Paroxysmal slow wave events predict epilepsy following a first seizure

Does the interval between the first unprovoked seizure and EEG influence the diagnostic yield?

OBJECTIVE

There is no consensus on the optimum time for an EEG after the first seizure. We sought to investigate whether the timing of an EEG after a first unprovoked seizure influences its diagnostic yield.

METHODS

A retrospective analysis was conducted at a tertiary hospital in Australia. Adult patients who presented with a first unprovoked seizure were studied. Using multivariable logistic regression, we investigated the association of EEG timing, seizure presentation, and risk factors for epilepsy with the presence of interictal epileptiform discharges (IED) in the EEG as the outcome. The chi-square test compared EEG yields across each week after the seizure.

RESULTS

Among 452 patients, the time from seizure to EEG did not show a statistically significant impact on the presence of IEDs (OR = 1, 95 % CI 0.99-1, p = 0.095). The yield of epileptiform abnormalities generally declined over time but was not statistically significant across weeks (p = 0.40). A modest but significant relationship was found between age and the likelihood of detecting IEDs, with older age associated with a lower yield of abnormalities (OR = 0.98, 95 % CI 0.973-0.997, p = 0.016).

CONCLUSION

Our results suggest that the timing of the EEG following the first unprovoked seizure does not significantly impact the diagnostic yield.

Computer-assisted analysis of routine EEG to identify hidden biomarkers of epilepsy: A systematic review

Background

Computational analysis of routine electroencephalogram (rEEG) could improve the accuracy of epilepsy diagnosis. We aim to systematically assess the diagnostic performances of computed biomarkers for epilepsy in individuals undergoing rEEG.

Methods

We searched MEDLINE, EMBASE, EBM reviews, IEEE Explore and the grey literature for studies published between January 1961 and December 2022. We included studies reporting a computational method to diagnose epilepsy based on rEEG without relying on the identification of interictal epileptiform discharges or seizures. Diagnosis of epilepsy as per a treating physician was the reference standard. We assessed the risk of bias using an adapted QUADAS-2 tool.

Results

We screened 10 166 studies, and 37 were included. The sample size ranged from 8 to 192 (mean=54). The computed biomarkers were based on linear (43%), non-linear (27%), connectivity (38%), and convolutional neural networks (10%) models. The risk of bias was high or unclear in all studies, more commonly from spectrum effect and data leakage. Diagnostic accuracy ranged between 64% and 100%. We observed high methodological heterogeneity, preventing pooling of accuracy measures.

Conclusion

The current literature provides insufficient evidence to reliably assess the diagnostic yield of computational analysis of rEEG.

Significance

We provide guidelines regarding patient selection, reference standard, algorithms, and performance validation.

Research progress of epileptic seizure prediction methods based on EEG

At present, at least 30% of refractory epilepsy patients in the world cannot be effectively controlled and treated. The suddenness and unpredictability of seizures greatly affect the physical and mental health and even the life safety of patients, and the realization of early prediction of seizures and the adoption of interventions are of great significance to the improvement of patients' quality of life. In this paper, we firstly introduce the design process of EEG-based seizure prediction methods, introduce several databases commonly used in the research, and summarize the commonly used methods in pre-processing, feature extraction, classification and identification, and post-processing. Then, based on scalp EEG and intracranial EEG respectively, we reviewed the current status of epileptic seizure prediction research from five commonly used feature analysis methods, and make a comprehensive evaluation of both. Finally, this paper describes the reasons why the current algorithms cannot be applied to the clinic, summarizes their limitations, and gives corresponding suggestions, aiming to provide improvement directions for subsequent research. In addition, deep learning algorithms have emerged in recent years, and this paper also compares the advantages and disadvantages of deep learning algorithms with traditional machine learning methods, in the hope of providing researchers with new technologies and new ideas and making significant breakthroughs in the field of epileptic seizure prediction.

Improving epilepsy diagnosis across the lifespan: approaches and innovations

Epilepsy diagnosis is often delayed or inaccurate, exposing people to ongoing seizures and their substantial consequences until effective treatment is initiated. Important factors contributing to this problem include delayed recognition of seizure symptoms by patients and eyewitnesses; cultural, geographical, and financial barriers to seeking health care; and missed or delayed diagnosis by health-care providers. Epilepsy diagnosis involves several steps. The first step is recognition of epileptic seizures; next is classification of epilepsy type and whether an epilepsy syndrome is present; finally, the underlying epilepsy-associated comorbidities and potential causes must be identified, which differ across the lifespan. Clinical history, elicited from patients and eyewitnesses, is a fundamental component of the diagnostic pathway. Recent technological advances, including smartphone videography and genetic testing, are increasingly used in routine practice. Innovations in technology, such as artificial intelligence, could provide new possibilities for directly and indirectly detecting epilepsy and might make valuable contributions to diagnostic algorithms in the future.

Atypical paroxysmal slow cortical activity in healthy adults: Relationship to age and cognitive performance

Paroxysmal patterns of slow cortical activity have been detected in EEG recordings from individuals with age-related neuropathology and have been shown to be correlated with cognitive dysfunction and blood-brain barrier disruption in these participants. The prevalence of these events in healthy participants, however, has not been studied. In this work, we inspect MEG recordings from 623 healthy participants from the Cam-CAN dataset for the presence of paroxysmal slow wave events (PSWEs). PSWEs were detected in approximately 20% of healthy participants in the dataset, and participants with PSWEs tended to be older and have lower cognitive performance than those without PSWEs. In addition, event features changed linearly with age and cognitive performance, resulting in longer and slower events in older adults, and more widespread events in those with low cognitive performance. These findings provide the first evidence of PSWEs in a subset of purportedly healthy adults. Going forward, these events may have utility as a diagnostic biomarker for atypical brain activity in older adults.

Machine-learning for the prediction of one-year seizure recurrence based on routine electroencephalography

Predicting seizure recurrence risk is critical to the diagnosis and management of epilepsy. Routine electroencephalography (EEG) is a cornerstone of the estimation of seizure recurrence risk. However, EEG interpretation relies on the visual identification of interictal epileptiform discharges (IEDs) by neurologists, with limited sensitivity. Automated processing of EEG could increase its diagnostic yield and accessibility. The main objective was to develop a prediction model based on automated EEG processing to predict one-year seizure recurrence in patients undergoing routine EEG. We retrospectively selected a consecutive cohort of 517 patients undergoing routine EEG at our institution (training set) and a separate, temporally shifted cohort of 261 patients (testing set). We developed an automated processing pipeline to extract linear and non-linear features from the EEGs. We trained machine learning algorithms on multichannel EEG segments to predict one-year seizure recurrence. We evaluated the impact of IEDs and clinical confounders on performances and validated the performances on the testing set. The receiver operating characteristic area-under-the-curve for seizure recurrence after EEG in the testing set was 0.63 (95% CI 0.55-0.71). Predictions were still significantly above chance in EEGs with no IEDs. Our findings suggest that there are changes other than IEDs in the EEG signal embodying seizure propensity.

Paroxysmal Slow-Wave Events Are Uncommon in Parkinson's Disease

Background: Parkinson’s disease (PD) is currently considered to be a multisystem neurodegenerative disease that involves cognitive alterations. EEG slowing has been associated with cognitive decline in various neurological diseases, such as PD, Alzheimer’s disease (AD), and epilepsy, indicating cortical involvement. A novel method revealed that this EEG slowing is composed of paroxysmal slow-wave events (PSWE) in AD and epilepsy, but in PD it has not been tested yet. Therefore, this study aimed to examine the presence of PSWE in PD as a biomarker for cortical involvement. Methods: 31 PD patients, 28 healthy controls, and 18 juvenile myoclonic epilepsy (JME) patients (served as positive control), underwent four minutes of resting-state EEG. Spectral analyses were performed to identify PSWEs in nine brain regions. Mixed-model analysis was used to compare between groups and brain regions. The correlation between PSWEs and PD duration was examined using Spearman’s test. Results: No significant differences in the number of PSWEs were observed between PD patients and controls (p > 0.478) in all brain regions. In contrast, JME patients showed a higher number of PSWEs than healthy controls in specific brain regions (p < 0.023). Specifically in the PD group, we found that a higher number of PSWEs correlated with longer disease duration. Conclusions: This study is the first to examine the temporal characteristics of EEG slowing in PD by measuring the occurrence of PSWEs. Our findings indicate that PD patients who are cognitively intact do not have electrographic manifestations of cortical involvement. However, the correlation between PSWEs and disease duration may support future studies of repeated EEG recordings along the disease course to detect early signs of cortical involvement in PD.