Anti-seizure medications in patients with renal failure undergoing dialysis: how to manage?

Introduction: Managing epilepsy in patients with end-stage kidney disease presents unique challenges due to altered pharmacokinetics of anti-seizure medications (ASMs) and the effects of dialysis treatments. Dialysis can significantly affect ASM clearance, requiring careful dosing adjustments to maintain therapeutic efficacy while avoiding toxicity. This review aims to provide an up-to-date overview of the current knowledge and to offer practical clinical guidance on the use of ASMs in patients undergoing hemodialysis and peritoneal dialysis.

Fatigue in natalizumab-treated Multiple Sclerosis patients: How much is wearing-off to blame?

Introduction: Fatigue is a widely reported symptom of Multiple Sclerosis and it is the main Wearing-off Symptom (WoS) in Natalizumab (NTZ) treated patients. Whether fatigue presenting as a WoS exclusively depends on NTZ or is influenced by other factors, such as Mood Disturbances, has not been thoroughly investigated.

Objectives: The primary aim of the study is to investigate the possible correlation of fatigue with depression and to compare fatigue as a chronic symptom to fatigue as a WoS.

Effectiveness of perampanel as only concomitant antiseizure medication for highly active epilepsy: insight from a real-world, multicenter retrospective study.

Introduction: Managing patients with highly frequent seizures poses significant challenges for clinicians due to their high resistance to therapy. This study aims to evaluate the 12-month efficacy, safety, and tolerability of PER as the sole add-on therapy for patients with highly active epilepsy in a real-world setting.

Methods: Data from the previous Italian retrospective, observational, multicenter "PERampanel as Only Concomitant Antiseizure Medication" (PEROC) study were analyzed, categorizing patients by baseline seizure frequency into three groups: < 5, 5-20, and > 20 seizures/month.

Provocative techniques for functional/dissociative seizure: the colored pad test - a safe and reliable procedure.

Introduction: Suggestive seizure induction during video-EEG is a widely used and valuable tool for diagnosing functional/dissociative seizures (FDS). However, there is currently no standardized protocol. In this study, we describe the technical procedure of the induction/suppression test using colored cotton pads applied to the patient's neck and report our experience with this method over an eight-year period in routine clinical practice.

Utility and limitations of homemade videos in differentiating functional seizures from other paroxysmal events: An Italian cohort study.

Objectives: The gold standard for distinguishing epileptic seizures (ES) from non-epileptic events is video-EEG monitoring. In some cases, video alone might suffice, leading to increased utilization of home videos, to support the diagnosis. This study aimed to assess the feasibility of such practice and its accuracy compared to video-EEG, to identify key signs and symptoms of functional seizure (FS) and to establish if self-reported questionnaires would improve diagnostic accuracy.

Investigating Peri-Ictal MRI Abnormalities: A Prospective Neuroimaging Study on Status Epilepticus, Seizure Clusters, and Single Seizures.

: Brain magnetic resonance imaging (MRI) often reveals acute peri-ictal abnormalities (PMAs) during or shortly after status epilepticus (SE) but also following single seizures (SiS) or clusters of seizures (CS). However, the incidence, characteristics, and progression remain not clearly known. This study aimed to investigate incidence, clinical correlations, and evolution of PMAs in SE, CS, and SiS patients.

When the practice does not meet the evidence: An Italian survey on the use of antiseizure medications in routine neurosurgery practice.

Purpose: Anti-seizure medications (ASMs) to prevent seizures after craniotomy are not currently recommended. This survey investigates practice patterns and decision-making strategies regarding post-craniotomy ASM prophylaxis among Italian neurosurgeons.

Methods: An online cross-sectional survey was conducted (November 2022-March 2023).

HMGA1 deficiency: a pathogenic link between tau pathology and insulin resistance.

Background: Growing evidence links tau-related neurodegeneration with insulin resistance and type 2 diabetes (T2D), though the underlying mechanisms remain unclear. Our previous research identified HMGA1 as crucial for insulin receptor (INSR) expression, with defects in the HMGA1 gene associated with insulin resistance and T2D. Here, we explore HMGA1 deficiency as a potential contributor to tauopathies, such as Alzheimer's disease (AD), and its connection to insulin resistance.

Investigation into the casual or causal association of cerebral venous thrombosis and myelin oligodendrocyte glycoprotein antibody‑associated disease: A case report and literature review.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a central nervous system demyelinating syndrome (DS) typically presenting with optic neuritis or myelitis. The association between cerebral venous thrombosis (CVT) and demyelinating diseases, including multiple sclerosis (MS), is rare. In the present study, a 37-year-old man presented with sensory disturbances in the lower limbs and urinary incontinence, consistent with myelitis.

Effectiveness and safety of adjunctive cenobamate in people with focal-onset epilepsy: Interim results after 24-week observational period from the BLESS study.

Objective: Cenobamate is an antiseizure medication (ASM) with a dual mechanism of action that was recently approved for the treatment of focal seizures in adults. This analysis aimed to describe the outcomes at 12 and 24 weeks after starting cenobamate therapy in a real-world setting.

Methods: BLESS [NCT05859854] is an ongoing, observational, retrospective and prospective cohort study to evaluate the real-world effectiveness and safety of adjunctive cenobamate in adults with uncontrolled focal epilepsy.

Second-Line Medications for Women Aged 10 to 50 Years With Idiopathic Generalized Epilepsy.

Importance: Women with idiopathic generalized epilepsy (IGE) face challenges in treatment due to limited options that are both effective and safe.

Objective: To evaluate the effectiveness and safety of substitution monotherapy vs add-on therapy as second-line options for women who might become pregnant with IGE after failure of first-line antiseizure medications (ASMs) other than valproic acid.

Design, Setting, And Participants: Multicenter retrospective comparative effectiveness cohort study at 18 primary, secondary, and tertiary adult and children epilepsy centers across 4 countries, analyzing data from 1995 to 2023.

Exploring the Effectiveness of Adjunctive Cenobamate in Focal Epilepsy: A Time-Based Analysis.

Background: A growing body of evidence supports the effectiveness of cenobamate (CNB). This study aimed to assess the clinical response to add-on CNB through a time-to-event approach and explore the potential contribution of the concomitant classes of antiseizure medications (ASMs) to improve CNB clinical use.

Patients And Methods: This study is a subgroup analysis of a larger retrospective, multicenter study on adults with focal-onset seizures participating in the Italian Expanded Access Program at five pre-established centers.

Functional seizures and binge eating disorder: A cross-sectional study.

Objective: Functional seizures (FS) are brief, involuntary changes in behaviour or consciousness, distinct from epileptic seizures, potentially associated with psychological dissociation. Binge eating disorder (BED) was linked to psychological and somatic dissociation also. However, any connection between FS and BED is insufficiently explored.

Modern neurophysiological techniques indexing normal or abnormal brain aging.

Brain aging is associated with a decline in cognitive performance, motor function and sensory perception, even in the absence of neurodegeneration. The underlying pathophysiological mechanisms remain incompletely understood, though alterations in neurogenesis, neuronal senescence and synaptic plasticity are implicated. Recent years have seen advancements in neurophysiological techniques such as electroencephalography (EEG), magnetoencephalography (MEG), event-related potentials (ERP) and transcranial magnetic stimulation (TMS), offering insights into physiological and pathological brain aging.

The hidden link between late-onset seizures and cerebral amyloid angiopathy: A case-control study.

Objective: Epileptic seizures occurring in late adulthood often remain of unknown origin. Sporadic cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease characterized by intracerebral hemorrhage, microhemorrhage and superficial siderosis, occurring mostly in elderly. This observational case-control study aimed to assess the occurrence of CAA in patients experiencing their first seizure in late adulthood.

Perampanel in post-stroke epilepsy: Clinical practice data from the PERampanel as Only Concomitant antiseizure medication (PEROC) study.

Introduction: Post-stroke epilepsy (PSE) is one of the most common causes of acquired epilepsy. Nevertheless, there is limited evidence regarding the clinical profile of antiseizure medications (ASMs) in PSE. This study aims to evaluate the 12-month effectiveness and tolerability of perampanel (PER) used as only add-on treatment in patients with PSE in a real-world setting.

The neurological core features of the infantile-onset multisystem neurologic, endocrine, and pancreatic disease: A novel nonsense mutation in an Italian family.

Aim: Biallelic mutations in the PTRH2 gene have been associated with infantile multisystem neurological, endocrine, and pancreatic disease (IMNEPD), a rare autosomal recessive disorder of variable expressivity characterized by global developmental delay, intellectual disability or borderline IQ level, sensorineural hearing loss, ataxia, and pancreatic insufficiency. Various additional features may be included, such as peripheral neuropathy, facial dysmorphism, hypothyroidism, hepatic fibrosis, postnatal microcephaly, cerebellar atrophy, and epilepsy. Here, we report the first Italian family presenting only predominant neurological features.

Topiramate ban in women of childbearing potential with idiopathic generalized epilepsy: Does effectiveness offset the teratogenic risks?

Regulatory agencies have recently discouraged the prescription of topiramate (TPM) to women of childbearing potential with epilepsy due to growing evidence of the teratogenic and neurodevelopmental risks associated with its use during pregnancy. It remains, however, unclear whether the use of TPM in this population can be supported to some extent by its high effectiveness. In this multicenter, retrospective, cohort study performed at 22 epilepsy centers, we investigated the comparative effectiveness of TPM and levetiracetam (LEV) given as first-line antiseizure medication in a cohort of women of childbearing potential with idiopathic generalized epilepsy (IGE).