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Seizure Aug 2023Objective seizure count estimates are crucial for ambulatory epilepsy management. Wearables have shown promise for the detection of tonic-clonic seizures but may suffer...
OBJECTIVE
Objective seizure count estimates are crucial for ambulatory epilepsy management. Wearables have shown promise for the detection of tonic-clonic seizures but may suffer from false alarms and undetected seizures. Seizure signatures recorded by wearables often occur over prolonged periods, including increased levels of electrodermal activity and heart rate long after seizure EEG onset, however, previous detection methods only partially exploited these signatures. Understanding the utility of these prolonged signatures for seizure count estimation and what factors generally determine seizure logging performance, including the role of data quality vs. algorithm performance, is thus crucial for improving wearables-based epilepsy monitoring and determining which patients benefit most from this technology.
METHODS
In this retrospective study we examined 76 pediatric epilepsy patients during multiday video-EEG monitoring equipped with a wearable (Empatica E4; records of electrodermal activity, EDA, accelerometry, ACC, heart rate, HR; 1983 h total recording time; 45 tonic-clonic seizures). To log seizures on prolonged data trends, we applied deep learning on continuous overlapping 1-hour segments of multimodal data in a leave-one-subject-out approach. We systematically examined factors influencing logging performance, including patient age, antiseizure medication (ASM) load, seizure type and duration, and data artifacts. To gain insights into algorithm function and feature importance we applied Uniform Manifold Approximation and Projection (UMAP, to represent the separability of learned features) and SHapley Additive exPlanations (SHAP, to represent the most informative data signatures).
RESULTS
Performance for tonic-clonic seizure logging increased systematically with patient age (AUC 0.61 for patients 〈 11 years, AUC 0.77 for patients between 11-15 years, AUC 0.85 for patients 〉 15 years). Across all ages, AUC was 0.75 corresponding to a sensitivity of 0.52 and a false alarm rate of 0.28/24 h. Seizures under high ASM load or with shorter duration were detected worse (P=.025, P=.033, respectively). UMAP visualized discriminatory power at the individual patient level, SHAP analyses identified clonic motor activity and peri/postictal increases in HR and EDA as most informative. In contrast, in missed seizures, these features were absent indicating that recording quality but not the algorithm caused the low sensitivity in these patients.
SIGNIFICANCE
Our results demonstrate the utility of prolonged, postictal data segments for seizure logging, contribute to algorithm explainability and point to influencing factors, including high ASM dose and short seizure duration. Collectively, these results may help to identify patients who particularly benefit from such technology.
Topics: Humans; Child; Infant; Retrospective Studies; Data Accuracy; Seizures; Epilepsy; Electroencephalography; Wearable Electronic Devices
PubMed: 37336056
DOI: 10.1016/j.seizure.2023.06.002 -
Revue Neurologique Apr 2024In childhood absence epilepsy, pharmaco-resistance occurs in 20-30% of patients. In that situation, glucose transporter type 1 deficiency has to be ruled out, especially... (Review)
Review
In childhood absence epilepsy, pharmaco-resistance occurs in 20-30% of patients. In that situation, glucose transporter type 1 deficiency has to be ruled out, especially if absences started before the age of four years and if neurological signs are present. If ethosuximide, valproate and lamotrigine have failed in monotherapy or in association, there are currently no valuable therapeutic options. The same rules apply for epilepsy with myoclonic absences. Importantly, arguments supporting that making the patient seizure-free will improve eventual associated cognitive deficits such as attention deficit are very weak. Therefore, limiting the cognitive side effects of the anti-epileptic drugs has always to be a priority when faced with typical refractory absences in childhood. In epilepsy with eyelid myoclonia, the majority of patients are pharmaco-resistant. However, absence seizures, if present, tend to be very brief, and seizures are limited in many patients to eyelid myoclonia that eventually do not affect their quality of life and are well attenuated by wearing blue lenses. Atypical absences occurring in the course a developmental and/or epileptic encephalopathy are often pharmaco-resistant. In that situation, characterizing the type of epilepsy syndrome and searching for a specific genetic or structural etiology are needed to offer the best therapeutic options to the patient.
Topics: Humans; Epilepsy, Absence; Child; Anticonvulsants; Drug Resistant Epilepsy; Child, Preschool; Seizures
PubMed: 38388226
DOI: 10.1016/j.neurol.2024.01.002 -
Emergency Medicine Journal : EMJ Oct 2023
Topics: Humans; Seizures; Headache
PubMed: 37758295
DOI: 10.1136/emermed-2022-212841 -
Seizure Oct 2023
Topics: Humans; MELAS Syndrome; Seizures; Mutation
PubMed: 37827598
DOI: 10.1016/j.seizure.2023.03.001 -
Epilepsy & Behavior : E&B Nov 2023Status epilepticus (SE) is defined by abnormally prolonged seizures that may lead to brain damage and death. Our aim was to evaluate the efficacy and tolerability...
PURPOSE
Status epilepticus (SE) is defined by abnormally prolonged seizures that may lead to brain damage and death. Our aim was to evaluate the efficacy and tolerability (effectiveness) of intravenous brivaracetam (BRV) as a second-line treatment.
METHODS
Twenty-one patients (median age 68 years ± 17.28) were prospectively recruited between June 2019 and December 2022. Patients were treated with BRV (50-200 mg) as a second-line add-on therapy for SE. We evaluated the response of SE to the administration of BRV in terms of SE termination and recurrence of epileptic seizures at 6, 12, and 24 h, also monitoring safety. The first-line therapy was represented by intravenous benzodiazepines (mainly diazepam).
RESULTS
Almost a quarter of patients had generalized seizures, whereas the vast majority (76.2%) presented focal seizures. In 52.4% of patients, the underlying cause was cerebrovascular. Fourteen (66.7%) patients displayed a good early response in the subsequent 6 h. At 12 and 24 h, 8 (38%) and 11 (52.4%) patients, respectively, did not present seizures.
CONCLUSION
The present study highlights the potential of BRV when used as an early add-on therapy in SE, further confirming its good safety profile.
Topics: Humans; Aged; Anticonvulsants; Treatment Outcome; Status Epilepticus; Seizures; Pyrrolidinones; Drug Therapy, Combination
PubMed: 37839249
DOI: 10.1016/j.yebeh.2023.109464 -
Epilepsy Research Aug 2023Generalised spike and wave discharges (SWDs) are pathognomonic EEG signatures for diagnosing absence seizures in patients with Genetic Generalized Epilepsy (GGE). The...
OBJECTIVE
Generalised spike and wave discharges (SWDs) are pathognomonic EEG signatures for diagnosing absence seizures in patients with Genetic Generalized Epilepsy (GGE). The Genetic Absence Epilepsy Rats from Strasbourg (GAERS) is one of the best-validated animal models of GGE with absence seizures.
METHODS
We developed an SWDs detector for both GAERS rodents and GGE patients with absence seizures using a neural network method. We included 192 24-hour EEG sessions recorded from 18 GAERS rats, and 24-hour scalp-EEG data collected from 11 GGE patients.
RESULTS
The SWDs detection performance on GAERS showed a sensitivity of 98.01% and a false positive (FP) rate of 0.96/hour. The performance on GGE patients showed 100% sensitivity in five patients, while the remaining patients obtained over 98.9% sensitivity. Moderate FP rates were seen in our patients with 2.21/hour average FP. The detector trained within our patient cohort was validated in an independent dataset, TUH EEG Seizure Corpus (TUSZ), that showed 100% sensitivity in 11 of 12 patients and 0.56/hour averaged FP.
CONCLUSIONS
We developed a robust SWDs detector that showed high sensitivity and specificity for both GAERS rats and GGE patients.
SIGNIFICANCE
This detector can assist researchers and neurologists with the time-efficient and accurate quantification of SWDs.
Topics: Rats; Animals; Epilepsy, Absence; Rats, Wistar; Epilepsy, Generalized; Seizures; Electroencephalography; Disease Models, Animal
PubMed: 37364342
DOI: 10.1016/j.eplepsyres.2023.107181 -
Neurological Research Dec 2023The goal of the present study is to examine pretreatment with Schiff bases and derivatives of pregabalin along with their metal (Zn and Cu) complexes on the severity of...
OBJECTIVE
The goal of the present study is to examine pretreatment with Schiff bases and derivatives of pregabalin along with their metal (Zn and Cu) complexes on the severity of epilepsy, latency time, duration of convulsions, seizure score and survival rate in mice.
METHODS
To achieve the goal, a molecular docking study of analogues was carried out on a specific molecular target, such as the alpha-2δ receptor (PDB ID: 6ND9); which revealed the significant binding affinity of the analogs to their respective target. Based on the docking information, all pregabalin derivatives were synthesized and antiepileptic effect was confirmed by applying the PTZ model that prioritized the most crucial significant points responsible for biological activity.
RESULTS
The test compounds markedly increased the latency of the first seizure and reduced the frequency of seizures throughout the body and frequent spinning and jumps. Additionally, treatment with pregabalin derivatives in mice that received PTZ significantly reduced the duration of seizures and seizure score. However, it increased the survival rate of the mice.
DISCUSSION
Since the newly synthesized compounds were more active as compared to the parent drug in some respects; therefore, the expansion of the project can be planned to explore clinical side of the drugs in the future.
Topics: Mice; Animals; Anticonvulsants; Pregabalin; Molecular Docking Simulation; Seizures; Epilepsy
PubMed: 37751764
DOI: 10.1080/01616412.2023.2257440 -
Primary Care Jun 2024Seizures and epilepsy are common neurologic conditions that are frequently encountered in the outpatient primary care setting. An accurate diagnosis relies on a thorough... (Review)
Review
Seizures and epilepsy are common neurologic conditions that are frequently encountered in the outpatient primary care setting. An accurate diagnosis relies on a thorough clinical history and evaluation. Understanding seizure semiology and classification is crucial in conducting the initial assessment. Knowledge of common seizure triggers and provoking factors can further guide diagnostic testing and initial management. The pharmacodynamic characteristics and side effect profiles of anti-seizure medications are important considerations when deciding treatment and counseling patients, particularly those with comorbidities and in special populations such as patient of childbearing potential.
Topics: Humans; Epilepsy; Primary Health Care; Seizures; Anticonvulsants; Physicians, Primary Care; Female; Medical History Taking
PubMed: 38692771
DOI: 10.1016/j.pop.2024.02.008 -
Epilepsy & Behavior : E&B Dec 2023Antiseizure medications (ASM) effectively prevent seizures in about 70% of adult epilepsy patients, but nonadherence to medication is the primary cause of breakthrough...
BACKGROUND AND PURPOSE
Antiseizure medications (ASM) effectively prevent seizures in about 70% of adult epilepsy patients, but nonadherence to medication is the primary cause of breakthrough seizures, accounting for 26% to 79% of cases. Factors such as age, education, dosing frequency, forgetfulness, fear of side effects, and socioeconomic status contribute to poor adherence, especially among underserved populations. This study aimed to assess medication adherence during routine follow-up visits and identify the role of education in reducing non adherence in an underserved patient population.
METHODS
The study involved a retrospective chart review of adult epilepsy patients seen at the University of Illinois Hospital between December 2016 and April 2020. Data on patient demographics, epilepsy and seizure classification, medication details, emergency visits, and adherence were collected from electronic medical records using the RedCap system. Descriptive statistics and statistical tests were conducted using STATA 17.0 for data analysis, including chi-squared analysis for categorical data and t-tests for continuous data.
RESULTS
The study enrolled a total of 286 adult epilepsy patients who met the eligibility criteria. Among them, 111 patients (38.81 %) were classified as nonadherent based on ASM levels. Caucasian/white race and income > $50,000 per year, were significantly associated with adherence (p = 0.009 and p = 0.006 respectively). Moreover, patients with weekly seizures were more likely to be adherent (p = 0.042). No significant differences were found regarding medication adherence and sex, education, employment, epilepsy type, age at diagnosis, seizure type or number of current ASM medications. Even though not significant, a trend towards college educated patients being more adherent was observed (70.37 %). Of self-reported adherent patients, 33.33 % were found to be nonadherent based on ASM levels. Nurse phone calls reminding 70 non adherent patients about adherence increased the chances of becoming adherent by 80.39 %. Finally, although not statistically significant, the majority of adherent patients had no history of hospitalizations for breakthrough seizures (73.89 %).
CONCLUSION
More than a third of our patients were found to be non-adherent during routine follow-up visits. Lower socio-economic status and lower education were associated with increased chances of being non adherent. Rates of adherence were improved by nurse's phone calls discussing the importance of adherence and risks of SUDEP. The findings emphasize the importance of education in improving medication adherence among these populations, suggesting the need for social interventions, community outreach programs, and targeted educational initiatives.
Topics: Adult; Humans; Vulnerable Populations; Retrospective Studies; Epilepsy; Seizures; Medication Adherence
PubMed: 37988904
DOI: 10.1016/j.yebeh.2023.109484 -
Annals of Neurology Jun 2024The objective was to analyze seizure semiology in pediatric frontal lobe epilepsy patients, considering age, to localize the seizure onset zone for surgical resection in...
OBJECTIVE
The objective was to analyze seizure semiology in pediatric frontal lobe epilepsy patients, considering age, to localize the seizure onset zone for surgical resection in focal epilepsy.
METHODS
Fifty patients were identified retrospectively, who achieved seizure freedom after frontal lobe resective surgery at Great Ormond Street Hospital. Video-electroencephalography recordings of preoperative ictal seizure semiology were analyzed, stratifying the data based on resection region (mesial or lateral frontal lobe) and age at surgery (≤4 vs >4).
RESULTS
Pediatric frontal lobe epilepsy is characterized by frequent, short, complex seizures, similar to adult cohorts. Children with mesial onset had higher occurrence of head deviation (either direction: 55.6% vs 17.4%; p = 0.02) and contralateral head deviation (22.2% vs 0.0%; p = 0.03), ictal body-turning (55.6% vs 13.0%; p = 0.006; ipsilateral: 55.6% vs 4.3%; p = 0.0003), and complex motor signs (88.9% vs 56.5%; p = 0.037). Both age groups (≤4 and >4 years) showed hyperkinetic features (21.1% vs 32.1%), contrary to previous reports. The very young group showed more myoclonic (36.8% vs 3.6%; p = 0.005) and hypomotor features (31.6% vs 0.0%; p = 0.003), and fewer behavioral features (36.8% vs 71.4%; p = 0.03) and reduced responsiveness (31.6% vs 78.6%; p = 0.002).
INTERPRETATION
This study presents the most extensive semiological analysis of children with confirmed frontal lobe epilepsy. It identifies semiological features that aid in differentiating between mesial and lateral onset. Despite age-dependent differences, typical frontal lobe features, including hyperkinetic seizures, are observed even in very young children. A better understanding of pediatric seizure semiology may enhance the accuracy of onset identification, and enable earlier presurgical evaluation, improving postsurgical outcomes. ANN NEUROL 2024;95:1138-1148.
Topics: Humans; Child; Male; Female; Epilepsy, Frontal Lobe; Child, Preschool; Electroencephalography; Retrospective Studies; Adolescent; Seizures; Infant; Frontal Lobe; Video Recording
PubMed: 38624073
DOI: 10.1002/ana.26922