Left-sided epileptiform activity influences language lateralization in right mesial temporal sclerosis.

OBJECTIVE: To investigate the association between left epileptiform activity and language laterality indices (LI) in patients with right mesial temporal sclerosis (MTS). METHODS: Twenty-two patients with right MTS and 22 healthy subjects underwent fMRI scanning while performing a language task. LI was calculated in multiple regions of interest (ROI). Data on the presence of left epileptiform abnormalities were obtained during prolonged video-EEG monitoring. RESULTS: After correction for multiple comparisons, LI was reduced in the middle temporal gyrus in the left interictal epileptiform discharges (IED+) group, compared with the left IED- group (p < 0.05). SIGNIFICANCE: Using a responsive reading naming fMRI paradigm, right MTS patients who presented left temporal interictal epileptiform abnormalities on video-EEG showed decreased LI in the middle temporal gyrus, indicating decreased left middle temporal gyrus activation, increased right middle temporal gyrus activation or a combination of both, demonstrative of language network reorganization, specially in the MTG, in this patient population. PLAIN LANGUAGE SUMMARY: This research studied 22 patients with right mesial temporal sclerosis (a specific type of epilepsy) comparing them to 22 healthy individuals. Participants were asked to perform a language task while undergoing a special brain imaging technique (fMRI). The findings showed that patients with epilepsy displayed a change in the area of the brain typically responsible for language processing. This suggests that their brains may have adapted due to their condition, altering the way language is processed.

Characteristics of Neonates with Cardiopulmonary Disease Who Experience Seizures: A Multicenter Study.

OBJECTIVE: To compare key seizure and outcome characteristics between neonates with and without cardiopulmonary disease. STUDY DESIGN: The Neonatal Seizure Registry is a multicenter, prospectively acquired cohort of neonates with clinical or electroencephalographic (EEG)-confirmed seizures. Cardiopulmonary disease was defined as congenital heart disease, congenital diaphragmatic hernia, and exposure to extracorporeal membrane oxygenation. We assessed continuous EEG monitoring strategy, seizure characteristics, seizure management, and outcomes for neonates with and without cardiopulmonary disease. RESULTS: We evaluated 83 neonates with cardiopulmonary disease and 271 neonates without cardiopulmonary disease. Neonates with cardiopulmonary disease were more likely to have EEG-only seizures (40% vs 21%, P < .001) and experience their first seizure later than those without cardiopulmonary disease (174 vs 21 hours of age, P < .001), but they had similar seizure exposure (many-recurrent electrographic seizures 39% vs 43%, P = .27). Phenobarbital was the primary initial antiseizure medication for both groups (90%), and both groups had similarly high rates of incomplete response to initial antiseizure medication administration (66% vs 68%, P = .75). Neonates with cardiopulmonary disease were discharged from the hospital later (hazard ratio 0.34, 95% CI 0.25-0.45, P < .001), although rates of in-hospital mortality were similar between the groups (hazard ratio 1.13, 95% CI 0.66-1.94, P = .64). CONCLUSION: Neonates with and without cardiopulmonary disease had a similarly high seizure exposure, but neonates with cardiopulmonary disease were more likely to experience EEG-only seizures and had seizure onset later in the clinical course. Phenobarbital was the most common seizure treatment, but seizures were often refractory to initial antiseizure medication. These data support guidelines recommending continuous EEG in neonates with cardiopulmonary disease and indicate a need for optimized therapeutic strategies.

Actualización en manejo del status convulsivo en niños / Status epilepticus in childhood. An Update

El estatus epiléptico (SE) en pediatría es una emergencia neurológica ya que presenta morbimortalidad. Existen diferencias con los adultos y su reconocimiento puede ser más difícil especialmente a edades tempranas. Se han precisado distintas etapas en el SE y se ha acortado el tiempo en su definición, lo anterior con el objetivo de dar opciones terapéuticas más precoces. Existen diversos protocolos terapéuticos y en todos ellos las benzodiazepinas constituyen la primera etapa, incluyendo la terapia pre-hospitalaria que si es bien realizada puede evitar la progresión al SE en un paciente con una crisis epiléptica. En estatus refractario y super refractario la evidencia es menor y el rol de los anestésicos es protagónico con la necesidad de un manejo integral en una unidad de cuidados intensivos pediátricos (UCIP) y con un monitoreo electroencefalográfico continuo (cEEG), este último resulta ser un recurso limitado especialmente en el sistema público.

Status epilepticus (SE) in pediatric patients is a neurological emergency because it is associated to morbidity and mortality. There are differences between children and adults, making its recognition harder, especially in early ages. Different stages have been defined in SE and the time has been shortened in its definition, with the aim to give earlier therapeutic options. There are several protocols and in all of them benzodiazepines are the first option, even in the pre-hospital scenario, which, if managed well, can avoid progression to SE in a patient with an epileptic seizure. In refractory SE the evidence is poor and the role of anesthetics is more important with the need for an comprehensive management in a pediatric intensive care unit (PICU) and with continuous electroencephalographic monitoring (eEEG), the latter being a limited resource especially in our public health system.

Papel de la monitorización electroencefalográfica continua en el diagnóstico de la epilepsia pediátrica / Role of continuous EEG monitoring in the diagnosis of pediatric epilepsy

El diagnóstico de la epilepsia es fundamentalmente clínico, pero frecuentemente se plantea el diagnóstico diferencial con fenómenos no epilépticos. El desarrollo de la monitorización EEG continua (MEEGC) en las últimas dos décadas ha permitido mejorar el diagnóstico de pacientes epilépticos de todas las edades. En este trabajo se revisan los datos de la literatura sobre la eficacia de los distintos tipos de MEEGC en el diagnóstico de la epilepsia pediátrica, resaltando especialmente nuestra experiencia personal. En nuestros estudios, la MEEGC ambulatoria suplementada con video permitió contestar la pregunta que determinó su petición en el 80% de pacientes diagnosticados de epilepsia y en el 83% de aquéllos con sospecha diagnóstica de epilepsia. Con la MEEGC ambulatoria asistida por ordenador, dichas cifras fueron 88% y 89%, respectivamente y con la MEEGC intrahospitalaria con video fueron 82% y 51%, respectivamente. La MEEGC intrahospitalaria con video es crucial en la evaluación de pacientes con epilepsia, candidatos al tratamiento quirúrgico. La MEEGC es también importante en pacientes con encefalopatías agudas ingresados en las unidades de cuidados intensivos. La MEEGC, tanto ambulatoria como intrahospitalaria, es muy útil en el diagnóstico diferencial de fenómenos clínicos epilépticos y no epilépticos y en la confirmación del tipo de epilepsia o síndrome epiléptico. Los avances tecnológicos y el desarrollo de nuevas modalidades de EEG en el futuro, harán que la electroencefalografía siga siendo una técnica muy importante en el estudio de la función cerebral en pacientes con enfermedades neurológicas agudas o crónicas.

The diagnosis of epilepsy is basically clinical, but it frequently raises the differential diagnosis with non-epileptic events. The development of continuous EEG monitoring (CEEGM) in the past decades has allowed a better diagnosis of epileptic patients of all ages. In this paper we review the data available in the literature about the efficacy of the different modalities of CEEGM in the diagnosis of pediatric epilepsy, emphasizing our personal experience. In our studies the ambulatory CEEGM supplemented with video allowed to answer the question that prompted its request in 80% of patients diagnosed with epilepsy and in 83% of those with the suspected diagnosis of epilepsy. With ambulatory computer-assisted CEEGM those figures were 88% and 89%, respectively, and with inpatient video-CEEGM they were 82% and 51%, respectively. The latter is crucial in the evaluation of epilepsy patients who are candidates for surgical treatment. Inpatient video-CEEGM is also very important in the management of patients with acute encephalopathies admitted to the Intensive Care Units. Both, ambulatory or inpatient CEEGM, are very useful in the differential diagnosis of clinical epileptic versus non-epileptic events, as well as in the confirmation of the type of epilepsy or epileptic syndrome. The development of technological advances and new EEG modalities in the future will help to continue to consider electroencephalography as a very important technique in the study of brain function in patients with acute or chronic encephalopathies.

Orientações ao paciente epiléptico submetido ao vídeo-eletrencefalograma: comparação dos níveis de ansiedade com o uso de diferentes estratégias / Orientations to epileptic patient undergoing a video-EEG monitoring: comparison of anxiety levels using different strategies

Trata-se de um estudo experimental, correlacional, com abordagem quantitativa que compara os níveis de ansiedade de dois grupos de pacientes epilépticos submetidos ao vídeo-eletrencefalograma (vídeo-EEG) que tiveram diferentes estratégias de orientação para o exame; o controle teve apenas orientações verbais e o experimental, além das orientações verbais, também, recebeu um manual de orientações, variável independente do estudo. A amostra foi, aleatoriamente, composta por dois grupos de 30 pacientes. Para avaliar o uso de diferentes estratégias de orientação, foi comparada a ansiedade dos grupos, por meio da aplicação do Inventário de Ansiedade Traço-Estado (IDATE), sendo o estado de ansiedade, avaliado pré e pós-exame. Os resultados mostraram que o grupo experimental apresentou perfil de ansiedade superior, porém, estado de ansiedade inferior, antes do exame, em relação ao controle. A ansiedade do grupo experimental foi mais baixa, antes do exame do que seu perfil, entretanto, o mesmo não ocorreu com o grupo controle. Após o exame, a grande maioria de ambos os grupos apresentou ansiedade baixa e menor que seu perfil. A estratégia de orientação com o manual parece ter beneficiado os pacientes que o receberam, promovendo a redução da ansiedade antes do exame ser realizado.

This exploratory, correlated and quantitative study had the objective to identify and compare the anxiety level between two groups of epileptic patients undergoing a video-EEG monitoring using different patients guidelines strategies. The random sample was composed by two groups of 30 patients each one. The control group only had verbal orientations and the experimental group, beyond the same orientations received a written guide (a booklet) with all the procedures too. The anxiety was assessed using State-Trait Anxiety Inventory (STAI-T and STAI-S) with the STAI-S being applied for both groups before and after examination as described above. The results demonstrated that, before video-EEG, the anxiety-trait score of the experimental group was higher and the anxiety-state was lower than the control group. After video-EEG, the majority of both groups demonstrated low anxiety-state score and lower than their anxiety-trait score. The strategy used with the written guide associated to verbal orientations seems to help to reduce the anxiety level before the video-EEG.