Seizure-European Journal of Epilepsy最新文献_第7页

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 : 2026-01-01 Epub 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

Does 7 T MRI offer an added value in drug resistant temporal lobe epilepsy? 7 T MRI对耐药颞叶癫痫是否有附加价值？

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-01-01 Epub Date: 2025-11-04 DOI: 10.1016/j.seizure.2025.11.004

Ariadne Zampeli , Miroslav Malac , Isabella M. Björkman-Burtscher , Boel Hansson , Linda Wennberg , Karin Markenroth Bloch , Kristina Källén , Maria Compagno Strandberg

Purpose

To evaluate the added value of 7 Tesla (T) magnetic resonance imaging (MRI) in the presurgical assessment of patients with temporal lobe epilepsy (TLE), considering its overall impact on clinical decision-making, including both MRI-positive and MRI-negative cases, and its timing during the evaluation process.

Methods

Sixty-one patients with drug-resistant TLE, enrolled in this study underwent both 3 T and 7 T MRI, along with other diagnostic assessments (video electroencephalography, positron emission tomography, stereo electroencephalography). Patients were categorized into three phases of the presurgical evaluation: basic, intermediate, and advanced. The added value of 7 T MRI was assessed based on its ability to confirm, exclude, or detect new epileptogenic lesions, as well as its influence on surgical decision-making.

Results

7 T MRI provided added clinical value in 51 % of cases, improving lesion detection and contributing to clinical decisions, particularly in patients with unclear or ambiguous findings. In some instances, it confirmed previously suspected lesions or revealed previously undetected lesions, leading to surgical interventions. It also helped exclude possible lesions, influencing decisions to avoid unnecessary surgery. Notably, hippocampal malrotation (HIMAL) was identified in several patients, warranting further investigation regarding its potential epileptogenic role.

Conclusion

7 T MRI enhances the presurgical evaluation of TLE by improving lesion detection, clarifying ambiguous findings, and aiding clinical decision-making. Its use should be considered at various stages of the evaluation process, as it offers valuable diagnostic information for both MRI-positive and MRI-negative patients. Further research is needed to explore the possible epileptogenic significance of HIMAL.

目的：探讨7特斯拉(T)磁共振成像（MRI）在颞叶癫痫（TLE）患者术前评估中的附加价值，考虑其对临床决策的整体影响，包括MRI阳性和MRI阴性病例，以及在评估过程中的时机。方法：纳入本研究的61例耐药TLE患者接受了3t和7t MRI检查，并进行了其他诊断评估（视频脑电图、正电子发射断层扫描、立体脑电图）。患者被分为三个阶段的术前评估：基础，中期和晚期。7 T MRI的附加价值是根据其确认、排除或发现新的癫痫性病变的能力以及对手术决策的影响来评估的。结果：7t MRI在51%的病例中提供了额外的临床价值，改善了病变检测并有助于临床决策，特别是在发现不明确或模棱两可的患者中。在某些情况下，它证实了以前怀疑的病变或发现了以前未发现的病变，导致手术干预。它还有助于排除可能的病变，影响决定避免不必要的手术。值得注意的是，在一些患者中发现了海马旋转不良（HIMAL），需要进一步研究其潜在的致痫作用。结论：7 T MRI通过改善病变发现、澄清模糊表现、辅助临床决策，增强了TLE的术前评估。应在评估过程的各个阶段考虑其使用，因为它为mri阳性和mri阴性患者提供了有价值的诊断信息。HIMAL可能的致痫意义有待进一步研究。

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引用次数: 0

History of lennox-gastaut syndrome: Sixty years of advancements in therapeutic practices lenox -胃综合征的历史：60年的治疗实践进展

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-01-01 Epub Date: 2025-12-06 DOI: 10.1016/j.seizure.2025.12.004

Philippe Gélisse , Arielle Crespel , Pierre Genton , Charlotte Dravet

Lennox-Gastaut Syndrome (LGS) is a severe, lifelong form of epileptic encephalopathy that presents significant treatment challenges. The management of LGS remains primarily symptomatic. Historically, the effectiveness of traditional antiseizure medications (ASMs) has been limited, prompting practitioners to explore off-label treatments and anecdotal drugs, including medications not originally intended for epilepsy. Although some controlled clinical trials have been conducted, LGS management often remains empirical and largely dependent on clinical experience. Recent advances in ASMs and adjunctive therapies have enhanced patient outcomes, yet LGS remains one of the most treatment-resistant forms of epilepsy, with complete seizure control rarely being achieved. Beyond ASMs, interventions such as a ketogenic diet, vagus nerve stimulation, and callosotomy may be considered based on individual patient needs. Recent developments in deep brain stimulation have also presented promising new therapeutic options. This article aims to provide a comprehensive overview of both pharmacological and non-pharmacological treatment strategies for LGS, tracing progress from the syndrome's first description in 1966 to the current management approaches.

lenox - gastaut综合征（LGS）是一种严重的，终身形式的癫痫性脑病，提出了重大的治疗挑战。LGS的管理仍然主要是症状性的。从历史上看，传统的抗癫痫药物（asm）的有效性有限，促使从业者探索标签外治疗和轶事药物，包括最初不是用于癫痫的药物。虽然已经进行了一些对照临床试验，但LGS的管理往往仍然是经验性的，很大程度上依赖于临床经验。asm和辅助疗法的最新进展提高了患者的预后，但LGS仍然是最难以治疗的癫痫形式之一，几乎无法完全控制癫痫发作。除asm外，可根据患者个体需要考虑生酮饮食、迷走神经刺激和胼胝体切开术等干预措施。脑深部刺激的最新发展也提供了有希望的新治疗选择。本文旨在提供LGS的药物和非药物治疗策略的全面概述，追踪从1966年该综合征的首次描述到当前管理方法的进展。

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引用次数: 0

Nutritional status and functional gastrointestinal disorders in pediatric patients with drug-resistant epilepsy: Impact of vagus nerve stimulation 小儿耐药癫痫患者的营养状况和胃肠功能紊乱：迷走神经刺激的影响

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-01-01 Epub Date: 2025-12-10 DOI: 10.1016/j.seizure.2025.12.005

Ayse Akcay , Zeynep Ozturk , Alev Elci Karaduman , Esra Serdaroglu , Ebru Arhan , Ercan Demir , Tugba Hirfanoglu

Purpose

To evaluate the nutritional status and functional gastrointestinal disorders (FGIDs) in children with drug-resistant epilepsy (DRE) and determine whether vagus nerve stimulation (VNS) influences gastrointestinal outcomes.

Methods

This cross-sectional study included 98 pediatric patients with DRE (30 with VNS and 68 without). Anthropometric status was assessed using LMS-derived Z-scores, and FGIDs were diagnosed according to the Rome IV criteria. Logistic regression and ROC analyses were used to investigate the relationship between antiseizure medication (ASM) burden and constipation.

Results

Each additional ASM increased the odds of constipation by 1.63 (95 % CI: 1.08–2.47; p = 0.021). A cutoff of ≥3 ASMs demonstrated a moderate predictive value for constipation (AUC 0.63). Earlier epilepsy onset was significantly associated with lower weight, height, and BMI Z-scores (all p < 0.05). Despite the higher ASM burden, children treated with VNS did not exhibit an increased frequency of gastrointestinal adverse effects.

Conclusion

ASM polytherapy is a measurable risk factor for constipation in pediatric DRE, and early epilepsy onset is associated with impaired growth. The absence of increased gastrointestinal symptoms among VNS recipients, despite a higher medication load, suggests a potential modulatory role of vagal neuromodulation. These findings highlight the need for routine nutritional surveillance and structured gastrointestinal assessments and support future longitudinal studies incorporating objective GI measures and biomarker-based evaluations.

目的评价耐药癫痫（DRE）患儿的营养状况和胃肠功能紊乱（fgid），探讨迷走神经刺激（VNS）是否影响胃肠道预后。方法本横断面研究纳入98例DRE患儿（30例伴有VNS， 68例无VNS）。使用lms衍生的z分数评估人体测量状态，并根据Rome IV标准诊断fgid。采用Logistic回归和ROC分析探讨抗癫痫药物负担与便秘的关系。结果每增加1次ASM，便秘发生率增加1.63例（95% CI: 1.08 ~ 2.47; p = 0.021）。≥3 asm的临界值显示便秘的中等预测价值（AUC 0.63）。早期癫痫发作与较低的体重、身高和BMI z评分显著相关（均p <； 0.05）。尽管有较高的ASM负担，但接受VNS治疗的儿童并未表现出胃肠道不良反应的频率增加。结论asm综合治疗是儿童DRE便秘的可测量危险因素，早期癫痫发作与生长障碍有关。在VNS受者中，尽管药物负荷较高，但胃肠道症状没有增加，提示迷走神经调节的潜在调节作用。这些发现强调了常规营养监测和结构化胃肠道评估的必要性，并支持未来纳入客观GI测量和基于生物标志物的评估的纵向研究。

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引用次数: 0

Clinical and genetic analysis of epilepsy in children with SCN8A gene variants SCN8A基因变异儿童癫痫的临床与遗传分析。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-01-01 Epub Date: 2025-12-02 DOI: 10.1016/j.seizure.2025.12.002

Rui Li , Chu Wang , Runlu Geng , Xiaoqing Xu , Yichen Tao , Yuanyuan Dai

Objective

To analyse the clinical and genetic characteristics of children with epilepsy associated with SCN8A gene variants.

Methods

High-throughput whole-exome sequencing was performed on children suspected of having gene variant-related epilepsy. A total of 14 children with seizures caused by SCN8A gene variants were identified. A retrospective analysis was conducted to collect and summarise the medical records and genetic results of these children.

Results

Eleven cases were identified with de novo variants and three with inherited heterozygous variants. The earliest age of onset was 10 min after birth, and the maximum age of onset was 2 years. Three patients were treated with a single drug, four were treated with two anti-seizure medicines (ASMs), seven were treated with three or more ASMs and two were treated with a ketogenic diet, but the efficacy was not satisfactory. Eight patients responded to sodium channel blockers, with doses ranging from higher than the standard paediatric dosage. Except for one case with a normal electroencephalogram, all others showed abnormalities, mainly characterised by multifocal and widespread discharges.

Conclusion

Typically, SCN8A gene variants cause early-onset childhood epilepsy, often within the first year of life, even in the neonatal period, and most cases are caused by de novo variants. Sodium channel blockers show some efficacy, but often require higher doses, and single-drug therapy is usually insufficient. The clinical phenotype of de novo variants is severe, with frequent seizures. Most patients still experience seizures despite treatment with 3–4 drugs, and focal or focal secondary generalised seizures are common. Seizure types such as spasms and myoclonus are rare.

目的：分析小儿癫痫SCN8A基因变异的临床及遗传特点。方法：对怀疑患有基因变异相关性癫痫的儿童进行高通量全外显子组测序。共鉴定出14例由SCN8A基因变异引起的癫痫患儿。回顾性分析收集和总结了这些儿童的医疗记录和遗传结果。结果：11例为新生变异，3例为遗传杂合变异。最早发病年龄为出生后10分钟，最大发病年龄为2岁。单药治疗3例，双药治疗4例，三药及以上治疗7例，生酮饮食治疗2例，疗效均不理想。8名患者对钠通道阻滞剂有反应，剂量从高于标准儿科剂量不等。除1例脑电图正常外，其余均表现异常，主要表现为多灶性和广泛性放电。结论：SCN8A基因变异通常会引起早发性儿童癫痫，通常发生在生命的第一年，甚至在新生儿时期，大多数病例是由新生变异引起的。钠通道阻滞剂显示出一定的疗效，但通常需要更高的剂量，单药治疗通常不够。新发变异的临床表型是严重的，经常发作。尽管使用3-4种药物治疗，大多数患者仍会出现癫痫发作，局灶性或局灶继发性全身性癫痫发作很常见。发作类型如痉挛和肌阵挛是罕见的。

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引用次数: 0

Epilepsy and marriage - the story of the abolition of laws that discriminated people with epilepsy in Norway 癫痫和婚姻——挪威废除歧视癫痫患者的法律的故事。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-01-01 Epub Date: 2025-10-30 DOI: 10.1016/j.seizure.2025.10.026

Mia Tuft , Karl O. Nakken

Objective

Norwegian legislators have for centuries discriminated people with epilepsy. This article specifically addresses the Norwegian marriage laws, and we discuss possible explanations for the discrimination.

Methods

At the library in the faculty of law at the University of Oslo, we have performed a historical search in Norwegian marriage laws and their preparatory works.

Results

The last law change that regulated epilepsy and marriage was passed in 1969. Before this, those with epilepsy had to disclose the disease before marriage, and if such information was withheld, the marriage could be annulled.

Significance

The laws that restricted people with epilepsy from marrying were based on long standing official discrimination due to an overestimation of heredity and/or simply lack of knowledge. We suspect that the discriminatory laws had roots in old theories about eugenics.

目的：几个世纪以来，挪威立法者一直歧视癫痫患者。这篇文章专门讨论了挪威的婚姻法，我们讨论了歧视的可能解释。方法：在奥斯陆大学法律系图书馆，我们对挪威婚姻法及其筹备工作进行了历史检索。结果：规范癫痫和婚姻的最后一次法律变更是在1969年通过的。在此之前，患有癫痫的人必须在结婚前透露病情，如果隐瞒这些信息，婚姻可能会被取消。意义：限制癫痫患者结婚的法律是基于长期存在的官方歧视，这是由于对遗传的高估和/或仅仅是缺乏知识。我们怀疑歧视性法律的根源是关于优生学的旧理论。

引用次数: 0

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 : 2026-01-01 Epub 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

Clinical practice guidelines for the administration of third-generation anti-seizure medications 第三代抗癫痫药物的临床应用指南。

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-01-01 Epub Date: 2025-11-03 DOI: 10.1016/j.seizure.2025.11.002

Xintong Wu , Yangmei Chen , Li Feng , Xiong Han , Yanbing Han , Huapin Huang , Qifu Li , Xiaorong Liu , Liankun Ren , Yanping Sun , Qun Wang , Tiancheng Wang , Xiangqing Wang , Bo Xiao , Huiqin Xu , Peimin Yu , Hong Zhang , Guoxing Zhu , Suiqiang Zhu , Dong Zhou

Purpose

This guideline evaluated previous clinical studies that examined the use of third-generation antiseizure medications (ASMs) to treat epilepsy in order to provide treatment recommendations from a clinical practice perspective, thus aiming to enhance clinicians’ understanding of these drugs and improve the standardization of clinical treatment.

Methods

A systematic literature search was conducted to identify studies that examined third-generation ASMs. The included literature was rated using the 2011 Oxford Centre for Evidence-based Medicine (OCEBM) levels of evidence, and recommendations were formulated. The strength of the recommendations was determined based on the evidence level and drug safety profiles.

Results

This guideline examines 10 third-generation ASMs: pregabalin (PGB), rufamide (RFN), lacosamide (LCM), perampanel (PER), eslicarbazepine (ESL), brivaracetam (BRV), stripentol (STP), cannabidiol (CBD), cenobamate (CNB) and fenfluramine (FFA). Recommendations were developed for 13 clinical questions.

Conclusion

This guideline provides a detailed evaluation of the current evidence and treatment recommendations regarding third-generation ASMs. This guideline will help clinicians to better understand these medications and offer guidance for clinical practice.

目的：本指南通过对以往应用第三代抗癫痫药物（asm）治疗癫痫的临床研究进行评价，从临床实践的角度提出治疗建议，旨在提高临床医生对该类药物的认识，促进临床治疗的规范化。方法：进行系统的文献检索，以确定有关第三代asm的研究。纳入的文献使用2011年牛津循证医学中心（OCEBM）证据水平进行评级，并制定建议。建议的力度是根据证据水平和药物安全性概况确定的。结果：本指南检查了10种第三代ams：普瑞巴林（PGB）、鲁福胺（RFN）、拉可沙胺（LCM）、perampanel （PER）、eslicarbazepine （ESL）、布瓦西坦（BRV）、stripentool （STP）、大麻二酚（CBD）、cenobamate （CNB）和芬氟拉明（FFA）。针对13个临床问题提出了建议。结论：本指南提供了关于第三代asm的现有证据和治疗建议的详细评估。本指南将有助于临床医生更好地了解这些药物，并为临床实践提供指导。

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引用次数: 0

Efficacy and safety of cenobamate in developmental and epileptic encephalopathies: A systematic review and meta-analysis cenobamate治疗发育性和癫痫性脑病的疗效和安全性：一项系统综述和荟萃分析

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy

Pub Date : 2026-01-01 Epub Date: 2025-11-23 DOI: 10.1016/j.seizure.2025.11.016

Debopam Samanta , Sunil Naik

Objective

To evaluate the efficacy and safety of cenobamate in developmental and epileptic encephalopathies (DEE) through systematic review and meta-analysis.

Methods

We systematically searched electronic databases for studies reporting cenobamate outcomes in DEE. Primary outcome was the proportion of patients achieving ≥50 % seizure reduction. Secondary outcomes included seizure freedom, treatment retention, and treatment-emergent adverse events (TEAEs). Study quality was assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Generalized linear mixed-model (GLMM) meta-analyses with logit transformation were performed. Between-study heterogeneity was assessed using I² statistics. Leave-one-out sensitivity analysis identified influential studies. Meta-regression explored associations between study characteristics and outcomes. Evidence quality was evaluated using GRADE criteria.

Results

Fourteen studies involving 368 DEE patients were included; individual studies reported mean ages ranging from 8.7 to 42 years and follow-up durations of 3 to 24 months. Patients had extensive treatment histories (8–15 prior antiseizure medications). The pooled ≥50 % responder rate was 56.8 % (95 % CI: 41.9–70.6 %; I² = 74.9 %). Sensitivity analysis excluding four influential studies produced a similar estimate (63.4 %, 95 % CI: 46.5–77.6 %) with no heterogeneity. Seizure freedom was achieved in 10.3 % (95 % CI: 6.6–15.7 %; I² = 21.3 %). Treatment retention was high at 88.6 % (95 % CI: 66.9–96.7 %), though longitudinal data showed decline over time. TEAEs occurred in 60.3 % (95 % CI: 53.5–66.7 %), most often somnolence, dizziness, and ataxia, typically manageable with dose adjustments. No cases of DRESS were reported. Meta-regression found no significant association between age, follow-up duration, or prior/current antiseizure medication burden and treatment response.

Significance

Cenobamate demonstrates promising efficacy in highly refractory DEEs, with over half of patients achieving ≥50 % seizure reduction and ∼10 % attaining seizure freedom despite extensive prior treatment failures. The high retention rate and manageable safety profile support its use as a valuable therapeutic option in this difficult-to-treat population.

目的通过系统评价和荟萃分析，评价欣奥巴肽治疗发育性和癫痫性脑病（DEE）的疗效和安全性。方法系统地检索电子数据库中报道DEE预后良好的研究。主要结局是癫痫发作减少≥50%的患者比例。次要结局包括癫痫发作自由、治疗保留和治疗出现的不良事件（teae）。使用非随机干预研究的偏倚风险（ROBINS-I）工具评估研究质量。采用logit变换进行广义线性混合模型（GLMM）元分析。采用I²统计量评估研究间异质性。留一敏感性分析确定了有影响的研究。荟萃回归探讨了研究特征与结果之间的关系。采用GRADE标准评价证据质量。结果纳入14项研究，共368例DEE患者；个别研究报告的平均年龄为8.7至42岁，随访时间为3至24个月。患者有广泛的治疗史（既往抗癫痫药物8-15次）。总有效率≥50%为56.8% （95% CI: 41.9 - 70.6%; I²= 74.9%）。排除四项有影响的研究的敏感性分析得出了类似的估计（63.4%,95% CI: 46.5 - 77.6%），没有异质性。10.3%的患者癫痫发作自由（95% CI: 6.6 - 15.7%; I²= 21.3%）。治疗保留率高达88.6% (95% CI: 66.9 - 96.7%)，尽管纵向数据显示随着时间的推移而下降。teae发生率为60.3% (95% CI: 53.5 - 66.7%)，最常见的是嗜睡、头晕和共济失调，通常可以通过剂量调整来控制。无DRESS病例报告。meta回归发现年龄、随访时间或既往/当前抗癫痫药物负担与治疗反应之间无显著关联。ecenobamate在高度难治性癫痫患者中显示出良好的疗效，超过一半的患者实现≥50%的癫痫发作减少，约10%的患者实现癫痫发作自由，尽管先前的治疗大量失败。高保留率和可管理的安全性支持其作为这一难以治疗人群的宝贵治疗选择。

{"title":"Efficacy and safety of cenobamate in developmental and epileptic encephalopathies: A systematic review and meta-analysis","authors":"Debopam Samanta , Sunil Naik","doi":"10.1016/j.seizure.2025.11.016","DOIUrl":"10.1016/j.seizure.2025.11.016","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy and safety of cenobamate in developmental and epileptic encephalopathies (DEE) through systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>We systematically searched electronic databases for studies reporting cenobamate outcomes in DEE. Primary outcome was the proportion of patients achieving ≥50 % seizure reduction. Secondary outcomes included seizure freedom, treatment retention, and treatment-emergent adverse events (TEAEs). Study quality was assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Generalized linear mixed-model (GLMM) meta-analyses with logit transformation were performed. Between-study heterogeneity was assessed using I² statistics. Leave-one-out sensitivity analysis identified influential studies. Meta-regression explored associations between study characteristics and outcomes. Evidence quality was evaluated using GRADE criteria.</div></div><div><h3>Results</h3><div>Fourteen studies involving 368 DEE patients were included; individual studies reported mean ages ranging from 8.7 to 42 years and follow-up durations of 3 to 24 months. Patients had extensive treatment histories (8–15 prior antiseizure medications). The pooled ≥50 % responder rate was 56.8 % (95 % CI: 41.9–70.6 %; I² = 74.9 %). Sensitivity analysis excluding four influential studies produced a similar estimate (63.4 %, 95 % CI: 46.5–77.6 %) with no heterogeneity. Seizure freedom was achieved in 10.3 % (95 % CI: 6.6–15.7 %; I² = 21.3 %). Treatment retention was high at 88.6 % (95 % CI: 66.9–96.7 %), though longitudinal data showed decline over time. TEAEs occurred in 60.3 % (95 % CI: 53.5–66.7 %), most often somnolence, dizziness, and ataxia, typically manageable with dose adjustments. No cases of DRESS were reported. Meta-regression found no significant association between age, follow-up duration, or prior/current antiseizure medication burden and treatment response.</div></div><div><h3>Significance</h3><div>Cenobamate demonstrates promising efficacy in highly refractory DEEs, with over half of patients achieving ≥50 % seizure reduction and ∼10 % attaining seizure freedom despite extensive prior treatment failures. The high retention rate and manageable safety profile support its use as a valuable therapeutic option in this difficult-to-treat population.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"134 ","pages":"Pages 86-96"},"PeriodicalIF":2.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624253","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

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 : 2026-01-01 Epub 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