Presence Of Epileptiform Discharges Research Articles

Risk of recurrence after a first unprovoked seizure with different risk factors: A 10-year prospective cohort study

ObjectiveTo evaluate the recurrence risk following a first unprovoked seizure using both single-factor and multiple-factor approaches, as well as to further analyze the potential risk factors associated with recurrence. MethodsIn a prospective cohort study, a total of 201 individuals who experienced their initial unprovoked seizure were recruited from January 2010 to December 2019. The cumulative recurrence rates were calculated by Kaplan–Meier survival curves. Multivariate analyses for recurrence risk were conducted utilizing the Cox regression model. Additionally, interaction effects were evaluated by quantifying the attributable proportion due to interaction (AP). ResultsThe cumulative recurrence rates were as follows: 29.4 % at 6 months, 35.8 % at 1 year, 41.1 % at 2 years, 47.9 % at 5 years, and 57.5 % at 10 years. Notably, the majority of recurrences, specifically 61.2 %, manifested within the initial 6 months following the onset, with 74.4 % occurring within the first year, and 82.6 % within the initial 2 years. The recurrence risk of patients with epileptic abnormal discharges on VEEG, nocturnal seizure, abnormal MRI, prior brain insult and focal seizure was 71.9 %, 61.4 %, 61.5 %, 75.0 %, and 69.7 %, respectively. Epileptiform discharges (RR 2.5, 95 % CI 1.4–4.3, P=0.001) and prior brain insult (RR 2.1, 95 % CI 1.2–3.7, P=0.007) were predictors of recurrence. Interaction analysis showed the combination of epileptiform discharges and prior brain insult was associated with a 7-fold increased risk of recurrence (RR 7.0, 95 %CI 3.5–14.2)，with AP estimated at 0.34, the combination of epileptiform discharges and nocturnal seizure was associated with a 4-fold increased risk of recurrence(RR 4.3, 95 %CI 2.4–7.4), with AP estimated at −0.25,and the combination of prior brain insult and nocturnal seizures was associated with a 4-fold increased risk of recurrence(RR 4.1, 95 %CI 1.9–8.9), with AP estimated at −0.03. ConclusionsPatients with epileptiform discharges VEEG, nocturnal seizures, abnormal MRI findings, prior brain insult, or focal seizures exhibited a substantial recurrence rate. Specifically, the presence of epileptiform discharges in VEEG recordings, and a history of prior brain insult were identified as independent risk factors associated with recurrence following an initial unprovoked seizure. Notably, individuals with multiple risk factors exhibited a significantly higher recurrence risk compared to those with no or a single risk factor.

FREQUENCY OF NORMAL INTERICTAL EEG IN ADULTS PRESENTING WITH FIRST SEIZURE

First-time seizure often triggers elaborate neurologic examination to define its etiology and assess the likelihood of its repetition. Objective: The study's main objective is to find the frequency of normal interictal EEG in adults presenting with the first seizure. Methods: This cross-sectional study used data collected from 75 patients. Patient demographic details, seizure characteristics, and EEG findings were documented. EEG results were categorized as normal or abnormal (presence of epileptiform discharges, spikes, or sharp waves). Results: Data were collected from 75 patients with a mean age of 38.23 ± 12.09 years, ranging from 18 to 72 years. Among them, 53% were male, and 47% were female. Generalized tonic-clonic seizures were the most common, seen in 67% of patients, while 33% had focal seizures. EEG results showed that 43% had normal interictal EEGs, and 57% had abnormal findings. Imaging revealed structural abnormalities in 35% of patients, while 65% had normal imaging. At the 6-month follow-up, seizure recurrence was observed in 38% of those with normal EEGs and 58% in those with abnormal EEGs. Conclusion: It is concluded that a significant proportion of adults presenting with their first seizure may have normal interictal EEGs yet still face a risk of seizure recurrence.

Attention deficit hyperactivity disorder in children with epilepsy: a multicenter cross-sectional analysis in China.

The diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) comorbid with epilepsy have been insufficiently addressed in China. We conducted a study in China to investigate the current status, diagnosis, and treatment of ADHD in children to further our understanding of ADHD comorbid with epilepsy, strengthen its management, and improve patients' quality of life. We carried out a multicenter cross-sectional survey of children with epilepsy across China between March2022 and August2022. We screened all patients for ADHD and compared various demographic and clinical factors between children with and without ADHD, including gender, age, age at epilepsy onset, duration of epilepsy, seizure types, seizure frequency, presence of epileptiform discharges, and treatment status. Our objective was to explore any possible associations between these characteristics and the prevalence of ADHD. Overall, 395 epilepsy patients aged 6-18years were enrolled. The age at seizure onset and duration of epilepsy ranged from 0.1-18 to 0.5-15years, respectively. Focal onset seizures were observed in 212 (53.6%) patients, while 293 (76.3%) patients had epileptiform interictal electroencephalogram (EEG) abnormalities. Among the 370 patients treated with anti-seizure medications, 200 (54.1%) had monotherapy. Although 189 (47.8%) patients had ADHD, only 31 received treatment for it, with the inattentive subtype being the most common. ADHD was more common in children undergoing polytherapy compared to those on monotherapy. Additionally, poor seizure control and the presence of epileptiform interictal EEG abnormalities may be associated with a higher prevalence of ADHD. While the prevalence of ADHD was higher in children with epilepsy than in normal children, the treatment rate was notably low. This highlights the need to give more importance to the diagnosis and treatment of ADHD in children with epilepsy.

Prevalence and pattern of electroencephalographic changes associated with clozapine treatment: a cross-sectional study

BackgroundClozapine is a second-generation antipsychotic which is known to have superior efficacy as compared to other antipsychotics. It is particularly used in treatment-resistant schizophrenia (10–30%). However, its use is limited due to the serious side effect of inducing seizures which can occur at all doses. The purpose of our study was to analyse patients taking clozapine for any electroencephalographic (EEG) abnormalities. We undertook a cross-sectional study on 107 patients with a different diagnosis taking clozapine who visited the outdoor treatment facility of a tertiary care psychiatric diseases hospital in Kashmir. A 32-channel digital EEG was obtained and evaluated visually for any abnormalities in these patients. The data was tabulated and analysed using SPSS 23.0.ResultsEEG abnormalities were reported in 60.75% of patients receiving clozapine out of which slow waves and epileptiform activities were present in 48.60% and 30.84% of patients, respectively. Background slowing was often in the delta and theta ranges. Our study showed that there was a statistically significant relationship between the dose of clozapine and EEG abnormalities. Clinical seizure occurred in only one patient receiving clozapine 450 mg/day and was a smoker who had recently stopped smoking.ConclusionsEEG abnormalities occur frequently in clozapine-treated patients specifically those taking higher doses of clozapine. This calls for utilising EEG as a useful clinical investigation in these patients along with clinical monitoring of seizures especially in those taking higher doses of clozapine in order to hint towards early signs of clozapine toxicity. Caution needs to be taken in patients who are smokers and show a pattern of change in their smoking habits. Moreover, EEG abnormalities though frequently associated with clozapine are not reliable predictors of seizures. Therefore, anticonvulsants may not be routinely indicated in patients on clozapine even in the presence of epileptiform discharges.

Epileptiform Discharges in Patients with Psychogenic Non-Epileptic Attacks: A Case Series (P1-1.009)

<h3>Objective:</h3> We present a small case series of patients with psychogenic non-epileptic attacks (PNEA), who were misdiagnosed with “refractory epilepsy” based on the presence of epileptiform discharges (EDs), particularly generalized spike-and-wave, on their EEG. This diagnosis was reversed after admission to the epilepsy monitoring unit for spell characterization, where all stereotypical events of interest were captured and were deemed non-epileptic. <h3>Background:</h3> Over the past decade, there was an increased emphasis on the need to correctly diagnose patients with PNEA to avoid unnecessary treatment with anti-seizure drugs and initiate psychotherapy to attain good clinical outcome. Misdiagnosing PNEA with “refractory epilepsy” could be due to misinterpreted EEG as “abnormal with epileptiform discharges” or co-existence of PNEA with EDs in the absence of clinical seizures. Although, PNEA is seen in up to 12% of epilepsy patients, there are rare cases where PNEA only occurs without confirmed epilepsy despite the presence of EDs. <h3>Design/Methods:</h3> We identified seven patients with only PNEA and EDs admitted to Epilepsy Monitoring Unit for “refractory epilepsy” and retrospectively reviewed their records including their EEG. <h3>Results:</h3> None of the stereotypical events captured on video-EEG was associated with ictal EEG correlates. Six had generalized spike-and-wave discharges (GSW) without clinical accompaniments. Of patients who initiated psychotherapy, 60% had ≥ 50% reduction in frequency of PNEA. <h3>Conclusions:</h3> EDs can occur in “PNEA-only” patients and shouldn’t delay PNEA diagnosis or effective psychotherapeutic treatment. <b>Disclosure:</b> Dr. Afify has nothing to disclose. The institution of Dr. Tolchin has received research support from C.G. Swebilius Trust. The institution of Dr. Altalib has received research support from UCB. The institution of Dr. Altalib has received research support from Eisai. The institution of Dr. Altalib has received research support from Sunovian. The institution of Dr. Altalib has received research support from DEPARTMENT OF DEFENSE - CONGRESSIONALLY DIRECTED MEDICAL RESEARCH PROGRAMS. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Aquestive. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for marinus. Dr. Hirsch has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Hirsch has received personal compensation in the range of $0-$499 for serving as a Consultant for Accure. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuropace. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rafa Laboratories, Ltd. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Neuropace. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Natus. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a speaker with UCB. Dr. Herlopian has nothing to disclose.

Juvenile Myoclonic Epilepsy: Seizure and Social Outcomes in Taiwan.

Patients with juvenile myoclonic epilepsy (JME) may not achieve seizure freedom despite optimal treatment with antiseizure medications (ASMs). The aim of this study was to investigate the clinical and social features of patients with JME, and to determine the factors associated with outcomes. We retrospectively identified 49 patients with JME (25 females, mean age 27.6 ± 8.9 years) who were assessed at the Epilepsy Centre of Linkou Chang Gung Memorial Hospital in Taiwan. The patients were divided into two groups, those who were seizure-free and those with ongoing seizures according to their seizure outcome at the last follow-up for one year. Clinical features and social status were compared between these two groups. Twenty-four (49%) of the JME patients were seizure-free for at least one year, while 51% continued to experience seizures despite being treated with multiple ASMs. The presence of epileptiform discharges in the last electroencephalogram and seizures during sleep were significantly associated with worse seizure outcomes (p < 0.05). The patients who were seizure-free had a higher employment rate compared to those who continued to experience seizures (75% vs. 32%, p = 0.004). Despite receiving ASM treatment, a considerable proportion of the patients with JME continued to have seizures. Moreover, poor seizure control was associated with a lower employment rate, which may lead to negative socioeconomic consequences related to JME.

Quantitative artifact reduction and pharmacologic paralysis improve detection of EEG epileptiform activity in critically ill patients

ObjectiveEpileptiform activity is common in critically ill patients, but movement-related artifacts—including electromyography (EMG) and myoclonus—can obscure EEG, limiting detection of epileptiform activity. We sought to determine the ability of pharmacologic paralysis and quantitative artifact reduction (AR) to improve epileptiform discharge detection. MethodsRetrospective analysis of patients who underwent continuous EEG monitoring with pharmacologic paralysis. Four reviewers read each patient’s EEG pre- and post- both paralysis and AR, and indicated the presence of epileptiform discharges. We compared the interrater reliability (IRR) of identifying discharges at baseline, post-AR, and post-paralysis, and compared the performance of AR and paralysis according to artifact type. ResultsIRR of identifying epileptiform discharges at baseline was slight (N = 30; κ = 0.10) with a trend toward increase post-AR (κ = 0.26, p = 0.053) and a significant increase post-paralysis (κ = 0.51, p = 0.001). AR was as effective as paralysis at improving IRR of identifying discharges in those with high EMG artifact (N = 15; post-AR κ = 0.63, p = 0.009; post-paralysis κ = 0.62, p = 0.006) but not with primarily myoclonus artifact (N = 15). ConclusionsParalysis improves detection of epileptiform activity in critically ill patients when movement-related artifact obscures EEG features. AR improves detection as much as paralysis when EMG artifact is high, but is ineffective when the primary source of artifact is myoclonus. SignificanceIn the appropriate setting, both AR and paralysis facilitate identification of epileptiform activity in critically ill patients.

Acute physiologic prediction of pediatric post-traumatic epilepsy

ObjectivePost-traumatic epilepsy (PTE) is a known complication of traumatic brain injury (TBI). Limited physiologic biomarkers have been investigated in relation to pediatric PTE. Our aim is to identify clinical, physiologic and neuroimaging biomarkers predictive of pediatric PTE arising during the acute care phase after injury. MethodsWe performed a retrospective analysis from a prospectively collected clinical database of pediatric patients who underwent multimodality neurologic monitoring that included continuous electroencephalography and intracranial pressure (ICP) monitoring. Biomarkers included hemodynamic vital signs, model-based indices of cerebrovascular pressure reactivity (CVPR) and autonomic function (AF), electroencephalographic abnormalities, and neuroimaging abnormalities on the initial CT scan on day of imaging. Our primary outcome, PTE, was classified as the presence of unprovoked seizures 2 months post-injury or the continued need for antiseizure medications at 12-month post-injury. We utilized univariate logistic regression to identify biomarkers associated with PTE. Results61 surviving patients were included in this study, among which 10 (16.4%) developed PTE. We identified that PTE was associated with increased ICP (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.02–1.52), increased pressure reactivity indices (92.53, 2.84->999.99), increased wavelet pressure reactivity indices (121.76, 2.84->999.99), increased CT Marshall scores (1.76, 1.13–2.74), decreased HRsd (0.54, 0.33–0.87) and the presence of epileptiform discharges (8.06, 1.85–35.17), and abnormal sleep spindles (4.88, 1.18–20.00). Whereas early post-traumatic seizures within the first 7 days post-injury were associated with PTE development (7.58, 1.81–39.68), this association was significant for such seizures occurring between 24 and 168 h post-injury (21.47, 4.18–110.38), and not for seizures occurring within 24 h post-injury. Among patients experiencing early post-traumatic seizures, increased time with seizures on surface electroencephalography was associated with PTE development (7.28, 2.05–73.14). We also identified that development of PTE was associated with worsened functional outcomes identified by increased Glasgow Outcome Scale – Extended Pediatric (GOSE-PEDs) scores (3.18, 1.68–8.01). ConclusionPediatric PTE development is associated with increased ICP, impaired CVPR, low heart rate variability, worsened neuroimaging findings, and electroencephalographic abnormalities identified during intensive care. Further studies are needed to investigate strategies to mitigate pediatric PTE development.

Association between EEG Paroxysmal Abnormalities and Levels of Plasma Amino Acids and Urinary Organic Acids in Children with Autism Spectrum Disorder.

Abnormalities in the plasma amino acid and/or urinary organic acid profile have been reported in autism spectrum disorder (ASD). An imbalance between excitatory and inhibitory neuronal activity has been proposed as a mechanism to explain dysfunctional brain networks in ASD, as also suggested by the increased risk of epilepsy in this disorder. This study explored the possible association between presence of EEG paroxysmal abnormalities and the metabolic profile of plasma amino acids and urinary organic acids in children with ASD. In a sample of 55 children with ASD (81.8% male, mean age 53.67 months), EEGs were recorded, and 24 plasma amino acids and 56 urinary organic acids analyzed. EEG epileptiform discharges were found in 36 (65%) children. A LASSO regression, adjusted by age and sex, was applied to evaluate the association of plasma amino acids and urinary organic acids profiles with the presence of EEG epileptiform discharges. Plasma levels of threonine (THR) (coefficient = −0.02, p = 0.04) and urinary concentration of 3-Hydroxy-3-Methylglutaric acid (HMGA) (coefficient = 0.04, p = 0.02) were found to be associated with the presence of epileptiform discharges. These results suggest that altered redox mechanisms might be linked to epileptiform brain activity in ASD.

Treatment outcome following the transition to adult epilepsy care in childhood-onset epilepsy

IntroductionTransition from pediatric to adult epilepsy care in patients with childhood-onset epilepsy can be challenging, and several aspects should be considered, including comorbidities, achieving social milestones, and adjustment of anti-seizure medications (ASMs). However, there is limited information regarding the treatment outcome following the transition to adult epilepsy care in childhood-onset epilepsy. Materials and methodsWe performed a 13-year retrospective study of patients with childhood-onset epilepsy who had been transferred to our adult epilepsy clinic. Treatment outcomes were divided into two groups: seizure improvement (at least 50% reduction of seizure) and stationary or worsening seizures. ResultsAmong the 2,365 patients in our epilepsy cohort, 140 with childhood-onset epilepsy were transferred to adult epilepsy care. Forty-nine patients (35.0%) experienced improvement of seizures, whereas 91 patients (65.0%) reported stationary or worsening seizures following transition. Patients in the improvement group were younger at the time of transition than patients in the stationary or worsening group (p = 0.004) and had a lower number of ASMs before the adjustment (p = 0.001). Interestingly, patients in the improvement group had a greater chance of epileptiform discharges on EEG than patients in the stationary or worsening group (38/49 vs 54/91, p = 0.03). ConclusionOur study shows that one-third of patients having childhood-onset epilepsy can experience seizure improvement following transition to adult epilepsy care, and the presence of epileptiform discharges on EEG may not necessarily mean a poor prognosis or drug-resistant epilepsy following the transition.

Factors Associated with Short-Term Seizure Recurrence in Extratemporal Epilepsy Surgery

Introduction: Drug-resistant extratemporal epilepsy is the second cause of referral to epilepsy surgery. Objectives: To identify factors associated with short-term seizure recurrence following extratemporal epilepsy surgery. Materials and Methods: We performed a retrospective study of 19 consecutive patients who underwent surgery for drug-resistant extratemporal epilepsy at the National Institute of Neurology and Neurosurgery of Havana, Cuba, from September 2014 to October 2019. All patients had at least one year of postoperative follow-up. Fisher's exact test was used to search for an association between dichotomous variables. A value of p≤0.05 was considered significant. Results: After one year of follow-up, seizure freedom reached 31.6% (Engel I) and 36.8% showed significant improvement in the number of seizures (Engel II). The frontal location (p=0.046) and incomplete resection of the epileptogenic zone (p=0.017), bilateral interictal discharges on the preoperative electroencephalogram (EEG) (p=0.017), the presence of epileptiform discharges on the postsurgical EEG (p=0.001), and the occurrence of seizures after the sixth month of surgery (p=0.001), were associated with seizures recurrence. Conclusions: After one year, 31.6% of patients operated on for extratemporal epilepsy were seizure-free. The incomplete resection of the epileptogenic zone and the presence of epileptogenic discharges in the postsurgical EEG, and the presence of seizures after the sixth month of surgery were the most significant factors of seizure recurrence.

Bedside interpretation of simplified continuous EEG after cardiac arrest.

Continuous EEG-monitoring (cEEG) in the ICU is recommended to assess prognosis and detect seizures after cardiac arrest but implementation is often limited by the lack of EEG-technicians and experts. The aim of the study was to assess ICU physicians ability to perform preliminary interpretations of a simplified cEEG in the post cardiac arrest setting. Five ICU physicians received training in interpretation of simplified cEEG - total training duration 1day. The ICU physicians then interpreted 71 simplified cEEG recordings from 37 comatose survivors of cardiac arrest. The cEEG included amplitude-integrated EEG trends and two channels with original EEG-signals. Basic EEG background patterns and presence of epileptiform discharges or seizure activity were assessed on 5-grade rank-ordered scales based on standardized EEG terminology. An EEG-expert was used as reference. There was substantial agreement (κ 0.69) for EEG background patterns and moderate agreement (κ 0.43) for epileptiform discharges between ICU physicians and the EEG-expert. Sensitivity for detecting seizure activity by ICU physicians was limited (50%), but with high specificity (87%). After cardiac arrest, preliminary bedside interpretations of simplified cEEGs by trained ICU physicians may allow earlier detection of clinically relevant cEEG changes, prompting changes in patient management as well as additional evaluation by an EEG-expert. This strategy requires awareness of limitations of both the simplified electrode montage and the cEEG interpretations performed by ICU physicians. cEEG evaluation by an expert should not be delayed.

O-44 Clinical validation of criteria for identification of epileptiform EEG discharges in sensor and source space

Background Presence of Epileptiform Discharges (ED) in EEG recordings are highly associated with an epilepsy diagnosis. The International Federation of Clinical Neurophysiology (IFCN) suggested 6 criteria in EEG sensor-space, so that presence of at least 4 of them defines a waveform as ED. The aim of our study to assess inter-rater agreement (IRA) and accuracy of identifying spikes in sensor space (using the IFCN criteria at different thresholds) and in source space. Methods EEG samples from 100 consecutive patients with epilepsy and non-epileptic paroxysmal events were reviewed separately in sensor-space and source-space, in different, randomized order, by 7 raters, who scored the presence/absence of each IFCN-criterion in sensor-space, and presence/absence of EDs in source-space. EDs were defined in sensor-space using different thresholds (2–6 criteria) and without counting criteria. Accuracy was determined for each rater and for the majority decisions for each sample. Material and results IRA was moderate both in sensor space and in source space (k: 0.49–0.60). In sensor-space, the highest accuracy (91%) and sensitivity (96%) was achieved using a threshold of 4 criteria. However, this gave a specificity that was lower than acceptable for EEG (85%). Using a threshold of 5 criteria in sensor-space specificity of 96% was achieved, at a sensitivity of 83% and accuracy of 89%. Results in source-space were identical to using the threshold of 5 criteria in sensor-space. Conclusions Using a threshold of 5 IFCN-criteria in sensor-space, and using source-space yields a high specificity and acceptable sensitivity for identifying EDs.

No Further Yield of Ambulatory EEG for Epileptiform Discharges Beyond 13 Hours

Introduction: This study aimed at evaluating the value added by 24-hour ambulatory EEG (AEEG) by comparing the presence of epileptiform discharges (EDs) between the first 30 minutes of recording versus the following 23.5 hours.Materials and Methods: A retrospective review of AEEGs of subjects divided into two groups, epilepsy and undiagnosed episodes of loss of consciousness, was conducted. AEEGs were divided into early EEG (E-EEG) (first 30 minutes) and extended EEG (remaining 23.5 hours). Extended EEGs were further divided into segments (S): 31st minute to 8th hour (SI), 9th to 16th hours (SII) and 17th to 24th hours (SIII). Each consecutive segment was reviewed to identify new EDs not seen previously.Results: Fifty-seven AEEGs were included, the median age being 36.3 years, the range being 18.7 to 78.6 years. There were 38 (66.6%) females. The collective yield of AEEG for detecting EDs was 19/57 (33.4%). The yield of E-EEG of new EDs was 5/57 (9%). During extended EEG, the distribution of EDs was as follows: SI, 5/57 (9%); SII, 13/55 (24%); and SIII, 1/32 (3%). The yield, however, did not increase beyond the 13th hour. In undiagnosed episodes of loss of consciousness group (11), yield was 0/11 in all segments.Conclusions: (1) There was no value added for yield of EDs by extending the EEG recording beyond 13 hours in epilepsy group. (2) The probability of capturing EDs is negligible if the clinical history does not clearly support the diagnosis of seizure or epilepsy.

Time interval providing highest yield for initial EEG in patients with new onset seizures

PurposeTiming providing highest yield of initial electroencephalogram (EEG) after new onset unprovoked seizures, is an important and practical issue both in diagnosis and patient care. Current guidelines suggest routine EEG is the standard of care in work-up. However, yield of the initial EEG and exact timeframe in which to perform remain unclear and standardization in both adult and pediatric populations is still lacking. Our objective was to determine a concrete timeframe to perform initial EEG in patients with new onset unprovoked seizures and provide greater yield of EEG benefits in patient management. MethodThis is a retrospective chart review study of both pediatric and adult patients identified from EEG Database over 1999–2014 located at Kaleida Health at Buffalo using keyword “new onset seizure”. ResultsThe percentage of EEGs revealing epileptiform discharges is much higher if EEGs are performed within 12hours after the seizure onset compared to studies done beyond this timeframe (53.1% versus 23.9%). There was no significant difference in the presence of epileptiform discharges if the study is done 12hours after the seizure onset. Odds ratio was 3.599 (the presence of epileptiform discharges) with a Confidence Interval of 1.691–7.660 (p=0.001) within first 12hours of initial event. ConclusionThis study demonstrated statistical significance in yield of epileptiform discharges by performing EEG within the first 12hours of seizure onset, in both adult and pediatric populations, which should be considered for clinical practice and patient care.

Electroencephalographic features of anti-N-methyl-D-aspartate receptor encephalitis in children

To investigate electroencephalographic (EEG) characteristics of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis in children. Clinical data of 28 children diagnosed as anti-NMDAR encephalitis were retrospectively analyzed for EEG characteristics in different periods and severity of disease and outcome. Among the 28 patients with anti-NMDAR encephalitis, 15 were males and 13 were females. Their age at disease onset ranged from 1 year 3 months to 12 years 4 months. Patients were divided into mild group (5 cases) and severe group (23 cases). In the different stage of the disease, occipital background activity of the EEG was preserved in more than half of patients. Accompanied by the evolution of disease course, the occipital background activity and slow waves gradually recovered to normal. In the peak phase of disease, occipital background activity in the awake state was preserved in 4/5 patients of the mild group and 9/17 patients of the severe group. Alpha and theta band rhythms in non-rapid eye movement (NREM) sleep existed in 77% (17/22) patients. EEG monitoring showed delta brushes in 2 cases, and the delta brushes were mixed with background fast waves in one case; 71% (20/28) patients had epileptiform discharges in EEG during the course, and among them, 6 patients had secondary epilepsy. The background activity in the awake state and abnormal diffuse slow waves of EEG were evolved and gradually recovered during the course of the disease. Regardless milder or severe illness condition, occipital background activity was still preserved during different stages in most patients. Alpha and theta rhythms in NREM sleep might represent a relatively overt EEG characteristic. The presence of delta brush in EEG was rare, and sometimes they were difficult to be distinguished from fast wave activities caused by drugs. The presence of epileptiform discharges in EEG suggested the possibility of secondary epilepsy.

Electroencephalogram In Intensive Care Unit

Introduction: The electroencephalogram (EEG) is the electrophysiological recording of synaptic activation of a lot of pyramidal neurons of the cerebral cortex. The applicability of the EEG in the diagnostic investigation of central nervous system diseases (CNS) such as epilepsy was readily established and widespread.Objectives: Know the main findings and EEG indications in a intensive care unit, trace the epidemiological profile of ICU patients, and correlate EEG findings to possible changes in therapy.Method: Descriptive and retrospective study conducted in the ICU of Hospital Medical Center Maranhense analyzing all EEG conducted from October 2011 to October 2012.Results: 35 EEG were analyzed in 29 patients. Of these patients, 1758.6% were male and 12-41.4% were female. In our study we found that the cerebrovascular accident was the clinical condition most often observed, corresponding to 28.5% (brain hemorrhagic stroke - 17.1% and ischemic stroke - 11.4%), followed by traumatic brain injury (17.1%), severe sepsis (17.1%), other causes (14.3%), toxic-metabolic encephalopathy (11.4%), and Status epilepticus (11.4%). Coma was present in (11.4%) and only 2.9% had EEG to assess post-PCR. We found a disorganized background activity (35 - 100%), the asymmetrical pattern is found in 21 (60%) and symmetrical in 14 (40%) The presence of epileptiform discharges was identified in 12 (34.2%). A change of therapy occurred in 8 (22.9%) patients who underwent electroencephalographic examination.Conclusion: We note that the indications responsible for electroencephalographic monitoring on the edge of the bed were frequently altered level of consciousness and seizures. Before electroencephalographic patterns analyzed by the study, we realized that in all tests the background activity was disorganized and there was a significant incidence of epileptiform discharges.

The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure.

The clinical utility of routine electroencephalography (EEG) after a first unprovoked seizure remains uncertain. Its diagnostic accuracy in identifying adults and children with new onset epilepsy was examined. A systematic review and meta-analysis of studies examining individuals who underwent routine EEG after a first unprovoked seizure and were followed for seizure recurrence for at least 1 year was performed. A 'positive' test was defined by the presence of epileptiform discharges (ED). Pooled sensitivity and specificity estimates were calculated using a bivariate random effects regression model. In all, 3096 records were reviewed, from which 15 studies were extracted with a total of 1799 participants. Amongst adult studies, the sensitivity and specificity (95% confidence interval) of routine EEG were 17.3% (7.9, 33.8) and 94.7% (73.7, 99.1), respectively. Amongst child studies, the pooled sensitivity and specificity were 57.8% (49.7, 65.6) and 69.6% (57.5, 79.5), respectively. Based upon our positive likelihood ratios, and assuming a pre-test probability of 50%, an adult with ED on routine EEG after a first unprovoked seizure has a 77% probability of having a second seizure, whilst a child with similar findings has a 66% probability. Further studies are required to examine the impact of patient characteristics and EEG features on the diagnostic accuracy of routine EEG for new onset epilepsy.

Zonisamid: az elsőként választandó antiepileptikumok között fokális epilepsziában

[Chronic administration of antiepileptic drugs without history of unprovoked epileptic seizures are not recommended for epilepsy prophylaxis. Conversely, if the patient suffered the first unprovoked seizure, then the presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy). Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors (for example signs of previous stroke, neurotrauma, or encephalitis on the MRI) can predict >70% seizure recurrence. Thus the International League Against Epilepsy (ILAE) re-defined the term ’epilepsy’ which can be diagnosed even after the first seizure, if the risk of seizure recurrence is high. According to this definition, we can start antiepileptic drug therapy after a single unprovoked seizure. There are four antiepileptic drugs which has the highest evidence (level „A”) as first-line initial monotherapy for treating newly diagnosed epilepsy. These are: carbamazepine, phenytoin, levetiracetam, and zonisamide (ZNS). The present review focuses on the ZNS. Beacuse ZNS can be administrated once a day, it is an optimal drug for maintaining patient’s compliance and for those patients who have a high risk for developing a non-compliance (for example teenagers and young adults). Due to the low interaction potential, ZNS treatment is safe and effective in treating epilepsy of elderly people. ZNS is an ideal drug in epilepsy accompanied by obesity, because ZNS has a weight loss effect, especially in obese patients.]

Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes.

The aim of the study was to determine sociodemographic, biological epilepsy-specific, and adherence predictors of long-term pediatric seizure outcomes. This study is a prospective, longitudinal, observational study of antiepileptic drug (AED) adherence and seizure outcomes in children with newly diagnosed epilepsy. Patients were recruited from April 2006 to March 2009 and followed for 2 years. Objective, electronic monitors were used to assess AED adherence. Medical chart reviews assessed medical variables and seizure outcomes. Participants (n = 109) were 7.3 ± 2.9 years of age, and 62% male. Four adherence trajectory groups were identified: severe early nonadherence (n = 10), variable nonadherence (n = 16), moderate nonadherence (n = 40), and high adherence (n = 43). Two seizure probability trajectory groups were identified: high seizure (n = 28) and low seizure probability (n = 81). Participants with recognizable syndromes were less likely to be a member of the high seizure probability group (b = -2.372; odds ratio [OR] = 0.093; 95% confidence interval [CI]OR = 0.015, 0.595); those with the presence of epileptiform discharges on EEG were more likely to be in the high seizure probability group (b = 1.649; OR = 5.203; 95% CIOR = 1.422, 19.037). Adherence trajectory group status was a significant predictor of seizure trajectory group status (partial max-rescaled R(2) = 0.13). Adherence trajectories and 2 biological epilepsy-specific variables explain a similar proportion of the variability in longitudinal seizure outcomes. The relationship between AED nonadherence and seizure outcomes is not linear. Early adherence interventions could change the course of seizure outcomes, particularly if variability in adherence was minimized postdiagnosis.