Epilepsy as a disease affecting neural networks: A neurophysiological perspective

Effects of anti-seizure medications on resting-state functional networks in juvenile myoclonic epilepsy: An EEG microstate analysis

OBJECTIVE

Juvenile myoclonic epilepsy (JME) is associated with large-scale brain network dysfunction. This study aims to investigate how anti-seizure medication (ASM) treatment alters resting-state functional networks in JME patients through resting-state EEG microstate analysis.

METHODS

Ninety-six subjects participated in this study: 24 healthy controls (HC), 29 newly diagnosed JME patients who had not started ASMs therapy (JME-NM), and 43 JME patients on ASMs treatment with effective seizure control (JME-M). EEG data were collected for 10 min while participants were awake and resting with their eyes closed, using a standard 19-channel recording system. EEG topographies were categorized into four microstate classes (A, B, C, D), and parameters such as mean duration, occurrence rate, time coverage, and transition probabilities between microstates were computed and compared among the three groups. Advanced statistical methods were employed to ensure the robustness and validity of the findings.

RESULTS

Significant alterations in EEG microstate characteristics were observed in untreated JME patients (JME-NM) compared to both healthy controls and treated patients. Microstate B had a markedly reduced mean duration in the JME-NM group, while microstate A displayed an increased occurrence rate and greater time coverage. Transition probabilities between specific microstates, such as from A to C, A to D, and B to C, were also significantly different in the JME-NM group. The normalization of these parameters in the JME-M group suggests that ASMs effectively stabilize altered brain networks, potentially mitigating the pathophysiological disruptions associated with JME.

CONCLUSION

This study demonstrates that ASMs effectively normalize disruptions in sensory-motor and visual networks in JME patients. EEG microstate analysis provides a dynamic view of brain network alterations and offers potential as a biomarker for the diagnosis and monitoring of JME, as well as for evaluating treatment response. These findings advance our understanding of the neurophysiological mechanisms underlying JME.

Impact of being a relative of a patient with epilepsy on the association of attitudes toward epilepsy and disease knowledge levels

OBJECTIVE

The social prognosis for individuals with epilepsy is often poorer than their clinical prognosis, highlighting the significant influence of social factors on the progression of the disease. Relatives of patients with epilepsy (RPEs) generally have more positive attitudes towards epilepsy compared to the general population. This study aimed to examine the effect of being an RPE on the relationship between attitudes toward epilepsy and levels of disease knowledge.

METHODS

This cross-sectional analytical study included 217 adult participants, comprising 93 RPEs and 124 controls (non-RPEs), selected through convenience sampling. Data were collected via face-to-face interviews using a questionnaire that included sections on socio-demographic characteristics, the Epilepsy Knowledge Scale, and the Public Attitudes Toward Epilepsy (PATE) Scale. Path analysis was conducted using the Maximum Likelihood method. Due to the non-normal distribution of exogenous variables, the robust Huber/White/sandwich estimator method was used to calculate confidence intervals and fit indices.

RESULTS

The mean age of the participants was 34.7 ± 11.5 years, with 128 (59.0 %) being female. RPEs scored an average of 26.8 ± 9.9 on the PATE Scale, which was significantly lower than the average score of 29.7 ± 11.0 for non-RPEs (p = 0.047). Path analysis indicated that being an RPE indirectly fosters a positive attitude through increased knowledge levels. While the direct effect of being an RPE on attitudes was not statistically significant, the indirect effect mediated by knowledge was significant.

SIGNIFICANCE

This study highlights that the level of knowledge about epilepsy, a key predictor of positive attitudes, remains important even among RPEs. In kinship contexts where neurobiological and psychosocial factors are at play, the primary determinant of attitudes toward epilepsy is still the level of knowledge about the condition. Consequently, focusing on increasing knowledge about epilepsy should be the main strategy to promote positive attitudes, providing a more promising avenue for future research and interventions.

Nanotechnological advances in the treatment of epilepsy: a comprehensive review

Epilepsy is one of the most prevalent chronic neurological disorders characterized by frequent unprovoked epileptic seizures. Epileptic seizures can develop from a broad range of underlying abnormalities such as tumours, strokes, infections, traumatic brain injury, developmental abnormalities, autoimmune diseases, and genetic predispositions. Sometimes epilepsy is not easily diagnosed and treated due to the large diversity of symptoms. Undiagnosed and untreated seizures deteriorate over time, impair cognition, lead to injuries, and can sometimes result in death. This review gives details about epilepsy, its classification on the basis of International League Against Epilepsy, current therapeutics which are presently offered for the treatment of epilepsy. Despite of the fact that more than 30 different anti-epileptic medication and antiseizure drugs are available, large number of epileptic patients fail to attain prolonged seizure independence. Poor onsite bioavailability of drugs due to blood brain barrier poses a major challenge in drug delivery to brain. The present review covers the limitations with the state-of-the-art strategies for managing seizures and emphasizes the role of nanotechnology in overcoming these issues. Various nano-carriers like polymeric nanoparticles, dendrimers, lipidic nanoparticles such as solid lipid nanoparticles, nano-lipid carriers, have been explored for the delivery of anti-epileptic drugs to brain using oral and intranasal routes. Nano-carries protect the encapsulated drugs from degradation and provide a platform to deliver controlled release over prolonged periods, improved permeability and bioavailability at the site of action. The review also emphasises in details about the role of neuropeptides for the treatment of epilepsy.