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Abdi-Sargezeh B, Shirani S, Sanei S, Took CC, Geman O, Alarcon G, Valentin A. A review of signal processing and machine learning techniques for interictal epileptiform discharge detection. Comput Biol Med 2024; 168:107782. [PMID: 38070202 DOI: 10.1016/j.compbiomed.2023.107782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024]
Abstract
Brain interictal epileptiform discharges (IEDs), as one of the hallmarks of epileptic brain, are transient events captured by electroencephalogram (EEG). IEDs are generated by seizure networks, and they occur between seizures (interictal periods). The development of a robust method for IED detection could be highly informative for clinical treatment procedures and epileptic patient management. Since 1972, different machine learning techniques, from template matching to deep learning, have been developed to automatically detect IEDs from scalp EEG (scEEG) and intracranial EEG (iEEG). While the scEEG signals suffer from low information details and high attenuation of IEDs due to the high skull electrical impedance, the iEEG signals recorded using implanted electrodes enjoy higher details and are more suitable for identifying the IEDs. In this review paper, we group IED detection techniques into six categories: (1) template matching, (2) feature representation (mimetic, time-frequency, and nonlinear features), (3) matrix decomposition, (4) tensor factorization, (5) neural networks, and (6) estimation of the iEEG from the concurrent scEEG followed by detection and classification. The methods are compared quantitatively (e.g., in terms of accuracy, sensitivity, and specificity), and their general advantages and limitations are described. Finally, current limitations and possible future research paths related to this field are mentioned.
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Affiliation(s)
- Bahman Abdi-Sargezeh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; School of Science and Technology, Nottingham Trent University, Nottingham, UK.
| | - Sepehr Shirani
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Saeid Sanei
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Clive Cheong Took
- Department of Electronic Engineering, Royal Holloway, University of London, London, UK
| | - Oana Geman
- Computer, Electronics and Automation Department, University Stefan cel Mare, Suceava, Romania
| | - Gonzalo Alarcon
- Department of Clinical Neurophysiology, Royal Manchester Children's Hospital, Manchester, UK
| | - Antonio Valentin
- Department of Clinical Neuroscience, King's College London, London, UK
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Silva AB, Leonard MK, Oganian Y, D’Esopo E, Krish D, Kopald B, Tran EB, Chang EF, Kleen JK. Interictal epileptiform discharges contribute to word-finding difficulty in epilepsy through multiple cognitive mechanisms. Epilepsia 2023; 64:3266-3278. [PMID: 37753856 PMCID: PMC10841419 DOI: 10.1111/epi.17781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Cognitive impairment often impacts quality of life in epilepsy even if seizures are controlled. Word-finding difficulty is particularly prevalent and often attributed to etiological (static, baseline) circuit alterations. We sought to determine whether interictal discharges convey significant superimposed contributions to word-finding difficulty in patients, and if so, through which cognitive mechanism(s). METHODS Twenty-three patients undergoing intracranial monitoring for drug-resistant epilepsy participated in multiple tasks involving word production (auditory naming, short-term verbal free recall, repetition) to probe word-finding difficulty across different cognitive domains. We compared behavioral performance between trials with versus without interictal discharges across six major brain areas and adjusted for intersubject differences using mixed-effects models. We also evaluated for subjective word-finding difficulties through retrospective chart review. RESULTS Subjective word-finding difficulty was reported by the majority (79%) of studied patients preoperatively. During intracranial recordings, interictal epileptiform discharges (IEDs) in the medial temporal lobe were associated with long-term lexicosemantic memory impairments as indexed by auditory naming (p = .009), in addition to their established impact on short-term verbal memory as indexed by free recall (p = .004). Interictal discharges involving the lateral temporal cortex and lateral frontal cortex were associated with delayed reaction time in the auditory naming task (p = .016 and p = .018), as well as phonological working memory impairments as indexed by repetition reaction time (p = .002). Effects of IEDs across anatomical regions were strongly dependent on their precise timing within the task. SIGNIFICANCE IEDs appear to act through multiple cognitive mechanisms to form a convergent basis for the debilitating clinical word-finding difficulty reported by patients with epilepsy. This was particularly notable for medial temporal spikes, which are quite common in adult focal epilepsy. In parallel with the treatment of seizures, the modulation of interictal discharges through emerging pharmacological means and neurostimulation approaches may be an opportunity to help address devastating memory and language impairments in epilepsy.
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Affiliation(s)
- Alexander B. Silva
- Department of Neurosurgery, Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Medical Scientist Training Program, University of California, San Francisco, CA, USA
- University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
| | - Matthew K. Leonard
- Department of Neurosurgery, Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Emma D’Esopo
- Department of Neurology, Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Devon Krish
- Department of Neurology, Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Brandon Kopald
- Department of Neurology, Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Edwina B. Tran
- Department of Neurology, Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Edward F. Chang
- Department of Neurosurgery, Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, USA
- University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
| | - Jonathan K. Kleen
- Department of Neurology, Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, USA
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Hoshino H, Miyasato Y, Handa T, Tomi Y, Kanemura H. Effect of Lacosamide on Interictal Epileptiform Discharges in Pediatric Patients With Newly Diagnosed Focal Epilepsy. Pediatr Neurol 2023; 147:1-8. [PMID: 37499552 DOI: 10.1016/j.pediatrneurol.2023.06.022] [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: 08/10/2022] [Revised: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The purpose of this study was to determine the efficacy of lacosamide (LCM) on interictal epileptiform discharges (IEDs) and evaluate the relationships between IEDs and seizure outcome in pediatric patients with focal epilepsy. METHODS Patient inclusion criteria included (1) newly diagnosed focal epilepsy with unknown etiology; and (2) electroencephalogram recorded twice (before and after starting LCM) under the same conditions. The difference between the highest number of IEDs over five successive minutes (IEDs/5 min) and the location of IEDs was determined. Seizure outcome was evaluated one year after achieving the maintenance dose of LCM. Responders were identified as showing a ≥50% reduction in the pre-LCM seizure frequency. RESULTS Of 22 patients, 10 showed an increase in IEDs/5 min after starting LCM. The median IEDs/5 min before and after starting LCM was not significantly different, at 1.5 (interquartile range: 0, 31.75) and 10.5 (0, 80.5), respectively. No relationship was identified between the difference in IEDs/5 min and seizure outcome. Patients with multiple regional or diffuse IEDs had significantly poorer seizure outcome compared with patients without those IEDs (P = 0.036 and P = 0.039, respectively). Of 10 patients with single regional IEDs, a tendency of IEDs to disappear was observed between patients with frontal and non-frontal IEDs. CONCLUSION The effects of LCM on the number of IEDs may be unrelated to seizure outcome. LCM may be ineffective at improving seizure outcomes in patients with multiple regional or diffuse IEDs.
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Affiliation(s)
- Hiroki Hoshino
- Department of Pediatrics, Toho University Medical Center Sakura Hospital, Sakura, Chiba, Japan.
| | - Yoshihiro Miyasato
- Department of Pediatrics, Toho University Medical Center Sakura Hospital, Sakura, Chiba, Japan
| | - Takayuki Handa
- Department of Pediatrics, Toho University Medical Center Sakura Hospital, Sakura, Chiba, Japan; Department of Pediatrics, Toho University Medical Center Omori Hospital, Ota, Tokyo, Japan
| | - Yutaro Tomi
- Department of Pediatrics, Toho University Medical Center Sakura Hospital, Sakura, Chiba, Japan; Department of Pediatrics, Toho University Medical Center Omori Hospital, Ota, Tokyo, Japan
| | - Hideaki Kanemura
- Department of Pediatrics, Toho University Medical Center Sakura Hospital, Sakura, Chiba, Japan
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Dellavale D, Bonini F, Pizzo F, Makhalova J, Wendling F, Badier JM, Bartolomei F, Bénar CG. Spontaneous fast-ultradian dynamics of polymorphic interictal events in drug-resistant focal epilepsy. Epilepsia 2023; 64:2027-2043. [PMID: 37199673 DOI: 10.1111/epi.17655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE We studied the rate dynamics of interictal events occurring over fast-ultradian time scales, as commonly examined in clinics to guide surgical planning in epilepsy. METHODS Stereo-electroencephalography (SEEG) traces of 35 patients with good surgical outcome (Engel I) were analyzed. For this we developed a general data mining method aimed at clustering the plethora of transient waveform shapes including interictal epileptiform discharges (IEDs) and assessed the temporal fluctuations in the capability of mapping the epileptogenic zone (EZ) of each type of event. RESULTS We found that the fast-ultradian dynamics of the IED rate may effectively impair the precision of EZ identification, and appear to occur spontaneously, that is, not triggered by or exclusively associated with a particular cognitive task, wakefulness, sleep, seizure occurrence, post-ictal state, or antiepileptic drug withdrawal. Propagation of IEDs from the EZ to the propagation zone (PZ) could explain the observed fast-ultradian fluctuations in a reduced fraction of the analyzed patients, suggesting that other factors like the excitability of the epileptogenic tissue could play a more relevant role. A novel link was found between the fast-ultradian dynamics of the overall rate of polymorphic events and the rate of specific IEDs subtypes. We exploited this feature to estimate in each patient the 5 min interictal epoch for near-optimal EZ and resected-zone (RZ) localization. This approach produces at the population level a better EZ/RZ classification when compared to both (1) the whole time series available in each patient (p = .084 for EZ, p < .001 for RZ, Wilcoxon signed-rank test) and (2) 5 min epochs sampled randomly from the interictal recordings of each patient (p < .05 for EZ, p < .001 for RZ, 105 random samplings). SIGNIFICANCE Our results highlight the relevance of the fast-ultradian IED dynamics in mapping the EZ, and show how this dynamics can be estimated prospectively to inform surgical planning in epilepsy.
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Affiliation(s)
- Damián Dellavale
- Institut de Neurosciences des Systèmes (INS, UMR1106), Aix Marseille Université, INSERM, Marseille, France
- Centro Atómico Bariloche and Instituto Balseiro, Comisión Nacional de Energía Atómica (CNEA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Cuyo (UNCUYO), Río Negro, San Carlos de Bariloche, Argentina
| | - Francesca Bonini
- Institut de Neurosciences des Systèmes (INS, UMR1106), Aix Marseille Université, INSERM, Marseille, France
- Epileptology and Cerebral Rhythmology, APHM, Timone Hospital, Marseille, France
| | - Francesca Pizzo
- Institut de Neurosciences des Systèmes (INS, UMR1106), Aix Marseille Université, INSERM, Marseille, France
- Epileptology and Cerebral Rhythmology, APHM, Timone Hospital, Marseille, France
| | - Julia Makhalova
- Institut de Neurosciences des Systèmes (INS, UMR1106), Aix Marseille Université, INSERM, Marseille, France
- Epileptology and Cerebral Rhythmology, APHM, Timone Hospital, Marseille, France
| | | | - Jean-Michel Badier
- Institut de Neurosciences des Systèmes (INS, UMR1106), Aix Marseille Université, INSERM, Marseille, France
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes (INS, UMR1106), Aix Marseille Université, INSERM, Marseille, France
- Epileptology and Cerebral Rhythmology, APHM, Timone Hospital, Marseille, France
| | - Christian-George Bénar
- Institut de Neurosciences des Systèmes (INS, UMR1106), Aix Marseille Université, INSERM, Marseille, France
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Feng Y, Quon RJ, Jobst BC, Casey MA. Evoked responses to note onsets and phrase boundaries in Mozart's K448. Sci Rep 2022; 12:9632. [PMID: 35688855 PMCID: PMC9187696 DOI: 10.1038/s41598-022-13710-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Understanding the neural correlates of perception of hierarchical structure in music presents a direct window into auditory organization. To examine the hypothesis that high-level and low-level structures—i.e. phrases and notes—elicit different neural responses, we collected intracranial electroencephalography (iEEG) data from eight subjects during exposure to Mozart’s K448 and directly compared Event-related potentials (ERPs) due to note onsets and those elicited by phrase boundaries. Cluster-level permutation tests revealed that note-onset-related ERPs and phrase-boundary-related ERPs were significantly different at \documentclass[12pt]{minimal}
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\begin{document}$$-150$$\end{document}-150, 200, and 450 ms relative to note onset and phrase markers. We also observed increased activity in frontal brain regions when processing phrase boundaries. We relate these observations to (1) a process which syntactically binds notes together hierarchically to form larger phrases; (2) positive emotions induced by successful prediction of forthcoming phrase boundaries and violations of melodic expectations at phrase boundaries.
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Affiliation(s)
- Yijing Feng
- Department of Computer Science, Dartmouth College, Hanover, NH, 03755, USA
| | - Robert J Quon
- Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Barbara C Jobst
- Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Michael A Casey
- Department of Computer Science, Dartmouth College, Hanover, NH, 03755, USA. .,Department of Music, Dartmouth College, Hanover, NH, 03755, USA.
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Klimes P, Peter-Derex L, Hall J, Dubeau F, Frauscher B. Spatio-temporal spike dynamics predict surgical outcome in adult focal epilepsy. Clin Neurophysiol 2021; 134:88-99. [PMID: 34991017 DOI: 10.1016/j.clinph.2021.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We hypothesized that spatio-temporal dynamics of interictal spikes reflect the extent and stability of epileptic sources and determine surgical outcome. METHODS We studied 30 consecutive patients (14 good outcome). Spikes were detected in prolonged stereo-electroencephalography recordings. We quantified the spatio-temporal dynamics of spikes using the variance of the spike rate, line length and skewness of the spike distribution, and related these features to outcome. We built a logistic regression model, and compared its performance to traditional markers. RESULTS Good outcome patients had more dominant and stable sources than poor outcome patients as expressed by a higher variance of spike rates, a lower variance of line length, and a lower variance of positive skewness (ps < 0.05). The outcome was correctly predicted in 80% of patients. This was better or non-inferior to predictions based on a focal lesion (p = 0.016), focal seizure-onset zone, or complete resection (ps > 0.05). In the five patients where traditional markers failed, spike distribution predicted the outcome correctly. The best results were achieved by 18-h periods or longer. CONCLUSIONS Analysis of spike dynamics shows that surgery outcome depends on strong, single and stable sources. SIGNIFICANCE Our quantitative method has the potential to be a reliable predictor of surgical outcome.
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Affiliation(s)
- Petr Klimes
- Analytical Neurophysiology Lab, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic.
| | - Laure Peter-Derex
- Analytical Neurophysiology Lab, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Center, Lyon, France
| | - Jeff Hall
- Montreal Neurological Hospital, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- Montreal Neurological Hospital, McGill University, Montreal, Quebec, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
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Quon RJ, Meisenhelter S, Camp EJ, Testorf ME, Song Y, Song Q, Culler GW, Moein P, Jobst BC. AiED: Artificial intelligence for the detection of intracranial interictal epileptiform discharges. Clin Neurophysiol 2021; 133:1-8. [PMID: 34773796 DOI: 10.1016/j.clinph.2021.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/02/2021] [Accepted: 09/21/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Deep learning provides an appealing solution for the ongoing challenge of automatically classifying intracranial interictal epileptiform discharges (IEDs). We report results from an automated method consisting of a template-matching algorithm and convolutional neural network (CNN) for the detection of intracranial IEDs ("AiED"). METHODS 1000 intracranial electroencephalogram (EEG) epochs extracted randomly from 307 subjects with refractory epilepsy were annotated independently by two expert neurophysiologists. These annotated epochs were divided into 1062 two-second epochs with IEDs and 1428 two-second epochs without IEDs, which were transformed into spectrograms prior to training the neural network. The highest performing network was validated on an annotated external test set. RESULTS The final network had an F1-score of 0.95 (95% CI: 0.91-0.98) and an average Area Under the Receiver Operating Characteristic of 0.98 (95% CI: 0.96-1.00). For the external test set, it showed an overall F1-score of 0.71, correctly identifying 100% of all high-amplitude IED complexes, 96.23% of all high-amplitude isolated IEDs, and 66.15% of all IEDs of atypical morphology. CONCLUSIONS Template-matching combined with a CNN offers a fast, robust method for detecting intracranial IEDs. SIGNIFICANCE "AiED" is generalizable and achieves comparable performance to human reviewers; it may support clinical and research EEG analyses.
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Affiliation(s)
- Robert J Quon
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | | | - Edward J Camp
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Markus E Testorf
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Thayer School of Engineering at Dartmouth College, Hanover, NH, USA.
| | - Yinchen Song
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Qingyuan Song
- Department of Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - George W Culler
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Payam Moein
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Musical components important for the Mozart K448 effect in epilepsy. Sci Rep 2021; 11:16490. [PMID: 34531410 PMCID: PMC8446029 DOI: 10.1038/s41598-021-95922-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
There is growing evidence for the efficacy of music, specifically Mozart’s Sonata for Two Pianos in D Major (K448), at reducing ictal and interictal epileptiform activity. Nonetheless, little is known about the mechanism underlying this beneficial “Mozart K448 effect” for persons with epilepsy. Here, we measured the influence that K448 had on intracranial interictal epileptiform discharges (IEDs) in sixteen subjects undergoing intracranial monitoring for refractory focal epilepsy. We found reduced IEDs during the original version of K448 after at least 30-s of exposure. Nonsignificant IED rate reductions were witnessed in all brain regions apart from the bilateral frontal cortices, where we observed increased frontal theta power during transitions from prolonged musical segments. All other presented musical stimuli were associated with nonsignificant IED alterations. These results suggest that the “Mozart K448 effect” is dependent on the duration of exposure and may preferentially modulate activity in frontal emotional networks, providing insight into the mechanism underlying this response. Our findings encourage the continued evaluation of Mozart’s K448 as a noninvasive, non-pharmacological intervention for refractory epilepsy.
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Quon RJ, Leslie GA, Camp EJ, Meisenhelter S, Steimel SA, Song Y, Ettinger AB, Bujarski KA, Casey MA, Jobst BC. 40-Hz auditory stimulation for intracranial interictal activity: A pilot study. Acta Neurol Scand 2021; 144:192-201. [PMID: 33893999 DOI: 10.1111/ane.13437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To study the effects of auditory stimuli on interictal epileptiform discharge (IED) rates evident with intracranial monitoring. MATERIALS AND METHODS Eight subjects undergoing intracranial EEG monitoring for refractory epilepsy participated in this study. Auditory stimuli consisted of a 40-Hz tone, a 440-Hz tone modulated by a 40-Hz sinusoid, Mozart's Sonata for Two Pianos in D Major (K448), and K448 modulated by a 40-Hz sinusoid (modK448). Subjects were stratified into high- and low-IED rate groups defined by baseline IED rates. Subject-level analyses identified individual responses to auditory stimuli, discerned specific brain regions with significant reductions in IED rates, and examined the influence auditory stimuli had on whole-brain sigma power (12-16 Hz). RESULTS All subjects in the high baseline IED group had a significant 35.25% average reduction in IEDs during the 40-Hz tone; subject-level reductions localized to mesial and lateral temporal regions. Exposure to Mozart K448 showed significant yet less homogeneous responses. A post hoc analysis demonstrated two of the four subjects with positive IED responses had increased whole-brain power at the sigma frequency band during 40-Hz stimulation. CONCLUSIONS Our study is the first to evaluate the relationship between 40-Hz auditory stimulation and IED rates in refractory epilepsy. We reveal that 40-Hz auditory stimuli may be a noninvasive adjunctive intervention to reduce IED burden. Our pilot study supports the future examination of 40-Hz auditory stimuli in a larger population of subjects with high baseline IED rates.
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Affiliation(s)
- Robert J. Quon
- Department of Neurology Geisel School of Medicine at Dartmouth Hanover NH USA
| | - Grace A. Leslie
- Department of Music Georgia Institute of Technology Atlanta GA USA
| | - Edward J. Camp
- Department of Neurology Dartmouth‐Hitchcock Medical Center Lebanon NH USA
| | | | - Sarah A. Steimel
- Department of Neurology Geisel School of Medicine at Dartmouth Hanover NH USA
| | - Yinchen Song
- Department of Neurology Geisel School of Medicine at Dartmouth Hanover NH USA
- Department of Neurology Dartmouth‐Hitchcock Medical Center Lebanon NH USA
| | | | - Krzysztof A. Bujarski
- Department of Neurology Geisel School of Medicine at Dartmouth Hanover NH USA
- Department of Neurology Dartmouth‐Hitchcock Medical Center Lebanon NH USA
| | - Michael A. Casey
- Department of Music at Dartmouth College Hanover NH USA
- Department of Computer Science at Dartmouth College Hanover NH USA
| | - Barbara C. Jobst
- Department of Neurology Geisel School of Medicine at Dartmouth Hanover NH USA
- Department of Neurology Dartmouth‐Hitchcock Medical Center Lebanon NH USA
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10
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Steinhoff BJ. [Cenobamate-a new perspective for epilepsy treatment]. DER NERVENARZT 2020; 92:150-160. [PMID: 32990790 DOI: 10.1007/s00115-020-01000-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
In spite of the introduction of numerous new antiseizure drugs (ASD) over the last decades, the percentage of drug-resistant epilepsies has remained almost stable. To achieve seizure freedom in such patients with any modified ASD regimen is an exception. Cenobamate (CNB) is a new ASD that showed unusually high efficacy in the pivotal placebo controlled, randomized trials. In both studies (C013 and C017), the rate of seizure-free patients was sometimes more than 20% and thus in a range never reached over the last decades in comparable trials with other new ASDs. This suggests that CNB which is already approved in the USA might actually offer a new and encouraging perspective for epilepsy treatment concerning efficacy. In this review the pharmacological profile, the currently known mode of action, and the results of the clinical trials are summarized.
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Affiliation(s)
- Bernhard J Steinhoff
- Epilepsiezentrum Kork, Landstraße 1, 77694, Kehl-Kork, Deutschland. .,Klinik für Neurologie, Albert-Ludwigs Universität Freiburg, Freiburg, Deutschland.
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