Routine and sleep EEG: Minimum recording standards of the International Federation of Clinical Neurophysiology and the International League Against Epilepsy.

This article provides recommendations on the minimum standards for recording routine ("standard") and sleep electroencephalography (EEG). The joint working group of the International Federation of Clinical Neurophysiology (IFCN) and the International League Against Epilepsy (ILAE) developed the standards according to the methodology suggested for epilepsy-related clinical practice guidelines by the Epilepsy Guidelines Working Group. We reviewed the published evidence using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of evidence for sleep induction methods was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method. A tool for Quality Assessment of Diagnostic Studies (QUADAS-2) was used to assess the risk of bias in technical and methodological studies. Where high-quality published evidence was lacking, we used modified Delphi technique to reach expert consensus. The GRADE system was used to formulate the recommendations. The quality of evidence was low or moderate. We formulated 16 consensus-based recommendations for minimum standards for recording routine and sleep EEG. The recommendations comprise the following aspects: indications, technical standards, recording duration, sleep induction, and provocative methods.

Ictal paraphasia as an atypical manifestation of temporal lobe epilepsy.

Language disturbances are common manifestations of non-convulsive seizures in focal epilepsy. Ictal aphasia and speech arrest are the most representative. On the other hand, ictal paraphasia is a rare clinical manifestation of dominant temporal lobe epilepsy, with few cases reported in the literature. We describe a 73-year-old woman with focal onset unaware seizures presenting with phonemic paraphasias related to a left anterior temporal low-grade glioma. This ictal speech manifestation can be easily misdiagnosed and treated as other neurological or mental illnesses and can be considered a lateralizing sign in epilepsy when an appropriate anatomo - electro - clinical correlation is done.

An international consortium in epilepsy surgery education: Clinical case-based discussions between Latin-American and Canadian Epilepsy Centers.

An international consortium with a focus on Epilepsy Surgery Education was established with members from different centers in Latin America and Canada. All members of the consortium and attendees from different centers in Latin America and Canada have been meeting to discuss epilepsy surgery cases in a virtual manner. We surveyed all to assess the value of the meetings. The results and description of these meetings are being presented.

Efficacy and safety of Levetiracetam vs. other antiepileptic drugs in Hispanic patients with glioblastoma.

Epilepsy is a common symptom in patients with glioblastoma (GB). 213 patients with GB from RedLANO follow-up registry were included. All patients underwent surgery, if feasible, followed by chemoradiation based on temozolomide (Stupp platform). Information was recorded regarding demographics, seizure timing, anti-epileptic drugs (AEDs), dosage, time to next seizure, total seizures in 6 months, and main side effects of AEDs. The relationship between epilepsy treatment and overall survival (OS) was evaluated. Mean age was 53 years old and 56.8% were male. Seventy-eight patients (37%) were treated with levetiracetam (LEV), 27% were given another AED and 36% did not require any AED. Choice of AED was not associated with age (p = 0.67), performance status (p = 0.24) or anatomic tumor site (p = 0.34). Seizures and AED requirement were greater in those having primary GB (p = 0.04). After starting an AED, the mean time until next crisis was 9.9 days (SD ± 6.3), which was shorter in those receiving LEV (p = 0.03); mean number of seizures during the first 3 and 6 months were 2.9 and 4, respectively. Most patients treated with LEV (n = 46) required less than two medication adjustments compared to those treated with other AEDs (p = 0.02). Likewise, less patients exposed to LEV required a coadjuvant drug (p = 0.04). Additionally, patients receiving LEV had significantly less adverse effects compared to patients treated with another AED. OS was significantly higher in the group treated with LEV compared to other AEDs (25.5 vs. 17.9 months; p = 0.047). Patients treated with LEV had better seizure control and longer OS compared to other AEDs.

Routine and sleep EEG: Minimum recording standards of the International Federation of Clinical Neurophysiology and the International League Against Epilepsy.

This article provides recommendations on the minimum standards for recording routine ("standard") and sleep electroencephalography (EEG). The joint working group of the International Federation of Clinical Neurophysiology (IFCN) and the International League Against Epilepsy (ILAE) developed the standards according to the methodology suggested for epilepsy-related clinical practice guidelines by the Epilepsy Guidelines Working Group. We reviewed the published evidence using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of evidence for sleep induction methods was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method. A tool for Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the risk of bias in technical and methodological studies. Where high-quality published evidence was lacking, we used modified Delphi technique to reach expert consensus. The GRADE system was used to formulate the recommendations. The quality of evidence was low or moderate. We formulated 16 consensus-based recommendations for minimum standards for recording routine and sleep EEG. The recommendations comprise the following aspects: indications, technical standards, recording duration, sleep induction, and provocative methods.

Modern technology calls for a modern approach to classification of epileptic seizures and the epilepsies.

In the last 10-15 years the ILAE Commission on Classification and Terminology has been presenting proposals to modernize the current ILAE Classification of Epileptic Seizures and Epilepsies. These proposals were discussed extensively in a series of articles published recently in Epilepsia and Epilepsy Currents. There is almost universal consensus that the availability of new diagnostic techniques as also of a modern understanding of epilepsy calls for a complete revision of the Classification of Epileptic Seizures and Epilepsies. Unfortunately, however, the Commission is still not prepared to take a bold step ahead and completely revisit our approach to classification of epileptic seizures and epilepsies. In this manuscript we critically analyze the current proposals of the Commission and make suggestions for a classification system that reflects modern diagnostic techniques and our current understanding of epilepsy.

Seizure semiology: ILAE glossary of terms and their significance.

This educational topical review and Task Force report aims to address learning objectives of the International League Against Epilepsy (ILAE) curriculum. We sought to extract detailed features involving semiology from video recordings and interpret semiological signs and symptoms that reflect the likely localization for focal seizures in patients with epilepsy. This glossary was developed by a working group of the ILAE Commission on Diagnostic Methods incorporating the EEG Task Force. This paper identifies commonly used terms to describe seizure semiology, provides definitions, signs and symptoms, and summarizes their clinical value in localizing and lateralizing focal seizures based on consensus in the published literature. Video-EEG examples are included to illustrate important features of semiology in patients with epilepsy.

The multiple faces of encephalitis: Antibody profile in a case series of autoimmune encephalitis in Bogotá, Colombia.

There is a lack of population based studies of autoimmune encephalitis (AE) in Latin American countries, especially in Colombia. The aim of this study is to characterize patients with AE managed in three centers in Bogotá-Colombia, emphasizing on antibody profile. We conducted a retrospective case-series study, including 9 patients. The most prevalent antibody found was NMDAR, followed by LGI1. Some distinguishing features included: faciobrachial dystonia and hyponatremia in LGI1, a younger age and good outcome in NMDAR, a notable response to steroids in anti TPO-Thyroglobulin, a cerebellar syndrome associated with Anti-Yo, and epilepsy with insomnia in CASPR2.

Estimulador del nervio vago, ¿se puede quedar libre de crisis?, presentación de un caso y revisión de la literatura / Vagus nerve stimulator, is it possible to be free of crisis ?, presentation of a case and review of the literature

RESUMEN La estimulación del nervio vago es una técnica aprobada por la FDA, para epilepsia focal refractaria. Presentamos un caso de un paciente, con epilepsia de probable origen frontal, el cual cumplió criterios para epilepsia refractaria, y fue llevado a implantación de estimulador del nervio vago, quedando libre de crisis.

SUMMARY Vagal nerve stimulation is an FDA-approved technique for focal refractory epilepsy. We present the case of a patient, with epilepsy of probable frontal origin, who met criteria for refractory epilepsy, and was taken to implantation of vagus nerve stimulator, currently free of crisis.

Estatus epiléptico estado del arte / Status epilepticus: state of the art

El estatus epiléptico (EE) es una emergencianeurológica relativamente frecuente; es importantepara el neurólogo y el cuerpo médico en general,tener un conocimiento adecuado de esta entidadtanto en su reconocimiento como en el manejomédico interdisciplinario. Es esta la razón por lacual se realizó una revisión actualizada y novedosasobre estatus epiléptico.

Electroencefalografía y vídeo-EEG enestatus epiléptico / Electroencephalogram and continuous EEG monitoring in status epilepticus

El registro electroencefalográfico en especial cuando se combina con video (Video-EEG / Videotelemetria) aunquecon frecuencia subutilizado; es de gran utilidad en el diagnóstico y seguimiento de pacientes en estatus epilépticoo con sospecha de él.Algunos patrones ictales del electroencefalograma que son la clave en el diagnóstico de estatus epiléptico, son difícilesde interpretar y requieren de un neurólogo o neuropediatra con entrenamiento adecuado en neurofisiología clínicaque sepa reconocerlos, entrenamiento que usualmente es de 1 a 2 años una vez terminado el tiempo de residencia.El video-EEG continuo ayuda a determinar si el paciente está en estatus, si el tratamiento instaurado es efectivo,si se requiere más medicación o sedación y por último si él se ha controlado del todo.Algunos pacientes con estatus convulsivo evolucionan hacia uno no convulsivo, el cual es de difícil diagnóstico,con manifestándose diversas que van desde un cuadro confusional hasta el coma; en estos pacientes el video-EEGcontinuo permite reconocer que el paciente esta aun en estatus epiléptico.Una vez controlado el estatus epiléptico, se debe continuarse con registro de video-EEG por 24 o 48 horas adicionalescon el fin de evidenciar si hay recurrencia de las crisis y si el paciente requiere un tratamiento más agresivo.

Depresión y epilepsia / Epilepsy and depression

Los síntomas depresivos postictales se pueden presentar minutos después hasta pocos días luego de una crisis y son más frecuentes en pacientes con epilepsia refractaria. El uso de escalas, como la de Hamilton, ha permitido establecer que la depresión mayor ocurre en mayor proporción en pacientes con epilepsia que en la población general. Se ha estimado un 30 -50 por ciento la prevalencia de depresión mayor para pacientes con epilepsia refractaria . La depresión ocurre con mayor frecuencia con las crisis del lóbulo temporal comparada con la epilepsia idiopática generalizada, siendo más frecuente la depresión interictal; la depresión preictal puede aparecer horas antes de la crisis, mientras que la depresión ictal es rara. La terapéutica en pacientes con depresión y epilepsia incluye el inicio de psicoterapia y con frecuencia el uso de antidepresivos. En pacientes con epilepsia y depresión severa que no responde a la medicación puede ser útil la terapia electroconvulsiva.Los síntomas depresivos aunque frecuentes en los pacientes con epilepsia, son poco reconocidos y tratados. Los pacientes más susceptibles son aquellos con epilepsia del lóbulo temporal y con pobre control de crisis. La depresión también se ha informado como complicación posquirúrgica en pacientes que han recibido cirugía para epilepsia