Pro-Ictal EEG Scheduling Improves the Yield of Epilepsy Monitoring: Validating the Use of Multiday Seizure Cycles to Optimize Video-EEG Timing

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY

Annals of Neurology Pub Date : 2024-10-01 DOI:10.1002/ana.27078

Jodie Naim-Feil PhD, Rachel E. Stirling PhD, Philippa J. Karoly PhD, Daniel Payne PhD, Nicholas Winterling MEng, Dominique Eden BEng(Hons), Mark J. Cook MBBS, MD, David B. Grayden PhD, Matias Maturana PhD, Dean R. Freestone PhD, Ewan S. Nurse PhD

{"title":"Pro-Ictal EEG Scheduling Improves the Yield of Epilepsy Monitoring: Validating the Use of Multiday Seizure Cycles to Optimize Video-EEG Timing","authors":"Jodie Naim-Feil PhD, Rachel E. Stirling PhD, Philippa J. Karoly PhD, Daniel Payne PhD, Nicholas Winterling MEng, Dominique Eden BEng(Hons), Mark J. Cook MBBS, MD, David B. Grayden PhD, Matias Maturana PhD, Dean R. Freestone PhD, Ewan S. Nurse PhD","doi":"10.1002/ana.27078","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>A significant challenge of video-electroencephalography (vEEG) in epilepsy diagnosis is timing monitoring sessions to capture epileptiform activity. In this study, we introduce and validate “pro-ictal EEG scheduling”, a method to schedule vEEG monitoring to coincide with periods of increased seizure likelihood as a low-risk approach to enhance the diagnostic yield.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A database of long-term ambulatory vEEG monitoring sessions (n = 5,038) of adults and children was examined. Data from linked electronic seizure diaries were extracted (minimum 10 self-reported events) to generate cycle-based estimates of seizure risk. In adults, vEEG monitoring sessions coinciding with periods of estimated high-risk were allocated to the high-risk group (n = 305) and compared to remaining studies (baseline: n = 3,586). Test of proportions and risk-ratios (RR) were applied to index differences in proportions and likelihood of capturing outcome measures (abnormal report, confirmed seizure, and diary event) during monitoring. The impact of clinical and demographic factors (age, sex, epilepsy-type, and medication) was also explored.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>During vEEG monitoring, the high-risk group was significantly more likely to have an abnormal vEEG report (190/305:62% vs 1,790/3,586:50% [%change = 12%], RR = 1.25, 95% confidence interval [CI] = [1.137–1.370], <i>p</i> < 0.001), present with a confirmed seizure (56/305:18% vs 424/3,586:11% [%change = 7%], RR = 1.63, 95% CI = [1.265–2.101], <i>p</i> < 0.001) and report an event (153/305:50% vs 1,267/3,586:35% (%change = 15%), RR = 1.420, 95% CI = [1.259:1.602], <i>p</i> < 0.001). Similar effects were observed across clinical and demographic features.</p>\n </section>\n \n <section>\n \n <h3> Interpretation</h3>\n \n <p>This study provides the first large-scale validation of pro-ictal EEG scheduling in improving the yield of vEEG. This innovative approach offers a pragmatic and low-risk strategy to enhance the diagnostic capabilities of vEEG monitoring, significantly impacting epilepsy management. ANN NEUROL 2024;96:1148–1159</p>\n </section>\n </div>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":"96 6","pages":"1148-1159"},"PeriodicalIF":8.1000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ana.27078","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Neurology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ana.27078","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

A significant challenge of video-electroencephalography (vEEG) in epilepsy diagnosis is timing monitoring sessions to capture epileptiform activity. In this study, we introduce and validate “pro-ictal EEG scheduling”, a method to schedule vEEG monitoring to coincide with periods of increased seizure likelihood as a low-risk approach to enhance the diagnostic yield.

Methods

A database of long-term ambulatory vEEG monitoring sessions (n = 5,038) of adults and children was examined. Data from linked electronic seizure diaries were extracted (minimum 10 self-reported events) to generate cycle-based estimates of seizure risk. In adults, vEEG monitoring sessions coinciding with periods of estimated high-risk were allocated to the high-risk group (n = 305) and compared to remaining studies (baseline: n = 3,586). Test of proportions and risk-ratios (RR) were applied to index differences in proportions and likelihood of capturing outcome measures (abnormal report, confirmed seizure, and diary event) during monitoring. The impact of clinical and demographic factors (age, sex, epilepsy-type, and medication) was also explored.

Results

During vEEG monitoring, the high-risk group was significantly more likely to have an abnormal vEEG report (190/305:62% vs 1,790/3,586:50% [%change = 12%], RR = 1.25, 95% confidence interval [CI] = [1.137–1.370], p < 0.001), present with a confirmed seizure (56/305:18% vs 424/3,586:11% [%change = 7%], RR = 1.63, 95% CI = [1.265–2.101], p < 0.001) and report an event (153/305:50% vs 1,267/3,586:35% (%change = 15%), RR = 1.420, 95% CI = [1.259:1.602], p < 0.001). Similar effects were observed across clinical and demographic features.

Interpretation

This study provides the first large-scale validation of pro-ictal EEG scheduling in improving the yield of vEEG. This innovative approach offers a pragmatic and low-risk strategy to enhance the diagnostic capabilities of vEEG monitoring, significantly impacting epilepsy management. ANN NEUROL 2024;96:1148–1159

Abstract Image

查看原文本刊更多论文

前直肠脑电图调度提高了癫痫监测的收益率：验证使用多日发作周期来优化视频脑电图时间。

目的：视频脑电图（vEEG）在癫痫诊断中面临的一个重大挑战是如何把握监测时间以捕捉癫痫样活动。在本研究中，我们介绍并验证了 "发作前脑电图调度"，这是一种在癫痫发作可能性增加时调度视频脑电图监测的方法，是一种提高诊断率的低风险方法：方法：研究了一个成人和儿童长期非卧床 vEEG 监测会话数据库（n = 5,038 次）。从关联的电子癫痫发作日记中提取数据（至少 10 次自我报告事件），生成基于周期的癫痫发作风险估计值。在成人中，将与估计高风险期重合的 vEEG 监测时段分配到高风险组（n = 305），并与其余研究（基线：n = 3,586）进行比较。采用比例检验和风险比 (RR) 来衡量监测期间捕获结果指标（异常报告、确诊癫痫发作和日记事件）的比例和可能性的差异。此外，还探讨了临床和人口统计学因素（年龄、性别、癫痫类型和药物治疗）的影响：结果：在 vEEG 监测过程中，高风险组出现异常 vEEG 报告的几率明显更高（190/305:62% vs 1,790/3,586:50% [%change = 12%]，RR = 1.25，95% 置信区间 [CI] = [1.137-1.370]，p 解释：该研究首次大规模验证了 vEEG 监测对癫痫发作的影响：本研究首次大规模验证了发作前脑电图调度在提高 vEEG 收率方面的作用。这种创新方法提供了一种务实、低风险的策略来提高 vEEG 监测的诊断能力，从而对癫痫管理产生重大影响。ann neurol 2024。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.