Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.253
Filtrar
1.
Zhonghua Er Ke Za Zhi ; 58(1): 35-40, 2020 Jan 02.
Artículo en Chino | MEDLINE | ID: mdl-31905474

RESUMEN

Objective: To investigate the genotype and phenotype of children with KCNA2 gene related developmental and epileptic encephalopathy (DEE). Methods: Clinical data including the manifestations and electroencephalogram of 8 children with KCNA2 variants treated in the Department of Pediatrics, Peking University First Hospital from March 2017 to June 2019 were collected and analyzed retrospectively. Results: Among the 8 epileptic patients with KCNA2 variants, 5 were males and 3 were females. The age of onset was from 1 day to 11 months. The age at last follow-up ranged from 4 months to 86 months. Two variants including c.1214C>T (loss-of-function) and c.1120A>G (gain-and loss-of-function) were identified. The variant of c.1214C>T was found in six patients (case 1-6). For these patients, the age of onset was from 5 to 11 months and they were characterized by multiple seizure types. All had focal seizures and had normal development before seizure onset with developmental regression after seizure onset. The first electroencephalogram showed epileptic discharges in Rolandic region in two, epileptic discharges in Rolandic region combined with generalized discharge in one, generalized discharge with posterior predominance in two (combined with or transferred to Rolandic region during the course) and epileptic discharges in posterior region combined with generalized discharge in one. And in 5 of them the Rolandic discharges developed into epileptic electrical status (ESES) during sleep. All the six patients were still treated with a combination of multiple antiepileptic drugs. Two of them had seizure controlled at 80 months and 68 months, respectively. The variant of c.1120A>G were identified in two of eight patients (case 7 and 8) and they had seizure onset on the 1st day after birth. Their epileptic seizures were frequent and difficult to control. They had remarkably developmental delay and microcephaly since birth. One case (case 8) had a wide forehead. They had frequent seizures up to the last follow-up. In case 7, the early electroencephalogram showed epileptic discharges in temporal region, and interictal electroencephalogram at 3 months of age showed multifocal discharge with posterior and temporal region predominance. In case 8, the early electroencephalogram was normal and electroencephalogram showed burst suppression at 2 months of age, and it developed epileptiform discharge in posterior region at 1 year of age. Conclusions: KCNA2 gene variants can lead to DEE with multiple seizures types. Among them, loss-of-function c.1214C>T is the most common, and these patients have seizure onset at infancy with Rolandic discharges tended to develop into to ESES pattern. The variant of c.1120A>G is a gain-of- and loss-of-function variant, patients with c.1120A>G have seizure onset in neonatal period, the phenotype overlaps with the former but is more severe.


Asunto(s)
Encefalopatías/genética , Epilepsia/diagnóstico , Canal de Potasio Kv.1.2/genética , Convulsiones , Edad de Inicio , Encéfalo/fisiopatología , Encefalopatías/fisiopatología , Niño , Preescolar , Discapacidades del Desarrollo/fisiopatología , Epilepsia/complicaciones , Epilepsia/genética , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Lactante , Recién Nacido , Masculino , Fenotipo , Estudios Retrospectivos
2.
Zhonghua Er Ke Za Zhi ; 57(11): 830-836, 2019 Nov 02.
Artículo en Chino | MEDLINE | ID: mdl-31665836

RESUMEN

Objective: To summarize the clinical and genetic features of ß-propeller protein-associated neurodegeneration (BPAN). Methods: The clinical data of 17 patients with BPAN with WDR45 gene variants were retrospectively collected at Children's Hospital of Fudan University, Peking University First Hospital, Capital Institute of Pediatrics, Shengjing Hospital of China Medical University and Shanghai Children's Hospital from June 2016 to December 2018, and their clinical manifestations, electroencephalogram, neuroimaging and genetics were analyzed. Results: Seventeen cases (13 females, 4 males), aged 1.1-8.8 years, were included. The median age of seizure onset was 14.5 months, from 3 months to 24 months of age, manifested with epileptic spasm in 6 cases and focal seizures in 5 cases. Eight patients had only one seizure type and 8 patients had two or more seizure types. Nine patients had complete remission of seizures. All 16 patients with seizures had developmental delay before the seizure onset, of whom 13 patients had moderate to severe seizures. The brain magnetic resonance imaging (MRI) was abnormal in 13 patients, including cerebral atrophy (10 cases) and thinning of the corpus callosum (9 cases). The brain magnetic susceptibility weighted imaging (SWI) in preschool stage showed prominent T2 hypointense signals in bilateral globus pallidus and brainstem ventral in two cases. Five seizure types (spasm, focal, absence, myodonic and generalized tonic clonic seizures)were found on ictal electroencephalogram(EEG) recordings. Compared to female patients(17(6-24) months of ege), male cases had earlier seizure onset (3, 4, 5, 18 months of age) . All patients had de novo variations in WDR45(6 nonsense, 4 frameshift, 3 missense and 4 splicing variations), with hemizygous variants in 3 males, mosaic variants in a male and heterozygous variants in 13 females, within which 5 variations had not been reported (c.977-1C>T,c.976+1G>C,c.10C>T,c.806del and c.110T>C). Conclusions: The patients with BPAN have profound developmental delay and are vulnerable to seizures. The male patients with BPAN tend to have more severer clinical phenotype than females. Early brain SWI could facilitate the timely diagnosis of this disease.


Asunto(s)
Proteínas Portadoras/genética , Epilepsia/genética , Enfermedades Neurodegenerativas/genética , China , Electroencefalografía , Epilepsia/diagnóstico , Femenino , Humanos , Lactante , Masculino , Enfermedades Neurodegenerativas/diagnóstico por imagen , Estudios Retrospectivos , Convulsiones
3.
Nervenarzt ; 90(12): 1221-1231, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31673723

RESUMEN

Wearables are receiving much attention from both epilepsy patients and treating physicians, for monitoring of seizure frequency and warning of seizures. They are also of interest for the detection of seizure-associated risks of patients, for differential diagnosis of rare seizure types and prediction of seizure-prone periods. Accelerometry, electromyography (EMG), heart rate and further autonomic parameters are recorded to capture clinical seizure manifestations. Currently, a clinical use to document nocturnal motor seizures is feasible. In this review the available devices, data on the performance in the documentation of seizures, current options for clinical use and developments in data analysis are presented and critically discussed.


Asunto(s)
Epilepsia , Monitoreo Ambulatorio , Acelerometría/instrumentación , Sistema Nervioso Autónomo , Electroencefalografía/instrumentación , Epilepsia/diagnóstico , Frecuencia Cardíaca , Humanos , Monitoreo Ambulatorio/instrumentación , Convulsiones/diagnóstico
4.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 36(10): 1019-1021, 2019 Oct 10.
Artículo en Chino | MEDLINE | ID: mdl-31598950

RESUMEN

OBJECTIVE: To identify pathogenic mutation of TSC1 and TSC2 genes in a patient with long-time misdiagnosis of epilepsy. METHODS: Peripheral blood samples and clinical data of the patient and her 2 parents were collected. Potential mutation of TSC1 and TSC2 genes were detected by direct sequencing. RESULTS: The patient had frequent episodes of epilepsy in addition with Shagreen patches for 10 years. A frame-shifting mutation c.2509_2512delAACA was detected in exon 20 of the TSC1 gene. This same mutation was not found in her unaffected parents. CONCLUSION: The recurrent frame-shifting mutation c.2509_2512delAACA (p.Asn837ValfsX11) of the TSC1 gene probably underlies the disease in this patient.


Asunto(s)
Epilepsia/diagnóstico , Epilepsia/genética , Esclerosis Tuberosa/diagnóstico , Esclerosis Tuberosa/genética , Errores Diagnósticos , Femenino , Mutación del Sistema de Lectura , Humanos , Proteína 1 del Complejo de la Esclerosis Tuberosa/genética , Proteína 2 del Complejo de la Esclerosis Tuberosa/genética
5.
Medicina (B Aires) ; 79 Suppl 3: 20-24, 2019.
Artículo en Español | MEDLINE | ID: mdl-31603838

RESUMEN

Neurometabolic diseases that manifest seizures and epilepsy are a large group of inherited disorders. They can present at any age from the neonatal period to adolescence. The epileptic manifestations can be very varied and, in general, they are epilepsies refractory to antiepileptic drugs. Epileptic phenomenology does not contribute to the diagnosis. The inborn errors of metabolism that respond to the use of cofactors should be known. In acute decompensation, it is essential to provide nutritional, hydroelectrolytic and respiratory support. It is possible that in a few years we can detect the metabolomic profile of these diseases, thus knowing better the diagnosis non-invasively and offering greater therapeutic possibilities for their epilepsy and especially for the underlying disease. We must not forget the transitory metabolic disorders and the electrolyte imbalances within the causes of seizures, especially in the neonatal period, and must be identified and treated early to avoid major damages.


Asunto(s)
Epilepsia/etiología , Enfermedades Metabólicas/complicaciones , Electroencefalografía , Epilepsia/diagnóstico , Epilepsia/terapia , Humanos , Recién Nacido , Convulsiones/clasificación , Convulsiones/etiología , Convulsiones/terapia
6.
Ideggyogy Sz ; 72(7-8): 257-263, 2019 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-31517458

RESUMEN

Background and purpose: Nonconvulsive status epilepticus (NCSE) is a heterogeneous, severe neurological disorder of different etiologies. In this study, the outcomes of NCSE episodes was assessed in a large series of adult patients. Our objective was to evaluate relationship between Status Epilepticus Severity Score (STESS) and etiology and the role of etiological factors on predicting the outcomes. Methods: In this retrospective study, the medical records of 95 patients over 18 years of age who were diagnosed with NCSE between June 2011 and December 2015 were reviewed. Their treatment and follow-up for NCSE was performed at the Epilepsy Unit in Department of Neurology, Antalya Research and Training Hospital. Etiological factors thought to be responsible for NCSE episodes as well as the prognostic data were retrieved. The etiological factors were classified into three groups as those with a known history of epilepsy (Group 1), primary neurological disorder (Group 2), or systemic/unknown etiology (Group 3). STESS was retrospectively applied to patients. Results: There were 95 participants, 59 of whom were female. Group 1, Group 2, and Group 3 consisted of 11 (7 female), 54 (33 female), and 30 (19 female) patients, respectively. Of the 18 total deaths, 12 occurred in Group 2, and 6 in Group 3. The negative predictive value for a STESS score of ≤ 2 was 93.88% (+LR 2.05 95% CI: 1.44-2.9 and -LR 0.3 95% CI 0.10-0.84 ) in the overall study group. While the corresponding values for Group 1 (patients with epilepsy), Group 2 (patients with primary neurological disorder), and group 3 (patients with systemic or unknown etiology) were 100%, 92.59% (+LR 2.06 95%CI: 1.32-3.21 and -LR 0.28 95% CI 0.08-1.02 ) 83.33% (+LR 1.14 95%CI: 0.59-2.9 and -LR 0.80 95% CI 0.23-2.73). Conclusion: This study included the one of the largest patients series ever reported in whom STESS, a clinical scoring system proposed for use in patients with status epilepticus, has been implemented. Although STESS appeared to be quite useful for predicting a favorable outcome in NCSE patients with epilepsy and primary neurological disorders, its predictive value in patients with systemic or unknown etiology was lower. Further prospective studies including larger NCSE samples are warranted.


Asunto(s)
Electroencefalografía/estadística & datos numéricos , Estado Epiléptico/diagnóstico , Estado Epiléptico/etiología , Adolescente , Adulto , Área Bajo la Curva , Epilepsia/diagnóstico , Epilepsia/epidemiología , Femenino , Humanos , Pronóstico , Curva ROC , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Estado Epiléptico/epidemiología
7.
J Clin Neurophysiol ; 36(5): 330-336, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31490450

RESUMEN

Identifying the localization, distribution, and polarity of waveforms are the prime goals of clinical scalp EEG analysis. Appropriate choices of bipolar and referential montages are keys to emphasizing the diagnostic features of interest, and demand some understanding of the spatiotemporal physical behavior of the underlying neuronal generators. Several examples drawn from canonical epilepsy syndromes are used to illustrate this general message.


Asunto(s)
Encéfalo/fisiopatología , Electroencefalografía/instrumentación , Electroencefalografía/métodos , Epilepsia/fisiopatología , Epilepsia/diagnóstico , Humanos , Cuero Cabelludo/fisiología , Factores de Tiempo
8.
Neurology ; 93(10): 450-458, 2019 09 03.
Artículo en Inglés | MEDLINE | ID: mdl-31477610

RESUMEN

OBJECTIVE: We hypothesized that cardiac electrical instability and abnormal autonomic tone result from cumulative cardiac injury sustained in recurrent seizures. We tested this hypothesis by comparing T-wave alternans (TWA) and heart rate variability (HRV), both established markers of sudden cardiac death (SCD) risk, in patients with chronic as compared to newly diagnosed epilepsy. METHODS: In this prospective, observational cohort study, patients (newly diagnosed epilepsy, n = 6, age 41.8 ± 6.8 years; chronic epilepsy, n = 6, age 40.2 ± 5.6 years [p = 0.85]) were monitored either with Holter recorder alone or simultaneously with 14-day Zio XT extended continuous ECG patch monitor. TWA was assessed by Food and Drug Administration-cleared Modified Moving Average analysis; HRV was calculated by rMSSD. RESULTS: TWA levels in chronic epilepsy were significantly higher than in newly diagnosed epilepsy (62 ± 5.4 vs 35 ± 1.3 µV, p < 0.002); the latter did not differ from healthy control adults. In all patients with chronic epilepsy, TWA exceeded the established ≥47-µV TWA cutpoint and rMSSD HRV was inversely related to TWA levels. Patients with chronic epilepsy exhibited elevated TWA levels equivalently on Holter and ECG patch recordings (p = 0.38) with a high correlation (r 2 = 0.99, p < 0.01) across 24 hours. CONCLUSION: Based on the limited number of patients studied, it appears that chronic epilepsy, the common use of sodium channel antagonists, or other factors are associated with higher TWA levels and simultaneously with lower rMSSD HRV, which is suggestive of autonomic dysfunction or higher sympathetic tone. The ECG patch monitor used has equivalent accuracy to Holter monitoring for TWA and HRV and permits longer-term ECG sampling.


Asunto(s)
Electrocardiografía Ambulatoria/métodos , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Frecuencia Cardíaca/fisiología , Adulto , Enfermedad Crónica , Estudios de Cohortes , Electrocardiografía/instrumentación , Electrocardiografía/métodos , Electrocardiografía Ambulatoria/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Ambulatorio/instrumentación , Monitoreo Ambulatorio/métodos , Estudios Prospectivos
9.
Artículo en Ruso | MEDLINE | ID: mdl-31407693

RESUMEN

The review considers the results of domestic and foreign studies of modern neurophysiological diagnosis of vestibular disorders in migraine and epilepsy. Currently, there is a large number of physiological and clinical methods to evaluate the functions of the peripheral and central parts of the vestibular sensory system. However, among the tests, the samples for the assessment of the physiological state of horizontal semicircular canals and associated stem canals predominate. In recent years, neurophysiological techniques that reflect the work of the structures of the nervous system, previously inaccessible to direct study, are being actively introduced. Modern effective neurophysiological methods of rehabilitation of patients with migraine-associated and other various vestibular disorders have been developed. Further study of neurophysiological approaches to the diagnosis of vestibular disorders in migraine and epilepsy will significantly expands the current understanding of neurophysiological mechanisms of brain functions.


Asunto(s)
Epilepsia , Trastornos Migrañosos , Enfermedades Vestibulares , Epilepsia/diagnóstico , Humanos , Trastornos Migrañosos/diagnóstico , Neurofisiología/métodos , Canales Semicirculares , Enfermedades Vestibulares/diagnóstico
10.
Epileptic Disord ; 21(4): 366-369, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31366451

RESUMEN

Recently, decanoic acid (C10), a medium-chain fatty acid, was shown to be a direct inhibitor of the AMPA receptor. Accordingly, C10 has been suggested as a potential anticonvulsant factor in the ketogenic diet (KD) or the medium-chain triglyceride KD. Here, we tested whether C10 serum levels correlate with the response to KD in five children (1.5 ± 0.6 years of age) with epilepsy. The serum levels of C10 were measured before and after KD initiation (n=2 at one month, n=3 at three months, and n=1 at six months after initiation) by gas chromatography-mass spectrometry. After three months on KD, two patients were found to be responders. The mean serum level before KD initiation was 63.2 µM. Only one patient, who was a non-responder, showed an increase (5%) in C10 serum level after a month of KD. The remaining four patients (two responders) showed a decrease in the C10 level from -5.3% to -75.5%. Our preliminary data show that KD does not lead to an increase in C10 serum levels, suggesting that increased concentration of C10 might not be directly involved in the anticonvulsant effects of classic KD.


Asunto(s)
Ácidos Decanoicos/sangre , Dieta Cetogénica , Epilepsia/sangre , Convulsiones/sangre , Adolescente , Anticonvulsivantes/uso terapéutico , Niño , Dieta Cetogénica/métodos , Epilepsia/diagnóstico , Epilepsia/tratamiento farmacológico , Femenino , Humanos , Masculino , Convulsiones/diagnóstico , Convulsiones/tratamiento farmacológico
11.
Nat Commun ; 10(1): 3096, 2019 07 30.
Artículo en Inglés | MEDLINE | ID: mdl-31363096

RESUMEN

Natural communication often occurs in dialogue, differentially engaging auditory and sensorimotor brain regions during listening and speaking. However, previous attempts to decode speech directly from the human brain typically consider listening or speaking tasks in isolation. Here, human participants listened to questions and responded aloud with answers while we used high-density electrocorticography (ECoG) recordings to detect when they heard or said an utterance and to then decode the utterance's identity. Because certain answers were only plausible responses to certain questions, we could dynamically update the prior probabilities of each answer using the decoded question likelihoods as context. We decode produced and perceived utterances with accuracy rates as high as 61% and 76%, respectively (chance is 7% and 20%). Contextual integration of decoded question likelihoods significantly improves answer decoding. These results demonstrate real-time decoding of speech in an interactive, conversational setting, which has important implications for patients who are unable to communicate.


Asunto(s)
Mapeo Encefálico/métodos , Corteza Cerebral/fisiología , Habla/fisiología , Interfaces Cerebro-Computador , Electrocorticografía/instrumentación , Electrocorticografía/métodos , Electrodos Implantados , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Femenino , Humanos , Factores de Tiempo
12.
Rev. neurol. (Ed. impr.) ; 69(4): 145-151, 16 ago., 2019. tab, graf
Artículo en Inglés | IBECS | ID: ibc-184072

RESUMEN

Introduction. Psychogenic non-epileptic seizures (PNES) are paroxysmal changes in behavior that resemble epileptic seizures, although they have no electrophysiological correlation or clinical evidence of epilepsy. Aim. To compare clinical and sociodemographic characteristics of patients diagnosed with PNES-alone and PNES-andepilepsy. Patients and methods. A cross-sectional study of consecutive patients diagnosed with PNES in a 20-month period was carried out. A video-EEG was performed in all patients. Socio-demographical, clinical and semiological characteristics were compared between those patients with and without concomitant epilepsy. Results. Sixty-five patients were included, 35 (53.9%) had PNES-alone and 30 (46.1%) had PNES-and-epilepsy. The proportion of women in the study was 70.8%. The median age at seizure onset was 16 years. A late start was recorded in PNES-alone group (23 years) compared to PNES-and-epilepsy group (11 years), however, it was not significant. There was a lower frequency of antiepileptic drugs use in the PNES-alone group compared with the PNES-and-epilepsy group. The most frequent semiological features were the gradual onset of events (69.2%) and the duration longer than two minutes (63.1%). Conclusion. The waxing and waning pattern during paroxysmal events suggest a non-epileptic origin. However, it is not uncommon to find patients with concomitant epileptic seizures


Introducción. Las crisis psicógenas no epilépticas (CPNE) son cambios paroxísticos en el comportamiento que se asemejan a las crisis epilépticas, aunque no tienen correlación electrofisiológica ni evidencia clínica de epilepsia. Objetivo. Comparar las características clínicas y sociodemográficas entre pacientes diagnosticados con CPNE, con y sin epilepsia concomitante. Pacientes y métodos. Estudio transversal de pacientes consecutivamente diagnosticados de CPNE durante un período de 20 meses. A todos los participantes se les realizó un videoelectroencefalograma (video-EEG). Se compararon las características sociodemográficas, clínicas y semiológicas entre los que presentaban y los que no presentaban epilepsia concomitante. Resultados. Se incluyó a 65 pacientes, 35 con CPNE (53,9%), y 30 con CPNE y epilepsia (46,1%). La edad mediana en el inicio del video-EEG fue de 33 años, y un 70,8% eran mujeres. La edad mediana de inicio de las crisis fue de 16 años. En el grupo de CPNE hubo un inicio más tardío (23 años) en comparación con el grupo de CNPE y epilepsia (11 años), pero la diferencia no fue significativa. La proporción de pacientes en terapia con fármacos antiepilépticos fue significativamente mayor en el grupo con CPNE y epilepsia comparado con el grupo con CPNE. Las características semiológicas más frecuentemente encontradas fueron el inicio gradual de las crisis (69,2%) y una duración de más de dos minutos (63,1%). Conclusión. La variabilidad en los síntomas sugiere un origen no epiléptico de los eventos paroxísticos, los cuales se presentan frecuentemente en pacientes con epilepsia


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Epilepsia/diagnóstico , Estudios Transversales , Diagnóstico Diferencial , Factores Socioeconómicos , Colombia
13.
Handb Clin Neurol ; 162: 415-433, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31324323

RESUMEN

Although the majority of seizures in neonates are related to acute brain injury, a substantial minority are the first symptom of a neonatal-onset epilepsy often linked to a pathogenic genetic variant. Historically, studies on neonatal seizures including treatment response and long-term consequences have lumped all etiologies together. However, etiology has been consistently shown to be the most important determinant of outcome. In the past few years, an increasing number of monogenic disorders have been described and might explain up to a third of neonatal-onset epilepsy syndromes previously included under the umbrella of Ohtahara syndrome and early myoclonic encephalopathy. In this chapter, we define the concept of genetic epilepsy and review the classification. Then, we review the most relevant monogenic neonatal-onset epilepsies, detail their underlying pathophysiologic mechanisms, and present their electroclinical phenotypes. We highlight that, in some cases, such as neonates with KCNQ2 or KCNT1 gene mutations, the early recognition of the electroclinical phenotype can lead to targeted diagnostic testing and precision medicine treatment, enabling the possibility of improved outcome.


Asunto(s)
Epilepsia/congénito , Epilepsia/genética , Enfermedades del Recién Nacido/genética , Adulto , Epilepsia/diagnóstico , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Canal de Potasio KCNQ2/genética , Mutación , Proteínas del Tejido Nervioso/genética , Embarazo
14.
EBioMedicine ; 45: 422-431, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31300348

RESUMEN

BACKGROUND: The inability to reliably assess seizure risk is a major burden for epilepsy patients and prevents developing better treatments. Recent advances have paved the way for increasingly accurate seizure preictal state detection algorithms, primarily using electrocorticography (ECoG). To develop seizure forecasting for broad clinical and ambulatory use, however, less complex and invasive modalities are needed. Algorithms using scalp electroencephalography (EEG) and electrocardiography (EKG) have also achieved better than chance performance. But it remains unknown how much preictal information is in ECoG versus modalities amenable to everyday use - such as EKG and single channel EEG - and how to optimally extract that preictal information for seizure prediction. METHODS: We apply deep learning - a powerful method to extract information from complex data - on a large epilepsy data set containing multi-day, simultaneous recordings of EKG, ECoG, and EEG, using a variety of feature sets. We use the relative performance of our algorithms to compare the preictal information contained in each modality. RESULTS: We find that single-channel EKG contains a comparable amount of preictal information as scalp EEG with up to 21 channels and that preictal information is best extracted not with standard heart rate measures, but from the power spectral density. We report that preictal information is not preferentially contained in EEG or ECoG channels within the seizure onset zone. CONCLUSION: Collectively, these insights may help to devise future prospective, minimally invasive long-term epilepsy monitoring trials with single-channel EKG as a particularly promising modality.


Asunto(s)
Aprendizaje Profundo/estadística & datos numéricos , Electrocorticografía/métodos , Epilepsia/diagnóstico , Convulsiones/diagnóstico , Electrocardiografía/estadística & datos numéricos , Electrocorticografía/estadística & datos numéricos , Electroencefalografía/estadística & datos numéricos , Epilepsia/fisiopatología , Epilepsia/terapia , Femenino , Humanos , Masculino , Medicina de Precisión/métodos , Medicina de Precisión/estadística & datos numéricos , Convulsiones/fisiopatología , Convulsiones/terapia
15.
Value Health ; 22(7): 822-828, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31277830

RESUMEN

OBJECTIVES: To study the extent to which parents are able to serve as true proxies for their children with epilepsy using a more granular approach than has been found in any study to date. METHODS: Proxy resemblance to the child was based on discrepancy in z-centered child minus parent scores of matching quality-of-life (QOL) domains for 477 dyads. Latent class mixed models (LCMMs) were built, with child's age as the independent variable for epilepsy-specific and generic QOL. Data were obtained from the QUALITÉ Canadian cohort, which recruited children with epilepsy aged 8 to 14 years at baseline and their parents. RESULTS: Both epilepsy-specific and generic LCMMs produced latent classes representing proxies that were overly positive, overly negative, or in agreement relative to their children with posterior probabilities of 79% to 84%. The "agreement" classes had N = 411 and N = 349 in the epilepsy-specific and generic LCMMs, respectively. The epilepsy-specific LCMM had a small unique class of N = 5 with a posterior probability of 88% called "growing discrepancy." CONCLUSIONS: Most parents of children with epilepsy can serve as valid proxies for their children on QOL scales. Poorer parental adaptation is more related to overly negative proxies, whereas low peer support from the child's perspective is more related to overly positive proxies.


Asunto(s)
Conducta del Adolescente , Conducta Infantil , Epilepsia/psicología , Padres/psicología , Apoderado/psicología , Calidad de Vida , Autoinforme , Adaptación Psicológica , Adolescente , Factores de Edad , Niño , Preescolar , Costo de Enfermedad , Epilepsia/diagnóstico , Epilepsia/terapia , Femenino , Humanos , Estudios Longitudinales , Masculino , Salud Mental , Influencia de los Compañeros , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Apoyo Social
16.
Handb Clin Neurol ; 160: 103-124, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31277842

RESUMEN

After more than 85 years of development and use in clinical practice, the electroencephalogram (EEG) remains a dependable, inexpensive, and useful diagnostic tool for the investigation of the electrophysiologic activity of the brain. The advent of digital technology has led to greater sophistication and multiple software applications to extend the utility of EEG beyond the confines of the laboratory. Despite the discovery of new waveforms, basic neurophysiologic principles remain essential to the clinical care of patients. Patterns in the interictal EEG make it possible to clarify the differential diagnosis of paroxysmal neurological events, classify seizure type and epilepsy syndromes, and characterize and quantify seizures when ictal recordings are obtained. EEG can also demonstrate cerebral dysfunction when structural imaging is normal to detect focal or lateralized abnormalities in patients with encephalopathy. High-density EEG with electrical source imaging has improved localization in candidates for epilepsy surgery. Quantitative EEG and broadband EEG are advancing our understanding of the functional processes of the brain itself.


Asunto(s)
Encéfalo/fisiología , Electroencefalografía/instrumentación , Electroencefalografía/métodos , Adulto , Encéfalo/fisiopatología , Encefalopatías/diagnóstico , Encefalopatías/fisiopatología , Electrodos/normas , Electroencefalografía/normas , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Humanos
17.
Handb Clin Neurol ; 160: 161-170, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31277845

RESUMEN

Ambulatory electroencephalography (aEEG) is a technique of continuous EEG recording while ensuring maximum mobility of the patient in a more naturalistic setting. The initial technological drawbacks of aEEG have been circumvented by incorporating digital and computer technology. Some of the current devices provide the facility of synchronous video recording. Low cost, convenience, higher diagnostic yield, and the ability to capture circadian patterns are the main advantages of aEEG. It is a useful tool in the diagnosis of epilepsy and nonepileptic paroxysmal disorders. Ambulatory EEG is superior to routine EEG in capturing interictal epileptiform abnormalities particularly in relation to natural sleep. However, the use of aEEG in presurgical workup is still unclear and more research is needed. At present, the place of EEG in the decision making for antiepileptic drug withdrawal is unclear and aEEG is an ideal tool to study this research question. Well-designed studies are needed to evaluate the use of aEEG in the assessment of response to antiepileptic therapy and occupational safety. Ambulatory EEG is an underutilized tool and more research is needed to expand the horizon of its applications in clinical practice.


Asunto(s)
Electroencefalografía/métodos , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Monitoreo Ambulatorio/métodos , Anticonvulsivantes/farmacología , Anticonvulsivantes/uso terapéutico , Ritmo Circadiano/fisiología , Electroencefalografía/efectos de los fármacos , Epilepsia/tratamiento farmacológico , Humanos
18.
Handb Clin Neurol ; 160: 171-183, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31277846

RESUMEN

Indications for video-EEG monitoring (VEM) include differential diagnosis of paroxysmal events including epileptic seizures, organic nonepileptic seizures, and psychogenic nonepileptic seizures; classification of seizure types and electroclinical syndromes; quantification of seizures and of interictal and ictal epileptiform discharges; and presurgical evaluation in medically refractory epilepsy patients. Standardized questionnaires and examinations should be used on admission to the epilepsy monitoring unit (EMU). Patients should be provided with comprehensive information concerning purpose and procedures during VEM and need to sign informed consents. Staff working in the EMU needs to be properly trained in the management of seizures and periictal testing according to written protocols as well as in cardiopulmonary resuscitation. Minimum staffing ratios of dedicated healthcare professionals to patients have been recommended. Antiepileptic drug tapering/withdrawal needs to be individualized for each patient. EEG recordings have to be performed according to established guidelines. Cardiorespiratory monitoring including continuous ECG monitoring and continuous measurement of oxygen saturation is strongly recommended. Patient safety is of utmost importance during VEM. Indicators for reporting quality and safety have been developed. Standardized ictal testing protocols and standardized computer-based organized reporting should further improve standards of VEM and training of EMU staff, and facilitate data exchange and collaborations between EMUs.


Asunto(s)
Encéfalo/fisiología , Electroencefalografía/métodos , Grabación en Video/métodos , Encéfalo/fisiopatología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Electroencefalografía/tendencias , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Humanos , Grabación en Video/tendencias
19.
Handb Clin Neurol ; 160: 203-214, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31277848

RESUMEN

Magnetoencephalography (MEG) is the noninvasive measurement of the miniscule magnetic fields produced by electrical currents flowing in the brain-the same neuroelectric activity that produces the EEG. MEG is one of several diagnostic tests employed in the evaluation of patients with epilepsy, but without the need to expose the patient to any potentially harmful agents. MEG is especially important in those being considered for epilepsy surgery, in whom accurate localization of the epileptic focus is paramount. While other modalities infer brain function indirectly by measuring changes in blood flow, metabolism, oxygenation, etc., MEG, as well as EEG, measures neuronal and synaptic function directly and, like EEG, MEG enjoys submillisecond temporal resolution. The measurement of magnetic fields provides information not only about the amplitude of the current but also its orientation. MEG picks up the magnetic field from neuromagnetometers surrounding the head in a helmet-shaped array of sensors. Clinical whole-head systems currently have 200-300 magnetic sensors, thereby offering very high resolution. The magnetic signals are not distorted by anatomy, because magnetic susceptibility is the same for all tissues, including the skull. Hence, MEG allows for a more accurate measurement and localization of brain activities than does EEG. Because one of its primary strengths is the ability to precisely localize electromagnetic activity within brain areas, MEG results are always coregistered to the patient's MRI. When combined in this way with structural imaging, it has been called magnetic source imaging (MSI), but MEG is properly understood as a clinical neurophysiologic diagnostic test. Signal processing and clinical interpretation in magnetoencephalography require sophisticated noise reduction and computerized mathematical modeling. Technological advances in these areas have brought MEG to the point where it is now part of routine clinical practice. MEG has become an indispensable part of the armamentarium at epilepsy centers where MEG laboratories are located, especially when patients are MRI-negative or where results of other structural and functional tests are not entirely concordant.


Asunto(s)
Encéfalo/fisiopatología , Electroencefalografía/métodos , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Magnetoencefalografía/métodos , Electroencefalografía/normas , Humanos , Magnetoencefalografía/normas
20.
Seizure ; 70: 59-62, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31280099

RESUMEN

PURPOSE: To evaluate the accuracy of expert estimations of achieving seizure freedom after epilepsy surgery in the context of presurgical patient counseling. METHOD: The retrospective study comprised a random sample of 200 patients who underwent any type of resective epilepsy surgery at the University of Bonn Epilepsy Center and the routine 1-year postoperative control visit in the years from 2008-2016. The prediction by a team of epileptologists and the actual seizure outcome were extracted from the pre- and postsurgical medical files, respectively. A deviation of >10% was a priori defined as a relevant discrepancy. RESULTS: Estimated chances of achieving seizure freedom ranged from 30 to 90% (mean: 67%). The actual seizure freedom rate was 66% (Engel Ia/ ILAE 1a). Nine of 12 estimation categories showed a tolerable deviation of ≤10%, none of these with a worse than expected outcome. Two estimation categories (40-50%, and 80%) showed a worse actual seizure outcome with deviations of -40% (n = 3); and -17% (n = 30), respectively. All in all, for 83% of the patients a correct prediction was provided. CONCLUSIONS: For the vast majority of surgical patients, the expert prediction of postsurgical seizure freedom at the 1-year follow-up was accurate despite the heterogeneity of patients and surgical procedures.


Asunto(s)
Epilepsia/diagnóstico , Epilepsia/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Convulsiones/diagnóstico , Convulsiones/cirugía , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA