Epilepsia. Official Journal of the International League Against Epilepsy

Abstract

Objective

Seizure detection is a major facet of electroencephalography (EEG) analysis in neurocritical care, epilepsy diagnosis and management, and the instantiation of novel therapies such as closed‐loop stimulation or optogenetic control of seizures. It is also of increased importance in high‐throughput, robust, and reproducible pre‐clinical research. However, seizure detectors are not widely relied upon in either clinical or research settings due to limited validation. In this study, we create a high‐performance seizure‐detection approach, validated in multiple data sets, with the intention ...

Abstract

Objective

Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immune‐mediated diseases characterized by an extensive loss of the epidermal skin layer, often resulting in death. SJS and TEN are often triggered by certain drugs, including antiepileptic drugs (AEDs). Epilepsy is very difficult to treat and often involves the combination of two or more AEDs. In this study, we quantified not only the risk of SJS or TEN associated with single‐AED therapy but also the risk related to concomitant AED treatment ...

Abstract

Objective

Initial identification of new investigational drugs for the treatment of epilepsy is commonly conducted in well‐established mouse acute and chronic seizure models: for example, maximal electroshock (MES), 6 Hz, and corneal kindling. Comparison of the median effective dose (ED50) of approved antiseizure drugs (ASDs) vs investigational agents in these models provides evidence of their potential for clinical efficacy. Inbred and outbred mouse strains exhibit differential seizure susceptibility. However, few comparisons exist of the ED50 or median behaviorally impairing dose (TD50) of ...

Abstract

The cyclical organization of seizures in epilepsy has been described since antiquity. However, historical explanations for seizure cycles—based on celestial, hormonal, and environmental factors—have only recently become testable with the advent of chronic electroencephalography (cEEG) and modern statistical techniques. Here, factors purported over millennia to influence seizure timing are viewed through a contemporary lens. We discuss the emerging concept that seizures are organized over multiple timescales, each involving differential influences of external and endogenous rhythm generators. Leveraging large cEEG datasets ...

Abstract

Psychogenic nonepileptic seizures (PNES) are paroxysmal clinical events that are often misdiagnosed as epileptic seizures, but which are not associated with electrographic discharge. Brain connectivity changes occurring during PNES are not known. We studied functional connectivity (Fc) in two patients with drug‐resistant epilepsy, explored by stereotactic electroencephalography (EEG), in whom we recorded both epileptic seizures (ES) and PNES. Functional connectivity using pair‐wise nonlinear correlation was computed between signals from seven brain areas: amygdala, hippocampus, lateral temporal cortex, anterior insula, orbitofrontal ...

Abstract

High‐frequency oscillations (HFOs) in intracranial electroencephalography (EEG) are a promising biomarker of the epileptogenic zone and tool for surgical planning. Many studies have shown that a high rate of HFOs (number per minute) is correlated with the seizure‐onset zone, and complete removal of HFO‐generating brain regions has been associated with seizure‐free outcome after surgery. In order to use HFOs as a biomarker, these transient events must first be detected in electrophysiological data. Because visual detection of HFOs is time‐consuming and ...

Abstract

Objective

To identify the timelines of magnetic resonance imaging (MRI) abnormalities and their relationships with the clinical outcomes of patients with new‐onset refractory status epilepticus (NORSE).

Methods

This retrospective observational study enrolled patients with NORSE who were admitted from March 2008 to July 2018. MRI abnormalities were analyzed visually with the readers blinded to the clinical characteristics of the patients. Poor functional outcome was defined as a Glasgow Outcome Scale score ≤ 3 at discharge. Subsequent pharmacoresistant epilepsy was defined as seizures not controlled by ...

Abstract

Objective

To determine the utility of suggestive seizure induction for inpatient work‐up of suspected psychogenic nonepileptic seizures (PNES).

Methods

Prospective study of epilepsy center inpatient admissions with suspected PNES. Patients were randomized to undergo suggestive induction first (group A) and then, if necessary, long‐term video–electroencephalography (EEG) monitoring, or vice versa (group B). Diagnostic pathways were compared. Potential clinical predictors for diagnostic success were evaluated.

Results

Length of in‐hospital stay did not significantly differ between groups. Suspicion of PNES was confirmed in 43 of 77 (56%) ...

Abstract

Epilepsy is a unique neurologic condition characterized by recurrent seizures, where causes, underlying biomarkers, triggers, and patterns differ across individuals. The unpredictability of seizures can heighten fear and anxiety in people with epilepsy, making it difficult to take part in day‐to‐day activities. Epilepsy researchers have prioritized developing seizure prediction algorithms to combat episodic seizures for decades, but the utility and effectiveness of prediction algorithms has not been investigated thoroughly in clinical settings. In contrast, seizure forecasts, which theoretically provide the ...

Abstract

Machine learning (ML) is increasingly recognized as a useful tool in healthcare applications, including epilepsy. One of the most important applications of ML in epilepsy is seizure detection and prediction, using wearable devices (WDs). However, not all currently available algorithms implemented in WDs are using ML. In this review, we summarize the state of the art of using WDs and ML in epilepsy, and we outline future development in these domains. There is published evidence for reliable detection of epileptic ...