Pub Date : 2026-03-01Epub Date: 2026-02-14DOI: 10.1016/j.seizure.2026.02.008
Ariadne Zampeli , Miroslav Malac , Isabella M. Björkman-Burtscher , Boel Hansson , Linda Wennberg , Karin Markenroth Bloch , Kristina Källén , Maria Compagno Strandberg
{"title":"Corrigendum to “Does 7 T MRI offer an added value in drug resistant temporal lobe epilepsy?” [Seizure: European Journal of Epilepsy 134 (2026) 27–36]","authors":"Ariadne Zampeli , Miroslav Malac , Isabella M. Björkman-Burtscher , Boel Hansson , Linda Wennberg , Karin Markenroth Bloch , Kristina Källén , Maria Compagno Strandberg","doi":"10.1016/j.seizure.2026.02.008","DOIUrl":"10.1016/j.seizure.2026.02.008","url":null,"abstract":"","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"136 ","pages":"Page 76"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203471","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 : 2026-03-01Epub Date: 2026-02-02DOI: 10.1016/j.seizure.2026.02.001
Frank J.E. Vajda , Terence J. O’Brien , Janet E. Graham , Alison E. Hitchcock , Piero Perucca , Cecilie M. Lander , Mervyn J. Eadie
Aim
To try to ascertain in APR data why lamotrigine was the preferred ASM in treating women with epilepsy,
Method
Statistical analysis of foetal malformation and seizure free pregnancy occurrence rates associated with lamotrigine use in monotherapy and polytherapy
Results
Among commonly used ASMs, lamotrigine (4.6%) and levetiracetam (4.5%) in monotherapy had the lowest associated foetal malformation rates, compared with a 3.2% rate in ASM-untreated pregnancy in women with epilepsy. The lamotrigine monotherapy seizure freedom rate during pregnancy (56.6%) was lower than that associated with all other ASM monotherapy combined (68.7%; R.R. 1.21, 95% C.I. 1.12, 1.32).
Conclusion
Those prescribing ASM therapy for women capable of pregnancy seem to have given priority to avoiding foetal malformation over achieving seizure freedom in pregnancy.
{"title":"Lamotrigine as an antiseizure medication in pregnancy","authors":"Frank J.E. Vajda , Terence J. O’Brien , Janet E. Graham , Alison E. Hitchcock , Piero Perucca , Cecilie M. Lander , Mervyn J. Eadie","doi":"10.1016/j.seizure.2026.02.001","DOIUrl":"10.1016/j.seizure.2026.02.001","url":null,"abstract":"<div><h3>Aim</h3><div>To try to ascertain in APR data why lamotrigine was the preferred ASM in treating women with epilepsy,</div></div><div><h3>Method</h3><div>Statistical analysis of foetal malformation and seizure free pregnancy occurrence rates associated with lamotrigine use in monotherapy and polytherapy</div></div><div><h3>Results</h3><div>Among commonly used ASMs, lamotrigine (4.6%) and levetiracetam (4.5%) in monotherapy had the lowest associated foetal malformation rates, compared with a 3.2% rate in ASM-untreated pregnancy in women with epilepsy. The lamotrigine monotherapy seizure freedom rate during pregnancy (56.6%) was lower than that associated with all other ASM monotherapy combined (68.7%; R.R. 1.21, 95% C.I. 1.12, 1.32).</div></div><div><h3>Conclusion</h3><div>Those prescribing ASM therapy for women capable of pregnancy seem to have given priority to avoiding foetal malformation over achieving seizure freedom in pregnancy.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"136 ","pages":"Pages 18-22"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138047","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 : 2026-03-01Epub Date: 2026-02-13DOI: 10.1016/j.seizure.2026.02.013
Magdalena Bosak , Hanna Podraza , Dorota Włoch-Kopeć , Andrzej Rysz , Kamil Wężyk , Katarzyna Grabska-Radzikowska , Piotr Sobolewski , Tomasz Siwek , Iwona Kurkowska-Jastrzębska , Monika Służewska-Niedźwiedź , Katarzyna Sulima , Lech Kipiński , Lidia Kiryła , Katarzyna Stopińska , Elżbieta Płonka-Półtorak , Justyna Tabaka-Pradela , Magdalena Konopko , Agnieszka Meller , Monika Chorąży , Maja Kopytek-Beuzen , Katarzyna Zawiślak-Fornagiel
Introduction
In a secondary analysis of a cohort of 475 adults with drug-resistant epilepsy treated with adjunctive cenobamate, we assessed whether treatment outcomes were influenced by concomitant antiseizure medication class and cenobamate dose.
Materials and methods
Concomitant antiseizure medications (ASMs) were grouped as sodium channel blockers (SCBs), SV2A ligands, valproate, carbonic anhydrase inhibitors, or GABA analogs. Efficacy and safety outcomes were analyzed using multivariate logistic regression, adjusting for confounders.
Results
Baseline use of valproate was associated with higher odds of achieving ≥50 % seizure reduction and seizure freedom, whereas SCB co-therapy was associated with lower odds of seizure freedom. At the final follow-up, these efficacy differences largely disappeared, except that SCB use modestly favored ≥50 % response. SCB co-medication was associated with a decreased risk of somnolence, while the presence of an SV2A ligands, valproate, or carbonic anhydrase inhibitors was correlated with lower treatment discontinuation rates. Cenobamate dose showed no significant association with achieving ≥50 % response, seizure freedom, or overall AE occurrence, reflecting the pragmatic character of the studied cohort.
Conclusion
Cenobamate demonstrated optimal efficacy when combined with valproate and broad-spectrum agents, and suboptimal efficacy when coadministered with SCB. Substantial seizure improvements were often achieved at moderate doses of cenobamate, underscoring the value of individualized titration and comedication management.
{"title":"Efficacy and safety of cenobamate-based combination therapy in drug-resistant epilepsy: Secondary analysis by mechanisms of action of concomitant antiseizure medications","authors":"Magdalena Bosak , Hanna Podraza , Dorota Włoch-Kopeć , Andrzej Rysz , Kamil Wężyk , Katarzyna Grabska-Radzikowska , Piotr Sobolewski , Tomasz Siwek , Iwona Kurkowska-Jastrzębska , Monika Służewska-Niedźwiedź , Katarzyna Sulima , Lech Kipiński , Lidia Kiryła , Katarzyna Stopińska , Elżbieta Płonka-Półtorak , Justyna Tabaka-Pradela , Magdalena Konopko , Agnieszka Meller , Monika Chorąży , Maja Kopytek-Beuzen , Katarzyna Zawiślak-Fornagiel","doi":"10.1016/j.seizure.2026.02.013","DOIUrl":"10.1016/j.seizure.2026.02.013","url":null,"abstract":"<div><h3>Introduction</h3><div>In a secondary analysis of a cohort of 475 adults with drug-resistant epilepsy treated with adjunctive cenobamate, we assessed whether treatment outcomes were influenced by concomitant antiseizure medication class and cenobamate dose.</div></div><div><h3>Materials and methods</h3><div>Concomitant antiseizure medications (ASMs) were grouped as sodium channel blockers (SCBs), SV2A ligands, valproate, carbonic anhydrase inhibitors, or GABA analogs. Efficacy and safety outcomes were analyzed using multivariate logistic regression, adjusting for confounders.</div></div><div><h3>Results</h3><div>Baseline use of valproate was associated with higher odds of achieving ≥50 % seizure reduction and seizure freedom, whereas SCB co-therapy was associated with lower odds of seizure freedom. At the final follow-up, these efficacy differences largely disappeared, except that SCB use modestly favored ≥50 % response. SCB co-medication was associated with a decreased risk of somnolence, while the presence of an SV2A ligands, valproate, or carbonic anhydrase inhibitors was correlated with lower treatment discontinuation rates. Cenobamate dose showed no significant association with achieving ≥50 % response, seizure freedom, or overall AE occurrence, reflecting the pragmatic character of the studied cohort.</div></div><div><h3>Conclusion</h3><div>Cenobamate demonstrated optimal efficacy when combined with valproate and broad-spectrum agents, and suboptimal efficacy when coadministered with SCB. Substantial seizure improvements were often achieved at moderate doses of cenobamate, underscoring the value of individualized titration and comedication management.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"136 ","pages":"Pages 102-106"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776848","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 : 2026-03-01Epub Date: 2026-01-17DOI: 10.1016/j.seizure.2026.01.009
Jialu Xu , Chenyu Yan , Xiaoyan Shen , Tiejia Jiang , Wencong Ruan , Haifeng Li , Ning Ma
Purpose
To develop effective visual AI recognition models for epileptic spasm (ES), and to promote the professionalism and convenience of ES detection.
Method
We collected about 330 hours of infant motion videos with epileptic spasm in Children's Hospital, Zhejiang University School of Medicine from November 2022 to October 2024. A video-centered AI model was constructed, with a pre-trained Vision Transformer (ViT) via Contrastive Language-Image Pre-training (CLIP), serving as the core to extract spatial features. Additionally, a temporal convolution module was integrated to extract temporal information and a multi-layer perceptron was used to perform a normal-abnormal binary classification task. Focal loss was applied to mitigate class imbalance, prioritizing the learning of hard-to-classify samples. The model was trained for 100 epochs with 5-times random dataset splitting, in which the dataset was partitioned by individual infants to ensure disjoint training and test sets. Model performance was validated using metrics (including Precision, Recall, F-score, Accuracy, AUROC) based on test set results.
Results
The median age of ES onset was 0.4 (0.3, 0.7) years. All patients exhibited isolated or clustered epileptic spasms. By employing a CLIP-based classifier, the system reached a recall rate of 1.00 ± 0.00, a precision of 0.78 ± 0.01, an F-score of 0.87 ± 0.01, an accuracy of 0.98 ± 0.01, and an AUROC of 0.99 ± 0.01 in detecting epileptic spasm — outperforming previously reported methods. Case studies involving four infants’ motion videos showed a high degree of consistency between the model’s predictions and expert annotations. The model effectively distinguished ES episodes from normal patterns, even in videos with multiple intermittent ES segments.
Conclusion
We developed an automatic motion recognition model that holds significant potential in early automated detection of ES.
{"title":"Automatic recognition of epileptic spasm via large-scale visual AI model","authors":"Jialu Xu , Chenyu Yan , Xiaoyan Shen , Tiejia Jiang , Wencong Ruan , Haifeng Li , Ning Ma","doi":"10.1016/j.seizure.2026.01.009","DOIUrl":"10.1016/j.seizure.2026.01.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop effective visual AI recognition models for epileptic spasm (ES), and to promote the professionalism and convenience of ES detection.</div></div><div><h3>Method</h3><div>We collected about 330 hours of infant motion videos with epileptic spasm in Children's Hospital, Zhejiang University School of Medicine from November 2022 to October 2024. A video-centered AI model was constructed, with a pre-trained Vision Transformer (ViT) via Contrastive Language-Image Pre-training (CLIP), serving as the core to extract spatial features. Additionally, a temporal convolution module was integrated to extract temporal information and a multi-layer perceptron was used to perform a normal-abnormal binary classification task. Focal loss was applied to mitigate class imbalance, prioritizing the learning of hard-to-classify samples. The model was trained for 100 epochs with 5-times random dataset splitting, in which the dataset was partitioned by individual infants to ensure disjoint training and test sets. Model performance was validated using metrics (including Precision, Recall, F-score, Accuracy, AUROC) based on test set results.</div></div><div><h3>Results</h3><div>The median age of ES onset was 0.4 (0.3, 0.7) years. All patients exhibited isolated or clustered epileptic spasms. By employing a CLIP-based classifier, the system reached a recall rate of 1.00 ± 0.00, a precision of 0.78 ± 0.01, an F-score of 0.87 ± 0.01, an accuracy of 0.98 ± 0.01, and an AUROC of 0.99 ± 0.01 in detecting epileptic spasm — outperforming previously reported methods. Case studies involving four infants’ motion videos showed a high degree of consistency between the model’s predictions and expert annotations. The model effectively distinguished ES episodes from normal patterns, even in videos with multiple intermittent ES segments.</div></div><div><h3>Conclusion</h3><div>We developed an automatic motion recognition model that holds significant potential in early automated detection of ES.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"136 ","pages":"Pages 23-30"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144495","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 : 2026-02-18DOI: 10.1016/j.seizure.2026.02.016
Gavin P McStay
Primary mitochondrial diseases are caused by mutations in genes required for expression, function or assembly of the mitochondrial oxidative phosphorylation system. The pathology of primary mitochondrial diseases is varied and a subset of these are associated with epilepsy and seizures. Mutations are found in each of the 5 complexes of the oxidative phosphorylation system in both structural subunits and assembly factors along with mitochondrially encoded components of the protein synthesis machinery. This review will highlight the mutations identified in clinical case studies that are associated with epilepsy and seizures and include the studies using cell systems and other model organisms where molecular characterisation of oxidative phosphorylation is more extensive. The molecular causes of epilepsy have not been well characterised in the relevant cells. This review identifies gaps in knowledge and suggestions for future studies to advance the understanding of the molecular pathogenesis of epilepsy that is associated with primary mitochondrial disease.
{"title":"Mitochondrial complex assembly in epilepsy of primary mitochondrial disease origin.","authors":"Gavin P McStay","doi":"10.1016/j.seizure.2026.02.016","DOIUrl":"https://doi.org/10.1016/j.seizure.2026.02.016","url":null,"abstract":"<p><p>Primary mitochondrial diseases are caused by mutations in genes required for expression, function or assembly of the mitochondrial oxidative phosphorylation system. The pathology of primary mitochondrial diseases is varied and a subset of these are associated with epilepsy and seizures. Mutations are found in each of the 5 complexes of the oxidative phosphorylation system in both structural subunits and assembly factors along with mitochondrially encoded components of the protein synthesis machinery. This review will highlight the mutations identified in clinical case studies that are associated with epilepsy and seizures and include the studies using cell systems and other model organisms where molecular characterisation of oxidative phosphorylation is more extensive. The molecular causes of epilepsy have not been well characterised in the relevant cells. This review identifies gaps in knowledge and suggestions for future studies to advance the understanding of the molecular pathogenesis of epilepsy that is associated with primary mitochondrial disease.</p>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349606","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 : 2026-02-01Epub Date: 2026-01-07DOI: 10.1016/j.seizure.2026.01.001
Jeongsik Kim , Seung Hwan Moon , Hea Ree Park , Eun Yeon Joo , Dae-Won Seo , Young-Min Shon
Purpose
This study aimed to compare the localizing accuracy, interobserver reliability, and prognostic value of ictal SPECT analyzed by Statistical Parametric Mapping (ISAS) versus Subtraction Ictal SPECT Co-registered to MRI (SISCOM) in patients with drug-resistant temporal lobe epilepsy (TLE).
Methods
Sixty consecutive TLE patients who underwent resective epilepsy surgery were analyzed. All ictal SPECT studies were processed by ISAS and SISCOM. Two blinded reviewers independently identified the most prominent hyperperfusion regions across 40 predefined brain subregions. Localization concordance with the actual resection site was scored at both lobar and sublobar levels. Interobserver agreement and the correlation between imaging localization and postsurgical seizure outcomes were analyzed.
Results
ISAS achieved significantly higher interobserver agreement than SISCOM for the localization (κ = 0.34–0.88 vs. 0.14–0.69). ISAS concordance with surgical resection was 88.7% at the lobar level and 79.7% at the sublobar level, compared to 71.7% and 60.9% for SISCOM, respectively. Logistic regression revealed that only ISAS localization at both scales significantly predicted seizure-free outcome, whereas SISCOM did not.
Conclusions
ISAS outperforms SISCOM in both localizing accuracy and observer reliability, and its concordance with surgical resection robustly predicts postoperative seizure freedom. These findings support the adoption of ISAS as the first-line SPECT postprocessing technique for presurgical evaluation of TLE.
目的：本研究旨在比较统计参数映射（ISAS）与减相颅面SPECT （SISCOM）在耐药颞叶癫痫（TLE）患者中的定位准确性、观察者间可靠性和预后价值。方法对60例连续接受癫痫切除手术的TLE患者进行分析。所有关键性SPECT研究均由ISAS和SISCOM处理。两名盲法审稿人独立确定了40个预先定义的脑亚区中最突出的高灌注区。在大叶和叶下水平对与实际切除部位的定位一致性进行评分。分析了观察者之间的一致性以及成像定位与术后癫痫发作结果的相关性。结果isas的定位一致性显著高于SISCOM （κ = 0.34-0.88 vs. 0.14-0.69）。ISAS与手术切除在大叶水平和叶下水平的一致性分别为88.7%和79.7%，而SISCOM的一致性分别为71.7%和60.9%。逻辑回归显示，只有ISAS定位在两个尺度上显著预测无癫痫发作的结果，而SISCOM没有。结论sisas在定位准确性和观察者可靠性方面优于SISCOM，其与手术切除的一致性有力地预测了术后癫痫发作的自由度。这些发现支持采用ISAS作为手术前评估TLE的一线SPECT后处理技术。
{"title":"Superior localizing and prognostic value of statistical parametric SPECT analysis in temporal lobe epilepsy: A comparative study of ISAS and SISCOM","authors":"Jeongsik Kim , Seung Hwan Moon , Hea Ree Park , Eun Yeon Joo , Dae-Won Seo , Young-Min Shon","doi":"10.1016/j.seizure.2026.01.001","DOIUrl":"10.1016/j.seizure.2026.01.001","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to compare the localizing accuracy, interobserver reliability, and prognostic value of ictal SPECT analyzed by Statistical Parametric Mapping (ISAS) versus Subtraction Ictal SPECT Co-registered to MRI (SISCOM) in patients with drug-resistant temporal lobe epilepsy (TLE).</div></div><div><h3>Methods</h3><div>Sixty consecutive TLE patients who underwent resective epilepsy surgery were analyzed. All ictal SPECT studies were processed by ISAS and SISCOM. Two blinded reviewers independently identified the most prominent hyperperfusion regions across 40 predefined brain subregions. Localization concordance with the actual resection site was scored at both lobar and sublobar levels. Interobserver agreement and the correlation between imaging localization and postsurgical seizure outcomes were analyzed.</div></div><div><h3>Results</h3><div>ISAS achieved significantly higher interobserver agreement than SISCOM for the localization (κ = 0.34–0.88 vs. 0.14–0.69). ISAS concordance with surgical resection was 88.7% at the lobar level and 79.7% at the sublobar level, compared to 71.7% and 60.9% for SISCOM, respectively. Logistic regression revealed that only ISAS localization at both scales significantly predicted seizure-free outcome, whereas SISCOM did not.</div></div><div><h3>Conclusions</h3><div>ISAS outperforms SISCOM in both localizing accuracy and observer reliability, and its concordance with surgical resection robustly predicts postoperative seizure freedom. These findings support the adoption of ISAS as the first-line SPECT postprocessing technique for presurgical evaluation of TLE.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 39-45"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023819","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 : 2026-02-01Epub Date: 2024-04-21DOI: 10.1016/j.seizure.2024.04.018
G Van Cutsem , JN Siewe Fodjo , A Hadermann , L-J Amaral , C Trevisan , S Pion , R Colebunders
This narrative review intends to inform neurologists and public health professionals about Onchocerciasis-Associated Epilepsy (OAE), a neglected public health problem in many remote onchocerciasis-endemic areas. For epidemiological purposes, we define OAE as sudden-onset of convulsive and non-convulsive seizure types, including head nodding seizures (nodding syndrome) in a previously healthy child aged 3 to 18 years in the absence of any other obvious cause for epilepsy, all happening within an area with high ongoing Onchocerca volvulus transmission. Several OAE pathophysiological mechanisms have been proposed, but none has been proven yet. Recent population-based studies showed that strengthening onchocerciasis elimination programs was followed by a significant reduction in the incidence of OAE and nodding syndrome. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted, free access to anti-seizure medication to persons with epilepsy in these remote, impoverished areas. It is crucial todevelop policies and increase funding for the prevention and treatment of OAE to reduce the associated burden of disease, notably via the establishment of morbidity management and disability prevention programs (MMDP). Moreover, effective collaboration between onchocerciasis elimination and mental health programs is imperative to alleviate the burden of OAE. This synergy promises reciprocal advantages and underscores the need for a comprehensive approach to address this multifaceted challenge.
{"title":"Onchocerciasis-associated epilepsy: Charting a path forward","authors":"G Van Cutsem , JN Siewe Fodjo , A Hadermann , L-J Amaral , C Trevisan , S Pion , R Colebunders","doi":"10.1016/j.seizure.2024.04.018","DOIUrl":"10.1016/j.seizure.2024.04.018","url":null,"abstract":"<div><div>This narrative review intends to inform neurologists and public health professionals about Onchocerciasis-Associated Epilepsy (OAE), a neglected public health problem in many remote onchocerciasis-endemic areas. For epidemiological purposes, we define OAE as sudden-onset of convulsive and non-convulsive seizure types, including head nodding seizures (nodding syndrome) in a previously healthy child aged 3 to 18 years in the absence of any other obvious cause for epilepsy, all happening within an area with high ongoing <em>Onchocerca volvulus</em> transmission. Several OAE pathophysiological mechanisms have been proposed, but none has been proven yet. Recent population-based studies showed that strengthening onchocerciasis elimination programs was followed by a significant reduction in the incidence of OAE and nodding syndrome. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted, free access to anti-seizure medication to persons with epilepsy in these remote, impoverished areas. It is crucial todevelop policies and increase funding for the prevention and treatment of OAE to reduce the associated burden of disease, notably via the establishment of morbidity management and disability prevention programs (MMDP). Moreover, effective collaboration between onchocerciasis elimination and mental health programs is imperative to alleviate the burden of OAE. This synergy promises reciprocal advantages and underscores the need for a comprehensive approach to address this multifaceted challenge.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 105-114"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766218","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 : 2026-02-01Epub Date: 2024-09-19DOI: 10.1016/j.seizure.2024.09.012
Mary Nyakato , Shubaya Kasule Naggayi , Pamela Rosemary Akun , Sam Ononge , Alfred Odong , Erias Adams Baguma , Hellen Nansiiro , Dennis Kalibbala , Simple Ouma , Innocent Besigye , Richard Idro
Introduction
Nodding syndrome (NS), a poorly understood severe neurological disorder develops in children. In Uganda, some NS cases have grown into child-bearing adults. Babies born to mothers with NS may be prone to impaired neurodevelopmental outcomes. Cognitive deficits in mothers with NS may further inhibit care offered to their children hence compromising neurocognitive development, physical growth, and behaviour.
Objectives
The study aimed to determine the neurodevelopmental, behavioural, nutritional, and physical growth outcomes of children whose mothers have nodding syndrome.
Methods
A comparative cross-sectional study was conducted between May 2021 and April 2022 in Northern Uganda. Children aged 0-5 years of mothers with NS were compared to those of mothers without NS, matched by age, gender and neighbouring residence. Neurodevelopment, behaviour, nutrition, and physical growth were assessed using standardized measures and t-tests employed for group comparisons of outcomes.
Results
Overall,106 children participated. Fifty-three (53) were offspring of mothers with NS and 53 of mothers without NS; having a mean age of 26.9 (2.22) and 27.5(2.12) months respectively. Children whose mothers have NS had significantly lower neurodevelopmental scores than those of NS-unaffected mothers in fine motor (37.5(12.1) vs 44.2(14.3), p = 0.011), receptive language (37.8(10.8) vs 43.9(12.9), p = 0.010), overall cognitive development (74.36(17.8) vs 83.34(19.6), p = 0.015), and attention (0.64(0.20) vs 0.76(0.15), p = 0.001). There were no differences in the behaviour scores. Children of mothers with NS also had significantly lower weight-for-age z scores (WAZ) (p = 0.003) and length/height-for-age z scores (LAZ/HAZ) (p = 0.001); with 19(35.9 %) of them stunted.
Conclusion
Children whose mothers have NS have poorer neurodevelopmental, nutritional, and physical growth outcomes. Interventions to improve outcomes in these children are warranted.
简介点头综合征（NS）是一种在儿童中发病的严重神经系统疾病，人们对其了解甚少。在乌干达，一些 NS 病例已成长为有生育能力的成年人。患有 NS 的母亲所生的婴儿可能容易出现神经发育障碍。患有 NS 的母亲在认知方面的缺陷可能会进一步影响对其子女的照顾，从而影响神经认知发育、身体发育和行为：本研究旨在确定母亲患有点头综合征的儿童在神经发育、行为、营养和身体发育方面的结果：2021 年 5 月至 2022 年 4 月在乌干达北部进行了一项横断面比较研究。母亲患有点头综合征的 0-5 岁儿童与母亲未患有点头综合征的 0-5 岁儿童进行了比较，两者的年龄、性别和居住地相匹配。采用标准化方法对神经发育、行为、营养和身体发育情况进行评估，并采用 t 检验对结果进行分组比较：共有 106 名儿童参加了研究。53名儿童的母亲患有NS，53名儿童的母亲未患有NS；他们的平均年龄分别为26.9（2.22）个月和27.5（2.12）个月。母亲患有 NS 的儿童在精细运动（37.5(12.1) vs 44.2(14.3)，P = 0.011）、接受性语言（37.8（10.8） vs 43.9（12.9），p = 0.010）、整体认知发展（74.36（17.8） vs 83.34（19.6），p = 0.015）和注意力（0.64（0.20） vs 0.76（0.15），p = 0.001）。行为评分方面没有差异。母亲患有 NS 的儿童的年龄体重 z 分数（WAZ）（p = 0.003）和年龄身长/身高 z 分数（LAZ/HAZ）（p = 0.001）也明显较低；其中有 19 人（35.9%）发育不良：结论：母亲患有 NS 的儿童在神经发育、营养和体格生长方面都较差。结论：母亲患有 NS 的儿童在神经发育、营养和身体发育方面都较差，因此有必要采取干预措施来改善这些儿童的发育状况。
{"title":"Poor neurodevelopment, nutritional and physical growth outcomes among children born to mothers with nodding syndrome","authors":"Mary Nyakato , Shubaya Kasule Naggayi , Pamela Rosemary Akun , Sam Ononge , Alfred Odong , Erias Adams Baguma , Hellen Nansiiro , Dennis Kalibbala , Simple Ouma , Innocent Besigye , Richard Idro","doi":"10.1016/j.seizure.2024.09.012","DOIUrl":"10.1016/j.seizure.2024.09.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Nodding syndrome (NS), a poorly understood severe neurological disorder develops in children. In Uganda, some NS cases have grown into child-bearing adults. Babies born to mothers with NS may be prone to impaired neurodevelopmental outcomes. Cognitive deficits in mothers with NS may further inhibit care offered to their children hence compromising neurocognitive development, physical growth, and behaviour.</div></div><div><h3>Objectives</h3><div>The study aimed to determine the neurodevelopmental, behavioural, nutritional, and physical growth outcomes of children whose mothers have nodding syndrome.</div></div><div><h3>Methods</h3><div>A comparative cross-sectional study was conducted between May 2021 and April 2022 in Northern Uganda. Children aged 0-5 years of mothers with NS were compared to those of mothers without NS, matched by age, gender and neighbouring residence. Neurodevelopment, behaviour, nutrition, and physical growth were assessed using standardized measures and t-tests employed for group comparisons of outcomes.</div></div><div><h3>Results</h3><div>Overall,106 children participated. Fifty-three (53) were offspring of mothers with NS and 53 of mothers without NS; having a mean age of 26.9 (2.22) and 27.5(2.12) months respectively. Children whose mothers have NS had significantly lower neurodevelopmental scores than those of NS-unaffected mothers in fine motor (37.5(12.1) vs 44.2(14.3), p = 0.011), receptive language (37.8(10.8) vs 43.9(12.9), p = 0.010), overall cognitive development (74.36(17.8) vs 83.34(19.6), p = 0.015), and attention (0.64(0.20) vs 0.76(0.15), p = 0.001). There were no differences in the behaviour scores. Children of mothers with NS also had significantly lower weight-for-age z scores (WAZ) (p = 0.003) and length/height-for-age z scores (LAZ/HAZ) (p = 0.001); with 19(35.9 %) of them stunted.</div></div><div><h3>Conclusion</h3><div>Children whose mothers have NS have poorer neurodevelopmental, nutritional, and physical growth outcomes. Interventions to improve outcomes in these children are warranted.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 129-133"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331056","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 : 2026-02-01Epub Date: 2024-06-26DOI: 10.1016/j.seizure.2024.06.019
Christoph Kaiser , Walter Kipp , Nolbert Gumisiriza , George Asaba
Purpose
To assess long-term mortality and causes of death in children with nodding syndrome, an epileptic disorder of sub-Sahara Africa.
Methods
Ten children with nodding syndrome were followed over 24 years. The mortality rate was determined as the number of deaths per 1000 person-years of observation. The standard mortality ratio (SMR) was calculated as the number of observed deaths divided by the number of expected deaths in the general population. Patients were started on phenobarbital and treatment response was monitored during the first 20 months of follow-up.
Results
During an observation period of 89.8 person-years, eight patients had died, one patient was found alive, and one patient had been lost to follow-up. This corresponded to a mortality rate of 89.1 deaths per 1000 person-years and a SMR of 21.4 (95 % CI 6.6–36.2). Five deaths were related to status epilepticus, in two cases occurring after inadvertent drug withdrawal. All patients responded on phenobarbital with a reduction of seizure frequency but only four reached a seizure-free period of at least 6 months.
Conclusions
This long-term follow-up demonstrated high mortality in patients with nodding syndrome. Anti-seizure treatment with phenobarbital was of moderate efficacy. Abrupt interruption of phenobarbital was found leading to seizure aggravation, status epilepticus, and death. Our findings point out the importance of securing continuity of treatment access once anti-seizure therapy is included in health services in resource-poor settings. More rigorous observations and controlled studies are needed to improve the therapeutic options for nodding syndrome.
{"title":"Long-term observation and mortality of children with nodding syndrome in western Uganda, 1994 – 2018","authors":"Christoph Kaiser , Walter Kipp , Nolbert Gumisiriza , George Asaba","doi":"10.1016/j.seizure.2024.06.019","DOIUrl":"10.1016/j.seizure.2024.06.019","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess long-term mortality and causes of death in children with nodding syndrome, an epileptic disorder of sub-Sahara Africa.</div></div><div><h3>Methods</h3><div>Ten children with nodding syndrome were followed over 24 years. The mortality rate was determined as the number of deaths per 1000 person-years of observation. The standard mortality ratio (SMR) was calculated as the number of observed deaths divided by the number of expected deaths in the general population. Patients were started on phenobarbital and treatment response was monitored during the first 20 months of follow-up.</div></div><div><h3>Results</h3><div>During an observation period of 89.8 person-years, eight patients had died, one patient was found alive, and one patient had been lost to follow-up. This corresponded to a mortality rate of 89.1 deaths per 1000 person-years and a SMR of 21.4 (95 % CI 6.6–36.2). Five deaths were related to status epilepticus, in two cases occurring after inadvertent drug withdrawal. All patients responded on phenobarbital with a reduction of seizure frequency but only four reached a seizure-free period of at least 6 months.</div></div><div><h3>Conclusions</h3><div>This long-term follow-up demonstrated high mortality in patients with nodding syndrome. Anti-seizure treatment with phenobarbital was of moderate efficacy. Abrupt interruption of phenobarbital was found leading to seizure aggravation, status epilepticus, and death. Our findings point out the importance of securing continuity of treatment access once anti-seizure therapy is included in health services in resource-poor settings. More rigorous observations and controlled studies are needed to improve the therapeutic options for nodding syndrome.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 123-128"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499452","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}
Self-limited focal epilepsies of childhood (SeLFE), while predominantly considered benign, are known to potentially manifest with spike-and-wave activation in sleep (SWAS) in a minority of patients
Methods
The medical records of individuals diagnosed with one of the SeLFE syndromes according to the ILAE 2022 diagnostic criteria, who were followed in our center between 1989–2023, were retrospectively analyzed. At least two awake and sleep EEGs were performed during a minimum 2-year follow-up. SWAS is considered as spike and wave discharges occupying ≥50% of NREM sleep with symmetrical or mildly asymmetrical bilateral or unilateral hemispheric distribution.
Results
Among 144 patients with SeLFE, 57(39.6%) were diagnosed with self-limited epilepsy with centrotemporal spikes (SeLECTS); 65(45.1%) with self-limited epilepsy with autonomic seizures (SeLEAS); and 22 (15.3%) with childhood occipital visual epilepsy (COVE). The mean age of seizure onset was 7.6, 5.6, and 8.5 years, respectively. Twelve (8.3%) evolved into SWAS (5 from SeLECTS, 6 from SeLEAS, 1 from COVE). Time elapsed between onset of first seizure and evolution into SWAS ranged from 5.2 to 75 months (mean: 26.8±19.8), 6.2–42.8 months (mean: 20.1±14.7 for patients with SeLECTS; 5.2–75.0 months (mean: 32.7±24.5) with SeLEAS, and 25.0 months with COVE). All except two patients had also cognitive or behavioral regression and were diagnosed as epileptic encephalopathy with spike-wave activation in sleep(EE-SWAS) and one patient was diagnosed with Landau–Kleffner syndrome.
Conclusions
The most recent definition of ILAE highlights that SeLFEs are no longer recognized as “benign” epilepsies. Even with a low incidence rate, clinicians should always be cautious about the risk of SWAS development in these syndromes.
{"title":"Evolution into spike-and-wave activation in sleep in patients with self-limited focal epilepsies","authors":"Merve İriş, Miray Atacan Yaşgüçlükal, Cengiz Yalçınkaya, Veysi Demirbilek","doi":"10.1016/j.seizure.2026.01.006","DOIUrl":"10.1016/j.seizure.2026.01.006","url":null,"abstract":"<div><h3>Purposes</h3><div>Self-limited focal epilepsies of childhood (SeLFE), while predominantly considered benign, are known to potentially manifest with spike-and-wave activation in sleep (SWAS) in a minority of patients</div></div><div><h3>Methods</h3><div>The medical records of individuals diagnosed with one of the SeLFE syndromes according to the ILAE 2022 diagnostic criteria, who were followed in our center between 1989–2023, were retrospectively analyzed. At least two awake and sleep EEGs were performed during a minimum 2-year follow-up. SWAS is considered as spike and wave discharges occupying ≥50% of NREM sleep with symmetrical or mildly asymmetrical bilateral or unilateral hemispheric distribution.</div></div><div><h3>Results</h3><div>Among 144 patients with SeLFE, 57(39.6%) were diagnosed with self-limited epilepsy with centrotemporal spikes (SeLECTS); 65(45.1%) with self-limited epilepsy with autonomic seizures (SeLEAS); and 22 (15.3%) with childhood occipital visual epilepsy (COVE). The mean age of seizure onset was 7.6, 5.6, and 8.5 years, respectively. Twelve (8.3%) evolved into SWAS (5 from SeLECTS, 6 from SeLEAS, 1 from COVE). Time elapsed between onset of first seizure and evolution into SWAS ranged from 5.2 to 75 months (mean: 26.8±19.8), 6.2–42.8 months (mean: 20.1±14.7 for patients with SeLECTS; 5.2–75.0 months (mean: 32.7±24.5) with SeLEAS, and 25.0 months with COVE). All except two patients had also cognitive or behavioral regression and were diagnosed as epileptic encephalopathy with spike-wave activation in sleep(EE-SWAS) and one patient was diagnosed with Landau–Kleffner syndrome.</div></div><div><h3>Conclusions</h3><div>The most recent definition of ILAE highlights that SeLFEs are no longer recognized as “benign” epilepsies. Even with a low incidence rate, clinicians should always be cautious about the risk of SWAS development in these syndromes.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 34-38"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023818","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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