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Montenegro MA, Valente K. EEG in focal and generalized epilepsies: Pearls and perils. Epilepsy Behav 2024; 156:109825. [PMID: 38838461 DOI: 10.1016/j.yebeh.2024.109825] [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: 04/01/2024] [Revised: 04/28/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
Correctly diagnosing and classifying seizures and epilepsies is vital to ensure a tailored approach to patients with epilepsy. The ILAE seizure classification consists of two main groups: focal and generalized. Establishing if a seizure is focal or generalized is essential to classify the epilepsy type and the epilepsy syndrome, providing more personalized treatment and counseling about prognosis. EEG is one of the most essential tools for this classification process and further localization of the epileptogenic focus. However, some EEG findings are misleading and may postpone the correct diagnosis and proper treatment. Knowing the most common EEG pitfalls in focal and generalized epilepsies is valuable for clinical practice, avoiding misinterpretations. Some atypical features can be challenging in focal epilepsies, such as secondary bilateral synchrony, focal epileptiform activity induced by hyperventilation and photic stimulation, and non-focal slowing. On the other hand, more than 60 % of persons with idiopathic generalized epilepsies have at least one type of atypical abnormality. In this manuscript, we describe and illustrate some of the most common EEG findings that can make even experienced epileptologists question not only where the epileptogenic focus is but also if the patient has focal or generalized epilepsy. This review summarizes the perils and provide some pearls to assist EEG readers.
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Affiliation(s)
| | - Kette Valente
- University of São Paulo Medical School (USP), São Paulo, Brazil.
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Heebner M, Mainali G, Wei S, Kumar A, Naik S, Pradhan S, Kandel P, Tencer J, Carney P, Paudel S. Importance of Genetic Testing in Children With Generalized Epilepsy. Cureus 2024; 16:e59991. [PMID: 38854234 PMCID: PMC11162283 DOI: 10.7759/cureus.59991] [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] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION Epilepsy is a neurological disorder characterized by the predisposition for recurrent unprovoked seizures. It can broadly be classified as focal, generalized, unclassified, and unknown in its onset. Focal epilepsy originates in and involves networks localized to one region of the brain. Generalized epilepsy engages broader, more diffuse networks. The etiology of epilepsy can be structural, genetic, infectious, metabolic, immune, or unknown. Many generalized epilepsies have presumed genetic etiologies. The aim of this study is to compare the role of genetic testing to brain MRI as diagnostic tools for identifying the underlying causes of idiopathic (genetic) generalized epilepsy (IGE). METHODS We evaluated the diagnostic yield of these two categories in children diagnosed with IGE. Data collection was completed using ICD10 codes filtered by TriNetX to select 982 individual electronic medical records (EMRs) of children in the Penn State Children's Hospital who received a diagnosis of IGE. The diagnosis was confirmed after reviewing the clinical history and electroencephalogram (EEG) data for each patient. RESULTS From this dataset, neuroimaging and genetic testing results were gathered. A retrospective chart review was done on 982 children with epilepsy, of which 143 (14.5%) met the criteria for IGE. Only 18 patients underwent genetic testing. Abnormalities that could be a potential cause for epilepsy were seen in 72.2% (13/18) of patients with IGE and abnormal genetic testing, compared to 30% (37/123) for patients who had a brain MRI with genetic testing. CONCLUSION This study suggests that genetic testing may be more useful than neuroimaging for identifying an etiological diagnosis of pediatric patients with IGE.
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Affiliation(s)
| | - Gayatra Mainali
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Sharon Wei
- Neurology, Penn State University, Hershey, USA
| | - Ashutosh Kumar
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Sunil Naik
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | | | - Prakash Kandel
- Biostatistics, Penn State College of Medicine, Hershey, USA
| | - Jaclyn Tencer
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Paul Carney
- Pediatrics and Neurology, University of Missouri, Columbia, USA
| | - Sita Paudel
- Pediatric Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Jiang S, Pei H, Chen J, Li H, Liu Z, Wang Y, Gong J, Wang S, Li Q, Duan M, Calhoun VD, Yao D, Luo C. Striatum- and Cerebellum-Modulated Epileptic Networks Varying Across States with and without Interictal Epileptic Discharges. Int J Neural Syst 2024; 34:2450017. [PMID: 38372049 DOI: 10.1142/s0129065724500175] [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] [Indexed: 02/20/2024]
Abstract
Idiopathic generalized epilepsy (IGE) is characterized by cryptogenic etiology and the striatum and cerebellum are recognized as modulators of epileptic network. We collected simultaneous electroencephalogram and functional magnetic resonance imaging data from 145 patients with IGE, 34 of whom recorded interictal epileptic discharges (IEDs) during scanning. In states without IEDs, hierarchical connectivity was performed to search core cortical regions which might be potentially modulated by striatum and cerebellum. Node-node and edge-edge moderation models were constructed to depict direct and indirect moderation effects in states with and without IEDs. Patients showed increased hierarchical connectivity with sensorimotor cortices (SMC) and decreased connectivity with regions in the default mode network (DMN). In the state without IEDs, striatum, cerebellum, and thalamus were linked to weaken the interactions of regions in the salience network (SN) with DMN and SMC. In periods with IEDs, overall increased moderation effects on the interaction between regions in SN and DMN, and between regions in DMN and SMC were observed. The thalamus and striatum were implicated in weakening interactions between regions in SN and SMC. The striatum and cerebellum moderated the cortical interaction among DMN, SN, and SMC in alliance with the thalamus, contributing to the dysfunction in states with and without IEDs in IGE. The current work revealed state-specific modulation effects of striatum and cerebellum on thalamocortical circuits and uncovered the potential core cortical targets which might contribute to develop new clinical neuromodulation techniques.
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Affiliation(s)
- Sisi Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Haonan Pei
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Junxia Chen
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Hechun Li
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Zetao Liu
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Yuehan Wang
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Jinnan Gong
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
- School of Computer Science, Chengdu University of Information Technology, Chengdu, P. R. China
| | - Sheng Wang
- Department of Neurology, Hainan Medical University, Hainan 571199, P. R. China
| | - Qifu Li
- Department of Neurology, Hainan Medical University, Hainan 571199, P. R. China
| | - Mingjun Duan
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
- Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, 2019RU035 Chengdu, P. R. China
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA 30303, USA
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
- Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, 2019RU035 Chengdu, P. R. China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
- Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, 2019RU035 Chengdu, P. R. China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P. R. China
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Rana M, Steenari M, Shrey D. Hyperventilation and Seizures: Not a New Sense: A Literature Review. Neuropediatrics 2023; 54:359-364. [PMID: 37813123 DOI: 10.1055/s-0043-1774808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Hyperventilation and seizures have a long association in the clinical literature and were known to have a relationship long before the electroencephalogram (EEG) was used to record changes in brain activity. As the use of EEG recording progressed, hyperventilation was the first activation method used to assist with diagnosis of epilepsy. Along with slowing of brain activity, hyperventilation can activate epileptiform spiking activity in patients with epilepsy. Currently, hyperventilation is used in standard practice to assist with the diagnosis of epilepsy during EEG recording. Hyperventilation activates epileptiform spiking activity more often than seizures but can trigger clinical seizures in up to 50% of patients with generalized epilepsy. It is more likely to trigger events in children with absence seizures than adults, and it acts as a trigger in patients with focal epilepsy far less often. However, while some clinicians suggest that its diagnostic value is limited, especially in adults with focal epilepsies, others suggest that it is simple, safe, and an important diagnostic tool, even in these patients. This review presents the history of hyperventilation and seizures, its use in the clinical practice, and possible mechanisms involved.
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Affiliation(s)
- Mandeep Rana
- Department of Pediatrics, Section of Pediatric Neurology, Carilion Clinic, Virginia Tech Carilion School of Medicine Roanoke, Virginia, United States
| | - Maija Steenari
- Department of Pediatrics, University of California, Irvine Division of Neurology, CHOC, 1201 W La Veta Avenue, Orange, California, United States
| | - Daniel Shrey
- Department of Pediatrics, University of California, Irvine Division of Neurology, CHOC, 1201 W La Veta Avenue, Orange, California, United States
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Janmohamed M, Nhu D, Shakathreh L, Gonen O, Kuhlman L, Gilligan A, Tan CW, Perucca P, O'Brien TJ, Kwan P. Comparison of Automated Spike Detection Software in Detecting Epileptiform Abnormalities on Scalp-EEG of Genetic Generalized Epilepsy Patients. J Clin Neurophysiol 2023:00004691-990000000-00110. [PMID: 37934089 DOI: 10.1097/wnp.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Despite availability of commercial EEG software for automated epileptiform detection, validation on real-world EEG datasets is lacking. Performance evaluation of two software packages on a large EEG dataset of patients with genetic generalized epilepsy was performed. METHODS Three epileptologists labelled IEDs manually of EEGs from three centres. All Interictal epileptiform discharge (IED) markings predicted by two commercial software (Encevis 1.11 and Persyst 14) were reviewed individually to assess for suspicious missed markings and were integrated into the reference standard if overlooked during manual annotation during a second phase. Sensitivity, precision, specificity, and F1-score were used to assess the performance of the software packages against the adjusted reference standard. RESULTS One hundred and twenty-five routine scalp EEG recordings from different subjects were included (total recording time, 310.7 hours). The total epileptiform discharge reference count was 5,907 (including spikes and fragments). Encevis demonstrated a mean sensitivity for detection of IEDs of 0.46 (SD 0.32), mean precision of 0.37 (SD 0.31), and mean F1-score of 0.43 (SD 0.23). Using the default medium setting, the sensitivity of Persyst was 0.67 (SD 0.31), with a precision of 0.49 (SD 0.33) and F1-score of 0.51 (SD 0.25). Mean specificity representing non-IED window identification and classification was 0.973 (SD 0.08) for Encevis and 0.968 (SD 0.07) for Persyst. CONCLUSIONS Automated software shows a high degree of specificity for detection of nonepileptiform background. Sensitivity and precision for IED detection is lower, but may be acceptable for initial screening in the clinical and research setting. Clinical caution and continuous expert human oversight are recommended with all EEG recordings before a diagnostic interpretation is provided based on the output of the software.
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Affiliation(s)
- Mubeen Janmohamed
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Duong Nhu
- Department of Data Science and AI, Faculty of IT, Monash University, Clayton, Victoria, Australia
| | - Lubna Shakathreh
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ofer Gonen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Levin Kuhlman
- Department of Data Science and AI, Faculty of IT, Monash University, Clayton, Victoria, Australia
| | - Amanda Gilligan
- Neurosciences Clinical Institute, Epworth Healthcare Hospital, Melbourne, Victoria, Australia
| | - Chang Wei Tan
- Department of Data Science and AI, Faculty of IT, Monash University, Clayton, Victoria, Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Epilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia; and
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
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Lemoine É, Toffa D, Pelletier-Mc Duff G, Xu AQ, Jemel M, Tessier JD, Lesage F, Nguyen DK, Bou Assi E. Machine-learning for the prediction of one-year seizure recurrence based on routine electroencephalography. Sci Rep 2023; 13:12650. [PMID: 37542101 PMCID: PMC10403587 DOI: 10.1038/s41598-023-39799-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023] Open
Abstract
Predicting seizure recurrence risk is critical to the diagnosis and management of epilepsy. Routine electroencephalography (EEG) is a cornerstone of the estimation of seizure recurrence risk. However, EEG interpretation relies on the visual identification of interictal epileptiform discharges (IEDs) by neurologists, with limited sensitivity. Automated processing of EEG could increase its diagnostic yield and accessibility. The main objective was to develop a prediction model based on automated EEG processing to predict one-year seizure recurrence in patients undergoing routine EEG. We retrospectively selected a consecutive cohort of 517 patients undergoing routine EEG at our institution (training set) and a separate, temporally shifted cohort of 261 patients (testing set). We developed an automated processing pipeline to extract linear and non-linear features from the EEGs. We trained machine learning algorithms on multichannel EEG segments to predict one-year seizure recurrence. We evaluated the impact of IEDs and clinical confounders on performances and validated the performances on the testing set. The receiver operating characteristic area-under-the-curve for seizure recurrence after EEG in the testing set was 0.63 (95% CI 0.55-0.71). Predictions were still significantly above chance in EEGs with no IEDs. Our findings suggest that there are changes other than IEDs in the EEG signal embodying seizure propensity.
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Affiliation(s)
- Émile Lemoine
- Department of Neurosciences, Université de Montréal, Montréal, Qc, Canada
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montréal, Qc, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, Qc, Canada
| | - Denahin Toffa
- Department of Neurosciences, Université de Montréal, Montréal, Qc, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, Qc, Canada
| | - Geneviève Pelletier-Mc Duff
- Department of Neurosciences, Université de Montréal, Montréal, Qc, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, Qc, Canada
| | - An Qi Xu
- Centre de Recherche du CHUM (CRCHUM), Montréal, Qc, Canada
| | - Mezen Jemel
- Department of Neurosciences, Université de Montréal, Montréal, Qc, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, Qc, Canada
| | - Jean-Daniel Tessier
- Department of Neurosciences, Université de Montréal, Montréal, Qc, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, Qc, Canada
| | - Frédéric Lesage
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montréal, Qc, Canada
- Centre de Recherche de l'institut de Cardiologie de Montréal, Montréal, Qc, Canada
| | - Dang K Nguyen
- Department of Neurosciences, Université de Montréal, Montréal, Qc, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, Qc, Canada
| | - Elie Bou Assi
- Department of Neurosciences, Université de Montréal, Montréal, Qc, Canada.
- Centre de Recherche du CHUM (CRCHUM), Montréal, Qc, Canada.
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Edizer S, Baysal BT, Ünalp A, Yılmaz Ü. Changes in awake and sleep electroencephalography characteristics after 1-year treatment for childhood and juvenile absence epilepsy. Seizure 2023; 110:244-252. [PMID: 37441906 DOI: 10.1016/j.seizure.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE To compare electroencephalography (EEG) features of newly diagnosed drug-naive childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE) patients and analyze their response to anti-seizure medications (ASMs). METHOD EEG characteristics between CAE and JAE patients and responders and non-responders to ASM at baseline and 12 months were compared, and the changes from baseline were analysed. RESULTS A total of 62 patients (32 CAE and 30 JAE) were included. Discharges in baseline awake and sleep EEGs and interictal and polyspike discharges in baseline sleep EEGs were more frequent in JAE patients. Although the median discharge densities (discharge containing seconds per minute) were similar in baseline awake and sleep EEGs between the groups, the median was higher in the JAE group at 12 months and decreased significantly in both groups at 12 months compared to the baseline values. Responses to initial ASMs were 94% and 77% in the CAE and JAE groups, respectively. In initial sleep EEGs of non-responders with JAE, focal onset generalized spike and slow wave discharges (GSWDs) were more frequent, and the median ictal and interictal discharge densities were higher. CONCLUSION JAE patients had more frequent disorganized discharges at baseline in both awake and sleep EEGs and interictal and polyspike discharges in sleep EEGs than those of CAE patients. Improvement in EEG was more pronounced in CAE patients than in JAE patients. Focal-onset GSWDs and higher ictal and interictal discharge densities on baseline EEG were associated with a poor response to initial ASMs in JAE patients.
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Affiliation(s)
- Selvinaz Edizer
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey.
| | - Bahar Toklu Baysal
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Aycan Ünalp
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Ünsal Yılmaz
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
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Mangaard S, Gesche J, Krøigård T, Beier CP. Association of symptoms of psychiatric disease and electroencephalographic patterns in idiopathic generalized epilepsy. Epilepsy Behav 2023; 145:109293. [PMID: 37315408 DOI: 10.1016/j.yebeh.2023.109293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Idiopathic generalized epilepsies (IGE) are genetic epilepsies with alterations of thalamo-frontocortical circuits that play a major role in seizure generation and propagation. Psychiatric diseases and drug resistance are strongly associated, but it remains unknown if they are symptoms of the same pathophysiological process. Hypothesizing that the same network alterations are associated with the frequency of epileptic discharges (ED) and psychiatric symptoms, we here tested the association of self-reported psychiatric symptoms and IGE severity estimated by electroencephalographic (EEG) biomarkers. METHODS Idiopathic generalized epilepsies patients were asked to fill out four validated psychiatric screening tools assessing symptoms of personality disorders (Standard Assessment of Personality- Abbreviated Scale), depression (Major Depression Inventory), impulsiveness (Barratt Impulsiveness Scale), and anxiety (brief Epilepsy Anxiety Survey Instrument). Blinded to results and clinical data on the patients, we analyzed the patients' EEGs, assessed, and quantified ED. The number and duration of ED divided by the duration of the EEG served as a proxy for the severity of IGE that was correlated with the results of the psychiatric screening. RESULTS Paired data from 64 patients were available for analysis. The duration of EDs per minute EEG was inversely associated with the time since the last seizure. The number of patients with generalized polyspike trains (n = 2), generalized paroxysmal fast activity (n = 3), and prolonged epileptiform discharges (n = 10) were too low for statistically meaningful analyses. Self-reported symptoms of depression, personality disorder, and impulsivity were not associated with EDs. In contrast, the duration of EDs per minute EEG was associated with self-reported symptoms of anxiety in univariate analyses, not significant, however, following adjustment for time since the last seizure in regression models. SIGNIFICANCE Self-reported symptoms of psychiatric diseases were not strongly associated with EDs as the best available quantifiable biomarker of IGE severity. As expected, the duration of EDs per minute and anxiety was inversely associated with time since the last seizure. Our data argue against a direct link between the frequency of EDs - as an objective proxy of IGE severity - and psychiatric symptoms.
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Affiliation(s)
- Sofie Mangaard
- Department of Neurology, Odense University Hospital, Denmark
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Thomas Krøigård
- Department of Neurophysiology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; OPEN, University of Southern Denmark, Denmark.
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Harvey S, Shahwan A. Typical absence seizures in children: Review with focus on EEG predictors of treatment response and outcome. Seizure 2023; 110:1-10. [PMID: 37295276 DOI: 10.1016/j.seizure.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Typical absence seizures (TAS) occur in idiopathic generalized epilepsy (IGE) syndromes and are a common presentation to paediatric neurologists. Considerable overlap in clinical features of IGE syndromes comprising TAS often complicates prognostication. Clinical and EEG diagnostic features in TAS are well known. However, knowledge of prognostic features for each syndrome, whether clinical or EEG-related, is less clear. Perpetuated impressions in clinical practice regarding the role of EEG when used for prognostication in TAS are known. Assumed prognostic features, particularly those relating to EEG have been rarely studied systematically. Despite rapid expansion in epilepsy genetics, the complex and presumed polygenic inheritance of IGE, means that clinical and EEG features are likely to remain the main guide to management and prognostication of TAS for the foreseeable future. We comprehensively reviewed available literature and hereby summarize current knowledge of clinical and EEG characteristics (ictal and interictal) in children with TAS. The literature focuses predominantly on ictal EEG. Where studied, interictal findings reported relate to focal discharges, polyspike discharges, and occipital intermittent rhythmic delta activity, with generalized interictal discharges not thoroughly studied. Furthermore, reported prognostic implications of EEG findings are often conflicting. Limitations of available literature include inconsistent clinical syndrome and EEG finding definitions, and variable EEG analysis methods, particularly lack of raw EEG data analysis. These conflicting findings coupled with varying study methodologies cause lack of clear information or evidence on features which may influence treatment response, outcome, or natural history of TAS.
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Affiliation(s)
- Susan Harvey
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Temple Street, Dublin 1, Ireland; School of Medicine, University College Dublin, Dublin Ireland.
| | - Amre Shahwan
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Temple Street, Dublin 1, Ireland; School of Medicine, Royal College of Surgeons Ireland, Dublin, Ireland
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Phamnguyen TJ, Szekely A, Swinburn S, Babu S, Boland-Freitas R, Reutens D, Wolfe N. Usefulness and yield of routine electroencephalogram: a retrospective study. Intern Med J 2023; 53:236-241. [PMID: 34611977 DOI: 10.1111/imj.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The electroencephalogram (EEG) is a common diagnostic tool used to investigate patients for various indications including seizure disorders. AIMS To investigate factors that predict the presence of epileptiform abnormalities on EEG and review the common indications for ordering an EEG. METHODS We retrospectively reviewed all routine adult EEG performed in a hospital over a 6-month period. Data collated included patient demographics, clinical indication for EEG, setting in which EEG was performed, activation procedures utilised, history of epilepsy, and whether the patient was on antiepileptic medication. Our primary objective was to evaluate the factors that were predictive of an EEG with epileptiform abnormalities. RESULTS Two hundred and thirty-nine routine EEG were included with indications, including first seizure (25.9%), known epilepsy (25.1%), cognitive change (15.9%), syncope (15.0%), movement disorder (6.7%), psychogenic non-epileptic events (5.4%), unresponsiveness/intensive care unit (4.6%) and psychiatric presentation (1.3%). Most (48.1%) EEG were normal; 8.9% of the EEG demonstrated epileptiform abnormalities. Using multivariate logistic regression, three variables proved significant in predicting an EEG with epileptiform abnormalities. Any seizure as an indication (first seizure or seizure in known epileptic), increasing patient age, and EEG conducted in an inpatient setting and within 48 h of seizure event were all statistically more likely to yield epileptiform abnormalities on EEG. CONCLUSIONS Our findings suggest that careful selection of patients based on appropriate indications for EEG referral would likely improve the yield of an EEG. Depending on the indication, a normal EEG result can be of similar usefulness to an abnormal EEG demonstrating epileptiform abnormalities.
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Affiliation(s)
- Thienan John Phamnguyen
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia.,Neurology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Alison Szekely
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Samuel Swinburn
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Sangamithra Babu
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia.,Neurology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | | | - David Reutens
- Neurology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Nigel Wolfe
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia.,Neurology Department, Westmead Hospital, Sydney, New South Wales, Australia
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11
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Alpha2-Adrenergic Receptors as a Pharmacological Target for Spike-Wave Epilepsy. Int J Mol Sci 2023; 24:ijms24021477. [PMID: 36674992 PMCID: PMC9862736 DOI: 10.3390/ijms24021477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Spike-wave discharges are the hallmark of idiopathic generalized epilepsy. They are caused by a disorder in the thalamocortical network. Commercially available anti-epileptic drugs have pronounced side effects (i.e., sedation and gastroenterological concerns), which might result from a low selectivity to molecular targets. We suggest a specific subtype of adrenergic receptors (ARs) as a promising anti-epileptic molecular target. In rats with a predisposition to absence epilepsy, alpha2 ARs agonists provoke sedation and enhance spike-wave activity during transitions from awake/sedation. A number of studies together with our own observations bring evidence that the sedative and proepileptic effects require different alpha2 ARs subtypes activation. Here we introduce a new concept on target pharmacotherapy of absence epilepsy via alpha2B ARs which are presented almost exclusively in the thalamus. We discuss HCN and calcium channels as the most relevant cellular targets of alpha2 ARs involved in spike-wave activity generation.
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12
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Taylor JA, Smith ZZ, Barth DS. Spike-wave discharges in Sprague-Dawley rats reflect precise intra- and interhemispheric synchronization of somatosensory cortex. J Neurophysiol 2022; 128:1152-1167. [PMID: 36169203 PMCID: PMC9621715 DOI: 10.1152/jn.00303.2022] [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: 07/19/2022] [Revised: 09/01/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Spike-wave discharges (SWDs) are among the most prominent electrical signals recordable from the rat cerebrum. Increased by inbreeding, SWDs have served as an animal model of human genetic absence seizures. Yet, SWDs are ubiquitous in inbred and outbred rats, suggesting they reflect normal brain function. We hypothesized that SWDs represent oscillatory neural ensemble activity underlying sensory encoding. To test this hypothesis, we simultaneously mapped SWDs from wide areas (8 × 8 mm) of both hemispheres in anesthetized rats, using 256-electrode epicortical arrays that covered primary and secondary somatosensory, auditory and visual cortex bilaterally. We also recorded the laminar pattern of SWDs with linear microelectrode arrays. We compared the spatial and temporal organization of SWDs to somatosensory-evoked potentials (SEPs), as well as auditory- and visual-evoked potentials (AEPs and VEPs) to examine similarities and/or differences between sensory-evoked and spontaneous oscillations in the same animals. We discovered that SWDs are confined to the facial representation of primary and secondary somatosensory cortex (SI and SII, respectively), areas that are preferentially engaged during environmental exploration in the rat. Furthermore, these oscillations exhibit highly synchronized bilateral traveling waves in SI and SII, simultaneously forming closely matched spread patterns in both hemispheres. We propose that SWDs could reflect a previously unappreciated capacity for rat somatosensory cortex to perform precise spatial and temporal analysis of rapidly changing sensory input at the level of large neural ensembles synchronized both within and between the cerebral hemispheres.NEW & NOTEWORTHY We simultaneously mapped electrocortical SWDs from both cerebral hemispheres of Sprague-Dawley rats and discovered that they reflect systematic activation of the facial representation of somatosensory cortex. SWDs form mirror spatiotemporal patterns in both hemispheres that are precisely aligned in both space and time. Our data suggest that SWDs may reflect a substrate by which large neural ensembles perform precise spatiotemporal processing of rapidly changing somatosensory input.
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Affiliation(s)
- Jeremy A Taylor
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
| | - Zachary Z Smith
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
| | - Daniel S Barth
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
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13
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Bauer LO, Hesselbrock VM. Signal in the noise: Altered brain activation among adolescent alcohol users detected via the analysis of intra-individual variability 1. Psychopharmacology (Berl) 2022; 239:3595-3604. [PMID: 36102952 PMCID: PMC9471029 DOI: 10.1007/s00213-022-06234-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE Unlike its average level, the variability in brain activation over time or trials can capture subtle and brief disruptions likely to occur among participants with low-to-moderate levels of substance use or misuse. OBJECTIVE The present study used this intra-individual variability measurement approach to detect neural processing differences associated with light-to-moderate use of alcohol among 14-19-year-old adolescents. METHOD A total of 128 participants reporting any level of alcohol use during the previous 6 months and 87 participants reporting no use during this period completed intake questionnaires and interviews as well as an assessment of P300 electroencephalographic responses to novel stimuli recorded during two separate tasks. RESULTS In addition to differing in recent alcohol use, the groups differed in nicotine and cannabis use, risk-taking behavior and conduct disorder symptoms, and P300 amplitude inter-trial variability (ITV) across both tasks. Across all participants, P300 ITV was positively correlated with a family history of depression but not with a family history of alcohol dependence. There were no group differences in P300 amplitude averaged across trials. CONCLUSIONS Recent reports attributing brain volume or brain function differences to an effect of light-to-moderate alcohol use should be viewed with great caution. In the present analysis of brain function differences among substance-using adolescents, the group differences were small, complicated by many factors coinciding with or preceding alcohol use, and not reflected in a stable central tendency.
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Affiliation(s)
- Lance O Bauer
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030-1410, USA.
| | - Victor M Hesselbrock
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030-1410, USA
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14
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Conrad EC, Chugh N, Ganguly TM, Gugger JJ, Tizazu EF, Shinohara RT, Raghupathi R, Becker DA, Gelfand MA, Omole AT, Decker BM, Pathmanathan JS, Davis KA, Ellis CA. Using Generalized Polyspike Train to Predict Drug-Resistant Idiopathic Generalized Epilepsy. J Clin Neurophysiol 2022; 39:459-465. [PMID: 33298682 PMCID: PMC8184865 DOI: 10.1097/wnp.0000000000000803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The authors tested the hypothesis that the EEG feature generalized polyspike train (GPT) is associated with drug-resistant idiopathic generalized epilepsy (IGE). METHODS The authors conducted a single-center case-control study of patients with IGE who had outpatient EEGs performed between 2016 and 2020. The authors classified patients as drug-resistant or drug-responsive based on clinical review and in a masked manner reviewed EEG data for the presence and timing of GPT (a burst of generalized rhythmic spikes lasting less than 1 second) and other EEG features. A relationship between GPT and drug resistance was tested before and after controlling for EEG duration. The EEG duration needed to observe GPT was also calculated. RESULTS One hundred three patients were included (70% drug-responsive and 30% drug-resistant patients). Generalized polyspike train was more prevalent in drug-resistant IGE (odds ratio, 3.8; 95% confidence interval, 1.3-11.4; P = 0.02). This finding persisted when controlling for EEG duration both with stratification and with survival analysis. A median of 6.5 hours (interquartile range, 0.5-12.7 hours) of EEG recording was required to capture the first occurrence of GPT. CONCLUSIONS The findings support the hypothesis that GPT is associated with drug-resistant IGE. Prolonged EEG recording is required to identify this feature. Thus, >24-hour EEG recording early in the evaluation of patients with IGE may facilitate prognostication.
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Affiliation(s)
- Erin C. Conrad
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nanak Chugh
- Department of Community Physicians, John Hopkins Medicine, Baltimore, Maryland, U.S.A
| | - Taneeta M. Ganguly
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - James J. Gugger
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Etsegenet F. Tizazu
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ramya Raghupathi
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Danielle A. Becker
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Michael A. Gelfand
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Armina T. Omole
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Barbara M. Decker
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jay S. Pathmanathan
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Kathryn A. Davis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Colin A. Ellis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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15
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Lehner J, Frueh JS, Datta AN. Sleep quality and architecture in Idiopathic generalized epilepsy: A systematic review and meta-analysis. Sleep Med Rev 2022; 65:101689. [PMID: 36037570 DOI: 10.1016/j.smrv.2022.101689] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
Idiopathic generalized epilepsies are a group of sleep related epilepsy syndromes with sleep deprivation as a strong trigger for seizures and increased spike-wave activity during sleep and transition to sleep. Neuropsychological deficits are common in Idiopathic generalized epilepsy patients. Learning and memory processes are closely linked to sleep. Therefore, this systematic review and meta-analysis investigates the evidence of sleep disturbances in Idiopathic generalized epilepsy patients. A search of the databases EMBASE, Medline and Scopus identified 22 studies comparing polysomnographic parameters and scores of sleep questionnaires between Idiopathic generalized epilepsy patients and healthy controls. Random effect univariate meta-analyses revealed reduced sleep efficiency, total sleep time, proportion of N2 stage and prolonged REM onset latency in Idiopathic generalized epilepsy patients. Self-assessed sleep quality of patients measured by the Pittsburgh sleep quality index was lower in two thirds of reporting studies. Considering the influence on behavioral issues, cognitive performance and quality of life, the revealed alteration in sleep architecture and lower subjective sleep quality emphasizes the importance of screening for sleep disturbances in the medical care of patients with Idiopathic generalized epilepsy.
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Affiliation(s)
- Julia Lehner
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Julia S Frueh
- Department of Pediatric Neurology, Boston Children's Hospital, Boston, MA, United States of America
| | - Alexandre N Datta
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel UKBB, Basel, Switzerland.
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16
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McKavanagh A, Kreilkamp BAK, Chen Y, Denby C, Bracewell M, Das K, De Bezenac C, Marson AG, Taylor PN, Keller SS. Altered Structural Brain Networks in Refractory and Nonrefractory Idiopathic Generalized Epilepsy. Brain Connect 2022; 12:549-560. [PMID: 34348477 DOI: 10.1089/brain.2021.0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Idiopathic generalized epilepsy (IGE) is a collection of generalized nonlesional epileptic network disorders. Around 20-40% of patients with IGE are refractory to antiseizure medication, and mechanisms underlying refractoriness are poorly understood. Here, we characterize structural brain network alterations and determine whether network alterations differ between patients with refractory and nonrefractory IGE. Methods: Thirty-three patients with IGE (10 nonrefractory and 23 refractory) and 39 age- and sex-matched healthy controls were studied. Network nodes were segmented from T1-weighted images, while connections between these nodes (edges) were reconstructed from diffusion magnetic resonance imaging (MRI). Diffusion networks of fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and streamline count (Count) were studied. Differences between all patients, refractory, nonrefractory, and control groups were computed using network-based statistics. Nodal volume differences between groups were computed using Cohen's d effect size calculation. Results: Patients had significantly decreased bihemispheric FA and Count networks and increased MD and RD networks compared with controls. Alterations in network architecture, with respect to controls, differed depending on treatment outcome, including predominant FA network alterations in refractory IGE and increased nodal volume in nonrefractory IGE. Diffusion MRI networks were not influenced by nodal volume. Discussion: Although a nonlesional disorder, patients with IGE have bihemispheric structural network alterations that may differ between patients with refractory and nonrefractory IGE. Given that distinct nodal volume and FA network alterations were observed between treatment outcome groups, a multifaceted network analysis may be useful for identifying imaging biomarkers of refractory IGE.
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Affiliation(s)
- Andrea McKavanagh
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Barbara A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Yachin Chen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Christine Denby
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Martyn Bracewell
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
- School of Psychology, Bangor University, Bangor, United Kingdom
| | - Kumar Das
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Christophe De Bezenac
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Peter N Taylor
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle, United Kingdom
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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17
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Kim KY, Moon JU, Lee JY, Eom TH, Kim YH, Lee IG. Distributed source localization of epileptiform discharges in juvenile myoclonic epilepsy: Standardized low-resolution brain electromagnetic tomography (sLORETA) Study. Medicine (Baltimore) 2022; 101:e29625. [PMID: 35777062 PMCID: PMC9239631 DOI: 10.1097/md.0000000000029625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Juvenile myoclonic epilepsy (JME) is a common generalized epilepsy syndrome considered the prototype of idiopathic generalized epilepsy. To date, generalized and focal seizures have been the fundamental concepts for classifying seizure types. In several studies, focal features of JME have been reported predominantly in the frontal lobe. However, results in previous studies are inconsistent. Therefore, we investigated the origin of epileptiform discharges in JME. We performed electroencephalography source localization using a distributed model with standardized low-resolution brain electromagnetic tomography. In 20 patients with JME, standardized low-resolution brain electromagnetic tomography images corresponding to the midpoint of the ascending phase and the negative peak of epileptiform discharges were obtained from a total of 362 electroencephalography epochs (181 epochs at each timepoint). At the ascending phase, the maximal current source density was located in the frontal lobe (58.6%), followed by the parietal (26.5%) and occipital lobes (8.8%). At the negative peak, the maximal current source density was located in the frontal lobe (69.1%), followed by the parietal (11.6%) and occipital lobes (9.4%). In the ascending phase, 41.4% of discharges were located outside the frontal lobe, and 30.9% were in the negative peak. Frontal predominance of epileptiform discharges was observed; however, source localization extending to various cortical regions also was identified. This widespread pattern was more prominent in the ascending phase (P = .038). The study results showed that JME includes widespread cortical regions over the frontal lobe. The current concept of generalized epilepsy and pathophysiology in JME needs further validation.
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Affiliation(s)
- Kwang Yeon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja-Un Moon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Hoon Eom
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In-Goo Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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18
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Omitting Hyperventilation in Electroencephalogram during the COVID-19 Pandemic May Reduce Interictal Epileptiform Discharges in Patients with Juvenile Myoclonic Epilepsy. Brain Sci 2022; 12:brainsci12060769. [PMID: 35741654 PMCID: PMC9220821 DOI: 10.3390/brainsci12060769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To prevent the spread of coronavirus disease 2019 (COVID-19), hyperventilation (HV) activation has been avoided in electroencephalograms (EEGs) since April 2020. The influence of omitting HV in EEG on epilepsy diagnosis remains uncertain for patients with epilepsies other than child absence epilepsy. We hypothesized that EEGs with HV would show more interictal epileptiform discharges (IEDs) than EEGs without HV in patients with juvenile myoclonic epilepsy (JME). METHODS We reviewed the EEGs of seizure-free patients with JME who underwent EEG, both with and without HV, from January 2019 to October 2021, in our institution, and compared IEDs between EEG with and without HV. RESULTS This study analyzed 23 JME patients. The IED-positive rate was significantly higher in EEG with HV (65.2%) than in EEG without HV (34.8%, p = 0.016). The mean ± standard deviation number of IEDs per minute was significantly larger during HV (1.61 ± 2.25 × 10-1) than during non-activation of both first EEG (0.57 ± 0.93 × 10-1, p = 0.039) and second EEG (0.39 ± 0.76 × 10-1, p = 0.009). CONCLUSIONS In JME patients, performing HV during EEG may increase IEDs and appears to facilitate the accurate diagnosis of epilepsy.
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19
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Das Pektezel L, Tezer FI, Saygi S. Electroclinical spectrum of generalized paroxysmal fast activity in adults without epileptic encephalopathy. Neurol Sci 2022; 43:3857-3866. [DOI: 10.1007/s10072-021-05808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
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20
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The role of thalamic nuclei in genetic generalized epilepsies. Epilepsy Res 2022; 182:106918. [DOI: 10.1016/j.eplepsyres.2022.106918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/11/2022] [Accepted: 03/28/2022] [Indexed: 01/10/2023]
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21
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Das S, Paramita P, Swain N, Roy R, Padhi S, Rath S, Mishra S, Mohakud NK. Hospital-Based Prevalence, Electroencephalogram (EEG), and Neuroimaging Correlation in Seizures Among Children in Odisha, India. Cureus 2022; 14:e21103. [PMID: 35165562 PMCID: PMC8829822 DOI: 10.7759/cureus.21103] [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] [Accepted: 01/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Febrile seizures are very common in pediatric practice. We need to differentiate between febrile seizures and other seizures due to central nervous system (CNS) infection by various means of investigation. Though approximately 30% of patients with febrile seizure have later epilepsy and the risk is around 20% even if electroencephalogram (EEG), and neuro-imagings are normal. But data regarding this is laking in developing countries like India. Aim: The primary objective of this study is to determine the hospital-based prevalence among various types and etiologies of seizures in children admitted to the pediatric department in a teaching hospital of a developing country, India. Besides, the different types of seizures were correlated with the EEG and neuroimaging findings along with the acute onset of seizures among children. Methods: In this prospective observational study, children from two months to 15 years of age admitted to the Pediatrics Department, KIMS, Bhubaneswar in India between September 2017 and September 2019 were taken. The patients having seizures were included in the study based on the inclusion criteria. Neurological and systemic examinations of the children were recorded and the neuroimaging reports were analyzed. Results: A total of 19,553 patients aged two months to 15 years were admitted during the study period. Of that, 1,192 cases were diagnosed with febrile and unprovoked seizures. It was observed that the hospital-based prevalence of seizures among children in Odisha was 6%. Besides, it is found that generalized seizure disorder was the most common among the children. It was found that abnormal EEG, magnetic resonance imaging (MRI), and computed tomography (CT) brain in 60% (202/340), 49% (113/230), and 47% (136/288) of cases, respectively. MRI is a better modality of investigation in partial seizure cases 22 (64%) to detect CNS abnormality. Also, MRI of the brain is better in evaluating CNS abnormality in complex febrile cases 4 (31%) than CT brain (0%). Conclusion: The study concluded that EEG must be the standard modality of test for patients' diagnosis of seizure in children with seizures. CT/MRI scan can give a better supplement to the results but MRI findings are more accurate in cases of complex febrile seizures.
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22
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-EEG monitoring: A clinical practice guideline of the international league against epilepsy and international federation of clinical neurophysiology. Clin Neurophysiol 2021; 134:111-128. [PMID: 34955428 DOI: 10.1016/j.clinph.2021.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events (see Table S1). For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, WV, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, France.
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich Switzerland.
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Danish Epilepsy Center, Dianalund, Denmark.
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23
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-electroencephalographic monitoring: A clinical practice guideline of the International League Against Epilepsy and International Federation of Clinical Neurophysiology. Epilepsia 2021; 63:290-315. [PMID: 34897662 DOI: 10.1111/epi.16977] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events. For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and to establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, Nancy, France
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich,, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Danish Epilepsy Center, Dianalund, Denmark
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High rates of early remission pattern in adult-onset compared with earlier-onset idiopathic generalized epilepsy: A long-term follow-up study. Seizure 2021; 94:52-56. [PMID: 34864252 DOI: 10.1016/j.seizure.2021.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate electroclinical characteristics and prognostic patterns of adult-onset vs. younger-onset idiopathic generalized epilepsy (IGE) patients during long-term follow-up. METHODS In this single-center retrospective cohort comparative study, adult-onset IGE was defined as onset after 20 years of age. Patients with a follow-up duration between 10 and 30 years from epilepsy diagnosis were enrolled. Maximum follow-up duration was limited to 30 years to ensure a better comparison of prognostic data between adult-onset and younger-onset patients. The Benjamini-Hochberg false discovery rate (FDR) method was applied to obtain FDR-adjusted p-values. RESULTS A total of 177 IGE patients were recruited and 27 adult-onset IGE patients were identified (15.3%). Follow-up duration was similar between younger- and adult-onset IGE patients and 74% of subjects performed at least one 24-hour EEG recording. Of adult-onset IGE patients, 8/27 were diagnosed with juvenile myoclonic epilepsy, while 19/27 were diagnosed with generalized tonic-clonic seizures (GTCS) only. EEG photosensitivity and absence seizures were significantly less frequent among adult-onset IGE patients as compared with younger subjects. When considering prognostic patterns, an early remission pattern was significantly higher among adult-onset IGE patients as compared with younger-onset IGE patients (55.6% vs. 24%, adjusted p value = 0.007). Antiseizure medication withdrawal was attempted in 3/27 adult-onset patients, and all had GTCS relapses. CONCLUSION Our study contributes to better defining the electroclinical characteristics and long-term follow-up of adult-onset IGE patients. A favorable long-term seizure outcome was found in adult-onset IGE patients, as evidenced by the high rates of early remission pattern when compared with younger onset patients.
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25
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Seneviratne U, Cook M, D'Souza W. Brainwaves beyond diagnosis: Wider applications of electroencephalography in idiopathic generalized epilepsy. Epilepsia 2021; 63:22-41. [PMID: 34755907 DOI: 10.1111/epi.17119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
Electroencephalography (EEG) has long been used as a versatile and noninvasive diagnostic tool in epilepsy. With the advent of digital EEG, more advanced applications of EEG have emerged. Compared with technologically advanced practice in focal epilepsies, the utilization of EEG in idiopathic generalized epilepsy (IGE) has been lagging, often restricted to a simple diagnostic tool. In this narrative review, we provide an overview of broader applications of EEG beyond this narrow scope, discussing how the current clinical and research applications of EEG may potentially be extended to IGE. The current literature, although limited, suggests that EEG can be used in syndromic classification, guiding antiseizure medication therapy, predicting prognosis, unraveling biorhythms, and investigating functional brain connectivity of IGE. We emphasize the need for longer recordings, particularly 24-h ambulatory EEG, to capture discharges reflecting circadian and sleep-wake cycle-associated variations for wider EEG applications in IGE. Finally, we highlight the challenges and limitations of the current body of literature and suggest future directions to encourage and enhance more extensive applications of this potent tool.
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Affiliation(s)
- Udaya Seneviratne
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Mark Cook
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Wendyl D'Souza
- Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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26
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Whitney R, Nair A, McCready E, Keller AE, Adil IS, Aziz AS, Borys O, Siu K, Shah C, Meaney BF, Jones K, RamachandranNair R. The spectrum of epilepsy in children with 15q13.3 microdeletion syndrome. Seizure 2021; 92:221-229. [PMID: 34601452 DOI: 10.1016/j.seizure.2021.09.016] [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: 07/15/2021] [Revised: 09/02/2021] [Accepted: 09/23/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To further define the epilepsy phenotype in a cohort of children with 15q13.3 microdeletion syndrome. METHODS We retrospectively reviewed the phenotypic spectrum of all children aged < 18 years with epilepsy and 15q13.3 microdeletion syndrome. RESULTS Thirteen children were included, 69% were female. The median age of children in the cohort was 12 years (age range: 3 years-15 years). Median age at seizure onset was 4 years. Eleven children (85%) had intellectual disability. Nine of 13 children (69%) had a history of typical absence seizures with median age of onset at 5 years (2 had absence status epilepticus). Thirty-one percent (4/13) had focal with impaired awareness non-motor onset seizures. ILAE recognized absence epilepsy syndromes were diagnosed in 6/13 (46%). The remainder were classified as having genetic generalized epilepsies with overlap clinical features, combined or focal epilepsies. Electroencephalogram in the cohort showed generalized (85%) and focal epileptiform discharges (62%) and posterior dominant rhythm slowing (33%). One child had electrical status epilepticus of sleep. Neuroimaging was performed in 5 children (38%) and revealed abnormal findings in 3. Seizures were drug resistant in a third of the cohort. Valproate resulted in seizure freedom in 5 (42%). Oxcarbazepine caused clinical worsening in one child with combined seizure types. Two children tried cannabidiol and one tried the ketogenic diet; neither was effective. CONCLUSIONS The epilepsy phenotype in children with 15q13.3 microdeletion syndrome is defined by childhood onset absence seizures, and may have atypical features such as, early onset absences, persistence into adolescence, status epilepticus, intellectual disability and treatment resistance. Focal seizures and focal EEG findings may be observed and should be treated cautiously, given the possibility of combined seizure types. Valproate appeared effective, although other treatments must be explored further.
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Affiliation(s)
- Robyn Whitney
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada.
| | - Arjun Nair
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Elizabeth McCready
- Division of Clinical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Anne E Keller
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Ishita Siddiq Adil
- Pediatric Neurology Clinic, Oakville, ON, Canada; Division of Neurology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Aly Shah Aziz
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada; Pediatric Neurology Clinic, Oakville, ON, Canada
| | - Oksana Borys
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada; Pediatric Neurology Clinic, Oakville, ON, Canada
| | - Kaitlyn Siu
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Chintan Shah
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Brandon F Meaney
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Kevin Jones
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada
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27
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Karoly PJ, Freestone DR, Eden D, Stirling RE, Li L, Vianna PF, Maturana MI, D'Souza WJ, Cook MJ, Richardson MP, Brinkmann BH, Nurse ES. Epileptic Seizure Cycles: Six Common Clinical Misconceptions. Front Neurol 2021; 12:720328. [PMID: 34421812 PMCID: PMC8371239 DOI: 10.3389/fneur.2021.720328] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Philippa J. Karoly
- Seer Medical, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Rachel E. Stirling
- Seer Medical, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Lyra Li
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Pedro F. Vianna
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Matias I. Maturana
- Seer Medical, Melbourne, VIC, Australia
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Wendyl J. D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark J. Cook
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark P. Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Benjamin H. Brinkmann
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Ewan S. Nurse
- Seer Medical, Melbourne, VIC, Australia
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
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28
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Clarke S, Karoly PJ, Nurse E, Seneviratne U, Taylor J, Knight-Sadler R, Kerr R, Moore B, Hennessy P, Mendis D, Lim C, Miles J, Cook M, Freestone DR, D'Souza W. Computer-assisted EEG diagnostic review for idiopathic generalized epilepsy. Epilepsy Behav 2021; 121:106556. [PMID: 31676240 DOI: 10.1016/j.yebeh.2019.106556] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 11/25/2022]
Abstract
Epilepsy diagnosis can be costly, time-consuming, and not uncommonly inaccurate. The reference standard diagnostic monitoring is continuous video-electroencephalography (EEG) monitoring, ideally capturing all events or concordant interictal discharges. Automating EEG data review would save time and resources, thus enabling more people to receive reference standard monitoring and also potentially heralding a more quantitative approach to therapeutic outcomes. There is substantial research into the automated detection of seizures and epileptic activity from EEG. However, automated detection software is not widely used in the clinic, and despite numerous published algorithms, few methods have regulatory approval for detecting epileptic activity from EEG. This study reports on a deep learning algorithm for computer-assisted EEG review. Deep convolutional neural networks were trained to detect epileptic discharges using a preexisting dataset of over 6000 labelled events in a cohort of 103 patients with idiopathic generalized epilepsy (IGE). Patients underwent 24-hour ambulatory outpatient EEG, and all data were curated and confirmed independently by two epilepsy specialists (Seneviratne et al., 2016). The resulting automated detection algorithm was then used to review diagnostic scalp EEG for seven patients (four with IGE and three with events mimicking seizures) to validate performance in a clinical setting. The automated detection algorithm showed state-of-the-art performance for detecting epileptic activity from clinical EEG, with mean sensitivity of >95% and corresponding mean false positive rate of 1 detection per minute. Importantly, diagnostic case studies showed that the automated detection algorithm reduced human review time by 80%-99%, without compromising event detection or diagnostic accuracy. The presented results demonstrate that computer-assisted review can increase the speed and accuracy of EEG assessment and has the potential to greatly improve therapeutic outcomes. This article is part of the Special Issue "NEWroscience 2018".
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Affiliation(s)
- Shannon Clarke
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia.
| | - Philippa J Karoly
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia; Graeme Clark Institute, The University of Melbourne, Building 261, 203 Bouverie Street, Carlton, VIC 3053, Australia
| | - Ewan Nurse
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
| | - Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, VIC 3800, Australia
| | - Janelle Taylor
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | | | - Robert Kerr
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Braden Moore
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Patrick Hennessy
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Dulini Mendis
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Claire Lim
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
| | - Jake Miles
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
| | - Mark Cook
- Graeme Clark Institute, The University of Melbourne, Building 261, 203 Bouverie Street, Carlton, VIC 3053, Australia
| | - Dean R Freestone
- Seer Medical, 278 Queensberry St., Melbourne, VIC 3000, Australia
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, VIC 3010, Australia
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Khalily MA, Akhtar M, Ali S, Rafique S, Sultan T, Wasim A. Spectrum of Electroencephalography Findings in Newly Diagnosed Epilepsy. Cureus 2021; 13:e15938. [PMID: 34336438 PMCID: PMC8312348 DOI: 10.7759/cureus.15938] [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] [Accepted: 06/26/2021] [Indexed: 11/05/2022] Open
Abstract
Background Epilepsy is a neurological disorder that presents with recurrent seizures associated with erratic brain activity which can be measured through EEG in addition to other neurological investigations. However, EEG may show abnormal patterns and waveforms while the patient is having a seizure which is crucial for making an accurate diagnosis. Objective This study aims to evaluate the spectrum of EEG findings in newly diagnosed epileptic patients as part of a neurological investigation. Material and methods This cross-sectional study was carried out at the Department of Paediatric Neurology, the Children's Hospital, and the Institute of Child Health, Lahore for six months. A sample of 122 patients was enrolled in this study with an age range of >1 month and <18 years, with a diagnosis of epilepsy based upon ≥2 unprovoked seizures that occurred ≥ 24 hours apart. After obtaining informed consent from the patients, a one-time EEG was carried out and details were noted such as type and frequency of the discharge, site of maximum amplitude, paroxysm morphology, and onset and offset (focal/generalized) of the discharges. The data was analyzed using SPSS v.25 (IBM SPSS Statistics for Windows, Armonk, NY). Results The mean age of children enrolled in this study was 5.58 ± 3.46 years. There were 70 (57.4%) males and 52 (42.6%) females. The mean age at the onset of seizures was 4.85 ± 3.16 years. Out of 122 children, focal onset aware epilepsy type was noted in 8 cases, focal onset impaired awareness was noted in 19 cases and generalized onset motor type of epilepsy was noted in 95 cases. Furthermore, EEG findings were normal in 41 (33.61%) patients; however, 81 (66.39%) EEG findings of the patients place them in the abnormal range. On EEG, paroxysm morphology was typical in 78 (96.3%) patients while atypical in 3 (3.7%) patients. Discharge spectrum was generalized in 46 (56.8%) patients, localized in 19 (23.5%) patients, bilateral independent in 1 (1.2%) patient and multifocal in 15 (18.5%) patients. Discharge pattern was periodic in seven (8.6%) cases, rhythmic delta activity was noted in 4 (4.9%) cases, spike and wave pattern was noted in 68 (84.0%) cases and sharp and wave pattern was observed in 36 (44.4%) patients. Conclusion Our study concluded that EEG findings were abnormal in 81 (66.39%) patients. Thus to make the recommendations locally and nationally, we observed that EEG can highlight the abnormal pattern and discharges in newly diagnosed individuals with epilepsy. Our findings could be instrumental to identify the type of EEG discharges in a timely fashion while making diagnoses and treatment plan protocols accordingly. This study finding recommends the early application of EEG after the presentation of epileptic symptoms by the patient. We further recommend that further similar studies be conducted in multiple tertiary care settings to reach a firm and valuable conclusion.
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Affiliation(s)
- Muhammad A Khalily
- Department of Pediatric Neurology, The Children's Hospital and The Institute Of Child Health, Lahore, PAK
| | - Muhammad Akhtar
- Department of Pediatric Neurology, The Children's Hospital and The Institute Of Child Health, Lahore, PAK
| | - Shaila Ali
- Department of Pediatric Neurology, The Children's Hospital and The Institute Of Child Health, Lahore, PAK
| | - Shumaila Rafique
- Department of Pediatric Neurology, The Children's Hospital and The Institute Of Child Health, Lahore, PAK
| | - Tipu Sultan
- Department of Pediatric Neurology, The Children's Hospital and The Institute Of Child Health, Lahore, PAK
| | - Areeba Wasim
- Department of Pediatric Neurology, The Children's Hospital and The Institute Of Child Health, Lahore, PAK
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30
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Hasan TF, Tatum WO. When should we obtain a routine EEG while managing people with epilepsy? Epilepsy Behav Rep 2021; 16:100454. [PMID: 34041475 PMCID: PMC8141667 DOI: 10.1016/j.ebr.2021.100454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022] Open
Abstract
More than eight decades after its discovery, routine electroencephalogram (EEG) remains a safe, noninvasive, inexpensive, bedside test of neurological function. Knowing when a routine EEG should be obtained while managing people with epilepsy is a critical aspect of optimal care. Despite advances in neuroimaging techniques that aid diagnosis of structural lesions in the central nervous system, EEG continues to provide critical diagnostic evidence with implications on treatment. A routine EEG performed after a first unprovoked seizure can support a clinical diagnosis of epilepsy and differentiate those without epilepsy, classify an epilepsy syndrome to impart prognosis, and characterize seizures for antiseizure management. Despite a current viral pandemic, EEG services continue, and the value of routine EEG is unchanged.
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Affiliation(s)
- Tasneem F. Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - William O. Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
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31
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Owolabi LF, Reda AA, Ahmed RE, Enwere OO, Adamu B, AlGhamdi M. Electroencephalography findings in childhood epilepsy in a Saudi population: Yield, pattern and determinants of abnormality. J Taibah Univ Med Sci 2021; 16:86-92. [PMID: 33603636 PMCID: PMC7858024 DOI: 10.1016/j.jtumed.2020.10.016] [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: 04/16/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The study was designed to evaluate the yield, pattern, and factors that are independently associated with electroencephalography (EEG) abnormalities in childhood epilepsy in a Saudi population. METHODS We characterised the features of the first EEG and evaluated the associated factors in children with epilepsy in a Saudi population. The features of interictal epileptiform discharges (interictal epileptiform activity (IEA)) adopted by the International Federation of Societies for Electroencephalography and Clinical Neurophysiology were used in the study. RESULT A total of 756 paediatric patients, comprised of 427 men (56.5%) and 329 women (43.5%) with a clinical diagnosis of epilepsy, underwent EEG. Clinically, seizure was generalised in 619 (81.9%) patients and focal in 137 (18.1%). Among the patients, 397 (52.51%) had an abnormal EEG, while EEG was normal in 359 (47.49%) patients. Seizure frequency, gender, family history of epilepsy, and age were independent predictors of the presence of EEG abnormalities. CONCLUSION This study revealed a yield of 52% abnormal EEG findings in children with epilepsy. Age, gender, family history, and seizure frequency were independent predictors of the presence of EEG abnormalities in childhood epilepsy.
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Affiliation(s)
- Lukman F Owolabi
- Department of Medicine, College of Medicine, University of Bisha, Bisha, KSA
| | - AbdulRazeq A Reda
- Department of Medicine, College of Medicine, University of Bisha, Bisha, KSA
| | - Raafat E Ahmed
- Department of Medicine, King Abdullah Hospital, Bisha, KSA
| | | | - Bappa Adamu
- Department of Medicine, College of Medicine, University of Bisha, Bisha, KSA
| | - Mushabab AlGhamdi
- Department of Medicine, College of Medicine, University of Bisha, Bisha, KSA
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32
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Haki C, Akdogan O, Bora IH. DIAGNOSTIC DIFFICULTIES IN PATIENTS WITH JUVENILE MYOCLONIC EPILEPSY. SANAMED 2020. [DOI: 10.24125/sanamed.v15i3.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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33
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Owolabi LF, Reda AA, El Sayed R, Morsy DFM, Enwere OO, Mba UA, Adamu B, AlGhamdi M. Study of electroencephalography in people with generalized epilepsy in a Saudi population. J Community Hosp Intern Med Perspect 2020; 10:549-554. [PMID: 33194127 PMCID: PMC7599013 DOI: 10.1080/20009666.2020.1809255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Bappa Adamu
- College of Medicine, University of Bisha, Bisha, Saudi Arabia
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34
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Hatton SN, Huynh KH, Bonilha L, Abela E, Alhusaini S, Altmann A, Alvim MKM, Balachandra AR, Bartolini E, Bender B, Bernasconi N, Bernasconi A, Bernhardt B, Bargallo N, Caldairou B, Caligiuri ME, Carr SJA, Cavalleri GL, Cendes F, Concha L, Davoodi-bojd E, Desmond PM, Devinsky O, Doherty CP, Domin M, Duncan JS, Focke NK, Foley SF, Gambardella A, Gleichgerrcht E, Guerrini R, Hamandi K, Ishikawa A, Keller SS, Kochunov PV, Kotikalapudi R, Kreilkamp BAK, Kwan P, Labate A, Langner S, Lenge M, Liu M, Lui E, Martin P, Mascalchi M, Moreira JCV, Morita-Sherman ME, O’Brien TJ, Pardoe HR, Pariente JC, Ribeiro LF, Richardson MP, Rocha CS, Rodríguez-Cruces R, Rosenow F, Severino M, Sinclair B, Soltanian-Zadeh H, Striano P, Taylor PN, Thomas RH, Tortora D, Velakoulis D, Vezzani A, Vivash L, von Podewils F, Vos SB, Weber B, Winston GP, Yasuda CL, Zhu AH, Thompson PM, Whelan CD, Jahanshad N, Sisodiya SM, McDonald CR. White matter abnormalities across different epilepsy syndromes in adults: an ENIGMA-Epilepsy study. Brain 2020; 143:2454-2473. [PMID: 32814957 PMCID: PMC7567169 DOI: 10.1093/brain/awaa200] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/07/2020] [Accepted: 04/30/2020] [Indexed: 12/22/2022] Open
Abstract
The epilepsies are commonly accompanied by widespread abnormalities in cerebral white matter. ENIGMA-Epilepsy is a large quantitative brain imaging consortium, aggregating data to investigate patterns of neuroimaging abnormalities in common epilepsy syndromes, including temporal lobe epilepsy, extratemporal epilepsy, and genetic generalized epilepsy. Our goal was to rank the most robust white matter microstructural differences across and within syndromes in a multicentre sample of adult epilepsy patients. Diffusion-weighted MRI data were analysed from 1069 healthy controls and 1249 patients: temporal lobe epilepsy with hippocampal sclerosis (n = 599), temporal lobe epilepsy with normal MRI (n = 275), genetic generalized epilepsy (n = 182) and non-lesional extratemporal epilepsy (n = 193). A harmonized protocol using tract-based spatial statistics was used to derive skeletonized maps of fractional anisotropy and mean diffusivity for each participant, and fibre tracts were segmented using a diffusion MRI atlas. Data were harmonized to correct for scanner-specific variations in diffusion measures using a batch-effect correction tool (ComBat). Analyses of covariance, adjusting for age and sex, examined differences between each epilepsy syndrome and controls for each white matter tract (Bonferroni corrected at P < 0.001). Across 'all epilepsies' lower fractional anisotropy was observed in most fibre tracts with small to medium effect sizes, especially in the corpus callosum, cingulum and external capsule. There were also less robust increases in mean diffusivity. Syndrome-specific fractional anisotropy and mean diffusivity differences were most pronounced in patients with hippocampal sclerosis in the ipsilateral parahippocampal cingulum and external capsule, with smaller effects across most other tracts. Individuals with temporal lobe epilepsy and normal MRI showed a similar pattern of greater ipsilateral than contralateral abnormalities, but less marked than those in patients with hippocampal sclerosis. Patients with generalized and extratemporal epilepsies had pronounced reductions in fractional anisotropy in the corpus callosum, corona radiata and external capsule, and increased mean diffusivity of the anterior corona radiata. Earlier age of seizure onset and longer disease duration were associated with a greater extent of diffusion abnormalities in patients with hippocampal sclerosis. We demonstrate microstructural abnormalities across major association, commissural, and projection fibres in a large multicentre study of epilepsy. Overall, patients with epilepsy showed white matter abnormalities in the corpus callosum, cingulum and external capsule, with differing severity across epilepsy syndromes. These data further define the spectrum of white matter abnormalities in common epilepsy syndromes, yielding more detailed insights into pathological substrates that may explain cognitive and psychiatric co-morbidities and be used to guide biomarker studies of treatment outcomes and/or genetic research.
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Affiliation(s)
- Sean N Hatton
- Department of Neurosciences, Center for Multimodal Imaging and Genetics,
University of California San Diego, La Jolla 92093 CA, USA
| | - Khoa H Huynh
- Center for Multimodal Imaging and Genetics, University of California San
Diego, La Jolla 92093 CA, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina,
Charleston 29425 SC, USA
| | - Eugenio Abela
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry,
Psychology and Neuroscience, Kings College London, London SE5 9NU UK
| | - Saud Alhusaini
- Neurology Department, Yale School of Medicine, New Haven 6510 CT,
USA
- Molecular and Cellular Therapeutics, The Royal College of Surgeons in
Ireland, Dublin, Ireland
| | - Andre Altmann
- Centre of Medical Image Computing, Department of Medical Physics and Biomedical
Engineering, University College London, London WC1V 6LJ, UK
| | - Marina K M Alvim
- Department of Neurology, University of Campinas - UNICAMP, Campinas 13083-888
São Paulo, Brazil
| | - Akshara R Balachandra
- Center for Multimodal Imaging and Genetics, UCSD School of
Medicine, La Jolla 92037 CA, USA
- Boston University School of Medicine, Boston 2118 MA, USA
| | - Emanuele Bartolini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories,
Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano,
Prato, Italy
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital
Tübingen, Tübingen 72076, Germany
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill
University, Montreal H3A 2B4 QC, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill
University, Montreal H3A 2B4 QC, Canada
| | - Boris Bernhardt
- Montreal Neurological Institute, McGill University, Montreal
H3A2B4 QC, Canada
| | - Núria Bargallo
- Magnetic Resonance Image Core Facility, Institut d’Investigacions Biomèdiques
August Pi i Sunyer (IDIBAPS), Barcelona 8036 Barcelona, Spain
| | - Benoit Caldairou
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill
University, Montreal H3A 2B4 QC, Canada
| | - Maria E Caligiuri
- Neuroscience Research Center, University Magna Graecia, viale Europa,
Germaneto, 88100, Catanzaro, Italy
| | - Sarah J A Carr
- Neuroscience, Institute of Psychiatry, Psychology and
Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Gianpiero L Cavalleri
- Royal College of Surgeons in Ireland, School of Pharmacy and Biomolecular
Sciences, Dublin D02 YN77 Ireland
- FutureNeuro Research Centre, Science Foundation Ireland, Dublin
D02 YN77, Ireland
| | - Fernando Cendes
- Department of Neurology, University of Campinas - UNICAMP, Campinas 13083-888
São Paulo, Brazil
| | - Luis Concha
- Institute of Neurobiology, Universidad Nacional Autonoma de
Mexico, Queretaro 76230, Mexico
| | - Esmaeil Davoodi-bojd
- Radiology and Research Administration, Henry Ford Hospital, 1
Detroit 48202 MI, USA
| | - Patricia M Desmond
- Department of Radiology, Royal Melbourne Hospital, University of
Melbourne, Melbourne 3050 Victoria, Australia
| | | | - Colin P Doherty
- Division of Neurology, Trinity College Dublin, TBSI, Pearce
Street, Dublin D02 R590, Ireland
- FutureNeuro SFI Centre for Neurological Disease, RCSI, St Stephen’s
Green, Dublin D02 H903, Ireland
| | - Martin Domin
- Functional Imaging Unit, University Medicine Greifswald,
Greifswald 17475 M/V, Germany
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of
Neurology, Queen Square, London WC1N 3BG, UK
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont-St-Peter,
Buckinghamshire SL9 0RJ, UK
| | - Niels K Focke
- Clinical Neurophysiology, University Medicine Göttingen, 37099
Göttingen, Germany
- Department of Epileptology, University of Tübingen, 72076
Tübingen, Germany
| | | | - Antonio Gambardella
- Royal College of Surgeons in Ireland, School of Pharmacy and Biomolecular
Sciences, Dublin D02 YN77 Ireland
- Institute of Neurology, University Magna Graecia, 88100,
Catanzaro, Italy
| | | | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories,
Children’s Hospital A. Meyer-University of Florence, Florence, Italy
| | - Khalid Hamandi
- The Wales Epilepsy Unit, Cardiff and Vale University Health
Board, Cardiff CF144XW, UK
- Brain Research Imaging Centre, Cardiff University, Cardiff CF24
4HQ, UK
| | - Akari Ishikawa
- Department of Neurology, University of Campinas - UNICAMP, Campinas 13083-888
São Paulo, Brazil
| | - Simon S Keller
- Institute of Translational Medicine, University of Liverpool,
Liverpool L69 3BX, UK
- Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Peter V Kochunov
- Maryland Psychiatric Research Center, 55 Wade Ave, Baltimore
21228, MD, USA
| | - Raviteja Kotikalapudi
- Department of Neurology and Epileptology, University Hospital
Tübingen, Tübingen 72076 BW, Germany
- Department of Diagnostic and Interventional Neuroradiology, University Hospital
Tübingen, Tübingen 72076 BW, Germany
| | - Barbara A K Kreilkamp
- Institute of Translational Medicine, University of Liverpool,
Liverpool L69 3BX, UK
- Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash
University, Melbourne 3004 Victoria, Australia
- Department of Medicine, University of Melbourne, Royal Melbourne
Hospital, Parkville 3050 Victoria, Australia
| | - Angelo Labate
- Neuroscience Research Center, University Magna Graecia, viale Europa,
Germaneto, 88100, Catanzaro, Italy
- Institute of Neurology, University Magna Graecia, 88100,
Catanzaro, Italy
| | - Soenke Langner
- Institute for Diagnostic Radiology and Neuroradiology, Ernst Moritz Arndt
University Greifswald Faculty of Medicine, Greifswald 17475, Germany
- Institute for Diagnostic and Interventional Radiology, Pediatric and
Neuroradiology, Rostock University Medical Centre, Rostock 18057, Germany
| | - Matteo Lenge
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories,
Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Children’s Hospital A.
Meyer-University of Florence, Florence 50139, Italy
| | - Min Liu
- Department of Neurology, Montreal Neurological Institute,
Montreal H3A 2B4 QC, Canada
| | - Elaine Lui
- Department of Radiology, Royal Melbourne Hospital, University of
Melbourne, Melbourne 3050 Victoria, Australia
- Department of Medicine and Radiology, University of Melbourne,
3Parkville 3050 Victoria, Australia
| | - Pascal Martin
- Department of Epileptology, University of Tübingen, 72076
Tübingen, Germany
| | - Mario Mascalchi
- Meyer Children Hospital University of Florence, Florence 50130
Tuscany, Italy
| | - José C V Moreira
- Department of Neurology, University of Campinas - UNICAMP, Campinas 13083-888
São Paulo, Brazil
| | - Marcia E Morita-Sherman
- Department of Neurology, University of Campinas - UNICAMP, Campinas 13083-888
São Paulo, Brazil
- Cleveland Clinic, Cleveland 44195 OH, USA
| | - Terence J O’Brien
- Department of Neuroscience, Central Clinical School, Monash
University, Melbourne 3004 Victoria, Australia
- Department of Medicine, University of Melbourne, Royal Melbourne
Hospital, Parkville 3050 Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne 3004 Victoria,
Australia
| | - Heath R Pardoe
- Department of Neurology, New York University School of Medicine,
New York City 10016 NY, USA
| | - José C Pariente
- Magnetic Resonance Image Core Facility, Institut d’Investigacions Biomèdiques
August Pi i Sunyer (IDIBAPS), Barcelona 8036 Barcelona, Spain
| | - Letícia F Ribeiro
- Department of Neurology, University of Campinas - UNICAMP, Campinas 13083-888
São Paulo, Brazil
| | - Mark P Richardson
- Division of Neuroscience, King’s College London, Institute of
Psychiatry, London SE5 8AB, UK
| | - Cristiane S Rocha
- Department of Neurology, University of Campinas - UNICAMP, Campinas 13083-888
São Paulo, Brazil
| | - Raúl Rodríguez-Cruces
- Montreal Neurological Institute, McGill University, Montreal
H3A2B4 QC, Canada
- Institute of Neurobiology, Universidad Nacional Autonoma de
Mexico, Queretaro 76230, Mexico
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt,
Germany, Frankfurt 60528 Hesse, Germany
- Center for Personalized Translational Epilepsy Research (CePTER),
Goethe-University Frankfurt, Frankfurt a. M. 60528, Germany
| | - Mariasavina Severino
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa 16147
Liguria, Italy
| | - Benjamin Sinclair
- Department of Medicine, University of Melbourne, Royal Melbourne
Hospital, Parkville 3050 Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne 3004 Victoria,
Australia
| | - Hamid Soltanian-Zadeh
- Radiology and Research Administration, Henry Ford Health System,
Detroit 48202-2692 MI, USA
- School of Electrical and Computer Engineering, University of
Tehran, Tehran 14399-57131, Iran
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genoa 16147 Liguria, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal
and Child Health, University of Genova, Genova, Italy
| | - Peter N Taylor
- School of Computing, Newcastle University, Urban Sciences Building, Science
Square, Newcastle upon Tyne NE4 5TG, UK
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle
University, Newcastle upon Tyne NE2 4HH, UK
- Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Domenico Tortora
- Radiology and Research Administration, Henry Ford Health System,
Detroit 48202-2692 MI, USA
| | - Dennis Velakoulis
- Royal Melbourne Hospital, Melbourne 3050 Victoria, Australia
- University of Melbourne, Parkville, Melbourne 3050 Victoria,
Australia
| | - Annamaria Vezzani
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano
20156 Italy
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Monash
University, Melbourne 3004 Victoria, Australia
- Department of Medicine, University of Melbourne, Royal Melbourne
Hospital, Parkville 3050 Victoria, Australia
| | - Felix von Podewils
- Epilepsy Center, University Medicine Greifswald, Greifswald 17489
Mecklenburg-Vorpommern, Germany
| | - Sjoerd B Vos
- Centre for Medical Image Computing, University College London,
London, WC1V 6LJ, UK
- Epilepsy Society, MRI Unit, Chalfont St Peter, Buckinghamshire,
SL9 0RJ, UK
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University of
Bonn, Venusberg Campus 1, Bonn 53127 NRW, Germany
| | - Gavin P Winston
- Epilepsy Society, MRI Unit, Chalfont St Peter, Buckinghamshire,
SL9 0RJ, UK
- Department of Medicine, Division of Neurology, Queen's
University, Kingston K7L 3N6 ON, Canada
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont-St-Peter,
Buckinghamshire, SL9 0RJ UK
| | - Clarissa L Yasuda
- Department of Neurology, University of Campinas - UNICAMP, Campinas 13083-888
São Paulo, Brazil
| | - Alyssa H Zhu
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and
Informatics, USC Keck School of Medicine, Los Angeles 90232 CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and
Informatics, USC Keck School of Medicine, Los Angeles 90232 CA, USA
| | - Christopher D Whelan
- Molecular and Cellular Therapeutics, The Royal College of Surgeons in
Ireland, Dublin, Ireland
- Research and Early Development (RED), Biogen Inc., Cambridge, MA
02139, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and
Informatics, USC Keck School of Medicine, Los Angeles 90232 CA, USA
| | - Sanjay M Sisodiya
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont-St-Peter,
Buckinghamshire, SL9 0RJ UK
- Chalfont Centre for Epilepsy, Chalfont-St-Peter, SL9 0RJ Bucks,
UK
| | - Carrie R McDonald
- Department of Psychiatry, Center for Multimodal Imaging and Genetics,
University of California San Diego, La Jolla 92093 CA, USA
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Al-Asmi A, Poothrikovil RP, Nandhagopal R, Al-Zakwani I, Al-Futaisi A, Al-Abri M, Gujjar AR. Clinico-electrographic characteristics and classification of genetic generalized epilepsy in Oman. Epilepsy Res 2020; 166:106380. [PMID: 32590287 DOI: 10.1016/j.eplepsyres.2020.106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a lack of information on the annual incidence of genetic generalized epilepsy (GGE) in the Arab countries, especially Oman. Ascertaining the true burden of illness has crucial implications for health policies and priorities. We aim to study the clinico-electrographic characteristics, classification, and annual incidence of GGE in Oman. METHOD Using the cross-sectional data of EEGs obtained from all patients with GGE who presented to Sultan Qaboos University hospital (major referral center for epilepsy in Oman) from January 2007 to June 2014. Analyses were performed using univariate statistics. RESULTS Approximately 10,423 patients had EEG studies during the study period of which 376 patients (3.6 %) had EEG abnormalities suggestive of GGE. Forty two percent of the 376 GGE patients were male with ages ranging from 3 to 58 years. We were able to classify 273 patients to one of the GGE syndromes. Forty-three percent of 130 patients had a positive family history of epilepsy in their first or second-degree relatives. The generalized tonic-clonic seizure was the most common seizure type observed in 242 patients (64 %; 95 %CI: 59.2 %-68.9 %). Juvenile myoclonic epilepsy was the most common epilepsy syndrome (41 % of the total GGE patients) encountered in our region. A significant female predominance (9.7 % vs 2.5 %; p = 0.016) was observed in juvenile absence epilepsy. Certain interictal focal EEG abnormalities did not exclude a diagnosis of GGE. An average annual GGE incidence of 2.9 % (95 % CI: 2.6 %-3.2 %) was observed during the study period. CONCLUSION This hospital-based study is the first of its kind in the Arabian Gulf region, classifying the different subcategories of GGE. Our results indicate that GGE is a common epilepsy subtype in Oman. A prospective population-based epidemiological study is required to estimate the precise frequency of GGE in Oman.
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Affiliation(s)
- Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | | | - Ramachandiran Nandhagopal
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Amna Al-Futaisi
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Abri
- Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Arunodaya R Gujjar
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Hamdy MM, Elfatatry AM, Mekky JF, Hamdy E. Rapid eye movement (REM) sleep and seizure control in idiopathic generalized epilepsy. Epilepsy Behav 2020; 107:107064. [PMID: 32320932 DOI: 10.1016/j.yebeh.2020.107064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/01/2020] [Accepted: 03/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sleep and epilepsy are bedfellows, and they affect each other reciprocally. Despite the well-known relationship between sleep and epilepsy, data about the impact of sleep on seizure control and responsiveness to therapy are scarce. OBJECTIVE The aim of this work was to study the impact of sleep architecture in drug-naïve patients with idiopathic generalized epilepsy (IGE) on seizure control and responsiveness to treatment. METHODS This is a prospective cohort study conducted on thirty newly diagnosed patients with IGE attending the epilepsy clinic in Alexandria University Hospital in Egypt and thirty healthy controls. All recruited subjects had a baseline overnight polysomnographic study, then patients were given sodium valproate in therapeutic doses and followed up for six months for assessment of seizure control. After follow-up, they were classified into fully controlled and inadequately controlled patients, and a comparison between them was made. RESULTS Of the recruited patients, 13 were fully controlled. Rapid eye movement (REM) sleep % was significantly lower among inadequately controlled patients (9.01 ± 6.23) than fully controlled group (19.6 ± 9.01) and controls (18.17 ± 4.85) (p = 0.002), and the REM sleep latency was significantly longer among the inadequately controlled patients (115.7 ± 72.8 min) than fully controlled patients (54.6 ± 77.3 min) and controls (68.75 ± 37.95 min) (p = 011). On univariate regression analysis, the Odd's ratio (OR) for REM sleep percentage was 3.04 (p = 0.001). CONCLUSION Rapid eye movement sleep percentage and latency can contribute to seizure control in IGE.
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Affiliation(s)
- Mohamed M Hamdy
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
| | - Amr M Elfatatry
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
| | - Jaidaa F Mekky
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
| | - Eman Hamdy
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt.
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Routley B, Shaw A, Muthukumaraswamy SD, Singh KD, Hamandi K. Juvenile myoclonic epilepsy shows increased posterior theta, and reduced sensorimotor beta resting connectivity. Epilepsy Res 2020; 163:106324. [PMID: 32335503 PMCID: PMC7684644 DOI: 10.1016/j.eplepsyres.2020.106324] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 12/16/2022]
Abstract
We investigated whole brain source space connectivity in JME using across standard MEG frequency bands. Connectivity was increased in posterior theta and alpha bands in JME, and decreased in sensorimotor beta band. Our findings highlight altered interactions between posterior networks of arousal and attention and the motor system in JME.
Background Widespread structural and functional brain network changes have been shown in Juvenile Myoclonic Epilepsy (JME) despite normal clinical neuroimaging. We sought to better define these changes using magnetoencephalography (MEG) and source space connectivity analysis for optimal neurophysiological and anatomical localisation. Methods We consecutively recruited 26 patients with JME who underwent resting state MEG recording, along with 26 age-and-sex matched controls. Whole brain connectivity was determined through correlation of Automated Anatomical Labelling (AAL) atlas source space MEG timeseries in conventional frequency bands of interest delta (1−4 Hz), theta (4−8 Hz), alpha (8−13 Hz), beta (13−30 Hz) and gamma (40−60 Hz). We used a Linearly Constrained Minimum Variance (LCMV) beamformer to extract voxel wise time series of ‘virtual sensors’ for the desired frequency bands, followed by connectivity analysis using correlation between frequency- and node-specific power fluctuations, for the voxel maxima in each AAL atlas label, correcting for noise, potentially spurious connections and multiple comparisons. Results We found increased connectivity in the theta band in posterior brain regions, surviving statistical correction for multiple comparisons (corrected p < 0.05), and decreased connectivity in the beta band in sensorimotor cortex, between right pre- and post- central gyrus (p < 0.05) in JME compared to controls. Conclusions Altered resting-state MEG connectivity in JME comprised increased connectivity in posterior theta – the frequency band associated with long range connections affecting attention and arousal - and decreased beta-band sensorimotor connectivity. These findings likely relate to altered regulation of the sensorimotor network and seizure prone states in JME.
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Affiliation(s)
- Bethany Routley
- Cardiff University Brain Research Imaging, School of Psychology, Cardiff University, United Kingdom
| | - Alexander Shaw
- Cardiff University Brain Research Imaging, School of Psychology, Cardiff University, United Kingdom
| | - Suresh D Muthukumaraswamy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Krish D Singh
- Cardiff University Brain Research Imaging, School of Psychology, Cardiff University, United Kingdom
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging, School of Psychology, Cardiff University, United Kingdom; The Wales Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, United Kingdom.
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Abstract
Identifying the localization, distribution, and polarity of waveforms are the prime goals of clinical scalp EEG analysis. Appropriate choices of bipolar and referential montages are keys to emphasizing the diagnostic features of interest, and demand some understanding of the spatiotemporal physical behavior of the underlying neuronal generators. Several examples drawn from canonical epilepsy syndromes are used to illustrate this general message.
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Loonen ICM, Jansen NA, Cain SM, Schenke M, Voskuyl RA, Yung AC, Bohnet B, Kozlowski P, Thijs RD, Ferrari MD, Snutch TP, van den Maagdenberg AMJM, Tolner EA. Brainstem spreading depolarization and cortical dynamics during fatal seizures in Cacna1a S218L mice. Brain 2019; 142:412-425. [PMID: 30649209 DOI: 10.1093/brain/awy325] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/29/2018] [Indexed: 12/26/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a fatal complication of epilepsy in which brainstem spreading depolarization may play a pivotal role, as suggested by animal studies. However, patiotemporal details of spreading depolarization occurring in relation to fatal seizures have not been investigated. In addition, little is known about behavioural and neurophysiological features that may discriminate spontaneous fatal from non-fatal seizures. Transgenic mice carrying the missense mutation S218L in the α1A subunit of Cav2.1 (P/Q-type) Ca2+ channels exhibit enhanced excitatory neurotransmission and increased susceptibility to spreading depolarization. Homozygous Cacna1aS218L mice show spontaneous non-fatal and fatal seizures, occurring throughout life, resulting in reduced life expectancy. To identify characteristics of fatal and non-fatal spontaneous seizures, we compared behavioural and electrophysiological seizure dynamics in freely-behaving homozygous Cacna1aS218L mice. To gain insight on the role of brainstem spreading depolarization in SUDEP, we studied the spatiotemporal distribution of spreading depolarization in the context of seizure-related death. Spontaneous and electrically-induced seizures were investigated by video monitoring and electrophysiological recordings in freely-behaving Cacna1aS218L and wild-type mice. Homozygous Cacna1aS218L mice showed multiple spontaneous tonic-clonic seizures and died from SUDEP in adulthood. Death was preceded by a tonic-clonic seizure terminating with hindlimb clonus, with suppression of cortical neuronal activity during and after the seizure. Induced seizures in freely-behaving homozygous Cacna1aS218L mice were followed by multiple spreading depolarizations and death. In wild-type or heterozygous Cacna1aS218L mice, induced seizures and spreading depolarization were never followed by death. To identify temporal and regional features of seizure-induced spreading depolarization related to fatal outcome, diffusion-weighted MRI was performed in anaesthetized homozygous Cacna1aS218L and wild-type mice. In homozygous Cacna1aS218L mice, appearance of seizure-related spreading depolarization in the brainstem correlated with respiratory arrest that was followed by cardiac arrest and death. Recordings in freely-behaving homozygous Cacna1aS218L mice confirmed brainstem spreading depolarization during spontaneous fatal seizures. These data underscore the value of the homozygous Cacna1aS218L mouse model for identifying discriminative features of fatal compared to non-fatal seizures, and support a key role for cortical neuronal suppression and brainstem spreading depolarization in SUDEP pathophysiology.
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Affiliation(s)
- Inge C M Loonen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Jansen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stuart M Cain
- Michael Smith Laboratories and Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Maarten Schenke
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A Voskuyl
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew C Yung
- UBC MRI Research Center, University of British Columbia, Vancouver, Canada
| | - Barry Bohnet
- UBC MRI Research Center, University of British Columbia, Vancouver, Canada
| | - Piotr Kozlowski
- UBC MRI Research Center, University of British Columbia, Vancouver, Canada
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,SEIN Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Terrance P Snutch
- Michael Smith Laboratories and Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Arn M J M van den Maagdenberg
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Else A Tolner
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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EEG changes in patients on antipsychotic therapy: A systematic review. Epilepsy Behav 2019; 95:1-9. [PMID: 30999157 DOI: 10.1016/j.yebeh.2019.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/02/2019] [Accepted: 02/10/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The objective of the study was to characterize the electroencephalogram (EEG) changes associated with different antipsychotic medications based on the evidence from the literature. METHODS A systematic search of the databases Medline, PsycINFO, and PubMed was conducted. The Preferred Items Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the construction of this systematic review. Primary research articles that reported descriptive EEG results, included comparisons of subjects with and without antipsychotic therapy, and excluded patients with epilepsy were included in the analysis. The outcome was the presence of epileptiform discharges or slowing on EEG. We analyzed pooled data, where possible, from studies with a similar intervention and methodology. RESULTS Fourteen articles reporting on a total of 665 patients were reviewed. Among the publications, clozapine was the drug most consistently accompanied by EEG slowing and epileptiform discharges, with an odds ratio of 16.9 (95% confidence intervals (CI): 5.4 to 53.2) and 6.2 (95% CI: 3.4 to 11.3), respectively in the analysis of pooled data. Only one study reported a significant increase in epileptiform discharges with phenothiazine antipsychotic therapy as a group, but the impact of individual drugs was not analyzed separately. CONCLUSIONS This systematic review suggests that, among antipsychotics, clozapine most frequently induces EEG slowing and epileptiform discharges. There remains limited data with respect to other individual antipsychotic agents and covariates including drug dose, plasma levels, dose adjustments, and treatment duration that influence EEG changes.
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Sun Y, Seneviratne U, Perucca P, Chen Z, Kee MT, O'Brien TJ, D'Souza W, Kwan P. Generalized polyspike train: An EEG biomarker of drug-resistant idiopathic generalized epilepsy. Neurology 2018; 91:e1822-e1830. [PMID: 30315071 DOI: 10.1212/wnl.0000000000006472] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 08/01/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify clinical and EEG biomarkers of drug resistance in adults with idiopathic generalized epilepsy. METHODS We conducted a case-control study consisting of a discovery cohort and a replication cohort independently assessed at 2 different centers. In each center, patients with the idiopathic generalized epilepsy phenotype and generalized spike-wave discharges on EEG were classified as drug-resistant or drug-responsive. EEG changes were classified into predefined patterns and compared between the 2 groups in the discovery cohort. Factors associated with drug resistance in multivariable analysis were tested in the replication cohort. RESULTS The discovery cohort included 85 patients (29% drug-resistant and 71% drug-responsive). Their median age at assessment was 32 years and 50.6% were female. Multivariable analysis showed that higher number of seizure types ever experienced (3 vs 1: odds ratio [OR] = 31.1, 95% confidence interval [CI]: 4.5-214, p < 0.001; 3 vs 2: OR = 14.6, 95% CI: 2.3-93.1, p = 0.004) and generalized polyspike train (burst of generalized rhythmic spikes lasting less than 1 second) during sleep were associated with drug resistance (OR = 10.8, 95% CI: 2.4-49.4, p = 0.002). When these factors were tested in the replication cohort of 80 patients (27.5% drug-resistant and 72.5% drug-responsive; 71.3% female; median age 27.5 years), the proportion of patients with generalized polyspike train during sleep was also higher in the drug-resistant group (OR = 4.0, 95% CI: 1.35-11.8, p = 0.012). CONCLUSION Generalized polyspike train during sleep may be an EEG biomarker for drug resistance in adults with idiopathic generalized epilepsy.
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Affiliation(s)
- Yanping Sun
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Udaya Seneviratne
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Piero Perucca
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Zhibin Chen
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Meng Tan Kee
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Terence J O'Brien
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia.
| | - Wendyl D'Souza
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Patrick Kwan
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia.
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Abstract
PURPOSE To evaluate EEG differences among syndromes in genetic generalized epilepsy based on quantified data. METHODS Twenty-four-hour ambulatory EEGs were recorded in consecutive patients diagnosed with genetic generalized epilepsy. All epileptiform EEG abnormalities were quantified into density scores (total duration of epileptiform discharges per hour). One-way analysis of variance was conducted to find out differences in EEG density scores among the syndromes. Generalized linear mixed models were also fitted to explore the association between the proportion of "pure" generalized spike-wave paroxysms and fragments (without intervening polyspikes/polyspike-waves) and the syndromes. RESULTS In total, 6,923 epileptiform discharges were analyzed from 105 abnormal EEGs. In the analysis of variance, six EEG variables were significantly different among syndromes: total spike density (P = 0.001), total polyspike and polyspike-wave density (P = 0.049), generalized spike-wave-only density (P < 0.001), generalized paroxysm density (P < 0.001), generalized paroxysm duration mean (P = 0.018), and generalized paroxysm duration maximum (P = 0.009). The density of epileptiform discharges and the paroxysm durations were the highest in juvenile absence epilepsy followed by juvenile myoclonic epilepsy, childhood absence epilepsy, and generalized epilepsy with tonic-clonic seizures only. Generalized linear mixed models revealed that "pure" generalized spike-wave discharges (without intervening polyspikes/polyspike waves) tended to be more frequent in absence epilepsies, although the difference was not statistically significant (P = 0.21). CONCLUSIONS The findings of this study suggest that the density and duration of epileptiform discharges can help differentiate among genetic generalized epilepsy syndromes.
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43
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Tatum W, Rubboli G, Kaplan P, Mirsatari S, Radhakrishnan K, Gloss D, Caboclo L, Drislane F, Koutroumanidis M, Schomer D, Kasteleijn-Nolst Trenite D, Cook M, Beniczky S. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clin Neurophysiol 2018; 129:1056-1082. [DOI: 10.1016/j.clinph.2018.01.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 12/20/2022]
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44
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Owolabi LF, Sale S, Owolabi SD, Nalado A, Umar M, Taura AA. Electroencephalography abnormalities in generalized epilepsy and their predictors: A multicenter experience. Ann Afr Med 2018. [PMID: 29536959 PMCID: PMC5875121 DOI: 10.4103/aam.aam_2_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: In spite of the overwhelming significance of knowledge of basic elements of electroencephalography (EEG) in its application to the diagnostic workup and the management of patients with suspected or already established generalized epilepsy (GE), there is a dearth of data on the pattern and utility of clinical variables that can independently determine EEG abnormalities in GE. Objective: The study was designed to evaluate the frequency and pattern of EEG abnormality as well as assess the utility of clinical variables in predicting the likelihood of an abnormal EEG in GE. Methods: It was a cross-sectional study involving the analysis of EEGs of consecutive patients with clinical diagnosis of idiopathic GE from three centers over a 7-year period. Information on sociodemographic and seizure variables was obtained. The International Federation of Societies for Electroencephalography and Clinical Neurophysiology definition of interictal epileptiform discharges (interictal epileptiform activity [IEA]) was adopted in the study. Results: A total of 403 patients comprising 242 (60%) males and 161 (40%) females with clinical diagnosis of GE had EEG. Their age ranged between 2 weeks and 70 years, with a median age of 21 years and an interquartile age of 26 years. Two hundred and thirty-seven (58.8%) and 213 (52.9%) patients had abnormal EEG and IEA, respectively. Before adjustment for confounders, female gender (P = 0.0001), pediatric age group (P = 0.0388), duration of epilepsy of 1–4 years (P = 0.01387), uncontrolled seizure (P = 0.0060), and seizure frequency (P = 0.0001) were significantly associated with the presence of abnormal EEG. However, age, female gender, poor seizure control, and seizure frequencies were the independent predictors of EEG abnormality. Conclusion: The study showed that about 58% of patients with GE patients had abnormal EEG. Age, poor seizure control, and high frequency of seizure were independent predictors of the presence of EEG abnormality.
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Affiliation(s)
- Lukman Femi Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Shehu Sale
- Department of Psychiatry, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | | | - Aisha Nalado
- Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Muhammad Umar
- Department of Psychiatry, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Aminu Abdullahi Taura
- Department of Psychiatry, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
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45
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Seneviratne U, Boston RC, Cook MJ, D'Souza WJ. Characteristics of Epileptiform Discharge Duration and Interdischarge Interval in Genetic Generalized Epilepsies. Front Neurol 2018. [PMID: 29520250 PMCID: PMC5827541 DOI: 10.3389/fneur.2018.00036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We sought to investigate (1) the characteristics of epileptiform discharge (ED) duration and interdischarge interval (IDI) and (2) the influence of vigilance state on the ED duration and IDI in genetic generalized epilepsy (GGE). In a cohort of patients diagnosed with GGE, 24-h ambulatory EEG recordings were performed prospectively. We then tabulated durations, IDI, and vigilance state in relation to all EDs captured on EEGs. We used K-means cluster analysis and finite mixture modeling to quantify and characterize the groups of ED duration and IDI. To investigate the influence of sleep, we calculated the mean, median, and SEM in each population from all subjects for sleep state and wakefulness separately, followed by the Kruskal–Wallis test to compare the groups. We analyzed 4,679 EDs and corresponding IDI from 23 abnormal 24-h ambulatory EEGs. Our analysis defined two populations of ED durations and IDI: short and long. In all populations, both ED durations and IDI were significantly longer in wakefulness. Our results highlight different characteristics of ED populations in GGE and the influence by the sleep–wake cycle.
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Affiliation(s)
- Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Department of Neuroscience, Monash Medical Centre, Melbourne, VIC, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Ray C Boston
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Mark J Cook
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
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46
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Wielaender F, James FMK, Cortez MA, Kluger G, Neßler JN, Tipold A, Lohi H, Fischer A. Absence Seizures as a Feature of Juvenile Myoclonic Epilepsy in Rhodesian Ridgeback Dogs. J Vet Intern Med 2017; 32:428-432. [PMID: 29194766 PMCID: PMC5787207 DOI: 10.1111/jvim.14892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/10/2017] [Accepted: 10/31/2017] [Indexed: 01/17/2023] Open
Abstract
Myoclonic epilepsy in Rhodesian Ridgeback (RR) dogs is characterized by myoclonic seizures occurring mainly during relaxation periods, a juvenile age of onset and generalized tonic‐clonic seizures in one‐third of patients. An 8‐month‐old female intact RR was presented for myoclonic seizures and staring episodes that both started at 10 weeks of age. Testing for the DIRAS1 variant indicated a homozygous mutant genotype. Unsedated wireless video‐electroencephalography (EEG) identified frequent, bilaterally synchronous, generalized 4 Hz spike‐and‐wave complexes (SWC) during the staring episodes in addition to the characteristic myoclonic seizures with generalized 4–5 Hz SWC or 4–5 Hz slowing. Photic stimulation did not evoke a photoparoxysmal response. Repeat video‐EEG 2 months after initiation of levetiracetam treatment disclosed a >95% decrease in frequency of myoclonic seizures, and absence seizures were no longer evident. Absence seizures represent another seizure type in juvenile myoclonic epilepsy (JME) in RR dogs, which reinforces its parallels to JME in humans.
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Affiliation(s)
- F Wielaender
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - F M K James
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - M A Cortez
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Neurosciences & Mental Health Program, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
| | - G Kluger
- Department of Neuropediatrics, Epilepsy Center, Schoen Klinik, Vogtareuth, Germany.,Paracelsus Medical University, Salzburg, Austria
| | - J N Neßler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - A Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - H Lohi
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki and Folkhalsan Research Centre, Helsinki, Finland
| | - A Fischer
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
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47
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Nuyts S, D'Souza W, Bowden SC, Vogrin SJ. Structural brain abnormalities in genetic generalized epilepsies: A systematic review and meta-analysis. Epilepsia 2017; 58:2025-2037. [DOI: 10.1111/epi.13928] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Shauni Nuyts
- Department of Psychological Sciences; University of Leuven; Leuven Belgium
- Department of Statistics; University of Leuven; Leuven Belgium
- Melbourne School of Psychological Sciences; University of Melbourne; Parkville Victoria Australia
| | - Wendyl D'Souza
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Fitzroy Victoria Australia
| | - Stephen C. Bowden
- Melbourne School of Psychological Sciences; University of Melbourne; Parkville Victoria Australia
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Fitzroy Victoria Australia
| | - Simon J. Vogrin
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Fitzroy Victoria Australia
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48
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Seneviratne U, Cook MJ, D'Souza WJ. Electroencephalography in the Diagnosis of Genetic Generalized Epilepsy Syndromes. Front Neurol 2017; 8:499. [PMID: 28993753 PMCID: PMC5622315 DOI: 10.3389/fneur.2017.00499] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/07/2017] [Indexed: 01/05/2023] Open
Abstract
Genetic generalized epilepsy (GGE) consists of several syndromes diagnosed and classified on the basis of clinical features and electroencephalographic (EEG) abnormalities. The main EEG feature of GGE is bilateral, synchronous, symmetric, and generalized spike-wave complex. Other classic EEG abnormalities are polyspikes, epileptiform K-complexes and sleep spindles, polyspike-wave discharges, occipital intermittent rhythmic delta activity, eye-closure sensitivity, fixation-off sensitivity, and photoparoxysmal response. However, admixed with typical changes, atypical epileptiform discharges are also commonly seen in GGE. There are circadian variations of generalized epileptiform discharges. Sleep, sleep deprivation, hyperventilation, intermittent photic stimulation, eye closure, and fixation-off are often used as activation techniques to increase the diagnostic yield of EEG recordings. Reflex seizure-related EEG abnormalities can be elicited by the use of triggers such as cognitive tasks and pattern stimulation during the EEG recording in selected patients. Distinct electrographic abnormalities to help classification can be identified among different electroclinical syndromes.
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Affiliation(s)
- Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Department of Neuroscience, Monash Medical Centre, Melbourne, VIC, Australia
| | - Mark J Cook
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Wendyl Jude D'Souza
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
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49
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Clinical factors associated with the yield of routine outpatient scalp electroencephalograms: A retrospective analysis from a tertiary hospital. J Clin Neurosci 2017; 45:110-114. [PMID: 28919224 DOI: 10.1016/j.jocn.2017.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022]
Abstract
The routine outpatient electroencephalogram (EEG) is most often used in the diagnosis and classification of epilepsy. The diagnostic yield of outpatient EEGs is low and the clinical factors contributing to the EEG outcome have not been well established. In this study, we sought to determine the yield and the factors predicting the EEG outcome. We retrospectively analyzed 1092 routine adult EEGs that were performed in a tertiary referral center over a period of 1year. Patient demographics, sources of referral, and indications for EEG were recorded. The majority of the referrals were from neurologists (54.7%), followed by the emergency department (15.4%). The indications for requesting an EEG included patients with a provisional or established diagnosis of epilepsy (56.3%), first seizure (10.7%), and seizure mimickers (29.1%). The majority (66.7%) of the EEGs were normal, whereas 13.2% demonstrated epileptiform discharges. At the time of recording, epileptic seizures occurred in 0.6% of the cases. With logistic regression analysis, three factors were found to be significantly associated with an abnormal (epileptiform) EEG: no antiepileptic drug therapy, the age of the patient, and indication for EEG (pre-test provisional diagnosis). Patients who are not on antiepileptic drug therapy and with a diagnosis of epilepsy or seizures are more likely to have epileptiform abnormalities in EEGs. Our findings suggest that careful selection of patients is likely to improve the diagnostic yield and cost-effectiveness of routine outpatient EEG.
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50
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Proft J, Rzhepetskyy Y, Lazniewska J, Zhang FX, Cain SM, Snutch TP, Zamponi GW, Weiss N. The Cacna1h mutation in the GAERS model of absence epilepsy enhances T-type Ca 2+ currents by altering calnexin-dependent trafficking of Ca v3.2 channels. Sci Rep 2017; 7:11513. [PMID: 28912545 PMCID: PMC5599688 DOI: 10.1038/s41598-017-11591-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/29/2017] [Indexed: 12/12/2022] Open
Abstract
Low-voltage-activated T-type calcium channels are essential contributors to the functioning of thalamocortical neurons by supporting burst-firing mode of action potentials. Enhanced T-type calcium conductance has been reported in the Genetic Absence Epilepsy Rat from Strasbourg (GAERS) and proposed to be causally related to the overall development of absence seizure activity. Here, we show that calnexin, an endoplasmic reticulum integral membrane protein, interacts with the III-IV linker region of the Cav3.2 channel to modulate the sorting of the channel to the cell surface. We demonstrate that the GAERS missense mutation located in the Cav3.2 III-IV linker alters the Cav3.2/calnexin interaction, resulting in an increased surface expression of the channel and a concomitant elevation in calcium influx. Our study reveals a novel mechanism that controls the expression of T-type channels, and provides a molecular explanation for the enhancement of T-type calcium conductance in GAERS.
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Affiliation(s)
- Juliane Proft
- Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic, v.v.i., Prague, Czech Republic
| | - Yuriy Rzhepetskyy
- Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic, v.v.i., Prague, Czech Republic
| | - Joanna Lazniewska
- Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic, v.v.i., Prague, Czech Republic
| | - Fang-Xiong Zhang
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, T2N 4N1, Canada
| | - Stuart M Cain
- Michael Smith Laboratories and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Terrance P Snutch
- Michael Smith Laboratories and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Gerald W Zamponi
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, T2N 4N1, Canada.
| | - Norbert Weiss
- Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic, v.v.i., Prague, Czech Republic.
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