but whether thalamic function itself is abnormal remains unclear. We investigated whether thalamic blood flow, a marker of metabolism, differs between children with SeLECTS and controls, and examined the effects of spike distribution and antiseizure medications (ASMs) on thalamic perfusion. In this retrospective cohort study, we identified consecutive children with SeLECTS who underwent magnetic resonance imaging (MRI) for epilepsy evaluation (n = 44) and age- and sex-matched children who underwent MRI for non-epilepsy indications (n = 35). We quantified thalamic blood flow via manual segmentation of cerebral blood flow (CBF) sequences obtained from arterial spin labeling MRI. Clinical variables including sedation use during MRI, daily ASM use, and spike distribution (unilateral or bilateral) were extracted from medical records. Children with SeLECTS demonstrated elevated thalamic blood flow compared to controls, with the most pronounced differences in specific subgroups. Children with unilateral spikes showed the highest CBF, particularly in the thalamus contralateral to spike activity. ASM use significantly modulated thalamic blood flow: children taking oxcarbazepine showed the highest CBF, while those on levetiracetam had CBF similar to controls. Unmedicated children showed intermediate elevations. These findings demonstrate that elevated thalamic blood flow may be intrinsic to SeLECTS pathophysiology, with different ASMs producing distinct neurobiological effects. The differential medication effects may relate to their clinical efficacy and provide neurobiological rationale for treatment selection in this common childhood epilepsy syndrome.

伴有中央颞叶尖峰（SeLECTS）的自限性癫痫综合征患儿表现出丘脑皮质连通性改变，但丘脑功能本身是否异常尚不清楚。我们研究了丘脑血流量（代谢标志物）在select患儿和对照组之间是否存在差异，并研究了尖峰分布和抗癫痫药物（asm）对丘脑灌注的影响。在这项回顾性队列研究中，我们确定了连续接受磁共振成像（MRI）进行癫痫评估的select儿童（n = 44）和年龄和性别匹配的接受MRI检查非癫痫适应症的儿童（n = 35）。我们通过手工分割从动脉自旋标记MRI获得的脑血流量（CBF）序列来量化丘脑血流量。从医疗记录中提取临床变量，包括MRI期间镇静使用、每日ASM使用和尖峰分布（单侧或双侧）。与对照组相比，患有select的儿童表现出丘脑血流量升高，在特定亚组中差异最明显。单侧尖峰的儿童表现出最高的CBF，特别是在对侧的丘脑尖峰活动。ASM使用显著调节的丘脑血流：服用奥卡西平的儿童CBF最高，而服用左乙拉西坦的儿童CBF与对照组相似。未服药的儿童表现为中度升高。这些发现表明丘脑血流量升高可能是select病理生理的内在特征，不同的asm产生不同的神经生物学效应。不同的药物效果可能与临床疗效有关，并为这种常见的儿童癫痫综合征的治疗选择提供神经生物学依据。

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引用次数: 0

4-Phenylbutyrate rescues neurobehavioral phenotypes in SLC6A1-related encephalopathy 4-苯基丁酸盐可改善slc6a1相关脑病的神经行为表型。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-12-02 DOI: 10.1016/j.eplepsyres.2025.107708

Karishma Randhave, Kirill Zavalin, Jing-Qiong Kang

Developmental and epileptic encephalopathies (DEEs) caused by pathogenic variants in SLC6A1, encoding γ-aminobutyric acid (GABA) transporter 1 (GAT-1), present with seizures and severe comorbidities including cognitive impairment, developmental delay, motor difficulties, and social deficits. Current therapies focus on seizure reduction but do not address the disabling neurobehavioral symptoms. We previously showed that 4-phenylbutyrate (PBA), known as a chemical chaperone and histone deacetylase inhibitor, restores GAT-1 function and reduces seizures in both mouse models and humans with SLC6A1 variants. Here, we tested whether PBA can improve neurobehavioral deficits in the Slc6a1^+/S295L knock-in mouse model of DEE besides seizure mitigation. Longitudinal behavioral analysis revealed deficits in motor reflexes, locomotion, and sleep correlating patient comorbidities. Slc6a1^+/S295L mice exhibited prolonged righting reflexes in neonates and reduced locomotion at 1 month of age. In home cage monitoring, Slc6a1^+/S295L mice traveled less distance at 1 and 7 months; spent less time hanging at 1, 7, and 10 months; and showed changes in sleep patterns at 7 and 10 months. Acute treatment with intraperitoneal PBA (100 mg/kg/day for 7 days) improved travel at 1 month (27 %) and hanging at 1 month (35 %) and 7 months (24 %). Chronic oral PBA treatment (100 mg/kg/day for 28 days) at 7 months further improved hanging (56 %) and travel (16 %). Both acute and chronic PBA treatments increased sleep in the mutant mouse. These results demonstrate that PBA not only reduces seizures but also mitigates comorbidities including motor and behavioral outcomes in SLC6A1 DEE, supporting its potential as a disease-modifying therapy.

由编码γ-氨基丁酸（GABA）转运蛋白1 （GAT-1）的SLC6A1致病性变异引起的发育性和癫痫性脑病（des），表现为癫痫发作和严重的合并症，包括认知障碍、发育迟缓、运动困难和社交缺陷。目前的治疗侧重于减少癫痫发作，但不解决致残的神经行为症状。我们之前的研究表明，4-苯基丁酸盐（PBA），一种化学伴侣和组蛋白去乙酰化酶抑制剂，在SLC6A1变异的小鼠模型和人类中都能恢复GAT-1功能并减少癫痫发作。在这里，我们测试了PBA是否可以改善Slc6a1+/S295L敲入小鼠模型DEE的神经行为缺陷，除了缓解癫痫发作。纵向行为分析显示运动反射、运动和睡眠缺陷与患者合并症相关。Slc6a1+/S295L小鼠在1月龄时表现出长时间的转正反射和运动减少。在家笼监测中，Slc6a1+/S295L小鼠在1个月和7个月时行走距离较短；在1个月、7个月和10个月时，上吊的时间较少；并在7个月和10个月时显示了睡眠模式的变化。急性腹腔注射PBA（100 mg/kg/天，连续7天）可改善1个月时的行走（27 %）和1个月时（35 %）和7个月时（24 %）。慢性口服PBA治疗（100 mg/kg/天，连用28天）7个月后进一步改善悬挂（56 %）和旅行（16 %）。急性和慢性PBA治疗都增加了突变小鼠的睡眠。这些结果表明，PBA不仅可以减少癫痫发作，还可以减轻SLC6A1 DEE的合并症，包括运动和行为结果，支持其作为一种疾病改善疗法的潜力。

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引用次数: 0

Evaluating the impact of cenobamate in the management in patients with drug resistant focal epilepsy – A retrospective real world observational study of patients attending NHS Greater Glasgow and Clyde 评价cenobamate对耐药局灶性癫痫患者管理的影响——一项对大格拉斯哥和克莱德NHS患者的回顾性观察性研究

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-12-02 DOI: 10.1016/j.eplepsyres.2025.107717

M. Taha , L. Stephen , S. Nichol , S. Yule , S. MacBride-Stewart , AD Marshall , CA Heath

Introduction

Cenobamate (CNB) is the latest ASM to be licensed in the UK as an adjunctive treatment for adults with focal epilepsy. Early clinical trials have been encouraging with up to 50.4 % of patients showing a 50 % improvement at 12 weeks and 71 % were still receiving Cenobamate at 48 months. Regulatory studies of this nature provide useful information, but real-world data is often more informative.

Since Scottish Medicine Consortium approval in 2022, we have been collecting audit data on outcomes from patients receiving cenobamate.

Methods

Adult patients were included if they received at least one prescription for cenobamate between March 2022 and April 2024 and had at least 12 months of data available before their first prescription.

Patients dispensed cenobamate were identified from the national Prescribing Information System (PIS) to ensure complete patient capture.

A manual review of electronic patient records was undertaken. The primary outcome of interest was change in seizure frequency on a stable dose. Secondary outcomes included epilepsy-related admissions, changes in ASMs and healthcare resource utilisation costs.

Results

145 patients received at least 1 CNB prescription, 144 of whom had reached an endpoint. 94/144 (65.2 %) had a favourable response. The median length of treatment was 655 days (range 180–922 days), with a median dose of 150 mg/d (range 25–400 mg/d). The median number of previous ASM was 5 (1−13).

48/145 (33.1 %) discontinued CNB – 35 due to adverse effects, 6 due to lack of efficacy. 2 patients died.

Early analysis suggest a reduction in Health care resource use although long term follow up is required.

Conclusion

These results offer insights for clinicians regarding the real-world effectiveness, retention rates, and healthcare cost implications of CNB therapy in a cohort consisting largely of patients with severe drug resistant epilepsy. Further studies are ongoing to assess the efficacy of CNB when used earlier and also to provide a comprehensive assessment of health care resource use in this real world settings.

cenobamate （CNB）是最新在英国获得许可的ASM，作为成人局灶性癫痫的辅助治疗。早期临床试验结果令人鼓舞，在12周时，50.4% %的患者表现出50% %的改善，而在48个月时，仍有71% %的患者在服用Cenobamate。这种性质的监管研究提供了有用的信息，但真实世界的数据往往更有用。自苏格兰医学联盟于2022年批准以来，我们一直在收集接受cenobamate的患者的结果审计数据。方法纳入在2022年3月至2024年4月期间至少服用过一次cenobamate处方的成年患者，并且在首次处方前至少有12个月的数据。从国家处方信息系统（PIS）中识别分配了cenobamate的患者，以确保完整的患者捕获。对电子病历进行了人工审查。研究的主要结果是在稳定剂量下癫痫发作频率的变化。次要结局包括癫痫相关入院、asm变化和医疗资源利用成本。结果145例患者接受了至少1个CNB处方，其中144例达到终点。94/144（65.2 %）表示赞成。中位治疗时间为655天（180-922天），中位剂量为150 mg/d（25-400 mg/d）。既往ASM中位数为5（1 ~ 13）。48/145（33.1% %）因不良反应停用CNB - 35, 6因缺乏疗效。2例死亡。早期分析表明，尽管需要长期随访，但卫生保健资源的使用有所减少。这些结果为临床医生提供了关于CNB治疗在现实世界中的有效性、保留率和医疗成本影响的见解，这些队列主要由严重耐药癫痫患者组成。目前正在进行进一步的研究，以评估早期使用CNB的效果，并对现实世界环境中卫生保健资源的使用情况进行全面评估。

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引用次数: 0

Analysis of risk factors for recurrence after the withdrawal of ASMs in 135 children with epilepsy. 135例癫痫患儿停药后复发危险因素分析。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-12-01 Epub Date: 2025-08-06 DOI: 10.1016/j.eplepsyres.2025.107638

Yuchen Gao, Xuan Li, Zenghua Yong, Baoqiang Yuan, Yunlong Dou

Objective: To identify risk factors for seizure recurrence following anti-seizure medication (ASM) withdrawal in children with epilepsy who achieved sustained seizure freedom.

Methods: This retrospective cohort study analyzed 135 children with epilepsy from a single tertiary center (2022--2023) meeting withdrawal criteria (aged <16 years, seizure-free ≥2 years on stable ASMs, followed ≥1 year after withdrawal). Participants were grouped by postwithdrawal seizure relapse status: recurrent (n = 42) and nonrecurrent (n = 93). Thirteen risk factors were compared via chi-square tests. Variables significantly associated (P < 0.05) with recurrence in univariate analysis were entered into multivariate logistic regression to identify independent predictors (reported as ORs with 95 % CIs). The analyses were performed with SPSS 19.0.

Results: The overall recurrence rate was 31.11 % (42/135), with 80.95 % of recurrences occurring during ASM tapering or within the first year after withdrawal. Univariate analysis revealed significant differences between the recurrence and nonrecurrence groups regarding prewithdrawal EEG abnormalities (P = 0.006), ASM polytherapy (P = 0.003), time to seizure freedom > 1 year (P = 0.037), pretreatment epilepsy duration > 1 year (P = 0.011), presence of comorbidities (P < 0.001), and multiple seizure types (P = 0.020). Multivariate logistic regression confirmed three independent risk factors for recurrence: (1) abnormal EEG before withdrawal (OR=9.268, 95 % CI: 2.255-38.092, P = 0.002), (2) ASM polytherapy (OR=3.205, 95 % CI: 1.159-8.866, P = 0.025), and (3) pretreatment epilepsy duration > 1 year (OR=5.363, 95 % CI: 1.781-16.150, P = 0.003).

Conclusion: Abnormal EEG before withdrawal, polytherapy, and pretreatment duration > 1 year predicted recurrence. Enzyme-induction patterns showed exploratory associations requiring further validation.

目的：探讨癫痫患儿抗癫痫药物停药后癫痫复发的危险因素。方法：本回顾性队列研究分析了来自单一三级中心（2022- 2023）的135例符合停药标准的癫痫患儿（年龄）。结果：总复发率为31.11 %(42/135)，其中80.95 %的复发发生在ASM逐渐减少或停药后一年内。单变量分析发现复发之间的显著差异,但组织关于prewithdrawal脑电图异常(P = 0.006),ASM polytherapy (P = 0.003),发作时间自由> 1年(P = 0.037),预处理癫痫持续时间> 1年(P = 0.011),出现并发症(P  1年(或= 5.363,95 % CI: 1.781 - -16.150, P = 0.003)。结论：停药前、多药前、预处理时间> 1年脑电图异常预测复发。酶诱导模式显示探索性关联，需要进一步验证。

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引用次数: 0

The SEEG brain network predicts epileptic surgical outcomes of radiofrequency thermocoagulation SEEG脑网络预测射频热凝的癫痫手术结果。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-29 DOI: 10.1016/j.eplepsyres.2025.107715

Jingxian Shen , Hongping Tan , Bocheng Wu , Jiabin Luo , Guangrui Yang , Xuchu Weng , Qiang Guo , Jiuxing Liang

Predicting the postoperative outcome of stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) remains challenging despite its increasing use in epilepsy treatment. Although SEEG-guided RF-TC has attracted extensive clinical interest, reliable biomarkers for treatment efficacy are still lacking. This study aims to address this gap by analyzing the altered brain network to predict postoperative outcome. Thirty-one focal cortical dysplasia epileptic patients who underwent RF-TC based on SEEG were enrolled in this study. They were included in the favorable outcome and poor outcome groups according to the follow-up. Partial Directed Coherence and Directed Transfer Function were applied to construct SEEG brain networks, and then brain network features were extracted. Subsequently, the differences in the presurgical and postsurgical brain network features were compared using the Wilcoxon test in the favorable and poor outcome groups, respectively. Finally, four machine learning models were applied to predict the outcome of RF-TC. After RF-TC surgery, the Characteristic Path Length (L) and average Betweenness Centrality (BC) increased while the average Clustering Coefficient (C) and Assortativity Coefficient (R1, R2) decreased in the favorable outcomes group. In contrast, there were no significant changes in the patient group with poor outcomes. The Support Vector Machine (SVM) model achieved the highest performance, with accuracy, sensitivity, specificity, and ROC values of 0.887, 0.821, 0.920, and 0.879, respectively. This study sheds light on the mechanisms of epilepsy from the perspective of brain networks and introduces a novel therapeutic strategy by altering network features. These feature alterations can also support machine learning models in effectively distinguishing favorable from poor outcomes.

尽管立体脑电图引导的射频热凝术（SEEG-guided RF-TC）在癫痫治疗中的应用越来越多，但预测其术后结果仍然具有挑战性。尽管seeg引导的RF-TC已经引起了广泛的临床兴趣，但仍然缺乏可靠的治疗效果生物标志物。本研究旨在通过分析改变的脑网络来预测术后结果来解决这一差距。31例局灶性皮质发育不良癫痫患者接受了基于SEEG的RF-TC治疗。根据随访情况分为预后良好组和预后不良组。利用部分有向相干和有向传递函数构建SEEG脑网络，提取脑网络特征。随后，分别使用Wilcoxon检验比较好结局组和差结局组术前和术后脑网络特征的差异。最后，应用四种机器学习模型来预测RF-TC的结果。结果良好组RF-TC术后特征路径长度(L)和平均中间性中心性（BC）增加，平均聚类系数(C)和分类系数（R1, R2）下降。相比之下，预后较差的患者组没有明显变化。支持向量机（Support Vector Machine， SVM）模型的准确率、灵敏度、特异度和ROC值分别为0.887、0.821、0.920和0.879。本研究从脑网络的角度揭示了癫痫的发病机制，并提出了一种通过改变脑网络特征来治疗癫痫的新策略。这些特征的改变也可以支持机器学习模型有效地区分有利和不利的结果。

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引用次数: 0

Real-world evidence on the use of new antiseizure medications in brain tumor–related epilepsy 新的抗癫痫药物用于脑肿瘤相关癫痫的真实证据。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-22 DOI: 10.1016/j.eplepsyres.2025.107709

Nasim Tabrizi , Mehran Frouzanian , Sajad Shafiee , Reza Alizadeh-Navaei

Objective

Brain tumor-related epilepsy (BTRE) is a common and disabling complication of primary brain tumors. While older antiseizure medications (ASMs) are limited by adverse effects and drug interactions, newer ASMs such as levetiracetam (LEV), lamotrigine (LTG), and lacosamide (LCS) may offer better tolerability and seizure control. This study aimed to evaluate the efficacy and safety of these newer ASMs in patients with BTRE.

Methods

A retrospective observational study was conducted on BTRE patients treated between 2018 and 2023 at a university hospital and private neurology clinics. Adult patients with primary brain tumors and at least one seizure episode were included if treated with LEV, LTG, or LCS either as monotherapy or in polytherapy. Data on demographics, tumor characteristics, treatment strategies, seizure outcomes, and adverse events were collected. The primary outcomes were 12-month seizure freedom and retention rate.

Results

A total of 106 patients (mean age 55.3 ± 15.3 years; 52.8 % male) were analyzed. Monotherapy with LEV, LTG, or LCS was used in 74 patients, achieving an overall 12-month seizure freedom of 64.9 % and retention rate of 79.7 %. No significant differences in seizure freedom were found among the three monotherapies (p = 0.258).

Conclusion

Newer ASMs demonstrated favorable seizure control and tolerability in BTRE. LEV remains the most used agent, though LTG and LCS showed comparable efficacy. Tumor and treatment-related factors influenced outcomes more than ASM choice.

目的：脑肿瘤相关性癫痫（BTRE）是原发性脑肿瘤常见的致残并发症。虽然较老的抗癫痫药物（asm）受到不良反应和药物相互作用的限制，但较新的asm，如左乙拉西坦（LEV），拉莫三嗪（LTG）和拉科沙胺（LCS）可能具有更好的耐受性和癫痫发作控制。本研究旨在评估这些新asm在BTRE患者中的疗效和安全性。方法：回顾性观察研究2018 - 2023年在某大学医院和私立神经病学诊所治疗的BTRE患者。原发性脑肿瘤且至少有一次癫痫发作的成年患者，无论是单独治疗还是联合治疗，均纳入LEV、LTG或LCS治疗。收集了人口统计学、肿瘤特征、治疗策略、癫痫发作结局和不良事件的数据。主要观察指标为12个月癫痫发作自由率和滞留率。结果：共分析106例患者，平均年龄55.3 ± 15.3岁，男性52.8 %。74例患者采用LEV、LTG或LCS单药治疗，总体12个月癫痫发作自由度为64.9 %，保留率为79.7% %。三种单药治疗的癫痫发作自由度差异无统计学意义（p = 0.258）。结论：较新的asm在BTRE中表现出良好的癫痫控制和耐受性。LEV仍然是最常用的药物，尽管LTG和LCS的疗效相当。肿瘤和治疗相关因素对预后的影响大于ASM选择。

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引用次数: 0

Automated detection of the epileptogenic zone in stereoelectroencephalography for drug-resistant epilepsy using multi-epileptogenic biomarker machine learning 应用多致痫生物标志物机器学习在立体脑电图中自动检测耐药癫痫的致痫区。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-22 DOI: 10.1016/j.eplepsyres.2025.107710

Chuan Du , Weipeng Jin , Le Wang , Jingtao Yan , Guangfeng Li , Yuzhang Wu , Guangrui Zhao , Jingheng Wu , Deqiu Cui , Shaoya Yin

Objective

Neurosurgery is a viable treatment option for patients with drug-resistant epilepsy (DRE), where accurate localization of the epileptogenic zone (EZ) is crucial for surgical success. This study aims to develop an interpretable machine learning (ML) framework that integrates electrophysiological features to enhance EZ localization.

Methods

We retrospectively reviewed patients with DRE who underwent stereoelectroencephalography (SEEG) exploration between January 2020 and December 2023. Multiple epileptogenic biomarkers, including the Epileptogenicity Index (EI), spike rate, ripple rate, and fast ripple rate, were computed. For improved EZ localization, model development was conducted using various machine learning algorithms that integrated these interictal and ictal electrophysiological features. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). SHapley Additive exPlanations (SHAP) were employed to interpret the ML models.

Results

A total of 38 patients with 1671 SEEG channels were included in the final analysis. Four ML models were tested, achieving AUCs ranging from 0.767 to 0.798 for predicting the EZ in patients with DRE. Among these, the deep learning model demonstrated the highest performance, with an AUC of 0.798, and was selected as the optimal predictive model. SHAP analysis identified spike rate and the EI as the most influential features, underscoring their dominant role in the model's decision-making.

Conclusion

Machine learning is a reliable tool for predicting the epileptogenic zone in patients with drug-resistant epilepsy. The use of SHAP methods to interpret the deep learning model offers clinically relevant insights and may assist clinicians in optimizing patient-specific management strategies.

目的：神经外科手术是耐药癫痫（DRE）患者的一种可行的治疗选择，其中准确定位癫痫区（EZ）对手术成功至关重要。本研究旨在开发一种可解释的机器学习（ML）框架，该框架集成了电生理特征，以增强EZ定位。方法：我们回顾性分析了2020年1月至2023年12月期间接受立体脑电图（SEEG）探查的DRE患者。计算多种致痫性生物标志物，包括致痫性指数（EI）、峰值率、纹波率和快速纹波率。为了改进EZ定位，使用各种机器学习算法进行模型开发，这些算法集成了这些间歇期和间歇期电生理特征。使用接收器工作特征曲线下面积（AUC）评估模型性能。采用SHapley加性解释（SHAP）解释ML模型。结果：38例患者共1671个SEEG通道纳入最终分析。对四种ML模型进行了测试，预测DRE患者EZ的auc范围为0.767至0.798。其中，深度学习模型表现最好，AUC为0.798，被选为最优预测模型。SHAP分析发现尖峰率和EI是最具影响力的特征，强调了它们在模型决策中的主导作用。结论：机器学习是预测耐药癫痫患者致痫区可靠的工具。使用SHAP方法来解释深度学习模型提供了与临床相关的见解，并可能帮助临床医生优化针对患者的管理策略。

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引用次数: 0

Time-dependent risk of stroke following epilepsy: A nationwide cohort study in South Korea 癫痫后中风的时间依赖性风险：韩国一项全国性队列研究

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-22 DOI: 10.1016/j.eplepsyres.2025.107695

Seung Won Lee , Yejin Lee , Chaeyoon Kang , Haerim Cho , Nakyung Shin , Sunhwa Kim , Hohyun Jung , Youngoh Bae

Background

Epilepsy(ICD-10 G40–G41) and stroke—including hemorrhagic stroke (HS: I60–I62) and ischemic stroke (IS: I63))—are major neurological disorders. Although epilepsy has been proposed as a risk factor for stroke, large-scale evidence from Asian populations and analyses of time-dependent risk remain limited. This study investigated long-term risks of HS and IS after epilepsy using a nationwide cohort in South Korea.

Methods

A population-based retrospective cohort study was conducted using the Korean National Health Insurance Service–National Sample Cohort (2002–2013). Newly diagnosed epilepsy cases were identified after a 2-year washout and matched 1:10 with controls. Incident HS and IS were evaluated using crude incidence rates (IRs), incidence rate ratios (IRRs), Kaplan–Meier analyses, and 2-year interval time-stratified Cox models.

Results

Over 10 years of follow-up, epilepsy was associated with increased risks of HS (IRR 3.50, 95 % CI 2.50–4.91) and IS (IRR 2.52, 95 % CI 2.16–2.95). Risk elevations were more pronounced in males and individuals < 60 years. Time-dependent analyses revealed a biphasic pattern: HS risk peaked during the first 0–2 years (aHR 4.25, 95 % CI 2.68–6.74), while IS risk increased at 0–2 years (aHR 2.99, 95 % CI 2.41–3.71) and again at 6–8 years (aHR 3.00, 95 % CI 1.51–5.99).

Conclusion

Epilepsy was associated with substantial and time-varying risks of HS and IS. Although causal relationships cannot be confirmed, these findings highlight the need for vigilant early monitoring and sustained, individualized stroke prevention strategies in individuals with epilepsy.

癫痫（ICD-10 G40-G41）和中风（包括出血性中风（HS: I60-I62）和缺血性中风（IS: I63））是主要的神经系统疾病。虽然癫痫已被认为是中风的一个危险因素，但来自亚洲人群的大规模证据和对时间依赖性风险的分析仍然有限。本研究通过韩国全国队列调查癫痫后HS和IS的长期风险。方法采用韩国国民健康保险服务-国民样本队列（2002-2013）进行基于人群的回顾性队列研究。新诊断的癫痫病例在2年洗脱期后确定，并与对照组1:10匹配。使用粗发病率（IRs）、发病率比（IRRs）、Kaplan-Meier分析和2年间隔时间分层Cox模型对HS和IS事件进行评估。结果随访10年，癫痫与HS （IRR 3.50, 95 % CI 2.50-4.91）和IS （IRR 2.52, 95 % CI 2.16-2.95）风险增加相关。风险升高在男性和60岁以上的个体中更为明显。时间相关分析显示了双相模式：HS风险在前0-2年达到顶峰（aHR 4.25, 95 % CI 2.68-6.74），而IS风险在0-2年增加（aHR 2.99, 95 % CI 2.41-3.71），在6-8年再次增加（aHR 3.00, 95 % CI 1.51-5.99）。结论癫痫与HS和IS的风险存在显著的时变相关性。虽然因果关系不能得到证实，但这些发现强调了对癫痫患者进行警惕的早期监测和持续的、个性化的中风预防策略的必要性。

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引用次数: 0

Surgery for epilepsy secondary to vascular insults: A systematic review and meta-analysis of individual patient data 继发性血管损伤癫痫的手术治疗：对个体患者数据的系统回顾和荟萃分析。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-21 DOI: 10.1016/j.eplepsyres.2025.107711

Adrian E. Jimenez, Neil A. Feldstein, Guy M. McKhann, E. Sander Connolly, Brett E. Youngerman

Background

While epilepsy secondary to vascular insults represents a well-documented cause of drug-resistant epilepsy that requires surgical intervention for optimal management, the prognostic factors for postoperative seizure-freedom among this patient population have not been well-established. This individual-patient data (IPD) meta-analysis aimed to 1) determine prognostic factors associated with seizure-freedom postoperatively and 2) factors associated with postoperative complications.

Methods

This study was a PRISMA-compliant systematic review and IPD meta-analysis involving studies relating to the surgical treatment of post-stroke epilepsy. An IPD meta-analysis was conducted using mixed-effects, multivariable logistic regression models to identify predictors of seizure freedom (Engels class I or International League Against Epilepsy [ILAE] class 1 or 2) and postoperative complications.

Results

A total of 11 studies provided patient-level data for our IPD meta-analysis. Our results demonstrated that etiology of cerebrovascular insult, specifically ischemic or hemorrhagic stroke when compared to ulegyria, was significantly and independently associated with higher odds of postoperative seizure-freedom (OR=10.21, p = 0.031). Further, patients with a greater number of years between epilepsy onset and surgical treatment were significantly less likely to experience seizure-freedom postoperatively (OR=0.93, p = 0.023). Patients with ischemic or hemorrhagic strokes were significantly less likely to experience a postoperative complication relative to patients with ulegyria in univariate analysis (OR=0.053, p = 0.015), and this association remained significant in multivariable analysis (OR=0.16, p = 0.035).

Conclusion

Our findings synthesize the existing literature on the surgical treatment of stroke-related epilepsy and establish important prognostic factors for seizure-freedom in this patient population. We hope our results are useful in guiding future research efforts and further optimizing postoperative outcomes.

背景：虽然继发于血管损伤的癫痫是一种有充分文献记载的耐药癫痫的病因，需要手术干预以获得最佳治疗，但在这类患者群体中，术后癫痫发作自由的预后因素尚未确定。这项个体患者数据（IPD）荟萃分析旨在1)确定与术后癫痫发作自由相关的预后因素和2)与术后并发症相关的因素。方法：本研究是一项符合prisma标准的系统评价和IPD荟萃分析，涉及与卒中后癫痫手术治疗相关的研究。采用混合效应、多变量logistic回归模型进行IPD荟萃分析，以确定癫痫发作自由（恩格斯I级或国际抗癫痫联盟[ILAE] 1级或2级）和术后并发症的预测因素。结果：共有11项研究为我们的IPD荟萃分析提供了患者水平的数据。我们的研究结果表明，与尿失禁相比，脑血管损伤的病因学，特别是缺血性或出血性中风，与术后癫痫自由发作的几率较高有显著且独立的相关性（or =10.21, p = 0.031）。此外，癫痫发作和手术治疗之间的时间间隔较长的患者术后癫痫发作自由的可能性显着降低（OR=0.93, p = 0.023）。在单因素分析中，缺血性或出血性卒中患者发生术后并发症的可能性明显低于尿路患者（or =0.053, p = 0.015），在多变量分析中，这种相关性仍然显著（or =0.16, p = 0.035）。结论：我们的研究结果综合了卒中相关癫痫手术治疗的现有文献，并确定了卒中相关癫痫患者癫痫发作自由的重要预后因素。我们希望我们的结果对指导未来的研究工作和进一步优化术后结果有用。

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引用次数: 0

Hippocampal, fornix, and mammillary body atrophy in patients with mesial temporal sclerosis 内侧颞叶硬化患者的海马、穹窿和乳状体萎缩

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-21 DOI: 10.1016/j.eplepsyres.2025.107713

Mia Mojica , Hannah Fleming , Timo Krings , Mary Pat McAndrews

This study investigates structural changes in the hippocampus, fornix, and mammillary bodies in patients with mesial temporal sclerosis (MTS), examining their relationship to clinical characteristics and association with memory performance. We conducted a retrospective study involving 104 patients with unilateral MTS and 47 age-matched healthy controls. Automatic segmentation of MRI scans was performed to calculate volumes, and atrophy was assessed relative to average values in the control group. Volume differences between patients and controls as well as associations of circuit atrophy with clinical features and memory impairment were examined. In the left MTS group, all three structures showed significantly lower normalized volumes compared to healthy controls whereas atrophy was confined to the hippocampus and fornix in the right MTS group. No significant correlations were found between atrophy and disease duration or age at seizure onset for any structure, though age at MRI was significantly correlated with hippocampal atrophy. Volume reductions in each of the circuit endpoints (hippocampus and mammillary bodies) were correlated with the degree of atrophy in the bridging white matter structure, the fornix. Lastly, comparisons between subgroups with hippocampal atrophy only versus those with greater circuit damage revealed no significant differences in memory scores, age of onset, or duration. Our findings support the view that MTS involves network-level degeneration affecting multiple memory-related structures beyond the hippocampus. Unexpectedly, no significant associations were found between atrophy and clinical or memory measures, suggesting structural damage in this portion of the Papez circuit may be of limited clinical relevance in this population.

本研究探讨了内侧颞叶硬化（MTS）患者海马、穹窿和乳状体的结构变化，研究了它们与临床特征和记忆表现的关系。我们进行了一项回顾性研究，涉及104例单侧MTS患者和47例年龄匹配的健康对照。对MRI扫描进行自动分割以计算体积，并相对于对照组的平均值评估萎缩。检查了患者和对照组之间的体积差异以及电路萎缩与临床特征和记忆障碍的关联。在左侧MTS组中，与健康对照组相比，所有三个结构的标准化体积都显着降低，而在右侧MTS组中，萎缩仅限于海马和穹窿。对于任何结构而言，萎缩与疾病持续时间或癫痫发作年龄之间均未发现显著相关性，尽管MRI年龄与海马萎缩显著相关。每个回路端点（海马和乳状体）的体积减少与桥接白质结构穹窿的萎缩程度相关。最后，比较只有海马萎缩的亚组和有更大回路损伤的亚组，发现在记忆评分、发病年龄或持续时间方面没有显著差异。我们的研究结果支持MTS涉及影响海马以外多个记忆相关结构的网络级退化的观点。出乎意料的是，在萎缩和临床或记忆测量之间没有发现显著的关联，这表明这部分Papez回路的结构损伤在该人群中可能具有有限的临床相关性。

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引用次数: 0