Epilepsy Research最新文献_第4页

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

Long-term administration of EQU-001 (ivermectin) suppresses spasms in a rat model of infantile epileptic spasms syndrome 长期服用伊维菌素（eque -001）可抑制婴儿癫痫痉挛综合征大鼠模型中的痉挛。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-21 DOI: 10.1016/j.eplepsyres.2025.107712

Chian-Ru Chern , Antonia Schonwald , Kayla Vieira , Jana Velíšková , Libor Velíšek

We investigated effects of long-term and acute administration of EQU-001 (ivermectin) against NMDA-triggered spasms in immature rats prenatally exposed to betamethasone and in the model of infantile epilepsy spasms syndrome (IESS). Pregnant rats were injected with betamethasone on gestational day 15 (2 ×0.4 mg/kg, i.p.). Offspring were injected with ivermectin once daily (1–4 mg/kg, i.p.) from postnatal day (P) 10 through P15. Spasms were triggered on P15 with NMDA (17 mg/kg, i.p.). Other rats received a single dose of ivermectin (1–8 mg/kg, i.p.) on P15 prior to NMDA to test acute anticonvulsant activity. Also, a randomized model was used: The spasms were triggered on P12 and ivermectin treatment (4 mg/kg) was initiated after this bout of spasms on P12, P13 and P14, with additional spasms elicited on P13 and P15. A nicotinic cholinergic α7 agonist was used to mimic effects of ivermectin, and α7 antagonist was used together with ivermectin to prevent its effects. P10-P15 administration of 4 mg/kg of ivermectin significantly suppressed occurrence of spasms on P15, an effect comparable to that of ACTH (positive control). Conversely, an acute P15 administration of ivermectin had no effects on spasms. Ivermectin in the randomized trial suppressed occurrence of spasms as well P15/P12 ratio of spasms. Ivermectin also decreased body weight gain in those animals. None of the nicotinic cholinergic α7 drugs mimicked or prevented effects of ivermectin. Our data indicate that ivermectin may become a powerful tool in the armamentarium for treatment of IESS, however the mechanisms of this action remain to be determined.

我们在产前暴露于倍他米松的未成熟大鼠和婴儿癫痫痉挛综合征（IESS）模型中研究了长期和急性给药eque -001（伊维菌素）对nmda引发的痉挛的影响。妊娠大鼠在妊娠第15天注射倍他米松（2 ×0.4 mg/kg, i.p.）。子代从出生后第10天至第15天每天注射1次伊维菌素（1-4 mg/kg, i.p）。NMDA（17 mg/kg, i.p.）在P15上触发痉挛。其他大鼠在NMDA之前的P15给予单剂量伊维菌素（1-8 mg/kg, i.p），以测试急性抗惊厥活性。另外，采用随机模型：痉挛在P12部位触发，在P12、P13和P14部位痉挛发作后开始伊维菌素治疗（4 mg/kg）， P13和P15部位痉挛。采用烟碱类胆碱能α7激动剂模拟伊维菌素的作用，α7拮抗剂与伊维菌素联用抑制其作用。给药4 mg/kg伊维菌素可显著抑制P10-P15痉挛的发生，其效果与ACTH（阳性对照）相当。相反，急性P15给药伊维菌素对痉挛没有影响。伊维菌素在随机试验中抑制痉挛的发生以及痉挛的P15/P12比率。伊维菌素还减少了这些动物的体重增加。烟碱能α7类药物均不能模拟或阻止伊维菌素的作用。我们的数据表明，伊维菌素可能成为治疗IESS的有力工具，但这种作用的机制仍有待确定。

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引用次数: 0

Allostatic load of immune cells in the spleen and brain of the Kcna1-null mouse model of temporal lobe epilepsy kcna1缺失小鼠颞叶癫痫模型脾和脑免疫细胞的适应负荷

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-19 DOI: 10.1016/j.eplepsyres.2025.107697

Jillian E. Hinman , Ankita Aggarwal, Amberlee Haggerty, Stephanie A. Matthews, Malavika Deodhar, Shruthi Iyer, Kristina A. Simeone, Timothy A. Simeone

Human temporal lobe epilepsy (TLE), particularly drug-resistant TLE, is associated with chronic peripheral immune activation. Here, we determined whether a similar association was detectable in a genetic mouse model of TLE with spontaneous recurrent seizures (SRS), Kcna1-null mice. Flow cytometry was used with fluorescence-activated cell sorting to determine the presence of lymphocytes, macrophages and granulocytes in isolated brain and spleen of wildtype (WT) and Kcna1-null mice. Splenic analysis revealed uniformly elevated Mac-1⁺MHC-II⁺ macrophages across all epileptic mice, whereas CD8⁺ cytotoxic T-cells increased proportionally with severe seizure frequency and burden, resulting in reduced CD4⁺/CD8⁺ ratios—an immune risk phenotype. Brain tissue showed increased infiltration of both CD4⁺ and CD8⁺ T-cells. Importantly, Kv1.1 was not expressed on T-cells of WT mice. Using an allostatic interpretative framework, our results indicate that the immune system anticipates ongoing challenges (SRS) and maintains elevated readiness with an allostatic shift towards chronic adaptation (macrophages), but in doing so potentially damaging dynamic allostatic loads (CD8⁺ T-cells) are accumulated. The Kcna1-null model provides a valuable tool for investigating epilepsy immunopathogenesis without chemoconvulsant confounds. These findings support the notion that TLE has a significant immunological component which may participate in pathology and be a target for intervention.

人类颞叶癫痫（TLE），特别是耐药TLE，与慢性外周免疫激活有关。在这里，我们确定是否在TLE与自发性复发性癫痫（SRS）的遗传小鼠模型中检测到类似的关联，kcna1缺失小鼠。采用流式细胞术和荧光活化细胞分选法检测野生型（WT）和kcna1缺失小鼠离体脑和脾脏中淋巴细胞、巨噬细胞和粒细胞的存在。脾分析显示，所有癫痫小鼠的Mac-1+MHC-II+巨噬细胞均升高，而CD8+细胞毒性t细胞随着癫痫发作频率和负担的加重而成比例增加，导致CD4+/CD8+比例降低，这是一种免疫风险表型。脑组织CD4+和CD8+ t细胞浸润均增加。重要的是，Kv1.1没有在WT小鼠的t细胞上表达。使用适应解释框架，我们的研究结果表明，免疫系统预测持续的挑战（SRS），并通过适应向慢性适应（巨噬细胞）的转变保持高准备状态，但在这样做时，潜在的破坏性动态适应负荷（CD8+ t细胞）会累积。Kcna1-null模型为研究无化学惊厥药混杂的癫痫免疫发病机制提供了一个有价值的工具。这些发现支持了这样一种观点，即TLE具有重要的免疫学成分，可能参与病理并成为干预的目标。

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引用次数: 0

Predictors of surgical outcome in frontal lobe epilepsy: Experience from a single-center cohort in Latin America 额叶癫痫手术预后的预测因素：来自拉丁美洲单中心队列的经验。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-19 DOI: 10.1016/j.eplepsyres.2025.107693

Diana Margoth Riaño-Carreño , Andrés Felipe Cardenas , Jacobo Ramirez-Triana , Carmela Fawcett Martínez , Santiago Martínez Corredor , Sergio Esteban Chacón , Oscar Zorro Guio , Juan Carlos Perez Poveda , Daniel Nariño González

Background

Frontal lobe epilepsy (FLE) is the second most common type of focal epilepsy and among the most challenging to diagnose and treat. Although surgical resection offers potential seizure freedom, outcomes vary, and high-quality data from low- and middle-income countries are scarce. This study aimed to describe a cohort of patients with FLE undergoing epilepsy surgery and identify clinical, imaging, and pathological factors associated with favorable outcomes.

Methods

A retrospective observational study was conducted on 40 consecutive patients with drug-resistant FLE who underwent resective epilepsy surgery at a tertiary center in Bogotá, Colombia, between 2016 and 2024. Data on clinical features, neuroimaging, surgery, and histopathology were collected. Surgical outcomes were classified using the Engel Epilepsy Surgery Outcome Scale; Engel class I or II was considered favorable. Bivariate analyses were performed to identify predictors of good outcomes.

Results

Median age at surgery was 25.5 years (IQR: 14.8–34.8); 67.5 % were male and 92.5 % right-handed. Semiological group 1 (motor/premotor cortex) was most common (75 %). At median 29.7 months follow-up, 57.5 % achieved favorable outcomes. Astrogliosis was the only histopathological finding significantly associated with favorable outcomes among resective cases (p = 0.041). Trends toward better outcomes were seen in patients with standard resections (p = 0.053) and identifiable lesions, though not statistically significant.

Conclusions

Epilepsy surgery for FLE is feasible and safe in middle-income countries and can yield outcomes similar to global reports. These results underscore the importance of early referral, detailed semiological analysis, and lesion detection for surgical planning in drug-resistant FLE.

背景：额叶癫痫（FLE）是第二常见的局灶性癫痫类型，也是最具挑战性的诊断和治疗之一。尽管手术切除可能使癫痫发作自由，但结果各不相同，而且来自低收入和中等收入国家的高质量数据很少。本研究旨在描述一组接受癫痫手术的FLE患者，并确定与良好预后相关的临床、影像学和病理因素。方法：对2016年至2024年在哥伦比亚波哥大三级中心连续40例接受切除性癫痫手术的耐药FLE患者进行回顾性观察研究。收集临床特征、神经影像学、手术和组织病理学资料。采用Engel癫痫手术结果量表对手术结果进行分类；恩格尔I级或II级被认为是有利的。进行双变量分析以确定预后良好的预测因素。结果：手术年龄中位数为25.5岁（IQR: 14.8-34.8）；67.5 %为男性，92.5 %为右撇子。符号学组1（运动/前运动皮层）最常见（75% %）。在中位29.7个月的随访中，57.5 %获得了良好的结果。星形胶质细胞增生是各病例中唯一与预后显著相关的组织病理学发现（p = 0.041）。在标准切除（p = 0.053）和可识别病变的患者中可以看到更好的结果趋势，尽管没有统计学意义。结论：癫痫手术治疗FLE在中等收入国家是可行和安全的，并且可以产生与全球报告相似的结果。这些结果强调了早期转诊、详细的符号学分析和病变检测对耐药FLE手术计划的重要性。

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引用次数: 0

The utility of ketogenic diet therapy in the management of epileptic spasms: A systematic review and meta-analysis 生酮饮食疗法在癫痫性痉挛治疗中的应用：一项系统综述和荟萃分析。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-15 DOI: 10.1016/j.eplepsyres.2025.107694

Gabriella Yakemow , Stephanie Aleluya , Rajesh Ramachandrannair , Kevin C. Jones , Jessie Cunningham , Myanca Rodrigues , Vann Chau , Suvasini Sharma , Puneet Jain , Robyn Whitney

Objective

We systematically reviewed the existing literature on the efficacy of the ketogenic diet (KD) in patients with epileptic spasms (ES) and analyzed predictors of seizure outcomes.

Methods

The Preferred Report Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. The primary outcome was the proportion of patients achieving 50–99 % spasm reduction at 3 months following KD initiation. Additional outcomes included the proportion of patients achieving complete spasm freedom at 1, 3, and 6 months. Meta-regression was employed to examine clinical determinants of seizure outcomes.

Results

Twenty-two studies (n = 1077 individuals) were included. There were 607 males (62.2 %) and 369 females (37.8 %) (k = 16 studies). The mean age of KD initiation was 16 months (SD: 5.4, range: 8.4–23 months) (k = 11 studies). Epilepsy etiology was reported in 453 individuals (k = 15 studies), 297 (65.6 %) had a known etiology and 156 (34.4 %) were unknown. Structural (n = 178, 59.9 %) and genetic/metabolic (n = 80, 26.9 %) causes were common. Most received the classic ketogenic diet (n = 975/1077, 90.5 %) and 102 patients (9.5 %) received the modified Atkins diet (MAD). At 3 months, 48 % (95 % CI: 40 %, 57 %) achieved a 50–99 % spasm reduction and 25 % (95 % CI: 17 %, 34 %), achieved spasm freedom. At 6 months, 41 % (95 % CI: 32 %, 50 %) achieved 50–99 % spasm reduction and 25 % (95 % CI: 17 %,35 %), achieved spasm freedom. Meta-regression did not identify predictors of treatment response.

Conclusion

KD may be an effective treatment option for ES. However, predictors of clinical response were not identified, highlighting the need for larger studies to better understand them and long-term outcomes.

目的：我们系统地回顾了有关生酮饮食（KD）对癫痫性痉挛（ES）患者疗效的现有文献，并分析了癫痫发作结局的预测因素。方法：采用系统评价和荟萃分析首选报告项目（PRISMA）指南。主要结局是患者在KD开始后3个月痉挛减少50- 99% %的比例。其他结果包括患者在1、3和6个月时实现完全痉挛自由的比例。meta回归用于检查癫痫发作结局的临床决定因素。结果：纳入22项研究（n = 1077人）。男性607人（62.2 %），女性369人（37.8 %）（k = 16项研究）。KD起始平均年龄为16个月（SD: 5.4，范围：8.4-23 个月）（k = 11项研究）。453人报告了癫痫病因（k = 15项研究），297人（65.6% %）病因已知，156人（34.4% %）病因未知。结构原因（n = 178,59.9 %）和遗传/代谢原因（n = 80,26.9 %）常见。大多数患者接受经典生酮饮食（n = 975/1077,90.5 %），102例患者（9.5 %）接受改良阿特金斯饮食（MAD）。在3个月,48 %(95 % CI: 40 %,57 %)取得了50 - 99 %减少痉挛和25 %(95 % CI: 17 %,34 %),实现痉挛的自由。在6个月,41 %(95 % CI: 32 % 50 %)达到50 - 99 %减少痉挛和25 %(95 % CI: 17 % 35 %),实现痉挛的自由。meta回归没有确定治疗反应的预测因素。结论：KD可能是治疗ES的有效选择。然而，临床反应的预测因素尚未确定，这突出表明需要进行更大规模的研究来更好地了解它们和长期结果。

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引用次数: 0

The effectiveness and safety of lacosamide in infants with epilepsy aged under 2 years: A prospective study 拉科沙胺治疗2岁以下婴幼儿癫痫的有效性和安全性：一项前瞻性研究。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-14 DOI: 10.1016/j.eplepsyres.2025.107696

Liu Tailin , Xiong Li, Liu Jing, Wang Jiayi, Xiao Nong

Objective

To evaluate the effectiveness and safety of lacosamide (LCM) in children with epilepsy aged 1 month to 2 years, including those with developmental epileptic encephalopathy (DEE), and to identify risk factors influencing effectiveness.

Methods

This single-center prospective cohort study enrolled children who received LCM as monotherapy or adjunctive therapy at Children's Hospital of Chongqing Medical University between June 2020 and March 2023, with follow-up until March 2024. The primary outcome was time to treatment failure (TF), defined as LCM discontinuation or addition of other antiseizure treatments due to insufficient effectiveness and/or treatment-emergent adverse events (TEAEs). Secondary outcomes included retention time, responder rate and seizure-free rate. Safety was assessed by TEAEs incidence. Kaplan-Meier survival analysis and Cox regression were used.

Results

A total of 98 patients (25 with DEE) were included in final analysis. Median follow-up was 20.7 months; mean age at treatment initiation was 10.9 months. At 12, 24, and 36 months, probabilities of not experiencing LCM TF were 63.2 %, 54.1 %, and 54.1 %; probabilities of retention were 86.2 %, 81.3 %, and 81.3 %. At 12 months, overall responder and seizure-free rates were 76.6 % and 50.6 %. In the DEE subgroup, the 12-month probability of not experiencing TF was 37.9 %, and retention was 75.8 %. Higher baseline seizure frequency, abnormal neuroimaging, and history of status epilepticus were independent risk factors for TF. TEAEs occurred in 18.4 %, with somnolence most common.

Conclusion

LCM is effective and well tolerated in infants with epilepsy, including those with DEE, supporting it a viable treatment option in this population.

目的：评价拉科沙胺（lacosamide， LCM）治疗1个月~ 2岁癫痫患儿（包括发育性癫痫性脑病（DEE）患儿）的有效性和安全性，并探讨影响疗效的危险因素。方法：这项单中心前瞻性队列研究纳入了2020年6月至2023年3月在重庆医科大学儿童医院接受LCM作为单一或辅助治疗的儿童，随访至2024年3月。主要终点是治疗失败的时间（TF），定义为由于有效性不足和/或治疗出现的不良事件（teae）而导致LCM停药或添加其他抗癫痫治疗。次要结局包括滞留时间、应答率和无癫痫发作率。通过teae的发生率来评估安全性。采用Kaplan-Meier生存分析和Cox回归分析。结果：98例患者（DEE 25例）纳入最终分析。中位随访时间为20.7个月；治疗开始时的平均年龄为10.9个月。在12、24和36个月时，未经历LCM TF的概率分别为63.2 %、54.1 %和54.1 %；保留率分别为86.2 %、81.3 %和81.3 %。12个月时，总有效率和无癫痫发作率分别为76.6% %和50.6% %。在DEE亚组中，12个月未发生TF的概率为37.9 %，保留率为75.8% %。较高的基线发作频率、异常的神经影像学和癫痫持续状态史是TF的独立危险因素。teae发生率为18.4 %，以嗜睡最为常见。结论：LCM对癫痫患儿（包括DEE患儿）有效且耐受性良好，是该人群可行的治疗选择。

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引用次数: 0

Tailored provocation in functional seizures, a pilot study 针对功能性癫痫发作量身定制的刺激，一项试点研究

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-13 DOI: 10.1016/j.eplepsyres.2025.107692

Hendriëtte van Loo-Flier , Christoph Stephan Dietze , Anne Marthe Meppelink

Objective

To investigate whether Tailored Provocation (TP) can result in habitual seizures during electroencephalogram (EEG) recording in patients with a probable diagnosis of functional seizures (FS) and if future research is feasible.

Background

The integrative model for FS suggests that seizures can be triggered by internal and external stimuli like a conditioned reflex. Using these individual stimuli as TP to provoke habitual seizures may improve diagnostic yield during EEG recording.

Methods

We identified individual TP and evaluated practical applicability. If possible we applied TP and analyzed the occurrence of habitual seizures and the perceived burden on participants. TP was conducted during EEG recording, in addition to standard photic stimulation and hyperventilation.

Results

We included 15 of 38 patients (39 %). Of these patients, 9 (60 %) experienced a habitual seizure after TP, confirming the diagnosis of FS. Epilepsy was diagnosed in 2 patients (13.3 %). All participants supported the goal of TP, and none found TP to be very or excessively burdensome.

Conclusion

TP seems promising to increase diagnostic yield during EEG-diagnostics. Further research is needed to confirm this in larger cohorts. Still, delineating whether FS provocation is directly linked to TP or to related factors, like the effect of verbal suggestion or repeated provocation, remains challenging.

目的探讨可能诊断为功能性癫痫（FS）的患者，在脑电图（EEG）记录中，针对性刺激（TP）是否会导致习惯性癫痫发作，并探讨进一步研究的可行性。FS的综合模型表明，癫痫发作可以由内部和外部刺激触发，如条件反射。使用这些单独的刺激作为诱发习惯性癫痫发作的TP可以提高脑电图记录中的诊断率。方法对单个TP进行鉴定，并对其实用性进行评价。在可能的情况下，我们应用TP分析了习惯性癫痫发作的发生率和参与者的感知负担。除标准光刺激和过度通气外，在EEG记录期间进行TP。结果我们纳入了38例患者中的15例（39% %）。在这些患者中，9例（60 %）在TP后出现习惯性癫痫发作，证实了FS的诊断。癫痫2例（13.3 %）。所有参与者都支持TP的目标，没有人认为TP是非常或过度的负担。结论tp有望提高脑电图诊断的诊断率。需要进一步的研究在更大的人群中证实这一点。然而，描述FS挑衅是否直接与TP或相关因素（如言语暗示或重复挑衅的影响）相关，仍然具有挑战性。

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引用次数: 0

Multimodal diagnostic concordance and seizure outcomes following stereo-encephalography-guided volumetric radiofrequency thermocoagulation in drug-resistant epilepsy 立体脑电图引导下体积射频热凝治疗耐药癫痫的多模态诊断一致性和癫痫发作结果

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-11-07 DOI: 10.1016/j.eplepsyres.2025.107691

Zhimin Xu , Stéphane Jean , Yihai Dai , Weihong Liu , Weitao Chen , Xiaoqiang Wei , Xinrong Fang , Shiwei Song

Objective

To evaluate the relationship between multimodal diagnostic concordance and postoperative seizure outcomes in patients with drug-resistant epilepsy (DRE) undergoing stereo-electroencephalography (SEEG)-guided volumetric radiofrequency thermocoagulation (RFTC).

Methods

In this multicenter retrospective study, 63 patients with DRE (43 children and 20 adults) underwent SEEG-guided volumetric RFTC between January 2020 and January 2024. All patients received comprehensive presurgical evaluations, including high-resolution MRI, PET, interictal and ictal video-EEG (VEEG), interictal and ictal SEEG, and electrically elicited seizures (EES). Pairwise concordance among these modalities was analyzed to assess diagnostic alignment. Postoperative seizure outcomes were evaluated after a minimum follow-up period of 12 months.

Results

Compared to the other modalities, SEEG-based modalities (ictal SEEG, interictal SEEG, and EES) demonstrated the highest concordance and sensitivity, often approaching 100 %, but were associated with lower specificity and elevated false-positive rates. MRI and VEEG offered more balanced diagnostic profiles, with moderate sensitivity and higher specificity. PET showed moderate concordance (79.66 %–88.52 %) and sensitivity (77.78 %–92.31 %), but low specificity (13.64 %–27.27 %) and high false-positive rates (72.73 %–86.36 %). SEEG-based assessments had the lowest false-negative rates, reinforcing their critical role in localizing the epileptogenic zone (EZ).

Conclusion

Higher concordance among presurgical diagnostic modalities, particularly those involving SEEG-based techniques, is linked to more accurate EZ localization. The perfect (100 %) concordance between interictal/ictal SEEG and EES-induced seizures suggests EES can reliably replicate epileptiform activity. This supports its potential to reduce inpatient monitoring by triggering seizures without waiting for spontaneous events. By comparing prior VEEG semiology with interictal SEEG, clinicians can confirm whether EES accurately mirrors clinical and electrical features, allowing faster EZ identification and streamlined presurgical evaluation.

目的探讨立体脑电图（SEEG）引导下体积射频热凝（RFTC）治疗耐药癫痫（drug-resistant epilepsy， DRE）患者多模态诊断一致性与术后癫痫发作结局的关系。方法在这项多中心回顾性研究中，63例DRE患者（43名儿童和20名成人）在2020年1月至2024年1月期间接受了seeg引导的体积RFTC。所有患者接受了全面的术前评估，包括高分辨率MRI， PET，间歇期和间歇期视频脑电图（VEEG），间歇期和间歇期SEEG，以及电诱发癫痫发作（EES）。分析这些模式之间的两两一致性以评估诊断一致性。术后癫痫发作结果在至少12个月的随访期后评估。结果与其他方法相比，以SEEG为基础的方法（初始seg、间期SEEG和EES）显示出最高的一致性和敏感性，通常接近100% %，但特异性较低，假阳性率升高。MRI和VEEG提供了更平衡的诊断特征，具有中等敏感性和更高的特异性。PET具有中等的一致性（79.66 % ~ 88.52 %）和敏感性（77.78 % ~ 92.31 %），但特异性较低（13.64 % ~ 27.27 %），假阳性率较高（72.73 % ~ 86.36 %）。基于seeg的评估具有最低的假阴性率，加强了它们在定位癫痫区（EZ）中的关键作用。结论术前诊断方式的一致性较高，特别是那些涉及基于seeg的技术，与更准确的EZ定位有关。间歇期/间歇期SEEG与脑电图诱发的癫痫发作的完美一致性（100% %）表明脑电图可以可靠地复制癫痫样活动。这支持了它通过触发癫痫发作而无需等待自发事件来减少住院监护的潜力。通过将先前VEEG的符会学与间期SEEG进行比较，临床医生可以确认EES是否准确地反映了临床和电特征，从而更快地识别EZ并简化手术前评估。

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引用次数: 0

Effectiveness and tolerability of perampanel as first add-on treatment in pediatric patients with focal and generalized epilepsy perampanel作为小儿局灶性和全身性癫痫患者第一附加治疗的有效性和耐受性。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-10-24 DOI: 10.1016/j.eplepsyres.2025.107690

Bárbara Blanco Martínez, Elena Arce Portillo, María Muñoz Cabeza, Mercedes López Lobato, Beatriz Muñoz Cabello, Marta Correa Vela, Laura González Hernández, Carmen Cortés Jiménez, Olga Alonso Luengo

Purpose

To compare the effectiveness and safety of perampanel as first add-on vs. late add-on therapy in children with focal or generalized epilepsy.

Methods

Retrospective, single-center study conducted between March 2022 and April 2023, including children ≥ 4 years with focal an generalized epilepsy who started treatment with perampanel in November 2020 or later. Patients were classified into two groups: perampanel as first and as late add-on treatment. Effectiveness and safety data were collected at 3, 6, and 12 months after starting treatment. Primary outcomes were responder rates, seizure-freedom rates, and worsening.

Results

57 patients (45.6 % women) with a mean (SD) age of 8.8 (±3.5) years were included; 27 in the first and 30 in the late add-on group. Effectiveness was consistently higher throughout visits in patients receiving perampanel as first vs. late add-on treatment, with higher response rates (12 months, 95.0 % vs. 55.6 %, p = 0.003), higher seizure-freedom rates (12 months, 65 % vs. 37.0 %, p = 0.058), and fewer patients with worsening (12 months, 0 % vs. 12.8 %, p = 0.031). Retention rates remained high in both groups throughout visits. Sixteen patients discontinued treatment. Reasons were lack of effectiveness, which was more frequent in the late vs. first add-on group, with few patients discontinuing due to adverse events.

Conclusion

The improved effectiveness outcomes of perampanel used as first vs. late add-on therapy in a pediatric population and the favorable safety outcomes support its use as first add-on therapy in pediatric patients with focal and generalized epilepsy.

目的：比较perampanel作为局灶性或全面性癫痫患儿首次附加治疗与晚期附加治疗的有效性和安全性。方法：回顾性、单中心研究于2022年3月至2023年4月进行，纳入≥ 4岁局灶性和全面性癫痫患儿，这些患儿在2020年11月或之后开始使用perampanel治疗。患者分为两组：perampanel作为第一组和晚期附加治疗。在开始治疗后3、6和12个月收集有效性和安全性数据。主要结局是应答率、癫痫解除率和病情恶化。结果：纳入57例患者（45.6% %为女性），平均（SD）年龄为8.8（±3.5）岁；第一个组27人，最后一个组30人。有效性一直在访问病人接受高perampanel作为第一和附加治疗后期,高响应率(12个月,95.0 % 55.6 vs %,p = 0.003),更高的发作率(12个月,65 %与37.0 %,p = 0.058),和更少的患者恶化(12个月,0 % 12.8 vs % p = 0.031)。在整个访问过程中，两组的保留率都很高。16名患者停止治疗。原因是缺乏有效性，这在晚期加药组比首次加药组更常见，很少有患者因不良事件而停药。结论：perampanel作为儿科人群首次与晚期附加治疗的疗效改善以及良好的安全性结果支持其作为局灶性和全面性癫痫儿童患者的首次附加治疗。

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引用次数: 0

Trends, prescribing patterns and projections of antiseizure drug use in Europe 欧洲抗癫痫药物使用的趋势、处方模式和预测。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research

Pub Date : 2025-10-23 DOI: 10.1016/j.eplepsyres.2025.107689

Lilly Josephine Bindel, Roland Seifert

Purpose

Epilepsy represents a significant global burden, with antiseizure drugs (ASDs) essential for treatment. This study examines past and recent trends in ASD consumption in 11 European countries, forecasts future developments, analyses Anatomical Therapeutic Chemical Classification (ATC) subgroup use, and offers an initial assessment of treatment sufficiency.

Methods

Publicly available consumption data were collected for ATC group N03A and its subgroups. Past trends in defined daily doses per 1000 inhabitants per day (DID) were analysed, and projections to 2030 were made using Auto Regressive Integrated Moving Average (ARIMA) models. For each country, treatment coverage relative to epilepsy prevalence was estimated.

Results

In 2023, ASD consumption ranged from 6.9 to 14.0 DID, with varying past and projected trends. The most commonly and increasingly used subgroup was miscellaneous (e.g. levetiracetam). Other subgroup distributions differed across countries, with most showing declines. The analysed countries of Northern Europe had the highest use and share of miscellaneous drugs, while Southern and Eastern Europe showed greater use of barbiturates and benzodiazepines. Adjusted treatment coverage revealed potential undertreatment in several countries, particularly in Eastern Europe.

Conclusion

ASD use has shifted in subgroup patterns without a uniform trend in total volume, with strong regional differences. Evaluating treatment adequacy remains challenging due to non-epilepsy indications. The increase in miscellaneous use appears to be driven by broader applications rather than substitution for older ASDs. Evidence suggests a north-to-south-east gradient, with more rational use in Northern Europe. These disparities likely reflect systemic determinants. The ATC system’s limitations reduce interpretative capability.

目的：癫痫是一项重大的全球负担，抗癫痫药物（ASDs）对治疗至关重要。本研究考察了11个欧洲国家过去和最近的ASD消费趋势，预测了未来的发展，分析了解剖治疗化学分类（ATC）亚组的使用情况，并提供了治疗充分性的初步评估。方法：收集N03A ATC组及其亚组的公开消费资料。分析了每1000名居民每日限定日剂量（DID）的过去趋势，并使用自动回归综合移动平均（ARIMA）模型对2030年进行了预测。对每个国家的治疗覆盖率与癫痫患病率的关系进行了估计。结果：2023年，ASD的消费范围为6.9 - 14.0 DID，过去和预测趋势不同。最常用和越来越多地使用的亚组是杂项（例如左乙拉西坦）。其他亚组的分布在不同国家有所不同，大多数都出现了下降。所分析的北欧国家使用各种药物的比例最高，而南欧和东欧使用巴比妥类药物和苯二氮卓类药物的比例更高。调整后的治疗覆盖率显示，在一些国家，特别是东欧，可能存在治疗不足的情况。结论：ASD使用在亚组模式上发生了变化，但在总量上没有统一的趋势，区域差异较大。由于非癫痫适应症，评估治疗的充分性仍然具有挑战性。各种用途的增加似乎是由更广泛的应用驱动的，而不是替代旧的asd。有证据表明，从北到东南的梯度，在北欧更合理地使用。这些差异可能反映了系统性的决定因素。ATC系统的局限性降低了解释能力。

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引用次数: 0