Greater postictal severity, particularly concerning anxiety and depression, is associated with interictal psychiatric comorbidity, while altered temporal experience emerges as a distinct dimension of postictal dysfunction.
Abstract
Objective
The postictal state is a major yet underrecognized component of the epilepsy burden. We aimed to develop a structured patient-reported instrument to quantify postictal recovery, characterize its multidimensional burden, and identify demographic, clinical, psychiatric, and treatment-related factors associated with postictal severity and duration.
Methods
We conducted a prospective, single-center observational cohort study (Timone Hospital, Marseille, February 2025-March 2026). Consecutive patients aged ≥15 years admitted for scalp or stereo-EEG video-monitoring were included. Patients completed the Postictal Recovery Scale (PRS), an 11-domain questionnaire assessing fatigue, mood, sensory, motor, language, orientation, time perception, and postictal amnesia. Items were rated from 0 (severe impairment) to 3 (no symptoms), yielding a total score of 0-33. Internal consistency was assessed using Cronbach's alpha. Associations between PRS scores, subjective postictal duration and covariates were analyzed using group comparisons, correlations, and regression models.
Results
Of 107 enrolled patients, 96 were included. PRS showed good internal consistency (Cronbach's α = 0.79). 96% of patients reported experiencing postictal symptoms, with fatigue (80%) and postictal amnesia (79%) being the most frequent and severe manifestations. Recovery exceeded 1 h in 21% of patients. Greater postictal impairment was associated with higher interictal anxiety (Spearman ρ = -0.32, p = 0.0018) and depressive symptoms (Spearman ρ = -0.40, p = 0.0001), whereas demographic, epilepsy-related, and treatment variables showed no significant associations. Altered postictal time perception was reported by 40% of patients and was associated with disorientation, but not postictal psychiatric symptoms. Subjective postictal duration was longer than subjective ictal duration (Wilcoxon test, p < 0.0001).
Significance
The postictal state is a frequent and multidimensional patient-reported experience. Greater postictal severity, particularly concerning anxiety and depression, is associated with interictal psychiatric comorbidity, while altered temporal experience emerges as a distinct dimension of postictal dysfunction. These findings support integrating postictal measures into clinical practice and trials.
Improvements in group-level performance improved in six of the twenty tests administered, of which three remained significant after correction for multiple comparisons, while 28 of 42 patients (66.7%) still scored in the impaired range on at least one test at 12 months, and 17 (40.5%) on two or more.
Giulia Del Duca, M. Camici, Isabella Sperduti et al.· Neurology International· 0 citations
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
Objective.
To study the dynamics of changes in cognitive status in combination with spectroscopy data in patients with the post-COVID-19 condition.
Materials and methods.
Study design: prospective, cohort, completed; study period: 2024-2025. 28 patients (10 men and 18 women; median age – 48 [47,5; 55,5] years old) with clinical manifestations of the condition after COVID-19 were examined. A control group consisted of 12 healthy individuals (median age – 43 [36;48] years old, 7 women and 5 men). All subjects filled a checklist of post-COVID-19 conditions twice (with inclusion in the study and 6-9 months later), the Mini-Mental State Examination (MMSE), the A.M. Veyn autonomic questionnaire, and the Spielberger-Khanin questionnaire. To objectify the disorders, all the examined subjects underwent two magnetic resonance brain tomography (MRI) scans in a 3D pulse sequence with a slice thickness of 1 mm and a square matrix in various scanning planes, as well as multivoxel spectroscopy. A mathematical analysis was performed using the STATISTICA 10.0 software package. The images were generated using RStudio 2026.01.1.
Results.
In patients with the condition after COVID-19, no improvement in functional status was detected upon repeated examination according to the data of filling out the checklist (9 [6;12] points and 9 [6;12] points, p=0.98) MMSE (28 [26.5; 29] points and 28 [27; 29] points, p=0.24), the A.M.Wein questionnaire (33 [27.5; 52] points and repeated 33.5 [22.5; 51] points, p=0.84), personal (40 [37;44] and repeated 45 [41;45], p=1.0) and reactive anxiety (50 [47;53] and again 49 [47;58], p=0.72). Distribution of patients by severity subgroups revealed a deterioration in subjective neurological status (χ2=11.1759, df=4, p=0,24662). The data from MRI spectroscopy did not reveal any significant dynamics in the indicators, while the inter-zone differences were smoothed out based on the analysis of the N-acetylaspartate/creatinine ratio in the anterior regions of the precentral gyrus on the left (p=0.93) and right (p=0.63), and the choline/creatinine ratio in the anterior regions of the cingulate gyrus on the right (p=0.138).
Conclusion.
In patients with post-COVID-19 conditions during dynamic observation an aggravation of the subjective neurological status in the absence of positive dynamics of cognitive and vegetative status indicators and data from brain MRI spectroscopy was revealed.
A. Barbarovich· Health and Ecology Issues· 0 citations
PURPOSE
To evaluate clinical determinants of refractoriness and outcome in status epilepticus (SE) in a prospective low- and middle-income country (LMIC) cohort.
METHODS
In this single-centre prospective cohort study, 97 consecutive SE patients were classified as non-refractory status (NRSE, n = 50), refractory (RSE, n = 31), or super-refractory SE (SRSE, n = 16). A single 21 channel video-EEG was done within 24 h of presentation to the hospital. Clinical context, preexisting epilepsy history, etiology, Status Epilepticus Severity Score (STESS) and EEG findings were recorded, and outcome was assessed through in-hospital mortality.
RESULTS
The median age of our cohort was 32 years; most common etiologies were remote symptomatic (68%), acute symptomatic (19%) and progressive symptomatic (5%). Patients with drug-sensitive epilepsy (DSE) showed low refractoriness and mortality (29%, 6%), whereas drug-resistant epilepsy and new-onset status epilepticus (NOSE) were more likely to be refractory (68% and 70% respectively) and had higher mortality (26% and 30% respectively). Overall mortality was 16.5%, increasing stepwise from 4% (NRSE) to 13% (RSE) to 63% (SRSE; p < 0.001). STESS discriminated between non-survivors and survivors (median 3 vs 0; p < 0.001). Among 85 patients with available EEG, periodic discharges (PDs) were associated with 71% mortality (p < 0.001).
CONCLUSION
Status Epilepticus in the setting of DSE carries a favourable prognosis, while DRE and NOSE confer refractoriness. A short-term early EEG performed in the first 24 h is associated with refractoriness and its exact role warrants further studies.
S. Lodha, Babu Rao Challepalle, Shubho Acharya et al.· Epilepsy & Behavior· 0 citations
Introduction: Non-motor symptoms (NMS) are increasingly recognized to have disabling impact on the quality of life of idiopathic Parkinson’s disease (PD) patients, comparable to motor symptoms. However, their relationship with clinical and demographic factors remains obscure in local populations. Purpose: To determine the prevalence of NMS in idiopathic PD and evaluate their correlation with clinical variables, including disease duration, Hoehn & Yahr (H&Y) stage, and PD subtype. Methods: This cross-sectional study consecutively included idiopathic PD subjects evaluated between July-October 2025. Data collected included age, gender, age at onset, disease duration, H&Y stage, and PD subtype. NMS were assessed using the Indonesian version of Non-Motor Symptoms Questionnaire (NMS-Q). Correlation and multiple linear regression analyses performed. Results: Fifty-three subjects were included (mean age 66.9±10.5 years; 50.9% male). Median disease duration was 5 years (IQR 1–7.5), with majority in H&Y stage 2 (49%). Mean total NMS-Q score was 10.7±5.2. The most frequent NMS was urinary urgency (66%), with urinary domain being the most affected (64.2%). Total NMS-Q scores correlated with H&Y stage (r=0.427, p=0.001) and disease duration (r=0.309, p=0.025). Only H&Y stage independently predicted total NMS-Q scores (B=2.657, p=0.010). Conclusion: This study provides additional evidence from an Indonesian population using a standardized assessment tool, demonstrating that disease severity is an independent predictor of NMS burden, thus highlighting the importance of early and systematic evaluation of NMS in idiopathic PD.
The findings highlight the significance of the lateralization of the epileptic focus in the development of affective psychopathological symptoms, as well as the interplay between depressive and anxiety syndromes in patients with TLE.
V. Kalinin, A. Zemlyanaya, E. A. Fedorenko et al.· Zhurnal Nevrologii i Psikhia...· 0 citations
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