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Psychiatric symptoms predict drug-resistant epilepsy in newly treated patients.

In 2005 the ILAE defined epilepsy as “a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures, and by the neurobiologic, cognitive, psychological, and social consequences of this condition” (1). While not fully recognising epilepsy as a complex neurobiological disorder of the brain in which the development of seizures is often preceded by cognitive, psychological or psychiatric symptoms (2), this definition of epilepsy did embrace the most important non-seizure sequelae of epilepsy which, at least for those individuals whose epileptic seizures cannot be stopped completely with treatment, have greater effects on health-related quality of life than seizure frequency or severity itself (3).

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Neural antibodies in temporal lobe epilepsy

We are all aware of the important and life-changing limbic encephalitides that present with paraneoplastic and non-paraneoplastic antibodies. How to transport this information in to the clinic room with less severe epilepsies is a challenge – and one that is helped with clear clinical data. 163 people with temporal lobe epilepsy were studied and 5% (n=8) had significant levels of serum antibodies – namely to CASPR2, GAD, LGI1, and GABABR. Four cases also showed CSF antibody positivity (anti-GAD in 3). Seropositive patients were older when their epilepsy started, were more likely to have other autoimmune conditions, and 3/6 responded to immunotherapy (seizure reduction >50%). Seropositive cases are in your clinic and are undetectable unless you test.

Please see the article: The prevalence of neural antibodies in temporal lobe epilepsy and the clinical characteristics of seropositive patients

The causes of status epilepticus in children

Status epilepticus is a paradigm-breaker as you treat first and investigate later. So what is the cause of status epilepticus in children? 236 children were studied (median age 2years). For 60% status was their first presentation with a seizure. 46% had a defined electroclinical syndromes, 27% an acute symptomatic cause and 10% were unknown. The remainder were progressive encephalopathy (10%) or a remote symptomatic cause in 8%. Status epilepticus recurred in 17%. The children’s outcome was mainly driven by the aetiology – underlining the importance of a thorough investigation.

Please see the article: New-onset seizure presenting as status epilepticus: Etiology and clinical characteristics in a cohort of 236 children

Psychiatrists treating people with epilepsy: The state of play in the UK

Careful analysis of data, even from a single centre can help answer questions that would never be addressed in a trial; do all children with brain tumours need anti-epileptsy drugs?
22.5% of people with an intellectual disability (ID) have epilepsy and the Royal college of Psychiatrists in the UK have published recent guidelines to clarify the role of an ID psychiatrist’s role. Despite the ID Psychiatrists expressing an interest in epilepsy – minimum standards for the treatment of people with epilepsy are not met. 141 responses to an e-questionnaire (from a pool of 332) were received. Under two thirds had heard of SANAD, the NASH audit, or the new ILAE classification. 41% felt confident managing people with epilepsy. The enthusiasm is there, but there is clearly a knowledge and skills gap that needs to be bridged.

Please see the article: Awareness, attitudes, skills and training needs of psychiatrists working with adults with intellectual disability in managing epilepsy

Cover acknowledgement Volume 91:

Oscar Alberto Morales García is the vice principal of the Ernestina García Viuda de Recinos National Hospital where he works and is currently in charge of patients isolated because of Covid-19.
Oscar has been reading and writing since he was 4 years old and at 16 he was already a Teacher of Urban Primary Education. At that age, he entered the Faculty of Medicine of the University of San Carlos de Guatemala, where he obtained the title of Physician and Surgeon. He then completed his training in Internal Medicine and Adult Neurology at the Hospital General San Juan de Dios, one of the most prestigious hospitals in Guatemala.
He is self-taught in many sciences and is currently in the middle of the Legal and Social Sciences career. He also supports his patients in rehabilitation, for which he was forced to start studies in visual rehabilitation during the pandemic.
Oscar's father was a very prominent and dedicated pediatrician in Jutiapa. Oscar followed in his father’s altruistic footsteps and started a Neurological Care Clinic at the Ernestina García Viuda de Recinos National Hospital in 2011, when he was still a first-year Neurology resident. Currently this clinic follows approximately 2000 patients with epilepsy. He likes travelling, coffee, theatre, poetry, music from around the world and the beach.
He describes his painting "psychogenic nonepileptic seizure", pained at LASSE in 2020: "… tired and crestfallen, I could not avoid to feel, that his body was chained to a dark brain. I do not understand why it denies the brightness of the light..".


Seizure - European Journal of Epilepsy

Cover Image - Seizure - European Journal of Epilepsy, Volume 106, Issue undefined

Seizure - European Journal of Epilepsy is an international journal owned by Epilepsy Action (the largest member led epilepsy organisation in the UK). It provides a forum for papers on all topics related to epilepsy and seizure disorders.

Seizure focuses especially on clinical and psychosocial aspects, but will publish papers on the basic sciences related to the condition itself, the differential diagnosis, natural history and epidemiology of seizures, as well as the investigation and practical management of seizure disorders (including drug treatment, neurosurgery and non-medical or behavioural treatments).

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