Epilepsy Care Research Articles

Comparison of EEG Signal Characteristics of Subdural and Depth Electrodes.

Our study aimed to compare signal characteristics of subdural electrodes (SDE) and depth stereo EEG placed within a 5-mm vicinity in patients with drug-resistant epilepsy. We report how electrode design and placement collectively affect signal content from a shared source between these electrode types. In subjects undergoing invasive intracranial EEG evaluation at a surgical epilepsy center from 2012 to 2018, stereo EEG and SDE electrode contacts placed within a 5-mm vicinity were identified. Of these, 24 contacts (12 pairs) met our criteria for signal-to-noise ratio and data availability for final analysis. We used Welch method to analyze the correlation of power spectral densities of EEG segments, root mean square of 1-second windows, and fast-Fourier transform to calculate coherence across conventional frequency bands. We observed a median distance of 3.7 mm between the electrode contact pairs. Time-aware analysis highlighted the coherence's strength primarily in the high-gamma band, where the median (r) was 0.889. In addition, the median power ratios between the SDE and stereo EEG signal was 1.99. This ratio decreased from high-gamma to infra-low frequencies, with medians of 2.07 and 0.97, respectively. The power spectral densities for the stereo EEG and SDE electrodes demonstrated a strong correlation, with a median correlation coefficient (r) of 0.99 and an interquartile range from 0.915 to 0.996. Signals captured by standard subdural and depth (intracranial EEG) electrodes within a 5-mm radius exhibit band-specific coherence and are not identical. The association was most pronounced in the high-gamma band, with coherence decreasing with lower frequencies. Our findings underscore the combined effects of electrode size, design, placement, preferred bandwidth, and the nature of the activity source on signal recording. Particularly, SDE employed herein may offer advantages for high-frequency signals, but the impact of electrode size on recordings necessitates careful consideration in context-specific situations. The findings relate to surgical epilepsy care and may inform the design of brain-computer interface.

Psychiatric Comorbidities in Adults with Epilepsy: A Systematic Review

Abstract Epilepsy is a chronic neurological condition that is highly predisposed to a variety of mental health problems. This systematic literature review identified original research articles that reported the prevalence of psychiatric comorbidities based on clinical assessments amongst patients with epilepsy (PWE). The included articles were published from 2000 to 2022 and focused on adults aged ≥18 years who had psychiatric diagnoses. The primary outcome was the prevalence of psychiatric comorbidities amongst PWE. A modified Newcastle–Ottawa Scale was used to assess the quality of the studies. Thirty-three articles were reviewed in full-text screening. Out of these, 15 articles that were consistent with the inclusion criteria were included in our systematic review. This protocol was registered in PROSPERO with registration ID CRD42023461739. General Anxiety Disorder and Major Depressive Disorder were the most common psychiatric comorbidities, with prevalence rates of 20.14% and 23.94%, respectively. Other reported comorbidities included post-traumatic stress disorder (8.3%), obsessive–compulsive disorder (2.9%), bipolar disorder (7.1%), psychosis (8.2%) and phobia (18.25%). These findings suggest that screening tools for depression and anxiety should be included as part of the training for epilepsy care.

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

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. A baseline survey (2017-2018) identified persons with epilepsy (PWE) in four rural villages. Subsequently, PWE were invited to enroll in the epilepsy treatment program (2019-2022), where trained community health workers (CHWs) screened for epilepsy, promoted ivermectin intake to treat onchocerciasis, distributed ASMs, and monitored seizure frequency and ASM adherence monthly under supervision from the project clinician trained in epilepsy diagnosis and treatment. A concluding survey (2022) collected sociodemographic data and participants' status as alive, deceased, or lost to follow-up. Mixed-effects negative binomial regression analyzed risk factors for weekly seizure incidence rate. Of 206 participants, 77.7% reported bilateral tonic-clonic seizures, and 32.0% reported focal seizures. More than one third (38.5%) were suspected of having nodding syndrome. Weekly seizure frequency decreased significantly from a mean of 1.9 seizures (interquartile range [IQR] = 0-2) at enrollment to .4 seizures (IQR = 0-0) at the last follow-up (Wilcoxon test p < .0001), with significantly improved ASM adherence (57.5%-94.7%, McNemar test p < .0001). Factors associated with lower weekly seizure incidence included longer program participation, ASM adherence, carbamazepine use compared to phenobarbital, and ivermectin intake in 2022. ASM adverse events were associated with increased seizure frequency. The mortality rate was 32.7 deaths per 1000 person-years, with most deceased not fully adhering to ASM (88%) and having epilepsy-related causes of death (60%). 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.

Seizure Detection and Lateralization Using Thalamic Deep Brain Stimulator Recordings.

The lack of reliable seizure detection remains a significant challenge for epilepsy care. A clinical deep brain stimulation (DBS) system provides constrained ambulatory brain recordings; however, limited data exist on the use of DBS recordings for seizure detection and lateralization. We present the case of an 18-year-old patient with drug-resistant focal epilepsy, who had seizure detection and lateralization by DBS recordings. Prior stereotactic-EEG, including a thalamus lead, identified independent left orbitofrontal and mesial temporal onset seizures. Notably, low-frequency thalamic ictal power was significantly elevated relative to baseline awake and sleep states. The patient was subsequently implanted with an anterior nucleus of the thalamus DBS system. Postimplantation, low-frequency power-in-band (5.3-10.3 Hz) recordings were initiated. Nursing staff identified four typical clinical seizures during the inpatient DBS recording period. Thalamic DBS trends contained relative peaks that were coincident with each nurse-reported seizure. Peri-ictal power was uniformly maximal ipsilateral to the seizure network. This case demonstrates the feasibility of seizure detection and lateralization by a thalamic DBS system for some individuals, and suggests DBS sensing parameter selection may be guided by thalamic stereotactic EEG. Further research is necessary to assess the generalizability of DBS seizure detection across individuals and diverse seizure networks.

Prevalence and Risk Factors of Worsened Seizure Control in Pediatric Patients with Epilepsy during COVID-19 Pandemic in Tertiary Care Hospital

Background: Epilepsy can achieve remission through accessible medications and regular follow-up. However, maintaining remission became challenging due to the barriers to care that emerged during the COVID-19 pandemic. Objective: To assess the prevalence of worsened seizure control in pediatric patients with epilepsy during the COVID-19 pandemic. Associated factors would be defined and investigated. Materials and Methods: A cross-sectional study was conducted on patients with epilepsy at the Pediatric Outpatient Unit of Bhumibol Adulyadej Hospital in Bangkok, Thailand, between January and February 2022. The present study included patients aged 1 month to 18 years at the time of diagnosis, with epilepsy diagnosed at least six months before the COVID-19 pandemic, making the diagnosis between January 2012 and October 2019, and treated with at least one antiseizure medication. Guardians were interviewed via telephone to assess demographic data, epilepsy characteristics, and their views on changes in care. Results: Among the 509 patients, 128 were included. Forty percent of guardians reported facing challenges in scheduling follow-up doctor’s appointments, primarily due to the fear of COVID-19 infection for 61.9%. The prevalence of worsened seizure control during the COVID-19 pandemic was 4.7%. Uncontrolled seizures at baseline were identified as a significant factor influencing worsened seizure control (p=0.001). Conclusion: Approximately five percent of pediatric patients with epilepsy experienced worsened seizure control during the COVID-19 pandemic. This highlights the importance of continuous care for this vulnerable group, even between limitations in travel and access to medical services. Forty percent of guardians reported difficulty in scheduling follow-up physician appointments. These findings suggest the importance of establishing efficient medication delivery and that telemedicine services for epilepsy care be considered in future planning, especially in anticipation of potential future waves of COVID-19 or other disease outbreaks. Keywords: COVID-19; Epilepsy; Seizure control; Pediatric patients

The Epilepsy Centers of Excellence at the Veterans Health Administration.

The Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) was established in 2008 to provide specialized care for veterans with epilepsy. Although established more than a decade ago, there has been no systematic evaluation of the ECoE's performance in key mission areas. We evaluated their performance in several key mission areas-clinical care, research, education, and outreach-since inception to evaluate their success in meeting the initial mandate. We analyzed available data from relevant literature, ECoE annual reports, and the ECoE website between 2011 and 2023. Clinical care is the primary mission of the ECoE and was evaluated by examining utilization data for various clinical services and published literature. Research was assessed based on academic output and funding reported in the annual reports. Education and outreach were qualitatively assessed using recent data on the ECoE website and annual reports. Total unique patient clinical visits for therapeutic/diagnostic encounters increased by 74% (from 10,487 in 2011 to 18,285 in 2023), which was nearly twice the 39.5% growth in workforce strength (from 119 in 2011 to 166 in 2022) over a similar period. Care provided by the ECoE is associated with decreased mortality rates compared to patients who do not receive ECoE neurology care. Tele-epilepsy visits increased considerably following the COVID-19 pandemic, from 1,928 in 2019 to 4,950 in 2021 (a 157% increase over 2 years). Research grant funding in fiscal year 2023 totaled approximately $4 million for ECoE-affiliated investigators. Outreach efforts included several VHA/non-VHA collaborations. The ECoE organizational structure was found to be highly interconnected and regionally represented, with special committees devoted to many key mission areas of epilepsy care. Our analysis reveals progressive growth and improvements in the ECoE mission areas of clinical care, research, education, and outreach. Clinical utilization data have shown growth since inception, while also leading to lower mortality rates and lower costs per patient, fulfilling the organizational mandate to improve the care of veterans with epilepsy. There is substantial activity in research, education, and outreach. The ECoE governance hierarchy aims to facilitate smooth resource allocation both regionally and for the key mission areas. Our findings can help policymakers assess and prioritize future ECoE initiatives, while other clinical care organizations can seek to model their care based on the ECoE.

Anti-Epileptic Indian Medicinal Plants: A Comprehensive Review on their Ethnopharmacological Perspectives of Recent Advancement

The study explores the potential of Indian medicinal plants as botanical treasures for managing epilepsy. Epilepsy, a neurological disorder characterized by recurrent seizures, poses a significant global health challenge. Traditional medicinal practices in India have a rich history of incorporating various plant-based remedies for neurological ailments, including epilepsy. The data was collected from various scientific databases like Google Scholar, Science Direct, Elsevier, Springer and Pubmed. The collected data includes the following details - Plant part used, dose and type of extract, reference and inducing drug used and the mechanism of actions. The article thoroughly examines the phytochemical constituents found in Indian medicinal plants, elucidating their neuroprotective and anticonvulsant properties and their scrutinized bioactive compounds and therapeutic potential. The review integrates findings from preclinical and clinical studies, shedding light on the mechanisms of action and safety profiles of these plant-derived compounds. The conclusion of the manuscript emphasizes the promising role of Indian medicinal plants in epilepsy management. The identified botanical treasures offer a holistic and potentially sustainable approach to complement existing antiepileptic medications. The reviewed evidence underscores the need for further research, clinical trials, and integration of traditional knowledge into mainstream healthcare for the development of effective and accessible treatments for epilepsy. By recognizing the botanical wealth embedded in Indian traditional medicine, this review advocates for a paradigm shift toward harnessing nature's gifts in the pursuit of enhanced epilepsy care.

Establishing Priorities for Epilepsy Care and Electroencephalogram Use in Low-Resource Settings.

We convened an electroencephalography and epilepsy think tank in Blantyre, Malawi, bringing together American pediatric neurologist clinical researchers and Malawian clinicians. We worked with the aim of improving care for children with seizures and epilepsy in southern Malawi. By sharing and discussing ideas, six United States-based researchers and six Malawian end users developed consensus for directions of both current and future clinical research activities. Compared with our previous use of informal one-to-one discussions to generate research ideas, we found the structured think tank useful for generating ideas and better establishing links between clinical researchers and those who will eventually use the results of their work. We hope that these new interactions will lead to a self-sustaining environment integrating clinical care and research, leading to improvements in brain health for the children of Malawi and integrating technology in the places where it will be most clinically useful.

Big data research is everyone's research-Making epilepsy data science accessible to the global community: Report of the ILAE big data commission.

Epilepsy care generates multiple sources of high-dimensional data, including clinical, imaging, electroencephalographic, genomic, and neuropsychological information, that are collected routinely to establish the diagnosis and guide management. Thanks to high-performance computing, sophisticated graphics processing units, and advanced analytics, we are now on the cusp of being able to use these data to significantly improve individualized care for people with epilepsy. Despite this, many clinicians, health care providers, and people with epilepsy are apprehensive about implementing Big Data and accompanying technologies such as artificial intelligence (AI). Practical, ethical, privacy, and climate issues represent real and enduring concerns that have yet to be completely resolved. Similarly, Big Data and AI-related biases have the potential to exacerbate local and global disparities. These are highly germane concerns to the field of epilepsy, given its high burden in developing nations and areas of socioeconomic deprivation. This educational paper from the International League Against Epilepsy's (ILAE) Big Data Commission aims to help clinicians caring for people with epilepsy become familiar with how Big Data is collected and processed, how they are applied to studies using AI, and outline the immense potential positive impact Big Data can have on diagnosis and management.

New onset seizures in Octogenarians.

The occurrence of new seizure(s) in older adults is two- to three-fold higher as compared to the younger population, and previous studies have characterized the clinical features of seizures in patients beyond 60 or 65 years. This study, in response to the recent ILAE task force on epilepsy in the elderly (2023), has assessed the clinical characteristics of individuals who are over 85 years old. Data was collected from prospectively maintained electronic medical records, and the participants were divided into seizure-free and seizure-recurrence groups, and their clinical characteristics were compared. Over a 30-year period, a single comprehensive epilepsy care center included a total of 40 patients, with a mean age of 88.7 ± 2.79 years - most common seizure type was generalized tonic-clonic seizures (45%), with a positive neuroimaging yield of 42.5% and an EEG showing specific abnormalities in 50% of cases. Etiology was unidentified in 50%, while stroke was the most common among identified etiologies (27.5%). Over a mean follow-up of 1.4 [0.2-5.8] years, monotherapy effectively controlled 62.5% of patients, but 47.5% experienced recurrence. When compared to the non-recurrence group, these patients showed significant risk factors such as a history of prior stroke [47.3% versus 23.8%, p = 0.031], use of phenytoin [68.4% versus 33.3%, p = 0.056], and clobazam [42.1% vs. 19%, p = 0.049]. This study contributes to better identification and improved characterization of late-onset seizures and adds that appropriate, timely management results in better outcomes.

Real-world epilepsy monitoring with ultra long-term subcutaneous EEG: a 15-month prospective study.

Novel subcutaneous electroencephalography (sqEEG) systems enable prolonged, near-continuous cerebral monitoring in real-world conditions. Nevertheless, the feasibility, acceptability and overall clinical utility of these systems remains unclear. We report on the longest observational study using ultra long-term sqEEG to date. We conducted a 15-month prospective, observational study including ten adult people with treatment-resistant epilepsy. After device implantation, patients were asked to record sqEEG, to use an electronic seizure diary and to complete acceptability and usability questionnaires. sqEEG seizures were annotated visually, aided by automated detection. Seizure clustering was assessed via Fano Factor analysis and seizure periodicity at multiple timescales was investigated through circular statistics. Over a median duration of 438 days, ten patients recorded a median 18.8 hours/day, totalling 71,984 hours of real-world sqEEG data. Adherence and acceptability remained high throughout the study. While 754 sqEEG seizures were recorded across patients, over half (52%) of these were not reported in the patient diary. Of the 140 (27%) diary reports not associated with an identifiable sqEEG seizure, the majority (68%) were reported as seizures with preserved awareness. The sqEEG to diary F1 agreement score was highly variable, ranging from 0.06 to 0.97. Patient-specific patterns of seizure clustering and seizure periodicity were observed at multiple (circadian and multidien) timescales. We demonstrate feasibility and high acceptability of ultra long-term (months-years) sqEEG monitoring. These systems help provide real-world, more objective seizure counting compared to patient diaries. It is possible to monitor individual temporal fluctuations of seizure occurrence, including seizure cycles.

Level 4 seizure monitoring unit admissions are associated with reduced long-term health care costs.

This study was undertaken to determine whether admission to dedicated seizure monitoring units (SMUs) result in reduced health care use (HCU). This was a retrospective open cohort study covering the years 2010-2018 of patients residing in Alberta, Canada, who were referred to the Calgary Comprehensive Epilepsy Program and admitted to a level 4 SMU. Patients were required to have ≥3 years pre- and postadmission follow-up. The outcome was the change in trajectory of composite HCU (primary care, specialist outpatient visits, emergency department visits, and hospitalizations) for the 3 years prior to and 3 years following SMU admission using the point of admission as the "index date." Secondary outcomes were HCU limited to specific settings. We excluded the first 30 days following the point of admission to mitigate the confounding admission would have on the postadmission HCU trajectory. We used adjusted restricted maximum likelihood linear and nonlinear effects models to determine trajectories expressed as Canadian dollars. A total of 315 of 600 (53%) patients met eligibility criteria. Mean age was 40 years (SD = 17.4), 176 (56%) were female, 220 (70%) had focal epilepsy, and 60 (19%) had functional seizures or physiologic seizure mimics without epilepsy as adjudicated by the attending physician at the point of discharge. Mean per person health care costs increased by CAD$341.28 (95% confidence interval [CI] = -25.17 to 707.74) for each successive 6-month interval prior to SMU admission (p = .07). Following admission, mean per person costs decreased by CAD$802.34 (95% CI = 699.62-905.06, p < .001) for each successive 6-month interval up to 3 years postdischarge. Similar trends were noted for primary and specialist care, emergency department, admitted care, and when nonlinear models were applied. Admission to an SMU is associated with significant and enduring declines in HCU. Each 6-months following discharge overall HCU declined by a mean of CAD$802.34 and acute inpatient, emergency department, and outpatient physician interactions declined by 25%, 26%, and 18% respectively. Comprehensive epilepsy care not only reduces morbidity and mortality but also reduces cost.

Poor sleep hygiene practice and associated factors among adults with epilepsy attending follow up care at Mettu Karl comprehensive specialized hospitals in Illu Ababora Zone and general hospital in Buno Bedele zone, Southwest Ethiopia’

BackgroundGlobally, sleep disorders are an important global public health problem. Poor sleep hygiene is at the core of chronic insomnia and other sleep disorders. Sleep hygiene practices are effective, practical, and affordable, and have no side effects other than other therapies benefiting patients with epilepsy. However, there is no research regarding sleep hygiene practice and its awareness among people with epilepsy in Ethiopia. This study aimed to assess sleep hygiene practice and its factors in patients with epilepsy.MethodsAn institutional-based cross-sectional study was conducted. The study included 424 participants selected through systematic random sampling. An interviewer-administered Sleep Hygiene Index (SHI) questionnaire was used to collect data.The collected data was analyzed using SPSS Version 25.0. Bi-variable and multi-variable analyses were conducted to identify factors related to poor sleep hygiene.ResultsThe frequency of poor sleep hygiene practice among people with epilepsy was 59.5%. Non-adherence to AED (AOR = 1.86, 95% CI: 1.13, 3.23), depression (AOR = 2.10, 95% CI: 1.42, 4.21), poor sleep quality (AOR = 5.7, 95% CI: 3.12, 10.01), anxiety (AOR = 2.71, 95% CI: 1.67, 4.82), and current alcohol drinkers (AOR = 1.74, 95% CI: 1.27, 3.13) were associated with poor sleep hygiene practice.Conclusion and recommendationThe perception of sleep hygiene practice among patients with epilepsy was poor. Non-adherence to AED, depression, poor sleep quality, anxiety, and current use of alcohol were associated with poor sleep hygiene practices. Therefore, regular screening, sleep issue management, and expanded mental health support are crucial. Training programs and awareness strategies to improve sleep hygiene are highly recommended. Professionals should incorporate sleep hygiene in epilepsy care.

Epilepsy care pathway: The Finnish model.

Integrated care pathways are essential for consistent, effective epilepsy care, offering equal access and quality regardless of socioeconomic status. They must align with the WHO Global Action Plan on Epilepsy, ensuring best practices and cost-effective management. We describe the Finnish national epilepsy care pathway, which includes multiple levels of care, from initial diagnosis to long-term care for all types of epilepsy, with a specific focus on rare and complex cases integrated with the European Reference Network (ERN) for Rare and Complex Epilepsies EpiCARE. In 2017, the Finnish government nominated Kuopio University Hospital to coordinate diagnostics and care for severe epilepsy in Finland. A national multidisciplinary consensus panel, including specialists from both adult and pediatric neurology departments across all five Finnish university hospitals and from the patient organization, was established. The resulting pathway was adopted into the current Finnish evidence-based current care guidelines for epilepsy. The Finnish epilepsy care pathway focuses on timely referrals, continuity of care and enhanced communication between healthcare providers at different levels of care. Patient involvement is assured with an individualized digital application offering secure online messaging, a seizure calendar, and remote visits. The pathway enhances virtual consultations and includes regular national diagnostic multidisciplinary meetings for severe epilepsies before selected cases are consulted in ERN EpiCARE meetings. This Finnish model for epilepsy care provides a streamlined, multidisciplinary approach to diagnosis and treatment and combines modern digital tools, data sharing, and peer support. This pathway can serve to model how integrated healthcare systems can effectively manage complex conditions. We describe the Finnish national epilepsy care pathway, which includes multiple levels of care, from initial diagnosis to long-term care for all types of epilepsy, with a specific focus on rare and complex cases integrated with the European Reference Network (ERN) for Rare and Complex Epilepsies EpiCARE. Finnish model for epilepsy care provides a streamlined, multidisciplinary approach to diagnosis and long-term treatment of epilepsy. The pathway enhances virtual consultations and includes national and European-level diagnostic multidisciplinary meetings for severe epilepsies. To improve outcomes, we emphasize the use of modern digital tools, data sharing, and peer support.

Impact and Recovery of VHA Epilepsy Care Services During the COVID-19 Pandemic

Impact and Recovery of VHA Epilepsy Care Services During the COVID-19 Pandemic

CIC-Related Neurodevelopmental Disorder: A Review of the Literature and an Expansion of Genotype and Phenotype.

Genetic testing for neurodevelopmental disorders is now considered the standard of care for unexplained epilepsy as well as autism spectrum disorders, intellectual disability, and developmental delays with as many as 50% of individuals identified as having an underlying genetic etiology. Capicua (CIC) is a transcriptional repressor and is widely expressed among human brain tissue. Patients in the literature with pathogenic variants in CIC present with a broad spectrum of phenotypic abnormalities. Common features include epilepsy, developmental delay, intellectual disability, autism spectrum disorder, and MRI abnormalities amongst other neurodevelopmental symptoms. Variant type, age of onset, sex, and severity of manifestation also differ amongst probands. However, the full genotypic and phenotypic spectrum of CIC-related neurodevelopmental disorder has not been elucidated. Here we review patients reported in the literature with CIC variants and present two additional patients representing a novel genotype and phenotype. Whole exome sequencing (WES) in this proband identified a novel paternally inherited likely pathogenic variant in CIC c.1526del p.(Pro509Hisfs*14). Both proband and father present with isolated epilepsy without other significant neurodevelopmental disorders. A review of the previous literature identified 20 individuals harboring CIC variants; the majority of these individuals present with a combination of neurodevelopmental features. Sixteen distinct variants were identified amongst these 20 patients. This family represents an expansion of the genotypic and phenotypic spectrum of CIC-related neurodevelopmental disorder. This information may lead to clinically actionable management changes for future patients identified with CIC variants considering standard anti-epileptic medication-weaning protocols.

Proof of concept: Portable ultra-low-field magnetic resonance imaging for the diagnosis of epileptogenic brain pathologies.

High-field magnetic resonance imaging (MRI) is a standard in the diagnosis of epilepsy. However, high costs and technical barriers have limited adoption in low- and middle-income countries. Even in high-income nations, many individuals with epilepsy face delays in undergoing MRI. Recent advancements in ultra-low-field (ULF) MRI technology, particularly the development of portable scanners, offer a promising solution to the limited accessibility of MRI. In this study, we present and evaluate the imaging capability of ULF MRI in detecting structural abnormalities typically associated with epilepsy and compare it to high-field MRI at 3 T. Data collection was conducted within 3 consecutive weeks at the University Hospital Bonn. Inclusion criteria were a minimum age of 18 years, diagnosed epilepsy, and clinical high-field MRI with abnormalities. We used a .064 T Swoop portable MR Imaging System. Both high-field MRI and ULF MRI scans were evaluated independently by two experienced neuroradiologists as part of their clinical routine, comparing pathology detection and diagnosis completeness. Twenty-three individuals with epilepsy were recruited. One subject presented with a dual pathology. Across the entire cohort, in 17 of 24 (71%) pathologies, an anomaly colocalizing with the actual lesion was observed on ULF MRI. For 11 of 24 (46%) pathologies, the full diagnosis could be made based on ULF MRI. Tumors and posttraumatic lesions could be diagnosed best on ULF MRI, whereas cortical dysplasia and other focal pathologies were the least well diagnosed. This single-center series of individuals with epilepsy demonstrates the feasibility and utility of ULF MRI for the field of epileptology. Its integration into epilepsy care offers transformative potential, particularly in resource-limited settings. Further research is needed to position ULF MRI within imaging modalities in the diagnosis of epilepsy.

A global survey of telemedicine use in epilepsy care – practices before, during and after the COVID-19 pandemic

PurposeTelemedicine was widely adopted for epilepsy care during the COVID-19 pandemic. Its role extends beyond preventing disease transmission, offering an efficient and high-quality care alternative. To understand the global scenario, an international group conducted a survey comparing telemedicine practices in epilepsy care before, during, and after the pandemic. MethodsThe survey included 26 questions on demographics, telemedicine use for epilepsy care, regulations, reimbursement mechanisms, and tools used. Responses were collected via an online survey platform from June to October 2023. ResultsTwo hundred eighty-five respondents from 60 countries participated. The average telemedicine use in daily practice was 0 %, 0–10 % (median, IQR) before the pandemic, 65 %, 30–90 % during the pandemic, and 20 %,10–50 % after the COVID pandemic. Female respondents reported higher telemedicine use than males after the pandemic (25 %, 10–50 % vs 15 %, 5 %-30 %, p = 0.002). According to respondents' perceptions, post-pandemic telemedicine regulations flexibilities were reported as expanded by 36.8 %, restricted by 17.2 %, and unchanged by 46 %. Reimbursement for telemedicine increased during the pandemic but decreased afterward (Cochran's Q test, p < 0.001). Voice calls were the most used telemedicine platform (46.6 %). Privacy issues were reported by 49 respondents (18.3 %). ConclusionTelemedicine use for epilepsy care increased during the pandemic and remained higher than pre-pandemic levels. However, improvements are needed in telemedicine applications, regulations, reimbursement, and patient privacy. International collaboration and experience sharing can enhance telemedicine's acceptance and practice globally.

An advocacy based cross sectional study of healthcare professionals of factors impacting on medication adherence across nine Sub-Saharan African countries

BackgroundAdherence to anti-seizure medication (ASM) by people diagnosed with epilepsy in sub-Saharan Africa remains low. The factors for low adherence are not well understood. To improve adherence, it is important to understand the perceptions and views of healthcare professionals delivering epilepsy care to this population. The aim was to investigate the factors influencing ASM adherence. MethodsThis study uses a brief online questionnaire which asked healthcare professionals (both from nursing and medical backgrounds) who work in sub-Saharan African countries to rate a set of pre-established options designed with the feedback of a local focus group of epilepsy experts from countries targeted. The questionnaire consisted of six questions and was a mix of multiple choice and Likert scale questions. ResultsThere were 217 healthcare professionals who replied to the questionnaire. The most important factors believed to be influencing adherence from a healthcare professional perspective are; lack of availability of medication for epilepsy (71 %), affordability of medication (60 %), the patient, family, carer lacking in understanding of medication (43 %), cultural misconceptions about epilepsy (40 %) and side effects of the medication (32 %). The survey was answered by many different healthcare professionals; 65 participants were doctors and 152 were other healthcare professionals such as nurses (59 %) pharmacists (10 %) and when comparing them, the three most important categories were consistent across groups. ConclusionHealthcare workers in Sub-Saharan Africa identify that the primary factors impacting adherence to ASMs, in their view, is affordability and availability of ASMs.Addressing this issue may reduce the treatment gap.

Establishing the minimum clinically important difference of the Quality of Life in Childhood Epilepsy Questionnaire.

To estimate the minimum clinically important difference (MCID) for the parent-reported 55-item Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) and its shortened 16-item version, QOLCE-16. Data came from 74 children with epilepsy (CWE) (ages 4-10, mean age = 8 [SD = 1.8]) enrolled in the Making Mindfulness Matter in Epilepsy (M3-E) trial, a pilot, parallel randomized-controlled trial of a mindfulness-based intervention. Both anchor-based and distribution-based methods were used to estimate MCID values for the QOLCE-55 and QOLCE-16. For the anchor-based approach, the Patient Centered Global Ratings of Change (PCGRC) scale and linear regression analysis were used to estimate the MCID. For the distribution-based approach, .5 SD of the health-related quality of life (HRQOL) change score distribution was used to estimate the MCID. For the QOLCE-55, the MCID obtained using an anchor-based approach was 10 points and using a distribution-based method was 6 points. For the QOLCE-16, the MCID obtained using an anchor-based method was 13 points and using a distribution-based method was 7 points. This is the first study to estimate MCID values for the QOLCE-55 and the QOLCE-16. It has been well documented that CWE are at risk of experiencing psychological, behavioral, and cognitive impairments, which can negatively impact their HRQOL. Reporting MCID values for the QOLCE-55 and QOLCE-16 is important in determining whether changes in HRQOL observed are meaningful to CWE themselves, as a key factor in shaping the nature of epilepsy care delivered.