Epilepsia. Official Journal of the International League Against Epilepsy

Abstract

Objective

Surgical resection of the seizure onset zone can be an effective treatment for patients with drug-resistant focal epilepsy. Clinical, electrophysiological, and imaging data are all gathered prior to surgery to localize the seizure onset zone. However, only ~62% of patients become seizure-free after surgery, highlighting the need for improved methods to prospectively predict seizure recurrence after resection. ¹⁸F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) is routinely acquired to guide epilepsy surgery; however, these scans are often assessed qualitatively in the clinic. ...

Abstract

Objective

Variability in the frequency, timing, and pattern of seizures may influence the assessment of the effect of antiseizure medications (ASMs) when measuring seizure frequency, especially in patients with infrequent seizures. A low seizure rate is an exclusion criterion for enrollment of patients with epilepsy in clinical trials and requires prolonged periods of seizure monitoring, thus delaying appropriate treatment interventions. We investigated whether an electroencephalogram (EEG)–based complexity measure of seizure susceptibility of epileptic mice provides a reliable alternative to seizure frequency ...

Abstract

Objective

This study was undertaken to understand the circumstances surrounding pediatric sudden unexpected death in epilepsy (SUDEP) and identify clinical factors that may be associated with SUDEP in childhood.

Methods

A retrospective case series was conducted. Pediatric SUDEP cases were collected across Canada from the Ontario Forensic Pathology Service, Canadian Pediatric Surveillance Program, and Canadian Pediatric Epilepsy Network. Demographics, epilepsy history, comorbidities, and circumstances surrounding death were analyzed.

Results

Forty-nine children with pediatric SUDEP were analyzed; 25 (51%) were females, and the median age at ...

Abstract

Approximately 20% of epilepsy is caused by acute central nervous system insults such as traumatic brain injury (TBI), stroke, and infection. There is a latent period of weeks to years between the insult and epilepsy onset, which offers an opportunity to prevent epilepsy. No preventive treatments exist. Their development is a major unmet need in neurology. For logistical reasons, epilepsy acquired after TBI, posttraumatic epilepsy (PTE), is most suitable for epilepsy prevention studies. In the past 20 years, preclinical PTE research ...

Abstract

Epilepsy exemplifies many of the systemic challenges of modern health care—fragmented care delivery, inequitable access, financial strain, and so on. The current “system of systems” (SoS) structure of U.S. health care fosters siloed operations among its member systems (e.g., insurers, health care institutions, providers, researchers, pharmaceutical companies, and technology vendors), failing to address interconnected issues like care continuity, clinician burnout, and appropriate resource allocation. This article proposes embracing a health care ecosystem approach as a solution, emphasizing interdependence, collaboration, and ...

Abstract

Objective

The vast majority of refractory epilepsy cases have a complex oligogenic/polygenic origin, which presents a challenge to precision medicine in individual patients. Nonetheless, the high workload and lack of effective guidelines have limited the number of in-depth animal studies.

Methods

Whole-exon sequencing identified a case with refractory epilepsy caused by a combination of two rare and de novo heterozygous variants in CACNA1A and CELSR2, respectively. Polygenic mutation flies were established and logistic regression were applied to study the gene–gene interaction and quantify ...

Abstract

Objective

Acute ischemic stroke (AIS) is a leading hospitalization cause and significantly contributes to seizures among older adults. We examined outpatient epilepsy-specific medication (ESM) initiation patterns after AIS discharge in adults 65 years and older, trends over time (by stratifying the analysis from 2013 to 2021), and racial/ethnic differences.

Methods

We analyzed nationwide administrative claims data for a 20% sample of US Medicare beneficiaries (enrolled in Traditional Medicare Parts A, B, and D for at least 12 months before admission) aged ≥65 years and hospitalized for ...

Abstract

Objective

Postoperative neuropsychological deficits pose a significant challenge for temporal lobe epilepsy (TLE) surgery, particularly in the language-dominant hemisphere. Two surgical approaches have been suggested to mitigate such adverse outcomes: stereotactic laser amygdalohippocampectomy (SLAH) and hippocampus-sparing anterior temporal lobectomy (HSATL). This retrospective cohort study compares the seizure control and neuropsychological outcomes of HSATL and SLAH in language-dominant TLE.

Methods

A retrospective cohort study compared 27 patients (nine male, mean age = 35.8 years) with drug-resistant TLE and normal imaging localized to the language-dominant left temporal lobe, ...

Abstract

Objective

Functional seizures (FS) often disrupt the key regions integral to cognitive processing and emotional regulation (anterior insula, anterior cingulate, and temporoparietal junction). We investigated the potential neurophysiologic mechanism of action (MOA) of neurobehavioral therapy (NBT) using resting-state functional MRI seed-based whole-brain functional connectivity within these regions in adults with FS. We hypothesized that NBT would induce changes in functional connectivity in parallel with improving seizure frequency and behavioral outcomes.

Methods

Forty patients with traumatic brain injury and FS (TBI+FS) underwent 12 weekly ...