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Devulder A, Macea J, Kalkanis A, De Winter F, Vandenbulcke M, Vandenberghe R, Testelmans D, Van Den Bossche MJA, Van Paesschen W. Subclinical epileptiform activity and sleep disturbances in Alzheimer's disease. Brain Behav 2023; 13:e3306. [PMID: 37950422 PMCID: PMC10726840 DOI: 10.1002/brb3.3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Subclinical epileptiform activity (SEA) and sleep disturbances are frequent in Alzheimer's disease (AD). Both have an important relation to cognition and potential therapeutic implications. We aimed to study a possible relationship between SEA and sleep disturbances in AD. METHODS In this cross-sectional study, we performed a 24-h ambulatory EEG and polysomnography in 48 AD patients without diagnosis of epilepsy and 34 control subjects. RESULTS SEA, mainly detected in frontotemporal brain regions during N2 with a median of three spikes/night [IQR1-17], was three times more prevalent in AD. AD patients had lower sleep efficacy, longer wake after sleep onset, more awakenings, more N1%, less REM sleep and a higher apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). Sleep was not different between AD subgroup with SEA (AD-Epi+) and without SEA (AD-Epi-); however, compared to controls, REM% was decreased and AHI and ODI were increased in the AD-Epi+ subgroup. DISCUSSION Decreased REM sleep and more severe sleep-disordered breathing might be related to SEA in AD. These results could have diagnostic and therapeutic implications and warrant further study at the intersection between sleep and epileptiform activity in AD.
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Affiliation(s)
- Astrid Devulder
- Laboratory for Epilepsy Research, KU Leuven and Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Jaiver Macea
- Laboratory for Epilepsy Research, KU Leuven and Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Alexandros Kalkanis
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven and Department of Pulmonary DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - François‐Laurent De Winter
- Division of Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven and Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Mathieu Vandenbulcke
- Division of Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven and Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, KU Leuven and Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Dries Testelmans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven and Department of Pulmonary DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - Maarten J. A. Van Den Bossche
- Division of Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven and Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, KU Leuven and Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
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Süß AM, Hug M, Conradi N, Kienitz R, Rosenow F, Rampp S, Merkel N. Lateralization of delta band power in magnetoencephalography (MEG) in patients with unilateral focal epilepsy and its relation to verbal fluency. Brain Behav 2023; 13:e3257. [PMID: 37752097 PMCID: PMC10636394 DOI: 10.1002/brb3.3257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/22/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Delta power is a clinically established biomarker for abnormal brain processes. However, in patients with unilateral focal epilepsy (FE) it is still not well understood, how it relates to the epileptogenic zone and to neurocognitive functioning. The aim of the present study was thus to assess how delta power relates to the affected hemisphere, whether lateralization strength differs between the patients, and how changes in delta power correlate with cognitive functioning. METHOD We retrospectively studied patients with left (LFE) and right FE (RFE) who had undergone a resting-state magnetoencephalography measurement. We computed global and hemispheric delta power and lateralization indices and examined whether delta power correlates with semantic and letter verbal fluency (former being a marker for language and verbal memory, latter for executive functions) in 26 FE patients (15 LFE, 11 RFE) and 10 healthy controls. RESULTS Delta power was increased in FE patients compared to healthy controls. However, the increase across hemispheres was related to the site of the epileptic focus: On group level, LFE patients showed higher delta power in both hemispheres, whereas RFE patients primarily exhibited higher delta power in the ipsilateral right hemisphere. Both groups showed co-fluctuations of delta power between the hemispheres. Besides, delta power correlated negatively only with letter verbal fluency. CONCLUSION The findings confirm and provide further evidence that delta power is a marker of pathological activity and abnormal brain processes in FE. Delta power dynamics differ between patient groups, indicating that delta power could offer additional diagnostic value. The negative association of delta power and letter verbal fluency suggests that executive dysfunctions are related to low frequency abnormalities.
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Affiliation(s)
- Annika Melissa Süß
- Epilepsy Center Frankfurt Rhine‐MainCenter of Neurology and NeurosurgeryUniversity Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University FrankfurtFrankfurt am MainGermany
| | - Marion Hug
- Department of NeurologyUniversity Hospital Frankfurt and Goethe UniversityFrankfurt am MainGermany
| | - Nadine Conradi
- Epilepsy Center Frankfurt Rhine‐MainCenter of Neurology and NeurosurgeryUniversity Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University FrankfurtFrankfurt am MainGermany
| | - Ricardo Kienitz
- Epilepsy Center Frankfurt Rhine‐MainCenter of Neurology and NeurosurgeryUniversity Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University FrankfurtFrankfurt am MainGermany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine‐MainCenter of Neurology and NeurosurgeryUniversity Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University FrankfurtFrankfurt am MainGermany
| | - Stefan Rampp
- Department of NeurosurgeryUniversity Hospital ErlangenErlangenGermany
- Department of NeurosurgeryUniversity Hospital Halle (Saale)Halle (Saale)Germany
| | - Nina Merkel
- Epilepsy Center Frankfurt Rhine‐MainCenter of Neurology and NeurosurgeryUniversity Hospital FrankfurtFrankfurt am MainGermany
- Ernst Strüngmann Institute for Neuroscience in Cooperation with Max Planck SocietyFrankfurt am MainGermany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University FrankfurtFrankfurt am MainGermany
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Qin Y, Ma L, Kujala T, Silvennoinen J, Cong F. Neuroaesthetic exploration on the cognitive processing behind repeating graphics. Front Neurosci 2022; 16:1025862. [PMID: 36440292 PMCID: PMC9682169 DOI: 10.3389/fnins.2022.1025862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 09/19/2023] Open
Abstract
Repeating graphics are common research objects in modern design education. However, we do not exactly know the attentional processes underlying graphic artifacts consisting of repeating rhythms. In this experiment, the event-related potential, a neuroscientific measure, was used to study the neural correlates of repeating graphics within graded orderliness. We simulated the competitive identification process of people recognizing artifacts with graded repeating rhythms from a scattered natural environment with the oddball paradigm. In the earlier attentional processing related to the P2 component around the Fz electrode within the 150-250 ms range, a middle-grade repeating rhythm (Target 1) did not show a difference from a high-grade repeating rhythm (Target 2). However, in the later cognitive processes related to the P3b component around the Pz electrode within the 300-450 ms range, Target 1 had longer peak latency than Target 2, based on similar waveforms. Thus, we may suppose that the arrangement of the repeating graphics did not influence the earlier attentional processing but affected the later cognitive part, such as the categorization task in the oddball paradigm. Furthermore, as evidenced by the standard deviation wave across the trials, we suggest that the growing standard deviation value might represent the gradual loss of attentional focus to the task after the stimulus onset and that the zero-growth level may represent similar brain activity between trials.
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Affiliation(s)
- Yuan Qin
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - Lan Ma
- School of Architecture and Fine Art, Department of Industrial Design, Dalian University of Technology, Dalian, China
| | - Tuomo Kujala
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | | | - Fengyu Cong
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
- School of Artificial Intelligence, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
- Key Laboratory of Integrated Circuit and Biomedical Electronic System, Dalian University of Technology, Dalian, China
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Wang Z, Mengoni P. Seizure classification with selected frequency bands and EEG montages: a Natural Language Processing approach. Brain Inform 2022; 9:11. [PMID: 35622175 PMCID: PMC9142724 DOI: 10.1186/s40708-022-00159-3] [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: 01/04/2022] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
Individualized treatment is crucial for epileptic patients with different types of seizures. The differences among patients impact the drug choice as well as the surgery procedure. With the advance in machine learning, automatic seizure detection can ease the manual time-consuming and labor-intensive procedure for diagnose seizure in the clinical setting. In this paper, we present an electroencephalography (EEG) frequency bands (sub-bands) and montages selection (sub-zones) method for classifier training that exploits Natural Language Processing from individual patients' clinical report. The proposed approach is targeting for individualized treatment. We integrated the prior knowledge from patient's reports into the classifier-building process, mimicking the authentic thinking process of experienced neurologist's when diagnosing seizure using EEG. The keywords from clinical documents are mapped to the EEG data in terms of frequency bands and scalp EEG electrodes. The data of experiments are from the Temple University Hospital EEG seizure corpus, and the dataset is divided based on each group of patients with same seizure type and same recording electrode references. The classifier includes Random Forest, Support Vector Machine and Multi-Layer Perceptron. The classification performance indicates that competitive results can be achieve with a small portion of EEG the data. Using the sub-zones selection for Generalized Seizures (GNSZ) on all three electrodes, data are reduced by nearly 50% while the performance metrics remain at the same level with the whole frequency and zones. Moreover, when selecting by sub-zones and sub-bands together for GNSZ with Linked Ears reference, the data range reduced to 0.3% of whole range, and the performance deviates less than 3% from the results with whole range of data. Results show that using proposed approach may lead to more efficient implementations of the seizure classifier to be executed on power-efficient devices for long lasting real-time seizures detection.
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Affiliation(s)
- Ziwei Wang
- Institute of Interdisciplinary Studies, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Paolo Mengoni
- Department of Journalism, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China.
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Mikhailov A, Berezina I, Sumsky L, Scheidegger Y, Goretskaya T, Arzumanov Y. The changes in electroencephalogram parameters in patients in the somatogenic phase of acute poisoning with opioid receptor agonists. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:100-111. [DOI: 10.17116/jnevro2022122041100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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De Stefano P, Carboni M, Marquis R, Spinelli L, Seeck M, Vulliemoz S. Increased delta power as a scalp marker of epileptic activity: a simultaneous scalp and intracranial electroencephalography study. Eur J Neurol 2021; 29:26-35. [PMID: 34528320 PMCID: PMC9293335 DOI: 10.1111/ene.15106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The purpose was to evaluate whether intracranial interictal epileptiform discharges (IEDs) that are not visible on the scalp are associated with changes in the frequency spectrum on scalp electroencephalograms (EEGs). METHODS Simultaneous scalp high-density EEG and intracranial EEG recordings were recorded in nine patients undergoing pre-surgical invasive recordings for pharmaco-resistant temporal lobe epilepsy. Epochs with hippocampal IED visible on intracranial EEG (ic-IED) but not on scalp EEG were selected, as well as control epochs without ic-IED. Welch's power spectral density was computed for each scalp electrode and for each subject; the power spectral density was further averaged across the canonical frequency bands and compared between the two conditions with and without ic-IED. For each patient the peak frequency in the delta band (the significantly strongest frequency band in all patients) was determined during periods of ic-IED. The five electrodes showing strongest power at the peak frequency were also determined. RESULTS It was found that intracranial IEDs are associated with an increase in delta power on scalp EEGs, in particular at a frequency ≥1.4 Hz. Electrodes showing slow frequency power changes associated with IEDs were consistent with the hemispheric lateralization of IEDs. Electrodes with maximum power of slow activity were not limited to temporal regions but also involved frontal (bilateral or unilateral) regions. CONCLUSIONS In patients with a clinical picture suggestive of temporal lobe epilepsy, the presence of delta slowing ≥1.4 Hz in anterior temporal regions can represent a scalp marker of hippocampal IEDs. To our best knowledge this is the first study that demonstrates the co-occurrence of ic-IED and increased delta power.
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Affiliation(s)
- Pia De Stefano
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Margherita Carboni
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Renaud Marquis
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Laurent Spinelli
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, Neurology Department, University Hospitals of Geneva, Geneva, Switzerland
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Cokyaman T, Elli M, Aydin ÖF, Albayrak C, Albayrak D, Özyürek E. Neuroprotective Efficacy of Prophylactic Antiepileptic Therapies in Busulfan Conditioning Regimen. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1708833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractBusulfan (BU) is commonly used in the anticancer treatment and bone marrow/hematopoietic stem cell transplantation (BM/HSCT) conditioning regimen. This study aimed to evaluate the neuroprotective efficacy of antiepileptic therapies in the BU conditioning regimen. Patients who underwent BM/HSCT between January 1, 2009, and January 1, 2014, were evaluated retrospectively. Diagnosis, demographic characteristics, neurological side effects, electroencephalography (EEG) abnormalities, and antiepileptic drugs were determined. Levetiracetam was given to 49% and phenytoin to 23% of patients as antiepileptic prophylaxis. After BU treatment, seizures developed in three patients, posterior reversible leukoencephalopathy in two patients, and peripheral neuropathy in two patients. Forty-five patients who underwent EEG before and after BU treatment were identified. The effects of antiepileptic prophylaxis over the electroencephalographic abnormalities after the BU conditioning regimen were found to be not different (p = 0.491). Neurological side effects and electroencephalographic abnormalities following BU conditioning regimen under antiepileptic prophylaxis are comparable.
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Affiliation(s)
- Turgay Cokyaman
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Murat Elli
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ömer F. Aydin
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Canan Albayrak
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Davut Albayrak
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Emel Özyürek
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Li C, Sohrabpour A, Jiang H, He B. High-Frequency Hubs of the Ictal Cross-Frequency Coupling Network Predict Surgical Outcome in Epilepsy Patients. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1290-1299. [PMID: 34191730 DOI: 10.1109/tnsre.2021.3093703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Seizure generation is thought to be a process driven by epileptogenic networks; thus, network analysis tools can help determine the efficacy of epilepsy treatment. Studies have suggested that low-frequency (LF) to high-frequency (HF) cross-frequency coupling (CFC) is a useful biomarker for localizing epileptogenic tissues. However, it remains unclear whether the LF or HF coordinated CFC network hubs are more critical in determining the treatment outcome. We hypothesize that HF hubs are primarily responsible for seizure dynamics. Stereo-electroencephalography (SEEG) recordings of 36 seizures from 16 intractable epilepsy patients were analyzed. We propose a new approach to model the temporal-spatial-spectral dynamics of CFC networks. Graph measures are then used to characterize the HF and LF hubs. In the patient group with Engel Class (EC) I outcome, the strength of HF hubs was significantly higher inside the resected regions during the early and middle stages of seizure, while such a significant difference was not observed in the EC III group and only for the early stage in the EC II group. For the LF hubs, a significant difference was identified at the late stage and only in the EC I group. Our findings suggest that HF hubs increase at early and middle stages of the ictal interval while LF hubs increase activity at the late stages. In addition, HF hubs can predict treatment outcomes more precisely, compared to the LF hubs of the CFC network. The proposed method promises to identify more accurate targets for surgical interventions or neuromodulation therapies.
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Boland C, Jalihal V, Organ C, Oak K, McLean B, Laugharne R, Woldman W, Beck R, Shankar R. EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review. Clin EEG Neurosci 2021; 52:254-273. [PMID: 32635758 DOI: 10.1177/1550059420937948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.
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Affiliation(s)
- Cailín Boland
- Saint James's Hospital, Dublin, Ireland.,8809Trinity College Dublin, Dublin, Ireland
| | | | | | - Katy Oak
- 8028Royal Cornwall Hospitals Trust, Truro, UK
| | | | - Richard Laugharne
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
| | | | - Randy Beck
- Institute of Functional Neuroscience, Perth, Western Australia, Australia
| | - Rohit Shankar
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
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Andrade-Machado R, Benjumea Cuartas V, Muhammad IK. Recognition of interictal and ictal discharges on EEG. Focal vs generalized epilepsy. Epilepsy Behav 2021; 117:107830. [PMID: 33639439 DOI: 10.1016/j.yebeh.2021.107830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The differentiation between focal and generalized epilepsies based on clinical and electroencephalographic features is difficult and sometimes confusing. OBJECTIVE To review the EEG findings in patients with focal epilepsy. METHODS An extensive literature review was done. We used the following Pubmed and Medline descriptors alone and in different combinations for database searching: focal, partial, epilepsy, electroencephalographic findings, and EEG. Additional filters included review, original articles, and language limited to Spanish and English. Using the above criteria, a total of 69 articles showed the interictal and ictal EEG findings in focal epilepsy. DEVELOPMENT Focal epileptiform discharges and persistence of focal abnormalities, characterize the interictal EEG findings in focal epilepsies. To distinguish SBS from primary generalized spike waves are required to note: (a) a lead-in time of at least 2 s, (b) the morphology of the focal triggering spikes clearly differ from that of the bisynchronous epileptiform paroxysms, and (c) the morphology of triggering spikes resemble that of other focal spikes from the same region. Focal and Generalized Epilepsy can coexist. Delayed Lateralization on EEG with inconclusive onset and bizarre semiology confusing semiology should not be confused with generalized onset seizures with focal evolution. CONCLUSIONS A close attention to localization and morphology of epileptiform discharges, the correct interpretation of secondary bilateral synchrony, and provocative maneuvers help to correctly identify the EEG findings leading to diagnose focal epilepsies. The presence of generalized epileptiform activity does not rule out the existence of a focal epilepsy.
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Rampp S, Kakisaka Y, Shibata S, Wu X, Rössler K, Buchfelder M, Burgess RC. Normal Variants in Magnetoencephalography. J Clin Neurophysiol 2020; 37:518-536. [PMID: 33165225 DOI: 10.1097/wnp.0000000000000484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Normal variants, although not occurring frequently, may appear similar to epileptic activity. Misinterpretation may lead to false diagnoses. In the context of presurgical evaluation, normal variants may lead to mislocalizations with severe impact on the viability and success of surgical therapy. While the different variants are well known in EEG, little has been published in regard to their appearance in magnetoencephalography. Furthermore, there are some magnetoencephalography normal variants that have no counterparts in EEG. This article reviews benign epileptiform variants and provides examples in EEG and magnetoencephalography. In addition, the potential of oscillatory configurations in different frequency bands to appear as epileptic activity is discussed.
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Affiliation(s)
- Stefan Rampp
- Department of Neurosurgery, University Hospital, Erlangen, Germany.,Department of Neurosurgery, University Hospital, Halle (Saale), Germany
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan
| | - Sumiya Shibata
- Department of Neurosurgery and Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Xingtong Wu
- Department of Neurosurgery, University Hospital, Erlangen, Germany.,Department of Neurology, West China Hospital, Sichuan University, Sichuan, China; and
| | - Karl Rössler
- Department of Neurosurgery, University Hospital, Erlangen, Germany
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Raucci U, Pro S, Di Capua M, Di Nardo G, Villa MP, Striano P, Parisi P. A reappraisal of the value of video-EEG recording in the emergency department. Expert Rev Neurother 2020; 20:459-475. [PMID: 32249626 DOI: 10.1080/14737175.2020.1747435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Pro
- Neurophysiological Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Capua
- Neurophysiological Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, IRCCS ‘G. Gaslini’ Institute, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, ‘G. Gaslini’ Institute, Genova, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
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Poststroke seizures as stroke mimics: Clinical assessment and management. Epilepsy Behav 2020; 104:106297. [PMID: 31303444 DOI: 10.1016/j.yebeh.2019.04.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/27/2019] [Accepted: 04/27/2019] [Indexed: 11/23/2022]
Abstract
Epileptic seizures with postictal negative symptoms represent 20% of all suspected strokes and should be considered in the differential diagnosis of stroke in any patient presenting with an acute neurological deficit, mostly in absence of convulsions. Seizures may also occur at stroke onset, and the latter need to be promptly recognized in order to timely administer reperfusion therapies and reduce the risk of irreversible brain injury. Neuroimaging is essential in differentiating between postictal negative symptoms and deficits due to stroke. After the acute phase, poststroke seizures may worsen or cause the reappearance of neurological deficits and consciousness impairment; they can be also misinterpreted as stroke recurrence and lead to delayed treatment with antiepileptic drugs. It is mandatory to maintain a low threshold for suspecting epileptic seizures, and require appropriate electroencephalographic and neuroimaging investigations to promptly ascertain the etiology of any unexplained change in the neurological status and provide the most adequate treatment. This article is part of the Special Issue "Seizures & Stroke".
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Baldini S, Coito A, Korff CM, Garibotto V, Ndenghera M, Spinelli L, Bartoli A, Momjian S, Schaller K, Seeck M, Pittau F, Vulliemoz S. Localizing non-epileptiform abnormal brain function in children using high density EEG: Electric Source Imaging of focal slowing. Epilepsy Res 2019; 159:106245. [PMID: 31846783 DOI: 10.1016/j.eplepsyres.2019.106245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/01/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Electric Source Imaging (ESI) of interictal epileptiform discharges (IED) is increasingly validated for localizing epileptic activity. In children, IED can be absent or multifocal even in cases of a focal epileptogenic zone and additional electrophysiological markers are needed. Here, we investigated ESI of pathological focal slowing (FS) recorded on EEG as a new localizing marker in children with drug-resistant epilepsy. METHODS We selected 15 children (median: 12; range: 4-18yrs), with high-density EEG (hdEEG), presurgical evaluation and surgical resection. One patient had a non-lesional MRI. ESI of patient-specific focal slow activity was performed (distributed linear inverse solution and individual head model). The maximal average power in the band of interest was considered as the source of focal slowing (ESI-FS). The Euclidian distance between ESI-FS and the resection (5 mm margin) was compared to the localization of maximal ESI of interictal epileptiform discharges (ESI-IED), interictal FDG-PET and ictal SPECT/SISCOM. RESULTS In 9/15 patients (60%), ESI of focal slowing (ESI-FS) was inside or ≤5 mm from resection margins. The remaining 6/15 cases had distances ≤15 mm. In 9/15 patients with interictal spikes, the ESI-IED was concordant with the resection. 6/15 patients with concordant ESI-FS showed also interictal concordant ESI of IED; in 3/15 patients, ESI-FS but not ESI-IED was concordant with the resection. In 10/15 patients, ESI-FS was concordant with MRI lesion and for ESI-IED this concordance was on 8/15 patients. Maximal hypometabolism and SISCOM were concordant with the resection for 7/15 and 7/12, respectively. CONCLUSION These findings suggest that "non-epileptiform" EEG activity, such as focal slowing, could be a complementary useful marker to localize the epileptogenic zone. ESI-FS may notably be applied in young patients without focal interictal spikes or multifocal spikes. This potential new marker of brain dysfunction has potential applications to other neurological disorders associated with slow EEG activity.
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Affiliation(s)
- Sara Baldini
- Neurology Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland; Clinical Unit of Neurology, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Ana Coito
- Neurology Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland; Department of Neurology Cantonal Hospital Aarau, Aarau, Switzerland
| | - Christian M Korff
- Pediatric Neurology Unit, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Nuclear Medicine and Molecular Imaging, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Martin Ndenghera
- Neurology Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Laurent Spinelli
- Neurology Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Andrea Bartoli
- Neurosurgery Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Shahan Momjian
- Neurosurgery Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Karl Schaller
- Neurosurgery Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Margittta Seeck
- Neurology Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Francesca Pittau
- Neurology Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- Neurology Clinic, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland.
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Mina Y, Fahoum F, Abramovici S, Anis S, Kipervasser S. Clinical correlates and electroencephalographic features of FIRDA in a tertiary center. Acta Neurol Scand 2019; 140:405-413. [PMID: 31420976 DOI: 10.1111/ane.13157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/27/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to explore the diagnostic value, clinical correlates and electroencephalographic features of FIRDA (Frontal intermittent rhythmic delta activity). MATERIALS AND METHODS We retrospectively reviewed reports from EEG studies done in adults at our tertiary center between January 2015 and May 2018. For cases demonstrating FIRDA, medical files were reviewed and each case was given a diagnostic category. EEG recordings were reviewed and electrophysiologic data were extracted including FIRDA characteristics (frequency, location, duration, and symmetry). Then, a statistical analysis was done to evaluate the relationship between the diagnostic categories and EEG variables. RESULTS Ninety-four cases of FIRDA were found, with a frequency of 1.6% among inpatients. EEG recordings were available for review in 84 cases. FIRDA was asymmetric in 43 of these cases (49%), usually more prominent on the left (36/43, 84%). The diagnostic category groups included epilepsy (n = 39, 41%), other central nervous system (CNS) disease (n = 33, 35%), and systemic illness (n = 22, 23%). A significant difference in FIRDA location was found, as patients with epilepsy or other CNS disease, had a significantly higher probability for the delta activity to involve the temporal areas (frontotemporal location in 27/64 in these groups compared with 3/20 in the systemic illness group, P-value = .033). CONCLUSIONS This study provides insights to the diagnosis underlying FIRDA, especially the high rate of epilepsy patients, and calls for further neurologic investigation of cases in which FIRDA involves the temporal areas since most of these cases were due to epilepsy or other CNS disease and not a systemic illness.
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Affiliation(s)
- Yair Mina
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Neurological Institute Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Firas Fahoum
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Neurological Institute Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Sergiu Abramovici
- Neurology Department UPMC Hamot Medical Center Pittsburgh Pennsylvania
| | - Saar Anis
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Neurological Institute Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Svetlana Kipervasser
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Neurological Institute Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
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16
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Hippocampal CA1 and cortical interictal oscillations in the pilocarpine model of epilepsy. Brain Res 2019; 1722:146351. [DOI: 10.1016/j.brainres.2019.146351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 01/25/2023]
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17
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Jiang H, Cai Z, Worrell GA, He B. Multiple Oscillatory Push-Pull Antagonisms Constrain Seizure Propagation. Ann Neurol 2019; 86:683-694. [PMID: 31566799 PMCID: PMC6856814 DOI: 10.1002/ana.25583] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/06/2019] [Accepted: 08/18/2019] [Indexed: 02/03/2023]
Abstract
Objective Drug‐resistant focal epilepsy is widely recognized as a network disease in which epileptic seizure propagation is likely coordinated by different neuronal oscillations such as low‐frequency activity (LFA), high‐frequency activity (HFA), or low‐to‐high cross‐frequency coupling. However, the mechanism by which different oscillatory networks constrain the propagation of focal seizures remains unclear. Methods We studied focal epilepsy patients with invasive electrocorticography (ECoG) recordings and compared multilayer directional network interactions between focal seizures either with or without secondary generalization. Within‐frequency and cross‐frequency directional connectivity were estimated by an adaptive directed transfer function and cross‐frequency directionality, respectively. Results In the within‐frequency epileptic network, we found that the seizure onset zone (SOZ) always sent stronger information flow to the surrounding regions, and secondary generalization was accompanied by weaker information flow in the LFA from the surrounding regions to SOZ. In the cross‐frequency epileptic network, secondary generalization was associated with either decreased information flow from surrounding regions’ HFA to SOZ's LFA or increased information flow from SOZ's LFA to surrounding regions’ HFA. Interpretation Our results suggest that the secondary generalization of focal seizures is regulated by numerous within‐ and cross‐frequency push–pull dynamics, potentially reflecting impaired excitation–inhibition interactions of the epileptic network. ANN NEUROL 2019;86:683–694
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Affiliation(s)
- Haiteng Jiang
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Zhengxiang Cai
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | | | - Bin He
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
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18
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Abstract
INTRODUCTION Subclinical rhythmic EEG discharges in adults (SREDA) is a very rare benign EEG pattern. The electrophysiological features and atypical variants of SREDA has wide spectrum and they are poorly known. It resembles ictal discharges, and overinterpretation of SREDA may lead to misdiagnosis of epilepsy. Herein, we aimed to report patients with SREDA to identify the frequency and characterized clinical, demographic, electrophysiological features. METHODS We reviewed 22,234 EEG reports that are reported by the same experienced clinical neurophysiologists, between 2012 and 2018. The EEGs with SREDA were reevaluated blindly by three clinical neurophysiologists. The demographic, clinical characteristics, and neuroimaging features of the patients were reviewed. RESULTS Subclinical rhythmic EEG discharges in adults was present in 14 EEG records (0.06%), in nine patients. The mean age of patients was 52.1 ± 17.7 (range, 21-71) years. The patients had been diagnosed with several neurologic diseases, including cerebrovascular disease, epilepsy, psychogenic nonepileptic seizures, mental retardation, Alzheimer disease, and transient global amnesia. One patient had unilateral lesion, in whom SREDA had appeared on contralateral side of the lesion, whereas other patients with normal or nonlateralized lesions had SREDA bilaterally and symmetrical. This variant had been misdiagnosed as an ictal discharge in previous EEGs in three patients. CONCLUSIONS This study indicates that SREDA is difficult to associate with any specific condition. The pathophysiology of SREDA can not be explained by a single mechanism. Even if it is mostly observed in older adults, it is also observed in young adults in this study. It is important to differentiate SREDA from ictal discharge to prevent misdiagnosis of epilepsy especially in nonepileptic paroxysmal events.
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19
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van Mierlo P, Höller Y, Focke NK, Vulliemoz S. Network Perspectives on Epilepsy Using EEG/MEG Source Connectivity. Front Neurol 2019; 10:721. [PMID: 31379703 PMCID: PMC6651209 DOI: 10.3389/fneur.2019.00721] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022] Open
Abstract
The evolution of EEG/MEG source connectivity is both, a promising, and controversial advance in the characterization of epileptic brain activity. In this narrative review we elucidate the potential of this technology to provide an intuitive view of the epileptic network at its origin, the different brain regions involved in the epilepsy, without the limitation of electrodes at the scalp level. Several studies have confirmed the added value of using source connectivity to localize the seizure onset zone and irritative zone or to quantify the propagation of epileptic activity over time. It has been shown in pilot studies that source connectivity has the potential to obtain prognostic correlates, to assist in the diagnosis of the epilepsy type even in the absence of visually noticeable epileptic activity in the EEG/MEG, and to predict treatment outcome. Nevertheless, prospective validation studies in large and heterogeneous patient cohorts are still lacking and are needed to bring these techniques into clinical use. Moreover, the methodological approach is challenging, with several poorly examined parameters that most likely impact the resulting network patterns. These fundamental challenges affect all potential applications of EEG/MEG source connectivity analysis, be it in a resting, spiking, or ictal state, and also its application to cognitive activation of the eloquent area in presurgical evaluation. However, such method can allow unique insights into physiological and pathological brain functions and have great potential in (clinical) neuroscience.
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Affiliation(s)
- Pieter van Mierlo
- Medical Image and Signal Processing Group, Ghent University, Ghent, Belgium
| | - Yvonne Höller
- Faculty of Psychology, University of Akureyri, Akureyri, Iceland
| | - Niels K Focke
- Clinical Neurophysiology, University Medicine Göttingen, Göttingen, Germany
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, University Hospital of Geneva, Geneva, Switzerland
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20
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Electroencephalographic features associated with intermittent rhythmic delta activity. Neurophysiol Clin 2019; 49:227-234. [PMID: 30712784 DOI: 10.1016/j.neucli.2019.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/20/2019] [Accepted: 01/20/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the clinical importance of intermittent rhythmic delta activity (IRDA) in terms of accompanying electrophysiological findings on EEG and their association with IRDA. METHODS We retrospectively assessed all EEG studies recorded in our institution from 2011 to 2017. Patients with intermittent rhythmic delta activity (IRDA) in EEGs were included. Clinical data were collected from charts of the patients with IRDA. RESULTS We identified 69 EEGs with IRDA in 58 patients from a total of 18,625 EEG recordings. The most common IRDA type was frontal IRDA (FIRDA; 55%), followed by temporal IRDA (TIRDA; 28.9%). Unilateral (UL) distribution was present in 36.8% of FIRDAs and 95% of TIRDAs. The frequency of focal epileptiform discharges (FED) was 78.5% in UL FIRDA group and 89.4% in UL TIRDA group. Among the EEGs with FEDs, in UL FIRDA group 90.9% and in UL TIRDA group 70.5% of the FEDs were ipsilateral. Concordance of focal structural brain lesions and FEDs with UL TIRDA was 30.7%, and with UL FIRDA was 50%. UL FIRDA had a 71.4% positive predictive value for ipsilateral focal epileptic focus and UL TIRDA had 63.1%. The frequency of focal structural lesions and FEDs were significantly higher in the UL FIRDA group than bilateral FIRDA group (P=0.03; P=0.01). Among the patients with focal structural lesions, ipsilateral FED association is significantly higher in the UL FIRDA group than BL FIRDA group (P=0.03). CONCLUSIONS UL FIRDA is more likely to indicate a focal lesion and a focal epileptic focus compared to bilateral FIRDA, and it had similar characteristics to UL TIRDA. It can be considered that UL FIRDA has as good a lateralizing value for ipsilateral focal epileptic focus and focal lesion as UL TIRDA.
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21
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Viarasilpa T, Panyavachiraporn N, Osman G, Parres C, Varelas P, Van Harn M, Mayer SA. Electrographic Seizures in Patients with Acute Encephalitis. Neurocrit Care 2019; 30:207-215. [PMID: 30203384 DOI: 10.1007/s12028-018-0599-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Clinical seizures and status epilepticus are frequent complications of encephalitis, can lead to depressed level of consciousness, and are associated with poor outcome. We sought to determine the frequency, risk factors, and clinical impact of electrographic seizures detected with continuing electroencephalography (cEEG) in patients with encephalitis and altered level of consciousness. METHODS We retrospectively identified all patients with presumed or definite viral or autoimmune encephalitis who underwent cEEG monitoring at Henry Ford Hospital from January 2012 to October 2017. Clinical data and cEEG monitoring reports were abstracted and recorded. The primary outcome was electrographic seizures detected by cEEG. RESULTS Of 1,735 patients who underwent a minimum of 12 h of cEEG monitoring, we identified 54 with a verified discharge diagnosis of encephalitis. Twenty-two of these patients (41%) had electrographic seizures on cEEG. Compared with encephalitis patients without seizures, electrographic seizures were associated with lower serum sodium levels (137 ± 5 vs 141 ± 7, P = 0.027) and more often were on antiepileptic therapy (100% vs 78%, P = 0.033) on the first day of monitoring. Seizures were also associated with a higher frequency of cortical imaging abnormalities (68% vs 28%, P = 0.005), lateralized periodic discharges (LPDs; 50% vs 16%, P = 0.014), delta background frequency (81% vs 45%, P = 0.010), low or suppressed voltage (96% vs 62%, P = 0.005), and focal slowing (86% vs 47%, P = 0.004). There was no association between electrographic seizures and clinical outcome at discharge. CONCLUSION Electrographic seizures occur in approximately 40% of patients with acute encephalitis. Low serum sodium, cortical imaging abnormalities, and on cEEG LPDs and background abnormalities are associated factors. The lack of association with short-term outcome suggests that with aggressive treatment, the clinical impact of electrographic seizures in encephalitis can be minimized.
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Affiliation(s)
- Tanuwong Viarasilpa
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.,Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nicha Panyavachiraporn
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.,Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gamaleldin Osman
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Christopher Parres
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Panayiotis Varelas
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Meredith Van Harn
- Department of Public Health Sciences of Henry Ford Health System, Detroit, USA
| | - Stephan A Mayer
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
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22
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Electroclinical Features of Generalized Paroxysmal Fast Activity in Typical Absence Seizures. J Clin Neurophysiol 2019; 36:36-44. [DOI: 10.1097/wnp.0000000000000535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
After more than 85 years of development and use in clinical practice, the electroencephalogram (EEG) remains a dependable, inexpensive, and useful diagnostic tool for the investigation of the electrophysiologic activity of the brain. The advent of digital technology has led to greater sophistication and multiple software applications to extend the utility of EEG beyond the confines of the laboratory. Despite the discovery of new waveforms, basic neurophysiologic principles remain essential to the clinical care of patients. Patterns in the interictal EEG make it possible to clarify the differential diagnosis of paroxysmal neurological events, classify seizure type and epilepsy syndromes, and characterize and quantify seizures when ictal recordings are obtained. EEG can also demonstrate cerebral dysfunction when structural imaging is normal to detect focal or lateralized abnormalities in patients with encephalopathy. High-density EEG with electrical source imaging has improved localization in candidates for epilepsy surgery. Quantitative EEG and broadband EEG are advancing our understanding of the functional processes of the brain itself.
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Affiliation(s)
- Anteneh M Feyissa
- Department of Neurology, Mayo Clinic College of Medicine and Health Sciences, Jacksonville, FL, United States.
| | - William O Tatum
- Department of Neurology, Mayo Clinic College of Medicine and Health Sciences, Jacksonville, FL, United States
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24
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Tatum WO, Thottempudi N, Gupta V, Feyissa AM, Grewal SS, Wharen RE, Pizzi MA. De novo temporal intermittent rhythmic delta activity after laser interstitial thermal therapy for mesial temporal lobe epilepsy predicts poor seizure outcome. Clin Neurophysiol 2018; 130:122-127. [PMID: 30529878 DOI: 10.1016/j.clinph.2018.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/21/2018] [Accepted: 11/14/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate EEG abnormalities, particularly development of temporal intermittent rhythmic delta activity (TIRDA) after laser interstitial thermal therapy (LITT) and assess the role of further surgery after LITT. METHODS We retrospectively identified consecutive cases of LITT for the prevalence of post-operative TIRDA. We assessed baseline demographics, clinical variables including age of seizure onset, age at surgery, pre-operative and post-operative EEG changes. RESULTS 40 patients underwent LITT for drug-resistant temporal lobe epilepsy (TLE), 29 met inclusion criteria. Median duration of follow-up was 15 months. Ten patients had post-LITT ipsilateral TIRDA, another two demonstrated post-operative TIRDA but they occurred contralateral to the side of ablation. None of the patients with TIRDA on their post-LITT EEG became seizure-free. Six out of 29 patients (21%) eventually required anterior temporal lobectomy (ATL), and of those 6 patients 4 (66%) had evidence of TIRDA on their post-LITT follow up EEG. The sensitivity and specificity of post-LITT TIRDA in predicting surgical failure was 57.14% and 100% respectively. CONCLUSIONS Post-LITT TIRDA may serve as a biomarker to predict unsuccessful seizure outcome following LITT and be an early indicator for ATL. SIGNIFICANCE The presence of TIRDA following LITT should prompt early consideration for reoperation.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | | | - Vivek Gupta
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Robert E Wharen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
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25
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Stretz C, Sheikh Z, Maciel CB, Hirsch LJ, Gilmore EJ. Seizures, periodic and rhythmic patterns in primary intraventricular hemorrhage. Ann Clin Transl Neurol 2018; 5:1104-1111. [PMID: 30250866 PMCID: PMC6144442 DOI: 10.1002/acn3.627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/03/2018] [Accepted: 07/09/2018] [Indexed: 12/29/2022] Open
Abstract
Objective Primary intraventricular hemorrhage (pIVH) uncommonly presents with seizures. There are no prior data regarding the frequency of seizures, periodic and rhythmic patterns on continuous electroencephalography (EEG), (cEEG) in these patients. Methods We retrospectively assessed frequency of seizures, periodic discharges, and rhythmic patterns in pIVH patients undergoing cEEG monitoring. We reviewed indications for cEEG, demographics, GCS at presentation and during cEEG, modified Graeb score (mGS), presence of hydrocephalus, cEEG duration, findings and use of antiseizure medications (ASM). cEEG patterns were classified according to location and morphology. All patterns were considered “hyperexcitable” except GRDA. The ictal‐interictal continuum (IIC) was defined as LRDA, PDs, and/or SW >1 Hz but <2.5 Hz, not meeting criteria for definite electrographic seizures. Results Eleven patients had pIVH with median age of 81 (46–87) years and median mGS of 15 (9–23). Hydrocephalus was present in 7 (63.6%) and all underwent external ventricular drain (EVD) placement. Median cEEG recording was 19 (12–156) hours. Periodic or rhythmic EEG patterns were seen in 7 of 11 (64%), 5 of which were “hyperexcitable”. For the 5 patients with pIVH, EVDs, and hyperexcitable patterns, 4 (80%) were lateralized contralateral to the EVD and 1 (20%) was generalized to the EVD. The only significant difference between the hyperexcitable and non‐hyperexcitable group was duration of cEEG monitoring (P = 0.007). Interpretation Hyperexcitable patterns were common in our cases. Further research is warranted to assess prevalence of hyperexcitable patterns, their risk factors, underlying pathophysiology, and association with neuronal injury in pIVH.
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Affiliation(s)
- Christoph Stretz
- Division of Neurocritical Care and Emergency Neurology Department of Neurology Yale School of Medicine New Haven Connecticut
| | - Zubeda Sheikh
- Department of Neurology Comprehensive Epilepsy Center Yale University School of Medicine New Haven Connecticut
| | - Carolina B Maciel
- Department of Neurology Comprehensive Epilepsy Center Yale University School of Medicine New Haven Connecticut.,Division of Neurocritical Care Department of Neurology University of Florida College of Medicine Gainesville Florida
| | - Lawrence J Hirsch
- Department of Neurology Comprehensive Epilepsy Center Yale University School of Medicine New Haven Connecticut
| | - Emily J Gilmore
- Division of Neurocritical Care and Emergency Neurology Department of Neurology Yale School of Medicine New Haven Connecticut.,Department of Neurology Comprehensive Epilepsy Center Yale University School of Medicine New Haven Connecticut
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26
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Subclinical Rhythmic EEG Discharge of Adult (SREDA) in a Child With Generalized Epilepsy and Literature Review of SREDA in Children. J Clin Neurophysiol 2018; 35:270-272. [DOI: 10.1097/wnp.0000000000000408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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27
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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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Endres D, Maier S, Feige B, Mokhtar NB, Nickel K, Goll P, Meyer SA, Matthies S, Ebert D, Philipsen A, Perlov E, Tebartz van Elst L. Increased rates of intermittent rhythmic delta and theta activity in the electroencephalographies of adult patients with attention-deficit hyperactivity disorder. Epilepsy Behav 2017; 75:60-65. [PMID: 28830028 DOI: 10.1016/j.yebeh.2017.06.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/22/2017] [Accepted: 06/30/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Adult attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. In subgroups of patients with a (para)epileptic pathomechanism, this might be due to intermittent rhythmic delta or theta activity (IRDA/IRTA). PARTICIPANTS AND METHODS Using a fully data-driven analysis, we compared the IRDA/IRTA rates in the resting electroencephalography (EEG) results of 97 adult patients with ADHD and 30 control subjects. The IRDA/IRTA rates before hyperventilation (HV) and for HV difference (difference between IRDA/IRTA rate after and before HV) were compared between groups using a linear model. RESULTS We detected significantly increased rates of IRDA/IRTA before HV (F=4.209, p=0.042) in patients with ADHD but no significant difference between the groups for HV-difference (F=2.46, p=0.119). DISCUSSION The increased IRDA/IRTA rates before HV in the group with ADHD might lead to (para)epileptic short-term effects (e.g., impulsivity) via local area network inhibition, and to long-term effects (e.g., cognitive deficits) via connectivistic brain restructuring.
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Affiliation(s)
- Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Bernd Feige
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Nora Bel Mokhtar
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
| | - Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Peter Goll
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Simon A Meyer
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Swantje Matthies
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Dieter Ebert
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Alexandra Philipsen
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy - University Hospital, Karl-Jaspers-Klinik, Hermann-Ehlers-Str. 7, 26160 Bad Zwischenahn, Germany.
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany; Clinic for Psychiatry Luzern, Schafmattstrasse 1, 4915 St. Urban, Switzerland.
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
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Popova I, Malkov A, Ivanov AI, Samokhina E, Buldakova S, Gubkina O, Osypov A, Muhammadiev RS, Zilberter T, Molchanov M, Paskevich S, Zilberter M, Zilberter Y. Metabolic correction by pyruvate halts acquired epilepsy in multiple rodent models. Neurobiol Dis 2017; 106:244-254. [PMID: 28709994 DOI: 10.1016/j.nbd.2017.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 01/22/2023] Open
Abstract
Metabolic intervention strategy of epilepsy treatment has been gaining broader attention due to accumulated evidence that hypometabolism, manifested in humans as reduced brain glucose consumption, is a principal factor in acquired epilepsy. Therefore, targeting deficient energy metabolism may be an effective approach for treating epilepsy. To confront this pathology we utilized pyruvate, which besides being an anaplerotic mitochondrial fuel possesses a unique set of neuroprotective properties as it: (i) is a potent reactive oxygen species scavenger; (ii) abates overactivation of Poly [ADP-ribose] polymerase 1 (PARP-1); (iii) facilitates glutamate efflux from the brain; (iv) augments brain glycogen stores; (v) is anti-inflammatory; (vi) prevents neuronal hyperexcitability; and (vii) normalizes the cytosolic redox state. In vivo, chronic oral pyruvate administration completely abolished established epileptic phenotypes in three accepted and fundamentally different rodent acquired epilepsy models. Our study reports metabolic correction by pyruvate as a potentially highly effective treatment of acquired epilepsies.
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Affiliation(s)
- I Popova
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France; Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - A Malkov
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France; Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - A I Ivanov
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France
| | - E Samokhina
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - S Buldakova
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France
| | - O Gubkina
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France
| | - A Osypov
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - R S Muhammadiev
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | | | - M Molchanov
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - S Paskevich
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - M Zilberter
- Neuronal Oscillations Lab, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Y Zilberter
- Aix Marseille Université, Inserm, INS UMR_S 1106, 13005 Marseille, France.
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Abstract
The brain is one of the largest and most complex organs in the human body and EEG is a noninvasive electrophysiological monitoring method that is used to record the electrical activity of the brain. Lately, the functional connectivity in human brain has been regarded and studied as a complex network using EEG signals. This means that the brain is studied as a connected system where nodes, or units, represent different specialized brain regions and links, or connections, represent communication pathways between the nodes. Graph theory and theory of complex networks provide a variety of measures, methods, and tools that can be useful to efficiently model, analyze, and study EEG networks. This article is addressed to computer scientists who wish to be acquainted and deal with the study of EEG data and also to neuroscientists who would like to become familiar with graph theoretic approaches and tools to analyze EEG data.
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Affiliation(s)
- Nantia D Iakovidou
- Data Engineering Laboratory, Department of Informatics, Aristotle University of Thessaloniki , Thessaloniki, Greece
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Endres D, Maier S, Feige B, Posielski NA, Nickel K, Ebert D, Riedel A, Philipsen A, Perlov E, Tebartz van Elst L. Altered Intermittent Rhythmic Delta and Theta Activity in the Electroencephalographies of High Functioning Adult Patients with Autism Spectrum Disorder. Front Hum Neurosci 2017; 11:66. [PMID: 28265243 PMCID: PMC5316544 DOI: 10.3389/fnhum.2017.00066] [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: 08/11/2016] [Accepted: 01/31/2017] [Indexed: 12/27/2022] Open
Abstract
Background: Autism spectrum disorder (ASD) is often associated with epilepsy. Previous studies have also shown increased rates of electroencephalographic (EEG) alteration in ASD patients without epilepsy. The aim of this study was to compare the rate of intermittent rhythmic delta and theta activity (IRDA/IRTA) events between high-functioning adult patients with ASD and matched healthy controls. Materials and Methods: Routine EEG records of 19 ASD patients and 19 matched controls were screened for IRDA/IRTA using a fully data driven analysis with fixed thresholds. IRDA/IRTA rates before and after hyperventilation (HV) as well as the HV-induced difference in IRDA/IRTA rates (HV difference) were analyzed. For inter-group measures, we used the Wilcoxon rank sum test. Results: Significantly increased HV difference was detected in the ASD group (p = 0.0497). However, the groups showed no difference in IRDA/IRTA rates before HV (p = 0.564) and after HV (p = 0.163). Conclusions: The lack of any group differences regarding IRDA/IRTA before HV might be related to the fact that we only studied non-secondary high-functioning autism in a small sample of epilepsy-free adult patients. A significantly increased HV difference might be regarded as a marker of subtle neuronal network instability possibly causing short-term disturbances via local area network inhibition and long-term effects via epileptic encephalopathy.
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Affiliation(s)
- Dominique Endres
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Bernd Feige
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Nicole A Posielski
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Dieter Ebert
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Andreas Riedel
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Alexandra Philipsen
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy-University Hospital, Karl-Jaspers-Klinik Bad Zwischenahn, Germany
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg Freiburg, Germany
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Kim JA, Rosenthal ES, Biswal S, Zafar S, Shenoy AV, O'Connor KL, Bechek SC, Valdery Moura J, Shafi MM, Patel AB, Cash SS, Westover MB. Epileptiform abnormalities predict delayed cerebral ischemia in subarachnoid hemorrhage. Clin Neurophysiol 2017; 128:1091-1099. [PMID: 28258936 DOI: 10.1016/j.clinph.2017.01.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/14/2017] [Accepted: 01/21/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify whether abnormal neural activity, in the form of epileptiform discharges and rhythmic or periodic activity, which we term here ictal-interictal continuum abnormalities (IICAs), are associated with delayed cerebral ischemia (DCI). METHODS Retrospective analysis of continuous electroencephalography (cEEG) reports and medical records from 124 patients with moderate to severe grade subarachnoid hemorrhage (SAH). We identified daily occurrence of seizures and IICAs. Using survival analysis methods, we estimated the cumulative probability of IICA onset time for patients with and without delayed cerebral ischemia (DCI). RESULTS Our data suggest the presence of IICAs indeed increases the risk of developing DCI, especially when they begin several days after the onset of SAH. We found that all IICA types except generalized rhythmic delta activity occur more commonly in patients who develop DCI. In particular, IICAs that begin later in hospitalization correlate with increased risk of DCI. CONCLUSIONS IICAs represent a new marker for identifying early patients at increased risk for DCI. Moreover, IICAs might contribute mechanistically to DCI and therefore represent a new potential target for intervention to prevent secondary cerebral injury following SAH. SIGNIFICANCE These findings imply that IICAs may be a novel marker for predicting those at higher risk for DCI development.
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Affiliation(s)
- J A Kim
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - E S Rosenthal
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - S Biswal
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - S Zafar
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - A V Shenoy
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - K L O'Connor
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - S C Bechek
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - J Valdery Moura
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - M M Shafi
- Beth Israel Deaconess Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - A B Patel
- Massachusetts General Hospital, Department of Neurosurgery, Harvard Medical School Boston, MA, USA
| | - S S Cash
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - M B Westover
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA.
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Schönherr M, Stefan H, Hamer HM, Rössler K, Buchfelder M, Rampp S. The delta between postoperative seizure freedom and persistence: Automatically detected focal slow waves after epilepsy surgery. Neuroimage Clin 2016; 13:256-263. [PMID: 28018852 PMCID: PMC5167245 DOI: 10.1016/j.nicl.2016.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/03/2016] [Accepted: 12/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In this study, we use a novel automated method for localization and quantitative comparison of magnetoencephalographic (MEG) delta activity in patients with and without recurrent seizures after epilepsy surgery as well as healthy controls. METHODS We identified the generators of delta activity by source location in frequency domain between 1 and 4 Hz in spontaneous MEG data. Comparison with healthy control subjects by z-transform emphasized relative changes of activation in patients. The individual results were compared to spike localizations and statistical group analysis was performed. Additionally, MEG results were compared to 1-4 Hz activity in invasive EEG (iEEG) in two patients, in whom this data was available. RESULTS Patients with recurrent seizures exhibited significantly increased focal MEG delta activity both in comparison to healthy controls and seizure free patients. This slow activity showed a correlation to interictal epileptic activity and was not explained by consequences of the resection alone. In two patients with iEEG, iEEG analysis was concordant with the MEG findings. SIGNIFICANCE The quantity of delta activity could be used as a diagnostic marker for recurrent seizures. The close relation to epileptic spike localizations and the resection volume of patients with successful second surgery imply involvement in seizure recurrence. This initial evidence suggests a potential application in the planning of second epilepsy surgery.
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Affiliation(s)
- Margit Schönherr
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hermann Stefan
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hajo M. Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
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Epileptogenic Source Imaging Using Cross-Frequency Coupled Signals From Scalp EEG. IEEE Trans Biomed Eng 2016; 63:2607-2618. [DOI: 10.1109/tbme.2016.2613936] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Myers KA. Cell Phone Saccades: Electroencephalographic Artifact for the Twenty-first Century. Pediatr Neurol 2016; 63:82-83. [PMID: 27452425 DOI: 10.1016/j.pediatrneurol.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Kenneth A Myers
- Department of Medicine, Epilepsy Research Centre, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
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Endres D, Perlov E, Feige B, Fleck M, Bartels S, Altenmüller DM, Tebartz van Elst L. Electroencephalographic findings in schizophreniform and affective disorders. Int J Psychiatry Clin Pract 2016; 20:157-64. [PMID: 27181256 DOI: 10.1080/13651501.2016.1181184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Pathological findings in electroencephalography (EEG) are discussed as a possible marker of organic mental disorders and a therapeutic response to anticonvulsive medication under these conditions. METHODS We compared the prevalence of EEG abnormalities in 100 patients with schizophrenia, 100 patients with schizoaffective disorder, 51 patients with acute polymorphic psychotic disorder, 100 patients with bipolar disorder, 100 patients with unipolar major depression and 76 healthy control subjects with the findings of a previous study using well-diagnosed, large control samples (13,658 pilots and aircrew personnel). RESULTS We detected an increased number of pathological EEG findings with intermittent rhythmic delta or theta activity in 7% of patients with schizophrenia, 7% of patients with schizoaffective disorder, 5.9% of patients with acute polymorphic psychosis, 6% of patients with bipolar disorder, 4% of unipolar depressed patients and 3.9% of the own control group, compared to 1% of strictly controlled healthy subjects. One-sided logistic regression revealed an association between pathological EEGs and the diagnosis of schizophrenia (Wald W = 3.466, p = 0.0315), schizoaffective disorder (W = 3.466, p = 0.0315) and bipolar disorder (W = 2.862, p = 0.0455). CONCLUSIONS We suggest that the previously developed local area network inhibition model for a potential paraepileptic pathomechanism can explain the relevance of such findings in different psychiatric disorders.
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Affiliation(s)
- Dominique Endres
- a Department of Psychiatry and Psychotherapy , University Medical Center Freiburg, University of Freiburg , Freiburg , Germany
| | - Evgeniy Perlov
- a Department of Psychiatry and Psychotherapy , University Medical Center Freiburg, University of Freiburg , Freiburg , Germany
| | - Bernd Feige
- a Department of Psychiatry and Psychotherapy , University Medical Center Freiburg, University of Freiburg , Freiburg , Germany
| | - Max Fleck
- a Department of Psychiatry and Psychotherapy , University Medical Center Freiburg, University of Freiburg , Freiburg , Germany
| | - Susanne Bartels
- a Department of Psychiatry and Psychotherapy , University Medical Center Freiburg, University of Freiburg , Freiburg , Germany
| | - Dirk-Matthias Altenmüller
- b Freiburg Epilepsy Center, Department of Neurosurgery , University Medical Center Freiburg, University of Freiburg , Freiburg , Germany
| | - Ludger Tebartz van Elst
- a Department of Psychiatry and Psychotherapy , University Medical Center Freiburg, University of Freiburg , Freiburg , Germany
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Tebartz van Elst L, Fleck M, Bartels S, Altenmüller DM, Riedel A, Bubl E, Matthies S, Feige B, Perlov E, Endres D. Increased Prevalence of Intermittent Rhythmic Delta or Theta Activity (IRDA/IRTA) in the Electroencephalograms (EEGs) of Patients with Borderline Personality Disorder. Front Behav Neurosci 2016; 10:12. [PMID: 26941624 PMCID: PMC4763016 DOI: 10.3389/fnbeh.2016.00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 01/25/2016] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION An increased prevalence of pathological electroencephalography (EEG) signals has been reported in patients with borderline personality disorder (BPD). In an elaborative case description of such a patient with intermittent rhythmic delta and theta activity (IRDA/IRTA), the BPD symptoms where linked to the frequency of the IRDAs/IRTAs and vanished with the IRDAs/IRTAs following anticonvulsive therapy. This observation raised a question regarding the prevalence of such EEG abnormalities in BPD patients. The aim of this retrospective study was to identify the frequency of EEG abnormalities in a carefully analyzed psychiatric collective. Following earlier reports, we hypothesized an increased prevalence of EEG abnormalities in BPD patients. PARTICIPANTS AND METHODS We recruited 96 consecutive patients with BPD from the archive of a university clinic for psychiatry and psychotherapy, and compared the prevalence of EEG abnormalities to those of 76 healthy controls subjects. The EEGs were rated by three different blinded clinicians, including a consultant specializing in epilepsy from the local epilepsy center. RESULTS We found a significant increase in the prevalence of IRDAs and IRTAs in BPD patients (14.6%) compared to the control subjects (3.9%; p = 0.020). DISCUSSION In this blinded retrospective case-control study, we were able to confirm an increased prevalence of pathological EEG findings (IRDAs/IRTAs only) in BPD patients. The major limitation of this study is that the control group was not matched on age and gender. Therefore, the results should be regarded as preliminary findings of an open uncontrolled, retrospective study. Future research performing prospective, controlled studies is needed to verify our findings and answer the question of whether such EEG findings might predict a positive response to anticonvulsive pharmacological treatment.
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Affiliation(s)
- Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
| | - Max Fleck
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
| | - Susanne Bartels
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
| | - Dirk-Matthias Altenmüller
- Department of Neurosurgery, Freiburg Epilepsy Center, University Medical Center Freiburg Freiburg, Germany
| | - Andreas Riedel
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
| | - Emanuel Bubl
- Department for Psychiatry and Psychotherapy, Saarland University Medical Center Homburg, Germany
| | - Swantje Matthies
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
| | - Bernd Feige
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
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Kim DE, Shin JH, Kim YH, Eom TH, Kim SH, Kim JM. Source localization of intermittent rhythmic delta activity in a patient with acute confusional migraine: cross-spectral analysis using standardized low-resolution brain electromagnetic tomography (sLORETA). Neurol Sci 2015; 37:89-95. [PMID: 26292789 DOI: 10.1007/s10072-015-2367-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/12/2015] [Indexed: 01/03/2023]
Abstract
Acute confusional migraine (ACM) shows typical electroencephalography (EEG) patterns of diffuse delta slowing and frontal intermittent rhythmic delta activity (FIRDA). The pathophysiology of ACM is still unclear but these patterns suggest neuronal dysfunction in specific brain areas. We performed source localization analysis of IRDA (in the frequency band of 1-3.5 Hz) to better understand the ACM mechanism. Typical IRDA EEG patterns were recorded in a patient with ACM during the acute stage. A second EEG was obtained after recovery from ACM. To identify source localization of IRDA, statistical non-parametric mapping using standardized low-resolution brain electromagnetic tomography was performed for the delta frequency band comparisons between ACM attack and non-attack periods. A difference in the current density maximum was found in the dorsal anterior cingulated cortex (ACC). The significant differences were widely distributed over the frontal, parietal, temporal and limbic lobe, paracentral lobule and insula and were predominant in the left hemisphere. Dorsal ACC dysfunction was demonstrated for the first time in a patient with ACM in this source localization analysis of IRDA. The ACC plays an important role in the frontal attentional control system and acute confusion. This dysfunction of the dorsal ACC might represent an important ACM pathophysiology.
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Affiliation(s)
- Dae-Eun Kim
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Songeui Campus, 222 Banpo-daero, Seoul, 137-701, Republic of Korea
| | - Jung-Hyun Shin
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Songeui Campus, 222 Banpo-daero, Seoul, 137-701, Republic of Korea
| | - Young-Hoon Kim
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Songeui Campus, 222 Banpo-daero, Seoul, 137-701, Republic of Korea
| | - Tae-Hoon Eom
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Songeui Campus, 222 Banpo-daero, Seoul, 137-701, Republic of Korea.
| | - Sung-Hun Kim
- Department of Neurology, College of Medicine, Catholic University of Korea, Songeui Campus, 222 Banpo-daero, Seoul, 137-701, Republic of Korea
| | - Jung-Min Kim
- Department of Internal Medicine, Sanggye Paik Hospital, College of Medicine, Inje University, 1342 Dongil-ro, Seoul, 139-707, Republic of Korea
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Rosenow F, Klein KM, Hamer HM. Non-invasive EEG evaluation in epilepsy diagnosis. Expert Rev Neurother 2015; 15:425-44. [DOI: 10.1586/14737175.2015.1025382] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Guirgis M, Chinvarun Y, Del Campo M, Carlen PL, Bardakjian BL. Defining regions of interest using cross-frequency coupling in extratemporal lobe epilepsy patients. J Neural Eng 2015; 12:026011. [PMID: 25768723 DOI: 10.1088/1741-2560/12/2/026011] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Clinicians identify seizure onset zones (SOZs) for resection in an attempt to localize the epileptogenic zone (EZ), which is the cortical tissue that is indispensible for seizure generation. An automated system is proposed to objectively localize this EZ by identifying regions of interest (ROIs). METHODS Intracranial electroencephalogram recordings were obtained from seven patients presenting with extratemporal lobe epilepsy and the interaction between neuronal rhythms in the form of phase-amplitude coupling was investigated. Modulation of the amplitude of high frequency oscillations (HFOs) by the phase of low frequency oscillations was measured by computing the modulation index (MI). Delta- (0.5-4 Hz) and theta- (4-8 Hz) modulation of HFOs (30-450 Hz) were examined across the channels of a 64-electrode subdural grid. Surrogate analysis was performed and false discovery rates were computed to determine the significance of the modulation observed. Mean MI values were subjected to eigenvalue decomposition (EVD) and channels defining the ROIs were selected based on the components of the eigenvector corresponding to the largest eigenvalue. ROIs were compared to the SOZs identified by two independent neurologists. Global coherence values were also computed. MAIN RESULTS MI was found to capture the seizure in time for six of seven patients and identified ROIs in all seven. Patients were found to have a poorer post-surgical outcome when the number of EVD-selected channels that were not resected increased. Moreover, in patients who experienced a seizure-free outcome (i.e., Engel Class I) all EVD-selected channels were found to be within the resected tissue or immediately adjacent to it. In these Engel Class I patients, delta-modulated HFOs were found to identify more of the channels in the resected tissue compared to theta-modulated HFOs. However, for the Engel Class IV patient, the delta-modulated HFOs did not identify any of the channels in the resected tissue suggesting that the resected tissue was not appropriate, which was also suggested by the Engel Class IV outcome. A sensitivity of 75.4% and a false positive rate of 15.6% were achieved using delta-modulated HFOs in an Engel Class I patient. SIGNIFICANCE LFO-modulated HFOs can be used to identify ROIs in extratemporal lobe patients. Moreover, delta-modulated HFOs may provide more accurate localization of the EZ. These ROIs may result in better surgical outcomes when used to compliment the SOZs identified by clinicians for resection.
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Affiliation(s)
- Mirna Guirgis
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, M5S 3G9, Canada
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Hindriks R, Meijer HGE, van Gils SA, van Putten MJAM. Phase-locking of epileptic spikes to ongoing delta oscillations in non-convulsive status epilepticus. Front Syst Neurosci 2013; 7:111. [PMID: 24379763 PMCID: PMC3863724 DOI: 10.3389/fnsys.2013.00111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 11/26/2013] [Indexed: 12/05/2022] Open
Abstract
The EEG of patients in non-convulsive status epilepticus (NCSE) often displays delta oscillations or generalized spike-wave discharges. In some patients, these delta oscillations coexist with intermittent epileptic spikes. In this study we verify the prediction of a computational model of the thalamo-cortical system that these spikes are phase-locked to the delta oscillations. We subsequently describe the physiological mechanism underlying this observation as suggested by the model. It is suggested that the spikes reflect inhibitory stochastic fluctuations in the input to thalamo-cortical relay neurons and phase-locking is a consequence of differential excitability of relay neurons over the delta cycle. Further analysis shows that the observed phase-locking can be regarded as a stochastic precursor of generalized spike-wave discharges. This study thus provides an explanation of intermittent spikes during delta oscillations in NCSE and might be generalized to other encephathologies in which delta activity can be observed.
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Affiliation(s)
- Rikkert Hindriks
- Department of Clinical Neurophysiology, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente Enschede, Netherlands ; Computational Neuroscience Group, Department of Information and Communication Technologies, Center for Brain and Cognition, Universitat Pompeu Fabra Barcelona, Spain
| | - Hil G E Meijer
- Department of Electrical Engineering, Mathematics and Computer Science, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente Enschede, Netherlands
| | - Stephan A van Gils
- Department of Electrical Engineering, Mathematics and Computer Science, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente Enschede, Netherlands
| | - Michel J A M van Putten
- Department of Clinical Neurophysiology, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente Enschede, Netherlands ; Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente Enschede, Netherlands
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Abstract
PURPOSE OF REVIEW This article reviews the utility of EEG and prolonged video-EEG telemetry in the diagnosis and management of a patient with epilepsy. RECENT FINDINGS The EEG can be the most helpful test to determine a diagnosis of epilepsy; it can also distinguish focal and generalized neurophysiologic correlates of epilepsy. Furthermore, when paired with video monitoring, EEG can not only define epileptic and nonepileptic events but also aid in localization of seizures in patients with epilepsy. Finally, when history and other imaging modalities are considered with the EEG, the epileptic syndrome can usually be defined and the treatment can be focused. In critically ill patients, continuous EEG monitoring can define subclinical seizures, although a variety of periodic patterns may also be identified. SUMMARY EEG is an invaluable tool in the diagnosis and management of a patient with epilepsy, and continuous EEG monitoring is useful in identifying subclinical seizures and nonconvulsive status epilepticus in critically ill patients.
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Affiliation(s)
- Rama K Maganti
- Department of Neurology, University of Wisconsin, 1685 Highland Avenue, Madison, WI 53705, USA.
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Acute postictal confusion and violence: Two cases with unfortunate outcomes. EPILEPSY & BEHAVIOR CASE REPORTS 2013; 1:71-3. [PMID: 25667832 PMCID: PMC4150615 DOI: 10.1016/j.ebcr.2013.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 04/21/2013] [Accepted: 04/22/2013] [Indexed: 11/27/2022]
Abstract
Patients with temporal lobe epilepsy (TLE) often have a brief postictal state characterized by confusion and disorientation. Less common postictal behaviors include wandering and violence - both reactive and spontaneous. We describe two male patients with left TLE and unusual postictal states that led to unfortunate outcomes. The first patient's postictal state included an intense urge to peregrinate, as well as reactive violence. When a frightened houseguest prevented the patient from exiting his bedroom during a postictal state, the patient climbed out the window and fell to his death. The second patient's postictal state included menacing posturing, loud exclamation of guttural sounds or profanities, clapping or smacking his hands together, and punching nearby objects. During a postictal state at home, he grabbed a bat and destroyed furnishings. After he had two seizures at work followed by his typical postictal state, he was dismissed because of his perceived threat to coworkers.
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Lu XCM, Mountney A, Chen Z, Wei G, Cao Y, Leung LY, Khatri V, Cunningham T, Tortella FC. Similarities and differences of acute nonconvulsive seizures and other epileptic activities following penetrating and ischemic brain injuries in rats. J Neurotrauma 2013; 30:580-90. [PMID: 23234254 DOI: 10.1089/neu.2012.2641] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The similarities and differences between acute nonconvulsive seizures (NCS) and other epileptic events, for example, periodic epileptiform discharges (PED) and intermittent rhythmic delta activities (IRDA), were characterized in rat models of penetrating and ischemic brain injuries. The NCS were spontaneously induced by either unilateral frontal penetrating ballistic-like brain injury (PBBI) or permanent middle cerebral artery occlusion (pMCAO), and were detected by continuous electroencephalogram (EEG) monitoring begun immediately after the injury and continued for 72 h or 24 h, respectively. Analysis of NCS profiles (incidence, frequency, duration, and time distribution) revealed a high NCS incidence in both injury models. The EEG waveform expressions of NCS and PED exhibited intrinsic variations that resembled human electrographic manifestations of post-traumatic and post-ischemic ictal and inter-ictal events, but these waveform variations were not distinguishable between the two types of brain injury. However, the NCS after pMCAO occurred more acutely and intensely (latency=0.6 h, frequency=25 episodes/rat) compared with the PBBI-induced NCS (latency=24 h, frequency=10 episodes/rat), such that the most salient features differentiating post-traumatic and post-ischemic NCS were the intensity and time distribution of the NCS profiles. After pMCAO, nearly 50% of the seizures occurred within the first 2 h of injury, whereas after PBBI, NCS occurred sporadically (0-5%/h) throughout the 72 h recording period. The PED were episodically associated with NCS. By contrast, the IRDA appeared to be independent of other epileptic events. This study provided comprehensive comparisons of post-traumatic and post-ischemic epileptic profiles. The identification of the similarities and differences across a broad spectrum of epileptic events may lead to differential strategies for post-traumatic and post-stroke seizure interventions.
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Affiliation(s)
- Xi-Chun May Lu
- Branch of Brain Trauma Neuroprotection and Neurorestoration, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Vendrame M, Kothare SV. Recognizing Normal, Abnormal, and Benign Nonepileptiform Electroencephalographic Activity and Patterns in Polysomnographic Recordings. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2011.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andraus MEC, Alves-Leon SV. Non-epileptiform EEG abnormalities: an overview. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:829-35. [DOI: 10.1590/s0004-282x2011000600020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/24/2011] [Indexed: 11/21/2022]
Abstract
More than 80 years after its introduction by Hans Berger, the electroencephalogram (EEG) remains as an important supplementary examination in the investigation of neurological disorders and gives valuable and accurate information about cerebral function. Abnormal EEG findings may include ictal patterns, interictal epileptiform activity and non-epileptiform abnormalities. The aim of this study is to make an overview on the main non-epileptiform EEG abnormalities, emphasizing the pathologic findings and the importance of their recognition, excluding periodic patterns and EEG physiologic changes. Scientific articles were selected from MEDLINE and PubMed database. The presence of non-epileptiform EEG abnormalities provide evidence of brain dysfunction that are not specific to a particular etiology and may be related to a number of disorders affecting the brain. Although these abnormalities are not specific, they can direct attention to the diagnostic possibilities and guide the best treatment choice.
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