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Li R, Millist L, Foster E, Yuan X, Guvenc U, Radfar M, Marendy P, Ni W, O'Brien TJ, Casillas-Espinosa PM. Spike and wave discharges detection in genetic absence epilepsy rat from Strasbourg and patients with genetic generalized epilepsy. Epilepsy Res 2023; 194:107181. [PMID: 37364342 DOI: 10.1016/j.eplepsyres.2023.107181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/02/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Generalised spike and wave discharges (SWDs) are pathognomonic EEG signatures for diagnosing absence seizures in patients with Genetic Generalized Epilepsy (GGE). The Genetic Absence Epilepsy Rats from Strasbourg (GAERS) is one of the best-validated animal models of GGE with absence seizures. METHODS We developed an SWDs detector for both GAERS rodents and GGE patients with absence seizures using a neural network method. We included 192 24-hour EEG sessions recorded from 18 GAERS rats, and 24-hour scalp-EEG data collected from 11 GGE patients. RESULTS The SWDs detection performance on GAERS showed a sensitivity of 98.01% and a false positive (FP) rate of 0.96/hour. The performance on GGE patients showed 100% sensitivity in five patients, while the remaining patients obtained over 98.9% sensitivity. Moderate FP rates were seen in our patients with 2.21/hour average FP. The detector trained within our patient cohort was validated in an independent dataset, TUH EEG Seizure Corpus (TUSZ), that showed 100% sensitivity in 11 of 12 patients and 0.56/hour averaged FP. CONCLUSIONS We developed a robust SWDs detector that showed high sensitivity and specificity for both GAERS rats and GGE patients. SIGNIFICANCE This detector can assist researchers and neurologists with the time-efficient and accurate quantification of SWDs.
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Affiliation(s)
- Rui Li
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia; Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia
| | - Lyn Millist
- Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
| | - Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia; Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia
| | - Xin Yuan
- Department of Cyber-Physical Systems, Data61, CSIRO, Marsfield, New South Wales 2122, Australia
| | - Umut Guvenc
- Department of Microsystems, Data61, CSIRO, Pullenvale, Queensland 4069, Australia
| | - Mohsen Radfar
- Department of Microsystems, Data61, CSIRO, Pullenvale, Queensland 4069, Australia
| | - Peter Marendy
- Department of Microsystems, Data61, CSIRO, Pullenvale, Queensland 4069, Australia
| | - Wei Ni
- Department of Cyber-Physical Systems, Data61, CSIRO, Marsfield, New South Wales 2122, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia; Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia; Department of Medicine, The University of Melbourne, Parkville 3050, Victoria, Australia
| | - Pablo M Casillas-Espinosa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia; Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Medicine, The University of Melbourne, Parkville 3050, Victoria, Australia.
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Sultana S, Hitomi T, Kobayashi MD, Shimotake A, Matsuhashi M, Takahashi R, Ikeda A. Long Time Constant May Endorses Sharp Waves and Spikes Than Sharp Transients in Scalp Electroencephalography: A Comparison of Both After-Slow Among Different Time Constant and High-Frequency Activity Analysis. Front Hum Neurosci 2021; 15:748893. [PMID: 34744663 PMCID: PMC8569184 DOI: 10.3389/fnhum.2021.748893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: To clarify whether long time constant (TC) is useful for detecting the after-slow activity of epileptiform discharges (EDs): sharp waves and spikes and for differentiating EDs from sharp transients (Sts). Methods: We employed 68 after-slow activities preceded by 32 EDs (26 sharp waves and six spikes) and 36 Sts from 52 patients with partial and generalized epilepsy (22 men, 30 women; mean age 39.08 ± 13.13 years) defined by visual inspection. High-frequency activity (HFA) associated with the apical component of EDs and Sts was also investigated to endorse two groups. After separating nine Sts that were labeled by visual inspection but did not fulfill the amplitude criteria for after-slow of Sts, 59 activities (32 EDs and 27 Sts) were analyzed about the total area of after-slow under three TCs (long: 2 s; conventional: 0.3 s; and short: 0.1 s). Results: Compared to Sts, HFA was found significantly more with the apical component of EDs (p < 0.05). The total area of after-slow in all 32 EDs under TC 2 s was significantly larger than those under TC 0.3 s and 0.1 s (p < 0.001). Conversely, no significant differences were observed in the same parameter of 27 Sts among the three different TCs. Regarding separated nine Sts, the total area of after-slow showed a similar tendency to that of 27 Sts under three different TCs. Significance: These results suggest that long TC could be useful for selectively endorsing after-slow of EDs and differentiating EDs from Sts. These findings are concordant with the results of the HFA analysis. Visual inspection is also equally good as the total area of after-slow analysis.
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Affiliation(s)
- Shamima Sultana
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takefumi Hitomi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Akihiro Shimotake
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yıldırım S, Koçer HE, Ekmekçi AH. Automatic phase reversal detection in routine EEG. Med Hypotheses 2020; 142:109825. [DOI: 10.1016/j.mehy.2020.109825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
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Cohen E, Antwi P, Banz BC, Vincent P, Saha R, Arencibia CA, Ryu JH, Atac E, Saleem N, Tomatsu S, Swift K, Hu C, Krestel H, Farooque P, Levy S, Wu J, Crowley M, Vaca FE, Blumenfeld H. Realistic driving simulation during generalized epileptiform discharges to identify electroencephalographic features related to motor vehicle safety: Feasibility and pilot study. Epilepsia 2019; 61:19-28. [PMID: 31646628 DOI: 10.1111/epi.16356] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Generalized epileptiform discharges (GEDs) can occur during seizures or without obvious clinical accompaniment. Motor vehicle driving risk during apparently subclinical GEDs is uncertain. Our goals were to develop a feasible, realistic test to evaluate driving safety during GEDs, and to begin evaluating electroencephalographic (EEG) features in relation to driving safety. METHODS Subjects were aged ≥15 years with generalized epilepsy, GEDs on EEG, and no clinical seizures. Using a high-fidelity driving simulator (miniSim) with simultaneous EEG, a red oval visual stimulus was presented every 5 minutes for baseline testing, and with each GED. Participants were instructed to pull over as quickly and safely as possible with each stimulus. We analyzed driving and EEG signals during GEDs. RESULTS Nine subjects were tested, and five experienced 88 GEDs total with mean duration 2.31 ± 1.89 (SD) seconds. Of these five subjects, three responded appropriately to all stimuli, one failed to respond to 75% of stimuli, and one stopped driving immediately during GEDs. GEDs with no response to stimuli were significantly longer than those with appropriate responses (8.47 ± 3.10 vs 1.85 ± 0.69 seconds, P < .001). Reaction times to stimuli during GEDs were significantly correlated with GED duration (r = 0.30, P = .04). In addition, EEG amplitude was greater for GEDs with no response to stimuli than GEDs with responses, both for overall root mean square voltage amplitude (66.14 μV vs 52.99 μV, P = .02) and for fractional power changes in the frequency range of waves (P < .05) and spikes (P < .001). SIGNIFICANCE High-fidelity driving simulation is feasible for investigating driving behavior during GEDs. GEDs with longer duration and greater EEG amplitude showed more driving impairment. Future work with a large sample size may ultimately enable classification of GED EEG features to predict individual driving risk.
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Affiliation(s)
- Eli Cohen
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut.,Central Caribbean University School of Medicine, Bayamón, Puerto Rico
| | - Prince Antwi
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Barbara C Banz
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Peter Vincent
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Rick Saha
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | | | - Jun H Ryu
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Ece Atac
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut.,Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nehan Saleem
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Shiori Tomatsu
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Kohleman Swift
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Claire Hu
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Heinz Krestel
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut.,Epilepsy Center Frankfurt Rhein-Main, Center for Personalized Translational Epilepsy Research, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Pue Farooque
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Susan Levy
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Jia Wu
- Child Study Center, Yale School of Medicine, New Haven, Connecticut.,Developmental Neurocognitive Driving Simulation Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Michael Crowley
- Child Study Center, Yale School of Medicine, New Haven, Connecticut.,Developmental Neurocognitive Driving Simulation Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Federico E Vaca
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut.,Developmental Neurocognitive Driving Simulation Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Hal Blumenfeld
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut.,Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut.,Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
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Baiardi S, Vandi S, Pizza F, Alvisi L, Toscani L, Zambrelli E, Tinuper P, Mayer G, Plazzi G. Narcolepsy Type 1 and Idiopathic Generalized Epilepsy: Diagnostic and Therapeutic Challenges in Dual Cases. J Clin Sleep Med 2015; 11:1257-62. [PMID: 26156948 PMCID: PMC4623123 DOI: 10.5664/jcsm.5180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/11/2015] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES The aim of this study is to describe the possible co-occurrence of narcolepsy type 1 and generalized epilepsy, focusing on diagnostic challenge and safety of dual treatments. METHODS AND RESULTS Four patients with comorbidity for narcolepsy type 1 and idiopathic generalized epilepsy are reported: in three cases the onset of epilepsy preceded narcolepsy type 1 appearance, whereas in one case epileptic spells onset was subsequent. Patients presented with absences, myoclonic and tonic-clonic seizure type: in the patient with tonic-clonic seizures the dual pathology was easily recognized, in the other cases the first diagnosis caused the comorbid disease to be overlooked, independent of the time-course sequence. All four patients underwent neurological examination, video-electroencephalogram during which ictal and interictal epileptic discharges were recorded, and sleep polysomnographic studies. Repeated sleep onset rapid eye movement periods (SOREMPs) were documented with the multiple sleep latency test (MLST) in all the four cases. All patients had unremarkable brain magnetic resonance imaging studies and cerebrospinal hypocretin-1 was assessed in two patients, revealing undetectable levels. The association of antiepileptic drugs and substances currently used to treat narcolepsy type 1, including sodium oxybate, was effective in improving seizures, sleep disturbance, and cataplexy. CONCLUSIONS Narcolepsy type 1 may occur in association with idiopathic generalized epilepsy, leading to remarkable diagnostic and therapeutic challenges. Electrophysiological studies as well as a comprehensive somnologic interview can help confirm the diagnosis in patients with ambiguous neurological history. Sodium oxybate in combination with antiepileptic drugs is safe and effective in treating cataplexy and excessive daytime sleepiness.
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Affiliation(s)
- Simone Baiardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Lara Alvisi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | - Elena Zambrelli
- Regional Epilepsy Center–Sleep Medicine Center, San Paolo Hospital, Milan, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Geert Mayer
- Hephata Klinik, Schwalmstadt-Treysa, Germany; Department of Neurology, Philipps-Universität Marburg, Marburg, Germany
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
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Kurtis MM, Toledano R, García-Morales I, Gil-Nagel A. Immunomodulated parkinsonism as a presenting symptom of LGI1 antibody encephalitis. Parkinsonism Relat Disord 2015; 21:1286-7. [DOI: 10.1016/j.parkreldis.2015.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/19/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
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Englot DJ, Chang EF. Rates and predictors of seizure freedom in resective epilepsy surgery: an update. Neurosurg Rev 2014; 37:389-404; discussion 404-5. [PMID: 24497269 DOI: 10.1007/s10143-014-0527-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 10/26/2013] [Accepted: 10/27/2013] [Indexed: 12/26/2022]
Abstract
Epilepsy is a debilitating neurological disorder affecting approximately 1 % of the world's population. Drug-resistant focal epilepsies are potentially surgically remediable. Although epilepsy surgery is dramatically underutilized among medically refractory patients, there is an expanding collection of evidence supporting its efficacy which may soon compel a paradigm shift. Of note is that a recent randomized controlled trial demonstrated that early resection leads to considerably better seizure outcomes than continued medical therapy in patients with pharmacoresistant temporal lobe epilepsy. In the present review, we provide a timely update of seizure freedom rates and predictors in resective epilepsy surgery, organized by the distinct pathological entities most commonly observed. Class I evidence, meta-analyses, and individual observational case series are considered, including the experiences of both our institution and others. Overall, resective epilepsy surgery leads to seizure freedom in approximately two thirds of patients with intractable temporal lobe epilepsy and about one half of individuals with focal neocortical epilepsy, although only the former observation is supported by class I evidence. Two common modifiable predictors of postoperative seizure freedom are early operative intervention and, in the case of a discrete lesion, gross total resection. Evidence-based practice guidelines recommend that epilepsy patients who continue to have seizures after trialing two or more medication regimens should be referred to a comprehensive epilepsy center for multidisciplinary evaluation, including surgical consideration.
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Affiliation(s)
- Dario J Englot
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, CA, USA,
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