Epileptic Disorders最新文献

Objective: This study aimed to evaluate the clinical, electrophysiological, and radiological characteristics of pediatric patients diagnosed with developmental and epileptic encephalopathy with spike-wave activation during sleep (DEE-SWAS) and to identify factors associated with prognosis.

Methods: Twenty-five pediatric patients with a spike-wave index (SWI) ≥50% and a minimum of 2 years of follow-up were analyzed in this retrospective cohort study. Clinical data, electroencephalogram (EEG) findings, and neuroimaging results were assessed, and their relationship with residual neurological or electrophysiological abnormalities was examined.

Results: The patients' mean age was 9.4 ± 2.97 years, with a mean age at seizure onset of 6.6 ± 2.32 years. Etiologically, 60% of patients were unknown, and 40% were known. The baseline mean SWI was 67.1%, decreasing to 13.8% by the 24th month. Patients with residual findings had significantly higher SWI values at months 3, 6, and 24 (p = .04, p = .006, and p = .01, respectively). Additionally, these patients exhibited lower EEG background frequency and higher amplitude during wakefulness (p = .026 and p = .001). Abnormal neurological examination was significantly associated with the presence of residual findings (p = .02).

Significance: Early and substantial reduction in SWI is associated with better prognosis. Persistent high SWI and abnormal background EEG activity may serve as predictors of long-term neurological impairment. These findings underscored the importance of early identification of high-risk patients and personalized treatment strategies in the management of DEE-SWAS.

Objective: To quantitatively evaluate regional brain volume differences between pediatric patients with epilepsy and healthy controls using a fully automated volumetric magnetic resonance imaging (MRI) analysis performed with the Vol2Brain platform.

Methods: This retrospective study included 150 children (75 with epilepsy and 75 healthy controls) who underwent 1.5 T cranial MRI examinations. High-resolution three-dimensional T1-weighted images were processed using Vol2Brain, a fully automated segmentation tool based on SPM12 and CAT12 frameworks. Absolute and relative volumes of 135 cortical and subcortical structures were computed. Statistical comparisons between groups were performed using the Shapiro-Wilk and Mann-Whitney U tests (p < .05).

Results: Patients with epilepsy demonstrated significantly lower volumes in the hippocampus, frontal and temporal gray matter, thalamus, cerebellum, and total brain compared with controls, accompanied by a compensatory increase in cerebrospinal fluid volume. No significant volumetric differences were found in the remaining 128 brain structures, indicating a diffuse morphometric reorganization pattern extending beyond the epileptogenic focus.

Significance: Fully automated volumetric MRI analysis using vol2Brain can reliably detect widespread structural brain alterations in pediatric epilepsy. These findings support the concept of epilepsy as a diffuse network disorder extending beyond focal lesions. Quantitative morphometry provides an objective approach to characterize subtle structural reorganization and may serve as a basis for future studies investigating clinical and neurocognitive correlations in pediatric epileptology.

Purpose: We performed a comprehensive systematic review and meta-analysis of repetitive transcranial magnetic stimulation (rTMS) to explore its use as an adjunctive therapy for adult patients with drug-resistant epilepsy (DRE).

Methods: Following PRISMA guidelines, PubMed and Ovid MEDLINE databases were searched until January 2025 for English-language studies reporting pre- and post-rTMS seizure frequencies and detailed protocols in adult patients with DRE. Random-effects meta-analyses pooled standardized mean differences in weekly seizure frequency at immediate, 4-week, and 8-week follow-ups. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools, and evidence certainty was graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and Oxford Centre for Evidence-Based Medicine (OCEBM) frameworks.

Results: 12 studies involving 150 participants were included, with seven contributing to the meta-analysis. Meta-analysis demonstrated a small but statistically significant reduction in seizure frequency at 4 and 8 weeks following rTMS (pooled SMD -.49 [95% CI -.98 to -.01, p = .46] and -.19 [95% CI -.35 to -.02, p = .91]), with insignificant heterogeneity (I² = 0%). In contrast, no statistically significant difference was observed immediately after rTMS (pooled SMD .19 [95% CI -1.69 to 1.31, p = .38]). Common adverse effects included headaches (14%-33%) and hearing problems (9%-14%). Quality of life improved significantly in two of three studies, and one study reported depression improvement in 67% of participants. Risk of bias was low in three studies, moderate in five, and high in four.

Conclusion: rTMS use as adjunctive therapy for DRE demonstrated moderate (GRADE level 2) and low-quality (OCEBM level 3) evidence. rTMS was associated with modest reductions in seizure frequency in selected populations. However, effect sizes were small and heterogeneous. Larger, prospective, multicenter studies are needed to further evaluate its efficacy.

Registration: International Prospective Register of Systematic Reviews (PROSPERO) (ID #CRD42024553998).

Objective: We performed a systematic review of the ictal semiology of the lateral temporal lobe in focal epilepsy aiming to summarize the state-of-the-art anatomo-clinical correlations in the field and help guide interpretation of ictal semiology within the framework of pre-surgical evaluation.

Methods: After preregistration of the study protocol (PROSPERO-ID CRD42024498889), we used the PRISMA-based approach and systematically searched PubMed and EMBASE for relevant literature on the semiology of lateral temporal lobe epilepsy (TLE). A random-effects meta-analysis with the inverse variance method was used to calculate pooled estimates.

Results: Six studies with 94 patients fulfilled our inclusion criteria. All studies also included patients with TLE confined to other neocortical temporal structures without performing analyses specifically on lateral temporal structures. The most common signs comprised oral automatisms, manual automatisms, and behavioral arrests; however, these likely do not manifest at seizure onset but during propagation. Overall, GRADE evaluation indicated very low evidence for any signs or symptoms being associated with anatomic localization. We performed a meta-analysis of the diagnostic accuracy of the presence or absence of relevant ictal signs and symptoms for differentiating seizures in lateral versus mesial TLE. The presence of auditory auras was highly specific for lateral TLE (.98 [95% CI .88-1.00]) with an overall sensitivity of .06 [95% CI .02-.22]. Lack of epigastric or olfactory/gustatory aura was associated with a high sensitivity for differentiating lateral from mesial TLE (.93 [95% CI .80-.98] and .96 [95% CI .84-.99], respectively); specificity was .38 [95% CI .26-.51] for lack of epigastric aura and .13 [95% CI .06-.25] for lack of olfactory/gustatory aura.

Significance: The six studies included in this systematic review defined the boundaries of the lateral temporal lobe quite heterogeneously and only about two-thirds of patients unambiguously had lateral temporal lobe epilepsy likely explaining the wide spectrum of ictal semiologies. Furthermore, there is often no differentiation into seizure onset versus propagation. Auditory auras represent the only specific semiology for lateral TLE, though this symptom occurs in less than every 10th patient. Comparing lateral versus mesial temporal lobe epilepsy, the presence of epigastric auras and even more so of olfactory/gustatory auras indicates mesial rather than lateral seizure onset.