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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of starting antiepileptic treatment prior to electroencephalography in first epileptic seizures. Neurologia 2023; 38:647-652. [PMID: 37858895 DOI: 10.1016/j.nrleng.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHODS We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Quintana
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Fonseca
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Abraira
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Toledo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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2
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Reynolds A, Vranic-Peters M, Lai A, Grayden DB, Cook MJ, Peterson A. Prognostic interictal electroencephalographic biomarkers and models to assess antiseizure medication efficacy for clinical practice: A scoping review. Epilepsia 2023; 64:1125-1174. [PMID: 36790369 DOI: 10.1111/epi.17548] [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: 05/30/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Antiseizure medication (ASM) is the primary treatment for epilepsy. In clinical practice, methods to assess ASM efficacy (predict seizure freedom or seizure reduction), during any phase of the drug treatment lifecycle, are limited. This scoping review identifies and appraises prognostic electroencephalographic (EEG) biomarkers and prognostic models that use EEG features, which are associated with seizure outcomes following ASM initiation, dose adjustment, or withdrawal. We also aim to summarize the population and context in which these biomarkers and models were identified and described, to understand how they could be used in clinical practice. Between January 2021 and October 2022, four databases, references, and citations were systematically searched for ASM studies investigating changes to interictal EEG or prognostic models using EEG features and seizure outcomes. Study bias was appraised using modified Quality in Prognosis Studies criteria. Results were synthesized into a qualitative review. Of 875 studies identified, 93 were included. Biomarkers identified were classed as qualitative (visually identified by wave morphology) or quantitative. Qualitative biomarkers include identifying hypsarrhythmia, centrotemporal spikes, interictal epileptiform discharges (IED), classifying the EEG as normal/abnormal/epileptiform, and photoparoxysmal response. Quantitative biomarkers were statistics applied to IED, high-frequency activity, frequency band power, current source density estimates, pairwise statistical interdependence between EEG channels, and measures of complexity. Prognostic models using EEG features were Cox proportional hazards models and machine learning models. There is promise that some quantitative EEG biomarkers could be used to assess ASM efficacy, but further research is required. There is insufficient evidence to conclude any specific biomarker can be used for a particular population or context to prognosticate ASM efficacy. We identified a potential battery of prognostic EEG biomarkers, which could be combined with prognostic models to assess ASM efficacy. However, many confounders need to be addressed for translation into clinical practice.
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Affiliation(s)
- Ashley Reynolds
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurosciences, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michaela Vranic-Peters
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurosciences, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Alan Lai
- Department of Neurosciences, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - David B Grayden
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurosciences, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Graeme Clark Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark J Cook
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurosciences, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Graeme Clark Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Andre Peterson
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurosciences, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Graeme Clark Institute, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
SUMMARY Long-term video-EEG monitoring has been the gold standard for diagnosis of epileptic and nonepileptic events. Medication changes, safety, and a lack of recording EEG in one's habitual environment may interfere with diagnostic representation and subsequently affect management. Some spells defy standard EEG because of ultradian and circadian times of occurrence, manifest nocturnal expression of epileptiform activity, and require classification for clarifying diagnostic input to identify optimal treatment. Some patients may be unaware of seizures, have frequent events, or subclinical seizures that require quantification before optimal management. The influence on antiseizure drug management and clinical drug research can be enlightened by long-term outpatient ambulatory EEG monitoring. With recent governmental shifts to focus on mobile health, ambulatory EEG monitoring has grown beyond diagnostic capabilities to target the dynamic effects of medical and nonmedical treatment for patients with epilepsy in their natural environment. Furthermore, newer applications in ambulatory monitoring include additional physiologic parameters (e.g., sleep, detection of myogenic signals, etc.) and extend treatment relevance to patients beyond seizure reduction alone addressing comorbid conditions. It is with this focus in mind that we direct our discussion on the present and future aspects of using ambulatory EEG monitoring in the treatment of patients with epilepsy.
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Abstract
SUMMARY Recording of interictal epileptiform discharges to classify the epilepsy syndrome is one of the most common indications for ambulatory EEG. Ambulatory EEG has superior sampling compared with standard EEG recordings and advantages in terms of cost-effectiveness and convenience compared with a prolonged inpatient EEG study. Ambulatory EEG allows for EEG recording in all sleep stages and transitional states, which can be very helpful in capturing interictal epileptiform discharges. In the absence of interictal epileptiform discharges or in patients with atypical events, the characterization of an epilepsy syndrome may require recording of the habitual events. Diagnostic ambulatory EEG can be a useful alternative to inpatient video-EEG monitoring in a selected number of patients with frequent events who do not require medication taper or seizure testing for surgical localization.
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Hasan TF, Tatum WO. When should we obtain a routine EEG while managing people with epilepsy? Epilepsy Behav Rep 2021; 16:100454. [PMID: 34041475 PMCID: PMC8141667 DOI: 10.1016/j.ebr.2021.100454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022] Open
Abstract
More than eight decades after its discovery, routine electroencephalogram (EEG) remains a safe, noninvasive, inexpensive, bedside test of neurological function. Knowing when a routine EEG should be obtained while managing people with epilepsy is a critical aspect of optimal care. Despite advances in neuroimaging techniques that aid diagnosis of structural lesions in the central nervous system, EEG continues to provide critical diagnostic evidence with implications on treatment. A routine EEG performed after a first unprovoked seizure can support a clinical diagnosis of epilepsy and differentiate those without epilepsy, classify an epilepsy syndrome to impart prognosis, and characterize seizures for antiseizure management. Despite a current viral pandemic, EEG services continue, and the value of routine EEG is unchanged.
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Affiliation(s)
- Tasneem F. Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - William O. Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
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6
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of initiating antiseizure drugs prior to the performance of EEG in first epileptic seizures. Neurologia 2021; 38:S0213-4853(21)00053-0. [PMID: 33875301 DOI: 10.1016/j.nrl.2021.02.014] [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: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHOD We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Quintana
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Fonseca
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - L Abraira
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Toledo
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Santamarina
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España.
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Montoya Gutiérrez FJ, Díaz Román M, Cerveró Albert D. Electro-clinical analysis of epilepsy patients with generalized seizures on adjunctive perampanel treatment. Epilepsy Res 2020; 165:106378. [PMID: 32622260 DOI: 10.1016/j.eplepsyres.2020.106378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Quantifying epileptiform discharges before and after the initiation of treatment can be useful for evaluating the efficacy of antiepileptic drugs in generalized epilepsy. The aim of this study was to determine if the selective α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor antagonist perampanel alters the electroencephalographic signals in patients with drug resistant generalized seizures (primary or secondary). We also assessed the clinical efficacy, safety and tolerability of perampanel as an adjunctive treatment for patients with refractory generalized seizures after 3, 6 and 12 months of treatment to determine if there is an electro-clinical correlation. We carried out a 1-year retrospective, unicentric, observational, descriptive and non-interventional study to analyze changes in epileptiform discharges, seizure frequency and adverse effects in patients with generalized seizures taking perampanel as an add-on treatment. Perampanel significantly reduced the total number, total duration, maximal duration and average duration of epileptiform discharges in patients with primary generalized epilepsy (n = 44). In patients with focal onset epilepsy and secondary generalized seizures (n = 8) significant decreases in the maximal duration and average duration of epileptiform discharges were found. These findings correlate with the significant decrease in seizure frequency and clinical improvement observed after taking perampanel as an adjunctive therapy for 3, 6 and 12 months. To our knowledge, this is the first study to show that perampanel reduces epileptiform activity, and that this effect correlates with patients' clinical improvement. Analysing patients' electroencephalographic activity in response to perampanel could be useful for assessing the drug's efficacy and optimising adjunctive treatments.
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Affiliation(s)
- Francisco Javier Montoya Gutiérrez
- Epilepsy Unit, Department of Neurology, Hospital General Universitario de Valencia, Tres Cruces Av, 2, 46014, Valencia, Spain; Epilepsy Unit, Department of Clinical Neurophysiology, Lluis Alcanyis Hospital, Carretera Xátiva-Silla, Km 2, 46800, Xàtiva, Valencia, Spain.
| | - Mónica Díaz Román
- Epilepsy Unit, Department of Clinical Neurophysiology, Lluis Alcanyis Hospital, Carretera Xátiva-Silla, Km 2, 46800, Xàtiva, Valencia, Spain
| | - Dolors Cerveró Albert
- Epilepsy Unit, Department of Clinical Neurophysiology, Lluis Alcanyis Hospital, Carretera Xátiva-Silla, Km 2, 46800, Xàtiva, Valencia, Spain
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8
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Sokolov E, Abdoul Bachir DH, Sakadi F, Williams J, Vogel AC, Schaekermann M, Tassiou N, Bah AK, Khatri V, Hotan GC, Ayub N, Leung E, Fantaneanu TA, Patel A, Vyas M, Milligan T, Villamar MF, Hoch D, Purves S, Esmaeili B, Stanley M, Lehn-Schioler T, Tellez-Zenteno J, Gonzalez-Giraldo E, Tolokh I, Heidarian L, Worden L, Jadeja N, Fridinger S, Lee L, Law E, Fodé Abass C, Mateen FJ. Tablet-based electroencephalography diagnostics for patients with epilepsy in the West African Republic of Guinea. Eur J Neurol 2020; 27:1570-1577. [PMID: 32359218 DOI: 10.1111/ene.14291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- E Sokolov
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - F Sakadi
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - J Williams
- Department of Neurology, Mater Misericordiae University Hospital and Dublin Neurological Institute, Dublin, Ireland
| | - A C Vogel
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - N Tassiou
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - A K Bah
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - V Khatri
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - G C Hotan
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Boston, MA, USA
| | - N Ayub
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - E Leung
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, USA.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, USA
| | - T A Fantaneanu
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - A Patel
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - M Vyas
- Division of Neurology, University of Toronto, Toronto, ON, USA
| | - T Milligan
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M F Villamar
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - D Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - S Purves
- University of British Columbia, Vancouver, BC, Canada
| | - B Esmaeili
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M Stanley
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - J Tellez-Zenteno
- University of Saskatchewan College of Medicine, Saskatoon, SK, Canada
| | | | - I Tolokh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - L Worden
- Children's Hospital of Philadelphia, PA, USA
| | - N Jadeja
- University of Massachusetts School of Medicine, Boston, MA, USA
| | - S Fridinger
- Children's Hospital of Philadelphia, PA, USA
| | - L Lee
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Law
- University of Waterloo, Waterloo, ON, Canada
| | - C Fodé Abass
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - F J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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10
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Bentes C, Canhão P, Peralta AR, Viana P, Fonseca AC, Geraldes R, Pinho e Melo T, Paiva T, Ferro JM. Usefulness of EEG for the differential diagnosis of possible transient ischemic attack. Clin Neurophysiol Pract 2017; 3:11-19. [PMID: 30215000 PMCID: PMC6134195 DOI: 10.1016/j.cnp.2017.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE EEG value in possible transient ischemic attacks (TIA) is unknown. We aim to quantify focal slow wave activity (FSWA) and epileptiform activity (EA) frequency in possible TIA, and to analyse its contribution to the final diagnosis of seizures and/or definitive TIA. METHODS Prospective longitudinal study of possible TIA patients evaluated at a tertiary centre during 36 months and with 1-3 months follow-up. EEG was performed as soon as possible (early EEG) and one month later (late EEG). A stroke neurologist established final diagnosis after reassessing all clinical and diagnostic tests. RESULTS 80 patients underwent an early EEG (45.8 h after possible TIA): 52 had FSWA and 6 of them also EA. Early FSWA was associated with epileptic seizure or definitive TIA final diagnosis (p = .041). Patients with these diagnoses had more frequently early FSWA (19/23; 82.6%) than EA (6/23; 26.1%). 6/13 (46.2%) patients with epileptic seizure final diagnosis had EA.In the late EEG, 43 (58.1%) patients demonstrated persistent FSWA and 3 of them also EA. Persistent FSWA in the late EEG was more frequent in seizures than in TIA patients (91.7% vs. 45.5%). FSWA disappearance was associated with acute vascular lesion on neuroimage. CONCLUSIONS FSWA was the commonest EEG abnormality found in the early EEG of patients with possible TIA, but did not distinguish between TIA and seizure patients. In patients with seizures, FSWA was more common than EA and its presence in the late EEG was more likely in patients with epileptic seizures than with TIA. SIGNIFICANCE The majority of possible TIA patients with the final diagnosis of epileptic seizures do not have EA in the early or late EEG.
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Affiliation(s)
- Carla Bentes
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisboa, Portugal
- EEG/Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Patrícia Canhão
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Stroke Unit, Hospital de Santa Maria, CHLN, Lisboa, Portugal
| | - Ana Rita Peralta
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisboa, Portugal
- EEG/Sleep Laboratory, Hospital de Santa Maria, CHLN, Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Pedro Viana
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisboa, Portugal
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Stroke Unit, Hospital de Santa Maria, CHLN, Lisboa, Portugal
| | - Ruth Geraldes
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Stroke Unit, Hospital de Santa Maria, CHLN, Lisboa, Portugal
| | - Teresa Pinho e Melo
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Stroke Unit, Hospital de Santa Maria, CHLN, Lisboa, Portugal
| | - Teresa Paiva
- Centro de Electroencefalografia e Neurofisiologia Clínica, Lisboa, Portugal
| | - José Manuel Ferro
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal
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Kim MJ, Nam SO. Change of interictal epileptiform discharges after antiepiletic drug treatment in childhood epilepsy. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.4.560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Mun Ju Kim
- Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Gyeongnam, Korea
| | - Sang Ook Nam
- Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Gyeongnam, Korea
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