Heterogeneity of patients with functional/dissociative seizures: Three multidimensional profiles

ABSTRACT

Objective

Current concepts highlight the neurological and psychological heterogeneity of functional/dissociative seizures (FDS). However, it remains uncertain whether it is possible to distinguish between a limited number of subtypes of FDS disorders. We aimed to identify profiles of distinct FDS subtypes by cluster analysis of a multidimensional dataset without any a priori hypothesis.

Methods

We conducted an exploratory, prospective multicenter study of 169 patients with FDS. We collected biographical, trauma (childhood and adulthood traumatic experiences), semiological (seizure characteristics) and psychopathological data (psychiatric comorbidities, ...

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Trends in resource utilization and cost of illness in patients with active epilepsy in Germany from 2003 to 2020

Abstract

Objective

To calculate epilepsy-related direct, indirect, and total costs in adult patients with active epilepsy (ongoing unprovoked seizures) in Germany and to analyze cost components and dynamics compared to previous studies from 2003, 2008 and 2013. This analysis was part of the Epi2020 study.

Methods

Direct and indirect costs related to epilepsy were calculated with a multicenter survey using an established and validated questionnaire with a bottom-up design and human capital approach over a 3-month period in late 2020. Epilepsy-specific costs in the ...

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Sustained seizure freedom with adjunctive brivaracetam in patients with focal‐onset seizures

Summary

The maintenance of seizure control over time is a clinical priority in patients with epilepsy. The aim of this study was to assess the sustained seizure frequency reduction with adjunctive brivaracetam (BRV) in real-world practice. Patients with focal epilepsy prescribed to add-on BRV were identified. Study outcomes included the sustained seizure freedom and sustained seizure response, defined as a 100% and a ≥50% reduction in baseline seizure frequency that continued without interruption and without BRV withdrawal through the 12-month follow-up. ...

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Non‐Invasive Mobile EEG as a tool for seizure monitoring and management: a systematic review

Summary

Objective

In the last two decades new non-invasive mobile EEG solutions have been developed to overcome limitations of conventional clinical EEG and improve monitoring of patients with long-term conditions. Despite their availability, the adoption of mobile innovations is still very limited. The aim of this study is to review the current state-of-the-art and highlight the main advantages of adopting non-invasive mobile EEG solutions in clinical trials and research studies of people with epilepsy or suspected seizures. Device characteristics are described, and ...

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Machine Learning Approaches for Imaging‐Based Prognostication of the Outcome of Surgery for Mesial Temporal Lobe Epilepsy

Summary

Objectives

Around 30% of patients undergoing surgical resection for drug-resistant mesial temporal lobe epilepsy (MTLE) do not obtain seizure freedom. Success of anterior temporal lobe resection (ATLR) critically depends on the careful selection of surgical candidates, aiming at optimizing seizure freedom while minimizing postoperative morbidity. Structural MRI and FDG-PET neuroimaging are routinely used in presurgical assessment and guide the decision to proceed to surgery. In this study, we evaluate the potential of machine learning techniques (logistic regression, support vector machines, random ...

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Using nirmatrelvir/ritonavir in patients with epilepsy: An update from the Israeli chapter of the International League Against Epilepsy

Abstract

Presented herein are recommendations for use of nirmatrelvir/ritonavir in patients with epilepsy, as issued by the Steering Committee of the Israeli chapter of the International League Against Epilepsy. The recommendations suggest that patients on moderate-to-strong enzyme-inducing antiseizure medications (ASMs) and everolimus should not be treated with nirmatrelvir/ritonavir; rectal diazepam may be used as an alternative to buccal midazolam; doses of ASMs that are cytochrome P450 (CYP3A4) substrates might be adjusted; and patients treated with combinations of nirmatrelvir/ritonavir and ASMs that are ...

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Anticipatory anxiety of seizures is associated with ictal emotional distress and amygdala onset seizures

Summary

Objective

Anxiety disorders are a frequent psychiatric condition in patients with epilepsy. Anticipatory Anxiety of Seizures (AAS) is described as a daily persistent fear, or excessive worry of having a seizure. AAS seems to be related to “subjective ictal anxiety” reported by patient. The current study aimed to assess the association between objective ictal features and the presence of AAS.

Methods

Ninety-one patients with drug-resistant focal epilepsy underwent a standardized psychiatric assessment, specific for epilepsy, and a pre-surgical long term video-EEG or stereoelectroencephalography ...

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Stiripentol inhibits spike‐and‐wave discharges in animal models of absence seizures: A new mechanism of action involving T‐type calcium channels

Summary

Objective

Stiripentol (STP; Diacomit®) is an antiepileptic drug indicated for Dravet syndrome that has been identified as a γ-aminobutyric acid (GABAergic) positive allosteric modulator. Dravet syndrome is characterized by multiple seizure types: generalized tonic–clonic, focal, myoclonic, and absence seizures. In addition to its antiepileptic effects on tonic–clonic seizures, STP has also been reported to reduce the frequency of atypical absence seizures in patients. Our study focused on STP potential effects on absence seizures, to better characterize its full spectrum of mechanisms ...

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Accurate identification of EEG recordings with interictal epileptiform discharges using a hybrid approach: Artificial intelligence supervised by human experts

Abstract

Objective

To evaluate the diagnostic performance of artificial intelligence (AI)–based algorithms for identifying the presence of interictal epileptiform discharges (IEDs) in routine (20-min) electroencephalography (EEG) recordings.

Methods

We evaluated two approaches: a fully automated one and a hybrid approach, where three human raters applied an operational IED definition to assess the automated detections grouped into clusters by the algorithms. We used three previously developed AI algorithms: Encevis, SpikeNet, and Persyst. The diagnostic gold standard (epilepsy or not) was derived from video-EEG recordings of ...

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