Epilepsia. Official Journal of the International League Against Epilepsy

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 ...

Abstract

Objectives

Photoplethysmography (PPG) reflects variations of blood perfusion in tissues, which may signify seizure‐related autonomic changes. The aim of this study is to assess the variability of PPG signals and their value in detecting peri‐ictal changes in patients with focal impaired awareness seizures (FIASs).

Methods

PPG data were recorded using a wearable sensor placed on the wrist or ankle of children with epilepsy admitted for long‐term video‐electroencephalographic monitoring. We analyzed PPG data in four different periods: seizure‐free, preictal, ictal, and postictal. Multiple features ...

Summary

Objective

To define the association between late‐onset epilepsy (LOE) and 25‐year change in cognitive performance.

Methods

The Atherosclerosis Risk in Communities (ARIC) study is a multicenter longitudinal cohort study with participants from four U.S. communities. From linked Medicare claims, we identified cases of LOE, defined as ≥2 seizure‐related diagnostic codes starting at age ≥67. The ARIC cohort underwent evaluation with in‐person visits at intervals of 3‐15 years. Cognition was evaluated 4 times over >25 years (including before the onset of seizures) using the Delayed Word ...

Abstract

Objective

We compared women with drug‐resistant focal epilepsy who had undergone surgery (WWE‐S) with those who were managed medically (WWE‐M) for maternal and fetal outcomes of their pregnancies.

Methods

We classified all WWE‐S who were enrolled in a prospective registry of epilepsy and pregnancy (1998‐2015) as those who underwent the surgery before pregnancy (WWE‐SF) or after pregnancy (WWE‐PF). The comparator group (WWE‐M) was twice that number of age‐matched women with focal epilepsy in this registry. Their clinical profile, anti‐epileptic drug (AED) use, and ...

Abstract

Precision medicine in the epilepsies has gathered much attention, especially with gene discovery pushing forward new understanding of disease biology. Several targeted treatments are emerging, some with considerable sophistication and individual‐level tailoring. There have been rare achievements in improving short‐term outcomes in a few very select patients with epilepsy. The prospects for further targeted, repurposed, or novel treatments seem promising. Along with much‐needed success, difficulties are also arising. Precision treatments do not always work, and sometimes are inaccessible or do ...