Seizure-European Journal of Epilepsy最新文献

Well preserved versus severely impaired memory 10-44 years after temporal lobe epilepsy surgery: "How did the patients get there?" 颞叶癫痫手术后10-44年的记忆保存完好与严重受损：“患者是如何做到的？”

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-12 DOI: 10.1016/j.seizure.2026.03.008

Eli B Kyte, Annette Holth Skogan, Jugoslav Ivanovic, Einar C Heminghyt, Morten I Lossius, Christoph Helmstaedter, Kristin Å Alfstad

Purpose: This study aimed to identify factors influencing long-term memory outcomes after temporal lobe epilepsy surgery, focusing on patients with well-preserved functioning versus those with severe impairments.

Method: Ninety-nine patients underwent epilepsy surgery and completed neuropsychological assessments preoperatively (T1) and two years postoperatively (T2), with follow-up 10-44 years after surgery (T3). Memory scores were categorized as severely impaired (>2 SD below the mean) or good (≥ average).

Results: At T3, 46% of patients reported surgery-related memory decline and 9% reported later decline. Objectively, verbal memory was severely impaired in 21% and good in 14%, while figural memory was severely impaired in 34% and good in 12%. Continuous seizure freedom occurred in 45%, late seizure freedom in 24%, relapse in 11%, and ongoing seizures in 20%. Seizure-free patients performed better. Among those severely impaired in verbal memory at T3, 45% had declined by T2 and 20% declined later; among good performers, 79% improved late. For figural memory, 8% declined by T2 and 65% declined later; among good performers, 27% improved after surgery and 64% improved later. Surgical side, education, and age predicted outcomes.

Conclusion: Many years after temporal lobe epilepsy surgery, 45% of patients achieved continuous seizure freedom and 20% late seizure freedom. Only 9% reported late memory decline. Verbal memory tended to decline shortly after surgery but showed recovery over time, whereas figural memory more often declined later. These patterns suggest late mechanisms of functional recovery, compensation, and reorganization.

目的：本研究旨在确定影响颞叶癫痫手术后长期记忆预后的因素，重点关注功能保存良好的患者与严重损伤的患者。方法：99例患者行癫痫手术，术前（T1）、术后2年（T2）完成神经心理评估，术后随访10 ~ 44年（T3）。记忆评分分为严重受损（低于平均值0.2 SD）和良好（≥平均值）。结果：在T3时，46%的患者报告了手术相关的记忆衰退，9%的患者报告了后来的衰退。客观地说，言语记忆严重受损的占21%，良好的占14%，而图形记忆严重受损的占34%，良好的占12%。持续发作自由占45%，晚期发作自由占24%，复发占11%，持续发作占20%。无癫痫发作的患者表现更好。在T3时言语记忆严重受损的受试者中，45%在T2时下降，20%在T2后下降；在表现良好的学生中，有79%的学生在晚些时候有所改善。在图形记忆方面，8%在T2时下降，65%在T2后下降；在表现良好的患者中，27%的患者术后改善，64%的患者术后改善。手术部位、教育程度和年龄预测预后。结论：颞叶癫痫手术多年后，45%的患者实现了持续发作自由，20%的患者实现了晚期发作自由。只有9%的人报告记忆力衰退。言语记忆往往在手术后不久就会下降，但随着时间的推移会恢复，而图形记忆往往在手术后下降。这些模式提示了功能恢复、补偿和重组的晚期机制。

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引用次数: 0

Mortality and cause of death in childhood onset epilepsy: A population-based cohort study in Finland. 儿童癫痫发病的死亡率和死因：芬兰一项基于人群的队列研究

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-10 DOI: 10.1016/j.seizure.2026.03.006

Christian Starck, Mika Helminen, Olli Po Nevalainen, Kai Eriksson, Anssi Auvinen

Objective: To estimate mortality, causes of death, and sudden unexpected death in epilepsy (SUDEP) in childhood onset epilepsy (COE).

Methods: We identified a population-based cohort of 312 individuals with COE in Tampere University Hospital district with an inception date of December 31, 1992. We gathered death certificates and forensic autopsy records from the Finnish Institute for Health and Welfare and the National Archives of Finland, with follow-up ending in January 2018. Population mortality rates by age and sex were obtained from Statistics Finland for the study period to calculate standardized mortality rates (SMRs). Statistics Finland also provided yearly life expectancy estimates for calculating potential years of life lost (YLL).

Results: A total of 29 patients died during the follow-up, corresponding to a mortality of 3.9 (2.6-5.6) per 1000 person-years, with a median age at time of death of 22.6 years (IQR 19.4-27.0). We identified ten SUDEP cases (34.5 % of all deaths). All-cause SMR was 6.78 (4.54-9.73). Patients without disabilities had a non-significantly increased SMR (2.56, 0.94-5.58). Patients who were seizure-free for a year or more at baseline had a lower SMR than patients with continued seizures (2.94, 1.18-6.06 vs. 11.59, 7.27-17.55). Symptomatic etiology predicted increased mortality (12.82, 7.6-20.26), whereas genetic etiology was not associated with a significantly increased mortality (3.28, 0.89-8.39).

Conclusions: COE was associated with increased mortality, with SUDEP accounting a third of all deaths. Seizure freedom at baseline and genetic etiology related to lower mortality than continued seizures or symptomatic etiology.

目的：评估儿童期癫痫（COE）患者的死亡率、死亡原因和癫痫猝死（SUDEP）。方法：我们在坦佩雷大学医院区确定了一个以人群为基础的队列，包括312名COE患者，起始日期为1992年12月31日。我们从芬兰健康与福利研究所和芬兰国家档案馆收集了死亡证明和法医尸检记录，随访于2018年1月结束。从芬兰统计局获得了研究期间按年龄和性别分列的人口死亡率，以计算标准化死亡率（SMRs）。芬兰统计局还提供了用于计算潜在寿命损失年数（YLL）的年度预期寿命估计数。结果：随访期间共有29例患者死亡，死亡率为3.9(2.6-5.6)/ 1000人年，死亡时的中位年龄为22.6岁（IQR为19.4-27.0）。我们确定了10例猝死病例（占所有死亡病例的34.5%）。全因SMR为6.78（4.54-9.73）。无残疾患者的SMR无显著升高（2.56,0.94-5.58）。基线时一年或一年以上无发作的患者的SMR低于持续发作的患者（2.94,1.18-6.06 vs. 11.59, 7.27-17.55）。症状性病因预测死亡率增加（12.82,7.6-20.26），而遗传病因与死亡率显著增加无关（3.28,0.89-8.39）。结论：COE与死亡率增加有关，SUDEP占所有死亡的三分之一。基线时癫痫发作自由和遗传病因与持续发作或症状性病因相关的死亡率较低。

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引用次数: 0

Sequential radiological manifestations in Dyke-Davidoff-Masson Syndrome—Comparison with recent systematic review Dyke-Davidoff-Masson综合征的序贯影像学表现——与近期系统综述的比较。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-01 Epub Date: 2025-10-04 DOI: 10.1016/j.seizure.2025.09.022

Suat Yee Lee , Fatt Yang Chew

引用次数: 0

Are enlarged perivascular spaces a predictor of early post-traumatic seizures after traumatic brain injury?- A pilot study 血管周围空间扩大是外伤性脑损伤后早期创伤后癫痫发作的预测因子吗？-试点研究。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-01 Epub Date: 2026-02-11 DOI: 10.1016/j.seizure.2026.02.010

G. Hlauschek , B. Sinclair , H․Flatmark Sødal , E. Taubøll , E. Helseth , C․Buaas Tverdal , P. Sowa , P. Kwan , T.J. O'Brien , L. Vivash , M. Law , M.I. Lossius

Objective

Post-traumatic epilepsy (PTE) is a significant long-term complication following traumatic brain injury (TBI), while early post-traumatic seizures (EPTS), occurring within the first week after TBI, are a critical risk factor that can elevate the likelihood of developing PTE later on. Here we investigate the potential of MRI-based enlarged perivascular space (ePVS) analysis as an imaging biomarker for acute in-hospital EPTS.

Methods

Forty patients who experienced a moderate-severe TBI with early post-traumatic seizures (EPTS+) (32.5% female, median age 52 years) and 88 patients without (EPTS-) (35.2% female, median age 53 years) were recruited from the Oslo University Hospital's head injury registry. PVS were measured on brain MRIs taken within one month post- TBI using an automated ePVS segmentation algorithm. The analysis included PVS count, volume, and asymmetry index (AI) across both hemispheres and vascular territories. Brain volume analysis was conducted using the FreeSurfer software suite, and PVS characteristics were compared between EPTS+ and EPTS- patients using non-parametric tests and generalized linear models.

Results

The study found no statistically significant differences in the number, volume, or asymmetry of ePVS between EPTS+ and EPTS- patients. Specifically, the median counts of ePVS and the volume fractions did not vary between the groups, indicating that ePVS did not correlate with the occurrence of EPTS in the studied cohort.

Conclusion

Our findings suggest that ePVS may not be reliable biomarkers for predicting EPTS (after TBI). However, future longitudinal studies that track ePVS changes over time could better illuminate their relationship with PTE development. This approach may reveal critical mechanisms influencing seizure risk and identify potential intervention points for at-risk patients, ultimately enhancing strategies for managing TBI-related epilepsy.

目的：创伤后癫痫（PTE）是创伤性脑损伤（TBI）后的一个重要的长期并发症，而早期创伤后癫痫发作（EPTS），发生在TBI后的第一周内，是一个关键的危险因素，可以提高以后发生PTE的可能性。在这里，我们研究了基于mri的血管周围空间扩大（ePVS）分析作为急性院内EPTS的成像生物标志物的潜力。方法：从奥斯陆大学医院的头部损伤登记处招募了40例中重度TBI伴早期创伤后癫痫发作（EPTS+）的患者（32.5%为女性，中位年龄52岁）和88例无EPTS-的患者（35.2%为女性，中位年龄53岁）。在脑外伤后一个月内用自动脑电信号分割算法测量脑电信号。分析包括两个半球和血管区域的PVS计数、体积和不对称指数（AI）。使用FreeSurfer软件套件进行脑容量分析，并使用非参数检验和广义线性模型比较EPTS+和EPTS-患者的PVS特征。结果：研究发现EPTS+和EPTS-患者ePVS的数量、体积和不对称性没有统计学差异。具体来说，ePVS的中位数计数和体积分数在两组之间没有变化，表明ePVS与研究队列中EPTS的发生无关。结论：我们的研究结果表明ePVS可能不是预测脑外伤后EPTS的可靠生物标志物。然而，未来追踪ePVS随时间变化的纵向研究可以更好地阐明它们与PTE发展的关系。该方法可能揭示影响癫痫发作风险的关键机制，并确定高危患者的潜在干预点，最终增强tbi相关癫痫的管理策略。

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引用次数: 0

Clinical reliability and concordance of drug-drug interaction tools as clinical decision support systems in patients with epilepsy 药物-药物相互作用工具作为癫痫患者临床决策支持系统的临床可靠性和一致性。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-01 Epub Date: 2026-01-23 DOI: 10.1016/j.seizure.2026.01.011

Maria Krayem , Milena van der Goten , Adam Strzelczyk , Felix Rosenow , Felix von Podewils , Susanne Knake , Stjepana Kovac , Lisa Langenbruch , Catrin Mann , Johann Philipp Zöllner , Laurent M. Willems

Purpose

To evaluate the concordance and clinical correlation of drug-drug interaction tools (DDITs) as clinical decision support systems (CDSS) in patients with epilepsy.

Methods

All patients from the Epi2020 study cohort receiving ≥1 anti-seizure medication (ASM) and ≥1 concomitant drug (CD) were included. Individual treatment regimens were analyzed for drug-drug interactions (DDIs) using five DDITs (Drugbank, Drugs.com, mediQ, Medscape and WebMD). To address the clinical significance of possible DDIs, Spearman correlation between the number of detected DDIs and two established adverse event (AE) metrics (LAEP, QOLIE-31) was performed using post-hoc correction by Fisher’s z-transformation (FZT) for the total number of drugs taken. Multivariate ordinal regression analysis (MORA) was performed to identify ASM or CD classes associated with severe DDIs.

Results

Overall, 140 patients (57.9% female, median age 48 years) taking a median number of 4.0 drugs (2.0 ASMs and 2.0 CDs) were included. DDI were found in 51.4%–84.3% and severe interactions in 2.1%–17.8% of patients, depending on the DDIT. The concordance rate between DDITs was only 6.4% for all and only 63.6% for severe detected DDI, respectively. All concordant cases involved no detected interactions. The number of DDIs significantly correlated with AE metrics in 3/5 DDITs. Following the FZT, none of the DDI/AE correlations were superior to that between the number of DDIs and the number of drugs taken. MORA identified topiramate, valproate, zonisamide, hormones, and antipsychotics as independent predictors for the detection of severe DDIs.

Conclusion

When using DDITs as CDSS, it is important to consider that the results of different tools may vary greatly from one another and do not necessarily correlate with clinical AEs.

Study registration

The Epi2020 study was registered under the trial registration number: DRKS00022024, U1111-1252-5331.

目的：评价药物-药物相互作用工具（dddits）作为癫痫患者临床决策支持系统（CDSS）的一致性和临床相关性。方法：纳入Epi2020研究队列中所有接受≥1种抗癫痫药物（ASM）和≥1种伴随药物（CD）的患者。使用5个ddi （Drugbank、Drugs.com、mediQ、Medscape和WebMD）分析个别治疗方案的药物-药物相互作用（ddi）。为了解决可能的ddi的临床意义，检测到的ddi数量与两个既定的不良事件（AE）指标（LAEP, QOLIE-31）之间的Spearman相关性使用Fisher z变换（FZT）对所服用药物总数进行事后校正。采用多变量有序回归分析（MORA）确定与严重ddi相关的ASM或CD类别。结果：共纳入140例患者（女性57.9%，中位年龄48岁），中位用药数4.0种（asm 2.0, cd 2.0）。DDI发生率为51.4% ~ 84.3%，严重相互作用发生率为2.1% ~ 17.8%，取决于DDI。所有DDI的符合率仅为6.4%，严重DDI的符合率仅为63.6%。所有病例均未检测到相互作用。在3/5的ddi中，ddi的数量与AE指标显著相关。在FZT之后，DDI/AE的相关性并不优于DDI次数与服药次数之间的相关性。MORA发现托吡酯、丙戊酸、唑尼沙胺、激素和抗精神病药物是检测严重ddi的独立预测因子。结论：当使用ddi作为CDSS时，重要的是要考虑到不同工具的结果可能彼此差异很大，并且不一定与临床ae相关。研究注册：Epi2020研究注册，试验注册号：DRKS00022024， U1111-1252-5331。

{"title":"Clinical reliability and concordance of drug-drug interaction tools as clinical decision support systems in patients with epilepsy","authors":"Maria Krayem , Milena van der Goten , Adam Strzelczyk , Felix Rosenow , Felix von Podewils , Susanne Knake , Stjepana Kovac , Lisa Langenbruch , Catrin Mann , Johann Philipp Zöllner , Laurent M. Willems","doi":"10.1016/j.seizure.2026.01.011","DOIUrl":"10.1016/j.seizure.2026.01.011","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the concordance and clinical correlation of drug-drug interaction tools (DDITs) as clinical decision support systems (CDSS) in patients with epilepsy.</div></div><div><h3>Methods</h3><div>All patients from the Epi2020 study cohort receiving ≥1 anti-seizure medication (ASM) and ≥1 concomitant drug (CD) were included. Individual treatment regimens were analyzed for drug-drug interactions (DDIs) using five DDITs (Drugbank, Drugs.com, mediQ, Medscape and WebMD). To address the clinical significance of possible DDIs, Spearman correlation between the number of detected DDIs and two established adverse event (AE) metrics (LAEP, QOLIE-31) was performed using post-hoc correction by Fisher’s z-transformation (FZT) for the total number of drugs taken. Multivariate ordinal regression analysis (MORA) was performed to identify ASM or CD classes associated with severe DDIs.</div></div><div><h3>Results</h3><div>Overall, 140 patients (57.9% female, median age 48 years) taking a median number of 4.0 drugs (2.0 ASMs and 2.0 CDs) were included. DDI were found in 51.4%–84.3% and severe interactions in 2.1%–17.8% of patients, depending on the DDIT. The concordance rate between DDITs was only 6.4% for all and only 63.6% for severe detected DDI, respectively. All concordant cases involved no detected interactions. The number of DDIs significantly correlated with AE metrics in 3/5 DDITs. Following the FZT, none of the DDI/AE correlations were superior to that between the number of DDIs and the number of drugs taken. MORA identified topiramate, valproate, zonisamide, hormones, and antipsychotics as independent predictors for the detection of severe DDIs.</div></div><div><h3>Conclusion</h3><div>When using DDITs as CDSS, it is important to consider that the results of different tools may vary greatly from one another and do not necessarily correlate with clinical AEs.</div></div><div><h3>Study registration</h3><div>The Epi2020 study was registered under the trial registration number: DRKS00022024, U1111-1252-5331.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"136 ","pages":"Pages 31-39"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Secondary hemophagocytic lymphohistiocytosis concurrent with febrile infection-related epilepsy syndrome in a child 儿童继发性噬血细胞性淋巴组织细胞增多症并发发热性感染相关性癫痫综合征

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 10.1016/j.seizure.2026.01.015

Oi-Wa Chan , Chun-Nun Chao , Shao-Hsuan Hsia , En-Pei Lee , Kuang-Lin Lin , Jainn-Jim Lin

引用次数: 0

Pediatric new-onset super refractory status epilepticus: Potential of timely immunotherapy in a resource-limited PICU 儿童新发超级难治性癫痫持续状态：在资源有限的PICU中及时免疫治疗的潜力。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-01 Epub Date: 2026-01-31 DOI: 10.1016/j.seizure.2026.01.021

Aakash Chandran Chidambaram , Jerin C Sekhar , Suresh Kumar Angurana , Karthi Nallasamy , Muralidharan Jayashree , Naveen Sankhyan , Jitendra Kumar Sahu , Renu Suthar , Arushi Gahlot Saini , Arun Bansal

PURPOSE

To describe the clinical profile, management, and outcomes of children with new-onset super-refractory status epilepticus (NOSRSE), and to identify predictors of survival.

METHOD

This was a retrospective observational study conducted in the Pediatric Intensive Care Unit at PGIMER, Chandigarh, India, from January 2019 to August 2024. Thirty-six children diagnosed with NORSE who progressed to super-refractory status epilepticus were included. Clinical characteristics, neurodiagnostic findings, treatment details, and outcomes were analyzed. Univariate logistic regression was used to identify predictors of survival.

RESULTS

Median age was 8 years; 63.9 % were male. No etiology was identified in 28 (77.7 %) children, autoimmune encephalitis in 5 (13.9 %) and viral encephalitis in 3 (8.3 %) children. MRI abnormalities were seen in 72.7 %, and non-convulsive seizures on EEG in 55.6 %. Seizure control was achieved in 80.6 %, and 72.2 % survived to hospital discharge. Median PCPC score improved from 5 at discharge to 3 at 6-month follow-up. Early immunotherapy (OR 0.83; 95 % CI (0.69, 0.99); p 0.04) was associated with better survival.

CONCLUSION

Despite the severity of illness, favorable outcomes were achievable. Early immunotherapy was associated with improved survival. These findings underscore the need for time-sensitive, protocolized care in pediatric NOSRSE, especially in resource-limited settings.

目的：描述新发超难治性癫痫持续状态（NOSRSE）儿童的临床概况、治疗和结局，并确定生存的预测因素。方法：这是一项回顾性观察性研究，于2019年1月至2024年8月在印度昌迪加尔的PGIMER儿科重症监护室进行。36名诊断为NORSE的儿童进展为超难治性癫痫持续状态。分析临床特征、神经诊断结果、治疗细节和结果。单变量逻辑回归用于确定生存预测因子。结果：中位年龄8岁；63.9%为男性。28例（77.7%）患儿病因不明，5例（13.9%）患儿为自身免疫性脑炎，3例（8.3%）患儿为病毒性脑炎。MRI异常占72.7%，脑电图非惊厥发作占55.6%。80.6%的患者癫痫发作得到控制，72.2%的患者存活至出院。中位PCPC评分从出院时的5分提高到随访6个月时的3分。早期免疫治疗(OR 0.83; 95% CI (0.69, 0.99)；P 0.04)与较好的生存率相关。结论：尽管病情严重，但良好的结果是可以实现的。早期免疫治疗与生存率提高有关。这些发现强调了在儿童NOSRSE中，特别是在资源有限的情况下，需要时间敏感的、协议化的护理。

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引用次数: 0

Levetiracetam vs. valproate: Which antiseizure medication worsens insulin resistance and metabolic health? 左乙拉西坦vs丙戊酸钠：哪种抗癫痫药物会加重胰岛素抵抗和代谢健康？

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-01 Epub Date: 2026-03-10 DOI: 10.1016/j.seizure.2024.08.025

Prateek Kumar Panda, Indar Kumar Sharawat

引用次数: 0

Applications and impact of telemedicine for persons with epilepsy: a scoping review 远程医疗对癫痫患者的应用和影响：范围审查。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 10.1016/j.seizure.2026.01.016

Jitendra Kumar Sahu , Ana Carolina Coan , Josephine Chan , Bosanka Jocic-Jakubi , Pooja Dhir , Mamidi Niveditha , Nagita Devi , Mamta Bhushan Singh , Patricia Osborne Shafer , Yu Hsiang-Yu , Amza Ali , Ji Yeoun Yoo , Johan Zelano , Fred Stephen Sarfo , Fortini Pablo Sebastián , Samson Awili Gwer , Yanin Rivera , Najib Kissani , Roberto Horacio Caraballo , Dipika Bansal , Pauline Samia

Telemedicine is emerging as a promising strategy to overcome geographical and specialist access constraints in epilepsy care. This scoping review, conducted by the International League Against Epilepsy (ILAE) Telemedicine Task Force, aimed to map the existing evidence on the applications, effectiveness, and challenges of telemedicine in epilepsy management. A systematic search of PubMed, Embase, and Web of Science, conducted up to May 2025 without language restrictions, identified original studies evaluating telemedicine for epilepsy diagnosis, management, or follow-up. Data were extracted and synthesized narratively. Of the 201 included studies, approximately 70% originated from high-income settings. Evidence demonstrated diagnostic accuracy ranging from 75% to 97%, cost savings of about US$30 per consultation, and high satisfaction levels among patients (87–95%) and physicians (74–94%). Telemedicine also reduced no-shows by 45%, ensuring continuity of care during healthcare disruptions such as the COVID-19 pandemic. Overall, telemedicine is a feasible adjunct to conventional epilepsy care, enhancing access, accuracy, and cost-effectiveness. To substantiate its role in diverse settings, well-designed randomized controlled trials are needed to evaluate long-term outcomes, equity, and sustainability.

远程医疗正在成为一种有希望的战略，以克服癫痫治疗方面的地理和专家准入限制。这项范围审查由国际抗癫痫联盟（ILAE）远程医疗工作组进行，目的是绘制关于远程医疗在癫痫管理中的应用、有效性和挑战的现有证据。到2025年5月，在没有语言限制的情况下，对PubMed、Embase和Web of Science进行了系统搜索，发现了评估远程医疗用于癫痫诊断、管理或随访的原始研究。数据提取和综合叙述。在纳入的201项研究中，大约70%来自高收入环境。有证据表明，诊断准确率在75%至97%之间，每次咨询可节省约30美元的费用，患者（87-95%）和医生（74-94%）的满意度很高。远程医疗还将缺勤率降低了45%，确保了在COVID-19大流行等医疗中断期间的护理连续性。总体而言，远程医疗是传统癫痫治疗的可行辅助手段，可提高可及性、准确性和成本效益。为了证实其在不同环境中的作用，需要设计良好的随机对照试验来评估长期结果、公平性和可持续性。

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引用次数: 0

Characteristics associated with first anti-seizure medication prescribed in a cohort of adults with newly diagnosed epilepsy 新诊断癫痫的成人队列中首次抗癫痫药物处方的相关特征

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.seizure.2026.02.007

Leah J. Blank , Rachelle Morgenstern , Kenneth Boockvar , Nihal Mohamed , Nathalie Jetté

Background

Anti-seizure medication (ASM) is the primary treatment modality in epilepsy. There exist evidence-based recommendations published by the American Academy of Neurology and American Epilepsy Society for ASM selection in epilepsy, but these medication recommendations are inconsistently followed. We sought to examine predictors of recommended first ASM in newly diagnosed adults with epilepsy.

Methods

We conducted a retrospective cohort study of adults (≥18 years) newly diagnosed with epilepsy in New York, identified using validated ICD-CM codes, for the period 2011 to 2019. The primary outcome of interest was use of an AES/AAN guideline-informed ASM, and exposures of interest included patient characteristics (e.g. age), provider characteristics (e.g. specialty) and structural characteristics (e.g., practice setting). Multivariable Poisson regression for risk ratios modeled the probability of being prescribed a neutral/recommended or non-recommended ASM, adjusting for covariates.

Results

2340 adults with newly diagnosed epilepsy were prescribed an ASM within 1-year. The most frequently prescribed ASM was levetiracetam (45.5%), which aligns with recommendations. However, 39% were prescribed a non-recommended medication. The prescription of a recommended ASM was associated with older age at diagnosis (relative risk (RR) 1.01; 95% confidence interval (CI) 1.00–1.01), Black race (RR 1.12; 95% CI 1.03–1.23), being in a relationship (vs. divorced/separated/single or widowed) (RR 1.13; 95% CI 1.06–1.22) and a history of stroke (RR 1.19; 95% CI 1.05–1.34). Prescriptions from physician trainees (vs. non-trainees) were more likely to align with recommended ASMs (RR 1.15; 95% CI 1.06–1.25), with no differences by physician specialty. Inpatient setting was associated with fewer recommended ASM prescriptions (vs. outpatient setting) (RR 0.82; 95% CI 0.75–0.89). There was no difference between emergency department and outpatient prescriptions.

Conclusions

Understanding where/why less favorable ASM prescription may occur is important to target potential prescribing interventions. In this study, recommended ASM prescriptions were associated with patient, prescriber and setting characteristics. Notably, trainees prescribed recommended/neutral ASM more often, which underscores the importance of prescriber education in improving prescribing practices.

背景：抗癫痫药物（ASM）是癫痫的主要治疗方式。美国神经病学学会和美国癫痫学会发表了针对癫痫患者ASM选择的循证建议，但这些药物建议并没有得到一致的遵循。我们试图检查新诊断的成人癫痫患者推荐的首次ASM的预测因素。方法：我们对2011年至2019年期间纽约新诊断为癫痫的成人（≥18岁）进行了回顾性队列研究，使用经过验证的ICD-CM代码进行鉴定。关注的主要结果是使用AES/AAN指南告知的ASM，关注的暴露包括患者特征（如年龄）、提供者特征（如专业）和结构特征（如实践环境）。风险比的多变量泊松回归模拟了规定中性/推荐或非推荐ASM的概率，调整了协变量。结果2340例成人新诊断癫痫患者在1年内接受了ASM治疗。最常见的ASM处方是左乙拉西坦（45.5%），这与建议一致。然而，39%的人服用了非推荐药物。推荐的ASM处方与诊断时年龄较大相关(相对风险（RR） 1.01；95%可信区间（CI） 1.00-1.01)、黑人（RR 1.12; 95% CI 1.03-1.23）、恋爱（相对于离婚/分居/单身或丧偶）（RR 1.13; 95% CI 1.06-1.22）和中风史（RR 1.19; 95% CI 1.05-1.34）。实习医师开具的处方（与非实习医师相比）更有可能与推荐的asm一致（RR 1.15; 95% CI 1.06-1.25），不同医师专业之间没有差异。住院环境与较少推荐的ASM处方相关（与门诊环境相比）（RR 0.82; 95% CI 0.75-0.89）。急诊和门诊处方之间没有差异。结论了解不良ASM处方可能发生的地点/原因对于针对潜在的处方干预措施非常重要。在本研究中，推荐的ASM处方与患者、处方者和环境特征相关。值得注意的是，受训者开推荐/中性ASM的频率更高，这强调了开处方者教育在改善开处方实践中的重要性。

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引用次数: 0