Artificial intelligence (AI) has emerged as a powerful tool for improving the detection of high-frequency oscillations (HFOs) and automated seizure recognition in epilepsy. This narrative review synthesizes recent advances published between 2022 and 2025, focusing on AI-based methodologies applied to intracranial and scalp EEG recordings. The review highlights the transition from classical machine learning approaches toward deep learning architectures, including convolutional neural networks, recurrent neural networks, and Transformer-based models. In the context of HFO analysis, hybrid and attention-based frameworks demonstrate superior performance for distinguishing pathological from physiological oscillations and for localizing the epileptogenic zone, although challenges related to noise sensitivity, computational complexity, and cross-patient generalization persist. For seizure recognition, modern AI models enable improved spatiotemporal modeling and real-time monitoring, yet remain constrained by limited interpretability and the scarcity of large, expert-annotated datasets. Overall, this review underscores the clinical potential of AI-driven approaches while emphasizing the need for standardized datasets, explainable models, and prospective validation to support reliable integration into clinical neurophysiology.

This mini-review aims to summarize current evidence regarding folic acid supplementation for women with epilepsy (WWE). While periconceptional folic acid supplementation is recommended to reduce the risk of neural tube defects and has been associated with better neurodevelopmental outcomes in offspring exposed to antiseizure medications, recent studies have suggested a possible association between high-dose intake and an increased risk of maternal and childhood cancer. Although older guidelines commonly recommend high-dose supplementation, typically 5 mg/day, several recently updated epilepsy-specific guidelines recommend lower doses (0.4–0.8 mg/day or at least 0.4 mg/day), while recommendations remain heterogeneous across guidelines. In addition to dosage, the timing of supplementation is also critical, as neural tube closure occurs early in pregnancy, often before pregnancy is clinically recognized. This review highlights dosing and timing strategies, informed by recently updated guideline recommendations, to optimize both maternal and fetal outcomes.

Purpose: Depression and anxiety are common among people with epilepsy (PWE), yet structured psychiatric screening remains infrequent in routine epilepsy care in Japan. Measurement-based care (MBC) using patient-reported outcome measures may enhance early detection and clinical decision-making. However, routine psychiatric screening remains limited in Japanese epilepsy care. Implementing MBC may help bridge this mental health service gap. This study evaluated the feasibility and clinical utility of integrating brief self-administered psychiatric screening tools into a tertiary epilepsy outpatient clinic. Methods: A prospective observational study was conducted from April 2023 to March 2024. Fifty-one adult PWE completed the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Generalized Anxiety Disorder-7 (GAD-7), Epilepsy Self-Stigma Scale (ESSS), a subjective overall Quality of Life (QOL), and health degree, prior to routine consultations. Questionnaire completion rates, prevalence of depressive symptoms (NDDI-E > 16), and longitudinal changes at a nine-month follow-up were analyzed. Statistical analyses included t-tests, chi-square tests, correlation analyses, and repeated measures ANOVA. Results: Questionnaire completion was high across visits (baseline: 100%; nine months: 80%). Depressive symptoms were present in 49% of the participants. Those with depressive symptoms showed significantly lower QOL and health degree, with strong correlations between depression and anxiety (all p < 0.001). Repeated measures analyses revealed a significant improvement in subjective health over time (p = 0.031). Changes in depressive symptom trajectories did not differ clearly by antidepressant use, possibly reflecting limited statistical power. Conclusion: This study provides preliminary evidence supporting the feasibility and clinical utility of MBC focused on psychiatric symptoms in Japanese epilepsy outpatient care. Routine screening using brief patient-reported measures may enhance detection and monitoring of mental health concerns in PWE and contribute to more integrated and interdisciplinary epilepsy care.

Purpose : Patients with childhood-onset epilepsy frequently present psychiatric comorbidities, which can become a barrier when transferring the patient from pediatric to adult care. Moreover, the clinical characteristics of these patients and approaches to managing their psychiatric symptoms after transfer remain insufficiently described. This case series aims to clarify the clinical characteristics and course of patients with childhood-onset epilepsy, who were referred to adult psychiatrists with expertise in epilepsy during their transfer to adult care.

Methods : We retrospectively reviewed patients with childhood-onset epilepsy who were transferred from pediatric services to adult psychiatrists. Clinical, psychiatric, seizure, and treatment data were extracted. Descriptive statistics were used to summarize patient characteristics.

Results : Among the 37 patients included in the review, 49% were diagnosed with comorbid mental disorders and 62% exhibited psychiatric symptoms. Twelve patients required psychiatrist-led pharmacological management for psychiatric symptoms. Psychiatric manifestations included psychosis, irritability, agitation, and depression. During follow-up, medication regimens were reviewed or modified as part of comprehensive clinical management, including the adjustment of antiseizure and psychotropic medications.

Discussion: Psychiatric profiles observed during the transfer period frequently included neurodevelopment-related features, necessitating comprehensive clinical reassessment. This study highlights the potential contribution of psychiatrists with expertise in epilepsy in addressing these clinical challenges, although broader systemic and organizational changes will be necessary to improve psychiatric care during the transition from pediatric to adult services.

Purpose: We used the Epi Passport to support collaboration between epilepsy specialists and community clinics. This study compares occupational status at the time of Epi Passport introduction and the most recent follow-up among patients with epilepsy who had achieved seizure control or treatment goals. Methods: During the period of December 2014 to November 2022, 1,154 patients were issued with an Epi Passport. Of these patients, we included those who had at least one follow-up visit through the Epi Passport and were followed for ≥6 months. Patients who were lost during follow-up, not successfully introduced to Epi Net, transferred to another epilepsy center, or students at the time of introduction were excluded from the study. Occupations were compared using ISCO-08, an ordinal classification, in which lower codes indicate occupations requiring higher skill levels. Results: 515 patients met the study criteria. Among 514 participants with valid occupational codes at all three time points, the paired distribution of ISCO-08 codes shifted toward occupations requiring higher skill levels, from a median of 9 (IQR 5–10) at introduction to 9 (IQR 4–10) after introduction (P < 0.001). No significant change was observed between the initial consultation and introduction (P = 0.360). In paired analyses of 514 participants, caregivers decreased from 1.02 to 0.44 (P < 0.001), and median travel distance decreased from 10.5 to 3.8 km (P < 0.001). Discussion: Epi Passport-based collaborative care was associated with a shift to more skilled occupations, reduced caregiver support, and shorter travel distances. These findings may reflect reduced time and distance burdens and greater daily independence, although controlled studies are needed to establish causality.

A 51-year-old woman developed focal to bilateral tonic-clonic seizures, 5 years after trapping of a giant right internal carotid artery aneurysm, following placement of a high-flow cervical external carotid artery-to-middle cerebral artery bypass using a radial artery graft. Peri-ictal magnetic resonance imaging (MRI), including arterial spin labeling (ASL) perfusion imaging, revealed prominent hyperperfusion supplied through the bypass, with a close anatomical relationship to a postoperative infarction in the right frontal lobe. Electroencephalography (EEG) performed 2 hours later revealed periodic discharges of approximately 1.2 Hz in the right frontal region. To our knowledge, peri-ictal hyperperfusion supplied by bypass has not been previously documented using ASL. Although this is a single case report, further use of peri-ictal MRI, including ASL, in addition to EEG in neurological emergency settings, will help elucidate the pathogenesis of epilepsy after bypass surgery.

Subcortical band heterotopia (SBH) represents a neuronal migration disorder most commonly associated with doublecortin (DCX) mutations. In this study, we report the case of a 5-year-old female patient with infantile epileptic spasms syndrome caused by the somatic mosaicism of a DCX variant. The patient developed epileptic spasms at the age of 5 months, and her electroencephalography indicated modified hypsarrhythmia. Initial magnetic resonance imaging (MRI) was interpreted as normal. ACTH therapy rapidly controlled the seizures, and the patient remained seizure-free with preserved development. However, repeated MRI at the age of 4 years and 4 months revealed bilateral SBH. Genetic testing identified a somatic mosaic DCX variant (NM_017815.3:c.668G>A, p.(Gly223Glu)). Retrospective review of the initial MRI demonstrated subtle occipital abnormalities. Repeated MRI after myelination should be considered in patients with infantile epileptic spasms syndrome, even when initial MRI findings are interpreted as normal.

Seizures trigger rapid microglial responses in the hippocampus, but the accompanying organelle-level changes remain poorly understood. Since mitochondria regulate cellular metabolism and stress signaling, we examined whether kainic acid (KA)-induced seizures alter mitochondrial volume and subcellular localization in hippocampal microglia. Microglial mitochondria were labeled in Cx3cr1-CreERT2;Rosa26-LSL-mitoGFP mice by tamoxifen administration. Twenty-four hours after KA injection, microglia in the dentate hilus, a region within the dentate gyrus relevant to seizure pathology, were analyzed by confocal microscopy and three-dimensional reconstruction. Compared with control mice, KA-treated mice showed increased total mitochondrial volume in dentate hilar microglia without a significant change in microglial volume. This increase was evident in the cell body and nucleus-contacting mitochondrial compartments, whereas process-associated mitochondrial volume was not significantly changed. These findings indicate that KA-induced seizures are accompanied by increased mitochondrial volume in dentate hilar microglia.