Pub Date : 2025-08-27DOI: 10.1016/j.ebr.2025.100825
Xiao-Lai Ye , Cui-Jing Wang , Min-Zhi Yin , Ru-En Yao , Ying Zhou , Fo-Yang Fan , Qin-Chuan Liang
Coffin–Siris syndrome is a rare multiple congenital anomaly syndrome. We report a case of medically refractory epilepsy developing in a pediatric patient with ARID1B-related Coffin–Siris syndrome, with pachygyria and polymicrogyria in right frontal lobe. Following presurgical evaluations, surgical disconnection of the epileptogenic zone was performed. Postoperative follow-up at 18 months demonstrated complete seizure freedom, with concomitant improvements in speech development and motor strength. This expands the phenotypes associated with ARID1B-related Coffin–Siris syndrome and underscores the importance of early genetic testing for DEEs, along with timely surgical evaluation and treatment for genetic epilepsies where applicable.
{"title":"Case report: Surgical disconnection for medically refractory epilepsy in ARID1B-related Coffin-Siris syndrome","authors":"Xiao-Lai Ye , Cui-Jing Wang , Min-Zhi Yin , Ru-En Yao , Ying Zhou , Fo-Yang Fan , Qin-Chuan Liang","doi":"10.1016/j.ebr.2025.100825","DOIUrl":"10.1016/j.ebr.2025.100825","url":null,"abstract":"<div><div>Coffin–Siris syndrome is a rare multiple congenital anomaly syndrome. We report a case of medically refractory epilepsy developing in a pediatric patient with ARID1B-related Coffin–Siris syndrome, with pachygyria and polymicrogyria in right frontal lobe. Following presurgical evaluations, surgical disconnection of the epileptogenic zone was performed. Postoperative follow-up at 18 months demonstrated complete seizure freedom, with concomitant improvements in speech development and motor strength. This expands the phenotypes associated with ARID1B-related Coffin–Siris syndrome and underscores the importance of early genetic testing for DEEs, along with timely surgical evaluation and treatment for genetic epilepsies where applicable.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100825"},"PeriodicalIF":1.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916535","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}
Pub Date : 2025-08-11DOI: 10.1016/j.ebr.2025.100822
Stacey Kim , Christel Benny , Alan Salim , Charles Liu , Brian Lee , Hari Prasad Kunhi Veedu
While many patients treated with Responsive Neurostimulation (RNS) experience a significant reduction in seizures, poor responders to traditional high frequency stimulation (HFS) may experience a meaningful reduction in seizure frequency when switched to low frequency stimulation (LFS). This case report presents a patient who developed post-traumatic pharmacoresistant bitemporal epilepsy and underwent unsuccessful treatments, including antiseizure polytherapy and implantation of a vagus nerve stimulator (VNS). Due to ongoing seizures, the patient underwent RNS System implantation with bilateral hippocampal depth electrodes. Prior to RNS implantation, the patient experienced a median frequency of 6.5 seizures per month. At traditional HFS settings applied for 30 months, the patient experienced a 31 % reduction from baseline. After switching to LFS for 8 months, the patient experienced an 85 % reduction. HFS delivered 6.02 min per day, compared to 113.77 min per day with LFS. This patient experienced a substantial and meaningful reduction in seizure frequency after switching to LFS, suggesting that LFS may be an effective alternative for RNS patients who do not have a satisfactory seizure reduction to traditional HFS. Furthermore, this case report highlights the importance of collaboration between academic medical centers with public safety net hospitals in delivering advanced epilepsy care to people in underserved communities.
{"title":"Significant seizure frequency reduction in a patient with refractory bitemporal epilepsy following transition from high-frequency to low-frequency responsive neurostimulation","authors":"Stacey Kim , Christel Benny , Alan Salim , Charles Liu , Brian Lee , Hari Prasad Kunhi Veedu","doi":"10.1016/j.ebr.2025.100822","DOIUrl":"10.1016/j.ebr.2025.100822","url":null,"abstract":"<div><div>While many patients treated with Responsive Neurostimulation (RNS) experience a significant reduction in seizures, poor responders to traditional high frequency stimulation (HFS) may experience a meaningful reduction in seizure frequency when switched to low frequency stimulation (LFS). This case report presents a patient who developed post-traumatic pharmacoresistant bitemporal epilepsy and underwent unsuccessful treatments, including antiseizure polytherapy and implantation of a vagus nerve stimulator (VNS). Due to ongoing seizures, the patient underwent RNS System implantation with bilateral hippocampal depth electrodes. Prior to RNS implantation, the patient experienced a median frequency of 6.5 seizures per month. At traditional HFS settings applied for 30 months, the patient experienced a 31 % reduction from baseline. After switching to LFS for 8 months, the patient experienced an 85 % reduction. HFS delivered 6.02 min per day, compared to 113.77 min per day with LFS. This patient experienced a substantial and meaningful reduction in seizure frequency after switching to LFS, suggesting that LFS may be an effective alternative for RNS patients who do not have a satisfactory seizure reduction to traditional HFS. Furthermore, this case report highlights the importance of collaboration between academic medical centers with public safety net hospitals in delivering advanced epilepsy care to people in underserved communities.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100822"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841364","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}
Pub Date : 2025-08-10DOI: 10.1016/j.ebr.2025.100821
Paola Vassallo , Josemir W. Sander
Perampanel, a non-competitive AMPA receptor antagonist, is widely used in treating focal and generalised epilepsy. We report the case of a 26-year-old man with pharmaco-resistant focal epilepsy who developed nocturnal compulsive food-seeking behaviour after off-label titration of perampanel to 24 mg/day. Symptoms resolved entirely after dose reduction, supporting a possible causal relationship. Pharmacokinetic data showed a 26 % increase in serum levels between near-trough and peak, potentially explaining the timing of nocturnal symptoms. This case underscores the importance of recognising atypical behavioural adverse events. Direct questioning is essential, as individuals may not spontaneously report such symptoms due to stigma or fear of losing seizure control.
{"title":"Emptying the fridge syndrome: a case of nocturnal food craving associated with peak perampanel concentration","authors":"Paola Vassallo , Josemir W. Sander","doi":"10.1016/j.ebr.2025.100821","DOIUrl":"10.1016/j.ebr.2025.100821","url":null,"abstract":"<div><div>Perampanel, a non-competitive AMPA receptor antagonist, is widely used in treating focal and generalised epilepsy. We report the case of a 26-year-old man with pharmaco-resistant focal epilepsy who developed nocturnal compulsive food-seeking behaviour after off-label titration of perampanel to 24 mg/day. Symptoms resolved entirely after dose reduction, supporting a possible causal relationship. Pharmacokinetic data showed a 26 % increase in serum levels between near-trough and peak, potentially explaining the timing of nocturnal symptoms. This case underscores the importance of recognising atypical behavioural adverse events. Direct questioning is essential, as individuals may not spontaneously report such symptoms due to stigma or fear of losing seizure control.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100821"},"PeriodicalIF":1.5,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827314","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}
Epilepsy and depression frequently coexist, with depressive symptoms affecting up to 50 % of patients, particularly those with drug-resistant epilepsy (DRE). Underdetection of depression in general neurology settings can worsen seizure control, treatment adherence, and overall prognosis. This study aimed to characterize the prevalence of undiagnosed depression in epilepsy outpatients and to evaluate the Neurological Disorders Depression Inventory for Epilepsy (NDDIE) as a screening tool, as well as the impact of early SSRI treatment. In a single-center, observational, non-interventional, prospective design, 82 consenting adults (mean age 50.8 ± 23 years; 59.8 % female) with diagnosed epilepsy (focal, idiopathic generalized, or unknown onset) and no prior psychiatric history or antidepressant use were enrolled over one year. Participants completed the NDDIE at baseline; those screening positive (score > 13) began SSRI therapy and were referred to psychiatry for diagnostic confirmation. Repeat NDDIE assessments occurred at three months. Of 82 patients, 35 (42.7 %) screened positive on NDDIE and 24 (29.3 % overall) were confirmed depressed by psychiatry (κ = 0.71). Baseline mean NDDIE was 12.17 ± 5.46, decreasing to 10.78 ± 4.36 at three months across all participants (Δ = 1.39; p < 0.05). In treated patients (n = 35), NDDIE fell from 17.83 ± 2.74 to 14.74 ± 3.48 (Δ = 3.09; p < 0.001). Patients with DRE (n = 10) had higher baseline scores than non-DRE (19.40 ± 1.96 vs 11.00 ± 5.40; p < 0.05) and those on ≥ 2 anti-seizure medications (ASM) scored higher than monotherapy (17.52 ± 4.08 vs 9.82 ± 4.20; p < 0.001). Patients > 60 years had lower scores than younger patients (10.68 ± 4.58 vs 13.23 ± 5.82; p < 0.05). No sex or epilepsy type differences were significant. Depression is common and underdiagnosed in epilepsy outpatients, especially among those with DRE or on multiple ASMs. The NDDIE demonstrates good agreement with psychiatric diagnosis and detects clinically meaningful improvements following early SSRI treatment. Systematic depression screening using NDDIE in neurology clinics is recommended to identify and treat comorbid depression, potentially improving quality of life and seizure outcomes.
癫痫和抑郁症经常共存，高达50%的患者，特别是耐药癫痫患者出现抑郁症状。在一般神经病学设置中，抑郁症的检测不足会使癫痫发作控制、治疗依从性和总体预后恶化。本研究旨在描述癫痫门诊患者未确诊抑郁症的患病率，并评估癫痫神经障碍抑郁量表（NDDIE）作为筛查工具，以及早期SSRI治疗的影响。在一项单中心、观察性、非干预性、前瞻性设计中，82名同意的成年人(平均年龄50.8±23岁；59.8%的女性)被诊断为癫痫（局灶性、特发性全身性或不明起病），并且在一年内没有精神病史或使用抗抑郁药。参与者在基线完成NDDIE；筛查呈阳性(评分>；13)开始SSRI治疗，并被转介到精神病学确诊。3个月时再次进行NDDIE评估。82例患者中，35例（42.7%）NDDIE筛查阳性，24例（29.3%）精神病学确诊为抑郁症（κ = 0.71）。基线平均NDDIE为12.17±5.46，三个月后降至10.78±4.36 (Δ = 1.39；p & lt;0.05)。治疗组患者（n = 35） NDDIE从17.83±2.74降至14.74±3.48 (Δ = 3.09；p & lt;0.001)。DRE患者（n = 10）的基线评分高于非DRE患者(19.40±1.96 vs 11.00±5.40；p & lt;≥2种抗癫痫药物（ASM）组评分高于单药组(17.52±4.08 vs 9.82±4.20；p & lt;0.001)。病人在60岁患者的评分低于年轻患者(10.68±4.58 vs 13.23±5.82；p & lt;0.05)。性别和癫痫类型无显著差异。抑郁症在癫痫门诊患者中很常见，但诊断不足，特别是在那些有DRE或多次asm的患者中。NDDIE与精神病学诊断有良好的一致性，并在早期SSRI治疗后发现临床有意义的改善。推荐在神经病学诊所使用NDDIE进行系统的抑郁症筛查，以识别和治疗共病抑郁症，潜在地改善生活质量和癫痫发作结果。
{"title":"EPIDEP: Prevalence of undiagnosed depression in an epilepsy outpatient clinic","authors":"Alejandro Fernández-Cabrera , Paula Santamaría-Montero , Jesús García-de Soto , Antía Figueira-Gómez , Martín Rodríguez-Botana , Benigno Pérez-Regojo , Robustiano Pego-Reigosa","doi":"10.1016/j.ebr.2025.100819","DOIUrl":"10.1016/j.ebr.2025.100819","url":null,"abstract":"<div><div>Epilepsy and depression frequently coexist, with depressive symptoms affecting up to 50 % of patients, particularly those with drug-resistant epilepsy (DRE). Underdetection of depression in general neurology settings can worsen seizure control, treatment adherence, and overall prognosis. This study aimed to characterize the prevalence of undiagnosed depression in epilepsy outpatients and to evaluate the Neurological Disorders Depression Inventory for Epilepsy (NDDIE) as a screening tool, as well as the impact of early SSRI treatment. In a single-center, observational, non-interventional, prospective design, 82 consenting adults (mean age 50.8 ± 23 years; 59.8 % female) with diagnosed epilepsy (focal, idiopathic generalized, or unknown onset) and no prior psychiatric history or antidepressant use were enrolled over one year. Participants completed the NDDIE at baseline; those screening positive (score > 13) began SSRI therapy and were referred to psychiatry for diagnostic confirmation. Repeat NDDIE assessments occurred at three months. Of 82 patients, 35 (42.7 %) screened positive on NDDIE and 24 (29.3 % overall) were confirmed depressed by psychiatry (κ = 0.71). Baseline mean NDDIE was 12.17 ± 5.46, decreasing to 10.78 ± 4.36 at three months across all participants (Δ = 1.39; p < 0.05). In treated patients (n = 35), NDDIE fell from 17.83 ± 2.74 to 14.74 ± 3.48 (Δ = 3.09; p < 0.001). Patients with DRE (n = 10) had higher baseline scores than non-DRE (19.40 ± 1.96 vs 11.00 ± 5.40; p < 0.05) and those on ≥ 2 anti-seizure medications (ASM) scored higher than monotherapy (17.52 ± 4.08 vs 9.82 ± 4.20; p < 0.001). Patients > 60 years had lower scores than younger patients (10.68 ± 4.58 vs 13.23 ± 5.82; p < 0.05). No sex or epilepsy type differences were significant. Depression is common and underdiagnosed in epilepsy outpatients, especially among those with DRE or on multiple ASMs. The NDDIE demonstrates good agreement with psychiatric diagnosis and detects clinically meaningful improvements following early SSRI treatment. Systematic depression screening using NDDIE in neurology clinics is recommended to identify and treat comorbid depression, potentially improving quality of life and seizure outcomes.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100819"},"PeriodicalIF":1.5,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826650","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}
Pub Date : 2025-08-09DOI: 10.1016/j.ebr.2025.100820
Amirtha Shekar , Sreekanth Koneru , Charles Ákos Szabó
We present a 57 year-old right-handed female with a history of idiopathic generalized epilepsy since age two years old as well as mild-to-moderate intellectual impairment and behavioral dyscontrol. She was seizure free for many years on ethosuximide, but her absence seizures recurred as her dose was gradually decreased. After raising her dose, she also began to experience falls, at times with decreased responsiveness. She was admitted for inpatient video-EEG monitoring for quantification of her absence seizures and characterization of her falls. Our patient had 3–6 absence seizures per hour. In addition to a brief alteration of awareness, her absence seizures were frequently associated with belching and eyelid myoclonia lasting for 3–4 s. Her belching was correlated with a generalized ictal discharge and was not noted interictally. Several episodes of unsteadiness were noted, at times the patient falling backwards into her bed, but never falling to the ground from a standing position; none of these episodes associated with ictal EEG correlate. In summary, our patient demonstrated and absence seizures with ictal eructation or belching, which has not been reported as an ictal symptom of generalized seizures, and episodes of unsteadiness of unknown characterization.
{"title":"Ictal eructation in a case of idiopathic generalized epilepsy","authors":"Amirtha Shekar , Sreekanth Koneru , Charles Ákos Szabó","doi":"10.1016/j.ebr.2025.100820","DOIUrl":"10.1016/j.ebr.2025.100820","url":null,"abstract":"<div><div>We present a 57 year-old right-handed female with a history of idiopathic generalized epilepsy since age two years old as well as mild-to-moderate intellectual impairment and behavioral dyscontrol. She was seizure free for many years on ethosuximide, but her absence seizures recurred as her dose was gradually decreased. After raising her dose, she also began to experience falls, at times with decreased responsiveness. She was admitted for inpatient video-EEG monitoring for quantification of her absence seizures and characterization of her falls. Our patient had 3–6 absence seizures per hour. In addition to a brief alteration of awareness, her absence seizures were frequently associated with belching and eyelid myoclonia lasting for 3–4 s. Her belching was correlated with a generalized ictal discharge and was not noted interictally. Several episodes of unsteadiness were noted, at times the patient falling backwards into her bed, but never falling to the ground from a standing position; none of these episodes associated with ictal EEG correlate. In summary, our patient demonstrated and absence seizures with ictal eructation or belching, which has not been reported as an ictal symptom of generalized seizures, and episodes of unsteadiness of unknown characterization.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"31 ","pages":"Article 100820"},"PeriodicalIF":1.5,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829486","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}
Infantile epileptic spasms syndrome is characterized by epileptic spasms (ES), neurodevelopmental regression, and variable electroclinical features. Early recognition and prompt treatment are crucial for improving outcomes; however, subtle ictal manifestations are often overlooked by caregivers. We describe a male infant who exhibited repeated upward eye deviation beginning at 5 months of age, preceding the onset of typical ES. Prolonged scalp video electroencephalography (EEG) monitoring captured both isolated upward eye deviation and typical ES preceded by upward eye deviation. Despite the introduction of two antiseizure medications, ES persisted. Given the absence of lateralizing findings on neuroimaging and the presence of bilaterally synchronous ictal discharges on EEG, corpus callosotomy (CC) was performed at 7 months of age without prior adrenocorticotropic hormone (ACTH) therapy, in accordance with parental preference. The patient has remained seizure free for 1 year and 3 months postoperatively, with age-appropriate neurodevelopmental scores on the Vineland Adaptive Behavior Scales, Second Edition. This case highlights the importance of identifying subtle signs, such as upward eye deviation, as potential early ictal precursors in ES. CC may represent a viable first-line treatment in selected cases.
{"title":"Upward eye deviation as a precursor to epileptic spasms: A case successfully treated with early corpus callosotomy without adrenocorticotropic hormone therapy","authors":"Yasushi Iimura , Hiroharu Suzuki , Takumi Mitsuhashi , Tetsuya Ueda , Kazuki Nishioka , Kazuki Nomura , Shimpei Abe , Takato Akiba , Shimpei Matsuda , Hidenori Sugano , Akihide Kondo","doi":"10.1016/j.ebr.2025.100818","DOIUrl":"10.1016/j.ebr.2025.100818","url":null,"abstract":"<div><div>Infantile epileptic spasms syndrome is characterized by epileptic spasms (ES), neurodevelopmental regression, and variable electroclinical features. Early recognition and prompt treatment are crucial for improving outcomes; however, subtle ictal manifestations are often overlooked by caregivers. We describe a male infant who exhibited repeated upward eye deviation beginning at 5 months of age, preceding the onset of typical ES. Prolonged scalp video electroencephalography (EEG) monitoring captured both isolated upward eye deviation and typical ES preceded by upward eye deviation. Despite the introduction of two antiseizure medications, ES persisted. Given the absence of lateralizing findings on neuroimaging and the presence of bilaterally synchronous ictal discharges on EEG, corpus callosotomy (CC) was performed at 7 months of age without prior adrenocorticotropic hormone (ACTH) therapy, in accordance with parental preference. The patient has remained seizure free for 1 year and 3 months postoperatively, with age-appropriate neurodevelopmental scores on the Vineland Adaptive Behavior Scales, Second Edition. This case highlights the importance of identifying subtle signs, such as upward eye deviation, as potential early ictal precursors in ES. CC may represent a viable first-line treatment in selected cases.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"32 ","pages":"Article 100818"},"PeriodicalIF":1.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810213","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}
Pub Date : 2025-08-05DOI: 10.1016/j.ebr.2025.100816
Michelle Zachman , Lixin Gong , Lingling An , Mark B. Halvorsen
The prescribing information for the antiseizure medication Vigadrone® (vigabatrin) Powder for Oral Solution advises only reconstituting the powder in water prior to administration and discarding unused solution. However, caregivers may seek to reconstitute vigabatrin in a pediatric patient’s preferred liquid rather than water to ease administration. We performed an in-use dissolution and stability study of vigabatrin powder reconstituted in 4 liquids—water, apple juice, whole milk, and infant formula—with testing performed 0, 24, and 48 h after preparation with storage at 2–8 °C in a capped, glass container. Vigabatrin reconstituted in each liquid was clear and free of visible particulates compared with matched drug-free liquid controls. In subsequent analyses using US Pharmacopeia (USP) procedures, high-performance liquid chromatography spectra and chromatograms for each sample solution matched the vigabatrin reference standard. At all time points, all sample solutions met USP-acceptance criteria of 95.0–105.0 % for product stability and USP-acceptance criteria for related substances/organic impurities testing for total impurities. Together, these results indicate that vigabatrin powder reconstituted in liquids other than water was stable for up to 48 h of refrigeration. This study provides useful information to help healthcare providers address real-world medication questions from caregivers.
{"title":"Dissolution and stability of vigabatrin powder in water, fruit juice, milk, and infant formula","authors":"Michelle Zachman , Lixin Gong , Lingling An , Mark B. Halvorsen","doi":"10.1016/j.ebr.2025.100816","DOIUrl":"10.1016/j.ebr.2025.100816","url":null,"abstract":"<div><div>The prescribing information for the antiseizure medication Vigadrone® (vigabatrin) Powder for Oral Solution advises only reconstituting the powder in water prior to administration and discarding unused solution. However, caregivers may seek to reconstitute vigabatrin in a pediatric patient’s preferred liquid rather than water to ease administration. We performed an in-use dissolution and stability study of vigabatrin powder reconstituted in 4 liquids—water, apple juice, whole milk, and infant formula—with testing performed 0, 24, and 48 h after preparation with storage at 2–8 °C in a capped, glass container. Vigabatrin reconstituted in each liquid was clear and free of visible particulates compared with matched drug-free liquid controls. In subsequent analyses using US Pharmacopeia (USP) procedures, high-performance liquid chromatography spectra and chromatograms for each sample solution matched the vigabatrin reference standard. At all time points, all sample solutions met USP-acceptance criteria of 95.0–105.0 % for product stability and USP-acceptance criteria for related substances/organic impurities testing for total impurities. Together, these results indicate that vigabatrin powder reconstituted in liquids other than water was stable for up to 48 h of refrigeration. This study provides useful information to help healthcare providers address real-world medication questions from caregivers.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"31 ","pages":"Article 100816"},"PeriodicalIF":1.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829487","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}
Pub Date : 2025-08-05DOI: 10.1016/j.ebr.2025.100814
Ken Ling, Xinghui He, Zhiquan Yang
This study aimed to examine the association between dietary niacin intake and the prevalence of epilepsy. We conducted a cross-sectional analysis of 14,236 participants from the National Health and Nutrition Examination Survey (NHANES) 2013–2018. Multivariable logistic regression, generalized additive models, and subgroup analyses were employed to assess the relationship. An inverse association was found between dietary niacin intake and the prevalence of epilepsy: for every 10 mg/day increase, the odds of having epilepsy were reduced by 15 % (OR = 0.85, p = 0.0266). Participants in the highest quintile of niacin intake had a significantly lower odds of epilepsy compared to those in the lowest quintile (OR = 0.45, p = 0.0187). This negative association remained consistent across groups with diverse demographic characteristics, medical conditions, and lifestyle choices. Our findings suggest a possible inverse association between dietary niacin intake and the prevalence of epilepsy.
本研究旨在研究膳食烟酸摄入量与癫痫患病率之间的关系。我们对2013-2018年国家健康与营养检查调查（NHANES）的14236名参与者进行了横断面分析。采用多变量逻辑回归、广义加性模型和亚组分析来评估两者之间的关系。饮食中烟酸摄入量与癫痫患病率呈负相关：每增加10毫克/天，患癫痫的几率降低15% （OR = 0.85, p = 0.0266）。烟酸摄入量最高的五分之一的参与者患癫痫的几率明显低于摄入量最低的五分之一的参与者（OR = 0.45, p = 0.0187）。这种负相关在不同人口特征、医疗条件和生活方式选择的群体中保持一致。我们的研究结果表明，饮食中烟酸摄入量与癫痫患病率之间可能存在负相关。
{"title":"Dietary niacin intake and epilepsy: a cross-sectional study","authors":"Ken Ling, Xinghui He, Zhiquan Yang","doi":"10.1016/j.ebr.2025.100814","DOIUrl":"10.1016/j.ebr.2025.100814","url":null,"abstract":"<div><div>This study aimed to examine the association between dietary niacin intake and the prevalence of epilepsy. We conducted a cross-sectional analysis of 14,236 participants from the National Health and Nutrition Examination Survey (NHANES) 2013–2018. Multivariable logistic regression, generalized additive models, and subgroup analyses were employed to assess the relationship. An inverse association was found between dietary niacin intake and the prevalence of epilepsy: for every 10 mg/day increase, the odds of having epilepsy were reduced by 15 % (OR = 0.85, p = 0.0266). Participants in the highest quintile of niacin intake had a significantly lower odds of epilepsy compared to those in the lowest quintile (OR = 0.45, p = 0.0187). This negative association remained consistent across groups with diverse demographic characteristics, medical conditions, and lifestyle choices. Our findings suggest a possible inverse association between dietary niacin intake and the prevalence of epilepsy.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"31 ","pages":"Article 100814"},"PeriodicalIF":1.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779643","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}
Pub Date : 2025-07-30DOI: 10.1016/j.ebr.2025.100811
Rahel M. Burger , Gadi Miron , Pascal Fenske , Cornelia Potratz , Angela M. Kaindl , Christian Meisel
Home videos are increasingly presented in clinical practice, and secure digital tools for clinical video sharing are urgently needed. This study evaluated the feasibility of a secure video-sharing digital platform in pediatric epilepsy diagnostics. We conducted a prospective pilot study that included 60 children (median age 5.5 years) with suspected seizures and their caregivers at a tertiary pediatric center. Participants were invited to submit videos of suspected events through a secure smartphone application. Videos were reviewed by an epileptologist and in parallel participants underwent standard diagnostic evaluation. Outcome measures included video quality, concordance of video assessment with diagnostic workup, and user evaluation questionnaires. Of recruited participants, 16 (26.7 %) used the app to submit 81 videos (median 5.1 videos per patient), with 94 % (76/81 videos) having sufficient quality for meaningful clinical review. Among these participants, 11 (68.8 %) had confirmed epilepsy as their final diagnosis, while 5 (31.2 %) did not. Expert review classified 48.1 % of videos as likely epileptic events, with generalized tonic-clonic seizures being most common (24.7 %). Concordance between submitted videos and final clinical diagnosis was demonstrated in 68.8 % of cases, with higher concordance significantly related to the number of videos submitted (mean 6.4 vs. 2.2 videos per patient, p = 0.04). User evaluation showed favorable ratings for app usability (mean score 5.4/7). This study demonstrates the feasibility of secure digital video transfer in pediatric epilepsy diagnostics, emphasizing the importance of multiple video submissions for accurate diagnosis. Future implementation should address barriers to wider adoption and investigate clinical impact.
家庭视频越来越多地出现在临床实践中，迫切需要安全的临床视频共享数字工具。本研究评估了安全视频共享数字平台在儿童癫痫诊断中的可行性。我们进行了一项前瞻性试点研究，包括60名疑似癫痫发作的儿童（中位年龄5.5岁）及其在三级儿科中心的护理人员。参与者被邀请通过一个安全的智能手机应用程序提交可疑事件的视频。视频由癫痫学家审查，同时参与者接受标准诊断评估。结果测量包括视频质量、视频评估与诊断检查的一致性以及用户评估问卷。在招募的参与者中，16人（26.7%）使用该应用程序提交了81个视频（平均每位患者5.1个视频），其中94%（76/81个视频）具有足够的质量进行有意义的临床评价。在这些参与者中，11人（68.8%）确诊为癫痫，5人（31.2%）未确诊为癫痫。专家评审将48.1%的视频归类为可能的癫痫事件，其中全身性强直-阵挛性发作最为常见（24.7%）。提交的视频与最终临床诊断之间的一致性在68.8%的病例中得到证实，更高的一致性与提交的视频数量显著相关（平均6.4 vs 2.2视频/患者，p = 0.04）。用户评价显示，应用可用性获得好评（平均得分5.4/7）。本研究证明了安全数字视频传输在儿童癫痫诊断中的可行性，强调了多视频提交对准确诊断的重要性。未来的实施应解决阻碍更广泛采用的障碍，并调查临床影响。
{"title":"Implementation of a digital health tool for seizure video transfer in a pediatric epilepsy center: A prospective pilot study","authors":"Rahel M. Burger , Gadi Miron , Pascal Fenske , Cornelia Potratz , Angela M. Kaindl , Christian Meisel","doi":"10.1016/j.ebr.2025.100811","DOIUrl":"10.1016/j.ebr.2025.100811","url":null,"abstract":"<div><div>Home videos are increasingly presented in clinical practice, and secure digital tools for clinical video sharing are urgently needed. This study evaluated the feasibility of a secure video-sharing digital platform in pediatric epilepsy diagnostics. We conducted a prospective pilot study that included 60 children (median age 5.5 years) with suspected seizures and their caregivers at a tertiary pediatric center. Participants were invited to submit videos of suspected events through a secure smartphone application. Videos were reviewed by an epileptologist and in parallel participants underwent standard diagnostic evaluation. Outcome measures included video quality, concordance of video assessment with diagnostic workup, and user evaluation questionnaires. Of recruited participants, 16 (26.7 %) used the app to submit 81 videos (median 5.1 videos per patient), with 94 % (76/81 videos) having sufficient quality for meaningful clinical review. Among these participants, 11 (68.8 %) had confirmed epilepsy as their final diagnosis, while 5 (31.2 %) did not. Expert review classified 48.1 % of videos as likely epileptic events, with generalized tonic-clonic seizures being most common (24.7 %). Concordance between submitted videos and final clinical diagnosis was demonstrated in 68.8 % of cases, with higher concordance significantly related to the number of videos submitted (mean 6.4 vs. 2.2 videos per patient, p = 0.04). User evaluation showed favorable ratings for app usability (mean score 5.4/7). This study demonstrates the feasibility of secure digital video transfer in pediatric epilepsy diagnostics, emphasizing the importance of multiple video submissions for accurate diagnosis. Future implementation should address barriers to wider adoption and investigate clinical impact.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"31 ","pages":"Article 100811"},"PeriodicalIF":1.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144748990","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}
Pub Date : 2025-07-29DOI: 10.1016/j.ebr.2025.100813
Maya A. Jayaram , Andrew I. Yang , Ashley L.B. Raghu , Peter A. Rozman , Denise F. Chen , Jon T. Willie , Ammar Kheder , Robert E. Gross
The temporal pole (TP) is an under-investigated region in temporal lobe epilepsy, often overlooked during stereoEEG (sEEG) due to the lack of characteristic Phase 1 findings and technical limitations in implanting using traditional orthogonal trajectories. We retrospectively reviewed consecutive patients with TP-onset seizures confirmed on sEEG. Two non-orthogonal trajectories were utilized targeting the inferior (iTP) and superior (sTP) aspects of TP. TP was implanted in 43 hemispheres of 30 patients, in whom seizure onset in TP was identified in 32 hemispheres. Seizure foci were spatially limited to TP in 50 % of cases, whereas the remainder involved broader regions, most commonly mesial temporal structures (88 %). In a subset of cases (22 %), TP seizures emerged from either the sTP or iTP, in contrast to those emerging more diffusely across both sub-regions. Encephaloceles were found in 43 % of patients and were associated with ipsilateral TP-onset seizures in 93 % of those cases. In a heterogeneous cohort who underwent surgical intervention, 50 % achieved Engel class I outcomes at 2 years. Our series illustrates the considerable variability in the seizure onset zone across patients with TP epilepsy, both within TP as well as in its involvement of neighboring regions. Inclusion of TP during invasive monitoring can inform subsequent surgical interventions.
{"title":"Temporopolar epilepsy stereoEEG: implant technique and outcomes","authors":"Maya A. Jayaram , Andrew I. Yang , Ashley L.B. Raghu , Peter A. Rozman , Denise F. Chen , Jon T. Willie , Ammar Kheder , Robert E. Gross","doi":"10.1016/j.ebr.2025.100813","DOIUrl":"10.1016/j.ebr.2025.100813","url":null,"abstract":"<div><div>The temporal pole (TP) is an under-investigated region in temporal lobe epilepsy, often overlooked during stereoEEG (sEEG) due to the lack of characteristic Phase 1 findings and technical limitations in implanting using traditional orthogonal trajectories. We retrospectively reviewed consecutive patients with TP-onset seizures confirmed on sEEG. Two non-orthogonal trajectories were utilized targeting the inferior (iTP) and superior (sTP) aspects of TP. TP was implanted in 43 hemispheres of 30 patients, in whom seizure onset in TP was identified in 32 hemispheres. Seizure foci were spatially limited to TP in 50 % of cases, whereas the remainder involved broader regions, most commonly mesial temporal structures (88 %). In a subset of cases (22 %), TP seizures emerged from either the sTP or iTP, in contrast to those emerging more diffusely across both sub-regions. Encephaloceles were found in 43 % of patients and were associated with ipsilateral TP-onset seizures in 93 % of those cases. In a heterogeneous cohort who underwent surgical intervention, 50 % achieved Engel class I outcomes at 2 years. Our series illustrates the considerable variability in the seizure onset zone across patients with TP epilepsy, both within TP as well as in its involvement of neighboring regions. Inclusion of TP during invasive monitoring can inform subsequent surgical interventions.</div></div>","PeriodicalId":36558,"journal":{"name":"Epilepsy and Behavior Reports","volume":"31 ","pages":"Article 100813"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772986","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}
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