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Liu C, Qi Y, Wang L, Zhang C, Kang L, Shang S, Dang J. Latencies to the first interictal epileptiform discharges recorded by the electroencephalography in different epileptic patients. BMC Neurol 2023; 23:427. [PMID: 38041003 PMCID: PMC10691041 DOI: 10.1186/s12883-023-03474-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE Interictal epileptiform discharges (IEDs) captured in electroencephalography (EEG) have a high diagnostic value for epileptic patients. Extending the recording time may increase the possibility of obtaining IEDs. The purpose of our research was to determine how long it took for various epileptic individuals to receive their first IEDs. METHODS We retrospectively analyzed patients who were diagnosed with epilepsy and had no anti-seizure medications (ASMs) between September 2018 and March 2019 in the neurology department of the First Affiliated Hospital of Xi'an Jiaotong University. Each individual underwent a 24-h long-term video electroencephalographic monitoring (VEM) procedure. Clinical information including age, gender, age of seizure onset, frequency of seizures, the interval between last seizure and VEM, and results of neuroimaging were gathered. We also calculated the times from the start of the VEM to the first definite IEDs. RESULTS A total of 241 patients were examined, including 191 with focal-onset epilepsy and 50 with generalized epilepsy. In individuals with focal-onset epilepsy, the median latency to the first IED was 63.0 min (IQR 19.0-299.0 min), as compared to 30.0 min (IQR 12.5-62.0 min) in patients with generalized epilepsy (p < 0.001). The latency to the first IED is significantly related to the age of seizure onset (HR = 0.988, p = 0.049), the interval between last seizure and VEM (HR = 0.998, p = 0.013). But it is not correlated with seizure frequency, gender and age. CONCLUSIONS IEDs were discovered during 24-h EEG monitoring in 222/241(92.1%) of the epilepsy patients that were included. Compared to focal-onset epilepsy, generalized epilepsy demonstrated a much shorter latency to IED. Patients with late-onset epilepsy or those without recent episodes may require longer EEG monitoring periods.
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Affiliation(s)
- Chenyu Liu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, China
| | - Yi Qi
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, China
| | - Liang Wang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, China
| | - Ce Zhang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, China
| | - Li Kang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, China
| | - Suhang Shang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, China
| | - Jingxia Dang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, China.
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Morano A, Cerulli Irelli E, Salamone EM, Orlando B, Fanella M, Tinelli E, Ruffolo G, Zuliani L, Fattouch J, Manfredi M, Giallonardo AT, Di Bonaventura C. Late-onset seizures and epilepsy: Electroclinical features suggestive of autoimmune etiology. Front Neurol 2022; 13:924859. [PMID: 36034285 PMCID: PMC9412019 DOI: 10.3389/fneur.2022.924859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Late-onset epilepsy (LOE) has recently become a topic of intense research. Besides stroke, tumors, and dementia, autoimmune encephalitis (AE) has emerged as another possible cause of recurrent seizures in the elderly, and may account for a proportion of cases of LOE of unknown origin (LOEUO). This 24-h ambulatory electroencephalography (AEEG)-based study compared patients with LOEUO and AE to identify features suggestive of immune-mediated seizures in the elderly. Materials and methods We retrospectively reviewed 232 AEEG examinations performed in patients over 55 years with ≥6-month follow-up, and selected 21 subjects with AE and 25 subjects with LOEUO. Clinical charts and AEEG recordings were carefully analyzed. Results Twenty-five patients with LOEUO (12 women, mean age at onset 67.9 years) and 21 AE subjects (8 women, mean age at onset 65.7 years) were enrolled. High-frequency seizures were reported in 20/21 AE and 7/25 LOEUO cases (p < 0.00001). Focal aware seizures were more common in AE (14/21 vs. 6/25, p = 0.00058), whereas “isolated” focal-to-bilateral tonic-clonic seizures occurred in 5/25 patients with LOEUO only (p = 0.053). AE subjects reported ictal autonomic manifestations more frequently (p = 0.0033). Three-hundred-seventy and 24 seizures were recorded in 13/21 patients with AE and 3/25 patients with LOEUO, respectively (p = 0.0006). Interictal epileptiform discharges were observed in 70% of both groups, but their sleep activation was more common in AE (p = 0.06). Conclusion Our study shows that high-frequency focal seizures with autonomic manifestations should raise the suspicion of AE in the elderly with new-onset seizures. It also highlights the relevant contribution of AEEG, which might reduce the diagnostic delay and provide useful clues to recognize AE.
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Affiliation(s)
- Alessandra Morano
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Enrico Michele Salamone
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Biagio Orlando
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Martina Fanella
- Neurology Unit, Ospedale “Fabrizio Spaziani”, Frosinone, Italy
| | - Emanuele Tinelli
- Unit of Neuroradiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy
| | - Gabriele Ruffolo
- Department of Physiology and Pharmacology, Istituto Pasteur-Fondazione Cenci Bolognetti, “Sapienza” University of Rome, Rome, Italy
- Istituto di ricerca e cura a carattere scientifico (IRCCS) San Raffaele Roma, Rome, Italy
| | | | - Jinane Fattouch
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Mario Manfredi
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Carlo Di Bonaventura
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Kleine BU, Miosge RJ, Krümmer N, Krause T, Weise G, Berrouschot J. [Inferior temporal electrodes in 24-h EEG]. DER NERVENARZT 2021; 93:575-582. [PMID: 34731278 DOI: 10.1007/s00115-021-01217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND To improve the sensitivity of the EEG in the diagnosis and classification of seizures or epilepsy, long-term recording with inferior temporal electrodes are recommended. MATERIAL AND METHODS The spatial distribution of epileptiform discharges from 24‑h EEG with 25 electrodes (10-20, extended by F9/F10, T9/T10, P9/P10) was retrospectively analyzed in 25 cases. RESULTS Maximum negativity was located below the 10-20 electrodes in 84%. Epileptiform discharges were more clearly detected on inferior temporal electrodes in 64%. In the intention-to-test population of 77 patients the number needed to test with extra electrodes was estimated as 5. CONCLUSION Recording EEG with 25 electrodes for 24 h improves the detection and localization of temporal epileptiform discharges also in geriatric patients with suspected nonlesional epilepsy.
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Affiliation(s)
- Bert-Ulrich Kleine
- Klinik für Neurologie und Neurologische Intensivmedizin, Klinikum Altenburger Land, Am Waldessaum 10, 04600, Altenburg, Deutschland. .,MVZ Altenburg, Medizinische Versorgungszentren Altenburger Land, Altenburg, Deutschland.
| | - Ragna-Jill Miosge
- Klinik für Neurologie und Neurologische Intensivmedizin, Klinikum Altenburger Land, Am Waldessaum 10, 04600, Altenburg, Deutschland.,MVZ Schmölln, Medizinische Versorgungszentren Altenburger Land, Schmölln, Deutschland
| | - Norma Krümmer
- Klinik für Neurologie und Neurologische Intensivmedizin, Klinikum Altenburger Land, Am Waldessaum 10, 04600, Altenburg, Deutschland.,MVZ Altenburg, Medizinische Versorgungszentren Altenburger Land, Altenburg, Deutschland
| | - Thomas Krause
- Klinik für Neurologie und Neurologische Intensivmedizin, Klinikum Altenburger Land, Am Waldessaum 10, 04600, Altenburg, Deutschland.,MVZ Altenburg, Medizinische Versorgungszentren Altenburger Land, Altenburg, Deutschland
| | - Gesa Weise
- Klinik für Neurologie und Neurologische Intensivmedizin, Klinikum Altenburger Land, Am Waldessaum 10, 04600, Altenburg, Deutschland
| | - Jörg Berrouschot
- Klinik für Neurologie und Neurologische Intensivmedizin, Klinikum Altenburger Land, Am Waldessaum 10, 04600, Altenburg, Deutschland
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Alreefi H, AlKhateeb M. Blue rubber bleb nevus syndrome associated with tuberous sclerosis complex and CNS involvement. ACTA ACUST UNITED AC 2021; 26:207-211. [PMID: 33814375 PMCID: PMC8024125 DOI: 10.17712/nsj.2021.2.20200111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/03/2020] [Indexed: 11/20/2022]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder that is characterized by multiple dome-shaped cutaneous venous malformations on the skin and visceral organs. Typical extra-cutaneous lesions have the appearance of blueish nipple-shaped nodules that can easily compress and refill. We described a rare case of a 23-year-old female with BRBNS and tuberous sclerosis complex (TSC) that presented with central nervous system (CNS) involvement including unprovoked focal impaired awareness seizure. Her BRBNS presents with hemangiomas involving multiple organs in the body including the brain, gastrointestinal (GI) system, and skin. This case highlights the importance of studying and understanding the association between BRBNS and TSC as it may lead to improved understanding
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Affiliation(s)
- Hajar Alreefi
- From the Department of Neuroscience, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mashael AlKhateeb
- From the Department of Neuroscience, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Reus EEM, Visser GH, Cox FME. Using sampled visual EEG review in combination with automated detection software at the EMU. Seizure 2020; 80:96-99. [PMID: 32554293 DOI: 10.1016/j.seizure.2020.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Complete visual review of prolonged video-EEG recordings at an EMU (Epilepsy Monitoring Unit) is time consuming and can cause problems in times of paucity of educated personnel. In this study we aimed to show non inferiority for electroclinical diagnosis using sampled review in combination with EEG analysis softreferware (P13 software, Persyst Corporation), in comparison to complete visual review. METHOD Fifty prolonged video-EEG recordings in adults were prospectively evaluated using sampled visual EEG review in combination with automated detection software of the complete EEG record. Visually assessed samples consisted of one hour during wakefulness, one hour during sleep, half an hour of wakefulness after wake-up and all clinical events marked by the individual and/or nurses. The final electro-clinical diagnosis of this new review approach was compared with the electro-clinical diagnosis after complete visual review as presently used. RESULTS The electro-clinical diagnosis based on sampled visual review combined with automated detection software did not differ from the diagnosis based on complete visual review. Furthermore, the detection software was able to detect all records containing epileptiform abnormalities and epileptic seizures. CONCLUSION Sampled visual review in combination with automated detection using Persyst 13 is non-inferior to complete visual review for electroclinical diagnosis of prolonged video-EEG at an EMU setting, which makes this approach promising.
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Affiliation(s)
- Elisabeth E M Reus
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.
| | - Gerhard H Visser
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Fieke M E Cox
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
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