Early detection rate changes from a brain‐responsive neurostimulation system predict efficacy of newly added antiseizure drugs

Abstract

Objective

Brain‐responsive neurostimulation (RNS System, NeuroPace) is used to treat medically refractory focal epilepsy and also provides long‐term ambulatory neurophysiologic data. We sought to determine whether these data could predict the clinical response to antiseizure drugs (ASDs).

Methods

First, newly added medications were identified in RNS System patients followed at a single epilepsy center. Daily detection rates including “episode starts” (predominantly interictal activity) and “long episodes” (often electrographic seizures) were compared before and after ASD initiation. Efficacy was determined from documentation of clinical ...

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Diagnosis of pyridoxine‐dependent epilepsy in an adult presenting with recurrent status epilepticus

Abstract

Pyridoxine‐dependent epilepsy (PDE) is a genetic metabolic disease caused by inborn errors affecting vitamin B6 metabolism, which typically presents with neonatal seizures resistant to antiepileptic drugs (AEDs). Treatment with pyridoxine terminates seizures and prevents neurological decline. We describe a case in which the diagnosis was established at the age of 22 years. Birth and development were normal, but there was a history of three isolated tonic‐clonic seizures during childhood and adolescence. At the age of 18 years, she developed frequent focal motor ...

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External validation and comparison of two prediction models for seizure recurrence after the withdrawal of antiepileptic drugs in adult patients

Abstract

Objective

The models currently available for predicting the risk of seizure recurrence after antiepileptic drug (AED) withdrawal in adult epilepsy patients include the prediction model developed by Lamberink et al (Lamberink model, 2017) and the Medical Research Council prediction model (MRC model, 1993). However, there was no external validation for the two models. The purpose of this study was to perform an independent external validation and a comparison of the Lamberink model and the MRC model in adult patients.

Methods

The study population ...

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Prospective validation study of an epilepsy seizure risk system for outpatient evaluation

Abstract

Objective

We conducted clinical testing of an automated Bayesian machine learning algorithm (Epilepsy Seizure Assessment Tool [EpiSAT]) for outpatient seizure risk assessment using seizure counting data, and validated performance against specialized epilepsy clinician experts.

Methods

We conducted a prospective longitudinal study of EpiSAT performance against 24 specialized clinician experts at three tertiary referral epilepsy centers in the United States. Accuracy, interrater reliability, and intra‐rater reliability of EpiSAT for correctly identifying changes in seizure risk (improvements, worsening, or no change) were evaluated using 120 seizures from four synthetic seizure diaries ...

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Readmission after neurosurgical intervention in epilepsy: A nationwide cohort analysis

Abstract

Objective

Hospital readmissions result in increased health care costs and are associated with worse outcomes after neurosurgical intervention. Understanding factors associated with readmissions will inform future studies aimed at improving quality of care in those with epilepsy.

Methods

Patients of all ages with epilepsy who underwent a neurosurgical intervention were identified in the 2014 Nationwide Readmissions Database, a nationally representative dataset containing data from roughly 17 million US hospital discharges. Diagnosis of epilepsy was based on International Classification of Diseases, Ninth Revision, Clinical ...

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Clinical benefit of presurgical EEG‐fMRI in difficult‐to‐localize focal epilepsy: A single‐institution retrospective review

Abstract

Objective

The aim of this report is to present our clinical experience of electroencephalography–functional magnetic resonance imaging (EEG‐fMRI) in localizing the epileptogenic focus, and to evaluate the clinical impact and challenges associated with the use of EEG‐fMRI in pharmacoresistant focal epilepsy.

Methods

We identified EEG‐fMRI studies (n = 118) in people with focal epilepsy performed at our center from 2003 to 2018. Participants were referred from our Comprehensive Epilepsy Program in an exploratory research effort to address often difficult clinical questions, due to complex and ...

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Comparisons of direct and indirect utilities in adult epilepsy populations: A systematic review

Abstract

Objective

Epilepsy is common and carries substantial morbidity, and therefore identifying cost‐effective health interventions is essential. Cost‐utility analysis is a widely used method for such analyses. For this, health conditions are rated in terms of utilities, which provide a standardized score to reflect quality of life. Utilities are obtained either indirectly using quality of life questionnaires, or directly from patients or the general population. We sought to describe instruments used to estimate utilities in epilepsy populations, and how results differ according ...

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Prospective validation of a machine learning model that uses provider notes to identify candidates for resective epilepsy surgery

Abstract

Objective

Delay to resective epilepsy surgery results in avoidable disease burden and increased risk of mortality. The objective was to prospectively validate a natural language processing (NLP) application that uses provider notes to assign epilepsy surgery candidacy scores.

Methods

The application was trained on notes from (1) patients with a diagnosis of epilepsy and a history of resective epilepsy surgery and (2) patients who were seizure‐free without surgery. The testing set included all patients with unknown surgical candidacy status and an upcoming neurology ...

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Automated detection of hippocampal sclerosis using clinically empirical and radiomics features

Abstract

Objective

Temporal lobe epilepsy is a common form of epilepsy that might be amenable to surgery. However, magnetic resonance imaging (MRI)‐negative hippocampal sclerosis (HS) can hamper early diagnosis and surgical intervention for patients in clinical practice, resulting in disease progression. Our aim was to automatically detect and evaluate the structural alterations of HS.

Methods

Eighty patients with pharmacoresistant epilepsy and histologically proven HS and 80 healthy controls were included in the study. Two automated classifiers relying on clinically empirical and radiomics features were ...

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