Epilepsia. Official Journal of the International League Against Epilepsy

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 ...

Abstract

Objectives

The current COVID‐19 pandemic stresses an urgency to accelerate much needed health service reform. Rapid and courageous changes being made to address its immediate impact are demonstrating that the means and technology to enable new models of healthcare exist. For example, innovations such as electronic patient portals (ePortal) can facilitate: a) radical reform of out‐patient care; b) cost containment in the economically constrained aftermath of the pandemic; c) environmental sustainability by reduction of unnecessary journeys/transport. Herein the development of PiSCES, ...

Abstract

Objective

Delineation of malformations of cortical development (MCD) is central in presurgical evaluation of drug‐resistant epilepsy. Delineation using magnetic resonance imaging (MRI) can be ambiguous, however, because the conventional T₁‐ and T₂‐weighted contrasts depend strongly on myelin for differentiation of cortical tissue and white matter. Variations in myelin content within both cortex and white matter may cause MCD findings on MRI to change size, become undetectable, or disagree with histopathology. The novel tensor‐valued diffusion MRI (dMRI) technique maps microscopic diffusion anisotropy, ...

Abstract

Objective

Drebrins are crucial for synaptic function and dendritic spine development, remodeling, and maintenance. In temporal lobe epilepsy (TLE) patients, a significant hippocampal synaptic reorganization occurs, and synaptic reorganization has been associated with hippocampal hyperexcitability. This study aimed to evaluate, in TLE patients, the hippocampal expression of drebrin using immunohistochemistry with DAS2 or M2F6 antibodies that recognize adult (drebrin A) or adult and embryonic (pan‐drebrin) isoforms, respectively.

Methods

Hippocampal sections from drug‐resistant TLE patients with hippocampal sclerosis (HS; TLE, n = 33), of whom 31 ...

Abstract

Objective

Previous research suggests that natural fluctuations in seizure rates within individuals have a quantifiable impact on therapeutic clinical trial outcomes.

Methods

A trial simulator estimated the statistical power of clinical trials with a typical trial design with and without patients included who exhibited a range of means (1‐15 seizures/mo) and standard deviations (1‐15 seizures/mo) in their baseline seizure rates. Trial outcomes were evaluated using 50% responder rates, median percentage change, and time to prerandomization.

Results

Patients with higher seizure frequencies and lower standard deviations ...