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Clemens B, Emri M, Dömötör J, Fekete I, Fekete K. Left hemispheric epilepsy is more frequent and has worse clinical course that right hemispheric epilepsy. Epilepsy Behav 2024; 159:110006. [PMID: 39181104 DOI: 10.1016/j.yebeh.2024.110006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/12/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Few studies demonstrated that focal epilepsy (FE) with left hemispheric (LH) seizure onset is more frequent than with right hemispheric (RH) seizure onset. In addition, patients with LH seizure onset show worse clinical course compared to those with RH seizure onset. The aim of our study was to investigate both issues in a great cohort of FE patients. METHODS In the retrospective study, we reviewed the clinical and paraclinical data of 682 patients with exclusively LH or RH seizure onset. We ascertained the laterality of seizure onset mainly by ictal and postictal semiology and ictal EEG findings. In the absence of ictal data, the basis of lateralization was the evidence of unilateral structural brain abnormality together with a corresponding interictal EEG finding. The endpoint of analysis of the clinical course was the presence/absence of five-year remission on drug treatment in the first ten years of treatment. RESULTS Out of the 682 patients, 378 (55.4 per cent) had LH and 304 (44.6 per cent) had RH seizure onset. The difference was statistically significant (p = 0.04). Out of them, 213 LH and 156 RH patients were eligible to evaluate prognosis. Five-years-remission was attained by 71 patients (33.3 per cent) in the LH, and 65 (41.7 per cent) in the RH group. The difference was statistically significant (p = 0.05). CONCLUSION We demonstrated the LH dominance of seizure onset and the worse clinical course of the patients with LH seizure onset. The findings are manifestations of the lateralized epileptic propensity of the brain. The dissimilar clinical course of the patient with LH and RH seizure onset may shape the general prognostic scheme in FE patients.
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Affiliation(s)
- Béla Clemens
- Department of Neurology, Kenézy Gyula Campus, Faculty of Medicine, University of Debrecen, Hungary
| | - Miklós Emri
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Hungary
| | - Johanna Dömötör
- Department of Neurology, Kenézy Gyula Campus, Faculty of Medicine, University of Debrecen, Hungary
| | - István Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Hungary
| | - Klára Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Hungary.
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Bauer T, von Wrede RD, Pujar S, Rácz A, Hoppe C, Baumgartner T, Varadkar S, Held NR, Reiter JT, Enders S, David B, Prillwitz CC, Brugues M, Keil VCW, Jeub M, Borger V, Sander JW, Kunz WS, Radbruch A, Weber B, Helmstaedter C, Vatter H, Baldeweg T, Becker AJ, Cross JH, Surges R, Rüber T. Rasmussen's encephalitis: structural, functional, and clinical correlates of contralesional epileptiform activity. J Neurol 2024:10.1007/s00415-024-12607-7. [PMID: 39138652 DOI: 10.1007/s00415-024-12607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/19/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024]
Abstract
Progressive inflammation of one hemisphere characterises Rasmussen's encephalitis (RE), but contralesional epileptiform activity has been repeatedly reported. We aimed to quantify contralesional epileptiform activity in RE and uncover its functional and structural underpinnings. We retrospectively ascertained people with RE treated between 2000 and 2018 at a tertiary centre (Centre 1) and reviewed all available EEG datasets. The temporal occurrence of preoperative contralesional epileptiform activity (interictal/ictal) was evaluated using mixed-effects logistic regression. Cases with/without contralesional epileptiform activity were compared for cognition, inflammation (ipsilesional brain biopsies), and MRI (cortical and fixel-based morphometry). EEG findings were validated in a second cohort treated at another tertiary centre (Centre 2) between 1995 and 2020. We included 127 people with RE and 687 EEG samples. Preoperatively, contralesional epileptiform activity was seen in 30/68 (44%, Centre 1) and 8/59 (14%, Centre 2). In both cohorts, this activity was associated with younger onset age (OR = 0.9; 95% CI 0.83-0.97; P = 0.006). At centre 1, contralesional epileptiform activity was associated with contralesional MRI alterations, lower intelligence (OR = 5.19; 95% CI 1.28-21.08; P = 0.021), and impaired verbal memory (OR = 10.29; 95% CI 1.97-53.85; P = 0.006). After hemispherotomy, 11/17 (65%, Centre 1) and 28/37 (76%, Centre 2) were seizure-free. Contralesional epileptiform activity was persistent postoperatively in 6/12 (50%, Centre 1) and 2/34 (6%, Centre 2). Preoperative contralesional epileptiform activity reduced the chance of postoperative seizure freedom in both cohorts (OR = 0.69; 95% CI 0.50-0.95; P = 0.029). Our findings question the concept of strict unilaterality of RE and provide the evidence of contralesional epileptiform activity as a possible EEG predictor for persisting postoperative seizures.
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Affiliation(s)
- Tobias Bauer
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Suresh Pujar
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Christian Hoppe
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Sophia Varadkar
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
- Developmental Neurosciences Research and Teaching Department, UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Nina R Held
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Johannes T Reiter
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Selma Enders
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Bastian David
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Mar Brugues
- Section for Translational Epilepsy Research, Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Vera C W Keil
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Monika Jeub
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wolfram S Kunz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | | | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Torsten Baldeweg
- Developmental Neurosciences Research and Teaching Department, UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Albert J Becker
- Section for Translational Epilepsy Research, Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - J Helen Cross
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
- Developmental Neurosciences Research and Teaching Department, UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
- Young Epilepsy Lingfield, Lingfield, UK
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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Fotedar N, Lüders HO. Nocturnal paroxysmal dystonia to sleep-related hypermotor epilepsy: A critical review. Epilepsia 2024. [PMID: 39046177 DOI: 10.1111/epi.18067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
Sleep-related paroxysmal motor episodes (SPMEs) have been described by various names, including nocturnal paroxysmal dystonia, nocturnal frontal lobe epilepsy (NFLE), and sleep-related hypermotor epilepsy. The underlying pathophysiology has been debated over the years, with these episodes assumed to be a form of paroxysmal dystonia or parasomnia versus a form of epilepsy. In most studies published on SPMEs and their variants (paroxysmal arousals, nocturnal paroxysmal dystonia, and episodic nocturnal wanderings) in the early 1990s, the authors speculated on the pathophysiology but did not commit to one idea. It was not until the mid-1990s that epilepsy became the leading prospect. We performed a narrative review of the major articles that have described this syndrome in a chronological fashion. We identified three eras, 1972-1993, 1994-1998, and 1999 to the present, each era marked by a landmark study. Our critical review of these early studies shows that the neurophysiological data supporting epilepsy as the sole basis for all SPME cases is very weak. In 1994-1995, a familial pattern of this syndrome was described and the term autosomal dominant NFLE was coined, with the authors claiming that all their patients had a form of frontal lobe epilepsy. With the exception of a few reference cases, the neurophysiological evidence that all patients had frontal lobe epilepsy was very weak. Compared to articles published on surgical series of frontal lobe epilepsy, the percentage of SPME cases with positive interictal/ictal electroencephalograms remained very low, seriously questioning the epileptic basis of the syndrome. Our critical review and analysis of the published literature shows that the evidence presented in favor of SPMEs being a homogenous focal epilepsy syndrome is very weak. Neurologists must recognize that SPMEs could be a form of movement disorder, parasomnia, or epilepsy. We recommend a pragmatic semiology-based classification of these episodes using the four-dimensional classification system.
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Affiliation(s)
- Neel Fotedar
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Hans O Lüders
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Kalss G, Pelliccia V, Zimmermann G, Trinka E, Tassi L. The Fingerprint of Scalp-EEG in Drug-Resistant Frontal Lobe Epilepsies. J Clin Neurophysiol 2024:00004691-990000000-00162. [PMID: 39042052 DOI: 10.1097/wnp.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Scalp-EEG incompletely covers the frontal lobe cortex. Underrepresentation of frontobasal or frontomesial structures, fast ictal spreading, and false lateralization impede scalp-EEG interpretation. Hence, we investigated the significance of scalp-EEG in the presurgical workup of frontal lobe epilepsy. METHODS Using descriptive statistical methods and Pearson chi-squared test for group comparisons, we retrospectively investigated postsurgical outcome, interictal epileptiform discharges (iiEDs), and electrographic seizure patterns on scalp-EEG in 81 consecutive patients undergoing resective epilepsy surgery within the margins of the frontal lobe. RESULTS Postoperatively, patients with frontopolar iiEDs (n = 7) or concordant frontopolar iiED focus and seizure-onset (n = 2) were seizure free (n = 7/7, Engel Ia). MRI-positive patients with frontopolar iiEDs or frontopolar seizure-onset (n = 1/8 Engel Id, n = 7/8 Engel Ia) underwent surgery without stereo-EEG. Thirteen of 16 patients with frontolateral (n = 8/10, Engel Ia), or left frontobasal (n = 5/6, Engel Ia) seizure-onset undergoing further stereo-EEG, were seizure-free postoperatively. Seizure-onset prevalent over one electrode (n = 37/44 Engel I, p = 0.02), fast activity (FA)/flattening at seizure-onset (n = 29/33 Engel I, p = 0.02), FA/flattening during the seizure (n = 38/46 Engel I, p = 0.05), or focal rhythmic sharp-/spike-/polyspike-and-slow waves during the seizure (n = 24/31, Engel Ia, p = 0.05) were favorable prognostic markers. Interictal polyspike waves (p = 0.006 for Engel Ia) and interictal paroxysmal FA (p = 0.02 for Engel I) were unfavorable prognostic markers. CONCLUSIONS Frontopolar scalp-EEG findings serve as biomarkers for predicting favorable surgical outcome in lesional frontal lobe epilepsy. Consequently, careful analysis of scalp-EEG assists in bypassing stereo-EEG in these patients.
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Affiliation(s)
- Gudrun Kalss
- Department of Neurology and Centre for Cognitive Neurosciences, Christian Doppler University Hospital, Paracelsus Medical University, Member of the European Reference Network EpiCARE, Salzburg, Austria
| | - Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Milan, Italy
| | - Georg Zimmermann
- Department of Neurology and Centre for Cognitive Neurosciences, Christian Doppler University Hospital, Paracelsus Medical University, Member of the European Reference Network EpiCARE, Salzburg, Austria
- Department of Mathematics, Paris-Lodron-University of Salzburg, Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria; and
| | - Eugen Trinka
- Department of Neurology and Centre for Cognitive Neurosciences, Christian Doppler University Hospital, Paracelsus Medical University, Member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Centre for Cognitive Neurosciences, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Milan, Italy
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Li H, Meng Q, Liu Y, Wu H, Dong Y, Ren Y, Zhang J, Du C, Dong S, Liu X, Zhang H. The value of ictal scalp EEG in focal epilepsies surgery: a retrospective analysis. Neurol Sci 2024:10.1007/s10072-024-07657-8. [PMID: 38902569 DOI: 10.1007/s10072-024-07657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To describe the association between preoperative ictal scalp electroencephalogram (EEG) results and surgical outcomes in patients with focal epilepsies. METHODS The data of consecutive patients with focal epilepsies who received surgical treatments at our center from January 2012 to December 2021 were retrospectively analyzed. RESULTS Our data showed that 44.2% (322/729) of patients had ictal EEG recorded on video EEG monitoring during preoperative evaluation, of which 60.6% (195/322) had a concordant ictal EEG results. No significant difference of surgery outcomes between patients with and without ictal EEG was discovered. Among MRI-negative patients, those with concordant ictal EEG had a significantly better outcome than those without ictal EEG (75.7% vs. 43.8%, p = 0.024). Further logistic regression analysis showed that concordant ictal EEG was an independent predictor for a favorable outcome (OR = 4.430, 95%CI 1.175-16.694, p = 0.028). Among MRI-positive patients, those with extra-temporal lesions and discordant ictal EEG results had a worse outcome compared to those without an ictal EEG result (44.7% vs. 68.8%, p = 0.005). Further logistic regression analysis showed that discordant ictal EEG was an independent predictor of worse outcome (OR = 0.387, 95%CI 0.186-0.807, p = 0.011) in these patients. Furthermore, our data indicated that the number of seizures was not associated with the concordance rates of the ictal EEG, nor the surgical outcomes. CONCLUSIONS The value of ictal scalp EEG for epilepsy surgery varies widely among patients. A concordant ictal EEG predicts a good surgical outcome in MRI-negative patients, whereas a discordant ictal EEG predicts a poor postoperative outcome in lesional extratemporal lobe epilepsy.
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Affiliation(s)
- Huanfa Li
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Qiang Meng
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Yong Liu
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Hao Wu
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yicong Dong
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yutao Ren
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
| | - Jiale Zhang
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
| | - Changwang Du
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Shan Dong
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Xiaofang Liu
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Hua Zhang
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China.
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China.
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
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Bolzan A, Benoit J, Pizzo F, Makhalova J, Villeneuve N, Carron R, Scavarda D, Bartolomei F, Lagarde S. Correspondence between scalp-EEG and stereoelectroencephalography seizure-onset patterns in patients with MRI-negative drug-resistant focal epilepsy. Epilepsia Open 2024; 9:568-581. [PMID: 38148028 PMCID: PMC10984298 DOI: 10.1002/epi4.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE Our objective was to evaluate the relationship between scalp-EEG and stereoelectroencephalography (SEEG) seizure-onset patterns (SOP) in patients with MRI-negative drug-resistant focal epilepsy. METHODS We analyzed retrospectively 41 patients without visible lesion on brain MRI who underwent video-EEG followed by SEEG. We defined five types of SOPs on scalp-EEG and eight types on SEEG. We examined how various clinical variables affected scalp-EEG SOPs. RESULTS The most prevalent scalp SOPs were rhythmic sinusoidal activity (56.8%), repetitive epileptiform discharges (22.7%), and paroxysmal fast activity (15.9%). The presence of paroxysmal fast activity on scalp-EEG was always seen without delay from clinical onset and correlated with the presence of low-voltage fast activity in SEEG (sensitivity = 22.6%, specificity = 100%). The main factor explaining the discrepancy between the scalp and SEEG SOPs was the delay between clinical and scalp-EEG onset. There was a correlation between the scalp and SEEG SOPs when the scalp onset was simultaneous with the clinical onset (p = 0.026). A significant delay between clinical and scalp discharge onset was observed in 25% of patients and featured always with a rhythmic sinusoidal activity on scalp, corresponding to similar morphology of the discharge on SEEG. The presence of repetitive epileptiform discharges on scalp was associated with an underlying focal cortical dysplasia (sensitivity = 30%, specificity = 90%). There was no significant association between the scalp SOP and the epileptogenic zone location (deep or superficial), or surgical outcome. SIGNIFICANCE In patients with MRI-negative focal epilepsy, scalp SOP could suggest the SEEG SOP and some etiology (focal cortical dysplasia) but has no correlation with surgical prognosis. Scalp SOP correlates with the SEEG SOP in cases of simultaneous EEG and clinical onset; otherwise, scalp SOP reflects the propagation of the SEEG discharge. PLAIN LANGUAGE SUMMARY We looked at the correspondence between the electrical activity recorded during the start of focal seizure using scalp and intracerebral electrodes in patients with no visible lesion on MRI. If there is a fast activity on scalp, it reflects similar activity inside the brain. We found a good correspondence between scalp and intracerebral electrical activity for cases without significant delay between clinical and scalp electrical onset (seen in 75% of the cases we studied). Visualizing repetitive epileptic activity on scalp could suggest a particular cause of the epilepsy: a subtype of brain malformation called focal cortical dysplasia.
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Affiliation(s)
- Anna Bolzan
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
| | - Jeanne Benoit
- CHU de Nice, Epileptology DepartmentUniversité Côte d'Azur, UMR2CA (URRIS)NiceFrance
| | - Francesca Pizzo
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | - Julia Makhalova
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
- APHM, Timone Hospital, CEMEREMMarseilleFrance
| | | | - Romain Carron
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
- APHM, Timone Hospital, Stereotactic and Functional Neurosurgery, Gamma UnitMarseilleFrance
| | - Didier Scavarda
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
- APHM, Timone Hospital, Paediatric NeurosurgeryMarseilleFrance
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | - Stanislas Lagarde
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
- University Hospitals of Geneva (HUG), University of Geneva (UNIGE)GenevaSwitzerland
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7
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Greenblatt AS, Beniczky S, Nascimento FA. Pitfalls in scalp EEG: Current obstacles and future directions. Epilepsy Behav 2023; 149:109500. [PMID: 37931388 DOI: 10.1016/j.yebeh.2023.109500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
Although electroencephalography (EEG) serves a critical role in the evaluation and management of seizure disorders, it is commonly misinterpreted, resulting in avoidable medical, social, and financial burdens to patients and health care systems. Overinterpretation of sharply contoured transient waveforms as being representative of interictal epileptiform abnormalities lies at the core of this problem. However, the magnitude of these errors is amplified by the high prevalence of paroxysmal events exhibited in clinical practice that compel investigation with EEG. Neurology training programs, which vary considerably both in the degree of exposure to EEG and the composition of EEG didactics, have not effectively addressed this widespread issue. Implementation of competency-based curricula in lieu of traditional educational approaches may enhance proficiency in EEG interpretation amongst general neurologists in the absence of formal subspecialty training. Efforts in this regard have led to the development of a systematic, high-fidelity approach to the interpretation of epileptiform discharges that is readily employable across medical centers. Additionally, machine learning techniques hold promise for accelerating accurate and reliable EEG interpretation, particularly in settings where subspecialty interpretive EEG services are not readily available. This review highlights common diagnostic errors in EEG interpretation, limitations in current educational paradigms, and initiatives aimed at resolving these challenges.
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Affiliation(s)
- Adam S Greenblatt
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund and Aarhus University Hospital, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Fábio A Nascimento
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
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Shrivastava M, Asranna A, Kenchiah R, Mundlamuri R, Viswanathan LG, Kulanthaivelu K, Bharath RD, Saini J, Sadashiva N, Arimappamagan A, Mahadevan A, Rajeswaran J, Malla BR, Sinha S. Yield of video electro encephalography for phase 1 pre-surgical evaluation of drug resistant epilepsy in 1200 adults: retrospective study from a tertiary center situated in a lower-middle-income country. Acta Neurol Belg 2023; 123:1773-1780. [PMID: 35908016 DOI: 10.1007/s13760-022-02031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Video Electroencephalography (VEEG) is crucial for presurgical evaluation of Drug Refractory Epilepsy (DRE). The yield of VEEG in large volume centers, particularly those situated in Low-and Middle-Income countries (LMIC) is not well studied. METHODOLOGY We studied 1200 adults with drug resistant focal epilepsy whose seizures were recorded during VEEG in the epilepsy monitoring unit. VEEG review and analysis was done independently by trained epileptologists. Video EEG and MRI data were examined for concordance in order to generate a hypothesis for the presumed epileptogenic zone. RESULTS Analysis of seizure semiology provided information on the symptomatogenic zone in most cases except for 33 (2.75%) patients. A total of 1050 (87.5%) patients showed interictal epileptiform discharges (IEDs) with most (58.3%) showing unilateral IEDs. Most patients (n = 1162, 96.83%) showed ictal EEG discharges of which 951(81.8%) had unilateral ictal onset. Abnormal MRI was seen in 978 (81.5%) patients. Concordance of electroclinical data obtained by analysis of VEEG with MRI abnormality could be established in most patients (63%). Concordance was higher for patients with ictal onset from temporal regions (83.71%) as compared to posterior cortex (55.4%) and frontal regions (43.5%.) CONCLUSION: This study highlights the high yield of VEEG in phase 1 presurgical evaluation in DRE. Systematic evaluation of data from VEEG provided lateralizing and localizing information in most cases. Concordance between VEEG and MRI findings was noted in most patients. These findings support steps to increase referral for pre-surgical evaluation in DRE.
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Affiliation(s)
- Mayank Shrivastava
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Ajay Asranna
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Raghavendra Kenchiah
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Ravindranath Mundlamuri
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Karthik Kulanthaivelu
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Rose Dawn Bharath
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Jitender Saini
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Nishanth Sadashiva
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Anita Mahadevan
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Jamuna Rajeswaran
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Bhaskara Rao Malla
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Sanjib Sinha
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
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9
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Santalucia R, Carapancea E, Vespa S, Germany Morrison E, Ghasemi Baroumand A, Vrielynck P, Fierain A, Joris V, Raftopoulos C, Duprez T, Ferrao Santos S, van Mierlo P, El Tahry R. Clinical added value of interictal automated electrical source imaging in the presurgical evaluation of MRI-negative epilepsy: A real-life experience in 29 consecutive patients. Epilepsy Behav 2023; 143:109229. [PMID: 37148703 DOI: 10.1016/j.yebeh.2023.109229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE During the presurgical evaluation, manual electrical source imaging (ESI) provides clinically useful information in one-third of the patients but it is time-consuming and requires specific expertise. This prospective study aims to assess the clinical added value of a fully automated ESI analysis in a cohort of patients with MRI-negative epilepsy and describe its diagnostic performance, by evaluating sublobar concordance with stereo-electroencephalography (SEEG) results and surgical resection and outcome. METHODS All consecutive patients referred to the Center for Refractory Epilepsy (CRE) of St-Luc University Hospital (Brussels, Belgium) for presurgical evaluation between 15/01/2019 and 31/12/2020 meeting the inclusion criteria, were recruited to the study. Interictal ESI was realized on low-density long-term EEG monitoring (LD-ESI) and, whenever available, high-density EEG (HD-ESI), using a fully automated analysis (Epilog PreOp, Epilog NV, Ghent, Belgium). The multidisciplinary team (MDT) was asked to formulate hypotheses about the epileptogenic zone (EZ) location at sublobar level and make a decision on further management for each patient at two distinct moments: i) blinded to ESI and ii) after the presentation and clinical interpretation of ESI. Results leading to a change in clinical management were considered contributive. Patients were followed up to assess whether these changes lead to concordant results on stereo-EEG (SEEG) or successful epilepsy surgery. RESULTS Data from all included 29 patients were analyzed. ESI led to a change in the management plan in 12/29 patients (41%). In 9/12 (75%), modifications were related to a change in the plan of the invasive recording. In 8/9 patients, invasive recording was performed. In 6/8 (75%), the intracranial EEG recording confirmed the localization of the ESI at a sublobar level. So far, 5/12 patients, for whom the management plan was changed after ESI, were operated on and have at least one-year postoperative follow-up. In all cases, the EZ identified by ESI was included in the resection zone. Among these patients, 4/5 (80%) are seizure-free (ILAE 1) and one patient experienced a seizure reduction of more than 50% (ILAE 4). CONCLUSIONS In this single-center prospective study, we demonstrated the added value of automated ESI in the presurgical evaluation of MRI-negative cases, especially in helping to plan the implantation of depth electrodes for SEEG, provided that ESI results are integrated into the whole multimodal evaluation and clinically interpreted.
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Affiliation(s)
- Roberto Santalucia
- Cliniques Universitaires Saint-Luc, Paediatric Neurology Unit, Brussels, Belgium; Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Centre Hospitalier Neurologique William Lennox (CHNWL), Clinical Neurophysiology, Ottignies, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium.
| | - Evelina Carapancea
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Simone Vespa
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Enrique Germany Morrison
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Amir Ghasemi Baroumand
- Medical Image and Signal Processing, Ghent University, Ghent, Belgium; Epilog NV, Ghent, Belgium
| | - Pascal Vrielynck
- Centre Hospitalier Neurologique William Lennox (CHNWL), Clinical Neurophysiology, Ottignies, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium
| | - Alexane Fierain
- Centre Hospitalier Neurologique William Lennox (CHNWL), Clinical Neurophysiology, Ottignies, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium
| | - Vincent Joris
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurosurgery Unit, Brussels, Belgium
| | - Christian Raftopoulos
- Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurosurgery Unit, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Medical Imaging Department, Neuroradiology Unit, Belgium
| | - Susana Ferrao Santos
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium
| | - Pieter van Mierlo
- Medical Image and Signal Processing, Ghent University, Ghent, Belgium; Epilog NV, Ghent, Belgium
| | - Riëm El Tahry
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium; WELBIO Department, WEL Research Institute, Avenue Pasteur 6, 1300 Wavre, Belgium
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10
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Piccenna L, O'Dwyer R, Leppik I, Beghi E, Giussani G, Costa C, DiFrancesco JC, Dhakar MB, Akamatsu N, Cretin B, Krämer G, Faught E, Kwan P. Management of epilepsy in older adults: A critical review by the ILAE Task Force on Epilepsy in the elderly. Epilepsia 2023; 64:567-585. [PMID: 36266921 DOI: 10.1111/epi.17426] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022]
Abstract
Older adults represent a highly heterogeneous population, with multiple diverse subgroups. Therefore, an individualized approach to treatment is essential to meet the needs of each unique subgroup. Most comparative studies focusing on treatment of epilepsy in older adults have found that levetiracetam has the best chance of long-term seizure freedom. However, there is a lack of studies investigating other newer generation antiseizure medications (ASMs). Although a number of randomized clinical trials have been performed on older adults with epilepsy, the number of participants studied was generally small, and they only investigated short-term efficacy and tolerability. Quality of life as an outcome is often missing but is necessary to understand the effectiveness and possible side effects of treatment. Prognosis needs to move beyond the focus on seizure control to long-term patient-centered outcomes. Dosing studies with newer generation ASMs are needed to understand which treatments are the best in the older adults with different comorbidities. In particular, more high-level evidence is required for older adults with Alzheimer's disease with epilepsy and status epilepticus. Future treatment studies should use greater homogeneity in the inclusion criteria to allow for clearer findings that can be comparable with other studies to build the existing treatment evidence base.
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Affiliation(s)
- Loretta Piccenna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Rebecca O'Dwyer
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Ilo Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ettore Beghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Giorgia Giussani
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Cinzia Costa
- Neuroscience Platform, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, Azienda Socio Sanitaria Territoriale (ASST) - San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - Monica B Dhakar
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Naoki Akamatsu
- Department of Neurology, Fukuoka Sanno Hospital, International University of Health and Welfare School of Medicine, Fukuoka, Japan
| | - Benjamin Cretin
- Neuropsychology Unit, Department of Neurology, Strasbourg University Hospitals, Strasbourg, France
| | | | - Edward Faught
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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11
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Gupta S, Razdan R, Hanumanthu R, Tomycz L, Ghesani N, Pak J, Kannurpatti SS. MRI based composite parameter of multiple tissue types for improved patient-level hemispheric and regional level lateralization in pediatric epilepsy. Magn Reson Imaging 2022; 94:174-180. [PMID: 36241030 DOI: 10.1016/j.mri.2022.10.003] [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: 07/06/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Although voxel-based morphometry (VBM) of gray matter (GM), white matter (WM) and cerebrospinal fluid (CSF) changes aid in epileptic seizure lateralization, type of T1 pulse sequence, preprocessing steps and tissue segmentation methods lead to variation in tissue classification. Here, we test the prediction accuracy of individual MRI based tissue types and a novel composite ratio parameter [(GM + WM)/CSF], sensitive to parenchymal changes and independent of tissue classification variations. Pediatric patients with partial seizures (both simple and complex), but normal and lesion-free MRI were considered (33 patients; unilateral EEG; 17 female / 16 male; age mean ± SD = 11.5 ± 5 years). MRI based seizure lateralization was performed for each patient and verified with EEG findings alone or in combination with seizure semiology. T1 weighted MRI from patients and normal control subjects was spatially transformed to the Talairach atlas and automatically segmented into GM, WM and CSF tissue types. 41 age matched normal controls (11 female / 30 male; age mean ± SD = 14.6 ± 3 years) served as the null distribution to test tissue type deviations across each epilepsy patient. When verified with the patient EEG prediction, WM, GM and CSF had a hemispheric match of 76%, 70% and 55% respectively, while the composite ratio [(GM + WM)/CSF)] showed the highest accuracy of 85%. When EEG findings and seizure semiology were combined, MRI predictions using the composite ratio improved further to 88%. To further localize the epileptic focus, regional level (frontal, temporal, parietal and occipital) MRI predictions were obtained. The composite ratio performed at 88-91% accuracy, revealing regional MRI changes, not predictable with EEG. The results show inconsistent changes in GM and WM in majority of the pediatric epilepsy patients and demonstrate the applicability of the composite ratio [(GM + WM)/CSF)] as a superior predictor, independent of tissue classification variations. Clinical EEG findings combined with seizure semiology, can overcome scalp EEG's limitations and lean towards the MRI lateralization in specific cases.
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Affiliation(s)
- Siddharth Gupta
- Department of Neurology, Rutgers Biomedical and Health Sciences-New Jersey Medical School, Newark, NJ, USA
| | - Reena Razdan
- Department of Radiology, Rutgers Biomedical and Health Sciences-New Jersey Medical School, Newark, NJ, USA
| | | | - Luke Tomycz
- Department of Neurosurgery, Rutgers Biomedical and Health Sciences-New Jersey Medical School, Newark, NJ, USA
| | - Nasrin Ghesani
- Department of Radiology, Rutgers Biomedical and Health Sciences-New Jersey Medical School, Newark, NJ, USA
| | - Jayoung Pak
- Department of Neurology, Rutgers Biomedical and Health Sciences-New Jersey Medical School, Newark, NJ, USA
| | - Sridhar S Kannurpatti
- Department of Radiology, Rutgers Biomedical and Health Sciences-New Jersey Medical School, Newark, NJ, USA.
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12
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Al-Bakri AF, Martinek R, Pelc M, Zygarlicki J, Kawala-Sterniuk A. Implementation of a Morphological Filter for Removing Spikes from the Epileptic Brain Signals to Improve Identification Ripples. SENSORS (BASEL, SWITZERLAND) 2022; 22:7522. [PMID: 36236621 PMCID: PMC9571066 DOI: 10.3390/s22197522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Epilepsy is a very common disease affecting at least 1% of the population, comprising a number of over 50 million people. As many patients suffer from the drug-resistant version, the number of potential treatment methods is very small. However, since not only the treatment of epilepsy, but also its proper diagnosis or observation of brain signals from recordings are important research areas, in this paper, we address this very problem by developing a reliable technique for removing spikes and sharp transients from the baseline of the brain signal using a morphological filter. This allows much more precise identification of the so-called epileptic zone, which can then be resected, which is one of the methods of epilepsy treatment. We used eight patients with 5 KHz data set and depended upon the Staba 2002 algorithm as a reference to detect the ripples. We found that the average sensitivity and false detection rate of our technique are significant, and they are ∼94% and ∼14%, respectively.
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Affiliation(s)
- Amir F. Al-Bakri
- Department of Biomedical Engineering, College of Engineering, University of Babylon, Hillah 51001, Iraq
| | - Radek Martinek
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University Ostrava—FEECS, 708 00 Ostrava–Poruba, Czech Republic
| | - Mariusz Pelc
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
- School of Computing and Mathematical Sciences, University of Greenwich, Park Row, London SE10 9LS, UK
| | - Jarosław Zygarlicki
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
| | - Aleksandra Kawala-Sterniuk
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
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13
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Lau LA, Staley KJ, Lillis KP. In vitro ictogenesis is stochastic at the single neuron level. Brain 2022; 145:531-541. [PMID: 34431994 PMCID: PMC9014754 DOI: 10.1093/brain/awab312] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 11/14/2022] Open
Abstract
Seizure initiation is the least understood and most disabling element of epilepsy. Studies of ictogenesis require high speed recordings at cellular resolution in the area of seizure onset. However, in vivo seizure onset areas cannot be determined at the level of resolution necessary to enable such studies. To circumvent these challenges, we used novel GCaMP7-based calcium imaging in the organotypic hippocampal slice culture model of post-traumatic epilepsy in mice. Organotypic hippocampal slice cultures generate spontaneous, recurrent seizures in a preparation in which it is feasible to image the activity of the entire network (with no unseen inputs existing). Chronic calcium imaging of the entire hippocampal network, with paired electrophysiology, revealed three patterns of seizure onset: (i) low amplitude fast activity; (ii) sentinel spike; and (iii) spike burst and low amplitude fast activity onset. These patterns recapitulate common features of human seizure onset, including low voltage fast activity and spike discharges. Weeks-long imaging of seizure activity showed a characteristic evolution in onset type and a refinement of the seizure onset zone. Longitudinal tracking of individual neurons revealed that seizure onset is stochastic at the single neuron level, suggesting that seizure initiation activates neurons in non-stereotyped sequences seizure to seizure. This study demonstrates for the first time that transitions to seizure are not initiated by a small number of neuronal 'bad actors' (such as overly connected hub cells), but rather by network changes which enable the onset of pathology among large populations of neurons.
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Affiliation(s)
- Lauren A Lau
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Kevin J Staley
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Kyle P Lillis
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
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14
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Thamcharoenvipas T, Takahashi Y, Kimura N, Matsuda K, Usui N. Localizing and Lateralizing Value of Seizure Onset Pattern on Surface EEG in FCD Type II. Pediatr Neurol 2022; 129:48-54. [PMID: 35231790 DOI: 10.1016/j.pediatrneurol.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/26/2021] [Accepted: 01/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surface ictal electroencephalographic (EEG) monitoring has an important role in the presurgical evaluation of patients with focal cortical dysplasia (FCD). This study aimed to examine the characteristics of seizure onset pattern (SOP) on surface ictal EEG. This information will be useful for invasive monitoring planning. METHODS We reviewed 290 seizures from 31 patients with intractable seizures related to FCD type II (6 patients with FCD IIa and 25 patients with FCD IIb). We categorized the SOPs into five patterns and evaluated the relationships between the SOPs and the location and pathology of the FCD II subtype. RESULTS The most common SOP was no apparent change (39.0%), followed by rhythmic slow wave and repetitive spikes/sharp waves. The SOP of rhythmic slow wave was associated with FCD II in the temporal lobe (P < 0.001), and the SOP of no apparent change was associated with FCD II in the occipital lobe (P = 0.012). The SOPs of rhythmic slow waves and fast activity were most common in FCD IIa, P < 0.001 and 0.031, respectively. The repetitive spikes/sharp waves SOP was the most common pattern in FCD IIb (P < 0.001). The surface SOPs provided correct localization and lateralization of epileptic foci in FCD in 62.1% and 62.7%, respectively. In 61.3% of the patients, over 50% of the SOPs in each patient indicated accurate localization. CONCLUSIONS SOPs in surface EEG monitoring are beneficial for presurgical evaluation and lead to localization of epileptic foci and pathologic subtypes of FCD.
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Affiliation(s)
- Titaporn Thamcharoenvipas
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan; Division of Neurology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan; Department of Pediatrics, Gifu University School of Medicine, Gifu, Japan; School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan.
| | - Nobusuke Kimura
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Kazumi Matsuda
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Naotaka Usui
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
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15
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Park DK, Kim W, Thornburg O, McBrian D, McKhann G, Feldstein N, Maddocks A, Gonzalez E, Shen MY, Akman C, Provenzano F. Convolutional Neural Network-aided Tuber Segmentation in Tuberous Sclerosis Complex Patients Correlates with EEG. Epilepsia 2022; 63:1530-1541. [PMID: 35301716 DOI: 10.1111/epi.17227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE One of the clinical hallmarks of tuberous sclerosis complex is radiologically-identified cortical tubers present in most patients. Intractable epilepsy may require surgery, often involving invasive diagnostic procedures such as intracranial EEG. Identifying the location of the dominant tuber responsible for generating epileptic activities, is a critical issue. However, the link between cortical tubers and epileptogenesis is poorly understood. Given this, we hypothesized that tuber voxel intensity may be an indicator of the dominant epileptogenic tuber. Also, via tuber segmentation based on deep learning, we explore whether an automatic quantification of the tuber burden is feasible. METHODS We annotated tubers from structural MRIs across 29 TSC subjects, summarized tuber statistics in eight brain lobes, and determined suspected epileptogenic lobes from the same group using EEG monitoring data. Then logistic regression analyses are performed to demonstrate the linkage between the statistics of cortical tuber and the epileptogenic zones. Furthermore, we test the ability of a neural network to identify and quantify tuber burden. RESULTS Logistic regression analyses show that the volume and count of tubers per lobe, not the mean or variance of tuber voxel intensity, are positively correlated with electrophysiological data. In 47.6% of subjects, the lobe with the largest tuber volume concurred with the epileptic brain activity. A neural network model on the test dataset shows a sensitivity of 0.83 for localizing individual tubers. The predicted masks from the model highly correlated with the neurologist labels, thus may be a useful tool for determining tuber burden and searching for epileptogenic zone. SIGNIFICANCE we prove the feasibility of an automatic segmentation of tubers and a derivation of tuber burden across brain lobes. Our method may provide crucial insights in the treatment and outcome of TSC patients.
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Affiliation(s)
- David K Park
- Department of Biomedical Engineering, Columbia University
| | - Woojoong Kim
- Columbia University Irving Medical Center.,Child Neurology, Columbia University Medical Center
| | | | | | - Guy McKhann
- Neurological Surgery, Columbia University Medical Center
| | - Neil Feldstein
- Neurological Surgery, Columbia University Medical Center
| | | | | | - Min Y Shen
- Columbia University Irving Medical Center
| | - Cigdem Akman
- Columbia University Irving Medical Center.,Child Neurology, Columbia University Medical Center
| | - Frank Provenzano
- Columbia University Irving Medical Center.,Department of Neurology, Columbia University
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16
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Elezi L, Koren JP, Pirker S, Baumgartner C. Automatic seizure detection and seizure pattern morphology. Clin Neurophysiol 2022; 138:214-220. [DOI: 10.1016/j.clinph.2022.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
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17
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de Borman A, Vespa S, Absil PA, El Tahry R. Estimation of seizure onset zone from ictal scalp EEG using independent component analysis in extratemporal lobe epilepsy. J Neural Eng 2022; 19. [PMID: 35172295 DOI: 10.1088/1741-2552/ac55ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study is to localize the seizure onset zone of patients suffering from drug-resistant epilepsy. During the last two decades, multiple studies proposed the use of Independent Component Analysis (ICA) to analyze ictal electroencephalogram (EEG) recordings. This study aims at evaluating ICA potential with quantitative measurements. In particular, we address the challenging step where the components extracted by ICA of an ictal nature must be selected. APPROACH We considered a cohort of 10 patients suffering from extratemporal lobe epilepsy who were rendered seizure-free after surgery. Different sets of pre-processing parameters were compared and component features were explored to help distinguish ictal components from others. Quantitative measurements were implemented to determine whether some of the components returned by ICA were located within the resection zone and thus likely to be ictal. Finally, an assistance to the component selection was proposed based on the implemented features. MAIN RESULTS For every seizure, at least one component returned by ICA was localized within the resection zone, with the optimal pre-processing parameters. Three features were found to distinguish components localized within the resection zone: the dispersion of their active brain sources, the ictal rhythm power and the contribution to the EEG variance. Using the implemented component selection assistance based on the features, the probability that the first proposed component yields an accurate estimation reaches 51.43% (without assistance: 24.74%). The accuracy reaches 80% when considering the best result within the first five components. SIGNIFICANCE This study confirms the utility of ICA for ictal EEG analysis in extratemporal lobe epilepsy, and suggests relevant features to analyze the components returned by ICA. A component selection assistance is proposed to guide clinicians in their choice for ictal components.
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Affiliation(s)
- Aurélie de Borman
- ICTEAM, Université catholique de Louvain, Avenue Georges Lemaitre 4, Louvain-la-Neuve, 1348, BELGIUM
| | - Simone Vespa
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Avenue Mounier 53 bte B1.53.02, Louvain-la-Neuve, 1348, BELGIUM
| | - Pierre-Antoine Absil
- ICTEAM, Université catholique de Louvain, Avenue Georges Lemaître 4 bte L4.05.01, Louvain-la-Neuve, 1348, BELGIUM
| | - Riëm El Tahry
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Avenue Mounier 53 bte B1.53.02, Louvain-la-Neuve, 1348, BELGIUM
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Frazzini V, Cousyn L, Navarro V. Semiology, EEG, and neuroimaging findings in temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:489-518. [PMID: 35964989 DOI: 10.1016/b978-0-12-823493-8.00021-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy. First descriptions of TLE date back in time and detailed portraits of epileptic seizures of temporal origin can be found in early medical reports as well as in the works of various artists and dramatists. Depending on the seizure onset zone, several subtypes of TLE have been identified, each one associated with peculiar ictal semiology. TLE can result from multiple etiological causes, ranging from genetic to lesional ones. While the diagnosis of TLE relies on detailed analysis of clinical as well as electroencephalographic (EEG) features, the lesions responsible for seizure generation can be highlighted by multiple brain imaging modalities or, in selected cases, by genetic investigations. TLE is the most common cause of refractory epilepsy and despite the great advances in diagnostic tools, no lesion is found in around one-third of patients. Surgical treatment is a safe and effective option, requiring presurgical investigations to accurately identify the seizure onset zone (SOZ). In selected cases, presurgical investigations need intracerebral investigations (such as stereoelectroencephalography) or dedicated metabolic imaging techniques (interictal PET and ictal SPECT) to correctly identify the brain structures to be removed.
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Affiliation(s)
- Valerio Frazzini
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Louis Cousyn
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Vincent Navarro
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France.
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19
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-EEG monitoring: A clinical practice guideline of the international league against epilepsy and international federation of clinical neurophysiology. Clin Neurophysiol 2021; 134:111-128. [PMID: 34955428 DOI: 10.1016/j.clinph.2021.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events (see Table S1). For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, WV, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, France.
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich Switzerland.
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Danish Epilepsy Center, Dianalund, Denmark.
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20
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-electroencephalographic monitoring: A clinical practice guideline of the International League Against Epilepsy and International Federation of Clinical Neurophysiology. Epilepsia 2021; 63:290-315. [PMID: 34897662 DOI: 10.1111/epi.16977] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events. For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and to establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, Nancy, France
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich,, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Danish Epilepsy Center, Dianalund, Denmark
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21
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Detection of preictal state in epileptic seizures using ensemble classifier. Epilepsy Res 2021; 178:106818. [PMID: 34847427 DOI: 10.1016/j.eplepsyres.2021.106818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/10/2021] [Accepted: 11/12/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Epilepsy affected patient experiences more than one frequency seizures which can not be treated with medication or surgical procedures in 30% of the cases. Therefore, an early prediction of these seizures is inevitable for these cases to control them with therapeutic interventions. METHODS In recent years, researchers have proposed multiple deep learning based methods for detection of preictal state in electroencephalogram (EEG) signals, however, accurate detection of start of preictal state remains a challenge. We propose a novel ensemble classifier based method that gets the comprehensive feature set as input and combines three different classifiers to detect the preictal state. RESULTS We have applied the proposed method on the publicly available scalp EEG dataset CHBMIT of 22 subjects. An average accuracy of 94.31% with sensitivity and specificity of 94.73% and 93.72% respectively has been achieved with the method proposed in this study. CONCLUSIONS Proposed study utilizes the preprocessing techniques for noise removal, combines deep learning based and handcrafted features and an ensemble classifier for detection of start of preictal state. Proposed method gives better results in terms of accuracy, sensitivity, and specificity.
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Abstract
BACKGROUND A large number of patients have epilepsy that is intractable and adversely affects a child's lifelong experience with addition societal burden that is disabling and expensive. The last two decades have seen a major explosion of new antiseizure medication options. Despite these advances, children with epilepsy continue to have intractable seizures. An option that has been long available but little used is epilepsy surgery to control intractable epilepsy. METHODS This article is a review of the literature as well as published opinions. RESULTS Epilepsy surgery in pediatrics is an underused modality to effectively treat children with epilepsy. Adverse effects of medication should be weighed against risks of surgery as well as risks of nonefficacy. CONCLUSIONS We discuss an approach to selecting the appropriate pediatric patient for consideration, a detailed evaluation including necessary evaluation, and the creation of an algorithm to approach patients with both generalized and focal epilepsy. We then discuss surgical options available including outcome data. New modalities are also addressed including high-frequency ultrasound and co-registration techniques including magnetic resonance imaging-guided laser therapy.
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23
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Vandecasteele K, De Cooman T, Chatzichristos C, Cleeren E, Swinnen L, Macea Ortiz J, Van Huffel S, Dümpelmann M, Schulze-Bonhage A, De Vos M, Van Paesschen W, Hunyadi B. The power of ECG in multimodal patient-specific seizure monitoring: Added value to an EEG-based detector using limited channels. Epilepsia 2021; 62:2333-2343. [PMID: 34240748 PMCID: PMC8518059 DOI: 10.1111/epi.16990] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022]
Abstract
Objective Wearable seizure detection devices could provide more reliable seizure documentation outside the hospital compared to seizure self‐reporting by patients, which is the current standard. Previously, during the SeizeIT1 project, we studied seizure detection based on behind‐the‐ear electroencephalography (EEG). However, the obtained sensitivities were too low for practical use, because not all seizures are associated with typical ictal EEG patterns. Therefore, in this paper, we aim to develop a multimodal automated seizure detection algorithm integrating behind‐the‐ear EEG and electrocardiography (ECG) for detecting focal seizures. In this framework, we quantified the added value of ECG to behind‐the‐ear EEG. Methods This study analyzed three multicenter databases consisting of 135 patients having focal epilepsy and a total of 896 seizures. A patient‐specific multimodal automated seizure detection algorithm was developed using behind‐the‐ear/temporal EEG and single‐lead ECG. The EEG and ECG data were processed separately using machine learning methods. A late integration approach was applied for fusing those predictions. Results The multimodal algorithm outperformed the EEG‐based algorithm in two of three databases, with an increase of 11% and 8% in sensitivity for the same false alarm rate. Significance ECG can be of added value to an EEG‐based seizure detection algorithm using only behind‐the‐ear/temporal lobe electrodes for patients with focal epilepsy.
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Affiliation(s)
- Kaat Vandecasteele
- Department of Electrical Engineering, STADIUS Center for Dynamic Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Thomas De Cooman
- Department of Electrical Engineering, STADIUS Center for Dynamic Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Christos Chatzichristos
- Department of Electrical Engineering, STADIUS Center for Dynamic Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Evy Cleeren
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Lauren Swinnen
- Laboratory for Epilepsy Research, Department of Neurology, University Hospital, KU Leuven, Leuven, Belgium
| | - Jaiver Macea Ortiz
- Laboratory for Epilepsy Research, Department of Neurology, University Hospital, KU Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering, STADIUS Center for Dynamic Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Matthias Dümpelmann
- Faculty of Medicine, Department of Neurosurgery, Epilepsy Center, University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Faculty of Medicine, Department of Neurosurgery, Epilepsy Center, University of Freiburg, Freiburg, Germany
| | - Maarten De Vos
- Department of Electrical Engineering, STADIUS Center for Dynamic Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, Department of Neurology, University Hospital, KU Leuven, Leuven, Belgium
| | - Borbála Hunyadi
- Department of Microelectronics, TU Delft, Delft, Netherlands
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24
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Hu D, Cao J, Lai X, Liu J, Wang S, Ding Y. Epileptic Signal Classification Based on Synthetic Minority Oversampling and Blending Algorithm. IEEE Trans Cogn Dev Syst 2021. [DOI: 10.1109/tcds.2020.3009020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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25
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Frey J, Seachrist E. Clinical Reasoning: A 70-Year-Old Man With Right Arm and Leg Shaking. Neurology 2021; 96:1098-1101. [PMID: 33849992 DOI: 10.1212/wnl.0000000000012047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jessica Frey
- From the Department of Neurology, West Virginia University, Morgantown.
| | - Eric Seachrist
- From the Department of Neurology, West Virginia University, Morgantown
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26
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Andrade-Machado R, Benjumea Cuartas V, Muhammad IK. Recognition of interictal and ictal discharges on EEG. Focal vs generalized epilepsy. Epilepsy Behav 2021; 117:107830. [PMID: 33639439 DOI: 10.1016/j.yebeh.2021.107830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The differentiation between focal and generalized epilepsies based on clinical and electroencephalographic features is difficult and sometimes confusing. OBJECTIVE To review the EEG findings in patients with focal epilepsy. METHODS An extensive literature review was done. We used the following Pubmed and Medline descriptors alone and in different combinations for database searching: focal, partial, epilepsy, electroencephalographic findings, and EEG. Additional filters included review, original articles, and language limited to Spanish and English. Using the above criteria, a total of 69 articles showed the interictal and ictal EEG findings in focal epilepsy. DEVELOPMENT Focal epileptiform discharges and persistence of focal abnormalities, characterize the interictal EEG findings in focal epilepsies. To distinguish SBS from primary generalized spike waves are required to note: (a) a lead-in time of at least 2 s, (b) the morphology of the focal triggering spikes clearly differ from that of the bisynchronous epileptiform paroxysms, and (c) the morphology of triggering spikes resemble that of other focal spikes from the same region. Focal and Generalized Epilepsy can coexist. Delayed Lateralization on EEG with inconclusive onset and bizarre semiology confusing semiology should not be confused with generalized onset seizures with focal evolution. CONCLUSIONS A close attention to localization and morphology of epileptiform discharges, the correct interpretation of secondary bilateral synchrony, and provocative maneuvers help to correctly identify the EEG findings leading to diagnose focal epilepsies. The presence of generalized epileptiform activity does not rule out the existence of a focal epilepsy.
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Morphological Description of Frontal EEG Interictal and Ictal Discharges in an Adult Cohort of 175 Patients. J Clin Med 2021; 10:jcm10061219. [PMID: 33804106 PMCID: PMC7999909 DOI: 10.3390/jcm10061219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/12/2021] [Accepted: 03/11/2021] [Indexed: 12/03/2022] Open
Abstract
Clinical and electroencephalogram (EEG) features in frontal lobe epilepsy (FLE) vary considerably among patients, making the diagnosis a challenge. The objective of this study was to describe interictal and ictal EEG activity, identifying variables that could help to differentiate and diagnose frontal lobe epilepsy cases. A prospective cross-sectional study from patients with frontal interictal epileptiform discharges (IED) referred to the Vall d’Hebron University Hospital (Barcelona, Spain) after a clinical event compatible with epileptic seizures was designed. The interictal and ictal activity were analyzed to provide a detailed EEG description of the cases, using different statistical analyses. The morphological seizure pattern at the ictal onset remained globally unchanged over time in seizures arising from the frontal lobe for each patient. Isolated sharp waves were the most frequent waveforms in the expression of IED. Frontal lobe seizures are frequently short and sometimes appear grouped in clusters within the same recording. Often the ictal expression of the electrical activity in frontal lobe seizure is subtle and challenging to interpret. A description of the main findings is summarized to identify seizures arising from the frontal lobe and avoid false negatives findings in EEG interpretations.
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28
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Bonilha L. Artificial intelligence to enhance the evaluation of refractory epilepsies. Epilepsy Behav 2021; 116:107776. [PMID: 33582012 DOI: 10.1016/j.yebeh.2021.107776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, United States.
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29
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Erturk Cetin O, Sirin NG, Elmali AD, Baykan B, Bebek N. Different faces of frontal lobe epilepsy: The clinical, electrophysiologic, and imaging experience of a tertiary center. Clin Neurol Neurosurg 2021; 203:106532. [PMID: 33618170 DOI: 10.1016/j.clineuro.2021.106532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Frontal lobe epilepsy (FLE) is the second most common epilepsy among drug-resistant focal epilepsies. Semiologic and electrophysiologic features of FLE present some difficulties because frontal lobe seizures are brief, accompanied by complex motor activities and emotional signs. The rich connectivity of the frontal lobe with other areas leads to the rapid and widespread propagation of seizure activity, which contribute to the difficulty of evaluating the semiologic and EEG patterns of the seizure. In this study, we investigated semiologic, interictal, ictal, and postictal EEG characteristics; the imaging data of patients with FLE and the possible contribution of these data to localization and lateralization of seizures. MATERIALS AND METHODS The medical records of patients who were diagnosed as having FLE between 2010 and 2019 in our clinic were evaluated retrospectively. The diagnosis of FLE was considered either when patients had a structural lesion in the frontal region or seizure semiology and EEG characteristics were compatible with FLE. Clinical, electrophysiologic, and imaging features were investigated in these patients. RESULTS We have evaluated 146 seizures in 36 patients (17 lesional and 19 non-lesional according to MRI). There were 110 focal motor or nonmotor seizures, 18 bilateral tonic-clonic seizures, and 18 subclinical seizures. There were 16 patients with aura. The most common semiologic feature was hyperkinetic movements. Among the interictal EEGs, 30.5 % included focal anomalies. Among the ictal EEGs, 69.1 % were non-localizing or lateralizing. The most common ictal pattern was rhythmic theta activity (21.2 %). In four patients, who had non-localizing or lateralizing EEG, the postictal EEG was informative. Our study showed a low percentage of localized FDG-PET, which, however, involved visual analysis. CONCLUSION Our results support the previously known difficulties in the determination of the epileptogenic zone of FLE. Semiologic and electrophysiologic correlation studies, longer postictal records, and quantitative analysis of FDG-PET may contribute to a better characterization of the disease.
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Affiliation(s)
- Ozdem Erturk Cetin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey; Istanbul University, Graduate School of Health Sciences, Department of Neuroscience, Istanbul, Turkey; University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
| | - Nermin Gorkem Sirin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Ayse Deniz Elmali
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Betul Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Nerses Bebek
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
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Baud MO, Schindler K, Rao VR. Under-sampling in epilepsy: Limitations of conventional EEG. Clin Neurophysiol Pract 2020; 6:41-49. [PMID: 33532669 PMCID: PMC7829106 DOI: 10.1016/j.cnp.2020.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/26/2022] Open
Abstract
The cyclical structure of epilepsy was recently (re)-discovered through years-long intracranial electroencephalography (EEG) obtained with implanted devices. In this review, we discuss how new revelations from chronic EEG relate to the practice and interpretation of conventional EEG. We argue for an electrographic definition of seizures and highlight the caveats of counting epileptiform discharges in EEG recordings of short duration. Limitations of conventional EEG have practical implications with regard to titrating anti-seizure medications and allowing patients to drive, and we propose that chronic monitoring of brain activity could greatly improve epilepsy care. An impending paradigm shift in epilepsy will involve using next-generation devices for chronic EEG to leverage known biomarkers of disease state.
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Affiliation(s)
- Maxime O. Baud
- Sleep Wake Epilepsy Center, NeuroTec and Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Switzerland
- Wyss Center for Bio- and Neuro-engineering, Geneva, Switzerland
| | - Kaspar Schindler
- Sleep Wake Epilepsy Center, NeuroTec and Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Switzerland
| | - Vikram R. Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, United States
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31
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Tanaka H, Gotman J, Khoo HM, Olivier A, Hall J, Dubeau F. Neurophysiological seizure-onset predictors of epilepsy surgery outcome: a multivariable analysis. J Neurosurg 2020; 133:1863-1872. [PMID: 31783358 DOI: 10.3171/2019.9.jns19527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to determine which neurophysiological seizure-onset features seen during scalp electroencephalography (EEG) and intracerebral EEG (iEEG) monitoring are predictors of postoperative outcome in a large series of patients with drug-resistant focal epilepsy who underwent resective surgery. METHODS The authors retrospectively analyzed the records of 75 consecutive patients with focal epilepsy, who first underwent scalp EEG and then iEEG (stereo-EEG) for presurgical assessment and who went on to undergo resective surgery between 2004 and 2015. To determine the independent prognostic factors from the neurophysiological scalp EEG and iEEG seizure-onset information, univariate and standard multivariable logistic regression analyses were used. Since scalp EEG and iEEG data were recorded at different times, the authors matched scalp seizures with intracerebral seizures for each patient using strict criteria. RESULTS A total of 3057 seizures were assessed. Forty-eight percent (36/75) of patients had a favorable outcome (Engel class I-II) after a minimum follow-up of at least 1 year. According to univariate analysis, a localized scalp EEG seizure onset (p < 0.001), a multilobar intracerebral seizure-onset zone (SOZ) (p < 0.001), and an extended SOZ (p = 0.001) were significantly associated with surgical outcome. According to multivariable analysis, the following two independent factors were found: 1) the ability of scalp EEG to localize the seizure onset was a predictor of a favorable postoperative outcome (OR 6.073, 95% CI 2.011-18.339, p = 0.001), and 2) a multilobar SOZ was a predictor of an unfavorable outcome (OR 0.076, 95% CI 0.009-0.663, p = 0.020). CONCLUSIONS The study findings show that localization at scalp seizure onset and a multilobar SOZ were strong predictors of surgical outcome. These predictors can help to select the better candidates for resective surgery.
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Affiliation(s)
- Hideaki Tanaka
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- 2Department of Neurosurgery, Fukuoka University Hospital
- 3Fukuoka Sanno Hospital, Epilepsy and Sleep Center, Fukuoka; and
| | - Jean Gotman
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Hui Ming Khoo
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- 4Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - André Olivier
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeffery Hall
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Pacia SV, Doyle WK, Friedman D, H Bacher D, Kuzniecky RI. Intracranial EEG Validation of Single-Channel Subgaleal EEG for Seizure Identification. J Clin Neurophysiol 2020; 39:283-288. [PMID: 32925251 DOI: 10.1097/wnp.0000000000000774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE A device that provides continuous, long-term, accurate seizure detection information to providers and patients could fundamentally alter epilepsy care. Subgaleal (SG) EEG is a promising modality that offers a minimally invasive, safe, and accurate means of long-term seizure monitoring. METHODS Subgaleal EEG electrodes were placed, at or near the cranial vertex, simultaneously with intracranial EEG electrodes in 21 epilepsy patients undergoing intracranial EEG studies for up to 13 days. A total of 219, 10-minute single-channel SGEEG samples, including 138 interictal awake or sleep segments and 81 seizures (36 temporal lobe, 32 extra-temporal, and 13 simultaneous temporal/extra-emporal onsets) were reviewed by 3 expert readers blinded to the intracranial EEG results, then analyzed for accuracy and interrater reliability. RESULTS Using a single-channel of SGEEG, reviewers accurately identified 98% of temporal and extratemporal onset, intracranial, EEG-verified seizures with a sensitivity of 98% and specificity of 99%. All focal to bilateral tonic--clonic seizures were correctly identified. CONCLUSIONS Single-channel SGEEG, placed at or near the vertex, reliably identifies focal and secondarily generalized seizures. These findings demonstrate that the SG space at the cranial vertex may be an appropriate site for long-term ambulatory seizure monitoring.
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Affiliation(s)
- Steven V Pacia
- Department of Neurology, Zucker-Hofstra School of Medicine, Hempstead, New York, U.S.A
| | | | - Daniel Friedman
- Neurology, NYU Langone Medical Center, NYU School of Medicine, New York, New York, U.S.A
| | | | - Ruben I Kuzniecky
- Department of Neurology, Zucker-Hofstra School of Medicine, Hempstead, New York, U.S.A
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Rémi J, Shen S, Tacke M, Probst P, Gerstl L, Peraud A, Kunz M, Vollmar C, Noachtar S, Borggraefe I. Congruence and Discrepancy of Interictal and Ictal EEG With MRI Lesions in Pediatric Epilepsies. Clin EEG Neurosci 2020; 51:412-419. [PMID: 32420750 PMCID: PMC7457449 DOI: 10.1177/1550059420921712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To evaluate the congruence or discrepancy of the localization of magnetic resonance imaging (MRI) lesions with interictal epileptiform discharges (IEDs) or epileptic seizure patterns (ESPs) in surface EEG in lesional pediatric epilepsy patients. Methods. We retrospectively analyzed presurgical MRI and video-EEG monitoring findings of patients up to age 18 years. Localization of MRI lesions were compared with ictal and interictal noninvasive EEG findings of patients with frontal, temporal, parietal, or occipital lesions. Results. A total of 71 patients were included. Localization of ESPs showed better congruence with MRI in patients with frontal lesions (n = 21, 77.5%) than in patients with temporal lesions (n = 24; 40.7%) (P = .009). No significant IED distribution differences between MRI localizations could be found. Conclusions. MRI lesions and EEG findings are rarely fully congruent. Congruence of MRI lesions and ESPs was highest in children with frontal lesions. This is in contrast to adults, in whom temporal lesions showed the highest congruency with the EEG localization of ESP. Lesional pediatric patients should be acknowledged as surgical candidates despite incongruent findings of interictal and ictal surface EEG.
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Affiliation(s)
- Jan Rémi
- Department of Neurology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany.,Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany
| | - Sophie Shen
- Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
| | - Moritz Tacke
- Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
| | - Philipp Probst
- Department of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany
| | - Lucia Gerstl
- Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
| | - Aurelia Peraud
- Department of Neurosurgery, Pediatric Section, University of Ulm, Ulm, Germany
| | - Mathias Kunz
- Department of Neurosurgery, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany.,Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany
| | - Soheyl Noachtar
- Department of Neurology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany.,Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany
| | - Ingo Borggraefe
- Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany.,Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
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Polidoro D, Van Ham L, Santens P, Cornelis I, Charalambous M, Broeckx BJG, Bhatti SFM. Phenotypic characterization of paroxysmal dyskinesia in Maltese dogs. J Vet Intern Med 2020; 34:1541-1546. [PMID: 32415795 PMCID: PMC7379016 DOI: 10.1111/jvim.15804] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 01/03/2023] Open
Abstract
Background Paroxysmal dyskinesias (PDs) are a group of central nervous system diseases characterized by episodes of abnormal involuntary hyperkinetic movement without altered consciousness that increasingly have been recognized in dogs. Objectives To present the phenotypical characterization, treatment, and outcome of a PD observed in Maltese dogs. Animals Client‐owned Maltese dogs (n = 19) with presumed diagnosis of PD. Methods Data were collected retrospectively from medical records (2014‐2019), and supporting information was added prospectively by using a questionnaire directed to the owners of the affected dogs. Results The episodes were characterized mainly by sudden dystonia of ≥1 limbs and generalized body tremors with preserved consciousness. The mean age of clinical onset was 5.4 years. Episode frequency varied widely both among and within individuals. Median episode duration was 4.5 minutes. Most episodes were stress‐ or exercise‐induced. Acetazolamide was administered to 6 dogs, and 4 dogs experienced a decrease in episode frequency. In 7 dogs that received a gluten‐free diet, 6 dogs became episode‐free. In 4 dogs, the episodes stopped spontaneously and in 2 dogs no medication or specific diet was given and the episodes continued at the same frequency. Conclusions and Clinical Importance Given the breed predisposition and regional distribution of the disease, additional research should focus on elucidating the underlying genetic cause doing so might advance both our understanding of the pathophysiology and treatment of this disease, not only in dogs, but also in humans. Regardless of the treatment protocol selected, prognosis appears fair to good.
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Affiliation(s)
- Dakir Polidoro
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luc Van Ham
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Patrick Santens
- Department of Neurology, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Ine Cornelis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bart J G Broeckx
- Laboratory of Animal Genetics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie F M Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Vespa S, Baroumand AG, Ferrao Santos S, Vrielynck P, de Tourtchaninoff M, Feys O, Strobbe G, Raftopoulos C, van Mierlo P, El Tahry R. Ictal EEG source imaging and connectivity to localize the seizure onset zone in extratemporal lobe epilepsy. Seizure 2020; 78:18-30. [DOI: 10.1016/j.seizure.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 12/16/2022] Open
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36
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Rikir E, Maillard LG, Abdallah C, Gavaret M, Bartolomei F, Vignal JP, Colnat-Coulbois S, Koessler L. Respective Contribution of Ictal and Inter-ictal Electrical Source Imaging to Epileptogenic Zone Localization. Brain Topogr 2020; 33:384-402. [DOI: 10.1007/s10548-020-00768-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
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37
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Kang J, Kadam SD, Elmore JS, Sullivan BJ, Valentine H, Malla AP, Harraz MM, Rahmim A, Kang JU, Loew LM, Baumann MH, Grace AA, Gjedde A, Boctor EM, Wong DF. Transcranial photoacoustic imaging of NMDA-evoked focal circuit dynamics in the rat hippocampus. J Neural Eng 2020; 17:025001. [PMID: 32084654 DOI: 10.1088/1741-2552/ab78ca] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We report the transcranial functional photoacoustic (fPA) neuroimaging of N-methyl-D-aspartate (NMDA) evoked neural activity in the rat hippocampus. Concurrent quantitative electroencephalography (qEEG) and microdialysis were used to record real-time circuit dynamics and excitatory neurotransmitter concentrations, respectively. APPROACH We hypothesized that location-specific fPA voltage-sensitive dye (VSD) contrast would identify neural activity changes in the hippocampus which correlate with NMDA-evoked excitatory neurotransmission. MAIN RESULTS Transcranial fPA VSD imaging at the contralateral side of the microdialysis probe provided NMDA-evoked VSD responses with positive correlation to extracellular glutamate concentration changes. qEEG validated a wide range of glutamatergic excitation, which culminated in focal seizure activity after a high NMDA dose. We conclude that transcranial fPA VSD imaging can distinguish focal glutamate loads in the rat hippocampus, based on the VSD redistribution mechanism which is sensitive to the electrophysiologic membrane potential. SIGNIFICANCE Our results suggest the future utility of this emerging technology in both laboratory and clinical sciences as an innovative functional neuroimaging modality.
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Affiliation(s)
- Jeeun Kang
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, United States of America. Laboratory of Computational Sensing and Robotics, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States of America
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Alhilani M, Tamilia E, Ricci L, Ricci L, Grant PE, Madsen JR, Pearl PL, Papadelis C. Ictal and interictal source imaging on intracranial EEG predicts epilepsy surgery outcome in children with focal cortical dysplasia. Clin Neurophysiol 2020; 131:734-743. [PMID: 32007920 DOI: 10.1016/j.clinph.2019.12.408] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/12/2019] [Accepted: 12/04/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To localize the seizure onset zone (SOZ) and irritative zone (IZ) using electric source imaging (ESI) on intracranial EEG (iEEG) and assess their clinical value in predicting epilepsy surgery outcome in children with focal cortical dysplasia (FCD). METHODS We analyzed iEEG data from 25 children with FCD-associated medically refractory epilepsy (MRE) who underwent surgery. We performed ESI on ictal onset to localize SOZ (ESI-SOZ) and on interictal discharges to localize IZ (ESI-IZ). We tested whether resection of ESI-SOZ and ESI-IZ predicted good surgical outcome (Engel 1). We further compared the prediction performance of ESI-SOZ and ESI-IZ to those of SOZ and IZ defined using conventional methods, i.e. by identifying iEEG-contacts showing ictal onsets (conventional-SOZ) or being the most interictally active (conventional-IZ). RESULTS The proximity of ESI-SOZ (p = 0.043, odds-ratio = 3.9) and ESI-IZ (p = 0.011, odds-ratio = 7.04) to resection has higher effect on patients' outcome than proximity of conventional-SOZ (p = 0.17, odds-ratio = 1.7) and conventional-IZ (p = 0.038, odds-ratio = 2.6). Resection of ESI-SOZ and ESI-IZ presented higher discriminative power in predicting outcome (68% and 60%) than conventional-SOZ and conventional-IZ (48% and 53%). CONCLUSIONS Localizing SOZ and IZ via ESI on iEEG offers higher predictive value compared to conventional-iEEG interpretation. SIGNIFICANCE iEEG-ESI may help surgical planning and facilitate prognostic assessment of children with FCD-associated MRE.
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Affiliation(s)
- Michel Alhilani
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; The Hillingdon Hospital NHS Foundation Trust, London, UK
| | - Eleonora Tamilia
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorenzo Ricci
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Laura Ricci
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA.
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Diaz-Abad M, Sanchez AM, Kabir A, Konikkara J. A Case of Complex and Abnormal Behaviors at Night: The Role of the Epilepsy Monitoring Unit in Diagnosis. Case Rep Neurol 2020; 12:18-23. [PMID: 32095127 PMCID: PMC7011724 DOI: 10.1159/000505230] [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: 10/17/2019] [Accepted: 11/19/2019] [Indexed: 12/04/2022] Open
Abstract
Complex nocturnal behaviors associated with sleep have many potential causes, including parasomnias and epilepsy. Although the type of event and description can frequently lead to a diagnosis, sometimes it is challenging clinically to determine the cause of the behaviors, requiring a more in-depth investigation. We report the case of a 29-year-old woman with a long history of complex abnormal behaviors and visual hallucinations at night. An extensive clinical evaluation failed to reveal a definitive cause of these episodes, prompting a 3-day epilepsy monitoring unit admission. During the stay, several events were captured on video electroencephalography, leading to a conclusive final diagnosis. This case highlights the challenging task of finding a definitive diagnosis in cases of complex nocturnal behaviors and the potential role of an admission to an epilepsy monitoring unit to help diagnose the cause of these behaviors.
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Affiliation(s)
- Montserrat Diaz-Abad
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- *Montserrat Diaz-Abad, MD, Department of Medicine, Sleep Disorders Center, University of Maryland School of Medicine, 100 North Greene Street Room 214, Baltimore, MD 21201 (USA), E-Mail
| | - Ana M. Sanchez
- Department of Neurology, Kaiser Permanente, Denver, Colorado, USA
| | - Arif Kabir
- Department of Neurology, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - John Konikkara
- Department of Neurology, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
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40
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Andrews JP, Chang EF. Epilepsy: Neocortical. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
PURPOSE OF REVIEW Epilepsy is a heterogeneous disorder that is often associated with abnormal electroencephalogram (EEG) findings. This article provides an overview of common EEG findings in epileptic disorders. The physiologic basis of EEG and intracranial EEG studies is also discussed. RECENT FINDINGS EEG is widely used in clinical practice. Because of the paroxysmal nature of seizure disorders, interictal epileptiform discharges, such as spikes and sharp waves, are often used to support the diagnosis of epilepsy when a habitual seizure is not captured by EEG. Interictal and ictal EEG findings also underlie the classification of seizures and epilepsy. Continuous critical care EEG monitoring has become an invaluable study in the diagnosis and treatment of subclinical seizures and nonconvulsive status epilepticus. Intracranial EEG with subdural or intraparenchymal electrodes is warranted when localization of the seizure focus and mapping of eloquent brain areas are required to plan epilepsy surgery. SUMMARY The EEG is a key tool in the diagnosis of epilepsy. Interictal and ictal EEG findings are crucial for the confirmation and classification of seizure disorders. Intracranial EEG monitoring is also indispensable for planning surgery for some patients.
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Wang S, Wang ZI, Tang Y, Alexopoulos AV, Chen C, Katagiri M, Aung T, Najm IM, Ding M, Wang S, Chauvel P. Localization value of subclinical seizures on scalp video‐EEG in epilepsy presurgical evaluation. Epilepsia 2019; 60:2477-2485. [PMID: 31755095 DOI: 10.1111/epi.16383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Shan Wang
- Department of Neurology Epilepsy Center Second Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
| | - Z. Irene Wang
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
| | - Yingying Tang
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | | | - Cong Chen
- Department of Neurology Epilepsy Center Second Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
| | - Masaya Katagiri
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
| | - Thandar Aung
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
| | - Imad M. Najm
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
| | - Meiping Ding
- Department of Neurology Epilepsy Center Second Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
| | - Shuang Wang
- Department of Neurology Epilepsy Center Second Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
| | - Patrick Chauvel
- Epilepsy Center Neurological Institute Cleveland Clinic Cleveland OH USA
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Alkawadri R, Burgess RC, Kakisaka Y, Mosher JC, Alexopoulos AV. Assessment of the Utility of Ictal Magnetoencephalography in the Localization of the Epileptic Seizure Onset Zone. JAMA Neurol 2019; 75:1264-1272. [PMID: 29889930 DOI: 10.1001/jamaneurol.2018.1430] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Literature on ictal magnetoencephalography (MEG) in clinical practice and the relationship to other modalities is limited because of the brevity of routine studies. Objective To investigate the utility and reliability of ictal MEG in the localization of the epileptogenic zone. Design, Setting, and Participants A retrospective medical record review and prospective analysis of a novel ictal rhythm analysis method was conducted at a tertiary epilepsy center with a wide base of referrals for epilepsy surgery evaluation and included consecutive cases of patients who experienced epileptic seizures during routine MEG studies from March 2008 to February 2012. A total of 377 studies screened. Data were analyzed from November 2011 to October 2015. Main Outcomes and Measures Presurgical workup and interictal and ictal MEG data were reviewed. The localizing value of using extended-source localization of a narrow band identified visually at onset was analyzed. Results Of the 44 included patients, the mean (SD) age at the time of recording was 19.3 (14.9) years, and 25 (57%) were male. The mean duration of recording was 51.2 minutes. Seizures were provoked by known triggers in 3 patients and were spontaneous otherwise. Twenty-five patients (57%) had 1 seizure, 6 (14%) had 2, and 13 (30%) had 3 or more. Magnetoencephalography single equivalent current dipole analysis was possible in 29 patients (66%), of whom 8 (28%) had no clear interictal discharges. Sublobar concordance between ictal and interictal dipoles was seen in 18 of 21 patients (86%). Three patients (7%) showed clear ictal MEG patterns without electroencephalography changes. Ictal MEG dipoles correlated with the lobe of onset in 7 of 8 patients (88%) who underwent intracranial electroencephalography evaluations. Reasons for failure to identify ictal dipoles included diffuse or poor dipolar ictal patterns, no MEG changes, and movement artifact. Resection of areas containing a minimum-norm estimate of a narrow band at onset, not single equivalent current dipole, was associated with sustained seizure freedom. Conclusions and Significance Ictal MEG data can provide reliable localization, including in cases that are difficult to localize by other modalities. These findings support the use of extended-source localization for seizures recorded during MEG.
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Affiliation(s)
- Rafeed Alkawadri
- The Epilepsy Center at Cleveland Clinic Foundation, Cleveland, Ohio.,Yale Comprehensive Epilepsy Center, School of Medicine, Yale University, New Haven, Connecticut.,Yale Human Brain Mapping Program, School of Medicine, Yale University, New Haven, Connecticut
| | | | - Yosuke Kakisaka
- The Epilepsy Center at Cleveland Clinic Foundation, Cleveland, Ohio.,The Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - John C Mosher
- The Epilepsy Center at Cleveland Clinic Foundation, Cleveland, Ohio
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Tiefes AM, Hartlieb T, Tacke M, von Stülpnagel-Steinbeis C, Larsen LHG, Hao Q, Dahl HA, Neubauer BA, Gerstl L, Kudernatsch M, Kluger GJ, Borggraefe I. Mesial Temporal Sclerosis in SCN1A-Related Epilepsy: Two Long-Term EEG Case Studies. Clin EEG Neurosci 2019; 50:267-272. [PMID: 30117335 DOI: 10.1177/1550059418794347] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with temporal lobe epilepsy (TLE) due to mesial temporal sclerosis (MTS) are eligible candidates for resective epilepsy surgery. We report on 2 male patients aged 4 years with suspected TLE due to MTS who were referred for presurgical evaluation. Both patients came to medical attention within the first year of life suffering from febrile status epileptici and subsequent unprovoked seizures. The following years, moderate developmental delay was present. High-resolution magnetic resonance imaging confirmed hippocampal sclerosis. Continuous EEG video monitoring revealed seizure patterns contralateral to the MTS in both patients. Genetic analysis was performed as both the clinical presentation of the patients and EEG video monitoring findings were not consistent with the presence of the hippocampal sclerosis alone and revealed de novo mutations within exon of the SCN1A gene. Resective surgical strategies were omitted due to the genetic findings. In conclusion, both patients suffered from a dual pathology syndrome with ( a) TLE related to MTS resulting most likely from recurrent febrile status in early childhood and ( b) Dravet syndrome, which is most likely the cause of the febrile convulsions leading to the MTS in these 2 patients.
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Affiliation(s)
- Anna M Tiefes
- 1 Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Dr von Haunersches Children's Hospital, University of Munich, Munich, Germany
| | - Till Hartlieb
- 2 Hospital for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Vogtareuth, Germany.,3 Research Institute for Rehabilitation, Transition and Palliation, Paracelsus Medical University, Salzburg, Austria
| | - Moritz Tacke
- 1 Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Dr von Haunersches Children's Hospital, University of Munich, Munich, Germany
| | - Celina von Stülpnagel-Steinbeis
- 1 Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Dr von Haunersches Children's Hospital, University of Munich, Munich, Germany.,3 Research Institute for Rehabilitation, Transition and Palliation, Paracelsus Medical University, Salzburg, Austria
| | | | - Quin Hao
- 4 Amplexa Genetics, Odense, Denmark
| | | | - Bernd A Neubauer
- 5 Department of Neuropediatrics, Justus Liebig University of Giessen, Giessen, Germany
| | - Lucia Gerstl
- 1 Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Dr von Haunersches Children's Hospital, University of Munich, Munich, Germany
| | - Manfred Kudernatsch
- 6 Epilepsy Center and Department of Neurosurgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Gerhard J Kluger
- 2 Hospital for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Vogtareuth, Germany.,3 Research Institute for Rehabilitation, Transition and Palliation, Paracelsus Medical University, Salzburg, Austria
| | - Ingo Borggraefe
- 1 Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Dr von Haunersches Children's Hospital, University of Munich, Munich, Germany.,7 Epilepsy Center, University of Munich, Munich, Germnay
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O'Dwyer R, Byrne R, Lynn F, Nazari P, Stoub T, Smith MC, Sani S. Age is but a number when considering epilepsy surgery in older adults. Epilepsy Behav 2019; 91:9-12. [PMID: 29997038 DOI: 10.1016/j.yebeh.2018.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND A quarter of patients with newly diagnosed epilepsy are older, yet they are less likely to be offered resective surgery potentially because of clinical bias that they incur increased surgical risks. There are few peer-reviewed case series that address this cohort and their outcomes. OBJECTIVE In the context of current literature, the objective of this study was to report on all epilepsy surgeries in patients aged 50 years or older from a tertiary care center over 15 years with an average follow-up period of 6 years. METHODS Patients with epilepsy who underwent surgery between 2001 and 2016 were reviewed retrospectively. Inclusion criteria were age > 50 at surgery, availability of presurgical evaluation data, and minimum one year of follow-up data. We identified 34 patients. Seizure outcome was evaluated using the Engel classification system. RESULTS Thirty-four patients aged 50 years and older out of 276 underwent epilepsy surgery. Average age at time of surgery was 55 years, and average duration of epilepsy was 30 years. Average length of follow-up was 6 years (1-15 years). Twenty-two out of 34 patients (64%) were seizure-free (Engel class I) at their last follow-up visit. Patients with lesional pathology on neuroimaging were more likely to achieve seizure freedom (p < 0.02). Parameters associated with poorer outcome included extratemporal epileptogenic focus (p = 0.07) and bitemporal interictal epileptiform activity (p = 0.003). CONCLUSION Our study cohort is one of the largest and most representative outcome studies of this age group, following the cohort for 6 years. Our findings demonstrated that when considering epilepsy surgery in an older adult, their age should not play a determining role in the decision-a finding that is more common in modern literature.
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Affiliation(s)
- Rebecca O'Dwyer
- Rush Epilepsy Center, Rush University Medical Center, Chicago, IL, USA.
| | - Richard Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Fiona Lynn
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Pouya Nazari
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Travis Stoub
- Rush Epilepsy Center, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Smith
- Rush Epilepsy Center, Rush University Medical Center, Chicago, IL, USA
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Abstract
Electroencephalographic (EEG) investigations are crucial in the diagnosis and management of patients with focal epilepsies. EEG may reveal different interictal epileptiform discharges (IEDs: abnormal spikes, sharp waves). The EEG visibility of a spike depends on the surface area of cortex involved (>10cm2) and the brain localization of cortical generators. Regions generating IEDs (defining the "irritative zone") are not necessarily equivalent to the seizure onset zone. Focal seizures are dynamic processes originating from one or several brain regions (that generate fast oscillations and are called the epileptogenic zone) before spreading to other structures (that generate lower frequency oscillations and are called the propagation zone). Several factors limit the expression of seizures on scalp EEG, such as the area involved, degree of synchronization, and depth of the cortical generators. Different scalp EEG seizure onset patterns may be observed: fast discharge, background flattening, rhythmic spikes, sinusoidal discharge, or sharp activity. However, to a large extent EEG changes are linked to seizure propagation. Finally, in the context of presurgical evaluation, the combination of interictal and ictal EEG features is crucial to provide an optimal hypothesis concerning the epileptogenic zone.
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Affiliation(s)
- Stanislas Lagarde
- Institut de Neurosciences des Systèmes, Aix Marseille Université, Marseille, France; Department of Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, Aix Marseille Université, Marseille, France; Department of Clinical Neurophysiology, Timone Hospital, Marseille, France.
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Yang Y, Wang H, Zhou W, Qian T, Sun W, Zhao G. Electroclinical characteristics of seizures arising from the precuneus based on stereoelectroencephalography (SEEG). BMC Neurol 2018; 18:110. [PMID: 30103717 PMCID: PMC6088396 DOI: 10.1186/s12883-018-1119-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 08/06/2018] [Indexed: 01/26/2023] Open
Abstract
Background Seizures arising from the precuneus are rare, and few studies have aimed at characterizing the clinical presentation of such seizures within the anatomic context of the frontoparietal circuits. We aimed to characterize the electrophysiological properties and clinical features of seizures arising from the precuneus based on data from stereoelectroencephalography (SEEG). Methods The present retrospective study included 10 patients with medically intractable epilepsy, all of whom were diagnosed with precuneal epilepsy via stereoelectroencephalography (SEEG) at Yuquan Hospital and Xuan Wu Hospital between 2014 and 2016. Clinical semiology, scalp electroencephalography (EEG) findings, magnetic resonance images (MRI), and positron emission tomography (PET) images were analyzed during phase I preoperative evaluations. Following electrode implantation, the semiological sequence, ictal SEEG evolution, and anatomy of the relevant brain structures were analyzed for each seizure. Results Seven of ten patients reported auras, including body image disturbance (2/7), vestibular responses (2/7), somatosensory auras (1/7), visual auras (1/7), and non-specific auras (1/7). Primary motor manifestations included bilateral asymmetric tonic seizures (BATS) (7/10) and hypermotor seizures (HMS) (3/10). In one patient, epileptiform discharge on interictal EEG occurred ipsilateral to the side of the epileptogenic zone (EZ). Discharge was non-lateralized in the remaining nine patients. In six patients, interictal EEG signals were primarily localized in the temporal–parietal–occipital area. In two patients, ictal onset occurred ipsilateral to the EZ, which was mainly located in the temporal–parietal–occipital area. Two patterns of seizure spread were observed. The first pattern was characterized by BATS activity with ictal spread to the supplementary motor area (SMA), paracentral lobule (PCL), precentral gyrus (PrCG), or postcentral gyrus (PoCG). The second pattern was characterized by HMS activity with ictal spread to middle cingulate cortex (MCC) and posterior cingulate cortex (PCC). Conclusion Aura type (e.g., body image disturbance and vestibular response), BATS, and HMS are the main indicators of precuneal epilepsy. Scalp EEG is of little use when attempting to localize precuneal seizures. Our findings indicate that the clinical characteristics of precuneal epilepsy vary among patients, and that the final electro–clinical phenotype depends on the pattern of seizure spread.
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Affiliation(s)
- Yanfeng Yang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing, 100053, China.,Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Haixiang Wang
- Epilepsy Center, Yuquan hospital, Tsinghua University, Beijing, 100049, China
| | - Wenjing Zhou
- Epilepsy Center, Yuquan hospital, Tsinghua University, Beijing, 100049, China
| | - Tianyi Qian
- Department of Radiology, Beijing Key Lab of magnetic resonance imaging (MRI) and Brain Informatics, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China
| | - Wei Sun
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Guoguang Zhao
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing, 100053, China.
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Abramovici S, Antony A, Baldwin ME, Urban A, Ghearing G, Pan J, Sun T, Krafty RT, Richardson RM, Bagic A. Features of Simultaneous Scalp and Intracranial EEG That Predict Localization of Ictal Onset Zone. Clin EEG Neurosci 2018; 49:206-212. [PMID: 29067832 DOI: 10.1177/1550059417738688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the utility of simultaneous scalp EEG in patients with focal epilepsy undergoing intracranial EEG evaluation after a detailed presurgical testing, including an inpatient scalp video EEG evaluation. METHODS Patients who underwent simultaneous scalp and intracranial EEG (SSIEEG) monitoring were classified into group 1 or 2 depending on whether the seizure onset zone was delineated or not. Seizures were analyzed using the following 3 EEG features at the onset of seizures latency, location, and pattern. RESULTS The criteria showed at least one of the following features when comparing SSIEEG: prolonged latency, absence of anatomical congruence, lack of concordance of EEG pattern in 11.11% (1/9) of the patients in group 1 and 75 % (3/4) of the patients in group 2. These 3 features were not present in any of the 5 patients who had Engel class I outcome compared with 1 of the 2 patients (50%) who had seizure recurrence after resective surgery. The mean latency of seizure onset in scalp EEG compared with intracranial EEG of patients in group 1 was 17.48 seconds (SD = 16.07) compared with 4.33 seconds (SD = 11.24) in group 2 ( P = .03). None of the seizures recorded in patients in group 1 had a discordant EEG pattern in SSIEEG. CONCLUSION Concordance in EEG features like latency, location, and EEG pattern, at the onset of seizures in SSIEEG is associated with a favorable outcome after epilepsy surgery in patients with intractable focal epilepsy. SIGNIFICANCE Simultaneous scalp EEG complements intracranial EEG evaluation even after a detailed inpatient scalp video EEG evaluation and could be part of standard intracranial EEG studies in patients with intractable focal epilepsy.
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Affiliation(s)
| | - Arun Antony
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Maria Elizabeth Baldwin
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alexandra Urban
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gena Ghearing
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Julie Pan
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tao Sun
- 3 Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Todd Krafty
- 3 Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Mark Richardson
- 4 Department of Neurosurgery, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, PA, USA
| | - Anto Bagic
- 2 University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Tatum W, Rubboli G, Kaplan P, Mirsatari S, Radhakrishnan K, Gloss D, Caboclo L, Drislane F, Koutroumanidis M, Schomer D, Kasteleijn-Nolst Trenite D, Cook M, Beniczky S. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clin Neurophysiol 2018; 129:1056-1082. [DOI: 10.1016/j.clinph.2018.01.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 12/20/2022]
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