ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology

Predictive value of the polygenic risk score for developing epilepsy: a systematic review and meta-analysis

PURPOSE

This study aimed to integrate the findings of previous studies to clarify the predictive value of the polygenic risk score (PRS) for epilepsy.

METHODS

The MEDLINE, EMBASE, and CENTRAL databases were systematically searched for studies investigating PRS in epilepsy. Additionally, a meta-analysis was performed using random-effects models of studies that included PRS calculations using similar methodologies. The main outcome was the odds ratio (OR) for developing epilepsy based on the generalized or focal epilepsy PRS. The risk of bias (Q-Genie tool) and heterogeneity between the studies were also assessed.

RESULTS

Overall, 585 records were retrieved on April 27, 2024. Eleven studies were included in this systematic review. Most studies were conducted on cohorts with European ancestry. The risk of developing epilepsy increased with a higher PRS, which was more pronounced in patients with generalized epilepsy. The total Q-Genie tool score of the included studies was 50.9 (good quality: >45). The meta-analysis included two studies and found that the ORs for generalized epilepsy were 2.18 (95 % confidence interval [CI] 1.91-2.48), 2.65 (95 % CI 2.07-3.39), and 4.62 (95 % CI 3.45-6.20) for the top 20 %, 5 %, and 0.5 % of the PRS distribution, respectively; the respective ORs for focal epilepsy were 1.19 (95 % CI 0.84-1.67), 1.40 (95 % CI 1.28-1.52), and 1.69 (95 % CI 1.27-2.24). Significant heterogeneity was found only in the top 20 % of PRS cases for focal epilepsy (I2 = 97.0 %; Q test p < 0.0001).

CONCLUSION

The PRS could be an effective tool for predicting development of epilepsy.

Comprehensive genetic diagnosis and therapeutic perspectives in 155 children with developmental and epileptic encephalopathy

We studied a retrospective cohort of children with developmental and epileptic encephalopathy (DEE), a group of neurological conditions characterized by early onset epilepsy and severe developmental delay. Cases were recruited from three university hospitals based on clinical criteria, after a blinded cross-validation process, and most were subject to both array-CGH and exome-based gene panel analyses. 155 subjects were included. A genetic diagnosis was identified in 105 (68 %). A majority of patients (71 %) had onset of symptoms before the age of one year. In this age group a disease-causing variant was identified in 73 % of children, the highest proportion of cases reported so far. Genetic heterogeneity was high, involving 40 different genes. The most prevalent gene was SCN1A. Eight genes were identified in multiple patients and accounted for 50 % of all diagnoses. The remaining genes represented ultra-rare disorders. In many cases, molecular diagnosis leads to treatment adaptation and allows for genetic counseling. Those results highlight the growing importance of genetic investigations especially in children with symptoms onset before the age of 1. Finally, we evaluated the disease-causing variants in an intention-to-treat approach and found that almost half would theoretically be amenable to personalized therapy using antisense oligonucleotides (ASOs).

Multiple Sclerosis and Seizures: Clinical, Diagnostic and Therapeutic Correlations

INTRODUCTION

Seizures occur more commonly in people with multiple sclerosis (pwMS) than in the general population. Existing studies correlating clinical, diagnostic and therapeutic outcomes for pwMS and seizures are lacking. We determine the prevalence of seizure(s) in people with MS/clinically isolated syndrome (CIS) and characterize a population-based cohort of pwMS/CIS and seizure(s).

METHODS

We used the South Wales MS registry to identify all people with MS/CIS and a lifetime history of seizure living within Cardiff and Vale. Retrospective clinical data were extracted from electronic records. Prevalent populations of (i) lifetime history of seizure(s) (ii) epilepsy diagnosis in pwMS/CIS were calculated on the January 1st, 2020 for the catchment area. MR brain images nearest to time of first seizure were reviewed and compared to a contemporary, matched cohort of pwMS without seizures.

RESULTS

We identified 49 historical cases of co-existent MS/CIS and seizure(s). On January 1st, 2020, we found that 2.4% (23/950, 95% CI 1.4%-3.4%) of the prevalent population of people with MS/CIS had experienced a seizure and 2.1% (20/950, 95% CI 1.2%-3.0%) had a diagnosis of epilepsy, which is higher than the general population (0.76%). Seizure(s) occurred before other symptoms of MS in 15/49 and after MS in 34/49. One patient (2%) experienced a seizure during MS relapse. First seizure occurred during treatment with fingolimod in three patients and with fampridine in one patient. Analysis of MR brain images suggests that pwMS and seizures have a higher number of T2 lesions and more marked brain atrophy.

CONCLUSION

This study suggests that approximately 2.4% of people with MS/CIS are expected to experience seizure(s). Seizures in MS are associated with higher overall brain disease burden.

Distinctive seizure signature in the first video case-control study of a naturally-occurring feline autoimmune encephalitis model

BACKGROUND AND OBJECTIVE

Autoimmune encephalitis (AE) is a form of brain inflammation where pathogenic autoantibodies bind surface proteins. In humans, AE is at least as common as infective encephalitis, and seizures are a prominent manifestation. The most common adult human AE is associated with antibodies to leucine-rich glioma-inactivated 1 (LGI1-Ab-E). AE in non-human mammals is also recognised, notably the polar bear 'Knut', diagnosed with N-methyl D-aspartate receptor antibody encephalitis. LGI1-Ab-E is an emerging cause of spontaneously-arising AE in domestic cats. Our objective was to phenotype the seizure profile of feline LGI1-Ab-E and probe parallels to its human counterpart.

METHODS

We characterised seizures in naturally-occurring feline LGI1-Ab-E. Three veterinary and two human neurologists independently blind-rated 35 LGI1-antibody positive and negative feline seizure videos from 24 cats (16 LGI1-Ab-E positive, 8 negative). Data analysed included seizure frequency, semiologies and their co-occurrence, localisation, inter-rater agreement, and predictive factors.

RESULTS

The mean number of daily seizures at peak was significantly higher in LGI1-antibody positive compared to LGI1-antibody-negative cats (12.6 vs. 1.9/day, pcorr = 0.011). Semiologies statistically significantly enriched in LGI1-Ab-E observations included orofacial automatisms (88/120, 73 % vs. 26/55, 47 %, pcorr = 0.024), salivation (87/120, 73 % vs. 23/55, 42 %, pcorr = 0.004); and mydriasis (79/120, 66 % vs 19/55, 35 %, pcorr = 0.004), and almost exclusively seen in LGI1-Ab-E were circling (39/120, 33 % vs. 1/55, 2 %, pcorr=<0.001) and aggression (14/120, 12 % vs. 0/55, 0 %, non significant after correction). A temporal lobe onset was proposed in 67 % (80/120) of seropositive ratings, compared to 28 % (15/55) LGI1-Ab-E negative (p < 0.0001). Network analysis depicted complex and overlapping relationships between features, akin to the frequent and multifaceted seizures of human LGI1-Ab-E. Orofacial automatisms, mydriasis and temporal lobe localisation were predictive semiological features of feline LGI1-Ab-E.

SIGNIFICANCE

Feline LGI1-Ab-E represents a clinically distinctive seizure disorder. Our findings highlight the value of studying naturally-occurring, biologically representative animal models which closely mimic human diseases. This bidirectional translational approach confers benefits across species and unites human and veterinary neurology.

Autoimmune-associated epilepsy - a challenging concept

The current International League Against Epilepsy (ILAE) definition and classification guidelines for the first time introduced the category of immune-mediated focal epilepsy in addition to structural, genetic, infectious, and metabolic aetiologies. Moreover, the ILAE Autoimmunity and Inflammation Taskforce recently provided a conceptual framework for the distinction between acute "provoked" seizures in the acute phase of autoimmune encephalitis from chronic "unprovoked" seizures due to autoimmune-associated epilepsy. The first category predominately applies to those autoimmune encephalitis patients with autoantibodies against cell surface neural antigens, in whom autoantibodies are assumed to exert a direct ictogenic effect without overt structural damage. These patients do not exhibit enduring predisposition to seizures after the "acute phase" encephalitis, and thus do not fulfil the definition of epilepsy. The second category applies to those autoimmune encephalitis patients with autoantibodies against intracellular neural antigens and Rasmussen's encephalitis, in whom T cells are assumed to cause epileptogenic effects through immune-inflammation and overt structural damage. These patients do exhibit enduring predisposition to seizures after the "acute phase" of encephalitis and thus fulfil the definition of epilepsy. AAE may result from both, ongoing brain autoimmunity and associated structural brain damage according to the current ILAE definition and classification guideline. We here discuss the difficulties of this concept and suggest an unbiased translationally validated and data-driven approach to predict in an individual encephalitis patient the propensity to develop (or not) AAE and the cognitive and behavioural outcome.

Investigation of Gait Characteristics and Kinematic Deviations in Rare Genetic Disorders with Instrumented Gait Analysis

BACKGROUND

Dravet Syndrome (DS), Helsmoortel-Van Der Aa Syndrome (HVDAS) and Tuberous Sclerosis Complex (TSC) are rare genetic syndromes, sharing intellectual disability (ID) and motor delay. In DS, two distinct gait patterns, crouch and non-crouch, have been described using instrumented 3D gait analysis (i3DGA). This cross-sectional study measures gait in participants with TSC and HVDAS. The findings are compared to the known crouch and non-crouch gait patterns observed in DS and to typical gait.

METHODS

Participants (6-22 years) with DS (n = 37; 19 crouch and 18 non-crouch), HVDAS (n = 12) or TSC (n = 8) were compared with typically developing (TD) peers (n = 33). All participants underwent i3DGA (Plugin Gait model processed with Vicon Nexus and MATLAB®) to investigate spatiotemporal and lower-limb kinematics.

RESULTS

All three genetic syndromes showed increased step width. Participants with HVDAS and DS, but not participants with TSC walked with decreased step length and velocity compared to TD. HVDAS demonstrated increased knee flexion during the stance phase, lack of hip extension during pre-swing, and increased ankle dorsiflexion during some phases of the gait cycle (p < 0.001). Additionally, HVDAS showed similar kinematic deviations to DS-NonCrouch. No significant differences were found in terms of kinematics between TSC and TD peers (p > 0.05).

CONCLUSION

The current study reveals differences in gait characteristics from typical functional gait in rare genetic disorders. DS-Crouch, DS-NonCrouch and HVDAS display a more impaired gait from a biomechanical perspective than TSC. The variability of clinical and genetic features might explain heterogeneity in gait deviations and should be further explored.

Grapheme-color synesthesia in patients with epilepsy: A pilot study

BACKGROUND

Synesthesia is a condition in which the stimulation of one sensory modality triggers unusual experiences in a second sensory modality such as colors or shapes. Synesthesia has been linked to specific conditions such as autism spectrum disorder, although the mechanisms underlying synesthesia remain largely unclear.

OBJECTIVE

This pilot study aimed to investigate the prevalence of grapheme-color synesthesia (GCS) in patients with epilepsy and to characterize the epilepsy features associated with GCS experiences.

METHODS

Participants were asked whether they reported experiences suggesting GCS. Those reporting GCS underwent a standard online consistency and congruency battery test (http://www.synesthete.org). Epilepsy features, electroencephalogram (EEG) findings, and magnetic resonance imaging (MRI) findings were collected and analyzed.

RESULTS

Of the 40 study participants, 21 reported GCS experiences and 3 (7.5 %) resulted synesthetes from the battery test. Analysis of the test results showed that participants with focal seizures had lower median consistency scores (indicating they were less consistent in their color assignments) and higher congruency scores (indicating they were more accurate in quickly identifying matching color and letter/number combinations) compared to patients with generalized-onset seizures (2.9 and 51.4 respectively; p = 0.006, p = 0.001). Participants with non-motor seizures had lower median consistency scores (1.1) and higher congruency scores (79.2) compared to patients with motor seizures (2.8 and 52.8, respectively; p = 0.011, p = 0.036).

CONCLUSION

GCS may be more prevalent in patients with epilepsy than the general population. Focal and non-motor seizures may be associated with predisposition to GCS. Further larger scale studies are needed to confirm and expand these observations.

Artificial intelligence (ChatGPT 4.0) vs. Human expertise for epileptic seizure and epilepsy diagnosis and classification in Adults: An exploratory study

AIMS

Artificial intelligence (AI) tools like ChatGPT hold promise for enhancing diagnostic accuracy and efficiency in clinical practice. This exploratory study evaluates ChatGPT's performance in diagnosing and classifying epileptic seizures, epilepsy, and underlying etiologies in adult patients compared to epileptologists and neurologists.

METHODS

A prospective simulation study assessed 37 clinical vignettes based on real adult patient cases. ChatGPT was 'trained' using official ILAE documents on epilepsy diagnosis and classification. Diagnoses and classifications by ChatGPT, two epileptologists, and two neurologists were compared against a reference standard set by a senior epileptologist. Diagnostic accuracy was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Cohen's kappa (κ) was calculated to assess agreement.

RESULTS

ChatGPT demonstrated high sensitivity (≥96.9 %) in identifying epileptic seizures and diagnosing epilepsy, ensuring no cases were missed. However, its specificity was lower, particularly for distinguishing acute symptomatic from unprovoked seizures (33.3 %) and diagnosing epilepsy (26.7 %), leading to frequent false positives. ChatGPT excelled in diagnosing epileptic syndromes (κ = 1.00) and structural etiologies (accuracy = 90.0 %) but struggled with ambiguous cases such as unknown seizure onset (accuracy = 12.5 %) and rare etiologies. Human experts consistently outperformed ChatGPT with near-perfect accuracy and higher κ values.

CONCLUSION

ChatGPT shows potential as a supplementary diagnostic tool but requires human oversight due to reduced specificity and limitations in nuanced clinical judgment. Further development with diverse datasets and targeted training is necessary to improve AI performance. Integrating AI with expert clinicians can optimize diagnostic workflows in epilepsy care.

Relationship between scalp high-frequency oscillations and time since the last seizure in epilepsy

OBJECTIVE

The accuracy of self-reported seizure-freedom duration are essentially limited. Scalp high-frequency oscillations (HFOs) are more tightly linked to seizures than spikes alone and are a promising new biomarker. The purpose of this study is to determine the relationship between scalp HFO and time since the last reported seizure.

METHODS

The study population consisted of 169 pediatric epilepsy patients (91 males; age range, 0-20 years). A holdout method was used to develop and validate a predictive model (multivariate HFO model) to estimate the time since the last reported seizure.

RESULTS

The multivariate HFO model was created with four variables: scalp HFO detection rate, developmental delay, epilepsy duration, and the use of antiepileptic drugs. The area under the curve (AUC) of the multivariate HFO model was higher than that for the HFO and spike models in all four discriminations for time since the last reported seizure (≥ 2 years: AUC = 0.95, ≥ 1 year: 0.91, ≥ 2 months: 0.82, and ≥ 2 weeks: 0.76).

CONCLUSIONS

The multivariate HFO model showed higher performance in patients with a longer time since the last reported seizure (≥ 1 year).

SIGNIFICANCE

This model may help establish a new measure of epilepsy remission.

High-Frequency Oscillations in Self-Limited Epilepsy With Centrotemporal Spikes: Potential Predictors of Attention Deficit Hyperactivity Disorder?

OBJECTIVE

The aim of this study was to examine the possible effect of HFOs detected in children with SeLECTS, who have rolandic spikes with or without ADHD, in predicting cognitive comorbidities with the fully automatic ripple detector program we developed.

METHODS

A total of 40 patients diagnosed with SeLECTS with at least a 1-year follow-up were included in this study. The patients were divided into two groups: those diagnosed with SeLECTS only and those diagnosed with SeLECTS+ADHD. For ripple detection, EEG data recorded for at least 10 min during non-REM stage 2 sleep with a sampling frequency of 2000 Hz was analysed in the MATLAB environment. After the data in each channel was filtered at 80-200 Hz, ripple detection was made with the fully automatically developed ripple detector program.

RESULTS

At least one ripple was detected in 29 of 40 patients (72.5%). The total number of spikes in both groups had a mean of 1435.8 ± 1626.9 (5-6183). The number of spikes in the rolandic region was found to be statistically significantly higher in the SeLECTS+ADHD group (p = 0.042). The total number of ripples in both groups was the mean: 9.5 ± 26.5 (0-158). The highest ripples count was detected in a patient in the SeLECTS+ADHD group; 158 ripples were counted, and the ripple distribution was found to be 33 ripples in the centrotemporal region and 125 ripples in the frontal region. The ripple of number (p = 0.009) and ripple ratio in the 'Fz-Cz' electrode were found to be statistically significantly higher in the SeLECTS + ADHD group (p = 0.009, p = 0.019, respectively).

SIGNIFICANCE

Our study showed that the presence of interictal scalp HFOs has the effect of predicting neurocognitive comorbidities. We think that ripple analysis with the can be used as a potential biomarker to predict neurocognitive comorbidities.

Individualized morphological covariation network aberrance associated with seizure relapse after antiseizure medication withdrawal

This study intents to detect graphical network features associated with seizure relapse following antiseizure medication (ASM) withdrawal. Twenty-four patients remaining seizure-free (SF-group) and 22 experiencing seizure relapse (SR-group) following ASM withdrawal as well as 46 matched healthy participants (Control) were included. Individualized morphological similarity network was constructed using T1-weighted images, and graphic metrics were compared between groups. Relative to the Control, the SF-group exhibited lower local efficiency, while the SR-group displayed lower global and local efficiency and longer characteristic path length. Both patient groups displayed reduced centrality in certain subcortical and cortical nodes than the Control, with a more pronounced reduction in the SR-group. Additionally, the SR-group exhibited lower centrality of the right pallidum than the SF-group. Decreased subcortical-cortical connectivity was found in both patient groups than the Control, with a more extensive decrease in the SR-group. Furthermore, an edge connecting the right pallidum and left middle temporal gyrus exhibited decreased connectivity in the SR-group than in the SF-group. A weaker small-worldization network upon medication withdrawal, potentially underpinned by node decentralization and subcortical-cortical decoupling, may elevate the risk of seizure relapse.

Psychological status and family burden in caregivers of adult people with epilepsy

PURPOSE

The study aimed to assess anxiety and depression symptoms as well as family burden in the caregivers of adult people with epilepsy (PWE), and to illustrate the influencing factors in depression and anxiety in the caregivers of adult PWE.

METHODS

178 pairs of adult PWE and their caregivers attending our epilepsy center participated in this study. Demographic characteristics, and anxiety and depression scores were collected for both PWE and their caregivers. Family burden and stress were also assessed by caregivers.

RESULTS

In PWE, 45 (31.69 %) participants suffered anxiety symptoms, and 51 (35.92 %) suffered depression symptoms. Anxiety and depression symptoms were detected in 42 (29.58 %) and 40 (28.17 %) of caregivers for adult PWE respectively. Caregivers reported moderate levels of family burden (0.52 ± 0.50), while family economic burden gained the highest score (0.79 ± 0.65). Depression in PWE (B = 0.238, p < 0.001; B = 0.319, p < 0.001), the mental health of family members (B = 10.240, p < 0.001; B = 8.281, p < 0.001) and stress (B = 0.075, p = 0.002; B = 0.091, p = 0.008) in caregivers were independently associated with both anxiety and depression in caregivers.

CONCLUSION

Depression in PWE was independently associated with anxiety and depression in caregivers, respectively. Stress and the mental health of family members in caregivers were independently associated with anxiety and depression in caregivers, separately. Levels of anxiety and depression in caregivers were significantly related to family burden. Therefore, the psychological status of caregivers for adult PWE should be paid more attention in epilepsy treatment.

Prevalence of Vision and Eye Movement Abnormalities in Children Referred to the Children's Epilepsy Surgery Service: A 5-Year Observational Study

PURPOSE

To report the prevalence of visual acuity, visual field, and ocular motility problems in children with epilepsy referred to the Children's Epilepsy Surgery Service (CESS) for surgery.

METHODS

This was a retrospective observational study of all children referred to the CESS in Bristol between 2015 and 2020. Data extraction included age, age at epilepsy diagnosis, epilepsy etiology (as determined by seizure semiology, neuroimaging, and electroencephalography), anti-seizure drugs, visual acuity, visual field, ocular motility, and fundus imaging.

RESULTS

A total of 221 children with epilepsy were seen during the study period: 60% (132/221) had structural etiologies, 8% (18/221) were genetic, and in 28% (62/221) the etiology was unknown. Overall, 53% (117/221) were found to have abnormalities, particularly strabismus (16%, 36/221), visual field defects (14%, 27/198), and reduced visual acuity (12%, 26/219). Notably, 54% (63/117) of children with ophthalmic abnormalities were new diagnoses in the CESS clinic. Younger children and those with neurodevelopmental disorders were less likely to complete all vision tests.

CONCLUSIONS

Ophthalmic abnormalities were prevalent among children referred for epilepsy surgery in Bristol and more than half were previously undiag-nosed. The data support the adoption of an orthopticled vision screening service for children with medically refractory epilepsy, structural etiologies, and focal seizures, to better support their needs in the community. [J Pediatr Ophthalmol Strabismus. 2025;62(3):211-219.].

Cognitive and neuro-psychiatric profile in adult patients with epilepsy secondary to Tuberous Sclerosis Complex

INTRODUCTION

Tuberous Sclerosis Complex (TSC) is a neurocutaneous disorder associated with epilepsy (70-90% of cases) and neuropsychiatric symptoms (NPS). However, the influence of epilepsy on NPS remains unclear.

OBJECTIVES

This study aimed to describe the presence of NPS in our cohort and to establish their relationship with epilepsy severity and other clinical characteristics (genetic, neuroimaging, and EEG findings).

PATIENTS AND METHODS

Descriptive, cross-sectional, single-centre study of adults (18-65 years) with TSC, without significant intellectual disability. Patients underwent comprehensive neurological and neuropsychological assessment, which included cognitive, depression, and quality of life evaluations, alongside the TAND-checklist for NPS.

RESULTS

Twenty-eight patients with TSC were included (19 women, 44.7 ± 14.4 years). Seven patients had TSC1 variants and 11 had TSC2 variants. Nineteen (67.86 %) patients had epilepsy, 7(36.84 %) of them exhibiting drug-resistant epilepsy. Five (17.86 %) presented Infantile Spasms in the past. Regarding TAND-L, the most frequent NPS were: mood swings (80 %), excessive shyness (70 %), sleep/attention disorders (60 %) and low self-esteem (50 %). A longer duration of epilepsy and a higher number of anti-seizure medications (ASM) trials correlated with poorer total IQ -Intelligence Quotient- (Pearson correlation = -0.53, significant at 0.007 and -0.45, significant at 0.03, respectively). Patients carrying a TSC2 variant or with a history of Infantile Spasms had higher intellectual disability and worse TAND scores (p < 0.05). Despite the high prevalence of NPS, only 4(14.28 %) patients had received specific psychiatric care.

CONCLUSION

Patients with TSC and severe epilepsy showed worse neuropsychiatric outcomes. The high prevalence of NPS underscores the need for specific protocols for early detection and intervention.

Williams-Beuren Syndrome and Epilepsy: A Retrospective Analysis of 589 Patients

Although many reports have described the characteristics of Williams-Beuren syndrome, few specifically analyzed epilepsy in patients with Williams-Beuren syndrome. In this retrospective study, we map the prevalence, types, and prognosis of epileptic seizures in a large cohort of 589 patients with Williams-Beuren syndrome, as well as associations between deletions of the membrane-associated guanylate kinase inverted-2-gene (MAGI2 gene), which is associated with infantile spasms (IS), and epilepsy in patients with Williams-Beuren syndrome.Our findings indicate that the incidence of epilepsy in patients with Williams-Beuren syndrome is approximately 1.02% (6 in 589), and is thus not higher than the incidence in the general population (0.5%-1.0%). West syndrome emerged as the most common epileptic syndrome in patients with Williams-Beuren syndrome (4 of 6) and typically has a favorable prognosis. There was no genotype-phenotype correlation between MAGI2 deletions and West syndrome in this cohort.

Development of a Novel Epilepsy and Dyskinesia Survey for Large-Scale Characterization of Seizure Semiology in Dogs

BACKGROUND

Diagnosing epilepsy and dyskinesia in dogs relies on seizure semiology, laboratory workup, brain imaging, and electroencephalography. Variability in existing epilepsy surveys complicates comparison and impedes epidemiologic and genetic research.

OBJECTIVE

To characterize the semiology of epileptic seizures and dyskinesia episodes using a novel, owner-completed, multi-language online questionnaire.

ANIMALS

A cohort of 606 dogs from 96 breeds with paroxysmal events, perceived by their owners as epilepsy or dyskinesia.

MATERIALS AND METHODS

A comprehensive epilepsy and dyskinesia questionnaire featuring pragmatic seizure categories and video upload was developed in German, Finnish, and English. The reliability of the questionnaire was assessed, and the study cohort analyzed.

RESULTS

The questionnaire demonstrated strong internal consistency and interrater agreement. Owners correctly classified paroxysmal events in 90.1% of cases (95% CI 88.18-92.11). Video footage was submitted from 23.8% (143/606) and supported the seizure type in the questionnaire in 96.5%. The age of onset ranged from 6 months to 6 years in 80.2% (median 2 years; IQR 1-5 years). Generalized (epileptic) convulsive seizures occurred in 58.6% of dogs, non-generalized paroxysmal motor events without convulsions in 58.1%, sudden falls without movement in 6.1%, episodes of impaired awareness in 15.8%, and other unclassified events in 7.1%. Multiple seizure types were reported in 25.2% of the dogs. Labrador Retrievers exhibited a higher prevalence of non-generalized motor events compared to Border Collies, Siberian Huskies, and other breeds (p < 0.001).

CONCLUSIONS

The questionnaire reliably characterizes epileptic seizures and dyskinesia episodes in dogs, making it a valuable tool for large-scale epidemiological and genetic studies.

Association of serum insulin-like growth factor-1 and adrenocorticotropic hormone therapeutic response in patients with infantile epileptic spasms syndrome

Background

Infantile epileptic spasm syndrome (IESS), a rare age-specific epileptic encephalopathy, exhibits limited therapeutic efficacy, with approximately 50% of patients showing resistance to adrenocorticotropic hormone (ACTH) monotherapy. Herein, we investigated the association between serum insulin-like growth factor-1 (IGF-1), insulin-like growth factor-binding protein-3 (IGFBP-3), their ratio, and short-term ACTH therapeutic response in IESS, alongside their correlation with video-electroencephalogram (VEEG) characteristics.

Methods

This retrospective study included IESS patients who received ACTH treatment at Shanghai Children's Medical Center from July 2021 to November 2024. Clinical data, including serum IGF-1, IGFBP-3 levels, VEEG findings, and short-term treatment responses, were collected. Before ACTH therapy, we classified patients into hypsarrhythmia and non-hypsarrhythmia groups based on VEEG findings. The hypsarrhythmia cohort was further subdivided into ACTH responders and non-responders. Statistical analyses employed independent t-tests, Mann-Whitney U tests, chi-square tests, and Spearman's rank correlation.

Results

A total of 21 patients (14 hypsarrhythmia, 7 non-hypsarrhythmia) were enrolled. The hypsarrhythmia population exhibited significantly lower serum IGF-1 levels and IGF-1/IGFBP-3 ratios (p < 0.05) compared to the non-hypsarrhythmia population. Within the hypsarrhythmia population, responders (n = 9) showed higher IGF-1, IGFBP-3 levels, and IGF-1/IGFBP-3 ratios than non-responders (n = 5) before ACTH treatment (p < 0.05). Post-ACTH treatment, serum IGF-1 and IGFBP-3 levels increased in all patients, with greater elevation observed in responders.

Conclusion

Our findings demonstrate that serum IGF-1, IGFBP-3 levels, and their ratio correlate with both hypsarrhythmia severity and short-term ACTH response in IESS patients. These biomarkers may help guide personalized treatment decisions.

Event-related potential biomarkers in temporal lobe epilepsy: N170, vertex positive potential, late positive potential, and P3 signatures of depression comorbidity

Objective

This study aimed to identify which components of the event-related potentials N170, vertex positive potential, late positive potential, and P3 were most significantly associated with depression in temporal lobe epilepsy.

Methods

Patients with temporal lobe epilepsy were divided into two groups based on the presence or absence of comorbid depression as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: those with depression (epilepsy patients with depression group) and those without depression (epilepsy patients without depression group). Both groups were matched for age, education, and seizure-related parameters. A control group of volunteers without epilepsy and depression was also included. Participants underwent electroencephalographic recordings while performing the Oddball task, and the emotional conflict Stroop face-word task. The electroencephalographic data were analyzed using the EEGLAB software.

Results

The study included 20 patients in the epilepsy patients with depression group and 16 in the epilepsy without depression group, matched for age, gender, and seizure-related parameters. In the epilepsy patients with depression group, the N170 peak amplitude and latency, the vertex positive potential peak latency, and the area under the late positive potential waveform were significantly greater, while the P3 peak latency was shorter compared to the epilepsy without depression group. The areas under the curve for N170, vertex positive potential, late positive potential, and P3 were 0.755, 0.692, 0.645, and 0.731, respectively. Notably, when these four event-related potential components were combined, the areas under the curve increased to 0.922, with a sensitivity of 0.950 and specificity of 0.812 for assessing depression based on the 17-item Hamilton Depression Rating Scale score.

Conclusion

Specific features of N170, vertex positive potential, late positive potential, and P3 components were significantly associated with depression in patients with temporal lobe epilepsy. These findings suggest that event-related potential components may provide an objective and quantitative approach to enhance the assessment and treatment of depression in epilepsy.

Seizure-relapse risk following antiseizure medication withdrawal in children with non-lesional focal epilepsy

AIMS

We investigated seizure-relapse risk following antiseizure medication (ASM) withdrawal in children with focal epilepsy (FE) who were leading to seizure remission by ASM monotherapy without drug replacement.

METHODS

Participants were treated at our hospital between 1 July 1999 and 30 June 2015. Children showing abnormalities on brain MRI and self-limited FE were excluded. All children discontinued ASMs after more than 2 years of a seizure-free state. Associations between seizure relapse within 2 years following ASM withdrawal and age at onset, seizure-free interval before ASM withdrawal, duration of tapering, presence of interictal epileptiform discharges (IEDs) on electroencephalogram (EEG), and type of ASM used were evaluated.

RESULTS

Participants comprised 128 FE children. Twelve children (9.7 %) experienced seizure relapse. Ages at both onset and ASM withdrawal were significantly higher in the relapse group than in the non-relapse group (p < 0.0001 and p = 0.0003, respectively). Seizure-free interval before ASM withdrawal was significantly shorter in the relapse (mean, 2.6 years) than in the non-relapse group (3.6 years; p < 0.0001). Duration of tapering was significantly shorter in the relapse (mean, 5.3 months) than in the non-relapse group (9.2 months; p < 0.0001). Presence of IEDs was significantly more frequent in the relapse than in the non-relapse group (p = 0.03). Seizure relapse tended to be less frequent with levetiracetam treatment than with carbamazepine, but the difference was not significant (p = 0.067).

CONCLUSIONS

Among FE children who achieve a seizure-free state on ASMs for more than 3 years, clinicians should recommend withdrawal of ASM using a slow tapering schedules lasting more than 6 months.

[The Japanese term "kishitsu" as the antonym of the functional neurological disorder]

The term organic disease has been used as the antonym of functional neurological disorder (FND), which was once called hysteria. Recently, the term "structural" is proposed instead of "organic". This is because the English word "organic" has two meanings: "related to the living organism" and "related to the organ, a part of the body". When the first meaning is thought of, the traditional usage of the "non-organic" seems strange since even FND takes place within the human body. There has been two Japanese translations for the word "organic", "yuki" and "kishitsu". Ogata Koan used the term "kishitsu-henseibyou" as the translation for a German word "desorganisationen" in 1857. Kawamoto Komin is known to have established the term "yuki kagaku" as the translation of organic chemistry in 1861, at the end of the Edo era. Kuwata Kohei used the term "kishitsu" as the translation for "structural" in 1872. In 1875, Tsuboi Ishun used "kishitsu" as the translation of "organic". He also used the term "yuki" in another book, and it is noteworthy that he used the two words as the translations of "organic" in two different meanings depending on the contexts. Thereafter, the lectures of Erwin von Bälz, Jean-Martin Charcot's "Tuesday Lessons", and other foreign texts were translated using the term "kishitsu" as the antonym of hysteria. Kawahara Hiroshi and Miura Kinnosuke also used "kishitsu", and the term was established as the standard. It is surprising and worth praise that the pioneers in late Edo and Meiji periods invented two Japanese terms translating "organic" corresponding to the two meanings of this foreign word. Considering these backgrounds, we would like to argue that the term "kishitsu (sei)" continues to be an appropriate term in Japanese used for the antonym of FND, and we need not to change the Japanese term to "kozo (sei)" in response to the change of the term in English.

Epilepsy Diagnosis When the Routine Ancillary Tests Are Normal

Background/Objectives: In a patient suspected of having epilepsy, routine EEG primarily contributes to the recording of interictal epileptiform discharges (IEDs). Similarly, magnetic resonance imaging (MRI) has become the gold standard imaging technique for identifying epileptogenic structural brain abnormalities. Various EEG and MRI tools to improve epilepsy diagnosis will be presented. Methods: When the initial EEG fails to record IEDs, various EEG measures that can improve EEG performance are presented; a comprehensive epilepsy-targeted MRI protocol to identify, localize, and characterize an epileptogenic lesion will also be described. Results: Studies show that the initial routine EEG fails to record IEDs in approximately 47-50% of epileptic patients. To improve the yield of EEG, subsequent EEG recording should include sleep deprivation, sleep recording, prolonged hyperventilation, optimized light stimulation, addition of an inferior temporal electrode chain, extended EEG duration, and continuous video-EEG monitoring, all measures known to activate IEDs. Furthermore, MRI is interpreted as "normal" in many epilepsy patients, even when performed according to an epilepsy-specific protocol and evaluated by a specialized MRI reader. In such case, the use of the Harmonized Epilepsy Structural Sequence Imaging (HARNESS-MRI) protocol and other imaging tools will improve the detection of potential epileptic lesions, as described in this study. Conclusions: In a patient with a clinical diagnosis of epilepsy but a normal EEG and brain MRI, several options can improve the performance of subsequent EEG and MRI examinations, the subjects of this review.

Antiepileptic Drug Combinations for Epilepsy: Mechanisms, Clinical Strategies, and Future Prospects

Epilepsy is a chronic neurological disorder characterized by abnormal neuronal discharge, leading to recurrent and unpredictable disruptions in brain function. Despite over 30 antiepileptic drugs (AEDs), 30% of patients develop drug-resistant epilepsy, requiring combination therapy. This review explores epilepsy's pathogenesis, including neuronal hyperexcitability, neurotransmitter imbalances, and ion channel dysfunction, alongside genetic, inflammatory, immune, and oxidative stress factors. AEDs are classified by mechanisms like voltage-gated ion channel modulation and GABA/glutamate regulation, tracing their evolution from traditional (e.g., phenobarbital) to modern therapies (e.g., lamotrigine). Combination therapy, using complementary mechanisms (e.g., lacosamide with levetiracetam), enhances efficacy but poses risks like drug interactions and cognitive impairment. Integrating molecular biology and pharmacology advances, this review highlights the need for rational drug selection and individualized strategies to improve epilepsy treatment outcomes and patient quality of life. Future directions include personalized treatments, optimized dosage forms, novel drug targets, and multi-target drugs.

A Case of Generalized Epilepsy with Asymmetric Features vs. Focal Epilepsy with Rapid Bilateral Synchronization in a Patient with Multiple Seizure Types

Deciding whether an epilepsy is of focal or generalized origin is necessary for establishing treatment options. Sometimes it is not a clear diagnosis. It is important to consider patient history, EEG presentation, clinical semiology, and imaging with these decisions. Presented is a case study of a patient with presumed generalized epilepsy but with focal features. A diagnostic evaluation was performed to ultimately decide if her epilepsy was focal or generalized, and whether she could be a surgical candidate for resection.

The impact of sleep disorders on quality of life in patients with epilepsy

OBJECTIVE

We aimed to explore the prevalence of sleep disorders and their impact on the quality of life (QoL) in patients with epilepsy (PWE) in western China.

METHODS

This cross-sectional study included PWE aged ≥14 years who were assessed using QoL in epilepsy-31 inventory (QOLIE-31), Insomnia Severity Index (ISI), STOP-BANG questionnaire, Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), Chinese version of Neurological Disorders Depression Inventory for Epilepsy (CNDDI-E) and Generalized Anxiety Disorder-7 (GAD-7). The impact of sleep disorders, depression and anxiety on all aspects of QOLIE-31 scores in PWE were assessed.

RESULTS

A total of 458 PWE were enrolled. Mean QOLIE-31 score was 51.27±9.69. Relevant assessment scales showed that 10.3 % of the patients suffered from insomnia, 12.9 % of the cohort had a high risk of obstructive sleep apnea (OSA), 33.0 % of the patients had excessive daytime sleepiness (EDS), 48.0 % of the patients reported poor sleep, while 46.3 % and 36.5 % of the patients reported depression and anxiety, respectively. The stepwise multivariate linear regression analysis highlighted that depression(β=-0.638, 95 %CI:0.876∼-0.401, p < 0.05), anxiety(β=-0.508, 95 %CI:0.708∼-0.307, p < 0.05), EDS(β=-0.210, 95 % CI:0.364∼-0.057, p = 0.007), number of antiseizure medications (ASMs)(β=-1.268, 95 % CI:2.318∼-0.217, p = 0.018), insomnia(β=-0.161, 95 % CI:0.292∼-0.030, p = 0.016) and seizure frequency(β=-0.570, 95 % CI:1.129∼-0.011, p = 0.046) were the main factors that influenced the total score of QOLIE-31 in PWE.

CONCLUSIONS

PWE showed a high prevalence of sleep disorders, especially insomnia, OSA and EDS, which significantly reduced the QoL of PWE in western China. Addressing sleep and psychiatric disorders might improve the overall QoL of PWE.

Efficacy of treating Helicobacter pylori infection on seizure frequency in children with drug-resistant idiopathic generalized epilepsy: a randomized controlled trial

BACKGROUND

Helicobacter pylori (H. pylori) causes chronic infection in more than half of the population worldwide. Accumulating body of evidence indicates the possible role of H. Pylori infection in extra-intestinal health problems, including epilepsy. This study aims to investigate the efficacy of treating H. pylori infection on seizure frequency among children with drug-resistant idiopathic generalized epilepsy (IGE).

METHODS

A parallel, two-arm, open-label, randomized controlled trial was conducted on 126 children with drug-resistant IGE and positive H. pylori stool antigen test who were randomly assigned to study and comparison groups in 1.2:1 ratio. Only the study group received H. pylori eradication therapy (esomeprazole, amoxicillin, and clarithromycin) for two weeks. The primary outcome was seizure improvement (≥ 50% seizure frequency reduction compared with baseline) after 2.5 months. Secondary outcomes were occurrence of status epilepticus, escalation of antiseizure medication (ASMs), and adverse effects. Outcomes between the two groups were compared using Chi-square/Fisher exact tests on an intention-to-treat principle. Logistic regression analysis was performed to investigate possible effects of baseline variables on primary outcome.

RESULTS

Seizure improvement occurred in 23 (33%) children in the study group compared with seven (12%) children in the comparison group (Risk ratio [RR] 2.7, 95% confidence interval [CI]: 1.3-5.9; p 0.006). The study group had lower occurrence of status epilepticus (2.9% vs. 14%; RR 0.21, 95%CI: 0.05-0.93; p 0.042) and lesser need for ASMs escalation (4.4% vs. 19.3%; RR 0.23, 95%CI: 0.07-0.77; p 0.010). Adverse effects were more frequent among subjects in the study group, including nausea (15.9% vs. 10.5%) vomiting (8.7% vs. 3.5%), diarrhea (11.6% vs. 5.3%), and skin rash (4.4% vs. 1.8%), but the differences were not statistically significant (p > 0.05). None of baseline participants' variables was significantly associated with the primary outcome.

CONCLUSION

Treating H. pylori infection may improve seizure control in children with drug-resistant IGE, but further studies are warranted to confirm our findings and explore mechanisms behind seizure improvement following H. pylori eradication therapy.

TRIAL REGISTRATION

Registered on www.

CLINICALTRIALS

gov (identifier: NCT05297695) on 17 March 2022. https://clinicaltrials.gov/study/NCT05297695 .

Intestinal microbiome alterations in pediatric epilepsy: Implications for seizures and therapeutic approaches

The intestinal microbiome plays a pivotal role in maintaining host health through its involvement in gastrointestinal, immune, and central nervous system (CNS) functions. Recent evidence underscores the bidirectional communication between the microbiota, the gut, and the brain and the impact of this axis on neurological diseases, including epilepsy. In pediatric patients, alterations in gut microbiota composition-called intestinal dysbiosis-have been linked to seizure susceptibility. Preclinical models revealed that gut dysbiosis may exacerbate seizures, while microbiome-targeted therapies, including fecal microbiota transplantation, pre/pro-biotics, and ketogenic diets, show promise in reducing seizures. Focusing on clinical and preclinical studies, this review examines the role of the gut microbiota in pediatric epilepsy with the aim of exploring its implications for seizure control and management of epilepsy. We also discuss mechanisms that may underlie mutual gut-brain communication and emerging therapeutic strategies targeting the gut microbiome as a novel approach to improve outcomes in pediatric epilepsy. PLAIN LANGUAGE SUMMARY: Reciprocal communication between the brain and the gut appears to be dysfunctional in pediatric epilepsy. The composition of bacteria in the intestine -known as microbiota- and the gastrointestinal functions are altered in children with drug-resistant epilepsy and animal models of pediatric epilepsies. Microbiota-targeted interventions, such as ketogenic diets, pre-/post-biotics administration, and fecal microbiota transplantation, improve both gastrointestinal dysfunctions and seizures in pediatric epilepsy. These findings suggest that the gut and its microbiota represent potential therapeutic targets for reducing drug-resistant seizures in pediatric epilepsy.

Narrative Review on Common Traits of Parkinson's Disease and Epilepsy

Epilepsy and Parkinson's disease (PD) are two common neurological disorders, with a lifetime prevalence of approximately 1% and 0.4%, respectively. Both conditions affect movement and brain function and were traditionally considered distinct, with different pathophysiological mechanisms. However, recent research suggests potential links between them. Some studies indicate that epilepsy may contribute to the development of PD due to chronic neuroinflammation, excitotoxicity, and neuronal loss. Conversely, PD-related neurodegeneration in dopaminergic pathways might increase susceptibility to seizures. This article presents a narrative review of the limited literature on the pathophysiological mechanisms linking epilepsy and PD, including shared genetic factors, neurodegenerative processes, and alterations in the neurotransmitter system. It also examines the influence of anti-seizure medications and dopaminergic treatments on the symptoms and progression of both disorders, as well as their common clinical features. Additionally, the limitations of the existing data on this topic are discussed. Understanding the true relationship between these two disorders is crucial, as it could provide insight into common neurobiological mechanisms and lead to improved therapeutic strategies.

Physical activity and risk of epilepsy: A 2-sample Mendelian randomization study

OBJECTIVE

There is currently a lack of evidence from earlier studies about the impact of exercise on the risk of epilepsy. We conducted a 2-sample Mendelian randomization (MR) study to identify the potential causal relationship between physical activity and epilepsy.

METHODS

We identified single nucleotide polymorphisms (SNPs) associated with physical activity from a recent genome-wide association study of the UK Biobank. Summary statistics of epilepsy were derived from the International League Against Epilepsy (ILAE) Consortium genome-wide association study (GWAS) database.

RESULTS

We found that self-reported moderate-to-vigorous physical activity increases the incidence of focal epilepsy with hippocampal sclerosis(OR: 1.18; 95% CI: 1.07-1.30, p = 9 × e-4) and overall acceleration average reduces the risk of childhood absence epilepsy(OR: .99; 95% CI: .98 to 1.00; p = .013).

SIGNIFICANCE

Different types of epilepsy respond differently to physical activity; it needs further research to explore the physiological mechanism of physical activity and epilepsy.

Cenobamate: A Review in Focal-Onset Seizures

Cenobamate (Ontozry®) is a once-daily oral antiseizure medication (ASM) approved in the EU for the adjunctive treatment of focal-onset seizures, with or without secondary generalisation, in adults with epilepsy that have not been adequately controlled despite previous treatment with ≥ 2 anti-epileptic drugs. In clinical studies, its short-term use significantly reduced seizure frequency and was associated with significantly higher odds of achieving a ≥ 50% reduction in seizure frequency in adults with uncontrolled focal-onset seizures despite treatment with 1-3 concomitant ASMs. Seizure freedom rates were also improved. All these benefits were sustained over up to 48 months. Cenobamate was generally well tolerated across both the short- and longer-term (up to 94 months) clinical studies, with its low starting dosage (12.5 mg/day) and slow (12-week) titration schedule appearing to result in fewer severe treatment-emergent adverse events (TEAEs) during the titration period. Somnolence, dizziness and fatigue were the most frequently reported TEAEs. The effectiveness and adverse events of cenobamate in real-world studies were consistent with those seen in the clinical studies. Thus, cenobamate continues to represent a useful adjunctive treatment option in adults with uncontrolled focal-onset seizures.

Novel compound heterozygous mutations in LMAN2L cause early childhood refractory epilepsy

BACKGROUND

Autosomal recessive mental retardation-52(MRT52) is a subtype of mental retardation whose clinical features include global developmental delay, severe intellectual disability with poor speech, and mild seizures in early childhood. Mutations in the LMAN2L gene resulting in mental retardation and seizures have been previously reported in 3 families. Here we describe 2 children in 1 family who presented with severe intellectual disability and drug-refractory epilepsy( DRE) at 2 months of age.

METHODS

Two individuals from 1 family admitted to the pediatric department of Qilu Hospital were included in the study. Whole exome sequencing (WES) was used to detect LMAN2L gene variants. The clinical manifestations, electroencephalography, neuroimaging characteristics and treatment of epilepsy were retrospectively analyzed.

RESULT

We identified two new LMAN2L compound heterozygous variants, c.476A > G, p.D159G, c.1060_1061del, p.S354Pfs*29, which appeared in two children from the same family. Both cases showed severe postnatal psychomotor developmental lag and developed seizures at 2 months of age, which manifested themselves in a variety of ways and were not relieved by the administration of multiple antiepileptic drugs.

CONCLUSION

Complex heterozygous mutations at the newly identified locus of LMAN2L cause refractory epilepsy, with epileptic symptoms beginning at 2 months of age and manifesting as multiple seizure types and developmental delays. This is the first report to link LMAN2L to the phenotype of epileptic encephalopathy and refractory epilepsy, suggesting that the heterozygous p.D159G, p.S354Pfs*29 LMAN2L variants are likely pathogenic. These 2 newly identified pathogenic variants enrich the spectrum of pathogenic variants in the LMAN2L gene.

The Diagnostic Value of EEG Wave Trains for Distinguishing Immature Absence Seizures and Sleep Spindles: Evidence from the WAG/Rij Rat Model

Background: Absence epilepsy is a non-convulsive form of genetic generalized epilepsy characterized by spontaneous bilateral spike-and-wave discharges (SWDs) in EEG. In contrast to grand-mal epilepsy, absence epilepsy without greatly expressed motor and interictal EEG abnormalities is difficult to detect, especially at the early stages. The WAG/Rij rat strain is a well-validated animal model of childhood absence epilepsy. At the early, preclinical stage, precursors or immature SWDs appear. Then, with age, immature discharges gradually turn into mature ones and mature SWDs prevail at the clinical stage. Mature SWDs, with an amplitude several times higher than the background EEG, can be easily distinguished visually. However, the amplitude of immature discharges is significantly lower than that of mature SWDs and is comparable to the amplitude of sleep spindles. Therefore, it is quite a difficult problem to distinguish immature discharges from sleep spindles. The task is further complicated by the fact that absence seizures mainly appear in a state of drowsiness and slow-wave (non-REM) sleep, when a lot of sleep spindles occur. The purpose of the present study was to develop a diagnostic method that allows us to precisely distinguish immature forms of epileptic seizures from background EEG and sleep spindles. Methods: The idea of analyzing wave-train electrical activity is to investigate the wavelet spectrum, find local peculiarities in this spectrum, and estimate generalized time-frequency peculiarities of the signal in terms of the found local peculiarities. Results: The criteria for diagnosis of the immature form of epileptic discharges and sleep spindles have been developed based on the analysis of wave-train activity with the construction of AUC diagrams (area under the curve diagrams). Conclusions: The method of wave-train analysis with the construction of AUC diagrams can be used for extracting the diagnostic features necessary for the diagnosis of absence epilepsy at the early stages of the disease in people with a genetic predisposition.

Genome-wide association meta-analyses of drug-resistant epilepsy

BACKGROUND

Epilepsy is one of the most common neurological disorders, affecting over 50 million people worldwide. One-third of people with epilepsy do not respond to currently available anti-seizure medications, constituting one of the most important problems in epilepsy. Little is known about the molecular pathology of drug resistance in epilepsy, in particular, possible underlying genetic factors are largely unknown.

METHODS

We performed a genome-wide association study (GWAS) in two epilepsy cohorts of European ancestry, comparing drug-resistant (N = 4208) to drug-responsive individuals (N = 2618) followed by meta-analyses across the studies. Next, we performed subanalyses split into two broad subtypes: acquired or non-acquired focal and genetic generalized epilepsy.

FINDINGS

Our drug-resistant versus drug-responsive epilepsy GWAS meta-analysis showed no significant loci when combining all epilepsy types. Sub-analyses on individuals with focal epilepsy (FE) identified a significant locus on chromosome 1q42.11-q42.12 (lead SNP: rs35915186, P = 1·51 × 10-8, OR[C] = 0·74). This locus was not associated with any epilepsy subtype in the latest epilepsy GWAS (lowest uncorrected P = 0·009 for FE vs. healthy controls), and drug resistance in FE was not genetically correlated with susceptibility to FE itself. Seven genome-wide significant SNPs within this locus, encompassing the genes CNIH4, WDR26, and CNIH3, were identified to protect against drug-resistant FE. Further transcriptome-wide association studies (TWAS) imply significantly higher expression levels of CNIH3 and WDR26 in drug-resistant FE than in drug-responsive FE. CNIH3 is implicated in AMPA receptor assembly and function, while WDR26 haploinsufficiency is linked to intellectual disability and seizures. These findings suggest that CNIH3 and WDR26 may play a role in mediating drug response in focal epilepsy.

INTERPRETATION

We identified a contribution of common genetic variation to drug-resistant focal epilepsy. These findings provide insights into possible mechanisms underlying drug response variability in epilepsy, offering potential targets for personalised treatment approaches.

FUNDING

This work is part of the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 279062 (EpiPGX) and the Centers for Common Disease Genomics (CCDG) program, funded by the National Human Genome Research Institute (NHGRI) and the National Heart, Lung, and Blood Institute (NHLBI).

Change of heart rate variability in children and adolescent with drug resistant epilepsy

Heart rate variability (HRV) has been examined and employed as a predictive biomarker for epilepsy. Patients with epilepsy exhibit reduced HRV as a result of heightened sympathetic activity. Reductions in HRV are observed in patients with sudden unexpected death in epilepsy (SUDEP). Our study aims to determine the change in HRV among children and adolescents with drug-resistant epilepsy (DRE) and advocate for its use as a biomarker to assess cardiovascular health in this population. Fifty-four children and adolescents, aged between 6 and 20 years, were enrolled and divided into two groups: the epilepsy group comprised 27 children diagnosed with DRE. Thirty minutes of HRV measurements were performed on both patients and controls. The median age was 12 years old. Malnutrition was the most common comorbidity in the epilepsy group. 75% have been diagnosed with DRE for more than 10 years. 44% had daily seizures. Generalized tonic-clonic seizures (GTCs) were the most common seizure type, accounting for 55.6% of cases. The most frequent cause of epilepsy was structural brain lesions (55.6%), followed by genetic disorders (18.5%). Patients with DRE had a significant reduction in both HRV's time domain (RMSSD and pNN50) and frequency domain (HF and LF). Patients who had GTC and had epilepsy for more than 10 years had a significant reduction in the low-frequency domain of HRV, according to the subgroup analysis. Children and adolescents with DRE exhibited a marked decrease in HRV measures, thereby increasing the likelihood of cardiovascular health issues in these patients. HRV can be used as a biomarker to effectively assess cardiovascular health in DRE patients.

Prevalence of epilepsy: a population-based cohort study in Denmark with comparison to Global Burden of Disease (GBD) prevalence estimates

BACKGROUND

The Global Burden of Disease Study (GBD) produces prevalence estimates for 'idiopathic epilepsy' (ie, of unknown aetiology) and 'secondary epilepsy' (ie, with known aetiology) but does not report prevalence by underlying aetiologies for 'secondary epilepsy'.

METHODS

We used nationwide, population-based register data from Denmark to identify underlying causes of epilepsy and their contribution to prevalence of 'secondary epilepsy' and compared with global prevalence data from GBD 2019. We identified all persons with a hospital-based epilepsy diagnosis and a filled prescription for antiseizure medication between 1 January 2009 and 31 December 2018. Epilepsy was categorised into 'idiopathic' or 'secondary' and 'total epilepsy' as the sum of the two epilepsy categories.

RESULTS

On 31 December 2018, a total of 5 784 284 individuals (49.7% males) were living in Denmark including 40 336 with epilepsy (51.5% males). Perinatal conditions, traumatic brain injury, brain tumours and stroke were prominent underlying causes of 'secondary epilepsy'. The prevalence of 'total epilepsy' in Denmark was 697 (95% CI 691 to 704) per 100 000 population (264 (95% CI 260 to 269) for 'secondary epilepsy' and 433 (95% CI 428 to 438) for 'idiopathic epilepsy'). In the GBD 2019 Study, the prevalence of 'total epilepsy' in 2018 was 682 (95% uncertainty interval (UI) 586 to 784) per 100 000 population (359 (95% UI 324-397) for 'secondary epilepsy' and 324 (95% UI 249 to 404) for 'idiopathic epilepsy').

CONCLUSIONS

Prevalence estimates of 'total epilepsy', 'idiopathic epilepsy' and 'secondary epilepsy' in Denmark align with the GBD 2019 estimates. In future studies, it is suggested to explicitly include all types of epilepsy, including 'secondary epilepsy', which is currently estimated as sequelae (consequences) of underlying diseases.

Precision medicine approach for in vitro modeling and computational screening of anti-epileptic drugs in pediatric epilepsy patients with SCN2A (R1629L) mutation

This study aimed to develop personalized anti-epileptic drugs for pediatric patients with an SCN2A (R1629L) mutation, which is unresponsive to conventional sodium channel blockers. The mutation was identified using genomic DNA sequencing, and patient-derived induced pluripotent stem cells (iPSCs) were differentiated into the neuronal network to mimic seizure activity. A total of 1.6 million compounds were screened using computational methods, identifying five candidates with high affinity to the mutant SCN2A protein, low potential toxicity, and high blood-brain barrier permeability. These compounds were pharmacologically evaluated using the patient-derived in vitro seizure model, which replicated the abnormal electrophysiological characteristics of epilepsy. Two of the five candidate compounds effectively modulated electrophysiological activities; moreover, these compounds were 100 times more potent than phenytoin. Therefore, this study demonstrates the feasibility of precision medicine in epilepsy treatment, emphasizing the benefits of patient-derived in vitro seizure models and computational drug screening. Additionally, this study highlights the potential of targeted therapeutic development for patients unresponsive to conventional therapies, showcasing a promising approach for personalized medical interventions in epilepsy.

The Oral Findings and Dental Management of Patients with West Syndrome: A Case Series and Literature Review

Objectives: West syndrome (WS) is a rare disorder with an estimated prevalence of 1 in 4000 live births, characterized by infantile spasms, hypsarrhythmia, and psychomotor developmental impairment. The available information on dental care forWS patients remains limited. The aim of this study was to describe oral manifestations and dental management in a series of WS patients. Methods: Fourteen patients diagnosed with WS were evaluated, including 10 males and 4 females, aged 12-41 years. Medical and dental variables were collected for all patients. Results: The most frequent oral findings were poor oral hygiene (64.2%), gingivitis (64.2%), dental caries (57.1%), and bruxism/tooth wear (28.5%). Only one patient had dental fractures (due to trauma), and none exhibited drug-induced gingival enlargement. Initial dental treatment was carried out under general anesthesia in 42.3% of the patients. However, following desensitization, half of the patients showed improved behavior and were ultimately treated using non-pharmacological behavioral support techniques. Conclusions: This series represents the largest published to date on the dental aspects of WS. Dental treatment needs of WS patients are considerable, and their management is primarily determined by the degree of epilepsy control, the presence of comorbidities, and the level of cooperation. Nevertheless, these patients may benefit from desensitization strategies to improve their behavior. As subsequent sessions were conducted, the behavior of 1 in every 3 initially non-compliant patients showed significant improvement.

Genetic aetiologies in relation to response to the ketogenic diet in 226 children with epilepsy

A ketogenic diet is used in children with drug-resistant epilepsy but predictors for efficacy are largely lacking. Our aim was to evaluate if causative genetic variants could predict seizure response to the ketogenic diet. A cohort study of 226 children with refractory epilepsy and classic ketogenic diet treatment for at least 3 months (76.9% of the 294 who started) was performed. The median age at diet start was 5.1 years (range 0.1-17.8), 118 were girls and 108 boys. They had previous trials of a median of 6.0 anti-seizure medications (range 0-12) and intellectual disability was found in 87%. Seizure response (≥50% reduction) was found in 138/226 patients (61.1%) at 3 months, 121 (53.5%) at 6 months, 107 (47.3%) at 1 year and in 80 (37.0%) at 2 years follow-up of ketogenic diet. Age of epilepsy onset was lower and combined epilepsy type less common in responders compared to non-responders but no differences were found for specific seizure types, ketogenic ratio or beta-hydroxybutyric acid blood levels. A causative pathogenic/likely pathogenic variant was detected in 107/153 = 69.9% in 48 different genes. Next generation sequencing was used in 91/226 (40%) cases with a diagnostic yield of 58.2% (53/91). In comparison with cases without a revealed genetic aetiology, patients with a causative genetic variant had less atonic seizures and epileptic spasms and a better seizure response with 17.3% seizure free and 25% with >90% seizure reduction at 2-year follow-up. Causative variants in SLC2A1, SCN1A, STXBP1 and PAFAH1B1 showed significant diet response (P < 0.05) and good efficacy was also associated with DEPDC5, GLDC, KCNT1, PDHA1, SLC25A12 and TSC1. Causative variants in COL4A1 and DYNC1H1 were among genes linked to a lack of response. To our knowledge not described previously, we report a good ketogenic diet response related to causative variants in CSNK2A1, FARS2, GABRB3, GRIN1, KCNA2, KCTD3, STX1B and SLC16A2 but a lack of response for causative variants in CLN5, GLI3, MACF1, MAGEL2, NANS, NEMO/IKBKG, RORB, SLC17A5 and UFSP2. After grouping of genes into functional groups, causative variants in transporter genes had the best response (P = 0.009) and variants in other membrane-related proteins (ion channels and neurotransmitter receptors) also showed good efficacy. However, the gene group related to cell structural integrity and/or homeostasis had the worst diet response (P = 0.00006). In conclusion, our results support that causative genetic variants may be used as prognostic markers of ketogenic diet response, constituting an example in the expanding area of precision medicine.

Association of seizure control during pregnancy with adverse offspring outcomes in women with epilepsy

BACKGROUND

Information on fetal risks with maternal seizures during pregnancy is scarce. This study investigates seizure control during pregnancy and fetal risks associated with maternal seizures in different stages of pregnancy among pregnant women with epilepsy (PWWE).

METHODS

The nested case-control study enrolled PWWE between 2009 and 2023 in China. Information was obtained on maternal seizures, antiseizure medication (ASM), folic acid supplementation and pregnancy outcomes. The primary outcome was composite including major congenital malformations (MCMs), neurodevelopmental delay, low birth weight (LBW) and fetal death. Univariate and multivariate logistic regression analyses were conducted to adjust for ASM effects and other confounders.

RESULTS

Among 1110 pregnancies from 934 PWWE included, 56.6% experienced seizures. Seizure deterioration during pregnancy compared with prepregnancy was observed in 25.9% of pregnancies, while 20.9% experienced worsening seizures from the first to second or third trimesters. Seizures (adjusted OR (aOR) 1.472, 95% CI 1.024 to 2.137), particularly status epilepticus (aOR 2.906, 95% CI 1.364 to 5.93), generalised tonic-clonic seizures (aOR 1.581, 95% CI 1.066 to 2.354) and seizure deterioration (aOR 1.829, 95% CI 1.233 to 2.69) were associated with composite adverse outcomes. Specifically, seizures occurring (aOR 2.324, 95% CI 1.320 to 4.084) or deteriorating (aOR 2.396, 95% CI 1.471 to 3.866) during second and third trimesters were associated with the risk of LBW. No significant association was found between seizures and MCMs.

CONCLUSIONS

While nearly half of PWWE remain seizure-free during pregnancy, those who do experience seizures face increased risks of adverse offspring outcomes. For PWWE, every effort should be made to optimise seizure control in order to minimise risks to both mother and child.

TRIAL REGISTRATION NUMBER

ChiCTR2100046318.

Autism Spectrum Disorder and Epilepsy: Pathogenetic Mechanisms and Therapeutic Implications

The co-occurrence of autism spectrum disorder (ASD) and epilepsy is a complex neurological condition that presents significant challenges for both patients and clinicians. ASD is a group of complex developmental disorders characterized by the following: (1) Social communication difficulties: challenges in understanding and responding to social cues, initiating and maintaining conversations, and developing and maintaining relationships. (2) Repetitive behaviors: engaging in repetitive actions, such as hand-flapping, rocking, or lining up objects. (3) Restricted interests: focusing intensely on specific topics or activities, often to the exclusion of other interests. (4) Sensory sensitivities: over- or under-sensitivity to sensory input, such as sounds, touch, tastes, smells, or sights. These challenges can significantly impact individuals' daily lives and require specialized support and interventions. Early diagnosis and intervention can significantly improve the quality of life for individuals with ASD and their families. Epilepsy is a chronic brain disorder characterized by recurrent unprovoked (≥2) seizures that occur >24 h apart. Single seizures are not considered epileptic seizures. Epilepsy is often idiopathic, but various brain disorders, such as malformations, strokes, and tumors, can cause symptomatic epilepsy. While these two conditions were once considered distinct, growing evidence suggests a substantial overlap in their underlying neurobiology. The prevalence of epilepsy in individuals with ASD is significantly higher than in the general population. This review will explore the epidemiology of this comorbidity, delve into the potential mechanisms linking ASD and epilepsy, and discuss the implications for diagnosis, treatment, and management.

PPP5C pathogenic variant identified: a potential key to gaining insight into developmental and epileptic encephalopathy?

BACKGROUND

Emerging evidence suggesting a possible link between the PPP5C gene (protein phosphatase 5 catalytic subunit; OMIM#600658) and developmental and epileptic encephalopathy (DEE, OMIM#308350), although the clinical significance of pathogenic variants in this gene remains unclear. PPP5C is a member of the protein phosphatase catalytic subunit family, which is involved in various signaling pathways governing cell growth, differentiation, and responses to hormonal signals or cellular stress. To date, only one case with a PPP5C variant has been reported, associated with a severe neurological phenotype, including microcephaly, failure to thrive, and early-onset seizures.

RESULTS

We report a 12-year-old girl affected by epilepsy and learning disorders. At the age of five, she presented convulsive status epilepticus with respiratory failure at onset and she started anticonvulsant therapy with Levetiracetam with a significant improvement. Genetic analysis revealed a de novo heterozygous missense variant of PPP5C gene (c.202 C > T: p.Arg68Cys), which had not been previously described in the literature.

CONCLUSION

This case expands the phenotypic spectrum associated with PPP5C variants, highlighting the potential role of this gene inneurological disorders. Our findings may provide some valuable insights into the spectrum of phenotypic manifestations linked to this gene less investigated in neuropediatrics.

Progressive Myoclonus Epilepsy and Beyond: A Systematic Review of SEMA6B-related Disorders

Progressive myoclonus epilepsy (PME) is a rare, clinically and genetically heterogeneous epilepsy syndrome, and pathogenic variants in the semaphorin 6B (SEMA6B) gene have recently been reported to be among the causes of PME. Cases with pathogenic variants in the SEMA6B gene are extremely rare, only a limited number of cases have been reported in the literature. In this systematic review, we aimed to present a summary of a PME case in which a heterozygous nonsense variant of c.2086C > T p.(Gln696*) in the SEMA6B gene was detected in the etiology and other cases with SEMA6B pathogenic variant in the literature. Except for our case, 35 cases from 12 studies were included. The main clinical findings in these patients were cognitive problems, seizures, gait and speech disturbances, and cognitive and/or motor regression, and they had a wide spectrum of severity. Response to antiseizure medications was also highly variable, almost half of the patients had pharmacoresistant seizures. Patients were divided into four different phenotypic groups according to their clinical presentations: PME (18/36), developmental and epileptic encephalopathy (13/36), neurodevelopmental disorder (4/36), and epilepsy (1/36), respectively. In conclusion, although SEMA6B has been associated with PME, it may actually cause a much broader phenotypic spectrum. Due to their extreme rarity, our knowledge of SEMA6B-related disorders is limited. As with all other rare diseases, each new SEMA6B-related disorder case could contribute to a better understanding of the disease. A better understanding of the disease may allow the development of specific treatment options in the future.

Operational definition of developmental and epileptic encephalopathies to underpin the design of therapeutic trials

Developmental and epileptic encephalopathies (DEEs) are the most severe group of epilepsies, characterized by drug-resistant seizures and developmental slowing or regression. DEEs encompass many epilepsy syndromes, although not all patients with a DEE can be classified into a specific syndrome. Our understanding of the etiologies of DEEs has been revolutionized with next-generation sequencing, with more than 900 genes implicated, in addition to structural causes. It is therefore now possible to consider precision medicine and novel therapeutic approaches for these devastating diseases with trials of repurposed and new drugs, including gene therapies. Trials are being designed to target either DEE diseases more broadly, specific DEE syndromes, or specific genetic DEEs. To serve this purpose, a clear operational definition of DEEs is needed to ensure that appropriate patients are selected for trials with precisely defined, targeted outcome measures. Herein we propose the operational definition of DEEs to set the stage for the development of DEE therapies.

Unseen yet overcounted: The paradox of seizure frequency reporting

OBJECTIVE

Seizure control is often assessed using patient-reported seizure frequencies. Despite its subjectivity, self-reporting remains essential for guiding anti-seizure medication (ASM) decisions and ongoing patient investigations. This study aims to compare patient-reported seizure frequencies with electrographic frequencies captured via ambulatory video EEG (avEEG).

METHODS

Data from intake forms and seizure diaries were collected from patients undergoing home-based avEEG in Australia (April 2020-April 2022). Intake forms included monthly seizure frequency estimates. Only avEEG-confirmed epilepsy cases were analyzed. Univariate and multivariate analyses compared seizure frequencies reported via EEG, diaries, and surveys.

RESULTS

Of 3,407 reports, 853 identified epilepsy cases, with 234 studies analyzed after excluding outliers. Diary-reported frequencies correlated with EEG frequency (p < 0.00001), but survey-reported frequencies did not (p > 0.05). Surveys significantly overestimated true seizure frequency (median = 3.98 seizures/month, p < 0.0001), while diaries showed substantially smaller differences (median = 0.01 seizures/month, p < 0.0001). Carer presence was associated with higher diary-reported frequencies (p = 0.047). Age negatively correlated with survey frequency estimation error (p = 0.016). Multivariate analysis identified age and carer status as significant predictors of residuals.

CONCLUSIONS

Most patients overestimate their true seizure frequency, potentially influencing therapeutic decisions and raising concerns about the reliability of some participants and carers to self-report seizures in clinical trials.

SIGNIFICANCE

An "over-reporting, over-prescribing" cascade may affect epilepsy treatment and highlights the potential issue of clinical drug trials relying on self-reported seizure rates for primary endpoints.

Genotype-phenotype correlation of ODLURO syndrome comorbid epilepsy associated with KMT2E variations: Report on a novel case and systematic literature review

BACKGROUND

O'Donnell-Luria-Rodan (ODLURO) syndrome is a newly described neurodevelopmental disorder caused by a pathogenic KMT2E variant. The primary clinical phenotypes include developmental delay, intellectual disability (ID), and epilepsy. Epilepsy, observed in 29% of affected individuals, has not been thoroughly investigated. In this study, we describe the phenotypes and genetic profiles of patients with ODLURO syndrome and epilepsy.

METHODS

We summarized and analyzed data from 30 patients with ODLURO syndrome and epilepsy from the systematic literature and DECIPHER database. Information regarding seizure classification, brain MRI findings, antiseizure medications, and genetics variations was collected and analyzed retrospectively.

RESULTS

The risk factors associated with epilepsy in ODLURO syndrome remain unclear, and clinical heterogeneity exists. While focal seizures are most prevalent, various epilepsy classifications are observed. Brain MRI findings indicated that cerebral atrophy and cystic changes were common, though no correlation with epilepsy was established. Among ten individuals with a record of antiseizure medication, approximately 70% required two or more antiseizure medications.

CONCLUSIONS

A clear genotype-phenotype correlation remains elusive even among individuals with the same KMT2E variation. The pathogenesis of epilepsy associated with KMT2E variation is complex and necessitates further molecular genetic studies to elucidate the mechanisms underlying these genetic disorders. This research provides essential evidence for specific and individualized treatment approaches.

Screening of cognitive and behavioral comorbidity in children with recently diagnosed epilepsy: A pilot study exploring the feasibility and validity of a newly composed online screening tool

OBJECTIVES

Cognitive and behavioral comorbidity is frequent in childhood epilepsy and impacts on prognosis and QOL. Comorbidity often precedes seizure onset. Early screening is recommended but no consensus exists on the screening method. The current pilot study investigated the feasibility and validity of a newly developed screening method in children with recently diagnosed epilepsy.

METHODS

An online screening method was developed using a combination of existing and validated screening instruments (i.e. 2 standardised questionnaires and 2 psychometric tests), selected to detect the most common comorbid problems in childhood epilepsies. Feasibility was studied using patient and parent questionnaires and drop-out rates. Validity was studied by comparing the screening results to an in-depth diagnostic assessment. Descriptive statistics were used to analyse results.

RESULTS

Out of twenty referred children, 13 entered the study, of whom 1 dropped out (retention rate 93 %). Of those, ten were girls. Most patients were aged 9-12 year (38 %) or 12-15-year (38 %). Eighty-three percent of tested children proved to have cognitive or behavioral comorbidity. Screening results corresponded with diagnostic assessment results in most cases (9 true positives, one true negative), there was 1 false positive and 1 false negative screening result. Sensitivity of the screening amounts to 90 % (CI 73-107).

CONCLUSIONS

The current pilot study shows promising results with regards to feasibility and validity of the tested screening method for cognitive and behavioral comorbidity in childhood epilepsy. This warrants further investigation of the method.

Epilepsy

Epilepsy is a common neurologic condition characterized by at least 1 unprovoked seizure and a high risk for recurrent seizures. Distinguishing epilepsy from conditions that can mimic seizures is important for accurate diagnosis and effective treatment. This article reviews the evaluation of patients suspected of having epilepsy and discusses behavioral strategies and pharmacologic and surgical therapies that can help reduce morbidity associated with recurrent seizures.

A Review of the Advances in the Medical Management of Epilepsy Associated With Myoclonic Epilepsy With Ragged-Red Fibers (MERRF) Syndrome

Myoclonic epilepsy with ragged-red fibers (MERRF) syndrome is a rare syndromic mitochondrial disorder in which epilepsy is one of the main phenotypic features. Although myoclonic seizures are most common in MERRF, several other seizure types (e.g., focal and generalized seizures with motor or nonmotor onset) have been reported. The literature search was conducted via PubMed and Google Scholar and covered the years 1966-2024. The author analyzes recent advances in treating epilepsy in MERRF with antiseizure medications (ASMs). Also discussed are the treatment of status epilepticus and stroke-like episodes (SLEs), and alternative methods of treating epilepsy. Treatment of epilepsy in MERRF depends on the phenotype (classic MERRF, MERRF-plus, overlaps, and SLEs), degree of progression, seizure types, type of epilepsy, seizure frequency, and the presence/absence of status epilepticus. ASMs and non-ASMs with a potentially mitochondrial toxic effect, as shown by clinical and experimental studies, should be administered with caution. MERRF patients should be closely monitored for epilepsy as the disease progresses, as new types of seizures or an increase in seizure frequency and intensity may occur. Recent advances suggest that myoclonic epilepsy responds most effectively to levetiracetam, benzodiazepines, and possibly zonisamide. If epilepsy is drug-resistant, alternative measures should be considered, as some of them may be very effective.

Neurofilament light chain and glial fibrillary acidic protein as diagnostic and prognostic biomarkers in epileptic seizures and epilepsy: A systematic review

Epileptology - with epilepsy as one of the most common neurological diseases - has an urgent need for easily accessible biomarkers to improve diagnosis, prognosis and therapeutic monitoring. Neurofilament light chain (NfL) and Glial Fibrillary Acidic Protein (GFAP) have emerged as promising fluid biomarkers in various neurological disorders. Their potential role in epileptic seizures and epilepsy remains largely unexplored. To assess the current state of research on this topic we comprehensively searched the published literature for studies on GFAP and/or NfL in cerebrospinal fluid and/or blood in adult humans with epileptic seizures, status epilepticus or epilepsy (last data base search on 10th of May 2024). We identified a total of 2285 publications of which 19 fulfilled our search criteria. The studies targeted various outcomes such as prognosis in status epilepticus, differentiation of seizure semiology and etiology, differentiation of epileptic seizures from non-epileptic conditions, prediction of epilepsy in autoimmune epilepsy, after a stroke or after a first unprovoked seizure, the role of the time interval from seizure to sampling, the association with disease duration as well as seizure frequency and the influence of seizure suppressing medication. The results are heterogeneous but indicate promising applications for both NfL and GFAP in diagnosis and prognostication of patients with epileptic seizures and epilepsy. In the present review we summarize the current evidence, future perspectives, but also limitations, of NfL and GFAP as fluid biomarkers in epilepsy and epileptic seizures.

No single treatment modality exhibits clear superiority for infantile spasms syndrome: insights from a retrospective cohort study

BACKGROUND

Infantile spasms syndrome is a severe form of infantile epilepsy. It is commonly treated with hormonal therapies or vigabatrin, either alone or in combination. This study aimed to assess the efficacy of these treatment modalities and explore associations with aetiology, and pre-existing developmental delay.

METHODS

Patients diagnosed with and treated for infantile spasms syndrome at the University Hospital of Leuven between 1 January 2018 and 23 November 2022, were identified. Retrospective clinical data were analysed descriptively. Short-term and long-term outcomes determined the efficacy of the current treatments, with seizure freedom and sustained normal development at 6 and 12 months after treatment initiation as primary treatment goals.

RESULTS

The study included 26 patients. No single treatment modality demonstrated clear superiority in terms of both short-term and long-term outcomes. Patients with unknown aetiology showed better developmental outcomes after 12 months than those with proven aetiology (30.77% with normal development versus 7.69%.) Another clear difference in treatment efficacy emerged between patients with and without pre-existing developmental issues, with only 6.67% achieving normal development after 12 months compared to 36.36%, respectively.

CONCLUSION

No single treatment modality demonstrated clear superiority. Associations were found between treatment efficacy and aetiology as well as pre-existing developmental delay, suggesting these as potential prognostic indicators.