Overall, the presence of SCSs alone was not associated with a poor outcome, but the spatial non-concordance with the seizure-onset zone was highly predictive for poor seizure outcome.
Abstract
Objective
Subclinical seizures (SCSs) remain an understudied aspect of presurgical evaluation in patients with drug-resistant epilepsy (DRE), with uncertain prevalence, distribution among epilepsy types, and predictive value for surgical outcomes. This systematic review and meta-analysis aims to explore the occurrence of SCSs, their concordance with the seizure-onset zone (SOZ), and their association with postoperative seizure outcomes.
Methods
A systematic search of Medline, Embase, and Web of Science was performed to identify studies reporting SCSs during scalp electroencephalography (EEG) monitoring or intracranial EEG (iEEG) monitoring in patients with DRE undergoing epilepsy surgery. Data on SCS prevalence, concordance with SOZ, and postoperative outcomes were extracted. Pooled proportions and odds ratios (ORs) were estimated using random-effects generalized linear mixed models. Subgroup analyses evaluated the proportions of SCSs in temporal vs extratemporal epilepsy.
Results
Thirteen studies comprising 1174 patients met the inclusion criteria. The pooled prevalence of SCSs was 32% (95% confidence interval [CI] 8-73) during scalp EEG monitoring and 50% (95% CI 38-62) during iEEG monitoring. Concordant SCSs with SOZ occurred in 37% of patients undergoing iEEG. Non-concordant SCSs were associated with a nearly fivefold higher odds of poor postoperative seizure control (OR 4.82, 95% CI 1.80-12.96; p = 0.002). SCSs were more frequent in temporal lobe epilepsy than in extratemporal epilepsy (57% vs 44%, p = 0.046). Within temporal lobe epilepsy, the highest prevalence was observed in the mesiotemporal region (69%). Overall, the presence of SCSs alone was not associated with a poor outcome, but the spatial non-concordance with the SOZ was highly predictive for poor seizure outcome.
Significance
SCSs are common in presurgical evaluation, particularly in temporal lobe epilepsy. Although their presence alone is not prognostic, non-concordant SCSs are associated with worse postoperative outcomes. Systematic assessment, especially using iEEG, may improve delineation of the epileptogenic zone and surgical planning in DRE.
SCSs are present in approximately one quarter of presurgical epilepsy patients and show moderate concordance with CS and IED localization and their distinct localization profile and frequent containment within CS zones support their value as complementary information in epilepsy care.
L. Lankhuijzen, Monique Cloherty, J. Winston et al.· Frontiers in Neurology· 0 citations
Seizures and epilepsy are increasingly recognized in neurodegenerative diseases, yet their burden in frontotemporal dementia (FTD) remains poorly defined. We conducted a systematic review and meta-analysis to estimate the prevalence of epilepsy or seizures in FTD, assess comparative risk versus controls, and explore variation across clinical subtypes. MEDLINE/PubMed, Embase, Cochrane Library, LILACS, and ClinicalTrials.gov were searched from inception to August 15, 2025, without language restrictions. Observational studies reporting epilepsy or clinical seizures in adults with FTD were included. Two reviewers independently screened and extracted data following PRISMA 2020 guidelines, with risk of bias assessed using Joanna Briggs Institute checklists. Random-effects meta-analyses were used to pool prevalence estimates. Eleven studies with 3,182 individuals were included; 5 were at low and 6 at high risk of bias. The pooled prevalence of epilepsy or seizures was 7% (95% CI, 4%-11%), but heterogeneity was substantial (I² = 82.3%). Prevalence varied across clinical variants (P = .04), including 3% (95% CI, 1%-11%) in behavioral-variant FTD and 9% (95% CI, 0%-69%) in primary progressive aphasia. Comparative data were sparse: the 2 studies with control counts showed increased odds in FTD but were too heterogeneous to pool, and an exploratory synthesis of all 3 gave a ratio measure of 3.72 (95% CI, 1.38-10.06). Epilepsy and seizures occur in a nontrivial proportion of individuals with FTD. However, substantial heterogeneity, variable methodological quality, and inconsistent definitions compromise the reliability of prevalence estimates. Prospective studies with standardized seizure phenotyping are needed.
Lucca Passow Carpinelli, João Pedro Sá Lins, Albert Abad Velazquez et al.· Seizure· 0 citations
Abstract Background Drug-resistant epilepsy (DRE) remains a major cause of neurological morbidity worldwide, affecting approximately one-third of patients with epilepsy despite advances in antiseizure medications. Persistent seizures are associated with increased mortality, cognitive decline, psychosocial impairment, and reduced quality of life. Surgical intervention represents the most effective treatment for carefully selected patients; however, substantial delays in referral and underutilization of epilepsy surgery continue to be reported globally. This study is done to provide a contemporary evidence-based review of patient selection, presurgical evaluation, surgical decision-making, and outcomes across the spectrum of epilepsy surgery modalities. Methods A narrative review of the current literature was performed, focusing on the definition of DRE, indications for surgical referral, presurgical investigations, resective and disconnective surgical procedures, minimally invasive techniques, and neuromodulation strategies. Emphasis was placed on practical clinical decision-making and contemporary developments influencing patient selection. Results Successful epilepsy surgery depends primarily on accurate localization of the epileptogenic zone and careful multidisciplinary evaluation. Temporal lobe epilepsy remains the most favorable indication for resective surgery, while advances in stereoelectroencephalography, neuroimaging, laser interstitial thermal therapy, and neuromodulation have expanded treatment options for patients previously considered unsuitable for surgery. Contemporary presurgical assessment integrates clinical semiology, prolonged video-electroencephalographic monitoring, high-resolution magnetic resonance imaging, functional imaging, and neuropsychological evaluation to optimize patient selection and maximize postoperative seizure control. Conclusion Appropriate patient selection remains the cornerstone of successful epilepsy surgery. Continued advances in imaging, electrophysiology, minimally invasive techniques, and neuromodulation are transforming the management of DRE and facilitating increasingly individualized treatment strategies.
Vartika Gupta, Pankaj Gupta· Asian Journal of Neurosurger...· 0 citations
Abstract Objective To determine the extent to which electroclinical information available at initial evaluation allows classification of idiopathic generalized epilepsy (IGE) syndromes, and to assess the contributions of seizure semiology and age at seizure onset to early syndromic diagnosis. Methods We prospectively analyzed a cohort of patients with new‐onset seizures who underwent a structured clinical evaluation, including detailed history‐taking, 3‐h video‐EEG, and epilepsy‐protocol MRI. Seizure semiology was assessed at three levels: index seizure, initial seizure type, and seizure types identified at initial evaluation. Syndromic classification followed International League Against Epilepsy criteria. Final electroclinical diagnosis, established after longitudinal follow‐up, served as reference. Within patients ultimately diagnosed with one of the four IGE syndromes, baseline data were used to determine whether the final syndrome could be assigned at initial evaluation. Results Of 2699 patients evaluated, 498 (18.4%) met criteria for genetic generalized epilepsy, of whom 401 (80.5%) were classified as having one of the IGE syndromes. Based on initial evaluation, the correct syndrome could be assigned in 366 patients (91.3%), whereas 7 (1.7%) would have been misclassified and 28 (7.0%) were not assignable. Non‐assignability was confined to absence epilepsies, reflecting overlap between childhood (CAE) and juvenile absence epilepsy (JAE), whereas misclassification occurred only in juvenile myoclonic epilepsy (JME) presenting with isolated generalized tonic–clonic (GTC) seizures. Classification based on the index seizure alone showed limited accuracy (63.6%), whereas incorporation of seizure types identified through structured history improved classification to 95.0%. Myoclonic seizures were highly specific for JME, whereas absence and GTC seizures required integration with additional features. Age at seizure onset strongly differentiated CAE from JAE (AUC 0.935). Significance Electroclinical classification of IGE syndromes is frequently achievable at initial evaluation when based on seizure semiology and age at onset. When classification is not possible, limitations follow predictable electroclinical patterns, supporting a structured, history‐driven diagnostic approach. Plain Language Summary This study examined how accurately doctors can identify specific types of generalized epilepsy when patients are first evaluated. Among 401 patients with generalized epilepsy, the correct epilepsy syndrome could be identified in more than 90% at the first visit. Looking beyond the first seizure and asking about all seizure types together with age at seizure onset greatly improved diagnosis. While some overlap exists between specific types (like childhood versus juvenile absence epilepsy), a thorough clinical evaluation from the start provides reliable diagnostic direction for patients and supports early and accurate diagnosis.
Omar Nawfal, Heba Samara, W. Nasreddine et al.· Epilepsia Open· 0 citations
Objective:
To summarize current evidence on the prevalence, phenomenology, and temporal characteristics of prodromal symptoms and early ictal manifestations (auras) in focal epilepsy, and to clarify their clinical relevance for patient counseling and management.
Material and methods.
A narrative review of the literature on prodromal symptoms and auras in focal epilepsy was conducted. Publications were identified through searches in PubMed/MEDLINE and by screening reference lists of key articles. Given the heterogeneity in definitions and time frames across studies, findings were analyzed qualitatively without meta-analysis, particularly emphasizing on practical aspects of clinical interviewing and safety recommendations.
Results.
Prodromal symptoms are reported in a substantial proportion of patients with focal epilepsy; reported prevalence varies depending on assessment methods and diagnostic criteria. Prodromes typically occur minutes to hours (less commonly a day or more) before seizure onset and may include affective, cognitive, and autonomic manifestations. According to the current classification by the International League Against Epilepsy, an aura is defined as a focal aware seizure and represents the ictal phase of the epileptic event. Clinically, auras are characterized by brief, stereotyped subjective experiences occurring seconds to minutes before potential seizure propagation. Patients’ responses to warning symptoms often include cessation of ongoing activities, seeking a safe environment, and alerting others, which may reduce the risk of injury. However, in some individuals, anticipatory anxiety and avoidance behaviors develop, negatively affecting quality of life.
Conclusion.
In patients with focal epilepsy, routine and systematic inquiry about prodromal symptoms and auras during clinical evaluation is advisable. Clinicians should carefully distinguish between prodromal and early ictal manifestations and help patients adopt proportionate safety measures without reinforcing hypervigilance or unnecessary restrictions in daily activities.
E. Narodova, V. Narodova, E. Erakhtin· Epilepsy and paroxysmal cond...· 0 citations
Focal seizures are the predominant type of seizure among pediatric patients and are primarily managed with benzodiazepines such as clobazam and lorazepam, followed by levetiracetam.
Kothai Ramalingam, Rangasamy Krishnamoorthi, Magesh Elango et al.· Asian Journal of Pharmaceuti...· 0 citations
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