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Saetre E, Abdelnoor M. Incidence rate of sudden death in epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2018; 86:193-199. [PMID: 30017838 DOI: 10.1016/j.yebeh.2018.06.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of the study was to summarize the pooled incidence rate of sudden unexpected death in epilepsy (SUDEP) in patients. Meta-regression analysis was applied to identify factors influencing the incidence rate. DESIGN The study was a systematic review and critical appraisal with a meta-analysis of cohort studies, both prospective and retrospective. MATERIAL AND METHOD In a literature search, a total of 45 cohort studies were identified. A random effect model was used to synthesize the results. Heterogeneity between studies was examined by subgroup and meta-regression analysis. The small-study effect was evaluated and not corrected for by the "trim and fill" method because of great heterogeneity. RESULTS A substantial heterogeneity was present. The pooled estimated incidence rate for SUDEP was 1.4/1000 patient years. A meta-regression pinpointed a negative association between the incidence rate of SUDEP and the mean follow-up time and a positive association with the mean age of the patient. The definition of epilepsy showed statistical significance, with a higher incidence rate of SUDEP in studies where the definition of epilepsy was described and clear (p = 0.019) compared with studies having an inadequate or failing epilepsy definition. CONCLUSION Evidence from this study suggests a high incidence rate of sudden death in epilepsy. Its incidence rate was 23 times the incidence rate of sudden death in the total population of the same age. There was heterogeneity and variability of incidence rate depending on the quality of the study and on the definition of epilepsy and the mean age of the patients.
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Affiliation(s)
- Erik Saetre
- National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway.
| | - Michael Abdelnoor
- Centre of Epidemiology and Biostatistics, Oslo University Hospital, Oslo, Norway; Centre of Clinical Heart Research, Oslo University Hospital, Oslo, Norway
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Thirumala PD, Natarajan P, Thiagarajan K, Crammond DJ, Habeych ME, Chaer RA, Avgerinos ED, Friedlander R, Balzer JR. Diagnostic accuracy of somatosensory evoked potential and electroencephalography during carotid endarterectomy. Neurol Res 2016; 38:698-705. [PMID: 27342607 DOI: 10.1080/01616412.2016.1200707] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Perioperative stroke risk following carotid endarterectomy (CEA) is reported to be approximately 2-3%. The diagnostic accuracies of intraoperative EEG and SSEP monitoring during CEA have been studied separately. However, to date, the effectiveness of simultaneous EEG and SSEP monitoring during CEA has only been evaluated in small study populations. This study examined the diagnostic accuracy of combined EEG and SSEP monitoring in a large (N = 1165) patient population. METHODS This study included 1165 patients who underwent CEA from 2000 to 2012 at the University of Pittsburgh Medical Center. The sensitivities, specificities, and diagnostic odds ratio of EEG and SSEP monitoring methods were examined separately and together. Receiver operating characteristic curves were plotted to assess sensitivity and specificity of single and combined Intraoperative monitoring (IONM) methods. RESULTS Maximum sensitivity was obtained with multimodality monitoring with an IONM change in either EEG or SSEP of 50.00 (95% CI, 30.66-69.34). The specificity of simultaneous EEG and SSEP changes was 93.95 (95% CI, 92.28-95.35%). Maximum area under ROC curve obtained for IONM change in either EEG or SSEP was 0.660 (95% CI, 0.547-0.773, p-value 0.004). CONCLUSION The diagnostic accuracy of multimodality IONM during CEA is higher than an approach using single modality IONM. Simultaneous EEG and SSEP monitoring improves the likelihood of detecting periprocedural strokes after CEA. Neuro protective therapies to prevent periprocedural strokes can be based on changes in SSEP and EEG during CEA.
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Affiliation(s)
- Parthasarathy D Thirumala
- a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA.,b Department of Neurology , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Piruthiviraj Natarajan
- a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Karthy Thiagarajan
- a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Donald J Crammond
- a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Miguel E Habeych
- a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Rabih A Chaer
- c Division of Vascular Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Efthymios D Avgerinos
- c Division of Vascular Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Robert Friedlander
- a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Jeffrey R Balzer
- a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA
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Thirumala PD, Wang X, Shah A, Habeych M, Crammond D, Balzer JR, Sekula R. Clinical impact of residual lateral spread response after adequate microvascular decompression for hemifacial spasm: A retrospective analysis. Br J Neurosurg 2015; 29:818-22. [PMID: 26098605 DOI: 10.3109/02688697.2015.1054351] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Residual lateral spread response (LSR) after seemingly adequate decompression for hemifacial spasms (HFSs) can provide prognostic information about the outcome of microvascular decompression (MVD). In the present study, the main objective was to evaluate the clinical and prognostic impact of residual LSR after adequate MVD for HFS. METHODS An observational study was conducted in patients who underwent MVD for HFS at the University of Pittsburgh Medical Center between January 2000 and December 2007. Clinical and neurophysiological outcomes after pre- and post-MVD, including spasm relief, amplitude and latency of LSR, and postoperative complications were collected from groups with and without residual LSR after adequate decompression. Data analysis was performed to see the impact of residual LSR on HFS outcomes. RESULTS There was no significant difference in preoperative clinical characteristics as well as postoperative complications between the two groups. The patient had significantly higher spasm relief in immediate postoperative period (p = 0.01) and at discharge (p = 0.002) when LSR disappeared during the procedure. There is no difference in spasm relief at follow-up period between the two groups (p = 0.69). CONCLUSION Lateral spread is an invaluable tool in MVD for HFSs. Adequate decompression in patients with residual LSR improved long-term spasm relief. Constant communication between neurophysiologists and the surgeon might be vital to achieve adequate decompression. The amplitude of residual LSR after adequate decompression does not significantly affect the long-term spasm relief.
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Affiliation(s)
- Parthasarathy D Thirumala
- a Department of Neurological Surgery , University of Pittsburgh , PA , USA.,b Department of Neurology , University of Pittsburgh , PA , USA
| | - Xuhui Wang
- e Department of Neurological Surgery , Xinhua Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P. R. China
| | - Aalap Shah
- d Department of Anesthesia , University of Washington , WA , USA
| | - Miguel Habeych
- a Department of Neurological Surgery , University of Pittsburgh , PA , USA
| | - Donald Crammond
- a Department of Neurological Surgery , University of Pittsburgh , PA , USA
| | - Jeffrey R Balzer
- a Department of Neurological Surgery , University of Pittsburgh , PA , USA.,c Department of Neuroscience , University of Pittsburgh , PA , USA
| | - Raymond Sekula
- a Department of Neurological Surgery , University of Pittsburgh , PA , USA
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Wang X, Thirumala PD, Shah A, Gardner P, Habeych M, Crammond D, Balzer J, Burkhart L, Horowitz M. The role of vein in microvascular decompression for hemifacial spasm: a clinical analysis of 15 cases. Neurol Res 2013; 35:389-94. [DOI: 10.1179/1743132812y.0000000153] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Xuhui Wang
- Department of Neurological SurgeryXinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China,
| | | | - Aalap Shah
- Department of AnesthesiologyUniversity of Washington Medical Center, Seattle, WA, USA,
| | - Paul Gardner
- Department of Neurological SurgeryUniversity of Pittsburgh, PA, USA,
| | - Miguel Habeych
- Department of Neurological SurgeryUniversity of Pittsburgh, PA, USA,
| | - Donald Crammond
- Department of Neurological SurgeryUniversity of Pittsburgh, PA, USA,
| | - Jeffrey Balzer
- Department of Neurological SurgeryUniversity of Pittsburgh, PA, USA,
| | - Lois Burkhart
- Department of Neurological SurgeryUniversity of Pittsburgh, PA, USA,
| | - Michael Horowitz
- Department of Neurological SurgeryUniversity of Pittsburgh, PA, USA,
- Department of RadiologyUniversity of Pittsburgh, PA, USA
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Kunieda T, Mikuni N, Shibata S, Inano R, Yamao Y, Kikuchi T, Matsumoto R, Takahashi J, Ikeda A, Fukuyama H, Miyamoto S. Long-term seizure outcome following resective surgery for epilepsy: to be or not to be completely cured? Neurol Med Chir (Tokyo) 2013; 53:805-13. [PMID: 24140768 PMCID: PMC4508714 DOI: 10.2176/nmc.oa2013-0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Surgical intervention is expected to improve the quality of life in patients with intractable epilepsy by providing adequate seizure control. Although many previous studies showed various rates of seizure freedom, definite conclusions have not yet been made regarding outcomes. In order to clarify the long-term postoperative outcome for a period up to 10 years, a retrospective review of our patients was performed longitudinally by using the survival analysis method. The postoperative state of epilepsy in 76 patients who underwent resection surgery was assessed based on Engel’s criteria. In addition, Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom. In this patient group, abnormal lesion were detected by MRI in 70 out of 76 cases, and the ictal onset zone was finally identified within temporal lobe in 51 cases. The most favorable outcome, defined as Engel Class Ia, was observed in 26 (37%), 24 (40%), and 18 (41%) cases at 2, 5, and 10 years after surgery, respectively. The Kaplan-Meier survival curve in the overall group estimated the probability of seizure freedom as 75% (95% confidence interval [CI] 70–80%), 67% (62–72%), and 51% (45–57%) at 2, 5, and 10 years follow up, respectively. Half of all seizure recurrences occurred within the first 2 postoperative years. In this study, we showed that long-term favorable outcome of seizure control following resection surgery can be achieved in more than half of the patients.
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Affiliation(s)
- Takeharu Kunieda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
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Thirumala PD, Kodavatiganti HS, Habeych M, Wichman K, Chang YF, Gardner P, Snyderman C, Crammond DJ, Balzer J. Value of multimodality monitoring using brainstem auditory evoked potentials and somatosensory evoked potentials in endoscopic endonasal surgery. Neurol Res 2013; 35:622-30. [PMID: 23561292 DOI: 10.1179/1743132813y.0000000174] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To evaluate the value of intraoperative neurophysiological monitoring (IONM) using brainstem auditory evoked potential (BAEP) and somatosensory evoked potential (SSEP) monitoring to predict and/or prevent postoperative neurological deficits during endoscopic endonasal surgery (EES). METHODS We retrospectively identified 138 consecutive patients who had BAEP monitoring in addition to SSEP monitoring during EES at our institution. We reviewed the postoperative clinical outcomes and neurophysiological changes independently. RESULTS The total of number of patients with any IONM changes was 10. The incidence of BAEP changes was 3.62%. The incidence of SSEP changes was 3.62% as well. One patient had changes in both BAEPs and SSEPs. Majority of the changes were observed during changes in mean arterial pressure (MAP) without any postoperative neurological deficits. There were two postoperative neurological deficits. DISCUSSION BAEPs and SSEPs provide unique information about integrity of brainstem function during EES procedures involving tumors in the and around clival region. We advocate a comprehensive multimodality approach to IONM during EESs including BAEPs and SSEPs depending on the location of the neural structures at risk.
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