Bupropion is an atypical antidepressant that inhibits norepinephrine and dopamine reuptake. Poison control data demonstrate toxic effects at doses as low as 600 mg. Common adverse effects of overdose include tachycardia, seizures, and cardiac arrhythmias. Gastrointestinal complications are rarely described. Our case shows an 18-year-old male presented to the emergency department after witnessed seizure-like activity. Family reported ingestion of approximately thirty 300-mg sustained-release bupropion tablets 4-5 hours prior to presentation. On arrival, he required endotracheal intubation for airway protection. Sedation was initiated with propofol and fentanyl; fentanyl was rapidly discontinued. Given delayed presentation and sustained-release ingestion, whole bowel irrigation was initiated with nasogastric administration of 50 g activated charcoal followed by 6 L polyethylene glycol-electrolyte solution. Subcutaneous methylnaltrexone (12 mg) was administered to reverse potential opioid-related ileus without effect. Worsening abdominal distension prompted contrast-enhanced computed tomography of the abdomen and pelvis, which demonstrated diffuse fluid-filled colonic distension with distal small bowel dilation and no evidence of mechanical obstruction or pill bezoar. Gastroenterology performed colonoscopic decompression with rectal tube placement. This resulted in successful decompression. The patient was extubated the following day with return of bowel function on post-decompression day two. In supratherapeutic states, bupropion exhibits anticholinergic properties through poorly understood mechanisms, which may impair intestinal motility. Colonic complications remain rare, with only isolated reports describing colonic ischemia or pseudo-obstruction associated with bupropion toxicity. Clinicians should consider severe gastrointestinal dysmotility when managing sustained-release bupropion toxicity.

Pathogenic KCNQ2 variants are the most common genetic cause of neonatal-onset epilepsies, with phenotypes ranging from self-limited (familial) neonatal epilepsy (SeL(F)NE) to severe developmental and epileptic encephalopathy (KCNQ2-DEE). Sodium channel blockers (SCBs) have shown promise for seizure control in these disorders, but their impact on neurodevelopmental outcomes and possible relationship with timing of initiation remain incompletely understood. We leveraged a large, multicentre international cohort comprising 282 individuals with pathogenic KCNQ2 variants to retrospectively assess the effectiveness of antiseizure medications (ASMs), particularly SCBs, on seizure control and neurodevelopment. Individuals were grouped according to the predicted variant-specific functional effects: loss-of-function (LOF) variants known to be associated with SeL(F)NE or DEE respectively, and gain-of-function (GOF) variants. Epilepsy course, ASM effectiveness, and neurodevelopmental milestones were systematically collected and analysed, including time-to-event and adjusted outcome analyses. SCBs, especially carbamazepine (CBZ) and oxcarbazepine (OXC), emerged as the most effective ASMs in both LOF groups. In LOF KCNQ2-DEE, time-to-event analyses showed that early SCB initiation (≤1 month) was associated with earlier seizure offset. Early SCB initiation was also associated with significantly more favourable neurodevelopmental outcomes, including higher rates of attaining major motor milestones. This association remained significant after adjustment for seizure control by 1 month and total ASM burden. Considerable phenotypic variability persisted, with some individuals experiencing severe impairment despite early seizure control and SCB initiation, suggesting that variant severity and additional genetic or biological modifiers contribute to outcome heterogeneity.Our results support the use of SCBs, particularly CBZ and OXC, as first-line therapy in (LOF) KCNQ2-DEE and SeL(F)NE. Earlier SCB initiation was associated with earlier seizure offset and more favourable developmental outcomes, underscoring the importance of early genetic diagnosis and timely SCB therapy. We however emphasise that early treatment is not universally transformative and further prospective work, including exploration of targeted therapies and standardised neurodevelopmental assessments, is needed to optimise long-term outcomes in this heterogeneous population.

Aim: To synthesize evidence on the multisystem clinical burden of Rett syndrome, integrating comorbidity prevalence and concomitant medication use to inform proactive care. Materials & methods: A structured search of PubMed, Embase and Cochrane (January 2000 to July 2024), plus gray literature, identified clinical trials, observational studies, registries, and case series (n >10). Non-English articles, case reports, reviews and commentaries were excluded. Two investigators independently screened studies, extracted data and synthesized the evidence using a descriptive approach with evidence mapping. Results: Of 6253 records screened, 148 studies met inclusion criteria, spanning 24 countries and participants aged 7 months to 37 years. Neurological, musculoskeletal and developmental manifestations predominated (reported in 62.0%, 44.0% and 41.0% of studies, respectively). Epilepsy prevalence ranged from 15.0% to 91.0%, scoliosis 8.9-100% and gastrointestinal dysfunction was common, including constipation (16.4-82.8%) and gastroesophageal reflux (15.8-100.0%). Hand stereotypies were reported in 11.4% of studies, with prevalence of 70.0-100.0%. Among studies reporting developmental burden, inability to walk ranged from 19.0% to 100.0%. Additional comorbidities included sleep, oral, and endocrine disorders, among others. Antiepileptic medications contributed most to treatment burden (14.3-33.0% for monotherapy). Other commonly used medications targeted sleep (melatonin, 7.7-30.0%), gastrointestinal symptoms (proton-pump inhibitors, 37.0-61.0%) and behavioral symptoms (anti-anxiety agents, 10.0-21.4%). Conclusion: Rett syndrome imposes a substantial, lifelong multisystem burden requiring continuous surveillance. Findings highlight the importance of anticipatory, multidisciplinary care rather than symptom-driven management. Patterns of medication use, particularly for epilepsy, reflect reliance on symptom-directed therapies and highlight the need for routine medication review, careful prescribing and longitudinal monitoring to optimize outcomes.

Developmental and/or epileptic encephalopathy with spike-wave activation during sleep (DE SWAS), including electrical status epilepticus during sleep (ESES/CSWS), is associated with seizures, neurocognitive regression, and characteristic electroencephalographic abnormalities. This study aimed to evaluate the clinical, electrophysiological, neurocognitive, and molecular response to corticosteroid therapy in children diagnosed with DE-SWAS, with a particular focus on serum glial fibrillary acidic protein (GFAP) as a potential biomarker of treatment response. Eleven children aged 6-12 years were retrospectively evaluated using clinical records, sleep electroencephalography with quantification of the spike-wave index (SWI), standardized neuropsychological test results, and serum GFAP measurements obtained before and after corticosteroid treatment. Neurocognitive assessment included the Wechsler Intelligence Scale for Children-Revised (WISC-R), Stroop Color and Word Test, Bender Visual-Motor Gestalt Test, and Turkish Receptive and Expressive Language Test (TIFALDI)High-dose intravenous methylprednisolone was administered monthly for six months. During follow-up, four patients became seizure-free, while the remaining seven demonstrated a reduction in seizure frequency and duration exceeding 50%. Complete normalization of electroencephalographic findings was observed in four patients, and a ≥ 50% reduction in SWI was observed in the remaining seven. Post-treatment neurocognitive evaluations demonstrated overall improvement, particularly in attention, executive functions, and receptive language domains. Mean serum GFAP levels decreased significantly following corticosteroid therapy (p = .017). These findings suggest that corticosteroid therapy is associated with favorable clinical, electrophysiological, and neurocognitive outcomes in children with DE-SWAS and that GFAP may represent a promising biomarker of disease activity and therapeutic response. Larger prospective studies are warranted to validate these results.

Numerous studies have investigated the mechanisms underlying photosensitive epilepsy, yet they remain poorly understood. Progress in this field has been substantially hampered by the scarcity of valid animal models and the difficulty in establishing them. Here we presented flashing lights at varying frequencies to head-fixed mice while recording local field potentials (LFPs) in the primary visual cortex (V1). We identified approximately 5 Hz as the resonant frequency for eliciting photosensitive responses. By modulating the luminance within the behavioural chamber we found that the response amplitude diminished with reduced stimulus contrast. Dual-region LFP recordings revealed that the photosensitive response propagated to the medial prefrontal cortex (mPFC), with the response in V1 being both stronger and earlier than those in the mPFC. Acute treatment with pentylenetetrazole (PTZ) enhanced the photosensitive response in V1, whereas chronic PTZ treatment did not. Furthermore we demonstrated that several anti-epileptic drugs effectively attenuated the photosensitive response in both V1 and mPFC. Collectively our findings establish a murine photosensitivity model as a promising platform for the investigation of the mechanisms underlying photosensitive epilepsy and for the initial screening of potential antiepileptic therapeutics. KEY POINTS: The resonant frequency of the photosensitive response in mice is approximately 5 Hz. Photosensitive response decreases as the stimulus contrast reduces, and its response to red light is weaker than that to white light. The photosensitive response can propagate to the medial prefrontal cortex (mPFC) region but does not induce clinical epileptic seizures. Some anti-epileptic drugs can alleviate the photosensitive response.

TANGO2 deficiency disorder (TDD), characterized by developmental delays, intellectual disability, gait incoordination, speech difficulties, seizures, and hypothyroidism, is a rare genetic disease caused by biallelic pathogenic variants of the TANGO2 gene (NM_152906.7).

Light sheet microscopy is a powerful tool for imaging live organisms. To enable high-speed volumetric imaging, we have developed a light sheet system incorporating an electrically tunable lens (ETL) capable of capturing volumes up to 499 × 499 × 150 μm3 at 4 volumes per second with near diffraction-limited resolution. The system employs sensorless adaptive optics to correct ETL induced system aberrations, extending the usable field of view by fivefold. We apply this system to image the propagation of seizures in zebrafish larvae and observe that seizures originate in the posterior brain, propagate anteriorly toward the optic tectum and gradually subside over tens of seconds.

Phytomedicines have played a vital role in traditional medical systems globally, particularly in providing culturally relevant and accessible healthcare solutions. P. methysticum, known as Kava, is a traditional Pacific Island phytomedicine with clinically validated anxiolytic properties, primarily attributed to its Kavalactones (KL). However, P. methysticum is biogeographically restricted and there are ecological and cultural concerns that limits its widespread therapeutic adoption. This study investigates if other Piper species, used phytomedically outside the Pacific, offer therapeutic efficacy for anxiety, stress, and related disorders as alternatives to Kava. We used a hybrid computational and experimental validation approach.

The EEFSEC gene encodes eukaryotic elongation factor selenocysteine-tRNA-specific, an essential component of the selenoprotein biosynthesis machinery required for normal neurodevelopment. Biallelic EEFSEC variants have recently been associated with a rare autosomal recessive neurodevelopmental disorder with variable neurological severity. Here, we describe a Turkish proband carrying the recurrent homozygous EEFSEC (NM_021937.5) variant c.1169A>C; p.Asp390Ala, together with his younger brother, who was identified with the same homozygous variant through familial testing. The proband presented with intellectual disability, delayed motor and expressive language development, mild hypotonia, subtle dysmorphic features, and self-limited early childhood febrile seizures. Compared with previously reported Turkish patients carrying the same variant, his absence of ocular motor involvement, normal neuroimaging, lack of persistent epileptiform abnormalities, and partial developmental gains suggest a relatively milder neurological presentation. The younger brother was initially identified before overt neurological manifestations and subsequently showed delayed expressive language development during early follow-up. This report provides comparative data on the recurrent EEFSEC p.Asp390Ala variant and highlights the value of familial testing, early molecular diagnosis, and longitudinal developmental monitoring in families with confirmed biallelic EEFSEC variants.