Epilepsy and Behavior Reports最新文献

Feasibility and impact of virtual reality exposure therapy on epilepsy-specific anxiety: Phase 3 of the AnxEpiVR pilot clinical trial 虚拟现实暴露疗法对癫痫特异性焦虑的可行性和影响：AnxEpiVR临床试验3期

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2026-01-03 DOI: 10.1016/j.ebr.2025.100845

Hannah Gabrielle Gray , Danielle Tchao , Samantha Lewis-Fung , Glenda Carman-Gray , Susanna Pardini , Laurence R. Harris , Lora Appel

People with epilepsy (PwE) commonly experience interictal anxiety related to their epilepsy and seizures. However, therapeutic interventions have received minimal investigation. This study was the third phase of the “AnxEpiVR” pilot that examined the feasibility and effectiveness of a novel virtual reality exposure therapy (VR-ET) program to treat epilepsy-specific (ES) interictal anxiety in PwE. Participants (N = 5) completed the Epilepsy Anxiety Survey Instrument (EASI), Perceived Stress Scale, Igroup Presence Questionnaire, System Usability Scale, and an adapted version of the diagnostic protocol that Hingray et al. (2019) proposed. They also participated in a semi-structured interview. Participants were assigned to a personally relevant VR-ET scenario (dinner party, shopping mall, or a subway station/train). Over 12 to 14 days within a 14-day period, participants engaged in the VR-ET intervention, progressing through an individualized hierarchy of exposures. Preliminary findings suggest promising feasibility of VR-ET and high tolerability, achieving a 100% completion rate. The EASI scores showed that two of the four participants who scored above the cut-off for a probable anxiety disorder before VR-ET (brief EASI ≥ 7) scored below the cut-off after VR-ET (brief EASI < 7). Subjective reports of the VR-ET’s impact supported the intervention’s potential for reducing ES-interictal anxiety. This trial represents the inaugural use of VR-ET as a potential remote intervention for ES-interictal anxiety. Moreover, these findings support the feasibility of conducting larger clinical trials to further evaluate and to validate VR-ET as a therapeutic tool for managing interictal anxiety in PwE.

癫痫患者（PwE）通常会经历与癫痫和癫痫发作相关的间歇焦虑。然而，对治疗干预的研究很少。本研究是“AnxEpiVR”试点项目的第三阶段，该项目检验了一种新型虚拟现实暴露疗法（VR-ET）治疗PwE患者癫痫特异性（ES）间期焦虑的可行性和有效性。参与者（N = 5）完成了癫痫焦虑调查工具（EASI）、感知压力量表、iggroup Presence问卷、系统可用性量表以及Hingray等人（2019）提出的诊断方案的改编版本。他们还参加了一个半结构化的面试。参与者被分配到一个与个人相关的VR-ET场景（晚宴、购物中心或地铁站/火车）。在14天的时间内，参与者进行了12至14天的VR-ET干预，通过个性化的暴露层次进行。初步研究结果表明，VR-ET具有良好的可行性和高耐受性，可达到100%的完成率。EASI得分显示，在VR-ET（简要EASI≥7）之前，四名参与者中有两名在可能的焦虑障碍方面得分高于临界值（简要EASI≥7），在VR-ET（简要EASI <； 7）之后得分低于临界值。VR-ET影响的主观报告支持干预减少es -间期焦虑的潜力。该试验首次使用VR-ET作为es -间期焦虑的潜在远程干预手段。此外，这些发现支持进行更大规模临床试验的可行性，以进一步评估和验证VR-ET作为治疗PwE间期焦虑的治疗工具。

{"title":"Feasibility and impact of virtual reality exposure therapy on epilepsy-specific anxiety: Phase 3 of the AnxEpiVR pilot clinical trial","authors":"Hannah Gabrielle Gray , Danielle Tchao , Samantha Lewis-Fung , Glenda Carman-Gray , Susanna Pardini , Laurence R. Harris , Lora Appel","doi":"10.1016/j.ebr.2025.100845","DOIUrl":"10.1016/j.ebr.2025.100845","url":null,"abstract":"<div><div>People with epilepsy (PwE) commonly experience interictal anxiety related to their epilepsy and seizures. However, therapeutic interventions have received minimal investigation. This study was the third phase of the “AnxEpiVR” pilot that examined the feasibility and effectiveness of a novel virtual reality exposure therapy (VR-ET) program to treat epilepsy-specific (ES) interictal anxiety in PwE. Participants (N = 5) completed the Epilepsy Anxiety Survey Instrument (EASI), Perceived Stress Scale, Igroup Presence Questionnaire, System Usability Scale, and an adapted version of the diagnostic protocol that Hingray et al. (2019) proposed. They also participated in a semi-structured interview. Participants were assigned to a personally relevant VR-ET scenario (dinner party, shopping mall, or a subway station/train). Over 12 to 14 days within a 14-day period, participants engaged in the VR-ET intervention, progressing through an individualized hierarchy of exposures. Preliminary findings suggest promising feasibility of VR-ET and high tolerability, achieving a 100% completion rate. The EASI scores showed that two of the four participants who scored above the cut-off for a probable anxiety disorder before VR-ET (brief EASI ≥ 7) scored below the cut-off after VR-ET (brief EASI < 7). Subjective reports of the VR-ET’s impact supported the intervention’s potential for reducing ES-interictal anxiety. This trial represents the inaugural use of VR-ET as a potential remote intervention for ES-interictal anxiety. Moreover, these findings support the feasibility of conducting larger clinical trials to further evaluate and to validate VR-ET as a therapeutic tool for managing interictal anxiety in PwE.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"33 ","pages":"Article 100845"},"PeriodicalIF":1.5,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Influence of cannabis use on length of stay in patients admitted to the epilepsy monitoring unit 大麻使用对癫痫监测单位收治患者住院时间的影响

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2026-01-02 DOI: 10.1016/j.ebr.2025.100846

Oliver Hoerth , Ejerzain Aniles-Renova , Nan Zhang , Emily Thompson , Kristin A. Kirlin , Joseph Drazkowski

Purpose

Epilepsy affects approximately 50 million people worldwide, many of whom undergo evaluation in Epilepsy Monitoring Units (EMUs) for seizure classification, medication management, or presurgical assessment. With increasing numbers of states legalizing marijuana use, a growing number of EMU admissions involve individuals who use cannabis-based products. If cannabis users are unable to use cannabis products during their EMU admission, this may lead patients to be discharged before recording typical events. This study evaluates the impact of cannabis use on EMU outcomes, specifically length of stay (LOS) and likelihood of capturing a clinical event.

Methods

A retrospective chart review was conducted using a REDCap database including demographics, epilepsy risk factors, anti-seizure medication use, social history, urine drug screen results, and final diagnoses. Patients were categorized as users (self-reported use, positive urine test, or both) or non-users (negative test and no self-report). Primary outcomes in the analysis were LOS and event capture rates.

Results

Cannabis use was associated with a 0.9 day LOS reduction compared to non-users. Among patients admitted for spell classification, event capturability was 18.1 % higher in cannabis users. Additionally, cannabis users had increased prevalence of psychosocial comorbidities: 12.6 % reported physical abuse, 11.1 % sexual abuse, and 10.2 % mental abuse. Psychiatric diagnoses were also more prevalent; users were 18.9 % more likely to have Major Depressive Disorder and 22.1 % more likely to have Generalized Anxiety Disorder.

Conclusions

Cannabis use significantly affects EMU evaluation outcomes and correlates with distinct psychosocial and psychiatric profiles. These findings support a holistic approach in epilepsy patient management.

目的：全世界约有5000万人患有癫痫，其中许多人在癫痫监测单位（emu）接受癫痫发作分类、药物管理或手术前评估。随着越来越多的州将大麻使用合法化，越来越多的欧洲货币联盟的录取涉及使用大麻产品的个人。如果大麻使用者在EMU入院期间无法使用大麻产品，这可能导致患者在记录典型事件之前出院。本研究评估了大麻使用对EMU结果的影响，特别是停留时间（LOS）和捕获临床事件的可能性。方法采用REDCap数据库进行回顾性图表分析，包括人口统计学、癫痫危险因素、抗癫痫药物使用、社会病史、尿药筛查结果和最终诊断。患者被分类为使用者（自我报告使用，尿检阳性，或两者兼而有之）或非使用者（尿检阴性，无自我报告）。分析的主要结果是LOS和事件捕获率。结果与不使用扫描抗体的患者相比，使用扫描抗体可使LOS减少0.9天。在接受法术分类的患者中，大麻使用者的事件捕获率高出18.1%。此外，大麻使用者的社会心理合并症患病率增加：12.6%的人报告身体虐待，11.1%的人报告性虐待，10.2%的人报告精神虐待。精神病诊断也更为普遍；使用者患重度抑郁症的可能性高出18.9%，患广泛性焦虑症的可能性高出22.1%。结论使用扫描抗体显著影响EMU评估结果，并与不同的心理社会和精神病学特征相关。这些发现支持癫痫患者管理的整体方法。

{"title":"Influence of cannabis use on length of stay in patients admitted to the epilepsy monitoring unit","authors":"Oliver Hoerth , Ejerzain Aniles-Renova , Nan Zhang , Emily Thompson , Kristin A. Kirlin , Joseph Drazkowski","doi":"10.1016/j.ebr.2025.100846","DOIUrl":"10.1016/j.ebr.2025.100846","url":null,"abstract":"<div><h3>Purpose</h3><div>Epilepsy affects approximately 50 million people worldwide, many of whom undergo evaluation in Epilepsy Monitoring Units (EMUs) for seizure classification, medication management, or presurgical assessment. With increasing numbers of states legalizing marijuana use, a growing number of EMU admissions involve individuals who use cannabis-based products. If cannabis users are unable to use cannabis products during their EMU admission, this may lead patients to be discharged before recording typical events. This study evaluates the impact of cannabis use on EMU outcomes, specifically length of stay (LOS) and likelihood of capturing a clinical event.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted using a REDCap database including demographics, epilepsy risk factors, anti-seizure medication use, social history, urine drug screen results, and final diagnoses. Patients were categorized as users (self-reported use, positive urine test, or both) or non-users (negative test and no self-report). Primary outcomes in the analysis were LOS and event capture rates.</div></div><div><h3>Results</h3><div>Cannabis use was associated with a 0.9 day LOS reduction compared to non-users. Among patients admitted for spell classification, event capturability was 18.1 % higher in cannabis users. Additionally, cannabis users had increased prevalence of psychosocial comorbidities: 12.6 % reported physical abuse, 11.1 % sexual abuse, and 10.2 % mental abuse. Psychiatric diagnoses were also more prevalent; users were 18.9 % more likely to have Major Depressive Disorder and 22.1 % more likely to have Generalized Anxiety Disorder.</div></div><div><h3>Conclusions</h3><div>Cannabis use significantly affects EMU evaluation outcomes and correlates with distinct psychosocial and psychiatric profiles. These findings support a holistic approach in epilepsy patient management.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"33 ","pages":"Article 100846"},"PeriodicalIF":1.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trigeminal neuralgia-like pain in a vagus nerve stimulation super-responder with drug-resistant idiopathic generalized epilepsy: A case report 迷走神经刺激超反应患者伴耐药性特发性全身性癫痫三叉神经痛样疼痛1例报告

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-12-24 DOI: 10.1016/j.ebr.2025.100844

Javier Peña-Ceballos , Tenzin Choekyi , Aoife Walsh , Breege Staunton-Grufferty , Vicente Casitas-Hernando , Donncha O’Brien , Norman Delanty

We report a 38-year-old man with drug-resistant idiopathic generalized epilepsy (IGE) who became seizure-free after being implanted with vagus nerve stimulation (VNS). He developed a trigeminal neuralgia-like pain (TNLP) time-locked with ON stimulations. TNLP did not cease after restoring the initial stimulation parameters. After an unsuccessful trial with carbamazepine, the patient reported a moderate improvement with pregabalin. He remained seizure-free, being able to partially rationalize his ASM therapy and the ability to start driving lessons, with the normalization of his routine electroencephalogram (EEG).

我们报告一位38岁的男性耐药特发性全身性癫痫（IGE）患者在植入迷走神经刺激（VNS）后无癫痫发作。他出现了三叉神经痛样疼痛（TNLP），时间锁定与ON刺激。在恢复初始增产参数后，TNLP并未停止。卡马西平试验失败后，患者报告普瑞巴林有中度改善。他仍然没有癫痫发作，能够部分地合理化他的ASM治疗和开始驾驶课程的能力，他的常规脑电图（EEG）正常化。

引用次数: 0

Implementation of a ketogenic diet clinic in Mexico: A pilot program in a resource-limited setting 墨西哥生酮饮食诊所的实施：资源有限环境下的试点项目

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-12-16 DOI: 10.1016/j.ebr.2025.100842

Melissa Chavez-Castillo , Paloma Hurtado-Cuan , Maria Alejandra Soto-Blanquel , Amado Jimenez-Ruiz , Enrique Gomez-Figueroa , Rosa Marquez-Palacios

This study describes the implementation and outcomes of the first protocolized Ketogenic Diet Clinic (KDC) in Mexico for pediatric drug-resistant epilepsy (DRE). We conducted a retrospective analysis of 20 patients with DRE who initiated KDT between July 2022 and July 2024 in a multidisciplinary KDC at a public tertiary hospital. All patients were newly started on KDT under a structured protocol; none followed a classic 4:1 ketogenic diet, all received modified regimens. Clinical, nutritional, and socioeconomic data were collected. Seizure outcomes were categorized by percent reduction, and antiseizure medication (ASM) burden was evaluated through changes in cumulative daily dose and ASM count. Hospital admissions were recorded, and caregivers were asked about barriers to implementation. At the first follow-up visit (≈3 months), with complete data for all 20 patients, 10/20 (50 %) achieved ≥50 % seizure reduction and 4/20 (20 %) achieved ≥90 % reduction. Due to staggered recruitment, later visits included fewer patients (n = 18 and n = 14). Among the 14 patients who reached the third visit, 9/14 (64 %) achieved ≥90 % reduction. ASM dose decreased in 12/20 (60 %), and ASM count decreased in 6/20 (30 %). Hospital visits declined from 16 events the prior year to 4 after KDT initiation. Despite cultural, nutritional, educational, and access-related barriers, no patient discontinued the diet, as treatment plans were adapted to maintain feasibility. A structured KDC is feasible and clinically beneficial in a resource-limited setting. Modified KDT regimens reduced seizure burden and treatment intensity, supporting expansion of KDT programs in low-resource contexts.

本研究描述了墨西哥第一个针对儿童耐药癫痫（DRE）的生酮饮食诊所（KDC）的实施和结果。我们对2022年7月至2024年7月在一家公立三级医院多学科KDC接受KDT治疗的20例DRE患者进行了回顾性分析。所有患者均在结构化方案下新开始KDT治疗；没有人遵循经典的4:1生酮饮食，所有人都接受了改良的方案。收集临床、营养和社会经济数据。癫痫发作结果按减少百分比分类，并通过累积日剂量和ASM计数的变化评估抗癫痫药物（ASM）负担。记录了住院情况，并询问了护理人员实施过程中的障碍。第一次随访（≈3个月），所有20例患者数据完整，10/20（50%）患者癫痫发作减少≥50%，4/20（20%）患者癫痫发作减少≥90%。由于错开招募，后期访问的患者较少（n = 18和n = 14）。在到达第三次就诊的14例患者中，9/14（64%）的患者减少≥90%。ASM剂量在12/20（60%）减少，ASM计数在6/20（30%）减少。医院就诊次数从前一年的16次下降到KDT开始后的4次。尽管存在文化、营养、教育和获取相关的障碍，但由于治疗计划被调整以保持可行性，没有患者停止饮食。在资源有限的情况下，结构化的KDC是可行的，在临床上是有益的。改进的KDT方案减少了癫痫发作负担和治疗强度，支持在资源匮乏的情况下扩大KDT方案。

{"title":"Implementation of a ketogenic diet clinic in Mexico: A pilot program in a resource-limited setting","authors":"Melissa Chavez-Castillo , Paloma Hurtado-Cuan , Maria Alejandra Soto-Blanquel , Amado Jimenez-Ruiz , Enrique Gomez-Figueroa , Rosa Marquez-Palacios","doi":"10.1016/j.ebr.2025.100842","DOIUrl":"10.1016/j.ebr.2025.100842","url":null,"abstract":"<div><div>This study describes the implementation and outcomes of the first protocolized Ketogenic Diet Clinic (KDC) in Mexico for pediatric drug-resistant epilepsy (DRE). We conducted a retrospective analysis of 20 patients with DRE who initiated KDT between July 2022 and July 2024 in a multidisciplinary KDC at a public tertiary hospital. All patients were newly started on KDT under a structured protocol; none followed a classic 4:1 ketogenic diet, all received modified regimens. Clinical, nutritional, and socioeconomic data were collected. Seizure outcomes were categorized by percent reduction, and antiseizure medication (ASM) burden was evaluated through changes in cumulative daily dose and ASM count. Hospital admissions were recorded, and caregivers were asked about barriers to implementation. At the first follow-up visit (≈3 months), with complete data for all 20 patients, 10/20 (50 %) achieved ≥50 % seizure reduction and 4/20 (20 %) achieved ≥90 % reduction. Due to staggered recruitment, later visits included fewer patients (n = 18 and n = 14). Among the 14 patients who reached the third visit, 9/14 (64 %) achieved ≥90 % reduction. ASM dose decreased in 12/20 (60 %), and ASM count decreased in 6/20 (30 %). Hospital visits declined from 16 events the prior year to 4 after KDT initiation. Despite cultural, nutritional, educational, and access-related barriers, no patient discontinued the diet, as treatment plans were adapted to maintain feasibility. A structured KDC is feasible and clinically beneficial in a resource-limited setting. Modified KDT regimens reduced seizure burden and treatment intensity, supporting expansion of KDT programs in low-resource contexts.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"33 ","pages":"Article 100842"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

“I’m lonely”: An underrecognized marker of silent suffering in PWE in underresourced settings? “我很孤独”：在资源不足的环境中，PWE沉默痛苦的一个未被认识的标志？

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-12-08 DOI: 10.1016/j.ebr.2025.100841

Amza Ali

Loneliness is increasingly recognized as a significant psychosocial determinant of health, yet it remains comparatively underexplored in the context of epilepsy, and particularly in under-resourced environments. Unlike depression or anxiety, loneliness is less specifically sought, nor readily disclosed, despite its profound impact on well-being. This article draws on clinical experience and a small observational audit in Jamaica to highlight loneliness as a distinct and pervasive issue among people with epilepsy (PWE). While loneliness frequently co-occurs with depression, it may exist independently and may precede diagnosable mood disorders. Contributing factors include societal stigma, physician-advised safety restrictions, antiseizure medication side effects, and systemic gaps in epilepsy care, factors often greatly intensified in low-resource settings. By focusing on the lived experience of patients, this article argues that loneliness may silently erode quality of life, autonomy, and treatment adherence, in part also from its seemingly close association with depression. It proposes low-cost, socially focused interventions as potentially transformative and suggests the need for inclusion of loneliness as a modifiable factor in clinical practice and future research. A simple question, “Do you feel lonely?” could facilitate the identification of loneliness in PWE, and particularly in underserved communities and LMICs with high social stigma, may help improve psychosocial outcomes, and epilepsy control.

孤独感越来越被认为是健康的一个重要的社会心理决定因素，但在癫痫的情况下，特别是在资源不足的环境中，孤独感的探索仍然相对不足。与抑郁或焦虑不同，尽管孤独对幸福感有深远的影响，但它不太容易被寻找，也不容易被披露。本文借鉴牙买加的临床经验和一项小型观察性审计，强调孤独是癫痫患者（PWE）中一个明显而普遍的问题。虽然孤独经常与抑郁症同时发生，但它可能独立存在，可能先于可诊断的情绪障碍。造成这种情况的因素包括社会污名、医生建议的安全限制、抗癫痫药物副作用以及癫痫治疗方面的系统性差距，这些因素在资源匮乏的环境中往往大大加剧。通过关注患者的生活经历，这篇文章认为孤独可能会默默地侵蚀生活质量、自主性和治疗依从性，部分原因也在于它与抑郁症的密切联系。它提出低成本、以社会为重点的干预措施具有潜在的变革性，并建议在临床实践和未来的研究中，需要将孤独作为一个可改变的因素。一个简单的问题，“你感到孤独吗？”可以促进PWE孤独感的识别，特别是在服务不足的社区和社会耻辱感高的中低收入国家，这可能有助于改善社会心理结果和癫痫控制。

{"title":"“I’m lonely”: An underrecognized marker of silent suffering in PWE in underresourced settings?","authors":"Amza Ali","doi":"10.1016/j.ebr.2025.100841","DOIUrl":"10.1016/j.ebr.2025.100841","url":null,"abstract":"<div><div>Loneliness is increasingly recognized as a significant psychosocial determinant of health, yet it remains comparatively underexplored in the context of epilepsy, and particularly in under-resourced environments. Unlike depression or anxiety, loneliness is less specifically sought, nor readily disclosed, despite its profound impact on well-being. This article draws on clinical experience and a small observational audit in Jamaica to highlight loneliness as a distinct and pervasive issue among people with epilepsy (PWE). While loneliness frequently co-occurs with depression, it may exist independently and may precede diagnosable mood disorders. Contributing factors include societal stigma, physician-advised safety restrictions, antiseizure medication side effects, and systemic gaps in epilepsy care, factors often greatly intensified in low-resource settings. By focusing on the lived experience of patients, this article argues that loneliness may silently erode quality of life, autonomy, and treatment adherence, in part also from its seemingly close association with depression. It proposes low-cost, socially focused interventions as potentially transformative and suggests the need for inclusion of loneliness as a modifiable factor in clinical practice and future research. A simple question, “Do you feel lonely?” could facilitate the identification of loneliness in PWE, and particularly in underserved communities and LMICs with high social stigma, may help improve psychosocial outcomes, and epilepsy control.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"33 ","pages":"Article 100841"},"PeriodicalIF":1.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Health economic analysis of seizure-related emergency visits of pediatric patients with drug-resistant epilepsy in Japan 日本儿童耐药癫痫患者癫痫相关急诊的卫生经济分析

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-12-08 DOI: 10.1016/j.ebr.2025.100840

Ayataka Fujimoto , Takuya Kumagai , Kazuaki Yamamoto , Katsuhiko Iwasaki , Kinya Kokubo , Ataru Igarashi

This study estimates the cost of emergency transport and the total cost of medical care for pediatric patients with drug-resistant epilepsy (DRE) in Japan. We perform a retrospective analysis of patients aged less than 18 years with DRE. We use a health insurance claims database to identify the patients. The data are combined with published information, including government statistics and prior studies. We calculate the median medical cost for these patients after emergency and the cost per emergency transport service using recent data published by the Fire and Disaster Management Agency and calculation logic. The cost per emergency transport service is approximately 138,600 yen. Additionally, the cost of emergency transport for pediatric patients with DRE and the total medical cost in Japan are approximately 511,949,800 and 597,536,619 yen per year, respectively. This study is among the first to estimate the annual costs of seizure-related emergency transport and medical care for pediatric patients with DRE in Japan. These estimates can serve as baseline data for use in future assessments of the cost-effectiveness of acute medical care in this population.

本研究估算了日本儿童耐药癫痫（DRE）患者的紧急运输费用和医疗保健总费用。我们对年龄小于18 岁的DRE患者进行回顾性分析。我们使用健康保险索赔数据库来识别患者。这些数据与已公布的信息相结合，包括政府统计数据和先前的研究。我们使用消防和灾害管理局公布的最新数据和计算逻辑计算了这些病人在紧急情况下的医疗费用中位数和每次紧急运输服务的费用。每次紧急运输服务的费用约为138,600日元。此外，在日本，患有DRE的儿科患者的紧急运输费用和医疗总费用每年分别约为511,949,800日元和597,536,619日元。这项研究是日本第一个估计癫痫相关紧急运输和儿科DRE患者医疗护理年度成本的研究之一。这些估计值可作为基线数据，用于未来评估这一人群急性医疗护理的成本效益。

{"title":"Health economic analysis of seizure-related emergency visits of pediatric patients with drug-resistant epilepsy in Japan","authors":"Ayataka Fujimoto , Takuya Kumagai , Kazuaki Yamamoto , Katsuhiko Iwasaki , Kinya Kokubo , Ataru Igarashi","doi":"10.1016/j.ebr.2025.100840","DOIUrl":"10.1016/j.ebr.2025.100840","url":null,"abstract":"<div><div>This study estimates the cost of emergency transport and the total cost of medical care for pediatric patients with drug-resistant epilepsy (DRE) in Japan. We perform a retrospective analysis of patients aged less than 18 years with DRE. We use a health insurance claims database to identify the patients. The data are combined with published information, including government statistics and prior studies. We calculate the median medical cost for these patients after emergency and the cost per emergency transport service using recent data published by the Fire and Disaster Management Agency and calculation logic. The cost per emergency transport service is approximately 138,600 yen. Additionally, the cost of emergency transport for pediatric patients with DRE and the total medical cost in Japan are approximately 511,949,800 and 597,536,619 yen per year, respectively. This study is among the first to estimate the annual costs of seizure-related emergency transport and medical care for pediatric patients with DRE in Japan. These estimates can serve as baseline data for use in future assessments of the cost-effectiveness of acute medical care in this population.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"33 ","pages":"Article 100840"},"PeriodicalIF":1.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early antiseizure response to cenobamate (200 mg/day) in focal drug-resistant epilepsy: a retrospective single-center analysis 局灶性耐药癫痫患者早期使用cenobamate （200mg /天）抗癫痫反应：一项回顾性单中心分析

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ebr.2025.100839

Ewa Czapińska-Ciepiela, Agnieszka Kondak, Monika Kowalczyk, Piotr Czapiński

Clinical studies have shown cenobamate (CNB) is effective for treating drug-resistant focal epilepsy. This study examines Polish patients with epilepsy, assessing the efficacy and safety of CNB at 200 mg/day and factors influencing early therapeutic response. A retrospective observational study involved 100 patients with drug-resistant focal epilepsy, treated in a private Polish epilepsy outpatient clinic from March 2022 to March 2025. The primary goal was to evaluate response to CNB 200 mg/day, using seizure reduction thresholds (50 %, 75 %, 100 %), and to identify determinants such as demographic data, disease duration and etiology, intellectual disability, baseline seizure frequency, previous antiseizure medications (ASMs) and medication combinations. Adverse reactions and changes in concomitant ASMs were also evaluated. Of the 100 patients, 95 continued CNB therapy. Most had multi-drug resistance. After three months at 200 mg/day, ≥50 % seizure reduction was seen in 63 %, ≥75 % in 36 %, and 100 % in 18 %. Age, sex, epilepsy etiology or duration, intellectual disability, prior seizure count, previous ASMs, and medication combinations did not affect CNB’s efficacy. Most tolerated CNB well, with adverse effects including dizziness and balance disorders (49 %), somnolence (38 %), diplopia (17 %), weakness (10 %), and concentration or memory issues (10 %). Lacosamide use increased adverse effects, which mostly resolved after dose reduction. Other adjusted drugs were lamotrigine, topiramate, and oxcarbazepine. CNB at 200 mg/day was highly effective and generally well-tolerated, especially with reduced doses of other ASMs. Efficacy was independent of epilepsy severity or treatment factors, suggesting CNB’s promise in multi-drug-resistant patients.

临床研究表明，cenobamate （CNB）是治疗耐药局灶性癫痫的有效药物。本研究以波兰癫痫患者为研究对象，评估200 mg/天CNB的疗效和安全性以及影响早期治疗反应的因素。一项回顾性观察性研究纳入了100例耐药局灶性癫痫患者，这些患者于2022年3月至2025年3月在波兰一家私营癫痫门诊接受治疗。主要目的是通过癫痫发作减少阈值（50%、75%、100%）来评估对CNB 200mg /天的反应，并确定诸如人口统计数据、疾病持续时间和病因、智力残疾、基线癫痫发作频率、既往抗癫痫药物（asm）和药物组合等决定因素。并对不良反应及伴随的asm变化进行了评价。在100名患者中，95名患者继续接受CNB治疗。大多数有多药耐药。服药200 mg/天3个月后，63%的患者癫痫发作减少≥50%，36%的患者癫痫发作减少≥75%，18%的患者癫痫发作减少100%。年龄、性别、癫痫病因或持续时间、智力残疾、既往癫痫发作次数、既往asm和药物组合不影响CNB的疗效。大多数人对CNB耐受良好，其不良反应包括头晕和平衡障碍（49%）、嗜睡（38%）、复视（17%）、虚弱（10%）以及注意力或记忆力问题（10%）。拉科沙胺的使用增加了不良反应，这些不良反应大多在剂量减少后消失。其他调整药物为拉莫三嗪、托吡酯和奥卡西平。200毫克/天的CNB非常有效，一般耐受性良好，特别是减少其他asm的剂量。疗效与癫痫严重程度或治疗因素无关，提示CNB在多重耐药患者中的应用前景。

{"title":"Early antiseizure response to cenobamate (200 mg/day) in focal drug-resistant epilepsy: a retrospective single-center analysis","authors":"Ewa Czapińska-Ciepiela, Agnieszka Kondak, Monika Kowalczyk, Piotr Czapiński","doi":"10.1016/j.ebr.2025.100839","DOIUrl":"10.1016/j.ebr.2025.100839","url":null,"abstract":"<div><div>Clinical studies have shown cenobamate (CNB) is effective for treating drug-resistant focal epilepsy. This study examines Polish patients with epilepsy, assessing the efficacy and safety of CNB at 200 mg/day and factors influencing early therapeutic response. A retrospective observational study involved 100 patients with drug-resistant focal epilepsy, treated in a private Polish epilepsy outpatient clinic from March 2022 to March 2025. The primary goal was to evaluate response to CNB 200 mg/day, using seizure reduction thresholds (50 %, 75 %, 100 %), and to identify determinants such as demographic data, disease duration and etiology, intellectual disability, baseline seizure frequency, previous antiseizure medications (ASMs) and medication combinations. Adverse reactions and changes in concomitant ASMs were also evaluated. Of the 100 patients, 95 continued CNB therapy. Most had multi-drug resistance. After three months at 200 mg/day, ≥50 % seizure reduction was seen in 63 %, ≥75 % in 36 %, and 100 % in 18 %. Age, sex, epilepsy etiology or duration, intellectual disability, prior seizure count, previous ASMs, and medication combinations did not affect CNB’s efficacy. Most tolerated CNB well, with adverse effects including dizziness and balance disorders (49 %), somnolence (38 %), diplopia (17 %), weakness (10 %), and concentration or memory issues (10 %). Lacosamide use increased adverse effects, which mostly resolved after dose reduction. Other adjusted drugs were lamotrigine, topiramate, and oxcarbazepine. CNB at 200 mg/day was highly effective and generally well-tolerated, especially with reduced doses of other ASMs. Efficacy was independent of epilepsy severity or treatment factors, suggesting CNB’s promise in multi-drug-resistant patients.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100839"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Special issue on advancing physical activity and exercise research in epilepsy and seizure disorders 关于在癫痫和发作性疾病中推进身体活动和运动研究的特刊

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ebr.2025.100827

Jane B. Allendorfer

引用次数: 0

Electroceuticals for Motherhood: Utility of responsive neurostimulation and Proactive antiseizure medication management in two pregnancies 母性电治疗：反应性神经刺激和主动抗癫痫药物管理在两次妊娠中的效用

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-11-18 DOI: 10.1016/j.ebr.2025.100838

Aisha Abdulrazaq , Dorothee Kasteleijn , Thomas Henry , Sandipan Pati

Females with drug-resistant epilepsy (DRE) face unique challenges in balancing seizure control with the teratogenic risks of anti-seizure medications (ASMs) during pregnancy. This case study highlights the use of responsive neurostimulation (RNS) as an electroneuromodulatory strategy to enable safer pregnancies by reducing ASM burden while maintaining seizure control. A 25-year-old woman with bilateral limbic epilepsy secondary to autoimmune encephalitis underwent RNS implantation targeting the hippocampi. Over a multi-year preconception planning period, RNS optimization allowed for tapering of high-risk ASMs and stabilization of seizure frequency. Across two pregnancies, neuromodulation enabled stable epilepsy control and reduced reliance on polytherapy, despite pharmacokinetic ASM variability. Both pregnancies resulted in healthy infants with no major congenital anomalies, despite episodes of breakthrough seizures. This case underscores the transformative potential of RNS in the reproductive care of women with DRE—not only by improving maternal safety but also by reducing fetal exposure to teratogenic drugs. As the first report to demonstrate how RNS can facilitate pregnancy planning with details on how ASM was minimized and complex therapeutic monitoring, this study sets the stage for integrating electroneuromodulation into preconception counselling and epilepsy management for women of childbearing age.

女性耐药癫痫（DRE）面临着独特的挑战，平衡癫痫发作控制与致畸风险的抗癫痫药物（asm）在怀孕期间。本案例研究强调了使用反应性神经刺激（RNS）作为电子神经调节策略，通过减少ASM负担，同时保持癫痫控制，从而实现更安全的妊娠。一名25岁的双侧边缘癫痫继发于自身免疫性脑炎的女性接受了针对海马的RNS植入。在多年的孕前计划期间，RNS优化允许减少高风险的asm和稳定癫痫发作频率。在两次怀孕期间，尽管ASM的药代动力学变异性，神经调节使癫痫控制稳定，减少了对多种治疗的依赖。两次怀孕都产生了健康的婴儿，没有重大的先天性异常，尽管有突发性癫痫发作。该病例强调了RNS在安德安德妇女生殖保健方面的变革性潜力——不仅可以提高产妇安全性，还可以减少胎儿接触致畸药物。作为第一份展示RNS如何促进妊娠计划的报告，详细介绍了如何最小化ASM和复杂的治疗监测，本研究为将神经电调节整合到育龄妇女的孕前咨询和癫痫管理中奠定了基础。

{"title":"Electroceuticals for Motherhood: Utility of responsive neurostimulation and Proactive antiseizure medication management in two pregnancies","authors":"Aisha Abdulrazaq , Dorothee Kasteleijn , Thomas Henry , Sandipan Pati","doi":"10.1016/j.ebr.2025.100838","DOIUrl":"10.1016/j.ebr.2025.100838","url":null,"abstract":"<div><div>Females with drug-resistant epilepsy (DRE) face unique challenges in balancing seizure control with the teratogenic risks of anti-seizure medications (ASMs) during pregnancy. This case study highlights the use of responsive neurostimulation (RNS) as an electroneuromodulatory strategy to enable safer pregnancies by reducing ASM burden while maintaining seizure control. A 25-year-old woman with bilateral limbic epilepsy secondary to autoimmune encephalitis underwent RNS implantation targeting the hippocampi. Over a multi-year preconception planning period, RNS optimization allowed for tapering of high-risk ASMs and stabilization of seizure frequency. Across two pregnancies, neuromodulation enabled stable epilepsy control and reduced reliance on polytherapy, despite pharmacokinetic ASM variability. Both pregnancies resulted in healthy infants with no major congenital anomalies, despite episodes of breakthrough seizures. This case underscores the transformative potential of RNS in the reproductive care of women with DRE—not only by improving maternal safety but also by reducing fetal exposure to teratogenic drugs. As the first report to demonstrate how RNS can facilitate pregnancy planning with details on how ASM was minimized and complex therapeutic monitoring, this study sets the stage for integrating electroneuromodulation into preconception counselling and epilepsy management for women of childbearing age.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100838"},"PeriodicalIF":1.5,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of neurosarcoidosis presenting as hippocampal sclerosis: Clinicopathological correlation and proposed mechanistic link 以海马硬化为表现的神经结节病1例：临床病理相关性及提出的机制联系

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-11-07 DOI: 10.1016/j.ebr.2025.100837

Elham Rahimian , Guive Sharifi , Hans Jürgen Huppertz , Majid Reza Tahsini , Behnam Safarpour Lima , Elham Naderi , Yalda Nilipour , Melika Javani , Soudeh Ghafouri-Fard

Neurosarcoidosis is a rare manifestation of systemic sarcoidosis, typically affecting the meninges, cranial nerves, and hypothalamic–pituitary axis. Parenchymal brain involvement—particularly of the hippocampus—is uncommon and only rarely associated with epilepsy or hippocampal sclerosis (HS). Here, we describe a rare coexistence of biopsy-proven neurosarcoidosis and hippocampal sclerosis, suggesting secondary hippocampal injury due to chronic inflammation presenting with drug-resistant right mesial temporal lobe epilepsy (MTLE). We reviewed the clinical electrophysiological imaging and histopathological findings of a 47-year-old male who underwent anterior temporal lobectomy (ATL) after seizure onset which was localized to the right anterior to mid temporal region. Preoperative MRI was consistent with mesial temporal sclerosis. Histopathological analysis revealed both classic features of HS (neuronal loss and gliosis) and non-caseating granulomas diagnostic of neurosarcoidosis distributed within the medial temporal lobe and involving the amygdala. These findings suggest chronic inflammation may have contributed to hippocampal injury and epileptogenesis. The patient became seizure-free postoperatively. This case underscores the potential for neurosarcoidosis to mimic isolated MTLE and coexist with HS as a rare co-localized pathology. It raises the hypothesis that immune-mediated inflammation may play a pathogenic role in hippocampal degeneration. Recognition of such cases may enhance diagnostic accuracy and inform surgical planning in epilepsy associated with systemic inflammatory disorders.

神经结节病是一种罕见的系统性结节病，通常累及脑膜、脑神经和下丘脑-垂体轴。脑实质受累-特别是海马-是罕见的，很少与癫痫或海马硬化（HS）有关。在这里，我们描述了一个罕见的活组织检查证实的神经结节病和海马硬化共存，提示慢性炎症引起的继发性海马损伤表现为耐药右侧内侧颞叶癫痫（MTLE）。我们回顾了一位47岁男性患者的临床电生理成像和组织病理学结果，他在癫痫发作后接受了颞叶前部切除术（ATL）。术前MRI符合内侧颞叶硬化。组织病理学分析显示HS的典型特征（神经元丢失和神经胶质瘤）和非干酪化肉芽肿诊断为神经结节病分布在内侧颞叶和累及杏仁核。这些发现提示慢性炎症可能导致海马损伤和癫痫发生。患者术后无癫痫发作。本病例强调了神经结节病可能与孤立的MTLE相似，并与HS共存，这是一种罕见的共定位病理。它提出了免疫介导的炎症可能在海马变性中起致病作用的假设。识别这类病例可以提高诊断的准确性，并为与全身炎症性疾病相关的癫痫的手术计划提供信息。

{"title":"A case of neurosarcoidosis presenting as hippocampal sclerosis: Clinicopathological correlation and proposed mechanistic link","authors":"Elham Rahimian , Guive Sharifi , Hans Jürgen Huppertz , Majid Reza Tahsini , Behnam Safarpour Lima , Elham Naderi , Yalda Nilipour , Melika Javani , Soudeh Ghafouri-Fard","doi":"10.1016/j.ebr.2025.100837","DOIUrl":"10.1016/j.ebr.2025.100837","url":null,"abstract":"<div><div>Neurosarcoidosis is a rare manifestation of systemic sarcoidosis, typically affecting the meninges, cranial nerves, and hypothalamic–pituitary axis. Parenchymal brain involvement—particularly of the hippocampus—is uncommon and only rarely associated with epilepsy or hippocampal sclerosis (HS). Here, we describe a rare coexistence of biopsy-proven neurosarcoidosis and hippocampal sclerosis, suggesting secondary hippocampal injury due to chronic inflammation presenting with drug-resistant right mesial temporal lobe epilepsy (MTLE). We reviewed the clinical electrophysiological imaging and histopathological findings of a 47-year-old male who underwent anterior temporal lobectomy (ATL) after seizure onset which was localized to the right anterior to mid temporal region. Preoperative MRI was consistent with mesial temporal sclerosis. Histopathological analysis revealed both classic features of HS (neuronal loss and gliosis) and non-caseating granulomas diagnostic of neurosarcoidosis distributed within the medial temporal lobe and involving the amygdala. These findings suggest chronic inflammation may have contributed to hippocampal injury and epileptogenesis. The patient became seizure-free postoperatively. This case underscores the potential for neurosarcoidosis to mimic isolated MTLE and coexist with HS as a rare co-localized pathology. It raises the hypothesis that immune-mediated inflammation may play a pathogenic role in hippocampal degeneration. Recognition of such cases may enhance diagnostic accuracy and inform surgical planning in epilepsy associated with systemic inflammatory disorders.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100837"},"PeriodicalIF":1.5,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0