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Top Ten epilepsy research priorities: A UK priority setting partnership
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2024.12.008
Anna C Norton , Caoimhe Twohig-Bennett , Maxine Smeaton , Anthony Marson , Jack Armstrong , Adam Kovac , Samantha Ashby , Hannah Cock , Anne Coxon , Jon M Dickson , Abbie Fearon , Alison Fuller , Michael Kinney , Andrée Mayne , Tom McLaughlan , James W Mitchell , Rosemarie Pardington , Angie Pullen , Rohit Shankar , Juliet Solomon , Rhys H Thomas

Purpose

Research into epilepsy has experienced decades of chronic underfunding compared to other neurological conditions despite its prevalence and seriousness. To evidence the need for greater investment, the Epilepsy Research Institute (formerly Epilepsy Research UK) funded, led and managed a James Lind Alliance (JLA) Priority Setting Partnership (PSP). This “industry standard” methodology brings together healthcare professionals, patients, carers and patient group representatives to identify and prioritise research uncertainties within a defined area of health or care.

Methods

The UK Epilepsy PSP is a once-in-a-generation, national consensus that collated and ranked the research priorities of the UK epilepsy and associated condition community. Following JLA methodology, this 18-month project engaged over 100 patient groups and 5000 people affected by and working in epilepsy, including medics and allied healthcare professionals, from across the UK.

Results

Over 5400 priorities were received, with anti-seizure medication, sudden unexpected death in epilepsy (SUDEP) and epilepsy in women among the most frequently reported themes. The responses received were categorised and translated into distinct, researchable questions. Questions were excluded if deemed to be “answered” following an evidence check, while research uncertainties (i.e. unanswered and partially answered questions) formed the basis of a second, shortlisting survey. The shortlisted questions were then discussed and debated at the final workshop by participants that broadly represented the UK epilepsy and associated condition community. The final ranking and Top Ten priorities for research into epilepsy were then agreed.

Conclusion

The aim of the UK Epilepsy PSP is to encourage and inspire researchers to investigate the research areas prioritised by those most affected by the condition and provide the evidence of need to aid future policy making discussions and support research funding applications.
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引用次数: 0
A call for better information about epilepsy: The next of kin perspective 呼吁提供更好的癫痫信息:从近亲的角度看。
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.seizure.2024.12.012
Frida Knutstad Rusten , Karl O. Nakken , Morten I. Lossius , Oliver Henning

Purpose

For next of kin (NK) to people with epilepsy (PWE) insufficient knowledge about the disease might have a negative impact on disease management, utilization of the health care system and conveyance of attitudes in the society. The aim of this study was to investigate to which degree Norwegian NK to PWE called for and obtained relevant information about different epilepsy-related issues.

Methods

We invited NK visiting the homepage of the Norwegian Epilepsy Association to complete an online questionnaire regarding information about epilepsy. The survey was accessible for a five-month period.

Results

231 NK fulfilled the questionnaire. Almost 90 % of the respondents called for more information about specific topics, such as seizure management and premature death in epilepsy, in addition to more general information about the disease. Those who experienced high levels of psychological distress were particularly in need of more information about all epilepsy-related issues. Depending on the subject, the proportion of respondents that reported not to have obtained information on specific issues varied from 42 % to 88 %. Good seizure control in the person they cared for was significantly associated with receiving insufficient information about seizure management, seizure-related injuries, concentration and memory, and borderline significant about depression and anxiety.

Significans

The majority of Norwegian NK to PWE call for more and better information about the disease. Perceived lack of information among close relatives was associated with high levels of emotional stress. This should be a wake-up call for healthcare professionals working with this patient group.
目的:癫痫患者的近亲属(NK)对该病的认识不足可能会对疾病管理、卫生保健系统的利用和社会态度的传递产生负面影响。本研究的目的是调查挪威NK对PWE的要求程度,并获得不同癫痫相关问题的相关信息。方法:我们邀请NK访问挪威癫痫协会主页,填写一份关于癫痫信息的在线问卷。这项调查为期五个月。结果:231名NK满足问卷要求。几乎90%的答复者要求除了提供更多关于该病的一般信息外,还提供更多关于癫痫发作管理和癫痫过早死亡等具体主题的信息。那些经历过高度心理困扰的人尤其需要更多关于所有癫痫相关问题的信息。根据主题的不同,报告未获得具体问题信息的答复者比例从42%到88%不等。在他们所照顾的人身上,良好的癫痫控制与接收到的癫痫管理、癫痫相关损伤、注意力和记忆力的信息不足以及抑郁和焦虑的边缘性显著相关。意义:大多数挪威NK到PWE呼吁更多更好的疾病信息。近亲之间缺乏信息的感知与高水平的情绪压力有关。这应该为与该患者群体一起工作的医疗保健专业人员敲响警钟。
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引用次数: 0
Infantile Epileptic Spasms Syndrome: Unveiling clinical and genetic variability in a case series from Argentina
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-01-31 DOI: 10.1016/j.seizure.2025.01.025
María Eugenia Martín , Lenin Intriago , Mariana Loos , Gabriela Reyes Valenzuela , Gabriel Veneruzzo , María Eugenia Foncuberta , Gabriela Zelaya , Giovanna Aschettino , Francisco García , Giovanna Flores , Roberto Caraballo , Cristina Alonso , Matías Juanes

Purpose

Infantile Epileptic Spasms Syndrome (IESS) is the most prevalent epileptic encephalopathy (EE) in the first year of life, with approximately 40 % of cases of genetic or unknown origin. This study aims to describe the clinical and molecular characteristics of a group of Argentine patients diagnosed with IESS of unknown etiology.

Methods

A retrospective analysis was performed on the clinical data of 24 pediatric patients diagnosed with IESS with hypsarrhythmia, who underwent genomic studies between 2019 and 2022.

Results

A genetic etiology was identified in 50 % of cases (eight boys and four girls; median seizure onset age: 3 months). Most of them initiated with IESS and over half evolved into Lennox-Gastaut syndrome. Developmental delay preceded seizure onset in all patients, persisting or worsening thereafter. Notable features included hypotonia, microcephaly, and dysmorphisms. Half of the patients had a family history of epilepsy, and two of EE. Identified variants included 7/13 (53.8 %) single nucleotide variants in KCNQ2, STXBP1, SCN8A, CDKL5, UGDH, and WWOX; 5/13 (38.5 %) copy number variants involving the genes UBE3A-GABRB3-GABRA5, SCN2A-SCN1A-SCN9A, and WWOX; and a short tandem repeat in ARX. Inheritance patterns included autosomal dominant (n = 8), recessive (n = 2), and X-linked (n = 2). Nine variants (69.2 %) were presumed de novo.

Conclusion

These findings underscore the extensive genetic heterogeneity of IESS within the Argentine population, enriching the international literature and variant databases with Latin American data. In cases with an unknown cause, genetic testing is crucial in establishing an etiological diagnosis, guiding appropriate treatment, and facilitating genetic counseling.
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引用次数: 0
Cardiac arrest following lacosamide intoxication in an adolescent; a case report
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-01-28 DOI: 10.1016/j.seizure.2025.01.023
Gen Furukawa , Shun Imamura , Ayami Yoshikane , Hidetoshi Uchida , Kazuyoshi Saito , Tadayoshi Hata , Naoko Ishihara
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引用次数: 0
The clinical profile of adult-onset idiopathic generalised epilepsy
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-01-27 DOI: 10.1016/j.seizure.2025.01.024
Javier Peña-Ceballos , Patrick B. Moloney , Tenzin Choekyi , Hany El Naggar , Peter Widdess-Walsh , Norman Delanty

Objective

Idiopathic generalised epilepsies (IGE) tend to begin in childhood or adolescence, whereas adult-onset presentations are less frequently observed. In this study, we describe the disease course of a cohort of patients with adult-onset IGE.

Methods

In this retrospective observational study, we evaluated clinical features, seizure outcomes, and antiseizure medication (ASM) prescribing trends in a cohort of IGE patients with seizure onset aged 18 years or older.

Results

In a cohort of 425 IGE patients, we identified 55 with adult-onset IGE (12.9 %). Forty-nine patients (89.1 %) experienced seizure onset between ages 18 and 30 years, while the remaining six patients (10.9 %) had onset after the age of 30 years. Eleven patients were initially diagnosed with focal epilepsy (20 %). Most patients (98.2 %) initially presented with generalised tonic-clonic seizures (GTCS). Epilepsy with generalised tonic-clonic seizures alone (GTCA) was the most common syndrome (65.4 %). Thirty-five patients (63.6 %) were treated with ASM monotherapy, 17 (30.9 %) with polytherapy, and three (5.4 %) were not taking any ASM. Lamotrigine, levetiracetam (38.2 %), and valproate (27.3 %) were the most prescribed ASMs. At last clinical review, 40 patients (72.7 %) were seizure-free (no seizures for ≥12 months), including those with absence seizures and myoclonic seizures, and 46 were free of GTCS for a mean duration of 6.2 years (range 1–21 years). Eight patients (14.5 %) had drug-resistant epilepsy (DRE). Eight patients attempted ASM withdrawal, with seizure recurrence occurring in six (75 %), with the period off ASM ranging from one week to 26 years.

Significance

IGE should be considered as a possible diagnosis in people who first present with convulsive seizures in adulthood, particularly those aged between 18 and 30 years with normal neuroimaging. Adult-onset IGE has a good prognosis overall, with most people becoming seizure-free, although the risk of seizure recurrence appears to be high after ASM withdrawal. A minority develop DRE and require polytherapy with ≥2 ASMs.
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引用次数: 0
Utilizing machine learning techniques for EEG assessment in the diagnosis of epileptic seizures in the brain: A systematic review and meta-analysis
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-01-27 DOI: 10.1016/j.seizure.2025.01.021
Dikshit Chawla , Eshita Sharma , Numa Rajab , Paweł Łajczak , Yasmin P. Silva , João Marcelo Baptista , Beatriz W. Pomianoski , Aisha R. Ahmed , Mir wajid Majeed , Yan G. de Sousa , Manoela L. Pinto , Oğuz K. Sahin , Muhaison H. Ibrahim , Idrys H.L. Guedes , Anoushka Chatterjee , Ramon Guerra Barbosa , Walter Fagundes

Purpose

Advancements in Machine Learning (ML) techniques have revolutionized diagnosing and monitoring epileptic seizures using Electroencephalogram (EEG) signals. This analysis aims to determine the effectiveness of ML techniques in recognizing patterns of epileptic seizures in the brain using EEG signals.

Methods

We searched PubMed, Scopus, and Google Scholar for relevant RCTs, cohort studies, and case-control studies involving patients with prior epileptic seizures who underwent EEG analysis aided by ML techniques. Using the STATA software, we evaluated the accuracy of predicting epileptic seizures, measured using metrics such as Area under the curve (AUC), Sensitivity, and Specificity.

Results

The random effects bivariate model of 4 studies with 214 patients revealed high diagnostic performance for ML techniques in detecting epileptic signals in EEGs. The estimated sensitivity was 0.97 (95 % CI: 0.92–0.99), indicating its ability to accurately detect the condition in 97 % of cases. Similarly, the estimated specificity was 0.99 (95 % CI: 0.98–0.99), demonstrating its ability to correctly identify the absence of the condition in 99 % of cases. There was also a high AUC (1.00, 95 % CI: 0.99–1.00), indicating ML techniques can distinguish epileptic seizures from no seizures in EEG signals 100 % of the time. These findings underscore the test's robust diagnostic utility in sensitivity and specificity. There was a significant between-study variability (heterogeneity) with a chi-square p-value <0.001 and an I2 value of 95 %. A bivariate box plot further confirmed the heterogeneity. Deek's test for publication bias showed a non-significant p-value (p = 0.06) indicating the absence of publication bias.

Conclusion

ML techniques can potentially enhance diagnostic accuracy in epilepsy detection, offering valuable insights into developing advanced diagnostic tools for clinical practice.
{"title":"Utilizing machine learning techniques for EEG assessment in the diagnosis of epileptic seizures in the brain: A systematic review and meta-analysis","authors":"Dikshit Chawla ,&nbsp;Eshita Sharma ,&nbsp;Numa Rajab ,&nbsp;Paweł Łajczak ,&nbsp;Yasmin P. Silva ,&nbsp;João Marcelo Baptista ,&nbsp;Beatriz W. Pomianoski ,&nbsp;Aisha R. Ahmed ,&nbsp;Mir wajid Majeed ,&nbsp;Yan G. de Sousa ,&nbsp;Manoela L. Pinto ,&nbsp;Oğuz K. Sahin ,&nbsp;Muhaison H. Ibrahim ,&nbsp;Idrys H.L. Guedes ,&nbsp;Anoushka Chatterjee ,&nbsp;Ramon Guerra Barbosa ,&nbsp;Walter Fagundes","doi":"10.1016/j.seizure.2025.01.021","DOIUrl":"10.1016/j.seizure.2025.01.021","url":null,"abstract":"<div><h3>Purpose</h3><div>Advancements in Machine Learning (ML) techniques have revolutionized diagnosing and monitoring epileptic seizures using Electroencephalogram (EEG) signals. This analysis aims to determine the effectiveness of ML techniques in recognizing patterns of epileptic seizures in the brain using EEG signals.</div></div><div><h3>Methods</h3><div>We searched PubMed, Scopus, and Google Scholar for relevant RCTs, cohort studies, and case-control studies involving patients with prior epileptic seizures who underwent EEG analysis aided by ML techniques. Using the STATA software, we evaluated the accuracy of predicting epileptic seizures, measured using metrics such as Area under the curve (AUC), Sensitivity, and Specificity.</div></div><div><h3>Results</h3><div>The random effects bivariate model of 4 studies with 214 patients revealed high diagnostic performance for ML techniques in detecting epileptic signals in EEGs. The estimated sensitivity was 0.97 (95 % CI: 0.92–0.99), indicating its ability to accurately detect the condition in 97 % of cases. Similarly, the estimated specificity was 0.99 (95 % CI: 0.98–0.99), demonstrating its ability to correctly identify the absence of the condition in 99 % of cases. There was also a high AUC (1.00, 95 % CI: 0.99–1.00), indicating ML techniques can distinguish epileptic seizures from no seizures in EEG signals 100 % of the time. These findings underscore the test's robust diagnostic utility in sensitivity and specificity. There was a significant between-study variability (heterogeneity) with a chi-square p-value &lt;0.001 and an I<sup>2</sup> value of 95 %. A bivariate box plot further confirmed the heterogeneity. Deek's test for publication bias showed a non-significant p-value (<em>p</em> = 0.06) indicating the absence of publication bias.</div></div><div><h3>Conclusion</h3><div>ML techniques can potentially enhance diagnostic accuracy in epilepsy detection, offering valuable insights into developing advanced diagnostic tools for clinical practice.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 16-23"},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143169714","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
Adverse events of dual anti-seizure medication: Real-life data from a tertiary epilepsy clinic
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-01-26 DOI: 10.1016/j.seizure.2025.01.022
Alexander B. Kowski, Sophie Schlabitz, David Steinbart, Martin Holtkamp , Verena Gaus

Objective

In patients with epilepsy, adverse events (AE) of anti-seizure medication (ASM) may lead to unfavorable quality of life and non-adherence to treatment. This retrospective study aimed to identify risk factors for overall AE burden and specific AE in patients with dual ASM therapy.

Methods

All patients aged at least 18 years from a tertiary epilepsy outpatient clinic routinely complete the 19-item Liverpool Adverse Events Profile (LAEP). Demographic, epilepsy, and treatment variables were extracted from our outpatient database. Variables of clinical relevance were entered into a binary logistic regression model.

Results

Out of 2,106 patients, dual ASM was applied to 595 patients with 98 different combinations. We focused on the five most frequent ASM combinations; levetiracetam and lamotrigine (LEV/LTG, n=108), lacosamide and levetiracetam (LCM/LEV, n=53), lamotrigine and valproic acid (LTG/VPA, n=50), levetiracetam and valproic acid (LEV/VPA, n=27), and eslicarbazepine acetate and levetiracetam (ESL/LEV, n=22). Commonly reported specific AE were sleepiness (62 %), difficulty concentrating (55 %), memory problems (53 %), tiredness (46 %), and disturbed sleep (40 %). Relevant AE burden (LAEP score ≥45) was independently associated with female sex, LEV/VPA- and LTG/VPA-dual therapy, drug resistance, as well as focal and unclassified epilepsy. Distinct AE were associated mainly with female sex (6/19 AE), focal (5/19 AE), unclassified (7/19 AE) epilepsy, and drug resistance (4/10 AE). Concerning specific AE combination, only LTG/VPA was independently associated with hair loss (OR 6.766).

Significance

After controlling for potential confounders, our study found that the two ASM combinations involving valproic acid were significantly associated with higher LAEP scores, indicating poorer tolerability. Specific adverse events, such as hair loss, were independently associated with the LTG/VPA combination. Cognitive side effects were notably prominent across all five dual ASM combinations. While dual ASM therapy is associated with an increased burden of AE, this increase appears to be moderate when therapies are individually tailored. Increased awareness and systematic screening of AE, particularly cognitive side effects, are essential to optimize treatment outcomes.
{"title":"Adverse events of dual anti-seizure medication: Real-life data from a tertiary epilepsy clinic","authors":"Alexander B. Kowski,&nbsp;Sophie Schlabitz,&nbsp;David Steinbart,&nbsp;Martin Holtkamp ,&nbsp;Verena Gaus","doi":"10.1016/j.seizure.2025.01.022","DOIUrl":"10.1016/j.seizure.2025.01.022","url":null,"abstract":"<div><h3>Objective</h3><div>In patients with epilepsy, adverse events (AE) of anti-seizure medication (ASM) may lead to unfavorable quality of life and non-adherence to treatment. This retrospective study aimed to identify risk factors for overall AE burden and specific AE in patients with dual ASM therapy.</div></div><div><h3>Methods</h3><div>All patients aged at least 18 years from a tertiary epilepsy outpatient clinic routinely complete the 19-item Liverpool Adverse Events Profile (LAEP). Demographic, epilepsy, and treatment variables were extracted from our outpatient database. Variables of clinical relevance were entered into a binary logistic regression model.</div></div><div><h3>Results</h3><div>Out of 2,106 patients, dual ASM was applied to 595 patients with 98 different combinations. We focused on the five most frequent ASM combinations; levetiracetam and lamotrigine (LEV/LTG, n=108), lacosamide and levetiracetam (LCM/LEV, n=53), lamotrigine and valproic acid (LTG/VPA, n=50), levetiracetam and valproic acid (LEV/VPA, n=27), and eslicarbazepine acetate and levetiracetam (ESL/LEV, n=22). Commonly reported specific AE were sleepiness (62 %), difficulty concentrating (55 %), memory problems (53 %), tiredness (46 %), and disturbed sleep (40 %). Relevant AE burden (LAEP score ≥45) was independently associated with female sex, LEV/VPA- and LTG/VPA-dual therapy, drug resistance, as well as focal and unclassified epilepsy. Distinct AE were associated mainly with female sex (6/19 AE), focal (5/19 AE), unclassified (7/19 AE) epilepsy, and drug resistance (4/10 AE). Concerning specific AE combination, only LTG/VPA was independently associated with hair loss (OR 6.766).</div></div><div><h3>Significance</h3><div>After controlling for potential confounders, our study found that the two ASM combinations involving valproic acid were significantly associated with higher LAEP scores, indicating poorer tolerability. Specific adverse events, such as hair loss, were independently associated with the LTG/VPA combination. Cognitive side effects were notably prominent across all five dual ASM combinations. While dual ASM therapy is associated with an increased burden of AE, this increase appears to be moderate when therapies are individually tailored. Increased awareness and systematic screening of AE, particularly cognitive side effects, are essential to optimize treatment outcomes.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 86-94"},"PeriodicalIF":2.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403087","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
Education and empathy through cinema: Lessons from seizure: The medical treatment and social problems of epilepsy (1951)
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-01-23 DOI: 10.1016/j.seizure.2025.01.020
Francesco Brigo
{"title":"Education and empathy through cinema: Lessons from seizure: The medical treatment and social problems of epilepsy (1951)","authors":"Francesco Brigo","doi":"10.1016/j.seizure.2025.01.020","DOIUrl":"10.1016/j.seizure.2025.01.020","url":null,"abstract":"","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 14-15"},"PeriodicalIF":2.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081631","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
Is lamotrigine a teratogen?
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-01-21 DOI: 10.1016/j.seizure.2025.01.019
Frank JE Vajda , Simon R L Vajda , Mervyn J Eadie

Aim

To assess whether lamotrigine (Lamictal), when used in antiseizure medication (ASM) monotherapy, is a teratogen.

Materials/Methods

Analysis of data from 490 LTG monotherapy treated pregnancies and 214 pregnancies in women with epilepsy not exposed to any antiseizure medications during at least the first half of pregnancy.

Results

The LTG-treated and the untreated pregnancies were well matched in nearly all regards apart from ASM exposure. There was a foetal malformation (FM) occurrence rate of 4.49 % in the LTG-exposed pregnancies and 3.27 % in the untreated pregnancies (Risk Ratio = 1.37; 95 % C.I. 0.60, 3.16). Logistic regression produced no evidence that the extent of the LTG-associated malformation occurrence hazard was LTG dose related. However, the malformation-affected body regions tended to differ between the LTG-treated and untreated pregnancies.

Conclusion

The above findings do not reach a statistically significant level (P < 0.05) but, taken overall, they do not necessarily exclude the possibility that LTG may be a weak teratogen. If LTG monotherapy-associated foetal malformation occurrence rates are used as the comparator against which to evaluate the foetal malformation hazards associated with other ASMs, the findings may possibly be open to the risk of falsely reassuring outcomes.
{"title":"Is lamotrigine a teratogen?","authors":"Frank JE Vajda ,&nbsp;Simon R L Vajda ,&nbsp;Mervyn J Eadie","doi":"10.1016/j.seizure.2025.01.019","DOIUrl":"10.1016/j.seizure.2025.01.019","url":null,"abstract":"<div><h3>Aim</h3><div>To assess whether lamotrigine (Lamictal), when used in antiseizure medication (ASM) monotherapy, is a teratogen.</div></div><div><h3>Materials/Methods</h3><div>Analysis of data from 490 LTG monotherapy treated pregnancies and 214 pregnancies in women with epilepsy not exposed to any antiseizure medications during at least the first half of pregnancy.</div></div><div><h3>Results</h3><div>The LTG-treated and the untreated pregnancies were well matched in nearly all regards apart from ASM exposure. There was a foetal malformation (FM) occurrence rate of 4.49 % in the LTG-exposed pregnancies and 3.27 % in the untreated pregnancies (Risk Ratio = 1.37; 95 % C.I. 0.60, 3.16). Logistic regression produced no evidence that the extent of the LTG-associated malformation occurrence hazard was LTG dose related. However, the malformation-affected body regions tended to differ between the LTG-treated and untreated pregnancies.</div></div><div><h3>Conclusion</h3><div>The above findings do not reach a statistically significant level (<em>P</em> &lt; 0.05) but, taken overall, they do not necessarily exclude the possibility that LTG may be a weak teratogen. If LTG monotherapy-associated foetal malformation occurrence rates are used as the comparator against which to evaluate the foetal malformation hazards associated with other ASMs, the findings may possibly be open to the risk of falsely reassuring outcomes<strong>.</strong></div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 1-5"},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041396","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
Radiofrequency-thermocoagulation in pediatric epilepsy surgery: A systematic review and pooled analysis of cases
IF 2.7 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-01-13 DOI: 10.1016/j.seizure.2025.01.012
Juan S. Bottan , Fuad Almalki , Maryam Nabavi Nouri , Jonathan C. Lau , Alla Iansavichene , Greydon Gilmore , Michael Miller , Sandrine de Ribaupierre , Andrea V. Andrade

Objective

To conduct a systematic review on radiofrequency thermocoagulation (RF-TC) in pediatric epilepsy surgery. In addition, due to the low number of dedicated pediatric series, to conduct a pooled analysis of cases published in the literature.

Methods

We conducted a literature search using PUBMED and EMBASE which produced 432 results. We excluded studies on hypothalamic hamartomas and non-RF-TC procedures such as stereotactic radiosurgery and laser interstitial thermal ablation. Stereotactic RF-TC and SEEG-guided RF-TC procedures were included. Case series and case reports with individualized data were further reviewed and pediatric cases were extracted for pooled analysis. Patient demographics, electroclinical and neuroimaging data, procedure outcomes, responder rates and complications were collected. Our unpublished experience in pediatric SEEG-guided RF-TC was included in the pooled analysis.

Results

We identified 33 articles for the literature review, 24 of them were selected for pooled analysis (93 cases). Sixty patients underwent SEEG-guided RF-TC. For adult and pediatric mixed series reported a 67% responder rate and 32% seizure freedom at 1 year. For exclusively pediatric series, 90% responder rate and 71% Seizure freedom. In the pooled analysis, seizure freedom was achieved in 45.2% and responder rate was 74.2% with a mean follow-up was 25.2 months (SD ± 26.6). Complication rates were low, transient neurological deficits were reported in 18 cases (19.4%) and no deaths were associated with RF-TC. The insula and the dominant frontal lobe were the most frequent targets for ablation. Studies included were highly heterogenous and quality of evidence was low.

Significance

There are few pediatric studies evaluating RF-TC. Safety and efficacy in children seem to be similar to that reported in larger adult series, although more studies are needed. Most cases reviewed where extracted from heterogeneous adult and pediatric series. Patients with small, high-risk surgical targets are ideal candidates for this procedure.
{"title":"Radiofrequency-thermocoagulation in pediatric epilepsy surgery: A systematic review and pooled analysis of cases","authors":"Juan S. Bottan ,&nbsp;Fuad Almalki ,&nbsp;Maryam Nabavi Nouri ,&nbsp;Jonathan C. Lau ,&nbsp;Alla Iansavichene ,&nbsp;Greydon Gilmore ,&nbsp;Michael Miller ,&nbsp;Sandrine de Ribaupierre ,&nbsp;Andrea V. Andrade","doi":"10.1016/j.seizure.2025.01.012","DOIUrl":"10.1016/j.seizure.2025.01.012","url":null,"abstract":"<div><h3>Objective</h3><div>To conduct a systematic review on radiofrequency thermocoagulation (RF-TC) in pediatric epilepsy surgery. In addition, due to the low number of dedicated pediatric series, to conduct a pooled analysis of cases published in the literature.</div></div><div><h3>Methods</h3><div>We conducted a literature search using PUBMED and EMBASE which produced 432 results. We excluded studies on hypothalamic hamartomas and non-RF-TC procedures such as stereotactic radiosurgery and laser interstitial thermal ablation. Stereotactic RF-TC and SEEG-guided RF-TC procedures were included. Case series and case reports with individualized data were further reviewed and pediatric cases were extracted for pooled analysis. Patient demographics, electroclinical and neuroimaging data, procedure outcomes, responder rates and complications were collected. Our unpublished experience in pediatric SEEG-guided RF-TC was included in the pooled analysis.</div></div><div><h3>Results</h3><div>We identified 33 articles for the literature review, 24 of them were selected for pooled analysis (93 cases). Sixty patients underwent SEEG-guided RF-TC. For adult and pediatric mixed series reported a 67% responder rate and 32% seizure freedom at 1 year. For exclusively pediatric series, 90% responder rate and 71% Seizure freedom. In the pooled analysis, seizure freedom was achieved in 45.2% and responder rate was 74.2% with a mean follow-up was 25.2 months (SD ± 26.6). Complication rates were low, transient neurological deficits were reported in 18 cases (19.4%) and no deaths were associated with RF-TC. The insula and the dominant frontal lobe were the most frequent targets for ablation. Studies included were highly heterogenous and quality of evidence was low.</div></div><div><h3>Significance</h3><div>There are few pediatric studies evaluating RF-TC. Safety and efficacy in children seem to be similar to that reported in larger adult series, although more studies are needed. Most cases reviewed where extracted from heterogeneous adult and pediatric series. Patients with small, high-risk surgical targets are ideal candidates for this procedure.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"126 ","pages":"Pages 6-13"},"PeriodicalIF":2.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061276","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
期刊
Seizure-European Journal of Epilepsy
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