Epilepsia

ObjectiveNovel subcutaneous electroencephalography (sqEEG) systems enable prolonged, near-continuous cerebral monitoring in real-world conditions. Nevertheless, the feasibility, acceptability and overall clinical utility of these systems remains unclear. We report on the longest observational study using ultra long-term sqEEG to date. MethodsWe conducted a 15-month prospective, observational study including ten adult people with treatment-resistant epilepsy. After device implantation, patients ...

Background and ObjectivesThe proportion of patients becoming seizure-free after epilepsy surgery has stagnated. Large multi-center stereo-electroencephalography datasets can potentially allow comparing a new patient to past similar cases and make clinical decisions with the knowledge of how similar cases were treated in the past. However, the complexity of these evaluations makes the manual search for similar patients in a large database impractical. We aim to develop an automated system that el...

ImportanceMedication adherence is widely emphasized in epilepsy management, with a belief that missing even single doses can trigger seizures. However, scientific evidence supporting this specific claim is limited, particularly regarding the impact of occasional missed doses rather than prolonged non-adherence. ObjectiveTo determine whether missing individual doses of anti-seizure medications (ASMs) increases short-term seizure risk in people with drug-resistant epilepsy. DesignProspective coh...

BackgroundSudden Unexpected Death in Epilepsy (SUDEP) is the leading cause of death in epilepsy children and otherwise healthy adult epilepsy patients. About 70% of SUDEP occurs during sleep, and nearly 90% are found in the prone (face-down) position. SUDEP can likely be prevented by simple interventions such as turning and stimulating. Such intervention must be performed quickly within a 3-minute window prior to death. There are currently no products that detect the prone position or have the a...

ObjectivesWe comprehensively characterised a large paediatric cohort with histologically confirmed focal cortical dysplasia (FCD) type 1 to demonstrate the role of advanced multimodal pre-surgical evaluation and identify predictors of postsurgical outcomes. MethodsThis study comprised a systematic re-analysis of clinical, electrophysiological, and radiological features. The results of this re-analysis served as independent variables for subsequent statistical analyses of outcome predictors. Re...

BackgroundEpilepsy affects approximately 50 million people worldwide, and seizures remain difficult to predict in onset, severity, and duration. Real-time seizure prediction may enable proactive intervention and improve patient safety and quality of life. Despite the development of high-performing algorithms, translation remains limited by predictive accuracy, interpretability, and generalisability. ObjectivesThis systematic review evaluates artificial intelligence (AI) models for real-time epi...

ObjectiveStereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (sEEG) may miss seizure onset elsewhere. We hypothesized that sEEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure cont...

BackgroundNeurological manifestations of COVID-19 have only recently been described, with a paucity of literature reporting the potential relationship between COVID-19 and acute symptomatic seizures. Two prior studies found no clinical or electrographic seizures in their cohorts of COVID-19 patients with altered mental status (AMS) and clinical seizure-like events (SLEs). MethodsIn this retrospective cohort study, 22 critically-ill COVID-19 patients above the age of 18 years who underwent EEG (...

ObjectiveSeizure unpredictability is rated as one of the most challenging aspects of living with epilepsy. Seizure likelihood can be influenced by a range of environmental and physiological factors that are difficult to measure and quantify. However, some generalizable patterns have been demonstrated in seizure onset. A majority of people with epilepsy exhibit circadian rhythms in their seizure times and many also show slower, multiday patterns. Seizure cycles can be measured using a range of re...

IntroductionArgininosuccinate lyase is integral to the urea cycle, which enables nitrogen waste and biosynthesis of arginine, a precursor of nitric oxide. Inherited argininosuccinate lyase deficiency causes argininosuccinic aciduria, the second most common urea cycle defect and an inherited model of systemic nitric oxide deficiency. Patients present with developmental delay, epilepsy and movement disorder. Here we aim to characterise epilepsy, a common and neurodebilitating complication in argin...

ObjectiveEpilepsy surgery in the operculo-insular cortex is challenging due to the difficult delineation of the epileptogenic zone and the high risk of post-operative deficits following resections in this region. MethodsPre- and post-surgical data from 30 pediatric patients who underwent opercular-insular cortex surgery at Motol Epilepsy Center Prague from 2010 to 2022 were analyzed. ResultsFocal cortical dysplasia (FCD, n = 15) was the predominant cause of epilepsy in the patients studied, fo...

IMPORTANCEThis research describes a method to accurately predict the onset of epileptic seizures; this will help treat patients timely, prevent future seizures, and improve outcomes. OBJECTIVEWe aimed to assess whether the phase-amplitude coupling (PAC) between infraslow activities (ISA) and high-frequency activities (HFA) increases before seizure onset. DESIGN AND SETTINGThis retrospective, single-center case series included patients admitted to the neurosurgery department at Osaka University...

There is growing interest in machine learning based approaches to assist clinicians in treatment selection. In the treatment of epilepsy, a common neurological disorder that affects 70 million people worldwide, previous research has employed scoring methods generated from traditional machine learning methods based on pre-treatment patient characteristics to classify those with drug-resistant epilepsy (DRE). In this study, we used an attention-based approach in predicting the response to differen...

ObjectiveAccurate and timely epilepsy diagnosis is crucial to reduce delayed or unnecessary treatment. While language serves as an indispensable source of information for diagnosing epilepsy, its computational analysis remains relatively unexplored. This study assessed - and compared - the diagnostic value of different language model applications in extracting information and identifying overlooked language patterns from first-visit documentation to improve the early diagnosis of childhood epile...

ObjectivesDetermining patient-specific thalamic connectivity alterations may be an important step towards personalized surgical and neuromodulation strategies, but no data are available to support this concept in pediatric cohorts. This study investigated thalamocortical structural connectivity profiles in children with focal-onset epilepsy of different seizure onset zones. MethodsThis neuroimaging, case-control study compared structural connectivity of four thalamic nuclei (anteroventral (AV),...

IntroductionThis retrospective open cohort study develops and externally validates a clinical prediction model (CPM) to predict the joint risk of two important outcomes occurring within the next year in people with epilepsy (PWE): A) seizure-related emergency department or hospital admission; and B) epilepsy-related death. This will provide clinicians with a tool to predict either or both of these common outcomes. This has not previously been done despite both being potentially avoidable, interr...

BackgroundMany genetic epilepsy disorders are characterized by focal epilepsy or exhibit focal or lateralized features, which make individuals with such conditions potential surgical candidates. However, surgical outcomes in epilepsy caused by germline genetic variants and value of genetic testing in presurgical assessment remains unclear. MethodsThis retrospective cross-sectional study included people with germline genetic epilepsy and non-genetic epilepsy identified among 2879 people with epi...

Epilepsy affects over 50 million people worldwide, with anti-seizure medications (ASMs) as the primary treatment for seizure control. However, ASM selection remains a "trial and error" process due to the lack of reliable predictors of effectiveness and tolerability. While machine learning approaches have been explored, existing models are limited to predicting outcomes only for ASMs encountered during training and have not leveraged recent biomedical foundation models for this task. This work in...

ObjectivesWith the expected demographic shift toward those [≥]65 years of age in the United States, late-onset epilepsy (LOE) poses a significant public health issue, yet it has been historically understudied. We are undertaking an effort in the Epilepsy-Cog study to pool individual participant data from six US-based prospective cohort studies. In this paper, we outline the process for ascertaining epilepsy, harmonizing, and pooling individual participant data across the six cohorts. Methods...

Epilepsy affects around 1% of the global population and often requires long-term treatment with antiseizure medications (ASMs). However, the current treatment strategy is based on clinical acumen and trial and error, resulting in only about 50% of patients remaining seizure-free for at least 12 months with first-line ASMs. Valproic acid (VPA) is a commonly prescribed first-line ASM, yet <50% of patients experience inadequate seizure control (ISC) or unacceptable adverse reactions (UARs), necessi...