RESUMEN
Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence-based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta-analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non-randomised studies - of interventions (ROBINS-I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). If insufficient evidence was available, then expert opinion was sought using Delphi consensus methodology. The strength of recommendations was defined according to the ILAE Clinical Practice Guidelines development tool. There were six main recommendations. First, phenobarbital should be the first-line ASM (evidence-based recommendation) regardless of etiology (expert agreement), unless channelopathy is likely the cause for seizures (e.g., due to family history), in which case phenytoin or carbamazepine should be used. Second, among neonates with seizures not responding to first-line ASM, phenytoin, levetiracetam, midazolam, or lidocaine may be used as a second-line ASM (expert agreement). In neonates with cardiac disorders, levetiracetam may be the preferred second-line ASM (expert agreement). Third, following cessation of acute provoked seizures without evidence for neonatal-onset epilepsy, ASMs should be discontinued before discharge home, regardless of magnetic resonance imaging or electroencephalographic findings (expert agreement). Fourth, therapeutic hypothermia may reduce seizure burden in neonates with hypoxic-ischemic encephalopathy (evidence-based recommendation). Fifth, treating neonatal seizures (including electrographic-only seizures) to achieve a lower seizure burden may be associated with improved outcome (expert agreement). Sixth, a trial of pyridoxine may be attempted in neonates presenting with clinical features of vitamin B6-dependent epilepsy and seizures unresponsive to second-line ASM (expert agreement). Additional considerations include a standardized pathway for the management of neonatal seizures in each neonatal unit and informing parents/guardians about the diagnosis of seizures and initial treatment options.
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Anticonvulsivantes , Epilepsia , Recién Nacido , Humanos , Anticonvulsivantes/uso terapéutico , Levetiracetam/uso terapéutico , Fenitoína/uso terapéutico , Consenso , Epilepsia/tratamiento farmacológico , Convulsiones/diagnóstico , Convulsiones/tratamiento farmacológicoRESUMEN
OBJECTIVE: Accreditation Council for Graduate Medical Education (ACGME)-accredited epilepsy fellowships, like other ACGME accredited training programs, use Milestones to establish learning objectives and to evaluate how well trainees are achieving these goals. The ACGME began developing the second iteration of the Milestones 6 years ago, and these are now being adapted to all specialties. Here, we describe the process by which Epilepsy Milestones 2.0 were developed and summarize them. METHODS: A work group of nine board-certified, adult and pediatric epileptologists reviewed Epilepsy Milestones 1.0 and revised them using a modified Delphi approach. RESULTS: The new Milestones share structural changes with all other specialties, including a clearer stepwise progression in professional development and the harmonized Milestones that address competencies common to all medical fields. Much of the epilepsy-specific content remains the same, although a major addition is a set of Milestones focused on reading and interpreting electroencephalograms (EEGs), which the old Milestones lacked. Epilepsy Milestones 2.0 includes a Supplemental Guide to help program directors implement the new Milestones. Together, Epilepsy Milestones 2.0 and the Supplemental Guide recognize advances in epilepsy, including stereo-EEG, neurostimulation, genetics, and safety in epilepsy monitoring units. SIGNIFICANCE: Epilepsy Milestones 2.0 address the shortcomings of the old Milestones and should facilitate the assessment of epilepsy fellowships and fellows by program directors, faculty, and fellows themselves.
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Epilepsia , Internado y Residencia , Acreditación , Adulto , Niño , Competencia Clínica , Educación de Postgrado en Medicina , Epilepsia/diagnóstico , Epilepsia/terapia , Becas , HumanosRESUMEN
Seizures are the most common neurological emergency in the neonatal period and in contrast to those in infancy and childhood, are often provoked seizures with an acute cause and may be electrographic-only. Hence, neonatal seizures may not fit easily into classification schemes for seizures and epilepsies primarily developed for older children and adults. A Neonatal Seizures Task Force was established by the International League Against Epilepsy (ILAE) to develop a modification of the 2017 ILAE Classification of Seizures and Epilepsies, relevant to neonates. The neonatal classification framework emphasizes the role of electroencephalography (EEG) in the diagnosis of seizures in the neonate and includes a classification of seizure types relevant to this age group. The seizure type is determined by the predominant clinical feature. Many neonatal seizures are electrographic-only with no evident clinical features; therefore, these are included in the proposed classification. Clinical events without an EEG correlate are not included. Because seizures in the neonatal period have been shown to have a focal onset, a division into focal and generalized is unnecessary. Seizures can have a motor (automatisms, clonic, epileptic spasms, myoclonic, tonic), non-motor (autonomic, behavior arrest), or sequential presentation. The classification allows the user to choose the level of detail when classifying seizures in this age group.
Asunto(s)
Epilepsia Benigna Neonatal/clasificación , Epilepsia/clasificación , Convulsiones/clasificación , Comités Consultivos , Diagnóstico Diferencial , Electroencefalografía , Epilepsia/diagnóstico , Epilepsia Benigna Neonatal/diagnóstico , Humanos , Recién Nacido , Convulsiones/diagnósticoRESUMEN
OBJECTIVE: Evaluate the seizure-reduction response and safety of mesial temporal lobe (MTL) brain-responsive stimulation in adults with medically intractable partial-onset seizures of mesial temporal lobe origin. METHODS: Subjects with mesial temporal lobe epilepsy (MTLE) were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. RESULTS: There were 111 subjects with MTLE; 72% of subjects had bilateral MTL onsets and 28% had unilateral onsets. Subjects had one to four leads placed; only two leads could be connected to the device. Seventy-six subjects had depth leads only, 29 had both depth and strip leads, and 6 had only strip leads. The mean follow-up was 6.1 ± (standard deviation) 2.2 years. The median percent seizure reduction was 70% (last observation carried forward). Twenty-nine percent of subjects experienced at least one seizure-free period of 6 months or longer, and 15% experienced at least one seizure-free period of 1 year or longer. There was no difference in seizure reduction in subjects with and without mesial temporal sclerosis (MTS), bilateral MTL onsets, prior resection, prior intracranial monitoring, and prior vagus nerve stimulation. In addition, seizure reduction was not dependent on the location of depth leads relative to the hippocampus. The most frequent serious device-related adverse event was soft tissue implant-site infection (overall rate, including events categorized as device-related, uncertain, or not device-related: 0.03 per implant year, which is not greater than with other neurostimulation devices). SIGNIFICANCE: Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior MTL resection.
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Encéfalo/fisiopatología , Estimulación Encefálica Profunda/métodos , Epilepsia Refractaria/fisiopatología , Epilepsia Refractaria/terapia , Terapia por Estimulación Eléctrica/métodos , Electroencefalografía , Epilepsias Parciales/fisiopatología , Epilepsias Parciales/terapia , Epilepsia del Lóbulo Temporal/fisiopatología , Epilepsia del Lóbulo Temporal/terapia , Adolescente , Adulto , Dominancia Cerebral/fisiología , Electrodos Implantados , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVE: Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with medically intractable partial-onset seizures of neocortical origin. METHODS: Patients with partial seizures of neocortical origin were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Additional analyses considered safety and seizure reduction according to lobe and functional area (e.g., eloquent cortex) of seizure onset. RESULTS: There were 126 patients with seizures of neocortical onset. The average follow-up was 6.1 implant years. The median percent seizure reduction was 70% in patients with frontal and parietal seizure onsets, 58% in those with temporal neocortical onsets, and 51% in those with multilobar onsets (last observation carried forward [LOCF] analysis). Twenty-six percent of patients experienced at least one seizure-free period of 6 months or longer and 14% experienced at least one seizure-free period of 1 year or longer. Patients with lesions on magnetic resonance imaging (MRI; 77% reduction, LOCF) and those with normal MRI findings (45% reduction, LOCF) benefitted, although the treatment response was more robust in patients with an MRI lesion (p = 0.02, generalized estimating equation [GEE]). There were no differences in the seizure reduction in patients with and without prior epilepsy surgery or vagus nerve stimulation. Stimulation parameters used for treatment did not cause acute or chronic neurologic deficits, even in eloquent cortical areas. The rates of infection (0.017 per patient implant year) and perioperative hemorrhage (0.8%) were not greater than with other neurostimulation devices. SIGNIFICANCE: Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including adults with seizures of neocortical onset, and those with onsets from eloquent cortex.
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Corteza Cerebral/fisiopatología , Estimulación Encefálica Profunda/métodos , Epilepsia Refractaria/fisiopatología , Epilepsia Refractaria/terapia , Terapia por Estimulación Eléctrica/métodos , Electroencefalografía , Neocórtex/fisiopatología , Adolescente , Adulto , Mapeo Encefálico , Estimulación Encefálica Profunda/instrumentación , Terapia por Estimulación Eléctrica/instrumentación , Electrodos Implantados , Epilepsias Parciales/fisiopatología , Epilepsias Parciales/terapia , Epilepsia Parcial Compleja/fisiopatología , Epilepsia Parcial Compleja/terapia , Epilepsia Parcial Motora/fisiopatología , Epilepsia Parcial Motora/terapia , Epilepsia Tónico-Clónica/fisiopatología , Epilepsia Tónico-Clónica/terapia , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Evidence-based guidelines, or recommendations, for the management of infants with seizures are lacking. A Task Force of the Commission of Pediatrics developed a consensus document addressing diagnostic markers, management interventions, and outcome measures for infants with seizures. Levels of evidence to support recommendations and statements were assessed using the American Academy of Neurology Guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The report contains recommendations for different levels of care, noting which would be regarded as standard care, compared to optimal care, or "state of the art" interventions. The incidence of epilepsy in the infantile period is the highest of all age groups (strong evidence), with epileptic spasms the largest single subgroup and, in the first 2 years of life, febrile seizures are the most commonly occurring seizures. Acute intervention at the time of a febrile seizure does not alter the risk for subsequent epilepsy (class 1 evidence). The use of antipyretic agents does not alter the recurrence rate (class 1 evidence), and there is no evidence to support initiation of regular antiepileptic drugs for simple febrile seizures (class 1 evidence). Infants with abnormal movements whose routine electroencephalography (EEG) study is not diagnostic, would benefit from video-EEG analysis, or home video to capture events (expert opinion, level U recommendation). Neuroimaging is recommended at all levels of care for infants presenting with epilepsy, with magnetic resonance imaging (MRI) recommended as the standard investigation at tertiary level (level A recommendation). Genetic screening should not be undertaken at primary or secondary level care (expert opinion). Standard care should permit genetic counseling by trained personal at all levels of care (expert opinion). Genetic evaluation for Dravet syndrome, and other infantile-onset epileptic encephalopathies, should be available in tertiary care (weak evidence, level C recommendation). Patients should be referred from primary or secondary to tertiary level care after failure of one antiepileptic drug (standard care) and optimal care equates to referral of all infants after presentation with a seizure (expert opinion, level U evidence). Infants with recurrent seizures warrant urgent assessment for initiation of antiepileptic drugs (expert opinion, level U recommendation). Infantile encephalopathies should have rapid introduction and increment of antiepileptic drug dosage (expert opinion, level U recommendation). There is no high level evidence to support any particular current agents for use in infants with seizures. For focal seizures, levetiracetam is effective (strong evidence); for generalized seizures, weak evidence supports levetiracetam, valproate, lamotrigine, topiramate, and clobazam; for Dravet syndrome, strong evidence supports that stiripentol is effective (in combination with valproate and clobazam), whereas weak evidence supports that topiramate, zonisamide, valproate, bromide, and the ketogenic diet are possibly effective; and for Ohtahara syndrome, there is weak evidence that most antiepileptic drugs are poorly effective. For epileptic spasms, clinical suspicion remains central to the diagnosis and is supported by EEG, which ideally is prolonged (level C recommendation). Adrenocorticotropic hormone (ACTH) is preferred for short-term control of epileptic spasms (level B recommendation), oral steroids are probably effective in short-term control of spasms (level C recommendation), and a shorter interval from the onset of spasms to treatment initiation may improve long-term neurodevelopmental outcome (level C recommendation). The ketogenic diet is the treatment of choice for epilepsy related to glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency (expert opinion, level U recommendation). The identification of patients as potential candidates for epilepsy surgery should be part of standard practice at primary and secondary level care. Tertiary care facilities with experience in epilepsy surgery should undertake the screening for epilepsy surgical candidates (level U recommendation). There is insufficient evidence to conclude if there is benefit from vagus nerve stimulation (level U recommendation). The key recommendations are summarized into an executive summary. The full report is available as Supporting Information. This report provides a comprehensive foundation of an approach to infants with seizures, while identifying where there are inadequate data to support recommended practice, and where further data collection is needed to address these deficits.
Asunto(s)
Guías de Práctica Clínica como Asunto , Convulsiones Febriles/terapia , Espasmos Infantiles/terapia , Comités Consultivos , Anticonvulsivantes , Manejo de la Enfermedad , Electroencefalografía , Epilepsia/diagnóstico , Epilepsia/terapia , Humanos , Lactante , Recién Nacido , Neuroimagen , Convulsiones Febriles/diagnóstico , Espasmos Infantiles/diagnósticoRESUMEN
OBJECTIVE: The International League Against Epilepsy (ILAE) Neonatal Seizure Framework was tested by medical personnel. METHODS: Attendees at the 2016 ILAE European Congress on Epileptology in Prague, the International Video-EEG Course in Pediatric Epilepsies in Madrid 2017, and a local meeting in Utrecht 2018, were introduced to the proposed ILAE neonatal classification system with teaching videos covering the seven types of clinical seizures in the proposed neonatal classification system. Five test digital video recordings of electroencephalography (EEG)-confirmed motor neonatal seizures were then shown and classified by the rater based on their knowledge of the proposed ILAE Neonatal Seizure Framework. A multi-rater Kappa statistic was used to assess the agreement between observers and the true diagnosis. RESULTS: The responses of 194 raters were obtained. There was no single predominant classification system that was currently used by the raters. Using the ILAE framework, 78%-93% of raters correctly identified the clinical seizure type for each neonate; the overall inter-rater agreement (Kappa statistic) was 0.67. The clonic motor seizure type was most frequently accurately identified (93% of the time; κ = 0.870). EEG technicians correctly identified all presented motor seizure types more frequently than any other group (accuracy = 0.9). SIGNIFICANCE: The ILAE Neonatal Seizure Framework was judged by most raters to be better than other systems for the classification of clinical seizures. Among all seizure types presented, clonic seizures appeared to be the easiest to accurately identify. Average accuracy across the five seizure types was 84.5%. These data suggest that the ILAE neonatal seizure classification may be used by all healthcare professionals to correctly identify the predominant clinical seizure type.
Asunto(s)
Epilepsia , Enfermedades del Recién Nacido , Recién Nacido , Humanos , Niño , Convulsiones/diagnóstico , Epilepsia/diagnóstico , ElectroencefalografíaRESUMEN
BACKGROUND: Postoperative electroencephalographic (EEG) seizures are reported to occur in 14% to 20% of neonates after cardiac surgery with cardiopulmonary bypass (CPB). EEG seizures are associated with prolonged deep hypothermic circulatory arrest and with adverse long-term neurodevelopmental outcomes. We performed video/EEG monitoring before and for 72 hours after neonatal cardiac surgery, using a high-flow CPB protocol and cerebral oxygenation monitoring, to ascertain incidence, severity, and factors associated with EEG seizures. METHODS: The CPB protocol included 150 mL/kg/min flows, pH stat management, hematocrit >30%, and high-flow antegrade cerebral perfusion. Regional cerebral oxygen saturation (rSo(2)) was monitored, with a treatment protocol for rSo(2) <50%. EEG was assessed for seizures. RESULTS: Sixty-eight patients (36 single ventricle [SV] and 32 2-ventricle [2V]) were monitored for a total of 4824 hours. The total midazolam dose was 2.4 mg/kg (1.5-7.3 mg/kg) (median, 25th-75th percentile) for the SV group and 1.3 mg/kg (1.0-2.7 mg/kg) for the 2V group (P = 0.009). One SV patient experienced 2 brief EEG seizures postoperatively (1.5% incidence; 95% confidence interval: 0.3%-7.9%). The SV patients experienced a significant incidence of cerebral desaturation (rSo(2) <45% for >240 minutes total) perioperatively (18 of 36 SV vs 0 of 32 2V patients, P < 0.001). This difference did not affect electrographic seizure occurrence or other EEG characteristics. CONCLUSIONS: EEG seizures are infrequent in neonates undergoing surgery with high-flow CPB. Cerebral desaturation did not affect EEG seizure occurrence; however, benzodiazepines may play a role in suppressing postoperative seizures caused by cerebral hypoxemia in this patient population. Using this anesthetic and surgical protocol, EEG seizures are a poor surrogate marker for acute neurological injury in this population.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente Cardiopulmonar/efectos adversos , Electroencefalografía , Complicaciones Posoperatorias/epidemiología , Convulsiones/epidemiología , Convulsiones/etiología , Anestesia , Anestésicos/uso terapéutico , Química Encefálica/fisiología , Circulación Cerebrovascular/fisiología , Femenino , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/anomalías , Humanos , Hipnóticos y Sedantes/uso terapéutico , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Oxígeno/sangre , Consumo de Oxígeno/fisiología , Dolor Postoperatorio/tratamiento farmacológico , Perfusión , Cuidados Posoperatorios , Grabación en VideoRESUMEN
OBJECTIVE: To prospectively evaluate safety and efficacy of brain-responsive neurostimulation in adults with medically intractable focal onset seizures (FOS) over 9 years. METHODS: Adults treated with brain-responsive neurostimulation in 2-year feasibility or randomized controlled trials were enrolled in a long-term prospective open label trial (LTT) to assess safety, efficacy, and quality of life (QOL) over an additional 7 years. Safety was assessed as adverse events (AEs), efficacy as median percent change in seizure frequency and responder rate, and QOL with the Quality of Life in Epilepsy (QOLIE-89) inventory. RESULTS: Of 256 patients treated in the initial trials, 230 participated in the LTT. At 9 years, the median percent reduction in seizure frequency was 75% (p < 0.0001, Wilcoxon signed rank), responder rate was 73%, and 35% had a ≥90% reduction in seizure frequency. We found that 18.4% (47 of 256) experienced ≥1 year of seizure freedom, with 62% (29 of 47) seizure-free at the last follow-up and an average seizure-free period of 3.2 years (range 1.04-9.6 years). Overall QOL and epilepsy-targeted and cognitive domains of QOLIE-89 remained significantly improved (p < 0.05). There were no serious AEs related to stimulation, and the sudden unexplained death in epilepsy (SUDEP) rate was significantly lower than predefined comparators (p < 0.05, 1-tailed χ2). CONCLUSIONS: Adjunctive brain-responsive neurostimulation provides significant and sustained reductions in the frequency of FOS with improved QOL. Stimulation was well tolerated; implantation-related AEs were typical of other neurostimulation devices; and SUDEP rates were low. CLINICALTRIALSGOV IDENTIFIER: NCT00572195. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that brain-responsive neurostimulation significantly reduces focal seizures with acceptable safety over 9 years.
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Epilepsia Refractaria/terapia , Terapia por Estimulación Eléctrica/métodos , Epilepsias Parciales/terapia , Neuroestimuladores Implantables , Calidad de Vida , Adolescente , Adulto , Anciano , Trastorno Depresivo/epidemiología , Epilepsia Refractaria/fisiopatología , Epilepsia Refractaria/psicología , Epilepsias Parciales/fisiopatología , Epilepsias Parciales/psicología , Femenino , Estudios de Seguimiento , Humanos , Hemorragias Intracraneales/epidemiología , Masculino , Trastornos de la Memoria/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Infecciones Relacionadas con Prótesis/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Estado Epiléptico/epidemiología , Muerte Súbita e Inesperada en la Epilepsia/epidemiología , Suicidio/estadística & datos numéricos , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To evaluate the effects of anterior temporal lobectomy (ATL) on individual and group spatial and verbal learning and memory abilities as a function of side of surgery and seizure control outcome. METHODS: We evaluated pre- and postsurgical learning and memory abilities of 75 left-hemisphere language dominant individuals who underwent ATL (33 left, 42 right) using the 8-trial Nonverbal Selective Reminding test and the 12-trial Verbal Selective Reminding test. RESULTS: Reliable change index methods indicated that 40.5% of individuals who underwent right-ATL had a clinically significant decline in spatial memory, and 62.5% of individuals who underwent left-ATL had a significant reduction in verbal memory. Growth curve analyses indicated that both side of surgery and poor seizure outcome independently affected the learning slope in the best fitting models. Left-ATL reduced the slope, but did not affect the overall shape, of verbal learning across trials. On the other hand, poor seizure control outcome affected the slope of spatial learning regardless of the side of surgery. DISCUSSION: Results demonstrate both individual and group declines in spatial memory and learning after ATL. Results suggest that individuals who undergo right-ATL should be counseled regarding the likelihood of a decline in spatial memory and learning abilities after ATL. Results also suggest that individuals with poor seizure control after ATL should be referred for rehabilitation services given the significant declines in spatial and verbal memory that occurred in our sample regardless of side of surgery.
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Lobectomía Temporal Anterior/efectos adversos , Memoria/fisiología , Percepción Espacial/fisiología , Aprendizaje Verbal/fisiología , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Lateralidad Funcional , Humanos , Lenguaje , Pruebas Neuropsicológicas , Estudios Retrospectivos , Convulsiones/cirugía , Adulto JovenRESUMEN
The aim of this study was to evaluate whether specific etiologies of neonatal seizures have distinct ictal electroclinical features. A systematic review of English articles using the PubMed database since 2004 (last update 9/26/16). Search terms included text words and Medical Subject Headings (MeSH) terms related to neonatal seizures. Eligible articles included reports of neonates with seizures with a full description of seizure semiology and electroclinical findings. Independent extraction of data was performed by 2 authors using predefined data fields, including study quality indicators. Data were collected for every individual patient described in the articles. The dataset was analyzed with the Fisher exact test. The initial search led to 8507 titles; using filters, 2910 titles and abstracts were identified, with 177 full texts selected to be read. Fifty-seven studies were included in the analysis with 151 neonates (37.7 male and 62.9% term). Genetic etiologies (51%) and sequential seizures (41.1%) predominated in this sample and hypoxic-ischemic encephalopathy (HIE) accounted for only 4%. The low prevalence of HIE observed was probably due to a publication bias. A significant association was found between etiology and seizure type: hemorrhage with autonomic seizures (P = 0.003), central nervous system (CNS) infection and stroke with clonic seizures (P = 0.042, P < 0.001, respectively), metabolic/vitamin-related disorders, and inborn errors of metabolism with myoclonic seizures (P < 0.001). There were also specific electroencephalography (EEG) patterns seen with certain etiologies: vascular disorders and electrolyte imbalance with focal ictal discharges (P < 0.001, P = 0.049 respectively), vitamin-related disorders with multifocal (P = 0.003), and all categories of genetic disorders with burst-suppression (P < 0.001). Clonic and autonomic seizures were more frequently present with focal EEG abnormalities (P = 0.001 and P < 0.001), whereas tonic and myoclonic seizures present with burst-suppression (P = 0.001, P = 0.005). In conclusion, our data suggest that specific associations of etiologies of neonatal seizures with distinct clinical features and EEG patterns might help in the decision to establish appropriate treatment.
RESUMEN
Pachygyria, joint contractures and facial abnormalities have been reported in the literature very rarely. These features constitute a new lethal syndrome. We describe a male infant who represents an additional case of the same lethal syndrome first described in 1989. The patient also presented an early-onset epileptic encephalopathy with a suppression-burst EEG pattern.
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Anomalías Múltiples/fisiopatología , Encéfalo/fisiopatología , Contractura/congénito , Epilepsia/fisiopatología , Cara/anomalías , Articulaciones/anomalías , Anomalías Múltiples/patología , Encéfalo/anomalías , Electroencefalografía , Resultado Fatal , Femenino , Hepatitis C , Humanos , Recién Nacido , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo , Efectos Tardíos de la Exposición Prenatal , Trastornos Relacionados con SustanciasRESUMEN
OBJECTIVE: To determine seizure semiology in children with newly diagnosed childhood absence epilepsy and to evaluate associations with short-term treatment outcomes. METHODS: For participants enrolled in a multicenter, randomized, double-blind, comparative-effectiveness trial, semiologic features of pretreatment seizures were analyzed as predictors of treatment outcome at the week 16 to 20 visit. RESULTS: Video of 1,932 electrographic absence seizures from 416 participants was evaluated. Median seizure duration was 10.2 seconds; median time between electrographic seizure onset and clinical manifestation onset was 1.5 seconds. For individual seizures and by participant, the most common semiology features were pause/stare (seizure 95.5%, participant 99.3%), motor automatisms (60.6%, 86.1%), and eye involvement (54.9%, 76.5%). The interrater agreement for motor automatisms and eye involvement was good (72%-84%). Variability of semiology features between seizures even within participants was high. Clustering analyses revealed 4 patterns (involving the presence/absence of eye involvement and motor automatisms superimposed on the nearly ubiquitous pause/stare). Most participants experienced more than one seizure cluster pattern. No individual semiologic feature was individually predictive of short-term outcome. Seizure freedom was half as likely in participants with one or more seizure having the pattern of eye involvement without motor automatisms than in participants without this pattern. CONCLUSIONS: Almost all absence seizures are characterized by a pause in activity or staring, but rarely is this the only feature. Semiologic features tend to cluster, resulting in identifiable absence seizure subtypes with significant intraparticipant seizure phenomenologic heterogeneity. One seizure subtype, pause/stare and eye involvement but no motor automatisms, is specifically associated with a worse treatment outcome.
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Anticonvulsivantes/farmacología , Electroencefalografía/métodos , Epilepsia Tipo Ausencia/fisiopatología , Movimientos Oculares/fisiología , Evaluación de Resultado en la Atención de Salud/métodos , Convulsiones/fisiopatología , Adolescente , Niño , Preescolar , Método Doble Ciego , Epilepsia Tipo Ausencia/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Convulsiones/clasificación , Convulsiones/tratamiento farmacológicoRESUMEN
OBJECTIVE: This study was aimed at the development of a seizure detection system by training neural networks using quantitative motion information extracted by motion segmentation methods from short video recordings of infants monitored for seizures. METHODS: The motion of the infants' body parts was quantified by temporal motion strength signals extracted from video recordings by motion segmentation methods based on optical flow computation. The area of each frame occupied by the infants' moving body parts was segmented by direct thresholding, by clustering of the pixel velocities, and by clustering the motion parameters obtained by fitting an affine model to the pixel velocities. The computational tools and procedures developed for automated seizure detection were tested and evaluated on 240 short video segments selected and labeled by physicians from a set of video recordings of 54 patients exhibiting myoclonic seizures (80 segments), focal clonic seizures (80 segments), and random infant movements (80 segments). RESULTS: The experimental study described in this paper provided the basis for selecting the most effective strategy for training neural networks to detect neonatal seizures as well as the decision scheme used for interpreting the responses of the trained neural networks. Depending on the decision scheme used for interpreting the responses of the trained neural networks, the best neural networks exhibited sensitivity above 90% or specificity above 90%. CONCLUSIONS: The best among the motion segmentation methods developed in this study produced quantitative features that constitute a reliable basis for detecting myoclonic and focal clonic neonatal seizures. The performance targets of this phase of the project may be achieved by combining the quantitative features described in this paper with those obtained by analyzing motion trajectory signals produced by motion tracking methods. SIGNIFICANCE: A video system based upon automated analysis potentially offers a number of advantages. Infants who are at risk for seizures could be monitored continuously using relatively inexpensive and non-invasive video techniques that supplement direct observation by nursery personnel. This would represent a major advance in seizure surveillance and offers the possibility for earlier identification of potential neurological problems and subsequent intervention.
Asunto(s)
Movimiento (Física) , Movimiento/fisiología , Convulsiones/fisiopatología , Procesamiento de Señales Asistido por Computador , Grabación de Cinta de Video/métodos , Análisis por Conglomerados , Diagnóstico por Computador , Humanos , Lactante , Redes Neurales de la Computación , Convulsiones/diagnóstico , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
This study was carried out during the second phase of the project "Video Technologies for Neonatal Seizures" and aimed at the development of a seizure detection system by training neural networks, using quantitative motion information extracted by motion tracking methods from short video segments of infants monitored for seizures. The motion of the infants' body parts was quantified by temporal motion trajectory signals extracted from video recordings by robust motion trackers, based on block motion models. These motion trackers were developed to autonomously adjust to illumination and contrast changes that may occur during the video frame sequence. The computational tools and procedures developed for automated seizure detection were evaluated on short video segments selected and labeled by physicians from a set of 240 video recordings of 54 patients exhibiting myoclonic seizures (80 segments), focal clonic seizures (80 segments), and random infant movements (80 segments). This evaluation provided the basis for selecting the most effective strategy for training neural networks to detect neonatal seizures as well as the decision scheme used for interpreting the responses of the trained neural networks. The best neural networks exhibited sensitivity and specificity above 90%. The best among the motion trackers developed in this study produced quantitative features that constitute a reliable basis for detecting myoclonic and focal clonic neonatal seizures. The performance targets of the second phase of the project may be achieved by combining the quantitative features described in this paper with those obtained by analyzing motion strength signals produced by motion segmentation methods.
Asunto(s)
Movimiento/fisiología , Redes Neurales de la Computación , Convulsiones/diagnóstico , Convulsiones/fisiopatología , Procesamiento de Señales Asistido por Computador , Grabación en Video/métodos , Diagnóstico por Computador , Humanos , Lactante , Recién Nacido , Sensibilidad y Especificidad , Análisis EspectralRESUMEN
This paper presents an approach to detect epileptic seizure segments in the neonatal electroencephalogram (EEG) by characterizing the spectral features of the EEG waveform using a rule-based algorithm cascaded with a neural network. A rule-based algorithm screens out short segments of pseudosinusoidal EEG patterns as epileptic based on features in the power spectrum. The output of the rule-based algorithm is used to train and compare the performance of conventional feedforward neural networks and quantum neural networks. The results indicate that the trained neural networks, cascaded with the rule-based algorithm, improved the performance of the rule-based algorithm acting by itself. The evaluation of the proposed cascaded scheme for the detection of pseudosinusoidal seizure segments reveals its potential as a building block of the automated seizure detection system under development.
Asunto(s)
Algoritmos , Diagnóstico por Computador/métodos , Electroencefalografía/métodos , Epilepsia Benigna Neonatal/diagnóstico , Epilepsia Benigna Neonatal/fisiopatología , Redes Neurales de la Computación , Reconocimiento de Normas Patrones Automatizadas/métodos , Encéfalo/fisiopatología , Humanos , Recién Nacido , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
This paper introduces a methodology for the development of robust motion trackers for video based on block motion models. According to this methodology, the motion of a site between two successive frames is estimated by minimizing an error function defined in terms of the intensities at these frames. The proposed methodology is used to develop robust motion trackers that rely on fractional block motion models. The motion trackers developed in this paper are utilized to extract motor activity signals from video recordings of neonatal seizures. The experimental results reveal that the proposed motion trackers are more accurate and reliable than existing motion tracking methods relying on pure translation and affine block motion models.
Asunto(s)
Interpretación de Imagen Asistida por Computador/métodos , Modelos Biológicos , Movimiento , Reconocimiento de Normas Patrones Automatizadas/métodos , Convulsiones/clasificación , Convulsiones/diagnóstico , Grabación en Video/métodos , Algoritmos , Simulación por Computador , Electroencefalografía/métodos , Humanos , Conducta del Lactante , Recién Nacido , Actividad Motora , Reproducibilidad de los Resultados , Convulsiones/fisiopatología , Sensibilidad y Especificidad , Técnica de SustracciónRESUMEN
This paper presents an automated procedure developed to extract quantitative information from video recordings of neonatal seizures in the form of motor activity signals. This procedure relies on optical flow computation to select anatomical sites located on the infants' body parts. Motor activity signals are extracted by tracking selected anatomical sites during the seizure using adaptive block matching. A block of pixels is tracked throughout a sequence of frames by searching for the most similar block of pixels in subsequent frames; this search is facilitated by employing various update strategies to account for the changing appearance of the block. The proposed procedure is used to extract temporal motor activity signals from video recordings of neonatal seizures and other events not associated with seizures.
Asunto(s)
Inteligencia Artificial , Interpretación de Imagen Asistida por Computador/métodos , Enfermedades del Recién Nacido/diagnóstico , Actividad Motora , Reconocimiento de Normas Patrones Automatizadas/métodos , Convulsiones/diagnóstico , Grabación en Video/métodos , Algoritmos , Análisis por Conglomerados , Retroalimentación , Humanos , Aumento de la Imagen/métodos , Recién Nacido , Enfermedades del Recién Nacido/fisiopatología , Almacenamiento y Recuperación de la Información/métodos , Cuidado Intensivo Neonatal/métodos , Modelos Biológicos , Monitoreo Fisiológico/métodos , Análisis Numérico Asistido por Computador , Reproducibilidad de los Resultados , Convulsiones/fisiopatología , Sensibilidad y Especificidad , Procesamiento de Señales Asistido por Computador , Técnica de SustracciónRESUMEN
This paper presents an approach for improving the accuracy and reliability of motion tracking methods developed for video based on block motion models. This approach estimates the displacement of a block of pixels between two successive frames by minimizing an error function defined in terms of the pixel intensities at these frames. The minimization problem is made analytically tractable by approximating the error function using a second-order Taylor expansion. The improved reliability of the proposed method is illustrated by its application in the extraction of temporal motor activity signals from video recordings of neonatal seizures.