Association of Epileptiform Abnormality on Electroencephalography with Development of Epilepsy After Acute Brain Injury.

BACKGROUND/OBJECTIVES: Epileptiform abnormalities (EA) on continuous electroencephalography (cEEG) are associated with increased risk of acute seizures; however, data on their association with development of long-term epilepsy are limited. We aimed to investigate the association of EA in patients with acute brain injury (ABI): ischemic or hemorrhagic stroke, traumatic brain injury, encephalitis, or posterior reversible encephalopathy syndrome, and subsequent development of epilepsy. METHODS: This was a retrospective, single-center study of patients with ABI who had at least 6 hours of cEEG during the index admission between 1/1/2017 and 12/31/2018 and at least 12 months of follow-up. We compared patients with EAs; defined as lateralized periodic discharges (LPDs), lateralized rhythmic delta activity (LRDA), generalized periodic discharges (GPDs), and sporadic interictal epileptiform discharges (sIEDs) to patients without EAs on cEEG. The primary outcome was the new development of epilepsy, defined as the occurrence of spontaneous clinical seizures following hospital discharge. Secondary outcomes included time to development of epilepsy and use of anti-seizure medications (ASMs) at the time of last follow-up visit. RESULTS: One hundred and one patients with ABI met study inclusion criteria. Thirty-one patients (30.7%) had EAs on cEEG. The median (IQR) time to cEEG was 2 (1-5) days. During a median (IQR) follow-up period of 19.1 (16.2-24.3) months, 25.7% of patients developed epilepsy; the percentage of patients who developed epilepsy was higher in those with EAs compared to those without EAs (41.9% vs. 18.6%, p = 0.025). Patients with EAs were more likely to be continued on ASMs during follow-up compared to patients without EAs (67.7% vs. 38.6%, p = 0.009). Using multivariable Cox regression analysis, after adjusting for age, mental status, electrographic seizures on cEEG, sex, ABI etiology, and ASM treatment on discharge, patients with EAs had a significantly increased risk of developing epilepsy compared to patients without EA (hazard ratio 3.39; 95% CI 1.39-8.26; p = 0.007). CONCLUSIONS: EAs on cEEG in patients with ABI are associated with a greater than three-fold increased risk of new-onset epilepsy. cEEG findings in ABI may therefore be a useful risk stratification tool for assessing long-term risk of seizures and serve as a biomarker for new-onset epilepsy.

A review of the efficacy of a low-cost cancer screening test using cancer sniffing canines.

One of the most powerful tools in fighting cancer is early detection, as it has been strongly linked to greater chances of cancer survival. However, traditional cancer screening tests can cost hundreds if not thousands of dollars and are therefore not an affordable option for many marginalized populations. From a public health perspective, it is vital to research the use of inexpensive cancer detection so that low-resourced patients have greater access to affordable cancer screening. Numerous studies dating from the early 2000s to recent years have shown extensive evidence that the exceptional olfactory system of canines allows them to detect certain odors through exhaled breath condensate that are known to be biomarkers of a variety of cancers. In addition to providing a cheaper alternative to conventional cancer screening tests, the use of cancer sniffing dogs has other benefits, including great reliability and accuracy. There are a few major types of cancer for which the 'cancer dog test' proved to be remarkably effective, particularly colorectal, ovarian, and lung cancers. The test is non-invasive unlike most previous detection methods, meaning that it is also a safer option for individuals seeking cancer screening. Although the use of cancer sniffing dogs does have certain limitations and scope for error, it would provide a more affordable and accessible option for cancer screening, making it especially beneficial to low-resourced populations.