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Posar A, Visconti P. Continuous Spike-Waves during Slow Sleep Today: An Update. CHILDREN (BASEL, SWITZERLAND) 2024; 11:169. [PMID: 38397281 PMCID: PMC10887038 DOI: 10.3390/children11020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
In the context of childhood epilepsy, the concept of continuous spike-waves during slow sleep (CSWS) includes several childhood-onset heterogeneous conditions that share electroencephalograms (EEGs) characterized by a high frequency of paroxysmal abnormalities during sleep, which have negative effects on the cognitive development and behavior of the child. These negative effects may have the characteristics of a clear regression or of a slowdown in development. Seizures are very often present, but not constantly. The above makes it clear why CSWS have been included in epileptic encephalopathies, in which, by definition, frequent EEG paroxysmal abnormalities have an unfavorable impact on cognitive functions, including socio-communicative skills, causing autistic features, even regardless of the presence of clinically overt seizures. Although several decades have passed since the original descriptions of the electroclinical condition of CSWS, there are still many areas that are little-known and deserve to be further studied, including the EEG diagnostic criteria, the most effective electrophysiological parameter for monitoring the role of the thalamus in CSWS pathogenesis, its long-term evolution, the nosographic location of Landau-Kleffner syndrome, standardized neuropsychological and behavioral assessments, and pharmacological and non-pharmacological therapies.
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Affiliation(s)
- Annio Posar
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Disturbi dello Spettro Autistico, 40139 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, Bologna University, 40139 Bologna, Italy
| | - Paola Visconti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Disturbi dello Spettro Autistico, 40139 Bologna, Italy;
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Al-Omari MA, Andrade A, Prasad AN. Does the duration of video-EEG recording influence diagnostic yield in pediatric epilepsy: Results from a single center study. Epilepsy Behav 2023; 142:109172. [PMID: 36963318 DOI: 10.1016/j.yebeh.2023.109172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/25/2023] [Accepted: 03/08/2023] [Indexed: 03/26/2023]
Abstract
AIM This exploratory study examines the association of the duration of electroencephalography (EEG) recordings to diagnostic yield in children undergoing evaluation for seizures. METHOD Clinical and EEG data on three hundred and ten patients (167 males and 143 females) were reviewed retrospectively. 134 (43.2%) children with focal-onset seizures, and 59 (19%) children with generalized-onset seizures. The mean duration of recordings in studies interpreted as "diagnostic" was compared to studies that were interpreted as "non-diagnostic". EMU recordings were also compared to routine EEG studies to identify the relationship between routine EEG and diagnostic studies. RESULTS The principal finding of this study indicates that a longer duration of monitoring is more likely to be associated with a positive diagnostic yield. Mean duration of recording in children with a "non-diagnostic study" was 31.05 hours versus 44.27 hours; p < 0.001 in a "diagnostic study". EMU recordings are likely to be diagnostic with longer epilepsy duration (2.6 years vs 3.7 years; p < 0.01). A diagnostic EEG from a prolonged recording is more likely to be achieved in children with abnormal routine EEG and focal-onset seizures. p < 0.001. INTERPRETATION Tailoring the optimal duration of EEG recordings and factoring in confounding variables will reduce the need for repeated studies, improving diagnostic utility and permitting efficient utilization of resources.
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Affiliation(s)
- Mohammed A Al-Omari
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
| | - Andrea Andrade
- Depatment of Paediatrics, Schulich School of Medicine and Dentistry, Children's Hospital, London Health Science Center, Western University, London, ON, Canada
| | - Asuri N Prasad
- Depatment of Paediatrics, Schulich School of Medicine and Dentistry, Children's Hospital, London Health Science Center, Western University, London, ON, Canada.
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Aslan M, Gungor S. The Importance of Long-Term Video Electroencephalography Monitoring in the Differential Diagnosis of Epilepsy in Children. Cureus 2022; 14:e25700. [PMID: 35812582 PMCID: PMC9259997 DOI: 10.7759/cureus.25700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
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DiGiovine MP, Massey SL, LaFalce D, Vala L, Allen-Napoli L, Banwell BL, Abend NS. Video Ambulatory EEG in Children: A Quality Improvement Study. J Clin Neurophysiol 2022; 39:271-275. [PMID: 32956093 DOI: 10.1097/wnp.0000000000000781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We implemented a video ambulatory EEG (VA-EEG) Program as an alternative to inpatient video EEG monitoring for some patients given potential benefits related to quicker access, greater convenience, and lower cost. To evaluate the newly initiated program, we performed a quality improvement study to assess whether VA-EEG yielded studies with interpretable EEG and video quality that generated clinically beneficial data. METHODS This was a single-center prospective quality improvement study. We surveyed ordering clinicians, electroencephalographers, and caregivers regarding consecutive children who underwent clinically indicated VA-EEG. The primary outcome was the percentage of VA-EEG studies in which the ordering clinician reported that the study had answered the question of interest. RESULTS We evaluated 74 consecutive children selected to undergo clinically indicated VA-EEG by their clinicians and caregivers. Ordering clinicians reported that 77% of studies answered the question of interest. Electroencephalographers reported that the quality of the EEG and video was excellent or adequate in 100% and 92% of patients, respectively. Additionally, 84% of caregivers reported preferring VA-EEG if EEG data were needed in the future. CONCLUSIONS Video ambulatory EEG may be an effective diagnostic modality among children selected by clinicians and caregivers to undergo long-term EEG monitoring. Given it is effective as well as convenient, accessible, and lower cost than inpatient EEG monitoring, all of which align with our institution's quality goals, we intend to expand our VA-EEG Program.
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Affiliation(s)
- Marissa P DiGiovine
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Shavonne L Massey
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Denise LaFalce
- Department of Neurodiagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Lisa Vala
- Department of Neurodiagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Linda Allen-Napoli
- Department of Neurodiagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Brenda L Banwell
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nicholas S Abend
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Neurodiagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.; and
- Department of Information Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-EEG monitoring: A clinical practice guideline of the international league against epilepsy and international federation of clinical neurophysiology. Clin Neurophysiol 2021; 134:111-128. [PMID: 34955428 DOI: 10.1016/j.clinph.2021.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events (see Table S1). For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, WV, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, France.
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich Switzerland.
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Danish Epilepsy Center, Dianalund, Denmark.
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-electroencephalographic monitoring: A clinical practice guideline of the International League Against Epilepsy and International Federation of Clinical Neurophysiology. Epilepsia 2021; 63:290-315. [PMID: 34897662 DOI: 10.1111/epi.16977] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events. For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and to establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, Nancy, France
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich,, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Danish Epilepsy Center, Dianalund, Denmark
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Hanrahan B, Gross RA, Wychowski T, Erba G, Birbeck GL, Liu L. Improved ictal assessment performance in the epilepsy monitoring unit via standardization. Epilepsy Behav 2021; 122:108067. [PMID: 34147022 DOI: 10.1016/j.yebeh.2021.108067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether the standardization and implementation of an ictal testing protocol in the Epilepsy Monitoring Unit (EMU) leads to improvements in ictal testing performance. METHODS Ictal assessments completed in the EMU from a single center were retrospectively reviewed over a two-month period. Each assessment was evaluated to determine whether 8 high-yield aspects of the ictal assessment were performed. Following observation of performance, a standardized ictal testing protocol was developed based on a root cause analysis and review of consensus guidelines. This protocol was disseminated to staff in conjunction with an annual epilepsy education seminar. Ictal assessment performance was re-assessed during the subsequent two months (short-term follow-up) and again during a five- to seven-month period (long-term follow-up) beyond the initial intervention. For sub-group analysis, event characteristics (event type, time of assessment) and patient characteristics (age, gender) were also evaluated and analyzed in relation to ictal testing performance. RESULTS All eight individual ictal testing elements were more likely to be assessed in short-term and long-term follow-up periods when compared to pre-intervention assessments. The cumulative difference in ictal testing was 20.4% (95% CI 3.7-37.2, p = 0.02) greater for the short-term period and 16.7% (95% CI -0.3% to 33.8%, p = 0.05) greater in the long-term period when compared to baseline testing. CONCLUSIONS Utilization of a standardized ictal testing battery in conjunction with staff education leads to an objective improvement in ictal assessment performance. Further research is warranted to assess the replicability of our findings.
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Affiliation(s)
- Brian Hanrahan
- Department of Neurology, Epilepsy Division, St. Luke's University Health Network, Bethlehem, PA, United States.
| | - Robert A Gross
- Departments of Neurology and Pharmacology and Physiology, Epilepsy Division, University of Rochester Medical Center, Rochester, NY, United States.
| | - Thomas Wychowski
- Departments of Neurology and Pharmacology and Physiology, Epilepsy Division, University of Rochester Medical Center, Rochester, NY, United States.
| | - Giuseppe Erba
- Departments of Neurology and Pharmacology and Physiology, Epilepsy Division, University of Rochester Medical Center, Rochester, NY, United States.
| | - Gretchen L Birbeck
- Departments of Neurology and Pharmacology and Physiology, Epilepsy Division, University of Rochester Medical Center, Rochester, NY, United States.
| | - Lynn Liu
- Departments of Neurology and Pharmacology and Physiology, Epilepsy Division, University of Rochester Medical Center, Rochester, NY, United States.
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Benefits, safety and outcomes of long-term video EEG monitoring in pediatric patients. Eur J Paediatr Neurol 2021; 32:29-35. [PMID: 33743387 DOI: 10.1016/j.ejpn.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/19/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate benefits of in-hospital, long-term video EEG monitoring (LVEM) for pediatric patients, from a therapeutic perspective and from the perspectives of patients and their families. METHODS A monocentric retrospective cohort study was conducted. Patients aged 0-18 years who underwent LVEM for epilepsy surgery eligibility, epilepsy syndrome clarification, or medication adjustment were evaluated regarding paroxysmal event type, change in seizure frequency and patients' benefits using a standardized evaluation protocol. RESULTS A total of 163 (88 boys and 75 girls, mean age 10.9 years) pediatric patients underwent 178 LVEM sessions, with a mean duration of 5.4 days. The rate of habitual event detection was 69.1%. Epilepsy diagnosis was confirmed in 147 patients and excluded in 16 patients (9.8%). LVEM results altered the diagnosis of 37.4% of patients. Diagnosis remained unchanged in 49.1% of patients and was specified in 13.5% of patients. Epilepsy surgery was performed in 32 patients, and 64% of epilepsy patients deemed ineligible for epilepsy surgery underwent medication adjustments. Patients or their families found LVEM helpful in 75% of cases. Significant seizure reductions and improvements in the disease course were reported by 45% of epilepsy patients. Three episodes of non-convulsive status epilepticus occurred, representing 1.7% of admissions and 1.9% of patients diagnosed with epilepsy, while no injuries were observed. CONCLUSIONS LVEM is beneficial for pediatric patients from both a medical perspective and from the perspective of patients and their families, even if patients are ineligible for epilepsy surgery. LVEM is well-tolerated with a low risk of status epilepticus and injuries.
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Abstract
Pediatric epilepsy is a highly variable condition due to age-related expression of syndromes that require specific diagnosis, evaluations, and treatments. Children with epilepsy differ from their adult counterparts in many important ways, mostly related to the age-related expression of specific epilepsy syndromes. This results in many important considerations related to the epilepsy diagnosis, classification, evaluations to determine an etiology, as well as treatment guidelines. A good understanding of these factors will help to establish an accurate epilepsy diagnosis, which in turn will guide appropriate testing and treatment decisions. In this way, patients will have improved seizure outcomes, and families will be educated appropriately and provided with the most accurate prognostic information available. The purpose of this article is to review the diagnosis, work-up, and management of pediatric epilepsy.
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Affiliation(s)
- Jeffrey R Tenney
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Carlson S, Kandler RH, Moorhouse D, Ponnusamy A, Mordekar SR, Alix JJ. Home video telemetry in children: A comparison to inpatient video telemetry. Seizure 2018; 61:209-213. [DOI: 10.1016/j.seizure.2018.08.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022] Open
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Knox A, Arya R, Horn PS, Holland K. The Diagnostic Accuracy of Video Electroencephalography Without Event Capture. Pediatr Neurol 2018; 79:8-13. [PMID: 29248327 DOI: 10.1016/j.pediatrneurol.2017.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/19/2017] [Accepted: 10/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the accuracy of 24-hour video electroencephalography (vEEG) for the diagnosis of epilepsy when a patient's typical paroxysmal event was not captured (no-event vEEG). METHODS We performed a retrospective chart review of all first-time 24 hour no-event vEEG studies at Cincinnati Children's Hospital Medical Center. Clinician diagnosis of epilepsy with a minimum of one year follow-up was used as the reference standard to calculate diagnostic accuracy. Sensitivity and specificity of routine EEG (rEEG) and vEEG were compared in patients with both studies, and factors affecting the accuracy of vEEG were explored with a multivariable analysis. RESULTS No-event vEEG showed sensitivity of 0.54 (95% confidence interval [CI] 0.44 to 0.64) and specificity of 0.88 (95% CI 0.84 to 0.92) respectively, with a diagnostic odds ratio of 7.53 (95% CI 4.45 to 12.76). The sensitivity of vEEG was statistically superior to that of rEEG, whereas specificity was comparable. Age emerged as the only factor that affected the diagnostic accuracy of no-event vEEG. CONCLUSION Even in the absence of a typical seizure or spell, video EEG is a useful test for predicting or excluding epilepsy, with diagnostic accuracy that is superior to rEEG and unaffected by the presence of a chronic neurological condition.
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Affiliation(s)
- Andrew Knox
- Department of Neurology, University of Wisconsin, Madison, Wisconsin.
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katherine Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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