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Li C, Amin U, Rivera-Cruz A, Frontera AT, Benbadis SR. The Yield of Ambulatory Video-EEG: Predictors of Successful Event Capture. Neurol Clin Pract 2023; 13:e200194. [PMID: 37736066 PMCID: PMC10511269 DOI: 10.1212/cpj.0000000000200194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/11/2023] [Indexed: 09/23/2023]
Abstract
Background and Objectives The purpose of this study was to assess the likelihood of capturing a patient's typical event in question on ambulatory video-EEG monitoring (AVEM) based on certain baseline patient or event characteristics. Methods We retrospectively reviewed 300 studies that resulted between June 2021 and August 2022 ordered by adult epileptologists. Patients were included in event analysis if the study was ordered for the purpose of capturing an event (and excluded for all other purposes). Results A total of 149 studies were included in event analysis. Sixty-eight patients (46%) had their typical events captured on AVEM. Diagnosis was an epileptic seizure in 17 patients (25%), psychogenic nonepileptic seizure in 7 (10%), and other nonepileptic events in 44 (65%). Regarding event frequency, for patients who on average had daily events, 84% had events captured, which corresponds to a significantly increased odds ratio (OR 17.90, 95% CI 7.55-42.44, p < 0.001). For those who had events <1 per week to ≥1 per month, only 9% had events captured (OR 0.06, 95% CI 0.02-0.19, p < 0.001). No patients who had events less frequently than once per month had a diagnostic AVEM. Regarding the number of antiseizure medications (ASMs), the odds ratio was increased for those not on ASMs (OR 2.65, 95% CI 1.17 -6.03, p = 0.02) and decreased for those on 1 ASM (OR 0.28, 95% CI 0.13 -0.60, p = 0.001). There was no statistical significance based on event type (motor vs nonmotor), prior seizure diagnosis, history of psychiatric comorbidity, or presence of a focal brain lesion. Discussion Certain baseline characteristics can increase or decrease the pretest probability of capturing a typical event on AVEM, particularly the frequency of events and number of ASMs. This can be useful information for clinicians before ordering a study so that resources can be properly allocated.
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Affiliation(s)
- Caralynn Li
- Department of Neurology, University of South Florida Morsani College of Medicine
| | - Ushtar Amin
- Department of Neurology, University of South Florida Morsani College of Medicine
| | - Angelica Rivera-Cruz
- Department of Neurology, University of South Florida Morsani College of Medicine
| | - Alfred T Frontera
- Department of Neurology, University of South Florida Morsani College of Medicine
| | - Selim R Benbadis
- Department of Neurology, University of South Florida Morsani College of Medicine
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Tager D, Panjeti-Moore D, Yang JC, Rivera-Cruz A, Loring DW, Staikova E, Block C, Bullinger KL, Rodriguez-Ruiz AA, Cabaniss BT, Winkel D, Bonilha L, Willie JT, Gross RE, Drane DL, Karakis I. The effect of responsive neurostimulation (RNS) on neuropsychiatric and psychosocial outcomes in drug-resistant epilepsy. Epilepsy Behav 2023; 142:109207. [PMID: 37075511 PMCID: PMC10314372 DOI: 10.1016/j.yebeh.2023.109207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/05/2023] [Accepted: 03/30/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE The impact of responsive neurostimulation (RNS) on neuropsychiatric and psychosocial outcomes has not been extensively evaluated outside of the original clinical trials and post-approval studies. The goal of this study was to ascertain the potential real-world effects of RNS on cognitive, psychiatric, and quality of life (QOL) outcomes in relation to seizure outcomes by examining 50 patients undergoing RNS implantation for drug-resistant epilepsy (DRE). METHODS We performed a retrospective review of all patients treated at our institution with RNS for DRE with at least 12 months of follow-up. In addition to baseline demographic and disease-related characteristics, we collected cognitive (Full-Scale Intelligence Quotient, Verbal Comprehension, and Perceptual Reasoning Index), psychiatric (Beck Depression and Anxiety Inventory Scores), and QOL (QOLIE-31) outcomes at 6 and 12 months after RNS implantation and correlated them with seizure outcomes. RESULTS Fifty patients (median age 39.5 years, 64% female) were treated with RNS for DRE in our institution from 2005 to 2020. Of the 37 of them who had well-documented pre and post-implantation seizure diaries, the 6-month median seizure frequency reduction was 88%, the response rate (50% or greater seizure frequency reduction) was 78%, and 32% of patients were free of disabling seizures in this timeframe. There was no statistically significant difference at a group level in any of the evaluated cognitive, psychiatric, and QOL outcomes at 6 and 12 months post-implantation compared to the pre-implantation baseline, irrespective of seizure outcomes, although a subset of patients experienced a decline in mood or cognitive variables. SIGNIFICANCE Responsive neurostimulation does not appear to have a statistically significant negative or positive impact on neuropsychiatric and psychosocial status at the group level. We observed significant variability in outcome, with a minority of patients experiencing worse behavioral outcomes, which seemed related to RNS implantation. Careful outcome monitoring is required to identify the subset of patients experiencing a poor response and to make appropriate adjustments in care.
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Affiliation(s)
- Dale Tager
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Deepa Panjeti-Moore
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Neurology Consultants of Dallas, Dallas, TX, USA
| | - Jimmy C Yang
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurosurgery, Ohio State University, Columbus, OH, USA
| | - Angelica Rivera-Cruz
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of South Florida, Tampa, FL, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Ekaterina Staikova
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Katie L Bullinger
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Brian T Cabaniss
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel Winkel
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Leonardo Bonilha
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA.
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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