Abstract Objective To evaluate the occurrence, clinical correlates, and screening accuracy of depressive symptoms (DS) among adults with epilepsy in Georgia, a country with limited mental health resources. Methods We conducted a cross‐sectional study in adults with epilepsy attending a tertiary care center. We assessed DS using two validated tools: the Beck Depression Inventory‐II (BDI‐II) and the Neurological Disorders Depression Inventory for Epilepsy (NDDI‐E), combined with comprehensive clinical and demographic data. Results Two hundred and seven adults were included, and DS were identified in 47% using the BDI‐II and 22% using the NDDI‐E, with moderate agreement between the scales (Cohen's κ = 0.469). DS were associated with later epilepsy onset (median 15.0 vs. 13.5 years), frontal lobe epilepsy (26.3% vs. 8.3%), polytherapy with older ASMs (60.7% vs. 42.3%), and ongoing seizures. Significance DS represent a substantial psychiatric burden in adults with epilepsy in Georgia, influenced by epilepsy‐related factors and limitations of screening tools. These findings underscore the need for integrated mental health services and routine DS screening in epilepsy care. Longitudinal studies are warranted to clarify causal relationships and inform culturally tailored interventions. Plain Language Summary Many people with epilepsy have low mood, but this is often missed and untreated. A recent study in Georgia found that nearly half of people with epilepsy have signs of very low mood. Those who were having regular seizures or taking more medication were more likely to struggle with low mood. In contrast, people who do not have seizures or whose seizures started on the brain's right side showed fewer low mood signs. These findings show that checking mood is just as important as treating their seizures. Routine mental health checks should be part of epilepsy consultations.

OBJECTIVE:To assess the economic burden, cost components, and individual-level determinants of outpatient epilepsy care in adults in Georgia. METHODS:This longitudinal study of epilepsy-related costs in adults with active epilepsy attending a tertiary epilepsy centre in Tbilisi collected clinical and sociodemographic data over 6 months. Direct and indirect costs were analyzed using descriptive statistics and multivariate regression. RESULTS:Median total epilepsy-related costs in 351 adults (median age 31 years; 44.4% male) for six months were USD 402.22 (IQR: 293.33-578.15), with a mean cost of USD 572.54 ± 789.29, indicating a highly skewed distribution. Direct medical costs, mainly antiseizure medications, accounted for 83.5% of the mean total. Costs were similar across urban and rural residents. In multivariable analysis, males incurred lower total costs than females (CR = 0.86; 95% CI: 0.74-0.99), employment in non-professional roles (CR = 1.47; 95% CI: 1.19-1.81), health insurance coverage (overall p = 0.010), epilepsy type (overall p = 0.014), monotherapy compared with polytherapy (CR = 0.75; 95% CI: 0.64-0.88), and greater seizure frequency (per additional seizure: CR = 1.08; 95% CI: 1.05-1.11). Age showed a weak inverse association with costs, whereas epilepsy duration and disability/social benefit status were not significant predictors. Most participants incurred costs below 40% of their six-month income, although a subset faced a disproportionately high financial burden. SIGNIFICANCE:Epilepsy in Georgia imposes a significant economic burden on adults, driven mainly by medication costs, specialized services, and poor seizure control. This highlights the need for affordable therapies, optimized management, strengthened health system support, and expanded social protection. Future research needs to assess the long-term economic impact of drug-resistant epilepsy. PLAIN LANGUAGE SUMMARY:People with epilepsy often need lifelong treatment, but little is known about the financial burden of epilepsy in Georgia. We studied the cost of epilepsy care for 351 adults over six months. Most spending was on antiseizure medications and medical tests. People who had more seizures or needed more than one antiseizure medication had higher treatment costs. For most people, the cost of epilepsy care was not extremely high, but some experienced much greater expenses than others. Our findings show where the biggest costs come from and may help improve epilepsy care and make treatment more affordable in Georgia.

OBJECTIVE:One of the most significant challenges faced by people with epilepsy is the stigma imposed by the broader community. We aim to assess the dynamics of stigma and the level of misconceptions towards individuals with epilepsy by comparing two studies conducted decades apart. METHODS:Awareness-raising campaigns and professional skill development activities were conducted. We utilised a Georgian-adapted structured questionnaire and the Stigma Scale of Epilepsy (SSE) questionnaire, which had previously been validated in Georgian. A cross-sectional study was conducted. We used multivariable logistic regression analysis to develop a predictive model for stigma perception. To compare the two studies, we used the Chi-squared test to examine differences in proportions between the two populations, including the 95% Confidence Interval (CI) for the difference in proportions. A p-value of less than 0.05 was considered statistically significant. RESULTS:Of the 1,146 participants, 502 (43.8%) were female, and 207 (18.1%) had a medical education. Higher levels of stigma were observed more frequently among individuals without a medical background. Participants who perceived epilepsy as a psychiatric disorder, a hereditary condition, or a congenital disability exhibited higher levels of stigma. Comparisons between the two studies reveal a significant decrease in the number of individuals who would oppose their child marrying or playing with someone who has epilepsy. CONCLUSIONS:Respondents with medical backgrounds were less likely to express stigma and misconceptions. A comparison of the two studies indicates a statistically significant improvement over the past decade, likely to be partly attributable to regular awareness-raising campaigns.

Background/Objectives: Precise identification of seizure onset zones (SOZs) and their propagation pathways is essential for effective epilepsy surgery and other interventional therapies and is typically achieved through invasive electrophysiological recordings such as intracranial electroencephalography (EEG). Previous research has demonstrated that analyzing information flow patterns, particularly in high-frequency oscillations (>80 Hz) using parametric and Wilson algorithm (WL)-based nonparametric Granger causality (GC), is valuable for SOZ identification. In this study, we analyzed scalp EEG recordings from epilepsy patients using an alternative nonparametric GC approach based on spectral density matrix factorization via the Janashia-Lagvilava algorithm (JLA). The aim of this study is to evaluate the effectiveness of JLA-based matrix factorization in nonparametric GC for noninvasively identifying seizure onset zones from ictal EEG recordings in patients with drug-resistant epilepsy. Methods: Two regions of interest (ROIs) in pairs were isolated across different time epochs in six patients referred for presurgical evaluation. To apply the nonparametric Granger causality (GC) estimation approach to the EEG recordings from these regions, the cross-power spectral density matrix was first computed using the multitaper method and subsequently factorized using the JLA. This factorization yielded the transfer function and noise covariance matrix required for GC estimation. GC values were then obtained at different prediction time steps (measured in milliseconds). These estimates were used to confirm the visually suspected seizure onset regions and their propagation pathways. Results: JLA-based spectral factorization applied within the Granger causality framework successfully identified SOZs and their propagation patterns from scalp EEG recordings, demonstrating alignment with positive surgical outcomes (Engel Class I) in all six cases. Conclusions: JLA-based spectral factorization in nonparametric Granger causality shows strong potential not only for accurate SOZ localization to support diagnosis and treatment, but also for broader applications in uncovering information flow patterns in neuroimaging and computational neuroscience.

In patients with drug-resistant epilepsy, surgical resection of the seizure focus may represent the best treatment option. In Georgia, a structured epilepsy surgery program was lacking until 2017, when a German-Georgian project was initiated to establish necessary facilities, define diagnostic and treatment standards, and educate local healthcare providers. After a scientific symposium in Tbilisi in 2017, six surgical intervention visits have taken place. Georgian epileptologists and a neuropsychologist visited the Berlin-Brandenburg Epilepsy Center to observe presurgical evaluation procedures. Surgical indications are made by the Georgian team and discussed with German epileptologists either in Tbilisi or via online conferences. Scientific and educational efforts have been launched to address drug-resistant epilepsy topics more broadly. Since 2018, 13 patients with temporal lobe epilepsy and hippocampal sclerosis have undergone resective epilepsy surgery. In September 2023, seven patients with 12+ months follow-up were examined. Five patients became completely seizure-free (ILAE 1), one had auras (ILAE 2), and one had disabling seizures (ILAE 4). Quality of life improved substantially, and antiseizure medication was reduced in many cases. Most patients reported better memory function and returned to work. All except one patient rated their surgery decision as “good”. Supporting complex medical procedures in regions in need can be rewarding but must meet specialized standards. The seizure outcomes in Georgia compare favorably with existing literature, showing that careful education and teamwork can achieve excellent results despite technical limitations. The teams have become close collaborators, and efforts continue to provide high-quality epilepsy surgery for the Georgian population.

OBJECTIVES:The Quality of life (QoL) of people with epilepsy is significantly lower than of those with other chronic conditions. This is influenced by seizure type, etiology, severity, treatment efficacy, and particularly by stigma. These factors vary across geographical and cultural contexts, posing significant educational, employment, social integration, and family life challenges. We aimed to identify key predictors of QoL in people with epilepsy. METHODS:We conducted a cross-sectional study involving adults with epilepsy treated as outpatients at the Institute of Neurology and Neuropsychology in Georgia. We used the Quality of Life in Epilepsy Inventory (QOLIE-31) and the Beck Depression Inventory (BDI) to assess quality of life issues in people with epilepsy living in Georgia. We also collected data on the sociodemographic and clinical information related to epilepsy. RESULTS:Three hundred and fifty-one individuals participated. Older age, lower educational attainment, female sex, rural residence, focal seizures with impaired consciousness, uncontrolled seizures, and polytherapy were associated with lower overall QoL scores. A mild to moderate negative correlation was seen between Beck's Depression Inventory scores and QOLIE-31 domain scores. Higher education, employment, and being married were associated with better QoL. The associations between poorer QoL, age, and educational level were consistent with previous studies. CONCLUSIONS:Frequent seizures, polytherapy, rural residence, unemployment, and low educational attainment were associated with lower QoL. These findings underscore the need to improve academic and employment opportunities for people with epilepsy and emphasize the importance of raising epilepsy public awareness, particularly in rural areas.

Objective: Our study aimed to investigate the prevalence of depression, anxiety, and adjustment disorder in mothers of children with seizure disorders and to find the risk factors contributing to developing these diseases. Background: Around fifty million people worldwide have a seizure disorder, making it one of the most common neurological diseases globally. Studies have shown that caregivers of patients often experience mental health issues. However, there are few studies about the risk factors contributing to mental and adjustment disorders in mothers of children with seizures leading to chronic depression. Design/Methods: A cross-sectional study was conducted. Fifty-nine mothers of children with seizures aged 0–18 years were investigated in Georgia using questionnaires including information about sociodemographic, financial, and personal issues, as well as Patient Health Questionnaire-9 (PHQ9), General Anxiety Disorder-7 (GAD7), and Adjustment Disorder–New Module-7 (ADNM7). Results: Out of fifty-nine participants, fifty-five had one or more mental disorders. 37/59 had depression, 16/59 had adjustment disorder and 45/59 had GAD. The most common risk factor was financial issues. GAD and depression had a strong association with lack of family support. Adjustment disorder was mainly associated with patients' mothers being aware of the disease before diagnosis. Stigma was primarily associated with depression, while conflicts within the family were associated with depression and adjustment disorder. Conclusions: Results of the study suggest that the most common risk factors causing mental distress are financial issues and lack of family support. This opens new avenues to develop preventive and management strategies for these diseases. Disclosure: Miss Alavidze has nothing to disclose. Miss Dias has nothing to disclose. Prof. Tkemaladze has nothing to disclose. Prof. Kasradze has nothing to disclose.

Introduction Stigma Scale of Epilepsy (SSE), initially developed in Brazil, is accepted worldwide as a sensitive tool for assessing epilepsy-related stigma. We adapted and validated a Georgian version of SSE. Materials and methods The SSE originated in Brazil and was translated into Georgian by three independent experts through forward and backward translation. The final version was generated for validation after handling gross or conceptual inconsistencies between the source and the new format. We used Cronbach's alpha to assess the internal consistency of the Georgian version of SSE. To explore the construct of SSE subscales in the Georgian version, we used principal components and factor analysis. Varimax rotation was applied. The Kaiser-Meyer-Olkin Measure and Bartlett's test of sphericity were employed to assess the sampling adequacy. A probability <0.05 was considered statistically significant. Results 87 adults, 32 (37 %) with epilepsy and 55 (63 %) without epilepsy were enrolled. The overall mean score of SSE was 19.5 (SD 10.1; min. 2, max. 53), and the differences between people with [20.7 (SD 8.9; min. 2, max. 53)] and without epilepsy [17.5 (SD 10.4; min. 3, max. 42)] were not statistically significant. Cronbach's alpha for the overall sample was 0.854; for the epilepsy cohort it was 0.876, and for individuals without epilepsy 0.823, indicating good SSE internal consistency. Kaiser-Meyer-Olkin Measure was 0.705 and Bartlett's test of sphericity was 926.2 (df 276; p < 0.001), suggesting acceptable sample adequacy. Discussion The Georgian version of the SSE is a valid and reliable measurement tool for assessing epilepsy-related stigma determinants among the country's population.

Our primary goal was to measure the accuracy of fully automated absence seizure detection, using a wearable electroencephalographic (EEG) device. As a secondary goal, we also tested the feasibility of automated behavioral testing triggered by the automated detection. We conducted a phase 3 clinical trial (NCT04615442), with a prospective, multicenter, blinded study design. The input was the one-channel EEG recorded with dry electrodes embedded into a wearable headband device connected to a smartphone. The seizure detection algorithm was developed using artificial intelligence (convolutional neural networks). During the study, the predefined algorithm, with predefined cutoff value, analyzed the EEG in real time. The gold standard was derived from expert evaluation of simultaneously recorded full-array video-EEGs. In addition, we evaluated the patients' responsiveness to the automated alarms on the smartphone, and we compared it with the behavioral changes observed in the clinical video-EEGs. We recorded 102 consecutive patients (57 female, median age = 10 years) on suspicion of absence seizures. We recorded 364 absence seizures in 39 patients. Device deficiency was 4.67%, with a total recording time of 309 h. Average sensitivity per patient was 78.83% (95% confidence interval [CI] = 69.56%–88.11%), and median sensitivity was 92.90% (interquartile range [IQR] = 66.7%–100%). The average false detection rate was .53/h (95% CI = .32–.74). Most patients ( n  = 66, 64.71%) did not have any false alarms. The median F1 score per patient was .823 (IQR = .57–1). For the total recording duration, F1 score was .74. We assessed the feasibility of automated behavioral testing in 36 seizures; it correctly documented nonresponsiveness in 30 absence seizures, and responsiveness in six electrographic seizures. Automated detection of absence seizures with a wearable device will improve seizure quantification and will promote assessment of patients in their home environment. Linking automated seizure detection to automated behavioral testing will provide valuable information from wearable devices.

Objective:To assess whether implementing the freeware version of the SCORE EEG system (Standardized Computer-based Organized Reporting of EEG) leads to improvement in the quality of clinical EEG reading, and whether EEG reports in SCORE EEG are understood and accepted by the referring physicians. Methods:We generated EEG reports in the conventional, free-text style and then using SCORE EEG, in consecutive patients referred to routine EEG. We used the Georgian translation in the SCORE EEG Free Edition. We pre-defined quality indicators consisting of a list of 24 key features that need to be addressed in EEG reports. We compared these quality indicators in free-text reports with SCORE EEG. In addition, EEG reports in SCORE EEG format were assessed by ten referring physicians, who evaluated their usability on a 7-point Likert scale. Results:We included and evaluated EEG reports from 157 patients (80 female; age: 1-75 years; median: 28 years). Fourteen features were reported exclusively in SCORE EEG, four were reported significantly more often in SCORE EEG than in free-text format, and six features were reported equally often in SCORE EEG and in free-text format. Usability aspects of SCORE EEG were highly rated by the referring physicians (median 6-7 on the 7-point Likert scale). Conclusions:The structured system of EEG reporting in SCORE EEG helped the experts reading clinical EEG to cover the important aspects and increase the quality of clinical EEG reports. Significance:Implementing the freeware version of SCORE EEG in underprivileged areas will help improving management of patients with epilepsy.

INTRODUCTION:This study describes the specific neuropsychological abnormalities among children with epilepsy (CH-E) living in Georgia. METHODS:A cohort of CH-E and children without epilepsy (CH-NoE), aged 6-13 years, admitted to the epilepsy center of the Institute of Neurology and Neuropsychology from 1st January 2010 to 31st December 2015, was selected and investigated with a structured protocol. Neurological/epileptological assessments were made and neuropsychological testing was done on all study subjects. RESULTS:Abnormalities in praxis, verbal functions, verbal learning, visual-spatial matching, visual-motor ability, and fine motor skills, working memory, and phonological memory span were often revealed in CH-E as compared to CH-NoE. Early age of seizure onset, epilepsy duration, and anti-seizure medication (ASM) use, in combination with brain structural abnormalities on neuroimaging, and structural etiology were independent predictors of impaired functioning in various neuropsychological domains. DISCUSSION:More than half of children with epilepsy have a variety of cognitive impairments, which may increase with ASM therapy, especially when the cause of seizures is structural damage to the brain. Therefore, in the process of diagnosing epilepsy, evaluation of cognitive functions should become an integral part to ensure effective management of the disorder.

Surgery is the most effective therapeutic approach for medically refractory epilepsies and a safe and cost-efficient treatment in terms of long-term expenses of direct, indirect, and intangible costs. Georgia is a Caucasian low- to middle-income country with a remarkable effort to deal with epileptic diseases, but without an appropriate epilepsy surgery program. To address the needs for such a service in this country, two joint German–Georgian projects were initiated in 2017 and 2019. In the framework of these projects, a productive exchange program involving German and Georgian experts was undertaken in the past two years. This program included training and mentoring for Georgian clinical colleagues, as well as joint case conferences and workshops with the aim of optimizing presurgical diagnostics and preparing for an epilepsy surgery program in Georgia. Finally, a postsurgical medium- and long-term follow-up scheme was organized as the third component of this comprehensive approach. As a result of our efforts, the first patients underwent anterior temporal lobectomy and all of them remain seizure-free up to the present day. Hence, epilepsy surgery is not only feasible, but also already available in Georgia. In this report, we aim to share our experiences in the initiation and implementation of surgical epilepsy intervention in Georgia and illustrate our recent endeavor and achievements.