Search Results (39)

Developmental and/or epileptic encephalopathy with spike-wave activation in sleep (D/EE-SWAS), previously described as continuous spike-wave during slow-wave sleep (CSWS) or electrical status epilepticus in sleep (ESES), is a childhood-onset disorder characterized by cognitive, language, behavioral, and/or motor regression or stagnation associated with marked activation of epileptiform discharges during non-rapid eye movement sleep. Three themes are central to the evolving understanding of D/EE-SWAS. First, it is a network disorder in which thalamocortical dysfunction, impaired sleep-dependent synaptic homeostasis, and potentially neuroinflammatory mechanisms contribute to neurodevelopmental deterioration. Second, increasing recognition of its genetic and structural heterogeneity is reshaping diagnostic evaluation. Monogenic etiologies are identified in up to one-third of cases, with a higher yield in the developmental and epileptic encephalopathy subtype, supporting early genomic testing alongside prolonged sleep EEG, MRI, and serial neuropsychological assessment. Third, treatment remains empiric and constrained by limited comparative evidence. Corticosteroids retain the strongest evidence base for cognitive improvement, although the overall certainty of this evidence remains low to moderate. Benzodiazepines are commonly used alternatives, and epilepsy surgery can provide substantial benefit in appropriately selected patients with focal structural abnormalities. Emerging etiology-directed therapies, including L-serine for selected GRIN loss-of-function variants and primidone for TRPM3-related disease, illustrate a broader transition from syndrome-based to precision management. However, no pharmacological therapy is specifically approved for D/EE-SWAS, long-term neurodevelopmental morbidity remains common, and adequately powered trials using standardized EEG and neurocognitive outcomes are urgently needed. Full article

Patients with cerebrovascular disease frequently require concomitant antiplatelet and antiseizure therapy. However, experimental evidence regarding potential pharmacodynamic interactions between these medications remains limited. The present study investigated whether clopidogrel affects the anticonvulsant effects of valproic acid (VPA) or levetiracetam (LEV) in a pentylenetetrazol (PTZ)-induced seizure model. Forty-two male Wistar rats were randomly allocated to seven groups (n = 6/group): Control, PTZ, clopidogrel (CLP), VPA, LEV, VPA + CLP + PTZ, and LEV + CLP + PTZ. Electroencephalographic recordings, passive avoidance testing, histopathological examination, and glial fibrillary acidic protein (GFAP) immunohistochemistry were performed to evaluate seizure activity, behavioral performance, neuronal injury, and astroglial activation. Both VPA and LEV significantly reduced spike–wave discharge frequency and duration compared with the PTZ group (p < 0.05). Clopidogrel alone did not exhibit anticonvulsant activity, and co-administration with either VPA or LEV did not significantly alter electrophysiological, behavioral, histopathological, or GFAP-associated immunohistochemical outcomes. Overall, these findings indicate that clopidogrel did not significantly affect the anticonvulsant efficacy of VPA or LEV under the experimental conditions of this acute PTZ-induced seizure model. Full article

Automatic analysis of electroencephalography (EEG) recordings relies on large, high-quality labeled datasets. Manual segmentation by medical experts is resource-intensive and time-consuming. Moreover, to overcome potential subjectivity in labeling, independent annotation by at least two experts is required. Therefore, reliable automatic data labeling is essential for obtaining the large datasets needed to train robust AI models. In this paper, we show that a properly trained state-of-the-art deep neural network (DNN) achieves labeling performance comparable to inter-expert agreement in the task of segmenting epileptiform activity patterns. To this end, we first compiled a custom database of EEG recordings containing such patterns. Second, five experts based on part of these recordings independently assessed spike-wave index (SWI), which is a key diagnostic criterion that indicates the percentage of the EEG recording during which epileptic discharges are observed. Third, we compared the expert assessments with SWI calculated based on automatic segmentation by the trained DNN. Our results demonstrate that the 1D U-Net architecture achieves competitive overall performance and aligns well with both expert assessments and expert-derived SWI values. Thus, automated segmentation and analysis of EEG recordings holds great promise for accelerating diagnosis and developing targeted therapeutic strategies for epilepsy. Full article

Background: Eye-closure sensitivity (ECS) is a rare reflex epilepsy phenomenon characterized by epileptiform discharges on electroencephalogram (EEG), triggered by eye closure. It has been reported in all genetic generalized epilepsies (GGEs), particularly in adolescents and adults. However, pediatric cases remain uncommon in the literature. Case Presentation: We report a 10-year-old previously healthy girl who presented with recurrent generalized tonic–clonic seizures beginning at age nine. Seizures occurred every few months without identifiable triggers, lasting 1–2 min with complete loss of consciousness, limb stiffening, rhythmic jerking, and upward eye deviation. Her developmental history was unremarkable, with no family history of epilepsy or febrile seizures. Neurological examination was normal. Initial EEG revealed intermittent generalized spike-and-wave and polyspike-and-wave discharges at 3 Hz (range 2–4 Hz), triggered by eye closure, consistent with ECS. These discharges occurred immediately following both spontaneous and instructed eye closure, were more prominent during drowsiness, and resolved upon eye opening. The patient remained alert during these subclinical events. No photosensitivity or hyperventilation response was observed. Brain magnetic resonance imaging was normal. The patient’s electroclinical findings were most consistent with a GGE phenotype with prominent ECS. She was treated with levetiracetam and has remained seizure-free for approximately 1.5 years to date. Conclusions: This case demonstrates that ECS can present in pediatric patients with GGE primarily manifested as generalized tonic–clonic seizures. EEG evaluation should include repeated eye-open/close maneuvers to unmask ECS, particularly in children with suspected generalized seizures. Full article

Absence epilepsy (AE) is a common pediatric epilepsy syndrome marked by brief lapses in consciousness and characteristic 2.5–4 Hz spike-and-wave discharges on EEG. Although its clinical and electrophysiological features are well established, the molecular mechanisms underlying AE remain incompletely understood. Proteomic approaches offer a powerful means to explore these mechanisms; however, their application in AE remains limited and methodologically heterogeneous, which complicates data integration. In this review, proteomic methodologies applied in rodent models of absence epilepsy are critically examined, including genetic rat models such as Genetic Absence Epilepsy Rats from Strasbourg (GAERS) and Wistar Albino Glaxo rats from Rijswijk (WAG/Rij), monogenic mutant mouse models, and pharmacologically induced models. The technical workflow is described particularly, from tissue sampling and protein preparation (including gel-based and gel-free methods) to mass spectrometric analysis using data-dependent and data-independent acquisition strategies. Emerging technologies such as spatial proteomics, Trapped Ion Mobility Spectrometry coupled with Parallel Accumulation–Serial Fragmentation (TIMS-PASEF), and the integration of artificial intelligence are also evaluated in relation to their potential to address current technical limitations. Beyond synthesizing convergent molecular pathways including synaptic dysfunction, altered energy metabolism, and neuroinflammation, the review examines how methodological choices—such as model selection, brain region dissection, sample preparation protocols, and analytical platforms—contribute to experimental outcomes and data interpretation. By integrating current evidence with a focus on methodological aspects, this review provides a framework for designing more robust, reproducible, and clinically relevant proteomic studies in absence epilepsy. Full article

Lennox–Gastaut syndrome (LGS) is a rare and severe developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, mandatory tonic seizures, cognitive and behavioral impairment, and distinctive electroencephalographic features, including slow spike–wave discharges and generalized paroxysmal fast activity. Despite decades of therapeutic advances, LGS remains associated with profound lifelong disability and the absence of a single disease-defining molecular mechanism. Recent advances in genetics, neurophysiology, and network neuroscience have reframed LGS as a convergent network encephalopathy, in which diverse genetic, structural, metabolic, immune, and acquired insults funnel into shared molecular hubs, leading to thalamocortical network dysfunction. This framework helps explain the limited efficacy of purely syndrome-based treatments. This review synthesizes current evidence on electroclinical phenotyping, molecular and network pathogenesis, and contemporary diagnostic workflows and proposes a molecule-to-precision-therapy framework for LGS. We critically appraise pharmacologic, dietary, surgical, and neuromodulatory therapies, emphasizing drop seizures as a major driver of morbidity. Among available treatments, cannabidiol shows the most consistent and clinically meaningful efficacy for drop seizures, with benefits extending beyond seizure counts to seizure-free days and caregiver-relevant outcomes. Finally, we highlight key gaps and future directions, including etiology-stratified trials, network-guided interventions, and outcome measures that capture long-term developmental and quality-of-life impacts. Full article

The use of animal models of idiopathic generalized epilepsy (IGE) is of great importance in the field of epilepsy research, with IGE affecting more than 20 million people worldwide. IGEs are characterized by a high degree of genetic heterogeneity, which makes it difficult to understand the underlying mechanisms leading to seizures. The development of animal models, whether spontaneous or resulting from genetic manipulation, has significantly contributed to our understanding of the pathological processes underlying certain IGEs, notably absence epilepsy. Research suggests that the concept of generalized epilepsy covering the whole brain should be replaced by a model in which the thalamus and its various nuclei are integrated into thalamo-cortical loops. These then assume distinct roles in the generation and generalization of seizures, which may differ across the spectrum of IGE disorders. The study of epileptogenesis is also essential: this area of research, grounded in systematic developmental neuroscience, examines the intermediate stages of neuronal activity to determine when, and how, functional development diverges between healthy and pathological states. Understanding nervous system development requires a comprehensive view of how anatomic, molecular, and genetics factors relate to neuronal activity. The emerging use of optogenetic methods and human assembloids will greatly aid our understanding of the mechanisms underlying these processes. Full article

Background: It has been demonstrated that levetiracetam can decrease absence epileptic activity in both human patients and different types of animal models of absence epilepsy, such as the genetically absence epileptic Wistar Albino Glaxo/Rijswijk (WAG/Rij) rat. It was also suggested previously that exogenous ketone supplements (EKSs)-evoked ketosis not only decreases the number of spike-wave discharges (SWDs) but also enhances the anti-absence epileptic effect of pyrimidine nucleoside uridine in WAG/Rij rats. These findings suggest that EKSs may enhance the efficacy of clinically used anti-epileptic drugs, such as levetiracetam. Methods: We investigated the effect of not only levetiracetam (intraperitoneal/i.p. 200 mg/kg) alone and KEKS supplemented food (containing 10% ketone ester/KE and 10% ketone salt/KS in a normal rat chow) alone, but also the combination of levetiracetam and KEKS supplemented food on SWD number and SWD time for 5 days in WAG/Rij rats. For evaluation of SWDs, electroencephalographic (EEG) recordings were performed every day. Moreover, for the measurement of blood glucose and R-beta-hydroxybutyrate (R-βHB) levels, the blood was taken from the tail vein of rats after EEG registration. Results: It was demonstrated that the administration of both levetiracetam alone and KEKS food alone decreased the SWD number and time spent in SWD, compared to control. Moreover, after combined administration of levetiracetam with KEKS food, enhanced anti-absence epileptic effect was observed, compared to levetiracetam alone. Blood R-βHB level significantly increased after administration of both KEKS food alone and KEKS food in combination with levetiracetam. Nevertheless, these treatments did not significantly change the blood glucose levels. Conclusions: We can conclude that EKSs may be able to enhance the anti-epileptic effect of different drugs, and this combined treatment method may represent a promising new approach and effective therapy against epileptic seizures, especially in treatment-resistant patients. Full article

Background and Objectives: Febrile seizures (FS) are neuronal disturbances frequently associated with abnormal electroencephalographic activity (EEG) as spike-wave discharges (SWDs). Fish oil (FO) has high amounts of omega-3 fatty acids (θ-3), and its effects on FS alterations are poorly understood. The aim of this work was to evaluate the effect of long-term FO supplementation on the EEG of the amygdala of adult male rats with early-life FS. Materials and Methods: Progenitor female Wistar rats, from puberty to gestation and delivery, were fed daily with a commercial diet supplemented with either fish oil (FO), palm oil (PO), or deionized water (CTRL). After parturition, male pups were exposed for 30 min to hyperthermia (HP) and then returned to their dams. After weaning, pups were fed a commercial diet and the respective treatments up to 155 days of age when electrodes were implanted in the amygdala. Results: During early life HP, the PO and CTRL groups reached maximal core temperature (CT) in comparison with the FO group. Furthermore, the FO group only has fewer myoclonus and long latency to adopt an uncontrolled posture. At an adult age, the FO group with early-life FS scored shorter periods of SWDs in amygdala EEG but without seizures and presented minor values of absolute power than the PO and CTRL groups. Conclusions: In adult rats, the long-term supplementation of FO minimizes the deleterious behavioral effects caused by early-life FS and decreases the occurrence and amplitude of SWDs in the EEG of the amygdala. Full article

Background: Absence epilepsy is a non-convulsive form of genetic generalized epilepsy characterized by spontaneous bilateral spike-and-wave discharges (SWDs) in EEG. In contrast to grand-mal epilepsy, absence epilepsy without greatly expressed motor and interictal EEG abnormalities is difficult to detect, especially at the early stages. The WAG/Rij rat strain is a well-validated animal model of childhood absence epilepsy. At the early, preclinical stage, precursors or immature SWDs appear. Then, with age, immature discharges gradually turn into mature ones and mature SWDs prevail at the clinical stage. Mature SWDs, with an amplitude several times higher than the background EEG, can be easily distinguished visually. However, the amplitude of immature discharges is significantly lower than that of mature SWDs and is comparable to the amplitude of sleep spindles. Therefore, it is quite a difficult problem to distinguish immature discharges from sleep spindles. The task is further complicated by the fact that absence seizures mainly appear in a state of drowsiness and slow-wave (non-REM) sleep, when a lot of sleep spindles occur. The purpose of the present study was to develop a diagnostic method that allows us to precisely distinguish immature forms of epileptic seizures from background EEG and sleep spindles. Methods: The idea of analyzing wave-train electrical activity is to investigate the wavelet spectrum, find local peculiarities in this spectrum, and estimate generalized time-frequency peculiarities of the signal in terms of the found local peculiarities. Results: The criteria for diagnosis of the immature form of epileptic discharges and sleep spindles have been developed based on the analysis of wave-train activity with the construction of AUC diagrams (area under the curve diagrams). Conclusions: The method of wave-train analysis with the construction of AUC diagrams can be used for extracting the diagnostic features necessary for the diagnosis of absence epilepsy at the early stages of the disease in people with a genetic predisposition. Full article

Background/Objectives: Polyphenols have been suggested to possess anticonvulsant properties, which can be exploited as tools in novel strategies against epilepsy. Along that line, the aim of this study was to investigate the effects of a polyphenol-rich extract of white grape juice (WGJe) in different rodent models of epilepsy, exploring its putative mechanism of action. Methods: In this study, we employed pentylenetetrazole (PTZ)-injected ICR-CD1 mice, audiogenic seizure (AGS)-susceptible DBA/2 mice and WAG/Rij rats. Seizures were monitored and scored, while absence was assessed by electroencephalogram. The open-field test was employed to assess the anxiolytic effects of WGJe. In order to assess the involvement of the GABA_A receptor, we used the antagonist flumazenil in AGS-susceptible DBA/2 mice. Computational analyses were employed to evaluate the interaction of the main polyphenols of WGJe and GABA_A receptors. Results: Our results showed that the intraperitoneal injection of WGJe hindered tonic seizures in PTZ-injected ICR-CD1 mice. In WAG/Rij rats, WGJe did not elicit any significant effects on spike-wave discharges compared to untreated rats. In AGS-susceptible DBA/2 mice, WGJe significantly hampered both clonic and tonic seizures, as well as induced anxiolytic effects. Interestingly, when administering WGJe with flumazenil to DBA/2 mice, we noted that the observed effects were mediated by the GABA_A receptor. Moreover, docking simulations confirmed that the main polyphenols of WGJe are able to interact with the benzodiazepine sites located in both extracellular and transmembrane domains in the GABA_A receptor. Conclusions: This study outlines the mechanism underlying the anti-epileptic activity of WGJe, thus supporting its potential role in the management of epilepsy. Full article

Understanding the molecular mechanisms underlying the generation of absence seizures is crucial for developing effective, patient-specific treatments for childhood absence epilepsy (CAE). Currently, one-third of patients remain refractive to the antiseizure medications (ASMs), previously called antiepileptic drugs (AEDs), available to treat CAE. Additionally, these ASMs often produce serious side effects and can even exacerbate symptoms in some patients. Determining the precise cellular and molecular mechanisms directly responsible for causing this type of epilepsy has proven challenging as they appear to be complex and multifactorial in patients with different genetic backgrounds. Aberrant neuronal activity in CAE may be caused by several mechanisms that are not fully understood. Thus, dissecting the causal factors that could be targeted in the development of precision medicines without side effects remains a high priority and the ultimate goal in this field of epilepsy research. The aim of this review is to highlight our current understanding of potential causative mechanisms for absence seizure generation, based on the latest research using cutting-edge technologies. This information will be important for identifying potential targets for future therapeutic intervention. Full article

Some authors use the term cortical–subcortical myoclonus to identify a specific type of myoclonus, which differs from classical cortical myoclonus in that the abnormal neuronal activity spreads between the cortical and subcortical circuits, producing diffuse excitation. The EEG shows generalized spike-and-wave discharges that correlate with the myoclonic jerks. We report the case of a 79-year-old patient with a history of right thalamic deep hemorrhagic stroke, with favorable evolution. Fifteen years later, he was readmitted to the emergency department for episodes characterized by sudden falls without loss of consciousness. An EEG with EMG recording channel on the right deltoid muscle was performed, which documented frequent diffuse spike–wave and polyspike–wave discharges, temporally related to myoclonic jerks in the lower limbs. Brain MRI showed the persistence of a small right thalamic hemosiderin residue at the site of the previous hemorrhage. Antiseizure treatment with levetiracetam was started, with rapid clinical and electroencephalographic improvement. Our case may represent a lesion model of generalized epilepsy with myoclonic seizures. Furthermore, it highlights that lower limb myoclonus of cortical–subcortical origin may be an underestimate cause of gait disturbances and postural instability. Then, it may be reasonable to include the EEG in the diagnostic work-up of patients with recurrent falls. Full article

Generalized spike wave discharges (GSWDs) are the typical electroencephalographic findings of Idiopathic Generalized Epilepsies (IGEs). These discharges are either interictal or ictal and recent evidence suggests differences in their pathogenesis. The aim of this study is to investigate, through functional connectivity analysis, the pre-interictal network state in IGEs, which precedes the formation of the interictal GSWDs. A high-density electroencephalogram (HD-EEG) was recorded in twenty-one patients with IGEs, and cortical connectivity was analyzed based on lagged coherence and individual anatomy. Graph theory analysis was used to estimate network features, assessed using the characteristic path length and clustering coefficient. The functional connectivity analysis identified two distinct networks during the pre-interictal state. These networks exhibited reversed connectivity attributes, reflecting synchronized activity at 3–4 Hz (delta2), and desynchronized activity at 8–10.5 Hz (alpha1). The delta2 network exhibited a statistically significant (p < 0.001) decrease in characteristic path length and an increase in the mean clustering coefficient. In contrast, the alpha1 network showed opposite trends in these features. The nodes influencing this state were primarily localized in the default mode network (DMN), dorsal attention network (DAN), visual network (VIS), and thalami. In conclusion, the coupling of two networks defined the pre-interictal state in IGEs. This state might be considered as a favorable condition for the generation of interictal GSWDs. Full article

This paper investigates brain–behaviour associations between interictal epileptic discharges and cognitive performance in a population of children with self-limited focal epilepsy with centro-temporal spikes (SeLECTS). Sixteen patients with SeLECTS underwent an extensive neuropsychological assessment, including verbal short-term and episodic memory, non-verbal short-term memory, attentional abilities and executive function. Two quantitative EEG indices were analysed, i.e., the Spike Wave Index (SWI) and the Spike Wave Frequency (SWF), and one qualitative EEG index, i.e., the EEG score, was used to evaluate the spreading of focal SW to other parts of the brain. We investigated associations between EEG indices and neuropsychological performance with non-parametric Spearman correlation analyses, including correction for multiple comparisons. The results showed a significant negative correlation between (i) the awake EEG score and the Block Tapping Test, a visuo-spatial short-term memory task, and (ii) the sleep SWI and the Tower of London, a visuo-spatial planning task (p_corr < 0.05). These findings suggest that, in addition to the usual quantitative EEG indices, the EEG analysis should include the qualitative EEG score evaluating the spreading of focal SW to other parts of the brain and that neuropsychological assessment should include visuo-spatial skills. Full article