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

Neural circuit mechanisms of epilepsy: Maintenance of homeostasis at the cellular, synaptic, and neurotransmitter levels

Epilepsy, a common neurological disorder, is characterized by recurrent seizures that can lead to cognitive, psychological, and neurobiological consequences. The pathogenesis of epilepsy involves neuronal dysfunction at the molecular, cellular, and neural circuit levels. Abnormal molecular signaling pathways or dysfunction of specific cell types can lead to epilepsy by disrupting the normal functioning of neural circuits. The continuous emergence of new technologies and the rapid advancement of existing ones have facilitated the discovery and comprehensive understanding of the neural circuit mechanisms underlying epilepsy. Therefore, this review aims to investigate the current understanding of the neural circuit mechanisms in epilepsy based on various technologies, including electroencephalography, magnetic resonance imaging, optogenetics, chemogenetics, deep brain stimulation, and brain-computer interfaces. Additionally, this review discusses these mechanisms from three perspectives: structural, synaptic, and transmitter circuits. The findings reveal that the neural circuit mechanisms of epilepsy encompass information transmission among different structures, interactions within the same structure, and the maintenance of homeostasis at the cellular, synaptic, and neurotransmitter levels. These findings offer new insights for investigating the pathophysiological mechanisms of epilepsy and enhancing its clinical diagnosis and treatment.

Analysis of brain network effective connectivity in juvenile myoclonic epilepsy

Juvenile Myoclonic Epilepsy (JME) is a prevalent idiopathic generalized epilepsy whose neurophysiological mechanisms remain elusive. This study aims to elucidate the aberrant brain network patterns in JME through a multi-modal fMRI approach combining local consistency, functional connectivity, and causal interaction analysis. Resting-state fMRI data were acquired from 37 JME patients and 35 healthy controls. Regional homogeneity (ReHo) and amplitude of low-frequency fluctuations (ALFF) analyses identified eight brain regions with significant between-group differences (FDR-corrected p < 0.05), including the right middle frontal gyrus, right insula, right medial/paracingulate gyrus, bilateral superior frontal gyri, left postcentral gyrus, and left superior occipital gyrus. These regions served as regions of interest (ROIs) for subsequent functional and effective connectivity analyses. Functional connectivity analysis revealed increased connectivity strength between the right middle frontal gyrus and right medial or paracingulate gyrus, as well as between the right insula and right medial/paracingulate gyrus (two-sample t test, p < 0.01), despite decreased local synchrony in these regions. Dynamic causal modeling (DCM) demonstrated bidirectional enhancement of effective connectivity between the right insula and right medial or paracingulate gyrus in patients (Bayesian posterior probability > 0.95). These findings suggest that the observed decoupling of local neuronal synchronization and long-range connectivity may reflect compensatory neuroadaptive processes, particularly involving the salience network (insula) and cognitive control circuitry (cingulate regions).The integration of ReHo/ALFF mapping with DCM provides a novel framework for understanding the neurodevelopmental trajectory of JME, highlighting the critical role of cortico-subcortical dysregulation in its pathogenesis.

Reconstruction and application of multilayer brain network for juvenile myoclonic epilepsy based on link prediction

Juvenile myoclonic epilepsy (JME) exhibits abnormal functional connectivity of brain networks at multiple frequencies. We used the multilayer network model to address the heterogeneous features at different frequencies and assess the mechanisms of functional integration and segregation of brain networks in JME patients. To address the possibility of false edges or missing edges during network construction, we combined multilayer networks with link prediction techniques. Resting-state functional magnetic resonance imaging (rs-fMRI) data were procured from 40 JME patients and 40 healthy controls. The Multilayer Network framework is utilized to integrate information from different frequency bands and to fuse similarity metrics for link prediction. Finally, calculate the entropy of the multiplex degree and multilayer clustering coefficient of the reconfigured multilayer frequency network. The results showed that the multilayer brain network of JME patients had significantly reduced ability to integrate and separate information and significantly correlated with severity of JME symptoms. This difference was particularly evident in default mode network (DMN), motor and somatosensory network (SMN), and auditory network (AN). In addition, significant differences were found in the precuneus, suboccipital gyrus, middle temporal gyrus, thalamus, and insula. Results suggest that JME patients have abnormal brain function and reduced cross-frequency interactions. This may be due to changes in the distribution of connections within and between the DMN, SMN, and AN in multiple frequency bands, resulting in unstable connectivity patterns. The generation of these changes is related to the pathological mechanisms of JME and may exacerbate cognitive and behavioral problems in patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-024-10191-0.

Psychiatric comorbidities predict seizure recurrence in newly treated adults with epilepsy

OBJECTIVE

At least 30 % to 40 % of patients newly treated for epilepsy experience further seizures despite initiation of appropriate antiseizure medication (ASM) treatment. This study aimed to identify clinically useful predictors of seizure recurrence in newly treated adults with epilepsy which would have major clinical benefits.

METHODS

This work is a prospective cohort study conducted in Northeast China between June 2017 and May 2022. At enrolment, we collected information about demographics, clinical characteristics, and psychiatric comorbidities in newly treated adults with epilepsy. All patients were followed for 12 months for further seizures. Predictors of seizure recurrence were identified using logistic regression analyses.

RESULTS

A total of 836 newly treated adults with epilepsy were included in the final analysis. During follow-up, 362 (43.3 %) patients experienced at least one seizure recurrence, and 474 (56.7 %) entered seizure remission. Multivariable analysis showed that the odds of patients with depression having seizure recurrence were 1.74 times greater than those of patients without depression (Adjusted OR 1.74, 95 % CI 1.21-2.51). Similarly, the odds of patients with anxiety having seizure recurrence were 1.69 times greater than those of patients without anxiety (Adjusted OR 1.69, 95 % CI 1.21-2.37). Other Predictors of seizure recurrence included >5 seizures prior to treatment, brain MRI lesion, EEG epileptiform discharges.

CONCLUSION

We found that psychiatric comorbidities at baseline increase the risk of seizure recurrence in newly treated adults with epilepsy. Future studies are required to clarify the mechanisms underlying the links among psychiatric comorbidities and epilepsy. Furthermore, our findings might inform prospective studies investigating whether psychiatric treatment reduces the risk of seizure recurrence in these patients.

Response to nitrazepam in infantile epileptic spasms syndrome after failed standard treatment

OBJECTIVE

Over half of children with infantile epileptic spasms syndrome (IESS) do not respond to standard treatments. Nitrazepam has shown efficacy similar to adrenocorticotrophic hormone. This study evaluated response rates, adverse effects of nitrazepam, and factors associated with responders in children with IESS who failed standard treatment.

METHODS

We conducted a retrospective observational study of children with IESS who failed standard treatments and subsequently received nitrazepam between January 1, 2013, and December 31, 2021. Responders were defined as those achieving sustained clinical resolution of epileptic spasms without relapse at the 3-month follow-up. Etiologies were classified according to the 2017 International League Against Epilepsy classification.

RESULTS

The study included 85 children, with 26 (30.5 %) children showing a response to nitrazepam. Adverse effects occurred in 52 (61.2 %) children, with hypersalivation (47.1 %) being the most common. At the 12-month follow-up visit, 20 (23.5 %) children had sustained clinical resolution of epileptic spasms, with no recorded deaths. Etiology was known in 73.3 % (structural 52 %; infectious 10.7 %; genetic 8 %; metabolic 2.7 %) and unknown in 26.7 %. Known etiology increased the likelihood of responding to nitrazepam (adjusted OR 5.78, 95 % CI 1.17, 28.72, p = 0.032), while a longer duration from epileptic spasms onset to nitrazepam decreased the odds of response (adjusted OR 0.85, 95 % CI 0.74, 0.98, p = 0.021).

CONCLUSION

Approximately, 31% of children responded to nitrazepam. Early initiation of treatment with nitrazepam may be beneficial for children with IESS, particularly those with a known etiology, after failure of standard treatments.

Anti-seizure medication is a minor causative factor in behavioral problems of children with tuberous sclerosis complex

INTRODUCTION

Behavioral problems in Tuberous Sclerosis Complex (TSC) are considered among the highest disease burden for both patients and caregivers, while the cause is often not clear. The current study aimed to explore the relationship between anti-seizure medication (ASM) and behavioral manifestations in children with TSC and epilepsy.

METHODS

118 children referred to the University Medical Center Utrecht with definite TSC and epilepsy, aged 2-18 years, were included in a retrospective cohort study. Behavioral problems were categorized into: 'any behavioral problem', 'aggressive behavior', 'attentional', 'eating' and 'sleeping' problems, and 'temper tantrums'. In a descriptive analysis, we studied the relationship between behavioral problems and exposure to specific ASMs compared to any other ASM. We looked in detail at manifestations occurring within ninety days after ASM initiation. For both time points we calculated Odds Ratios, comparing use of a specific ASM with use of any other ASMs. In addition, behavioral problems were related to disease characteristics with multivariable multinomial log-linear modeling after variable selection.

RESULTS

During a mean follow-up of nine years, 616 ASM prescriptions were made. Behavioral problems were reported in 66% of patients, with temper tantrums showing the highest prevalence (53%). However, behavioral problems were low in association with a specific ASM. From the disease-inherent factors intellectual disability and autism spectrum disorder were significantly associated with attention and sleeping problems.

CONCLUSION

We did not find evidence for aggravation of behavioral problems with specific ASM use. In this complexity of symptoms of TSC the possible benefits of ASM, therefore, likely outweigh the risk of behavioral problems.

UGT polymorphisms and epileptic seizure control in pregnant women treated with Lamotrigine

OBJECTIVE

We investigated whether polymorphisms of selected uridine-diphospho-glucuronosyl-tranferases (UGT) involved in Lamotrigine (LTG) metabolism are associated with seizure control during pregnancy and post-partum in women with epilepsy treated with LTG.

METHODS

Single nucleotide polymorphisms for UGT1A4 * 2 (P24T, c.70 C>A), UGT1A4 * 3 (L48V c.142 T > G) and UGT2B7 * 2 (H268Y, c.802 C>T), were determined in 47 pregnancies in 40 non-smoking women with LTG-treated epilepsy. Retrospectively collected data included seizure type and frequency, LTG dosage and LTG plasma level changes during pregnancy and PP. We evaluated the effect of UGT genotype on seizure control throughout pregnancy and post-partum (T1-PP).

RESULTS

In 47 pregnancies, seizure control was achieved in 60 % in T1-PP. Occurrence of seizures T1-PP was not directly associated with UGT genotype, but with having pre-pregnant seizures within the past 6 months (OR 8.33 (95 % CI 1.53-45.41, p = 0.01) and 12 months (OR 5.25, 95 % CI 1.47-18.77, p = 0.02) preceding pregnancy.

CONCLUSION

We did not observe any proximate effect of UGT genotypes on seizure control during pregnancy and post-partum in women treated with LTG, but seizures within the year preceding pregnancy had a significant impact.

Enteral topiramate treatment in refractory status epilepticus

OBJECTIVE

Refractory status epilepticus (RSE) is defined as persistent seizure activity despite first- and second-line antiepileptic medications (ASMs). Although benzodiazepines and a range of iv ASMs are available, mortality is 3-4 times higher than in those without RSE. Topiramate (TPM), a broad-spectrum ASM, may have neuroprotective, anti-inflammatory, and mitigating effects on neuronal injury. We aimed to investigate the efficacy of TPM and mortality in RSE.

METHODS

This retrospective, multicentre study was conducted on RSE ≥ 18 years of age in six different universities and state hospitals in Ankara and Istanbul, Turkey. Demographic data, seizure classification and etiology were analyzed. TPM was loaded and a maintenance dose was scheduled. The outcomes, prognoses, comorbidities were analysed. The effectiveness of TPM and mortality rates of the patients were also analyzed.

RESULTS

The study includes 60 patients with a mean age of 51.6 (±20, 20-84) years, 46.7 % were women. The patients were classified as having convulsive SE or nonconvulsive SE. TPM was performed as median third order ASM. The loading dose varied between 200 and 500 mg bid. The dose was subsequently reduced and maintained at 100-200 mg/day. There were 6 patients in whom TPM could not be continued due to adverse effects. TPM was considered successful in 22 patients, possibly successful in 23 patients and unsuccessful in 15 patients. Thirty-three patients were discharged from hospital, 8 were transferred to a rehabilitation center, 4 were transferred to a palliative care center and 13 died. There was no effect of age, gender, whether intubation was performed or not, etiologic classification, SE type (convulsive or nonconvulsive), duration of TPM administration, TPM loading dose on TPM success. Patients with RSE who were successfully treated with TPM had shorter hospital stays. The mortality predicting variables were determined as older age, not having epilepsy, failure to terminate RSE and acute symptomatic etiology.

SIGNIFICANCE

This observational, multicenter study indicates that enteral TPM therapy is well tolerated, has a favorable safety profile, and is effective in patients with RSE. This is the first study in the literature to end SE with both high and low dose oral TPM treatment.

CSMD1 as a causative gene of developmental and epileptic encephalopathy and generalized epilepsies

Genetic factors are the major causes of epilepsies, such as developmental and epileptic encephalopathy (DEE) and idiopathic generalized epilepsy (IGE). However, the etiology of most patients remains elusive. This study performed exon sequencing in a cohort of 173 patients with IGE. Additional cases were recruited from the matching platform in China. The excess and damaging effect of variants, the genotype-phenotype correlation, and the correlation between gene expression and phenotype were studied to validate the gene-disease association. CSMD1 compound heterozygous variants were identified in four unrelated cases with IGE. Additional CSMD1 variants were identified in five cases with DEE featured by generalized seizures from the matching platform, including two with de novo and three with compound heterozygous variants. Two patients were refractory to antiseizure medications and all patients were on long-term therapy. The CSMD1 variants presented a significantly high excess of variants in the case-cohort. Besides de novo origination, the DEE cases had each of the paired variants located closer to each other than the IGE cases or more significant alterations in hydrophobicity. The DEE-associated variants were all absent in the normal population and presented significantly lower minor allele frequency than the IGE-associated variants, suggesting a minor allele frequency-phenotype severity correlation. Gene expression analysis showed that CSMD1 was extensively expressed throughout the brain, particularly in the cortex. The CSMD1 temporal expression pattern correlated with the disease onset and outcomes. This study suggests that CSMD1 is associated with epilepsy and is a novel causative gene of DEE and generalized epilepsies.

Balancing efficacy and safety: The dual impact of antiseizure medications on the developing brain

The number of neurons in the developing brain is greater than typically found in adulthood, and the brain possesses delicate mechanisms to induce the death of excess cells and refine neural circuitry. The correct tuning between the processes of neuronal death and survival generates a mature and functional brain in its complexity and plastic capacity. Epilepsy is a highly prevalent neurological condition worldwide, including among young individuals. However, exposure to the main treatment approaches, the long-term use of Antiseizure Medication (ASM), during the critical period of development can induce a series of changes in this delicate balance. Acting by various mechanisms of action, ASMs may induce an increase in neuronal death, something that translates into deleterious neuropsychiatric effects in adulthood. Several investigations conducted in recent years have brought to light new aspects related to this dynamic, yet many questions, such as the cellular mechanisms of death and the pathophysiology of late effects, still have unresolved elements. In this review, we aimed to explore the mechanisms of action of the most widely used ASMs in the treatment of neonatal epilepsy, the broad aspects of neuronal death in the developing brain and the repercussions of this death and other effects in adulthood. We review the evidence indicating a relationship between exposure to ASMs and the manifestation of associated psychiatric comorbidities in adulthood and discuss some possible mechanisms underlying the induction of this process by morphological and physiological changes in the related behaviors.

Evaluation of Neurovascular Coupling in Early-Onset and Late-Onset Epilepsy of Unknown Etiology

BACKGROUND

Previous studies have shown neurovascular coupling (NVC) dysfunction in epilepsy, suggesting its role in the pathological mechanisms. However, it remains unclear whether NVC abnormalities exist in epilepsy of unknown etiology (EU).

PURPOSE

To integrate multiparametric MRI to assess NVC and its relationship with cognition in early-onset and late-onset EU patients.

STUDY TYPE

Prospective.

POPULATION

Ninety-six EU patients (46 early-onset, M/F = 20/26; 50 late-onset, M/F = 29/21) and 60 healthy controls (HCs, M/F = 25/35).

FIELD STRENGTH/SEQUENCE

3.0 T, resting-state gradient echo-planar imaging, pseudo-continuous arterial spin labeling (pc-ASL), and T1-weighted brain volume sequence.

ASSESSMENT

Functional MRI data were analyzed to assess intrinsic brain activity including amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and functional connectivity strength (FCS), while pc-ASL provided cerebral blood flow (CBF) measurements. Coupling correlation coefficients and ratios of CBF to neural activity were calculated to evaluate global and regional NVC.

STATISTICAL TESTS

Two-sample t-test, Analysis of Variance, Kruskal-Wallis test, Chi-square test, Analysis of Covariance, family-wise error/Bonferroni correction, partial correlation analyses. Statistical significance was defined as P < 0.05.

RESULTS

Whole-brain analysis revealed increased ALFF values in both patient groups' left precentral and postcentral gyri. Both patient groups had lower global NVC coefficients than HCs, with reduced CBF-ALFF (0.28 vs. 0.30), CBF-fALFF (0.43 vs. 0.45), and CBF-ReHo (0.40 vs. 0.41) in early-onset patients, and lower CBF-fALFF (0.38 vs. 0.45) and CBF-ReHo (0.32 vs. 0.41) in late-onset patients. Regional analysis showed significantly decreased CBF/ALFF ratios in the left precentral and postcentral gyri (T = 3.85 to 5.33). Reduced global NVC in early-onset patients was significantly associated with poorer executive function (r = 0.323), while global coupling in late-onset patients was negatively correlated with disease duration (r = -0.348 to -0.426).

DATA CONCLUSION

This study showed abnormal global and regional NVC in both early-onset and late-onset EU patients, emphasizing the potential role of NVC in the pathophysiological mechanisms of EU.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY: Stage 1.

Sexual dysfunction in men with epilepsy - An observational case-control study

BACKGROUND

Epilepsy presents multifaceted challenges, including sexual dysfunction and psychiatric comorbidities in men. Understanding the interplay between epilepsy, antiseizure medications, hormonal alterations, and sexual dysfunction is crucial for tailored interventions and improved quality of life.

METHODS

This case-control study enrolled 226 married men (150 MWE, 76 controls) from a tertiary care neurology hospital in Southern India. Demographic, clinical, and hormonal data were collected. Sexual dysfunction was assessed using the Arizona Sexual Experience Scale (ASEX) and the Premature Ejaculation Diagnostic Tool (PEDT). Psychiatric symptoms were evaluated using the DASS-21 questionnaire.

RESULTS

Nineteen percent of MWE exhibited significant sexual dysfunction. Median ASEX scores were significantly higher in polytherapy (15) compared with monotherapy (13) and controls (10), (p < 0.0001). The cut-off score for sexual dysfunction (>18) was present in 20 individuals in the polytherapy group, 8 in the monotherapy group and none in the control group (p < 0.0001). PEDT scores showed a similar pattern, with statistically significant differences between subgroups. Hormonal analysis revealed dysregulated LH and testosterone levels in MWE and were significantly more on pairwise comparisons in the polytherapy subgroup. Epilepsy duration, valproate usage, and presence of anxiety/depression were associated with sexual dysfunction on a multivariable regression model using the Akaike information criterion.

CONCLUSION

This study elucidates the complex relationship between epilepsy, medications, hormonal alterations, and sexual dysfunction in men. Valproate was found to be strongly associated with sexual dysfunction and hormonal imbalance. Further research is warranted to address study limitations and advance our understanding of sexual dysfunction in MWE.

Gaze behavior in infancy associates with developmental outcome at the age of two years in early-onset epilepsies

PURPOSE

The neurodevelopmental outcome of infants with early-onset epilepsies varies widely, ranging from typical development to global developmental delay. Visual skills, which emerge during infancy, are crucial for the development of cognitive functions. The aim of this observational cohort study was to explore gaze behavior in infants with early-onset epilepsy and evaluate if eye tracking could support prognostication of their neurodevelopment.

METHODS

Fifty-one infants (22 females, mean seizure onset-age 5, SD ± 2, months) from a prospective epilepsy cohort underwent repeated eye tracking and Hammersmith Infantile/Neonatal Neurological examination (HINE/HNNE). Neurodevelopment at age two was categorized as typical development (mean Bayley [BSID-III] cognitive and language or Griffiths [GMDS-III] scales score ≥ 85) and developmental delay. At initial (age 3-10 months) and 12-month visit, we compared reliability of fixation, probability of gaze shifts and saccadic reaction times (SRTs) in a non-competitive SRT-task between developmental groups. Gaze behavior was also compared across etiologies, syndrome groups and between those with optimal versus suboptimal first HINE/HNNE.

RESULTS

Infants with typical developmental outcome (n = 23) had higher reliability of fixation (p = 0.007) and higher probability of gaze shifts (p = 0.012) at initial eye tracking than those with delay (n = 28). SRTs became faster during the follow-up but did not differ significantly between the developmental groups. Gaze behavior associated with epilepsy syndrome, etiology, and initial HINE/HNNE result.

CONCLUSIONS

Ability to fixate reliably and shift gaze soon after the epilepsy diagnosis is associated with developmental outcome in infants with early-onset epilepsy, suggesting that eye tracking could be useful as an additional prognostic tool.

Threshold-dependent association between non-rapid eye movement obstructive sleep apnea and interictal epileptiform discharges: A hospital study

Obstructive sleep apnea frequently coexists with epilepsy, potentially influencing its pathophysiology. However, the effect of obstructive sleep apnea severity on interictal epileptiform discharges is not well understood. To explore this, we studied 108 Asian patients with epilepsy who underwent single-night polysomnography. We utilized generalized linear models, adjusting for age, sex, epilepsy type (focal versus generalized), antiepileptic medication use and disease duration, to analyse the relationship between obstructive sleep apnea severity, as measured by the apnea-hypopnea index, and interictal epileptiform discharge frequency during non-rapid eye movement and rapid eye movement sleep. Our analysis revealed that severe obstructive sleep apnea (apnea-hypopnea index ≥ 30) was associated with a higher frequency of interictal epileptiform discharges during non-rapid eye movement sleep (p = 0.04), but no such association was observed during rapid eye movement sleep. Additionally, the frequency of interictal epileptiform discharges in non-rapid eye movement sleep was positively correlated with the wake time between sleep onset and offset (p = 0.03). Further studies are warranted to validate our findings across diverse ethnicities, and over multiple nights of sleep and interictal epileptiform discharge recordings.

The Metabolic Profile of Plasma During Epileptogenesis in a Rat Model of Lithium-Pilocarpine-Induced Temporal Lobe Epilepsy

Temporal lobe epilepsy (TLE) arises mostly because of an initial injury. Certain stimuli can make a normal brain prone to repeated, spontaneous seizures via a process called epileptogenesis. This study examined the plasma metabolomics profile in rats with the induced TLE to identify feasible biomarkers that can distinguish progression of epileptogenesis in three different time points and reveal the underlying mechanisms of epileptogenesis. Status epilepticus (SE) was induced by repetitive intraperitoneal injections of low-dose lithium chloride-pilocarpine hydrocholoride. Blood samples were collected 48 h, 1 week, and 6 weeks after SE, respectively. Plasma metabolites were analyzed by nuclear magnetic resonance (NMR) spectrometry. Statistical analysis was performed using MetaboAnalyst 6.0. An orthogonal partial least squares discriminant analysis (OPLS-DA) model was employed to represent variations between the TLE model groups and respective controls. Volcano plot analysis was used to identify key features, applying a fold-change criterion of 1.5 and a t-test threshold of 0.05. 48 h after SE, dimethyl sulfone (DMSO2) and creatinine levels were decreased, whereas glycine and creatine levels were increased. The only metabolite that changed 1 week after SE was pyruvic acid, which was increased compared to its control level. Lactic acid, pyruvic acid, and succinic acid levels were increased 6 weeks after SE. The identified metabolites were especially related to the tricarboxylic acid cycle and glycine, serine, and threonine metabolism. The results illustrate that distinct plasma metabolites can function as phase-specific biomarkers in TLE and reveal new insights into the mechanisms underlying SE.

Changes in topological properties of brain structural covariance networks and alertness in temporal lobe epilepsy with and without focal to bilateral tonic-clonic seizures

This study investigated brain structural covariance network (SCN) topological changes and alertness in temporal lobe epilepsy (TLE) with and without focal to bilateral tonic-clonic seizures (FBTCS). Seventy-eight subjects, including 32 TLE patients with FBTCS (TLE-FBTCS), 46 TLE patients without FBTCS (TLE-FS), and 42 healthy controls (HCs), underwent the Attention Network Test to assess alertness and volumetric MRI scans. SCNs were constructed and analyzed using graph theory. Results showed that TLE-FS patients had lower total cerebral volume than HCs, and the lowest volume was observed in the TLE-FBTCS group. Compared to HCs and TLE-FBTCS patients, TLE-FS patients exhibited increased small-worldness, normalized clustering coefficient, global efficiency, and modularity, but decreased normalized characteristic shortest path length and assortativity. Specific brain regions, such as the hippocampus, thalamus, and superior temporal sulcus, showed changes in nodal clustering coefficients and efficiency in TLE-FS patients. Further analysis revealed decreased intrinsic/phasic alertness in TLE-FBTCS patients. Correlation analysis indicated that SCN topological properties were associated with alertness in TLE-FS patients but not in TLE-FBTCS patients. These findings suggest that TLE-FS and TLE-FBTCS patients show different changes in SCN integration and segregation, with TLE-FS alertness linked to SCN topological properties, providing insights into TLE's neuropathological mechanisms.

Mechanistic strategies for secondary prevention of developmental and epileptic encephalopathy in children with tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder caused by pathogenic variants in TSC1 or TSC2, leading to mTOR pathway dysregulation and a spectrum of systemic and neurological manifestations. Tuberous Sclerosis Complex (TSC) is a multisystem genetic disorder frequently associated with early-onset, drug-resistant epilepsy, intellectual disability, and autism spectrum disorder-collectively known as TSC-associated developmental and epileptic encephalopathy (DEE). Advances in prenatal diagnostics and biomarker research now enable presymptomatic identification of high-risk infants. This review aims to synthesize current evidence on biomarker-informed, mechanism-based strategies for secondary prevention of DEE in TSC, offering a framework for personalized early interventions. Biomarkers, such as interictal epileptiform discharges, pathogenic TSC2 variants, and advanced neuroimaging metrics, predict epilepsy risk and neurodevelopmental trajectories. Preventive approaches include early initiation of vigabatrin and mTOR inhibitors, which show potential in reducing epilepsy severity and improving outcomes. Emerging strategies, including gene therapy, multi-omic profiling, and environmental enrichment, offer promise for disease modification. By linking predictive biomarkers to disease-modifying strategies, this review outlines a proactive and personalised approach to prevent or mitigate TSC-associated DEE. These insights help advance clinical decision-making and promote a shift toward precision prevention in paediatric epilepsy.

Anticonvulsant effect of Stachydrine on pentylenetetrazole-induced kindling seizure mouse model via Notch and NMDAR signaling pathways

ETHNOPHARMACOLOGICAL RELEVANCE

Stachydrine (STA), the principal bioactive alkaloid of Leonurus japonicus (Motherwort/"Yi Mu Cao"), may derive its ethnopharmacological relevance for epilepsy management from the botanical origin-Motherwort's documented traditional use in treating seizures and other neurological cardiovascular diseases.

AIM OF THE STUDY

To validate STA's ethnomedicinal claim an anticonvulsant by mechanistically interrogating its dual modulation of Notch1-driven neuroinflammation and NMDA receptor-mediated excitotoxicity, which are two key hallmarks of chronic epileptogenesis.

MATERIALS AND METHODS

Male C57BL/6 mice were divided into three groups to evaluate the neuroprotective and an anticonvulsant effects of STA in the PTZ-induced seizure model: Control group, PTZ group, and PTZ+STA group. Behavioral seizure scoring and cognitive tests were integrated with EEG recordings to assess neuronal synchronization. Molecular mechanisms were dissected via hippocampal immunohistochemistry and Western blotting.

RESULTS

Our results showed that daily oral administration of STA for a duration of 25 days significantly reduced seizure scores. EEG recordings indicated that STA treatment resulted in a notable reduction in both total brainwave power and firing amplitude within the groups receiving STA. Furthermore, STA administration provided cognitive protection against kindling-associated deficits, as demonstrated by improved alteration behavior and recognition index in Y-maze and object recognition tests. STA administration reduced neuronal loss and glial cell activation. Additionally, significant downregulation of NMDA receptor subunits, CAMK2, caspase-3, Notch1, and Hes1 expression levels was observed following STA administration.

CONCLUSION

These findings suggest that STA provides neuroprotection against PTZ-induced epilepsy by modulating the Notch and NMDA receptor pathways, thus addressing neuroinflammation and apoptosis resulting from excitotoxicity.

Neurological findings in a cohort of adults with down syndrome

The aim of this study is to describe the results of a comprehensive neurological assessment conducted on a cohort of 70 adults with Down syndrome (DS), aged 21 to 74 years, recruited in Bologna, Italy. Neurocognitive disorder (NcD) was identified in 28.6% of participants and showed a significant association with psychiatric disorders (p=0.03). Psychiatric conditions were present in 40% of the cohort, while Down Syndrome Regression Disorder (DSRD) was diagnosed in 7.1%. Transient loss of consciousness affected 28.6% of individuals. Epilepsy, observed in 7.1%, was significantly associated with NcD (p=0.02). Neurological examination revealed that stereotypic movements correlated with DSRD (p<0.01), tics with obsessive-compulsive disorders (p=0.01), and hypokinetic movement disorders with psychotic conditions (p=0.03). Additionally, nystagmus and cerebellar signs were significantly associated with elevated serum bilirubin levels (p<0.01). These findings underscore the high prevalence and complexity of neurological comorbidities in adults with DS, emphasizing the need for specialized, multidisciplinary care.

Addressing the gap: SUDEP knowledge and communication among patients and neurologists

OBJECTIVES

Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in epilepsy. Effective management of SUDEP risk depends on a solid understanding of SUDEP and its associated risk factors. This study evaluates the perspectives of both patients and neurologists on SUDEP discussion.

METHODS

A cross-sectional study was conducted at Mansoura University Hospital in Egypt, involving 173 adult epilepsy patients and 26 neurologists. Patients completed structured, in-person surveys assessing their awareness of SUDEP and preferences for receiving related information. Neurologists were surveyed regarding their knowledge of SUDEP risk factors, frequency of SUDEP discussions, and perceived barriers. Data analysis included descriptive statistics, Chi-square tests, and binary logistic regression.

RESULTS

Among patients, 84 % had never heard of SUDEP; however, 92 % expressed a desire to be informed, with 75 % preferring detailed information from a neurologist. Neurologists demonstrated limited knowledge, with only 27 % correctly identifying key SUDEP risk factors. Additionally, 65 % rarely or never discussed SUDEP with patients, citing concerns about inducing anxiety and impacting quality of life. Knowledge level among neurologists was not significantly associated with the frequency of SUDEP discussions.

CONCLUSION

This study identifies a major gap in SUDEP awareness among patients and neurologists, with patients expressing a strong preference for information despite limited discussions by clinicians. Targeted educational initiatives are needed to bridge this communication gap. As the first study from the MENA region to assess both perspectives, it also contributes a unique sociocultural understanding to global SUDEP research.

Herbal nanoparticles: bridging traditional medicine and modern science in epilepsy treatment

Millions of people worldwide suffer from epilepsy, a persistent neurological illness characterized by recurring seizures. Despite advances in anti-epileptic medications, a significant number of patients continue to have insufficient seizure control and have side effects. Nanotechnology has emerged as a promising alternative for increasing medicine delivery and therapeutic effects in recent years. The anti-epileptic potential of nanoparticles produced from herbal medicines such as berberine-loaded zein/hyaluronic acid composite, Cannabis sativa extract-loaded nanoliposomes and nanostructured lipids, nanostructured lipid vehicle-carried safranal, and cryptolepine solid-lipid NPs is reviewed in this work, which makes use of the synergistic effects of nanotechnology and natural substances. The manuscript presents an overview of the mechanisms underlying the anti-epileptic effects of these nanoparticles, ranging from regulating neurotransmitter systems and ion channels to lowering oxidative stress and inflammation. Preclinical studies using animal models of epilepsy have shown that herbal medicine nanoparticles can reduce seizure activity, prolong seizure latency, and improve cognitive function. The findings presented in this manuscript highlight the remarkable potential of herbal medicine nanoparticles as a novel approach to the management of epilepsy. Continued research and development in this field have the potential to revolutionize epilepsy therapy and improve the quality of life for people suffering from this debilitating condition.

Gut-immune-brain interactions during neurodevelopment: from a brain-centric to a multisystem perspective

BACKGROUND

Neurodevelopmental disorders (NDDs) and epileptic syndromes are complex neurological conditions linked by shared abnormal neurobiological processes. Existing therapies mostly target symptoms, rather than addressing the underlying causes of the disease, leaving a burden of unmet clinical needs.

MAIN BODY

Emerging evidence suggests a significant role for the gut microbiota and associated immune responses in influencing brain development and function, changing the paradigm of a brain-centric origin of NDDs. This review discusses the pivotal interactions within the gut-immune-brain axis, highlighting how microbial dysbiosis and immune signaling contribute to neurological pathologies. We also explore the potential of microbial management and immunomodulation as novel therapeutic avenues, emphasizing the need for a shift towards addressing the root causes of these disorders rather than just their symptoms.

CONCLUSIONS

This integrated perspective offers new insights into the biological underpinnings of NDDs and epilepsy, proposing innovative biomarkers and therapeutic strategies.

Knowledge, attitudes, and practices of epilepsy patients regarding the ketogenic diet therapy: A cross-sectional study

OBJECTIVE

The therapeutic ketogenic diet is typically used in epilepsy treatments, yet there has been insufficient understanding regarding the knowledge, attitudes, and practices (KAP) of epilepsy patients concerning this dietary therapy. This study aims to investigate the KAP of epilepsy patients regarding ketogenic diet therapy, with the goal of identifying gaps in knowledge and attitudes that may impact clinical outcomes.

METHOD

A cross-sectional study was conducted between November 2023 and December 2023 at three epilepsy centers in Shanxi Province: the First Hospital of Shanxi Medical University, the Second Hospital of Shanxi Medical University, and Taiyuan Epilepsy Hospital. Data, including demographic characteristics and KAP scores, were collected via online questionnaires, yielding a total of 612 valid responses, with 320 (52.29%) males.

RESULTS

The mean KAP scores were calculated as follows: knowledge score 4.99 ± 6.72 (possible range: 0-24), attitude score 24.82 ± 2.34 (possible range: 8-40), and practice score 29.48 ± 8.49 (possible range: 9-45). Multivariate analysis revealed that the attitude score (OR = 1.443, 95% CI: [1.296-1.607], p < 0.001) and an epilepsy duration of 5-10 years (OR = 3.086, 95% CI: [1.716-5.548], p < 0.001) were independently associated with positive practice. Additionally, Structural Equation Modeling indicated that knowledge (β = 0.034, p = 0.012) and attitude (β = 0.583, p = 0.010) directly influenced practice, while knowledge also directly affected attitude (β = 0.565, p = 0.013), with an indirect effect on practice through attitude (β = 0.329, p = 0.009).

SIGNIFICANCE

The study found insufficient knowledge, suboptimal attitudes, and negative practices toward the ketogenic diet among epilepsy patients. This underscores the need for targeted educational interventions to enhance patient engagement and optimize clinical outcomes.

PLAIN LANGUAGE SUMMARY

This study looked at how much epilepsy patients know about, feel about, and use the ketogenic diet as a treatment. We found that patients generally know little about the diet, have mixed feelings, and do not use it much. Better understanding and positive attitudes were linked to better use of the diet. The results suggest that more education could help patients use the diet more effectively, which might improve their health outcomes.

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.

Glymphatic system dysfunction and its impact on seizure severity, cognitive function, and affective symptoms in patients with generalized tonic-clonic seizures alone

BACKGROUND

Generalized tonic-clonic seizures alone (GTCS alone) represent a distinct idiopathic epilepsy syndrome. Glymphatic system (GS) dysfunction-a brain-wide perivascular clearance pathway-has been proposed as a contributing mechanism in epilepsy and its related comorbidities.

OBJECTIVE

To assess GS function in patients with GTCS alone using the Analysis Along the Perivascular Space (ALPS) index derived from diffusion spectrum imaging (DSI), and to explore its associations with clinical, cognitive, and emotional measures.

METHODS

A total of 101 patients with GTCS alone and 76 demographically matched healthy controls underwent DSI. The ALPS index was calculated and correlated with scores from standardized assessments, including the National Hospital Seizure Severity Scale (NHS3), Epileptic Discharge Index (EDI), Montreal Cognitive Assessment (MoCA), Kilifi Stigma Scale for Epilepsy (KSSE), and Hamilton Depression Rating Scale (HAMD).

RESULTS

Patients with GTCS alone had lower ALPS indices compared to healthy controls (1.43 vs. 1.52, p < 0.01). Among patients, the ALPS index positively correlated with MoCA scores (r = 0.30, p = 0.002) and negatively correlated with age (r = -0.22, p = 0.030), NHS3 (r = -0.27, p = 0.007), KSSE (r = -0.21, p = 0.038), and HAMD (r = -0.20, p = 0.042). The ALPS index was lower in patients with higher antiseizure medication loads (1.36 vs. 1.44, p = 0.042) and elevated EDI values (1.39 vs. 1.45, p = 0.039).

CONCLUSIONS

Glymphatic function is impaired in patients with GTCS alone, as indicated by reduced ALPS indices. These indices are associated with seizure severity, cognitive impairment, depressive symptoms, and perceived stigma. The ALPS index may serve as a noninvasive imaging biomarker of disease burden and a novel tool for understanding pathophysiological mechanisms in GTCS alone.

Efficacy of Stiripentol Beyond Dravet Syndrome: A Retrospective Medical Record Review of Patients with Drug-Resistant Epilepsies

INTRODUCTION

Stiripentol is approved as an add-on therapy with clobazam and/or valproate for seizures associated with Dravet syndrome (DS). Evidence of stiripentol efficacy in other drug-resistant epilepsies is limited.

METHODS

This was a single-centre, retrospective, observational study of patients aged ≤ 15 years with non-Dravet epilepsy or DS who initiated stiripentol treatment in Spain.

RESULTS

The study included 18 patients with DS and 17 with non-Dravet epilepsy; 76.5% of the latter had a developmental and epileptic encephalopathy. Median (range) age at stiripentol initiation was 52 (4-180) months. Three months of add-on stiripentol provided overall improvement in seizures (number, duration and/or intensity) for 76.5% of the non-Dravet and 61.1% of the DS patients (p = 0.30), all of whom were drug-resistant to prior antiseizure medications (ASMs). Stiripentol reduced seizure frequency by ≥ 50% in 58.8% of the non-Dravet patients and 44.4% of the DS cohort (p = 0.40); 20% of all patients became seizure-free. Stiripentol reduced all seizure types in both cohorts. Kaplan-Meier survival analysis found a higher probability of sustained stiripentol efficacy in the DS cohort (120 months) than the non-Dravet cohort (16 months; p = 0.012). Stiripentol improved cognition and Clinical Global Impression scale scores in approximately 60% of all patients; sleep improved for 19.2%. Acute stiripentol treatment (maximum dose 6.7-100 mg/kg/day) initiated in five patients (four with non-Dravet epilepsy and one with DS) during refractory status epilepticus (SE) successfully resolved SE over a median 0.5 days. Adverse events, mainly mild-to-moderate, occurred in 47.1% and 41.2% of patients in the non-Dravet and DS cohorts, respectively. Six patients (35.3%) with non-Dravet epilepsy discontinued ≥ 1 other ASMs after stiripentol initiation.

CONCLUSION

Add-on stiripentol provides overall improvement in different seizure types and non-seizure manifestations for paediatric patients with drug-resistant epilepsy, including epileptic syndromes besides DS, and appeared effective in acute treatment of SE. Stiripentol was generally well tolerated.

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.

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.

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.

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.

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.

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.

Mendelian randomization combined with single-cell sequencing data analysis of chemokines and chemokine receptors and key genes and molecular mechanisms associated with epilepsy

To explore the functions and potential regulatory mechanisms of chemokine and chemokine receptor (CCR)-related genes in epilepsy. CCRs were identified as candidate genes and their causal relationship with epilepsy was rigorously evaluated via Mendelian randomization analysis. Subsequently, single-cell RNA sequencing (scRNA-seq) data were analyzed to identify and classify cell clusters into distinct types based on cellular annotation. Differential expression analysis was conducted to pinpoint key genes by overlapping the candidate gene set with differentially expressed genes (DEGs). Furthermore, potential therapeutic drugs for epilepsy were predicted, offering novel avenues for disease management and treatment. In total, 6395 DEGs were identified across the six cell clusters. After their intersection,CCRL2, XCL2, CXCR5, CXCL1, and CX3CR1 were pinpointed as key genes. Microglia, T cells, B cells, and macrophages have been emerged as critical cells. Furthermore, CXCL1 was regulated by hsa-miR-570-3p and hsa-miR-532-5p. Notably, CXCR5, CXCL1, and CX3CR1 were associated with 27 drug compounds. This comprehensive study leveraged scRNA-seq and transcriptomic data to elucidate the roles of CCR-related genes in epilepsy. Notably, CCRL2, XCL2, CXCR5, CXCL1, and CX3CR1 were identified as key genes implicated in epilepsy, whereas microglia, T cells, B cells, and macrophages were recognized as critical contributors to the development of epilepsy. Regulating the expression of CCRL2, XCL2, CXCR5, CXCL1, and CX3CR1, along with the activity of these immune cells may offer therapeutic potential for the alleviation of epilepsy.

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.

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).

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.

Ontology accelerates few-shot learning capability of large language model: A study in extraction of drug efficacy in a rare pediatric epilepsy

OBJECTIVE

Dravet Syndrome (DS) is a developmental and epileptic encephalopathy that is characterized by severe, prolonged motor seizures and high resistance to multiple antiseizure medications (ASMs) with multiple comorbidities. Evaluating the efficacy of new drugs in DS preclinical models and mapping them to human phenotypes of DS through analysis of published literature is an important goal for improving outcomes in this rare pediatric epilepsy.

MATERIALS AND METHODS

Large language models (LLM) have demonstrated great promise in parsing published literature; however, the performance of LLMs falls short in medical applications. In this study, we investigate the effectiveness of domain ontology developed by human experts to optimize LLMs for medical text processing in a rare disease. Utilizing a benchmark dataset that describes the efficacy of 17 ASMs tested in preclinical models and DS patients, we define a new ontology-augmented phased in-context learning (PCL) approach to process 4935 full-text DS articles. We expand this analysis to 7 new drugs that demonstrate efficacy in reducing seizures to identify gaps in current knowledge for designing new experimental studies for drug discovery in DS.

RESULTS

Few-shot or in-context learning is a foundational capability of LLMs and the few-shot learning capability of the Gemini 1.0 Pro version LLM dramatically increases when we augment prompts with the DS epilepsy ontology. The DS epilepsy ontology is the largest epilepsy and seizure ontology in clinical use that was developed by DS basic scientists and clinical neurologists. The ontology-augmented PCL prompt achieves 100% accuracy in reproducing the benchmark drug efficacy dataset for 17 ASMs with only two examples for in-context learning.

CONCLUSION

The new ontology-augmented PCL approach significantly accelerates the few-shot learning capabilities of the Gemini LLM, thereby reducing the number of required examples and time needed to optimize LLMs for medical applications.

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.