Literature Monitor

Patients are more likely to die of sudden unexpected death in epilepsy (SUDEP) while they are asleep, according to a review of over 1000 SUDEP cases gleaned from 67 studies.

• Among 1025 patients with SUDEP, 880 cases had a circadian pattern.
• Of the 880 cases with a circadian pattern, 69.3% of the deaths occurred during sleep and 30.7% while patients were awake (P<0.001).
• Subgroup analysis found 272 patients in which both circadian pattern and age could be established.
• In this subgroup, patients aged 40 years and younger were more likely to die while asleep, when compared with older patients (odds ratio, 2.0).
• Among patients whose body position could also be verified, prone position was more often associated with death, when compared with those in prone position who were awake (87.6% vs 52.9%).

Ali A, Wu S, Issa NP, et al. Association of sleep with sudden unexpected death in epilepsy. [Published online ahead of print September 13, 2017] Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2017.08.021

Patients are more likely to die of sudden unexpected death in epilepsy (SUDEP) while they are asleep, according to a review of over 1000 SUDEP cases gleaned from 67 studies.

• Among 1025 patients with SUDEP, 880 cases had a circadian pattern.
• Of the 880 cases with a circadian pattern, 69.3% of the deaths occurred during sleep and 30.7% while patients were awake (P<0.001).
• Subgroup analysis found 272 patients in which both circadian pattern and age could be established.
• In this subgroup, patients aged 40 years and younger were more likely to die while asleep, when compared with older patients (odds ratio, 2.0).
• Among patients whose body position could also be verified, prone position was more often associated with death, when compared with those in prone position who were awake (87.6% vs 52.9%).

Ali A, Wu S, Issa NP, et al. Association of sleep with sudden unexpected death in epilepsy. [Published online ahead of print September 13, 2017] Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2017.08.021

Patients are more likely to die of sudden unexpected death in epilepsy (SUDEP) while they are asleep, according to a review of over 1000 SUDEP cases gleaned from 67 studies.

• Among 1025 patients with SUDEP, 880 cases had a circadian pattern.
• Of the 880 cases with a circadian pattern, 69.3% of the deaths occurred during sleep and 30.7% while patients were awake (P<0.001).
• Subgroup analysis found 272 patients in which both circadian pattern and age could be established.
• In this subgroup, patients aged 40 years and younger were more likely to die while asleep, when compared with older patients (odds ratio, 2.0).
• Among patients whose body position could also be verified, prone position was more often associated with death, when compared with those in prone position who were awake (87.6% vs 52.9%).

Ali A, Wu S, Issa NP, et al. Association of sleep with sudden unexpected death in epilepsy. [Published online ahead of print September 13, 2017] Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2017.08.021

Patients in their 50s who have chronic epilepsy seem to have cognitive deficits that may be linked to metabolic, inflammatory, and vascular abnormalities, according to a clinical study that included 40 patients with chronic localized epilepsy and 152 controls.

• To reach that conclusion, researchers conducted neuropsychological assessment, clinical examination, and blood testing to evaluate patients’ vascular status.
• The evaluation included systolic and diastolic blood pressure, body mass index (BMI), high density lipoprotein, homocysteine levels, and inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), and interleukin-6.
• The metabolic assessment included measurement of insulin resistance by means of glucose levels and homeostatic model assessment of insulin resistance (HOMA-IR).
• Patients with epilepsy had impaired cognitive factor scores across the board.
• These patients also had abnormal BMI, hs-CRP, fasting glucose, and HOMA-IR.
• There was also a link between higher HOMA-IR and poor immediate memory and visuospatial ability.
• Elevated hs-CRP was associated with poorer visuospatial and verbal abilities.

Hermann BP, Sager MA, Koscik RL, Young K, Nakamura K. Vascular, inflammatory, and metabolic factors associated with cognition in aging persons with chronic epilepsy. [Published online ahead of print Sept 4, 2017]. Epilepsia. 

Patients in their 50s who have chronic epilepsy seem to have cognitive deficits that may be linked to metabolic, inflammatory, and vascular abnormalities, according to a clinical study that included 40 patients with chronic localized epilepsy and 152 controls.

• To reach that conclusion, researchers conducted neuropsychological assessment, clinical examination, and blood testing to evaluate patients’ vascular status.
• The evaluation included systolic and diastolic blood pressure, body mass index (BMI), high density lipoprotein, homocysteine levels, and inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), and interleukin-6.
• The metabolic assessment included measurement of insulin resistance by means of glucose levels and homeostatic model assessment of insulin resistance (HOMA-IR).
• Patients with epilepsy had impaired cognitive factor scores across the board.
• These patients also had abnormal BMI, hs-CRP, fasting glucose, and HOMA-IR.
• There was also a link between higher HOMA-IR and poor immediate memory and visuospatial ability.
• Elevated hs-CRP was associated with poorer visuospatial and verbal abilities.

Hermann BP, Sager MA, Koscik RL, Young K, Nakamura K. Vascular, inflammatory, and metabolic factors associated with cognition in aging persons with chronic epilepsy. [Published online ahead of print Sept 4, 2017]. Epilepsia. 

Patients in their 50s who have chronic epilepsy seem to have cognitive deficits that may be linked to metabolic, inflammatory, and vascular abnormalities, according to a clinical study that included 40 patients with chronic localized epilepsy and 152 controls.

• To reach that conclusion, researchers conducted neuropsychological assessment, clinical examination, and blood testing to evaluate patients’ vascular status.
• The evaluation included systolic and diastolic blood pressure, body mass index (BMI), high density lipoprotein, homocysteine levels, and inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), and interleukin-6.
• The metabolic assessment included measurement of insulin resistance by means of glucose levels and homeostatic model assessment of insulin resistance (HOMA-IR).
• Patients with epilepsy had impaired cognitive factor scores across the board.
• These patients also had abnormal BMI, hs-CRP, fasting glucose, and HOMA-IR.
• There was also a link between higher HOMA-IR and poor immediate memory and visuospatial ability.
• Elevated hs-CRP was associated with poorer visuospatial and verbal abilities.

Hermann BP, Sager MA, Koscik RL, Young K, Nakamura K. Vascular, inflammatory, and metabolic factors associated with cognition in aging persons with chronic epilepsy. [Published online ahead of print Sept 4, 2017]. Epilepsia. 

Patients who have seizures at night are more likely to die suddenly from epilepsy, according to a recent study that compared seizures occurring while patients were awake to those who experienced them during sleep.

• Researchers point out that patients with epilepsy are 20 times more likely to experience sudden death, compared with the general public.
• The most frequent risk factor for these deaths is uncontrolled seizures.
• Researchers tracked respiratory parameters, comparing adults with epilepsy during wake and sleep periods.
• Sleep-related seizures were linked to lower oxygen saturation when compared with wakeful seizures, and this association remained significant during the ictal and postictal periods.
• Sleep-related seizures were also associated with greater drops in saturation.
• Postseizure EEG suppression occurred more often after sleep-related seizures as well.
• Researchers concluded that sudden unexpected death in epilepsy (SUDEP) is more likely to happen during sleep and that it is linked to more severe and longer occurrences of hypoxemia.

 Latreille V, Abdennadher M, Dworetzky BA, et al. Nocturnal seizures are associated with more severe hypoxemia and increased risk of postictal generalized EEG suppression. Epilepsia. 2017;58(9):e127-e131.

Patients who have seizures at night are more likely to die suddenly from epilepsy, according to a recent study that compared seizures occurring while patients were awake to those who experienced them during sleep.

• Researchers point out that patients with epilepsy are 20 times more likely to experience sudden death, compared with the general public.
• The most frequent risk factor for these deaths is uncontrolled seizures.
• Researchers tracked respiratory parameters, comparing adults with epilepsy during wake and sleep periods.
• Sleep-related seizures were linked to lower oxygen saturation when compared with wakeful seizures, and this association remained significant during the ictal and postictal periods.
• Sleep-related seizures were also associated with greater drops in saturation.
• Postseizure EEG suppression occurred more often after sleep-related seizures as well.
• Researchers concluded that sudden unexpected death in epilepsy (SUDEP) is more likely to happen during sleep and that it is linked to more severe and longer occurrences of hypoxemia.

 Latreille V, Abdennadher M, Dworetzky BA, et al. Nocturnal seizures are associated with more severe hypoxemia and increased risk of postictal generalized EEG suppression. Epilepsia. 2017;58(9):e127-e131.

Patients who have seizures at night are more likely to die suddenly from epilepsy, according to a recent study that compared seizures occurring while patients were awake to those who experienced them during sleep.

• Researchers point out that patients with epilepsy are 20 times more likely to experience sudden death, compared with the general public.
• The most frequent risk factor for these deaths is uncontrolled seizures.
• Researchers tracked respiratory parameters, comparing adults with epilepsy during wake and sleep periods.
• Sleep-related seizures were linked to lower oxygen saturation when compared with wakeful seizures, and this association remained significant during the ictal and postictal periods.
• Sleep-related seizures were also associated with greater drops in saturation.
• Postseizure EEG suppression occurred more often after sleep-related seizures as well.
• Researchers concluded that sudden unexpected death in epilepsy (SUDEP) is more likely to happen during sleep and that it is linked to more severe and longer occurrences of hypoxemia.

 Latreille V, Abdennadher M, Dworetzky BA, et al. Nocturnal seizures are associated with more severe hypoxemia and increased risk of postictal generalized EEG suppression. Epilepsia. 2017;58(9):e127-e131.

An anion gap above 10, measured in the first 2 hours after a seizure, may help clinicians in the emergency department distinguish between psychogenic nonepileptic seizures (PNES) and generalized convulsive epileptic seizures (ES), according to an analysis of more than 1300 patients at a tertiary care center. Details of the analysis include the following:

• Investigators looked at anion gap, bicarbonate, and Denver Seizure Scores and found 27 patients with PNES and 27 with ES, using clinical signs and symptoms in conjunction with EEGs.
• Multivariate logistic regression helped detect a link between an anion gap above 10 and seizure type but also found that sensitivity and negative predictive value dropped off dramatically when samples were drawn more than 2 hours after the event.
• Anion gap values above 10 yielded a sensitivity of 81.8% and specificity of 100% when measured within 2 hours of the seizure.

Li Y, Matzka L, Maranda L, Weber D. Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting. Epilepsia. 2017;58(9):e132-e135.

An anion gap above 10, measured in the first 2 hours after a seizure, may help clinicians in the emergency department distinguish between psychogenic nonepileptic seizures (PNES) and generalized convulsive epileptic seizures (ES), according to an analysis of more than 1300 patients at a tertiary care center. Details of the analysis include the following:

• Investigators looked at anion gap, bicarbonate, and Denver Seizure Scores and found 27 patients with PNES and 27 with ES, using clinical signs and symptoms in conjunction with EEGs.
• Multivariate logistic regression helped detect a link between an anion gap above 10 and seizure type but also found that sensitivity and negative predictive value dropped off dramatically when samples were drawn more than 2 hours after the event.
• Anion gap values above 10 yielded a sensitivity of 81.8% and specificity of 100% when measured within 2 hours of the seizure.

Li Y, Matzka L, Maranda L, Weber D. Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting. Epilepsia. 2017;58(9):e132-e135.

An anion gap above 10, measured in the first 2 hours after a seizure, may help clinicians in the emergency department distinguish between psychogenic nonepileptic seizures (PNES) and generalized convulsive epileptic seizures (ES), according to an analysis of more than 1300 patients at a tertiary care center. Details of the analysis include the following:

• Investigators looked at anion gap, bicarbonate, and Denver Seizure Scores and found 27 patients with PNES and 27 with ES, using clinical signs and symptoms in conjunction with EEGs.
• Multivariate logistic regression helped detect a link between an anion gap above 10 and seizure type but also found that sensitivity and negative predictive value dropped off dramatically when samples were drawn more than 2 hours after the event.
• Anion gap values above 10 yielded a sensitivity of 81.8% and specificity of 100% when measured within 2 hours of the seizure.

Li Y, Matzka L, Maranda L, Weber D. Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting. Epilepsia. 2017;58(9):e132-e135.

A recently published practical guide can help epilepsy specialists record and interpret high-frequency oscillations (HFOs), which have been implicated as promising markers for the disease. Such biomarkers may help better locate areas in which to perform surgery. Researchers offer the following observations:

• To accurately record HFOs, experts emphasize the importance of low noise recording to reduce artifacts.
• Even under ideal conditions, artifacts can still occur, including muscle contractions, movement, and filtering.
• Magnetoencephalography (MEG) and EEG recordings are capable of recording ripples while intracranial EEG can record ripples, fast ripples, and very high frequency oscillations.
• Nonetheless, MEG and intracranial EEG recordings can also experience artifacts.
• Researchers believe that HFOs represent a new type of electromagnetic biomarker that can detect epileptogenic brain tissue, but several technical barriers need to be overcome before clinicians can use them as tools in community practice.
• Software engineers are in the process of developing HFO filters and automatic detection tools to help bring this technology to market.

Zijlmans M, Worrell GA, Dümpelmann M, et al. How to record high-frequency oscillations in epilepsy: A practical guideline. Epilepsia. 2017;58(8):1305-1315. d

A recently published practical guide can help epilepsy specialists record and interpret high-frequency oscillations (HFOs), which have been implicated as promising markers for the disease. Such biomarkers may help better locate areas in which to perform surgery. Researchers offer the following observations:

• To accurately record HFOs, experts emphasize the importance of low noise recording to reduce artifacts.
• Even under ideal conditions, artifacts can still occur, including muscle contractions, movement, and filtering.
• Magnetoencephalography (MEG) and EEG recordings are capable of recording ripples while intracranial EEG can record ripples, fast ripples, and very high frequency oscillations.
• Nonetheless, MEG and intracranial EEG recordings can also experience artifacts.
• Researchers believe that HFOs represent a new type of electromagnetic biomarker that can detect epileptogenic brain tissue, but several technical barriers need to be overcome before clinicians can use them as tools in community practice.
• Software engineers are in the process of developing HFO filters and automatic detection tools to help bring this technology to market.

Zijlmans M, Worrell GA, Dümpelmann M, et al. How to record high-frequency oscillations in epilepsy: A practical guideline. Epilepsia. 2017;58(8):1305-1315. d

A recently published practical guide can help epilepsy specialists record and interpret high-frequency oscillations (HFOs), which have been implicated as promising markers for the disease. Such biomarkers may help better locate areas in which to perform surgery. Researchers offer the following observations:

• To accurately record HFOs, experts emphasize the importance of low noise recording to reduce artifacts.
• Even under ideal conditions, artifacts can still occur, including muscle contractions, movement, and filtering.
• Magnetoencephalography (MEG) and EEG recordings are capable of recording ripples while intracranial EEG can record ripples, fast ripples, and very high frequency oscillations.
• Nonetheless, MEG and intracranial EEG recordings can also experience artifacts.
• Researchers believe that HFOs represent a new type of electromagnetic biomarker that can detect epileptogenic brain tissue, but several technical barriers need to be overcome before clinicians can use them as tools in community practice.
• Software engineers are in the process of developing HFO filters and automatic detection tools to help bring this technology to market.

Zijlmans M, Worrell GA, Dümpelmann M, et al. How to record high-frequency oscillations in epilepsy: A practical guideline. Epilepsia. 2017;58(8):1305-1315. d

High frequency oscillations (HFOs) in certain regions of the brain have been associated with epilepsy. A recent review of the literature on HFOs is shedding new light on their possible role in the pathophysiology of the disease.

• Advances in recording technology and optogenetics have enhanced researchers’ ability to study HFOs.
• Substrates of HFOs linked to epilepsy have been identified with the help of sophisticated computer models.
• In the past, HFOs have been studied in animals and patients with temporal lobe epilepsy, but HFOs have recently been reported in patients with other types of seizures, including neocortical epilepsy, genetically induced epilepsy, and infantile spasms.
• High resolution in vivo imaging, optogenetics, and chemogenetic techniques are poised to help future investigators gain even deeper insights into the role of HFOs in seizures and epilepsy.
• The reviewers postulate that as investigators gain a better understanding of how HFOs are involved in the pathogenesis of epileptic disorders, it will allow them to better classify these diseases and improve diagnosis and treatment.

Jiruska P, Alvarado-Rojas C, Schevon CA, et al. Update on the mechanisms and roles of high-frequency oscillations in seizures and epileptic disorders. Epilepsia. 2017;58(8):1330-1339.

High frequency oscillations (HFOs) in certain regions of the brain have been associated with epilepsy. A recent review of the literature on HFOs is shedding new light on their possible role in the pathophysiology of the disease.

• Advances in recording technology and optogenetics have enhanced researchers’ ability to study HFOs.
• Substrates of HFOs linked to epilepsy have been identified with the help of sophisticated computer models.
• In the past, HFOs have been studied in animals and patients with temporal lobe epilepsy, but HFOs have recently been reported in patients with other types of seizures, including neocortical epilepsy, genetically induced epilepsy, and infantile spasms.
• High resolution in vivo imaging, optogenetics, and chemogenetic techniques are poised to help future investigators gain even deeper insights into the role of HFOs in seizures and epilepsy.
• The reviewers postulate that as investigators gain a better understanding of how HFOs are involved in the pathogenesis of epileptic disorders, it will allow them to better classify these diseases and improve diagnosis and treatment.

Jiruska P, Alvarado-Rojas C, Schevon CA, et al. Update on the mechanisms and roles of high-frequency oscillations in seizures and epileptic disorders. Epilepsia. 2017;58(8):1330-1339.

High frequency oscillations (HFOs) in certain regions of the brain have been associated with epilepsy. A recent review of the literature on HFOs is shedding new light on their possible role in the pathophysiology of the disease.

• Advances in recording technology and optogenetics have enhanced researchers’ ability to study HFOs.
• Substrates of HFOs linked to epilepsy have been identified with the help of sophisticated computer models.
• In the past, HFOs have been studied in animals and patients with temporal lobe epilepsy, but HFOs have recently been reported in patients with other types of seizures, including neocortical epilepsy, genetically induced epilepsy, and infantile spasms.
• High resolution in vivo imaging, optogenetics, and chemogenetic techniques are poised to help future investigators gain even deeper insights into the role of HFOs in seizures and epilepsy.
• The reviewers postulate that as investigators gain a better understanding of how HFOs are involved in the pathogenesis of epileptic disorders, it will allow them to better classify these diseases and improve diagnosis and treatment.

Jiruska P, Alvarado-Rojas C, Schevon CA, et al. Update on the mechanisms and roles of high-frequency oscillations in seizures and epileptic disorders. Epilepsia. 2017;58(8):1330-1339.

Researchers have devised a statistical approach that can take into account the variability in seizure frequency associated with a placebo response. In an article published in Epilepsy Research, Goldenholz et al explain their approach in more detail:

• The researchers compared the traditional 50% responder rate to a new measure called the variability-corrected score or Z_v.
• The analysis revealed that the new approach can predict the expected frequency of seizures several months in advance.
• When they compared the 50% responder rates to the variability-corrected score, Z_v was more useful in telling the difference between patients who had a placebo response and those who had a genuine response to a therapeutic intervention.
• Because Z_v scores were able to generate higher statistical power, the authors theorize that they may allow researchers to conduct randomized clinical trials that use fewer patients and cost less than traditional randomized controlled trials.

Goldenholz DM, Goldenholz SR, Moss R, et al. Does accounting for seizure frequency variability increase clinical trial power? [Published online ahead of pint July 25, 2017]. Epilepsy Res. doi.org/10.1016/j.eplepsyres.2017.07.013

Researchers have devised a statistical approach that can take into account the variability in seizure frequency associated with a placebo response. In an article published in Epilepsy Research, Goldenholz et al explain their approach in more detail:

• The researchers compared the traditional 50% responder rate to a new measure called the variability-corrected score or Z_v.
• The analysis revealed that the new approach can predict the expected frequency of seizures several months in advance.
• When they compared the 50% responder rates to the variability-corrected score, Z_v was more useful in telling the difference between patients who had a placebo response and those who had a genuine response to a therapeutic intervention.
• Because Z_v scores were able to generate higher statistical power, the authors theorize that they may allow researchers to conduct randomized clinical trials that use fewer patients and cost less than traditional randomized controlled trials.

Goldenholz DM, Goldenholz SR, Moss R, et al. Does accounting for seizure frequency variability increase clinical trial power? [Published online ahead of pint July 25, 2017]. Epilepsy Res. doi.org/10.1016/j.eplepsyres.2017.07.013

Researchers have devised a statistical approach that can take into account the variability in seizure frequency associated with a placebo response. In an article published in Epilepsy Research, Goldenholz et al explain their approach in more detail:

• The researchers compared the traditional 50% responder rate to a new measure called the variability-corrected score or Z_v.
• The analysis revealed that the new approach can predict the expected frequency of seizures several months in advance.
• When they compared the 50% responder rates to the variability-corrected score, Z_v was more useful in telling the difference between patients who had a placebo response and those who had a genuine response to a therapeutic intervention.
• Because Z_v scores were able to generate higher statistical power, the authors theorize that they may allow researchers to conduct randomized clinical trials that use fewer patients and cost less than traditional randomized controlled trials.

Goldenholz DM, Goldenholz SR, Moss R, et al. Does accounting for seizure frequency variability increase clinical trial power? [Published online ahead of pint July 25, 2017]. Epilepsy Res. doi.org/10.1016/j.eplepsyres.2017.07.013

Mutations in SCN1A, SCN2A, and SCN8A, which code for neuronal voltage-gated sodium channel alpha-subunits, have been associated with certain early onset epilepsy syndromes.  Despite this association, many clinicians are uncertain about the value of missense genetic variants in the management of epilepsy because many mutations are classified as having unknown significance. A recent database analysis identified gene variants that are pathogenic and benign, giving clinicians a better understanding of how to interpret SCN test results. Details of the investigation include the following:

• Investigators used 8 algorithms to evaluate the pathogenicity of various genetic variants. They also used logistic regression to help determine if combining algorithms might improve their ability to predict pathogenicity.
• 440 variants were considered pathogenic or likely pathogenic.
• Most computer algorithms that attempt to determine the value of SCN test results are very sensitive but also suffer from low specificity.
• The Mendelian Clinically Applicable Pathogenicity algorithm proved most valuable, with an accuracy of 0.90.

Holland KD, Bouley TM, Horn PS. Comparison and optimization of in silico algorithms for predicting the pathogenicity of sodium channel variants in epilepsy. Epilepsia. 2017;58(7):1190-1198.

Mutations in SCN1A, SCN2A, and SCN8A, which code for neuronal voltage-gated sodium channel alpha-subunits, have been associated with certain early onset epilepsy syndromes.  Despite this association, many clinicians are uncertain about the value of missense genetic variants in the management of epilepsy because many mutations are classified as having unknown significance. A recent database analysis identified gene variants that are pathogenic and benign, giving clinicians a better understanding of how to interpret SCN test results. Details of the investigation include the following:

• Investigators used 8 algorithms to evaluate the pathogenicity of various genetic variants. They also used logistic regression to help determine if combining algorithms might improve their ability to predict pathogenicity.
• 440 variants were considered pathogenic or likely pathogenic.
• Most computer algorithms that attempt to determine the value of SCN test results are very sensitive but also suffer from low specificity.
• The Mendelian Clinically Applicable Pathogenicity algorithm proved most valuable, with an accuracy of 0.90.

Holland KD, Bouley TM, Horn PS. Comparison and optimization of in silico algorithms for predicting the pathogenicity of sodium channel variants in epilepsy. Epilepsia. 2017;58(7):1190-1198.

Mutations in SCN1A, SCN2A, and SCN8A, which code for neuronal voltage-gated sodium channel alpha-subunits, have been associated with certain early onset epilepsy syndromes.  Despite this association, many clinicians are uncertain about the value of missense genetic variants in the management of epilepsy because many mutations are classified as having unknown significance. A recent database analysis identified gene variants that are pathogenic and benign, giving clinicians a better understanding of how to interpret SCN test results. Details of the investigation include the following:

• Investigators used 8 algorithms to evaluate the pathogenicity of various genetic variants. They also used logistic regression to help determine if combining algorithms might improve their ability to predict pathogenicity.
• 440 variants were considered pathogenic or likely pathogenic.
• Most computer algorithms that attempt to determine the value of SCN test results are very sensitive but also suffer from low specificity.
• The Mendelian Clinically Applicable Pathogenicity algorithm proved most valuable, with an accuracy of 0.90.

Holland KD, Bouley TM, Horn PS. Comparison and optimization of in silico algorithms for predicting the pathogenicity of sodium channel variants in epilepsy. Epilepsia. 2017;58(7):1190-1198.

Siblings tend to have a similar response to antiepileptic drugs (AEDs) suggests a study that compared drug response in sibling pairs. Details of the investigation include the following:

• Investigators collected records from a single-center database that included patients with a diagnosis of epilepsy in which their last names, addresses, and parents’ names were matched to determine the existence of siblings with the same disease.
• Twenty-eight sibling pairs were identified, along with 2 sibling trios with epilepsy.
• Seventeen of the sibling pairs had been taking the same initial AED, while 15 pairs had the same type of epilepsy.

• When at least one sibling in a pair improved on an initial AED, the other sibling was more likely to respond if they were taking the same AED compared with those who were taking a different AED.
• While a positive response to an AED predicted success in a sibling taking the same drug, investigators pointed out that their study was retrospective and involved a small sample, which is why they recommended larger prospective trials.

Ueda K, Serajee F, Rajilich J, Taraman S, Steckling L, Huq AM. Sibling response to initial antiepileptic medication predicts treatment success. Epilepsy Res. 2017;136:84-87.

Siblings tend to have a similar response to antiepileptic drugs (AEDs) suggests a study that compared drug response in sibling pairs. Details of the investigation include the following:

• Investigators collected records from a single-center database that included patients with a diagnosis of epilepsy in which their last names, addresses, and parents’ names were matched to determine the existence of siblings with the same disease.
• Twenty-eight sibling pairs were identified, along with 2 sibling trios with epilepsy.
• Seventeen of the sibling pairs had been taking the same initial AED, while 15 pairs had the same type of epilepsy.

• When at least one sibling in a pair improved on an initial AED, the other sibling was more likely to respond if they were taking the same AED compared with those who were taking a different AED.
• While a positive response to an AED predicted success in a sibling taking the same drug, investigators pointed out that their study was retrospective and involved a small sample, which is why they recommended larger prospective trials.

Ueda K, Serajee F, Rajilich J, Taraman S, Steckling L, Huq AM. Sibling response to initial antiepileptic medication predicts treatment success. Epilepsy Res. 2017;136:84-87.

Siblings tend to have a similar response to antiepileptic drugs (AEDs) suggests a study that compared drug response in sibling pairs. Details of the investigation include the following:

• Investigators collected records from a single-center database that included patients with a diagnosis of epilepsy in which their last names, addresses, and parents’ names were matched to determine the existence of siblings with the same disease.
• Twenty-eight sibling pairs were identified, along with 2 sibling trios with epilepsy.
• Seventeen of the sibling pairs had been taking the same initial AED, while 15 pairs had the same type of epilepsy.

• When at least one sibling in a pair improved on an initial AED, the other sibling was more likely to respond if they were taking the same AED compared with those who were taking a different AED.
• While a positive response to an AED predicted success in a sibling taking the same drug, investigators pointed out that their study was retrospective and involved a small sample, which is why they recommended larger prospective trials.

Ueda K, Serajee F, Rajilich J, Taraman S, Steckling L, Huq AM. Sibling response to initial antiepileptic medication predicts treatment success. Epilepsy Res. 2017;136:84-87.

Identifying a seizure propagation network in patients who have undergone surgery for unilateral temporal lobe epilepsy (TLE) may help determine which patients are most likely to remain seizure free over time, according to an analysis of patients who underwent magnetic resonance imaging (MRI) scans. Details of the investigation include the following:

• MRI of 22 unilateral TLE patients found functional connectivity that encompassed the ipsilateral (to seizure focus) and contralateral hippocampus, thalamus, and insula. 35 healthy individuals were included in the study to act as controls.
• Resting state functional and diffusion-weighted 3T magnetic resonance imaging was used in the study.
• The investigators discovered a consistent connectivity pattern representing the network expected in patients who remained seizure free. This was found in 8 patients who did not have seizures one year after surgery.
• Using this model, they were able to differentiate patients with unfavorable outcomes from those with long-term freedom from seizures.

This study provides evidence that network connectivity could be a clinical tool for epilepsy surgery outcome prediction.

Morgan VL, Englot DJ, Rogers BP, et al. Magnetic resonance imaging connectivity for the prediction of seizure outcome in temporal lobe epilepsy. Epilepsia. 2017;58(7):1251-1260.

Identifying a seizure propagation network in patients who have undergone surgery for unilateral temporal lobe epilepsy (TLE) may help determine which patients are most likely to remain seizure free over time, according to an analysis of patients who underwent magnetic resonance imaging (MRI) scans. Details of the investigation include the following:

• MRI of 22 unilateral TLE patients found functional connectivity that encompassed the ipsilateral (to seizure focus) and contralateral hippocampus, thalamus, and insula. 35 healthy individuals were included in the study to act as controls.
• Resting state functional and diffusion-weighted 3T magnetic resonance imaging was used in the study.
• The investigators discovered a consistent connectivity pattern representing the network expected in patients who remained seizure free. This was found in 8 patients who did not have seizures one year after surgery.
• Using this model, they were able to differentiate patients with unfavorable outcomes from those with long-term freedom from seizures.

This study provides evidence that network connectivity could be a clinical tool for epilepsy surgery outcome prediction.

Morgan VL, Englot DJ, Rogers BP, et al. Magnetic resonance imaging connectivity for the prediction of seizure outcome in temporal lobe epilepsy. Epilepsia. 2017;58(7):1251-1260.

Identifying a seizure propagation network in patients who have undergone surgery for unilateral temporal lobe epilepsy (TLE) may help determine which patients are most likely to remain seizure free over time, according to an analysis of patients who underwent magnetic resonance imaging (MRI) scans. Details of the investigation include the following:

• MRI of 22 unilateral TLE patients found functional connectivity that encompassed the ipsilateral (to seizure focus) and contralateral hippocampus, thalamus, and insula. 35 healthy individuals were included in the study to act as controls.
• Resting state functional and diffusion-weighted 3T magnetic resonance imaging was used in the study.
• The investigators discovered a consistent connectivity pattern representing the network expected in patients who remained seizure free. This was found in 8 patients who did not have seizures one year after surgery.
• Using this model, they were able to differentiate patients with unfavorable outcomes from those with long-term freedom from seizures.

This study provides evidence that network connectivity could be a clinical tool for epilepsy surgery outcome prediction.

Morgan VL, Englot DJ, Rogers BP, et al. Magnetic resonance imaging connectivity for the prediction of seizure outcome in temporal lobe epilepsy. Epilepsia. 2017;58(7):1251-1260.