Prognostic application of lesion network mapping to epilepsy surgery outcomes in pediatric tuberous sclerosis complex

病变网络映射在儿科结节性硬化症癫痫手术预后评估中的应用

Patients with tuberous sclerosis complex (TSC)-related epilepsy often have drug-refractory epilepsy and numerous potential epileptogenic tubers. Current clinical methods target tubers for resection, but prediction of resulting seizure relief is difficult. This study describes implementation of lesion network mapping in TSC patients undergoing epilepsy surgery to associate resection zone with seizure outcomes. This study provides methodology for lesion network mapping in TSC-related epilepsy. The results suggest a tendency for better outcomes when the resection zone is connected to certain networks, including the default mode and motor networks, that may support sustainment of seizures.

结节性硬化症（TSC）相关癫痫患者常患有药物难治性癫痫，且有大量潜在致痫结节。目前的临床方法以切除结节为目标，但难以预测术后癫痫缓解情况。本研究描述了在接受癫痫手术的TSC患者中实施病变网络映射，以将切除区域与癫痫发作结局相关联。本研究提供了用于TSC相关癫痫病变网络映射的方法。结果显示，当切除区域与某些可能支持癫痫发作持续的网络（包括默认模式网络和运动网络）相连时，手术结局往往更好。

REF: Miecznikowski KB, Greiner HM, Leach J, et al. Prognostic application of lesion network mapping to epilepsy surgery outcomes in pediatric tuberous sclerosis complex. Epilepsia. 2025;66(6):1854-1864. doi:10.1111/epi.18320 PMID: 40042434

Seizure outcomes following epilepsy surgery in pediatric and young adult patients with high-grade brain tumors: Results from a European survey

小儿和青年成人高级别脑肿瘤患者癫痫手术后的癫痫发作结局：一项欧洲调查结果

Epilepsy surgery is a standard treatment for drug-resistant epilepsy, resulting in seizure freedom in a significant number of cases. Although frequently performed for low-grade brain tumors, it is rarely considered for high-grade tumors, despite the impact of chronic epilepsy on quality of life and cognition. Epilepsy surgery is effective for medically refractory epilepsy in children with high-grade central nervous system tumors and should be considered early, as seizure freedom is achieved in the majority of patients. Despite involving numerous epilepsy centers, only 25 patients were recruited, indicating that this method is rarely considered for high-grade brain tumor patients with medically refractory epilepsy.

癫痫手术是耐药性癫痫的标准治疗方法，在很多病例中可使患者不再发作。虽然该手术常用于低级别脑肿瘤，但对于高级别肿瘤，尽管慢性癫痫会影响患者的生活质量和认知功能，却很少有人考虑采用这种手术。癫痫手术对患有高级别中枢神经系统肿瘤且药物治疗无效的儿童癫痫患者有效，应尽早考虑实施，因为大多数患者术后可不再发作。尽管有众多癫痫治疗中心参与，但仅招募到25名患者，这表明对于患有药物难治性癫痫的高级别脑肿瘤患者，很少有人会考虑采用这种治疗方法。

REF: Lersch R, Hartlieb T, Pieper T, et al. Seizure outcomes following epilepsy surgery in pediatric and young adult patients with high-grade brain tumors: Results from a European survey. Epilepsia. 2025;66(6):1865-1875. doi:10.1111/epi.18323 PMID: 40022587

Psychopathology in children before and after epilepsy surgery: a prospective controlled study

癫痫手术前后儿童的精神病理学表现：一项前瞻性对照研究

This study was undertaken to prospectively assess the frequency and type of psychiatric disorders (PDs) in pediatric surgical candidates and evaluate the effects of epilepsy surgery on their psychopathological profile. This prospective controlled study demonstrates a high prevalence of PD in pediatric surgical candidates and a correlation between successful surgery and reduced PD burden. An integrated approach encompassing diagnostic interviews and questionnaires, and accounting for potential disagreement between multiple informants, is essential for carefully assessing psychiatric comorbidities in children with drug-resistant seizures.

本研究旨在前瞻性评估儿科手术候选患者中精神障碍（PDs）的发生频率和类型，并评估癫痫手术对其精神病理学特征的影响。这项前瞻性对照研究表明，儿科手术候选患者中精神障碍的患病率很高，且手术成功与精神障碍负担减轻之间存在关联。一种综合的方法，包括诊断性访谈和问卷调查，并考虑到多个信息提供者之间可能存在的分歧，对于仔细评估耐药性癫痫患儿的精神共病至关重要。

REF: Matta G, Pisano T, Grisotto L, et al. Psychopathology in children before and after epilepsy surgery: a prospective controlled study. Epilepsia. 2025;66(6):1876-1887. doi:10.1111/epi.18345 PMID: 40072310

Evaluation of antiseizure medication concentration ranges in blood samples using an automated big data approach

采用自动化大数据方法评估血液样本中抗癫痫药物的浓度范围

The aim of the study is to provide insight into the real-world use of therapeutic drug monitoring (TDM) for the most common antiseizure medications (ASMs). The applied automated approach can facilitate a fast and efficient method for comparing established reference ranges with nationwide TDM datasets, thereby allowing continual monitoring of laboratory reference ranges. The findings from this study suggest that the Danish reference range for levetiracetam should be reevaluated. Furthermore, dose adjustment may be relevant for levetiracetam, topiramate, and lacosamide to account for age-related changes in metabolism. The lower concentration range for lamotrigine in the psychiatric population indicates that it may be effective at lower concentrations in patients with bipolar disorder compared to patients with epilepsy.

本研究的目的是深入了解最常见抗癫痫药物（ASM）的治疗药物监测（TDM）在实际临床中的应用情况。所采用的自动化方法能够为将已确立的参考范围与全国性TDM数据集进行比较提供一种快速有效的手段，从而实现对实验室参考范围的持续监测。本研究结果表明，应重新评估丹麦左乙拉西坦的参考范围。此外，考虑到代谢的年龄相关变化，可能需要对左乙拉西坦、托吡酯和拉科酰胺进行剂量调整。精神科人群中拉莫三嗪的较低浓度范围表明，与癫痫患者相比，双相情感障碍患者使用较低浓度的拉莫三嗪可能就有效。

REF: Nersesjan M, Hoffmann-Lücke E, Greibe E, et al. Evaluation of antiseizure medication concentration ranges in blood samples using an automated big data approach. Epilepsia. 2025;66(6):1888-1898. doi:10.1111/epi.18330 PMID: 40072331

Assisted reproduction and the fetal malformation risk associated with antiseizure medication exposure in pregnancy

辅助生殖与孕期暴露于抗癫痫药物相关的胎儿畸形风险

This study was undertaken to explore the possible role of assisted reproduction treatment (ART) in the occurrence of fetal malformation in women with antiseizure medication (ASM)-treated epilepsy. WWE undertaking pregnancy through ART should be aware of the increased risk of fetal malformation beyond that related to ASM exposure. If this finding is supported in further studies, evaluations of fetal malformation risk rates associated with ASM exposure may need to be adjusted for possible overestimation because of confounder effects of ART, if ART was involved in the pregnancies studied.

本研究旨在探讨辅助生殖技术（ART）在使用抗癫痫药物（ASM）治疗的癫痫女性胎儿畸形发生中的可能作用。通过辅助生殖技术怀孕的癫痫女性应意识到，除了抗癫痫药物暴露相关风险外，胎儿畸形风险还会增加。如果这一发现得到进一步研究的支持，那么在研究涉及辅助生殖技术妊娠的情况下，由于辅助生殖技术的混杂效应可能导致高估，可能需要调整与抗癫痫药物暴露相关的胎儿畸形风险率评估。

REF: Vajda F, O'Brien T, Graham J, et al. Assisted reproduction and the fetal malformation risk associated with antiseizure medication exposure in pregnancy. Epilepsia. 2025;66(6):1899-1906. doi:10.1111/epi.18335 PMID: 40019358

Comparative risk of major health events among individuals prescribed different antiseizure medications following ischemic stroke

缺血性卒中后服用不同抗癫痫药物的个体发生重大健康事件的比较风险

The aim of this study was to compare the risk of seizure, recurrent stroke, fall or fracture, and mortality in individuals prescribed different antiseizure medications (ASMs) following an ischemic stroke. At a population level, ASMs of different types showed no significant differences in the risk of hospitalization or emergency department presentation for seizure, fall or fracture, stroke, and mortality within 2 years of an incident stroke presentation, suggesting similar short-term health outcomes in a real-world setting. Future research should investigate decision-making around ASM choice for stroke survivors and examine the impact of long-term ASM exposure on health outcomes.

本研究旨在比较缺血性卒中后使用不同抗癫痫药物（ASM）的个体发生癫痫发作、复发性卒中、跌倒或骨折以及死亡的风险。在人群层面，不同类型的ASM在首次卒中发作后的2年内，在因癫痫发作、跌倒或骨折、卒中住院或前往急诊科就诊以及死亡的风险方面没有显著差异，这表明在现实世界中短期健康结局相似。未来的研究应探讨卒中幸存者选择ASM的决策过程，并研究长期使用ASM对健康结局的影响。

REF: Kim SJ, Marquina C, Foster E, Bell JS, Ilomäki J. Comparative risk of major health events among individuals prescribed different antiseizure medications following ischemic stroke. Epilepsia. 2025;66(6):1907-1918. doi:10.1111/epi.18336 PMID: 40067170

Long-term safety and effectiveness of fenfluramine in children and adults with Dravet syndrome

芬氟拉明治疗德拉韦综合征儿童和成人的长期安全性和有效性

We analyzed the long-term safety and effectiveness of fenfluramine (FFA) in patients with Dravet syndrome (DS) in an open-label extension (OLE) study after participating in randomized controlled trials (RCTs) or commencing FFA de novo as adults. Our OLE study of FFA in patients with DS confirmed previous positive findings and extended the exposure up to 3.5 years. No new or unexpected safety signals were observed and FFA demonstrated sustained and clinically meaningful reduction in MCSF.

我们在一项开放性扩展（OLE）研究中分析了芬氟拉明（FFA）对德拉韦综合征（DS）患者的长期安全性和有效性，这些患者此前参与过随机对照试验（RCTs），或成年后开始初次使用FFA。我们针对DS患者开展的FFA开放性扩展研究证实了此前的阳性结果，并将用药时间延长至3.5年。未观察到新的或意料之外的安全信号，且FFA显示出能持续且显著地临床降低运动性惊厥发作频率（MCSF）。

REF: Scheffer IE, Nabbout R, Lagae L, et al. Long-term safety and effectiveness of fenfluramine in children and adults with Dravet syndrome. Epilepsia. 2025;66(6):1919-1932. doi:10.1111/epi.18342 PMID: 40072476

Assessment of antiseizure medication adherence based on postmortem toxicology and claimed prescriptions in cases of sudden unexpected death in epilepsy

基于尸检毒理学和所申报处方情况评估癫痫患者不明原因猝死病例中抗癫痫药物的依从性

Individuals with epilepsy are at a higher risk of dying suddenly and without explanation, known as sudden unexpected death in epilepsy (SUDEP). Seizures are a risk factor for SUDEP, and nonadherence to antiseizure medication (ASM) increases this risk. We aimed to assess adherence to ASMs at the time of death among young SUDEP cases by comparing prescription claims with postmortem toxicology at an individual level. By uniquely matching register-based prescription data with postmortem toxicology findings, we ascertained that 73% of SUDEP cases adhered to their claimed ASM, underscoring the necessity for continued vigilance in seizure management. However, improving medication adherence may possess preventive potential for SUDEP, as 22% exhibited nonadherence to their claimed ASM.

癫痫患者发生不明原因突然死亡（即癫痫猝死综合征，SUDEP）的风险更高。癫痫发作是SUDEP的一个危险因素，不按时服用抗癫痫药物（ASM）会增加这种风险。我们旨在通过在个体层面将处方记录与尸检毒理学结果进行对比，评估年轻SUDEP病例死亡时的ASM服药依从性。通过将基于登记的处方数据与尸检毒理学结果进行独特匹配，我们确定73%的SUDEP病例遵循了其声称的ASM治疗方案，这凸显了在癫痫发作管理中持续保持警惕的必要性。然而，改善服药依从性可能对SUDEP具有预防作用，因为有22%的病例未遵循其声称的ASM治疗方案。

REF: Palsøe MK, Hansen CJ, Torp-Pedersen C, et al. Assessment of antiseizure medication adherence based on postmortem toxicology and claimed prescriptions in cases of sudden unexpected death in epilepsy. Epilepsia. 2025;66(6):1933-1944. doi:10.1111/epi.18354 PMID: 40171887

Differential functional connectivity of amygdala in drug-resistant temporal lobe epilepsy

药物难治性颞叶癫痫中杏仁核的差异性功能连接

Recent studies highlight the amygdala's crucial role in temporal lobe epilepsy (TLE), particularly in magnetic resonance imaging-negative cases and new TLE subtypes with structural amygdala changes. This study aims to investigate the electrophysiological properties and connectivity patterns of the amygdaloid complex in TLE patients using stereoelectroencephalography (SEEG). Our findings reveal distinct functional connectivity patterns and potentially divergent roles of DA and VA in TLE. These insights could refine intracranial sampling protocols of the amygdaloid complex, guiding more precise strategies for resection and neuromodulation in TLE patients.

近期研究强调了杏仁核在颞叶癫痫（TLE）中至关重要的作用，尤其是在磁共振成像阴性的病例以及存在杏仁核结构改变的新型颞叶癫痫亚型中。本研究旨在利用立体脑电图（SEEG）探究颞叶癫痫患者杏仁核复合体的电生理特性和连接模式。我们的研究结果揭示了颞叶癫痫中背侧杏仁核（DA）和腹侧杏仁核（VA）存在不同的功能连接模式以及可能不同的作用。这些见解有助于完善杏仁核复合体的颅内采样方案，为颞叶癫痫患者的切除手术和神经调控提供更精准的策略。

REF: Aung T, Tang LW, Ho J, et al. Differential functional connectivity of amygdala in drug-resistant temporal lobe epilepsy. Epilepsia. 2025;66(6):1945-1958. doi:10.1111/epi.18317 PMID: 39963075