BACKGROUND & OBJECTIVES:Status epilepticus (SE) poses high risks of death and disability, yet most prognostic tools focus solely on mortality. The END-IT score is the only scale specifically developed to predict 3-month functional outcomes of SE. Hence, this study evaluated the performance of END-IT in adults with SE and explored additional predictors of 3-month functional outcomes. METHODS:This prospective cohort study was conducted at a tertiary hospital in Egypt (August 2024-August 2025). Data collected included demographics, the Charlson Comorbidity Index (CCI), initial level of consciousness (as measured by the Glasgow Coma Scale [GCS] and FOUR score), seizure semiology, SE refractoriness, Status Epilepticus Severity Score (STESS), and all END-IT components. An unfavourable outcome was defined as a Modified Rankin Scale (mRS) score of 3-6 at the 3-month follow-up. RESULTS:A total of 114 patients were enrolled (median age 33 years [IQR 17.75-54.25]). Most episodes were convulsive SE, while non-convulsive SE accounted for 4.4%. At 3 months, 55.3% had unfavourable outcomes, including 36.8% deaths. The sensitivity and specificity for unfavourable outcome prediction after 3 months for END-IT (≥3) = 0.524 and 0.843, respectively (Area under the curve = 0.747). The regression model revealed that higher CCI scores (OR = 2.06, 95% CI: 1.31-3.23, P = 0.002) and higher END-IT scores (OR = 1.67, 95% CI: 1.12-2.49, P = 0.013) were independently associated with unfavourable outcomes. CONCLUSION:In this SE cohort, END-IT showed moderate prognostic performance for predicting 3-month functional outcomes. Incorporating comorbidity burden may enhance future prognostic models.
OBJECTIVE:Previous findings on valproate (VPA) and cognitive function are inconsistent. Given the shared signaling pathways between VPA and 5-HT1A receptors, this study examined whether prophylactic VPA administration is associated with improved spatial memory in pentylenetetrazol (PTZ)-kindled rats and whether 5-HT1A receptor blockade reverses this effect. METHODS:Adult male rats were divided into six groups (n = 10). PTZ (37 mg/kg) and VPA (300 mg/kg) were injected intraperitoneally every 48 h for four weeks. VPA was given 30 min before PTZ in combined groups. Seizure severity was scored daily. After kindling, NAD-299 (5 µg/0.5 µl, i.c.v.) was administered before Morris water maze testing. Spatial learning was assessed over four consecutive training days, followed by a probe trial on day five. RESULTS:VPA significantly attenuated seizure severity (P < 0.001). PTZ-kindled rats treated with VPA showed improved spatial learning and memory compared with the PTZ group, as evidenced by reduced escape latency (P < 0.001) and increased time in the target quadrant (P < 0.01). ANCOVA with cumulative seizure score as a covariate confirmed that VPA improved memory even after controlling for seizure burden (P = 0.042), suggesting a direct cognitive effect beyond seizure suppression. Co-administration of NAD-299 abolished these improvements, with performance comparable to the PTZ group (P > 0.05). CONCLUSION:Prophylactic VPA administration is associated with improved spatial memory in PTZ-kindled rats, an effect critically dependent on intact 5-HT1A receptor signaling. These findings highlight a potential dual benefit of VPA-seizure control and cognitive protection-though post-kindling studies are warranted to establish direct causality.
PURPOSE:The Czech version of the Eysenck Personality Questionnaire-Revised Short Scale (EPQ-R/S) has not been formally validated. This study examined its psychometric properties across two clinical cohorts and non-clinical subjects. METHODS:The total sample consisted of 2 560 participants: non-clinical adults (n = 382), patients with neurological and other disorders (PWND; n = 576), and patients with epilepsy (PWE; n = 1 602), aged 18-86 years. Internal consistency, item-level performance, and factorial validity were examined. Confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM) with target rotation were performed. RESULTS:Extraversion (E) and Neuroticism (N) showed acceptable to good reliability across cohorts (α = 0.79-.85; ω = 0.89-.93). The Lie (L) scale showed lower but mostly acceptable reliability, whereas Psychoticism (P) showed weak item coherence and poor internal consistency, particularly in non-clinical adults and people with epilepsy. The theoretical four-factor CFA model showed poor fit, χ2(1074) = 15005.28, CFI = 0.643, TLI = 0.625, RMSEA = 0.076. A target-rotated ESEM solution was more interpretable but showed mixed fit, χ2(942) = 5198.66, TLI = 0.838, RMSEA = 0.042, RMSR = 0.030. A reduced two-factor CFA model for E and N showed a more coherent structure, χ2(251) = 3296.72, CFI = 0.900, TLI = 0.890, RMSEA = 0.072. Measurement invariance analyses across cohorts and gender supported threshold and loading invariance of this model based on changes in approximate fit indices. Women scored higher on N in both clinical subsamples, whereas no significant gender difference was found in the non-clinical sample. Among people with epilepsy, higher seizure frequency was associated with higher N, longer epilepsy duration with lower E, and monotherapy with lower N compared with polytherapy. N correlated strongly and positively with depressive symptoms and negatively with quality of life, supporting concurrent validity. CONCLUSIONS:The Czech EPQ-R/S E and N scales showed adequate psychometric properties and appear suitable for research and clinical use in neurological and epilepsy populations.
BACKGROUND:This study evaluates the efficacy and safety of Vagus Nerve Stimulation (VNS) in the treatment of refractory Lennox-Gastaut Syndrome (LGS) in pediatric patients. METHODS:A systematic literature review was conducted based on observational studies and case series analyses, followed by assessment of risk of bias using the ROBINS-I tool. RESULTS:The results demonstrated that, among the combined sample of 527 patients included in the selected studies, 375 achieved a reduction greater than 50% in seizure frequency after VNS therapy, with some cases reporting complete seizure remission. The analysis suggests greater effectiveness for atonic seizures (drop attacks), followed by tonic and absence seizures. Regarding secondary outcomes, significant qualitative improvements were reported in alertness, attention, and sleep quality. Although the intervention appears to be relatively safe, the included studies presented a high risk of bias in the outcome measurement domain, mainly due to the impracticality of blinding in surgical procedures and the subjective nature of caregiver-reported outcomes. The heterogeneity of clinical responses appears to be associated with differences in stimulation parameters and variability in baseline clinical conditions. CONCLUSION:VNS yields results that suggest potential utility in the management of LGS. While the ideal scenario would require randomized clinical trials with representative and exclusive samples for the syndrome, as well as standardized stimulation protocols, it is understood that methodological limitations exist when dealing with a rare syndrome. Therefore, the importance of this systematic review is highlighted in order to encourage individualized and assertive clinical decisions in the management of these patients.
OBJECTIVE:This study aimed to investigate the measurement properties of the Multifactorial Memory Questionnaire (MMQ) for community-dwelling adults with epilepsy. METHODS:In phase one, 24 adults with epilepsy participated in semi-structured interviews to appraise the content validity of the MMQ. In phase two, adults with epilepsy (n = 290) completed a cross-sectional survey that evaluated structural validity (confirmatory factor analysis), internal consistency (Cronbach's Alpha and McDonald's Omega), and construct validity (hypothesis testing). A subset of these participants (n = 121) completed a second survey 4 weeks later to assess test-retest reliability (intraclass correlation coefficient) and measurement error (smallest detectable change and Bland-Altman Limits of Agreement). A priori criteria were set based on established criteria for good measurement properties. RESULTS:Adults with epilepsy deemed the MMQ to be relevant, comprehensive and comprehensible except for concerns about the appropriateness of the two-week recall period. Structural validity was partially supported: while the four-factor model fit best, only the SRMR met the a priori criterion. Internal consistency and test-retest reliability were sufficient, consistently exceeding the recommended threshold of ≥ 0.70. Measurement error parameters are reported to guide clinicians and researchers in interpreting changes in MMQ scores with repeated assessments. Construct validity was sufficient, with 90% of a priori hypotheses supported. CONCLUSIONS:As a comprehensive measure for evaluating subjective memory concerns in adults with epilepsy, the MMQ has demonstrated promising psychometric properties. However, future studies should clarify the dimensionality of the MMQ in this population and address measurement error, which could limit its utility in monitoring individual patients.
OBJECTIVE:Management of women with epilepsy (WWE) requires specialized guidance across different life stages. To inform priorities for future guideline development, we examined the methodological quality and the women-specific content of existing clinical practice guidelines (CPGs) for WWE. METHODS:We searched OVID Medline, Embase, the Guideline International Network, and KoreaMed for epilepsy CPGs developed de novo, including women's issues, published in English or Korean, between January 2014 and December 2024. Two independent reviewers and an AI-based language model independently assessed the quality of each CPG using the Appraisal of Guidelines for Research and Evaluation II instrument. The coverage of thirteen predefined women-specific topics was assessed for each CPG. RESULTS:Eleven CPGs met the inclusion criteria, all from the United States or Europe. The median overall quality score was 74.9% (IQR, 65.0-85.2%). Editorial independence scored the highest (median 92.5%), followed by clarity of presentation (86.3%), scope and purpose (85.7%), rigor of development (82.8%), stakeholder involvement (61.9%), and applicability (57.3%). Content analysis showed that pregnancy-related topics were well covered, with specific recommendations, whereas adolescence (n = 3), catamenial epilepsy (n = 1), menopause (n = 2), and bone health (n = 3) received limited attention and often lacked actionable guidance. Recommendations also varied across CPGs, most notably for therapeutic drug monitoring during pregnancy and folic acid dosing. SIGNIFICANCE:Current WWE CPGs generally show high methodological quality but have relative weaknesses in applicability and stakeholder involvement. Significant gaps exist in guidance for non-pregnancy life stages. Future guidelines should adopt a comprehensive lifespan approach, improve applicability, and broaden stakeholder engagement to better meet the diverse needs of WWE.
BACKGROUND:Although seizure self-efficacy is recognized as an important factor in epilepsy management, its relationship with psychological outcomes such as depression and anxiety in pediatric populations remains underexplored. This study aimed to evaluate seizure self-efficacy in children and adolescents with epilepsy and to examine its associations with depression, anxiety, and relevant clinical and psychosocial factors. METHODS:This cross-sectional observational study included 121 patients aged 9-17 years with epilepsy. Seizure self-efficacy was assessed using the Seizure Self-Efficacy Scale for Children (SSES-C), while depressive symptoms and anxiety levels were measured using the Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children (STAIC). Associations were analyzed using correlation and group comparison tests, and multivariable logistic regression was performed to identify independent predictors of depression. RESULTS:The median age was 14 years (IQR: 12-15), and 53.7% were male. The median self-efficacy score was 3.80 (IQR: 3.20-4.40). Seizure self-efficacy was significantly and inversely correlated with depression (r = - 0.546), state anxiety (r = - 0.437), and trait anxiety (r = - 0.348) (all p < 0.001). Depression showed strong positive correlations with both anxiety measures. Patients with lower self-efficacy had higher depression and anxiety scores, with a clear gradient across levels. In multivariable analysis, lower self-efficacy remained independently associated with depression (OR: 0.35, p = 0.001). Lower income and lack of family support were also independent risk factors. CONCLUSION:Seizure self-efficacy is closely associated with psychological outcomes in pediatric epilepsy and may represent a modifiable risk factor for depression. These findings support routine assessment and targeted interventions, although they should be interpreted in light of the study's single-center, cross-sectional design and reliance on self-reported measures, which may limit generalizability and preclude causal inferences.
Background Tuberous Sclerosis Complex (TSC) is a rare autosomal, genetic condition associated with epilepsy, neurodevelopmental challenges and multisystem involvement. While clinical manifestations of TSC are well documented, there is limited evidence on the lived experiences of people living with TSC (PLW) and their families. This study reports on these experiences in the Republic of Ireland (ROI). Objective To explore the lived experiences of people living with TSC (PLW TSC) and their families in the ROI. Methods A qualitative, phenomenological study was conducted involving thirty-four semi-structured interviews with PLW TSC and their families. Data were analysed using reflexive thematic analysis, following established methodological practices. Results The complexity and variability of TSC were reflected in the heterogeneity of participant experiences. Managing the progressive, multiorgan nature of TSC was arduous, while resilience in the face of TSC was evidenced. Difficult to control epilepsy and/or Tuberous Sclerosis Neuropsychiatric Disorders (TAND) were experienced as particularly problematic. Entire families experienced emotional strain. Fragmented TSC care, perceived inadequate health, social and educational services and poor disease awareness in the healthcare professional community, saw people feeling stressed and isolated. Conclusion PLW TSC and their families, face multidimensional challenges in coping with TSC in their daily lives, and in their interactions with the healthcare system. There is an urgent need to provide holistic coordinated health and social care and increase disease awareness among the clinical community.
Introduction The transition of epilepsy care from childhood to adulthood is a complex process that directly impacts treatment adherence, quality of life, and clinical outcomes. In Colombia, the implementation of structured transition programs is limited, representing a critical gap in care. Objective To assess the knowledge, attitudes, and perceptions regarding the transition in epilepsy care among residents and professionals in neurology and neuropediatrics in Colombia. Methods A mixed-methods study with a convergent design was conducted. The quantitative component included 60 participants (29 adult neurologists and 31 neuropediatricians) who completed a structured questionnaire. The qualitative component was conducted through focus groups (n = 8) using a phenomenological approach. Bivariate statistical analyses and odds ratio calculations were performed. Qualitative analysis was conducted using thematic coding. Results were integrated through methodological triangulation using joint matrices. Results No significant differences were found in most variables related to knowledge and practices. However, pediatric neurologists reported higher levels of training in transition care (52% vs. 21%; p = 0.013) and placed greater emphasis on psychosocial aspects and patient autonomy. The availability of formal protocols was low in both groups. Qualitative analysis revealed structural barriers such as system fragmentation, lack of coordination, and the absence of defined processes. Triangulation showed a predominance of convergent findings in emotional dimensions and patient-centered care, and divergences in organizational aspects of the health system. Conclusions There is a shared understanding of the transition process, but structural and training gaps persist that limit its implementation. It is necessary to develop structured programs, strengthen professional training, and improve coordination between levels of care. These findings should be interpreted considering the study’s limitations, including the small sample size, convenience sampling, and the limited qualitative sample.
OBJECTIVE:To develop questionnaires assessing physical activity (PA) across life domains, exercise and perceived fitness that are suitable for patients with difficult-to-treat epilepsy and/or functional/dissociative seizures (FDS), explore their psychometric properties, and examine the extent of PA, exercise and perceived fitness. METHODS:We developed a questionnaire on seizures and physical activity (QESA) based on the International Physical Activity Questionnaire, and two short instruments for exercise and perceived fitness. We analyzed data from the baseline assessment of a prospective study on an exercise and PA program for patients with epilepsy (PWE) and/or FDS. Retest reliability and construct validity were examined, while the extent of PA and perceived fitness were analyzed mainly descriptively. RESULTS:We included 240 inpatients (146 with epilepsy without FDS, 94 with FDS ± epilepsy) who were mostly not seizure-free (86.6%) and often had psychiatric comorbidities (65.4%). Retest reliabilities for the QESA total score, exercise and perceived fitness were fair to good (intraclass correlation coefficient: 0.54-0.75) and correlation analyses provided preliminary evidence supporting construct validity. PA was low, especially at work (60.0% without PA) and during leisure-time (41.3% without PA). PWE reported less exercise than those with FDS (no exercise: 57.2% vs. 42.6%, p = 0.038). CONCLUSION:The QESA may provide a practical approach to assess PA across life domains in patients with difficult-to-treat epilepsy and/or FDS and the perceived fitness scale is a useful supplement. The level of PA in patients with difficult-to-treat epilepsy and/or FDS is low. This highlights the need for interventions to increase PA in these patient groups.
People experiencing homelessness, or “unhoused people”, are eight times more likely to have a diagnosis of epilepsy compared to the general population. However, little is known about how epilepsy is experienced and understood within the context of homelessness. This study used Interpretative Phenomenological Analysis to explore the lived experience of epilepsy among six unhoused men in Ireland. Four group experiential themes were developed: Diagnosis as an Explanation with No Way Out, Dual Loss of Autonomy, Public Seizures and Social Devaluation, and Living Within Constrained Survival Pathways. Findings illustrate a dynamically reinforcing relationship between epilepsy and homelessness. Seizures undermined bodily reliability, while environmental instability associated with homelessness intensified unpredictability in managing safety and medical needs. This dual vulnerability meant participants navigated simultaneous bodily and environmental threats. The absence of private space made seizures public incidents, creating a double bind in which individuals depended on visibility and bystanders for assistance, yet were exposed to stigma and misrecognition. Services were often experienced as fragmented and cyclical, disrupting recovery and requiring individuals to prioritise survival over health through harmful trade-offs. Repeated exposure to these conditions contributed to a gradual erosion of agency and ongoing reconstruction of identity. These findings suggest that the burden of epilepsy in homelessness is compounding, with each condition significantly exacerbating the impact of the other. Epilepsy care for unhoused people should therefore incorporate trauma-informed approaches that address psychosocial needs and peer support, reduce stigma, improve staff awareness, and support integrated inclusion health pathways.
Determining candidacy for epilepsy surgery in children with intractable seizures where the MRI is negative is a common challenge facing epilepsy specialists. In recent years there has been an increasing array of investigative approaches that helps to formulate the hypothesis for the epileptogenic zone, with excellent seizure outcomes in some epilepsy surgery series. This narrative review will examine the approach to MRI negative epilepsy surgery in children, with a focus on the need for early recognition of potential surgical candidates, and the preoperative work-up including clinical features and contemporary investigations that help in the decision-making process for surgery. Seizure outcomes in common clinical and pathological subsets are discussed.
Epilepsy remains a major global health challenge, disproportionately affecting low- and middle-income countries (LMICs) where structural inequities and treatment gaps are persistent and impair the patient's outcomes. While integrative care models have increasingly explored complementary and alternative medicine, physical activity (PA) remains a neglected determinant of health in LMICs. This Brief Communication argues that PA can be a core, modifiable component of integrative care that mitigates the biopsychosocial burden of epilepsy. People with epilepsy (PWE) in LMICs face unique barriers to active living, including economic vulnerability, urban insecurity, low health literacy, and inconsistent professional counseling. These factors often lead to chronic physical inactivity and sedentary behavior, which may exacerbate comorbidities, impair mood, and deepen health inequities. Evidence suggests that PA is generally safe and associated with improved quality of life, physical fitness, and potentially better seizure-related outcomes. In resource-constrained environments, movement-based interventions offer a low-cost, scalable, and culturally adaptable strategy to enhance patient autonomy and social participation. We propose that a truly equitable model of epilepsy care must move beyond seizure control alone by incorporating safe, feasible, and context-sensitive opportunities for PA. Addressing the "physical inactivity gap" in LMICs is essential for exposing and mitigating the broader social determinants that prevent PWE from living well with their condition.
OBJECTIVE:Drug-resistant epilepsy (DRE) is associated with increased injury risk, cognitive decline, psychiatric illness, and premature death. Epilepsy surgery can be curative among well-selected individuals but remains underutilized. This study sought to identify people living with DRE in electronic health record (EHR) data and determine factors associated with initiation of presurgical evaluation. METHODS:Using a computable phenotypic algorithm, we identified people with probable DRE and an encounter in our medical system's EHR between 4/1/2020 and 6/1/2022. We randomly sampled 200 people for manual chart abstraction by two independent reviewers. People with confirmed DRE were classified according to stage in the presurgical evaluation care pathway. Demographic and clinical variables were tested for association with initiation of presurgical evaluation. RESULTS:The algorithm identified 3,027 people with probable DRE. Among 200 randomly sampled people, 87.5% (n = 175) had epilepsy, 42% (n = 84) had DRE, and 11.5% (n = 23) had epilepsy with undefined drug responsiveness. Among those with DRE, 57.1% (n = 48) had not initiated presurgical evaluation. Presurgical evaluation was associated with co-morbid mood disorder (OR = 3.88, 95% CI = 1.5-10.3, p = 0.007), shorter median time since last epilepsy-related visit (2.40 months, IQR: 0.72-6.60 vs 6.96 months, IQR: 3.00-21.84, p = 0.003) and 2nd to last epilepsy visit (8.76 months, IQR: 4.78-15.36 vs 13.08 months and IQR: 7.32-28.32, p = 0.008), and tracking by a surgical coordinator (OR = 46.00, 95% CI = 9.5-222.5, p < 0.001). Unknown MRI classification (OR = 0.04, 95% CI = 0.0-0.4, p = 0.001) and generalized seizures (OR = 0.04, 95% CI = 0.0-0.29, p < 0.001) were associated with lower odds of evaluation. CONCLUSIONS:An EHR algorithm can identify people with DRE and undefined drug responsiveness with potentially modifiable gaps in care.
BACKGROUND:China has approximately 10 million people with epilepsy, with western and rural regions facing substantial treatment gaps. The China Association Against Epilepsy launched the Western China Epilepsy Initiative (WCEI) in 2013 to improve epilepsy care in underserved hospitals. OBJECTIVE:To evaluate the impact of the WCEI on epilepsy care capacity at assisted hospitals and professional development of participating experts. METHODS:A nationwide cross-sectional survey was conducted targeting 115 hospitals that received WCEI assistance (2013-2025) and 96 expert team members. The hospital survey collected data on epilepsy center establishment, workforce certification, equipment, patient volumes, surgical capacity, and the use of unauthorized therapies. An interrupted time series analysis using linear mixed-effects models assessed pre- versus post-intervention trends on four key indicators. RESULTS:Among the 115 assisted hospitals, 49 (42.6%) were in western China. A total of 54 hospitals (47.0%) had established formal epilepsy centers, of which 43 (79.6%) were established after WCEI participation. Significant post-intervention acceleration was observed in EEG technician certifications (β2 = 10.2%/year, p = 0.007), epileptologist certifications (β2 = 14.9%/year, p < 0.001), and epilepsy patient visits (β2 = 4.7%/year, p = 0.001). Among 101 hospitals (87.8%) reporting a decline in the use of unauthorized therapies, the median decline was 15% (IQR 8-25%). Over 90% of expert respondents reported gains in clinical competence and professional fulfillment. CONCLUSIONS:The WCEI may have contributed to improvements in epilepsy care capacity in underserved Chinese hospitals, demonstrating a replicable model that can serve as a feasible strategy for narrowing the epilepsy treatment gap.
INTRODUCTION:Self-stigma is increasingly recognised as an important psychosocial burden among people with epilepsy (PWE), particularly among those experiencing depressive and anxiety symptoms. This study examined the association between self-stigma, psychological symptoms, self-esteem, work motivation, and quality of life in PWE. METHODS:In this cross-sectional study, adults with epilepsy were assessed using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Generalised Anxiety Disorder-7 (GAD-7), Epilepsy Self-Stigma Scale (ESSS), Rosenberg Self-Esteem Scale (RSES), Work Extrinsic and Intrinsic Motivation Scale (WEIMS), and Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Participants screening positive for depression and/or severe anxiety symptoms were offered psychiatric referral. Group comparisons and Pearson correlation analyses were performed. RESULTS:Of 207 patients, 34 (16.4%) screened positive for depression and/or severe anxiety symptoms. Compared with those screened negative, they had poorer seizure control (76.5% vs. 56.1%,p = 0.027), higher self-stigma (22.24 ± 4.09 vs. 18.49 ± 4.08,p < 0.001), lower self-esteem (p = 0.036), reduced work self-determination (WSDI 1.07 ± 6.62 vs. 5.21 ± 6.33, p < 0.001), and poorer quality of life (p < 0.05). Higher self-stigma was significantly correlated with greater depression and anxiety scores (NDDI-E: r = 0.401; GAD-7: r = 0.462, both p < 0.01), as well as lower self-esteem (r = - 0.140, p < 0.05), reduced work self-determination (r = - 0.209, p < 0.01), and poorer quality of life (r = - 0.436, p < 0.01). CONCLUSION:People with epilepsy who screened positive for depressive and/or severe anxiety symptoms had higher self-stigma, lower self-esteem, lower work self-determination, and poorer quality of life.
OBJECTIVE:Digital health literacy, defined as the ability to seek, understand, evaluate, and apply health information obtained from digital resources, has emerged as an important determinant of chronic disease management. However, the behavioral mechanisms linking digital health literacy to quality of life in epilepsy remain unclear. This study aimed to examine whether self-management mediates the relationship between digital health literacy and quality of life in adults with epilepsy. METHODS:In this cross-sectional study, 143 adults with epilepsy completed the eHealth Literacy Scale (eHEALS), the Epilepsy Self-Management Scale (ESMS), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Pearson correlations were conducted to examine bivariate associations. Multiple linear regression analyses were performed controlling for age, educational attainment, number of ASMs, and seizure frequency. Mediation analysis was conducted using 5,000 nonparametric bootstrap resamples and was adjusted for age, seizure frequency, number of antiseizure medications, and educational attainment. RESULTS:Seizure frequency was negatively correlated with quality of life (r = - 0.322, p < 0.001). Self-management showed the strongest positive correlation with quality of life (r = 0.547, p < 0.001). In regression analysis, seizure frequency (B = - 4.366, p = 0.008) and self-management (B = 0.416, p < 0.001) were significant independent predictors, and the model explained 37.9% of the variance in QOLIE-31 scores (R2 = 0.379). Digital health literacy was not a significant independent predictor after adjustment (p = 0.208). The covariate-adjusted indirect effect of digital health literacy on quality of life through self-management was statistically significant (B = 0.575, 95% bootstrap CI [0.331, 0.874]), whereas the direct effect was not significant. CONCLUSIONS:Digital health literacy was associated with quality of life in epilepsy, with self-management accounting for a significant indirect association. These findings highlight the potential value of combining digital health literacy initiatives with structured self-management support.
RATIONALE:Hormones such as estrogen and progesterone influence seizure thresholds resulting in catamenial epilepsy in a subset of women with epilepsy. While prior studies assessing the correlation between menarche and seizure onset have found mixed results, little is known about the effects of puberty on seizure burden in patients with developmental and epileptic encephalopathies, such as Lennox-Gastaut syndrome (LGS). Determining whether seizure burden in LGS is affected by pubertal changes such as menarche will inform prognosis and anticipatory guidance for caregivers of patients. METHODS:A single-center retrospective chart review of female patients with LGS who had a documented age of menarche and who had been evaluated at a single tertiary care children's hospital between 2013-2023 was performed. Menarche was used as a proxy for puberty. Seizure type, frequency, number of anti-seizure medications, and change in anti-seizure medications were recorded yearly between the ages of 5-21 years. Statistical analysis with cumulative logit mixed models was used to estimate the odds of a patient having higher seizure frequency by seizure type. A linear mixed model was used to assess change in antiseizure medications. RESULTS:A total of 22 patients met inclusion criteria. Menarche was not independently statistically significantly associated with increased overall seizure when controlling for age (OR 0.58, p = 0.195). However, age was independently positively associated with seizure frequency (OR 1.16 per year, p = 0.002). When controlling for age, most individual seizure types (non-motor, atonic, tonic, myoclonic, clonic, status epilepticus) did not significantly increase with menarche. Total number of antiseizure medications (ASMs) used significantly increased after menarche by an estimated 0.43 ASMs (p = 0.026), when controlling for age. CONCLUSIONS:After controlling for age, menarche in patients with LGS did not correlate with increased seizure frequency in total or if stratified by specific seizure types. However, overall seizure frequency and anti-seizure medication usage increased with age, suggesting a gradual worsening of epilepsy over adolescence. These data provide important information regarding the clinical course of LGS which may aid in both medical management and in anticipatory guidance for families as their children enter adolescence. Further study is needed for deeper understanding of long-term outcomes of LGS, and how age and puberty may affect seizures in males with LGS.
OBJECTIVE:To evaluate the impact of stereotactic laser amygdalohippocampectomy (SLAH) on verbal and visual memory functions in patients with intractable temporal lobe epilepsy (TLE) given that currently memory outcomes following SLAH are unclear with only scant conflicting findings. METHODS:A retrospective review of demographic, imaging, and memory data in patients with medically intractable epilepsy (N = 30 patients; 16 Right Temporal Lobe Epilepsy [RTLE; 14 Left Temporal Lobe Epilepsy [LTLE]). Means, standard deviations, and reliable change analyses were computed for demographic variables and memory tests. Reliable change index (RCI) analyses were used to evaluate memory change. RESULTS:Following left temporal surgery (LTS), 41.7% demonstrated stable verbal memory, while 58.3% showed declines in verbal memory. Inspection of visual memory performances revealed 77.8% also declined, while 11.1% remained stable and 11.1% improved. Post right temporal surgery (RTS) 33.3% demonstrated improved visual memory, 44.4% displayed stability, and 22.2% declined. Additionally, for RTS 77.8% displayed verbal memory performance stability, while 22.2% declined. CONCLUSIONS:Current data indicates mixed outcomes. 58.3% of patients displayed verbal memory declines following LTE ablation and none displayed improvements. However, 33.3% of RTL ablation patients displayed visual memory improvements. This study offers further evidence of potential adverse outcomes and need for review of surgical approach and/or patient selection.
OBJECTIVE:Novel proof-of-concept designs utilizing biomarkers associated with an established clinically meaningful outcome are needed for antiseizure medication (ASM) efficacy assessment in patients with epilepsy, including drug-resistant focal epilepsy. Changes in long episode (LE) frequency, recorded by the responsive neurostimulator (RNS® System), are associated with changes in clinical seizure (CS) frequency following ASM initiation, suggesting that LEs may serve as a valid biomarker. Here, we aimed to establish the LE reduction magnitude associated with a clinically meaningful CS reduction. METHODS:Post hoc retrospective analyses of CS and LE frequencies, responder rate, and receiver operating characteristics from a long-term RNS open-label treatment study in patients who met predefined criteria were performed to evaluate the association between changes in LE and CS frequency and the LE reduction cutpoint associated with a ≥ 50% CS reduction. RESULTS:Patients (N=45) initiated clobazam (n=15), levetiracetam (n=4), or lacosamide (n=26). Patients achieved a median 30% LE and 50% CS reduction. Patients with <50% and ≥50% CS reductions had a median 5.9% LE increase and 52.4% LE reduction, respectively. A positive association between LE and CS frequency reduction across the entire range of responses (0-100%) was observed. A ≥30% LE reduction was associated with a ≥50% CS reduction; AUC=0.765, N=45. SIGNIFICANCE:If LE reductions may serve as a potential biomarker, a threshold associated with meaningful improvement in CSs is paramount. Results from this hypothesis-generating analysis support the use of a ≥ 30% LE reduction as a biomarker associated with clinically meaningful improvement in focal epilepsy.
