Risk factors for reading disability in families with rolandic epilepsy.

OBJECTIVE: The high prevalence and impact of neurodevelopmental comorbidities in childhood epilepsy are now well known, as are the increased risks and familial aggregation of reading disability (RD) and speech sound disorder (SSD) in rolandic epilepsy (RE). The risk factors for RD in the general population include male sex, SSD, and ADHD, but it is not known if these are the same in RE or whether there is a contributory role of seizure and treatment-related variables. METHODS: An observational study of 108 probands with RE (age range: 3.6-22 years) and their 159 siblings (age range: 1-29 years; 83 with EEG data) were singly ascertained in the US or UK through a proband affected by RE. We used a nested case-control design, multiple logistic regression, and generalized estimating equations to test the hypothesis of an association between RD and seizure variables or antiepileptic drug treatment in RE; we also assessed an association between EEG focal sharp waves and RD in siblings. RESULTS: Reading disability was reported in 42% of probands and 22% of siblings. Among probands, RD was strongly associated with a history of SSD (OR: 9.64, 95% CI: 2.45-37.21), ADHD symptoms (OR: 10.31, 95% CI: 2.15-49.44), and male sex (OR: 3.62, 95% CI: 1.11-11.75) but not with seizure or treatment variables. Among siblings, RD was independently associated only with SSD (OR: 4.30, 95% CI: 1.42-13.0) and not with the presence of interictal EEG focal sharp waves. SIGNIFICANCE: The principal risk factors for RD in RE are SSD, ADHD, and male sex, the same risk factors as for RD without epilepsy. Seizure or treatment variables do not appear to be important risk factors for RD in probands with RE, and there was no evidence to support interictal EEG focal sharp waves as a risk factor for RD in siblings. Future studies should focus on the precise neuropsychological characterization of RD in families with RE and on the effectiveness of standard oral-language and reading interventions.

The value of Magnetoencephalography to guide electrode implantation in epilepsy.

To investigate if Magnetoencephalography (MEG) can add non-redundant information to guide implantation sites for intracranial recordings (IR). The contribution of MEG to intracranial recording planning was evaluated in 12 consecutive patients assessed pre-surgically with MEG followed by IR. Primary outcome measures were the identification of focal seizure onset in IR and favorable surgical outcome. Outcome measures were compared to those of 12 patients matched for implantation type in whom non-invasive pre-surgical assessment suggested clear hypotheses for implantation (non-MEG group). In the MEG group, non-invasive assessment without MEG was inconclusive, and MEG was then used to further help identify implantation sites. In all MEG patients, at least one virtual MEG electrode generated suitable hypotheses for the location of implantations. No differences in outcome measures were found between non-MEG and MEG groups. Although the MEG group included more complex patients, it showed similar percentage of successful implantations as the non-MEG group. This suggests that MEG can contribute to identify implantation sites where standard methods failed.

Regional differences in the sensitivity of MEG for interictal spikes in epilepsy.

MEG interictal spikes as recorded in epilepsy patients are a reflection of intracranial interictal activity. This study investigates the relationship between the estimated sources of MEG spikes and the location, distribution and size of interictal spikes in the invasive ECoG of a group of 38 epilepsy patients that are monitored for pre-surgical evaluation. An amplitude/surface area measure is defined to quantify and rank ECoG spikes. It is found that all MEG spikes are associated with an ECoG spike that is among the three highest ranked in a patient. Among the different brain regions considered, the fronto-orbital, inter-hemispheric, tempero-lateral and central regions stand out. In an accompanying simulation study it is shown that for hypothesized extended sources of larger sizes, as suggested by the data, source location, orientation and curvature can partly explain the observed sensitivity of MEG for interictal spikes.

Centromedian thalamic nuclei deep brain stimulation in refractory status epilepticus.

BACKGROUND: Refractory status epilepticus (RSE) is associated with high mortality. We report a potential treatment alternative. HYPOTHESIS: Deep brain stimulation (DBS) of the centromedian thalamic nuclei (CMN) can be effective in the treatment of RSE. METHODS: Report of the evolution of RSE after DBS of the CMN in a 27-year-old man. RESULTS: In the course of an encephalopathy of unknown origin, and after a cardiac arrest, the patient developed RSE with myoclonic jerks and generalized tonic-clonic seizures. The EEG showed continuous generalized periodic epileptiform discharges (GPEDS). Five weeks after RSE onset, bilateral DBS of the CMN was started. This treatment was immediately followed by disappearance of tonic-clonic seizures and GPEDS, suggesting a resolution of RSE. The patient continued having multifocal myoclonic jerks, probably subcortical in origin, which resolved after 4 weeks. The patient remained clinically stable for 2 months in a persistent vegetative state. CONCLUSIONS: The remission of RSE, the abolition of GPEDS, and the patient survival suggest that DBS of the CMN may be efficacious in the treatment of refractory, generalized status epilepticus.

Interictal ECoG spikes as reflected in MEG.

This study investigates the relationship between the sources of MEG interictal spikes and the distribution of spikes in invasive ECoG in a group of 38 epilepsy patients. An amplitude/surface area measure is defined to quantify ECoG spikes. It is found that all MEG spikes are associated with an ECoG spike that is, according to this measure, among the largest in each patient. For different brain regions considered the inter-hemispheric, tempero-lateral and central regions stand out. However, MEG may only see part of the often complex ECoG spike. In an accompanying simulation study it is shown that MEG as predicted from measured complex ECoG spikes resemble measured MEG and show similar shortcomings with respect to localization.