Epileptic Disorders最新文献

Unintended pregnancies are common among people with epilepsy of child-bearing potential (PWECP). Unplanned pregnancies are associated with higher risks of maternal and fetal complications. In contrast, planned pregnancies are associated with more favorable outcomes, including a higher likelihood of treatment with anti-seizure medication (ASM) monotherapy, appropriate folic acid supplementation, and better seizure control. Therefore, counseling and provision of effective contraception are essential in reducing unplanned pregnancies and minimizing adverse maternal and fetal outcomes in this population. Selecting the most appropriate contraceptive method requires an in-depth understanding of the complex, bidirectional interactions between ASMs and hormonal contraception. These interactions can influence seizure control, contraceptive efficacy, and ASM serum concentrations. Despite its importance, providers' awareness of these interactions remains sub-optimal. In this review, we aim to provide a comprehensive review of the different hormonal contraceptive methods and their interactions with different ASMs. We also address contraception considerations in special populations: adolescents and people with intellectual or neurodevelopmental disabilities. Lastly, we highlight the current gaps in research about contraception use in PWECP and future research directions.

Objectives: Approximately one-third of epilepsy patients will not achieve seizure freedom with current antiseizure medications, and the identification of novel treatment targets is needed. We characterized alterations in neuroinflammation-related mRNA levels to aid in the identification of possible molecular mediators of DRTLE and discuss the potential for immunomodulatory therapies in this condition.

Methods: Temporal lobe samples from DRTLE and postmortem controls without neurological conditions were obtained. RT-qPCR of 60 genes of interest was performed on BioMark Fluidigm custom-made gene expression integrated fluidic circuits (IFC) and cycle threshold values were obtained and analyzed using the $2^{-∆∆C_T}$ method. Correlation with various clinical parameters was assessed. Immunohistochemistry was performed on a subset of seven cases and four controls.

Results: Temporal lobe tissue from 17 DRTLE patients (age: 46.3 ± 12.8 years; female: 35.3%) and 12 controls (age: 56.1 ± 6.1 years; female: 33.3%) were analyzed. Compared to controls, TNF and CCL3 were upregulated 52.7 (p < .0002) and 68.9 (p < .0001)-fold, respectively. C3 was increased by 5.9-fold (p < .0001). IL1B and IL18 were increased 6.4 (p < .0001) and 5.2 (p < .0001) times, respectively. Microglial markers TMEM119 and P2RY12 had a 7.1 (p < .0001) and 5.9 (p < .0001)-fold increase, respectively, with overall lower but significant increases in general mononuclear cell-associated mRNA. There was only low-level or no upregulation of T cell and B cell associated mRNA. No correlation between mRNA alterations and clinical parameters was found. On immunohistochemistry, TMEM119 protein expression was noted in resected brain tissue from DRTLE but was largely absent from controls, consistent with the mRNA results.

Significance: Given the cross-sectional study design, causality cannot be determined. However, this study suggests that proinflammatory mechanisms may play a role in the pathogenesis of the ongoing epileptic state in DRTLE. In particular, complement, inflammasome, and microglial/mononuclear cell-mediated inflammatory processes had the most significant elevations in mRNA, while B and T cell associated mRNA were less altered.

Objective: Shortages of antiseizure medications (ASM) have been increasingly reported worldwide, threatening treatment continuity for patients with epilepsy. Since 2024, Colombia has experienced a nationwide shortage of medications for neurological diseases, particularly ASM, compromising disease control and healthcare outcomes. This study evaluated the impact of outpatient ASM shortages on seizure-related emergency department (ED) visits in a public hospital in Bogotá, Colombia.

Methods: We conducted a retrospective, descriptive study of adult patients with epilepsy admitted to the ED between March-May 2023 (no shortage) and March-May 2024 (shortage period). Demographic, clinical, and hospitalization data were collected from medical records. Statistical analyses included Fisher's exact and Mann-Whitney U tests, with significance set at p < .05.

Results: A total of 281 patients were included (107 in 2023, 174 in 2024). Sixty-one admissions were directly related to lack of outpatient ASM (7 in 2023, 54 in 2024). ED visits due to ASM unavailability increased from 6.5% to 31% (p < .001; OR = 6.4; 95% CI 2.7-17.4). Patients affected by shortages showed a higher risk of seizure clusters (OR = 2.43; 95% CI 1.2-5.1; p = .012) and a trend toward longer hospital stays, though mortality and ICU admissions remained unchanged.

Significance: Outpatient ASM shortages were associated with a marked rise in seizure-related ED visits and an increased risk of seizure clusters, reflecting greater hospital burden. Ensuring stable ASM supply through effective national distribution and monitoring strategies is essential to maintain seizure control and prevent avoidable complications in patients with epilepsy.

Objective: To evaluate the ictal semiology in seizures originating in the precuneus and to help guide seizure interpretation within the framework of presurgical evaluation.

Methods: This systematic review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and a Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS2) based approach. We searched PubMed and Embase with keywords related to the precuneus, parietal or posterior epilepsy, video-EEG, and epilepsy surgery. Included studies report patients with seizures originating in the precuneus and video-EEG-based description of seizure symptoms. Screening and data extraction of all studies were performed by two independent reviewers. The summary of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results: Nine studies reporting 29 patients were included in the final analysis. The most common symptoms at the onset of seizures were vestibular symptoms, visual illusions and hallucinations, and body perception illusions. Motor symptoms were either elementary or complex motor phenomena that emerged during seizure propagation. However, the overall quality of evidence remained moderate or low.

Significance: This systematic review suggests typical seizure symptoms associated with precuneus seizures. However, it also shows a paucity of reports on precuneus seizures. Larger prospective studies with more detailed anatomo-electro-clinical data are needed to better understand seizures with precuneal origin within the entity of posterior cortex seizures.