RESUMEN
Objective: Ambulatory electroencephalography (AEEG) monitoring allows for prolonged recordings in normal environments, such as patients' homes, and is recognized as a cost-effective alternative to inpatient long-term video-EEG primarily in resource-limited countries. We aim to describe the impact of AEEG on the assessment of patients with suspected or confirmed epilepsy in two independent Latin-American populations with limited resources. Methods: We included 63 patients who had undergone an AEEG due to confirmed/suspected epilepsy. Clinical (demographic, current antiseizure medication and indication) and electroencephalographic (duration of the study, result, and impact on clinical decision-making) were reviewed and compared. Results: The main indication for an AEEG was the differentiation of seizures from non-epileptic events with 57% of patients. It was categorized as positive in 36 patients and did have an impact on the clinical decision-making process in 57% of patients. AEEG captured clinical events in 35 patients (20 epileptic and 15 non-epileptic). Conclusions: AEEG proves to be a valuable tool in resource-limited settings for assessing suspected or confirmed epilepsy cases, with a significant impact on clinical decisions. Significance: Our study provides valuable insights into the use of AEEG in under-resourced regions, shedding light on the challenges and potential benefits of this tool in clinical practice.
RESUMEN
Ictal bradycardia (IB) and ictal asystole (IA) are uncommonly recognized phenomena that increase morbidity in patients with epilepsy by causing syncope and seizure-related falls. These arrhythmias are also suspected to be involved in the pathophysiology of sudden unexpected death in epilepsy (SUDEP). We report a case of a 57-year-old male with left temporal lobe epilepsy who experienced both IB and IA. This patient was initially managed with pacemaker implantation, prior to undergoing left temporal lobectomy. Following surgery, the patient had no ongoing IB or IA on his pacemaker recordings, and his seizure control was greatly improved. His pacemaker was removed approximately one year post-operatively and he continued treatment with anti-seizure drugs (ASDs). A literature review of cases of IB and IA that were managed with pacemakers was performed. Pacemaker implantation appears to be quite effective for reducing seizure-related syncope and falls in the setting of IB/IA. Epilepsy surgery also seems to be an effective treatment option for IB/IA, as many patients are able to have their pacemakers removed post-operatively. Further investigations into the pathophysiology of IB and IA and long-term outcomes using different treatment modalities are clearly needed to help formulate treatment guidelines and, potentially, to reduce the occurrence of SUDEP in these patients.
