Seizure-European Journal of Epilepsy最新文献

{"title":"Experiences of pregnancy and reproductive health for women living with epilepsy: A systematic review","authors":"Weckesser Annalise ,&nbsp;Hughes Anita ,&nbsp;Dyson Judith ,&nbsp;Raju Sereena ,&nbsp;Chatterjee Anwesa ,&nbsp;Nelson-Piercy Catherine ,&nbsp;Black Mairead ,&nbsp;Moss Ngawai ,&nbsp;Craig John ,&nbsp;Olalere Oladipupo ,&nbsp;Junaid Fatima ,&nbsp;Allotey John ,&nbsp;Thangaratinam Shakila ,&nbsp;Denny Elaine","doi":"10.1016/j.seizure.2025.10.011","DOIUrl":"10.1016/j.seizure.2025.10.011","url":null,"abstract":"<div><h3>Purpose</h3><div>This study provides an up-to-date systematic review and thematic synthesis of pregnancy and reproductive health experiences of women with epilepsy. Understandings of women’s experiences are essential to designing effective quality of care interventions that will lead to needed improvements in maternal health outcomes.</div></div><div><h3>Methods</h3><div>We undertook a systematic search of medical, social science and psychology databases to identify studies conducted from 2012 to 2024 that employed qualitative methods or qualitative methods within a mixed method design. We conducted a thematic analysis of qualitative results from identified studies to synthesize findings.</div></div><div><h3>Results</h3><div>Eleven publications from nine studies were identified. Six focused on the experiences of women with epilepsy during pregnancy, while five explored their experiences of reproductive health more generally. Most publications (<em>n</em> = 10) were of high methodological quality. Across the pre-pregnancy, antenatal, and postnatal periods, women navigate a landscape defined by uncertainty, inadequate and conflicting information, and poorly coordinated care, all while managing significant anxieties and stigma.</div></div><div><h3>Conclusion</h3><div>A persistent inertia exists in improvements to healthcare practice supporting the pregnancies of women with epilepsy. Gaps remain in the provision of timely pre-conception counselling, clear guidance on medication and breastfeeding, and crucially, of sensitive communication on the risk of Sudden Unexpected Death in Epilepsy. More research with women from a diversity of socio-cultural, ethnic, and socioeconomic backgrounds is needed to ensure interventions are informed by their experiences. Moving beyond the identified inertia requires a commitment to transforming care from a model of management to one of holistic, woman-centered support.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 106-113"},"PeriodicalIF":2.8,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364360","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}

{"title":"Novel PAK1 variants related to a variable phenotypic spectrum ranging from mild developmental delay to infantile epileptic spasms syndrome","authors":"Ting Wang ,&nbsp;Shijia Ouyang ,&nbsp;Dongfang Zou ,&nbsp;Zeyong Dong ,&nbsp;Zeshi Tan ,&nbsp;Haipo Yang ,&nbsp;Jianxiang Liao ,&nbsp;Dezhi Cao ,&nbsp;Yuehua Zhang","doi":"10.1016/j.seizure.2025.10.010","DOIUrl":"10.1016/j.seizure.2025.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the novel variants and explore the new phenotypes of patients with <em>PAK1</em>-related disorder.</div></div><div><h3>Methods</h3><div>Five patients with <em>PAK1</em> variants were identified by whole-exon sequencing. Damaging effects of variants were analyzed using protein modelling.</div></div><div><h3>Results</h3><div>In this study, 5 patients were identified with 5 de novo <em>PAK1</em> variants, including p.Ile312Ser, p.Asp407Asn, p.Met453Thr, p.Leu470Pro, and p.Ile476Thr. All variants were missense, and one of which was a mosaic variant (Leu470Pro), with a variant allele fraction of 13.4 % (13/97). Four of five patients with <em>PAK1</em> variants had epilepsy, the seizure types included focal seizures, generalized tonic-clonic seizure and epileptic spasms. One patient diagnosed with infantile epileptic spasms syndrome (IESS). Four patients had macrocephaly. One patient only had mild developmental delay (DD) and normal head circumference. All missense variants identified in this study were predicted to be “damaging” by multiple in silico tools and to alter the hydrogen bonds with surrounding residues and/or protein stability. Notably, the variant Asp407Asn associated with a milder phenotype is predicted to have increased hydrogen bonds with ATP in contrast to our other reported variants. Spatial and temporal expression analysis showed that <em>PAK1</em> had three peak expressions in infant, adolescent and early adult brain subregions. Collectively, in our study (<em>n</em> = 5) and published studies (<em>n</em> = 11), all variants were missense variants. <em>PAK1</em>-related disorders encompass a wide phenotypic spectrum, including macrocephaly, epilepsy and DD/intellectual disability (ID). Seizures were observed in 81.25 % (13/16) of patients, and 53.8 % (7/13) patients with epilepsy had febrile seizure.</div></div><div><h3>Conclusions</h3><div>All variants of <em>PAK1</em>-related disorders were missense variants. In this study, five de novo variants were included, and Leu470Pro was the first reported mosaic variant in <em>PAK1. PAK1</em>-related disorders encompass a wide phenotypic spectrum, including macrocephaly, epilepsy and DD/ID. IESS is a rare newly recognized phenotype of <em>PAK1</em>-related epilepsy. More than half of patients with epilepsy had febrile seizure.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 88-95"},"PeriodicalIF":2.8,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349577","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}

{"title":"Predicting oxcarbazepine-induced hyponatremia in adult epilepsy patients: A multicenter machine learning analysis using real-world CDM data","authors":"Gucheol Jung ,&nbsp;JaeHyeok Lee ,&nbsp;Sung-Min Gho ,&nbsp;YoungMi Han ,&nbsp;ByungKwan Choi ,&nbsp;Jae Wook Cho ,&nbsp;Jiyoung Kim ,&nbsp;Gha-hyun Lee","doi":"10.1016/j.seizure.2025.10.004","DOIUrl":"10.1016/j.seizure.2025.10.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Oxcarbazepine (OXC) is a widely used antiseizure medication (ASM) associated with hyponatremia. This study aimed to assess the prevalence and risk factors for OXC-induced severe hyponatremia using machine learning (ML) models applied to multicenter real-world data standardized within the Observational Medical Outcomes Partnership–Common Data Model (OMOP–CDM).</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using OMOP-CDM data from two tertiary hospitals in South Korea. Adult epilepsy patients prescribed OXC were included, and severe hyponatremia was defined as a serum sodium concentration ≤128 mmol/L. Two prediction experiments were conducted: (1) single-institution training and external validation of an XGBoost model; and (2) multicenter training and evaluation of five machine learning algorithms, including XGBoost, random forest, support vector machine, logistic regression, and naïve Bayes. SHAP (SHapley Additive exPlanations) values were used for model interpretation.</div></div><div><h3>Results</h3><div>Among 2253 patients, the prevalence of severe hyponatremia was 8.4%. In Experiment 1, XGBoost showed strong internal performance (AUROC 0.82) but decreased external performance (AUROC 0.72). In Experiment 2, XGBoost trained on multicenter data achieved the highest AUROC (0.83) and F1-score (0.41), outperforming other models. SHAP analysis identified key predictors including valproate use, diuretics, high OXC dosage, age, and stroke history. Additional medications such as beta-blockers, calcium channel blockers, hypnotics, and other ASMs (e.g., levetiracetam, pregabalin, lacosamide) also contributed to risk.</div></div><div><h3>Conclusion</h3><div>XGBoost demonstrated robust predictive performance for OXC-induced severe hyponatremia using multicenter CDM data. SHAP-based interpretation revealed clinically relevant risk factors, supporting the implementation of personalized monitoring strategies in epilepsy care.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 167-174"},"PeriodicalIF":2.8,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410622","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}

{"title":"Visualizing diagnostic delays in functional/dissociative seizures using the referral odyssey plot: A retrospective cohort study","authors":"Kazutoshi Konomatsu ,&nbsp;Yosuke Kakisaka ,&nbsp;Maimi Ogawa ,&nbsp;Mayu Fujikawa ,&nbsp;Makoto Ishida ,&nbsp;Takafumi Kubota ,&nbsp;Kazushi Ukishiro ,&nbsp;Nobukazu Nakasato ,&nbsp;Masashi Aoki ,&nbsp;Kazutaka Jin","doi":"10.1016/j.seizure.2025.10.009","DOIUrl":"10.1016/j.seizure.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Functional/dissociative seizures (FDS) are often misdiagnosed as epilepsy, leading to delays in appropriate interventions. Although certain factors are associated with diagnostic delays, the overall referral trajectory remains unclear. This study aimed to illustrate the diagnostic journey with a novel visual approach, the “referral odyssey plot,” and to depict patient pathways and identify factors associated with referral delays and diagnosis.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 50 patients diagnosed with documented FDS at Tohoku University Hospital (2014–2024). All patients underwent comprehensive inpatient evaluation, including long-term video-electroencephalogram monitoring, brain MRI, and psychosocial assessment. Four milestones were defined: seizure onset (T1), first non-epileptologist visit (T2), first epileptologist consultation (T3), and epilepsy monitoring unit admission (T4). Diagnostic pathways were visualized using a referral odyssey plot. Associations between variables and intervals were analyzed using Spearman’s correlation, Friedman test, Mann–Whitney <em>U</em> test, and Kruskal–Wallis test.</div></div><div><h3>Results</h3><div>The median total delay (T1–T4) was 51 months (interquartile range: IQR, 83.8). The longest delay occurred between T2 and T3 (median, 41 months; IQR, 74.8) and strongly correlated with total delay (ρ=0.95, <em>p</em> &lt; 0.001). Younger age at onset and a family history of epilepsy were significantly associated with longer T2–T3 intervals. Seizure worry scores were negatively correlated with T1–T2 intervals.</div></div><div><h3>Conclusion</h3><div>Referral delay to an epileptologist was the main contributor to prolonged diagnosis of FDS. The referral odyssey plot visualized individual trajectories and bottlenecks, supporting earlier specialist referrals. These findings highlight the need for timely access to epileptologists experienced in the comprehensive evaluation of epilepsy and FDS.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 61-67"},"PeriodicalIF":2.8,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318885","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}

{"title":"Efficacy and safety of vigabatrin as preventive therapy for children with tuberous sclerosis complex: A systematic review and meta-analysis","authors":"Nagita Devi ,&nbsp;Pooja Soni ,&nbsp;Priyanka Madaan ,&nbsp;Indrasish Ray Chaudhuri ,&nbsp;Vaishakh Anand ,&nbsp;Dipika Bansal ,&nbsp;Jitendra Kumar Sahu ,&nbsp;Kollencheri Puthenveettil Vinayan ,&nbsp;Sheffali Gulati","doi":"10.1016/j.seizure.2025.10.008","DOIUrl":"10.1016/j.seizure.2025.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Tuberous sclerosis complex (TSC) is associated with early-onset epilepsy, often leading to drug-resistant epilepsy (DRE) and developmental impairment. Preventive therapy with vigabatrin (VGB) has been proposed as a strategy to modify disease progression, but its efficacy and safety remain uncertain. This systematic review and meta-analysis aimed to evaluate the impact of preventive VGB therapy on seizure occurrence [including infantile epileptic spasms syndrome (IESS) and DRE], neurocognitive outcomes, and adverse events in infants with TSC.</div></div><div><h3>Methods</h3><div>We performed a systematic search of MEDLINE, EMBASE, Scopus, and Web of Science. Studies were eligible if they enrolled infants with TSC without prior seizures and compared preventive VGB to standard treatment. Risk of bias was assessed using the ROB 2.0 tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Meta-analyses were performed using a random-effects model, with results expressed as risk ratios (RR) or standardized mean differences (SMD) and 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Three studies with 149 children were included. There was reduced occurrence of seizures (including IESS and DRE) in the preventive therapy group (39/68 vs 64/81). However, the risk ratios were not statistically significant for occurrence of seizures (RR: 0.72; 95 % CI: 0.47–1.10), IESS (RR: 0.23; 95 % CI: 0.04–1.25), and DRE (RR: 0.74; 95 % CI: 0.49–1.12). Neurocognitive outcomes did not differ significantly between the two groups (SMD: 0.35; 95 % CI: -0.21– 0.91). Preventive vigabatrin was generally well-tolerated, with few adverse events and rare treatment discontinuation reported.</div></div><div><h3>Conclusion</h3><div>Preventive vigabatrin therapy may prevent the development of epilepsy, including IESS and DRE, in children with TSC, with an acceptable safety profile. Although statistical significance was not achieved, the favorable trend highlights the potential clinical benefits of early intervention with VGB. Larger, high-quality randomized trials are warranted to confirm these findings and explore the long-term neurodevelopmental outcomes.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 137-143"},"PeriodicalIF":2.8,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364362","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}

{"title":"Effectiveness of nurse led intervention on quality of life, cost effectiveness and drug management in patients with epilepsy: Systematic review of randomized control trials","authors":"Pushpa ,&nbsp;Mamta ,&nbsp;Uma Phalswal ,&nbsp;Raman Kalia","doi":"10.1016/j.seizure.2025.10.006","DOIUrl":"10.1016/j.seizure.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Epilepsy is a long-term neurological condition marked by recurring seizures and is among the most prevalent neurological disorders. The presence of stigma and negative societal views regarding epilepsy further exacerbates the condition. A wide treatment gap and a lack of medical professionals are major contributors; however, efforts to enhance care delivery and improve patient satisfaction have also emphasized the involvement of epilepsy specialist nurses. Nevertheless, the effectiveness of nurse-led interventions in improving the quality of life for individuals living with epilepsy remains uncertain.</div></div><div><h3>Objective</h3><div>To evaluate the effectiveness of nurse-led interventions on quality of life, cost-efficiency, and medication management among patients with epilepsy.</div></div><div><h3>Design</h3><div>Randomized controlled trials studies were selected only.</div></div><div><h3>Data sources</h3><div>A thorough literature search was carried out in PubMed Central, EBSCO host, Medline, and Scopus in January 2025 to locate peer-reviewed published studies. Two reviewers independently extracted and evaluated the data using a standardized assessment tool.</div></div><div><h3>Results</h3><div>Seven randomized controlled trials met the eligibility criteria and were included in this review. These studies detailed nurse-led interventions administered through both face-to-face interactions and telephone-based approaches. The interventions varied in their outcomes and the measurement instruments employed, with several studies noting participant attrition. Overall, the majority of studies indicated that nurse-led interventions led to improvements in quality of life, cost-effectiveness, and medication management among individuals with epilepsy.</div></div><div><h3>Conclusion</h3><div>The evidence indicates that nurse-led interventions are effective in managing care for individuals with epilepsy. This review highlights intervention strategies that may guide future clinical practice and research aimed at enhancing quality of life, cost-efficiency, and medication management for people living with epilepsy. Further investigations should focus on identifying the key components of successful nurse-led interventions, assessing their impact on quality of life and cost-effectiveness, and exploring their integration into routine clinical care.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 80-87"},"PeriodicalIF":2.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326147","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}

{"title":"The role of psychological well-being in the effect of spirituality on stigma in individuals with epilepsy","authors":"Yakup Sarpdağı ,&nbsp;Mustafa Kiraz ,&nbsp;Muhammet Okay Örün ,&nbsp;Özkan Sir ,&nbsp;Ebubekir Kaplan ,&nbsp;Kemal Atan ,&nbsp;Necmettin Çiftci ,&nbsp;Metin Yıldız","doi":"10.1016/j.seizure.2025.10.005","DOIUrl":"10.1016/j.seizure.2025.10.005","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to examine the mediating role of psychological well-being in the effect of spirituality on stigma in individuals with epilepsy.</div></div><div><h3>Methods</h3><div>This cross-sectional and descriptive study was conducted between March 2024 and January 2025 at a training and research hospital in Van, Turkey, with 257 individuals aged 18 and above diagnosed with epilepsy. Data were collected using a Personal Information Form, the Spirituality Scale, the Psychological Well-being Scale, and the Stigma Scale for Epilepsy Patients. Data were analyzed using SPSS, R programming language 4.1.3 and G*Power software.</div></div><div><h3>Results</h3><div>This study showed that an increase in spirituality was positively associated with psychological well-being (β = 0.976, p &lt; 0.001) and negatively associated with stigmatization (β = -0.752, p &lt; 0.001). Furthermore, psychological well-being was found to be a partial mediator of the relationship between spirituality and stigmatization (indirect effect = -0.2938, 95% CI: -0.4506, -0.1418), suggesting that spirituality may be related to levels of stigmatization not only directly but also through psychological well-being.</div></div><div><h3>Conclusion</h3><div>The findings of this study indicate that spirituality plays a significant role in reducing stigma among individuals with epilepsy, with psychological well-being acting as a partial mediator in this relationship. As levels of spirituality and psychological well-being increase, perceived stigma decreases. These results highlight the importance of spirituality and psychological well-being in interventions aimed at reducing stigma and improving mental health.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 128-136"},"PeriodicalIF":2.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364421","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}

{"title":"Understanding the neurobiology of infantile epileptic spasms syndrome (IESS): A comprehensive review","authors":"Abhinav Modgil ,&nbsp;Zubin Singh Rana ,&nbsp;Jitendra Kumar Sahu ,&nbsp;Pradeep Punnakkal","doi":"10.1016/j.seizure.2025.10.007","DOIUrl":"10.1016/j.seizure.2025.10.007","url":null,"abstract":"<div><div>Infantile Epileptic Spasms Syndrome (IESS) is a developmental and epileptic encephalopathy of infantile-onset and is characterized by epileptic spasms and often a hypsarrhythmia pattern on interictal electroencephalogram. The neurobiology of IESS involves diverse factors, including genetics, neurochemical imbalances, structural impairments, metabolic derangements, and immune system dysregulation, all of which contribute to its pathogenesis. A key mechanism in IESS is an imbalance between excitatory and inhibitory neurotransmission. Early disruption of GABAergic signaling, along with pathogenic variations in genes encoding ion channels leads to hyperexcitability observed in children with IESS. Neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), nerve growth factor (β-NGF), and insulin-like growth factors (IGF-1 and IGF-2) play a crucial role in forming neural connections, regulating nerve cell differentiation, and promoting normal brain development and function. An imbalance among these factors may also lead to brain hyperexcitability. Additionally, glutamate-mediated excitotoxicity also contributes to the development of IESS. Cortical and brainstem pathways, along with immune system dysregulations are involved in IESS pathogenesis. Conversely, Positron Emission Tomography (PET) imaging studies demonstrate that abnormal cortical activity influences downstream serotonergic nuclei in the brainstem. Temporal misalignment during central nervous system maturation is also hypothesized to trigger IESS. Animal models, including both genetic and acquired types have offered important insights into how <em>ARX</em> genetic variations, CRH signaling, and disruptions in cortical-subcortical interactions contribute to the condition. Despite the advancement in understanding of the disease, still IESS remains a significant therapeutic challenge. Early diagnosis and targeted interventions are critical for improving developmental outcomes, control of epileptic spasms, and treatment efficacy.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 177-188"},"PeriodicalIF":2.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418306","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}

{"title":"Clinical and demographic predictors of high epilepsy care utilization: mode of interaction, professionals involved, and reasons for contact","authors":"Anna Hjorth ,&nbsp;Saman Hosseini Ashtiani ,&nbsp;André Idegård ,&nbsp;Anneli Ozanne ,&nbsp;Johan Zelano","doi":"10.1016/j.seizure.2025.10.003","DOIUrl":"10.1016/j.seizure.2025.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Most studies of care utilization in epilepsy predate the pandemic and the recent digitization of care delivery. The objective of this study was to characterize patients with high care utilization and identify predictors allowing proactive support.</div></div><div><h3>Methods</h3><div>We analyzed all health care contacts (<em>n</em> = 4673) in a cohort of 396 participants in a prospective epilepsy study (PREDICT, clinicaltrials.org: NCT04559919). Data was collected from medical records, patient surveys, and national registers. Participants were categorized into quartiles of high and low utilizers based on contact frequency and compared regarding demographic and clinical variables, which were also assessed as predictors in regression models. Contact patterns were analyzed by clustering analysis.</div></div><div><h3>Results</h3><div>Patients with the highest care utilization accounted for 62 % of contacts, which were mainly patient-initiated nurse interactions. High utilizers were younger (<em>p</em> = 0.003), had an earlier epilepsy onset (<em>p</em> = 0.002), and higher seizure frequency (<em>p</em> &lt; 0.001) compared to those with the lowest utilization. Only 19 % of all contacts were physical appointments. The most common mode of contact with physicians was patient portal messages and with nurses phone calls. High utilizers had a predictable pattern of contacts and a high number of nurse contacts in the first three months was a signal for early identification of high utilizers (AUC 0.746).</div></div><div><h3>Conclusion</h3><div>Our study of epilepsy care utilization shows a high amount of digitized and patient-initiated contacts and an association between younger age and high utilization. A high number of initial nurse contacts is a predictor for high utilization, which could facilitate early identification.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 52-60"},"PeriodicalIF":2.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313743","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}

{"title":"Pediatric frontal lobe epilepsy (FLE): Semiological distinctions from adult-onset FLE","authors":"Dr Sujit A. Jagtap ,&nbsp;Dr Zubin A. Shah ,&nbsp;Dr Nilesh Kurwale ,&nbsp;Dr. Sandeep Patil ,&nbsp;Dr Aniruddha Joshi ,&nbsp;Dr. Yogeshwari Deshmukh ,&nbsp;Dr Sujit Nilegaonkar","doi":"10.1016/j.seizure.2025.10.002","DOIUrl":"10.1016/j.seizure.2025.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize seizure semiology, electroclinical features, and lesion localization in pediatric frontal lobe epilepsy (FLE), and to assess the applicability of the Bonini classification system, with comparison to adult-onset FLE.</div></div><div><h3>Methods</h3><div>We retrospectively analysed clinical, video-EEG, and neuroimaging data from 61 children with FLE who underwent presurgical evaluation between January 2015 and June 2023. Seizure semiology was categorised using Bonini’s system. Imaging findings were correlated with semiological features.</div></div><div><h3>Results</h3><div>The majority of patients had daily seizures (67.2 %) and clustering (88.5 %). Auras were rare (9.8 %), and focal to bilateral tonic-clonic seizures (FBTCS) occurred in only 3.2 %. Motor manifestations dominated the clinical picture, with Group 1 semiology (elementary motor signs) present in 59 % of cases, a frequency significantly higher than reported in adults. Emotional behaviours (Group 4) and integrated gestural behaviours (Group 3) were infrequent. Epileptic spasms occurred in children up to 5 years and were associated with focal lesions. Over half of the patients initially had normal MRIs, with subsequent detection of focal cortical dysplasia in 78.6 % of cases following advanced imaging techniques. There was no clear correlation between lesion location and seizure semiology. Fifty-three patients underwent surgery with 81 % seizure-free outcome after a median follow-up of 36 months.</div></div><div><h3>Significance</h3><div>Pediatric FLE exhibits distinct clinical patterns compared to adult FLE, including higher rates of motor-dominant semiology and lower incidence of auras and FBTCS. Bonini classification is applicable but may require pediatric-specific modifications. Accurate imaging interpretation is essential for identifying subtle dysplastic lesions in children.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"133 ","pages":"Pages 68-72"},"PeriodicalIF":2.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318894","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}