Learn how to interpret and use intracranial EEG findings.

Epilepsy surgery is the therapy of choice for many patients with drug-resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure-onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective "1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings" of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, and review available quantitative/signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology/epileptology by providing a basic understanding on the concepts of invasive intracranial EEG.

Automated Interictal Epileptiform Discharge Detection from Scalp EEG Using Scalable Time-series Classification Approaches.

Deep learning for automated interictal epileptiform discharge (IED) detection has been topical with many published papers in recent years. All existing works viewed EEG signals as time-series and developed specific models for IED classification; however, general time-series classification (TSC) methods were not considered. Moreover, none of these methods were evaluated on any public datasets, making direct comparisons challenging. This paper explored two state-of-the-art convolutional-based TSC algorithms, InceptionTime and Minirocket, on IED detection. We fine-tuned and cross-evaluated them on a public (Temple University Events - TUEV) and two private datasets and provided ready metrics for benchmarking future work. We observed that the optimal parameters correlated with the clinical duration of an IED and achieved the best area under precision-recall curve (AUPRC) of 0.98 and F1 of 0.80 on the private datasets, respectively. The AUPRC and F1 on the TUEV dataset were 0.99 and 0.97, respectively. While algorithms trained on the private sets maintained their performance when tested on the TUEV data, those trained on TUEV could not generalize well to the private data. These results emerge from differences in the class distributions across datasets and indicate a need for public datasets with a better diversity of IED waveforms, background activities and artifacts to facilitate standardization and benchmarking of algorithms.

Neurological factors and Cesarean section in Australian women with epilepsy.

OBJECTIVES: To analyze the records of the pregnancies of 2283 Australian women with epilepsy in the Australian Register of Antiepileptic Drugs in Pregnancy database to identify neurological factors relevant to the Cesarean sections carried out in these pregnancies. RESULTS: The Cesarean section rate in Australian women overall increased by an average of 0.59% annually over 20 years, from 26.0% to its calculated 2020 value of 37.3%. For the operations in women with epilepsy, the corresponding figures were 0.71% annually, and 34.4% and 48.7%. The average annual rate of increase for pre-labor operations was 0.89% to a 2020 value of 39.1%, the annual rate for operations during labor showing no statistically significant change. Multivariate regression analysis identified a number of characteristics of women with epilepsy that were statistically significantly associated with an increased likelihood of Cesarean section, but of these only seizures continuing to occur in the third trimester and having chronic illness, in particular migraine, were neurological ones. In 70 migraine-affected women, the Cesarean section rate was 51.4%, compared with 39% in the remaining pregnancies (P < 0.05). CONCLUSIONS: Having seizures in the final trimester of pregnancy and having chronic neurological illness, especially migraine, favored Cesarean section being carried out in Australian women with epilepsy, but did not adequately account for the increasing rates of occurrence of the operation over the past 20 years.

Adverse antiepileptic drug effects in new-onset seizures: a case-control study.

OBJECTIVE: Adverse effects (AEs) are a major concern when starting antiepileptic drug (AED) treatment. This study quantified the extent to which AE reporting in people with new-onset seizures started on AEDs is attributable to the medication per se, and investigated variables contributing to AE reporting. METHODS: We pooled data from 2 large prospective studies, the Multicenter Study of Early Epilepsy and Single Seizures and the Northern Manhattan Study of incident unprovoked seizures, and compared adverse event profile (AEP) total and factor scores between adult cases prescribed AEDs for new-onset seizures and untreated controls, adjusting for several demographic and clinical variables. Differences in AEP scores were also tested across different AED monotherapies and controls, and between cases and controls grouped by number of seizures. RESULTS: A total of 212 cases and 206 controls were identified. Most cases (94.2%) were taking low AED doses. AEP scores did not differ significantly between the 2 groups. Depression, female gender, symptomatic etiology, younger seizure onset age, ≥2 seizures, and history of febrile seizures were associated with higher AEP scores. There were no significant differences in AEP scores across different monotherapies and controls. AEP scores increased in both cases and controls with increasing number of seizures, the increment being more pronounced in cases. CONCLUSIONS: When AED treatment is started at low doses following new-onset seizures, AE reporting does not differ from untreated individuals. Targeting specific factors affecting AE reporting could lead to improved tolerability of epilepsy treatment.

Embarazo postrasplante hepático: reporte de un caso y revisión de la evidencia actual / Pregnancy after liver transplantation: a case report and literature review

Se estima que en Chile, hasta marzo de 2008 se han efectuado 637 trasplantes hepáticos ortotópicos (THO), siendo la principal causa la cirrosis hepática. Según estadísticas norteamericanas, en el año 2006 existían 3000 mujeres con THO en edad reproductiva. Presentamos el caso de una paciente de 25 años, trasplantada hepática hace 6 años, en terapia inmunosupresora, con buen resultado materno-perinatal.

Until March 2008, Chile had 637 orthotopic liver transplantation (OLT), the main cause was liver cirrhosis. According to US statistics, in 2006 there were 3000 women of reproductive age with OLT. We report a 25-year-old, liver transplant six years ago in immunosuppressive therapy, with good maternal and perinatal outcome.

Dispositivo intrauterino intravesical en expulsión en embarazo de tercer trimestre: reporte de un caso / Intravesical migration of intrauterine device in a pregnant woman

Se estima que en el mundo cerca de 160 millones de mujeres son usuarias de dispositivos intrauterinos (DIU), siendo Chile uno de los países con más alta tasa, con cerca del 70 por ciento de las usuarias en el sistema público. Sin embargo, su uso no está exento de complicaciones. Presentamos un caso infrecuente de DIU intravesical en expulsión en gestante de 28 semanas.

In the world, about 160 million women are users of intrauterine devices (IUD); Chile is one of the countries with the highest rate, with about 70 percent of users in public system. However, its use may be complications. We present an unusual case of intravesical IUD expulsion in 28 weeks pregnant.

Absceso hepático amebiano en el embarazo: reporte de un caso / Amebic liver abscess in pregnancy: a case report

La asociación de absceso hepático amebiano y embarazo es poco frecuente y se asocia a un aumento de la morbilidad y mortalidad materna. Presentamos el caso de una paciente de 33 años, cursando un embarazo de 35 semanas, que ingresó a nuestro servicio con el diagnóstico de absceso hepático, cuya etiología fue E. histolytica.

The appearance of amebic liver abscess in pregnancy is uncommon and is associated to increased maternal morbidity and mortality. We report the case of 33 years old woman, with a 35 weeks pregnancy that was admitted in our Hospital with the diagnosis of liver abscess, whose etiology was E. histolytica.

The resveratrol analogue 4,4'-dihydroxy-trans-stilbene inhibits cell proliferation with higher efficiency but different mechanism from resveratrol.

Resveratrol (3,4',5-trihydroxy-trans-stilbene) is a natural phytoalexin found in grapes and wine, which shows antiproliferative activity. We previously found that 4-hydroxy group in the trans conformation was absolutely required for the inhibition of cell proliferation. In the present work we have synthesized the resveratrol analogue 4,4'-dihydroxy-trans-stilbene, which contains two OH in 4' and 4 positions, with the aim of developing a compound with an antiproliferative potential higher than that of resveratrol, on the basis of the correlation between structure and activity previously observed. In comparison with resveratrol, 4,4'-dihydroxy-trans-stilbene inhibited cell clonogenic efficiency of fibroblasts nine times more although with a different mechanism. First, 4,4'-dihydroxy-trans-stilbene induced predominantly an accumulation of cells in G1 phase, whereas resveratrol perturbed the G1/S phase transition. Second, although both compounds were able to inhibit DNA polymerase (pol) delta in an in vitro assay, 4, 4'-dihydroxy-trans-stilbene did not affect pol alpha activity. Finally, 4,4'-dihydroxy-trans-stilbene increased p21(CDKN1A) and p53 protein levels, whereas resveratrol led to phosphorylation of the S-phase checkpoint protein Chk1. Taken together, our results demonstrated for the first time that the two hydroxyl groups on 4- and 4'- positions of the stilbenic backbone enhance the antiproliferative effect and introduce additional targets in the mechanism of action of resveratrol. In conclusion, 4,4'-dihydroxy-trans-stilbene has potent antiproliferative activities that differ from the effect of resveratrol shown in this system, suggesting that it warrants further development as a potential chemopreventive or therapeutic agent.

Hiperparatiroidismo primario y embarazo: reporte de un caso / Primary hyperparathyroidism and pregnancy: a case report

El hiperparatiroidismo primario (HPTP) se caracteriza por una hipersecreción autónoma de paratohormona (PTH), lo que provoca hipercalcemia e hipercalciuria, con afectación ósea, renal y de otras partes del organismo, en grado variable. El HPTP tiene una prevalencia de 1 en 1000 en la población general y se presenta con mayor frecuencia en mujeres que en hombres. Es infrecuente su presentación en el embarazo, y sus complicaciones derivadas de la hipercalcemia pueden afectar tanto a la madre como al feto. Presentamos el caso de una paciente de 37 años, cursando un embarazo de 10 semanas, que ingresó al servicio con los diagnósticos de nefrocalcinosis y pielonefritis aguda, a la que se diagnosticó un hiperparatiroidismo primario, cuya etiología fue un adenoma paratiroideo único.

Primary hyperparathyroidism (HPTP) is a disorder characterized by elevated levels of parathyroid hormone (PTH), which leads to hypercalcemia and hypercalciuria, with variable osseous, renal and other systems affectation. HPTP has a prevalence of 1:1000 in general population and is more frequent in women than men. It is very rare during pregnancy, and its complications are produced by hypercalcemia and they can affect the mother and the fetus. We present the case of a 37 year old woman, with a 10+2 weeks pregnancy that was admitted in our Hospital with nephrocalcinosis and urinary tract infection, whom was diagnosed primary hyperparathyroidism, whose etiology was a single parathyroid adenoma.

Psychotic disorder and focal epilepsy in a left-handed patient with chromosome XYY abnormality.

OBJECTIVE: To discuss the relationship between XYY chromosome abnormality, psychiatric disorders and epilepsy. METHOD: Single case report. RESULTS: A 34-year-old man with 47, XYY karyotype and normal intelligence was followed-up at a neuropsychiatric clinic for over 30 years. He was first seen at age 3 years with a history of delayed motor and language development and an immunodeficiency syndrome. At age 8 years he developed refractory focal epilepsy, and in late adolescence he started to exhibit increasingly prominent obsessive thoughts, paranoid ideation, and aggressive sexual fantasies and behaviour. CONCLUSIONS: When interpreted within the context of previous literature reports, this case suggests a pathophysiological link between XYY chromosome abnormality, characteristic psychiatric symptoms and epilepsy disorder.

Cuerpo extraño intravaginal secundario a migración de aguja de osteosíntesis de cadera / Intravaginal foreign body due to migration of needle hip fixation

Se presenta caso clínico de migración de aguja de fijación de artroplastia de cadera a vagina en mujer embarazada.

We report a case of an intravaginal foreign body due to migration of needle hip fixation from hip arthroplasty in a pregnant woman.

Síndrome de Eisenmenger y embarazo / Eisenmenger syndrome and pregnancy

ANTECEDENTES: El embarazo está contraindicado en toda paciente con hipertensión pulmonar, y particularmente en aquellas con síndrome de Eisenmenger. OBJETIVO: Describir 3 casos de embarazadas con síndrome de Eisenmenger, tratadas con sildenafil. RESULTADOS: El desarrollo del embarazo se complicó en las tres pacientes con parto prematuro, a las 30, 28 y 35 semanas, respectivamente. En 2 pacientes el parto se resolvió mediante operación cesárea. No hubo mortalidad materna ni perinatal. CONCLUSIÓN: El síndrome de Eisenmenger es de alto riesgo de morbimortalidad materno-perinatal y el manejo multidisciplinario optimiza los resultados. Se describe el uso de sildenafil.

BACKGROUND: Pregnancy in contraindicated in patient with pulmonary hypertension, especially in dose with Eisenmenger syndrome. OBJECTIVE: To present 3 cases of pregnancy in patients with Eisenmenger syndrome treated with sildenafil. RESULTS: The pregnancy becomes complicated in the 3 cases, with premature delivery at 30, 28 and 35 weeks respectively. Cesarean delivery was performed in two cases. There was no maternal or perinatal mortality. CONCLUSION: The Eisenmenger syndrome is a high risk condition of maternal-perinatal morbimortality and the multidisciplinary handling optimizes the results. The sildenafil use is described.

Rotura de un aneurisma esplénico durante el embarazo: a propósito de 2 casos clínicos / Splenic artery aneurysm rupture in pregnancies: report of 2 clinical cases

Se presentan 2 casos de rotura de aneurisma de la arteria esplénica ocurridos a las 35 y 22 semanas de gestación. Una de las pacientes falleció por hemoperitoneo masivo.

Miastenia gravis: embarazo e impacto perinatal / Myasthenia gravis: pregnancy and perinatal impact

Se analizan 19 embarazos en 9 pacientes con miastenia gravis. Hubo 2 exacerbaciones de la enfermedad, una de esta asociada al uso de aminoglicósidos en el tratamiento de pielonefritis aguda. En un caso la enfermedad debutó a las 24 semanas de gestación. Hubo tres casos de miastenia gravis neonatal en la misma gestante, 2 de los recién nacidos fallecieron a los 29 y 25 días respectivamente, pese al tratamiento. Hubo un recién nacido de pretérmino y 6 casos (35 por ciento) de restricción del crecimiento intrauterino.

Embarazo triple: complicaciones maternas y perinatales / Triplet pregnancy: maternal and perinatal complications

Objetivo: Revisar las complicaciones maternas y perinatales de los embarazos triples atendidos en el Servicio de Obstetricia del Hospital Barros Luco-Trudeau. Pacientes y Método: Se analizan 11 embarazos triples ocurridos entre enero de 1996 y diciembre de 2004. Resultados: Hubo una incidencia de 1 embarazo triple en 4.730 partos. Dos embarazos fueron resultado de tratamientos de fertilidad. Se registró 1 óbito y 1 muerte (polimalformado) a los 35 días de vida. El parto se resolvió entre las 29+1 y 36+3 semanas de gestación mediante cesárea, en 55 por ciento por inicio de trabajo de parto. Se utilizó surfactante pulmonar en 8 de los 32 recién nacidos (25 por ciento) y ventilación mecánica en 5 (16 por ciento). La complicación materna de mayor frecuencia fue el síndrome hipertensivo del embarazo (50 por ciento), dos preeclampsias y un síndrome de Hellp. La utilización de días cama por los recién nacidos fue de 822 días para 32 casos (mediana: 21 días; rango: 6-64 días). El total de días cama utilizados por las 11 gestantes fue 270 días, con promedio de 25 días. Conclusión: Aún cuando se registraron buenos resultados perinatales, los embarazos triples se asocian a mayor morbilidad materna y perinatal. Además producen un mayor gasto de recursos de neonatología, especialmente debido a prematurez.

Trombosis de la vena ovárica postcesárea / Ovarian vein thrombosis after cesarean section

Informamos un caso clínico de trombosis de la vena ovárica derecha post-cesárea. Se discute los métodos diagnósticos, el diagnóstico diferencial y el tratamiento.

Citología de base líquida: revisión de la historia y los estudios al respecto / Liquid based-cytology: review of the history and the studies on the matter

George Nicolas Papanicolaou introdujo la citología diagnóstica de frotis vaginal en 1940, técnica de tamizaje de bajo costo y de aplicación masiva. Donde se implementó, ha permitido aumentar la detección del cáncer cérvico uterino en etapas precoces y de lesiones premalignas, reduciendo significativamente la mortalidad por esta causa. El frotis tecnificado, de alto costo, en teoría resuelve los cinco problemas de la convencional: 1) captura de la totalidad de la muestra, 2) fijación deficiente, 3) distribución aleatoria de células anómalas, 4) existencia de elementos perturbadores, 5) calidad del frotis. Estudios en grandes poblaciones no evidencian diferencias significativas en su capacidad diagnóstica comparados con la citología convencional que permitan sugerir su uso en el sistema público de salud.

Fasceitis necrotizante después del nacimiento por cesárea / Necrotizing fasciitis later of the birth by cesarean

Informamos de un caso de fasceitis necrotizante posterior a una cesárea.

Embarazo heterotópico / Heterotopic pregnancy

Se informa un caso de embarazo heterotópico espontáneo en nuestro servicio.

Embarazo abdominal complicado del primer trimestre / Complicated abdominal pregnancy of the first trimester

Relatamos un caso de embarazo abdominal que se complicó con hemoperitoneo ocurrido en el primer trimestre. Ambas trompas, ovarios y el útero se encontró intacto. El sitio de implantación era el fondo de saco de Douglas, en la superficie anterior del recto.