Pub Date : 2025-02-07DOI: 10.1016/j.seizure.2025.02.004
Athina Firtinidou , Lennart Stieglitz , Lukas Imbach
Objective
Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a third-line treatment option for patients with refractory focal epilepsy. However, the effect on recurrent episodes of status epilepticus (SE) after ANT-DBS implantation has not been systematically investigated. Here, we set out to determine whether ANT-DBS has a preventive clinical effect on the risk of SE in difficult-to-treat epilepsies.
Methods
We performed a retrospective, monocentric analysis in a cohort of patients with refractory epilepsy who received bilateral DBS implantation in the ANT (n = 24). Medical records were reviewed to compare the total number of SE in each patient before and after surgery.
Results
Out of 24 patients, 11 (46 %) had 20 episodes of SE preoperatively, 17 of which were unprovoked. Postoperatively, only 2 patients developed SE, one of which was provoked. The relative annual risk of SE in this cohort was reduced from 28.8 % (per patient year) preoperatively to 1.9 % postoperatively, demonstrating a statistically significant reduction in SE incidence with ANT-DBS (p < 0.005). Survival analysis confirmed significantly longer status-free survival postoperatively.
Conclusion
ANT-DBS may be beneficial as a preventive intervention in patients with refractory epilepsy at high risk for recurrent SE.
{"title":"Deep brain stimulation of the anterior nucleus of the thalamus reduces the risk for status epilepticus in focal drug-resistant epilepsy","authors":"Athina Firtinidou , Lennart Stieglitz , Lukas Imbach","doi":"10.1016/j.seizure.2025.02.004","DOIUrl":"10.1016/j.seizure.2025.02.004","url":null,"abstract":"<div><h3>Objective</h3><div>Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a third-line treatment option for patients with refractory focal epilepsy. However, the effect on recurrent episodes of status epilepticus (SE) after ANT-DBS implantation has not been systematically investigated. Here, we set out to determine whether ANT-DBS has a preventive clinical effect on the risk of SE in difficult-to-treat epilepsies.</div></div><div><h3>Methods</h3><div>We performed a retrospective, monocentric analysis in a cohort of patients with refractory epilepsy who received bilateral DBS implantation in the ANT (<em>n</em> = 24). Medical records were reviewed to compare the total number of SE in each patient before and after surgery.</div></div><div><h3>Results</h3><div>Out of 24 patients, 11 (46 %) had 20 episodes of SE preoperatively, 17 of which were unprovoked. Postoperatively, only 2 patients developed SE, one of which was provoked. The relative annual risk of SE in this cohort was reduced from 28.8 % (per patient year) preoperatively to 1.9 % postoperatively, demonstrating a statistically significant reduction in SE incidence with ANT-DBS (<em>p</em> < 0.005). Survival analysis confirmed significantly longer status-free survival postoperatively.</div></div><div><h3>Conclusion</h3><div>ANT-DBS may be beneficial as a preventive intervention in patients with refractory epilepsy at high risk for recurrent SE.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 71-75"},"PeriodicalIF":2.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1016/j.seizure.2025.02.002
Leman Tekin Orgun , Adnan Deniz , Ayfer Sakarya Güneş , Deniz Akkoyunlu , Gökçe Cırdı , Anıl Gök , Bülent Kara
Background
N-methyl-D-aspartate receptor (NMDAR) blockers are important to control seizures in patients with refractory status epilepticus. ATP1A2 gene plays a role in protecting neurons from glutamate and NMDAR-related excitotoxicity. Although variations in the ATP1A2 gene are classically associated with hemiplegic migraine and alternating hemiplegia, in recent years, ATP1A2 variations have been reported with developmental and epileptic encephalopathy (DEE-98) and status epilepticus. Case report: An 11-month-old girl whose neuromotor development regressed following the onset of seizures at five months of age was admitted to the intensive care unit with a diagnosis of status epilepticus. Her seizure was partially responsive to ketamine, and she became seizure-free when memantine, another NMDA receptor blocker, was added to the treatment. Her WES analysis was completed during the second week of memantine treatment, revealing a heterozygous, de-nova, c.2432C>G variant in the ATP1A2 gene.
Conclusion
ATP1A2-related DEE-98 is seen as very rare, and some of the patients with DEE-98 died due to refractory status epilepticus. The ATP1A2 gene is important for protecting neurons from glutamate and NMDAR-related excitotoxicity. We want to present the infant to emphasize the importance of targeted therapy with MNDARs in ATP1A2-related seizures, even during the status epilepticus period.
{"title":"Apparent efficacy of NMDAR antagonist use as a targeted therapy for status epilepticus in an infant with ATP1A2-related developmental epileptic encephalopathy","authors":"Leman Tekin Orgun , Adnan Deniz , Ayfer Sakarya Güneş , Deniz Akkoyunlu , Gökçe Cırdı , Anıl Gök , Bülent Kara","doi":"10.1016/j.seizure.2025.02.002","DOIUrl":"10.1016/j.seizure.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>N-methyl-D-aspartate receptor (NMDAR) blockers are important to control seizures in patients with refractory status epilepticus. ATP1A2 gene plays a role in protecting neurons from glutamate and NMDAR-related excitotoxicity. Although variations in the ATP1A2 gene are classically associated with hemiplegic migraine and alternating hemiplegia, in recent years, ATP1A2 variations have been reported with developmental and epileptic encephalopathy (DEE-98) and status epilepticus. <strong><em>Case report:</em></strong> An 11-month-old girl whose neuromotor development regressed following the onset of seizures at five months of age was admitted to the intensive care unit with a diagnosis of status epilepticus. Her seizure was partially responsive to ketamine, and she became seizure-free when memantine, another NMDA receptor blocker, was added to the treatment. Her WES analysis was completed during the second week of memantine treatment, revealing a heterozygous, de-nova, c.2432C>G variant in the ATP1A2 gene.</div></div><div><h3>Conclusion</h3><div>ATP1A2-related DEE-98 is seen as very rare, and some of the patients with DEE-98 died due to refractory status epilepticus. The ATP1A2 gene is important for protecting neurons from glutamate and NMDAR-related excitotoxicity. We want to present the infant to emphasize the importance of targeted therapy with MNDARs in ATP1A2-related seizures, even during the status epilepticus period.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 95-98"},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436851","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}
Pub Date : 2025-02-05DOI: 10.1016/j.seizure.2025.02.007
Qi Huang , Kai Qian , Juan Ma , Meigang Ma , Lanfeng Sun , Xing Wei , Yuan Wu
Purpose
The ictal-interictal continuum (IIC) has been reported in various clinical conditions, but its relationship with intravascular treatments remains poorly understood. This study reports three cases of IIC following coil embolization (CE) of cerebral aneurysms and evaluates associated outcomes.
Methods
A retrospective review of medical records from May 2018 to May 2024 was conducted, focusing on patients with reduced consciousness after CE. IIC was diagnosed based on EEG patterns following the guidelines of the American Clinical Neurophysiology Society. Factors related to outcomes, including IIC development, were analyzed using a multivariable linear regression model with robust standard errors.
Results
Of 30 patients who underwent continuous (3-hour) EEG monitoring post-coiling, three exhibited IIC patterns characterized by lateralized epileptic activity ipsilateral to the coiling site. One patient also displayed repeated electrographic seizures associated with subtle motor phenomena. EEG abnormalities resolved immediately after intravenous benzodiazepines, but coma persisted. Full recovery of consciousness occurred approximately one week after benzodiazepines withdrawal. Adjusting for other risk factors, patients with IIC had a mean Glasgow Coma Scale score 3.13 points higher at 14 days compared to those without IIC (95 % CI, 0.43∼5.84; p = 0.025). Durations of ICU stay (95 %CI, -6.30–8.27; p = 0.782) and total hospital stay (95 %CI, -43.15∼20.79; p = 0.477) were comparable between groups.
Conclusions
This study highlights IIC as a potential complication of CE. The development of postoperative IIC does not necessarily correlate with worse outcomes.
{"title":"Ictal-interictal continuum following coil embolization of cerebral aneurysms","authors":"Qi Huang , Kai Qian , Juan Ma , Meigang Ma , Lanfeng Sun , Xing Wei , Yuan Wu","doi":"10.1016/j.seizure.2025.02.007","DOIUrl":"10.1016/j.seizure.2025.02.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The ictal-interictal continuum (IIC) has been reported in various clinical conditions, but its relationship with intravascular treatments remains poorly understood. This study reports three cases of IIC following coil embolization (CE) of cerebral aneurysms and evaluates associated outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of medical records from May 2018 to May 2024 was conducted, focusing on patients with reduced consciousness after CE. IIC was diagnosed based on EEG patterns following the guidelines of the American Clinical Neurophysiology Society. Factors related to outcomes, including IIC development, were analyzed using a multivariable linear regression model with robust standard errors.</div></div><div><h3>Results</h3><div>Of 30 patients who underwent continuous (3-hour) EEG monitoring post-coiling, three exhibited IIC patterns characterized by lateralized epileptic activity ipsilateral to the coiling site. One patient also displayed repeated electrographic seizures associated with subtle motor phenomena. EEG abnormalities resolved immediately after intravenous benzodiazepines, but coma persisted. Full recovery of consciousness occurred approximately one week after benzodiazepines withdrawal. Adjusting for other risk factors, patients with IIC had a mean Glasgow Coma Scale score 3.13 points higher at 14 days compared to those without IIC (95 % CI, 0.43∼5.84; <em>p</em> = 0.025). Durations of ICU stay (95 %CI, -6.30–8.27; <em>p</em> = 0.782) and total hospital stay (95 %CI, -43.15∼20.79; <em>p</em> = 0.477) were comparable between groups.</div></div><div><h3>Conclusions</h3><div>This study highlights IIC as a potential complication of CE. The development of postoperative IIC does not necessarily correlate with worse outcomes.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 43-47"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350123","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}
Pub Date : 2025-02-05DOI: 10.1016/j.seizure.2025.02.005
Lixia Li , Yankun Yao , Shiping Guan , Jingjing Ji , Yanting Lu , Lang Shen , Yongfeng Feng , Lu Yu
Objective
To investigate the risk factors for and prevention of seizures in cerebral venous sinus thrombosis patients.
Methods
This retrospective study included 216 patients with cerebral venous sinus thrombosis (CVST) from 3 hospitals in southern China from January 2010 to October 2020. Patients were divided into 2 groups comprising patients with and without early seizures (within 14 days of the diagnosis of CVST). The early seizure group was divided into 2 subgroups: those with late seizures (after 14 days of CVST diagnosis) and those without seizures. The non-early seizure group was also divided into 2 subgroups. The different groups were analyzed and compared in terms of demographics, laboratory indices, imaging data and the use of antiseizure medications (ASMs).
Results
A total of 216 patients with CVST were included in the study, including 33 patients in the early seizure group and 183 patients in the non-early seizure group. In this study, 9 (27.3 %) patients in the early seizure group and only 8 patients in the non-early seizure group experienced late seizures, and the difference in the incidence of late seizures between the two groups reached statistical significance (p < 0.05, 9/33 vs. 8/183). Univariable analysis revealed statistically significant differences in d-dimer levels (P = 0.030), parenchymal lesions (P = 0.008), intracranial hemorrhage (P < 0.001), superior sagittal sinus involvement (P = 0.003), and cortical venous involvement (P = 0.003) between the early seizure group and the non-early seizure group. Logistic regression analysis revealed that intracranial hemorrhage (P = 0.005, OR=6.303, 95 % CI 1.732–22.941) may be one of the risk factors for early seizures. There was no univariate difference between the late seizure subgroup in the early seizure group and the late seizure subgroup in the non-early seizure group, except for the involvement of three venous sinuses.
Conclusions
Patients with CVST who have early seizures are more likely to have late seizures than those who do not have early seizures. Intracranial hemorrhage may be one of the risk factors for early seizures. The risk factors for late seizures need to be identified in future clinical studies. There is insufficient evidence that the use of ASM prevents early seizures from progressing to late seizures.
{"title":"The factors related to epileptic seizures in cerebral venous sinus thrombosis in southern China: A retrospective, multicenter, self-controlled study","authors":"Lixia Li , Yankun Yao , Shiping Guan , Jingjing Ji , Yanting Lu , Lang Shen , Yongfeng Feng , Lu Yu","doi":"10.1016/j.seizure.2025.02.005","DOIUrl":"10.1016/j.seizure.2025.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the risk factors for and prevention of seizures in cerebral venous sinus thrombosis patients.</div></div><div><h3>Methods</h3><div>This retrospective study included 216 patients with cerebral venous sinus thrombosis (CVST) from 3 hospitals in southern China from January 2010 to October 2020. Patients were divided into 2 groups comprising patients with and without early seizures (within 14 days of the diagnosis of CVST). The early seizure group was divided into 2 subgroups: those with late seizures (after 14 days of CVST diagnosis) and those without seizures. The non-early seizure group was also divided into 2 subgroups. The different groups were analyzed and compared in terms of demographics, laboratory indices, imaging data and the use of antiseizure medications (ASMs).</div></div><div><h3>Results</h3><div>A total of 216 patients with CVST were included in the study, including 33 patients in the early seizure group and 183 patients in the non-early seizure group. In this study, 9 (27.3 %) patients in the early seizure group and only 8 patients in the non-early seizure group experienced late seizures, and the difference in the incidence of late seizures between the two groups reached statistical significance (<em>p</em> < 0.05, 9/33 vs. 8/183). Univariable analysis revealed statistically significant differences in d-dimer levels (<em>P</em> = 0.030), parenchymal lesions (<em>P</em> = 0.008), intracranial hemorrhage (<em>P</em> < 0.001), superior sagittal sinus involvement (<em>P</em> = 0.003), and cortical venous involvement (<em>P</em> = 0.003) between the early seizure group and the non-early seizure group. Logistic regression analysis revealed that intracranial hemorrhage (<em>P</em> = 0.005<em>, OR</em>=6.303, 95 % <em>CI</em> 1.732–22.941) may be one of the risk factors for early seizures. There was no univariate difference between the late seizure subgroup in the early seizure group and the late seizure subgroup in the non-early seizure group, except for the involvement of three venous sinuses.</div></div><div><h3>Conclusions</h3><div>Patients with CVST who have early seizures are more likely to have late seizures than those who do not have early seizures. Intracranial hemorrhage may be one of the risk factors for early seizures. The risk factors for late seizures need to be identified in future clinical studies. There is insufficient evidence that the use of ASM prevents early seizures from progressing to late seizures.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 64-70"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387850","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}
Pub Date : 2025-02-05DOI: 10.1016/j.seizure.2025.02.006
Subeikshanan Venkatesan , Abbas Babajani-Feremi , Kajal Patel , Steven N Roper , Giridhar Kalamangalam
Objective
Amygdalar volumes are right-left asymmetric in normal humans. Asymmetric amygdalar hyperplasia is described in temporal lobe epilepsy (TLE), but has unclear lateralizing significance. In this study of TLE patients undergoing stereo-electroencephalography (SEEG) we examined the lateralizing value of amygdalar volume (AV) asymmetry, and its relationship to amygdalar involvement in seizures.
Methods
Amygdalar volumes of 30 TLE patients without radiological hippocampal sclerosis undergoing SEEG were compared to those from a normative database. Devising a novel amygdalar (volume) asymmetry index (AAI), we correlated AAI to SEEG-ascertained TLE lateralization and amygdalar involvement in seizures.
Results
At the group level, right AVs in right TLE (RTLE) and left AVs in left TLE (LTLE) were significantly higher than in controls (right difference: mean 226 mm3; left difference: mean 206 mm3). AAI was significantly higher than in RTLE and bitemporal epilepsy than in controls (16/17 patients; mean AAI difference 8.4 %) and significantly lower than in LTLE than in controls (8/9 patients; mean AAI difference -8.3 %). Amygdalar involvement in seizures correlated positively with absolute AAI (Spearman's ρ = 0.45, p < 0.05).
Conclusions
Significant deviation from physiological right-left AV asymmetry is almost universal in TLE and has robust lateralizing value. Relatively positive AAI is associated with RTLE or bitemporal epilepsy; relatively negative AAI is associated with LTLE. Larger AAI deviations are associated with a higher proportion of seizures with amygdalar involvement, suggesting a causal influence of seizures on amygdalar expansion in TLE.
{"title":"Amygdalar volume asymmetry informs laterality in temporal lobe epilepsy: MRI-SEEG study","authors":"Subeikshanan Venkatesan , Abbas Babajani-Feremi , Kajal Patel , Steven N Roper , Giridhar Kalamangalam","doi":"10.1016/j.seizure.2025.02.006","DOIUrl":"10.1016/j.seizure.2025.02.006","url":null,"abstract":"<div><h3>Objective</h3><div>Amygdalar volumes are right-left asymmetric in normal humans. Asymmetric amygdalar hyperplasia is described in temporal lobe epilepsy (TLE), but has unclear lateralizing significance. In this study of TLE patients undergoing stereo-electroencephalography (SEEG) we examined the lateralizing value of amygdalar volume (AV) asymmetry, and its relationship to amygdalar involvement in seizures.</div></div><div><h3>Methods</h3><div>Amygdalar volumes of 30 TLE patients without radiological hippocampal sclerosis undergoing SEEG were compared to those from a normative database. Devising a novel amygdalar (volume) asymmetry index (AAI), we correlated AAI to SEEG-ascertained TLE lateralization and amygdalar involvement in seizures.</div></div><div><h3>Results</h3><div>At the group level, right AVs in right TLE (RTLE) and left AVs in left TLE (LTLE) were significantly higher than in controls (right difference: mean 226 mm<sup>3</sup>; left difference: mean 206 mm<sup>3</sup>). AAI was significantly higher than in RTLE and bitemporal epilepsy than in controls (16/17 patients; mean AAI difference 8.4 %) and significantly lower than in LTLE than in controls (8/9 patients; mean AAI difference -8.3 %). Amygdalar involvement in seizures correlated positively with absolute AAI (Spearman's ρ = 0.45, <em>p</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>Significant deviation from physiological right-left AV asymmetry is almost universal in TLE and has robust lateralizing value. Relatively positive AAI is associated with RTLE or bitemporal epilepsy; relatively negative AAI is associated with LTLE. Larger AAI deviations are associated with a higher proportion of seizures with amygdalar involvement, suggesting a causal influence of seizures on amygdalar expansion in TLE.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 58-63"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377552","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}
{"title":"Hemorrhagic complication due to vascular side branch injury from a distant site in stereoelectroencephalography: A case report and proposed rules for safer electrode implantation","authors":"Takahiro Suzuki , Tomotaka Ishizaki , Satoshi Maesawa , Miki Hashida , Yoshiki Ito , Takafumi Tanei , Ryuta Saito","doi":"10.1016/j.seizure.2024.12.019","DOIUrl":"10.1016/j.seizure.2024.12.019","url":null,"abstract":"","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"125 ","pages":"Pages 50-53"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972905","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}
Brivaracetam (BRV) sustained-release (SR) tablets have recently been approved to treat focal seizures in India. SR formulations enhance patient adherence and quality of life (QoL). We assessed safety and effectiveness of BRV-SR for epilepsy management in Indian real-life settings.
Methods
A post-approval observational study involving 1989 patients receiving BRV-SR from 181 centres were analysed. Primary endpoints are efficacy variables derived from seizure-related changes, and secondary endpoints include responder rate (≥50% reduction in focal-onset seizures [FoS]/focal-to-bilateral tonic-clonic seizures [FBTCS] frequency), usage pattern data, clinician's global impression on efficacy index (CGI-EI) and safety variables.
Results
Patients’ mean age was 42.33±12.33 years, and 1441 (72.44%) were men. Psychiatric comorbidities included depression (21.97%), sleep disturbance (15.54%), and anxiety (9.60%). The predominant seizure types were FoS (71.44%) and FBTCS (28.56%). BRV-SR 100 mg once-daily was most prescribed dose (57.37%) at baseline and follow-up visits (51.94%). Median seizure frequency decreased from 2 at baseline to 1 at follow-up visit. At follow-up, 72.1% patients were responders, and 63.75% were seizure-free. BRV-SR showed “marked” to “moderate” improvement in 92.99% of patients according to CGI-EI. Subgroup-analysis revealed a positive correlation between BRV-SR use in patients with drug-resistant epilepsy, psychiatric co-morbidities, and behavioural adverse events (AEs) with past anti-seizure medications. AEs were rare, with none reported in 97.39% patients during study period.
Conclusion
The BEAM study findings provide first real-world evidence on effectiveness and safety of BRV-SR in Indian real-life settings. Furthermore, BRV-SR is a feasible option for focal epilepsy management with good retention rates and improved QoL.
{"title":"First clinical post-approval, observational study to assess clinical safety and effectiveness of brivaracetam sustained-release formulation in real-life settings of India: BEAM study","authors":"Lakshmi Narasimhan Ranganathan , Girish Kulkarni , Ashutosh Kakkad , Krishnaprasad Korukonda , Narendra Chouksey","doi":"10.1016/j.seizure.2025.01.011","DOIUrl":"10.1016/j.seizure.2025.01.011","url":null,"abstract":"<div><h3>Purpose</h3><div>Brivaracetam (BRV) sustained-release (SR) tablets have recently been approved to treat focal seizures in India. SR formulations enhance patient adherence and quality of life (QoL). We assessed safety and effectiveness of BRV-SR for epilepsy management in Indian real-life settings.</div></div><div><h3>Methods</h3><div>A post-approval observational study involving 1989 patients receiving BRV-SR from 181 centres were analysed. Primary endpoints are efficacy variables derived from seizure-related changes, and secondary endpoints include responder rate (≥50% reduction in focal-onset seizures [FoS]/focal-to-bilateral tonic-clonic seizures [FBTCS] frequency), usage pattern data, clinician's global impression on efficacy index (CGI-EI) and safety variables.</div></div><div><h3>Results</h3><div>Patients’ mean age was 42.33±12.33 years, and 1441 (72.44%) were men. Psychiatric comorbidities included depression (21.97%), sleep disturbance (15.54%), and anxiety (9.60%). The predominant seizure types were FoS (71.44%) and FBTCS (28.56%). BRV-SR 100 mg once-daily was most prescribed dose (57.37%) at baseline and follow-up visits (51.94%). Median seizure frequency decreased from 2 at baseline to 1 at follow-up visit. At follow-up, 72.1% patients were responders, and 63.75% were seizure-free. BRV-SR showed “marked” to “moderate” improvement in 92.99% of patients according to CGI-EI. Subgroup-analysis revealed a positive correlation between BRV-SR use in patients with drug-resistant epilepsy, psychiatric co-morbidities, and behavioural adverse events (AEs) with past anti-seizure medications. AEs were rare, with none reported in 97.39% patients during study period.</div></div><div><h3>Conclusion</h3><div>The BEAM study findings provide first real-world evidence on effectiveness and safety of BRV-SR in Indian real-life settings. Furthermore, BRV-SR is a feasible option for focal epilepsy management with good retention rates and improved QoL.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"125 ","pages":"Pages 132-139"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epilepsy is a chronic neurological disorder with a burden of comorbidities. Knowledge regarding sarcopenia prevalence and associated risk factors in patients with epilepsy remains limited, which prompted us to conduct the present study.
Methods
This cross-sectional study enrolled patients with epilepsy from our epilepsy clinic and controls from the staff at National Cheng Kung University Hospital, Tainan, Taiwan. Sarcopenia was defined using the criteria outlined by the 2019 Asian Working Group for Sarcopenia and the 2010 European Working Group on Sarcopenia in Older People. Muscle mass (skeletal muscle mass index) was measured through bioelectrical impedance, muscle strength was assessed using hand grip tests, and physical performance was evaluated using the 6-m walk test. Hormone (testosterone, growth hormone, and insulin-like growth factor-1) and vitamin D levels were measured. Descriptive statistics and logistic regression models were used to estimate the prevalence of sarcopenia and identify sarcopenia risk factors in patients with epilepsy.
Results
This study enrolled 300 adults (mean age: 42.9 ± 14.7 years; women: 53.7 %). The epilepsy and control groups comprised 200 and 100 participants, respectively. The overall prevalence of sarcopenia was 31.3 % and it was significantly higher (p = 0.004) in women (20.7 %) than in men (10.6 %). The prevalence was higher in the epilepsy group than in the control group (36.0 % vs. 22.0 %, p = 0.014). Logistic regression revealed female, age (≥ 65 year) and low body mass index (BMI) were influenced the risk of sarcopenia in all participants. Importantly, epilepsy is significantly associated sarcopenia. The BMI, protein level, calf circumference, and use of enzyme-inducing antiseizure medications (EIASM) influenced the risk of sarcopenia in the epilepsy group.
Conclusion
The prevalence of sarcopenia is significantly higher in patients with epilepsy than in the control participants. Low BMI, protein level, calf circumference, and the use of EIASM may increase the risk of sarcopenia in this population. Our findings underscore the need for mitigating sarcopenia risk in patients with epilepsy.
{"title":"Prevalence of and risk factors for sarcopenia in patients with epilepsy","authors":"Yu-Shiue Chen , Hung-Ling Huang , Huai-Hsien Huang , Tzu-Hsin Huang , Ming-Chi Lai , Chin-Wei Huang","doi":"10.1016/j.seizure.2025.01.003","DOIUrl":"10.1016/j.seizure.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Epilepsy is a chronic neurological disorder with a burden of comorbidities. Knowledge regarding sarcopenia prevalence and associated risk factors in patients with epilepsy remains limited, which prompted us to conduct the present study.</div></div><div><h3>Methods</h3><div>This cross-sectional study enrolled patients with epilepsy from our epilepsy clinic and controls from the staff at National Cheng Kung University Hospital, Tainan, Taiwan. Sarcopenia was defined using the criteria outlined by the 2019 Asian Working Group for Sarcopenia and the 2010 European Working Group on Sarcopenia in Older People. Muscle mass (skeletal muscle mass index) was measured through bioelectrical impedance, muscle strength was assessed using hand grip tests, and physical performance was evaluated using the 6-m walk test. Hormone (testosterone, growth hormone, and insulin-like growth factor-1) and vitamin D levels were measured. Descriptive statistics and logistic regression models were used to estimate the prevalence of sarcopenia and identify sarcopenia risk factors in patients with epilepsy.</div></div><div><h3>Results</h3><div>This study enrolled 300 adults (mean age: 42.9 ± 14.7 years; women: 53.7 %). The epilepsy and control groups comprised 200 and 100 participants, respectively. The overall prevalence of sarcopenia was 31.3 % and it was significantly higher (<em>p</em> = 0.004) in women (20.7 %) than in men (10.6 %). The prevalence was higher in the epilepsy group than in the control group (36.0 % vs. 22.0 %, <em>p</em> = 0.014). Logistic regression revealed female, age (≥ 65 year) and low body mass index (BMI) were influenced the risk of sarcopenia in all participants. Importantly, epilepsy is significantly associated sarcopenia. The BMI, protein level, calf circumference, and use of enzyme-inducing antiseizure medications (EIASM) influenced the risk of sarcopenia in the epilepsy group.</div></div><div><h3>Conclusion</h3><div>The prevalence of sarcopenia is significantly higher in patients with epilepsy than in the control participants. Low BMI, protein level, calf circumference, and the use of EIASM may increase the risk of sarcopenia in this population. Our findings underscore the need for mitigating sarcopenia risk in patients with epilepsy.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"125 ","pages":"Pages 162-171"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025433","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}
Pub Date : 2025-02-01DOI: 10.1016/j.seizure.2025.01.018
Mohammad Mehdi Abbasi , Ali Jafari , Mahshad Mohtadi , Mahshad Shahabi , Farnush Bakhshimoghaddam , Hamid Abbasi , Ghazaleh Eslamian
Background
Diet therapies for epilepsy, including the ketogenic diets (KDs), have been used as a treatment for both pediatric and adult populations. Recent studies have focused on the safety, efficacy, and tolerability of various diet therapies for epilepsy. The objective of this scoping meta- review was to evaluate the evidence regarding different ketogenic diets for epilepsy.
Methods
This study followed the Arksey and O'Malley framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) reporting standards. The research question was formulated using the Population, Concept, Context (PCC) framework. A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science up to August 14, 2024.
Results
Out of the 152 papers identified, 38 systematic reviews and meta-analyses were included. The review examined the safety, tolerability, and efficacy of diet therapies for epilepsy, particularly in drug-resistant cases. The findings underscore the significant benefits of classic ketogenic diet (CKD) in reducing seizure frequency. The Modified Atkins Diet (MAD) and Medium-Chain Triglyceride (MCT) KD were found to be effective with improved tolerability. The Low Glycemic Index Diet (LGID) may be less effective. Further research is needed to refine these dietary approaches.
Conclusion
The KDs are effective in reducing seizure frequency in epilepsy, especially in drug-resistant cases. The results highlight the valuable advantages of the CKD in decreasing the frequency of seizures. The MCT KD and the MAD are also effective options and are generally better tolerated. The LGID shows potential but may be less effective. Further research is needed to enhance these dietary treatments and investigate their long-term impact.
{"title":"Illuminating the Safety, Tolerability, and Efficacy of Different Ketogenic Diets for Individuals with Epilepsy: A Scoping Meta-Review","authors":"Mohammad Mehdi Abbasi , Ali Jafari , Mahshad Mohtadi , Mahshad Shahabi , Farnush Bakhshimoghaddam , Hamid Abbasi , Ghazaleh Eslamian","doi":"10.1016/j.seizure.2025.01.018","DOIUrl":"10.1016/j.seizure.2025.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Diet therapies for epilepsy, including the ketogenic diets (KDs), have been used as a treatment for both pediatric and adult populations. Recent studies have focused on the safety, efficacy, and tolerability of various diet therapies for epilepsy. The objective of this scoping meta- review was to evaluate the evidence regarding different ketogenic diets for epilepsy.</div></div><div><h3>Methods</h3><div>This study followed the Arksey and O'Malley framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) reporting standards. The research question was formulated using the Population, Concept, Context (PCC) framework. A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science up to August 14, 2024.</div></div><div><h3>Results</h3><div>Out of the 152 papers identified, 38 systematic reviews and meta-analyses were included. The review examined the safety, tolerability, and efficacy of diet therapies for epilepsy, particularly in drug-resistant cases. The findings underscore the significant benefits of classic ketogenic diet (CKD) in reducing seizure frequency. The Modified Atkins Diet (MAD) and Medium-Chain Triglyceride (MCT) KD were found to be effective with improved tolerability. The Low Glycemic Index Diet (LGID) may be less effective. Further research is needed to refine these dietary approaches.</div></div><div><h3>Conclusion</h3><div>The KDs are effective in reducing seizure frequency in epilepsy, especially in drug-resistant cases. The results highlight the valuable advantages of the CKD in decreasing the frequency of seizures. The MCT KD and the MAD are also effective options and are generally better tolerated. The LGID shows potential but may be less effective. Further research is needed to enhance these dietary treatments and investigate their long-term impact.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"125 ","pages":"Pages 140-151"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025428","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}
Pub Date : 2025-02-01DOI: 10.1016/j.seizure.2024.12.017
Siqi Luo , Yaqin Xia , Chaogang Lu , Yi Wang , Zhongwei Qiao
Purpose
To complement the current research on altered white matter integrity in children with non-lesional temporal lobe epilepsy (NL-TLE), especially the correlation between diffusion metrics and clinical characteristics, so as to provide imaging evidence for clinical practice.
Methods
Children with temporal lobe epilepsy and no lesions on magnetic resonance imaging (MRI) were retrospectively collected from 2016.01.01 to 2022.12.31, and typically developing children (TDC) with normal MRI were collected as control group. Tract-based spatial statistics (TBSS) was used to compare the fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) between the two groups. Twenty fiber bundles were used as regions of interest (ROIs) to extract and compare the diffusion metrics. Partial correlation analysis was performed to assess the association between diffusion parameters within ROIs and clinical characteristics.
Results
TBSS and ROI analysis showed that FA values decreased and MD and RD values increased in the NL-TLE compared with the TDC, without significant differences in AD values. FA values in all ROIs increased with age, while the MD and RD values decreased in all ROIs, and the AD values decreased in most ROIs. Epilepsy duration was negatively correlated with FA values and positively correlated with MD and RD values in specific fibers. Frequency of seizures was negatively correlated with the FA values in a few trats. Full-scale intelligence quotient (FSIQ) was positively correlated with FA values and negatively with RD value in a few tracts.
Conclusion
Children with NL-TLE showed widespread alterations in white matter integrity, which were correlated with clinical characteristics.
{"title":"Alterations in white matter integrity and correlations with clinical characteristics in children with non-lesional temporal lobe epilepsy","authors":"Siqi Luo , Yaqin Xia , Chaogang Lu , Yi Wang , Zhongwei Qiao","doi":"10.1016/j.seizure.2024.12.017","DOIUrl":"10.1016/j.seizure.2024.12.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To complement the current research on altered white matter integrity in children with non-lesional temporal lobe epilepsy (NL-TLE), especially the correlation between diffusion metrics and clinical characteristics, so as to provide imaging evidence for clinical practice.</div></div><div><h3>Methods</h3><div>Children with temporal lobe epilepsy and no lesions on magnetic resonance imaging (MRI) were retrospectively collected from 2016.01.01 to 2022.12.31, and typically developing children (TDC) with normal MRI were collected as control group. Tract-based spatial statistics (TBSS) was used to compare the fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) between the two groups. Twenty fiber bundles were used as regions of interest (ROIs) to extract and compare the diffusion metrics. Partial correlation analysis was performed to assess the association between diffusion parameters within ROIs and clinical characteristics.</div></div><div><h3>Results</h3><div>TBSS and ROI analysis showed that FA values decreased and MD and RD values increased in the NL-TLE compared with the TDC, without significant differences in AD values. FA values in all ROIs increased with age, while the MD and RD values decreased in all ROIs, and the AD values decreased in most ROIs. Epilepsy duration was negatively correlated with FA values and positively correlated with MD and RD values in specific fibers. Frequency of seizures was negatively correlated with the FA values in a few trats. Full-scale intelligence quotient (FSIQ) was positively correlated with FA values and negatively with RD value in a few tracts.</div></div><div><h3>Conclusion</h3><div>Children with NL-TLE showed widespread alterations in white matter integrity, which were correlated with clinical characteristics.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"125 ","pages":"Pages 2-9"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899826","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}
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