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Nightscales R, Chen Z, Barnard S, Auvrez C, Tao G, Sivathamboo S, Bennett C, Rychkova M, D'Souza W, Berkovic SF, Nicolo J, O'Brien TJ, Perucca P, Scheffer IE, Kwan P. Applying the ILAE diagnostic criteria for Lennox-Gastaut syndrome in the real-world setting: A multicenter retrospective cohort study. Epilepsia Open 2024; 9:602-612. [PMID: 38135919 PMCID: PMC10984283 DOI: 10.1002/epi4.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/02/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Lennox-Gastaut syndrome (LGS) is an archetypal developmental and epileptic encephalopathy, for which novel treatments are emerging. Diagnostic criteria for LGS have recently been defined by the International League Against Epilepsy (ILAE). We aimed to apply these criteria in a real-world setting. METHODS We applied ILAE diagnostic criteria to a cohort of patients diagnosed with LGS by epileptologists following inpatient video-EEG monitoring (VEM) at tertiary comprehensive epilepsy centers between 1995 and 2015. We also assessed mortality in this cohort. RESULTS Sixty patients diagnosed with LGS and had complete records available for review were identified. Among them, 29 (48%) patients met ILAE diagnostic criteria for LGS (ILAE-DC group). Thirty-one did not meet criteria (non-ILAE-DC) due to the absence of documented tonic seizures (n = 7), EEG features (n = 12), or both tonic seizures and EEG features (n = 10), intellectual disability (n = 1), or drug resistance (n = 1). The ILAE-DC group had a shorter duration of epilepsy at VEM than the non-ILAE-DC group (median = 12.0 years vs. 23.7 years, respectively; p = 0.015). The proportions of patients with multiple seizure types (100% vs. 96.7%), ≤2.5 Hz slow spike-and-wave EEG activity (100% vs. 90%), seizure-related injuries (27.6% vs. 25.8%), and mortality (standardized mortality ratio 4.60 vs. 5.12) were similar between the groups. SIGNIFICANCE Up to 52% of patients diagnosed with LGS following VEM may not meet recently accepted ILAE criteria for LGS diagnosis. This may reflect both the limitations of retrospective medical record review and a historical tendency of applying the LGS diagnosis to a broad spectrum of severe, early-onset drug-resistant epilepsies with drop attacks. The ILAE criteria allow the delineation of LGS based on distinct electroclinical features, potentiating accurate diagnosis, prognostication, and management formulation. Nonetheless, mortality outcomes between those who did and did not meet ILAE diagnostic criteria for LGS were similarly poor, and both groups suffered high rates of seizure-related injury. PLAIN LANGUAGE SUMMARY More than half of patients diagnosed with Lennox-Gastaut Syndrome (LGS) at three Australian epilepsy monitoring units between 1995 and 2015 did not meet the recently devised International League Against Epilepsy (ILAE) diagnostic criteria for LGS. Mortality was equally high in those who did and did not meet the ILAE diagnostic criteria, and seizure-related injury was common. The ILAE diagnostic criteria will guide accurate diagnosis, management, prognostication, and research in patients with LGS, however may be limited in their practical application to patients with a longer duration of epilepsy, or to those for whom detailed assessment is difficult.
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Affiliation(s)
- Russell Nightscales
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Clinical Epidemiology, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneMelbourneVictoriaAustralia
| | - Sarah Barnard
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Clarissa Auvrez
- NorthWestern Mental HealthMelbourne HealthMelbourneVictoriaAustralia
| | - Gerard Tao
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneMelbourneVictoriaAustralia
| | - Shobi Sivathamboo
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneMelbourneVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Caitlin Bennett
- Epilepsy Research Centre, Department of Medicine (Austin Health)The University of MelbourneHeidelbergVictoriaAustralia
| | - Maria Rychkova
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneMelbourneVictoriaAustralia
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's HospitalThe University of MelbourneFitzroyVictoriaAustralia
| | - Samuel F. Berkovic
- Epilepsy Research Centre, Department of Medicine (Austin Health)The University of MelbourneHeidelbergVictoriaAustralia
- Bladin‐Berkovic Comprehensive Epilepsy Program, Department of NeurologyAustin HealthHeidelbergVictoriaAustralia
| | - John‐Paul Nicolo
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneMelbourneVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
- Epilepsy Research Centre, Department of Medicine (Austin Health)The University of MelbourneHeidelbergVictoriaAustralia
- Bladin‐Berkovic Comprehensive Epilepsy Program, Department of NeurologyAustin HealthHeidelbergVictoriaAustralia
| | - Ingrid E. Scheffer
- Epilepsy Research Centre, Department of Medicine (Austin Health)The University of MelbourneHeidelbergVictoriaAustralia
- Bladin‐Berkovic Comprehensive Epilepsy Program, Department of NeurologyAustin HealthHeidelbergVictoriaAustralia
- Department of Paediatrics, The University of Melbourne, Royal Children's HospitalFlorey and Murdoch Children's Research InstitutesMelbourneVictoriaAustralia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneMelbourneVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
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Szaflarski JP, Besson H, D'Souza W, Faught E, Klein P, Reuber M, Rosenow F, Salas-Puig J, Soto Insuga V, Steinhoff BJ, Strzelczyk A, Bourikas D, Daniels T, Floricel F, Friesen D, Laloyaux C, Villanueva V. Effectiveness and tolerability of brivaracetam in patients with epilepsy stratified by comorbidities and etiology in the real world: 12-month subgroup data from the international EXPERIENCE pooled analysis. J Neurol 2024:10.1007/s00415-024-12253-z. [PMID: 38436680 DOI: 10.1007/s00415-024-12253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To assess the effectiveness and tolerability of brivaracetam (BRV) in adults with epilepsy by specific comorbidities and epilepsy etiologies. METHODS EXPERIENCE/EPD332 was a pooled analysis of individual patient records from several non-interventional studies of patients with epilepsy initiating BRV in clinical practice. Outcomes included ≥ 50% reduction from baseline in seizure frequency, seizure freedom (no seizures within prior 3 months), continuous seizure freedom (no seizures since baseline), BRV discontinuation, and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Analyses were performed for all adult patients (≥ 16 years of age) and stratified by comorbidity and by etiology at baseline (patients with cognitive/learning disability [CLD], psychiatric comorbidity, post-stroke epilepsy, brain tumor-related epilepsy [BTRE], and traumatic brain injury-related epilepsy [TBIE]). RESULTS At 12 months, ≥ 50% seizure reduction was achieved in 35.6% (n = 264), 38.7% (n = 310), 41.7% (n = 24), 34.1% (n = 41), and 50.0% (n = 28) of patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, respectively; and continuous seizure freedom was achieved in 5.7% (n = 318), 13.7% (n = 424), 29.4% (n = 34), 11.4% (n = 44), and 13.8% (n = 29), respectively. During the study follow-up, in patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, 37.1% (n = 403), 30.7% (n = 605), 33.3% (n = 51), 39.7% (n = 68), and 27.1% (n = 49) of patients discontinued BRV, respectively; and TEAEs since prior visit at 12 months were reported in 11.3% (n = 283), 10.0% (n = 410), 16.7% (n = 36), 12.5% (n = 48), and 3.0% (n = 33), respectively. CONCLUSIONS BRV as prescribed in the real world is effective and well tolerated among patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE.
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Affiliation(s)
- Jerzy P Szaflarski
- University of Alabama at Birmingham (UAB) Heersink School of Medicine Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA.
| | | | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | - Victor Soto Insuga
- Pediatric Neurology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, EpiCARE member, Valencia, Spain
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Delanty N, Mohanraj R, Shankar R, Wehner T, Stephen LJ, D'Souza W, Cappucci S, McMurray R, Sainz-Fuertes R, Villanueva V. Perampanel for the treatment of epilepsy with genetic aetiology: Real-world evidence from the PERMIT Extension study. Epilepsy Res 2024; 202:107339. [PMID: 38492461 DOI: 10.1016/j.eplepsyres.2024.107339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Abstract
Genetic factors contribute to the aetiology of epilepsy in >50% of cases, and information on the use of antiseizure medications in people with specific aetiologies will help guide treatment decisions. The PERMIT Extension study pooled data from two real-world studies (PERMIT and PROVE) to investigate the effectiveness and safety/tolerability of perampanel (PER) when used to treat people with focal and generalised epilepsy in everyday clinical practice. This post-hoc analysis of PERMIT Extension explored the use of PER when used to treat individuals presumed to have epilepsy with a genetic aetiology. Assessments included retention rate (evaluated at 3, 6 and 12 months), effectiveness (responder and seizure freedom rates; evaluated at 3, 6, 12 months and the last visit [last observation carried forward) and tolerability (adverse events [AEs]). Of the 6822 people with epilepsy included in PERMIT Extension, 1012 were presumed to have a genetic aetiology. The most common genetic aetiologies were idiopathic generalised epilepsy (IGE; 58.2%), tuberous sclerosis (1.1%), Dravet syndrome (0.8%) and genetic epilepsy with febrile seizures plus (GEFS+; 0.5%). Retention rates at 3, 6 and 12 months in the total genetic aetiology population were 89.3%, 79.7% and 65.9%, respectively. In the total genetic aetiology population, responder rates at 12 months and the last visit were 74.8% and 68.3%, respectively, and corresponding seizure freedom rates were 48.9% and 46.5%, respectively. For the specific aetiology subgroups, responder rates at 12 months and the last visit were, respectively: 90.4% and 84.4% (IGE), 100% and 57.1% (tuberous sclerosis), 100% and 71.4% (Dravet syndrome), and 33.3% and 20.0% (GEFS+). Corresponding seizure freedom rates were, respectively: 73.1% and 64.6% (IGE), 33.3% and 22.2% (tuberous sclerosis), 20.0% and 28.6% (Dravet syndrome), and 0% and 0% (GEFS+). The incidence of AEs was 46.5% for the total genetic aetiology population, 48.8% for IGE, 27.3% for tuberous sclerosis, 62.5% for Dravet syndrome, and 20% for GEFS+. Tolerability findings were consistent with PER's known safety profile. PER was effective and generally well tolerated when used in individuals with a presumed genetic epilepsy aetiology in clinical practice. PER was effective across a wide range of genetic aetiologies.
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Affiliation(s)
- Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland.
| | - Rajiv Mohanraj
- Greater Manchester Neurosciences Centre, Salford Royal Hospital, UK
| | | | - Tim Wehner
- National Hospital for Neurology and Neurosurgery, UCLH Foundation Trust, and Department of Clinical and Experimental Epilepsy, UCL, London, UK
| | - Linda J Stephen
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital, Glasgow, Scotland, UK
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Victoria, Australia
| | | | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Wheless J, Wechsler RT, Penovich P, Segal E, Chez M, Coppola A, Datta A, D'Souza W, Najm I, Cappucci S, Sainz-Fuertes R, Villanueva V. Effectiveness, safety and tolerability of perampanel by age group when used to treat people with focal and generalized epilepsy in clinical practice: The PERMIT Extension study. Epilepsy Behav 2023; 147:109369. [PMID: 37619459 DOI: 10.1016/j.yebeh.2023.109369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To assess the effectiveness and safety/tolerability of perampanel (PER) in people with epilepsy (PWE) treated in everyday clinical practice for focal and generalized seizures, both in the total cohort and by age group. METHODS The PERMIT Extension study was a pooled analysis of data from PWE included in two large previous clinical practice studies (PERMIT and PROVE). Retention was assessed over 12 months. Effectiveness was assessed based on total seizures and by seizure type (focal and generalized) after 3, 6, and 12 months of PER treatment and at final follow-up (last observation carried forward; "last visit"); assessments included responder rate (≥50% seizure frequency reduction from baseline) and seizure freedom rate (no seizures since at least the previous visit). Safety/tolerability was assessed throughout PER treatment by evaluating adverse events (AEs). All assessments were conducted for the total population and by age category (<12, ≥12 to <18, ≥18 to <65, and ≥65 years at baseline). RESULTS Full Analysis Set included 6,822 PWE (51.1% female; mean age, 36.9 years; mean duration of epilepsy 21.4 years) with 6,433, 4,648, and 6,233 PWE assessed for retention, effectiveness, and safety/tolerability, respectively. The majority of PWE (81.1%) were aged 18-64 at baseline, with 4.5% aged <12 years, 8.4% aged 12-17 years, and 5.9% aged ≥65 years. In the overall population, retention rates at 3, 6, and 12 months were 88.0%, 77.6%, and 61.4%, respectively; responder rates at 12 months were 58.5% for total seizures, 54.6% for focal seizures, and 77.7% for generalized seizures, and corresponding seizure freedom rates were 23.6%, 19.0%, and 51.3%, respectively. PER was effective regardless of age category, although effectiveness was greatest in PWE aged ≥65 years, for both focal and generalized seizures. In the overall population, the incidence of AEs was 49.2% and the most frequent AEs (≥5% of PWE) were dizziness/vertigo (13.4%), somnolence (8.8%), irritability (7.3%), and behavioral disorders (5.3%); AEs led to treatment discontinuation in 18.3% of PWE over 12 months. The incidence of AEs and the discontinuation rate due to AEs increased with increasing age (55.0% and 23.9%, respectively, in PWE aged ≥65 years). CONCLUSION In this study, the largest pooled analysis of PER clinical practice data conducted to date, PER was shown to be effective and generally well tolerated when used to treat people with focal or generalized epilepsy in everyday clinical practice, regardless of age category. No new or unexpected side effects emerged following long-term use in the real-world setting.
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Affiliation(s)
- James Wheless
- University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA.
| | | | | | - Eric Segal
- Northeast Regional Epilepsy Group, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ, USA.
| | - Michael Chez
- Sutter Neuroscience Institute, Roseville, CA, USA.
| | - Antonietta Coppola
- Department of Neuroscience, Odontostomatological and Reproductive Sciences, Federico II University of Naples, Naples, Italy.
| | - Anita Datta
- BC Children's Hospital, Vancouver, BC, Canada.
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Victoria, Australia.
| | - Imad Najm
- Cleveland Clinic, Cleveland, OH, USA.
| | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
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Villanueva V, Laloyaux C, D'Souza W, Faught E, Klein P, Reuber M, Rosenow F, Salas-Puig J, Insuga VS, Strzelczyk A, Szaflarski JP, Chinn C, Daniels T, Floricel F, Friesen D, Sendersky V, Besson H, Steinhoff BJ. Effectiveness and Tolerability of 12-Month Brivaracetam in the Real World: EXPERIENCE, an International Pooled Analysis of Individual Patient Records. CNS Drugs 2023; 37:819-835. [PMID: 37684497 PMCID: PMC10501958 DOI: 10.1007/s40263-023-01033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Real-world evidence studies of brivaracetam (BRV) have been restricted in scope, location, and patient numbers. The objective of this pooled analysis was to assess effectiveness and tolerability of brivaracetam (BRV) in routine practice in a large international population. METHODS EXPERIENCE/EPD332 was a pooled analysis of individual patient records from multiple independent non-interventional studies of patients with epilepsy initiating BRV in Australia, Europe, and the United States. Eligible study cohorts were identified via a literature review and engagement with country lead investigators, clinical experts, and local UCB Pharma scientific/medical teams. Included patients initiated BRV no earlier than January 2016 and no later than December 2019, and had ≥ 6 months of follow-up data. The databases for each cohort were reformatted and standardised to ensure information collected was consistent. Outcomes included ≥ 50% reduction from baseline in seizure frequency, seizure freedom (no seizures within 3 months before timepoint), continuous seizure freedom (no seizures from baseline), BRV discontinuation, and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Patients with missing data after BRV discontinuation were considered non-responders/not seizure free. Analyses were performed for all adult patients (≥ 16 years), and for subgroups by seizure type recorded at baseline; by number of prior antiseizure medications (ASMs) at index; by use of BRV as monotherapy versus polytherapy at index; for patients who switched from levetiracetam to BRV versus patients who switched from other ASMs to BRV; and for patients with focal-onset seizures and a BRV dose of ≤ 200 mg/day used as add-on at index. Analysis populations included the full analysis set (FAS; all patients who received at least one BRV dose and had seizure type and age documented at baseline) and the modified FAS (all FAS patients who had at least one seizure recorded during baseline). The FAS was used for all outcomes other than ≥ 50% seizure reduction. All outcomes were summarised using descriptive statistics. RESULTS Analyses included 1644 adults. At baseline, 72.0% were 16-49 years of age and 92.2% had focal-onset seizures. Patients had a median (Q1, Q3) of 5.0 (2.0, 8.0) prior antiseizure medications at index. At 3, 6, and 12 months, respectively, ≥ 50% seizure reduction was achieved by 32.1% (n = 619), 36.7% (n = 867), and 36.9% (n = 822) of patients; seizure freedom rates were 22.4% (n = 923), 17.9% (n = 1165), and 14.9% (n = 1111); and continuous seizure freedom rates were 22.4% (n = 923), 15.7% (n = 1165), and 11.7% (n = 1111). During the whole study follow-up, 551/1639 (33.6%) patients discontinued BRV. TEAEs since prior visit were reported in 25.6% (n = 1542), 14.2% (n = 1376), and 9.3% (n = 1232) of patients at 3, 6, and 12 months, respectively. CONCLUSIONS This pooled analysis using data from a variety of real-world settings suggests BRV is effective and well tolerated in routine clinical practice in a highly drug-resistant patient population.
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Affiliation(s)
- Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, EpiCARE member, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | | | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Frankfurt am Main, Germany
| | | | - Victor Soto Insuga
- Pediatric Neurology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Frankfurt am Main, Germany
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham (UAB) Heersink School of Medicine, Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA
| | | | | | | | | | | | | | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork and Medical Faculty, University of Freiburg, Freiburg, Germany
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Broadley J, Wesselingh R, Beech P, Seneviratne U, Kyndt C, Buzzard K, Nesbitt C, D'Souza W, Brodtmann A, Macdonell R, Kalincik T, O'Brien TJ, Butzkueven H, Monif M. Neuroimaging characteristics may aid in diagnosis, subtyping, and prognosis in autoimmune encephalitis. Neurol Sci 2023; 44:1327-1340. [PMID: 36481972 DOI: 10.1007/s10072-022-06523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the utility of neuroimaging characteristics as biomarkers of prognosis in seropositive autoimmune encephalitis (AE). METHODS In this multi-center study, we retrospectively analyzed 66 cases of seropositive AE. The MRI and PET imaging was assessed by independent visual inspection. Whole brain and regional volumes were imputed by IcoMetrix, an automated volumetric assessment package. The modified Rankin Scale (mRS) was utilized to assess the patients' follow-up disability. Other outcomes were mortality, first line treatment failure, medial temporal lobe (MTL) atrophy, and clinical relapse. Univariate and multivariable regression analysis was performed. RESULTS Abnormalities on MRI were detected in 35.1% of patients, while PET was abnormal in 46.4%. Initial median whole brain and hippocampal volumes were below the 5th and 20th percentile respectively compared to an age-matched healthy database. After a median follow-up of 715 days, 85.2% had good functional outcome (mRS ≤ 2). Nine patients developed MTL atrophy during follow-up. On multivariable analysis, inflammatory MTL changes were associated with development of MTL atrophy (HR 19.6, p = 0.007) and initial hippocampal volume had an inverse relationship with mortality (HR 0.04, p = 0.011). Patients who developed MTL atrophy had a reduced chance of good final mRS (HR 0.16, p = 0.015). CONCLUSIONS Neuroimaging on initial hospital admission may be provide important diagnostic and prognostic information. This study demonstrates that structural and inflammatory changes of the MTL may have importance in clinical and radiological prognosis in seropositive AE.
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Affiliation(s)
- James Broadley
- Department of Neuroscience, Central Clinical School, Monash University, Level 6 Alfred Center, 55 Commercial Road, Melbourne, Australia
- Department of Neuroscience, Barwon Health, Geelong, Australia
| | - Robb Wesselingh
- Department of Neuroscience, Central Clinical School, Monash University, Level 6 Alfred Center, 55 Commercial Road, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Paul Beech
- Department of Radiology, Alfred Health, Melbourne, Australia
- Department of Radiology, Monash Health, Melbourne, Australia
| | - Udaya Seneviratne
- Department of Neuroscience, Central Clinical School, Monash University, Level 6 Alfred Center, 55 Commercial Road, Melbourne, Australia
- Department of Neuroscience, Monash Health, Melbourne, Australia
| | - Chris Kyndt
- Department of Neurosciences, Eastern Health, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Katherine Buzzard
- Department of Neurosciences, Eastern Health, Melbourne, Australia
- Department of Neurology, Melbourne Health, Melbourne, Australia
| | - Cassie Nesbitt
- Department of Neuroscience, Barwon Health, Geelong, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Amy Brodtmann
- Department of Neurosciences, Eastern Health, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | | | - Tomas Kalincik
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Neurology, Melbourne Health, Melbourne, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Level 6 Alfred Center, 55 Commercial Road, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Level 6 Alfred Center, 55 Commercial Road, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Level 6 Alfred Center, 55 Commercial Road, Melbourne, Australia.
- Department of Neurology, Alfred Health, Melbourne, Australia.
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Welton J, Stratton G, Schoeninger B, Low MH, Moody A, D'Souza W. Shortages of antiseizure medications in Australia and the association with patient switching, and adherence in a community setting. Epilepsy Behav 2023; 141:109145. [PMID: 36913876 DOI: 10.1016/j.yebeh.2023.109145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE To quantify sponsor-reported shortages of oral antiseizure medications in Australia, estimate the number of patients impacted, and the association between shortages and brand or formulation switching, and changes in adherence. METHODS A retrospective cohort study of sponsor-reported shortages (defined as where the supply of a medicine will not or will not be likely to meet the demand over a 6-month period) of antiseizure medications reported to the Medicine Shortages Reports Database (Therapeutic Goods Administration, Australia); cross-referencing shortages to the IQVIA-NostraData Dispensing Data (LRx) database, a deidentified, population-level dataset collecting longitudinal dispensation data on individual patients from ∼75% of Australian community pharmacy scripts. RESULTS Ninety-seven sponsor-reported ASM shortages were identified between 2019 and 2020; of those, 90 (93%) were shortages of generic ASM brands. Of 1,247,787 patients dispensed ≥1 ASMs, 242,947 (19.5%) were impacted by shortages. Sponsor-reported shortages occurred more frequently before the COVID-19 pandemic versus during the pandemic, however, shortages were estimated to affect more patients during the pandemic than before the pandemic. An estimated 330,872 patient-level shortage events were observed, and 98.5% were associated with shortages of generic ASM brands. Shortages occurred at a rate of 41.06 shortages per 100 person-years in patients on generic ASM brands versus 0.83 shortages per 100 person-years in patients on originator ASM brands. In patients taking a formulation of levetiracetam affected by a shortage, 67.6% switched to a different levetiracetam brand or formulation during shortages compared with 46.6% in non-shortage periods. CONCLUSIONS Approximately 20% of patients on ASMs were estimated to have been impacted by an ASM shortage in Australia. The rate of patient-level shortages was approximately 50 times higher for patients on generic ASM brands versus originator brands. Shortages of levetiracetam were associated with formulation and brand switching. Improved supply chain management amongst sponsors of generic ASMs is needed to maintain the continuity of supply in Australia.
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Affiliation(s)
- Jeremy Welton
- UCB Pharma, Level 1, 1155 Malvern Road, Malvern, VIC 3144, Australia; Department of Medicine - St Vincent's Hospital, The University of Melbourne, Clinical Sciences Building, Level 4 / 29 Regent Street, Fitzroy, VIC 3065, Australia.
| | - Giles Stratton
- IQVIA Australia, 8/201 Pacific Hwy, St Leonards, NSW 2065, Australia
| | | | - Min Hui Low
- IQVIA Australia, 8/201 Pacific Hwy, St Leonards, NSW 2065, Australia
| | - Anita Moody
- UCB Pharma, Level 1, 1155 Malvern Road, Malvern, VIC 3144, Australia
| | - Wendyl D'Souza
- Department of Medicine - St Vincent's Hospital, The University of Melbourne, Clinical Sciences Building, Level 4 / 29 Regent Street, Fitzroy, VIC 3065, Australia
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8
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Nightscales R, Barnard S, Laze J, Chen Z, Tao G, Auvrez C, Sivathamboo S, Cook MJ, Kwan P, Friedman D, Berkovic SF, D'Souza W, Perucca P, Devinsky O, O'Brien TJ. Risk of sudden unexpected death in epilepsy (SUDEP) with lamotrigine and other sodium channel-modulating antiseizure medications. Epilepsia Open 2023. [PMID: 36648376 DOI: 10.1002/epi4.12693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE In vitro data prompted U.S Food and Drug Administration warnings that lamotrigine, a common sodium channel modulating anti-seizure medication (NaM-ASM), could increase the risk of sudden death in patients with structural or ischaemic cardiac disease, however, its implications for Sudden Unexpected Death in Epilepsy (SUDEP) are unclear. METHODS This retrospective, nested case-control study identified 101 sudden unexpected death in epilepsy (SUDEP) cases and 199 living epilepsy controls from Epilepsy Monitoring Units (EMUs) in Australia and the USA. Differences in proportions of lamotrigine and NaM-ASM use were compared between cases and controls at the time of admission, and survival analyses from the time of admission up to 16 years were conducted. Multivariable logistic regression and survival analyses compared each ASM subgroup adjusting for SUDEP risk factors. RESULTS Proportions of cases and controls prescribed lamotrigine (P = 0.166), one NaM-ASM (P = 0.80), or ≥2NaM-ASMs (P = 0.447) at EMU admission were not significantly different. Patients taking lamotrigine (adjusted hazard ratio [aHR] = 0.56; P = 0.054), one NaM-ASM (aHR = 0.8; P = 0.588) or ≥2 NaM-ASMs (aHR = 0.49; P = 0.139) at EMU admission were not at increased SUDEP risk up to 16 years following admission. Active tonic-clonic seizures at EMU admission associated with >2-fold SUDEP risk, irrespective of lamotrigine (aHR = 2.24; P = 0.031) or NaM-ASM use (aHR = 2.25; P = 0.029). Sensitivity analyses accounting for incomplete ASM data at follow-up suggest undetected changes to ASM use are unlikely to alter our results. SIGNIFICANCE This study provides additional evidence that lamotrigine and other NaM-ASMs are unlikely to be associated with an increased long-term risk of SUDEP, up to 16 years post-EMU admission.
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Affiliation(s)
- Russell Nightscales
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Sarah Barnard
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Juliana Laze
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gerard Tao
- Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - Clarissa Auvrez
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Victoria, Australia
| | - Shobi Sivathamboo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mark J Cook
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Daniel Friedman
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Samuel F Berkovic
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Orrin Devinsky
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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9
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Seneviratne U, Christie H, D'Souza W, Cook M. Semiologic differences between bilateral tonic-clonic seizures of focal onset and generalized onset. Epilepsy Behav 2022; 134:108837. [PMID: 35840515 DOI: 10.1016/j.yebeh.2022.108837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Focal semiologies have been described in idiopathic generalized epilepsies (IGE) and generalized-onset bilateral tonic-clonic seizures (GBTCS). These focal signs may lead to wrong diagnosis and inappropriate choice of antiseizure medications. We sought to investigate the differences in focal semiologic features between GBTCS and focal-onset bilateral tonic-clonic seizures (FBTCS). METHODS We retrospectively reviewed video-EEG data of captured GBTCS and FBTCS over a period of five years. The presence or absence of 12 focal signs as well seizure duration and time to head version was tabulated for each seizure. We used the chi-square test for independence and Fisher's exact test to investigate the occurrence of each focal sign in FBTCS compared with GBTCS. Additionally, we used receiver operating characteristic (ROC) curves to explore if the seizure duration and time to head version from the ictal onset can reliably differentiate between FBTCS and GBTCS. Finally, we employed hierarchical cluster analysis to visualize how these focal signs appear in combination. RESULTS Head version (p <.001), preceding automatisms (p <.001), eye version (p <.001), unilateral facial clonic activity (p <.001), and mouth deviation (p =.004) were found to be significantly more frequent in FBTCS. Longer seizures were highly in favor of FBTCS whereas shorter time to head version from the ictal onset indicated GBTCS in the ROC curve analysis. CONCLUSIONS Though focal signs occur in GBTCS, careful evaluation of semiology can help the clinician distinguish FBTCS from GBTCS.
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Affiliation(s)
- Udaya Seneviratne
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; Department of Neuroscience, Monash Medical Centre, Melbourne, Australia.
| | - Harry Christie
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Wendyl D'Souza
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Mark Cook
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
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10
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Halliday A, Duncan A, Cheung M, Boston RC, Apiwattanakul M, Camacho X, Bowden S, D'Souza W. Second-line immunotherapy and functional outcomes in autoimmune encephalitis: A systematic review and individual patient data meta-analysis. Epilepsia 2022; 63:2214-2224. [PMID: 35700069 PMCID: PMC9796249 DOI: 10.1111/epi.17327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/01/2023]
Abstract
Autoimmune encephalitis (AE) is a neurological disorder caused by autoimmune attack on cerebral proteins. Experts currently recommend staged immunotherapeutic management, with first-line immunotherapy followed by second-line immunotherapy if response to first-line therapy is inadequate. Meta-analysis of the evidence base may provide higher quality evidence to support this recommendation. We undertook a systematic review of observational cohort studies reporting AE patients treated with either second-line immunotherapy or first-line immunotherapy alone, and outcomes reported using the modified Rankin Scale (mRS; search date: April 22, 2020). We performed several one-stage multilevel individual patient data (IPD) meta-analyses to examine the association between second-line immunotherapy and final mRS scores (PROSPERO ID CRD42020181805). IPD were obtained for 356 patients from 25 studies. Most studies were rated as moderate to high risk of bias. Seventy-one patients (71/356, 19%) were treated with second-line immunotherapy. We did not find a statistically significant association between treatment with second-line immunotherapy and final mRS score for the cohort overall (odds ratio [OR] = 1.74, 95% confidence interval [CI] = .98-3.08, p = .057), or subgroups with anti-N-methyl-D-aspartate receptor encephalitis (OR = 1.03, 95% CI = .45-2.38, p = .944) or severe AE (maximum mRS score > 2; OR = 1.673, 95% CI = .93-3.00, p = .085). Treatment with second-line immunotherapy was associated with higher final mRS scores in subgroups with anti-leucine-rich glioma-inactivated 1 AE (OR = 6.70, 95% CI = 1.28-35.1, p = .024) and long-term (at least 12 months) follow-up (OR = 3.94, 95% CI = 1.67-9.27, p = .002). We did not observe an association between treatment with second-line immunotherapy and lower final mRS scores in patients with AE. This result should be interpreted with caution, given the risk of bias, limited adjustment for disease severity, and insensitivity of the mRS in estimating psychiatric and cognitive disability.
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Affiliation(s)
- Amy Halliday
- Department of MedicineSt Vincents Hospital Melbourne, University of MelbourneMelbourneVictoriaAustralia,Department of Clinical NeurosciencesSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Andrew Duncan
- Department of MedicineSt Vincents Hospital Melbourne, University of MelbourneMelbourneVictoriaAustralia,Department of Clinical NeurosciencesSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Mike Cheung
- Department of PsychologyNational University of SingaporeSingapore
| | - Ray C. Boston
- Department of MedicineSt Vincents Hospital Melbourne, University of MelbourneMelbourneVictoriaAustralia,Department of Clinical Studies, New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Ximena Camacho
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Stephen Bowden
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Wendyl D'Souza
- Department of MedicineSt Vincents Hospital Melbourne, University of MelbourneMelbourneVictoriaAustralia,Department of Clinical NeurosciencesSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
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11
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Wesselingh R, Broadley J, Buzzard K, Tarlinton D, Seneviratne U, Kyndt C, Stankovich J, Sanfilippo P, Nesbitt C, D'Souza W, Macdonell R, Butzkueven H, O'Brien TJ, Monif M. Prevalence, risk factors, and prognosis of drug-resistant epilepsy in autoimmune encephalitis. Epilepsy Behav 2022; 132:108729. [PMID: 35623203 DOI: 10.1016/j.yebeh.2022.108729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the prevalence and biomarkers of drug-resistant epilepsy (DRE) in patients with autoimmune encephalitis (AIE). METHODS Sixty-nine patients with AIE were recruited retrospectively and electroencephalographies (EEGs) were reviewed using a standard reporting proforma. Associations between EEG biomarkers and DRE development at 12 months were examined using logistic regression modeling and were utilized to create a DRE risk score. RESULTS Sixteen percent of patients with AIE developed DRE at 12-month follow-up. The presence of status epilepticus (SE) (OR 11.50, 95% CI [2.81, 51.86], p-value <0.001), temporal lobe focality (OR 9.90, 95% CI [2.60, 50.71], p-value 0.001) and periodic discharges (OR 19.12, 95% CI [3.79, 191.10], p-value 0.001) on the admission EEG were associated with the development of DRE at 12 months. These variables were utilized to create a clinically applicable risk score for the prediction of DRE development. CONCLUSIONS Drug-resistant epilepsy is an infrequent complication of AIE. Electroencephalography changes during the acute illness can predict the risk of DRE at 12 months post-acute AIE. SIGNIFICANCE The identified EEG biomarkers provide the basis to generate a clinically applicable prediction tool which could be used to inform treatment, prognosis, and select patients for acute treatment trials.
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Affiliation(s)
- Robb Wesselingh
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - James Broadley
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Katherine Buzzard
- Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia; Department of Neuroscience, Eastern Health, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia
| | - David Tarlinton
- Department of Immunology and Pathology, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Burnett Building, 89 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Udaya Seneviratne
- Department of Neurosciences, Monash Health, Clayton Road, Clayton, Victoria 3168, Australia
| | - Chris Kyndt
- Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia; Department of Neuroscience, Eastern Health, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia
| | - Jim Stankovich
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Paul Sanfilippo
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Cassie Nesbitt
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, University Hospital of Geelong, Level 2, Kardinia House, Bellerine Street, Geelong, Victoria 3220, Australia
| | - Wendyl D'Souza
- Department of Neurosciences, Building D - Daly Wing, Level 5, St Vincent's Hospital, Fitzroy, Victoria 3065, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Level 6 North Austin Tower, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Helmut Butzkueven
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Terence J O'Brien
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Mastura Monif
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia.
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12
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Kanaan RA, Mullen SA, D'Souza W, Castro-de-Araujo LFS, Sharma A, Indranada AM. Hyperventilation in functional seizures: Evidence for subtypes. Seizure 2022; 99:8-11. [DOI: 10.1016/j.seizure.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022] Open
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13
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Benovitski Y, Lai A, Saunders A, McGowan C, Burns O, Nayagam D, Millard R, Harrison M, Rathbone GD, Williams RA, May CN, Murphy M, D'Souza W, Cook MJ, Williams C. Preclinical safety study of a fully implantable, sub-scalp ring electrode array for long-term EEG recordings. J Neural Eng 2022; 19:036027. [PMID: 35609552 DOI: 10.1088/1741-2552/ac72c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Long-term electroencephalogram (EEG) recordings can aid diagnosis and management of various neurological conditions such as epilepsy. In this study we characterize the safety and stability of a clinical grade ring electrode arrays by analyzing EEG recordings, fluoroscopy, and computed tomography (CT) imaging with long-term implantation and histopathological tissue response. APPROACH Seven animals were chronically implanted with EEG recording array consisting of four electrode contacts. Recordings were made bilaterally using a bipolar longitudinal montage. The array was connected to a fully implantable micro-processor controlled electronic device with two low-noise differential amplifiers and a transmitter-receiver coil. An external wearable was used to power, communicate with the implant via an inductive coil, and store the data. The sub-scalp electrode arrays were made using medical grade silicone and platinum. The electrode arrays were tunneled in the subgaleal cleavage plane between the periosteum and the overlying dermis. These were implanted for 3-7 months before euthanasia and histopathological assessment. EEG and impedance were recorded throughout the study. MAIN RESULTS Impedance measurements remained low throughout the study for 11 of 12 channels over the recording period ranged from 3 to 5 months. There was also a steady amplitude of slow-wave EEG and chewing artifact (noise). The post-mortem CT and histopathology showed the electrodes remained in the subgaleal plane in 6 of 7 sheep. There was minimal inflammation with a thin fibrotic capsule that ranged from 4 to 101μm. There was a variable fibrosis in the subgaleal plane extending from 210 to 3617μm (S3-S7) due to surgical cleavage. One sheep had an inflammatory reaction due to electrode extrusion. The passive electrode array extraction force was around 1N. SIGNIFICANCE Results show sub-scalp electrode placement was safe and stable for long term implantation. This is advantageous for diagnosis and management of neurological conditions where long-term, EEG monitoring is required.
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Affiliation(s)
- Yuri Benovitski
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA
| | - Alan Lai
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, St Vincent's Hospital, Fitzroy, Victoria, 3065, AUSTRALIA
| | - Alexia Saunders
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA
| | - Ceara McGowan
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA
| | - Owen Burns
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA
| | - David Nayagam
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA
| | - Rodney Millard
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA
| | - Mark Harrison
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA
| | - Graeme D Rathbone
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA
| | - Richard A Williams
- The University of Melbourne Department of Clinical Pathology, St Vincent's Hospital, Fitzroy, Victoria, 3065, AUSTRALIA
| | - Clive N May
- Florey Institute of Neuroscience and Mental Health, 30 Royal Parade, Parkville, Victoria, 3052, AUSTRALIA
| | - Michael Murphy
- The University of Melbourne Surgery at St Vincent's Hospital, St. Vincent's Hospital, Fitzroy, Victoria, 3065, AUSTRALIA
| | - Wendyl D'Souza
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, St Vincent's Hospital, Fitzroy, Victoria, 3065, AUSTRALIA
| | - Mark J Cook
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, St Vincent's Hospital, Fitzroy, Victoria, 3065, AUSTRALIA
| | - Chris Williams
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, 3002, AUSTRALIA
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14
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Griffith S, Wesslingh R, Broadley J, O'Shea M, Kyndt C, Meade C, Long B, Seneviratne U, Reidy N, Bourke R, Buzzard K, D'Souza W, Macdonell R, Brodtmann A, Butzkueven H, O'Brien TJ, Alpitsis R, Malpas CB, Monif M. Psychometric Deficits in Autoimmune Encephalitis: A retrospective study from the Australian Autoimmune Encephalitis Consortium. Eur J Neurol 2022; 29:2355-2366. [PMID: 35460305 DOI: 10.1111/ene.15367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the rapid increase in research examining outcomes in Autoimmune Encephalitis (AE) patients, there are few cohort studies examining cognitive outcomes in this population. METHODS This retrospective observational study collected psychometric data from 59 patients across six secondary and tertiary referral centres in metropolitan hospitals in Victoria, Australia between January 2008 and July 2019. Frequency and pattern analysis were employed to define and characterise psychometric outcomes. Univariable logistic regression was performed to examine predictors of intact and pathological psychometric outcomes. RESULTS Deficits in psychometric markers of executive dysfunction were the most commonly observed in this cohort, followed by deficits on tasks sensitive to memory. 54.2% were classified as having psychometric impairments across at least two cognitive domains. 29 patterns were observed, suggesting outcomes in AE are complex. None of the demographic data, clinical features, and auxiliary examination variables were predictors of psychometric outcome. CONCLUSIONS Cognitive outcomes in AE are complex. Further detailed and standardised cognitive testing in combination with MRI volumetrics and serum/CSF biomarkers is required to provide rigorous assessments of disease outcomes.
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Affiliation(s)
- Sarah Griffith
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Alfred Health, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004
| | - Robb Wesslingh
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Alfred Health, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004
| | - James Broadley
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Alfred Health, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004
| | - Marie O'Shea
- Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia, 3084.,Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Chris Kyndt
- Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria, Australia, 3050.,Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, VIC, Australia
| | - Catherine Meade
- Department of Neurosciences, Building D - Daly Wing, Level 5, St Vincent's Hospital, Fitzroy, Victoria, Australia, 3065
| | - Brian Long
- Neuropsychology Unit, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia, 3168
| | - Udaya Seneviratne
- Department of Neurosciences, Monash Health, Clayton Road, Clayton, Victoria, Australia, 3168
| | - Natalie Reidy
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, VIC, Australia
| | - Robert Bourke
- Neuropsychology Unit, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia, 3168
| | - Katherine Buzzard
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, VIC, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia, 3065
| | - Richard Macdonell
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia, 3084
| | - Amy Brodtmann
- Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria, Australia, 3050.,Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, VIC, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia, 3084
| | - Helmut Butzkueven
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Alfred Health, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004
| | - Terence J O'Brien
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Alfred Health, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004
| | - Rubina Alpitsis
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Alfred Health, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004
| | - Charles B Malpas
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Alfred Health, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria, Australia, 3050.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Alfred Health, Alfred Centre, Level 6, 99 Commercial Road, Melbourne, Victoria, Australia, 3004.,Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria, Australia, 3050
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15
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Chen ZS, Hsieh A, Sun G, Bergey GK, Berkovic SF, Perucca P, D'Souza W, Elder CJ, Farooque P, Johnson EL, Barnard S, Nightscales R, Kwan P, Moseley B, O'Brien TJ, Sivathamboo S, Laze J, Friedman D, Devinsky O. Interictal EEG and ECG for SUDEP Risk Assessment: A Retrospective Multicenter Cohort Study. Front Neurol 2022; 13:858333. [PMID: 35370908 PMCID: PMC8973318 DOI: 10.3389/fneur.2022.858333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality. Although lots of effort has been made in identifying clinical risk factors for SUDEP in the literature, there are few validated methods to predict individual SUDEP risk. Prolonged postictal EEG suppression (PGES) is a potential SUDEP biomarker, but its occurrence is infrequent and requires epilepsy monitoring unit admission. We use machine learning methods to examine SUDEP risk using interictal EEG and ECG recordings from SUDEP cases and matched living epilepsy controls. Methods This multicenter, retrospective, cohort study examined interictal EEG and ECG recordings from 30 SUDEP cases and 58 age-matched living epilepsy patient controls. We trained machine learning models with interictal EEG and ECG features to predict the retrospective SUDEP risk for each patient. We assessed cross-validated classification accuracy and the area under the receiver operating characteristic (AUC) curve. Results The logistic regression (LR) classifier produced the overall best performance, outperforming the support vector machine (SVM), random forest (RF), and convolutional neural network (CNN). Among the 30 patients with SUDEP [14 females; mean age (SD), 31 (8.47) years] and 58 living epilepsy controls [26 females (43%); mean age (SD) 31 (8.5) years], the LR model achieved the median AUC of 0.77 [interquartile range (IQR), 0.73–0.80] in five-fold cross-validation using interictal alpha and low gamma power ratio of the EEG and heart rate variability (HRV) features extracted from the ECG. The LR model achieved the mean AUC of 0.79 in leave-one-center-out prediction. Conclusions Our results support that machine learning-driven models may quantify SUDEP risk for epilepsy patients, future refinements in our model may help predict individualized SUDEP risk and help clinicians correlate predictive scores with the clinical data. Low-cost and noninvasive interictal biomarkers of SUDEP risk may help clinicians to identify high-risk patients and initiate preventive strategies.
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Affiliation(s)
- Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
- Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- *Correspondence: Zhe Sage Chen
| | - Aaron Hsieh
- Tandon School of Engineering, New York University, New York, NY, United States
| | - Guanghao Sun
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
| | - Gregory K. Bergey
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Samuel F. Berkovic
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, VIC, Australia
- Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Piero Perucca
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, VIC, Australia
- Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Christopher J. Elder
- Division of Epilepsy and Sleep, Columbia University, New York, NY, United States
| | - Pue Farooque
- Yale University School of Medicine, New Haven, CT, United States
| | - Emily L. Johnson
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sarah Barnard
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Russell Nightscales
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Brian Moseley
- Clinical Development Neurocrine Biosciences Inc., San Diego, CA, United States
| | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Shobi Sivathamboo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Juliana Laze
- Comprehensive Epilepsy Center, New York University Langone Health, New York, NY, United States
| | - Daniel Friedman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
- Comprehensive Epilepsy Center, New York University Langone Health, New York, NY, United States
| | - Orrin Devinsky
- Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
- Comprehensive Epilepsy Center, New York University Langone Health, New York, NY, United States
- Orrin Devinsky
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16
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Wesselingh R, Broadley J, Buzzard K, Tarlinton D, Seneviratne U, Kyndt C, Stankovich J, Sanfilippo P, Nesbitt C, D'Souza W, Macdonell R, Butzkueven H, O'Brien TJ, Monif M. Electroclinical biomarkers of autoimmune encephalitis. Epilepsy Behav 2022; 128:108571. [PMID: 35101840 DOI: 10.1016/j.yebeh.2022.108571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/25/2021] [Accepted: 01/10/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the utility of electroencephalography (EEG) changes as diagnostic and prognostic biomarkers in acute autoimmune encephalitis (AIE). METHODS One hundred and thirty-one patients with AIE were recruited retrospectively across 7 hospitals. Clinical data were collected during admission and at 12 months. EEGs were reviewed using a standard reporting proforma. Associations between EEG biomarkers, AIE subtypes, and clinical outcomes were assessed using logistic regression modeling. RESULTS Presence of superimposed fast activity (OR 34.33; 95% CI 3.90, 4527.27; p < 0.001), fluctuating EEG abnormality (OR 6.60; 95% CI 1.60, 37.59; p = 0.008), and hemispheric focality (OR 28.48; 95% CI 3.14, 3773.14; p < 0.001) were significantly more common in N-methyl-d-aspartate receptor (NMDAR) antibody-associated patients with AIE compared to other AIE subtypes. Abnormal background rhythm was associated with a poor mRS (modified Rankin score) at discharge (OR 0.29; 95% CI 0.10, 0.75; p = 0.01) and improvement in mRS at 12 months compared with admission mRS (3.72; 95% CI 1.14, 15.23; p = 0.04). SIGNIFICANCE We have identified EEG biomarkers that differentiate NMDAR AIE from other subtypes. We have also demonstrated EEG biomarkers that are associated with poor functional outcomes.
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Affiliation(s)
- Robb Wesselingh
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - James Broadley
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Katherine Buzzard
- Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia; Department of Neuroscience, Eastern Health, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia
| | - David Tarlinton
- Department of Immunology, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Burnett Building, 89 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Udaya Seneviratne
- Department of Neurosciences, Monash Health, Clayton Road, Clayton, Victoria 3168, Australia
| | - Chris Kyndt
- Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia; Department of Neuroscience, Eastern Health, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia
| | - Jim Stankovich
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Paul Sanfilippo
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Cassie Nesbitt
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Barwon Neurology, Level 2, Kardinia House, Bellerine Street, Geelong, Victoria 3220, Australia
| | - Wendyl D'Souza
- Department of Neurosciences, Building D - Daly Wing, Level 5, St Vincent's Hospital, Fitzroy, Victoria 3065, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Level 6 North Austin Tower, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Helmut Butzkueven
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Terence J O'Brien
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Mastura Monif
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia.
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17
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Foster E, Chen Z, Vaughan DN, Tailby C, Carney PW, D'Souza W, Au Yong HM, Nicolo JP, Pellinen J, Carrillo de Albornoz S, Liew D, O'Brien TJ, Kwan P, Ademi Z. Prospective multisite cohort study of patient-reported outcomes in adults with new-onset seizures. Epilepsia Open 2021; 7:201-209. [PMID: 34913272 PMCID: PMC8886095 DOI: 10.1002/epi4.12571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/27/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Objective New‐onset seizures affect up to 10% of people over their lifetime, however, their health economic impact has not been well‐studied. This prospective multicenter study will collect patient‐reported outcome measures (PROMs) from adults with new‐onset seizures seen in six Seizure Clinics across Melbourne, Australia and The University of Colorado, USA. Methods Approximately 450 eligible patients will be enrolled in the study at or following their initial attendance to Seizure Clinics at the study hospitals. Inclusion criteria for the study group are those with new‐onset acute symptomatic seizures, new‐onset unprovoked seizures, and new‐onset epilepsy. Inclusion criteria for the three comparator groups are those with noncardiac syncope, those with psychogenic nonepileptic seizures, as well as published PROMs data from the Australian general population. Exclusion criteria are those aged less than 18 years, those with a preexisting epilepsy diagnosis, and those with intellectual disabilities or other impairments which would preclude them from comprehending and completing the questionnaires. Patients will complete eight online questionnaires regarding the effect that their seizures (or seizure mimics) have had on various aspects of their life. These questionnaires will be readministered at 6 and 12 months. Patients with new‐diagnosis epilepsy will also be asked to share the reasons why they have accepted or declined antiseizure medications. Analysis Primary outcome measures will be quality of life, work productivity, informal care needs, and mood, at baseline compared to 6 and 12 months later for those with new‐onset seizures and comparing these outcomes to those in the three comparator groups. Secondary outcomes include mapping of QoLIE‐31 to the EQ‐5D‐5L in epilepsy, modelling indirect costs of new‐onset seizures, and exploring why patients may or may not wish to take antiseizure medications. Significance These data will form an evidence‐base for future studies that examine the effectiveness of various healthcare interventions for new‐onset seizure patients. Ethics and dissemination This study is approved by the Alfred Health Human Research Ethics Committee (SERP: 52 538, Alfred HREC: 307/19), the Austin Health Human Research Ethics Committee (HREC/59148/Austin‐2019), and the Colorado Multiple Institutional Review Board (COMIRB) (COMIRB #20‐3028). ANZCTR trial registration number ACTRN12621000908831.
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Affiliation(s)
- Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David N Vaughan
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher Tailby
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Patrick W Carney
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing, and Health Sciences, Clayton, Victoria, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, Victoria, Australia
| | - Hue Mun Au Yong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - John-Paul Nicolo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Jacob Pellinen
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sara Carrillo de Albornoz
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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18
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Sivathamboo S, Friedman D, Laze J, Nightscales R, Chen Z, Kuhlmann L, Devore S, Macefield V, Kwan P, D'Souza W, Berkovic SF, Perucca P, O'Brien TJ, Devinsky O. Association of Short-term Heart Rate Variability and Sudden Unexpected Death in Epilepsy. Neurology 2021; 97:e2357-e2367. [PMID: 34649884 DOI: 10.1212/wnl.0000000000012946] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We compared heart rate variability (HRV) in sudden unexpected death in epilepsy (SUDEP) cases and living epilepsy controls. METHODS This international, multicenter, retrospective, nested case-control study examined patients admitted for video-EEG monitoring (VEM) between January 1, 2003, and December 31, 2014, and subsequently died of SUDEP. Time domain and frequency domain components were extracted from 5-minute interictal ECG recordings during sleep and wakefulness from SUDEP cases and controls. RESULTS We identified 31 SUDEP cases and 56 controls. Normalized low-frequency power (LFP) during wakefulness was lower in SUDEP cases (median 42.5, interquartile range [IQR] 32.6-52.6) than epilepsy controls (55.5, IQR 40.7-68.9; p = 0.015, critical value = 0.025). In the multivariable model, normalized LFP was lower in SUDEP cases compared to controls (contrast -11.01, 95% confidence interval [CI] -20.29 to 1.73; p = 0.020, critical value = 0.025). There was a negative correlation between LFP and the latency to SUDEP, where each 1% incremental reduction in normalized LFP conferred a 2.7% decrease in the latency to SUDEP (95% CI 0.95-0.995; p = 0.017, critical value = 0.025). Increased survival duration from VEM to SUDEP was associated with higher normalized high-frequency power (HFP; p = 0.002, critical value = 0.025). The survival model with normalized LFP was associated with SUDEP (c statistic 0.66, 95% CI 0.55-0.77), which nonsignificantly increased with the addition of normalized HFP (c statistic 0.70, 95% CI 0.59-0.81; p = 0.209). CONCLUSIONS Reduced short-term LFP, which is a validated biomarker for sudden death, was associated with SUDEP. Increased HFP was associated with longer survival and may be cardioprotective in SUDEP. HRV quantification may help stratify individual SUDEP risk. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in patients with epilepsy, some measures of HRV are associated with SUDEP.
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Affiliation(s)
- Shobi Sivathamboo
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Daniel Friedman
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Juliana Laze
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Russell Nightscales
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Zhibin Chen
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Levin Kuhlmann
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Sasha Devore
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Vaughan Macefield
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Patrick Kwan
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Wendyl D'Souza
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Samuel F Berkovic
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Piero Perucca
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Terence J O'Brien
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Orrin Devinsky
- From the Department of Neuroscience, Central Clinical School (S.S., R.N., Z.C., M.B., V.M., P.K., P.P., T.J.O.), Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C., M.B.), and Department of Data Science and AI, Faculty of Information Technology (L.K.), Monash University; Department of Medicine (The Royal Melbourne Hospital) (S.S., R.N., Z.C., M.B., P.K., P.P., T.J.O.), The University of Melbourne; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), The Royal Melbourne Hospital; Department of Neurology (S.S., R.N., P.K., P.P., T.J.O.), Alfred Health, Melbourne, Australia; Department of Neurology (D.F., J.L., S.D., O.D.), New York University Grossman School of Medicine, New York; Human Autonomic Neurophysiology (V.M.), Baker Heart and Diabetes Institute, Melbourne; Department of Medicine (W.D., M.D.C.B.), St. Vincent's Hospital, The University of Melbourne, Fitzroy; and Department of Medicine (S.F.B.), Austin Health, The University of Melbourne, Heidelberg, Australia.
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19
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Tao G, Auvrez C, Nightscales R, Barnard S, McCartney L, Malpas CB, Perucca P, Chen Z, Adams S, McIntosh A, Ignatiadis S, O'Brien P, Cook MJ, Kwan P, Berkovic SF, D'Souza W, Velakoulis D, O'Brien TJ. Association Between Psychiatric Comorbidities and Mortality in Epilepsy. Neurol Clin Pract 2021; 11:429-437. [PMID: 34824893 PMCID: PMC8610550 DOI: 10.1212/cpj.0000000000001114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/07/2021] [Indexed: 01/26/2023]
Abstract
Objective To explore the impact of psychiatric comorbidities on all-cause mortality in adults with epilepsy from a cohort of patients admitted for video-EEG monitoring (VEM) over 2 decades. Methods A retrospective medical record audit was conducted on 2,709 adults admitted for VEM and diagnosed with epilepsy at 3 Victorian comprehensive epilepsy programs from 1995 to 2015. A total of 1,805 patients were identified in whom the record of a clinical evaluation by a neuropsychiatrist was available, excluding 27 patients who died of a malignant brain tumor known at the time of VEM admission. Epilepsy and lifetime psychiatric diagnoses were determined from consensus opinion of epileptologists and neuropsychiatrists involved in the care of each patient. Mortality and cause of death were determined by linkage to the Australian National Death Index and National Coronial Information System. Results Compared with the general population, mortality was higher in people with epilepsy (PWE) with a psychiatric illness (standardized mortality ratio [SMR] 3.6) and without a psychiatric illness (SMR 2.5). PWE with a psychiatric illness had greater mortality compared with PWE without (hazard ratio 1.41, 95% confidence interval 1.02-1.97) after adjusting for age and sex. No single psychiatric disorder by itself conferred increased mortality in PWE. The distribution of causes of death remained similar between PWE with psychiatric comorbidities and those without. Conclusion The presence of comorbid psychiatric disorders in adults with epilepsy is associated with increased mortality, highlighting the importance of identifying and treating psychiatric comorbidities in these patients.
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Affiliation(s)
- Gerard Tao
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Clarissa Auvrez
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Russell Nightscales
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Sarah Barnard
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Lara McCartney
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Charles B Malpas
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Piero Perucca
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Zhibin Chen
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Sophia Adams
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Anne McIntosh
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Sophia Ignatiadis
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Patrick O'Brien
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Mark J Cook
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Patrick Kwan
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Samuel F Berkovic
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Wendyl D'Souza
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Dennis Velakoulis
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Terence J O'Brien
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
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Seneviratne U, Cook M, D'Souza W. Brainwaves beyond diagnosis: Wider applications of electroencephalography in idiopathic generalized epilepsy. Epilepsia 2021; 63:22-41. [PMID: 34755907 DOI: 10.1111/epi.17119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
Electroencephalography (EEG) has long been used as a versatile and noninvasive diagnostic tool in epilepsy. With the advent of digital EEG, more advanced applications of EEG have emerged. Compared with technologically advanced practice in focal epilepsies, the utilization of EEG in idiopathic generalized epilepsy (IGE) has been lagging, often restricted to a simple diagnostic tool. In this narrative review, we provide an overview of broader applications of EEG beyond this narrow scope, discussing how the current clinical and research applications of EEG may potentially be extended to IGE. The current literature, although limited, suggests that EEG can be used in syndromic classification, guiding antiseizure medication therapy, predicting prognosis, unraveling biorhythms, and investigating functional brain connectivity of IGE. We emphasize the need for longer recordings, particularly 24-h ambulatory EEG, to capture discharges reflecting circadian and sleep-wake cycle-associated variations for wider EEG applications in IGE. Finally, we highlight the challenges and limitations of the current body of literature and suggest future directions to encourage and enhance more extensive applications of this potent tool.
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Affiliation(s)
- Udaya Seneviratne
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Mark Cook
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Wendyl D'Souza
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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21
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Karoly PJ, Stirling RE, Freestone DR, Nurse ES, Maturana MI, Halliday AJ, Neal A, Gregg NM, Brinkmann BH, Richardson MP, La Gerche A, Grayden DB, D'Souza W, Cook MJ. Multiday cycles of heart rate are associated with seizure likelihood: An observational cohort study. EBioMedicine 2021; 72:103619. [PMID: 34649079 PMCID: PMC8517288 DOI: 10.1016/j.ebiom.2021.103619] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/23/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Circadian and multiday rhythms are found across many biological systems, including cardiology, endocrinology, neurology, and immunology. In people with epilepsy, epileptic brain activity and seizure occurrence have been found to follow circadian, weekly, and monthly rhythms. Understanding the relationship between these cycles of brain excitability and other physiological systems can provide new insight into the causes of multiday cycles. The brain-heart link has previously been considered in epilepsy research, with potential implications for seizure forecasting, therapy, and mortality (i.e., sudden unexpected death in epilepsy). Methods We report the results from a non-interventional, observational cohort study, Tracking Seizure Cycles. This study sought to examine multiday cycles of heart rate and seizures in adults with diagnosed uncontrolled epilepsy (N=31) and healthy adult controls (N=15) using wearable smartwatches and mobile seizure diaries over at least four months (M=12.0, SD=5.9; control M=10.6, SD=6.4). Cycles in heart rate were detected using a continuous wavelet transform. Relationships between heart rate cycles and seizure occurrence were measured from the distributions of seizure likelihood with respect to underlying cycle phase. Findings Heart rate cycles were found in all 46 participants (people with epilepsy and healthy controls), with circadian (N=46), about-weekly (N=25) and about-monthly (N=13) rhythms being the most prevalent. Of the participants with epilepsy, 19 people had at least 20 reported seizures, and 10 of these had seizures significantly phase locked to their multiday heart rate cycles. Interpretation Heart rate cycles showed similarities to multiday epileptic rhythms and may be comodulated with seizure likelihood. The relationship between heart rate and seizures is relevant for epilepsy therapy, including seizure forecasting, and may also have implications for cardiovascular disease. More broadly, understanding the link between multiday cycles in the heart and brain can shed new light on endogenous physiological rhythms in humans. Funding This research received funding from the Australian Government National Health and Medical Research Council (investigator grant 1178220), the Australian Government BioMedTech Horizons program, and the Epilepsy Foundation of America's ‘My Seizure Gauge’ grant.
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Affiliation(s)
- Philippa J Karoly
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Australia; Seer Medical, Australia.
| | - Rachel E Stirling
- Department of Biomedical Engineering, The University of Melbourne, Australia
| | | | - Ewan S Nurse
- Seer Medical, Australia; Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Matias I Maturana
- Seer Medical, Australia; Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Amy J Halliday
- Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Andrew Neal
- Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Nicholas M Gregg
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Benjamin H Brinkmann
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN
| | | | - Andre La Gerche
- Sports Cardiology Laboratory, Baker Heart & Diabetes Institute, Melbourne, Australia
| | - David B Grayden
- Department of Biomedical Engineering, The University of Melbourne, Australia
| | - Wendyl D'Souza
- Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Mark J Cook
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Australia; Departments of Medicine and Neurology, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia
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22
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Swarup O, Waxmann A, Chu J, Vogrin S, Lai A, Laing J, Barker J, Seiderer L, Ignatiadis S, Plummer C, Carne R, Seneviratne U, Cook M, Murphy M, D'Souza W. Long-term mood, quality of life, and seizure freedom in intracranial EEG epilepsy surgery. Epilepsy Behav 2021; 123:108241. [PMID: 34450387 DOI: 10.1016/j.yebeh.2021.108241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the long-term outcomes in patients undergoing intracranial EEG (iEEG) evaluation for epilepsy surgery in terms of seizure freedom, mood, and quality of life at St. Vincent's Hospital, Melbourne. METHODS Patients who underwent iEEG between 1999 and 2016 were identified. Patients were retrospectively assessed between 2014 and 2017 by specialist clinic record review and telephone survey with standardized validated questionnaires for: 1) seizure freedom using the Engel classification; 2) Mood using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); 3) Quality-of-life outcomes using the QOLIE-10 questionnaire. Summary statistics and univariate analysis were performed to investigate variables for significance. RESULTS Seventy one patients underwent iEEG surgery: 49 Subdural, 14 Depths, 8 Combination with 62/68 (91.9%) of those still alive, available at last follow-up by telephone survey or medical record review (median of 8.2 years). The estimated epileptogenic zone was 62% temporal and 38% extra-temporal. At last follow-up, 69.4% (43/62) were Engel Class I and 30.6% (19/62) were Engel Class II-IV. Further, a depressive episode (NDDI-E > 15)was observed in 34% (16/47), while a 'better quality of life' (QOLIE-10 score < 25) was noted in 74% (31/42). Quality of life (p < 0.001) but not mood (p = 0.24) was associated with seizure freedom. SIGNIFICANCE Long-term seizure freedom can be observed in patients undergoing complex epilepsy surgery with iEEG evaluation and is associated with good quality of life.
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Affiliation(s)
- Oshi Swarup
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Medicine, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, Victoria 3050, Australia.
| | - Alexandra Waxmann
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Jocelyn Chu
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Simon Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Faculty of Health Arts and Design, Swinburne University of Technology, John St, Hawthorn, Victoria 3122, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Joshua Laing
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - James Barker
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Medicine, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, Victoria 3050, Australia
| | - Linda Seiderer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Sophia Ignatiadis
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Chris Plummer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Faculty of Health Arts and Design, Swinburne University of Technology, John St, Hawthorn, Victoria 3122, Australia
| | - Ross Carne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Neurosciences, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168, Australia
| | - Mark Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Michael Murphy
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
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23
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Stirling RE, Maturana MI, Karoly PJ, Nurse ES, McCutcheon K, Grayden DB, Ringo SG, Heasman JM, Hoare RJ, Lai A, D'Souza W, Seneviratne U, Seiderer L, McLean KJ, Bulluss KJ, Murphy M, Brinkmann BH, Richardson MP, Freestone DR, Cook MJ. Seizure Forecasting Using a Novel Sub-Scalp Ultra-Long Term EEG Monitoring System. Front Neurol 2021; 12:713794. [PMID: 34497578 PMCID: PMC8419461 DOI: 10.3389/fneur.2021.713794] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Accurate identification of seizure activity, both clinical and subclinical, has important implications in the management of epilepsy. Accurate recognition of seizure activity is essential for diagnostic, management and forecasting purposes, but patient-reported seizures have been shown to be unreliable. Earlier work has revealed accurate capture of electrographic seizures and forecasting is possible with an implantable intracranial device, but less invasive electroencephalography (EEG) recording systems would be optimal. Here, we present preliminary results of seizure detection and forecasting with a minimally invasive sub-scalp device that continuously records EEG. Five participants with refractory epilepsy who experience at least two clinically identifiable seizures monthly have been implanted with sub-scalp devices (Minder®), providing two channels of data from both hemispheres of the brain. Data is continuously captured via a behind-the-ear system, which also powers the device, and transferred wirelessly to a mobile phone, from where it is accessible remotely via cloud storage. EEG recordings from the sub-scalp device were compared to data recorded from a conventional system during a 1-week ambulatory video-EEG monitoring session. Suspect epileptiform activity (EA) was detected using machine learning algorithms and reviewed by trained neurophysiologists. Seizure forecasting was demonstrated retrospectively by utilizing cycles in EA and previous seizure times. The procedures and devices were well-tolerated and no significant complications have been reported. Seizures were accurately identified on the sub-scalp system, as visually confirmed by periods of concurrent conventional scalp EEG recordings. The data acquired also allowed seizure forecasting to be successfully undertaken. The area under the receiver operating characteristic curve (AUC score) achieved (0.88), which is comparable to the best score in recent, state-of-the-art forecasting work using intracranial EEG.
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Affiliation(s)
- Rachel E. Stirling
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Matias I. Maturana
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Philippa J. Karoly
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Ewan S. Nurse
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | | | - David B. Grayden
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | | | - John M. Heasman
- Epi-Minder Pty. Ltd., Melbourne, VIC, Australia
- Cochlear Limited, Sydney, NSW, Australia
| | | | - Alan Lai
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Wendyl D'Souza
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Udaya Seneviratne
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, Monash Medical Centre, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Linda Seiderer
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Karen J. McLean
- Epi-Minder Pty. Ltd., Melbourne, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Kristian J. Bulluss
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Michael Murphy
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Benjamin H. Brinkmann
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Mark P. Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Mark J. Cook
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Epi-Minder Pty. Ltd., Melbourne, VIC, Australia
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24
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Clarke S, Karoly PJ, Nurse E, Seneviratne U, Taylor J, Knight-Sadler R, Kerr R, Moore B, Hennessy P, Mendis D, Lim C, Miles J, Cook M, Freestone DR, D'Souza W. Computer-assisted EEG diagnostic review for idiopathic generalized epilepsy. Epilepsy Behav 2021; 121:106556. [PMID: 31676240 DOI: 10.1016/j.yebeh.2019.106556] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 11/25/2022]
Abstract
Epilepsy diagnosis can be costly, time-consuming, and not uncommonly inaccurate. The reference standard diagnostic monitoring is continuous video-electroencephalography (EEG) monitoring, ideally capturing all events or concordant interictal discharges. Automating EEG data review would save time and resources, thus enabling more people to receive reference standard monitoring and also potentially heralding a more quantitative approach to therapeutic outcomes. There is substantial research into the automated detection of seizures and epileptic activity from EEG. However, automated detection software is not widely used in the clinic, and despite numerous published algorithms, few methods have regulatory approval for detecting epileptic activity from EEG. This study reports on a deep learning algorithm for computer-assisted EEG review. Deep convolutional neural networks were trained to detect epileptic discharges using a preexisting dataset of over 6000 labelled events in a cohort of 103 patients with idiopathic generalized epilepsy (IGE). Patients underwent 24-hour ambulatory outpatient EEG, and all data were curated and confirmed independently by two epilepsy specialists (Seneviratne et al., 2016). The resulting automated detection algorithm was then used to review diagnostic scalp EEG for seven patients (four with IGE and three with events mimicking seizures) to validate performance in a clinical setting. The automated detection algorithm showed state-of-the-art performance for detecting epileptic activity from clinical EEG, with mean sensitivity of >95% and corresponding mean false positive rate of 1 detection per minute. Importantly, diagnostic case studies showed that the automated detection algorithm reduced human review time by 80%-99%, without compromising event detection or diagnostic accuracy. The presented results demonstrate that computer-assisted review can increase the speed and accuracy of EEG assessment and has the potential to greatly improve therapeutic outcomes. This article is part of the Special Issue "NEWroscience 2018".
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Affiliation(s)
- Shannon Clarke
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia.
| | - Philippa J Karoly
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia; Graeme Clark Institute, The University of Melbourne, Building 261, 203 Bouverie Street, Carlton, VIC 3053, Australia
| | - Ewan Nurse
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
| | - Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, VIC 3800, Australia
| | - Janelle Taylor
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | | | - Robert Kerr
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Braden Moore
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Patrick Hennessy
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Dulini Mendis
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Claire Lim
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
| | - Jake Miles
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
| | - Mark Cook
- Graeme Clark Institute, The University of Melbourne, Building 261, 203 Bouverie Street, Carlton, VIC 3053, Australia
| | - Dean R Freestone
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
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25
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Stirling RE, Grayden DB, D'Souza W, Cook MJ, Nurse E, Freestone DR, Payne DE, Brinkmann BH, Pal Attia T, Viana PF, Richardson MP, Karoly PJ. Forecasting Seizure Likelihood With Wearable Technology. Front Neurol 2021; 12:704060. [PMID: 34335457 PMCID: PMC8320020 DOI: 10.3389/fneur.2021.704060] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/17/2021] [Indexed: 12/11/2022] Open
Abstract
The unpredictability of epileptic seizures exposes people with epilepsy to potential physical harm, restricts day-to-day activities, and impacts mental well-being. Accurate seizure forecasters would reduce the uncertainty associated with seizures but need to be feasible and accessible in the long-term. Wearable devices are perfect candidates to develop non-invasive, accessible forecasts but are yet to be investigated in long-term studies. We hypothesized that machine learning models could utilize heart rate as a biomarker for well-established cycles of seizures and epileptic activity, in addition to other wearable signals, to forecast high and low risk seizure periods. This feasibility study tracked participants' (n = 11) heart rates, sleep, and step counts using wearable smartwatches and seizure occurrence using smartphone seizure diaries for at least 6 months (mean = 14.6 months, SD = 3.8 months). Eligible participants had a diagnosis of refractory epilepsy and reported at least 20 seizures (mean = 135, SD = 123) during the recording period. An ensembled machine learning and neural network model estimated seizure risk either daily or hourly, with retraining occurring on a weekly basis as additional data was collected. Performance was evaluated retrospectively against a rate-matched random forecast using the area under the receiver operating curve. A pseudo-prospective evaluation was also conducted on a held-out dataset. Of the 11 participants, seizures were predicted above chance in all (100%) participants using an hourly forecast and in ten (91%) participants using a daily forecast. The average time spent in high risk (prediction time) before a seizure occurred was 37 min in the hourly forecast and 3 days in the daily forecast. Cyclic features added the most predictive value to the forecasts, particularly circadian and multiday heart rate cycles. Wearable devices can be used to produce patient-specific seizure forecasts, particularly when biomarkers of seizure and epileptic activity cycles are utilized.
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Affiliation(s)
- Rachel E. Stirling
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - David B. Grayden
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Wendyl D'Souza
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark J. Cook
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Ewan Nurse
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Seer Medical, Melbourne, VIC, Australia
| | | | - Daniel E. Payne
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin H. Brinkmann
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Tal Pal Attia
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Pedro F. Viana
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Mark P. Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Philippa J. Karoly
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Departments of Medicine and Neurology, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
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26
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Dell KL, Payne DE, Kremen V, Maturana MI, Gerla V, Nejedly P, Worrell GA, Lenka L, Mivalt F, Boston RC, Brinkmann BH, D'Souza W, Burkitt AN, Grayden DB, Kuhlmann L, Freestone DR, Cook MJ. Seizure likelihood varies with day-to-day variations in sleep duration in patients with refractory focal epilepsy: A longitudinal electroencephalography investigation. EClinicalMedicine 2021; 37:100934. [PMID: 34386736 PMCID: PMC8343264 DOI: 10.1016/j.eclinm.2021.100934] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND While the effects of prolonged sleep deprivation (≥24 h) on seizure occurrence has been thoroughly explored, little is known about the effects of day-to-day variations in the duration and quality of sleep on seizure probability. A better understanding of the interaction between sleep and seizures may help to improve seizure management. METHODS To explore how sleep and epileptic seizures are associated, we analysed continuous intracranial electroencephalography (EEG) recordings collected from 10 patients with refractory focal epilepsy undergoing ordinary life activities between 2010 and 2012 from three clinical centres (Austin Health, The Royal Melbourne Hospital, and St Vincent's Hospital of the Melbourne University Epilepsy Group). A total of 4340 days of sleep-wake data were analysed (average 434 days per patient). EEG data were sleep scored using a semi-automated machine learning approach into wake, stages one, two, and three non-rapid eye movement sleep, and rapid eye movement sleep categories. FINDINGS Seizure probability changes with day-to-day variations in sleep duration. Logistic regression models revealed that an increase in sleep duration, by 1·66 ± 0·52 h, lowered the odds of seizure by 27% in the following 48 h. Following a seizure, patients slept for longer durations and if a seizure occurred during sleep, then sleep quality was also reduced with increased time spent aroused from sleep and reduced rapid eye movement sleep. INTERPRETATION Our results suggest that day-to-day deviations from regular sleep duration correlates with changes in seizure probability. Sleeping longer, by 1·66 ± 0·52 h, may offer protective effects for patients with refractory focal epilepsy, reducing seizure risk. Furthermore, the occurrence of a seizure may disrupt sleep patterns by elongating sleep and, if the seizure occurs during sleep, reducing its quality.
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Affiliation(s)
- Katrina L. Dell
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, Fitzroy, Victoria 3065, Australia
- Corresponding author.
| | - Daniel E. Payne
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, Fitzroy, Victoria 3065, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Vaclav Kremen
- Department of Neurology, Mayo Clinic, Rochester, United States
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Matias I. Maturana
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, Fitzroy, Victoria 3065, Australia
- Seer Medical, Melbourne, Victoria, Australia
| | - Vaclav Gerla
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Petr Nejedly
- Department of Neurology, Mayo Clinic, Rochester, United States
| | | | - Lhotska Lenka
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Filip Mivalt
- Department of Neurology, Mayo Clinic, Rochester, United States
| | - Raymond C. Boston
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, Fitzroy, Victoria 3065, Australia
- Department of Clinical Studies - NBC, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, PA, United States
| | | | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, Fitzroy, Victoria 3065, Australia
| | - Anthony N. Burkitt
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - David B. Grayden
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Levin Kuhlmann
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, Fitzroy, Victoria 3065, Australia
- Department of Data Science and AI, Faculty of Information and Technology, Monash University, Clayton, Victoria, Australia
| | | | - Mark J. Cook
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, Fitzroy, Victoria 3065, Australia
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27
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Bergin P, Langan Y, Beghi E, Donner E, Cock H, D'Souza W, Thomas R, Scragg R. Invitation to participate in a prospective case-control study of sudden unexpected death in epilepsy. Epilepsia 2021; 62:1280-1281. [PMID: 33934347 DOI: 10.1111/epi.16898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Bergin
- Neurology Department, Auckland City Hospital, Auckland, New Zealand
| | - Yvonne Langan
- Department of Clinical Neurophysiology, St. James's Hospital, Dublin, Ireland
| | - Ettore Beghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Elizabeth Donner
- Comprehensive Epilepsy Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hannah Cock
- Atkinson Morley Regional Epilepsy Network, St. George's University Hospitals National Health Service Foundation Trust, London, UK
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, Victoria, Australia
| | - Rhys Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Robert Scragg
- School of Population Health, Grafton Campus, University of Auckland, Auckland, New Zealand
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28
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Christie H, D'Souza W, Cook M, Seneviratne U. Can semiology differentiate between bilateral tonic-clonic seizures of focal-onset and generalized-onset? A systematic review. Epilepsy Behav 2021; 116:107769. [PMID: 33556863 DOI: 10.1016/j.yebeh.2021.107769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bilateral tonic-clonic seizures are encountered in both focal and generalized epilepsies. We reviewed the literature regarding the presence of focal signs in generalized-onset tonic-clonic seizures (GOTCS) and the utility of semiology in differentiating those from focal to bilateral tonic-clonic seizures (FBTCS). METHODS We conducted a comprehensive literature search using four electronic databases (Medline, Embase, Web of Science, and Psychinfo) and constructed a systematic review in keeping with the Preferred Items for Systematic Reviews and Meta-analyses guidelines. RESULTS We included 13 studies on focal semiological features of GOTCS. These studies included a total of 952 participants. The key focal signs described in GOTCS included: early head version, figure of four sign, asymmetric seizure termination, and a multitude of auras as well as automatisms. Additionally, we reviewed five studies that investigated the use of semiology to differentiate GOTCS from FBTCS; these studies had a total of 289 participants. Asymmetry in clonic phase, side-to-side axial movements, asymmetrical seizure termination, figure of four sign, index finger pointing, and fanning posture of the hand were found to be significantly more frequent in FBTCS compared with GOTCS. Furthermore, combinations of focal semiological features occurring in a single seizure were found to be suggestive of FBTCS rather than GOTCS. CONCLUSION Focal signs are often evident in GOTCS. Though the observation of multiple focal signs within a given seizure may be in favor of an FBTCS, our findings caution against differentiating between the two seizure types based on semiology alone due to considerable overlap in focal features.
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Affiliation(s)
- Harry Christie
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Wendyl D'Souza
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Mark Cook
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Udaya Seneviratne
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; Department of Neuroscience, Monash Medical Centre, Melbourne, Australia.
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29
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Broadley J, Wesselingh R, Seneviratne U, Kyndt C, Beech P, Buzzard K, Nesbitt C, D'Souza W, Brodtmann A, Kalincik T, Butzkueven H, O'Brien TJ, Monif M. Peripheral Immune Cell Ratios and Clinical Outcomes in Seropositive Autoimmune Encephalitis: A Study by the Australian Autoimmune Encephalitis Consortium. Front Immunol 2021; 11:597858. [PMID: 33519810 PMCID: PMC7840591 DOI: 10.3389/fimmu.2020.597858] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To examine the utility of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) as biomarkers of prognosis in seropositive autoimmune encephalitis (AE). Methods In this multicenter study, we retrospectively analyzed 57 cases of seropositive AE with hospital admissions between January 2008 and June 2019. The initial full blood examination was used to determine each patients’ NLR and MLR. The modified Rankin Scale (mRS) was utilized to assess the patients’ follow-up disability at 12 months and then at final follow-up. Primary outcomes were mortality and mRS, while secondary outcomes were failure of first line treatment, ICU admission, and clinical relapse. Univariate and multivariable regression analysis was performed. Results During initial hospital admission 44.7% of patients had unsuccessful first line treatment. After a median follow-up of 700 days, 82.7% had good functional outcome (mRS ≤2) while five patients had died. On multivariable analysis, high NLR was associated with higher odds of first line treatment failure (OR 1.32, 95% CI 1.03–1.69, p = 0.029). Increased MLR was not associated with any short or long-term outcome. Conclusions NLR on initial hospital admission blood tests may be provide important prognostic information for cases of seropositive AE. This study demonstrates the potential use of NLR as a prognostic marker in the clinical evaluation of patients with seropositive AE.
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Affiliation(s)
- James Broadley
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Robb Wesselingh
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Udaya Seneviratne
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Neuroscience, Monash Health, Melbourne, VIC, Australia.,Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Chris Kyndt
- Department of Neurosciences, Eastern Health, Melbourne, VIC, Australia.,Department of Neurology, Melbourne Health, Melbourne, VIC, Australia
| | - Paul Beech
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia.,Department of Radiology, Monash Health, Melbourne, VIC, Australia
| | - Katherine Buzzard
- Department of Neurosciences, Eastern Health, Melbourne, VIC, Australia.,Department of Neurology, Melbourne Health, Melbourne, VIC, Australia
| | - Cassie Nesbitt
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia.,Department of Neuroscience, Barwon Health, Geelong, VIC, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy Brodtmann
- Department of Neurosciences, Eastern Health, Melbourne, VIC, Australia.,Department of Neurology, Melbourne Health, Melbourne, VIC, Australia
| | - Tomas Kalincik
- Department of Neurology, Melbourne Health, Melbourne, VIC, Australia.,Clinical Outcomes Research, The University of Melbourne, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Mastura Monif
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia.,Department of Neurology, Melbourne Health, Melbourne, VIC, Australia.,Department of Physiology, The University of Melbourne, Melbourne, VIC, Australia
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Allebone J, Kanaan RA, Maller JJ, O'Brien T, Mullen S, Cook M, Adams S, Vogrin S, Vaughan D, Connelly A, Kwan P, Berkovic SF, D'Souza W, Jackson G, Velakoulis D, Wilson SJ. Enlarged hippocampal fissure in psychosis of epilepsy. Epilepsy Behav 2020; 111:107290. [PMID: 32759068 DOI: 10.1016/j.yebeh.2020.107290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/26/2020] [Indexed: 12/29/2022]
Abstract
Psychosis of epilepsy (POE) can be a devastating condition, and its neurobiological basis remains unclear. In a previous study, we identified reduced posterior hippocampal volumes in patients with POE. The hippocampus can be further subdivided into anatomically and functionally distinct subfields that, along with the hippocampal fissure, have been shown to be selectively affected in other psychotic disorders and are not captured by gross measures of hippocampal volume. Therefore, in this study, we compared the volume of selected hippocampal subfields and the hippocampal fissure in 31 patients with POE with 31 patients with epilepsy without psychosis. Cortical reconstruction, volumetric segmentation, and calculation of hippocampal subfields and the hippocampal fissure were performed using FreeSurfer. The group with POE had larger hippocampal fissures bilaterally compared with controls with epilepsy, which was significant on the right. There were no significant differences in the volumes of the hippocampal subfields between the two groups. Our findings suggest abnormal development of the hippocampus in POE. They support and expand the neurodevelopmental model of psychosis, which holds that early life stressors lead to abnormal neurodevelopmental processes, which underpin the onset of psychosis in later life. In line with this model, the findings of the present study suggest that enlarged hippocampal fissures may be a biomarker of abnormal neurodevelopment and risk for psychosis in patients with epilepsy.
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Affiliation(s)
- James Allebone
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, Australia.
| | - Richard A Kanaan
- The Florey Institute of Neuroscience and Mental Health, Australia; Department of Psychiatry, Austin Health, University of Melbourne, Australia
| | - Jerome J Maller
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Melbourne, Australia; Centre for Research on Ageing, Health and Wellbeing, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | | | - Saul Mullen
- Comprehensive Epilepsy Program, Austin Health, Melbourne, Australia
| | - Mark Cook
- St Vincent's Hospital Melbourne, Australia
| | | | | | - David Vaughan
- Comprehensive Epilepsy Program, Austin Health, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, Australia
| | - Alan Connelly
- Comprehensive Epilepsy Program, Austin Health, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, Australia
| | | | | | | | - Graeme Jackson
- Comprehensive Epilepsy Program, Austin Health, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, Australia
| | | | - Sarah J Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia; Comprehensive Epilepsy Program, Austin Health, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, Australia
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31
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Nightscales R, McCartney L, Auvrez C, Tao G, Barnard S, Malpas CB, Perucca P, McIntosh A, Chen Z, Sivathamboo S, Ignatiadis S, Jones S, Adams S, Cook MJ, Kwan P, Velakoulis D, D'Souza W, Berkovic SF, O'Brien TJ. Mortality in patients with psychogenic nonepileptic seizures. Neurology 2020; 95:e643-e652. [DOI: 10.1212/wnl.0000000000009855] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 02/06/2020] [Indexed: 02/07/2023] Open
Abstract
ObjectiveTo investigate the hypothesis that patients diagnosed with psychogenic nonepileptic seizures (PNES) on video-EEG monitoring (VEM) have increased mortality by comparison to the general population.MethodsThis retrospective cohort study included patients evaluated in VEM units of 3 tertiary hospitals in Melbourne, Australia, between January 1, 1995, and December 31, 2015. Diagnosis was based on consensus opinion of experienced epileptologists and neuropsychiatrists at each hospital. Mortality was determined in patients diagnosed with PNES, epilepsy, or both conditions by linkage to the Australian National Death Index. Lifetime history of psychiatric disorders in PNES was determined from formal neuropsychiatric reports.ResultsA total of 5,508 patients underwent VEM. A total of 674 (12.2%) were diagnosed with PNES, 3064 (55.6%) with epilepsy, 175 (3.2%) with both conditions, and 1,595 (29.0%) received other diagnoses or had no diagnosis made. The standardized mortality ratio (SMR) of patients diagnosed with PNES was 2.5 (95% confidence interval [CI] 2.0–3.3). Those younger than 30 had an 8-fold higher risk of death (95% CI 3.4–19.8). Direct comparison revealed no significant difference in mortality rate between diagnostic groups. Among deaths in patients diagnosed with PNES (n = 55), external causes contributed 18%, with 20% of deaths in those younger than 50 years attributed to suicide, and “epilepsy” was recorded as the cause of death in 24%.ConclusionsPatients diagnosed with PNES have a SMR 2.5 times above the general population, dying at a rate comparable to those with drug-resistant epilepsy. This emphasizes the importance of prompt diagnosis, identification of risk factors, and implementation of appropriate strategies to prevent potential avoidable deaths.
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32
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Cook M, Murphy M, Bulluss K, D'Souza W, Plummer C, Priest E, Williams C, Sharan A, Fisher R, Pincus S, Distad E, Anchordoquy T, Abrams D. Anti-seizure therapy with a long-term, implanted intra-cerebroventricular delivery system for drug-resistant epilepsy: A first-in-man study. EClinicalMedicine 2020; 22:100326. [PMID: 32395709 PMCID: PMC7205744 DOI: 10.1016/j.eclinm.2020.100326] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A clinical feasibility study was undertaken at a single center of long-term intra-cerebroventricular drug delivery of the anti-seizure medication valproic acid, into the cerebrospinal fluid (CSF) in order to treat drug resistant focal seizures, using an implantable infusion system. The primary objective was to establish the dose range of VPA administered in this manner. Secondarily, safety, pharmacokinetics (PK) and a preliminary estimate of effectiveness were evaluated. METHODS In this single arm study, five adult subjects, with 29-234 focal onset seizures per month from a seizure focus involving the mesial temporal lobe were implanted with the system (clinicaltrials.gov identifier NCT02899611). Oral valproic acid (VPA) had previously been ineffective in all subjects. Post-surgery, pharmacokinetic studies of CSF infused VPA were performed. Valproic acid doses were increased stepwise in a standardised protocol. FINDINGS The procedure and implantation were well-tolerated by all subjects. Four subjects responded with > 50% seizure reduction at the highest tested dose of 160 mg/day. Two subjects experienced extended periods of complete seizure freedom. All five subjects reported significant quality of life improvement. No clinical dose limiting side effects were encountered and there was no evidence of local periventricular toxicity in three subjects who were evaluated with imaging (T2 MRI). Side effects included nausea and appetite loss but were not dose-limiting. Mean CSF valproic acid levels were 45 μg per ml (range 20-120 μg per ml), with corresponding serum levels of 4-14 μg per ml. Subjects have received therapy for up to 2.5 years in total . The efficacy analysis presented focuses on the period of time with the current pump with a mean 12.5 months, range 11.5-15 months. Pump failure requiring reimplantation was a significant initial issue in all subjects but resolved with use of pumps suitably compatible with long-term exposure to valproic acid. INTERPRETATION The study demonstrated that chronic intraventricular administration of valproic acid is safe and effective in subjects with medically refractory epilepsy over many months. The procedure for implanting the infusion system is safe and well-tolerated. High CSF levels are achieved with corresponding low serum levels and this therapy is shown to be effective despite unsuccessful earlier use of oral valproate preparations. Drug side effects were minimal. FUNDING The study was funded by Cerebral Therapeutics Inc., Suite 137 12635 East Montview Blvd Aurora CO 80045.
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Affiliation(s)
- Mark Cook
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
- Graeme Clark Institute, The University of Melbourne, 203 Bouverie St, Melbourne 3010, Australia
| | - Michael Murphy
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Kristian Bulluss
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Wendyl D'Souza
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Chris Plummer
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Emma Priest
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Catherine Williams
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Ashwini Sharan
- Thomas Jefferson University, 4201 Henry Ave, Philadelphia, PA 19144, United States
| | - Robert Fisher
- Stanford University Stanford Epilepsy Center and EEG Lab, 213 Quarry Road, Room 4865, Palo Alto, CA 94304-5979, United States
| | - Sharon Pincus
- Cerebral Therapeutics, 12635 E. Montview Blvd., Aurora, CO 80010, Australia
| | - Eric Distad
- Cerebral Therapeutics, 12635 E. Montview Blvd., Aurora, CO 80010, Australia
| | - Tom Anchordoquy
- Skaggs School of Pharmacy and Pharmaceutical Sciences University of Colorado School of Pharmacy 12850 E. Montview Blvd., V20-4120, Aurora, CO 80045, United States
| | - Dan Abrams
- Cerebral Therapeutics, 12635 E. Montview Blvd., Aurora, CO 80010, Australia
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33
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Maturana MI, Meisel C, Dell K, Karoly PJ, D'Souza W, Grayden DB, Burkitt AN, Jiruska P, Kudlacek J, Hlinka J, Cook MJ, Kuhlmann L, Freestone DR. Critical slowing down as a biomarker for seizure susceptibility. Nat Commun 2020; 11:2172. [PMID: 32358560 PMCID: PMC7195436 DOI: 10.1038/s41467-020-15908-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 03/30/2020] [Indexed: 02/04/2023] Open
Abstract
The human brain has the capacity to rapidly change state, and in epilepsy these state changes can be catastrophic, resulting in loss of consciousness, injury and even death. Theoretical interpretations considering the brain as a dynamical system suggest that prior to a seizure, recorded brain signals may exhibit critical slowing down, a warning signal preceding many critical transitions in dynamical systems. Using long-term intracranial electroencephalography (iEEG) recordings from fourteen patients with focal epilepsy, we monitored key signatures of critical slowing down prior to seizures. The metrics used to detect critical slowing down fluctuated over temporally long scales (hours to days), longer than would be detectable in standard clinical evaluation settings. Seizure risk was associated with a combination of these signals together with epileptiform discharges. These results provide strong validation of theoretical models and demonstrate that critical slowing down is a reliable indicator that could be used in seizure forecasting algorithms. Critical slowing (associated with increased variance and autocorrelation) can precede critical state transitions. Here, the authors show critical slowing can be used as a marker in seizure forecasting algorithms.
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Affiliation(s)
- Matias I Maturana
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia. .,Seer Medical, Melbourne, Australia.
| | - Christian Meisel
- Department of Neurology, University Clinic Carl Gustav Carus, Dresden, Germany.,Boston Children's Hospital, Boston, MA, USA
| | - Katrina Dell
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Philippa J Karoly
- Graeme Clark Institute, The University of Melbourne, Melbourne, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - David B Grayden
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia
| | - Anthony N Burkitt
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia
| | - Premysl Jiruska
- Department of Physiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, Prague, Czech Republic
| | - Jan Kudlacek
- Department of Physiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, Prague, Czech Republic.,Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jaroslav Hlinka
- Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic
| | - Mark J Cook
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia.,Graeme Clark Institute, The University of Melbourne, Melbourne, Australia
| | - Levin Kuhlmann
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia.,Faculty of Information Technology, Monash University, Clayton, Victoria, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Seneviratne U, Lai A, Cook M, D'Souza W, Boston RC. “Sleep Surge”: The impact of sleep onset and offset on epileptiform discharges in idiopathic generalized epilepsies. Clin Neurophysiol 2020; 131:1044-1050. [DOI: 10.1016/j.clinph.2020.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/19/2019] [Accepted: 01/22/2020] [Indexed: 11/29/2022]
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35
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Eden D, Nurse ES, Clarke S, Karoly PJ, Seneviratne U, Cook M, Freestone DR, D'Souza W. Computer-assisted estimation of interictal discharge burden in idiopathic generalized epilepsy. Epilepsy Behav 2020; 105:106970. [PMID: 32114187 DOI: 10.1016/j.yebeh.2020.106970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Dominique Eden
- Seer Medical, 278 Queensberry Street, Melbourne 3000, Victoria, Australia
| | - Ewan S Nurse
- Seer Medical, 278 Queensberry Street, Melbourne 3000, Victoria, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia.
| | - Shannon Clarke
- Seer Medical, 278 Queensberry Street, Melbourne 3000, Victoria, Australia
| | - Philippa J Karoly
- Seer Medical, 278 Queensberry Street, Melbourne 3000, Victoria, Australia; Graeme Clark Institute, The University of Melbourne, Building 261, 203 Bouverie Street, Carlton, VIC 3053, Australia
| | - Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
| | - Mark Cook
- Graeme Clark Institute, The University of Melbourne, Building 261, 203 Bouverie Street, Carlton, VIC 3053, Australia
| | - Dean R Freestone
- Seer Medical, 278 Queensberry Street, Melbourne 3000, Victoria, Australia
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
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Gunawan C, Seneviratne U, D'Souza W. The effect of antiepileptic drugs on epileptiform discharges in genetic generalized epilepsy: A systematic review. Epilepsy Behav 2019; 96:175-182. [PMID: 31150997 DOI: 10.1016/j.yebeh.2019.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/02/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the current evidence regarding the effect of antiepileptic drugs (AEDs) on epileptiform discharge (ED) burden in genetic generalized epilepsy (GGE). METHODS We conducted a comprehensive literature search of PubMed, Embase, PsycINFO, and the Web of Science Core Collection databases using the keywords 'genetic generalized epilepsy', 'antiepileptic drugs' and 'epileptiform discharge'. Primary human studies published in English that reported the effect of AEDs on EDs captured on electroencephalogram (EEG) recordings of at least 24 h in duration in patients with GGE were included. RESULTS Six studies published between 1984 and 2017, which reported the effect of AEDs on EDs, involving a total of 116 patients with GGE, were analyzed. Our systematic review found a tendency for AEDs to reduce ED density, frequency, cumulative duration, and burst duration in GGE. Furthermore, we found evidence that the AED-mediated reduction in ED burden was associated with improved seizure control and cognitive outcomes. CONCLUSIONS Antiepileptic drugs tend to reduce ED burden in GGE, but the significance of this association remains uncertain.
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Affiliation(s)
- Claire Gunawan
- St Vincent's Clinical School, The University of Melbourne, Melbourne, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
| | - Wendyl D'Souza
- St Vincent's Clinical School, The University of Melbourne, Melbourne, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia
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Imms P, Clemente A, Cook M, D'Souza W, Wilson PH, Jones DK, Caeyenberghs K. The structural connectome in traumatic brain injury: A meta-analysis of graph metrics. Neurosci Biobehav Rev 2019; 99:128-137. [PMID: 30615935 PMCID: PMC7615245 DOI: 10.1016/j.neubiorev.2019.01.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/22/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022]
Abstract
Although recent structural connectivity studies of traumatic brain injury (TBI) have used graph theory to evaluate alterations in global integration and functional segregation, pooled analysis is needed to examine the robust patterns of change in graph metrics across studies. Following a systematic search, 15 studies met the inclusion criteria for review. Of these, ten studies were included in a random-effects meta-analysis of global graph metrics, and subgroup analyses examined the confounding effects of severity and time since injury. The meta-analysis revealed significantly higher values of normalised clustering coefficient (gö=ö1.445, CI=[0.512, 2.378], pö=ö0.002) and longer characteristic path length (gö=ö0.514, CI=[0.190, 0.838], pö=ö0.002) in TBI patients compared with healthy controls. Our findings suggest that the TBI structural network has shifted away from the balanced small-world network towards a regular lattice. Therefore, these graph metrics may be useful markers of neurocognitive dysfunction in TBI. We conclude that the pattern of change revealed by our analysis should be used to guide hypothesis-driven research into the role of graph metrics as diagnostic and prognostic biomarkers.
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Affiliation(s)
- Phoebe Imms
- Mary MacKillop Institute for Heatlh Research, Faculty of Health Sciences, Australian Catholic University. 115 Victoria Parade, Melbourne, VIC, 3065, Australia.
| | - Adam Clemente
- Mary MacKillop Institute for Heatlh Research, Faculty of Health Sciences, Australian Catholic University. 115 Victoria Parade, Melbourne, VIC, 3065, Australia.
| | - Mark Cook
- Department of Medicine, St. Vincent's Hospital, University of Melbourne. 41 Victoria Parade, Melbourne, VIC, 3065, Australia.
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital, University of Melbourne. 41 Victoria Parade, Melbourne, VIC, 3065, Australia.
| | - Peter H Wilson
- Mary MacKillop Institute for Heatlh Research, Faculty of Health Sciences, Australian Catholic University. 115 Victoria Parade, Melbourne, VIC, 3065, Australia.
| | - Derek K Jones
- Mary MacKillop Institute for Heatlh Research, Faculty of Health Sciences, Australian Catholic University. 115 Victoria Parade, Melbourne, VIC, 3065, Australia; Cardiff University Brain Research Imaging Centre, School of Psychology, and Neuroscience and Mental Health Research Institute, Cardiff University, Maindy Rd, Cardiff, CF24 4HQ, United Kingdom.
| | - Karen Caeyenberghs
- Mary MacKillop Institute for Heatlh Research, Faculty of Health Sciences, Australian Catholic University. 115 Victoria Parade, Melbourne, VIC, 3065, Australia.
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Sun Y, Seneviratne U, Perucca P, Chen Z, Kee MT, O'Brien TJ, D'Souza W, Kwan P. Generalized polyspike train: An EEG biomarker of drug-resistant idiopathic generalized epilepsy. Neurology 2018; 91:e1822-e1830. [PMID: 30315071 DOI: 10.1212/wnl.0000000000006472] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 08/01/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify clinical and EEG biomarkers of drug resistance in adults with idiopathic generalized epilepsy. METHODS We conducted a case-control study consisting of a discovery cohort and a replication cohort independently assessed at 2 different centers. In each center, patients with the idiopathic generalized epilepsy phenotype and generalized spike-wave discharges on EEG were classified as drug-resistant or drug-responsive. EEG changes were classified into predefined patterns and compared between the 2 groups in the discovery cohort. Factors associated with drug resistance in multivariable analysis were tested in the replication cohort. RESULTS The discovery cohort included 85 patients (29% drug-resistant and 71% drug-responsive). Their median age at assessment was 32 years and 50.6% were female. Multivariable analysis showed that higher number of seizure types ever experienced (3 vs 1: odds ratio [OR] = 31.1, 95% confidence interval [CI]: 4.5-214, p < 0.001; 3 vs 2: OR = 14.6, 95% CI: 2.3-93.1, p = 0.004) and generalized polyspike train (burst of generalized rhythmic spikes lasting less than 1 second) during sleep were associated with drug resistance (OR = 10.8, 95% CI: 2.4-49.4, p = 0.002). When these factors were tested in the replication cohort of 80 patients (27.5% drug-resistant and 72.5% drug-responsive; 71.3% female; median age 27.5 years), the proportion of patients with generalized polyspike train during sleep was also higher in the drug-resistant group (OR = 4.0, 95% CI: 1.35-11.8, p = 0.012). CONCLUSION Generalized polyspike train during sleep may be an EEG biomarker for drug resistance in adults with idiopathic generalized epilepsy.
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Affiliation(s)
- Yanping Sun
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Udaya Seneviratne
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Piero Perucca
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Zhibin Chen
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Meng Tan Kee
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Terence J O'Brien
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia.
| | - Wendyl D'Souza
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Patrick Kwan
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia.
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Payne DE, Karoly PJ, Freestone DR, Boston R, D'Souza W, Nurse E, Kuhlmann L, Cook MJ, Grayden DB. Postictal suppression and seizure durations: A patient‐specific, long‐term
iEEG
analysis. Epilepsia 2018; 59:1027-1036. [DOI: 10.1111/epi.14065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel E. Payne
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Philippa J. Karoly
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Dean R. Freestone
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Ray Boston
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Wendyl D'Souza
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Ewan Nurse
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Levin Kuhlmann
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
- Brain Dynamics Unit Centre for Human Psychopharmacology Swinburne University of Technology Hawthorn Vic. Australia
| | - Mark J. Cook
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - David B. Grayden
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
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Neal A, D'Souza W, Hepworth G, Lawn N, Cook M, Nikpour A. Efficacy and tolerability of adjuvant lacosamide: The role of clinical characteristics and mechanisms of action of concomitant AEDs. Epilepsy Behav 2018; 80:25-32. [PMID: 29396359 DOI: 10.1016/j.yebeh.2017.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The objective of this study was to analyze the effectiveness and long-term tolerability of adjuvant lacosamide (LCM) in a multicenter cohort. We aim to assess outcomes of LCM-containing antiepileptic drug (AED) combinations based upon 'mechanism of action' (MoA) and patient's clinical features. METHODS Consecutive patients commenced on LCM, with focal epilepsy were identified from three Australian hospitals. The 12-month efficacy endpoints were greater than 50% reduction in seizure frequency (responders) and seizure freedom. Tolerability endpoints were cessation of LCM for any reason, cessation due to side-effects and censoring due to inefficacy. Outcomes were assessed according to concomitant AEDs according to their MoA and the clinical risk factor profile. RESULTS Three hundred ten patients were analyzed and followed for median 17.3months. Two hundred ninety-nine (97%) had drug-resistant epilepsy, and 155 (50%) had tried more than 7 AEDs at LCM commencement. Adjuvant LCM was associated with responder and seizure freedom rate of 29% and 9% respectively at 12months. Lower baseline seizure frequency, a prior 6-month period of seizure freedom at any time since epilepsy diagnosis and being on fewer concomitant AEDs were predictive of 12-month seizure freedom. Previous focal to bilateral tonic-clonic seizures (FBTCS), lower baseline seizure frequency, and concomitant AED reduction after LCM commencement were associated with improved LCM tolerability. No specific MoA AED combinations offered any efficacy or tolerability advantage. SIGNIFICANCE Adjuvant LCM is associated with seizure freedom rates of 9% at 12months after commencement and is predicted by lower prior seizure frequency, a period of 6months or longer of seizure freedom since diagnosis and fewer concomitant AEDs. While the broad MoA of concomitant AEDs did not influence efficacy or tolerability outcomes, we have provided a framework that may be utilized in future studies to help identify optimal synergistic AED combinations.
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Affiliation(s)
- Andrew Neal
- Department of Medicine, The University of Melbourne, Australia; Department of Neurology, St Vincent's Hospital Melbourne, Australia.
| | - Wendyl D'Souza
- Department of Medicine, The University of Melbourne, Australia; Department of Neurology, St Vincent's Hospital Melbourne, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Australia
| | - Nicholas Lawn
- Western Australian Adult Epilepsy Service, Sir Charles Gairdner Hospital, Perth, Australia
| | - Mark Cook
- Department of Medicine, The University of Melbourne, Australia; Department of Neurology, St Vincent's Hospital Melbourne, Australia
| | - Armin Nikpour
- Department of Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Australia
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41
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Nuyts S, D'Souza W, Bowden SC, Vogrin SJ. Structural brain abnormalities in genetic generalized epilepsies: A systematic review and meta-analysis. Epilepsia 2017; 58:2025-2037. [DOI: 10.1111/epi.13928] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Shauni Nuyts
- Department of Psychological Sciences; University of Leuven; Leuven Belgium
- Department of Statistics; University of Leuven; Leuven Belgium
- Melbourne School of Psychological Sciences; University of Melbourne; Parkville Victoria Australia
| | - Wendyl D'Souza
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Fitzroy Victoria Australia
| | - Stephen C. Bowden
- Melbourne School of Psychological Sciences; University of Melbourne; Parkville Victoria Australia
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Fitzroy Victoria Australia
| | - Simon J. Vogrin
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Fitzroy Victoria Australia
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Wickens S, Bowden SC, D'Souza W. Cognitive functioning in children with self-limited epilepsy with centrotemporal spikes: A systematic review and meta-analysis. Epilepsia 2017; 58:1673-1685. [DOI: 10.1111/epi.13865] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Steven Wickens
- Melbourne School of Psychological Sciences; University of Melbourne; Parkville Victoria Australia
| | - Stephen C. Bowden
- Department of Clinical Neurosciences; St. Vincent's Hospital Melbourne; Fitzroy Victoria Australia
| | - Wendyl D'Souza
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Fitzroy Victoria Australia
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Abstract
Background We investigated the association between epileptiform EEG abnormalities and the preceding duration of seizure freedom in genetic generalized epilepsies (GGE). Methods We analyzed 24-hour ambulatory EEG recordings of patients with GGE diagnosed and classified according to the International League Against Epilepsy criteria. We quantified epileptiform EEG abnormalities into density scores (total duration of epileptiform discharges per hour) and estimated the preceding seizure-free duration at the time of EEG recording based on the last self-reported seizure. We then employed regression analysis to quantitate the relationship between the duration of seizure freedom and EEG variables. Results We analyzed 6,923 epileptiform discharges from 105 patients with abnormal 24-hour EEGs. In the regression analysis exploring the crude associations, we found significant correlations between 6 EEG variables and the duration of seizure freedom indicating that shorter duration of seizure freedom was associated with higher spike densities and longer paroxysms. These associations were not affected by confounders such as syndrome, age at EEG, age at epilepsy onset, sex, duration of epilepsy, or number of antiepileptic drugs. Conclusions Higher densities and longer durations of epileptiform discharges may be retrospectively associated with a shorter duration of self-reported seizure freedom. Hence, EEG can potentially be used as a biomarker of prognosis in GGE. These findings need to be validated in a prospective study in order to define EEG markers of future seizure freedom.
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Affiliation(s)
- Udaya Seneviratne
- St. Vincent's Hospital (US, RCB, MC, WD), University of Melbourne; Monash Medical Centre (US); and Monash University (US), Melbourne, Australia
| | - Ray C Boston
- St. Vincent's Hospital (US, RCB, MC, WD), University of Melbourne; Monash Medical Centre (US); and Monash University (US), Melbourne, Australia
| | - Mark Cook
- St. Vincent's Hospital (US, RCB, MC, WD), University of Melbourne; Monash Medical Centre (US); and Monash University (US), Melbourne, Australia
| | - Wendyl D'Souza
- St. Vincent's Hospital (US, RCB, MC, WD), University of Melbourne; Monash Medical Centre (US); and Monash University (US), Melbourne, Australia
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Seneviratne U, Boston RC, Cook M, D'Souza W. Temporal patterns of epileptiform discharges in genetic generalized epilepsies. Epilepsy Behav 2016; 64:18-25. [PMID: 27728899 DOI: 10.1016/j.yebeh.2016.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/09/2016] [Accepted: 09/10/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We sought to investigate the temporal patterns and sleep-wake cycle-related epileptiform discharges (EDs) in genetic generalized epilepsies (GGEs). METHODS We studied 24-hour ambulatory electroencephalography (EEG) recordings of patients with GGE, diagnosed and classified according to the International League against Epilepsy criteria. We manually coded the type of discharge, time of occurrence, duration, and arousal state of each ED. We employed mixed effects Poisson regression modeling to study the temporal distribution of epileptiform discharges. Additionally, we used multinomial regression analysis to explore the significance of the relationship between different states of arousal and types of epileptiform discharges. RESULTS We analyzed 6923 EDs from 105 abnormal 24-hour EEGs. Mixed effects Poisson regression analysis demonstrated significant changes in ED counts across time blocks. This distribution was largely influenced by the state of arousal. Generalized fragments (duration<2s) and focal discharges were more frequent during non-REM sleep while paroxysms (duration≥2s) were more frequent in wakefulness. Overall, 67% of epileptiform discharges occurred in non-REM sleep and only 33% occurred in wakefulness. Twenty-four patients (23%) had ED exclusively in sleep. Epileptiform discharges peaked from 23:00 through 07:00h. SIGNIFICANCE There is a time-of-day dependency of ED with a significant influence exerted by the state of arousal. Our observations suggest that the generation of epileptiform discharges is not a random process but is the result of complex interactions among biological rhythms such as the sleep-wake cycle and the intrinsic circadian pacemaker. High density of ED in sleep suggests that 24-hour EEG recording with the capture of natural sleep may be more useful than routine EEG to diagnose GGE.
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Affiliation(s)
- Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; Department of Neuroscience, Monash Medical Centre, Melbourne, Australia; School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Australia.
| | - Ray C Boston
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Mark Cook
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
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Shukla K, Shahane S, D'Souza W. Role of demographic and job-related variables in determining work-related quality of life of hospital employees. J Postgrad Med 2016; 63:4-10. [PMID: 27779152 PMCID: PMC5394816 DOI: 10.4103/0022-3859.192794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Considering a huge working population in health sector faced with stressful work life, limited autonomy in work and declining work contentment calls for an overemphasis on evaluating and monitoring their satisfaction associated with work-related quality of life (WRQoL). This study evaluates WRQoL of hospital employees and validates the bilingual (English and Marathi) version of WRQoL scale. METHODS The study was conducted during March-April'2014 on employees of a corporate hospital of Pune, India after ethical approval and informed consent from employees. The bilingual WRQoL scale has been tested for reliability and validity, and WRQoL scores have been reported. RESULTS A total of 132 hospital employees (mean age 31 [±8] years, 55% males) who participated in the study reported overall moderate WRQoL scores. The scale showed high internal consistency (Cronbach's alpha = 0.82, P < 0.0001) and moderate to high validity. WRQoL did not significantly vary across marital status, family size, and gender. "Stress at work" score of WRQoL increased with age of employees. Higher work experience, employment at higher positions and those working in clinical and diagnostic departments reported a higher WRQoL. CONCLUSION WRQoL scale is a reliable and valid instrument. Better WRQoL in employees placed in higher organizational positions indicates a need for focused measures to enhance WRQoL of employees in lower hierarchical levels, especially in control at work and home life interface domains. WRQoL needs regular monitoring for employees in lower positions and aging employees.
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Affiliation(s)
- K Shukla
- Department of MBA (HHM), Symbiosis Institute of Health Sciences (SIU), Pune, Maharashtra, India
| | - S Shahane
- Department of PGPHS, Sancheti Healthcare Academy, Pune, Maharashtra, India
| | - W D'Souza
- Department of PGPHS, Sancheti Healthcare Academy, Pune, Maharashtra, India
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Zhang H, Molitoris J, Tan S, Giacomelli I, Scartoni D, Gzell C, Bhooshan N, Choi W, Lu W, Mehta M, D'Souza W. SU-F-R-04: Radiomics for Survival Prediction in Glioblastoma (GBM). Med Phys 2016. [DOI: 10.1118/1.4955776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lan F, Jeudy J, Senan S, van Sornsen de Koste J, Tseng H, Zhou J, D'Souza W, Zhang H. WE-AB-202-02: Incorporating Regional Ventilation Function in Predicting Radiation Fibrosis After Concurrent Chemoradiotherapy for Lung Cancer. Med Phys 2016. [DOI: 10.1118/1.4957743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kirlik G, D'Souza W, Zhang H. SU-G-BRC-02: A Novel Multi-Criteria Optimization Approach to Generate Deliverable Intensity-Modulated Radiation Therapy (IMRT) Treatment Plans. Med Phys 2016. [DOI: 10.1118/1.4956892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Zhang B, Lee S, Chen S, Zhou J, Prado K, D'Souza W, Yi B. SU-C-202-03: A Tool for Automatic Calculation of Delivered Dose Variation for Off-Line Adaptive Therapy Using Cone Beam CT. Med Phys 2016. [DOI: 10.1118/1.4955571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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50
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Lee S, Chen S, Zhang B, Xu H, Prado K, D'Souza W, Yi B. SU-F-T-519: Is Geometry Based Setup Sufficient for All of the Head and Neck Treatment Cases?: A Feasibility Study Towards the Dose Based Setup. Med Phys 2016. [DOI: 10.1118/1.4956704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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