Tablet-based electroencephalography diagnostics for patients with epilepsy in the West African Republic of Guinea

BACKGROUND AND PURPOSE

Epilepsy is most common in lower-income settings where access to electroencephalography (EEG) is generally poor. A low-cost tablet-based EEG device may be valuable, but the quality and reproducibility of the EEG output are not established.

METHODS

Tablet-based EEG was deployed in a heterogeneous epilepsy cohort in the Republic of Guinea (2018-2019), consisting of a tablet wirelessly connected to a 14-electrode cap. Participants underwent EEG twice (EEG1 and EEG2), separated by a variable time interval. Recordings were scored remotely by experts in clinical neurophysiology as to data quality and clinical utility.

RESULTS

There were 149 participants (41% female; median age 17.9 years; 66.6% ≤21 years of age; mean seizures per month 5.7 ± SD 15.5). The mean duration of EEG1 was 53 ± 12.3 min and that of EEG2 was 29.6 ± 12.8 min. The mean quality scores of EEG1 and EEG2 were 6.4 [range, 1 (low) to 10 (high); both medians 7.0]. A total of 44 (29.5%) participants had epileptiform discharges (EDs) at EEG1 and 25 (16.8%) had EDs at EEG2. EDs were focal/multifocal (rather than generalized) in 70.1% of EEG1 and 72.5% of EEG2 interpretations. A total of 39 (26.2%) were recommended for neuroimaging after EEG1 and 22 (14.8%) after EEG2. Of participants without EDs at EEG1 (n = 53, 55.8%), seven (13.2%) had EDs at EEG2. Of participants with detectable EDs on EEG1 (n = 23, 24.2%), 12 (52.1%) did not have EDs at EEG2.

CONCLUSIONS

Tablet-based EEG had a reproducible quality level on repeat testing and was useful for the detection of EDs. The incremental yield of a second EEG in this setting was ~13%. The need for neuroimaging access was evident.

An oncoplastic procedure for central and medio-cranial breast cancer

Breast conserving therapy shows remarkable oncologic results and is eligible for up to 73% of patients with breast cancer. Cosmetic results are good, however, in patients with central or medio-cranial ("no-man's land") located breast cancer, the cosmetic result may be unsatisfying. The use of different breast reduction techniques have been shown to increase resection free margins and improve cosmetic results. We report here about the use of the Hall Findlay breast reduction technique for oncoplastic surgery to improve the cosmetic result in 11 patients. The Hall Findlay technique shows good postoperative breast symmetry, all patients had resection free margins above 5mm and are free of disease at a mean follow-up of 12 months. The technique may be used for breast cancer at various locations and reduces scar visibility and morbidity.

Age dependence of complete heart block complicating radiofrequency ablation of the atrioventricular nodal slow pathway

A significant age dependence of the risk of complete heart block complicating radiofrequency ablation of the AV nodal slow pathway was noticed, with no patients <45 years of age experiencing this complication.

Outbreak of histoplasmosis among employees in a paper factory--Michigan, 1993

In December 1993, four reported cases of histoplasmosis among employees in a Michigan pulp paper factory prompted an investigation. A cohort of employees was surveyed to identify additional cases. A case of acute histoplasmosis was defined as an influenza-like illness in a plant employee with the onset of illness during October or November 1993 and laboratory evidence of recent infection with Histoplasma capsulatum. Among the 96 employees surveyed, 18 persons met the case definition; all of these had illness onset during the last week of October in 1993. The attack rate among maintenance employees (16 of 53 [30%]) was much greater than that among nonmaintenance employees (2 of 43 [5%]) (relative risk = 6.5; 95% confidence interval = 1.6 to 26.7; P = 0.003). On October 22, a dry, windy day, one maintenance worker swept bird guano, approximately 10 cm deep, from an adjacent roof < 20 m from the maintenance building. The disturbance of the bird guano was the likely event which caused this outbreak. H. capsulatum remains an important pathogen among immunocompetent hosts. We recommended that the plant authorities (i) discourage birds from roosting at the facility and (ii) use safe procedures for the cleanup and disposal of soil contaminated with bird droppings.

Implantable cardioverter defibrillator: use in patients with no symptoms and at high risk

Twenty-seven patients with asymptomatic, nonsustained ventricular tachycardia whose evaluation suggested they were at high risk for sustained ventricular arrhythmias were treated with implantable cardioverter defibrillators. The option of conventional therapy (including the option of no therapy) was presented to each patient and rejected in favor of defibrillator implantation on an experimental basis. Eighteen patients had coronary artery disease and inducible sustained ventricular tachycardia, 8 had idiopathic dilated cardiomyopathy, and 1 had hypertrophic cardiomyopathy and a strong family history of sudden cardiac death. The mean ejection fraction was 27% +/- 10%. Operative morbidity (3%) and mortality (3%) were low. Mean overall survival was 92% and 88% at 1 and 2 years, respectively. Sixteen (59%) of the 27 patients had appropriate defibrillator discharges during a mean follow-up of 35 +/- 15 months. The mean time to first appropriate discharge was 18 +/- 17 months, and mean follow-up after first discharge was 17 +/- 20 months. In conclusion, implantable cardioverter defibrillator placement in high-risk patients without symptoms is a feasible approach that may have resulted in benefit in selected patients. Large-scale randomized trials currently under way will determine the risk/benefit ratio of this management approach.

Monitoring carotid test occlusions with continuous EEG and clinical examination

We routinely monitor invasive neuroradiologic carotid balloon test occlusions with continuous polygraph and quantitative EEG along with repeated detailed clinical examinations. Four of 17 consecutive cases showed changes during carotid occlusion. In one instance, an immediate delta increase was accompanied by slurred speech and aphasia. Another showed alpha attenuation without clinical change. A third patient had significant clinical change without EEG change. Nine of the 17 cases underwent permanent therapeutic carotid occlusion as treatment of an intracerebral vascular abnormality. Seven of these nine had no EEG or clinical changes during monitoring and have had no functional abnormalities on follow-up. The patient with focal alpha attenuation had an accidental balloon detachment but has had no functional or structural neurologic abnormalities. The patient with minor regional increased delta received a permanent carotid occlusion and went on to develop clinical signs 24 h later. We believe that continuous EEG monitoring and repeated clinical examinations provide useful ways of evaluating cerebral circulation during carotid test occlusions.

Thiazide therapy and severe hypercalcemia in a patient with hyperparathyroidism

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[Pollen counts (from Ambrosia and Artemisia) in Lyon-Bron from 1982 to 1985]

The purpose of this work is to distinguish the broad outlines of the pollen calendar in the Lyons area for the 5th year, using the same method (P. COUR) and the same location--Lyon-Bron weather station. Weekly data is given for 1982, 1983, 1984, 1985 (1986 data was not complete at the time of the conference, October 1986). This work is the fruit of numerical counts integrated into a data processing program which enables pollens tested and not tested in allergology to be identified. In Lyon, we observe 3 pollen seasons: early Spring (TREES), Spring (TREES and GRAMINEAE) and Summer-Autumn (TREES, GRAMINEAE, and COMPOSITAE). During the late the following are present: Artemisia vulgaris (last 10 days of July), RAGWEED (mid-August-1st fortnight of October), Artemisia annua (end September-early October). The particularity of our region is that not only ragweed pollen is collected but also two categories of Mugwort pollen, at different periods.

Hematocrit and hemoglobin concentration in four chromosomal species and some isolated populations of actively speciating subterranean mole rats in Israel

Hematocrit (HCT) and hemoglobin (Hb) concentration were measured in four chromosomal species and some peripherally semi-isolated and isolated populations of the mole rat superspecies Spalax ehrenbergi in Israel. HCT was 52.0, 51.4, 50.9, and 47.8%, and Hb was 16.0, 16.6, 16.3, and 14.7 g/100 ml for 2n = 52, 58, 54, and 60, respectively. The species 2n = 60, which lives in arid habitats, had lower HCT and Hb than the other three species. HCT decreased as aridity increased between the species and within the species 2n = 60. Changes in HCT probably reflect clinal changes in both soil permeability to gases and ambient temperature.