Seizure-European Journal of Epilepsy最新文献_第4页

Utilizing natural language processing to identify pediatric patients experiencing status epilepticus 利用自然语言处理技术识别癫痫状态的儿科患者。

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2025.01.008

Molly Ann Puckett , Fatemeh Mohammad Alizadeh Chafjiri , Jennifer V. Gettings , Assaf Landschaft , Tobias Loddenkemper

Purpose

Compare the identification of patients with established status epilepticus (ESE) and refractory status epilepticus (RSE) in electronic health records (EHR) using human review versus natural language processing (NLP) assisted review.

Methods

We reviewed EHRs of patients aged 1 month to 21 years from Boston Children's Hospital (BCH). We included all patients with convulsive ESE or RSE during admission. We employed and validated a pre-trained NLP tool, Document review Tool (DrT), to identify patients from 2013–2020, excluding training years (2017–2019). DrT notes a machine-learning score based on a support vector machine (SVM) and bag-of-n-grams. Higher scores indicated more likely ESE/RSE cases. To further evaluate the effectiveness of DrT-assisted review, we compared the results to human-reviewed notes from the pediatric Status Epilepticus Research Group (pSERG) consortium at BCH.

Results

The pre-trained algorithm identified 170 patients with RSE using DrT (Sensitivity: 98.8%), compared to 116 patients identified during human review (Sensitivity: 67.4%). Additionally, we identified 207 patients with ESE using DrT (Sensitivity: 99.5%), compared to 91 patients identified using human review (Sensitivity: 43.8%). Overall, DrT missed 3 cases (2 RSE and 1 ESE cases) that were identified during human review and identified 173 cases (56 RSE and 117 ESE cases) that were not found during the human review.

Conclusion

DrT-assisted manual review demonstrated higher sensitivity in identifying patients with ESE and RSE than the current standard of human review. This suggests that in contexts characterized by resource constraints NLP-related software like DrT can considerably enhance patient identification for research studies, treatment protocols, and preventative care interventions.

目的：比较人工回顾与自然语言处理（NLP）辅助回顾对电子健康记录（EHR）中确定的癫痫持续状态（ESE）和难治性癫痫持续状态（RSE）患者的识别。方法：我们回顾了波士顿儿童医院（BCH） 1个月至21岁患者的电子病历。我们纳入了入院时所有惊厥性ESE或RSE患者。我们使用并验证了一种预训练的NLP工具——文档审查工具（DrT），以识别2013-2020年（不包括2017-2019年）的患者。DrT记录了一个基于支持向量机（SVM）和n-grams袋的机器学习分数。得分越高，越有可能出现ESE/RSE病例。为了进一步评估drt辅助审查的有效性，我们将结果与BCH儿童癫痫持续状态研究组（pSERG）联盟的人类审查笔记进行了比较。结果：预先训练的算法使用DrT识别出170例RSE患者（灵敏度：98.8%），相比之下，在人类审查中识别出116例患者（灵敏度：67.4%）。此外，我们使用DrT识别了207例ESE患者（敏感性：99.5%），相比之下，使用人类回顾识别了91例患者（敏感性：43.8%）。总的来说，DrT遗漏了3例（2例RSE和1例ESE），这些病例是在人类审查中发现的，而在人类审查中没有发现173例（56例RSE和117例ESE）。结论：drt辅助人工评价在识别ESE和RSE患者方面比目前标准的人工评价具有更高的敏感性。这表明，在资源受限的情况下，与nlp相关的软件（如DrT）可以大大提高患者对研究、治疗方案和预防性护理干预的识别能力。

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引用次数: 0

Higher plasma total tau concentrations among patients reporting CNS-related side effects from antiseizure medication 报告抗癫痫药物引起中枢神经系统相关副作用的患者血浆总tau浓度较高。

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2025.01.015

Klara Andersson , Sarah Akel , Fredrik Asztély , David Larsson , Henrik Zetterberg , Johan Zelano

Background

Side effects from antiseizure medication (ASM) are common in epilepsy but biomarkers for detection and monitoring are missing. This study investigated associations between CNS-related side effects from ASM and blood concentrations of the brain injury markers neurofilament-light (NFL), total tau, glial acidic fibrillary protein (GFAP), S100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE).

Methods

This is a population-based cohort study of adults with epilepsy recruited from five Swedish outpatient neurology clinics from December 2020 to April 2023. Side effects classified as CNS-related: tiredness, dizziness, headache, concentration, memory, mood, motor/tremor, or sleep. Marker concentrations in the groups CNS side effects/no side effects were analyzed with Mann-Whitney U-test and significant differences were included in multivariable logistic regression models adjusting for age, epilepsy duration, seizure status, acquired structural lesion, and mono-/polytherapy.

Results

The cohort consisted of 367 patients, 187 (51 %) were females, the median age was 43 years (IQR 30–61), and 123 (34 %) reported CNS side effects. Total tau was higher among participants reporting CNS side effects (median 4.44 (95 %CI 4.12–4.88) pg/ml) compared with participants without side effects (3.84 (95 %CI 3.52–4.07) pg/ml, p < 0.01). The difference remained significant in multivariable regression models. NSE was higher among participants without side effects but did not remain significant in the multivariable regression model. No differences were observed for NFL, GFAP or S100B.

Conclusions

Higher total tau plasma concentration could be associated with increased risk of CNS side effects from ASM. Longitudinal studies could determine if this reflects vulnerability or detrimental effects of ASM. Trial registration: PREDICT, clinicaltrials.gov identifier NCT04559919.

背景：抗癫痫药物（ASM）的副作用在癫痫中很常见，但缺乏检测和监测的生物标志物。本研究探讨了ASM的中枢神经系统相关副作用与脑损伤标志物神经丝光（NFL）、总tau、胶质酸性纤维蛋白（GFAP）、S100钙结合蛋白B （S100B）和神经元特异性烯醇化酶（NSE）血药浓度的关系。方法：这是一项基于人群的队列研究，从2020年12月至2023年4月从瑞典的五个门诊神经病学诊所招募成人癫痫患者。归类为中枢神经系统相关的副作用：疲劳、头晕、头痛、注意力不集中、记忆力、情绪、运动/震颤或睡眠。采用Mann-Whitney u检验分析CNS副作用组/无副作用组的标志物浓度，并在调整年龄、癫痫持续时间、发作状态、获得性结构病变和单一/多种治疗后的多变量logistic回归模型中纳入显著差异。结果：该队列包括367例患者，187例（51%）为女性，中位年龄为43岁（IQR 30-61）， 123例（34%）报告中枢神经系统副作用。报告中枢神经系统副作用的参与者的总tau蛋白（中位数4.44 (95% CI 4.12-4.88) pg/ml）高于无副作用的参与者（中位数3.84 (95% CI 3.52-4.07) pg/ml, p < 0.01）。在多变量回归模型中，差异仍然显著。NSE在没有副作用的参与者中较高，但在多变量回归模型中没有保持显著性。NFL、GFAP和S100B均无差异。结论：较高的tau总血浆浓度可能与ASM引起的中枢神经系统副作用的风险增加有关。纵向研究可以确定这是否反映了ASM的脆弱性或有害影响。试验注册：PREDICT， clinicaltrials.gov识别码NCT04559919。

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引用次数: 0

Validation of the Chinese version of the Epilepsy Anxiety Survey Instrument (EASI) and its brief version (brEASI) in Western China 中国西部地区中文版癫痫焦虑量表（EASI）及其简易量表（brEASI）的验证。

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2025.01.004

Chenshi Liu , Lan Mou , Yuwen Zhang , Mingming Zhang , Ping Yang , Shuai Ma , Min Zhang , Jie Huang , Xiaoqiang Xiao , Jie Liu

Objective

To translate and validate the Chinese version of the Epilepsy Anxiety Survey Instrument (EASI) and its brief version (brEASI) among Chinese people with epilepsy.

Methods

Adult outpatients from Sichuan Provincial People's Hospital were recruited. The type of anxiety disorder was determined via the Mini International Neuropsychiatric Interview (MINI). All patients completed the Chinese version of the Generalized Anxiety Disorders-7 (GAD-7), the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (C-NDDIE), and the EASI/brEASI. Cronbach's α coefficient was calculated, and receiver operating characteristic (ROC) curves were analyzed.

Results

A total of 110 patients with epilepsy were included. Twenty-six (23.6 %) patients were found to have anxiety disorder according to the MINI criteria. The Cronbach's α coefficient for the Chinese brEASI was 0.873. In the study, the AUC of the brEASI for detecting all anxiety disorders was 0.883, and the optimal cutoff score was > 7, with a sensitivity of 92.3 % and a specificity of 72.6 %. For the diagnosis of non-GAD disorders, the brEASI had a greater AUC (0. 886) and performed better than the GAD-7 (AUC = 0. 824).

Conclusion

The Chinese version of the EASI and brEASI may be reliable and superior to the GAD-7 for anxiety screening in patients with epilepsy.

目的：翻译并验证中国癫痫患者癫痫焦虑量表（EASI）及其简易量表（brEASI）的中文版。方法：选取四川省人民医院成年门诊患者。焦虑症的类型通过Mini国际神经精神病学访谈（Mini）确定。所有患者均完成中文版广泛性焦虑障碍-7 （GAD-7）、中文版癫痫神经障碍抑郁量表（C-NDDIE）和EASI/brEASI。计算Cronbach’s α系数，分析受试者工作特征（ROC）曲线。结果：共纳入110例癫痫患者。根据MINI标准发现26例（23.6%）患者存在焦虑障碍。中国brEASI的Cronbach’s α系数为0.873。在本研究中，brEASI检测所有焦虑症的AUC为0.883，最佳临界值为bb0.7，敏感性为92.3%，特异性为72.6%。对于非广泛性焦虑症的诊断，brEASI有更高的AUC(0。886)，性能优于GAD-7 （AUC = 0）。824)。结论：中文版EASI和brEASI在癫痫患者焦虑筛查中可能可靠且优于GAD-7。

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引用次数: 0

A non-inferiority randomized controlled study of Perampanel versus Oxcarbazepine monotherapy for post-stroke epilepsy

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2025.01.016

Cuihua Yan , Jing Liu , Jing Jiang , Yanping Sun , Juan Chen , Kunkun Wei , Xiaoyun Liu , Qi Xiang , Anru Liu , Yuxiang Han , Liling Yang , Tao Han , Xuewu Liu

Background

Post-stroke epilepsy (PSE) poses a significant challenge despite advances in stroke treatment. This study compares the efficacy of the novel anti-seizure medication (ASM) Perampanel with the classical ASM Oxcarbazepine in treating PSE.

Methods

This prospective randomized controlled trial recruited PSE patients from September 2022 to January 2024 across multiple hospitals. Patients were randomly assigned to receive either Perampanel or Oxcarbazepine monotherapy. Baseline seizure frequency was measured over three months prior to treatment. Efficacy was assessed at six months, with a ≥ 50 % reduction in seizure frequency deemed effective. Perampanel was considered non-inferior to Oxcarbazepine if its lower 95 % confidence limit for efficacy was above 80 % of Oxcarbazepine's six-month seizure freedom rate. Intention-to-treat analysis and Kaplan-Meier methods evaluated retention rates and side effects.

Results

A total of 67 patients were included in this study: 33 patients in the Perampanel group (26 males, 78.8 %; 7 females, 21.2 %) and 34 patients in the Oxcarbazepine group (26 males, 76.5 %; 8 females, 23.5 %). There were no statistically significant differences in the baseline data between the two groups. This indicates that the groups are comparable. Treatment efficacy was 75.0 % and 78.8 % in the Perampanel and Oxcarbazepine groups at three months, and 80.6 % and 75.0 % at six months, respectively. At six months, the lower limit of the 95 % confidence interval for efficacy in the Perampanel group was higher than the prespecified non-inferiority threshold, indicating that Perampanel was noninferior than Oxcarbazepine. The rates of drug retention and adverse effects were similar in the two groups, with no statistically significant difference (P > 0.05).

Conclusion

Perampanel is noninferior to Oxcarbazepine and is considered a good option for the management of post-stroke epilepsy.

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引用次数: 0

The relationship between attitudes toward epilepsy and health literacy in Turkey: The mediating role of epilepsy knowledge

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2025.01.017

Emre Erkal

Objective

This study determined the mediating role of knowledge about epilepsy in the relationship between attitudes toward epilepsy and health literacy in Turkey.

Methods

This descriptive and cross-sectional study was conducted in Turkey with 4,393 participants. The sociodemographic form, Epilepsy Attitude Scale, Epilepsy Knowledge Scale, and Health Literacy Scale were used for data collection.

Results

The participants’ mean attitude score was 57.05 ± 10.15, mean knowledge score was 7.70 ± 4.22, and mean health literacy score was 51.95 ± 9.61. Health literacy scores significantly predicted attitude (β = 0.498) and knowledge (β = 0.382) scores (p < 0.05). Knowledge scores significantly predicted attitude scores (β = 0.529; p < 0.05). However, health literacy (β = 0.346) and knowledge scores (β = 0.397) together significantly predicted attitude scores (p < 0.05). The knowledge score has a mediating role between health literacy and attitude score (β = 0.152; p < 0.05).

Conclusion

Individuals had relatively positive attitudes toward epilepsy and moderate levels of knowledge and health literacy. Health literacy positively affected knowledge and attitude towards epilepsy. However, knowledge about epilepsy also positively affected attitude. Additionally, health literacy and knowledge of epilepsy together positively affected attitudes toward epilepsy. Knowledge about epilepsy mediated the relationship between health literacy and attitude toward epilepsy. In this context, it is recommended that programs to raise awareness and improve health literacy be organized, social sensitivity should be increased, and additional epilepsy research should be conducted.

{"title":"The relationship between attitudes toward epilepsy and health literacy in Turkey: The mediating role of epilepsy knowledge","authors":"Emre Erkal","doi":"10.1016/j.seizure.2025.01.017","DOIUrl":"10.1016/j.seizure.2025.01.017","url":null,"abstract":"<div><h3>Objective</h3><div>This study determined the mediating role of knowledge about epilepsy in the relationship between attitudes toward epilepsy and health literacy in Turkey.</div></div><div><h3>Methods</h3><div>This descriptive and cross-sectional study was conducted in Turkey with 4,393 participants. The sociodemographic form, Epilepsy Attitude Scale, Epilepsy Knowledge Scale, and Health Literacy Scale were used for data collection.</div></div><div><h3>Results</h3><div>The participants’ mean attitude score was 57.05 ± 10.15, mean knowledge score was 7.70 ± 4.22, and mean health literacy score was 51.95 ± 9.61. Health literacy scores significantly predicted attitude (β = 0.498) and knowledge (β = 0.382) scores (<em>p</em> < 0.05). Knowledge scores significantly predicted attitude scores (β = 0.529; <em>p</em> < 0.05). However, health literacy (β = 0.346) and knowledge scores (β = 0.397) together significantly predicted attitude scores (<em>p</em> < 0.05). The knowledge score has a mediating role between health literacy and attitude score (β = 0.152; <em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Individuals had relatively positive attitudes toward epilepsy and moderate levels of knowledge and health literacy. Health literacy positively affected knowledge and attitude towards epilepsy. However, knowledge about epilepsy also positively affected attitude. Additionally, health literacy and knowledge of epilepsy together positively affected attitudes toward epilepsy. Knowledge about epilepsy mediated the relationship between health literacy and attitude toward epilepsy. In this context, it is recommended that programs to raise awareness and improve health literacy be organized, social sensitivity should be increased, and additional epilepsy research should be conducted.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"125 ","pages":"Pages 186-191"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043075","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

Glymphatic system dysfunction in epilepsy related to focal cortical dysplasia and its relationship with antiseizure medication response 与局灶性皮质发育不良相关的癫痫中淋巴系统功能障碍及其与抗癫痫药物反应的关系。

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2024.12.021

Bo Jin , Jiahui Xu , Jing Hu , Hong Li , Shan Wang , Cong Chen , Linqi Ye , Hui Cheng , Lisan Zhang , Shuang Wang , Jin Wang , Thandar Aung

Purpose

Glymphatic function has not been explored in patients with focal cortical dysplasia (FCD)-related epilepsy. This study aimed to investigate the glymphatic system's involvement in these patients and to evaluate its correlation with response patterns to different antiseizure medications (ASMs) using diffusion tensor imaging along the perivascular space (DTI-ALPS).

Methods

Fifty-two patients with FCD-related epilepsy (10 with drug-responsive epilepsy and 42 with drug-resistant epilepsy) and 24 healthy controls (HC) were included. Bilateral DTI-ALPS index were calculated and compared among drug-responsive epilepsy, drug-resistant epilepsy, and HC groups. Additionally, we analyzed correlations between the DTI-ALPS index and clinical characteristics.

Results

Compared to HC, patients with FCD-related epilepsy showed significantly lower DTI-ALPS index in the bilateral hemispheres (p < 0.001). Notably, a significant decrease in the DTI-ALPS index was noted in the hemisphere ipsilateral to the epileptogenic foci, compared to the contralateral hemisphere (p < 0.001). Further analysis revealed that, in patients with drug-resistant epilepsy, the ipsilateral DTI-ALPS index was significantly lower than the contralateral DTI-ALPS index (p < 0.001), whereas patients with drug-responsive epilepsy did not show a significant difference between ipsilateral and contralateral DTI-ALPS index. No significant correlations were found between the DTI-ALPS index and clinical characteristics such as age and duration of epilepsy.

Conclusion

Our findings suggest a correlation between glymphatic system dysfunction and patients with FCD-related epilepsy, particularly in drug-resistant patients.

目的：尚未探讨局灶性皮质发育不良（FCD）相关癫痫患者的淋巴功能。本研究旨在探讨这些患者中淋巴系统的参与，并利用沿血管周围间隙扩散张量成像（DTI-ALPS）评估其与不同抗癫痫药物反应模式的相关性。方法：选取52例fcd相关性癫痫患者（药物反应性癫痫10例，耐药性癫痫42例）和24例健康对照（HC）。计算药物反应性癫痫组、耐药癫痫组和HC组的双侧DTI-ALPS指数并进行比较。此外，我们分析了DTI-ALPS指数与临床特征之间的相关性。结果：与HC相比，fcd相关性癫痫患者双侧半球DTI-ALPS指数明显降低（p < 0.001）。值得注意的是，与对侧半球相比，与致痫灶同侧半球的DTI-ALPS指数显著下降（p < 0.001）。进一步分析发现，耐药癫痫患者的同侧DTI-ALPS指数显著低于对侧DTI-ALPS指数（p < 0.001），而药物反应性癫痫患者的同侧DTI-ALPS指数与对侧DTI-ALPS指数无显著差异。DTI-ALPS指数与年龄、癫痫病程等临床特征无显著相关性。结论：我们的研究结果表明，淋巴系统功能障碍与fcd相关癫痫患者，特别是耐药患者之间存在相关性。

{"title":"Glymphatic system dysfunction in epilepsy related to focal cortical dysplasia and its relationship with antiseizure medication response","authors":"Bo Jin , Jiahui Xu , Jing Hu , Hong Li , Shan Wang , Cong Chen , Linqi Ye , Hui Cheng , Lisan Zhang , Shuang Wang , Jin Wang , Thandar Aung","doi":"10.1016/j.seizure.2024.12.021","DOIUrl":"10.1016/j.seizure.2024.12.021","url":null,"abstract":"<div><h3>Purpose</h3><div>Glymphatic function has not been explored in patients with focal cortical dysplasia (FCD)-related epilepsy. This study aimed to investigate the glymphatic system's involvement in these patients and to evaluate its correlation with response patterns to different antiseizure medications (ASMs) using diffusion tensor imaging along the perivascular space (DTI-ALPS).</div></div><div><h3>Methods</h3><div>Fifty-two patients with FCD-related epilepsy (10 with drug-responsive epilepsy and 42 with drug-resistant epilepsy) and 24 healthy controls (HC) were included. Bilateral DTI-ALPS index were calculated and compared among drug-responsive epilepsy, drug-resistant epilepsy, and HC groups. Additionally, we analyzed correlations between the DTI-ALPS index and clinical characteristics.</div></div><div><h3>Results</h3><div>Compared to HC, patients with FCD-related epilepsy showed significantly lower DTI-ALPS index in the bilateral hemispheres (<em>p</em> < 0.001). Notably, a significant decrease in the DTI-ALPS index was noted in the hemisphere ipsilateral to the epileptogenic foci, compared to the contralateral hemisphere (<em>p</em> < 0.001). Further analysis revealed that, in patients with drug-resistant epilepsy, the ipsilateral DTI-ALPS index was significantly lower than the contralateral DTI-ALPS index (<em>p</em> < 0.001), whereas patients with drug-responsive epilepsy did not show a significant difference between ipsilateral and contralateral DTI-ALPS index. No significant correlations were found between the DTI-ALPS index and clinical characteristics such as age and duration of epilepsy.</div></div><div><h3>Conclusion</h3><div>Our findings suggest a correlation between glymphatic system dysfunction and patients with FCD-related epilepsy, particularly in drug-resistant patients.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"125 ","pages":"Pages 31-36"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933259","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

Impact of lifetime antiepileptic drug history on cenobamate efficacy in adults with focal epilepsy 终生抗癫痫药物史对成人局灶性癫痫疗效的影响。

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2024.12.010

Eva Martinez-Lizana, Armin Brandt, Yulia Novitskaya, Martin Hirsch, Andreas Schulze-Bonhage

Purpose

To evaluate the efficacy of cenobamate (CNB) in adults with focal epilepsy based on the number of previous lifetime antiseizure medications (ASMs).

Methods

Twenty patients receiving add-on treatment with CNB with <6 lifetime ASMs were retrospectively compared to 20 Patients with >10 ASMs and approximately the same age. Efficacy was assessed at 3, 6, and 12 months following CNB initiation.

Results

In patients with <6 lifetime ASMs, seizure frequency significantly decreased at 3, 6, and 12 months (p = 0.03, 0.027, 0.048, respectively), while no significant changes were observed in the >10 lifetime ASM group. The median percentage of seizure reduction in the <6 lifetime ASMs group was 58 % at 3 months, 50 % at 6 months, and 92 % at 12 months, compared to 36 %, 50 %, and 42 % in the >10 lifetime ASM group. The seizure-free rate was significantly higher in the <6 lifetime ASMs group at all-time points (p < 0.01), despite a lower median daily dose of CNB in this group. There was a trend toward higher responder rates at 12 months in the <6 lifetime ASMs group, again despite the lower median daily dose of CNB.

Conclusions

This study highlights greater efficacy of CNB in patients with <6 lifetime ASMs, showing a significantly higher seizure-free rate and greater seizure reduction compared to those with >10 lifetime ASMs. Despite lower overall response in the latter group, CNB treatment still provided meaningful benefits in highly drug-resistant epilepsy.

目的：根据既往抗癫痫药物（asm）使用次数，评价辛奥巴酸（CNB）治疗局灶性癫痫的疗效。方法：20例年龄大致相同的患者接受CNB加药治疗。在CNB启动后3、6和12个月评估疗效。结果：10例患者终身ASM组。10期ASM组癫痫发作减少的中位数百分比。结论：本研究强调了CNB对10次终生性痉挛患者的更大疗效。尽管后一组的总体反应较低，但CNB治疗仍然为高度耐药癫痫提供了有意义的益处。

{"title":"Impact of lifetime antiepileptic drug history on cenobamate efficacy in adults with focal epilepsy","authors":"Eva Martinez-Lizana, Armin Brandt, Yulia Novitskaya, Martin Hirsch, Andreas Schulze-Bonhage","doi":"10.1016/j.seizure.2024.12.010","DOIUrl":"10.1016/j.seizure.2024.12.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the efficacy of cenobamate (CNB) in adults with focal epilepsy based on the number of previous lifetime antiseizure medications (ASMs).</div></div><div><h3>Methods</h3><div>Twenty patients receiving add-on treatment with CNB with <6 lifetime ASMs were retrospectively compared to 20 Patients with >10 ASMs and approximately the same age. Efficacy was assessed at 3, 6, and 12 months following CNB initiation.</div></div><div><h3>Results</h3><div>In patients with <6 lifetime ASMs, seizure frequency significantly decreased at 3, 6, and 12 months (<em>p</em> = 0.03, 0.027, 0.048, respectively), while no significant changes were observed in the >10 lifetime ASM group. The median percentage of seizure reduction in the <6 lifetime ASMs group was 58 % at 3 months, 50 % at 6 months, and 92 % at 12 months, compared to 36 %, 50 %, and 42 % in the >10 lifetime ASM group. The seizure-free rate was significantly higher in the <6 lifetime ASMs group at all-time points (<em>p</em> < 0.01), despite a lower median daily dose of CNB in this group. There was a trend toward higher responder rates at 12 months in the <6 lifetime ASMs group, again despite the lower median daily dose of CNB.</div></div><div><h3>Conclusions</h3><div>This study highlights greater efficacy of CNB in patients with <6 lifetime ASMs, showing a significantly higher seizure-free rate and greater seizure reduction compared to those with >10 lifetime ASMs. Despite lower overall response in the latter group, CNB treatment still provided meaningful benefits in highly drug-resistant epilepsy.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"125 ","pages":"Pages 94-98"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015049","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}

引用次数: 0

Presenteeism in people with previous and current epilepsy: Determinants and psychosocial associations 既往和当前癫痫患者的出勤：决定因素和社会心理关联。

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2024.12.011

Shuichiro Neshige , Yoshiko Takebayashi , Ruoyi Ishikawa , Narumi Ohno , Koji Iida , Hirofumi Maruyama , Takahiro Tabuchi

Objective

We examined people with epilepsy (PWE) regarding presenteeism, an aspect of reduced work productivity due to health-related issues despite physical presence, with a focus on epilepsy treatment and psychosocial factors.

Methods

We used data from 32,000 participants aged 16–83 years old that were obtained through a 2024 nationwide internet survey. The Work Functioning Impairment Scale, which measures "presenteeism," was used to compare participants with and without a history of epilepsy. Odds ratios for presenteeism were calculated using univariable and multivariable analyses with two models based on sociodemographic and health-related variables. Propensity score matching was applied to equate groups with and without epilepsy in health-related variables.

Results

Among 29,268 participants with valid responses, those with current epilepsy (n = 351) and in remission (n = 429) exhibited significantly higher presenteeism (p < 0.0001) and psychological distress (p < 0.0001) versus participants without epilepsy (n = 28,488). Multivariable analysis confirmed current epilepsy was independently associated with higher presenteeism (odds ratio: 2.61; 95 % confidence interval: 2.05–3.33, p < 0.0001) in the sociodemographic model. After propensity score matching of 277 non-epilepsy and epilepsy participants, presenteeism remained significantly higher in current epilepsy patients versus those without (44.0 % vs. 28.2 %, p < 0.0001). When further adjusted for psychological disorders, the difference in presenteeism became negligible (46.2 % vs. 44.0 %, p = 0.716).

Significance

This cross-sectional study confirms significant presenteeism in PWE, which persists even in remission cases. This suggests that multiple causal conditions, rather than epileptic activity itself, affect presenteeism. As the epilepsy effect on presenteeism substantially decreases when accounting for psychological disorders, addressing these disorders may promote social productivity in PWE.

目的：我们检查了癫痫患者（PWE）的出勤情况，这是尽管身体存在，但由于健康相关问题导致工作效率降低的一个方面，重点关注癫痫治疗和社会心理因素。方法：我们使用了来自32,000名年龄在16-83岁之间的参与者的数据，这些数据是通过2024年全国互联网调查获得的。测量“出勤率”的工作功能障碍量表被用来比较有和没有癫痫史的参与者。出勤的优势比采用单变量和多变量分析计算，采用基于社会人口统计学和健康相关变量的两种模型。应用倾向评分匹配将与健康相关变量相等的有癫痫和无癫痫组。结果：在29,268名有有效反应的参与者中，患有癫痫（n = 351）和缓解期（n = 429）的参与者与没有癫痫的参与者（n = 28,488）相比，显着更高的出勤率（p < 0.0001）和心理困扰（p < 0.0001）。多变量分析证实当前癫痫与较高出勤率独立相关(优势比：2.61；95%置信区间：2.05-3.33,p < 0.0001)。在对277名非癫痫和癫痫参与者进行倾向评分匹配后，患有癫痫的患者出勤率明显高于没有癫痫的患者（44.0%比28.2%,p < 0.0001）。当进一步调整心理障碍时，出勤率的差异变得可以忽略不计（46.2%对44.0%,p = 0.716）。意义：这项横断面研究证实了PWE患者的显著出勤，即使在缓解病例中也持续存在。这表明，影响出勤的是多种病因，而不是癫痫活动本身。当考虑到心理障碍时，癫痫对出勤的影响大大降低，解决这些障碍可能会促进PWE的社会生产力。

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引用次数: 0

Management of epilepsia partialis continua: A systematic review 部分持续性癫痫的治疗：系统回顾。

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2025.01.005

Sheryn Tan , Jeng Swen Ng , Jinara Devinuwara , Sze Tong Ong , Pany Virdi , Rudy Goh , Shaddy El-Masri , Joshua Kovoor , Brandon Stretton , Aashray Gupta , Jamie Bellinge , Tony Zhang , Toby Gilbert , Gregory Crawford , Peter Bergin , W. Taylor Kimberly , Adil Harroud , Sybil Stacpoole , Michelle Kiley , Stephen Bacchi

Purpose

Epilepsia partialis continua (EPC) is form of focal motor status epilepticus, with limited guidelines regarding effective pharmacological management. This systematic review aimed to describe previously utilized pharmacological management strategies for EPC, with a focus on patient outcomes.

Methods

A systematic review of the databases PubMed, EMBASE, and SCOPUS was performed from inception to May 2024. The review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was prospectively registered on PROSPERO.

Results

Five studies fulfilled the inclusion criteria. All studies were case series, and in total included 51 patients. The mortality rate was 11.8 % (6/51). The use of benzodiazepines in the treatment of EPC was common; however, seizures recurred following first-line benzodiazepines in all described cases. Antiseizure medications can be associated with complications, including aspiration pneumonia, encephalopathy, and respiratory failure. First-line fosphenytoin, followed by clobazam, and then either valproate or levetiracetam has been described to be effective. Described cases also support the earlier use of levetiracetam. Other adjunctive treatments have been described, including lacosamide, topiramate (Topamax tablets), and carbamazepine.

Conclusion

Despite treatment, EPC typically lasts at least hours, and often days or longer. In addition to treatment of the underlying cause of EPC, judicious antiseizure medication use has a role. However, care should be taken not to cause harm (such as respiratory depression) with antiseizure medications, particularly noting that seizures are likely to be prolonged irrespective of antiseizure medication choice.

目的：部分持续性癫痫（EPC）是局灶性运动癫痫持续状态的一种形式，在有效的药物治疗方面有有限的指导方针。本系统综述旨在描述以前用于EPC的药理学管理策略，重点关注患者的预后。方法：对PubMed、EMBASE和SCOPUS数据库进行系统回顾，从建立到2024年5月。按照系统评价和荟萃分析（PRISMA）指南的首选报告项目进行评价和报告。该评论有望在PROSPERO上注册。结果：5项研究符合纳入标准。所有研究均为病例系列，共纳入51例患者。死亡率为11.8%（6/51）。苯二氮卓类药物在EPC治疗中的应用较为普遍；然而，在所有描述的病例中，癫痫发作在一线苯二氮卓类药物后复发。抗癫痫药物可引起并发症，包括吸入性肺炎、脑病和呼吸衰竭。一线使用磷妥英，其次是氯巴唑，然后丙戊酸盐或左乙拉西坦被认为是有效的。所描述的病例也支持较早使用左乙拉西坦。其他辅助治疗方法包括拉可沙胺、托吡酯（托帕麦片）和卡马西平。结论：尽管治疗，EPC通常持续至少几个小时，经常是几天或更长时间。除了治疗EPC的根本原因外，明智地使用抗癫痫药物也有作用。然而，应注意使用抗癫痫药物不要造成伤害（如呼吸抑制），特别要注意，无论选择何种抗癫痫药物，癫痫发作都可能延长。

{"title":"Management of epilepsia partialis continua: A systematic review","authors":"Sheryn Tan , Jeng Swen Ng , Jinara Devinuwara , Sze Tong Ong , Pany Virdi , Rudy Goh , Shaddy El-Masri , Joshua Kovoor , Brandon Stretton , Aashray Gupta , Jamie Bellinge , Tony Zhang , Toby Gilbert , Gregory Crawford , Peter Bergin , W. Taylor Kimberly , Adil Harroud , Sybil Stacpoole , Michelle Kiley , Stephen Bacchi","doi":"10.1016/j.seizure.2025.01.005","DOIUrl":"10.1016/j.seizure.2025.01.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Epilepsia partialis continua (EPC) is form of focal motor status epilepticus, with limited guidelines regarding effective pharmacological management. This systematic review aimed to describe previously utilized pharmacological management strategies for EPC, with a focus on patient outcomes.</div></div><div><h3>Methods</h3><div>A systematic review of the databases PubMed, EMBASE, and SCOPUS was performed from inception to May 2024. The review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was prospectively registered on PROSPERO.</div></div><div><h3>Results</h3><div>Five studies fulfilled the inclusion criteria. All studies were case series, and in total included 51 patients. The mortality rate was 11.8 % (6/51). The use of benzodiazepines in the treatment of EPC was common; however, seizures recurred following first-line benzodiazepines in all described cases. Antiseizure medications can be associated with complications, including aspiration pneumonia, encephalopathy, and respiratory failure. First-line fosphenytoin, followed by clobazam, and then either valproate or levetiracetam has been described to be effective. Described cases also support the earlier use of levetiracetam. Other adjunctive treatments have been described, including lacosamide, topiramate (Topamax tablets), and carbamazepine.</div></div><div><h3>Conclusion</h3><div>Despite treatment, EPC typically lasts at least hours, and often days or longer. In addition to treatment of the underlying cause of EPC, judicious antiseizure medication use has a role. However, care should be taken not to cause harm (such as respiratory depression) with antiseizure medications, particularly noting that seizures are likely to be prolonged irrespective of antiseizure medication choice.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"125 ","pages":"Pages 79-83"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015098","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}

引用次数: 0

Drug reaction with eosinophilia and systemic symptoms (DRESS) associated with the use of antiseizure medications—An overview of clinical data 与抗癫痫药物使用相关的嗜酸性粒细胞增多和全身症状（DRESS）的药物反应-临床资料综述

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2024.12.020

Naina Mohamed Pakkir Maideen , Krishnaveni Kandasamy , Rajkapoor Balasubramanian , Ananda Thangadurai Subramani

The United States Food and Drug Administration (US FDA) released a warning regarding Drug Reactions with Eosinophilia and Systemic Symptoms (DRESS) linked to the use of antiseizure drugs, including levetiracetam and clobazam, on November 28, 2023. Hence, our review focuses on DRESS associated with the use of antiseizure drugs, including Levetiracetam, Clobazam, Carbamazepine, Phenytoin, Phenobarbital, Valproate, Oxcarbazepine, and Lamotrigine. The online databases, such as Medline/Pubmed/PMC, Scopus, Web of Science, Google Scholar, Science Direct, Ebsco, Embase, and reference lists, were searched for relevant publications. Several case reports and reviews of pharmacovigilance data by different regulatory bodies were published regarding DRESS associated with antiseizure drugs. Management strategies for DRESS may include immediate discontinuation of offending medication, administration of systemic corticosteroids, and administration of cyclosporine and intravenous immunoglobulin in cases that are not responding to systemic corticosteroids. Early detection and treatment of DRESS by healthcare professionals is necessary to lower mortality and improve outcomes. The US FDA advises healthcare professionals to be aware of the connection between DRESS and specific antiseizure medications. Patients should be informed by medical professionals about the symptoms and signs of DRESS as well as the risks associated with it. In conclusion, DRESS syndrome, though rare, is a serious hypersensitivity reaction linked to antiseizure drugs like levetiracetam and clobazam. Early detection and discontinuation of the offending drug, coupled with systemic corticosteroids, are essential for effective management. Healthcare professionals must be vigilant in identifying DRESS to reduce mortality and improve patient outcomes.

美国食品和药物管理局（FDA）于2023年11月28日发布了一项关于与使用抗癫痫药物（包括左乙拉西坦和氯巴唑）相关的嗜酸性粒细胞增加和全身症状（DRESS）的药物反应的警告。因此，我们的综述重点关注与抗癫痫药物使用相关的DRESS，包括左乙拉西坦、氯巴唑、卡马西平、苯妥英、苯巴比妥、丙戊酸、奥卡西平和拉莫三嗪。检索Medline/Pubmed/PMC、Scopus、Web of Science、谷歌Scholar、Science Direct、Ebsco、Embase等在线数据库和参考文献列表，查找相关出版物。关于与抗癫痫药物相关的DRESS，发表了几例病例报告和不同监管机构的药物警戒数据综述。DRESS的治疗策略可能包括：立即停用违规药物，给予全身皮质类固醇，在对全身皮质类固醇无反应的病例中给予环孢素和静脉注射免疫球蛋白。医疗保健专业人员早期发现和治疗DRESS对于降低死亡率和改善预后是必要的。美国食品和药物管理局建议医疗保健专业人员要意识到DRESS和特定抗癫痫药物之间的联系。医疗专业人员应告知患者DRESS的症状和体征以及与之相关的风险。总之，DRESS综合征虽然罕见，但却是一种与左乙拉西坦和氯巴唑等抗癫痫药物有关的严重超敏反应。早期发现和停药，加上全身皮质类固醇，是有效管理的必要条件。医疗保健专业人员必须警惕识别DRESS，以降低死亡率和改善患者预后。

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引用次数: 0