Generalized epilepsy

广义癫痫
  • 文章类型: Journal Article
    目标:尽管>30%的癫痫患者患有耐药性癫痫(DRE),通常患有全身性或多灶性疾病的患者传统上不被视为手术候选人.丘脑中部(CM)区域的响应性神经刺激(RNS)现在似乎是该患者人群的有希望的治疗选择。我们介绍了13例特发性全身性癫痫(IGE)和8例多灶性发作的CMRNS后的结果,这些发作迅速推广为双侧强直阵挛性(局灶性至双侧强直阵挛性[FBTC])癫痫发作。
    方法:作者对所有接受双侧CMRNS的患者进行了回顾性回顾,直至2022年7月。定位电极并在Lead-DBS中对组织活化体积进行建模。从电子病历中提取患者癫痫发作频率的变化。
    结果:21例DRE患者接受了双侧CMRNS植入。对于17例植入后随访至少1年的患者,术前基线平均癫痫发作减少82.6%(SD=19.0%,中位数=91.7%),18%的患者恩格尔1级,29%的恩格尔2级,53%的恩格尔3级和0%的恩格尔4级。非病灶性FBTC癫痫发作患者的平均癫痫发作减少趋势大于其他患者。对于至少达到Engel3级结果的患者,有价值的癫痫发作减少的中位时间为203.5天(四分位距=110.5-343.75天).与其他患者相比,患有肌阵挛性癫痫发作的IGE患者的癫痫发作减少时间明显更短。手术靶向策略在前四名受试者之后发展以实现更高的解剖准确性。
    结论:接受CMRNS的原发性和快速全身性癫痫患者的癫痫发作均得到了实质性缓解。这些患者群体的子集可能特别受益于CMRNS。铅靶向的细化,调整RNS系统参数,和患者选择是正在进行的调查领域。
    OBJECTIVE: Although >30% of epilepsy patients have drug-resistant epilepsy (DRE), typically those with generalized or multifocal disease have not traditionally been considered surgical candidates. Responsive neurostimulation (RNS) of the centromedian (CM) region of the thalamus now appears to be a promising therapeutic option for this patient population. We present outcomes following CM RNS for 13 patients with idiopathic generalized epilepsy (IGE) and eight with multifocal onsets that rapidly generalize to bilateral tonic-clonic (focal to bilateral tonic-clonic [FBTC]) seizures.
    METHODS: A retrospective review of all patients undergoing bilateral CM RNS by the senior author through July 2022 were reviewed. Electrodes were localized and volumes of tissue activation were modeled in Lead-DBS. Changes in patient seizure frequency were extracted from electronic medical records.
    RESULTS: Twenty-one patients with DRE underwent bilateral CM RNS implantation. For 17 patients with at least 1 year of postimplantation follow-up, average seizure reduction from preoperative baseline was 82.6% (SD = 19.0%, median = 91.7%), with 18% of patients Engel class 1, 29% Engel class 2, 53% Engel class 3, and 0% Engel class 4. There was a trend for average seizure reduction to be greater for patients with nonlesional FBTC seizures than for other patients. For patients achieving at least Engel class 3 outcome, median time to worthwhile seizure reduction was 203.5 days (interquartile range = 110.5-343.75 days). Patients with IGE with myoclonic seizures had a significantly shorter time to worthwhile seizure reduction than other patients. The surgical targeting strategy evolved after the first four subjects to achieve greater anatomic accuracy.
    CONCLUSIONS: Patients with both primary and rapidly generalized epilepsy who underwent CM RNS experienced substantial seizure relief. Subsets of these patient populations may particularly benefit from CM RNS. The refinement of lead targeting, tuning of RNS system parameters, and patient selection are ongoing areas of investigation.
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  • 文章类型: Journal Article
    尽管先前的研究报道了缺血性卒中(IS)和癫痫之间的双向关系,因果关系的存在及其方向性仍然是一个有争议的话题。
    与IS相关的单核苷酸多态性(SNP)从全基因组关联研究(GWAS)数据库中提取。包含所有癫痫病例的汇总遗传数据,以及全身性和局灶性癫痫亚型,是从国际抗癫痫联盟的GWAS研究中获得的。在这项研究中,主要分析方法使用方差逆加权(IVW)方法作为主要分析技术。为了增强研究结果对潜在多效性的稳健性,进行了额外的敏感性分析.
    在正向分析中,IVW方法显示IS与所有癫痫(比值比(OR)=1.127,95%置信区间(CI)=1.038~1.224,P=0.004)和全身性癫痫(IVW:OR=1.340,95%CI=1.162~1.546,P=5.70×10~5)的风险增加相关.IS与局灶性癫痫之间无显著因果关系(P>0.05)。此外,全身性癫痫,局灶性癫痫,所有癫痫均未显示与IS有因果关系.
    这项孟德尔随机化(MR)分析表明,IS会增加患癫痫的风险,尤其是全身性癫痫.相反,在癫痫发作和卒中发作之间没有明确的因果关系.因此,癫痫对IS发病机制的影响可能机制仍需进一步研究。
    UNASSIGNED: Although previous studies have reported a bidirectional relationship between ischemic stroke (IS) and epilepsy, the existence of a causal nexus and its directionality remains a topic of controversy.
    UNASSIGNED: The single nucleotide polymorphisms (SNPs) associated with IS were extracted from the Genome-Wide Association Study (GWAS) database. Pooled genetic data encompassing all epilepsy cases, as well as generalized and focal epilepsy subtypes, were acquired from the International League Against Epilepsy\'s GWAS study. In this study, the primary analysis approach utilized the inverse variance weighting (IVW) method as the main analytical technique. To enhance the robustness of the findings against potential pleiotropy, additional sensitivity analyses were conducted.
    UNASSIGNED: In the forward analysis, the IVW method demonstrated that IS was associated with an increased risk of all epilepsy (odds ratio (OR) = 1.127, 95 % confidence interval (CI) = 1.038-1.224, P = 0.004) and generalized epilepsy (IVW: OR = 1.340, 95 % CI = 1.162-1.546, P = 5.70 × 10-5). There was no substantial causal relationship observed between IS and focal epilepsy (P > 0.05). Furthermore, generalized epilepsy, focal epilepsy, and all epilepsy did not show a causal relationship with IS.
    UNASSIGNED: This Mendelian randomization (MR) analysis demonstrates that IS increases the risk of developing epilepsy, especially generalized epilepsy. Conversely, no clear causal association was found between epilepsy and the onset of stroke. Therefore, the possible mechanisms of the effect of epilepsy on the pathogenesis of IS still need to be further investigated.
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  • 文章类型: Journal Article
    癫痫的特点是反复发作,慢性,和无缘无故的癫痫发作。即使癫痫发作得到良好控制,癫痫也会对患者的生活质量产生显著的负面影响。除了癫痫发作引起的痛苦,癫痫(PwE)患者可能患有认知障碍,具有严重的社会后果,如人际关系不良,失业,减少社交网络。在PwE中观察到的病理变化和功能连接异常可以破坏负责心理理论的神经网络。心理理论是将精神状态归因于其他人(意图,信仰,和情感)。它是社会认知的一个复杂方面,包括认知和情感结构。近年来,许多研究评估了社会认知之间的关系,包括心理理论,在PwE,并建议在这一领域进行减值。针对心理理论的干预措施可能有助于提高PwE的生活质量。
    Epilepsy is characterized by recurrent, chronic, and unprovoked seizures. Epilepsy has a significant negative impact on a patient\'s quality of life even if seizures are well controlled. In addition to the distress caused by seizures, patients with epilepsy (PwE) may suffer from cognitive impairment with serious social consequences such as poor interpersonal relationships, loss of employment, and reduced social networks. Pathological changes and functional connectivity abnormalities observed in PwE can disrupt the neural network responsible for the theory of mind. Theory of mind is the ability to attribute mental states to other people (intentions, beliefs, and emotions). It is a complex aspect of social cognition and includes cognitive and affective constructs. In recent years, numerous studies have assessed the relationship between social cognition, including the theory of mind, in PwE, and suggested impairment in this domain. Interventions targeting the theory of mind can be potentially helpful in improving the quality of life of PwE.
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  • 文章类型: Journal Article
    丘脑的中央中央(CM)核是一系列脑疾病的有希望的目标,包括耐药的全身性和多灶性癫痫。CM与皮层和皮层下区域高度相连,包括额叶顶/感觉运动皮层,纹状体,脑干,还有小脑,涉及一些全身性癫痫综合征,如Lennox-Gastaut综合征(LGS)。在这个视频中,作者描述了他们针对CM进行深部脑刺激(DBS)的方法。最佳和一致的目标的划定将扩大CM在难治性癫痫中的神经调节功效。视频可以在这里找到:https://stream。cadmore.媒体/r10.3171/2024.4。FOCVID245。
    The centromedian (CM) nucleus of the thalamus is a promising target for a range of brain diseases including drug-resistant generalized and multifocal epilepsy. CM is highly connected to cortical and subcortical regions including frontoparietal/sensorimotor cortex, striatum, brainstem, and cerebellum, which are involved in some generalized epilepsy syndromes like Lennox-Gastaut syndrome (LGS). In this video, the authors describe their methodology for targeting CM for deep brain stimulation (DBS). Delineation of an optimal and consistent target will expand the efficacy of neuromodulation of CM in intractable epilepsy. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID245.
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  • 文章类型: Journal Article
    背景:癫痫是一种神经系统疾病,其特征是易感反复发作。它可以大致归类为病灶,广义的,未分类,它的发病未知。局灶性癫痫起源于并涉及局限于大脑一个区域的网络。广泛性癫痫参与范围更广,更分散的网络。癫痫的病因可以是结构性的,遗传,传染性,新陈代谢,免疫,或未知。许多全身性癫痫已推测为遗传病因。这项研究的目的是比较基因检测与脑MRI作为诊断工具的作用,以确定特发性(遗传)全身性癫痫(IGE)的根本原因。
    方法:我们评估了诊断为IGE的儿童中这两个类别的诊断率。使用TriNetX过滤的ICD10代码完成数据收集,以选择宾夕法尼亚州立大学儿童医院接受IGE诊断的982名儿童的个人电子病历(EMR)。在回顾每位患者的临床病史和脑电图(EEG)数据后确认了诊断。
    结果:从这个数据集中,收集神经影像学和基因检测结果。对982例癫痫患儿进行了回顾性图表回顾,其中143人(14.5%)符合IGE标准。只有18名患者接受了基因检测。在72.2%(13/18)的IGE和异常基因检测患者中发现了可能是癫痫的潜在原因的异常,与进行脑部MRI和基因检测的患者相比,这一比例为30%(37/123)。
    结论:这项研究表明,在确定儿童IGE患者的病因诊断方面,基因检测可能比神经影像学更有用。
    BACKGROUND: Epilepsy is a neurological disorder characterized by the predisposition for recurrent unprovoked seizures. It can broadly be classified as focal, generalized, unclassified, and unknown in its onset. Focal epilepsy originates in and involves networks localized to one region of the brain. Generalized epilepsy engages broader, more diffuse networks. The etiology of epilepsy can be structural, genetic, infectious, metabolic, immune, or unknown. Many generalized epilepsies have presumed genetic etiologies. The aim of this study is to compare the role of genetic testing to brain MRI as diagnostic tools for identifying the underlying causes of idiopathic (genetic) generalized epilepsy (IGE).
    METHODS:  We evaluated the diagnostic yield of these two categories in children diagnosed with IGE. Data collection was completed using ICD10 codes filtered by TriNetX to select 982 individual electronic medical records (EMRs) of children in the Penn State Children\'s Hospital who received a diagnosis of IGE. The diagnosis was confirmed after reviewing the clinical history and electroencephalogram (EEG) data for each patient.
    RESULTS: From this dataset, neuroimaging and genetic testing results were gathered. A retrospective chart review was done on 982 children with epilepsy, of which 143 (14.5%) met the criteria for IGE. Only 18 patients underwent genetic testing. Abnormalities that could be a potential cause for epilepsy were seen in 72.2% (13/18) of patients with IGE and abnormal genetic testing, compared to 30% (37/123) for patients who had a brain MRI with genetic testing.
    CONCLUSIONS: This study suggests that genetic testing may be more useful than neuroimaging for identifying an etiological diagnosis of pediatric patients with IGE.
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  • 文章类型: Systematic Review
    背景:似曾相识(DV),一个法语术语,意思是“已经见过,“指的是当下不适当的熟悉感,好像以前经历过,没有具体的回忆。传统上,DV与源自内侧颞叶的局灶性癫痫发作密切相关。然而,偶尔有特发性全身性癫痫(IGEs)发生DV的报道.我们研究的目的是评估IGE患者中DV的存在和频率。
    方法:我们在2000年1月至2022年7月期间使用了用于方案系统评价和Meta分析的首选报告项目(PRISMA-P),并检索了PubMed和Embase。
    结果:纳入了5项研究,共1177例IGE和1026例颞叶癫痫(TLE)患者。在IGE中DV的频率范围从0到11%,平均为3%,与TLE的19.6%相比。广义上,40%的IGE患者报告了某种类型的先兆。在研究中,未适当评估IGE中DV的EEG相关性。
    结论:临床医生应该意识到IGE患者可能会经历DV和其他类型的光环。认识到这些光环对于避免将IGE误诊为局灶性癫痫至关重要。这对于防止不必要的调查和不正确的治疗决定是重要的。
    BACKGROUND: Déjà vu (DV), a French term meaning \"already seen,\" refers to inappropriate sensation of familiarity in the present moment, as if it had been experienced before without a specific recollection of when or where. Traditionally, DV has been closely associated with focal seizures originating from the medial temporal lobe. However, there are occasional reports of DV occurring in idiopathic generalized epilepsies (IGEs). The objective of our study was to assess the presence and frequency of DV in individuals with IGE.
    METHODS: We used the Preferred Reporting Items for Systematic Review and Meta-Analysis for protocols (PRISMA-P) and searched PubMed and Embase from January 2000 to July 2022.
    RESULTS: 5 studies were included with a total of 1177 IGE and 1026 with temporal lobe epilepsy (TLE) patients. The frequency of DV in IGE ranged from 0 to 11 %, and the average was 3 %, compared to 19.6 % in TLE. Broadly, 40 % of patients with IGE reported some type of aura. EEG correlation of DV in IGE was not appropriately evaluated in the studies.
    CONCLUSIONS: Clinicians should be aware that individuals with IGE may experience DV and other types of auras. Recognizing these auras is crucial in order to avoid misdiagnosing IGE as focal epilepsy. This is important to prevent unnecessary investigations and incorrect treatment decisions.
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  • 文章类型: Journal Article
    癫痫是一组异质性的脑部疾病,抗癫痫药物(ASM)是治疗的主要手段。尽管有30多种药物,至少三分之一的癫痫患者是耐药的.这强调需要将功效与改善的耐受性相结合的新型化合物。
    关于药理学的文献综述,功效,耐受性,和阿泽卡纳的安全性(XEN1101),第二代神经元钾通道开放剂,目前处于ASM的第三阶段。
    2b期临床试验的结果有力地支持了Azetukalner作为一种新的ASM正在进行的临床开发。它的药代动力学特性支持方便的每日一次给药,消除了在开始时滴定或在治疗结束时逐渐减少的需要。CYP3A4是参与其代谢的主要酶,药物-药物相互作用可影响药物暴露。对正在进行的开放标签研究的初步分析显示,没有报道的色素异常。即将进行的3期临床试验预计将进一步了解疗效,耐受性,以及azetukalner治疗局灶性发作和原发性全身性强直阵挛性癫痫发作的安全性。在结构上与目前销售的ASM不同,经过监管部门批准,azetukalner有可能成为市场上唯一的同类Kv7.2/7.3开瓶器。
    UNASSIGNED: Epilepsies are a group of heterogeneous brain disorder, and antiseizure medications (ASMs) are the mainstay of treatment. Despite the availability of more than 30 drugs, at least one third of individuals with epilepsy are drug-resistant. This emphasizes the need for novel compounds that combine efficacy with improved tolerability.
    UNASSIGNED: A literature review on the pharmacology, efficacy, tolerability, and safety of azetukalner (XEN1101), a second-generation opener of neuronal potassium channels currently in Phase 3 development as ASM.
    UNASSIGNED: Results from the phase 2b clinical trial strongly support the ongoing clinical development of azetukalner as a new ASM. Its pharmacokinetic properties support convenient once-daily dosing, eliminating the need for titration at initiation or tapering at the conclusion of treatment. CYP3A4 is the main enzyme involved in its metabolism and drug-drug interactions can affect the drug exposure. Preliminary analysis of an ongoing open-label study reveals no reported pigmentary abnormalities. The upcoming Phase 3 clinical trials are expected to provide further insight into the efficacy, tolerability, and safety of azetukalner in treating focal-onset and primary generalized tonic-clonic seizures. Structurally distinct from currently marketed ASMs, azetukalner has the potential to be the only-in-class Kv7.2/7.3 opener on the market upon regulatory approval.
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  • 文章类型: Journal Article
    目的是使用增强深度成像光学相干断层扫描(EDI-OCT)评估癫痫患者和亚型的视网膜和脉络膜组织的结构改变。
    在研究中分析了46例癫痫患者和50例性别和年龄匹配的对照患者。记录患者的癫痫类型。黄斑中心厚度(CMT),视网膜神经纤维层(RNFL),神经节细胞层(GCL),和脉络膜厚度(CT)通过光谱OCT设备(SD-OCT)进行研究。Image-J程序用于计算脉络膜总面积(TCA),管腔面积(LA),基质面积(SA),和脉络膜血管指数(CVI)。
    CMT,TCA,洛杉矶,与健康对照组相比,癫痫患者的SA结局显著降低.CT、RNFL,GCL,CVI结果。部分性癫痫和全身性癫痫患者之间差异无统计学意义(p均>0.05)。
    根据我们的研究结果,癫痫疾病对眼睛的后段有影响。据我们所知,我们的研究首次评估癫痫患者和癫痫亚组的CVI.
    UNASSIGNED: The objective were to evaluate structural alterations in the retina and choroid tissue of epilepsy patients and subtypes using enhanced depth imaging optic coherence tomography (EDI-OCT).
    UNASSIGNED: 46 epilepsy patients and 50 sex- and age-matched control patients were analyzed in the study. Patients\' epilepsy types were recorded. The central macular thickness (CMT), retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and choroidal thickness (CT) were investigated through the Spectralis-OCT device (SD-OCT). Image-J program was used to calculate the total choroidal area (TCA), the luminal area (LA), stromal area (SA), and the choroidal vascularity index (CVI).
    UNASSIGNED: CMT, TCA, LA, and SA outcomes were substantially reduced in epilepsy patients than in healthy controls. There was no significant difference between CT, RNFL, GCL, CVI results. There were no statistically significant differences between patients with partial and generalized epilepsy (p>0.05 for each).
    UNASSIGNED: According to the results of our study, epilepsy disease has effects on the posterior segment of the eye. To the best of our knowledge, our study is the first to evaluate CVI in patients with epilepsy and the epilepsy subgroups.
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  • 文章类型: Journal Article
    目的:伴有局灶性符号学或局灶性发作间期脑电图(EEG)的双侧强直阵挛性癫痫发作可发生在局灶性和全身性癫痫类型中,导致诊断错误和不适当的治疗。我们调查了特发性全身性癫痫(IGE)患者局灶性特征的患病率和预后价值,我们提出了一个决策流程图来区分双侧强直阵挛性癫痫发作和局灶性脑电图或符号学患者的局灶性和全身性癫痫。
    方法:我们回顾性分析了60例患者的101例双侧强直阵挛性癫痫发作的视频脑电图记录(18例IGE,42患有局灶性癫痫)。≥1年随访后提取诊断和治疗反应。决策流程图基于先前的观察结果,并评估了发作间和发作间EEG之间的一致性。
    结果:在75%的癫痫发作和77.8%的患者中观察到IGE的局灶性符号学,最常见的对应于强制头版本(66.7%)。在多次癫痫发作的患者中,头部版本的方向在整个癫痫发作中是一致的。在61.1%的IGE患者中观察到局灶性发作间癫痫样放电(IED),而局灶性发作性脑电图发作仅发生在13%的癫痫发作和16.7%的患者中。然而,在癫痫发作的后期,在56%的癫痫发作中观察到7Hz侧向性发作性节律的可重复模式,与对侧头部版本相关。我们没有发现IGE患者局灶性特征的存在与治疗反应之间的相关性。我们的决策流程图区分了双侧强直阵挛性癫痫发作和局灶性特征的局灶性和全身性癫痫,准确率为96.6%。
    结论:与双侧强直阵挛性癫痫发作和局灶性IED相关的局灶性符号学是IGE患者的共同特征,但局灶性脑电图发作很少见。这些局灶性发现似乎都不影响治疗反应。通过评估发作间和发作间脑电图结果之间的一致性,可以准确区分局灶性和全身性癫痫。
    OBJECTIVE: Bilateral tonic-clonic seizures with focal semiology or focal interictal electroencephalography (EEG) can occur in both focal and generalized epilepsy types, leading to diagnostic errors and inappropriate therapy. We investigated the prevalence and prognostic values of focal features in patients with idiopathic generalized epilepsy (IGE), and we propose a decision flowchart to distinguish between focal and generalized epilepsy in patients with bilateral tonic-clonic seizures and focal EEG or semiology.
    METHODS: We retrospectively analyzed video-EEG recordings of 101 bilateral tonic-clonic seizures from 60 patients (18 with IGE, 42 with focal epilepsy). Diagnosis and therapeutic response were extracted after ≥1-year follow-up. The decision flowchart was based on previous observations and assessed concordance between interictal and ictal EEG.
    RESULTS: Focal semiology in IGE was observed in 75% of seizures and 77.8% of patients, most often corresponding to forced head version (66.7%). In patients with multiple seizures, direction of head version was consistent across seizures. Focal interictal epileptiform discharges (IEDs) were observed in 61.1% of patients with IGE, whereas focal ictal EEG onset only occurred in 13% of seizures and 16.7% of patients. However, later during the seizures, a reproducible pattern of 7-Hz lateralized ictal rhythm was observed in 56% of seizures, associated with contralateral head version. We did not find correlation between presence of focal features and therapeutic response in IGE patients. Our decision flowchart distinguished between focal and generalized epilepsy in patients with bilateral tonic-clonic seizures and focal features with an accuracy of 96.6%.
    CONCLUSIONS: Focal semiology associated with bilateral tonic-clonic seizures and focal IEDs are common features in patients with IGE, but focal ictal EEG onset is rare. None of these focal findings appears to influence therapeutic response. By assessing the concordance between interictal and ictal EEG findings, one can accurately distinguish between focal and generalized epilepsies.
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  • 文章类型: Journal Article
    背景:据报道,抗癫痫药对平衡功能有影响。该研究的目的是使用客观测试方法评估和比较丙戊酸和左乙拉西坦单药治疗对全身性癫痫患者平衡功能的影响。
    方法:本研究纳入43名18-60岁的全身性癫痫患者,包括20名接受丙戊酸单药治疗的患者,23例患者接受左乙拉西坦单药治疗,和25名健康个体作为对照,在土耳其东部一所大学医院的神经科诊所。填写人口统计学数据表,并进行视频头脉冲测试和前庭诱发肌电位测试。
    结果:在横向,后部,V-HIT检验中的前半规管增益和RALP和LARP不对称值(p<0.05)。C-VEMP检验中P1、N1潜伏期和不对称值与N1、P1潜伏期组间差异有统计学意义,振幅,和o-VEMP检验中的不对称值(p<0.05)。
    结论:丙戊酸和左乙拉西坦可能对前庭室和前庭收缩反射通路产生负面影响。在这个队列中,与左乙拉西坦相比,丙戊酸对平衡功能的不利影响更为明显。
    BACKGROUND: It is reported that antiepileptic drugs have an effect on balance functions. The aim of the study was to evaluate and compare the effects of valproic acid and levetiracetam monotherapy on balance functions in patients with generalized epilepsy using objective test methods.
    METHODS: The study included 43 generalized epilepsy patients aged 18-60 years, including 20 patients receiving valproic acid monotherapy, 23 patients receiving levetiracetam monotherapy, and 25 healthy individuals as controls, in the Neurology Clinic of a university hospital in eastern Turkey. The demographic data form was filled out and the Video Head Impulse Test and Vestibular Evoked Myogenic Potentials test were performed.
    RESULTS: Statistically significant differences were obtained between the groups in lateral, posterior, and anterior semicircular canal gains and RALP and LARP asymmetry values in the V-HIT test (p < 0.05). Statistically significant differences were obtained between the groups in P1, N1 latency and asymmetry values in the C-VEMP test and in N1, P1 latency, amplitude, and asymmetry values in the o-VEMP test (p < 0.05).
    CONCLUSIONS: Valproic acid and levetiracetam may affect the vestibulocular and vestibulocolic reflex pathways negatively. In this cohort, valproic acid had more pronounced adverse effects on balance functions as compared to levetiracetam.
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