Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly among elderly patients. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive adjunctive treatment aimed at reducing recurrence. However, its comparative efficacy and safety remain under investigation. Methods: In this systematic review and meta-analysis, randomized-controlled clinical trial (RCT) data evaluating MMA embolization combined with best medical therapy (BMT) versus BMT alone in adult patients with symptomatic cSDH were pooled. The primary efficacy outcome was recurrence or progression of hematoma at follow-up. Secondary efficacy outcomes included good functional outcome [modified Rankin Scale (mRS) score ≤ 2], independent ambulation (mRS score ≤ 3), and hematoma thickness at follow-up. The primary safety outcome was all-cause mortality. Procedure-related complications were assessed as a secondary safety outcome. Results: Six RCTs were included, comprising 760 patients treated with MMA embolization and 788 patients treated with BMT alone. MMA embolization significantly reduced recurrence compared to BMT alone (RR: 0.50; 95% CI: 0.37–0.69; six studies; I² = 0%; number-needed-to-treat = 13). No significant differences were observed in good functional outcome (RR: 1.01; 95% CI: 0.97–1.05; three studies; I² = 0%), independent ambulation (RR: 1.01; 95% CI: 0.99–1.04; three studies; I² = 0%), or hematoma thickness at follow-up (SMD: −0.1; 95% CI: −0.3 to 0; four studies; I² = 42%). All-cause mortality was similar between the two groups (RR: 1.01; 95% CI: 0.42–2.40; five studies; I² = 44%). The pooled rate of procedure-related adverse events in the MMA embolization-group was 1% (95% CI: 0–3%; two studies; I² = 35%). Conclusions: MMA embolization significantly reduced cSDH recurrence when used as an adjunct to BMT. However, it did not demonstrate a significant impact on functional outcomes or mortality in this meta-analysis. Further research is needed to identify patient subgroups that benefit most from MMA embolization and to evaluate its impact on cognitive function and quality of life using longer follow-up periods.

Objective: To assess and compare the detection rates of peri‐ictal abnormalities using magnetic resonance imaging (MRI) and computed tomography perfusion (CTP) in patients with non‐convulsive status epilepticus (NCSE). Methods: We conducted a systematic literature search in five databases up to February 2025. Studies reporting peri‐ictal MRI abnormalities (PMAs) or cerebral perfusion abnormalities (CPAs) in patients with NCSE were included. Meta‐analyses of proportions were performed using a random‐effects model. Subgroup analyses and meta‐regression were used to compare detection rates across imaging modalities. Results: Nineteen studies were included (15 MRI, 4 CTP), comprising 562 patients for MRI and 72 for CTP. The pooled detection rate of peri‐ictal abnormalities was 50.0% (95% confidence interval [CI]: 34.0%–65.0%) for MRI and 79.3% (95% CI: 54.3%–92.5%) for CTP. Among the MRI modalities, arterial spin labeling (ASL) demonstrated the highest detection rate at 88.8% (95% CI: 32.9%–99.2%). CTP showed a significantly higher detection rate than MRI ( χ ² = 3.97, p = 0.046); meta‐regression indicated increased odds of detection with CTP (odds ratio [OR] = 4.06, 95% CI: 0.97–16.99, p = 0.055). No statistically significant difference was found between ASL and CTP ( χ ² = 0.22, p = 0.636). Conclusions: CTP demonstrates a higher detection rate than conventional MRI for peri‐ictal abnormalities in patients with NCSE, supporting its utility in rapid diagnosis and differential workup. Among MRI sequences, ASL showed the highest detection rates, highlighting its potential role in the diagnostic assessment of NCSE. Although MRI remains essential for clarifying etiology, its effectiveness in detecting PMA is highly dependent on the sequences used.

Background: To mitigate the potential consequences of the coronavirus disease 2019 (COVID-19) pandemic on public life, the German Federal Government and Ministry of Health enacted a strict lockdown protocol on March 16, 2020. This study aimed to evaluate the impact of the COVID-19 pandemic on physical and mental health status and the supply of medical care and medications for people with epilepsy (PWE) in Germany. Methods: The Epi2020 study was a large, multicenter study focused on different healthcare aspects of adults with epilepsy. In addition to clinical and demographic characteristics, patients were asked to answer a questionnaire on the impact of the first wave of the COVID-19 pandemic between March and May 2020. Furthermore, the population-based number of epilepsy-related admissions in Hessen was evaluated for the January-June periods of 2017–2020 to detect pandemic-related changes. Results: During the first wave of the pandemic, 41.6% of PWE reported a negative impact on their mental health, while only a minority reported worsening of their seizure situation. Mental and physical health were significantly more negatively affected in women than men with epilepsy and in PWE without regular employment. Moreover, difficulties in ensuring the supply of sanitary products (25.8%) and antiseizure medications (ASMs; 19.9%) affected PWE during the first lockdown; no significant difference regarding these impacts between men and women or between people with and without employment was observed. The number of epilepsy-related admissions decreased significantly during the first wave. Conclusions: This analysis provides an overview of the general and medical care of epilepsy patients during the COVID-19 pandemic. PWE in our cohort frequently reported psychosocial distress during the first wave of the pandemic, with significant adverse effects on mental and physical health. Women and people without permanent jobs especially reported distress due to the pandemic. The COVID‐19 pandemic has added to the mental health burden and barriers to accessing medication and medical services, as self-reported by patients and verified in population-based data on hospital admissions. Trial registration: German Clinical Trials Register (DRKS), DRKS00022024. Registered October 2, 2020, http://www.drks.de/DRKS00022024

Objective: To investigate correlates in hippocampal subfield volume and verbal and visual memory function in patients with temporal lobe epilepsy (TLE), mild amnestic cognitive impairment (MCI) and heathy participants (HP).Methods: 50 right-handed participants were included in this study; 11 patients with temporal lobe epilepsy (TLE), 18 patients with mild amnestic cognitive impairment (MCI) and 21 healthy participants (HP). Verbal memory performance was evaluated via the verbal memory test (VLMT) and visual memory performance via the diagnosticum for cerebral damage (DCM). Hippocampal subfield volumes of T1-weighted Magnetic Resonance Imaging (MRI) scans were computed with FreeSurfer version 7.1. Stepwise correlation analyses were performed between the left hippocampal subfield volumes and learning, free recall, consolidation and recognition performance scores of the VLMT as well as between right hippocampal subfield volumes and visual memory performance.Results: The volume of the left subicular complex was highly correlated to learning performance (β = 0.284; p = 0.042) and free recall performance in the VLMT (β = 0.434; p = 0.001). The volume of the left CA3 subfield showed a significant correlation to the consolidation performance in the VLMT (β = 0.378; p = 0.006) and recognition performance in the VLMT (β = 0.290; p = 0.037). There was no significant correlation identified between the right hippocampal subfields and the visual memory performance.Conclusion: The results of this study show verbal memory correlates with hippocampal subfields and support the role of left subiculum and left CA2/CA3 in verbal memory performance.

Objective: This study was undertaken to identify temporal encephaloceles (TEs) and examine their characteristics in patients with temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE), as well as in asymptomatic cases.Methods: Four hundred fifty‐eight magnetic resonance imaging scans were examined retrospectively to identify TE in 157 patients with TLE, 150 patients with ETLE, and 151 healthy controls (HCs).Results: At least one TE was identified in 9.6% of the TLE patients (n = 15, 95% confidence interval [CI] = 5.3%–15.3%), in 3.3% of patients with ETLE (n = 5, 95% CI = 1.1%–7.6%), and in 2.0% of the HCs (n = 3, 95% CI = .4%–5.7%), indicating a significantly higher frequency in patients with TLE compared to ETLE and HC subjects (p = .027, p = .005). Examining the characteristics of TEs in both asymptomatic and epilepsy patients, we found that TEs with a diameter of less than 6.25 mm were more likely to be asymptomatic, with a sensitivity of 91.7% and a specificity of 73.3% (area under the curve = .867, 95% CI = .723–1.00, p = .001).Significance: Temporal encephaloceles may occur without presenting any clinical symptoms. Patients with TLE show a higher frequency of TEs compared to the ETLE and HC groups. According to our study, TE size could be used to suggest potential epileptogenicity.

Background: Repurposing glucagon‐like peptide‐1 (GLP‐1) and GIP/GLP‐1 receptor agonists (RAs) for idiopathic intracranial hypertension (IIH) represents an attractive alternative to current treatments, supported by evidence of potent metabolic effects and reductions in cerebrospinal fluid secretion and intracranial pressure in vivo.Methods: We evaluated the safety and efficacy of GLP‐1 RAs and GIP/GLP‐1 RAs in IIH. MEDLINE and Scopus databases were searched for randomized‐controlled trials (RCT), non‐randomized clinical trials, or registries in adults with IIH.Results: Two clinical trials (one RCT and one non‐randomized case–control) and two registries, comprising 1550 IIH patients (768 receiving GLP‐1 or GIP/GLP‐1 RAs) were included. Compared with standard‐of‐care, GLP‐1 or GIP/GLP‐1 RAs were associated with a significantly lower risk of papilledema (RR: 0.25; 95% CI: 0.15–0.43; p < 0.01) and visual disturbances or blindness (RR: 0.41; 95% CI: 0.18–0.92; p = 0.03), and a near‐significant trend toward reduced headache risk (RR: 0.61; 95% CI: 0.34–1.07; p = 0.08). Additionally, GLP‐1 RAs significantly reduced monthly headache days at 3 months (MD = −3.64; 95% CI: −6.26 to −1.03; p < 0.01) and at the end of follow‐up (MD = −4.82; 95% CI: −8.80 to −0.85; p = 0.02). No association was detected between GLP‐1 RAs and body mass index. No serious adverse events or treatment discontinuations were reported; mild gastrointestinal adverse events and nausea occurred in 88% (95% CI: 0.46–1.00) of GLP‐1 RA‐treated patients.Conclusions: GLP‐1 and dual GIP/GLP‐1 RAs are associated with a significantly lower risk of papilledema and visual disturbances or blindness and a lower headache risk compared with standard‐of‐care. Additionally, GLP‐1 RAs significantly reduce the monthly headache burden. Well‐designed RCTs are needed to robustly evaluate the effects of GLP‐1 and GIP/GLP‐1 RAs in IIH, which likely extend beyond their weight‐loss‐inducing properties.Trial Registration: PROSPERO registration ID: CRD42025650082