Background and Purpose: Extraoperative subdural grid electrode (SDE) implantation with cortical stimulation mapping (CSM) is a cornerstone of presurgical evaluation in medically intractable epilepsy, enabling localization of epileptogenic and eloquent cortex. Precise identification of the primary motor cortex (PMC) is essential to minimize postoperative motor deficits, particularly in pediatric patients. This study evaluated the clinical utility of extraoperative CSM for PMC localization and examined factors associated with stimulation amplitude thresholds in a large cohort.Methods: We retrospectively reviewed 297 patients with medically refractory epilepsy who underwent SDE implantation with extraoperative CSM. Motor mapping was performed using standardized stimulation parameters. Postoperative motor outcomes were assessed and correlated with preservation of mapped PMC. Associations between stimulation amplitude thresholds and demographic, clinical, radiological, pathological, and antiseizure medication (ASM)-related factors were analyzed.Results: The PMC was successfully identified in all patients. Although motor responses were most commonly localized to the precentral gyrus, atypical PMC localization was observed in 11.1% of patients. Preservation of mapped PMC was associated with a significantly lower rate of persistent postoperative motor deficits. Younger age demonstrated a significant inverse correlation with stimulation amplitude threshold (p=0.001), with children younger than 7 years requiring higher stimulation amplitudes. This association remained significant after controlling for ASM burden.Conclusions: Extraoperative CSM using SDEs is a reliable and clinically impactful method for PMC localization in medically intractable epilepsy. Functional motor areas may deviate from classical anatomical landmarks, underscoring the necessity of direct functional mapping.
Background and Purpose: Approximately 19% of the U.S population live in rural locales, which are disproportionally afflicted by health disparities. While people with epilepsy (PWE) living in rural areas may have difficulties receiving appropriate care, little is known about differences in PWE due to geography. This study evaluated whether clinical and demographic characteristics among PWE differed by geographic region to better characterize potential differences in care and outcomes faced by rural people with epilepsy (RPWE).Methods: This cross-sectional baseline data analysis from an epilepsy self-management clinical trial examined quality of life, functional status, self-management, self-efficacy, depression, and social support. The independent variable of interest was geography of residence (categorized using Rural-Urban Continuum Codes (RUCC): metro areas [RUCC 1-3], adjacent to metro areas [RUCC 4, 6, 8], and rural [RUCC 5, 7, 9]). Amongst covariates were other social determinants of health (SDOH): income and education. Multivariable linear regression models were conducted, including the three SDOH and other covariates.Results: Adjusting for likely confounders, geography was independently associated with three outcomes: the epilepsy self-efficacy scale (ESES) scores, quality of life in epilepsy (QOLIE-31) total scores, and QOLIE-31 cognition sub scores. RPWE had lower ESES scores (p=0.045), lower QOLIE-31 total scores (p=0.025), and lower QOLIE-31-cognition sub scores (p=0.043) compared to urban PWE. On average, RPWE had an 11-point lower QOLIE-31 total score.Conclusions: RPWE have lower self-efficacy, worse quality of life, and perceived cognitive functioning compared to urban PWE. These geographic disparities may reflect disparities in access to epilepsy care that are associated with worse outcomes among RPWE.
This study aimed to systematically review randomized controlled trials (RCTs) evaluating self-management interventions for adult patients with epilepsy, examine their characteristics and effects, and suggest suitable intervention strategies for clinical application. A comprehensive literature search was conducted in five databases: CINAHL, Cochrane Library, Embase, PubMed, and Web of Science. RCTs published between January 2019 and October 2024 were included. Eight eligible studies were selected and analyzed in terms of intervention content, duration, frequency, delivery method, and outcome measures, including quality of life, self-management ability, and self-efficacy. Among the eight included studies, statistically significant improvements were reported in quality of life in three studies (37.5%), self-management ability in three studies (37.5%), and self-efficacy in two studies (25.0%). Interventions conducted over 6 months with biweekly or weekly sessions tended to show more favorable outcomes. Face-to-face education and telephone-based support were commonly used and were associated with positive results. Digital interventions, such as mobile applications, showed limited effectiveness when used alone but tended to be more effective when interactive features were included. These findings suggest that a hybrid approach combining initial face-to-face education with ongoing telephone or digital support may be appropriate for adults with epilepsy. A 6-month intervention period with regular biweekly or weekly sessions may be optimal. For digital tools, interactive components should be integrated to sustain engagement and enhance outcomes.
Autoimmune encephalitis typically presents with an acute or subacute onset of cognitive decline, altered mental status, and seizures. Here, we report a case of anti-leucine-rich glioma-inactivated 1 encephalitis characterized by an atypically protracted period of cognitive decline, followed by the delayed onset of seizures. We describe the clinical characteristics, unique neuroimaging findings, and the patient’s response to treatment. By discussing the implications of this unusual clinical trajectory, we aim to enhance diagnostic awareness and prevent potential misdiagnosis in cases with atypically prolonged presentations.
Background and Purpose: Seizure triggers-such as stress, sleep deprivation, and missed medication-are commonly reported by patients with epilepsy. Understanding these perceived triggers is critical for patient counseling and preventive strategies. However, no validated self-report instrument exists to systematically assess them. To develop and conduct a preliminary psychometric evaluation of the epileptic seizure trigger questionnaire (EST-Q).Methods: We conducted a cross-sectional study with 100 adults with active epilepsy recruited from two public hospitals in Rio de Janeiro, Brazil. The initial 12-item questionnaire was refined into an 11-item instrument after removing one poorly performing item. Psychometric evaluation was conducted exclusively on the seven-item core module, after exclusion of four items with high non-response rates. Analyses included exploratory and confirmatory factor analyses, internal consistency assessment, and item response theory (IRT). Given the modest sample size, confirmatory factor analysis and IRT findings were interpreted as exploratory and preliminary.Results: The seven-item core suggested a predominantly unidimensional structure (Kaiser-Meyer-Olkin=0.578; variance explained=29.7%), with borderline internal consistency (α=0.699; ω=0.681), which is adequate for group-level research but insufficient for individual clinical decisions, and moderate to high item discrimination. The four excluded items remain clinically relevant but were unsuitable for psychometric evaluation due to limited applicability.Conclusions: The EST-Q shows promise as a standardized tool for assessing perceived seizure triggers. These preliminary findings support its potential utility, but validation in larger, multicenter cohorts is needed to confirm its factor structure, reliability, and generalizability before routine clinical use.
Background and Purpose: KCNT1, a gene which encodes sodium gated potassium channels, is associated with a spectrum of epilepsies and neurological disorders. This study has been done to overview the phenotype and genotype of KCNT1 related epilepsies in infancy.Method: This observational, cross-sectional study was conducted in the Department of Pediatric Neurology, Bangladesh Medical University. Detailed history taking and clinical examinations were done. Electroencephalogram and magnetic resonance imaging of the brain were done in each patient. The classification and description of seizures and epilepsy was done according to the international league against epilepsy guideline. Genetic test was done by targeted next-generation sequencing.Result: This study included six patients with developmental epileptic encephalopathy with KCNT1 gene mutation. The children had various types of seizures, mostly focal seizure, focal with bilateral tonic-clonic seizure, epileptic spasm and status epilepticus. Most patients had global developmental delay with normal birth history. In all patients, whole exome sequencing was done and KCNT1 mutation had been found.Conclusions: This study describes the genotype and phenotype of KCNT1 related epilepsy in infancy.
Background and Purpose: Insomnia is a common sleep disorder that is highly prevalent among patients with epilepsy. Despite the known benefits of melatonin for insomnia and its potential anticonvulsive effects, clinical evidence regarding its efficacy in epilepsy patients with comorbid insomnia remains limited. This pilot study aimed to evaluate the efficacy and safety of prolonged-release (PR) formulation of melatonin in epilepsy patients with insomnia.Methods: We prospectively enrolled 34 adult patients with epilepsy from March 2024 to February 2025. The insomnia severity index (ISI) and the Korean version of the Neurological Disorders of Depression Inventory for Epilepsy (K-NDDI-E) were assessed before and after 12 weeks of melatonin PR intake. Data were analyzed using the Wilcoxon signed-rank test. Changes in seizure status before and after treatment were analyzed using McNemar’s test.Results: A total of 25 patients (nine males, mean age 53.5±11.6 years) completed the study. Of these, 23 had focal-onset seizures and two had generalized-onset seizures. After 12 weeks of treatment, ISI scores significantly improved from 16.0±4.4 to 12.2±5.2 (p=0.001). Similarly, K-NDDI-E scores showed a significant reduction from 11.3±4.2 to 9.8±3.2 (p=0.041). Seizure status remained unchanged following treatment, with no statistically significant difference observed before and after melatonin PR administration (p=1.000). No patients discontinued the medication due to seizure aggravation.Conclusions: Our findings demonstrate that melatonin PR effectively improves both sleep quality and depression in epilepsy patients with insomnia. These results suggest that melatonin PR could be a potential therapeutic option for managing comorbid insomnia and depression in patients with epilepsy.
Psoas syndrome is a rare form of muscle irritation that causes pain and weakness in the lower extremities. A 52-year-old male presented to the emergency department with complaints of having had a seizure and weakness in the left lower extremity. A computerized tomography scan of the abdomen and pelvis revealed reversible thickening of the left psoas muscle, consistent with psoas syndrome. We report a case of psoas syndrome following a generalized seizure and discuss its clinical characteristics and differential diagnoses.
Magnetoencephalography (MEG) is a non-invasive neurophysiological technique offering high spatial resolution for localizing epileptogenic zones in epilepsy, especially when traditional electroencephalography or magnetic resonance imaging (MRI) is inconclusive. A systematic evaluation of MEG's diagnostic and prognostic utility within combination strategies is crucial, particularly in countries like South Korea with limited MEG access. We conducted a qualitative systematic review of nine studies (n=354 focal epilepsy patients) to evaluate MEG's clinical performance in presurgical workup. Databases (MEDLINE, EMBASE, Cochrane, KoreaMed, KMbase, RISS) were searched. Data extraction focused on localization accuracy and surgical outcomes (Engel class I); risk of bias was assessed using quality assessment of diagnostic accuracy studies-2. MEG alone achieved up to the mid-70% range; however, integration with other modalities (e.g., with positron emission tomography/high-density electroencephalography) significantly improved both localization and surgical outcomes. Pediatric focal cortical dysplasia patients showed Engel class I outcomes of 67-87%. Most studies had low-to-moderate bias. Only one MEG system is operational in South Korea (introduced 2023), limiting accessibility. Canadian economic evaluations, despite higher initial costs, suggest MEG is long-term cost-effective, improving quality-adjusted life years. MEG offers complementary diagnostic value in epilepsy evaluation and surgical planning, enhancing localization and outcome prediction, especially for pediatric and MRI-negative patients. Considering this clinical utility, national support for MEG equipment and its regional expansion in South Korea is crucial to ensure equitable access and optimal patient care.
Background and Purpose:S100B is a cytokine produced by astrocytes following glial and neuronal damage. This study aims to evaluate the impact of anti-epileptic drugs (AEDs) on serum S100B levels and health-related quality of life (HRQoL) indices. Methods:In this prospective observational study, serum S100B levels were compared between persons with epilepsy (PWE) and healthy controls. In the PWE group, serum S100B levels and HRQoL using patient weighted quality of life in epilepsy (QOLIE-10-P), pittsburgh sleep quality index (PSQI), and liverpool adverse event profile (LAEP) scores were assessed at baseline and after 12 weeks of AEDs treatment. Results:The mean baseline serum S100B level in the PWE group was 0.093±0.031 μg/L, significantly higher than in the control group, 0.050±0.020 μg/L. In PWE, after 12 weeks of treatment, this level decreased by 17.20% (p<0.001). QOLIE-10-P scores showed improvement (32.1%; p<0.001) across both conventional and newer AED types. PSQI scores improved by 6.9% with conventional AEDs (p=0.19) and 35.7% with newer AEDs (p<0.001). LAEP scores increased by 5.06% with conventional AEDs (p=0.06) and decreased by 5.63% with newer AEDs (p=0.10). Seizures were significantly reduced in both groups (overall 86.09%). Treatment costs were higher for newer AEDs ($39.10) than for conventional AEDs ($16.73). Conclusions:Over 12 weeks of AED therapy, PWE demonstrated significant reductions in both serum S100B levels and seizure frequency. While conventional and newer AEDs yielded comparable improvements in HRQoL, newer AEDs conferred an advantage in sleep quality.
Background and Purpose:In recent years, brain-derived neurotrophic factor (BDNF) and matrix metalloproteinase-9 (MMP-9) have garnered interest for their involvement in epilepsy. This study evaluated the serum levels of BDNF and MMP-9 in pediatric patients with epilepsy compared to healthy controls and assessed the effect of valproate on serum BDNF and MMP-9. Methods:Children aged 1 year to 12 years, diagnosed with epilepsy (n=30), and age-matched healthy controls (n=30) were included. All participants were followed up for 16 weeks and assessed for changes in serum BDNF and MMP-9 levels. Results:Children with epilepsy had significantly lower BDNF and higher MMP-9 levels compared to healthy controls at baseline. Following 16 weeks of treatment with valproate, BDNF levels were increased significantly (p<0.001), and MMP-9 levels decreased significantly (p<0.001). Conclusions:The findings suggest the involvement of BDNF and MMP-9 in the pathogenesis of epilepsy. Serum BDNF and MMP-9 levels were increased and decreased, respectively, following valproate treatment in children with epilepsy. Hence, BDNF and MMP-9 could be potential biomarkers in pediatric epilepsy. Large sample sizes and long-term studies are warranted to confirm the findings.
Drug-resistant epilepsy (DRE) remains a formidable clinical challenge, affecting nearly 30-40% of patients despite optimized pharmacotherapy. In patients for whom resective surgery is contraindicated or poses unacceptable risks, neuromodulatory therapies-most notably deep brain stimulation (DBS)-have emerged as viable and reversible treatment options. This narrative review critically examines the current applications of DBS for DRE, with a focus on major targets including the anterior thalamic nucleus, centromedian nucleus, hippocampus, and emerging targets such as the pulvinar. We provide an in-depth discussion of the therapeutic mechanisms underlying DBS-from local cellular inhibition and desynchronization to widespread network modulation and neuroplasticity induction-and review the latest advances in sensing technologies, patient-specific connectivity mapping, and closed loop stimulation paradigms. In addition to integrating data from randomized controlled trials, long-term observational studies, and advanced imaging investigations, we discuss limitations, persistent challenges, and future research directions that will guide clinical decision-making and optimize therapeutic outcomes.
Diagnosing and managing epilepsy is difficult for doctors. Surgery can help some patients, but it often takes a long time to get there. This research looks at scientific studies to see if artificial intelligence and machine learning (ML) can be used to improve epilepsy treatment. In-depth research was conducted across PubMed, Google Scholar, Scopus, Wiley, Web of Science, and Microsoft Academia. This search focused on studies exploring the use of ML for diagnosing epilepsy, predicting treatment response, and predicting outcomes of epilepsy surgery. The search was limited to original English-language articles published between 2015 and 2022. This review examined 36 studies on using ML to predict epilepsy. The studies fell into four categories: general diagnosis (27), treatment outcome (3), identifying surgical candidates (2), and predicting surgical results (4). Researchers employed a diverse set of data, including symptoms and brain scans, alongside machine learning algorithms like support vector machines and convolutional neural networks, to construct their models. Some models achieved impressive results with areas under the curve reaching up to 0.99, but most studies were limited by small sample sizes and a lack of independent validation. ML shows potential for epilepsy treatment based on initial studies, but real-world use is restricted due to small sample sizes and the need for more validation from other studies. Large collaborative research efforts and data on long-term outcomes are essential before ML can be widely adopted by doctors and make a positive difference for epilepsy patients.
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is characterised by the antibodies decreasing the NMDAR surface density and synaptic localization by selective antibody-mediated capping and internalization of surface NMDAR. Ketamine is a NMDAR antagonist which can produce dose-dependent, self-limiting side effects such as hypersalivation, hyperreflexia, transient clonus, dizziness, nausea, vomiting, tachycardia, hypertension, and detrusor muscle overactivity. A 22-year-old girl presented with recent onset behavioral change, progressive movement disorder and later lapsed into super refractory status epilepticus (SRSE). She was treated with at least four antiseizure medications, immunomodulation as well as anesthetic drugs with only partial relief in status. Ketamine was added for SRSE and led to a significant worsening of clinical symptoms with abatement after stopping. She finally responded to thiopentone infusion. Ketamine has been found to be beneficial in SRSE in encephalitis including anti-NMDAR encephalitis. This is seemingly counterintuitive given how the action of the drug mimics the pathophysiology of the disease. This report highlights the risk of paroxysmal sympathetic hyperactivity and aggravation of clinical and electrographic features of anti-NMDAR encephalitis with ketamine. Hence, ketamine and similar medications acting on the NMDAR should be used with caution in anti-NMDAR encephalitis.
Brivaracetam, a high-affinity synaptic vesicle 2A (SV2A) ligand and propyl analog of levetiracetam, has been approved as an adjunctive and monotherapy option for focal onset seizures in various age groups. This review synthesizes data from both clinical trials and real-world studies to evaluate brivaracetam's efficacy, safety, and tolerability profile. Notably, brivaracetam's rapid penetration across the blood-brain barrier, selective SV2A binding, and favorable pharmacokinetic properties contribute to its robust seizure control capabilities, setting it apart from other antiseizure medications. Studies have shown that brivaracetam consistently achieves significant seizure frequency reductions and high responder rates, demonstrating strong efficacy and an overall favorable safety profile. Importantly, brivaracetam also demonstrates effectiveness in special populations, including older individuals and patients with post-stroke epilepsy, maintaining good tolerability and favorable outcomes and achieving high rates of seizure freedom. Future research should further investigate brivaracetam's utility in broader patient groups to better understand its long-term safety and expand its therapeutic reach. With its unique pharmacological properties, clinical flexibility, and promising safety profile, brivaracetam stands as a valuable addition to current epilepsy treatment options, addressing several unmet needs in seizure management.
Recent research has disclosed significant associations between stigma suffered by people living with epilepsy (PWE) and psychiatric conditions, especially major depression. These results have practical implication when coupled with the precise regional-and-local prevalences of stigma in its heterogeneous manifestations among PWE. Here we review current research involving stigma in PWE to assess its prevalence and explore psychopathological associations. A systematic review was conducted in PubMed and Scopus to identify clinical trials objectively evaluating prevalence of any type of stigma, enacted and perceived, in PWE, published from database inception to 31 May 2024. A random effects meta-analysis was undertaken, with 6,072 participants, to obtain the meta-prevalence of stigma among PWE. Subgroup analysis moderated by major continent was delineated. A report was obtained from clinical documentation review and adjoined to the evidence generated. From the 105 records identified, 22 studies were eligible for inclusion. The meta-analysis revealed an overall stigma prevalence of 35% (29%; 41%), and subgroups, Africa or Asia (mostly); arbitrarily defined after analysis of geographical study distributions; indicated a prevalence of 40% (34%; 46%) and 28% (21%; 37%), respectively. Significant difference was identified (p=0.03). The case reported exemplifies how stigma may impair development, especially in children and adolescents. Stigmas among PWE are prevalent. More than one in three PWE has already experienced some form of stigma and there is potential to undermine quality of life and associate with psychiatric disorders. PWE may benefit from tailored screening and management approaches to decrease stigma burden.
Background and Purpose:Epilepsy is a common indication for medicinal cannabis (MC) prescription in Australia. Despite legal MC products being available for 8 years, some individuals continue to rely on illicit cannabis. Here, we conducted a survey of Australian persons/people with epilepsy (PWE) and caregivers of a PWE to assess whether the current legal framework supports PWE and/or their caregivers to access prescribed MC. Methods:The cross-sectional survey consisted of five sections examining sociodemographics, medical history, history of MC use, attitudes towards MC, and barriers to accessing MC. Results:Of the 126 respondents included in these analyses, 102 were PWE (mean age, 40.9±12.3 years) and 24 were caregivers of a PWE (mean age of PWE, 14.1±8.9 years). Among PWE, 27.5% (28/102) had only used illicit MC products, 27.5% (28/102) had transitioned to prescribed MC products, and 16.7% (17/102) used both. Most caregivers 70.8% (17/24) had only accessed prescribed MC products. Most respondents 77.0% (97/126) reported using MC as an adjunct to conventional anti-seizure medications. Caregivers were more likely to administer prescribed high-cannabidiol products to children using oral routes of administration (p<0.001). In contrast, PWE often used inhaled cannabis (p<0.001). Overall, 67.0% (83/124) of respondents reported that MC "improved" or "greatly improved" their epilepsy, irrespective of MC type. The main barrier to accessing prescribed MC was "cost" (69.0%, 87/126), while tetrahydrocannabinol (THC)-related driving restrictions were also a significant concern for PWE. Conclusions:The current regulatory framework in Australia supports MC access for PWE and their caregivers, primarily through cannabis clinics. However, cost remains a significant concern. The prevalent use of Δ9-THC-containing and inhaled MC products, either illicit or prescribed, highlights the urgent need to further investigate their safety and efficacy in epilepsy.
In this case report, we discuss the oldest patient, at 47-year-old, on record to receive anakinra in treatment for febrile infection-related epilepsy syndrome (FIRES). Additionally, our patient was treated with a shorter course compared to that seen in the current literature. FIRES is rarely seen in adults and remains an area of investigation for best treatment practices due to the refractory and often devastating clinical course. Anakinra is a recombinant interleukin-1 receptor antagonist that effectively targets central nervous system inflammation implicated in the pathogenesis of FIRES. The current literature regarding anakinra use in FIRES mostly represents the pediatric population with dose schedules continued into the chronic phase of the disease. There is a dearth of information regarding the response to anakinra in adult FIRES patients as well as the appropriate treatment duration. This patient presented in focal status epilepticus after 1 week of febrile illness. Focal status epilepticus remained refractory despite these of multiple anti-seizure medications, anesthetics, and steroids. An extensive workup yielded no clear underlying etiology to account for his presentation. Anakinra was started 9 days after seizure onset and continued for 2 weeks. After anakinra initiation, sedative medications were fully weaned within 8 days and all epileptiform activity on electroencephalogram resolved within 2 weeks. The patient eventually returned to his prior cognitive baseline and achieved approximately 1 year of seizure freedom. These outcomes support the use of anakinra in treating adults with FIRES. Further studies with a focus on determining the underlying mechanism that accounts for variability in patient response to anakinra are essential. Such studies may aid in the development of ideal dosing and therapy duration of anakinra in FIRES.
