Epileptic Disorders最新文献

Objective: Drug-resistant epilepsy is a disabling, chronic condition in children. Long-term prognosis depends on the extent of seizure control. Ensuring compliance with medication can help reduce the seizure burden. Forgetfulness is a key barrier to adherence. To address this, we used a mobile application, "Epilepto," to deliver regular medication reminders aimed at improving compliance.

Method: We enrolled children with drug-resistant epilepsy aged 3 months to 18 years with varied etiology and randomized them into two groups. The intervention group was trained to use the application to help remind them of the medications, along with the standard of care treatment given to the control group. Medication adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8), and seizure burden was assessed using the Early Childhood Epilepsy Severity Scale (E-Chess). All the children were assessed at 3 and 6 months after enrollment.

Results: A total of 100 children were randomized (1:1) to either the control or intervention group. The median age of children in the intervention group was 84 months (Interquartile range, 45-144), and the control group was 96 months (48-144). Overall, 70% of the children were boys, and 52% had generalized epilepsy. The majority of the cases had a structural (70%) or a genetic (20.6%) etiology. Most of the users found daily reminders useful (42/48). 81.2% found this an acceptable intervention at the 6-month follow-up. There was a gradual improvement in the MMAS-8 scores over 6 months, with a 30% rise in high adherence in the intervention group as compared to only a 6% rise in the control group. There was no reduction in seizure burden as assessed by E-Chess at the end of the study period.

Significance: The use of medication reminders appeared to be a feasible intervention for children with drug-resistant epilepsy to improve medication adherence.

Dr. Ruby M. Schwartz coined the term "classical" ketogenic diet (KD) in 1989, followed by Dr. Stephen L. Kinsman in the USA, who introduced the term "classic" KD in 1992. Over the next decade, the term "classic KD" became increasingly common. So, which term is preferable-classic or classical? Given the widespread usage, we advocate for consistently using "classic KD." As there is also significant ambiguity about what exactly defines the classic KD compared to other diets, we believe two key aspects are required for the definition of classic KD: the principle of administration and the minimum ketogenic ratio (grams of fat to carbohydrates and protein). Classic KD studies emphasize a tailored, individualized approach to caloric intake and macronutrient distribution, with food items precisely measured. This personalized prescription is the defining feature of classic KD. Recent studies have proposed lower ratios, such as 2:1 or 2.5:1, yet the modified Atkins diet, introduced 80 years later, shows that a 1:1 ratio or lower can also induce ketosis. Therefore, labeling a classic KD with a minimum ratio of 3:1 or 4:1 is misleading. We contend that the classic KD should primarily be defined by its precise, individualized ratios, rather than by an arbitrary minimum value.

The ILAE Neuroimaging Task Force publishes educational case reports that highlight basic aspects of neuroimaging in epilepsy consistent with the ILAE's educational mission. Tuberous sclerosis complex (TSC) is a rare, complex, and multisystem autosomal dominant genetic disorder that arises from variations in the TSC1 or TSC2 genes. While characterized by a wide range of clinical manifestations, TSC commonly presents with epilepsy, which is a clinically challenging feature of the condition. Neuroimaging plays a pivotal role in the early diagnosis, screening, and long-term monitoring of TSC patients. CT serves as the first-line imaging tool in emergency settings; yet MRI is the primary diagnostic modality for TSC. In this report, we present two patients with TSC-related epilepsy and analyze their neuroimaging findings. We also address the diagnostic and therapeutic challenges faced by TSC patients with epilepsy.

Objective: Folic acid supplementation is recommended by WHO for all pregnancies to reduce the risk of neural tube defects and improve neurodevelopmental outcomes. No study to date directly compares the effects on children's outcomes for different folic acid dosages taken by pregnant people with epilepsy. Thus, the optimal folic acid dosing remains unclear, with current guidelines recommending a wide range of doses (.4-5 mg/day). The optimal folic acid dosage is influenced by multiple factors, including dietary intake, food fortification, genetic background, interactions with antiseizure medications, and comorbidities such as anemia or obesity. This study aimed to survey experts on their current clinical practices and recommendations regarding folic acid supplementation dosage for pregnant people with epilepsy.

Methods: A survey was distributed to expert providers in the international Epilepsy in Childbearing Age through Menopause consortium. The survey collected open-ended responses regarding recommendations and practices for folic acid supplementation in pregnant people with epilepsy, categorizing responses by dosage ranges and clinical scenarios.

Results: Fifty-two experts responded to the survey: 42 adult epileptologists, 3 pediatric neurologists, 2 obstetrician/maternal-fetal medicine specialists, 1 epilepsy pharmacist, and 4 unspecified. Geographically, respondents were primarily from North America, a region with mandatory folate fortification, as well as from Northern Europe and Asia, where such practices vary. The majority of the respondents (73.1%, n = 38) recommended folic acid supplementation doses of 1-2 mg/day, with a recommendation of either 1 mg folic acid alone (24/52) or 1 mg folic acid plus prenatal vitamins (12/52). Lower doses (.4-.8 mg/day) were recommended by 15.4% (n = 8). Additionally, 42.3% (n = 22) of respondents recommended individualized dosing strategies, particularly higher doses for patients on valproate (36.5%, n = 19) or enzyme-inducing ASMs (17.3%, n = 9). A small proportion (1.9%, n = 1) recommended routine folate serum level testing to guide supplementation.

Significance: This international expert survey revealed that folate supplementation was favored at doses of 1-2 mg/day for pregnant people with epilepsy, reflecting a shift away from previously higher-dose practices. Many experts advocated individualized dosing strategies.

Objective: TikTok has rapidly become one of the most influential social media platforms, so understanding the quality of medical content on this platform is essential for evaluating its role in public health communication. This study aimed to assess the quality and educational value of non-ictal seizure-related information on the TikTok by analyzing content associated with the relevant seizure-related keywords.

Methods: A cross-sectional analysis was conducted on TikTok videos retrieved using the platform's default "Top" search function for a selected health-related hashtag. Engagement metrics (likes, comments, shares) were collected, and videos were categorized by source and content. Videos were evaluated for quality and reliability using the DISCERN instrument and the Global Quality Scale (GQS).

Results: The majority of analyzed videos were produced by non-healthcare professionals and scored low on both DISCERN and GQS assessments. Personal experiences and non-evidence-based content were prevalent. Despite low educational value, these videos demonstrated high levels of public engagement, with total views exceeding 60 million. A positive correlation was found between likes, comments, and shares, suggesting widespread appeal of the content regardless of quality. Videos created by healthcare professionals, although fewer in number, consistently scored higher in reliability and quality.

Significance: The overall quality of health information on TikTok remains low, highlighting the risks associated with user-generated medical content. However, the platform's popularity and the high public interest in health topics present an opportunity for meaningful intervention. Increased participation by healthcare professionals and academic institutions could significantly improve the accuracy of health communication and better serve public health needs on this influential platform.

Depression is a significant comorbidity of epilepsy that affects both quality of life and seizure control. Selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line treatment for depression in patients with epilepsy; however, the optimal management strategies for SSRI-resistant depression in this population remain unclear. We conducted a 10-year retrospective analysis of epilepsy patients with SSRI-resistant depression who were treated by either switching to a serotonin norepinephrine reuptake inhibitor (SNRI) or augmenting with aripiprazole. We compared demographic factors, seizure characteristics, and treatment outcomes between the two groups. Our study included 33 epilepsy patients with SSRI-resistant depression who switched to SNRIs and 36 patients who were treated with aripiprazole augmentation. There were no significant differences in demographic factors, seizure characteristics, mean initial depression scores, or seizure freedom between the groups. However, patients receiving aripiprazole augmentation showed higher retention rates than those switching to SNRIs at their last follow-up (28/36 vs. 13/33, p = .001). Our study suggests that aripiprazole augmentation may be a more favorable option than switching to SNRIs for epilepsy patients with SSRI-resistant depression. Further prospective studies are needed to investigate effective treatment strategies for epilepsy patients with SSRI-resistant depression.