Revue Neurologique[JOURNAL]
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200 papers
Granulomatous angiitis of the central nervous system (GANS) associated with Hodgkin lymphoma.
Jeantin L, Laurenge A, Lefevre E … +9 more , Mokhtari K, Le Garff-Tavernier M, Hesters A, Ghazanfari S, Méneret A, Psimaras D, Hoang-Xuan K, Ouzegdouh M, Touat M
Rev Neurol (Paris) · 2025 Jun · PMID 40287333 · Publisher ↗
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Superficial white matter hyperintensities are associated with mild tissue alterations in vascular aging.
Aghetti A, Bouteloup V, Lebenberg J … +7 more , Chupin M, Gourieux E, Mangin JF, Chêne G, Dufouil C, Jouvent E, behalf of the Memento Study Group
Rev Neurol (Paris) · 2025 Jun · PMID 40287332 · Publisher ↗
In the elderly, white matter hyperintensities (WMH) are usually rated as periventricular or deep. However, recent data suggest that superficial WMH may be associated with distinct mechanisms and may be associated with mi...
In the elderly, white matter hyperintensities (WMH) are usually rated as periventricular or deep. However, recent data suggest that superficial WMH may be associated with distinct mechanisms and may be associated with milder underlying tissue alterations. We developed and validated a new grading scale to differentiate superficial WMH from other WMH (either periventricular or deep). We evaluated individuals with high loads of WMH from MEMENTO, a multicenter memory-clinic study, to evaluate the links between superficial WMH and 1) MRI markers of cerebral small vessel disease (number of lacunes and microbleeds and normalized brain volume); 2) cognitive outcomes including global evaluation with Mini Mental State Examination (MMSE). Our analytical sample included 208 participants. Participants with higher grades of superficial WMH had larger normalized brain volumes (82.1±1.3% vs 81.0±1.1%, P<0.001) and were more frequently women (85.0% vs 51.4%, P=0.01). In total contrast but as expected, participants with higher grades of other WMH were older (79.8±8.1 vs 75.5±6.2 years, P<0.001), had more often lacunes (41.7% vs 7.1%, P<0.001) and performed worse at the MMSE (26.8±2.0 vs 28.1±1.7, P=0.01). Our results support the hypothesis that superficial WMH are distinct from other WMH and probably correspond to mild tissue alterations.
Evolution of epilepsy comorbidities in seizure free patients: Is no seizure a synonym of no epilepsy?
Lagarde S, Bartolomei F
Rev Neurol (Paris) · 2025 May · PMID 40246676 · Publisher ↗
Epilepsy is a prevalent neurological disorder, with most patients achieving seizure freedom through antiseizure medications (ASM). However, being seizure-free does not necessarily equate to being free from epilepsy-relat...
Epilepsy is a prevalent neurological disorder, with most patients achieving seizure freedom through antiseizure medications (ASM). However, being seizure-free does not necessarily equate to being free from epilepsy-related comorbidities. This review explores the persistence of psychiatric, cognitive, and social challenges in seizure-free patients and their impact on quality of life (QoL). Seizure-free patients generally report a better QoL than those with active epilepsy, with scores approaching those of the general population. However, detailed analyses reveal impairments in specific subdomains, such as emotional well-being, energy levels, and employment concerns. The most significant determinants of QoL in seizure-free patients include ASM side effects, psychiatric symptoms, and social functioning. Notably, polytherapy is associated with a poorer QoL. After epilepsy surgery, improvements in QoL are well documented, especially in the first two years postoperatively. However, for some patients, achieving seizure freedom does not necessarily result in significant QoL improvements, often due to persistent psychiatric or cognitive impairments. Psychiatric comorbidities, particularly depression and anxiety, remain a significant determinant of QoL in seizure-free patients, sometimes exerting a greater influence than seizure control itself. Depression is significantly more prevalent in patients treated with ASMs, especially those on polytherapy. After surgery, 15-45% of patients achieve remission from psychiatric disorders, particularly those who become seizure-free. Cognitive deficits could persist in seizure-free patients, particularly in those on ASMs. Studies have reported impairments in verbal fluency, memory, and processing speed, especially in patients with magnetic resonance imaging lesions or early epilepsy onset. ASM withdrawal has been associated with improved verbal fluency, psychomotor speed, and attention in some patients, but not necessarily in overall QoL. After epilepsy surgery, cognitive outcomes vary, with verbal memory decline being the most concerning effect, particularly after left-sided resections. However, some patients experience cognitive improvements, particularly in executive functioning and IQ in children. Importantly, QoL improvements post-surgery are generally independent of cognitive changes, as long as seizure control is achieved. Seizure freedom positively impacts employment, with studies reporting that seizure-free patients are significantly more likely to obtain or retain full-time employment. However, barriers remain, including stigma and employer perceptions of epilepsy. Driving ability is crucial to patient independence, with up to 80% of seizure-free patients regaining their license. While most seizure-free patients achieve financial and residential independence, social adaptation can be challenging. Some patients and families struggle with the "burden of normality," which describes difficulties adjusting to life without epilepsy. This can lead to strained family dynamics and, in some cases, divorce. Achieving seizure freedom is a critical goal, but it is not synonymous with complete recovery from epilepsy-related burdens. A comprehensive approach, including psychiatric, cognitive, and social assessments, is essential to optimize the well-being of seizure-free patients.
[Not Available].
Thezenas J, Ouederni A
Rev Neurol (Paris) · 2025 Apr · PMID 40246339 · Publisher ↗
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Psychoses onset in multiple sclerosis: A systematic review and meta-analysis.
Ketata I, Ellouz E, Ketata A
Rev Neurol (Paris) · 2025 Jun · PMID 40240221 · Publisher ↗
BACKGROUND: Psychotic symptoms in multiple sclerosis (MS) have been infrequently studied, despite the existence of numerous case reports showing inconsistent findings. Our aim was to assess the timing of psychosis onset...
BACKGROUND: Psychotic symptoms in multiple sclerosis (MS) have been infrequently studied, despite the existence of numerous case reports showing inconsistent findings. Our aim was to assess the timing of psychosis onset and examine its characteristics in MS cases. MATERIAL AND METHODS: We conducted a systematic review and meta-analysis according to PRISMA 2020. We searched for case reports and case series of psychosis in MS on MEDLINE through PubMed, Google Scholar, Web of Science, and Cochrane. SPSS 26 was used to perform the data analysis. RESULTS: Overall, 43 cases were reviewed. Bipolar disorder and schizophrenia (SCZ) were the most frequently observed types. Psychosis was often present before or at the time of MS diagnosis. For patients with prior psychosis before MS diagnosis, those with SCZ were less likely to develop neurologic symptoms compared to those with other psychosis types. Polymorphic delusions were significantly associated with psychosis onset either after or concurrently with MS. Extensive periventricular white matter lesions, cerebellar peduncles, and cerebellar lesions were significantly associated with the onset of psychosis following MS diagnosis. Resistant-treatment psychosis occurred in 59.4% of cases. A favorable outcome was significantly more common in patients with relapsing-remitting MS compared to those with other forms of MS. CONCLUSION: Our study highlights the importance of considering MS in patients with psychoses, especially those with SCZ or treatment-resistant psychosis. Some white matter lesions may trigger psychosis after MS diagnosis. While managing psychosis in MS can be challenging, MS-specific treatments have proven effective.
The diagnostic and therapeutic journey of Tourette syndrome: Thematic analysis of the difficulties experienced by parents of patients.
Breton Z, Denis P, Goussé V … +1 more , Hartmann A
Rev Neurol (Paris) · 2025 Jun · PMID 40234118 · Publisher ↗
OBJECTIVE: The aim of this thematic analysis is to formalize the parental trajectories of therapeutic wandering, from first symptoms to the diagnosis until disease management. METHODS: An inductive and deductive thematic...
OBJECTIVE: The aim of this thematic analysis is to formalize the parental trajectories of therapeutic wandering, from first symptoms to the diagnosis until disease management. METHODS: An inductive and deductive thematic analysis was carried out based on 25 interviews with parents of children with TS. Statistical and association tests were also conducted. RESULTS: From the interviews with parents, 284 codes were categorized into 19 inductive subthemes, which were then grouped into 5 deductive themes. Some of the subthemes were relevant to all interviewees, and ranged from the description of the disease characteristics, parental distress, the impact of the TS diagnosis, and the evaluation of the diagnostic journey. CONCLUSION: Our study sheds light on how the parents of children with TS experience the diagnostic and therapeutic journey. By highlighting recurrent themes experienced by families, we hope that the results will be beneficial to both parents and children with TS in avoiding future diagnostic and therapeutic delay.
Artificial intelligence for the detection of interictal epileptiform discharges in EEG signals.
Dessevres E, Valderrama M, Le Van Quyen M
Rev Neurol (Paris) · 2025 May · PMID 40221359 · Publisher ↗
INTRODUCTION: Over the past decades, the integration of modern technologies - such as electronic health records, cloud computing, and artificial intelligence (AI) - has revolutionized the collection, storage, and analysi...
INTRODUCTION: Over the past decades, the integration of modern technologies - such as electronic health records, cloud computing, and artificial intelligence (AI) - has revolutionized the collection, storage, and analysis of medical data in neurology. In epilepsy, Interictal Epileptiform Discharges (IEDs) are the most established biomarker, indicating an increased likelihood of seizures. Their detection traditionally relies on visual EEG assessment, a time-consuming and subjective process contributing to a high misdiagnosis rate. These limitations have spurred the development of automated AI-driven approaches aimed at improving accuracy and efficiency in IED detection. METHODS: Research on automated IED detection began 45 years ago, spanning from morphological methods to deep learning techniques. In this review, we examine various IED detection approaches, evaluating their performance and limitations. RESULTS: Traditional machine learning and deep learning methods have produced the most promising results to date, and their application in IED detection continues to grow. Today, AI-driven tools are increasingly integrated into clinical workflows, assisting clinicians in identifying abnormalities while reducing false-positive rates. DISCUSSION: To optimize the clinical implementation of automated AI-based IED detection, it is essential to render the codes publicly available and to standardize the datasets and metrics. Establishing uniform benchmarks will enable objective model comparisons and help determine which approaches are best suited for clinical use.
Targeted therapies in epilepsies.
Auvin S
Rev Neurol (Paris) · 2025 May · PMID 40221358 · Publisher ↗
In recent years, the increasing availability of antiseizure medications has not reduced the incidence of drug-resistant epilepsy. Precision medicine offers the potential for mechanism-driven treatments for rare pediatric...
In recent years, the increasing availability of antiseizure medications has not reduced the incidence of drug-resistant epilepsy. Precision medicine offers the potential for mechanism-driven treatments for rare pediatric epilepsies. The concept of precision medicine is not new in the field of epilepsy, as demonstrated by the use of pyridoxine for antiquitin deficiency (pyridoxine-dependent epilepsy) and the ketogenic diet for GLUT1 deficiency syndrome. More recently, preclinical evidence has led to phase 3 clinical trials, such as the use of everolimus to inhibit the mTOR pathway in tuberous sclerosis complex. However, preclinical findings do not always translate into effective treatments, as illustrated by the heterogeneous effects of quinidine in KCNT1-related epilepsy. Currently, an exponential increase in compounds identified at the preclinical level will require clinical trial validation. However, it remains uncertain whether these developments will lead to improved efficacy in drug-resistant epilepsy or have any disease-modifying effects. This article does not explicitly address antisense oligonucleotides or gene therapy.
Seizure-related cardiovascular symptoms: Comorbidities or SUDEP risk factors?
Surges R
Rev Neurol (Paris) · 2025 May · PMID 40210582 · Publisher ↗
Sudden unexpected death in epilepsy (SUDEP) is one of the leading drivers of premature mortality in people with epilepsy (PWE), especially in those with difficult-to-treat epilepsy and frequent tonic-clonic seizures (TCS...
Sudden unexpected death in epilepsy (SUDEP) is one of the leading drivers of premature mortality in people with epilepsy (PWE), especially in those with difficult-to-treat epilepsy and frequent tonic-clonic seizures (TCS). Cardiovascular symptoms commonly occur in association with seizures, prompting the hypothesis that SUDEP is primarily linked to seizure-related cardiovascular dysfunction. This short narrative review summarizes the spectrum of cardiovascular alterations in the context of seizures and discusses putative links to SUDEP. Focal seizures go frequently along with increased heart rates (HR) that resolve shortly after seizure cessation. HR decrease and ictal asystole (IA) are rarely observed in focal unaware seizures in a small proportion of people with temporal lobe epilepsy. IA is reported to be a self-limiting benign condition without a link to SUDEP. Focal to bilateral or generalized TCS are typically accompanied by excessively released catecholamines, which underlie, in turn, various postictal symptoms. Prominent, sustained sinus tachycardia is a common and benign finding, whereas ventricular fibrillation/tachycardia were only anecdotally reported in a few near-SUDEP or SUDEP patients. Cases of transient, non-fatal atrial fibrillation were also scarcely described in the aftermaths of TCS. Takotsubo cardiomyopathy was rarely reported following TCS, usually with a favorable outcome. In most recorded SUDEP cases, however, a rather stereotypical fatal cascade was consistently documented, characterized by primary central apnea that occurs in the early postictal phase after a TCS, secondarily followed by bradyarrhythmia and terminal asystole. Blood pressure commonly increases in association with focal seizures and TCS, but the pattern may be complex with transient decreases or no significant change during or after seizures. Apart from the immediate effects on cardiovascular function, increasing evidence suggests that recurrent seizures also have a remote impact on cardiac properties, coined by the term `epileptic heart syndrome'. In conclusion, cardiovascular symptoms related to focal seizures are typically transitory and benign. In contrast, TCS can rarely cause postical onset of ventricular tachycardia and acute cardiomyopathy, potentially leading to sudden cardiac death. SUDEP, in turn, was consistently reported to occur in the aftermaths of TCS primarily due to central apnea. To prevent potentially serious cardiovascular complications, full control of TCS whether by antiseizure medication, neuromodulatory devices or epilepsy surgery should be aimed at.
Pathophysiology of SUDEP: How far are we from understanding?
Boglietti E, Haddad D, Bezin L … +1 more , Rheims S
Rev Neurol (Paris) · 2025 May · PMID 40204591 · Publisher ↗
Sudden and unexpected death in epilepsy patients (SUDEP) is the leading cause of death in patients suffering from drug-resistant epilepsy. A significant number of studies have been conducted in both patients and animal m...
Sudden and unexpected death in epilepsy patients (SUDEP) is the leading cause of death in patients suffering from drug-resistant epilepsy. A significant number of studies have been conducted in both patients and animal models to examine the initial cascade of events that directly cause death as well as the factors that contribute to the long-term risk of SUDEP. This review aims to discuss the main pathophysiological hypotheses that are currently considered in both clinical and pre-clinical models of SUDEP. Studies have highlighted that SUDEP is typically triggered by a seizure, with central fatal apnea as the primary cause of death. Findings also suggest that chronic impairments in respiratory regulation may contribute to SUDEP risk, with serotonin dysfunction playing a key role in the associated respiratory abnormalities. These insights on SUDEP pathophysiology contribute to better risk assessment, though gaps remain in understanding the precise mechanisms linking SUDEP and transient peri-ictal respiratory dysfunction.
Shades of Babinski: Grading the absolute.
Sohrab SA
Rev Neurol (Paris) · 2025 Jun · PMID 40204590 · Publisher ↗
Plantar reflex has been an integral component of neurological examination since its introduction more than a century ago. Despite its simplicity of description, elicitation and interpretation of the reflex and inter-obse...
Plantar reflex has been an integral component of neurological examination since its introduction more than a century ago. Despite its simplicity of description, elicitation and interpretation of the reflex and inter-observer agreement have not proven as easily achievable or perfect as the original succinct description promises. We propose a method and a simple tool to grade and standardize performance of plantar reflex among different observers and patients.
Are antiseizure medications disease modifiers?
Tyvaert L
Rev Neurol (Paris) · 2025 May · PMID 40204589 · Publisher ↗
The International League Against Epilepsy (ILAE) is proposing a new nomenclature, replacing the confusing term antiepileptic drugs (AEDs) with antiseizure medications (ASMs). This approach has been partly motivated by th...
The International League Against Epilepsy (ILAE) is proposing a new nomenclature, replacing the confusing term antiepileptic drugs (AEDs) with antiseizure medications (ASMs). This approach has been partly motivated by the emergence of new treatments with antiepileptogenic or, more precisely, disease-modifying effects. This implies an effect on the temporal course of the disease, even when treatment is discontinued. However, the terms ASM and disease-modifying are not mutually exclusive. In some cases, ASMs can have this property. however, demonstrating this disease-modifying effect, and hence the development of these molecules, remains complex and difficult. The disease-modifying effect of ASM seems to depend on its etiological or pathophysiological effect on the developing epileptic disease, but also on other characteristics: target on etiological or pathophysiological mechanisms of the disease, level of cerebral maturation, time after onset of an epileptogenic event, dosage and duration of treatment. The development of this new type of treatment requires a better definition of the target populations, a better understanding of the cascade of epileptogenic phenomena, and the definition of new diagnostic and prognostic markers for epilepsy.
Detection of brain somatic mutations from stereo-EEG electrodes in focal epilepsy: Current advances and future perspectives.
Checri R, Baldassari S, Baulac S
Rev Neurol (Paris) · 2025 May · PMID 40187987 · Publisher ↗
Brain somatic mutations are increasingly recognized as major drivers of focal epilepsy particularly in malformations of cortical development. While traditionally relying on surgically resected tissue for genetic analysis...
Brain somatic mutations are increasingly recognized as major drivers of focal epilepsy particularly in malformations of cortical development. While traditionally relying on surgically resected tissue for genetic analysis, recent advances in molecular techniques now enable the recovery and analysis of DNA from stereo-electroencephalography (SEEG) electrodes. This minimally invasive approach provides unprecedented opportunities to identify somatic mutations in patients who may not undergo resective surgery. Here, we review the current state of molecular analyses from SEEG electrodes, including recent developments in DNA sequencing, transcriptomics, and epigenetic profiling. We discuss how genetic testing may be integrated into presurgical evaluations, providing new opportunities for comprehensive molecular phenotyping of focal epilepsies. These innovations hold promises in enhancing surgical outcome prediction and guiding toward targeted therapies.
Multiple sclerosis and epilepsy.
Catenoix H, Grabon W, Rheims S … +2 more , Vukusic S, Marignier R
Rev Neurol (Paris) · 2025 May · PMID 40180801 · Publisher ↗
Epilepsy is a notable comorbidity in multiple sclerosis (MS), with a prevalence significantly higher than in the general population. This co-occurrence suggests shared pathophysiological mechanisms, including cortical de...
Epilepsy is a notable comorbidity in multiple sclerosis (MS), with a prevalence significantly higher than in the general population. This co-occurrence suggests shared pathophysiological mechanisms, including cortical demyelination, chronic inflammation and neurodegeneration, which predispose MS patients to seizures. Advanced imaging studies highlight the role of cortical lesions and atrophy in epileptogenesis, while inflammatory processes further lower the seizure threshold. Additionally, MS-associated network dysfunction disrupts normal neural activity, contributing to seizure susceptibility. This review synthesizes epidemiological, neuroimaging, and clinical evidence to elucidate the complex relationship between epilepsy and MS. It emphasizes the importance of personalized care and the need for further research to refine treatment protocols, improve outcomes, and enhance the quality of life for this unique patient population.
Artificial intelligence applied to epilepsy imaging: Current status and future perspectives.
Berger M, Licandro R, Nenning KH … +2 more , Langs G, Bonelli SB
Rev Neurol (Paris) · 2025 May · PMID 40175210 · Publisher ↗
In recent years, artificial intelligence (AI) has become an increasingly prominent focus of medical research, significantly impacting epileptology as well. Studies on deep learning (DL) and machine learning (ML) - the co...
In recent years, artificial intelligence (AI) has become an increasingly prominent focus of medical research, significantly impacting epileptology as well. Studies on deep learning (DL) and machine learning (ML) - the core of AI - have explored their applications in epilepsy imaging, primarily focusing on lesion detection, lateralization and localization of epileptogenic areas, postsurgical outcome prediction and automatic differentiation between people with epilepsy and healthy individuals. Various AI-driven approaches are being investigated across different neuroimaging modalities, with the ultimate goal of integrating these tools into clinical practice to enhance the diagnosis and treatment of epilepsy. As computing power continues to advance, the development, research integration, and clinical implementation of AI applications are expected to accelerate, making them even more effective and accessible. However, ensuring the safety of patient data will require strict regulatory measures. Despite these challenges, AI represents a transformative opportunity for medicine, particularly in epilepsy neuroimaging. Since ML and DL models thrive on large datasets, fostering collaborations and expanding open-access databases will become increasingly pivotal in the future.
Epilepsy and Alzheimer disease: New insights and perspectives.
Dupont S
Rev Neurol (Paris) · 2025 May · PMID 40169335 · Publisher ↗
Numerous epidemiological and pathophysiological arguments suggest a bidirectional link between late-onset epilepsy and Alzheimer's disease. However, the temporal and causal relationship between the pathophysiological pro...
Numerous epidemiological and pathophysiological arguments suggest a bidirectional link between late-onset epilepsy and Alzheimer's disease. However, the temporal and causal relationship between the pathophysiological processes underlying these two conditions remains unclear. It is likely that these connections are complex, requiring consideration of various scenarios of causality and reciprocity. In the absence of targeted therapies that effectively address the progression of both diseases, specific measures can be taken to improve patient care. These include screening for cognitive disorders in patients with late-onset epilepsy, detecting subclinical EEG activity in patients with Alzheimer's disease, and identifying and managing cardiovascular risk factors in both populations. Looking ahead, it is evident that global population aging and the potential demographic surge in these two patient groups will necessitate greater efforts to raise awareness and enhance the training of physicians and healthcare professionals in the emerging field of "epileptogeriatrics".
Trends in the real-world management of patients with active relapsing-remitting multiple sclerosis treated with natalizumab (TYSABRI®) in France: An analysis of the PMSI database over five years (2019-2023).
Le Page E, Emery C, Fravalo A … +2 more , Fagnani F, Clement A
Rev Neurol (Paris) · 2025 Jun · PMID 40169334 · Publisher ↗
UNLABELLED: Several factors are changing the way relapsing-remitting multiple sclerosis (RRMS) is currently managed with natalizumab (NTZ), with increasing use of injections in home hospitalization structures, change in...
UNLABELLED: Several factors are changing the way relapsing-remitting multiple sclerosis (RRMS) is currently managed with natalizumab (NTZ), with increasing use of injections in home hospitalization structures, change in treatment formulation, strategy of use regarding pregnancies and sometimes extending interval dosing (EID) to reduce the risk of adverse events (AEs), notably progressive multifocal leukoencephalopathy (PML). OBJECTIVE: To describe changes in the real-world management of people with multiple sclerosis (PwMS) treated with natalizumab in France over the period 2019-2023. METHODS: This is a retrospective observational study using data extracted from the French national hospital database (PMSI) from the first of January 2019 to the 31st of December 2023 including data on all reimbursements of NTZ: patients' demographic characteristics, dates of deliveries and of infusions, formulation of the drug, type of facilities used (acute care, home hospitalization) and eventual pregnancies. RESULTS: A total number of 5,708 patients treated with NTZ were identified in 2019, increasing to 7,181 in 2023. The age/gender distribution was stable over the period with 76.9% of women and a mean age of 39.9 years (SD 11.40). The number of at home injections increased substantially from 6 in 2019 to 3,501 in 2023, particularly after COVID-19 health care reorganization. Since December 2021, when the NTZ subcutaneous (SC) formulation was launched, the percentage of intravenous infusions decreased from 71.0% in January 2022 to 29.2% in December 2023. Over the whole 5-year period, frequency of using NTZ with EID between 36-42 days increased from 5.9% in 2019 to 17.0% in 2023. Practices changed regarding NTZ and pregnancies since the number of patients with a delivery increased from 117 in 2019 to 179 in 2023. NTZ was stopped in nearly 20% of patients during the three months before conception in 2019 and 7-8% only from 2020. Maintenance of NTZ during the first as well as the second trimester of pregnancy clearly increased over the 2019-2023 period from 75% to 90% in the first trimester and 44% to nearly 78% in the second trimester. CONCLUSION: Natalizumab use was maintained and even increased in France over the 2019-2023 period despite enrichment of the therapeutic arsenal for PwMS. It was certainly facilitated by better therapeutic management with the development of at-home injections, simplification of the procedure with the SC formulation, the possibility of EID every 5-6 weeks for the intravenous formulation and better use regarding pregnancies.
Recent progress and challenges in gene therapy for pharmacoresistant focal epilepsy.
Kullmann DM
Rev Neurol (Paris) · 2025 May · PMID 40158911 · Publisher ↗
Pharmacoresistant focal epilepsy represents a major unmet need. Recent years have seen several gene therapy strategies validated mainly in rodent models of temporal lobe epilepsy, and some of these have been de-risked fo...
Pharmacoresistant focal epilepsy represents a major unmet need. Recent years have seen several gene therapy strategies validated mainly in rodent models of temporal lobe epilepsy, and some of these have been de-risked for clinical trials. This review considers some of the challenges in progressing from experimental models to the clinic. Among these are identifying promising promoter-transgene combinations, establishing safe and efficacious doses, achieving optimal delivery, and extrapolating across different aetiologies.
The different subtypes of temporal lobe seizures networks.
Bartolomei F, Makhalova J, Benoit J … +1 more , Lagarde S
Rev Neurol (Paris) · 2025 May · PMID 40158910 · Publisher ↗
Temporal lobe epilepsies (TLEs) are among the forms of epilepsy most frequently encountered in surgical evaluations, characterized by a wide range of anatomical, functional, and electroclinical subtypes. Traditional clas...
Temporal lobe epilepsies (TLEs) are among the forms of epilepsy most frequently encountered in surgical evaluations, characterized by a wide range of anatomical, functional, and electroclinical subtypes. Traditional classifications, such as mesial and lateral TLE, have been broadened by advances in stereoelectroencephalography (SEEG), revealing more complex forms such as mesio-lateral and temporal-plus seizures. These findings support the concept of epileptogenic networks, emphasizing interconnected regions rather than isolated focal areas in the genesis of seizures. Quantitative tools, such as the epileptogenicity index (EI), are improving the accuracy of SEEG interpretation, which is closely correlated with surgical results. Temporal-plus epilepsies, in particular, require full SEEG exploration due to their broader involvement in the network, necessitating tailored surgical approaches. A better understanding of TLEs subtypes and epileptogenic networks is an essential basis for advancing minimally invasive surgical techniques, including laser interstitial thermal therapy (LITT) and neuromodulation. These methods rely on the precise localization of epileptogenic networks. This network-based framework represents an important step towards optimizing surgical outcomes and advancing personalized epilepsy care.
Artificial intelligence applied to electroencephalography in epilepsy.
Alvarado-Rojas C, Huberfeld G
Rev Neurol (Paris) · 2025 May · PMID 40158909 · Publisher ↗
Artificial intelligence (AI) is progressively transforming all fields of medicine, promising substantial changes in clinical practice. In the context of epilepsy, electroencephalography (EEG), a technique used for over a...
Artificial intelligence (AI) is progressively transforming all fields of medicine, promising substantial changes in clinical practice. In the context of epilepsy, electroencephalography (EEG), a technique used for over a century, has historically been resistant to automated analysis due to the complexity of the signals and the challenges posed by artifact management. While the human eye excels at recognizing patterns, algorithms have demonstrated superior capabilities in detecting and characterizing specific features, such as long-term dynamics and synchrony. Furthermore, the advent of wearable EEG devices has led to an exponential increase in data volume, surpassing the limits of visual interpretation. AI algorithms are now being developed to address these limitations, offering enhanced efficiency in both identifying subtle signal features and managing massive datasets. This review explores the fundamental principles of AI and its transformative potential in the field of EEG. It discusses the implications and the current limitations, including improvements limited to aggregation of already known knowledge, for epilepsy diagnosis, medical and surgical treatment, and innovative approaches to patient monitoring, including seizure forecasting, highlighting how AI is poised to redefine the management of epilepsy.
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