Does missing medication acutely change seizure risk? A prospective study

Background: Seizures occur in 10% of stroke patients, but their predictors have not been clearly identified. Pre-existing dementia is present in 12–16% of stroke patients and, at the community level,...

Experience with continuous EEG monitoring in 29 consecutive infants at risk of neonatal seizures demonstrated that background abnormalities on the initial EEG were strongly associated with electrographic seizures in the subsequent 18-24 h. To test this association prospectively, we examined the relationship between EEG background and the presence of electrographic seizures in the next 22 at-risk infants monitored for seizures. A standard EEG was recorded for each infant at risk for seizures. Based on specific criteria, the background was graded as normal; immature for age; or mildly, moderately, or severely abnormal. The EEG was then monitored continuously until no electrographic seizures were recorded for 18-24 h. Findings in the retrospective group of 29 infants and the prospective group of 22 infants did not differ. For the combined 51 infants, a normal or immature initial EEG background predicted the absence of seizures in the subsequent 18-24 h with a sensitivity of 96% [confidence interval (CI) 0.88, 1.0] and specificity of 81% (CI 0.67, 0.96). Administration of antiepileptic drugs (AEDs) before the start of the EEG recording did not affect this association. In 51 consecutively monitored infants at risk for neonatal seizures, a normal or immature EEG background strongly predicted the absence of electrographic seizures in the subsequent 18-24 h; background abnormalities strongly predicted the occurrence of electrographic seizures concomitantly or in the subsequent 18-24 h of recording. Screening infants at risk for neonatal seizures with a routine EEG allows identification of infants at highest risk for seizures, thus conserving resources required for continuous EEG monitoring and facilitating early intervention for seizures.

High-Dose Tranexamic Acid Is an Independent Predictor of Early Seizure After Cardiopulmonary Bypass

Early seizures are a common complication after acute intracerebral hemorrhage (ICH). We tested the hypothesis of whether prophylactic antiseizure medication is associated with lower incidence of early seizures in patients with elevated risk of ICH. This study involved a retrospective analysis of a prospective observational cohort, including five academic medical centers with a focus on patients presenting spontaneous ICH on hospital admission in the years 2006 through 2023. We assessed the characteristics of acute ICH and the administration of antiseizure medication. In this observational cohort, the administration of antiseizure medication was at the discretion of the treating physician. We focused on the 300 patients with lobar hematoma location. Age, hematoma volume, and sex were included as covariates in an adjusted regression model to evaluate seizure occurrence. We prospectively recorded the use of antiseizure medications and identified the occurrence of early seizures. Additionally, we conducted an exploratory analysis defining patients who were at risk as those with lobar hematomas, age < 65years, and hematoma volume ≥ 10mL. Functional outcomes were assessed using modified Rankin Scale scores three months after event. The median age was 72.0 (interquartile range 62.0-80.0) years, and 158 (53%) were female. An early seizure occurred in 43 (14.3%). In patients who did not receive antiseizure prophylaxis, 34 of 157 (21.6%) had an early seizure, whereas in patients who did receive antiseizure prophylaxis, 9 of 143 (6.3%) had an early seizure. Prophylactic antiseizure medication was associated with a reduced incidence of early seizures (adjusted odds ratio 0.25, 95% confidence interval 0.11-0.54, P = 0.0005) in patients at high risk for early seizures. There was no association between prophylactic medication use and modified Rankin Scale scores at three-month follow-up. In a retrospective analysis of a multicenter cohort of patients at elevated seizure risk after ICH, prophylactic antiseizure medication was associated with a reduced likelihood of an early seizure.

To investigate the association of EEG-assessed Phase Lag Index (PLI) with cognitive dysfunction and seizure occurrence in pediatric patients with epilepsy. A retrospective cohort study enrolled 117 children with epilepsy aged 4 to 16 years. Participants were categorized into Normal PLI (n=53) and Abnormal PLI (n=64) groups based on EEG-assessed PLI values. EEG signals were collected using 87-channel Natus Brain Monitor amplifier, and PLI and coherence were calculated for various brain regions. Cognitive function and seizure occurrence were assessed using standardized tests and clinical parameters. Statistical analyses, including t-tests, Spearman correlation analysis, and logistic regression, were conducted to evaluate the associations between EEG-assessed PLI, cognitive dysfunction, and seizure occurrence. The Abnormal PLI group exhibited significantly higher PLI measurements across various brain regions compared to the Normal PLI group (P < 0.001 for all comparisons). Distinct EEG pattern alterations, especially in PLI and various frequency bands, were observed in the Abnormal PLI group. This group also displayed significant cognitive impairments across all cognitive measures (P < 0.001 for all comparisons) and experienced markedly higher seizure frequency, longer average seizure duration, and greater seizure severity compared to the Normal PLI group (P < 0.001 for all comparisons). Correlation and logistic regression analyses supported the robust relationships between PLI, cognitive dysfunction, and seizure parameters (P < 0.001 for all). EEG-assessed PLI shows promise as a valuable tool for assessing cognitive dysfunction and predicting seizure occurrence in children with epilepsy. The study's findings contribute to the understanding of the neuropathophysiology of epilepsy in children and offer implications for prognostic assessment and therapeutic intervention in this vulnerable patient population. The results emphasize the potential clinical utility of EEG-derived biomarkers in the evaluation and management of epilepsy in pediatric patients, suggesting avenues for personalized treatment strategies to optimize cognitive outcomes and seizure management in this population.

e13520 Background: Up to 90% of LGG patients present with seizures, but the risk of developing seizure is not known. Our goal was to determine the association between clinical and molecular factors with seizure incidence in LGG patients. Methods: Retrospective study from 2/2002-1/2015 involving 291 patients ≥18 years old, with diagnosis of WHO grade II glioma. Intractable seizure was defined as patients needing ≥2 anti-epileptic drugs. Chi-square tests of association were used to test for associations between factors and outcome measures. Results: Study population was 54% men, median age of 51, with oligodendroglioma (47%), oligoastrocytoma (25%), astrocytoma (21%), NOS (7%). Among patients with molecular testing (87%), 32% had IDH mutation (IDHmt) and 1p/19q co-deletion, 37% IDHmt and 1p/19q intact and 18% IDH wildtype LGG. Sixty-eight percent of patients had seizures prior to LGG diagnosis; 41% intractable seizures. A trend toward higher incidence of pre-operative seizure was observed in IDHmt LGG patients (p = 0.09). On univariate analysis (Table), oligodendroglioma was significantly associated with a higher risk of intractable seizures. Male gender was strongly associated with the risk of seizure at presentation, seizure development after surgery, and intractable seizures. Conclusions: Consistent with historical data, the majority of our patients presented with seizure; oligodendroglioma with higher risk of intractable seizures. Unexpectedly, gross resection did not favorably predict seizure outcome, possibly due to our small study population. Our study only showed a trend towards higher seizure occurrence in IDHmt LGG patients. Our finding of association between male gender and seizure risk in LGG patients mirrors that of Pallud et al (Brain 2014) and warrants further investigation into the possible molecular basis of sex differences in epileptogenesis in LGG.[Table: see text]

There is a close bidirectional relationship between sleep and epilepsy. Anti-seizure medications (ASM) act to reduce seizure frequency but can also impact sleep; this remains a relatively unexplored field given the importance of sleep on seizure occurrence, memory consolidation, and quality of life. We compared the effect of poly-ASM treatment on a night of sleep compared to an unmedicated night in patients with drug-resistant epilepsy, where ASMs were withdrawn and later restored as part of their pre-surgical evaluation. Within-subject analysis between medicated and unmedicated nights showed ASMs increased spindle (11–16 Hz) power and decreased slow wave (0.1–2 Hz) amplitude. Spindles became less strongly coupled to slow waves in the ASM night compared to no-ASM night, with effects to both the phase and strength of coupling and correlated with slow wave reduction. These effects were not seen in age-matched controls from the same unit where ASMs were not changed between two nights. Overall, we found that ASM polytherapy not only changed specific sleep waveforms, but also the fine interplay of spindle/slow wave coupling. Since these sleep oscillations impact both seizure occurrence and memory consolidation, our findings provide evidence towards a decoupling impact of ASMs on sleep that should be considered in future studies of sleep and memory disruption in people with epilepsy.

Epileptic seizures account for 24-40% of all clinical onsets in patients with brain arteriovenous malformations (AVMs). We retrospectively reviewed the angioarchitectural features of AVMs associated with seizures in 168 patients admitted to our Department from 1997 to 2012. Patients were dichotomized according to demographic characteristics, type of treatment, bleeding occurrence, and morphological and topographic features. Clinical status at admission and discharge was also recorded. The association of each one of these variables with seizures occurrence was statistically tested. Continuous variables and outcome were compared with Student's t-test, whereas categorical ones were compared using Fisher's exact test. The independent contribution of some seizures predictors was assessed with a logistic regression model. Associations were considered significant for P < 0.05. About 29% patients showed seizures and 47% bleeding. No significant difference in age and sex was observed between patients with and without seizures. AVMs > 4 cm (P = 0.001) and those fed by dilated arterial feeders (P = 0.02) were associated with increased risk of seizures. A higher risk of seizures occurrence was also observed in cortical AVMs compared with deeper ones (75.5% vs. 55.4%; P = 0.01), and in AVMs fed by middle and posterior cerebral arteries branches compared with the other vessels (81.6% vs. 45.3%; P < 0.001 and 48.9% vs. 23.5%; P = 0.002, respectively). No lobar predisposition was observed. A nidus > 4 cm also appeared as an independent risk factor of seizures occurrence (OR 2.82; 95% CI, 1.26-6.31; P = 0.009) at logistic regression analysis. AVM morphology, especially nidus dimension, appeared to more significantly influence seizures occurrence than their topography.

The management of epilepsy should be patient centered, and the treating team should carefully balance eliminating seizures while minimizing adverse effects associated with antiseizure medications. This article highlights important aspects of care related to sexual and reproductive health in people with epilepsy. Gender- and sex-based management in epilepsy can present unique challenges especially in people with epilepsy of childbearing potential. One of the most important considerations with the prescription of antiseizure medications to people of childbearing potential involves reproductive health. Folic acid supplementation is recommended to reduce the risk of congenital malformations, but there is no consensus on the optimal dose. The clinical management of pregnancy in the setting of epilepsy can be challenging. Significant knowledge gaps remain regarding the risks for most new antiseizure medications, neurostimulation therapy, and ketogenic diets during pregnancy. Ongoing multicenter pregnancy registries continue to inform practitioners on the medical treatment of people with epilepsy of childbearing potential. Data evaluating the effect of antiseizure medications on male patients with epilepsy, especially around conception, continue to be insufficient. The decision to prescribe an antiseizure medication depends on several considerations because of the potential for lifetime treatment with a daily medication. It is important to tailor management to the patient's specific circumstances. Seizures and antiseizure medications can both affect sexual and reproductive health. Furthermore, hormone fluctuations may affect seizure frequency, treatment, and contraception. All these factors should be considered when treating people with epilepsy during their reproductive years. In addition, it is important to foster a multidisciplinary approach for the treatment of people with epilepsy.

To determine the risk of seizures in critically ill patients receiving the antibiotic imipenem, a broad-spectrum antibiotic that has been associated with seizures. Reports generally have not considered other contributing factors such as dose, seizure history, and morbidity index of the underlying illness necessitating the antibiotic. Charts of all patients in a 450-bed municipal hospital who received imipenem in a 6-month period, as determined by pharmacy records, were reviewed for dosage and duration of imipenem use, occurrence of seizures. and mortality outcome. Attention was paid to demographic features; pattern of seizure occurrence during, before, and after imipenem use; renal function; and correction for dosage based on size. Seventy-five charts were reviewed. Sixty-three patients had no seizures during the hospitalization, four had seizures while receiving imipenem, and eight had seizures during the hospitalization but before or after imipenem use. The incidence of seizures was 4/1,000 patient-days on, and 3.9/1,000 patient-days off imipenem (not significant). The risk of seizure in both groups was considerably higher in those patients with a history of seizures before hospitalization. The presence of other factors that could contribute to increased concentration of imipenem in the brain, such as renal failure or acute stroke, did not contribute to seizure incidence. Metabolic derangement, anoxia, and phenytoin discontinuation did contribute to seizure incidence. Seizure incidence is increased in all critically ill patients (16% of patients studied), but with no added risk during the period patients received imipenem. Determining the proper dose based on a patient's body mass, correction of dose in the presence of renal failure, and avoidance of excess of 2 g/day of imipenem removes any added risk for seizures from imipenem. Despite experimental data to suggest action of imipenem on the glutamate/N-methyl-d-aspartate receptor, or interference with binding to the gamma-aminobutyric acid receptor, and early clinical studies that warned against its use because of seizure risk, we found that careful use of this antibiotic is safe.

A retrospective medical chart review was conducted to document seizure occurrence in 180 children and adolescents (newborn to 22 years of age) receiving hemodialysis (HD) and/or peritoneal dialysis (PD) from January 1974 through June 1988 at Children's Hospital and Medical Center in Seattle, Washington. The purpose of the review was to identify risk factors associated with seizure activity during or up to 24 h following dialysis treatment. Seventy-eight patients received only HD, 79 received only PD and 23 received both HD and PD. Dialysis-associated seizures (DAS) were seen in 7.2% (13/180) of all dialyzed patients; 12 occurred during HD and 1 occurred during PD. Patients receiving only HD were more likely to experience DAS (7/78, 9%), than patients receiving only PD (0/79, 0%) (chi-squared = 5.5, 1 df, P = 0.02). Among the 101 patients who received HD, the risk of HD-associated seizures among those with a prior history of seizure (6/21, 29%) was significantly higher than among those with no history of seizure (6/80, 8%) (chi-squared = 5.2, 1 df, P = 0.02). Prior history of seizure did not influence the risk of seizures among patients receiving PD. These data suggest that patients receiving HD, and especially those with a prior history of seizure, should be monitored closely during dialysis and measures taken to reduce the risk of seizures.

Introduction: Epilepsy is a common neurological disease especially in Sub-Saharan Africa. Medication adherence is key in seizure control; however, majority of patients have poor adherence to anti- seizure medications. In this study, we determined the prevalence, factors associated with and experiences on adherence to anti-seizure medications among patients with epilepsy attending a community- based epilepsy clinic in central-Uganda. Methods: In this cross-sectional mixed methods study 277 participants were enrolled while 20 in-depth interviews were conducted from April to July 2024. Using a structured questionnaire, socio-demographics and treatment related details were collected. Medication adherence was determined using a standardized Morisky Medication Adherence Scale (MMAS-8). Modified Poisson regression was used, and unadjusted and adjusted prevalence ratios (PR) at 95% confidence intervals determined with p-values of less than 0.05 were considered significant. Results: The overall prevalence of adherence to anti-seizure medications was 66.7%. Adherence was defined as 6 to 8 scores as per the MMAS-8. Factors associated with adherence to anti-seizure medications were: Earning a modest monthly income (aPR 1.29: CI 1.13-1.52), Receiving inadequate treatment dosage (aPR 0.80: 95% CI 0.64-0.92), waiting for three or more hours (aPR 0.79: 95% CI 0.61-0.91) and being 30 to 34 years (aPR 0.71: CI 0.53-0.95). The key themes on experiences to adherence to anti-seizure medications were fear of stigmatisation, injury and loss of life, social support, financial burden, individual motivation, misconception about ASMs and lack of awareness on the effectiveness of anti-seizure medications. Conclusion: This study revealed that about two-thirds of PLWE were adherent to ASMs. There is a need to implement strategies, including a medication adherence tool, during patient treatment in our settings.

Epileptic seizures are among the most common and disabling symptoms in patients with brain tumours, especially gliomas, often severely impacting quality of life and complicating oncologic management. This review synthesizes current evidence on brain tumour–related epilepsy (BTRE) treatment, focusing on antiseizure medication (ASM) choices, withdrawal timing, and surgical outcomes. A systematic search of PubMed and Google Scholar (2015–2025) identified five high-quality studies. Data show that seizure recurrence after ASM withdrawal remains significant, with up to 47% relapsing within three years, even after extended seizure-free periods. Comparative studies indicate that levetiracetam is associated with lower treatment failure rates than valproic acid, mainly due to fewer uncontrolled seizures, although both drugs have notable side effect profiles. Newer-generation ASMs like lacosamide and perampanel demonstrate high responder rates and acceptable tolerability but require monitoring for psychiatric and behavioural effects. Surgical resection remains a cornerstone of treatment, offering long-term seizure freedom for many; over half of patients undergoing surgery successfully withdrew from ASMs altogether. These findings highlight that optimal seizure management in BTRE demands an individualized, multidisciplinary strategy that considers tumour type, seizure risk, drug interactions, and patient preferences. Ultimately, careful ASM selection, timely withdrawal decisions, and integration of surgical interventions are essential to balancing seizure control with maintaining cognitive function and quality of life.

Seizure risk forecasting could reduce injuries and even deaths in people with epilepsy. There is great interest in using non-invasive wearable devices to generate forecasts of seizure risk. Forecasts based on cycles of epileptic activity, seizure times or heart rate have provided promising forecasting results. This study validates a forecasting method using multimodal cycles recorded from wearable devices. Seizure and heart rate cycles were extracted from 13 participants. The mean period of heart rate data from a smartwatch was 562 days, with a mean of 125 self-reported seizures from a smartphone app. The relationship between seizure onset time and phases of seizure and heart rate cycles was investigated. An additive regression model was used to project heart rate cycles. The results of forecasts using seizure cycles, heart rate cycles, and a combination of both were compared. Forecasting performance was evaluated in 6 of 13 participants in a prospective setting, using long-term data collected after algorithms were developed. The results showed that the best forecasts achieved a mean area under the receiver-operating characteristic curve (AUC) of 0.73 for 9/13 participants showing performance above chance during retrospective validation. Subject-specific forecasts evaluated with prospective data showed a mean AUC of 0.77 with 4/6 participants showing performance above chance. The results of this study demonstrate that cycles detected from multimodal data can be combined within a single, scalable seizure risk forecasting algorithm to provide robust performance. The presented forecasting method enabled seizure risk to be estimated for an arbitrary future period and could be generalised across a range of data types. In contrast to earlier work, the current study evaluated forecasts prospectively, in subjects blinded to their seizure risk outputs, representing a critical step towards clinical applications. This study was funded by an Australian Government National Health & Medical Research Council and BioMedTech Horizons grant. The study also received support from the Epilepsy Foundation of America's 'My Seizure Gauge' grant.

Seizure disorders are the most frequent major neurologic complication in pregnancy, affecting 0.3% to 0.8% of all gestations. Women of childbearing age with epilepsy require special care related to pregnancy. This article provides up-to-date information to guide practitioners in the management of epilepsy in pregnancy. Ongoing multicenter pregnancy registries and studies continue to provide important information on issues related to pregnancy in women with epilepsy. Valproate poses a special risk for malformations and cognitive/behavioral impairments. A few antiseizure medications pose low risks (eg, lamotrigine, levetiracetam), but the risks for many antiseizure medications remain uncertain. Although pregnancy rates differ, a prospective study found no difference in fertility rates between women with epilepsy who were attempting to get pregnant and healthy controls. During pregnancy, folic acid supplementation is important, and a dose greater than 400 mcg/d during early pregnancy (ie, first 12 weeks) is associated with better neurodevelopmental outcome in children of women with epilepsy. Breastfeeding is not harmful and should be encouraged in women with epilepsy even when they are on antiseizure medication treatment. Women with epilepsy should be counseled early and regularly about reproductive health. Practitioners should discuss the risks of various obstetric complications; potential anatomic teratogenicity and neurodevelopmental dysfunction related to fetal antiseizure medication exposure; and a plan of care during pregnancy, delivery, and postpartum. Women with epilepsy should also be reassured that the majority of pregnancies are uneventful.