Epileptic Disorders最新文献

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.

Introduction: Neurologic complications, including seizures, are common in pediatric patients undergoing heart surgery, especially those requiring postoperative extracorporeal membrane oxygenation (ECMO), requiring prompt, vigilant postoperative monitoring. Prolonged EEG monitoring in critically ill children presents a risk of scalp/pressure injuries. The skin's sensitivity to microcirculatory changes can also provide valuable insights into the patient's overall tissue perfusion, making it a critical component in the management of these vulnerable patients.

Methods: We initiated a quality improvement (QI) project to assess and reduce scalp injuries related to prolonged EEG monitoring in critically ill neonates and infants. The project involved reviewing baseline data, which included 2336 inpatient video EEGs performed from January 2022 to December 2024, and implementing interventions to improve skin safety during electrode placement, while incorporating best practices from ACNS and ASET guidelines.

Results: Five critically ill infants developed deep tissue injuries (DTIs) related to EEG electrodes, with most injuries occurring over the occipital region. The frequency of scalp injuries decreased from 0.30% in 2022 to 0% in 2024 after implementing the QI protocol, and was observed in conditions with known hypoperfusion.

Discussion: Electrode-related skin injuries are a common complication of prolonged EEG monitoring, particularly in critically ill pediatric patients. Our findings suggest that adherence to expert guidelines and tailored skin care protocols focused on skin preparation, electrode application, and monitoring parameters can reduce the risk of electrode-related skin injuries. Further research is needed to refine safety protocols and address the unique skin care challenges faced by this high-risk population.

This case study reports the first documented use of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) to treat refractory status epilepticus (RSE). A 33-year-old woman with drug-resistant epilepsy and recurrent RSE underwent SEEG to define her epileptogenic zone. A new RSE started shortly before and continued during the SEEG exploration, being unresponsive to multiple antiseizure medications, vagal nerve stimulation, and corticosteroid therapy. SEEG-signal quantification based on ictal biomarkers, that is, epileptogenicity index and connectivity epileptogenicity index, identified the epileptogenic zone network (EZN) within the mesial prefrontal, premotor, and parietal cortex, with major implication of the anterior-middle and posterior cingulate cortex. RFTC was performed on SEEG-identified targets within the EZN and resulted in rapid cessation of electroclinical seizure activity and full recovery from motor deficits. Seizure frequency remained reduced by over 90% at 4 months post-procedure. This case highlights the potential of RFTC as a possible therapeutic option for RSE by directly disrupting critical network nodes responsible for seizure generation and propagation. The findings also suggest a broader role of SEEG not only for diagnostic purposes but also for the therapeutic management of refractory seizures, including status epilepticus.

Mutations in the Methyl-CpG-binding protein 2 (MECP2) gene are associated with a spectrum of neurologic disorders, most commonly of which is Rett syndrome (RTT). As these mutations occur in germ cells, neurologic symptoms usually begin in early childhood. Seizures, a common feature of MECP2-related disorders, often occur later in childhood or early adolescence. However, there has never been a documented case of progressive epilepsy and cognitive decline with onset in adulthood. Here, we present a novel case of a woman with normal developmental history who develops progressive drug-resistant epilepsy at age 27. Whole-exome sequencing revealed a loss-of-function mutation in the MECP2 gene: c.1059_1190del132ins24 that has not been previously reported. This report expands the phenotypic spectrum of MECP2-related epilepsy.

This paper provides a practical guide to applying the updated seizure classification in clinical settings. The updated classification, published by the International League Against Epilepsy in 2025, builds on the operational classification introduced in 2017. It aims to enhance clarity, clinical relevance, and consistency in seizure terminology across various healthcare settings. The classification system distinguishes between four main seizure classes: focal, generalized, unknown whether focal or generalized, and unclassified. The basic version allows for application even in resource-limited or primary care environments, while the expanded version offers detailed semiological descriptors and supports advanced diagnostic and surgical decision-making. Consciousness, defined through awareness (recall) and responsiveness, is now considered a classifier. The paper also highlights the importance of distinguishing observable from non-observable features and integrates semiology into the expanded classification with attention to temporal sequence and somatotopic detail. Generalized seizures are categorized into seizure types having a direct impact on syndrome diagnosis and treatment decisions. Epileptic spasms are given special attention because of their unique presentation and the urgency of early intervention, particularly in infants. To support clinical implementation, this paper includes a comprehensive table of semiological descriptors, definitions of generalized seizure types, and a series of real-world case vignettes illustrating the application of the updated seizure classification. Supplementary figures and videos further support the educational aims of the paper. This practical guide is intended for healthcare professionals managing patients with epilepsy, providing a clear, structured approach to seizure classification that is adaptable to varying levels of clinical expertise and diagnostic resources.

Epilepsy is a common neurological disorder with a significant burden on patients, and ~30% of cases are resistant to standard antiepileptic treatments. This has led to the exploration of alternative therapies, such as cannabidiol (CBD). Studies suggest that CBD may reduce the frequency and severity of seizures in patients with drug-resistant epilepsy. In addition to clinical monitoring, EEG is frequently used to assess brain function and monitor CBD's effects on seizures, with documented improvements in EEG patterns among CBD-treated patients. Research indicates that CBD may decrease both the number and duration of seizures, observed clinically and in EEG manifestations. This narrative review summarizes current evidence on the efficacy of CBD in treating drug-resistant epilepsy and analyzes its mechanisms of action in various forms of treatment-resistant seizures and their EEG presentations.