Seizure-European Journal of Epilepsy最新文献_第6页

Cenobamate in adult patients with epilepsy and intellectual disability 在成人癫痫和智力残疾患者中使用

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-23 DOI: 10.1016/j.seizure.2025.11.017

David Steinbart , Rebekka Geelhaar , Rebekka Lehmann , Anja Grimmer , Martin Holtkamp

Objective

In people with intellectual disability (ID), prevalence of epilepsy is up to 50-times higher than in the general population and often difficult to treat. Multiple randomized controlled, observational and retrospective studies have demonstrated favorable efficacy of adjunctive cenobamate (CNB). So far, people with epilepsy and ID (PWE+ID) have remained significantly underrepresented. This retrospective study evaluated efficacy and tolerability of CNB specifically in adult PWE+ID compared to those without ID (PWE-ID).

Methods

Between 2021 and 2024, PWE at a tertiary epilepsy center were surveyed by telephone on a quarterly basis as part of clinical quality control after starting CNB. Retention rate, seizure outcome (comparing the preceding 3 months to 3 months baseline), and adverse events were assessed. Chi-square and Mann–Whitney U tests were used to compare groups, and a Bayesian analysis evaluated non-inferiority.

Results

A total of 108 PWE (51 PWE+ID) were monitored over 12 months after CNB initiation. Retention rates significantly differed between patients with and without ID after 3 months (100 % vs. 84 %, p = 0.04), but were not different after 6 (88 % vs. 77 %, p = 0.57) and 12 months (75 % vs. 70 %, p = 0.99). The 50 % responder rates were comparable at 6 months (46 % in PWE+ID vs. 47 % in PWE-ID, p = 0.99) and at 12 months (53 % vs. 53 %, p = 0.99). At 12 months, 21 % of PWE+ID (13 % of PWE-ID, p = 0.69) have remained free of disabling seizures. In Bayesian analysis, the probability of non-inferiority of 12-month outcomes in PWE+ID compared to PWE-ID was 97 % for retention and 94 % for 50 % responder rates. Adverse events (most frequently tiredness and dizziness) were reported by 59 % of PWE+ID (60 % of PWE-ID, p = 0.99) and resulted in CNB discontinuation within 12 months in 24 % of PWE+ID (28 % of PWE-ID, p = 0.70).

Significance

In adult PWE and intellectual disability, cenobamate is similarly efficacious and tolerated as in patients without ID.

目的在智力残疾人群中，癫痫的患病率是一般人群的50倍，且往往难以治疗。多项随机对照、观察性和回顾性研究表明，佐剂cenobamate （CNB）疗效良好。到目前为止，患有癫痫和ID （PWE+ID）的人仍然严重不足。本回顾性研究评估了CNB在成人PWE+ID与无PWE-ID患者（PWE-ID）中的疗效和耐受性。方法于2021 - 2024年间，对某三级癫痫中心的PWE进行季度电话调查，作为启动CNB后临床质量控制的一部分。评估留置率、癫痫发作结果（比较前3个月和3个月基线）和不良事件。组间比较采用卡方检验和Mann-Whitney U检验，贝叶斯分析评价非劣效性。结果CNB启动后12个月内共监测了108例PWE（51例PWE+ID）。3个月后患者与非ID患者的保留率差异显著（100%对84%，p = 0.04），但6个月后（88%对77%，p = 0.57）和12个月后（75%对70%，p = 0.99）没有差异。50%的应答率在6个月时（PWE+ID组46%对PWE-ID组47%，p = 0.99）和12个月时（53%对53%，p = 0.99）具有可比性。在12个月时，21%的PWE+ID患者（13%的PWE-ID患者，p = 0.69）没有出现致残性癫痫发作。在贝叶斯分析中，与PWE-ID相比，PWE+ID的12个月结果的非劣效性概率为保留率为97%，50%应答率为94%。59%的PWE+ID患者（60%的PWE-ID患者，p = 0.99）报告了不良事件（最常见的是疲倦和头晕），24%的PWE+ID患者（28%的PWE-ID患者，p = 0.70）在12个月内停止服用CNB。在成人PWE和智力残疾患者中，cenobamate与没有ID的患者同样有效和耐受性。

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引用次数: 0

Asymmetry in the diffusion tensor image analysis along the perivascular space index predicts seizure outcome in MRI-negative focal epilepsy 沿血管周围空间指数的扩散张量图像分析的不对称性预测mri阴性局灶性癫痫的发作结果

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-20 DOI: 10.1016/j.seizure.2025.11.015

Jungyon Yum , Wonwoo Lee , Woo-Seok Ha , JaeWook Jeong , Kyung Min Kim , Min Kyung Chu , Won-Joo Kim , Soomi Cho

Purpose

We evaluated diffusion tensor image analysis along the perivascular space (DTI-ALPS) index asymmetry as an imaging correlate of glymphatic activity and its prognostic value in MRI-negative focal epilepsy.

Methods

We retrospectively studied 134 patients with MRI-negative focal epilepsy who underwent DTI (3T MRI) with >2-year follow-up. DTI-ALPS asymmetry index (AI) was calculated as |left-right|/mean. Multivariable logistic regression identified predictors of seizure freedom (SF; >1 year seizure-free) at last follow-up. Significant AI-correlated variables underwent mediation analysis. Cox proportional hazards models evaluated the association between DTI-ALPS AI and time to (1) first post-MRI SF and (2) final SF.

Results

Of the 134 patients (median age, 31 years; 72 female), 76 (57%) achieved SF at last follow-up. Compared to those without SF, patients with SF had significantly shorter epilepsy duration (median, 8 years vs. 15 years; p = 0.029), lower seizure frequency (median, 1 vs. 5; p < 0.001), and lower DTI-ALPS AI (median, 0.064 vs. 0.119; p < 0.001). In multivariable logistic regression, DTI-ALPS AI (odds ratio [OR] per 0.1 increase, 0.271; 95% confidence interval [CI], 0.135–0.493; p < 0.001) and seizure frequency (OR, 0.967; 95% CI, 0.940–0.992; p = 0.013) predicted SF at last follow-up. The effect of DTI-ALPS AI on long-term seizure outcomes was not significantly mediated by disease duration (average direct effect, –0.670; 95% CI, –0.841 to –0.486; p < 0.001; average causal mediated effect, –0.098; 95% CI, –0.259 to 0.056; p = 0.266). Patients with low DTI-ALPS AI (< 0.074) achieved SF earlier after MRI (p_Log-rank = 0.012, p_{Cox regression} = 0.006) and were more likely to be seizure-free at last follow-up (both p_Log-rank and p_{Cox regression} < 0.001).

Conclusion

Asymmetry in the DTI-ALPS index may reflect interhemispheric differences in glymphatic function that are driven by localized, lateralized seizure activity, and may thereby serve as a prognostic marker in MRI-negative focal epilepsy.

目的探讨沿血管周围间隙弥散张量图像分析（DTI-ALPS）指数不对称性与mri阴性局灶性癫痫中淋巴活性的影像相关性及其预后价值。方法回顾性分析134例MRI阴性局灶性癫痫患者行DTI （3T MRI）检查，随访2年。DTI-ALPS不对称指数（AI）计算为|左右|/平均值。多变量logistic回归确定了最后随访时癫痫发作自由（SF; >；1年无癫痫发作）的预测因素。对显著ai相关变量进行中介分析。Cox比例风险模型评估了DTI-ALPS AI与到达(1)mri后首次SF和(2)最终SF的时间之间的关系。结果134例患者（中位年龄31岁，女性72例）中，76例（57%）在末次随访时实现SF。与没有SF的患者相比，SF患者癫痫持续时间明显缩短（中位数，8年对15年，p = 0.029），发作频率明显降低（中位数，1比5；p < 0.001）， DTI-ALPS AI明显降低（中位数，0.064比0.119;p < 0.001）。在多变量logistic回归中，DTI-ALPS AI（比值比[OR]每增加0.1,0.271；95%可信区间[CI]， 0.135-0.493; p < 0.001）和癫痫发作频率（OR, 0.967; 95% CI, 0.940-0.992; p = 0.013）预测末次随访时SF。DTI-ALPS AI对长期癫痫发作结局的影响不受疾病持续时间的显著介导（平均直接效应，-0.670;95% CI, -0.841 ~ -0.486; p < 0.001；平均因果介导效应，-0.098;95% CI, -0.259 ~ 0.056; p = 0.266）。低DTI-ALPS AI患者（< 0.074）在MRI后更早出现SF (pLog-rank = 0.012， pCox回归= 0.006)，并且在最后随访时更有可能无癫痫发作（pLog-rank和pCox回归<； 0.001）。结论DTI-ALPS指数的不对称可能反映了局部、偏侧癫痫活动驱动的半球间淋巴功能差异，因此可能作为mri阴性局灶性癫痫的预后指标。

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引用次数: 0

Response to comments of Ďurčová et al 对Ďurčová等人评论的回应

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-19 DOI: 10.1016/j.seizure.2025.11.014

Rekha Dwivedi, Yogendra Kumar Gupta, Meenakshi Singh, Rupa Joshi, Prabhakar Tiwari, Thomas Kaleekal, Manjari Tripathi

引用次数: 0

Scoping review: Sexual dysfunction in people with epilepsy 范围回顾：癫痫患者的性功能障碍。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-16 DOI: 10.1016/j.seizure.2025.11.013

Sumika Ouchida , Armin Nikpour , Greg Fairbrother

Background

There are many comorbidities related to epilepsy that affect the quality of life of people with epilepsy (PWE); sexual dysfunction (SD) is one of them.

Aim

We conducted a review to identify gaps in the literature to estimate the size of the problem and examined sexual dysfunction types, factors associated with SD, epilepsy care management, and facilitators/barriers reported for treatment success/failure.

Method

We searched for articles on sexual dysfunction, sexual problems, sexual behaviour, and erectile dysfunction in relation to epilepsy. We searched research databases, including Embase, Medline, PsycINFO, and PubMed, for articles written in English and published between 2000 and 2023.

Results

There is a high prevalence of SD in PWE, and multiple factors have been identified as being associated with SD. A range of validated questionnaire-based SD assessments is available. SD affects men and women differently. While several treatments and therapies are available to manage SD, there is limited evidence supporting their use for PWE. Healthcare professionals' lack of education relevant to SD affects their ability to treat PWE effectively.

Conclusion

Sexual problems are common in PWE. Healthcare providers should investigate drug-induced sexual problems as they can significantly affect patients' quality of life. Unfortunately, there are no established guidelines for treating sexual problems in epilepsy patients. More research is needed on treatments, and healthcare providers require additional education on SD-related issues to diagnose and effectively address these problems.

背景：有许多与癫痫相关的合并症影响癫痫患者（PWE）的生活质量；性功能障碍（SD）就是其中之一。目的：我们进行了一项综述，以确定文献中的差距，以估计问题的大小，并检查了性功能障碍的类型、与SD相关的因素、癫痫护理管理以及治疗成功/失败的促进因素/障碍。方法：我们检索与癫痫有关的性功能障碍、性问题、性行为和勃起功能障碍的文章。我们检索了研究数据库，包括Embase、Medline、PsycINFO和PubMed，检索了2000年至2023年间发表的英文文章。结果：PWE患者SD患病率高，且多种因素与SD相关。一系列有效的基于问卷的可持续发展评估是可用的。SD对男性和女性的影响是不同的。虽然有几种治疗方法可用于治疗SD，但支持它们用于PWE的证据有限。医疗保健专业人员缺乏与SD相关的教育影响了他们有效治疗PWE的能力。结论：PWE患者存在性问题。医疗保健提供者应调查药物引起的性问题，因为它们可以显著影响患者的生活质量。不幸的是，目前还没有治疗癫痫患者性问题的既定指南。需要对治疗方法进行更多的研究，医疗保健提供者需要更多关于sd相关问题的教育，以诊断和有效地解决这些问题。

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引用次数: 0

Seizures sparked by spironolactone: A case report 由螺内酯引起的癫痫发作：一例报告。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-11 DOI: 10.1016/j.seizure.2025.11.012

Mazieyar Azad , Thao Nguyen , Suparna Krishnaiengar , Katherine Zarroli

引用次数: 0

Brivaracetam vs. Oxcarbazepine in childhood self-limited focal epilepsies (BRAVO-SeLFEs): A pilot randomized controlled trial 布瓦西坦与奥卡西平治疗儿童自限性局灶性癫痫（BRAVO-SeLFEs）：一项随机对照试验

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-09 DOI: 10.1016/j.seizure.2025.11.011

Fathima Fasin , Ankit Kumar Meena , Saurabh Agarwal , Lokesh Saini , Sujatha Manjunathan , Tanu Gupta , Rahul Gupta , Ashwini Chityala , Jagdish Prasad Goyal , Naresh Nebhinani , Kuldeep Singh

Purpose

To compare the efficacy, safety, and behavioral outcomes of brivaracetam with oxcarbazepine in children with self-limited focal epilepsies (SeLFEs).

Methods

This is an open-label pilot randomized controlled trial conducted at a tertiary referral center in India. 50 children aged 2–18 years with SeLFEs were enrolled. They were randomized (1:1) to receive either brivaracetam (intervention) or oxcarbazepine (control) for 6 months. The primary endpoint was seizure freedom at 6 months. The secondary end points included epilepsy severity assessment using the Early Childhood Epilepsy Severity Scale (E-Chess), behavioral evaluation with the Child Behavior Checklist (CBCL), and functional assessment via the Vineland Social Maturity Scale (VSMS). Safety outcomes and feasibility parameters were recorded.

Results

At 6 months, seizure freedom was similar in the intervention (92 %) and control (86 %) groups with similar median cumulative seizures (16 vs. 22, p = 0.37). Both groups showed within-group reductions in median E-Chess scores [baseline, 5 (IQR 5–7); at 6 months, 3 (IQR 3–3)] but no intergroup differences at 6 months. The group x time interaction was not significant (ß = 0.44, p = 0.26). The median VSMS scores were comparable in both control [95 (IQR 91.5–97) to 96 (IQR 93–97)] and intervention [96 (IQR 93.5–98) to 97 (IQR 95–99.5)] groups. No behavioral abnormalities were noted in any participant (CBCL, T < 60). One child in the oxcarbazepine group developed a skin rash requiring drug withdrawal; no adverse effects were reported in the brivaracetam group. The retention rate was high (96 %) with comparable safety and feasibility.

Conclusion

Brivaracetam and oxcarbazepine achieved similar rates of seizure freedom at 6 months without causing any clinically significant behavioral abnormalities in either group.

目的比较布瓦西坦与奥卡西平治疗儿童自限性局灶性癫痫的疗效、安全性和行为结局。方法：这是一项在印度三级转诊中心进行的开放标签试点随机对照试验，招募了50名2-18岁的自恋儿童。他们随机（1:1）接受布伐西坦（干预）或奥卡西平（对照）治疗6个月。主要终点是6个月时癫痫发作自由。次要终点包括使用早期儿童癫痫严重程度量表（E-Chess）进行癫痫严重程度评估，使用儿童行为检查表（CBCL）进行行为评估，以及通过Vineland社会成熟度量表（VSMS）进行功能评估。记录安全结果和可行性参数。结果6个月时，干预组（92%）和对照组（86%）的癫痫发作自由度相似，中位累积癫痫发作相似（16 vs. 22, p = 0.37）。两组均显示组内电子象棋分数中位数下降[基线，5 (IQR 5 - 7)；6个月时，3 (IQR 3 - 3)]，但6个月时各组间无差异。组x时间交互作用不显著（ß = 0.44, p = 0.26）。对照组[95 （IQR 91.5-97）至96 (IQR 93-97)]和干预组[96 （IQR 93.5-98）至97 (IQR 95 - 99.5)]的中位VSMS评分具有可比性。未发现任何参与者的行为异常（CBCL, T < 60）。奥卡西平组的一名儿童出现皮疹，需要停药；布瓦西坦组未见不良反应。保留率高（96%），安全性和可行性相当。结论布瓦西坦和奥卡西平在6个月时癫痫发作自由率相似，两组患者均未出现明显的临床行为异常。

{"title":"Brivaracetam vs. Oxcarbazepine in childhood self-limited focal epilepsies (BRAVO-SeLFEs): A pilot randomized controlled trial","authors":"Fathima Fasin , Ankit Kumar Meena , Saurabh Agarwal , Lokesh Saini , Sujatha Manjunathan , Tanu Gupta , Rahul Gupta , Ashwini Chityala , Jagdish Prasad Goyal , Naresh Nebhinani , Kuldeep Singh","doi":"10.1016/j.seizure.2025.11.011","DOIUrl":"10.1016/j.seizure.2025.11.011","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the efficacy, safety, and behavioral outcomes of brivaracetam with oxcarbazepine in children with self-limited focal epilepsies (SeLFEs).</div></div><div><h3>Methods</h3><div>This is an open-label pilot randomized controlled trial conducted at a tertiary referral center in India. 50 children aged 2–18 years with SeLFEs were enrolled. They were randomized (1:1) to receive either brivaracetam (intervention) or oxcarbazepine (control) for 6 months. The primary endpoint was seizure freedom at 6 months. The secondary end points included epilepsy severity assessment using the Early Childhood Epilepsy Severity Scale (E-Chess), behavioral evaluation with the Child Behavior Checklist (CBCL), and functional assessment via the Vineland Social Maturity Scale (VSMS). Safety outcomes and feasibility parameters were recorded.</div></div><div><h3>Results</h3><div>At 6 months, seizure freedom was similar in the intervention (92 %) and control (86 %) groups with similar median cumulative seizures (16 vs. 22, <em>p</em> = 0.37). Both groups showed within-group reductions in median E-Chess scores [baseline, 5 (IQR 5–7); at 6 months, 3 (IQR 3–3)] but no intergroup differences at 6 months. The group x time interaction was not significant (<em>ß</em> = 0.44, <em>p</em> = 0.26). The median VSMS scores were comparable in both control [95 (IQR 91.5–97) to 96 (IQR 93–97)] and intervention [96 (IQR 93.5–98) to 97 (IQR 95–99.5)] groups. No behavioral abnormalities were noted in any participant (CBCL, <em>T</em> < 60). One child in the oxcarbazepine group developed a skin rash requiring drug withdrawal; no adverse effects were reported in the brivaracetam group. The retention rate was high (96 %) with comparable safety and feasibility.</div></div><div><h3>Conclusion</h3><div>Brivaracetam and oxcarbazepine achieved similar rates of seizure freedom at 6 months without causing any clinically significant behavioral abnormalities in either group.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"134 ","pages":"Pages 1-5"},"PeriodicalIF":2.8,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145537279","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

Exploration of the mechanism of action of cenobamate cenobamate的作用机制探讨。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-07 DOI: 10.1016/j.seizure.2025.11.010

Raman Sankar , Louis Ferrari , Marc Kamin

Antiseizure medications have varied effects on neurotransmitter receptors and ion channels in the brain, yet how these mechanisms of action (MoAs) translate to clinical efficacy is not well understood. Cenobamate, a tetrazole alkyl carbamate antiseizure medication (ASM), has a dual MoA: preferential inhibition of the persistent sodium current (I_NaP) while sparing the transient sodium current (I_NaT), combined with extrasynaptic tonic inhibition mediated by positive allosteric modulation of gamma-aminobutyric acid type A (GABA_A) receptors. In preclinical studies, cenobamate demonstrated broad-spectrum activity across various animal models of focal and generalized seizures. In clinical trials, cenobamate demonstrated rates of seizure freedom not observed with other voltage-gated sodium channel blockers (SCBs), whose main MoA involves modulating I_NaT or GABA_A. In addition, real-world evidence suggests cenobamate may have efficacy in adult Dravet syndrome, a loss-of-function sodium channelopathy typically aggravated by SCBs. Cenobamate’s selectivity for I_NaP occurs at therapeutic concentrations, a characteristic seemingly unique among ASMs. Moreover, cenobamate preferentially modulates tonic (extrasynaptic) currents over phasic (synaptic) GABA_A currents. These combined mechanistic effects may represent an emerging class of ASMs and could explain cenobamate’s broad-spectrum effect in animal seizure models and its efficacy for focal seizures in humans. In this review, we examine how cenobamate interacts with sodium currents and GABA receptor physiology and review cenobamate’s efficacy profile in humans. Finally, we will postulate how specific aspects of cenobamate’s dual MoA may contribute to its efficacy in comparison to other ASMs with similar MoAs.

抗癫痫药物对大脑中的神经递质受体和离子通道有不同的影响，但这些作用机制（MoAs）如何转化为临床疗效尚不清楚。Cenobamate是一种四唑烷基氨基甲酸酯类抗癫痫药物（ASM），具有双重MoA：优先抑制持续钠电流（INaP），同时保留瞬态钠电流（INaT），结合γ -氨基丁酸a型（GABAA）受体的正变构调节介导的突触外紧张性抑制。在临床前研究中，cenobamate在各种动物模型局灶性和全局性癫痫发作中表现出广谱活性。在临床试验中，cenobamate表现出的癫痫发作自由率与其他电压门控钠通道阻滞剂（scb）不同，后者的主要MoA涉及调节INaT或GABAA。此外，实际证据表明，cenobamate可能对成人Dravet综合征有效，这是一种功能丧失的钠通道病变，通常由scb加重。在治疗浓度下，Cenobamate对INaP的选择性发生，这似乎是asm中独有的特征。此外，相较于相位（突触）GABAA电流，左脑突起优先调节强直性（突触外）电流。这些综合的机制作用可能代表了一种新兴的asm，并可以解释cenobamate在动物癫痫模型中的广谱效应及其对人类局灶性癫痫发作的疗效。在这篇综述中，我们研究了cenobamate如何与钠电流和GABA受体生理相互作用，并回顾了cenobamate在人体中的疗效。最后，我们将假设与其他具有类似MoA的asm相比，cenobamate的双MoA的特定方面如何有助于其疗效。

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引用次数: 0

Educational attainment of children with self-limited epilepsy with CentroTemporal spikes (SELECTS), other epilepsies, and without epilepsy: A retrospective cohort study 伴有中央颞叶尖峰（SELECTS）、其他癫痫和无癫痫的自限性癫痫患儿的受教育程度：一项回顾性队列研究

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-07 DOI: 10.1016/j.seizure.2025.11.009

Arron S Lacey , Carys B Jones , Christopher J Weir , Jacqueline Stephen , William Owen Pickrell , Richard F Chin

Background

Children with epilepsy may have poorer educational outcomes—this may not be true for all epilepsy syndromes. We investigate educational attainment of children with Self-Limited Epilepsy with CentroTemporal Spikes (SELECTS) in Wales.

Method

A retrospective cohort study using routinely-collected data for children in Wales. We used primary care diagnosis codes to identify children (0–16 years) with SELECTS, other epilepsies, and children without epilepsy (comparators). We linked these records to Key Stage (KS) 2, 3 and 4 (ages 11,14, and 16) national educational test results (2003–2021). We performed logistic regression to analyse attainment (proportion achieving required attainment) in children with SELECTS, other epilepsies, and comparators.

Results

At KS 2,3 and 4: 101,92 and 81 children with SELECTS were matched to 299,274 and 243 children with other epilepsies and comparators. A lower proportion of the SELECTS and other epilepsies groups achieved required attainment than the comparators across all key stages.

After adjusting for sex, deprivation, year of study and Anti-Seizure Medications (ASM), children with SELECTS had similar achievement to comparators in KS2 and KS3:adjusted Odds Ratio (aOR,[95 %CI]) for achieving requirement:KS2:aOR=0.97[0.87–1.09];KS3:aOR=0.99[0.88–1.10]; but slightly reduced KS4 achievement:aOR=0.89,[0.80–1.00]. Children with other epilepsies were significantly less likely to achieve the requirement than comparators:KS2:aOR=0.79[0.72–0.87], KS3:aOR=0.78[0.71–0.86],KS4:aOR=0.72[0.65–0.80].

Conclusions

There was a trend for poorer educational achievement for children with SELECTS at KS4; this was only borderline statistically significant in the adjusted model. Children with other epilepsies had an increased risk of poorer attainment across all ages when compared to children without epilepsy.

背景：癫痫患儿的学习成绩可能较差，但并非所有癫痫综合征患者都是如此。我们调查了威尔士有中央颞叶尖峰（SELECTS）的自限性癫痫患儿的受教育程度。方法回顾性队列研究，使用常规收集的威尔士儿童数据。我们使用初级保健诊断代码来识别患有select、其他癫痫和无癫痫的儿童（0-16岁）（比较者）。我们将这些记录与关键阶段（KS） 2,3和4（11岁，14岁和16岁）国家教育考试结果（2003-2021）联系起来。我们采用逻辑回归分析select患儿、其他癫痫患儿和比较者的学业成就（达到要求学业成就的比例）。结果sks 2、3和4:select患儿101例、92例和81例与其他癫痫患儿299274例和243例相匹配。在所有关键阶段，与比较组相比，select组和其他癫痫组达到所需成就的比例较低。在调整性别、剥夺、学习年份和抗癫痫药物（ASM）后，select儿童在KS2和KS3方面的成就与比较者相似：达到要求的调整优势比（aOR,[95% CI]）：KS2:aOR=0.97[0.87-1.09], KS3:aOR=0.99[0.88-1.10]；但KS4成绩略有下降：aOR=0.89,[0.80-1.00]。其他癫痫患儿达到要求的可能性明显低于对照组：KS2:aOR=0.79[0.72 - 0.87], KS3:aOR=0.78[0.71-0.86],KS4:aOR=0.72[0.65-0.80]。结论小学四年级select儿童的学习成绩有较差的趋势；在调整后的模型中，这仅具有临界统计学意义。与没有癫痫的儿童相比，患有其他癫痫的儿童在所有年龄段的学习成绩较差的风险增加。

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引用次数: 0

Modified atkins diet in children with developmental and epileptic encephalopathy with spike-wave activation in sleep (D/EE-SWAS): A prospective interventional, non-randomized, single-arm study 改良阿特金斯饮食在发展性和癫痫性脑病伴睡眠尖波激活（D/EE-SWAS）患儿中的应用：一项前瞻性、非随机、单臂研究

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-06 DOI: 10.1016/j.seizure.2025.11.007

Shagun Singh , Arushi Gahlot Saini , Deepika Puri , Smita Pattanaik , Rajni Sharma , Prahbhjot Malhi , Renu Suthar , Jitendra K Sahu , Naveen Sankhyan

Purpose

Developmental and Epileptic encephalopathy with spike-wave activation in sleep (D/EE-SWAS) is a rare and severe childhood epilepsy syndrome often associated with cognitive and language regression. While the ketogenic diet has shown efficacy in drug-resistant epilepsy, its role in D/EE-SWAS remains inadequately studied. This prospective study aimed to evaluate the efficacy and tolerability of the modified Atkins diet (MAD) in children with D/EE-SWAS refractory to standard therapies.

Methods

This was a single-arm, prospective interventional study conducted at a tertiary pediatric neurology unit from January 2022 to June 2023. Children aged 2–16 years with a confirmed diagnosis of D/EE-SWAS, with SWI ≥50 % during NREM sleep on EEG, and clinical evidence of seizure or neurodevelopmental regression despite treatment with at least two ASMs and corticosteroids were enrolled. The primary outcome was the change in SWI at 12 weeks. Secondary outcomes included seizure burden, cognitive outcomes (social quotient), and parent-reported language and behaviour changes at 24 weeks.

Results

Twenty-two children were enrolled; 10 completed 12 weeks and five completed 24 weeks of MAD. At 12 weeks, only 33 % showed a good EEG response (>50 % SWI reduction); one child achieved complete resolution at 24 weeks. Seizure remission (including maintenance of remission in those with no clinical seizures) was observed in 82 %, 90 %, and 100 % at 4, 12, and 24 weeks, respectively. No significant change in cognitive scores was seen. However, 60 % and 40 % of parents reported improvements in language and behaviour. Adverse effects were mostly mild, and compliance was a major barrier, with 54 % discontinuing the diet before 12 weeks.

Conclusion

The MAD was safe but not effective in the treatment of D/EE-SWAS in the short-term, with improvements only seen in seizure control. Its impact on EEG and cognition appears limited in the short-term and poor adherence poses significant challenges.

目的：发展性和癫痫性脑病伴睡眠尖波激活（D/EE-SWAS）是一种罕见且严重的儿童癫痫综合征，常伴有认知和语言退化。虽然生酮饮食已显示出对耐药癫痫的疗效，但其在D/EE-SWAS中的作用仍未得到充分研究。这项前瞻性研究旨在评估改良阿特金斯饮食（MAD）对标准治疗难治性D/EE-SWAS患儿的疗效和耐受性。方法：这是一项单臂前瞻性介入研究，于2022年1月至2023年6月在一所三级儿科神经内科进行。年龄2-16岁的儿童，确诊为D/EE-SWAS，脑电图非快速眼动睡眠期间SWI≥50%，尽管接受了至少两次asm和皮质类固醇治疗，但仍有癫痫发作或神经发育倒退的临床证据。主要终点是12周时SWI的变化。次要结果包括癫痫发作负担、认知结果（社会商数）和父母报告的24周时的语言和行为变化。结果：22名儿童入组；10人完成了12周的MAD， 5人完成了24周的MAD。12周时，只有33%的患者表现出良好的脑电图反应（SWI减少50%）；一个孩子在24周时完全康复。在第4周、第12周和第24周，癫痫发作缓解（包括无临床癫痫发作患者的缓解维持）分别为82%、90%和100%。认知评分没有明显变化。然而，60%和40%的父母报告说，他们的语言和行为有所改善。副作用大多是轻微的，依从性是主要障碍，54%的患者在12周前停止饮食。结论：MAD在短期内治疗D/EE-SWAS是安全的，但并不有效，仅在癫痫发作控制方面有所改善。它对脑电图和认知的影响在短期内似乎有限，依从性差带来了重大挑战。

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引用次数: 0

Cytotoxic lesions of the corpus callosum related to epilepsy or anti-seizure medications: a systematic review 与癫痫或抗癫痫药物相关的胼胝体细胞毒性病变：系统综述

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2025-11-06 DOI: 10.1016/j.seizure.2025.11.008

Gianni Cutillo , Guido Bonelli , Martina Rubin , Giordano Cecchetti , Jacopo Lanzone , Davide G. Curti , Anna Bellini , Giovanna F. Fanelli , Massimo Filippi

Background

Cytotoxic lesions of the corpus callosum (CLOCCs) are unusual MRI findings in epilepsy patients, often related to sudden anti-seizure medication (ASM) discontinuation or seizures. We reviewed the data of patients with epilepsy and/or under ASMs who developed CLOCCs, defining their clinical course focusing on therapies and intercurrent seizures.

Methods

A systematic review was performed including articles reporting on adult and pediatric patients who developed a CLOCC following ASMs modification and/or related to epilepsy.

Results

80 patients from 45 studies were included (44 females), 19 (24%) pediatric patients and 61 (76%) adults. 86% lesions were classified as Starkey A. CLOCCs were related to ASM withdrawal in 27 (34%) patients, seizure activity in 23 (29%), seizure activity with concomitant ASM variation in 18 (23%), ASM initiation in 5 (6%), ASM switch in 3 (4%) cases. The most frequent ASMs used in the sample were carbamazepine (30), phenytoin (14) and lamotrigine (13) however, non-sodium-channel blockers, e.g., levetiracetam (9) and valproate (8) were reported. CLOCCS regressed in a median time of 15 days (interquartile range [IQR]=14-25) in pediatric patients and 42 days (IQR=28-120) in adults (p<0.01).

Conclusion

CLOCCS are associated to sudden ASM modification or seizures. Regression time may vary widely and seems to be faster in children; moreover, non-sodium channel blockers are an increasingly recognized association.

背景：胼胝体细胞毒性病变（CLOCCs）是癫痫患者罕见的MRI表现，通常与突然停用抗癫痫药物（ASM）或癫痫发作有关。我们回顾了发生CLOCCs的癫痫和/或asm患者的数据，定义了他们的临床过程，重点是治疗和并发性癫痫发作。方法系统回顾了成人和儿童患者在asm修改后发生CLOCC和/或与癫痫相关的文章。结果45项研究共纳入80例患者，其中女性44例，儿童19例（24%），成人61例（76%）。86%的病变被归类为Starkey a。CLOCCs与ASM戒断相关27例（34%），癫痫发作活性23例（29%），癫痫发作活性伴ASM变化18例（23%），ASM开始5例（6%），ASM切换3例（4%）。样本中最常使用的ASMs是卡马西平（30），苯妥英（14）和拉莫三嗪（13），然而，非钠通道阻滞剂，如左乙拉西坦(9)和丙戊酸(8)被报道。儿童患者CLOCCS的中位回归时间为15天（四分位数间距[IQR]=14-25），成人患者为42天（IQR=28-120）（p<0.01）。结论cloccs与突发性ASM改变或癫痫发作有关。回归时间可能差别很大，在儿童中似乎更快；此外，非钠通道阻滞剂也越来越被认可。

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