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Objectives We hypothesized that the frequency (in Hertz) of generalized spike–waves (GSWs) in patients with idiopathic generalized epilepsy (IGE) has associations with the syndromic diagnosis as well as with the prognosis of patients (their response to medical treatment). Methods This was a retrospective study of a prospectively developed database. All patients with a diagnosis of IGE were studied at the epilepsy center at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2022. Patients were classified into four IGE syndromes: childhood absence epilepsy; juvenile absence epilepsy; juvenile myoclonic epilepsy; and generalized tonic–clonic seizures alone. Results Five hundred and eighty‐three patients were studied. GSWs were commonly observed in all four syndromes of IGE. Frequency of GSW (in Hertz) did not have a significant association with the syndromic diagnosis of the patients (p = .179). The presence of GSW did not have a significant association with the seizure outcome (becoming seizure free or not) of the patients (p = .416). Frequency of GSW did not have a significant association with the seizure outcome of the patients either (p = .574). Conclusion GSWs are the hallmark electroencephalographic footprints of idiopathic generalized epilepsies; however, neither their presence nor their frequency has practical associations with the syndromic diagnosis of IGEs or their outcome (response to treatment).

The purpose of the current endeavor was to evaluate the feasibility of using easily accessible and applicable clinical information (based on history taking and physical examination) in order to make a reliable differentiation between idiopathic generalized epilepsy (IGE) versus focal epilepsy using machine learning (ML) methods. The first phase of the study was a retrospective study of a prospectively developed and maintained database. All patients with an electro-clinical diagnosis of IGE or focal epilepsy, at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2022, were included. The first author selected a set of clinical features. Using the stratified random portioning method, the dataset was divided into the train (70%) and test (30%) subsets. Different types of classifiers were assessed and the final classification was made based on their best results using the stacking method. A total number of 1445 patients were studied; 964 with focal epilepsy and 481 with IGE. The stacking classifier led to better results than the base classifiers in general. This algorithm has the following characteristics: precision: 0.81, sensitivity: 0.81, and specificity: 0.77. We developed a pragmatic algorithm aimed at facilitating epilepsy classification for individuals whose epilepsy begins at age 10 years and older. Also, in order to enable and facilitate future external validation studies by other peers and professionals, the developed and trained ML model was implemented and published via an online web-based application that is freely available at http://www.epiclass.ir/f-ige.

Purpose We investigated the rate of employment in patients with functional seizures (FS) in a follow‐up study. We also investigated the rate of receiving disability benefits in these patients. Finally, we investigated factors that are potentially associated with their employment status. Methods In this long‐term study, all patients with FS, who were diagnosed at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 to 2018, were investigated. In a phone call interview to the patients in February 2020, we tried to obtain the following information: seizure outcome, employment status, receiving disability benefits, and their current drug regimen, if any. The first call was made in the evening and after working hours. In case of no response, we made two more attempts in the following weeks to contact the patients during different time periods of the day. Results Eighty‐ four patients participated. Thirty‐one patients (37%) were employed, and 53 people (63%) were not; at the first visit, the rate of employment was 23%. Female sex (Odds Ratio [OR]: 12.18; 95% Confidence Interval [CI]: 3.51–42.18; p = .0001), taking psychiatric drugs (OR: 4.93; 95% CI: 1.17–20.73; p = .02), and being employed previously (OR: 0.19; 95% CI: 0.04–0.77; p = .02) were independently significantly associated with the current employment status. Three patients (4%) reported receiving disability social benefits, two women and one man. Conclusion This study highlights that unemployment is a serious issue in patients with FS and psychiatric comorbidities play a significant role in the employment status in these patients. We investigated the rate of employment in patients with functional seizures (FS) in a follow‐up study. We also investigated the rate of receiving disability benefits in these patients. Finally, we investigated factors that are potentially associated with their employment status.

PurposeTo find out what is known from literature about Long COVID until January 30, 2021.MethodsWe undertook a four-step search with no language restriction. A preliminary search was made to identify the keywords. A search strategy of all electronic databases resulted in 66 eligible studies. A forward and backward search of the references and citations resulted in additional 54 publications. Non-English language articles were translated using Google Translate. We conducted our scoping review based on the PRISMA-ScR Checklist.ResultsOf 120 papers, we found only one randomized clinical trial. Of the 67 original studies, 22 were cohort, and 28 were cross-sectional studies. Of the total 120 publications, 49.1% focused on signs and symptoms, 23.3% on management, and 10.8% on pathophysiology. Ten publications focused on imaging studies. The results are also presented extensively in a narrative synthesis in separated sections (nomenclature, diagnosis, pathophysiology, risk factors, signs/symptoms, management).ConclusionsThe controversies in its definition have impaired proper recognition and management. The predominant symptoms were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness.

Objective The glymphatic system is a critical brain waste‐clearance mechanism that facilitates the removal of metabolic byproducts and maintains neural homeostasis. Its dysfunction has been implicated in various neurological disorders; however, its role in functional (psychogenic nonepileptic) seizures (FS/PNES), a functional neurological condition, remains unexplored. This study aimed to indirectly evaluate glymphatic system function using the along the perivascular space (ALPS) index derived from diffusion tensor imaging (DTI) in patients with FS/PNES compared to healthy controls (HCs). Methods Twenty‐one patients with PNES and 21 HCs underwent DTI scans. Glymphatic system function was assessed using the DTI‐ALPS method. The DTI‐ALPS index was calculated and analyzed for differences between the groups. Correlations with clinical and cognitive measures, including the Addenbrooke's Cognitive Examination (ACE‐III), were investigated. Results Patients with FS/PNES demonstrated significantly lower DTI‐ALPS indices compared to those in HCs in the left hemisphere (1.306 ± 0.171 vs. 1.502 ± 0.224, p = 0.005) and the bilateral hemispheric average (1.262 ± 0.174 vs. 1.415 ± 0.195, p = 0.014). No significant correlations were found between the DTI‐ALPS index and clinical, demographic, or cognitive assessments. Significance This study identified alterations in the DTI‐ALPS index in patients with FS/PNES, particularly in the left hemisphere. This finding indirectly suggests disrupted perivascular fluid dynamics in FS/PNES and highlights the need for further research to elucidate the neurobiological underpinnings of FS/PNES with particular attention to the potential role of the glymphatic system in functional neurological disorders. Plain Language Summary The brain has a cleanup system called the glymphatic system, which removes waste to keep it functioning well. In this study, we examined whether this system works differently in people with functional seizures—seizures not caused by epilepsy. We compared brain scans from individuals with functional seizures and healthy controls. The results showed reduced activity in the glymphatic system, especially on the brain's left side, in those with functional seizures. This suggests that their brains may not clear waste as efficiently. Although this finding may point to brain differences in functional seizures, further research is needed to understand the connection.

Objective We investigated the associations between FKBP5 single‐nucleotide polymorphisms (SNPs) and functional seizures (FS). Methods Seventy patients with FS, 140 with major depressive disorder (MDD), and 140 healthy controls were studied. Their DNAs were analyzed for the rs1360780 in the 3′ region and rs9470080 in the 5′ region of the FKBP5. Childhood trauma questionnaire and hospital anxiety and depression scale were used. Results Patients with FS and those with MDD had less GG and more AA genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. Similar results were observed for allelic frequencies. There were no significant differences between FS and MDD groups in terms of genotype and allelic frequencies for both SNPs. The results of multinomial logistic regression analysis showed that FKBP5 polymorphisms were not associated with the diagnosis. Significance Patients with FS and those with MDD had significantly different genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. However, it seems that FKBP5 polymorphisms were not associated with FS in the absence of depression. Further genetic investigations of patients with FS may increase our understanding of the neurobiological underpinnings of this condition, but such studies should be large enough and very well designed; they should include a comparison group with depression in addition to a healthy control group.

Antiseizure medications (ASMs) constitute the principal of treatment for patients with epilepsy, where long‐term treatment is usually necessary. The purpose of this systematic review is to provide practical and useful information regarding various aspects of the interactions between ASMs and foods and drinks. MEDLINE and ScienceDirect, from the inception to July 15, 2023, were searched for related publications. In both electronic databases, the following search strategy was applied, and the following keywords were used (in title/): “food OR drink” AND “antiepileptic OR antiseizure.” The primary search yielded 738 studies. After implementing our inclusion and exclusion criteria, we could identify 19 studies on the issue of interest for our endeavor. Four studies were identified in the recheck process and not by the primary search. All studies provided low level of evidence. Interactions between foods and ASMs are a common phenomenon. Many factors may play a role for such an interaction to come to play; these include drug properties, administration route, and administration schedule, among others. Drugs‐foods (‐drinks) interactions may change the drug exposure or plasma levels of drugs (e.g., grapefruit juice increases carbamazepine concentrations and the bioavailability of cannabidiol is increased 4–5 folds with concomitant intake of fat‐rich food); this may require dosage adjustments. Interactions between ASMs and foods and drinks may be important. This should be taken seriously into consideration when consulting patients and their caregivers about ASMs. Future well‐designed investigations should explore the specific interactions between foods (and drinks) and ASMs to clarify whether they are clinically important. Plain Language Summary Interactions between antiseizure medications and foods and drinks may be important. This should be taken into consideration in patients with epilepsy.

We investigated the association between the glucocorticoid receptor (GR) gene, also known as the nuclear receptor subfamily 3, group C, member 1 (NR3C1), rs41423247 polymorphism, and functional seizures (psychogenic nonepileptic seizures/attacks) in a case-control study. We hypothesized that the tested polymorphism has significant associations with functional seizures (psychogenic nonepileptic seizures/attacks) independent from comorbid depression. Seventy patients with functional seizures (psychogenic nonepileptic seizures/attacks), 70 with major depressive disorder (MDD), and 70 healthy controls (HCs) were studied. Their DNAs were analyzed for NR3C1 rs41423247 polymorphism. Genotype and allele frequencies of rs41423247 were different between the three groups. G allele carriers were more frequent in patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD compared to HCs (p = 0.0001). However no significant difference was observed with respect to allele distributions between functional seizures (psychogenic nonepileptic seizures/attacks) and MDD groups (p = 0.391). CC genotype was less often associated with functional seizures (psychogenic nonepileptic seizures/attacks) versus HC: Codominant model; p = 0.001, OR = 0.11, 95% CI = 0.05-0.24, and -2loglilkelihood = 231.7. In comparison between functional seizures (psychogenic nonepileptic seizures/attacks) group and other (MDD + HC) groups, we observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks) (Codominant model; p = 0.001, OR = 5.63, 95% CI = 2.60-12.40 and -2loglikelihood = 245.99). Patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD were significantly more often G allele carriers in rs41423247 compared with HCs. We observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks). However, we could not exclude the possibility of confounding effects of depression. Future genetic studies of patients with functional seizures (psychogenic nonepileptic seizures/attacks) should include a comparison group with depression in addition to a comparison group of HCs.