Epilepsia Open最新文献

{"title":"Voxel-based and surface-based cortical morphometric MRI applications for identifying the epileptogenic zone: A narrative review.","authors":"Jacob Bunyamin, Benjamin Sinclair, Meng Law, Patrick Kwan, Terence J O'Brien, Andrew Neal","doi":"10.1002/epi4.70012","DOIUrl":"https://doi.org/10.1002/epi4.70012","url":null,"abstract":"<p><p>Approximately 40% of patients with drug-resistant epilepsy referred for surgical evaluation have no epileptogenic lesion on MRI (MRI-negative). MRI-negative epilepsy is associated with poorer seizure freedom prognosis and has therefore motivated the development of structural post-processing methods to \"convert\" MRI-negative to MRI-positive cases. In this article, we review the principles, advances, and challenges of voxel- and surface-based cortical morphometric MRI techniques in detecting the epileptogenic zone. The ground truth for the presumed epileptogenic zone in imaging studies can be classified into lesion-based (MRI lesion mask or histopathology) or epileptogenicity-based ground truth (anatomical-electroclinical correlations or resections that lead to seizure freedom). Voxel-based techniques are reported to have a 13%-97% concordance rate, while surface-based techniques have 67%-92% compared to lesion-based ground truths. Epileptogenicity-based ground truth may be more relevant in the case of MRI-negative cases; however, the sensitivity and concordance rate (voxel-based technique 7.1%-66.7%, and surface-based technique 62%) are limited by the reliance on scalp EEG and qualitative analysis of seizure-onset pattern. The use of stereo-EEG and quantitative EEG analysis may fill this gap to evaluate the correlation between cortical morphometry results and electrophysiological epileptogenic biomarkers of the epileptogenic zone and help improve the yield of structural post-processing tools. PLAIN LANGUAGE SUMMARY: Locating the epileptogenic zone (the brain area that is responsible for seizure generation) is important to diagnose and plan epilepsy treatments. An abnormal brain imaging (MRI) result can help clinical decision-making; however, around 40% of patients have normal MRI results (MRI-negative). We are reviewing the potential of two advanced MRI methods (voxel- and surface-based cortical morphometry) to localize the epileptogenic zone in the presence or absence of visible MRI abnormalities. We also describe the current challenge of applying the above methods in daily clinical practice and propose using advanced brain recording analysis to aid this translation process.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early rehabilitation and improved outcomes in patients with status epilepticus: Evidence from cases presenting to the emergency department.","authors":"Hidetaka Onda, Shoji Yokobori","doi":"10.1002/epi4.70017","DOIUrl":"https://doi.org/10.1002/epi4.70017","url":null,"abstract":"<p><strong>Objective: </strong>Status epilepticus (SE) is a common neurological emergency characterized by prolonged or recurrent seizures that can cause permanent brain damage. Although these seizures can be controlled with appropriate treatment, SE is associated with poor outcomes and a high mortality rate. SE can cause physical, cognitive, and psychological complications at every stage of treatment. Understanding the treatment of SE and its outcomes is important both clinically and socially. Intensive care unit-acquired weakness and post-intensive care syndrome are significant issues in survivors of SE. This study aimed to determine if early rehabilitation in the intensive care unit can improve outcomes in patients with SE, given the limited options for intervention after hospitalization.</p><p><strong>Methods: </strong>This observational study was approved by our ethics committee (B-2023-654) and included 1039 adult patients brought to our center with SE between 2011 and 2023. The patients were divided into a prospectively enrolled rehabilitation intervention group, in which rehabilitation was initiated within 24 h after admission post-2022, and a retrospective non-intervention group from before that time. We examined the current status of these patients to determine the value of ultra-acute rehabilitation and factors associated with favorable outcomes in these patients. The primary outcome was the proportion of patients with a Glasgow Outcome Scale score of 5 at discharge.</p><p><strong>Results: </strong>The average age was 52.3 years, with 619 cases aged 65 years or older. Mortality was 2.5%, and 519 patients achieved a Glasgow Outcome Scale score of 5. Rehabilitation initiated within 24 h of hospitalization did not significantly affect the length of hospital stay but did increase home discharge rates and functional independence, particularly in older patients.</p><p><strong>Significance: </strong>This study provides a systematic and insightful observational analysis suggesting that early rehabilitation may be associated with improved outcomes in patients with status epilepticus (SE). Further validation and investigation are required.</p><p><strong>Plain language summary: </strong>When patients experience the severe epileptic condition known as status epilepticus, they are often admitted to the intensive care unit (ICU), where their chances of recovery can be poor. However, this study shows that starting rehabilitation early, even in the ICU, can help improve the recovery of these patients. By beginning rehabilitation soon after admission, patients may have an increased chance of returning home rather than facing long-term care. This research highlights the potential benefits of early rehabilitation for improving outcomes in patients with severe epilepsy who require emergency care.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency thermocoagulation in focal epilepsy: A retrospective cohort study.","authors":"Alejandra Vasquez, Karimul Islam, Madeline R Cross, Kai J Miller, Jamie J Van Gompel, Brian Nils Lundstrom, Anthony L Fine","doi":"10.1002/epi4.70009","DOIUrl":"https://doi.org/10.1002/epi4.70009","url":null,"abstract":"<p><strong>Objective: </strong>Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RFTC) has been increasingly used as diagnostic and therapeutic approach for drug-resistant focal epilepsies (DREs). We aimed to describe seizure outcomes of RFTC before and after further neurosurgical intervention.</p><p><strong>Methods: </strong>Retrospective single-institution case series of patients who underwent SEEG-RFTC. The primary outcome was Engel class I-IV classification ([responders Engel I-III and non-responders Engel IV]) at last follow-up after RFTC and prior to further neurosurgical intervention (open surgical resection, laser ablation, and neuromodulation).</p><p><strong>Results: </strong>Twenty-five patients (median age 18.9 years) with DRE were included. The median follow-up time after RFTC was 7.2 months, including 20 patients who underwent further intervention (median follow-up time of 7.3 months) and 5 without intervention (median of 3.5 months). From the patients who had further intervention, 17 (85%) underwent surgical procedure (laser ablation 53%, open surgical resection 47%) (median 4.4 months) and 3 (15%) had responsive neurostimulators placed (median 6.9 months). Prior to further intervention (median follow-up 3.5 months after RFTC), 12 (48%) patients were classified as responders (12% Engel class I, 16% class II, and 20% class III) and 13 (52%) as non-responders. Following neurosurgical intervention, 17 (68%) patients were followed for a median time of 2.7 months and 3 were lost to follow-up. Of eight initial RFTC responders, 87.5% and 12.5% had Engel classes I and III, respectively. Of nine who were non-responders, 33% had Engel class I, 22% II and III, and 44% IV outcomes following further intervention. No neurologic complications were reported.</p><p><strong>Significance: </strong>SEEG-guided RFTC is a well-tolerated procedure and a beneficial diagnostic approach prior to further neurosurgical interventions in patients with DRE.</p><p><strong>Plain language summary: </strong>SEEG-guided RFTC is a well-tolerated procedure and in the patients who experienced initial seizure reduction (n = 8), subsequent neurosurgical intervention (surgery or neuromodulation) led to favorable seizure outcomes (87.5% seizure freedom and 12.5% worthwhile seizure improvement).</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and tolerability of low versus standard daily doses of antiseizure medications in newly diagnosed focal epilepsy. A multicenter, randomized, single-blind, non-inferiority trial (STANDLOW).","authors":"Giorgia Giussani, Elisa Bianchi, Edoardo Carlando, Jacopo Cosimo DiFrancesco, Payam Tabaee Damavandi, Francesco Pasini, Giulia Pederzoli, Stefania Filipponi, Alessandra Gaiani, Luca Massacesi, Eleonora Rosati, Ginevra Giovannelli, Teresa Anna Cantisani, Michela Cecconi, Rossella Papetti, Monica Brioschi, Francesco Aruta, Elio Clemente Agostoni, Francesco Paladin, Filippo Dainese, Marco Longoni, Bartolini Yerma, Sara Gasparini, Umberto Aguglia, Edoardo Ferlazzo, Roberto Cantello, Gionata Strigaro, Marta Maschio, Dario Benincasa, Angela La Neve, Giovanni Falcicchio, Alfonso Giordano, Lara Buttarelli, Gabriele Enia, Maurizio Leone, Carlo Ferrarese, Ettore Beghi, Simone Beretta","doi":"10.1002/epi4.70016","DOIUrl":"https://doi.org/10.1002/epi4.70016","url":null,"abstract":"<p><strong>Objective: </strong>The STANDLOW trial investigated whether first-line antiseizure monotherapy with low doses has a similar efficacy to standard doses, but with fewer adverse events, improved quality of life, and reduced costs for the National Health System.</p><p><strong>Methods: </strong>Multicenter, randomized, parallel-arm, single-blind, non-inferiority trial, comparing low dose versus standard dose of antiseizure medications (carbamazepine, levetiracetam, valproate, zonisamide, oxcarbazepine, topiramate, lamotrigine, gabapentin, lacosamide) in adults with newly diagnosed focal epilepsy.</p><p><strong>Results: </strong>The intention-to-treat (ITT) population consisted of 58 randomized patients, 29 in the low dose arm and 29 in the standard dose arm, 27 (46.6%) females and 31 (53.4%) males, with an age between 18 and 87 years (median 54.9, IQR 32-71). The seizure type was focal impaired awareness seizures in 44 (75.9%) and focal aware seizures in 14 (24.1%). Etiology was unknown in 43 (74.1%) and structural in 15 (25.9%). At study entry, EEG was epileptiform in 28 (48.2%) and seizure frequency was low (≤2 seizures/month) in 41 (70.7%). The estimated relapse proportions at 12 months were 47% for the low dose and 48% for the standard dose, with a difference of 1% (95% CI: -30%; 27%). At the end of the study visit (12 months of follow-up, or immediately after seizure relapse or study withdrawal for other reasons, whichever came first), no differences in the number or severity of adverse events or quality of life measures were observed between the two treatment groups. The total drug-related costs over the entire study period were lower in the low dose arm (median per participant 253 € versus 475 € in the standard dose arm).</p><p><strong>Significance: </strong>Although the efficacy of low doses versus standard doses appeared similar, non-inferiority could not be demonstrated due to slow recruitment and premature termination of the trial. Although statistically inconclusive, our findings suggest that a low dose of antiseizure medications may be considered as a first-line option in adult patients with a new diagnosis of focal epilepsy of unknown etiology and low seizure frequency.</p><p><strong>Plain language summary: </strong>This study aimed to see if low doses of anti-seizure medications (ASMs) could be as effective as standard doses in treating adults with newly diagnosed epilepsy. Subjects were assigned to receive either a low or standard dose of ASMs. 58 adults participated. Both low and standard doses seemed to have a similar effect on controlling seizures. The study was stopped early due to slow enrollment, making it difficult to definitively prove that low doses were non-inferior to standard doses. Low doses of ASMs might be a reasonable option for adults with newly diagnosed epilepsy with no clear cause and few seizures.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the effect of valproic acid levels on patients with epilepsy treated with ketogenic diet: An observational study.","authors":"Stacey Tarrant, Aurelija Liubauske, Guangyu Zhu, Bo Zhang, Heidi Pfeifer, Ann Paris, Ann M Bergin, Anna L Pinto","doi":"10.1002/epi4.13138","DOIUrl":"https://doi.org/10.1002/epi4.13138","url":null,"abstract":"<p><p>Ketogenic diet (KD) therapy is an effective treatment for children with refractory epilepsy. Concurrent treatment with KD and valproic acid (VPA) has previously been shown to affect VPA blood levels. The aim of this study was to explore how VPA levels affect beta-hydroxybutyrate (BHB) levels of children treated with both. We identified 36 children <18 years old concurrently treated with VPA and classic KD between 2018 and 2022. Retrospective data collected from the medical record: date of birth, sex, feeding method, diet initiation and discontinuance dates, VPA initiation and discontinuance dates; and serial weights, KD ratios, levocarnitine dosages, VPA dosages, and BHB, free carnitine, and VPA levels. Repeated-measure data was assessed using univariate and multivariate linear mixed-effects regression analysis. Results showed a statistically significant negative association between VPA and BHB levels based on a univariate LME regression analysis. Conversely, for each 1 mmol/L increase in BHB level, VPA level decreased by 6.39 μg/mL (p < 0.001). Our study indicates that VPA and BHB levels should be monitored closely for children on both treatments and treatment plans may need adjusting if seizure control is not achieved. PLAIN LANGUAGE SUMMARY: This study focuses on children with epilepsy treated with both the ketogenic diet and VPA. It shows that as levels of VPA increase, blood ketone levels decrease, and vice versa. These results suggest that doctors should closely monitor these levels and potentially adjust treatment plans for children on both therapies if seizures are not well controlled.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three cases of atypical Rasmussen's encephalitis with delayed-onset seizures.","authors":"Hongru Guo, Pan Gong, Guojing Yu, Chongyang Tang, Guoming Luan, Qingzhu Liu, Lixin Cai, Taoyun Ji","doi":"10.1002/epi4.13136","DOIUrl":"https://doi.org/10.1002/epi4.13136","url":null,"abstract":"<p><p>We retrospectively analyzed the clinical characteristics of three ARE cases with delayed-onset seizures treated at Peking University First Hospital and Sanbo Brain Hospital from May 2021 to January 2023. We also reviewed previously reported atypical cases of Rasmussen's encephalitis (RE) in the literature, summarizing onset symptoms, seizure symptomatology, imaging findings, electroencephalogram (EEG) results, treatment course, and prognosis. The onset age of the three cases ranged from 1 year and 9 months to 7 years and 5 months. All three initially presented with limb motor disorders, which progressively worsened. Two cases developed focal seizures within 1 month of onset, whereas the third case had no seizures over 3 years. Brain MRIs revealed progressive unilateral hemispheric atrophy with multifocal abnormal signals, and PET-CT showed decreased metabolism in the affected hemisphere. EEGs exhibited asymmetric background rhythms with slow waves in the affected hemisphere. In the two children with seizures, epileptiform discharges from the affected hemisphere were recorded, including one case of sustained partial epilepsy. One child was initially diagnosed with autoimmune encephalitis, whereas two were suspected of having RE at onset. The two children with seizures were treated with immunotherapy and various antiseizure medications. Both underwent hemispherectomy because neither seizures nor limb motor disorders were effectively controlled. Post-surgery, neither experienced seizures during 2 years of follow-up, and both showed cognitive and motor improvements. The child without seizures received intermittent steroids and immunoglobulin therapy over 3 years. During 18 months of follow-up, the patient's motor function improved, and no seizures occurred. Seizures are common initial symptoms of RE. Such cases are often misdiagnosed or missed, leading to delays in optimal treatment. If symptoms are predominantly unilateral and EEG and imaging findings show laterality, the possibility of RE should be considered. Early diagnosis and treatment can reduce unnecessary investigations and improve prognosis. PLAIN LANGUAGE SUMMARY: Rasmussen's encephalitis (RE) is a rare disease that typically begins with seizures and generally has a poor prognosis. However, over the past 20 years, there have been reports of RE cases where the initial symptoms are not seizures. Our center has diagnosed and treated three such cases in the past 5 years. We aim to provide an overview of these atypical RE patients, focusing on clinical features, electroencephalographic (EEG) findings, and imaging characteristics to inspire early detection and diagnosis of RE, thus improving treatment timing and outcomes for RE patients.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GATAD2B-related developmental and epileptic encephalopathy (DEE): Extending the epilepsy phenotype and a literature appraisal.","authors":"Giovanna Scorrano, Giulia Barcia, Jérôme Champ, Thomas Courtin, Nathalie Boddaert, Anna Kaminska, Nicole Chemaly, Rima Nabbout","doi":"10.1002/epi4.13133","DOIUrl":"https://doi.org/10.1002/epi4.13133","url":null,"abstract":"<p><p>Heterozygous pathogenic variants in GATAD2B gene have been related to the GATAD2B-associated neurodevelopmental disorders (GAND) characterized by neurodevelopmental delay with predominant language impairment, infantile hypotonia, macrocephaly, ophthalmological abnormalities, and dysmorphic facial features with nonspecific findings on brain magnetic resonance imaging (MRI). Occasionally, affected individuals exhibit drug responsive epilepsy, psychiatric disorders, and other extra-neurological comorbidities. We report a patient carrying a de novo heterozygous missense variant in GATAD2B gene. She presents a developmental and epileptic encephalopathy (DEE) with drug-resistant atypical absences. An extensive review of the literature did not show any similar phenotype. Our report broadens the electroclinical spectrum related to GATAD2B pathogenic variants and supports the inclusion of this monogenic etiology among the genetic causes of epilepsy with drug-resistant atypical absences, a group with few known genetic etiologies. PLAIN LANGUAGE SUMMARY: We describe a patient with drug-resistant atypical absences caused by a pathogenic variant in the GATAD2B gene. Mutations in the GATAD2B gene should be considered among the rare monogenic causes of atypical absences.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrinsic brain network stability during kainic acid-induced epileptogenesis.","authors":"Nastaran Jafari, Lingna He, Charbel Bou Khalil, Hsiang J Yeh, Neil G Harris, John M Stern, Jerome Engel, Anatol Bragin, Lin Li","doi":"10.1002/epi4.70002","DOIUrl":"10.1002/epi4.70002","url":null,"abstract":"<p><strong>Objective: </strong>Altered intrinsic brain networks have been revealed in patients with epilepsy and are strongly associated with network reorganization in the latent period. However, the development and reliability of intrinsic brain networks in the early period of epileptogenesis are not well understood. The current study aims to fill this gap by investigating the test-retest reliability of intrinsic brain networks in the early stage of epileptogenesis.</p><p><strong>Methods: </strong>We used the rat intrahippocampal kainic acid model of mesial temporal lobe epilepsy. Three sessions of resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired over a 2-week period from 9 sham control rats and 12 rats that later developed spontaneous epilepsy (KA). A group independent component analysis (GICA) approach was used to identify the intrinsic brain networks. Both within and between networks were identified, and test-retest reliability was assessed using the intraclass correlation coefficient (ICC).</p><p><strong>Results: </strong>Our results showed good-to-excellent within-network stability of resting-state functional brain connectivity in most intrinsic brain networks in sham control rats and in the KA group, except for frontal cortex (FCN) and hippocampal networks (HPN). Further analysis of the between networks showed an increase in variation in the KA brain compared to the sham controls.</p><p><strong>Significance: </strong>Overall, our study demonstrated a \"moderately stable\" phase of the intrinsic brain network in a 2-week latent period window, with an altered between- and within-network connectome feature.</p><p><strong>Plain language summary: </strong>This fMRI study explored how brain connectivity changes in healthy animals compared to animals in the latent period of epilepsy. We found that functional connectivity increased during the latent period compared to the control group, and this increase persisted across all tested sessions. Additionally, brain networks became less stable in the epilepsy group, particularly in the frontal cortex and hippocampus. These observations provide further insight into how brain networks change and persist during the early stages of epileptogenesis.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield of utilizing 24-72-hour video electroencephalographic monitoring in the diagnosis of seizures presenting as paroxysmal events in resource-limited settings.","authors":"Chukwudi Nwogu, Chukwuma Nwaze, Adaeze Avah, Benjamin Anyanwu, Chinekwu Anyanwu","doi":"10.1002/epi4.70000","DOIUrl":"https://doi.org/10.1002/epi4.70000","url":null,"abstract":"<p><strong>Objective: </strong>Long-term video electroencephalogram monitoring (LTVEM) is a standard practice in epilepsy centers to diagnose and characterize paroxysmal events. With the lack of data on LTVEM in Africa, we aimed to determine the clinical yield of LTVEM performed for 24-72 h to diagnose seizures in an epilepsy center in Nigeria.</p><p><strong>Methods: </strong>This was a retrospective review of all patients admitted to our Epilepsy Monitoring Unit (EMU) from September 2018 to September 2021, with monitoring lasting between 24 and 72 h. We reviewed the patients' seizure semiology, time to the first event, and final diagnosis. The frequency of seizures was classified as \"daily\" in patients with one or more seizures per day, \"persistent\" in patients with less than one seizure per day but at least once in 6 months, and \"rare\" in patients with less than one seizure in 6 months. Patients with unclear duration due to recent onset were classified as \"undefined\".</p><p><strong>Results: </strong>Seventy patients (34 males, 36 females) were included in our study. The mean age was 22.86 ± 18.00 years. The average duration of monitoring was 44.23 ± 16.16 h. Fifty-seven patients (81.4%) were confirmed to have seizures. Thirteen patients experienced non-epileptic events. Of these 13 patients, nine were diagnosed with psychogenic non-epileptic spells (PNES). Two patients were diagnosed with essential myoclonus and two patients were diagnosed with syncope. The time to the first interictal epileptiform discharge was within 8 h. In the first 24 h, 56 of 57 patients had ictal and interictal discharge (98.2%). These included 100% daily seizures, 100% persistent seizures, and 100% undefined events. One rare seizure was observed within 48 h.</p><p><strong>Significance: </strong>The diagnostic yield of the LTVEM in well-selected patients for seizures in this study is 81.4%. Most patients received a diagnosis within 48 h of monitoring, and we found that extending the study beyond 72 h may not offer significant additional benefits in diagnosing seizures in patients presenting with paroxysmal events.</p><p><strong>Plain language summary: </strong>There is limited information about the usefulness of long-term video electroencephalogram (EEG) monitoring in diagnosing seizures in Africa. Several conditions that resemble seizures (paroxysmal events) could be misdiagnosed, leading to inappropriate treatment. This study evaluated the effectiveness of 24- to 72-h video EEG monitoring in diagnosing seizures at an epilepsy center in Nigeria. Among 70 patients, 81.4% were diagnosed with seizures, with most diagnoses made within 48 h. The findings suggest that video EEG performed within 48 h can significantly help distinguish seizures from other paroxysmal events, thereby contributing to better management and outcomes.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spike detection in the wild: Screening of suspected temporal lobe epilepsy cases using a tailored 2-channel wearable EEG.","authors":"Daniel Filipe Borges, Joana Isabel Soares, Daniela Dias, Helena Cordeiro, Alberto Leal","doi":"10.1002/epi4.70004","DOIUrl":"https://doi.org/10.1002/epi4.70004","url":null,"abstract":"<p><strong>Objective: </strong>To clinically validate the contribution of a custom-built EEG wearable device (waEEG) compared to a full 10-20 electrode array ambulatory EEG (aEEG) for screening epilepsy cases in patients with suspected temporal lobe epilepsy (TLE) but negative routine EEGs.</p><p><strong>Methods: </strong>Patients (aged 16-91 years) with clinically suspected TLE who were referred for a 24 h aEEG were fitted with an additional 2-channel bipolar waEEG device and prospectively enrolled in the study until 20 TLE diagnoses were confirmed by aEEG. 41 patients were included and their waEEG was blindly reviewed by two experienced clinical neurophysiologists and a semi-automated spike detection software to categorize patients into TLE (spikes present) and non-TLE (no spikes) groups.</p><p><strong>Results: </strong>The experts achieved good sensitivity (95%-100%) and accuracy (98%-93%) with excellent interrater agreement (kappa>0.80) in patient labelling. The semi-automated software performed poorly (40% sensitivity, 68% accuracy) and failed to classify TLE in more than half the cases. Classification was not affected by restricting spike detection to the evening and night time, which reduced the average length of the analyzed EEG from 23.4 to 10.4 h. Three false-positive spike detections were thoroughly analyzed and reclassified as artifacts due to eye and body movements and electrocardiographic contamination. To better control cardiac artifacts, the addition of an ECG channel to the waEEG is recommended.</p><p><strong>Significance: </strong>Detection of spikes with waEEG allows accurate detection of epilepsy in suspected TLE cases, with less technical and professional effort and improved acceptance. This screening tool could improve the yield of follow-up with a conventional aEEG and provide an accessible method for monitoring interictal epileptiform activity in TLE.</p><p><strong>Plain language summary: </strong>Epilepsy is a chronic short circuit in the brain. In adults, it most often affects the temporal lobes, resulting in temporal lobe epilepsy (TLE). Seizures are infrequent but difficult to treat. Electroencephalography (EEG) is the best method to detect the electrical disturbances and is crucial to distinguish epilepsy from other non-epileptic disorders. Developing simple, inexpensive and easily accessible portable EEG methods that complement in-hospital assessment could significantly impact patient care. Our study aims to clinically validate a wearable epilepsy screening device to aid in TLE management, reduce delays in diagnosis and enable straightforward assessment of epileptic activity.</p>","PeriodicalId":12038,"journal":{"name":"Epilepsia Open","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}