Understanding Of Epilepsy Research Articles

Bibliometric analysis of research in epilepsy and comorbid depression from 2014 to 2023.

Epilepsy and depression have complicated bidirectional relationships. Our study aimed to explore the field of epilepsy comorbid with depression in a bibliometric perspective from 2014-2023. To improve our understanding of epilepsy and depression by evaluating the relationship between epilepsy and depression, bibliometric analyses were performed. Epilepsy and depression-related publications from the last decade were retrieved from the Web of Science Core Collection. We conducted bibliometric and visual analysis using VOSviewer and CiteSpace, examining authorships, countries, institutions, journals of publication, co-citations of references, connections between keywords, clusters of keywords, and keywords with citation bursts. Over the past ten years, we collected 1045 research papers focusing on the field of epilepsy and comorbid depression. Publications on epilepsy and depression have shown a general upward trend over time, though with some fluctuations. The United States, with 287 articles, and the University of Melbourne, contributing 34 articles, were the top countries and institutions, respectively. In addition, in the field of epilepsy and depression, Professor Lee, who has published 30 articles, was the most contributing author. The hot topics pay attention to the quality of life in patients with epilepsy and depression. We reported that quality of life and stigma in patients with epilepsy comorbid with depression are possible future hot topics and directions in the field of epilepsy and depression research.

Pediatric Epilepsy and its Health Conditions in UAE: A Review Article

Epilepsy is one of the major public health concerns in Arab countries, as it contains a total of 80% of cases worldwide. There are two age peaks for onset: childhood and adulthood, but children experience the highest burden. Epilepsy in childhood can have an impact on educational performance as well as psychological and social interaction. Epileptic patients are also susceptible to a wide range of other frequent health issues. The co-morbidities often cause more burdens and difficulties than the seizures themselves. Pathologically, epilepsy is of three types: acquired, idiopathic, and developmental or genetic origin. The disease is based on glutamate and GABA excitation and inhibition, respectively. EEG, MRI, PET, SPECT, and CT scan are among the main diagnostic procedures available for the treatment. This review covered all the research studies published in peer-reviewed journals on Web of Science between 2014 and 2024. It focused on seeking a better understanding of epilepsy, its kinds, accessible therapies, and co-morbidities by providing significant insights that can benefit the UAE’s healthcare system. EEG and MRI are the two effective techniques used for epilepsy treatment. The UAE healthcare system should focus on adopting the genetic basis of the disease for a precise and targeted treatment.

Navigating Neural Landscapes: A Comprehensive Review of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) Applications in Epilepsy.

This review comprehensively explores the evolving role of neuroimaging, specifically magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS), in epilepsy research and clinical practice. Beginning with a concise overview of epilepsy, the discussion emphasizes the crucial importance of neuroimaging in diagnosing and managing this complex neurological disorder. The review delves into the applications of advanced MRI techniques, including high-field MRI, resting-state fMRI, and connectomics, highlighting their impact on refining our understanding of epilepsy's structural and functional dimensions. Additionally, it examines the integration of machine learning in the analysis of intricate neuroimaging data. Moving to the clinical domain, the review outlines the utility of neuroimaging in pre-surgical evaluations and the monitoring of treatment responses and disease progression. Despite significant strides, challenges and limitations are discussed in the routine clinical incorporation of neuroimaging. The review explores promising developments in MRI and MRS technology, potential advancements in imaging biomarkers, and the implications for personalized medicine in epilepsy management. The conclusion underscores the transformative potential of neuroimaging and advocates for continued exploration, collaboration, and technological innovation to propel the field toward a future where tailored, effective interventions improve outcomes for individuals with epilepsy.

Epilepsy as a Disease Affecting Neural Networks

This research aims to investigate and analyze epilepsy as a disease that affects nervous tissue. The approach used in this research is a qualitative approach with literature study. Epilepsy is a neurological disease characterized by recurrent epileptic seizures. This disease affects the nerve tissue in the brain, causing disruption in the normal functioning of the nervous system. This research method includes analysis of literature studies relevant to the topic of epilepsy and its effect on neural networks. Various sources such as scientific journals, articles and books related to epilepsy and the nervous system were used in this research. Data collected through literature studies were then analyzed qualitatively to identify patterns, trends and important findings related to epilepsy as a disease that affects nervous tissue. The results of this study suggest that epilepsy can affect various aspects of neural networks, including brain structure, synapse connectivity, and electrical activity. Epileptic seizures that occur can cause damage to nerve tissue and affect overall brain function. Apart from that, epilepsy can also affect the development and growth of nervous tissue in children. These findings have important implications in the development of epilepsy diagnosis and treatment. With a better understanding of how epilepsy affects neural networks, we can develop more effective approaches to diagnosing this disease and design more appropriate treatment strategies. In addition, this research also provides additional insight into the pathophysiological mechanisms of epilepsy and strengthens our understanding of the complexity of this disease. This research highlights the importance of understanding epilepsy as a disease that affects neural networks. A qualitative approach with literature studies has helped reveal the relationship between epilepsy and neural networks, as well as the importance of diagnosis and treatment. Further research is needed to deepen our understanding of epilepsy and its effects on neural networks in more detail.

Common epilepsy variants from the general population are not associated with epilepsy among individuals with tuberous sclerosis complex.

Common genetic variants identified in the general population have been found to increase phenotypic risks among individuals with certain genetic conditions. Up to 90% of individuals with tuberous sclerosis complex (TSC) are affected by some type of epilepsy, yet the common variants contributing to epilepsy risk in the general population have not been evaluated in the context of TSC-associated epilepsy. Such knowledge is important to help uncover the underlying pathogenesis of epilepsy in TSC which is not fully understood, and critical as uncontrolled epilepsy is a major problem in this population. To evaluate common genetic modifiers of epilepsy, our study pooled phenotypic and genotypic data from 369 individuals with TSC to evaluate known and novel epilepsy common variants. We did not find evidence of enhanced genetic penetrance for known epilepsy variants identified across the largest genome-wide association studies of epilepsy in the general population, but identified support for novel common epilepsy variants in the context of TSC. Specifically, we have identified a novel signal in SLC7A1 that may be functionally involved in pathways relevant to TSC and epilepsy. Our study highlights the need for further evaluation of genetic modifiers in TSC to aid in further understanding of epilepsy in TSC and improve outcomes.

The time-evolving epileptic brain network: concepts, definitions, accomplishments, perspectives.

Epilepsy is now considered a network disease that affects the brain across multiple levels of spatial and temporal scales. The paradigm shift from an epileptic focus-a discrete cortical area from which seizures originate-to a widespread epileptic network-spanning lobes and hemispheres-considerably advanced our understanding of epilepsy and continues to influence both research and clinical treatment of this multi-faceted high-impact neurological disorder. The epileptic network, however, is not static but evolves in time which requires novel approaches for an in-depth characterization. In this review, we discuss conceptual basics of network theory and critically examine state-of-the-art recording techniques and analysis tools used to assess and characterize a time-evolving human epileptic brain network. We give an account on current shortcomings and highlight potential developments towards an improved clinical management of epilepsy.

Evaluation of the attitude and knowledge level of dentistry undergraduate and specialist students towards epilepsy patients

ObjectiveThe objective of this research, which was carried out at a faculty of Dentistry situated in Turkey, was to assess the differences in awareness, knowledge, and attitudes about epilepsy among preclinical and clinical undergraduate students as well as speciality students. Moreover, this study seeks to ascertain the adequacy of the curriculum and clinical training provided to dental students in the context of managing patients with epilepsy. The aim is to ensure a full grasp of the subject matter and the development of practical skills. Material-methodAt order to facilitate the research done at the Faculty of Dentistry at Afyonkarahisar Health Sciences University, Turkey, a comprehensive questionnaire including eight sections and a total of 60 questions was distributed to students at various stages of their dental education, including preclinical, clinical, and speciality students. ResultThe present study used a descriptive, cross-sectional methodology, including a total of 477 participants from various sections (preclinical, clinical, and speciality) within the Faculty of Dentistry at Afyonkarahisar Health Sciences University. When examining the overall understanding of epilepsy, a statistically significant difference was discovered across the various groups. It is noteworthy that a substantial proportion (68.4 %) of students specializing in a particular field displayed a high level of knowledge, which is in stark contrast to the percentages of clinical (40.5 %) and preclinical (29.4 %) students who exhibited similar levels of understanding. ConclusionThis study conducted at a dental college in Turkey revealed a discernible gradient of knowledge, with speciality students exhibiting the greatest degree of knowledge, followed by clinical students, and subsequently preclinical students. In clinical settings, it was observed that students generally had a favorable disposition while interacting with individuals afflicted with epilepsy. Nevertheless, there was a prevailing sentiment of insufficient preparation and instruction. Hence, it is feasible to augment instructional lectures via the use of problem-based or simulation-based learning frameworks.

Age-Related Changes in Epilepsy Characteristics and Response to Antiepileptic Treatment in Autism Spectrum Disorders.

Despite the high prevalence of epilepsy in individuals with autism spectrum disorder (ASD), there is little information regarding whether seizure characteristics and treatment effectiveness change across age. Using an online survey, seizure characteristics, effectiveness of antiepileptic treatments, comorbidities, potential etiologies, and ASD diagnosis were collected from individuals with ASD and seizures. We previously reported overall general patterns of treatment effectiveness but did not examine the effect of seizure characteristics or age on antiepileptic treatment effectiveness. Such information would improve the personalized medicine approach to the treatment of seizures in ASD. Survey data from 570 individuals with ASD and clinical seizures were analyzed. Seizure severity (seizure/week) decreased with age of onset of seizures, plateauing in adolescence, with a greater reduction in generalized tonic-clonic (GTC) seizures with age. Seizure severity was worse in those with genetic disorders, neurodevelopmental regression (NDR) and poor sleep maintenance. Carbamazepine and oxcarbazepine were reported to be more effective when seizures started in later childhood, while surgery and the Atkins/modified Atkins Diet (A/MAD) were reported to be more effective when seizures started early in life. A/MAD and the ketogenic diet were reported to be more effective in those with NDR. Interestingly, atypical Landau-Kleffner syndrome was associated with mitochondrial dysfunction and NDR, suggesting a novel syndrome. These interesting findings need to be verified in independent, prospectively collected cohorts, but nonetheless, these data provide insights into novel relationships that may assist in a better understanding of epilepsy in ASD and provide insight into personalizing epilepsy care in ASD.

Utility of Exome Sequencing for Diagnosis in Unexplained Pediatric-Onset Epilepsy

Genomic advances inform our understanding of epilepsy and can be translated to patients as precision diagnoses that influence clinical treatment, prognosis, and counseling. To delineate the genetic landscape of pediatric epilepsy and clinical utility of genetic diagnoses for patients with epilepsy. This cohort study used phenotypic data from medical records and treating clinicians at a pediatric hospital to identify patients with unexplained pediatric-onset epilepsy. Exome sequencing was performed for 522 patients and available biological parents, and sequencing data were analyzed for single nucleotide variants (SNVs) and copy number variants (CNVs). Variant pathogenicity was assessed, patients were provided with their diagnostic results, and clinical utility was evaluated. Patients were enrolled from August 2018 to October 2021, and data were analyzed through December 2022. Phenotypic features associated with diagnostic genetic results. Main outcomes included diagnostic yield and clinical utility. Diagnostic findings included variants curated as pathogenic, likely pathogenic (PLP), or diagnostic variants of uncertain significance (VUS) with clinical features consistent with the involved gene's associated phenotype. The proportion of the cohort with diagnostic findings, the genes involved, and their clinical utility, defined as impact on clinical treatment, prognosis, or surveillance, are reported. A total of 522 children (269 [51.5%] male; mean [SD] age at seizure onset, 1.2 [1.4] years) were enrolled, including 142 children (27%) with developmental epileptic encephalopathy and 263 children (50.4%) with intellectual disability. Of these, 100 participants (19.2%) had identifiable genetic explanations for their seizures: 89 participants had SNVs (87 germline, 2 somatic mosaic) involving 69 genes, and 11 participants had CNVs. The likelihood of identifying a genetic diagnosis was highest in patients with intellectual disability (adjusted odds ratio [aOR], 2.44; 95% CI, 1.40-4.26), early onset seizures (aOR, 0.93; 95% CI, 0.88-0.98), and motor impairment (aOR, 2.19; 95% CI 1.34-3.58). Among 43 patients with apparently de novo variants, 2 were subsequently determined to have asymptomatic parents harboring mosaic variants. Of 71 patients who received diagnostic results and were followed clinically, 29 (41%) had documented clinical utility resulting from their genetic diagnoses. These findings suggest that pediatric-onset epilepsy is genetically heterogeneous and that some patients with previously unexplained pediatric-onset epilepsy had genetic diagnoses with direct clinical implications.

Perceptions of teachers regarding the inclusion of epilepsy education in life skills for primary learners and teachers in Limpopo and Mpumalanga provinces (South Africa)

Background. Epilepsy is a frequent neurological condition with complicated effects, and it is characterized by seizures that can last quite a long time. It is important that people around treat epilepsy patients with understanding and be able to help them during seizures.Objective: to determine the perceptions of teachers regarding epilepsy education being included in life skills education considering that teachers spend a great deal of time with school students.Material and methods. The study employed an exploratory-descriptive design to explore primary school teachers' perceptions regarding the need to include epilepsy in life skills education. It was conducted in Limpopo and Mpumalanga provinces in South Africa. Data were collected from 20 primary school teachers in Limpopo and Mpumalanga using semi-structured interviews. Only primary school teachers who teach life skills were interviewed to reach data saturation.Results. The respondents revealed their knowledge that epilepsy is a disease associated with falling, shivering movements/ seizures, releasing saliva in a bubble foam, and being unconscious. However, they showed insufficient understanding regarding some aspects and expressed the opinion that there is a need of including epilepsy in life skills education, because it will assist the learners and teachers in knowing more about epilepsy. The participants consider that since epileptic seizure is an unpredictable condition that can happen to anyone, at any time, they feel it is important that learners and teachers are educated about it. For this purpose, they suggested various teaching methods and the necessary areas of knowledge about epilepsy.Conclusion. The findings of the study revealed that the inclusion of epilepsy in life skills education will enhance the knowledge and understanding of epilepsy through learning the aspects that have been suggested by the participants.

Pentylenetetrazole kindling-induced epilepsy rat models: Insight on the severity state, a comparative study.

This study aimed to carry out a comparative study of the main models of chronic epilepsy induced by pentylenetetrazole (PTZ)-kindling method and to assess the efficacy of sodium valproate, one of the main antiepileptics, on the best epilepsy-inducing kindling model. Two sets of 24 animals were divided into 4 groups of 6 animals and treated as follow: Set 1 included: group 1, control; group 2, the classic kindling PTZ group (UKEOD); group 3, PTZ kindling every other day group with challenge (CKEOD); group 4, PTZ kindling every day group, with challenge (CKED); Set 2 included: group 1, control; group 2, CKEOD group; group 3 and 4, receiving either valproate 200mg/kg or valproate 300mg/kg +CKEOD procedure. Results show that CKEOD group significantly reduced the number of injections necessary to reach the fully-kindled state, increased the severity of seizures and improved the stability of seizures. In addition, the CKEOD group significantly increased the level of malondialdehyde and GABA transaminase, reduced the level of reduced glutathione, catalase and GABA. Furthermore, it had no impact on plasma levels of alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT). Valproate 300mg/kg significantly protected animals against kindling induced by CKEOD. The kindling model with a challenge dose administered on day 1 (CKEOD) thus allows to induce more severe, more stable chronic epilepsy and in a shorter period of time, and could thus contribute to a better understanding of epilepsy, as well as its uses in drug discovery.

Knowledge of and Attitude towards Epilepsy among the Jordanian Community.

Background: Epilepsy is a disorder characterized by recurring seizures that do not have an immediate identifiable cause. It is a disorder with complex symptoms and a wide range of risk factors, with age, genetics, and origin being the most prevalent variations. This study aimed to evaluate the knowledge of and attitude towards epilepsy among the Jordanian community. Method: An online cross-sectional study using a self-administered questionnaire was conducted between 29 March and 15 May 2022 in Jordan. In this study, three previously validated questionnaire items were adapted and employed. Binary logistic regression was applied to identify predictors of good knowledge and a positive attitude. Results: A total of 689 participants were involved in this study. A weak level of knowledge about epilepsy was observed among the study participants (35.3%). The participants showed a moderately positive attitude towards epilepsy (63.3%). Being female, holding a bachelor’s degree, knowing anyone who had epilepsy and seeing anyone having an epileptic seizure were factors that positively affected participants’ knowledge about epilepsy. Being aged between 24 and 29 years or being divorced were factors that affected the participants’ attitudes negatively towards epilepsy. Conclusion: The study’s participants had limited knowledge of epilepsy and a favorable attitude toward it. The community’s understanding of epilepsy and attitude toward epilepsy patients should be improved by an informed educational effort on the part of various media platforms. All facets of the community, including parents, should be the focus of these initiatives.

An evaluation of the knowledge, attitudes, and behaviors of parents regarding epilepsy

Background and aimsKnowledge about epilepsy and attitudes toward people with epilepsy can influence measures taken to manage epilepsy and seizures. The support and understanding of parents of children with epilepsy are invaluable in helping develop ordinary living skills. To determine the educational needs of parents of children with epilepsy, their knowledge, attitudes, and behaviors should be evaluated. Therefore, we interviewed parents who had a child with epilepsy who was treated at the pediatric neurology clinic of a university hospital. We aimed to evaluate parents' knowledge, attitudes, and behaviors toward children with epilepsy to determine their educational needs. MethodsThis descriptive study included 221 parents of children with epilepsy who applied to Hatay Mustafa Kemal University Medical Faculty Hospital. A questionnaire was used to collect data. Pearson and exact chi-square tests were used for analysis. ResultsIn the present study, 221 parents were interviewed. A total of 66.5% of the participants were at the primary education level. The rate of participants who preferred healthcare professionals as a source of information about epilepsy was 78.9%. Forty-eight percent of the parents did not see consanguineous marriage as a reason. While some parents stated that epilepsy was supernatural, others had no idea whether it was contagious or not, and 46.2% of the participants stated that epilepsy is not a hereditary disease. The rate of those who tried nonphysician treatment was 16.3%. The rate of participants who thought that drinking alcohol would not trigger seizures was 86.9%. It was determined that 30.8% of the participants pulled the patient's tongue out during seizures. 16.7% of participants thought that patients with epilepsy were disabled. 50.7% of the participants stated that their children with epilepsy could do any profession. ConclusionsOur study documented parents' lack of knowledge about epilepsy. Many parents have significant misunderstandings, negative attitudes, and parenting practices, and their knowledge and understanding of epilepsy needs to be improved.

Knowledge and attitude toward epilepsy among the final and semi-final years medical students at University of Bahri, Sudan.

ObjectiveTo assess the knowledge and attitude toward epilepsy among the final and semi‐final years medical students at University of Bahri.MethodsAn observational cross‐sectional study was carried out at College of Medicine, University of Bahri. Self‐administered questionnaires were applied to 228 medical students in the final and semi‐final years.ResultsSixty‐three percent of students showed a high level of knowledge. Despite that 10.1% of the students do not know that atonic seizure is a type of epilepsy, 62.7% attributed the causes of epilepsy to psychological factors only, and 9.6% considered epilepsy is an untreatable disease. The majority of students are not aware that screaming is a manifestation of certain types of epilepsy. More than half of the students considered inserting something into the patient's mouth during the seizure will prevent tongue biting. Interestingly, a total of 8.3% of students thought that it is a demonic attack, whereas 34.6% of students thought the Holy Quran as an appropriate treatment for epilepsy (P = .026). Up to 77% of the students showed a positive attitude toward patients with epilepsy. However, 42.1% of students agreed that there should be some restrictions in sport and leisure activities for people who suffer from epilepsy, and 13.6% of students admitted they will not get married to someone with epilepsy.SignificanceOur study showed an overall relatively high level of knowledge toward epilepsy among medical students with a potentially positive attitude toward patients with the disease. However, there are still misconceptions of epilepsy in different aspects. This study showed some important facts for policymakers and key opinion leaders in curriculum preparation and training programs for medical schools which should be designed to increase knowledge and understanding of epilepsy among the medical students, not just the scientific knowledge but also discuss the social impact of epilepsy on a patient's life.

Seizure triggers identified postictally using a smart watch reporting system

Persons with epilepsy (PWE) often report that seizure triggers can influence the occurrence and timing of seizures. Some previous studies of seizure triggers have relied on retrospective daily seizure diaries or surveys pertaining to all past seizures, recent and/or remote, in respondents. To assess the characteristics of seizure triggers at the granularity of individual seizures, we used a seizure-tracking app, called EpiWatch, on a smart watch system (Apple Watch and iPhone) in a national study of PWE. Participants tracked seizures during a 16-month study period using the EpiWatch app. Seizure tracking was initiated during a pre-ictal state or as the seizure was occurring and included collection of biosensor data, responsiveness testing, and completion of an immediate post-seizure survey. The survey evaluated seizure types, auras or warning symptoms, loss of awareness, use of rescue medication, and seizure triggers for each tracked seizure. Two hundred and thirty four participants tracked 2493 seizures. Ninety six participants reported triggers in 650 seizures: stress (65.8%), lack of sleep (30.5%), menstrual cycle (19.7%), and overexertion (18%) were the most common. Participants often reported having multiple combined triggers, frequent stress with lack of sleep, overexertion, or menses. Participants who reported triggers were more likely to be taking 3 or more anti-seizure medications compared to participants who did not report triggers. Participants were able to interact with the app and use mobile technology in this national study to record seizures and report common seizure triggers. These findings demonstrate the promise of longitudinal, self-reported data to improve our understanding of epilepsy and its related comorbidities.

Awareness and attitude of first-year medical students toward epilepsy in University of Khartoum, Sudan.

PurposeVery little is known about the knowledge and attitude of students about epilepsy at Sudanese universities. Therefore, we aimed to assess knowledge and attitude of undergraduate medical students toward epilepsy.MethodsA 35‐items standardized questionnaire was self‐administered to 320 students between December 2020 and February 2021 with a recorded response rate of 61.8%. Google form was used to collect the data. The data was analyzed using R software.ResultsOverall, our findings showed a negative trend in the awareness and attitude towards epilepsy. While the majority of students (84.8%) had read or heard about epilepsy, only 43.9% of them had seen someone with epilepsy. Epilepsy was considered contagious and psychological by 1.7% and 56%, respectively. About 62.2% of students believed head / birth trauma is a cause of epilepsy. On the other hand, 15.7 % and 5.1 % of students thought evil eye and divine retribution are also causes of epilepsy, respectively. The latter beliefs were more uniform among participants from rural background (p < .05). Regarding attitude, 19.7% of students considered it inappropriate for a patient with epilepsy to have a child. This attitude correlates with the mother's education as the percentage was higher for students whose mothers had a lower education (pre‐college education) (p < .05). The majority of students were aware that certain people with epilepsy need long‐term drug treatment; this belief was more uniform among females than in males (p < .05). The vast majority of students (93.9%) thought that a child with epilepsy could succeed in a normal class. Compared to the corresponding group, this belief was found more common in students whose mothers had a higher education (university level and above) (p < .05).ConclusionThis study concludes that Sudanese undergraduate students' understanding of epilepsy was minimal, necessitating a well‐directed educational campaign to develop a well‐informed and tolerant society.

MEG Node Degree Differences in Patients with Focal Epilepsy vs. Controls-Influence of Experimental Conditions.

Drug-resistant epilepsy can be most limiting for patients, and surgery represents a viable therapy option. With the growing research on the human connectome and the evidence of epilepsy being a network disorder, connectivity analysis may be able to contribute to our understanding of epilepsy and may be potentially developed into clinical applications. In this magnetoencephalographic study, we determined the whole-brain node degree of connectivity levels in patients and controls. Resting-state activity was measured at five frequency bands in 15 healthy controls and 15 patients with focal epilepsy of different etiologies. The whole-brain all-to-all imaginary part of coherence in source space was then calculated. Node degree was determined and parcellated and was used for further statistical evaluation. In comparison to controls, we found a significantly higher overall node degree in patients with lesional and non-lesional epilepsy. Furthermore, we examined the conditions of high/reduced vigilance and open/closed eyes in controls, to analyze whether patient node degree levels can be achieved. We evaluated intraclass-correlation statistics (ICC) to evaluate the reproducibility. Connectivity and specifically node degree analysis could present new tools for one of the most common neurological diseases, with potential applications in epilepsy diagnostics.

Slow oscillations open susceptible time windows for epileptic discharges.

ObjectiveIn patients with epilepsy, interictal epileptic discharges are a diagnostic hallmark of epilepsy and represent abnormal, so‐called “irritative” activity that disrupts normal cognitive functions. Despite their clinical relevance, their mechanisms of generation remain poorly understood. It is assumed that brain activity switches abruptly, unpredictably, and supposedly randomly to these epileptic transients. We aim to study the period preceding these epileptic discharges, to extract potential proepileptogenic mechanisms supporting their expression.MethodsWe used multisite intracortical recordings from patients who underwent intracranial monitoring for refractory epilepsy, the majority of whom had a mesial temporal lobe seizure onset zone. Our objective was to evaluate the existence of proepileptogenic windows before interictal epileptic discharges. We tested whether the amplitude and phase synchronization of slow oscillations (.5–4 Hz and 4–7 Hz) increase before epileptic discharges and whether the latter are phase‐locked to slow oscillations. Then, we tested whether the phase‐locking of neuronal activity (assessed by high‐gamma activity, 60–160 Hz) to slow oscillations increases before epileptic discharges to provide a potential mechanism linking slow oscillations to interictal activities.ResultsChanges in widespread slow oscillations anticipate upcoming epileptic discharges. The network extends beyond the irritative zone, but the increase in amplitude and phase synchronization is rather specific to the irritative zone. In contrast, epileptic discharges are phase‐locked to widespread slow oscillations and the degree of phase‐locking tends to be higher outside the irritative zone. Then, within the irritative zone only, we observe an increased coupling between slow oscillations and neuronal discharges before epileptic discharges.SignificanceOur results show that epileptic discharges occur during vulnerable time windows set up by a specific phase of slow oscillations. The specificity of these permissive windows is further reinforced by the increased coupling of neuronal activity to slow oscillations. These findings contribute to our understanding of epilepsy as a distributed oscillopathy and open avenues for future neuromodulation strategies aiming at disrupting proepileptic mechanisms.

Making the Invisible Visible: Advanced Neuroimaging Techniques in Focal Epilepsy.

It has been a clinically important, long-standing challenge to accurately localize epileptogenic focus in drug-resistant focal epilepsy because more intensive intervention to the detected focus, including resection neurosurgery, can provide significant seizure reduction. In addition to neurophysiological examinations, neuroimaging plays a crucial role in the detection of focus by providing morphological and neuroanatomical information. On the other hand, epileptogenic lesions in the brain may sometimes show only subtle or even invisible abnormalities on conventional MRI sequences, and thus, efforts have been made for better visualization and improved detection of the focus lesions. Recent advance in neuroimaging has been attracting attention because of the potentials to better visualize the epileptogenic lesions as well as provide novel information about the pathophysiology of epilepsy. While the progress of newer neuroimaging techniques, including the non-Gaussian diffusion model and arterial spin labeling, could non-invasively detect decreased neurite parameters or hypoperfusion within the focus lesions, advances in analytic technology may also provide usefulness for both focus detection and understanding of epilepsy. There has been an increasing number of clinical and experimental applications of machine learning and network analysis in the field of epilepsy. This review article will shed light on recent advances in neuroimaging for focal epilepsy, including both technical progress of images and newer analytical methodologies and discuss about the potential usefulness in clinical practice.

Epilepsy in schools: Views on educational and therapeutic provision, understanding of epilepsy and seizure management

ObjectiveTo gain an understanding of the views of young people with epilepsy, their parents and school staff regarding educational and therapeutic provision, understanding of epilepsy and seizure management in schools. MethodsSchool-aged children (n = 20) with ‘active epilepsy’ (taking Anti-Seizure Medications (ASMs) for epilepsy), their parents (n = 68), and school staff (n = 56) were interviewed or completed bespoke questionnaires. In addition, all participating children underwent psychological assessment including measures of behavior and cognition. ResultsOnly 15% of participating children had received psychological support despite 60% scoring within the at-risk range on a measure of behavioral and emotional difficulties. More than half of the responding children reported that some of their teachers and friends did not know that they had epilepsy. A significant minority of parents (32%) did not feel that the child’s transition from preschool to primary, or primary to secondary school was managed well. Knowledge of the child’s epilepsy was felt to be significantly better in special schools than mainstream schools according to both parents and school staff. Staff in special schools perceived they were more knowledgeable about the child’s ASMs and changes to ASMs than staff in mainstream schools. Staff in special schools were significantly more likely to have received training on general aspects of epilepsy, seizure management, and impacts on learning and/or behavior. Parental interviews indicated difficulties accessing educational and therapeutic supports. Parents often felt that they had to drive the process to gain supports themselves. They also reported limited professional support, and inadequate communication between themselves and the school and school staff and medical/therapeutic professionals regarding their child’s needs. Parents would like more school staff to recognize the impacts of epilepsy on learning and behavior and to support their child more holistically. Many parents wanted more resources for assessment and therapeutic provision in relation to their child’s learning, behavior, and emotions. ConclusionKnowledge of epilepsy is felt by parents and staff to be significantly better in special schools compared with mainstream schools. Parents highlighted the need for increased knowledge of the impacts of epilepsy on learning and behavior and perceived a need for more resources for assessment of these difficulties.