Epileptic Disorders最新文献

Epilepsy surgery remains the most effective treatment for focal drug-resistant epilepsy, and stereoelectroencephalography (SEEG) is increasingly used to define the epileptogenic-zone network (EZN) and guide curative or palliative interventions. While SEEG is considered a safe invasive procedure, adverse events arising during monitoring itself are rarely described. We report three exceptional cases of postictal self-removal of intracerebral electrodes during SEEG monitoring. Among 591 implanted patients between January 2000 and October 2025 at Timone Hospital, Marseille, three patients (0.5%) met the inclusion criteria. All were young right-handed men with normal neurocognitive development, focal drug-resistant epilepsy and no psychiatric comorbidity. Self-removal occurred during the postictal phase of spontaneous seizures-two following focal-to-bilateral tonic-clonic seizures and one after a focal impaired-awareness seizure-on the second day of monitoring under complete or partial antiseizure medication withdrawal. Postictal behavior was characterized by agitation, wandering, and, in two cases, resistive aggression when nursing staff attempted to intervene. None of the patients sustained neurological sequelae or significant cerebrovascular complications. EZN involved the temporal lobe in all cases. These observations illustrate that postictal confusion, particularly under medication withdrawal, may occasionally manifest as resistive behavior capable of causing self-harm by means of device manipulation. Awareness of this rare, but potentially hazardous phenomenon, identification of at-risk patients, and implementation of tailored preventive measures may help improve the safety of invasive epilepsy monitoring.

Objective: To identify correlations between thalamic electroencephalographic (EEG) signal patterns and clinical seizure semiology in pediatric patients with drug-resistant epilepsy (DRE) treated with responsive neurostimulation (RNS).

Methods: We conducted a retrospective analysis of 14 pediatric patients (≤17 years old) with DRE who received thalamic RNS implants. EEG recordings from the RNS Patient Data Management System were reviewed and correlated with seizure semiology obtained from medical records and structured family interviews. Patterns between seizure types, EEG onset signals, and electrode placement were examined.

Results: Absence seizures were associated with bilateral 3 Hz delta spike-wave complexes in the centromedian (CM) nucleus. Drop seizures corresponded with bilateral hypersynchronous slow-to-fast gamma activity, primarily in patients with CM or anterior nucleus leads. Generalized tonic-clonic seizures exhibited the greatest variability, with gamma-to-delta transitions, synchronous gamma waves, or asynchronous slow-to-gamma patterns depending on whether leads were placed in the CM or pulvinar nuclei. These EEG patterns were consistent within nuclei, suggesting semiology-specific thalamic activity.

Significance: This study demonstrates that seizure onset EEG signals are nucleus- and semiology-specific in pediatric patients receiving thalamic RNS therapy. These findings highlight the CM nucleus's central role in seizure propagation and support individualized RNS programming based on EEG frequency signatures. While limited by sample size, this work provides early evidence that thalamic EEG biomarkers can inform more precise neuromodulation strategies for pediatric DRE.

Objective: This study aimed to compare EEG responses and clinical findings during video-based pattern stimulation in pediatric epilepsy and control groups, and to evaluate differences according to epilepsy subgroups and seizure control status.

Methods: A total of 438 children (190 with epilepsy, 248 controls) were included. All participants underwent a 100-second video protocol consisting of 10 different patterns. Epileptiform activity during pattern stimulation and simultaneous clinical symptoms (nausea, dizziness, lightheadedness, etc.) were recorded. Responses to hyperventilation and photic stimulation were also assessed. The epilepsy group was analyzed according to seizure control (controlled/uncontrolled) and epilepsy syndromes (juvenile idiopathic generalized epilepsy, childhood absence epilepsy, self-limited epilepsy with autonomic seizures (SeLEAS), self-limited epilepsy with centrotemporal spikes (SeLECTS), and focal epilepsy). Statistical analyses were performed using chi-square tests and multivariable logistic regression.

Results: EEG pattern sensitivity was observed in 8.9% of the epilepsy group and 3.2% of controls (p = .012). Clinical symptoms occurred in 11.5% of epilepsy patients and 15.7% of controls (p = .265). Pattern sensitivity was significantly higher in uncontrolled epilepsy (p = .009). Subgroup analysis revealed the most prominent difference in juvenile idiopathic generalized epilepsy. In multivariable analysis, hyperventilation (p = .044) and photic response (p = .042) were identified as independent predictors of pattern sensitivity.

Significance: Pattern sensitivity is not exclusive to children with epilepsy and may also occur at a lower rate in healthy controls. Children with uncontrolled epilepsy and those with juvenile idiopathic generalized epilepsy (JIGE) are particularly at risk. EEG abnormalities during pattern stimulation provide a more reliable indicator than clinical symptoms. The video-based protocol used in this study increases ecological validity by mimicking real-life visual stimuli. Our findings support the need for international standardization of pattern stimulation, similar to hyperventilation and photic stimulation protocols.

Objective: Crossed cerebellar diaschisis is a neuroimaging phenomenon observed in various neurological conditions, including status epilepticus. This systematic review aims to summarize the clinical and radiological characteristics of patients developing crossed cerebellar diaschisis following status epilepticus and to discuss potential pathophysiological mechanisms.

Methods: A systematic literature search was conducted using MEDLINE/PubMed, Embase, Web of Science, and CENTRAL from inception to October 2025. Studies reporting crossed cerebellar diaschisis in patients with status epilepticus, confirmed by neuroimaging (MRI, PET, or SPECT), were included. Data on demographics, semiology, etiology, imaging findings, EEG, and outcomes were extracted and synthesized. A spatial analysis of supratentorial MRI abnormalities associated with crossed cerebellar diaschisis was performed in 18 cases with suitable imaging.

Results: Sixty patients from 50 studies were included. Mean age was 46.1 years; 50% were female. Convulsive status epilepticus was present in 62% of cases. Etiology was acute in 40%, unknown in 45%. Crossed cerebellar diaschisis was most frequently detected via DWI hyperintensity (55%) and FLAIR/T2 changes (52%). Arterial spin labelling and SPECT often showed hyperperfusion in the acute phase. Spatial mapping of supratentorial MRI abnormalities revealed a predominant involvement of cortical temporo-occipital regions, with minimal subcortical involvement, aligning with known cerebro-cerebellar connectivity patterns. Cerebellar symptoms were rare (5%), but cerebellar atrophy was reported in 7% of cases. Mortality was 10%; 30% recovered completely, while 33% had neurological deficits at discharge.

Significance: Crossed cerebellar diaschisis is a dynamic phenomenon, presenting with both hyper- and hypoperfusion or metabolism, based on the timing and severity of status epilepticus. It may result from increased inhibitory cerebellar activity during seizures, followed by metabolic exhaustion and Purkinje cell loss. Although often clinically silent, it might lead to long-term cerebellar atrophy and neurological sequelae.

Objective: In June 2018, the US Food and Drug Administration (FDA) approved pharmaceutical grade cannabidiol (CBD; Epidiolex®) for the treatment of seizures associated with Lennox-Gastaut syndrome (LGS). We sought to examine whether the FDA approval of CBD was associated with changes in LGS diagnostic practices in the United States.

Methods: We computed the annual number of new LGS diagnoses in the United States from 2017 to 2023 using a large, population-based database of electronic health records.

Results: We identified a temporary increase in the number of new LGS diagnoses in 2019: the incidence rate rose by roughly 30% from 2018 to 2019, and almost 60% from 2017 to 2019, before it returned to pre-FDA CBD approval baseline (2020-2023).

Significance: This temporary increase occurred in temporal proximity to the 2018 FDA approval of CBD for LGS. While causality cannot be inferred, this descriptive finding may reflect a confluence of factors including patient-caregiver interest and clinician practices to gain access to CBD. Clinician practices may have involved applying/updating LGS ICD codes to patients previously diagnosed with LGS and misdiagnosing patients with severe epilepsies as LGS. These findings underscore the clinical and research importance of appropriately using the LGS ICD code and ensuring accurate, reliable diagnosis of LGS based on standardized, well-defined criteria. Nevertheless, given this work's reliance on administrative data, readers should interpret results cautiously, as misclassification and inconsistent coding practices can influence epidemiologic estimates and research conclusions.

Developmental venous anomalies (DVAs) are the most frequent cerebral venous malformations and are typically benign. However, under metabolic or hemodynamic stress, venous outflow restriction may occur, leading to transient parenchymal dysfunction and seizures. A 72-year-old man with poorly controlled diabetes (HbA1c 13.1%) and recent use of multiple herbal supplements presented with clusters of focal preserved consciousness seizures. Brain MRI revealed right temporal cortical swelling and subcortical T2 hypointensity with enhancing tubular structures, consistent with a developmental venous anomaly exhibiting venous congestion. EEG showed ictal rhythmic activity in the right posterior temporal region, confirming focal aura continua with visual symptoms. Following diazepam and levetiracetam-lacosamide therapy, seizures resolved completely. Repeat MRI and EEG at 3 months demonstrated full normalization. Venous congestion in DVA may develop through transient venous outflow restriction, particularly under hypercoagulable or metabolic stress conditions. The reversible course in our patient supports a dynamic hemodynamic mechanism rather than irreversible parenchymal damage. DVA-related venous congestion should be considered in patients presenting with focal seizures or status epilepticus in the context of prothrombotic or metabolic triggers. Early metabolic correction and conservative management can ensure complete clinical and radiologic recovery.

Objective: Memory impairment, particularly subjective memory complaints, is common among patients with epilepsy and significantly affects their quality of life and treatment adherence. This study aimed to investigate the factors influencing subjective memory in epilepsy, with a specific focus on the roles of psychological resilience and perceived stress, and to examine whether perceived stress mediates the relationship between psychological resilience and subjective memory.

Methods: A total of 145 patients with epilepsy were prospectively enrolled at the Epilepsy Center of a tertiary teaching hospital. Comprehensive assessments were conducted to evaluate psychological resilience, perceived stress, subjective and objective memory performance, and demographic and clinical characteristics. Statistical analyses included Pearson or Spearman correlation, group comparisons, and multiple regression analyses to identify the influencing factors. The mediation effects were tested using the bootstrap method with 5000 resamples.

Results: Subjective memory was positively correlated with psychological resilience (r = .441, p < .001) and negatively correlated with perceived stress (r = -.574, p < .001). Regression analysis indicated that psychological factors remained significant predictors after controlling for the relevant covariates. Mediation analysis demonstrated that perceived stress exerted a significant indirect effect on the association between psychological resilience and subjective memory (ACME = .1554, 95% CI [.03, .31], p = .015), which accounted for 32.96% of the total effect.

Significance: Psychological resilience and perceived stress are significant contributors to subjective memory in epilepsy. The mediating role of perceived stress suggests its potential as a target for psychological intervention.