Publications on epilepsy in 2018 have shed light on the aetiology and management of the condition and raised new questions. Translation from mechanisms to clinical practice, driven by cooperation among multiple fields, will be crucial to further advances.
Key advances
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A longitudinal observational cohort study in newly diagnosed patients with epilepsy revealed that long-term outcomes have not improved with the introduction of new antiepileptic drug (AED) regimens1.
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Mossy cells — key neurons in the hippocampal excitatory circuit — emerged as promising targets for new epilepsy treatments5.
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A randomized trial of stereotactic radiosurgery (SRS) versus anterior temporal lobectomy in patients with mesial temporal lobe epilepsy indicated that SRS is a viable alternative to open surgery in selected patients6.
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Advanced gene sequencing strategies that can detect parental mosaicism should allow more accurate genetic counselling of parents who have offspring with epileptic encephalopathies apparently caused by de novo mutations8.
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An epidemiological study found that the incidence of sudden unexpected death in epilepsy (SUDEP) in children was comparable to that in adults, suggesting that SUDEP in the paediatric population is more common than previously thought10.
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References
Chen, Z. et al. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: a 30-year longitudinal cohort study. JAMA Neurol. 75, 279–286 (2018).
Chi, X. et al. Response to treatment schedules after the first antiepileptic drug failed. Epilepsia 59, 2118–2124 (2018).
Gunning, B. et al. Cannabidiol in patients with seizures associated with Lennox–Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 391, 1085–1096 (2018).
Tomson, T. et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry. Lancet Neurol. 17, 530–538 (2018).
Bui, A. D. et al. Dentate gyrus mossy cells control spontaneous convulsive seizures and spatial memory. Science 359, 787–790 (2018).
Barbaro, N. M. et al. Radiosurgery versus open surgery for mesial temporal lobe epilepsy: the randomized, controlled ROSE trial. Epilepsia 59, 1198–1207 (2018).
Yu, T. et al. High-frequency stimulation of anterior nucleus of thalamus desynchronizes epileptic network in humans. Brain 141, 2631–2643 (2018).
Myers, C. T. et al. Parental mosaicism in “de novo” epileptic encephalopathies. N. Engl. J. Med. 378, 1646–1648 (2018).
Bailey, J. N. et al. Variant intestinal-cell kinase in juvenile myoclonic epilepsy. N. Engl. J. Med. 378, 1018–1028 (2018).
Keller, A. E. et al. Incidence of sudden unexpected death in epilepsy in children is similar to adults. Neurology 91, e107–e111 (2018).
Acknowledgements
The author’s work is supported by grant no. 81420108014 from the National Foundation of Natural Science of China.
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Zhou, D. Teamwork aids management and raises new issues in epilepsy. Nat Rev Neurol 15, 66–67 (2019). https://doi.org/10.1038/s41582-018-0130-8
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DOI: https://doi.org/10.1038/s41582-018-0130-8
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