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.
