BackgroundThe field of epilepsy neural regulation represented by VNS is rapidly developing. Our aim was to investigate the safety and effectiveness of vagus nerve stimulation (VNS) as an adjunct therapy for pediatric epilepsy in a multi-center study across China.MethodsChildren with epilepsy undergoing VNS as supplementary treatment were consecutively enrolled in this study. Eligibility was limited to children aged 1–16 years with a confirmed epilepsy diagnosis, a stable antiseizure medication regimen, and a minimum of two seizures per 28-day cycle during the 8-week retrospective baseline. ResultsEighty-seven children (54 males; mean age 8.21 ± 3.88 years, range 0–16) were included, with seizures beginning at an average age of 3.03 ± 2.90 years. A ≥ 50% reduction in seizure frequency was observed in 23.7% at 6 weeks, 20.3% at 10 weeks, 22.6% at 18 weeks, and 18.6% at 26 weeks. Seizure freedom was achieved in 17.1%, 15.9%, 11.3%, and 16.3% of patients at the same intervals. Two subjects experienced adverse events, both of which were mild and transient.ConclusionsVNS demonstrated moderate efficacy and a favorable safety profile as an adjunct treatment in children with epilepsy. Further large-scale, long-term studies are recommended to confirm these findings.

BackgroundTo provide new insights into the pathological mechanisms of epilepsy associated with variants in the calcium channel voltage-dependent L-type alpha1C subunit gene (CACNA1C, NM_001129837) and to expand the phenotype of CACNA1C-associated neurological disorders: familial mesial temporal lobe epilepsy (FMTLE).MethodsWe conducted a comprehensive analysis of clinical data from a family affected by FMTLE and carried out genetic screening of CACNA1C variants through whole-exome sequencing combined with Sanger sequencing for validation. The clinical characteristics of FMTLE were systematically reviewed, and the pathogenic potential of the identified variant was assessed following the guidelines established by the American College of Medical Genetics and Genomics (ACMG). To explore the underlying pathogenic mechanisms, we utilized bioinformatics tools alongside molecular dynamics simulation methods.ResultsA novel CACNA1C variant (c.5480G > A, p.R1827Q) was identified in a large family with FMTLE. Unlike previous reports, the clinical phenotype of this genotype differs from previous reports, being mild, with focal to bilateral tonic–clonic seizures being more common. Bioinformatics analysis and molecular dynamics simulations indicated that this variant induces local structural changes in the protein.ConclusionsThe findings of this study provide new insights into the complex molecular mechanisms underlying CACNA1C variants and their correlations with patient phenotypes. This research is the first to identify CACNA1C as a potentially new pathogenic gene in FMTLE.Supplementary InformationThe online version contains supplementary material available at 10.1186/s42494-025-00231-5.

Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures that affect approximately 50 million people worldwide. Despite the availability of numerous anti-seizure medicines (ASMs), about 30% of people develop drug-resistant epilepsy (DRE), defined as failure to achieve sustained seizure freedom after trials of two appropriately chosen and tolerated ASM regimens. This population faces significantly reduced quality of life, increased mortality risks, and substantial socioeconomic burdens due to frequent hospitalizations and limited employability.For these treatment-resistant cases, neurostimulation therapies have emerged as promising alternatives to conventional pharmacotherapy. Among these, vagus nerve stimulation (VNS) has become one of the most widely used neurostimulation techniques since approved in 1997. Clinical studies demonstrated that VNS provides meaningful clinical benefits, with approximately 50–60% of patients achieving over 50% reduction in seizure frequency within 12–24 months after implantation. Beyond seizure control, VNS has been associated with improved mood, cognition, and quality of life measures. The therapy is particularly valuable for patients not candidates for resective surgery.This paper presents a comprehensive cost-effectiveness analysis of VNS in DRE by reviewing relevant literature. We examine three key economic dimensions: (1) direct medical costs (including device implantation and maintenance), (2) indirect societal costs (such as productivity loss), and (3) long-term economic benefits. Our analysis reveals that in published papers mostly from developed countries, while VNS requires initial investment, it demonstrated remarkable long-term cost-effectiveness. The therapy significantly reduces healthcare utilization, medication costs, and socioeconomic burdens associated with uncontrolled epilepsy. Furthermore, we identify critical factors influencing cost-effectiveness and propose evidence-based optimization strategies to enhance the value proposition of VNS therapy for diverse healthcare systems and selected patients.

BackgroundSodium valproate (VPA) is widely recognized as the first-line treatment for patients with epilepsy (PWE). However, current studies lack evidence to determine the best add-on medication following VPA monotherapy failure. Lamotrigine (LTG), levetiracetam (LEV), oxcarbazepine (OXC), topiramate (TPM), and carbamazepine (CBZ) also exhibit broad-spectrum activity for seizures. This study aims to compare the therapeutic efficacy of different anti-seizure medication combinations in PWE following valproate monotherapy failure.MethodsIndividuals were categorized into five groups: VPA + LTG, VPA + LEV, VPA + TPM, VPA + OXC and VPA + CBZ. Each group was further subdivided based on seizure type: generalized onset, focal onset, or unknown onset. The effectiveness of these five groups was compared using variance, χ2 test and Kaplan–Meier survival analysis.ResultsA total of 2656 PWEs were included in this study. The ≥ 50% response rates for subjects with generalized epilepsy when combining VPA with LTG, OXC, LEV, TPM, and CBZ were 89.6%, 81.0%, 77.9%, 77.7%, and 75.9%, respectively. The LTG group demonstrated significantly higher efficacy than the LEV, TPM, and CBZ groups (P < 0.05). The ≥ 50% response rate of LTG, OXC, LEV, TPM and CBZ for subjects with focal epilepsy were 86.3%, 88.9%, 79.3%, 75.9% and 74.8%, respectively; with the OXC group being significantly more effective than the LEV, TPM, and CBZ groups (P < 0.05).ConclusionsIn this real-world study, we assessed the effectiveness of five anti-seizure medications as add-on therapy for PWE who failed sodium valproate monotherapy. Our findings suggest that combining LTG may be more effective for subjects with generalized epilepsy, while combining OXC may be more effective for subjects with focal epilepsy.

BackgroundThere are increasing incidence of psychiatric side effects associated with the use of anti-epileptics. Prospective observational studies on the effectiveness and safety of levetiracetam (LEV) and brivaracetam (BRV), along with the haematological abnormalities of both treatments, in seizure patients in an Indian population are lacking. Therefore, we aimed to compare the effectiveness and safety of LEV and BRV in seizure patients and evaluated behavioural and non-behavioural side effects, as well as outcomes when switching between LEV and BRV.MethodsA prospective observational study was conducted in newly diagnosed as well as previously diagnosed patients (n = 115) with epilepsy aged ≥ 5 years of age receiving LEV (n = 66) or BRV (n = 49). Baseline data were collected during the initiation of the study and were compared to the data obtained at the end of the study. A seizure severity questionnaire was used to assess the severity of seizures, and a brief psychiatric rating scale, Hamilton anxiety rating scale, and pediatric epilepsy side effects questionnaire were used to assess the behavioural and non-behavioural side effects.ResultsAt baseline, adults taking LEV showed higher rates of behavioral adverse events (BAEs) compared to those on BRV. During follow-up, the most common behavioural adverse event reported in both treatment groups (LEV and BRV) was depression. The most frequently reported non-behavioural side effect in patients taking BRV was drowsiness. Patients who switched from LEV to BRV due to psychiatric side effects showed positive results with BRV (n = 5).ConclusionsIn summary, the study found that BRV is a safe alternative, with fewer and less severe side effects compared to LEV. While LEV showed slightly higher efficacy and a lower probability of drowsiness, BRV proved more tolerable for patients experiencing LEV-induced side effects. Switching from LEV to BRV decreased the psychiatric side effects.Supplementary InformationThe online version contains supplementary material available at 10.1186/s42494-025-00229-z.

BackgroundThe detection of epileptic seizures is a crucial aspect of epilepsy care, requiring precision and reliability for effective diagnosis and treatment. Seizure detection plays a critical role in healthcare informatics, aiding in the timely diagnosis and management of epilepsy. The use of computational intelligence and optimization techniques has shown significant promise in improving the performance of automated seizure detection systems.MethodsThis research work proposes a novel hybrid approach that combines Ant Colony Optimization (ACO) for feature selection with Gray Wolf Optimization (GWO) to optimize the hyperparameters of a Random Forest (RF) classifier. In this patient-specific seizure detection, ACO effectively reduces the feature set, improving computational efficiency, while GWO ensures optimal RF performance. The method is evaluated on the Children’s Hospital Boston–Massachusetts Institute of Technology (CHB–MIT) and Seina datasets, which include multichannel EEG data from epileptic patients. Performance metrics such as accuracy, sensitivity, and specificity are employed to evaluate the effectiveness of the seizure detection system.ResultsThe proposed ACO-GWO-RF pipeline demonstrated excellent performance on the CHB-MIT dataset, with a mean accuracy of 96.70%, mean sensitivity of 92.66%, and mean specificity of 99.24%, outperforming existing approaches. The mean values of accuracy, sensitivity, and specificity obtained using the Seina dataset are 93.01%, 89.82%, and 96.26%, respectively. These improvements highlight the robustness of the hybrid metaheuristic method in handling complex EEG data.ConclusionsThe hybrid metaheuristic approach effectively optimizes the processing and classification of EEG data for seizure detection. Its strong performance across datasets suggests potential for integration into interactive health applications. Furthermore, its patient-specific adaptability makes it a promising tool for personalized epilepsy diagnosis, treatment, and long-term management.

BackgroundAt present, a number of indicators have been analyzed for the relationship with the efficacy of vagus nerve stimulation (VNS) in drug-resistant epilepsy (DRE) patients, but there is still no definite predictor of efficacy. This study is to assess the long-term effectiveness and predictors of VNS in DRE patients.MethodsWe analyzed DRE patients monitored for over a year post-surgery (2016–2019) to evaluate VNS outcomes. Logistic regression was used to identify efficacy predictors.ResultsOut of 162 DRE patients with VNS, 99 were followed for over 12 months, 80 for over 24 months, and 70 for over 36 months. At 12 months, 33 (33.4%) showed effectiveness, including 7 (7.1%) who were seizure-free. At 24 months, 32 (40.0%) were effective, including 12 (15.0%) who were seizure-free. At 36 months, 36 (51.4%) were effective, including 11 (15.7%) who were seizure-free. After 5 years, 27 (55.1%) were effective, including 8 (16.3%) who were seizure-free. Multivariate regression analysis identified structural etiology as a predictive factor for the effective VNS treatment (P = 0.039, OR = 0.35 [0.13–0.95]).ConclusionsVNS effectively controls seizures, with effectiveness and seizure-free rates improving over time. Patients with structural factors are at higher risk of ineffective VNS, suggesting epilepsy etiology may predict VNS outcomes.

Translocator protein positron emission tomography (TSPO-PET) is a novel imaging modality that leverages the high expression of TSPO in activated microglia and other cells within seizure foci. It has been increasingly applied in the preoperative evaluation of drug-resistant epilepsy (DRE) to aid in the localization of these foci. With advances in tracer development, TSPO-PET has achieved higher signal-to-noise ratios and broader clinical utility. Clinical studies indicate that TSPO-PET yields significantly higher positive detection rates for seizure foci compared to magnetic resonance imaging and fluorodeoxyglucose positron emission tomography. This review summarizes recent progress in TSPO-PET radiotracer technology, its mechanism of action, and its clinical applications for managing DRE.