Alessandra Nicoletti, Gianluca Latino, Calogero Edoardo Cicero, Anna Barbiero, Chiara Aguzzoli, Bianca Ribelli, Valentina Petrini, Maria Micieli, Sandra Padilla, Estela Vilte, Francesco Cosmi, Elizabeth Blanca Crespo Gomez, Alessandro Bartoloni, Loretta Giuliano
Objective
Epilepsy affects approximately 70 million people worldwide, with 80% living in low- and middle-income countries (LMICs), where many people with epilepsy (PWE) go undiagnosed or untreated. Over the last few decades, many efforts have been made worldwide to reduce the treatment gap (TG) in LMICs. However, while Western countries emphasize personalized antiseizure medications (ASM) management in Women with Epilepsy (WwE), little data are available on this topic in LMICs. Our study aimed to assess healthcare standards regarding epilepsy in women from a rural area of Bolivia.
Methods
We interviewed a sample of WwE living in rural communities of the Bolivian Chaco, previously identified by community health workers (CHWs) and/or general practitioners (GPs) and who had been prescribed at least one ASM. A previously validated questionnaire was used addressing epilepsy management and maternal health.
Results
We interviewed 54 women aged 7–64 years. Among them, 18 (33.3%) had experienced at least one pregnancy. Of these seven (38.9%) continued ASM treatment during pregnancy, but only two received specific counseling. One woman spontaneously discontinued treatment during the pregnancy. There were 15 pregnancies while on treatment, with ASM dosage adjusted in only two cases. No major congenital malformations were reported in the offspring.
Significance
This pilot study explored the reproductive health challenges faced by WwE in rural Bolivia. The lack of data in LMICs highlights the need for awareness campaigns to ensure an adequate management of WwE in these areas.
Plain Language Summary
Women with epilepsy face additional challenges related to their reproductive and social life. There are few data on the management of epilepsy in women living in low- and middle-income countries. We performed a study in the rural areas of Bolivia to explore the standard of care of women with epilepsy. We found a lack of systematic preconceptional counseling in these women. However, there were few negative outcomes reported in their children, which may relate to the small sample size, the variable rates of responses to specific questions, and conscious concealment.
{"title":"Unmet needs of women with epilepsy living in rural low- and middle-income countries: The experience of the Bolivian Chaco","authors":"Alessandra Nicoletti, Gianluca Latino, Calogero Edoardo Cicero, Anna Barbiero, Chiara Aguzzoli, Bianca Ribelli, Valentina Petrini, Maria Micieli, Sandra Padilla, Estela Vilte, Francesco Cosmi, Elizabeth Blanca Crespo Gomez, Alessandro Bartoloni, Loretta Giuliano","doi":"10.1002/epi4.13125","DOIUrl":"10.1002/epi4.13125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Epilepsy affects approximately 70 million people worldwide, with 80% living in low- and middle-income countries (LMICs), where many people with epilepsy (PWE) go undiagnosed or untreated. Over the last few decades, many efforts have been made worldwide to reduce the treatment gap (TG) in LMICs. However, while Western countries emphasize personalized antiseizure medications (ASM) management in Women with Epilepsy (WwE), little data are available on this topic in LMICs. Our study aimed to assess healthcare standards regarding epilepsy in women from a rural area of Bolivia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We interviewed a sample of WwE living in rural communities of the Bolivian Chaco, previously identified by community health workers (CHWs) and/or general practitioners (GPs) and who had been prescribed at least one ASM. A previously validated questionnaire was used addressing epilepsy management and maternal health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 54 women aged 7–64 years. Among them, 18 (33.3%) had experienced at least one pregnancy. Of these seven (38.9%) continued ASM treatment during pregnancy, but only two received specific counseling. One woman spontaneously discontinued treatment during the pregnancy. There were 15 pregnancies while on treatment, with ASM dosage adjusted in only two cases. No major congenital malformations were reported in the offspring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This pilot study explored the reproductive health challenges faced by WwE in rural Bolivia. The lack of data in LMICs highlights the need for awareness campaigns to ensure an adequate management of WwE in these areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Plain Language Summary</h3>\u0000 \u0000 <p>Women with epilepsy face additional challenges related to their reproductive and social life. There are few data on the management of epilepsy in women living in low- and middle-income countries. We performed a study in the rural areas of Bolivia to explore the standard of care of women with epilepsy. We found a lack of systematic preconceptional counseling in these women. However, there were few negative outcomes reported in their children, which may relate to the small sample size, the variable rates of responses to specific questions, and conscious concealment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 6","pages":"1774-1782"},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.13125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Drishti Shah, Vicente Villanueva, Dennis Dlugos, Arturo Benitez, Yasmin Taylor, Stevie Olsen, Hannah Connolly, Sophie Lai, J. Scott Andrews
<div> <section> <h3> Objective</h3> <p>To assess the burden of Dravet syndrome (DS) and Lennox–Gastaut syndrome (LGS), including managing seizure and nonseizure symptoms, on patients and caregivers.</p> </section> <section> <h3> Methods</h3> <p>Data were drawn from the Adelphi Real World DS and LGS Disease Specific Programme™, a cross-sectional survey in Asia (China, Japan), Europe (France, Germany, Italy, Spain, United Kingdom), and the United States of America between July 2022 and August 2023. Neurologists/pediatric neurologists reported demographics, clinical characteristics, and nonseizure symptoms for up to 10 consecutively consulting patients. Caregivers provided data on patient nonseizure symptoms, quality of life (QoL), satisfaction with treatment, and caregiver burden. Analyses were descriptive.</p> </section> <section> <h3> Results</h3> <p>Physicians (<i>n</i> = 259) reported data on 547 patients with DS and 811 with LGS. Caregivers (<i>n</i> = 348) provided data on 157 patients with DS and 191 with LGS. In the previous 6 months, 51% of patients with DS experienced ≥1 seizure-related injury and 61% experienced status epilepticus. For LGS, this was 50% and 43% of patients, respectively. Rates of moderate to very severe impairment in nonseizure symptoms were reported by physicians in learning/intellect (DS 69%; LGS 78%), verbal communication (DS 69%; LGS 71%), severity of developmental delay (DS 65%; LGS 68%), overall mental status (DS 57%; LGS 67%), and nonverbal communication (DS 61%; LGS 64%). Caregivers reported moderate to very severe impairment in learning/intellect (DS 53%; LGS 67%), severity of developmental delay (DS 52%; LGS 56%), verbal communication (DS 48%; LGS 48%), and nonverbal communication (DS 42%; LGS 45%). Caregivers reported nonseizure symptoms moderately to significantly impacted QoL for 56% of patients (DS 49%; LGS 61%); satisfaction with treatment rate was low for control over cognition/memory, verbal communication, and nonverbal communication impairment.</p> </section> <section> <h3> Significance</h3> <p>In this study, considerable burden in DS and LGS management and care was driven by nonseizure symptoms, suggesting a need for treatments that manage the broad spectrum of disease symptoms.</p> </section> <section> <h3> Plain Language Summary</h3> <p>We asked doctors and caregivers to tell us about the symptoms that patients with Dravet syndrome and Lennox–Gastaut syndrome have. We asked how the symptoms affect the
{"title":"Nonseizure symptoms and broader seizure impacts in patients with Dravet syndrome and Lennox–Gastaut syndrome in clinical practice settings: Results from a multinational survey","authors":"Drishti Shah, Vicente Villanueva, Dennis Dlugos, Arturo Benitez, Yasmin Taylor, Stevie Olsen, Hannah Connolly, Sophie Lai, J. Scott Andrews","doi":"10.1002/epi4.70118","DOIUrl":"10.1002/epi4.70118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the burden of Dravet syndrome (DS) and Lennox–Gastaut syndrome (LGS), including managing seizure and nonseizure symptoms, on patients and caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were drawn from the Adelphi Real World DS and LGS Disease Specific Programme™, a cross-sectional survey in Asia (China, Japan), Europe (France, Germany, Italy, Spain, United Kingdom), and the United States of America between July 2022 and August 2023. Neurologists/pediatric neurologists reported demographics, clinical characteristics, and nonseizure symptoms for up to 10 consecutively consulting patients. Caregivers provided data on patient nonseizure symptoms, quality of life (QoL), satisfaction with treatment, and caregiver burden. Analyses were descriptive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Physicians (<i>n</i> = 259) reported data on 547 patients with DS and 811 with LGS. Caregivers (<i>n</i> = 348) provided data on 157 patients with DS and 191 with LGS. In the previous 6 months, 51% of patients with DS experienced ≥1 seizure-related injury and 61% experienced status epilepticus. For LGS, this was 50% and 43% of patients, respectively. Rates of moderate to very severe impairment in nonseizure symptoms were reported by physicians in learning/intellect (DS 69%; LGS 78%), verbal communication (DS 69%; LGS 71%), severity of developmental delay (DS 65%; LGS 68%), overall mental status (DS 57%; LGS 67%), and nonverbal communication (DS 61%; LGS 64%). Caregivers reported moderate to very severe impairment in learning/intellect (DS 53%; LGS 67%), severity of developmental delay (DS 52%; LGS 56%), verbal communication (DS 48%; LGS 48%), and nonverbal communication (DS 42%; LGS 45%). Caregivers reported nonseizure symptoms moderately to significantly impacted QoL for 56% of patients (DS 49%; LGS 61%); satisfaction with treatment rate was low for control over cognition/memory, verbal communication, and nonverbal communication impairment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>In this study, considerable burden in DS and LGS management and care was driven by nonseizure symptoms, suggesting a need for treatments that manage the broad spectrum of disease symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Plain Language Summary</h3>\u0000 \u0000 <p>We asked doctors and caregivers to tell us about the symptoms that patients with Dravet syndrome and Lennox–Gastaut syndrome have. We asked how the symptoms affect the ","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 6","pages":"1783-1797"},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vladimir Bascarevic, Zorica Jokovic, Sabrina Hadziosmanovic, Aleksa Pejovic, Matthias Koepp, Fenglai Xiao, Lawrence Binding, Zoran Bukumiric, Nikola Vojvodic, Dragoslav Sokic, Aleksandar J. Ristic
Objective
Alterations to brain structures and networks involved in central autonomic and respiratory control are possible biomarkers of SUDEP, but were mainly demonstrated in people at high risk. Postictal generalized EEG suppression (PGES) has been recorded in every case of near or confirmed SUDEP. The structural alterations underpinning PGES are not known.
Methods
This retrospective study included the brain MRIs of 100 patients with focal and generalized epilepsy who had experienced at least one generalized tonic-clonic seizure (GTCS) documented through long-term video-EEG monitoring, with PGES defined as postictal EEG activity below 10 microvolts lasting at least 20 s. Brain MRIs were parcellated into cortical and subcortical volumes, with further parcellation of thalamic subfields, and univariate and multivariate logistic regression models were applied to identify brain regions associated with PGES.
Results
PGES was observed in 52 of 100 patients. Patients with PGES were older and had a slower heart rate before and after seizures compared to those without PGES. The tonic phase of GTCS was longer in patients with PGES. Univariate logistic regression analysis identified significant associations between PGES and six brain regions: the left and right lateral occipital cortices, left and right precuneus, and left and right thalamus. Multivariate analysis revealed that the right thalamus and both precuneus were independent predictors of PGES. Further analysis of thalamic subfields showed an increased volume of the ventral anterior nucleus of the right thalamus in patients with PGES.
Significance
Structural alterations in the right thalamus and precuneus are significantly associated with the presence of PGES in epilepsy patients.
Plain Language Summary
Some people with epilepsy show a period of very low brain activity after a seizure, called PGES, which may be linked to a higher risk of sudden death. We analyzed brain scans from 100 people with epilepsy and found that two brain regions—the right thalamus and the precuneus—were different in those with PGES. These findings may help doctors understand which patients are more at risk after seizures and how to better protect them.
{"title":"The effect of cortical and subcortical parcel volumes on postictal generalized EEG suppression","authors":"Vladimir Bascarevic, Zorica Jokovic, Sabrina Hadziosmanovic, Aleksa Pejovic, Matthias Koepp, Fenglai Xiao, Lawrence Binding, Zoran Bukumiric, Nikola Vojvodic, Dragoslav Sokic, Aleksandar J. Ristic","doi":"10.1002/epi4.70150","DOIUrl":"10.1002/epi4.70150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Alterations to brain structures and networks involved in central autonomic and respiratory control are possible biomarkers of SUDEP, but were mainly demonstrated in people at high risk. Postictal generalized EEG suppression (PGES) has been recorded in every case of near or confirmed SUDEP. The structural alterations underpinning PGES are not known.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included the brain MRIs of 100 patients with focal and generalized epilepsy who had experienced at least one generalized tonic-clonic seizure (GTCS) documented through long-term video-EEG monitoring, with PGES defined as postictal EEG activity below 10 microvolts lasting at least 20 s. Brain MRIs were parcellated into cortical and subcortical volumes, with further parcellation of thalamic subfields, and univariate and multivariate logistic regression models were applied to identify brain regions associated with PGES.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PGES was observed in 52 of 100 patients. Patients with PGES were older and had a slower heart rate before and after seizures compared to those without PGES. The tonic phase of GTCS was longer in patients with PGES. Univariate logistic regression analysis identified significant associations between PGES and six brain regions: the left and right lateral occipital cortices, left and right precuneus, and left and right thalamus. Multivariate analysis revealed that the right thalamus and both precuneus were independent predictors of PGES. Further analysis of thalamic subfields showed an increased volume of the ventral anterior nucleus of the right thalamus in patients with PGES.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>Structural alterations in the right thalamus and precuneus are significantly associated with the presence of PGES in epilepsy patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Plain Language Summary</h3>\u0000 \u0000 <p>Some people with epilepsy show a period of very low brain activity after a seizure, called PGES, which may be linked to a higher risk of sudden death. We analyzed brain scans from 100 people with epilepsy and found that two brain regions—the right thalamus and the precuneus—were different in those with PGES. These findings may help doctors understand which patients are more at risk after seizures and how to better protect them.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 6","pages":"1798-1805"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michelle Y. Chiu, Cynthia G. Keator, Aaron E. L. Warren, Juliet K. Knowles, Debopam Samanta, Tracy Dixon-Salazar, Hyun Yong Koh, Syndi A. Seinfeld, Juliann Paolicchi, Jorge Vidaurre, Anup D. Patel, Tobias Loddenkemper, Renée A. Shellhaas, Dave F. Clarke, Anthony L. Fine, Sonam Bhalla, Dewi Depositario-Cabacar, Babitha Haridas, Carl E. Stafstrom, Gozde Erdemir, Cemal Karakas
<div> <section> <h3> Objective</h3> <p>The objective of this study is to characterize contemporary surgical management practices and factors influencing surgical decision-making in the management of Lennox–Gastaut Syndrome (LGS) across pediatric epilepsy centers in the United States.</p> </section> <section> <h3> Methods</h3> <p>A 45-item cross-sectional survey was developed and distributed to Pediatric Epilepsy Research Consortium centers. Domains included institutional demographics, surgical evaluation timing and goals, presurgical workup, procedural utilization and outcomes, and barriers to surgery. Descriptive statistics and thematic analysis were performed.</p> </section> <section> <h3> Results</h3> <p>Thirty-two pediatric epilepsy centers participated (38% response), the majority comprising pediatric epileptologists at Level 4 National Association of Epilepsy Centers. Most centers (66%) considered surgery after failure of 3–4 antiseizure medications. Presurgical workup typically included brain magnetic resonance imaging (MRI), long-term electroencephalography (EEG) monitoring, and neuropsychological assessment, while use of functional imaging, magnetoencephalography, and intracranial EEG varied considerably. All centers offered vagus nerve stimulation and corpus callosotomy; 80%–90% offered resection, hemispherectomy, responsive neurostimulation (RNS); 60%–65% offered deep brain stimulation (DBS) and laser ablation. Among centers offering RNS, half targeted thalamic structures exclusively, and the remainder targeted cortical or combined cortical-thalamic structures; the centromedian nucleus was the preferred thalamic target for RNS and DBS. Surgical decision-making was influenced by patient characteristics, procedural considerations, and systemic factors. Seizure frequency, family preference, and multidisciplinary input were highly rated across all interventions. Etiology was critical for resection and hemispherectomy, while financial constraints, insurance barriers, and the need for future neuroimaging impacted neuromodulation selection. Scenario-specific trends included less frequent consideration of DBS and RNS in children under five years, less use of hemispherectomy in older children, preference for corpus callosotomy in children with predominantly drop seizures, and procedural selection based on MRI findings.</p> </section> <section> <h3> Significance</h3> <p>Substantial variability exists in the surgical management of LGS. These findings highlight critical opportunities to harmonize practices, reduce disparities, and guide comparative
{"title":"Current practices and trends in surgical decision-making for children with Lennox–Gastaut syndrome: A cross-sectional survey by the Pediatric Epilepsy Research Consortium","authors":"Michelle Y. Chiu, Cynthia G. Keator, Aaron E. L. Warren, Juliet K. Knowles, Debopam Samanta, Tracy Dixon-Salazar, Hyun Yong Koh, Syndi A. Seinfeld, Juliann Paolicchi, Jorge Vidaurre, Anup D. Patel, Tobias Loddenkemper, Renée A. Shellhaas, Dave F. Clarke, Anthony L. Fine, Sonam Bhalla, Dewi Depositario-Cabacar, Babitha Haridas, Carl E. Stafstrom, Gozde Erdemir, Cemal Karakas","doi":"10.1002/epi4.70144","DOIUrl":"10.1002/epi4.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to characterize contemporary surgical management practices and factors influencing surgical decision-making in the management of Lennox–Gastaut Syndrome (LGS) across pediatric epilepsy centers in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 45-item cross-sectional survey was developed and distributed to Pediatric Epilepsy Research Consortium centers. Domains included institutional demographics, surgical evaluation timing and goals, presurgical workup, procedural utilization and outcomes, and barriers to surgery. Descriptive statistics and thematic analysis were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-two pediatric epilepsy centers participated (38% response), the majority comprising pediatric epileptologists at Level 4 National Association of Epilepsy Centers. Most centers (66%) considered surgery after failure of 3–4 antiseizure medications. Presurgical workup typically included brain magnetic resonance imaging (MRI), long-term electroencephalography (EEG) monitoring, and neuropsychological assessment, while use of functional imaging, magnetoencephalography, and intracranial EEG varied considerably. All centers offered vagus nerve stimulation and corpus callosotomy; 80%–90% offered resection, hemispherectomy, responsive neurostimulation (RNS); 60%–65% offered deep brain stimulation (DBS) and laser ablation. Among centers offering RNS, half targeted thalamic structures exclusively, and the remainder targeted cortical or combined cortical-thalamic structures; the centromedian nucleus was the preferred thalamic target for RNS and DBS. Surgical decision-making was influenced by patient characteristics, procedural considerations, and systemic factors. Seizure frequency, family preference, and multidisciplinary input were highly rated across all interventions. Etiology was critical for resection and hemispherectomy, while financial constraints, insurance barriers, and the need for future neuroimaging impacted neuromodulation selection. Scenario-specific trends included less frequent consideration of DBS and RNS in children under five years, less use of hemispherectomy in older children, preference for corpus callosotomy in children with predominantly drop seizures, and procedural selection based on MRI findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>Substantial variability exists in the surgical management of LGS. These findings highlight critical opportunities to harmonize practices, reduce disparities, and guide comparative ","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 6","pages":"1835-1846"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhannad Bushra Masaad Ahmed, Israa Alamin Mohammed Hussein, Ahmed Balla M. Ahmed, Eman Almuez Ahmed Alhaj, Sulafa Abdelaziz Ali Hussein, Duaa Hafiz Ali Omer, Hiba Abdallah Siadna Ali, Abdelmoula Hashim Abdelmagid Mohamed, Mohanned Abdalsalam Mohammed Salih, Hamdalneil Ahmed Hamdalneil Ahmed, Deya Eldin Abd Elbasit Ahmed Ibrahim, Sohaib Mohammed Mokhtar Ahmed
<div> <section> <h3> Objective</h3> <p>This study explored the most prevalent misconceptions about epilepsy among Sudanese individuals, focusing on knowledge, attitude, and practices in Sudan.</p> </section> <section> <h3> Methods</h3> <p>A community-based, cross-sectional study was conducted in the safe areas in Sudan due to the war from October 15 to November 30, 2024. A validated questionnaire, adapted from a previous study with cultural modifications, was administered both through face-to-face interviews and online platforms. Data were analyzed using R software, employing descriptive statistics and chi-square tests.</p> </section> <section> <h3> Results</h3> <p>Out of 3525 participants, 98.8% reported having heard of epilepsy. Nonetheless, 56.7% believed it could be caused by genetic factors, 14.1% viewed it as a contagious disease, 37.8% attributed it to witchcraft, and 17.7% considered it a punishment from God. In terms of attitudes, 54.7% believed epilepsy prevents individuals from living a happy life, 17.2% saw it as an obstacle to marriage, 56.9% thought it negatively impacts education, 26.1% viewed it as a barrier to employment, and 74% felt that society discriminates against those with epilepsy. As for practices, 47.6% regarded spiritual healing (ruqya) as effective, while 72.3% recommended consulting a doctor during seizures. Additionally, 49.7% expressed skepticism about the effectiveness of traditional medical treatment for epilepsy.</p> </section> <section> <h3> Significance</h3> <p>This study highlights considerable gaps in knowledge, attitudes, and practices related to epilepsy in Sudan. While many participants acknowledged genetic causes and endorsed the social inclusion of people with epilepsy (PWE), misconceptions—such as beliefs in contagion and supernatural causes—persist. Moreover, stigma and discrimination continue to pose significant challenges. Focused educational campaigns and public health interventions are essential to correct misconceptions, reduce stigma, and promote accurate, evidence-based awareness of epilepsy across Sudanese communities.</p> </section> <section> <h3> Plain Language Summary</h3> <p>This study among 3525 Sudanese adults assessed the most prevalent misconceptions about epilepsy by measuring their knowledge, attitudes, and practices related to the condition. Slightly more than half believed it could be inherited, about a third linked it to witchcraft, and some saw it as a punishment from God. Many par
{"title":"Beliefs, misconceptions, and practices related to epilepsy among adults in Sudan: A large-scale cross-sectional study","authors":"Muhannad Bushra Masaad Ahmed, Israa Alamin Mohammed Hussein, Ahmed Balla M. Ahmed, Eman Almuez Ahmed Alhaj, Sulafa Abdelaziz Ali Hussein, Duaa Hafiz Ali Omer, Hiba Abdallah Siadna Ali, Abdelmoula Hashim Abdelmagid Mohamed, Mohanned Abdalsalam Mohammed Salih, Hamdalneil Ahmed Hamdalneil Ahmed, Deya Eldin Abd Elbasit Ahmed Ibrahim, Sohaib Mohammed Mokhtar Ahmed","doi":"10.1002/epi4.70148","DOIUrl":"10.1002/epi4.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study explored the most prevalent misconceptions about epilepsy among Sudanese individuals, focusing on knowledge, attitude, and practices in Sudan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A community-based, cross-sectional study was conducted in the safe areas in Sudan due to the war from October 15 to November 30, 2024. A validated questionnaire, adapted from a previous study with cultural modifications, was administered both through face-to-face interviews and online platforms. Data were analyzed using R software, employing descriptive statistics and chi-square tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 3525 participants, 98.8% reported having heard of epilepsy. Nonetheless, 56.7% believed it could be caused by genetic factors, 14.1% viewed it as a contagious disease, 37.8% attributed it to witchcraft, and 17.7% considered it a punishment from God. In terms of attitudes, 54.7% believed epilepsy prevents individuals from living a happy life, 17.2% saw it as an obstacle to marriage, 56.9% thought it negatively impacts education, 26.1% viewed it as a barrier to employment, and 74% felt that society discriminates against those with epilepsy. As for practices, 47.6% regarded spiritual healing (ruqya) as effective, while 72.3% recommended consulting a doctor during seizures. Additionally, 49.7% expressed skepticism about the effectiveness of traditional medical treatment for epilepsy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>This study highlights considerable gaps in knowledge, attitudes, and practices related to epilepsy in Sudan. While many participants acknowledged genetic causes and endorsed the social inclusion of people with epilepsy (PWE), misconceptions—such as beliefs in contagion and supernatural causes—persist. Moreover, stigma and discrimination continue to pose significant challenges. Focused educational campaigns and public health interventions are essential to correct misconceptions, reduce stigma, and promote accurate, evidence-based awareness of epilepsy across Sudanese communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Plain Language Summary</h3>\u0000 \u0000 <p>This study among 3525 Sudanese adults assessed the most prevalent misconceptions about epilepsy by measuring their knowledge, attitudes, and practices related to the condition. Slightly more than half believed it could be inherited, about a third linked it to witchcraft, and some saw it as a punishment from God. Many par","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 6","pages":"1814-1823"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Status epilepticus (SE) consists of prolonged, self-sustaining seizures and is a common neurological emergency that causes respiratory compromise and neuronal injury. Without prompt treatment, the seizures can become resistant to benzodiazepines, leading to the progressive evolution of established, refractory, and super-refractory SE. Studies in experimental animals have found impaired GABAergic inhibition and potentiated glutamatergic neurotransmission in SE animals. These alterations increase the number of active neurons and expand the seizure network. Here, we first discuss the changes in GABA-A, NMDA, and AMPA receptor-mediated synaptic transmission during SE and elaborate on emerging studies showing the neuronal consumption of alternate energy sources to cope with increased energy demand. Then, we discuss the clinical studies that have tested the efficacy of various benzodiazepines and other anticonvulsant agents in treating SE in prehospital and in-hospital settings. Finally, we briefly summarize the ongoing clinical studies and the potential for other anticonvulsant agents to be tested for treating SE. PLAIN LANGUAGE SUMMARY: Most seizures are self-limiting, but some seizures change the brain such that a constant state of seizures, SE, is generated. These prolonged seizures can cause neuronal injury and increase the risk of death. We discuss the molecular mechanisms that sustain these seizures and the accompanying neuronal and network plasticity. We also review the current SE treatment and future directions.
{"title":"Status epilepticus: Updates on mechanisms and treatments.","authors":"Suchitra Joshi, Jaideep Kapur","doi":"10.1002/epi4.70146","DOIUrl":"10.1002/epi4.70146","url":null,"abstract":"<p><p>Status epilepticus (SE) consists of prolonged, self-sustaining seizures and is a common neurological emergency that causes respiratory compromise and neuronal injury. Without prompt treatment, the seizures can become resistant to benzodiazepines, leading to the progressive evolution of established, refractory, and super-refractory SE. Studies in experimental animals have found impaired GABAergic inhibition and potentiated glutamatergic neurotransmission in SE animals. These alterations increase the number of active neurons and expand the seizure network. Here, we first discuss the changes in GABA-A, NMDA, and AMPA receptor-mediated synaptic transmission during SE and elaborate on emerging studies showing the neuronal consumption of alternate energy sources to cope with increased energy demand. Then, we discuss the clinical studies that have tested the efficacy of various benzodiazepines and other anticonvulsant agents in treating SE in prehospital and in-hospital settings. Finally, we briefly summarize the ongoing clinical studies and the potential for other anticonvulsant agents to be tested for treating SE. PLAIN LANGUAGE SUMMARY: Most seizures are self-limiting, but some seizures change the brain such that a constant state of seizures, SE, is generated. These prolonged seizures can cause neuronal injury and increase the risk of death. We discuss the molecular mechanisms that sustain these seizures and the accompanying neuronal and network plasticity. We also review the current SE treatment and future directions.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069230","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}
Infantile epilepsy spasms syndrome (IESS), formerly known as infantile spasms or West Syndrome, is a severe epilepsy syndrome affecting about 3 in 10,000 newborns in the United States. Characterized by clusters of epileptic spasms, interictal hypsarrhythmia, and developmental delays, IESS has diverse causes, including structural-metabolic, genetic, infectious-immune, and unknown factors. FDA-approved therapies/medications, ACTH and vigabatrin, have limited efficacy and significant side effects, necessitating further research into better therapies. Our prenatal betamethasone-postnatal NMDA rat model provides valuable insights into IESS mechanisms and treatment responses. Mimicking human IESS in semiology, EEG patterns, and drug responsiveness, this model has been independently validated and adapted for infant mice. EEG recordings, crucial for validation and drug discovery, help assess treatment efficacy by tracking clinical spasms and the elimination of large amplitude irregular EEG waves occurring in clusters. Automated and manual EEG quantification enhance the model's precision. Proteomic analyses highlight significant differences in proteins like SNAP25 and creatine kinase between spasms and non-spasms groups. Imaging studies in the model reveal early activation of stress-responsive brain regions, consistent with epidemiological evidence linking prenatal stress to an increased risk of IESS in humans. ACTH and its analog, AQB-565, effectively suppress spasms, with AQB-565 potentially reducing corticosteroid-related side effects. The C5a receptor antagonist PMX53 shows efficacy in males, suggesting inflammation may be a therapeutic target. Neonatal β-estradiol increases GABAergic neurons but has limited impact on spasms and poses reproductive risks. These findings highlight the complexity of IESS and the need for targeted, sex-specific, and mechanism-based therapies to improve treatment outcomes for patients. PLAIN LANGUAGE SUMMARY: Infantile epilepsy spasms syndrome (IESS) is a severe epilepsy syndrome affecting 3 in 10 000 newborns in the United States, causing clusters of brief convulsions, abnormal brain activity, and developmental delays. It has various causes, including genetic and perinatal factors. Current medications, such as ACTH and vigabatrin, have limited effectiveness and side effects, highlighting the need for better options. We use a rodent model to study IESS and evaluate treatments. Some therapies, like AQB-565, show promise in reducing seizures with fewer side effects. Our findings suggest that personalized, targeted treatments based on individual causes and sex differences could improve outcomes.
{"title":"Prenatal betamethasone-postnatal N-methyl-D-aspartic acid model of spasms: Update on mechanisms and treatments.","authors":"Kayla Vieira, Antonia Schonwald, Chian-Ru Chern, Kamya Shah, Jana Velíšková, Libor Velíšek","doi":"10.1002/epi4.70140","DOIUrl":"https://doi.org/10.1002/epi4.70140","url":null,"abstract":"<p><p>Infantile epilepsy spasms syndrome (IESS), formerly known as infantile spasms or West Syndrome, is a severe epilepsy syndrome affecting about 3 in 10,000 newborns in the United States. Characterized by clusters of epileptic spasms, interictal hypsarrhythmia, and developmental delays, IESS has diverse causes, including structural-metabolic, genetic, infectious-immune, and unknown factors. FDA-approved therapies/medications, ACTH and vigabatrin, have limited efficacy and significant side effects, necessitating further research into better therapies. Our prenatal betamethasone-postnatal NMDA rat model provides valuable insights into IESS mechanisms and treatment responses. Mimicking human IESS in semiology, EEG patterns, and drug responsiveness, this model has been independently validated and adapted for infant mice. EEG recordings, crucial for validation and drug discovery, help assess treatment efficacy by tracking clinical spasms and the elimination of large amplitude irregular EEG waves occurring in clusters. Automated and manual EEG quantification enhance the model's precision. Proteomic analyses highlight significant differences in proteins like SNAP25 and creatine kinase between spasms and non-spasms groups. Imaging studies in the model reveal early activation of stress-responsive brain regions, consistent with epidemiological evidence linking prenatal stress to an increased risk of IESS in humans. ACTH and its analog, AQB-565, effectively suppress spasms, with AQB-565 potentially reducing corticosteroid-related side effects. The C5a receptor antagonist PMX53 shows efficacy in males, suggesting inflammation may be a therapeutic target. Neonatal β-estradiol increases GABAergic neurons but has limited impact on spasms and poses reproductive risks. These findings highlight the complexity of IESS and the need for targeted, sex-specific, and mechanism-based therapies to improve treatment outcomes for patients. PLAIN LANGUAGE SUMMARY: Infantile epilepsy spasms syndrome (IESS) is a severe epilepsy syndrome affecting 3 in 10 000 newborns in the United States, causing clusters of brief convulsions, abnormal brain activity, and developmental delays. It has various causes, including genetic and perinatal factors. Current medications, such as ACTH and vigabatrin, have limited effectiveness and side effects, highlighting the need for better options. We use a rodent model to study IESS and evaluate treatments. Some therapies, like AQB-565, show promise in reducing seizures with fewer side effects. Our findings suggest that personalized, targeted treatments based on individual causes and sex differences could improve outcomes.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069214","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}
<div> <section> <h3> Objective</h3> <p>Seizures not classified as epileptic or non-epileptic events remain poorly understood in terms of their healthcare impact. This study compares healthcare utilization and costs among U.S. adults with epilepsy and those with unclassified seizures.</p> </section> <section> <h3> Methods</h3> <p>This cross-sectional study used 2016–2022 Medical Expenditure Panel Survey data to analyze adults aged 18 years and older with epilepsy or unclassified seizures, weighted to represent the civilian, non-institutionalized U.S. population. Individuals with epilepsy were matched to those with unclassified seizures on demographics and socioeconomic characteristics. Healthcare utilization (e.g., office visits, hospitalizations, and prescription fills) was assessed using negative binomial regression, and all-cause expenditures were evaluated with two-part models, adjusting for patient characteristics and the COVID-19 pandemic period. Marginal effects were estimated using recycled predictions.</p> </section> <section> <h3> Results</h3> <p>An estimated 6.6 million adults had unclassified seizures, with annual healthcare spending totaling $38.9 billion, substantially more than $21.3 billion for 4.5 million adults with epilepsy. Adjusted analyses showed that individuals with unclassified seizures had 38% greater healthcare utilization and $1362 higher average marginal spending per person compared to those with epilepsy. They also had significantly higher rates of hospitalizations and emergency department visits.</p> </section> <section> <h3> Significance</h3> <p>Adults with unclassified seizures and epilepsy represent a high-need population with great healthcare use and costs. These findings highlight the impact of diagnostic uncertainty and care fragmentation, suggesting that improved identification and healthcare coordination could enhance outcomes and reduce inefficiencies. Although based on U.S. data, these insights may be relevant to other healthcare systems facing similar challenges in seizure management.</p> </section> <section> <h3> Plain Language Summary</h3> <p>Some people experience seizures that are not clearly diagnosed as epilepsy or another condition. This study found that U.S. adults with these “unclassified seizures” use more healthcare and experience higher medical costs than those with diagnosed epilepsy. People with unclassified seizures are more likely to visit the emergency department or be hospitalized, while th
{"title":"Characterizing the burden of healthcare utilization and expenditure for epilepsy and unclassified seizures in the U.S., 2016–2022","authors":"Pooja M. Rajadhyaksha, Kangho Suh","doi":"10.1002/epi4.70135","DOIUrl":"10.1002/epi4.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Seizures not classified as epileptic or non-epileptic events remain poorly understood in terms of their healthcare impact. This study compares healthcare utilization and costs among U.S. adults with epilepsy and those with unclassified seizures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study used 2016–2022 Medical Expenditure Panel Survey data to analyze adults aged 18 years and older with epilepsy or unclassified seizures, weighted to represent the civilian, non-institutionalized U.S. population. Individuals with epilepsy were matched to those with unclassified seizures on demographics and socioeconomic characteristics. Healthcare utilization (e.g., office visits, hospitalizations, and prescription fills) was assessed using negative binomial regression, and all-cause expenditures were evaluated with two-part models, adjusting for patient characteristics and the COVID-19 pandemic period. Marginal effects were estimated using recycled predictions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>An estimated 6.6 million adults had unclassified seizures, with annual healthcare spending totaling $38.9 billion, substantially more than $21.3 billion for 4.5 million adults with epilepsy. Adjusted analyses showed that individuals with unclassified seizures had 38% greater healthcare utilization and $1362 higher average marginal spending per person compared to those with epilepsy. They also had significantly higher rates of hospitalizations and emergency department visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>Adults with unclassified seizures and epilepsy represent a high-need population with great healthcare use and costs. These findings highlight the impact of diagnostic uncertainty and care fragmentation, suggesting that improved identification and healthcare coordination could enhance outcomes and reduce inefficiencies. Although based on U.S. data, these insights may be relevant to other healthcare systems facing similar challenges in seizure management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Plain Language Summary</h3>\u0000 \u0000 <p>Some people experience seizures that are not clearly diagnosed as epilepsy or another condition. This study found that U.S. adults with these “unclassified seizures” use more healthcare and experience higher medical costs than those with diagnosed epilepsy. People with unclassified seizures are more likely to visit the emergency department or be hospitalized, while th","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 5","pages":"1648-1659"},"PeriodicalIF":2.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alejandro Fernández-Cabrera, Paula Santamaría-Montero, Jesús García de-Soto, Robustiano Pego-Reigosa
<div> <section> <h3> Objective</h3> <p>To evaluate the effectiveness, tolerability, and retention of PER as monotherapy in adults with focal or idiopathic generalized epilepsy over a 12-month period in routine clinical practice.</p> </section> <section> <h3> Methods</h3> <p>In this single-center, ambispective, noninterventional observational study, 74 patients (age 18–90 years) initiated PER monotherapy—either as first-line treatment (n = 21) or conversion from another antiseizure medication (n = 53)—and were followed for 12 months. Demographic and clinical variables, prior antiseizure regimens, indication for PER initiation (suboptimal seizure control, adverse effects, or sleep improvement), PER dosage, seizure outcomes (seizure freedom and ≥ 50% reduction), and adverse events (AEs) were recorded at 6- and 12-month visits. Retention rates were calculated, and safety was assessed by AE reports and discontinuations.</p> </section> <section> <h3> Results</h3> <p>The mean PER dose was 7.22 ± 1.71 mg/day, with 85.1% of patients remaining on monotherapy at 12 months (first-line: 90.5%; conversion: 83.0%). Overall, 70.3% of patients achieved seizure freedom at 12 months (first-line: 81.0%; conversion: 66.0%), and 79.7% were ≥ 50% responders (first-line: 85.7%; conversion: 75.5%). In patients initiated for sleep improvement (n = 24), hypnotic medications were withdrawn in 87.5%, and 79% reported better sleep. AEs were reported in 46.2% of patients at 12 months, most commonly somnolence (28.4%), dizziness (18.9%), and irritability (10.8%). Severe AEs leading to discontinuation occurred in 6.7% of cases.</p> </section> <section> <h3> Significance</h3> <p>In a real-world cohort, PER monotherapy demonstrated high rates of seizure freedom and retention, with a manageable safety profile. These findings support PER as an effective and tolerable monotherapy option for adult patients with focal or idiopathic generalized epilepsy, corroborating similar observations in recent Epilepsia Open studies of antiseizure monotherapy.</p> </section> <section> <h3> Plain Language Summary</h3> <p>Perampanel (PER) is approved as an add-on treatment for seizures, but information on its use alone (monotherapy) is scarce. We studied 74 adults who started PER by itself—either as their first treatment or after stopping another medication—over 1 year. Eighty-five percent stayed on PER for the full year. Seventy percent became seizure-free, and nearly 80% had their seizures cut by at
{"title":"MonoPER study: Effectiveness and tolerability of PERampanel in monotherapy in real-world after 12 months of treatment","authors":"Alejandro Fernández-Cabrera, Paula Santamaría-Montero, Jesús García de-Soto, Robustiano Pego-Reigosa","doi":"10.1002/epi4.70122","DOIUrl":"10.1002/epi4.70122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the effectiveness, tolerability, and retention of PER as monotherapy in adults with focal or idiopathic generalized epilepsy over a 12-month period in routine clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-center, ambispective, noninterventional observational study, 74 patients (age 18–90 years) initiated PER monotherapy—either as first-line treatment (n = 21) or conversion from another antiseizure medication (n = 53)—and were followed for 12 months. Demographic and clinical variables, prior antiseizure regimens, indication for PER initiation (suboptimal seizure control, adverse effects, or sleep improvement), PER dosage, seizure outcomes (seizure freedom and ≥ 50% reduction), and adverse events (AEs) were recorded at 6- and 12-month visits. Retention rates were calculated, and safety was assessed by AE reports and discontinuations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean PER dose was 7.22 ± 1.71 mg/day, with 85.1% of patients remaining on monotherapy at 12 months (first-line: 90.5%; conversion: 83.0%). Overall, 70.3% of patients achieved seizure freedom at 12 months (first-line: 81.0%; conversion: 66.0%), and 79.7% were ≥ 50% responders (first-line: 85.7%; conversion: 75.5%). In patients initiated for sleep improvement (n = 24), hypnotic medications were withdrawn in 87.5%, and 79% reported better sleep. AEs were reported in 46.2% of patients at 12 months, most commonly somnolence (28.4%), dizziness (18.9%), and irritability (10.8%). Severe AEs leading to discontinuation occurred in 6.7% of cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>In a real-world cohort, PER monotherapy demonstrated high rates of seizure freedom and retention, with a manageable safety profile. These findings support PER as an effective and tolerable monotherapy option for adult patients with focal or idiopathic generalized epilepsy, corroborating similar observations in recent Epilepsia Open studies of antiseizure monotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Plain Language Summary</h3>\u0000 \u0000 <p>Perampanel (PER) is approved as an add-on treatment for seizures, but information on its use alone (monotherapy) is scarce. We studied 74 adults who started PER by itself—either as their first treatment or after stopping another medication—over 1 year. Eighty-five percent stayed on PER for the full year. Seventy percent became seizure-free, and nearly 80% had their seizures cut by at ","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 5","pages":"1587-1594"},"PeriodicalIF":2.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Levetiracetam (LEV) has been widely used as an antiseizure medication (ASM), but is associated with psychiatric and behavioral adverse effects (PBAEs). Brivaracetam (BRV) has demonstrated better psychiatric tolerability, albeit at a higher cost. This study aimed to evaluate the cost-effectiveness of initiating BRV versus LEV therapy with a subsequent switch to BRV in the event of PBAEs across the US, Australia, and Japan.
Methods
We developed a decision tree model with a 10-year time horizon comparing two strategies across the US, Australia, and Japan: initial BRV therapy versus initial LEV therapy with a switch to BRV upon the occurrence of PBAEs. We utilized clinical trial data and regional cost estimates to conduct base-case and probabilistic sensitivity analyses.
Results
The results of the base-case analyses indicated that initial BRV therapy was cost-effective only in Australia. The results of the sensitivity analyses revealed that the probability of initial BRV being cost-effective was 0% in the US, 49.6% in Japan, and 99.99% in Australia. In Japan, when the risk of LEV-induced PBAEs was assumed to be 24%, the probability that initial BRV therapy would be cost-effective rose to 70%, supporting the potential utility of an initial BRV strategy in high-risk populations. By contrast, in the US, the risk of PBAEs needed to exceed 76% to achieve a comparable cost-effectiveness probability.
Significance
While the initial BRV strategy consistently demonstrated cost-effectiveness in Australia, it failed to do so in Japan and the US. However, Japan presents a unique opportunity where BRV can be used cost-effectively when combined with pre-assessments of LEV-induced risk for PBAEs.
Plain Language Summary
BRV causes fewer PBAEs than LEV, but costs more, creating a clinical dilemma. A cost-effectiveness analysis comparing BRV versus LEV as initial monotherapy with a focus on PBAEs was conducted across the US, Australia, and Japan. The results indicated that compared with LEV, BRV is cost-effective in Australia, but not in the US. In Japan, BRV is cost-effective as initial treatment only for patients at high risk for LEV-induced PBAEs.
{"title":"A cross-national cost-effectiveness analysis of brivaracetam focusing on psychiatric and behavioral adverse effects","authors":"Yasushi Maruyama, Hiroki Kimura, Takuji Nishida, Shiori Ogawa, Kohei Ninomiya, Masashi Ikeda","doi":"10.1002/epi4.70142","DOIUrl":"10.1002/epi4.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Levetiracetam (LEV) has been widely used as an antiseizure medication (ASM), but is associated with psychiatric and behavioral adverse effects (PBAEs). Brivaracetam (BRV) has demonstrated better psychiatric tolerability, albeit at a higher cost. This study aimed to evaluate the cost-effectiveness of initiating BRV versus LEV therapy with a subsequent switch to BRV in the event of PBAEs across the US, Australia, and Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed a decision tree model with a 10-year time horizon comparing two strategies across the US, Australia, and Japan: initial BRV therapy versus initial LEV therapy with a switch to BRV upon the occurrence of PBAEs. We utilized clinical trial data and regional cost estimates to conduct base-case and probabilistic sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results of the base-case analyses indicated that initial BRV therapy was cost-effective only in Australia. The results of the sensitivity analyses revealed that the probability of initial BRV being cost-effective was 0% in the US, 49.6% in Japan, and 99.99% in Australia. In Japan, when the risk of LEV-induced PBAEs was assumed to be 24%, the probability that initial BRV therapy would be cost-effective rose to 70%, supporting the potential utility of an initial BRV strategy in high-risk populations. By contrast, in the US, the risk of PBAEs needed to exceed 76% to achieve a comparable cost-effectiveness probability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>While the initial BRV strategy consistently demonstrated cost-effectiveness in Australia, it failed to do so in Japan and the US. However, Japan presents a unique opportunity where BRV can be used cost-effectively when combined with pre-assessments of LEV-induced risk for PBAEs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Plain Language Summary</h3>\u0000 \u0000 <p>BRV causes fewer PBAEs than LEV, but costs more, creating a clinical dilemma. A cost-effectiveness analysis comparing BRV versus LEV as initial monotherapy with a focus on PBAEs was conducted across the US, Australia, and Japan. The results indicated that compared with LEV, BRV is cost-effective in Australia, but not in the US. In Japan, BRV is cost-effective as initial treatment only for patients at high risk for LEV-induced PBAEs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":"10 5","pages":"1684-1694"},"PeriodicalIF":2.9,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/epi4.70142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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