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This study was designed to assess the knowledge of patients following their first seizure or blackout of unknown cause. We aimed to compare the advice our cohort of patients recalled against that suggested in the current literature. 5 % of the population will experience a non- febrile seizure in their lifetime. Education and advice for the patient and their family is an important aspect of their care. After reviewing the recommended guidelines from both the Scottish Intercollegiate Guidelines Network and the National Institute for Health and Care Excellence, a questionnaire was developed. From 1st May 2020 to 1st September 2022, a questionnaire was given to eligible patients attending St. James's Hospital for an electroencephalogram (EEG) following their first possible seizure or blackout of unknown cause. The patients were provided with a list of topics and were asked to select which, if any, were discussed with them. A total of 50 eligible adults participated in the study. Driving was the topic most frequently recalled as having been discussed at 66 % followed by family education. It has been recognised that patients remember as little as a fifth of information initially discussed, failing to recall 40–80 % of content within medical encounters and our study supports this. This highlights the need to review the information delivered and how this is achieved as well as using new methods to help increase the retention of this vital information. [ABSTRACT FROM AUTHOR]

Copyright of Sakarya University Journal of Law Faculty (SHD) is the property of Sakarya University Journal of Law Faculty (SHD) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this study, the effectiveness of six machine learning and eight deep learning algorithms in analyzing electroencephalogram (EEG) signals for detecting epileptic seizures has been investigated. The study utilizes 14 channels in the EMOTIV EPOC+ device which is based on international 10-20 system. To find out the most informative and sensitive channel, one of the 14 channels has been dropped one at a time. The accuracy values were determined for all the methods using two different publicly available datasets: the Guinea-Bissau epilepsy dataset and the Nigeria epilepsy dataset. In case of machine learning models, the performance of SVM classifier performs best with maximum accuracy of 83.2% (Guinea-Bissau) and 77% (Nigeria) without excluding any channels. No significant performance degradation has been observed for single channel exclusion of this classifier. Among the deep learning models, the four best performing models in terms of accuracy are CNN-LSTM (92.5%), IC-RNN (91.8%), ChronoNet (91.1%) and C-DRNN (88.6%). After excluding one channel at a time and investigating their effect on the performance of the four DL models, it has been observed that the most significant and most sensitive channels lie within the frontal and parietal zone. This finding will be very useful in practice as it indicates that the electrodes in the frontal and parietal zone should be placed with absolute precision for accurate diagnosis of the diseases. In addition, this study also explore the effectiveness of the selected classifiers in detecting seizure in case of failure of any particular EEG signal channel. [ABSTRACT FROM AUTHOR]

"Body packing" involves concealing drugs filled in packets inside the body to traffic illicit drugs. Packets may leak and rupture, which may have drug-induced toxic effects. We present a case of a 25-year-old male patient brought to the emergency department because of a seizure during an international flight. He was diagnosed with status epilepticus, and tracheal intubation was performed; however, he had a cardiac arrest shortly after. Pinpoint pupils and unclear patient history led to naloxone administration. After successful cardiopulmonary resuscitation, the patient was examined using computed tomography, which revealed multiple foreign bodies in the distal bowels. Blood toxicology tests were positive for opiates and negative for heroin metabolites, amphetamine, cocaine, barbiturate, and benzodiazepine. An emergency colonoscopy was performed, and the patient remained in the intensive care unit for 17 days before he died of to complications of Body Packer syndrome. Early diagnosis and appropriate management of this rare but potentially fatal condition are vital to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Growing evidence demonstrates a relationship between epilepsy and the circadian system. However, relatively little is known about circadian function in disease states, such as epilepsy. This study aimed to characterize brain and peripheral core circadian clock gene expression in rat models of genetic and acquired epilepsy. Methods: For the Genetic Absence Epilepsy Rats from Strasbourg (GAERS) study, we used 40 GAERS and 40 non‐epileptic control (NEC) rats. For the kainic acid status epilepticus (KASE) study, we used 40 KASE and 40 sham rats. Rats were housed in a 7 am:7 pm light–dark cycle. Hypothalamus, hippocampus, liver, and small intestine samples were collected every 3 h throughout the light period. We then assessed core diurnal clock gene expression of per1, cry1, clock, and bmal1. Results: In the GAERS rats, all tissues exhibited significant changes in clock gene expression (P < 0.05) when compared to NEC. In the KASE rats, there were fewer effects of the epileptic condition in the hypothalamus, hippocampus, or small intestine (P > 0.05) compared with shams. Significance: These results indicate marked diurnal disruption to core circadian clock gene expression in rats with both generalized and focal chronic epilepsy. This could contribute to epileptic symptomology and implicate the circadian system as a viable target for future treatments. [ABSTRACT FROM AUTHOR]

Objective: We investigated the association between the glucocorticoid receptor (GR) gene, also known as the nuclear receptor subfamily 3, group C, member 1 (NR3C1), rs41423247 polymorphism, and functional seizures (psychogenic nonepileptic seizures/attacks) in a case–control study. We hypothesized that the tested polymorphism has significant associations with functional seizures (psychogenic nonepileptic seizures/attacks) independent from comorbid depression. Methods: Seventy patients with functional seizures (psychogenic nonepileptic seizures/attacks), 70 with major depressive disorder (MDD), and 70 healthy controls (HCs) were studied. Their DNAs were analyzed for NR3C1 rs41423247 polymorphism. Results: Genotype and allele frequencies of rs41423247 were different between the three groups. G allele carriers were more frequent in patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD compared to HCs (p = 0.0001). However no significant difference was observed with respect to allele distributions between functional seizures (psychogenic nonepileptic seizures/attacks) and MDD groups (p = 0.391). CC genotype was less often associated with functional seizures (psychogenic nonepileptic seizures/attacks) versus HC: Codominant model; p = 0.001, OR = 0.11, 95% CI = 0.05–0.24, and −2loglilkelihood = 231.7. In comparison between functional seizures (psychogenic nonepileptic seizures/attacks) group and other (MDD + HC) groups, we observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks) (Codominant model; p = 0.001, OR = 5.63, 95% CI = 2.60–12.40 and −2loglikelihood = 245.99). Significance: Patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD were significantly more often G allele carriers in rs41423247 compared with HCs. We observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks). However, we could not exclude the possibility of confounding effects of depression. Future genetic studies of patients with functional seizures (psychogenic nonepileptic seizures/attacks) should include a comparison group with depression in addition to a comparison group of HCs. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the current endeavor was to evaluate the feasibility of using easily accessible and applicable clinical information (based on history taking and physical examination) in order to make a reliable differentiation between idiopathic generalized epilepsy (IGE) versus focal epilepsy using machine learning (ML) methods. Method s : The first phase of the study was a retrospective study of a prospectively developed and maintained database. All patients with an electro‐clinical diagnosis of IGE or focal epilepsy, at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2022, were included. The first author selected a set of clinical features. Using the stratified random portioning method, the dataset was divided into the train (70%) and test (30%) subsets. Different types of classifiers were assessed and the final classification was made based on their best results using the stacking method. Results: A total number of 1445 patients were studied; 964 with focal epilepsy and 481 with IGE. The stacking classifier led to better results than the base classifiers in general. This algorithm has the following characteristics: precision: 0.81, sensitivity: 0.81, and specificity: 0.77. Significance: We developed a pragmatic algorithm aimed at facilitating epilepsy classification for individuals whose epilepsy begins at age 10 years and older. Also, in order to enable and facilitate future external validation studies by other peers and professionals, the developed and trained ML model was implemented and published via an online web‐based application that is freely available at http://www.epiclass.ir/f‐ige. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the epilepsy phenotype in a large international cohort of patients with KBG syndrome and to study a possible genotype–phenotype correlation. Methods: We collected data on patients with ANKRD11 variants by contacting University Medical Centers in the Netherlands, an international network of collaborating clinicians, and study groups who previously published about KBG syndrome. All patients with a likely pathogenic or pathogenic ANKRD11 variant were included in our patient cohort and categorized into an "epilepsy group" or "non‐epilepsy group". Additionally, we included previously reported patients with (likely) pathogenic ANKRD11 variants and epilepsy from the literature. Results: We included 75 patients with KBG syndrome of whom 26 had epilepsy. Those with epilepsy more often had moderate to severe intellectual disability (42.3% vs 9.1%, RR 4.6 [95% CI 1.7–13.1]). Seizure onset in patients with KBG syndrome occurred at a median age of 4 years (range 12 months – 20 years), and the majority had generalized onset seizures (57.7%) with tonic–clonic seizures being most common (23.1%). The epilepsy type was mostly classified as generalized (42.9%) or combined generalized and focal (42.9%), not fulfilling the criteria of an electroclinical syndrome diagnosis. Half of the epilepsy patients (50.0%) were seizure free on anti‐seizure medication (ASM) for at least 1 year at the time of last assessment, but 26.9% of patients had drug‐resistant epilepsy (failure of ≥2 ASM). No genotype–phenotype correlation could be identified for the presence of epilepsy or epilepsy characteristics. Significance: Epilepsy in KBG syndrome most often presents as a generalized or combined focal and generalized type. No distinctive epilepsy syndrome could be identified. Patients with KBG syndrome and epilepsy had a significantly poorer neurodevelopmental outcome compared with those without epilepsy. Clinicians should consider KBG syndrome as a causal etiology of epilepsy and be aware of the poorer neurodevelopmental outcome in individuals with epilepsy. [ABSTRACT FROM AUTHOR]

This article discusses a case of a 29-year-old man diagnosed with Dravet syndrome (DS), a severe form of epilepsy. The patient experienced pharmaco-resistant seizures and cognitive delay, as well as motor and gait problems, which worsened following epileptic seizures. The article suggests that recurrent seizures may contribute to the development of gait and motor impairments in DS patients. The patient showed improvement in symptoms after treatment with levodopa. This case highlights the importance of early and correct intervention for better prognosis in DS patients. [Extracted from the article]

Objective: To compare forgetting patterns between patients with temporal lobe (TLE) and generalized (GGE) epilepsies and to assess whether recall is associated with epileptic activity. Methods: Thirty‐three patients with TLE (13 left, 17 right, and 3 nonlateralized TLE), 42 patients with GGE, and 57 healthy controls (HCs) were asked to recall words, verbal story material, and the Rey‐Osterrieth complex figure at two delays. Accelerated long‐term forgetting (ALF) was defined by group performance comparable to HCs at 30 min and worse recall than HCs after 4 weeks. ALF was assessed by comparing raw test scores in a two‐way repeated measures analysis of variance (ANOVA) adjusted for the learning capacity. Results: Compared to HCs, patients with R‐TLE remembered fewer items of the word list after 30 min as well as after 4 weeks. Patients with L‐TLE and GGE had comparable learning‐adjusted performance to HCs at the 30 min delay but scored less after 4 weeks (group by delay interaction F(3, 124) = 3.2, P = 0.026, ηp2 = 0.07). The epilepsy group (patients with TLE and GGE combined) performed as well as HCs at 30 min but worse after 4 weeks irrespective of experienced seizures during the 4‐week delay or interictal bilateral (TLE) or generalized (GGE) activity before the study. We noted no statistically significant differences between patient and HC verbal story (group by delay interaction F(3, 124) = 0.7, P = 0.570, ηp2 = 0.02) or complex figure (F(3, 124) = 0.8, P = 0.488, ηp2 = 0.02) recall. Significance: Our data support verbal and visual memory impairment in both TLE and GGE with different performances between these groups in the task of word recall. We suggest the presence of ALF in patients with GGE and left TLE after adjusting for learning capacity. We could not confirm the influence of epileptic activity on long‐term forgetting patterns. Future studies are required to better define domain‐specific differences in memory impairment in TLE and GGE. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Infection / Çocuk Enfeksiyon Dergisi is the property of Journal of Pediatric Infection / Cocuk Enfeksiyon Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Perampanel is a promising option for the treatment of pediatric epilepsy, but its plasma concentration varies among patients. This retrospective study aimed to investigate the initial target attainment of perampanel plasma concentration in pediatric patients with epilepsy in China. Inpatients admitted from January 2020 to December 2021 in a tertiary hospital were retrospectively included according to pre-set criteria. Demographic characteristics of patients and dosing strategies and therapeutic drug monitoring results were collected. A total of 137 pediatric patients (84 females and 53 males, aged from 0.6 to 16.4 years) were include for analysis. The perampanel concentrations varied greatly from 60 to 1,560 mg/L among patients, but 89.8% had suitable perampanel concentrations (100–1,000 ng/mL). The concomitant use of enzyme-inductive antiepileptic drugs (AEDs) was the only identified risk factor associated with target nonattainment (OR = 5.92, 95% confidence interval 1.68–20.9). Initial perampanel target attainment in pediatric patients is satisfactory. Routine therapeutic drug monitoring to achieved the suggested concentration range for these patients may be unnecessary, except for those receiving combined enzyme inductive AEDs. [ABSTRACT FROM AUTHOR]

Background and purpose: Relapsing polychondritis (RP) is a rare rheumatologic disorder that may aect the neurological system with various presentations. In this study, we present a case and summarize the clinical characteristics of RP-associated meningoencephalitis. Case presentation: A 48-year-old man presented with first-ever seizures that were well controlled by valproate. Physical examination results were unremarkable, except for binaural deformation. The initial brain magnetic resonance imaging (MRI) without contrast and electroencephalogram (EEG) findings were normal. However, the patient subsequently developed recurrent fever, scleritis, headache, lethargy, and left arm paresis. Repeated brain MRI with contrast demonstrated increased enhancement of the pia mater and abnormal diusion-weighted imaging (DWI) signals in the bilateral auricles. The cerebrospinal fluid (CSF) analysis showed 2 leukocytes/µL, 736.5 mg/L of protein, and no evidence of infectious disease or autoimmune encephalitis. Meningoencephalitis secondary to RP was considered. The patient’s condition improved significantly and quickly with the administration of dexamethasone (10 mg per day). Oral methylprednisolone was continued, and the patient remained well without relapse during the 9-month follow-up period. Conclusion: RP-associated meningoencephalitis is rare but fatal. Although symptoms vary, red or deformed ears remain the most common and suggestive features. Non-specific parenchymal changes and/or meningeal enhancement can be observed on brain MRI scans. CSF lymphocytic pleocytosis with mild protein elevation was observed in most patients. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) allows data analysis and integration at an unprecedented granularity and scale. Here we review the technological advances, challenges, and future perspectives of using AI for electro‐clinical phenotyping of animal models and patients with epilepsy. In translational research, AI models accurately identify behavioral states in animal models of epilepsy, allowing identification of correlations between neural activity and interictal and ictal behavior. Clinical applications of AI‐based automated and semi‐automated analysis of audio and video recordings of people with epilepsy, allow significant data reduction and reliable detection and classification of major motor seizures. AI models can accurately identify electrographic biomarkers of epilepsy, such as spikes, high‐frequency oscillations, and seizure patterns. Integrating AI analysis of electroencephalographic, clinical, and behavioral data will contribute to optimizing therapy for patients with epilepsy. [ABSTRACT FROM AUTHOR]

Introduction The health-related quality of life (HRQoL) of people with (Pw) multiple sclerosis (MS) is usually deteriorated. It has been recently suggested that comorbidities may have the negative influence on the quality of life of the PwMS, but according to the best of our knowledge, only one study investigated, although in a very small cohort, the impact of individual comorbidity on the quality of life of PwMS. The aim of our investigation was to assess, in an international, multicentric study, the impact of comorbid seizure/epilepsy on the HRQoL in PwMS. Methods We conducted cross-sectional study at numerous neurological centers in Serbia, Croatia, Bulgaria, Montenegro, Northern Macedonia, and Bosnia and Herzegovina (Federation of Bosnia and Herzegovina and Republic of Srpska). For each patient, demographic and clinical data were collected, including Expanded disability status scale (EDSS) score. Beck Depression Inventory (BDI) and the 36-Item Short Form Health Survey (SF-36) questionnaires were administered to all patients. Results The study comprised 326 PwMS in total, 127 PwMS with seizure/epilepsy and 209 PwMS without. Both mean Physical health composite (PHC) and mental health composite (MHC) scores, were statistically significantly higher in PwMS without seizure/epilepsy, implicating worse quality of life in PwMS with comorbid seizure/epilepsy. Presence of seizure/epilepsy in pwMS was statistically significant independent predictor of both PHC and MHC, in multivariate linear regression model after adjustment for potential confounding variables. The hierarchical multivariate regression analysis was performed in order to establish the most important predictors of the PHC and MHC of the SF-36, in PwMS with seizure/epilepsy; older age, higher level of disability, as measured by EDSS, higher depression score, drug-resistant epilepsy and shorter time since last seizure were found to significantly predict worse MHC score in PwMS with seizure/epilepsy. Discussion Our results point to the possible role of theinterventions related to the adequate control of epilepsy along with improvement of the mental health status to be important in order to reduce MS burden in the PwMS with comorbid seizure/epilepsy. [ABSTRACT FROM AUTHOR]

The kindling model has been used extensively by researchers to study the neurobiology of temporal lobe epilepsy (TLE) due to its capacity to induce intensification of seizures by the progressive recruitment of additional neuronal clusters into epileptogenic networks. We applied repetitive focal optogenetic activation of putative excitatory neurons in the dorsal CA1 area of the hippocampus of mice to investigate the role of inhibitory signaling during this process. This experimental protocol resulted in a kindling phenotype that was maintained for 2weeks after the animals were fully kindled. As a result of the different phases of optogenetic kindling (OpK), key inhibitory signaling elements, such as KCC2 and NKCC1, exhibited distinct temporal and spatial dynamics of regulation. These alterations in protein expression were related to the distinct pattern of ictal activity propagation through the different hippocampal sublayers. Our results suggest the KCC2 disruption in the contralateral hippocampus of fully kindled animals progressively facilitated the creation of pathological pathways for seizure propagation through the hippocampal network. Upon completion of kindling, we observed animals that were restimulated after a rest period of 14-day showed, besides a persistent KCC2 downregulation, an NKCC1 upregulation in the bilateral dentate gyrus and hippocampus-wide loss of parvalbumin-positive interneurons. These alterations observed in the chronic phase of OpK suggest that the hippocampus of rekindled animals continued to undergo self-modifications during the rest period. The changes resulting from this period suggest the possibility of the development of a mirror focus on the hippocampus contralateral to the site of optical stimulations. Our results offer perspectives for preventing the recruitment and conversion of healthy neuronal networks into epileptogenic ones among patients with epilepsy. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) and stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-RFTC) are two effective, minimally invasive treatments for epilepsy with focal cortical dysplasia (FCD). The purpose of this study is to conduct a meta-analysis to evaluate and compare the efficacy and safety of these two therapies in epilepsy patients with FCD. Methods: We searched PubMed, Embase, Cochrane, and other databases for articles published before March 2023. The primary objective was to compare the effectiveness and complications of MRgLiTT and SEEG-RFTC in epilepsy patients with FCD. The second objective was to determine whichmethod provides a better prognosis for specific subgroup patients. Results: According to the inclusion and exclusion criteria, 18 studies were included, comprising 270 FCD patients including 37 patients from 6 MRgLiTT studies and 233 from12 SEEG-RFTC studies. There were no significant differences between MRgLiTT and SEEG-RFTC groups in the seizure-freedom rate (59%, 95% CI 44-74%; 52%, 95% CI 47-57%, P =0.86) and the rate of ≥50% seizure-reduction of FCD (90%, 95% CI 80-100%; 90%, 95% CI 86-94%, P = 0.42). Bothmethods had low complication rates (17.1%, 28/159) and long-term complication (2.5%, 4/159) rate, with no significant difference between them (P = 0.17). Conclusion: Both MRgLiTT and SEEG-RFTC are safe and minimally invasive treatments for patients with FCD. They have comparable performance in terms of postoperative seizure-freedom rates in patients with FCD, and both can be used as treatment options for patients with FCD. Our study found that SEEG-RFTC had a better therapeutic effect in the FCD2b subgroup. [ABSTRACT FROM AUTHOR]

Seizure liability remains a significant cause of attrition throughout drug development. Advances in stem cell biology coupled with an increased understanding of the role of ion channels in seizure offer an opportunity for a new paradigm in screening. We assessed the activity of 15 pro-seizurogenic compounds (7 CNS active therapies, 4 GABA receptor antagonists, and 4 other reported seizurogenic compounds) using automated electrophysiology against a panel of 14 ion channels (Nav1.1, Nav1.2, Nav1.6, Kv7.2/7.3, Kv7.3/7.5, Kv1.1, Kv4.2, KCa4.1, Kv2.1, Kv3.1, KCa1.1, GABA α1β2γ2, nicotinic α4β2, NMDA 1/2A). These were selected based on linkage to seizure in genetic/pharmacological studies. Fourteen compounds demonstrated at least one "hit" against the seizure panel and 11 compounds inhibited 2 or more ion channels. Next, we assessed the impact of the 15 compounds on electrical signaling using human-induced pluripotent stem cell neurons in microelectrode array (MEA). The CNS active therapies (amoxapine, bupropion, chlorpromazine, clozapine, diphenhydramine, paroxetine, quetiapine) all caused characteristic changes to electrical activity in key parameters indicative of seizure such as network burst frequency and duration. The GABA antagonist picrotoxin increased all parameters, but the antibiotics amoxicillin and enoxacin only showed minimal changes. Acetaminophen, included as a negative control, caused no changes in any of the parameters assessed. Overall, pro-seizurogenic compounds showed a distinct fingerprint in the ion channel/MEA panel. These studies highlight the potential utility of an integrated in vitro approach for early seizure prediction to provide mechanistic information and to support optimal drug design in early development, saving time and resources. [ABSTRACT FROM AUTHOR]

First-time seizures comprise 15% to 35% of all seizure-related complaints in the emergency department (ED). Emergent neuroimaging of first-time seizure patients is recommended by both the American Academy of Neurology and American College of Emergency Physicians. However, most of these studies are over 10 years old and included both adults and children. The goal of this investigation is to determine the rate of abnormal neuroimaging in adults with first-time seizures presenting to the ED during the current era. This was a prospective observational study of patients presenting to three urban EDs with a chief complaint of seizure over 18 months. Abnormal neuroimaging findings were defined a priori and were dichotomized into acute and subacute/chronic categories. Of the 2505 patients who presented with a seizure, 242 patients (9.7%) presented with a first-time seizure. The most common etiologies for first-time seizures were drug intoxication and drug withdrawal. Of those 242 patients, 29 (11.9%) patients had abnormal findings on brain computed tomography (CT). Brain CT demonstrated an acute finding in 13 (45%) patients and a subacute/chronic finding in 16 (55%) patients. The most common abnormality overall and the most common chronic finding was ischemic changes. The most common acute findings were traumatic intracranial hemorrhage and intracranial metastases. This study demonstrated that 11.9% of first-time seizure patients presenting to the ED had abnormal findings on neuroimaging. Our findings support current recommendations to obtain emergent neuroimaging for adult patients with first-time seizures. [ABSTRACT FROM AUTHOR]

Aims: Despite the availability of newer antiseizure medications, carbamazepine (CBZ) remains the gold standard. However, patients of Asian ancestry are susceptible to CBZ‐related severe cutaneous adverse reactions. Universal HLA‐B*15:02 screening is a promising intervention to address this. With the increasing recognition of integrating real‐world evidence in economic evaluations, the cost‐effectiveness of universal HLA‐B*15:02 screening was assessed using available real‐world data in Malaysia. Methods: A hybrid model of a decision tree and Markov model was developed to evaluate 3 strategies for treating newly diagnosed epilepsy among adults: (i) CBZ initiation without HLA‐B*15:02 screening (current practice); (ii) universal HLA‐B*15:02 screening prior to CBZ initiation; and (iii) alternative prescribing without HLA‐B*15:02 screening. The model was populated with real‐world inputs derived from the Malaysian population. From a societal perspective, base‐case analysis and sensitivity analyses estimated the costs and outcomes over a lifetime. Incremental cost‐effectiveness ratios were calculated. Results: In the base‐cases analysis, universal HLA‐B*15:02 screening yielded the lowest total costs and the highest total quality‐adjusted life years (QALYs) gained. Compared with current practice, universal screening was less costly by USD100 and more effective by QALYs increase of 0.1306, while alternative prescribing resulted in 0.1383 QALYs loss at additional costs of USD332. The highest seizure remission rate (56%) was estimated for universal HLA‐B*15:02 screening vs. current practice (54%) and alternative prescribing (48%). Conclusion: Our study suggests that universal HLA‐B*15:02 screening is a cost‐effective intervention in Malaysia. With the demonstrated value of real‐world evidence in economic evaluations, more relevant standardization efforts should be emphasized to better inform decision‐making. [ABSTRACT FROM AUTHOR]

Background: Glioblastoma, the most aggressive primary brain tumour in adults, poses significant challenges for patients and their caregivers. This study investigates a range of clinical parameters, such as symptoms, tumour characteristics, presence of seizures, mental status, and depression/anxiety, in glioblastoma patients. The rapid deterioration of physical and cognitive functions experienced by patients can have profound effects on both patients and their relatives throughout the course of the disease. The objective of this study was to examine and compare psychological symptoms between glioblastoma patients and their relatives. Materials and Methods: The study included 98 adult patients with glioblastoma who underwent pre‐ and postoperative cognitive assessments using the Mini‐Mental State Examination (MMSE). The Hospital Anxiety and Depression Scale (HADS) was also used to evaluate and compare psychological symptoms of patients and their relatives over time. Seizures were seen in 45.9% of patients, and the mean age of the patients was 60.1 ± 13.8 years. The patients were evaluated at various time intervals before and after surgery, and the data were retrospectively analyzed. Results: The study found that before surgery, the anxiety levels of caregivers were significantly higher than those of patients during all evaluation periods. Additionally, the depression scores of caregivers were significantly higher than those of patients only in the first month following the operation. There were no significant differences in depression scores between patients and caregivers in the other assessment intervals. The average cognitive level of patients, as assessed by the MMSE scale was 22.4 before the operation and 20.9 after the operation. Conclusion: Glioblastoma has a significant impact on the mental health and emotional well‐being of both patients and their relatives. This study highlights the importance of providing early support to both patients and their relatives before surgery. The study's strength is that it focuses on an early time point, prior to surgery, where both patients and their relatives are already affected and may require additional support. The results of this study can help healthcare professionals to better understand the psychological impact of glioblastoma and provide more targeted support to patients and their caregivers. [ABSTRACT FROM AUTHOR]

Aim: Glioma, particularly glioblastoma (GBM), represents a prevalent and aggressive primary brain tumor with limited curative options. Epileptic seizures often manifest as a common clinical symptom in these patients, but their prognostic significance remains debated. This study aimed to retrospectively analyze the clinical presentations, tumor characteristics, and the impact of seizures on the prognosis of GBM patients. Materials and Methods: A total of 113 adult patients with histologically confirmed GBM treated between April 2018 and January 2022 were included in this retrospective analysis. Data encompassed clinical symptoms, preoperative and postoperative seizures, tumor localization, overall survival (OS), and other relevant factors. Statistical analysis was performed to assess the relationships between seizures and various prognostic parameters. Results: Seizures were present in 39.8% of GBM patients, with 20 patients experiencing both preoperative and postoperative seizures. Preoperative and postoperative seizures were not significantly associated with differences in prognosis (p>0.05). Tumor localization, OS, Karnofsky performance score, and length of hospital stay showed significant differences between patients with and without seizures (p<0.05). Complete resection was achieved in 90.3% of patients, leading to a relatively lower incidence of postoperative seizures. Conclusion: Seizures in GBM patients are associated with OS, Karnofsky performance score, and hospitalization duration, independently of other factors. The presence of seizures serves as a valuable prognostic indicator for GBM, prompting further investigation into its influence on patient outcomes, quality of life, and socioeconomic aspects of survival. These findings emphasize the importance of early seizure management in GBM patients and the need for tailored treatment strategies. [ABSTRACT FROM AUTHOR]

Precision medicine has the potential to have a significant impact on both drug development and patient care. It is crucial to not only provide prompt effective antiseizure treatment for critically ill patients after seizures start but also have a proactive mindset and concentrate on epileptogenesis and the underlying cause of the seizures or seizure disorders. Critical illness presents different treatment issues compared with the ambulatory population, which makes it challenging to choose the best antiseizure medications and to administer them at the right time and at the right dose. Since there is a paucity of information available on antiseizure medication dosing in critically ill patients, therapeutic drug monitoring is a useful tool for defining each patient's personal therapeutic range and assisting clinicians in decision‐making. Use of pharmacogenomic information relating to pharmacokinetics, hepatic metabolism, and seizure etiology may improve safety and efficacy by individualizing therapy. Studies evaluating the clinical implementation of pharmacogenomic information at the point‐of‐care and identification of biomarkers are also needed. These studies may make it possible to avoid adverse drug reactions, maximize drug efficacy, reduce drug–drug interactions, and optimize medications for each individual patient. This review will discuss the available literature and provide future insights on precision medicine use with antiseizure therapy in critically ill adult patients. [ABSTRACT FROM AUTHOR]

Background and purpose: Research on the relationship between the gut microbiome and epilepsy is accumulating. The present study was conducted to evaluate the effect of probiotic supplementation on pentylenetetrazole (PTZ)‐induced seizures in rats. Methods: Twenty‐one adult male Wistar albino rats were included. The animals were divided into three groups of seven rats. Group 1 was a control group, whereas Group 2 rats received PTZ treatment and Group 3 rats had PTZ+PB (probiotic) treatment. For 6 weeks, Groups 1 and 2 were given saline (1 ml), whereas Group 3 had probiotic supplement. In the 5th week, tripolar electrodes were attached to the rats. Electrophysiological, behavioral, biochemical, and immunohistochemical evaluations were performed in the 6 weeks after the treatment. Results: PB treatment significantly reduced seizures. In the PTZ group, expression levels of brain‐derived neurotrophic factor, nerve growth factor (NGF), and Sox2 (SRY sex‐determining region Y‐box 2) in rat brains decreased significantly compared to the control group, whereas the expression levels of tumor necrosis factor‐alpha (TNF‐α), interleukin‐6 (IL‐6), total oxidant status (TOS), and nitric oxide (NO) levels increased. In the PTZ+PB group, NGF expression increased significantly compared to the PTZ group, whereas TNF‐α, IL‐6, TOS, and NO levels decreased. In histopathological examination, an abundance of necrotic neurons was notable in the PTZ group, which was less in the PTZ+PB group. In addition, body weight of the group supplemented with probiotics decreased after the treatment. Conclusions: Our results suggest that probiotic supplementation may alleviate seizure severity and exert neuroprotective effects by reducing neuroinflammation and oxidative stress and altering the expression of neurotrophins in epileptogenic brains. [ABSTRACT FROM AUTHOR]

Purpose: A retrospective study, based on a prospectively built database, presents the results of long-term follow-up care of pediatric vagus nerve stimulation (VNS) patients in terms of seizure outcome, surgical aspects, the potential impact of maturation, and medication changes. Methods: From a prospectively built database, 16 VNS patients (median age 12.0 years, range 6.0 to 16.0 years; median seizure duration 6.5 years, range 2.0 to 15.5 years) followed for at least 10 years were graded as non-responder – NR (seizure frequency reduction < 50%), responder – R (reduction ≥ 50% and < 80%), and 80% responder – 80R (reduction ≥ 80%). Data about surgical aspects (battery replacement, system complications), seizure dynamics, and medication changes were taken from the database. Results: The early percentages of good results (80R + R) were 43.8% (year 1), 50.0% (year 2), and 43.8% (year 3). These percentages remained stable between years 10 and 12 (50% year 10; 46.7% year 11; 50% year 12) and increased in years 16 (60%) and 17 (75%). Depleted batteries were replaced in ten patients, six of whom were either R or 80R. In the four NR, the indication for replacement was improved quality of life. Three patients had VNS explanted or switched off—one had repeated asystolia and two were NR. The effect of hormonal changes in menarche on seizure was not proven. During the study, antiseizure medication was changed in all patients. Conclusions: The study proved the efficacy and safety of VNS in pediatric patients over an exceptionally long follow-up period. The demand for battery replacements indicates a positive treatment effect. [ABSTRACT FROM AUTHOR]

Objective: We aimed to assess the incidence and risk factors for de novo epilepsy after arteriovenous malformation (AVM) resection and compare them with a nonresection cohort after propensity score matching, utilizing a national database. Methods: Utilizing the TriNetX Research Network, we queried cases from January 1, 2004 to March 1, 2022. We included patients of all ages who underwent supratentorial AVM resection, presenting without seizures on or before surgery and without being on antiseizure medications at least 1 day before surgery. The primary outcome was seizures manifesting at least 6 weeks after surgery. Patient characteristics and outcomes were compared between the cohorts with and without postoperative epilepsy. Further cohorts were created to compare cohorts with and without embolization or rupture. After propensity score matching, we compared an additional cohort of patients with an AVM diagnosis who did not undergo resection. Results: Of the 536 patients (mean age = 38.9 ± 19.6, 52% females) presenting without seizure who underwent AVM resection, 99 (18.5%) developed de novo epilepsy, with a 1‐year cumulative incidence of 13.8%. Patients with epilepsy had higher rates of intracerebral hemorrhage, and intracerebral hemorrhage was less common in the embolization cohort. Patients in the ruptured cohort were older and more often males. After propensity score matching with 18 588 patients with AVM diagnosis but no resection, each group consisted of 529 patients, and de novo epilepsy at 1 year was significantly higher in the AVM resection cohort compared to the nonresection cohort (11.5% vs. 3.4%, p <.001). Significance: This analysis of 536 patients provides evidence that de novo epilepsy after brain AVM resection occurs at a 1‐year cumulative incidence of 13.8%, with a total of 19.4% developing de novo epilepsy. Intracerebral hemorrhage was inconsistently associated with postoperative de novo epilepsy. De novo epilepsy was significantly less frequent after AVM diagnosis without resection. [ABSTRACT FROM AUTHOR]

Epileptic seizure detection has undergone progressive advancements since its conception in the 1970s. From proof-of-concept experiments in the latter part of that decade, it has now become a vibrant area of clinical and laboratory research. In an effort to bring this technology closer to practical application in human patients, this study introduces a customized approach to selecting electroencephalogram (EEG) features and electrode positions for seizure prediction. The focus is on identifying precursors that occur within 10 min of the onset of abnormal electrical activity during a seizure. However, there are security concerns related to safeguarding patient EEG recordings against unauthorized access and network-based attacks. Therefore, there is an urgent need for an efficient prediction and classification method for encrypted EEG data. This paper presents an effective system for analyzing and recognizing encrypted EEG information using Arnold transform algorithms, chaotic mapping, and convolutional neural networks (CNNs). In this system, the EEG time series from each channel is converted into a 2D spectrogram image, which is then encrypted using chaotic algorithms. The encrypted data is subsequently processed by CNNs coupled with transfer learning (TL) frameworks. To optimize the fusion parameters of the ensemble learning classifiers, a hybridized spoofing optimization method is developed by combining the characteristics of corvid and gregarious-seeking agents. The evaluation of the model's effectiveness yielded the following results: 98.9 ± 0.3% accuracy, 98.2 ± 0.7% sensitivity, 98.6 ± 0.6% specificity, 98.6 ± 0.6% precision, and an F1 measure of 98.9 ± 0.6%. When compared with other state-of-the-art techniques applied to the same dataset, this novel strategy demonstrated one of the most effective seizure detection systems, as evidenced by these results. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to investigate and identify the predictors associated with the incidence of seizures in patients with encephalocele (EC). Methods: A retrospective analysis was undertaken of patients treated for EC at a tertiary medical center in Tehran between 2010 and 2021. Data including age at presentation, gender, location, size, and content of EC, ventriculomegaly, hydrocephalus, associated anomalies, and neurodevelopmental delay (NDD) were evaluated for their prognostic value. In addition, univariate and multivariate analyses were performed to identify the correlation between independent predictors and seizure incidence. Results: One hundred and two cases of EC were identified. Seventy-one ECs (69.6%) were posterior ECs, while 31 (30.4%) were anterior. Neural tissue was found in 43 (42.2%) of the ECs. Thirty-three patients (32.4%) had ventriculomegaly, of which 90.9% underwent shunt placement for progressive or symptomatic hydrocephalus. Seizure was found in 26 (25.5%) patients. On univariate analysis, presence of other anomalies, postoperative infections, and NDD were associated with seizures (p < 0.05). When the anomalies were categorized into intracranial and extracranial groups in univariate analysis, none was associated with statistically significant increase in seizure (p values of 0.09 and 0.61, respectively). Although according to multivariate analysis, only the association between other associated anomalies and seizure was near significant (OR: 2.0, 95% CI: 0.95–4.2, p = 0.049). Children with NDD and postoperative infection were, respectively, 3.04 and 1.3 times more at risk to experience seizures compared to other patients. Conclusion: We found a rate of 25.5% risk of seizure in patients with EC. This study could not find any significant predictors of seizure in children with EC. However, pediatric patients with postoperative infections including sepsis, wound infection, and NDD require more consideration to reduce the risk of seizure. [ABSTRACT FROM AUTHOR]

Background: Rapidly progressive glomerulonephritis (RPGN) is clinically manifestations as a rapidly progressive renal failure and pathologically as crescentic and necrotizing lesions with infiltration of inflammatory cells in the glomeruli. Uremic encephalopathy (UE) usually develops in patients who are suffering from acute or chronic renal failure. Objective: The purpose of this article is to provide reference for clinical diagnosis and treatment of renal disease complicated with seizures. Patients Two cases of anti‐glomerular basement membrane type rapidly progressive glomerulonephritis complicated with seizures were reported. Materials & Methods: In case 1, a 40‐year‐old woman was hospitalized for the treatment of nausea, anorexia, and fever. On admission, she presented with elevated serum inflammatory indicators, moderate anemia, and advanced acute kidney injury requiring hemodialysis. Her anti‐glomerular basement membrane (GBM) antibody in serum and renal tissues was found to be extremely high. She was finally diagnosed with anti‐GBM disease. She was treated with a combination of corticosteroid pulse therapy, oral cyclophosphamide and prednisolone, and plasma exchange, while continued to require maintenance hemodialysis for end‐stage kidney disease. During treatment, she suddenly suffered blindness, seizure, and consciousness disturbance. She was diagnosed as posterior reversible leukoencephalopathy syndrome by magnetic resonance imaging (MRI). The posterior reversible leukoencephalopathy syndrome subsided quickly after control of her hypertension and reinforcement of immunosuppressive treatment. In case 2, the patient also developed epileptic symptoms on the basis of GBM disease, and was given treatment similar to that of Case 1, so that the epileptic symptoms were controlled. Result: Reversible posterior leukoencephalopathy syndrome, especially when accompanied by cerebral hemorrhage, may lead to irreversible and lethal neurological abnormalities, and nephrologists should, therefore, be aware of the potential risk of reversible posterior leukoencephalopathy syndrome in patients with anti‐GBM disease. We can discuss the current two cases in the light of the previous literature. [ABSTRACT FROM AUTHOR]

Epilepsy is a common chronic neurological disorder caused by aberrant neuronal electrical activity. Antiseizure medications (ASMs) are the first line of treatment for people with epilepsy (PWE). However, their effectiveness may be limited by their inability to cross the blood–brain barrier (BBB), among many other potential underpinnings for drug resistance in epilepsy. Therefore, there is a need to overcome this issue and, hopefully, improve the effectiveness of ASMs. Recently, synthetic nanoparticle‐based drug delivery systems have received attention for improving the effectiveness of ASMs due to their ability to cross the BBB. Furthermore, exosomes have emerged as a promising generation of drug delivery systems because of their potential benefits over synthetic nanoparticles. In this narrative review, we focus on various synthetic nanoparticles that have been studied to deliver ASMs. Furthermore, the benefits and limitations of each nano‐delivery system have been discussed. Finally, we discuss exosomes as potentially promising delivery tools for treating epilepsy. [ABSTRACT FROM AUTHOR]

Introduction: Annexin A2 (ANXA2) participates in the pathology of a variety of diseases. Nevertheless, the impact of ANXA2 on epilepsy remains to be clarified. Aims: Hence, the study aimed at investigating the underlying role of ANXA2 in epilepsy through behavioral, electrophysiological, and pathological analyses. Results: It was found that ANXA2 was markedly upregulated in the cortical tissues of temporal lobe epilepsy patients (TLE), kainic acid (KA)‐induced epilepsy mice, and in a seizure‐like model in vitro. ANXA2 silencing in mice suppressed first seizure latency, number of seizures, and seizure duration in behavioral analysis. In addition, abnormal brain discharges were less frequent and shorter in the hippocampal local field potential (LFP) record. Furthermore, the results showed that the frequency of miniature excitatory postsynaptic currents was decreased in ANXA2 knockdown mice, indicating that the excitatory synaptic transmission is reduced. Co‐immunoprecipitation (COIP) experiments demonstrated that ANXA2 interacted with the α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid receptor (AMPAR) subunit GluA1. Moreover, ANXA2 knockdown decreased GluA1 expression on the cell surface and its phosphorylation onserine 831 and serine 845, related to the decreased phosphorylation levels mediated by protein kinases A and C (PKA and PKC). Conclusions: This study covers a previously unknown and key function of ANXA2 in epilepsy. These findings indicate that ANXA2 can regulate excitatory synaptic activity mediated by AMPAR subunit GluA1 to improve seizure activity, which can provide novel insights for the treatment and prevention of epilepsy. [ABSTRACT FROM AUTHOR]

• Seizures are commonly seen among meningioma patients and may cause impaired quality of life. • Contains a considerable number of 333 patients. • Three factors were associated with poor seizure control. • Only study which has mentioned regarding the role of presence of intranuclear inclusion bodies. • Advocates a balanced approach. Seizures are commonly seen among meningioma patients and may cause impaired quality of life. These patients can be effectively treated with surgery. Still, many patients have persistent seizure episodes after surgery. The factors which are associated with worsening of seizure episodes remain critical in improving the quality of life for such patients. In this study, we aim to analyze the clinical and histopathological factors to predict the post excision seizure-outcome in meningioma and need of antiepileptic prophylaxis for these patients. Adult patients who underwent primary resection of meningioma at our institute between 2007 and 2020 were included in the study. Eligibility criteria were as follows: (i) Surgery for newly-diagnosed biopsy proven meningioma, (ii) Presence of pre-operative seizure (iii) A follow-up period ≥ 12 months. Of the 1145 patients in this series, 333 patients were recruited in study. The major determinants of prophylactic anti-epileptic were tumour size (S), Oedema (O), location (L), inclusion body (I), antiepileptic drugs (D) and surgical complication (C). The factors independently associated with poor seizure control after surgical resection were presence of brain parenchyma invasion (p < 0.001), pre-operative use of > 2 antiepileptics (p = 0.016) and presence of intranuclear inclusion bodies (p = 0.001). The identification and consideration of factors associated with prolonged seizure control after surgery may help us to guide treatment strategies aimed at improving the quality of life for patients with meningiomas. Authors have proposed a SOLID-C guideline to avoid the blanket approach of prophylactic AED in patients undergoing for meningioma resection. [ABSTRACT FROM AUTHOR]

In patients who experience a seizure, the seizure duration is a strong indicator of prognosis. Thus, reducing time to antiepileptic medications in patients who are actively seizing is critical. While findings from retrospective studies suggest that the rapid administration of undiluted intravenous (IV) levetiracetam may be safe, some gaps in the literature remain. The purpose of this research study was to prospectively assess adverse events associated with the rapid administration of undiluted IV levetiracetam. This was a prospective, observational cohort study of adult patients who received rapid administration of undiluted IV levetiracetam at doses up to 4500 mg in the emergency department (ED) of a large community, teaching hospital. The primary endpoint was the incidence of any pre-defined adverse event. Secondary endpoints included the incidence of each type of adverse event, the incidence of seizure termination, and the time to completion of drug administration in patients actively seizing at the time of study inclusion. A total of 321 doses of IV push levetiracetam were ordered for 318 patients and 250 patients were subsequently included. Fourteen (5.6%) patients experienced an adverse event, most commonly due to injection site reactions (9/14). Clinically relevant hypotension, tachycardia, and hypertension occurred in five patients. For actively seizing patients, 79% (15/19) achieved seizure termination and the median time from medication order to completion of therapy was 12 min. This study found that the rapid administration of undiluted IV levetiracetam in ED patients was associated with few adverse events. [ABSTRACT FROM AUTHOR]

Epilepsy is considered a widespread chronic illness; it is estimated that approximately 1% of all children have the condition. Parents and caregivers of children with seizures experience fear and anxiety relative to their perceived confidence to manage their child's seizures after leaving the hospital. Evidence supports the use of simulation to educate caregivers to improve their perceived level of self-efficacy. The evidence-based practice project examined the impact of utilizing a simulation training session on the self-efficacy of caregivers of children with seizures at a large pediatric medical center in the southern United States. Caregivers of children with newly diagnosed seizures or with a recent change to their seizure treatment plan attended a simulation training session individualized to their discharge instructions. Demographic data, pre- and post-training self-efficacy measurements, and program satisfaction data were collected. The 31 caregivers who participated during the 3-month implementation period experienced a statistically significant increase in self-efficacy (p <.0001 to 0.002) and reported being satisfied with the simulation education training. The project outcomes suggested simulation training was an effective method for improving the self-efficacy of caregivers of children with seizures and could be a feasible practice change at organizations with access to simulation technology. The outcomes of the project aligned with the evidence available in the literature. The results reinforced that education that includes simulated learning opportunities was generally well-received by caregivers and may improve their confidence to care for their child after discharge. • Simulation education that utilized experiential methods improved the self-efficacy of caregivers of children with seizures. • The improvement in self-efficacy occurred across a diverse demographic group of caregivers. • Caregivers of children with seizures were satisfied with their experience during simulation education training. [ABSTRACT FROM AUTHOR]

Purpose: Awake craniotomy with intraoperative functional brain mapping (FBM) bedside neurological testing is an important technique used to optimize resective brain surgeries near eloquent cortex. Awake craniotomy performed with electrocorticography (ECoG) and direct electrical stimulation (DES) for FBM can delineate eloquent cortex from lesions and epileptogenic regions. However, current electrode technology demonstrates spatial limitations. Our group has developed a novel circular grid with the goal of improving spatial recording of ECoG to enhance detection of ictal and interictal activity. Methods: This retrospective study was approved by the institutional review board at Mayo Clinic Florida. We analyzed patients undergoing awake craniotomy with ECoG and DES and compared ECoG data obtained using the 22 contact circular grid to standard 6 contact strip electrode. Results: We included 144 cases of awake craniotomy with ECoG, 73 using circular grid and 71 with strip electrode. No significant differences were seen regarding preoperative clinical and demographic data, duration of ECoG recording (p = 0.676) and use of DES (p = 0.926). Circular grid was more sensitive in detecting periodic focal epileptiform discharges (PFEDs) (p = 0.004), PFEDs plus (p = 0.032), afterdischarges (ADs) per case (p = 0.022) at lower minimum (p = 0.012) and maximum (p < 0.0012) intensity stimulation, and seizures (p = 0.048). PFEDs (p < 0.001), PFEDs plus (p < 0.001), and HFOs (p < 0.001) but not ADs (p = 0.255) predicted electrographic seizures. Conclusion: We demonstrate higher sensitivity in detecting ictal and interictal activity on ECoG during awake craniotomy with a novel circular grid compared to strip electrode, likely due to better spatial sampling during ECoG. We also found association between PFEDs and intraoperative seizures. [ABSTRACT FROM AUTHOR]

Purpose of review: The goal of this review is to outline important topics in epilepsy management for transgender and gender diverse individuals. Specifically, we describe the common gender-affirming hormone treatment regimens, how these changes in estrogens and androgens may affect seizure threshold and anti-seizure medications, and how anti-seizure medications may in turn impact hormone levels. Recent findings: Although data are mixed, most studies point to proconvulsant properties of estrogen and anticonvulsant properties of progesterone and testosterone, raising the possibility of an increased risk of breakthrough seizures when starting on feminizing gender-affirming hormone treatment. Feminizing hormone regimens containing estrogen are likely to significantly decrease serum concentration of lamotrigine. Enzyme-inducing anti-seizure medications decrease circulating levels of estrogens and androgens, which may potentially decrease the efficacy of gender-affirming hormone treatments. Summary: While a general approach to the care of transgender individuals with epilepsy may be extrapolated from existing studies on hormonal interactions in cisgender individuals, there is a clear need for further research more closely examining the complex interactions between epilepsy, anti-seizure medications, and gender-affirming hormone therapy in transgender and gender diverse individuals. [ABSTRACT FROM AUTHOR]

Epilepsies are a diverse group of disorders which differ regarding prognosis for seizure control and associated comorbidities. Accurate classification is critical to choose the highest yield investigations and best therapeutic options and to provide the most accurate prognoses regarding the expected degree of seizure control, possible remission, and risk of associated comorbidities to patients and their families. This article reviews the recent updates in epilepsy classification to illustrate how accurate classification impacts care for persons with epilepsy. The authors discuss the ILAE 2017 Classification of the Epilepsies along with the modification of the classification for neonatal seizures and epilepsies. They also discuss the ILAE position papers on Epilepsy syndromes in neonates and infants and children of variable age and the Idiopathic Generalized Epilepsies. Accurate epilepsy classification allows selection of the highest yield investigations, choice of optimal therapies, and accurate prognostication of seizures (likelihood of response to antiseizure treatments and likelihood of remission with age), as well as comorbidities (likelihood, type, and severity). As we move into the era of disease modifying therapy, early accurate identification of underlying causes with timely introduction of specific treatments will be crucial to lessen the severity of epilepsy, with improved seizure control and attenuation of associated comorbidities. [ABSTRACT FROM AUTHOR]

The article focuses on the formation of the international law principle of the right to peaceful enjoyment of possessions in the context of an international armed conflict, given the relevance of the issue of damage and destruction of property as part of the armed aggression of the Russian Federation against the sovereignty and territorial integrity of Ukraine. The author examines the right to peaceful enjoyment of possessions through the prism of international human rights law - as such, where the right to peaceful enjoyment of possessions (property rights) has been enshrined in the international law system, and also through the prism of international humanitarian law and international criminal law - as such, which are special in relation to the right to peaceful enjoyment of possessions in the context of international armed conflict. The article examines the principle of inviolability of property rights at the national level, in particular, in legislative and judicial sources, and its impact on the formation of the relevant international law principle. In particular, the author analyses the philosophical development of the concepts of "sacredness" of property rights and inviolability of property rights, as well as the natural essence of this right for a person. The author examines in detail the rules of conventional and customary international humanitarian law on the right to peaceful enjoyment of property/property rights depending on the type of acts that may be committed against property and the type of property against which certain acts are directed in the context of an international armed conflict or legal regime of occupation. The provisions on the protection of civilian objects, as well as the non-absolute nature of the protection of property rights in international armed conflict in cases of urgent military necessity, are carefully considered. Based on this analysis, the author identifies the key fundamental provisions on the basis of which the international legal principle of the right to peaceful enjoyment of property in the context o f international armed conflict is formed. [ABSTRACT FROM AUTHOR]

Electrical stimulation is an increasingly popular method to terminate epileptic seizures, yet it is not always successful. A potential reason for inconsistent efficacy is that stimuli are applied empirically without considering the underlying dynamical properties of a given seizure. We use a computational model of seizure dynamics to show that different bursting classes have disparate responses to aborting stimulation. This model was previously validated in a large set of human seizures and led to a description of the Taxonomy of Seizure Dynamics and the dynamotype, which is the clinical analog of the bursting class. In the model, the stimulation is realized as an applied input, which successfully aborts the burst when it forces the system from a bursting state to a quiescent state. This transition requires bistability, which is not present in all bursters. We examine how topological and geometric differences in the bistable state affect the probability of termination as the burster progresses from onset to offset. We find that the most significant determining factors are the burster class (dynamotype) and whether the burster has a DC (baseline) shift. Bursters with a baseline shift are far more likely to be terminated due to the necessary structure of their state space. Furthermore, we observe that the probability of termination varies throughout the burster's duration, is often dependent on the phase when it was applied, and is highly correlated to dynamotype. Our model provides a method to predict the optimal method of termination for each dynamotype. These results lead to the prediction that optimization of ictal aborting stimulation should account for seizure dynamotype, the presence of a DC shift, and the timing of the stimulation. [ABSTRACT FROM AUTHOR]

Autophagy is an explicit cellular process to deliver dissimilar cytoplasmic misfolded proteins, lipids and damaged organelles to the lysosomes for degradation and elimination. The mechanistic target of rapamycin (mTOR) is the main negative regulator of autophagy. The mTOR pathway is involved in regulating neurogenesis, synaptic plasticity, neuronal development and excitability. Exaggerated mTOR activity is associated with the development of temporal lobe epilepsy, genetic and acquired epilepsy, and experimental epilepsy. In particular, mTOR complex 1 (mTORC1) is mainly involved in epileptogenesis. The investigation of autophagy's involvement in epilepsy has recently been conducted, focusing on the critical role of rapamycin, an autophagy inducer, in reducing the severity of induced seizures in animal model studies. The induction of autophagy could be an innovative therapeutic strategy in managing epilepsy. Despite the protective role of autophagy against epileptogenesis and epilepsy, its role in status epilepticus (SE) is perplexing and might be beneficial or detrimental. Therefore, the present review aims to revise the possible role of autophagy in epilepsy. [ABSTRACT FROM AUTHOR]

Epilepsy is one of the most common neurologic disorders that is characterized by recurrent seizures, and depending on the type of seizure, it could lead to a severe outcome. Epilepsy’s mechanism of development is not fully understood yet, but some of the common features of the disease are blood-brain barrier disruption, microglia activation, and neuroinflammation. Those are also targets of activated protein C (APC). In fact, by downregulating thrombin, known as a pro-inflammatory, APC acts as an anti-inflammatory. APC is also an anti-apoptotic protein, instance by blocking p53-mediated apoptosis. APC’s neuroprotective effect could prevent blood-brain barrier dysfunction by acting on endothelial cells. Furthermore, through the downregulation of proapoptotic, and proinflammatory genes, APC’s neuroprotection could reduce the effect or prevent epilepsy pathogenesis. APC’s activity acts on blood-brain barrier disruption, inflammation, and apoptosis and causes neurogenesis, all hallmarks that could potentially treat or prevent epilepsy. Here we review both Activated Protein C and epilepsy mechanism, function, and the possible association between them. [ABSTRACT FROM AUTHOR]

Background: Juvenile myoclonus epilepsy (JME) is an idiopathic generalized epilepsy syndrome. Functional connectivity studies based on graph theory have demonstrated changes in functional connectivity among different brain regions in patients with JME and healthy controls. However, previous studies have not been able to clarify why visual stimulation or increased cognitive load induces epilepsy symptoms in only some patients with JME. Methods: This study constructed a small-world network for the visualization of functional connectivity of brain regions in patients with JME, based on system mapping. We used the node reduction method repeatedly to identify the core nodes of the resting brain network of patients with JME. Thereafter, a functional connectivity network of the core brain regions in patients with JME was established, and it was analyzed manually with white matter tracks restriction to explain the differences in symptom distribution in patients with JME. Results: Patients with JME had 21 different functional connections in their resting state, and no significant differences in their distribution were noted. The thalamus, cerebellum, basal ganglia, supplementary motor area, visual cortex, and prefrontal lobe were the core brain regions that comprised the functional connectivity network in patients with JME during their resting state. The betweenness centrality of the prefrontal lobe and the visual cortex in the core functional connectivity network of patients with JME was lower than that of the other brain regions. Conclusion: The functional connectivity and node importance of brain regions of patients with JME changed dynamically in the resting state. Abnormal discharges originating from the thalamus, cerebellum, basal ganglia, supplementary motor area, visual cortex, and prefrontal cortex are most likely to lead to seizures in patients with JME. Further, the low average value of betweenness centrality of the prefrontal and visual cortices explains why visual stimulation or increased cognitive load can induce epileptic symptoms in only some patients with JME. [ABSTRACT FROM AUTHOR]

Abstract Introduction Objective Methods Results Conclusion The World Health Organization (WHO) defines quality of life as a person’s assessment of their place in life in the context of the culture and value systems in which they live, as well as in connection to their objectives, expectations, standards, and worries. Physiological as well as emotional wellness both affect quality of life (QOL).To assess and evaluate the quality of life in epileptic patients by using Quality of life in epilepsy inventory for adolescent (QOLIE-AD-48) and Quality of life in epilepsy inventory for adults (QOLIE-31) at tertiary care hospital.After receiving approval from the Institution Ethics Committees (IEC) of the ISF College of Pharmacy and Guru Gobind Singh Medical College and Hospital, Faridkot. This observational and questionnaire based study was carried out for a period of six months. Quality of life in epilepsy inventory for adolescent (QOLIE-AD-48) and Quality of life in epilepsy inventory for adults (QOLIE-31) had been used for this research and got approval from Dr. Joyce A. Cramer to use the questionnaire.Except for the patients who declined to participate in the study, 109 individuals who participated in the observation and questionnaire-based study was enrolled. In this study, it was discovered that adolescents made up the majority of the patients with respect to adults and quality of life was found to be good (p = 0.062). The mean score of quality of life of the patients and standard deviation (SD) was found to be (M = 61.26) and (SD = 21.10). Males (63%, 69 patients) were found higher with respect to females (37%, 40 patients). Linear regression test was found to be significant (p = 0.003) of quality of life score (dependent variable) in relation to age and weight (independent variable) of the patients it. One way ANOVA test was found significant of quality of life score in relation to educational status (p = 0.001), epilepsy from last year (p = 0.001), and drug therapy (p = 0.017).The current study explains the relationship between quality of life and other dependent variables by using different statistical analysis techniques. The quality of life of epileptic patients must be assessed on an individual basis, taking into consideration the patient’s state of physical health and psychological state. This study concludes that the quality of life of epileptic patients was found to be good as per significant results. If any of factors changes then there will also be differ in quality of life score. [ABSTRACT FROM AUTHOR]

Drug-resistant epilepsy (DRE) has a strongly negative impact on quality of life, as well as the development of pediatric patients. Surgical treatments have evolved over time, including more invasive craniotomies for resection or disconnection. More recently, neuromodulation techniques have been employed as a less invasive option for patients. Responsive neurostimulation (RNS) is the first closed-loop technology that allows for both treatment and device data collection, which allows for an internal assessment of the efficacy of treatment. This novel technology has been approved in adults and has been used off label in pediatrics. This review seeks to describe this technology, its history, and future directions. [ABSTRACT FROM AUTHOR]

Introduction. Epilepsy is one of the most common neurological diseases. It is an uncontrollable neuronal activity of different parts of the brain leading to convulsion and/or fainting. Although epileptic seizure control and therapeutics have significant advances, 20% - 30% of individuals still have uncontrolled seizures. Patients under the medication's control are not free from the drug's side effects and complications. Epileptic patients experience many different challenges. Transcranial direct current stimulation (tDCS) is a safe and non-invasive brain stimulation method applied in drug-resistant seizures and epilepsies. It transmits positive/negative electrical current toward deep brain parts, modulating their electrical activity. Methods. This is a review article. All relevant articles which were accessible were reviewed. The effectiveness of tDCS in preventing epilepsy in patients undergoing seizures was reviewed in this article. Conclusion. According to the studies, this method can probably be an auxiliary method in preventing and treating seizures. As epileptic seizures were induced and confirmed in some studies after the application of tDCS, the method should be cautiously applied. [ABSTRACT FROM AUTHOR]

Dyke-Davidoff-Masson syndrome (DDMS) is a rare neuro-osteal syndrome of childhood and a constellation of cerebral hemiatrophy, facial asymmetry, seizures, osseous changes, and hemiplegia. It commonly presents with seizures and hemiplegia. The involvement of the kidney in DDMS is not known in the available literature, except in a case report that described ectopic kidney in DDMS. We present the case of a 15-year-old boy who presented with recurrent seizures, right facial palsy, left hemiparesis, and advanced renal failure. The neuroimaging revealed diffuse right cerebral atrophy, dilatation of the ipsilateral lateral ventricle, and ipsilateral thickening of the calvaria. The nephrological evaluation suggested the diagnosis of chronic kidney disease stage VD, probably secondary to congenital hypoplasia of the kidney. [ABSTRACT FROM AUTHOR]

Delayed responses (DRs) to single pulse electrical stimulation (SPES) in patients with severe refractory epilepsy, from their intracranial recordings, can help to identify regions associated with epileptogenicity. Automatic DR localization is a large step in speeding up the identification of epileptogenic focus. Here, for the first time, an adaptive iterative linearly constrained minimum variance beamformer (AI-LCMV) is developed and employed to localize the DR sources from intracranial electroencephalogram (EEG) recorded using subdural electrodes. The prime objective here is to accurately localize the regions for the corresponding DRs using an adaptive localization method that exploits the morphology of DRs as the desired sources. The traditional closed-form linearly constrained minimum variance (CF-LCMV) solution is meant for tracking the sources with dominating power. Here, by incorporating the morphology of DRs, as a constraint, to an iterative linearly constrained minimum variance (LCMV) solution, the array of subdural electrodes is used to localize the low-power DRs, some not even visible in any of the electrode signals. The results from the cases included in this study also indicate more distinctive locations compared to those achievable by conventional beamformers. Most importantly, the proposed AI-LCMV is able to localize the DRs invisible over other electrodes. [ABSTRACT FROM AUTHOR]

Antibiotics are medicines that fight against bacterial infections and are usually considered safe drugs. However, they can simultaneously cause several adverse reactions. Nitrofurantoin, which is mainly administered for treatment and prevention of urinary tract infections, causes seizure reportedly. Therefore, further research is required to be conducted to simulate the case report situations and examine whether nitrofurantoin is the main factor leading to seizures. To do this, NMRI male mice (20-30 gr) were chosen and classified into different groups in both acute and chronic phases. Each phase contained mice treated with nitrofurantoin, phenytoin and the combination of both drugs as well as untreated control group. An Electroshock device was used to induce seizure in mice and then the effect of nitrofurantoin and phenytoin was examined in acute and chronic phases. Seizure induction in mice was examined 30 minutes and one week after injection in acute and chronic phases, respectively. Results indicated that THE (Tonic Hind-limb Extension) duration was different among the studied groups. Nitrofurantoin-injected mice were revealed to have a higher THE duration in comparison with control group, while phenytoin-injected group showed a lower THE duration. Furthermore, administration of nitrofurantoin and phenytoin combination reduced THE duration in both acute and chronic phases. Our conclusion is that nitrofurantoin can possess convulsive effects and cause seizure as a side effect. [ABSTRACT FROM AUTHOR]

Background: In patients with cardiac arrest who remain comatose after return of spontaneous circulation, seizures and other abnormalities on electroencephalogram (EEG) are common. Thus, guidelines recommend urgent initiation of EEG for the evaluation of seizures in this population. Point-of-care EEG systems, such as Ceribell™ Rapid Response EEG (Rapid-EEG), allow for prompt initiation of EEG monitoring, albeit through a reduced-channel montage. Rapid-EEG incorporates an automated seizure detection software (Clarity™) to measure seizure burden in real time and alert clinicians at the bedside when a high seizure burden, consistent with possible status epilepticus, is identified. External validation of Clarity is still needed. Our goal was to evaluate the real-world performance of Clarity for the detection of seizures and status epilepticus in a sample of patients with cardiac arrest. Methods: This study was a retrospective review of Rapid-EEG recordings from all the patients who were admitted to the medical intensive care unit at Kent Hospital (Warwick, RI) between 6/1/2021 and 3/18/2022 for management after cardiac arrest and who underwent Rapid-EEG monitoring as part of their routine clinical care (n = 21). Board-certified epileptologists identified events that met criteria for seizures or status epilepticus, as per the 2021 American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology, and evaluated any seizure burden detections generated by Clarity. Results: In this study, 4 of 21 patients with cardiac arrest (19.0%) who underwent Rapid-EEG monitoring had multiple electrographic seizures, and 2 of those patients (9.5%) had electrographic status epilepticus within the first 24 h of the study. None of these ictal abnormalities were detected by the Clarity seizure detection system. Clarity showed 0% seizure burden throughout the entirety of all four Rapid-EEG recordings, including the EEG pages that showed definite seizures or status epilepticus. Conclusions: The presence of frequent electrographic seizures and/or status epilepticus can go undetected by Clarity. Timely and careful review of all raw Rapid-EEG recordings by a qualified human EEG reader is necessary to guide clinical care, regardless of Clarity seizure burden measurements. [ABSTRACT FROM AUTHOR]