Epilepsy and Behavior Reports最新文献_第2页

Network analysis of antiseizure medication use, efficacy, and safety in epilepsy: A retrospective cohort study in a tertiary care center 癫痫患者抗癫痫药物使用、疗效和安全性的网络分析：一项三级医疗中心的回顾性队列研究

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-11-03 DOI: 10.1016/j.ebr.2025.100836

Miguel Angel Morales-Morales , Emilio García-Gómez , Daniel San-Juan , Carlos Trenado , Daniela Carolina Pimentel-Saona , Yazmin Palomares-Salazar , Manuel Alejandro Del Río-Quiñones , Mónica Alejandra Montalvo-Hérnandez , Christopher De Jesús-Fernández , Jesús Iván Ruiz-Gutierrez , Clio Rubinos

Antiseizure medications (ASMs) remain the cornerstone of epilepsy treatment, yet data on prescription patterns, effectiveness, and safety in low- and middle-income countries are limited. This retrospective cohort study analyzed changes in ASM use, efficacy, and adverse effects across 10 years in a tertiary care center in Mexico, comparing two phases: 2011–2013 (n = 100) and 2021–2023 (n = 128). Data on seizure freedom, adverse effects, and ASM patterns were analyzed using descriptive statistics and comparative tests. Network analysis and centrality measures were performed with MATLAB Version 9.12.0 to explore the relationships among prescribed ASMs and their influence on outcomes. A total of 228 patients were included. Seizure freedom rates increased from 9 % in the first phase to 25.8 % in the second (p = 0.001). Valproic acid remained the most frequently prescribed ASM, while levetiracetam use markedly increased (49 %). Adverse effects rose from 10 % to 17 % despite a modest reduction in polytherapy (93 % to 87.5 %). The network analysis revealed clusters of ASMs commonly prescribed together that were associated with seizure freedom (valproic acid, lamotrigine, topiramate), whereas combinations including phenobarbital and lamotrigine were linked to more adverse effects. Valproate continues to play a key role in seizure control due to its efficacy, accessibility, and broad-spectrum profile. Despite advances in newer ASM use and improved seizure outcomes, adverse effects remain a concern. Continued monitoring of ASM combinations is warranted to better understand evolving treatment patterns and guide epilepsy management in resource-limited settings.

抗癫痫药物仍然是癫痫治疗的基石，但在低收入和中等收入国家，关于处方模式、有效性和安全性的数据有限。这项回顾性队列研究分析了墨西哥一家三级保健中心10年来ASM使用、疗效和不良反应的变化，比较了两个阶段：2011-2013年（n = 100）和2021-2023年（n = 128）。使用描述性统计和比较检验分析癫痫发作自由度、不良反应和ASM模式的数据。采用MATLAB 9.12.0版本进行网络分析和中心性测量，探讨处方asm之间的关系及其对预后的影响。共纳入228例患者。发作自由率从第一阶段的9%上升到第二阶段的25.8% （p = 0.001）。丙戊酸仍然是最常用的ASM处方，而左乙拉西坦的使用明显增加（49%）。不良反应从10%上升到17%，尽管复合治疗略有减少（93%到87.5%）。网络分析显示，通常同时使用的抗痉挛药物群（丙戊酸、拉莫三嗪、托吡酯）与癫痫发作自由有关，而包括苯巴比妥和拉莫三嗪在内的组合则与更多的不良反应有关。丙戊酸钠由于其疗效、可及性和广谱性，在癫痫发作控制中继续发挥关键作用。尽管新ASM的使用取得了进展，癫痫发作的结果也有所改善，但副作用仍然令人担忧。有必要继续监测ASM组合，以便更好地了解不断变化的治疗模式，并指导资源有限环境下的癫痫管理。

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引用次数: 0

Stereo-EEG associated anti-GAD65 autoimmune encephalitis – A report of two cases 立体脑电图相关抗gad65自身免疫性脑炎2例报告

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-10-25 DOI: 10.1016/j.ebr.2025.100835

Claude Steriade , Andrew Christiana , Giovanna Dane , Peter A. Rozman , Daniel Friedman

We present two cases of adult-onset temporal lobe epilepsy (TLE) who underwent stereo-EEG and, within weeks of explantation, experienced subacute encephalopathy and in one patient, seizure exacerbation. Diagnostic investigations revealed low titer GAD antibodies in serum and evidence of GAD intrathecal synthesis. Immunotherapy led to improvement in one patient. We posit a role for blood brain barrier disruption in the setting of a neurosurgical procedure leading to inflammation and intrathecal synthesis of GAD antibodies. Investigations for autoimmune causes of epilepsy should be undertaken prior to SEEG in patients with no known cause of epilepsy and a suggestive electroclinical phenotype.

我们报告了两例成人发作的颞叶癫痫（TLE），他们接受了立体脑电图，在移植后的几周内，经历了亚急性脑病，其中一名患者癫痫发作加剧。诊断调查显示血清中有低滴度GAD抗体，鞘内有GAD合成的证据。免疫疗法改善了一名患者。我们假设在神经外科手术中血脑屏障破坏的作用，导致炎症和鞘内GAD抗体的合成。对于没有已知癫痫病因和提示电临床表型的患者，应在SEEG之前进行自身免疫性癫痫病因的调查。

引用次数: 0

Prolonged psychiatric symptoms revealed as nonconvulsive status epilepticus in ring chromosome 20 syndrome 20环染色体综合征的长期精神症状表现为非惊厥性癫痫持续状态

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-10-19 DOI: 10.1016/j.ebr.2025.100834

Mihoko Kawai , Kento Nakamura , Ryosuke Aratake , Mayuko Ota , Koutaro Sakurai , Kousuke Kanemoto

Ring chromosome 20 (r[20]) syndrome is a rare epilepsy-associated chromosomal disorder often accompanied by intellectual disability and psychiatric symptoms. It lacks distinctive physical features and typically exhibits normal brain imaging; therefore, its diagnosis is frequently delayed, especially when clinicians are unfamiliar with it. Nonconvulsive status epilepticus (NCSE), a hallmark of this syndrome, can be overlooked even by epilepsy specialists, who interpret it as a psychiatric symptom, particularly in patients with limited expressive capacity. A 42-year-old woman with a long-standing history of drug-resistant epilepsy and behavioral symptoms was ultimately diagnosed with r(20) syndrome. She developed tonic seizures and fear episodes at age 6 and was diagnosed with epilepsy. After age 11, drug-resistant NCSE emerged and was not clearly identified as status epilepticus; it was considered to involve impaired awareness seizures and psychiatric symptoms. At age 41, perampanel (PER) was initiated, triggering aggressive behavior and new backward-falling episodes, further complicating her clinical presentation. Video electroencephalogram (EEG) confirmed NCSE, and chromosomal analysis identified r(20). After PER discontinuation, aggression and backward-falling episodes resolved. Lacosamide was introduced, reducing the frequency of NCSE from several daily episodes to 2–3 per week. This case underscores the diagnostic challenges of r(20) syndrome and the risk of misdiagnosing NCSE as a psychiatric illness. Additionally, PER may exacerbate psychiatric symptoms in r(20) cases with intellectual disability. Precise seizure classification and confirmation by ictal EEG, along with integrated neuropsychiatric care, are essential for accurate diagnosis and effective management.

20环染色体综合征是一种罕见的与癫痫相关的染色体疾病，常伴有智力障碍和精神症状。它缺乏明显的身体特征，通常表现为正常的脑成像；因此，它的诊断经常被延误，特别是当临床医生不熟悉它。非惊厥性癫痫持续状态（NCSE）是该综合征的一个标志，甚至被癫痫专家所忽视，他们将其解释为精神症状，特别是在表达能力有限的患者中。一名42岁女性，长期患有耐药癫痫和行为症状，最终被诊断为r（20）综合征。她在6岁时出现强直性癫痫发作和恐惧发作，并被诊断患有癫痫。11岁后出现耐药NCSE，但未明确确定为癫痫持续状态；它被认为涉及意识受损、癫痫发作和精神症状。41岁时，perampanel （PER）开始，引发了攻击行为和新的向后跌倒发作，进一步复杂化了她的临床表现。视频脑电图（EEG）证实NCSE，染色体分析证实r（20）。在PER停药后，攻击性和向后跌倒发作消失。引入拉科沙胺，将NCSE的频率从每天几次减少到每周2-3次。本病例强调了r（20）综合征的诊断挑战以及将NCSE误诊为精神疾病的风险。此外，PER可能加重r（20）例智力残疾患者的精神症状。准确的癫痫分类和发作期脑电图的确认，以及综合的神经精神护理，是准确诊断和有效管理的必要条件。

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引用次数: 0

Long-term efficacy and safety of perampanel in patients aged 60 years and older with focal seizures: Post hoc analysis of phase III open-label extension studies stratified by enzyme-inducing anti-seizure medication use perampanel在60岁及以上局灶性癫痫患者中的长期疗效和安全性：按酶诱导抗癫痫药物使用分层的III期开放标签扩展研究的事后分析

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-10-10 DOI: 10.1016/j.ebr.2025.100833

Rohit Marawar , Ilo E. Leppik , Robert T. Wechsler , Anna Patten , Leock Y. Ngo

Objective

Examine long-term findings from two Phase III open-label extension (OLEx) studies of adjunctive perampanel in patients aged ≥60 years experiencing focal seizures (FS), with/without focal to bilateral tonic-clonic seizures (FBTCS), with/without enzyme-inducing anti-seizure medications (EIASMs). Methods: Study 307 (NCT00735397) included a Conversion Period (16 weeks; blinded) and a Maintenance Period (256 weeks). Study 335 OLEx (NCT01618695) included Pre-conversion (4 weeks), Conversion (6 weeks), and Maintenance Periods (≥46 weeks). Perampanel (2–12 mg/day) was given alongside 1–3 concomitant ASMs, of which ≤2 (Study 307) and ≤1 (Study 335) were EIASMs. Efficacy and safety outcomes were analyzed. Results: Seventy-one patients aged ≥60 years were included in the Full and Safety Analysis Sets. Over 4 years, seizure frequency decreased regardless of EIASM use; seizure-freedom rates for FS were 0.0 % (n = 0/71) for Year 1, 2.6 % (n = 1/38) Year 2, 5.3 % (n = 1/19) Year 3, and 0.0 % (n = 0/14) Year 4. For FBTCS, these rates were 26.3 % (n = 5/19) for Year 1, 22.2 % (n = 2/9) Year 2, 40.0 % (n = 2/5) Year 3, and 0.0 % (n = 0/4) Year 4. The 90 % responder rates were ≥14.0 % for FS and ≥40.0 % for FBTCS. Incidence of treatment-emergent adverse events (TEAEs) was highest during Year 1 (87.3 % [n = 62/71]) but decreased across Years 2–4 (47.4 %–60.4 %). The most commonly reported TEAE during Years 1/2 was dizziness (47.9 % [n = 34/71] and 12.5 % [n = 6/48], respectively) and during Years 3/4 was fall (15.8 % [n = 3/19] and 14.3 % [n = 2/14]). Significance: Adjunctive perampanel conferred long-term seizure control in older patients with epilepsy; safety was aligned with established perampanel safety profile.

目的：研究两项III期开放标签扩展（OLEx）研究的长期结果，这些研究对年龄≥60岁的局灶性癫痫（FS）、伴/不伴局灶性至双侧强直-阵挛性癫痫（FBTCS）、伴/不伴酶促抗癫痫药物（EIASMs）的患者进行了辅助perampanel治疗。方法：研究307 （NCT00735397）包括一个转换期（16周，盲法）和一个维持期（256周）。研究335 OLEx （NCT01618695）包括预转化期（4周）、转化期（6周）和维持期（≥46周）。Perampanel （2 - 12mg /天）与1 - 3种asm同时给予，其中≤2（研究307）和≤1（研究335）为eiasm。对疗效和安全性结果进行分析。结果：71例年龄≥60岁的患者被纳入完整和安全分析集。4年后，癫痫发作频率下降，与使用EIASM无关；FS的发病自由率在第一年为0.0% (n = 0/71)，第二年为2.6% (n = 1/38)，第三年为5.3% (n = 1/19)，第四年为0.0% （n = 0/14）。FBTCS,这些利率26.3%为1年(n = 5/19), 22.2% (n = 2/9), 40.0% (n = 2/5) 3, 0.0% (n = 0/4) 4。90%应答率FS≥14.0%,FBTCS≥40.0%。治疗后出现的不良事件（teae）发生率在第1年最高（87.3% [n = 62/71]），但在第2-4年下降（47.4% - 60.4%）。1/2年最常见的TEAE为头晕（分别为47.9% [n = 34/71]和12.5% [n = 6/48]）， 3/4年为跌倒（15.8% [n = 3/19]和14.3% [n = 2/14]）。意义：辅助perampanel对老年癫痫患者具有长期癫痫控制作用；安全性与已建立的窗格安全配置文件保持一致。

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引用次数: 0

Electro-clinical correlation of rinch and peri-ictal vegetative symptoms 颈部和周周植物性症状的电临床相关性

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-10-09 DOI: 10.1016/j.ebr.2025.100831

Divya Nagabushana , Francesco Pucci , Huan Huynh , Julia Bodnya , Anna Serafini

Rhythmic ictal non-clonic hand (RINCH) movements and peri-ictal vegetative symptoms (PIVS) are rare semiological signs in temporal lobe epilepsy (TLE). RINCH refers to rhythmic, low-amplitude, complex hand movements that typically lateralize to the contralateral hemisphere, while PIVS includes manifestations such as ictal spitting and post-ictal coughing, more frequently associated with non-dominant TLE. We report a unique case of a 40-year-old woman with drug-resistant dominant TLE who exhibited both RINCH and PIVS as part of her habitual seizures. Non-invasive EEG and imaging localized the seizure onset to the left anterior temporal region. Stereoelectroencephalography (SEEG) confirmed seizure onset in the left mesial temporal pole with rapid propagation to the hippocampus, amygdala, and other limbic structures. Notably, RINCH was observed only in seizures that showed ictal spread to the superior temporal gyrus (STG) and superior temporal sulcus (STS), suggesting their role in mediating semi-automatic motor behaviors. Ictal spitting and other PIVS were linked to the spread to the entorhinal and parahippocampal regions. The patient underwent left anterior temporal lobectomy with histopathological confirmation of hippocampal sclerosis and has remained seizure-free at one-year follow-up. This case provides a rare anatomo-electro-clinical correlation of RINCH and PIVS using SEEG and emphasizes that while RINCH retains lateralizing value, PIVS may not. Our findings underscore the importance of invasive EEG in characterizing complex semiology and refining the epileptogenic zone in dominant TLE.

节律性突发性非阵挛性手（RINCH）运动和周周植物性症状（PIVS）是颞叶癫痫（TLE）罕见的符号学征象。RINCH指的是有节奏的、低幅度的、复杂的手部运动，通常向对侧半球偏侧，而PIVS包括发作时吐痰和发作后咳嗽等表现，更常与非显性TLE相关。我们报告一个独特的情况下，一个40岁的妇女抗药性显性TLE谁表现出RINCH和PIVS作为她的习惯性癫痫发作的一部分。无创脑电图和成像定位癫痫发作在左侧前颞区。立体脑电图（SEEG）证实癫痫发作于左内侧颞极，并迅速传播到海马、杏仁核和其他边缘结构。值得注意的是，RINCH仅在癫痫发作时表现出向颞上回（STG）和颞上沟（STS）的垂直扩散，这表明它们在调节半自动运动行为中起作用。口吐痰和其他PIVS与向内嗅和海马旁区扩散有关。患者接受了左侧颞叶前部切除术，组织病理学证实为海马硬化，并在一年的随访中保持无癫痫发作。本病例采用SEEG技术对RINCH和PIVS进行了罕见的解剖-电-临床相关性分析，并强调虽然RINCH保留了侧边定位的价值，但PIVS可能没有。我们的研究结果强调了侵入性脑电图在表征复杂的符号学和细化显性TLE的癫痫区方面的重要性。

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引用次数: 0

Modified Atkins Diet therapy during pregnancy for refractory idiopathic generalized epilepsy 妊娠期改良阿特金斯饮食治疗难治性特发性全身性癫痫

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-10-06 DOI: 10.1016/j.ebr.2025.100832

Ryoichi Inoue , Elizabeth Weinandy , Sarita Maturu , Nabil Khandker

The management of refractory epilepsy in pregnancy is challenging, and diet therapy has been rarely reported. We report a case of a 25-year-old woman with refractory idiopathic generalized epilepsy who achieved prolonged seizure freedom with the Modified Atkins Diet (MAD) during pregnancy. Her epilepsy began at age 3, with seizures occurring every two months despite multiple antiseizure medications and vagus nerve stimulation. Three months before her first pregnancy, MAD was initiated with a carbohydrate limit of 30 g daily, resulting in immediate seizure freedom. During the pregnancy, carbohydrate intake was gradually increased to 60–70 g daily to support fetal growth. She remained seizure-free for 10 months before experiencing breakthrough seizures in the third trimester. Oligohydramnios was subsequently detected, and she underwent induction of labor with vaginal delivery at 37 weeks. After delivery, she discontinued MAD for breastfeeding and remained seizure-free for 13 months. In her second pregnancy without MAD, she experienced two breakthrough seizures in the second trimester. She later achieved 23 months of seizure freedom. Both children have met developmental milestones appropriately.

This case adds to the limited literature on diet therapy in pregnancy and is, to our knowledge, the first involving generalized epilepsy. The case suggests MAD may provide seizure control during pregnancy, even with possible sustained benefit after discontinuation. However, given the occurrence of oligohydramnios and limited safety data, larger studies are needed to clarify the efficacy, safety, and long-term outcomes of diet therapy during pregnancy.

难治性癫痫在妊娠期的管理是具有挑战性的，饮食治疗已很少报道。我们报告一个25岁的难治性特发性广泛性癫痫的妇女，她在怀孕期间通过改良阿特金斯饮食（MAD）获得了长时间的癫痫发作自由。她的癫痫发作始于3岁，尽管有多种抗癫痫药物和迷走神经刺激，但每两个月发作一次。在她第一次怀孕前三个月，MAD开始时每天限制30 g的碳水化合物，导致立即癫痫发作。在怀孕期间，碳水化合物的摄入量逐渐增加到每天60-70 g，以支持胎儿的生长。在妊娠晚期经历突破性癫痫发作之前，她有10 个月没有癫痫发作。随后发现羊水过少，她在37 周时接受了阴道分娩引产。分娩后，她停止母乳喂养，并保持13 个月无癫痫发作。在她第二次没有患癫痫病的怀孕中，她在妊娠中期经历了两次突破性癫痫发作。她后来获得了23 个月的癫痫发作自由。两个孩子都达到了适当的发展里程碑。本病例增加了关于孕期饮食治疗的有限文献，据我们所知，这是第一例涉及全身性癫痫的病例。该病例提示MAD可在妊娠期间控制癫痫发作，甚至停药后仍有可能持续获益。然而，考虑到羊水过少的发生和有限的安全性数据，需要更大规模的研究来阐明妊娠期间饮食疗法的有效性、安全性和长期结果。

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引用次数: 0

Olfactory sensory phenomena as the main seizure type in a child with low-grade glioma: a case report 以嗅觉感觉现象为主要癫痫类型的儿童低级别胶质瘤：1例报告

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-09-27 DOI: 10.1016/j.ebr.2025.100830

Takato Akiba, Shinpei Abe, Junya Fujimura, Hiromichi Shoji

Olfactory sensory phenomena (OSP) are a rare and often underrecognized descriptor of seizures without observable clinical manifestations, particularly in children. We report a case involving a 7-year and 9-month-old boy who experienced OSP as the sole seizure manifestation for nearly a year, resulting in a delayed diagnosis. Symptoms were initially misattributed to gastroesophageal reflux but gradually progressed to include focal impaired consciousness seizures. Brain magnetic resonance imaging revealed a mass lesion involving the right optic nerve, hypothalamus, and medial temporal lobe, leading to the diagnosis of focal epilepsy owing to a structural etiology. Histopathological assessment confirmed a low-grade glioma (LGG). Because OSP persisted despite lacosamide therapy, perampanel (PER) was introduced based on prior reports of its efficacy in epilepsy associated with glioma; however, instead of reducing, the OSP frequency increased after PER initiation. This case highlights the diagnostic challenge posed by nonmotor seizures with subtle clinical presentations and underscores the importance of considering epilepsy in patients with recurrent, unexplained sensory symptoms such as abnormal smells or nausea. It also contributes to the limited literature on pediatric focal epilepsy associated with LGG, providing educational value for physicians less familiar with atypical seizure semiology.

嗅觉感觉现象（OSP）是一种罕见且经常被低估的癫痫发作描述，没有明显的临床表现，特别是在儿童中。我们报告一个7岁9个月的男孩，他经历了OSP作为唯一的癫痫表现近一年，导致延迟诊断。症状最初被误认为是胃食管反流，但逐渐发展为包括局灶性意识受损发作。脑磁共振成像显示肿块病变累及右侧视神经、下丘脑和内侧颞叶，由于结构病因导致局灶性癫痫的诊断。组织病理学检查证实为低级别胶质瘤（LGG）。由于尽管拉科沙胺治疗，OSP仍然存在，perampanel （PER）基于其对神经胶质瘤相关癫痫的疗效的先前报道而被引入；然而，在PER启动后，OSP频率不但没有降低，反而增加了。本病例强调了具有微妙临床表现的非运动性癫痫发作所带来的诊断挑战，并强调了在反复出现无法解释的感觉症状（如异常气味或恶心）的患者中考虑癫痫的重要性。它还有助于补充与LGG相关的儿科局灶性癫痫的有限文献，为不太熟悉非典型癫痫符号学的医生提供教育价值。

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引用次数: 0

Early detection of antiseizure medication inefficacy using an implantable continuous EEG system and a personalized model: a case study 使用可植入连续脑电图系统和个性化模型早期检测抗癫痫药物无效：一个案例研究

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-09-23 DOI: 10.1016/j.ebr.2025.100829

A. Reynolds , A. Lai , D.B. Grayden , M.J. Cook , A. Peterson

Evaluating anti-seizure medication (ASM) efficacy can be limited by inaccurate seizure diaries and periodic fluctuations in seizure frequency, known as seizure cycles. These limitations may prolong monitoring of ineffective treatments. This study explores implantable continuous EEG monitoring (iCEM™) with Epiminder’s Minder® system and timeseries modelling to improve efficacy assessments.

This retrospective case study examines a 49-year-old female with drug-resistant focal epilepsy with iCEM (Nov. 2019). The participant maintained a seizure diary and was followed-up for 3 years. ASMs were changed in Aug.-Oct. 2020. A personalised autoregressive model incorporating interictal epileptiform discharge cycles to project 3-monthly seizure rates was trained and validated on post-drug data then tested on four held-out datasets (two pre-drug and two post-drug). The Kruskal-Wallis test assessed model performance between drug periods (α = 0.05).

Only 37 % of seizures were reported. Post-drug, diary-reported seizures increased while detected seizures decreased, but both remained within normal seizure rate variability. ASM inefficacy was addressed after 3 years. The autoregressive model mean squared error post-drug was 0.17 and 0.13 seizures per day over 3-months², which were significantly different from pre-drug (0.49 and 0.58 seizures per day over 3-months²,

H

=336.82, p = 2.44exp.^-89), suggesting the model could recognise when an altered drug regimen affected seizure rate and interictal epileptiform discharges.

Seizures identified using iCEM combined with an individualised model may be able to distinguish drug-induced changes in seizure rate from normal variability. This proof-of-concept study offers useful information towards the development of methods that can support early treatment assessments, potentially shortening the time to find an optimal therapy.

评估抗癫痫药物（ASM）的疗效可能受到不准确的癫痫发作日记和癫痫发作频率的周期性波动（称为癫痫发作周期）的限制。这些限制可能会延长对无效治疗的监测时间。本研究利用Epiminder的Minder®系统和时间序列模型探索植入式连续脑电图监测（iCEM™），以改善疗效评估。本回顾性病例研究对一名49岁耐药局灶性癫痫女性患者进行了iCEM检查（2019年11月）。患者记录癫痫发作日记，随访3年。8月至10月，asm发生了变化。2020. 一个个性化的自回归模型结合癫痫样放电周期来预测3个月的癫痫发作率，在药物后数据上进行训练和验证，然后在四个固定数据集（两个药物前和两个药物后）上进行测试。Kruskal-Wallis检验评估各给药期模型性能（α = 0.05）。只有37%的癫痫发作被报道。服药后，日记报告的癫痫发作增加，而检测到的癫痫发作减少，但两者都保持在正常的癫痫发作率变异性范围内。3年后ASM无效。用药后的自回归模型均方误差分别为0.17和0.13次/ 3个月2，与用药前的0.49和0.58次/ 3个月2差异有统计学意义，H=336.82, p = 2.44exp。-89)，这表明该模型可以识别出改变的药物治疗方案何时会影响癫痫发作率和发作间期癫痫样放电。使用iCEM结合个性化模型识别癫痫发作可能能够区分药物引起的癫痫发作率变化和正常变异性。这项概念验证研究为开发支持早期治疗评估的方法提供了有用的信息，有可能缩短寻找最佳治疗方法的时间。

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引用次数: 0

Barriers to delivering optimal care in epilepsy surgery candidates during transition of care: a short case series 在护理过渡期间癫痫手术候选人提供最佳护理的障碍：一个简短的病例系列

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-09-17 DOI: 10.1016/j.ebr.2025.100828

Quynh Vo , Kathryn Lalor

Transition of care is becoming an increasingly discussed topic and is a necessary process that all young adults requiring medical care should undergo. The lack of transition of care in epilepsy can often lead to poor outcomes for young adults. Youths with drug-resistant epilepsy (DRE) requiring surgical intervention often face a more difficult transition and clinicians have more complexities to consider. Here we present four unique cases of surgical candidates undergoing transition of care, and highlight common issues encountered by young adults and pediatric and adult clinicians during this time. Cases 1 to 3 focus on young adults transitioning care after completion of surgical intervention, in the middle of a surgical workup, and before the consideration of surgical interventions, respectively. These cases examine how transition of care can affect treatment options and outcome. Case 4 highlights the impact considering surgical intervention can have on the transition process. Each case presents unique challenges facing young adults and their epilepsy surgical team. By highlighting barriers to care, changes can be made to facilitate better epilepsy management.

护理过渡正成为一个越来越多讨论的话题，是所有需要医疗护理的年轻人都应该经历的必要过程。在癫痫治疗中缺乏过渡护理往往会导致年轻人预后不良。需要手术干预的耐药癫痫（DRE）青少年往往面临更困难的过渡，临床医生有更多的复杂性需要考虑。在这里，我们提出了四个独特的病例外科候选人进行过渡护理，并强调了共同问题遇到的年轻人和儿科和成人临床医生在这段时间。病例1至3分别集中在手术干预完成后、手术检查中间和考虑手术干预之前的年轻人。这些病例研究了护理的转变如何影响治疗方案和结果。病例4强调了考虑手术干预对过渡过程的影响。每个病例都是年轻人和他们的癫痫手术团队面临的独特挑战。通过强调护理障碍，可以做出改变，促进更好地管理癫痫。

{"title":"Barriers to delivering optimal care in epilepsy surgery candidates during transition of care: a short case series","authors":"Quynh Vo , Kathryn Lalor","doi":"10.1016/j.ebr.2025.100828","DOIUrl":"10.1016/j.ebr.2025.100828","url":null,"abstract":"<div><div>Transition of care is becoming an increasingly discussed topic and is a necessary process that all young adults requiring medical care should undergo. The lack of transition of care in epilepsy can often lead to poor outcomes for young adults. Youths with drug-resistant epilepsy (DRE) requiring surgical intervention often face a more difficult transition and clinicians have more complexities to consider. Here we present four unique cases of surgical candidates undergoing transition of care, and highlight common issues encountered by young adults and pediatric and adult clinicians during this time. Cases 1 to 3 focus on young adults transitioning care after completion of surgical intervention, in the middle of a surgical workup, and before the consideration of surgical interventions, respectively. These cases examine how transition of care can affect treatment options and outcome. Case 4 highlights the impact considering surgical intervention can have on the transition process. Each case presents unique challenges facing young adults and their epilepsy surgical team. By highlighting barriers to care, changes can be made to facilitate better epilepsy management.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100828"},"PeriodicalIF":1.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109600","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

Vagus nerve stimulation in KCNB1-related developmental and epileptic encephalopathy: A case of seizure reduction and review of literature 迷走神经刺激治疗与kcnb1相关的发育性和癫痫性脑病：一例癫痫发作减少和文献复习

IF 1.5 Q3 CLINICAL NEUROLOGY

Epilepsy and Behavior Reports

Pub Date : 2025-08-30 DOI: 10.1016/j.ebr.2025.100826

Taichi Sayanagi , Kenzo Kosugi , Eri Ogawa , Toshiki Takenouchi , Mamiko Yamada , Kenjiro Kosaki , Ichiro Sugiyama , Masahiro Toda

Developmental and epileptic encephalopathies (DEEs) are devastating syndromes characterized by early-onset, treatment-resistant seizures, and significant developmental delays. KCNB1-related DEE, arising from pathogenic variants in the KCNB1 gene, presents with profound cognitive impairment and persistent seizures despite multiple antiseizure medications (ASMs). Vagus nerve stimulation (VNS) has emerged as a valuable adjunctive therapy for medically intractable epilepsy, yet its effectiveness in rare genetic DEEs remains unknown. We report the first case of VNS in a 5-year-old child with KCNB1-related DEE, achieving about 90% seizure reduction after one year. Prior treatments with multiple ASMs had minimal effect. After VNS implantation, optimized stimulation parameters combined with fenfluramine markedly improved seizure control. Although concurrent medication adjustments and transient seizure cessation during infection complicated interpretation, the sustained seizure improvement strongly suggests VNS’s efficacy in this genetic epilepsy.

This case illustrates VNS’s potential benefit and possible synergy with fenfluramine in KCNB1-related DEE. Further accumulation of case reports is necessary to confirm these findings.

发展性和癫痫性脑病（dee）是一种破坏性综合征，其特征是早发、治疗难治性癫痫发作和显著的发育迟缓。KCNB1相关DEE由KCNB1基因的致病变异引起，表现为严重的认知障碍和持续癫痫发作，尽管使用了多种抗癫痫药物（asm）。迷走神经刺激（VNS）已成为治疗难治性癫痫的一种有价值的辅助治疗方法，但其对罕见遗传性癫痫的有效性尚不清楚。我们报告了一例与kcnb1相关的DEE的5岁儿童的VNS，一年后癫痫发作减少了约90%。先前的多次asm治疗效果甚微。VNS植入后，优化刺激参数联合芬氟拉明明显改善癫痫发作控制。虽然在感染期间同时进行药物调整和短暂性癫痫发作停止的解释很复杂，但持续的癫痫发作改善强烈表明VNS对这种遗传性癫痫的疗效。该病例说明了VNS与芬氟拉明在kcnb1相关DEE中的潜在益处和可能的协同作用。需要进一步积累病例报告来证实这些发现。

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引用次数: 0