Background and Objectives Antiseizure medications (ASMs) are often taken long term by patients with epilepsy yet may be associated with differing metabolic and cardiovascular risks, including hyperlipidemia and weight changes. This systematic review and meta-analysis evaluated the effects of individual ASMs on lipid profiles and weight changes in patients with epilepsy. This paper also provides detailed insights into safety profiles across different patient subgroups and the impact of treatment duration, which was previously underrepresented in individual studies that showed conflicting results. Methods PubMed, Scopus, and Cochrane Central databases were searched from inception until June 2024 for studies reporting lipid derangements after ≥ 3 months of ASM monotherapy in patients with epilepsy in comparison with healthy controls. Primary outcomes were total cholesterol (TC) and low-density lipoprotein cholesterol (LDL) levels. Secondary endpoints were high-density lipoprotein cholesterol, triglycerides, and body mass index (BMI). Mean difference (MD) and standardized mean difference (SMD) were computed using a random-effects model. Further subgroup analyses were performed for adult and pediatric populations, as well as for the duration of treatment, and sensitivity, when feasible. Results In total, 28 studies, totaling 2231 patients and 1582 healthy controls, were included in this meta-analysis. Significant TC and LDL alterations were observed soon after introducing carbamazepine {TC SMD 1.23 [95% confidence interval (CI) 0.93–1.54]; LDL SMD 1.00 [95% CI 0.70–1.30]} and oxcarbazepine [TC SMD 1.0 (95% CI 0.67–1.34)] in all patient subgroups, as well as phenytoin [TC 0.72 (95% CI 0.37–1.06); LDL SMD 0.41 (95% CI 0.03–0.79)] and valproate in long-term therapy in adult patients. Lamotrigine reduces LDL levels over time [MD − 5.15 (95% CI − 9.51 to − 0.80)] in adults. Levetiracetam has a neutral effect on lipid profile. BMI increases on valproate treatment in the pediatric population [MD 0.58 (95% CI 0.01–1.16)] and adults, commonly seen with long-term therapy [MD 2.73 (95% CI 1.77–3.69)]. Insufficient data existed to assess most other approved ASMs. Conclusions Individual ASMs may contribute to the overall metabolic and cardiovascular risk profile in patients with epilepsy. This systematic review and meta-analysis identified the need for TC and LDL monitoring in the early stages of treatment for patients taking carbamazepine or oxcarbazepine, as well as adults on phenytoin and long-term valproate therapy. Lamotrigine was associated with a reduction in LDL levels over time in adults, whereas levetiracetam had a neutral effect on the lipid profile. Furthermore, weight gain was commonly observed in both children and adults undergoing long-term treatment with valproate. Regularly ordering lipid tests could play an important role in evaluating and mitigating the metabolic risk of ASMs and should be implemented in clinical practice. International Prospective Register of Systematic Reviews (PROSPERO) Protocol CRD42024583306.

Study design.: Systematic review and network meta-analysis (NMA). Objective.: This NMA evaluates the clinical efficacy and safety of various doses of Tranexamic acid (TXA) for adolescent idiopathic scoliosis (AIS) instrumentation. Summary of background data.: TXA is an antifibrinolytic agent widely used in spine surgery. However, the optimal TXA dose remains unclear, especially for younger patients. Methods.: We performed a systematic search across PubMed, Scopus, Web of Science, and the Cochrane Library up to March 2025. We included studies that compared different TXA doses or patients without TXA in AIS surgery. We evaluated five TXA doses: TXA 0 (control without TXA); TXA 1 (10 mg/kg bolus + 1 mg/kg/hr infusion); TXA 2 (15–20 mg/kg bolus + 1–10 mg/kg/hr infusion); TXA 3 (30–50 mg/kg bolus of TXA + 5–10 mg/kg/hr infusion); and TXA 4 (100 mg/kg bolus of TXA + 10 mg/kg/hr infusion). This meta-analysis compared bleeding volume, surgical time, transfusion rates, length of hospital stay, and complications. Random-effects frequentist NMA was employed. Treatments were ranked with P-scores. Results.: A total of 1,523 patients, mainly aged 13 to 18 years from 16 studies were included in this analysis (eight retrospective studies). TXA 4 outperformed other doses in reducing intraoperative bleeding, operation time, and cell saver volume. TXA 3 also showed significant benefits but was less effective than TXA 4. There was no difference in complication rates, although these data were not uniformly reported in the studies. No evidence of publication bias was found. Quality concerns were observed. Conclusion.: The tranexamic acid dose of 100 mg/kg bolus + 10 mg/kg/hr infusion (TXA 4) was the most effective in bleeding control during AIS instrumentation in teenagers. While these results are promising, more randomized trials are needed to directly compare various TXA doses.

Background: Aortic dissection (AoD) is a life-threatening medical emergency characterized by the separation of the layers of the aortic wall. The typical clinical presentation of AoD includes intense thoracic pain in the anterior chest or interscapular region, often described as migratory and tearing in nature. However, in rare cases, AoD can present without classic signs but with neurological symptoms, including seizures. Case Presentation: A 60-year-old patient experienced a sudden loss of consciousness followed by a tonic–clonic seizure and subsequently developed right-sided weakness. He had a medical history of hypertension and smoking. Although the symptoms quickly resolved, the brain imaging revealed signs of an acute ischemic stroke located in the left hemisphere. The seizures resumed, blood D-dimer levels were found to be highly elevated, and subsequent thoracic and abdominal computed tomography angiography revealed the presence of AoD, which originated at the proximal part of the ascending aorta. The patient received symptomatic treatment to alleviate his symptoms and prevent complications and was quickly transferred for surgical intervention, resulting in a favorable outcome. Conclusions: This case demonstrates that a tonic–clonic seizure can be the first clinical manifestation of AoD. Such atypical symptoms highlight the diverse and misleading nature of AoD presentations, underscoring the challenges in the diagnostic process. This emphasizes the need for increased clinical vigilance when treating a patient experiencing their first seizure episode.