A new perspective on drug-resistant epilepsy in children with focal cortical dysplasia type 1: From challenge to favorable outcome

局灶性皮质发育不良1型儿童耐药性癫痫的新视角: 从挑战到有利结果

We comprehensively characterized a large pediatric cohort with focal cortical dysplasia (FCD) type 1 to expand the phenotypic spectrum and to identify predictors of postsurgical outcomes. This study highlights the broad phenotypic spectrum of FCD type 1, which spans far beyond the narrow descriptions of previous studies. The applied multilayered presurgical approach helped localize the epileptogenic zone in many previously nonlesional cases, resulting in improved postsurgical seizure outcomes, which are more favorable than previously reported for FCD type 1 patients.

我们全面描述了一个大型儿科局灶性皮质发育不良 (FCD) 1型队列，以扩大表型谱并确定术后预后的预测因素。这项研究突出了FCD 1型的广泛表型谱，其范围远远超出了先前研究的狭窄描述。在许多先前的非病变病例中，应用多层术前方法有助于定位癫痫发生区，从而改善了术后癫痫发作的结局，这比先前报道的FCD 1型患者更有利。

REF: Splitkova B, Mackova K, Koblizek M, et al. A new perspective on drug-resistant epilepsy in children with focal cortical dysplasia type 1: From challenge to favorable outcome. Epilepsia. 2025;66(3):632-647. doi:10.1111/epi.18237 PMID: 39724384

Evolution in the prescription and cost of non-intravenous rescue benzodiazepines for the treatment of seizure emergencies

非静脉抢救苯二氮卓类药物治疗癫痫发作的处方和费用的演变

The proportion of patients with epilepsy who have a non-intravenous rescue benzodiazepine (non-IV-rBZD) available for seizure emergencies is unknown. This study aims to describe prescription patterns from 2006 to 2022, factors associated with prescription, and the impact of recently introduced intranasal benzodiazepines on prescription and cost. The vast majority of patients with epilepsy have not filled a prescription for non-IV-rBZDs. Seizure emergency readiness can be markedly improved, especially among adults. The cost of non-IV-rBZDs has increased with intranasal rescue medications.

癫痫患者中使用非静脉抢救性苯二氮卓类药物 (非iv-rbzd) 可用于癫痫发作紧急情况的比例尚不清楚。这项研究旨在描述2006年至2022年的处方模式，与处方相关的因素以及最近引入的鼻内苯二氮卓类药物对处方和成本的影响。绝大多数癫痫患者没有填写非iv-rbzds的处方。癫痫发作的应急准备可以明显改善，尤其是在成年人中。非iv-rbzd的成本随着鼻内救援药物的增加而增加。

REF: Sánchez Fernández I, Amengual-Gual M, Barcia Aguilar C, et al. Evolution in the prescription and cost of non-intravenous rescue benzodiazepines for the treatment of seizure emergencies. Epilepsia. 2025;66(3):648-661. doi:10.1111/epi.18232 PMID: 39891603

Lateralizing value of interictal epileptiform discharges and other parameters in hypothalamic hamartoma

下丘脑错构瘤发作间期癫痫样放电和其他参数的偏侧化值

Hypothalamic hamartomas (HHs) are associated with pharmacoresistant epilepsy. Stereotactic radiofrequency thermocoagulation (SRT) shows promise as a disconnecting intervention. Although magnetic resonance imaging (MRI) is typically used to determine the attachment and intervention side, it presents challenges in cases of bilaterally attached HH, where the epileptogenic side is unclear. The lateralizing potential of electroclinical parameters in such cases remains uncertain. This retrospective study evaluates the lateralization value of specific parameters, particularly in patients with unilateral HH, to improve future diagnostics and treatment approaches for bilateral HH. IEDss are promising biomarkers for HH lateralization in unilateral HH. The predominance of unilateral IEDss suggests ipsilateral HH. Even in cases with predominantly bilateral IEDss, a slight preponderance of unilateral IEDss can indicate the attachment side. In addition, combining IEDss and semiology provides a predictive model for HH lateralization.

下丘脑错构瘤 (HHs) 与耐药性癫痫有关。立体定向射频热凝 (SRT) 显示出作为断开干预的希望。尽管磁共振成像 (MRI) 通常用于确定附着和干预侧，但在双侧附着的HH情况下，其存在挑战，其中癫痫发生侧尚不清楚。在这种情况下，电临床参数的偏侧电位仍然不确定。这项回顾性研究评估了特定参数的偏侧化值，特别是在单侧HH患者中，以改善双侧HH的未来诊断和治疗方法。IEDss是单侧HH中HH偏侧化的有希望的生物标志物。单侧IEDss占优势，提示同侧HH。即使在主要是双侧IEDss的情况下，单侧IEDss的轻微优势也可以表明附着侧。此外，结合IEDss和符号学为HH偏侧化提供了预测模型。

REF: Niedermoser F, Metzger SM, Wagner K, et al. Lateralizing value of interictal epileptiform discharges and other parameters in hypothalamic hamartoma. Epilepsia. 2025;66(3):662-673. doi:10.1111/epi.18217 PMID: 39812607

Can the large language model ChatGPT-4omni predict outcomes in adult patients with status epilepticus?

大语言模型ChatGPT-4omni能预测成年癫痫持续状态患者的预后吗？

Large language models (LLMs) have recently gained attention for clinical decision-making and diagnosis. This study evaluates the performance of the recently updated LLM Chat Generative Pre-Trained Transformer-4omni (ChatGPT-4o) in predicting clinical outcomes in patients with status epilepticus and compares its prognostic performance to the Status Epilepticus Severity Score (STESS). ChatGPT-4o unreliably predicts outcomes in patients with status epilepticus. Clinicians should refrain from using ChatGPT-4o for prognostication in these patients.

大型语言模型 (llm) 最近在临床决策和诊断中受到关注。这项研究评估了最近更新的LLM聊天生成预训练Transformer-4omni (ChatGPT-4o) 在预测癫痫持续状态患者的临床结果方面的性能，并将其预后性能与癫痫持续状态严重程度评分 (STESS) 进行了比较。ChatGPT-4o不能可靠地预测癫痫持续状态患者的结局。临床医生应避免使用ChatGPT-4o对这些患者进行预后。

REF: Amacher SA, Baumann SM, Berger S, et al. Can the large language model ChatGPT-4omni predict outcomes in adult patients with status epilepticus?. Epilepsia. 2025;66(3):674-685. doi:10.1111/epi.18215 PMID: 39723845

Bridging the conversational gap in epilepsy: Using large language models to reveal insights into patient behavior and concerns from online discussions

弥合癫痫中的对话鸿沟: 使用大型语言模型从在线讨论中揭示患者行为和担忧的见解

This study was undertaken to explore the experiences and concerns of people living with epilepsy by analyzing discussions in an online epilepsy community, using large language models (LLMs) to identify themes, demographic patterns, and associations with emotional distress, substance use, and suicidal ideation. LLM analysis of online epilepsy communities provides novel insights into patient concerns often overlooked in clinical settings. These findings may improve patient-provider communication, inform personalized interventions, and support the development of patient-reported outcome measures. Additionally, hazard models can help identify at-risk individuals, offering opportunities for early mental health interventions.

本研究旨在通过分析在线癫痫社区中的讨论，使用大型语言模型 (LLMs) 来确定主题，人口统计学模式以及与情绪困扰，物质使用和自杀意念的关联，来探索癫痫患者的经历和担忧。在线癫痫社区的LLM分析为临床环境中经常被忽视的患者问题提供了新颖的见解。这些发现可能会改善患者与提供者之间的沟通，告知个性化干预措施，并支持制定患者报告的结局指标。此外，危险模型可以帮助识别风险个体，为早期精神卫生干预提供机会。

REF: Fennig U, Yom-Tov E, Savitzky L, et al. Bridging the conversational gap in epilepsy: Using large language models to reveal insights into patient behavior and concerns from online discussions. Epilepsia. 2025;66(3):686-699. doi:10.1111/epi.18226 PMID: 39655574

Unsupervised clustering of a deeply phenotyped cohort of adults with idiopathic generalized epilepsy

成人特发性全身性癫痫的深度表型队列的无监督聚类

Idiopathic generalized epilepsy (IGE) in adults comprise juvenile myoclonic epilepsy (JME), juvenile absence epilepsy (JAE), and epilepsy with generalized tonic-clonic seizures alone (EGTCS), which are defined by their seizure types but also cover a broad endophenotype of symptoms. Controversy exists on whether adult IGE is a group of distinct diseases or a clinical spectrum of one disease. Here, we used a deeply phenotyped cohort to test the hypothesis that IGE comprises three distinct clinical entities. IGE in adults is best described as a continuum of symptoms, where age at diagnosis and executive dysfunction are two main factors explaining most of its clinical variability. The seizure-defined syndromes cover different patient groups within the clinical spectrum.

成人特发性全身性癫痫 (IGE) 包括青少年肌阵挛性癫痫 (JME)，青少年失神癫痫 (JAE) 和仅全身性强直-阵挛性癫痫发作的癫痫 (egtc)，它们由其癫痫发作类型定义，但也涵盖了广泛的内表型症状。关于成人IGE是一组不同的疾病还是一种疾病的临床范围存在争议。在这里，我们使用一个深度表型队列来检验IGE包含三个不同临床实体的假设。成人中的IGE最好被描述为症状的连续体，其中诊断时的年龄和执行功能障碍是解释其大部分临床变异性的两个主要因素。癫痫发作定义的综合征涵盖了临床范围内的不同患者群体。

REF: Gavnholt L, Gesche J, Cerulli Irelli E, et al. Unsupervised clustering of a deeply phenotyped cohort of adults with idiopathic generalized epilepsy. Epilepsia. 2025;66(3):700-711. doi:10.1111/epi.18225 PMID: 39724391

Epilepsy and employment: A qualitative interview study with heads of human resources and occupational physicians in Austria — A call for legislative optimization according to the WHO Intersectoral Global Action Plan

癫痫与就业: 奥地利人力资源和职业医生负责人的定性访谈研究-根据世卫组织部门间全球行动计划呼吁立法优化

People with epilepsy (PWEs) often face difficulties in obtaining or keeping employment. To determine the views on this topic of the heads of human resources (HHRs) and occupational physicians (OCPs). The practical and simple classification of workplaces according to the D-system, and the concept of making medical information accessible only to OCPs may diminish stigma and discrimination in the working world for PWEs.

癫痫患者 (pwe) 在获得或保持就业方面经常面临困难。确定人力资源主管 (HHRs) 和职业医师 (OCPs) 对此主题的看法。根据D系统对工作场所进行实用而简单的分类，以及仅向ocp提供医疗信息的概念，可能会减少pwe在工作世界中的污名和歧视。

REF: Leitinger M, Klampfer C, Obermeyr L, et al. Epilepsy and employment: A qualitative interview study with heads of human resources and occupational physicians in Austria - A call for legislative optimization according to the WHO Intersectoral Global Action Plan. Epilepsia. 2025;66(3):712-724. doi:10.1111/epi.18221 PMID: 39821792

Community-onset pediatric status epilepticus: Barriers to care and outcomes in a real-world setting

社区发作的小儿癫痫持续状态: 现实环境中的护理障碍和结果

Status epilepticus (SE) is a neurological emergency in childhood, often leading to neuronal damage and long-term outcomes. The study aims to identify barriers in the pre-hospital and in-hospital management of community-onset pediatric SE and to evaluate the effectiveness of pediatric scores on outcomes prediction. Effective pre-hospital administration of rescue medications and prompt PED management are crucial to reduce SE duration and improve outcomes. Predictive scores can aid in assessment of the severity and prognosis of SE; their utility is still not defined. Identifying and addressing actionable care barriers in SE management pathways is essential to enhance patient outcomes in pediatric SE.

癫痫持续状态 (SE) 是儿童时期的神经紧急情况，通常导致神经元损伤和长期结果。该研究旨在确定社区发作的儿科SE的院前和院内管理中的障碍，并评估儿科评分对结果预测的有效性。有效的院前急救药物管理和及时的PED管理对于减少SE持续时间和改善预后至关重要。预测评分可以帮助评估SE的严重程度和预后; 它们的效用仍未确定。识别和解决SE管理途径中可行的护理障碍对于提高儿科SE患者的治疗效果至关重要。

REF: Fetta A, Bergonzini L, Dondi A, et al. Community-onset pediatric status epilepticus: Barriers to care and outcomes in a real-world setting. Epilepsia. 2025;66(3):725-738. doi:10.1111/epi.18216 PMID: 39704293

Community-based epilepsy care in an onchocerciasis-endemic area: A 3-year cohort study in Mahenge, Tanzania

盘尾丝虫病流行地区基于社区的癫痫护理: 坦桑尼亚马亨格的一项为期3年的队列研究

In onchocerciasis-endemic areas, limited access to antiseizure medications (ASMs) contributes to a high epilepsy burden. This study evaluated the impact of a community-based epilepsy care program in Mahenge, Tanzania, an onchocerciasis-endemic area with high epilepsy prevalence. The community-based program using CHWs was associated with a significant reduction in seizure frequency and improved ASM adherence. In onchocerciasis-endemic areas, it should be investigated whether carbamazepine should be a preferred ASM in PWE. Ivermectin's impact on seizure frequency merits further investigation in onchocerciasis-endemic areas. Community-based epilepsy care is a promising strategy for scaling up epilepsy care in rural areas in Africa.

在盘尾丝虫病流行地区，获得抗癫痫药物 (asm) 的机会有限，导致癫痫负担沉重。这项研究评估了以社区为基础的癫痫护理计划在坦桑尼亚的Mahenge的影响，该地区是盘尾丝虫病流行地区，癫痫患病率高。使用CHWs的基于社区的计划与癫痫发作频率的显着降低和ASM依从性的提高有关。在盘尾丝虫病流行地区，应调查卡马西平是否应成为PWE的首选ASM。伊维菌素对癫痫发作频率的影响值得在盘尾丝虫病流行地区进一步研究。基于社区的癫痫护理是在非洲农村地区扩大癫痫护理的一项有前途的策略。

REF: Bhwana D, Amaral LJ, Kamoen O, et al. Community-based epilepsy care in an onchocerciasis-endemic area: A 3-year cohort study in Mahenge, Tanzania. Epilepsia. 2025;66(3):739-752. doi:10.1111/epi.18230 PMID: 39698789