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Daily Medical Update
Seizures
Tuesday, July 21, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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Seizure (2026) - Network Meta-Analysis
Key Findings
- All evaluated add-on antiseizure medications significantly increased responder rates compared with placebo for focal epilepsy.
- Cenobamate had the greatest likelihood of seizure freedom, with 100% responder rates increased at 400 mg/day and 200 mg/day versus placebo.
📋 Practice Implication: For adolescents and adults with focal epilepsy needing adjunctive therapy, cenobamate deserves prominent consideration when seizure freedom is the primary goal and tolerability is acceptable.
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Neurology (2025) - Practice Guideline
Key Findings
- Psychological interventions increased the likelihood of functional seizure freedom and decreased functional seizure frequency.
- Psychological interventions also decreased anxiety and improved health-related quality of life and psychosocial functioning.
📋 Practice Implication: Patients diagnosed with functional seizures should receive a clear diagnostic explanation, screening for co-occurring epilepsy or psychiatric disease, and referral for evidence-supported psychological treatment rather than unnecessary antiseizure medication.
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Journal of neurology, neurosurgery, and psychiatry (2026) - Meta-Analysis
Key Findings
- Across 5588 patients, surgical success varied by anatomy, with temporal lobe surgery achieving 68.6% seizure freedom and insular surgery 66.2%.
- Tumor pathology had the highest seizure-freedom rate at 78.2%, while corpus callosotomy had the lowest success rate at 43.4%.
📋 Practice Implication: Referral discussions for drug-resistant epilepsy should use lesion type, lobar target, and planned procedure to give patients more realistic expectations about seizure freedom.
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Neurocritical care (2026) - Practice Guideline
Key Findings
- RCT meta-analysis found early seizures were reduced with prophylactic antiseizure medication, but late seizures and mortality were not improved.
- Levetiracetam reduced early seizure rates compared with phenytoin/fosphenytoin, with trends toward fewer late seizures and adverse events.
📋 Practice Implication: For seizure-naive adults after supratentorial neurosurgery, prophylaxis should be individualized; when used, levetiracetam for no more than 7 days aligns best with the guideline evidence.
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PloS one (2026) - Systematic Review
Key Findings
- In children with drug-resistant epilepsy, 37% may achieve at least a 50% seizure-frequency reduction with ketogenic diet therapy.
- In adolescents and adults, ketogenic diet therapy may increase the number achieving at least a 50% seizure-frequency reduction by 16 per 100 compared with usual care.
📋 Practice Implication: Ketogenic diet therapy remains a reasonable adjunct for drug-resistant epilepsy, but counseling should include adherence barriers and the limited certainty around quality-of-life and cognitive outcomes.
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Summary
Recent seizure literature emphasizes practical treatment selection across focal epilepsy, functional seizures, neurosurgical prophylaxis, drug-resistant epilepsy, and surgical referral. The strongest evidence supports individualized adjunctive ASM choice, structured functional seizure care, selective short-duration prophylaxis after supratentorial neurosurgery, and earlier use of nonpharmacologic or surgical options when drug resistance is established.
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