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1.
Maria-Ioanna Stefanou Debora Desideri Justus Marquetand Paolo Belardinelli Christoph Zrenner Holger Lerche Ulf Ziemann 《Clinical neurophysiology》2017,128(12):2503-2509
Objective
Mutations in STX1B encoding the presynaptic protein syntaxin-1B are associated with febrile seizures with or without epilepsy. It is unclear to what extent these mutations are linked to abnormalities of cortical glutamatergic or GABAergic neurotransmission. We explored this question using single- and paired-pulse transcranial magnetic stimulation (TMS) excitability markers.Methods
We studied nine currently asymptomatic adult STX1B mutation carriers with history of epilepsy and febrile seizures, who had been seizure-free for at least eight years without antiepileptic drug treatment, and ten healthy age-matched controls. Resting motor threshold (RMT), and input-output curves of motor evoked potential (MEP) amplitude, short-interval intracortical inhibition (SICI, marker of GABAAergic excitability) and intracortical facilitation (ICF, marker of glutamatergic excitability) were tested.Results
RMT, and input-output curves of MEP amplitude, SICI and ICF revealed no significant differences between STX1B mutation carriers and healthy controls.Conclusions
Findings suggest normal motor cortical GABAAergic and glutamatergic excitability in currently asymptomatic STX1B mutation carriers.Significance
TMS measures of motor cortical excitability show utility in demonstrating normal excitability in adult STX1B mutation carriers with history of seizures. 相似文献2.
Zhixian Yang Hui Li Jiao Xue Ping Qian Xiaoyan Liu Yuehua Zhang 《Brain & development》2017,39(10):828-835
Objective
To investigate the general characteristics and the category of myoclonic epilepsy in infancy (MEI) with or without afebrile generalized tonic-clonic seizures (GTCS).Methods
Thirty-three children were retrospectively recruited from approximately 42,814 video-electroencephalogram (VEEG) recordings monitored in our department over last nearly 10 years. Myoclonic seizures (MS) must be identified by VEEG in all patients. The clinical, EEG features and outcome were analyzed among these patients.Results
The 33 patients (25 boys and 8 girls) were divided into three groups: 11 patients with typical MEI; 16 patients with MEI experienced afebrile GTCS before MS onset; and 6 patients with MEI presented afebrile GTCS occurring concurrently with MS. No significant differences were found among the three groups, including gender distribution, family history, personal history of febrile seizures, the age at seizure onset and control, the duration of MS, the interval between age at onset and seizure control, the age at EEG normalization, the interval between seizure onset age and EEG normalization age and normal psychomotor development at the end of follow-up. More patients in group two and group three were controlled by two or three kinds of antiepileptic drugs compared with those in group one.Conclusions
In this study, three groups of patients had similar clinical, EEG features and outcome. Afebrile GTCS was associated with a stronger cortical hyperexcitability. It was worth considering whether MEI with preceding or concurrent afebrile GTCS should be recognized as subgroups or different epileptic syndromes independent of MEI. 相似文献3.
The use and yield of continuous EEG in critically ill patients: A comparative study of three centers
Vincent Alvarez Andres A. Rodriguez Ruiz Suzette LaRoche Lawrence J. Hirsch Christopher Parres Paula E. Voinescu Andres Fernandez Ognen A. Petroff Nishi Rampal Hiba Arif Haider Jong Woo Lee 《Clinical neurophysiology》2017,128(4):570-578
Objective
Continuous EEG (cEEG) monitoring of critically ill patients has gained widespread use, but there is substantial reported variability in its use. We analyzed cEEG and antiseizure drug (ASD) usage at three high volume centers.Methods
We utilized a multicenter cEEG database used daily as a clinical reporting tool in three tertiary care sites (Emory Hospital, Brigham and Women’s Hospital and Yale – New Haven Hospital). We compared the cEEG usage patterns, seizure frequency, detection of rhythmic/periodic patterns (RPP), and ASD use between the sites.Results
5792 cEEG sessions were analyzed. Indication for cEEG monitoring and recording duration were similar between the sites. Seizures detection rate was nearly identical between the three sites, ranging between 12.3% and 13.6%. Median time to first seizure and detection rate of RPPs were similar. There were significant differences in doses of levetiracetam, valproic acid, and lacosamide used between the three sites.Conclusions
There was remarkable uniformity in seizure detection rates within three high volume centers. In contrast, dose of ASD used frequently differed between the three sites.Significance
These large volume data are in line with recent guidelines regarding cEEG use. Difference in ASD use suggests discrepancies in how cEEG results influence patient management. 相似文献4.
J. Herta J. Koren F. Fürbass A. Zöchmeister M. Hartmann A. Hosmann C. Baumgartner A. Gruber 《Clinical neurophysiology》2017,128(6):1000-1007
Objective
To assess whether ICU caregivers can correctly read and interpret continuous EEG (cEEG) data displayed with the computer algorithm NeuroTrend (NT) with the main attention on seizure detection and determination of sedation depth.Methods
120 screenshots of NT (480 h of cEEG) were rated by 18 briefly trained nurses and biomedical analysts. Multirater agreements (MRA) as well as interrater agreements (IRA) compared to an expert opinion (EXO) were calculated for items such as pattern type, pattern location, interruption of recording, seizure suspicion, consistency of frequency, seizure tendency and level of sedation.Results
MRA as well as IRA were almost perfect (80–100%) for interruption of recording, spike-and-waves, rhythmic delta activity and burst suppression. A substantial agreement (60–80%) was found for electrographic seizure patterns, periodic discharges and seizure suspicion. Except for pattern localization (70.83–92.26%), items requiring a precondition and especially those who needed interpretation like consistency of frequency (47.47–79.15%) or level of sedation (41.10%) showed lower agreements.Conclusions
The present study demonstrates that NT might be a useful bedside monitor in cases of subclinical seizures. Determination of correct sedation depth by ICU caregivers requires a more detailed training.Significance
Computer algorithms may reduce the workload of cEEG analysis in ICU patients. 相似文献5.
Borgil Bayasgalan Masao Matsuhashi Tomoyuki Fumuro Haruhiko Nohira Naoki Nakano Koji Iida Masaya Katagiri Akihiro Shimotake Riki Matsumoto Takayuki Kikuchi Takeharu Kunieda Amami Kato Ryosuke Takahashi Akio Ikeda 《Clinical neurophysiology》2017,128(9):1583-1589
Objective
We investigated whether vagus nerve stimulation (VNS) induces a positive shift of slow cortical potentials (SCPs) in patients with >50% seizure reduction (responders) but not in non-responders.Methods
We analyzed routine clinical electroencephalograms (EEGs) from 24 patients who were undergoing seizure treatment by VNS. The patients were divided into 2 groups by hardware time constant (TC) of EEG: the TC 10-s group (10 patients) and TC 2-s group (14 patients). We compared SCPs at 5 electrodes (Cz and adjacent ones) between the 2 states of VNS: during stimulation and between stimulations. Seizure reduction was independently judged. Correlation between SCP (positivity or not) and seizure reduction (>50% or not) was estimated.Results
In the TC 10-s group, the correlation between SCP and seizure reduction was significant (p < 0.05) (i.e., both good results in 4 and both negative results in 5). In TC 2-s group, the correlation between SCP and seizure reduction was not significant (p = 0.209).Conclusions
A positive shift of SCP recorded by using a TC of 10 s could be a surrogate marker for VNS response.Significance
SCP could be a biomarker of good responders to VNS. 相似文献6.
Alice D. Lam Douglas Maus Sahar F. Zafar Andrew J. Cole Sydney S. Cash 《Clinical neurophysiology》2017,128(9):1647-1655
Objective
In mesial temporal lobe (mTL) epilepsy, seizure onset can precede the appearance of a scalp EEG ictal pattern by many seconds. The ability to identify this early, occult mTL seizure activity could improve lateralization and localization of mTL seizures on scalp EEG.Methods
Using scalp EEG spectral features and machine learning approaches on a dataset of combined scalp EEG and foramen ovale electrode recordings in patients with mTL epilepsy, we developed an algorithm, SCOPE-mTL, to detect and lateralize early, occult mTL seizure activity, prior to the appearance of a scalp EEG ictal pattern.Results
Using SCOPE-mTL, 73% of seizures with occult mTL onset were identified as such, and no seizures that lacked an occult mTL onset were identified as having one. Predicted mTL seizure onset times were highly correlated with actual mTL seizure onset times (r = 0.69). 50% of seizures with early mTL onset were lateralizable prior to scalp ictal onset, with 94% accuracy.Conclusions
SCOPE-mTL can identify and lateralize mTL seizures prior to scalp EEG ictal onset, with high sensitivity, specificity, and accuracy.Significance
Quantitative analysis of scalp EEG can provide important information about mTL seizures, even in the absence of a visible scalp EEG ictal correlate. 相似文献7.
Objective
We evaluated the performance of our previously developed seizure prediction approach on thirty eight seizures from ten patients with focal hippocampal epilepsy.Methods
The seizure prediction system was developed based on the extraction of correlation dimension, correlation entropy, noise level, Lempel-Ziv complexity, largest Lyapunov exponent, and nonlinear interdependence from segments of intracranial EEG.Results
Our results showed an average sensitivity of 86.7% and 92.9%, an average false prediction rate of 0.126 and 0.096/h, and an average minimum prediction time of 14.3 and 33.3 min, respectively, using seizure occurrence periods of 30 and 50 min and a seizure prediction horizon of 10 s. Two-third of the analyzed seizures showed significantly increased complexity in periods prior to the seizures in comparison with baseline.In four patients, strong bidirectional connectivities between epileptic contacts and the surrounding areas were observed. However, in five patients, unidirectional functional connectivities in preictal periods were observed from remote areas to epileptogenic zones.Conclusions
Overall, preictal periods in patients with focal hippocampal epilepsy were characterized with patient-specific changes in univariate and bivariate nonlinear measures.Significance
The spatio-temporal characterization of preictal periods may help to better understand the mechanism underlying seizure generation in patients with focal hippocampal epilepsy. 相似文献8.
Luis Velázquez-Pérez Johannes Tünnerhoff Roberto Rodríguez-Labrada Reidenis Torres-Vega Yusely Ruiz-Gonzalez Paolo Belardinelli Jacqueline Medrano-Montero Nalia Canales-Ochoa Yanetza González-Zaldivar Yaimeé Vazquez-Mojena Georg Auburger Ulf Ziemann 《Clinical neurophysiology》2017,128(12):2493-2502
Objective
Clinical data suggest early involvement of the corticospinal tract (CST) in spinocerebellar ataxia type 2 (SCA2). Here we tested if early CST degeneration can be detected in prodromal SCA2 mutation carriers by electrophysiological markers of CST integrity.Methods
CST integrity was tested in 15 prodromal SCA2 mutation carriers, 19 SCA2 patients and 25 age-matched healthy controls, using corticomuscular (EEG-EMG) and intermuscular (EMG-EMG) coherence measures in upper and lower limb muscles.Results
Significant reductions of EEG-EMG and EMG-EMG coherences were observed in the SCA2 patients, and to a similar extent in the prodromal SCA2 mutation carriers. In prodromal SCA2, EEG-EMG and EMG-EMG coherences correlated with the predicted time to ataxia onset.Conclusions
Findings indicate early CST neurodegeneration in SCA2. EEG-EMG and EMG-EMG coherence may serve as biomarkers of early CST neurodegeneration in prodromal SCA2 mutation carriers.Significance
Findings are important for developing preclinical disease markers in the context of currently emerging disease-modifying therapies of neurodegenerative disorders. 相似文献9.
Hiroshi Shirozu Akira Hashizume Hiroshi Masuda Yosuke Ito Yoko Nakayama Takefumi Higashijima Masafumi Fukuda Shigeki Kameyama 《Clinical neurophysiology》2017,128(8):1504-1512
Objective
We aimed to validate the usefulness of gradient magnetic-field topography (GMFT) for analysis of ictal magnetoencephalography (MEG) in patients with neocortical epilepsy.Methods
We identified 13 patients presenting with an ictal event during preoperative MEG. We applied equivalent current dipole (ECD) estimation and GMFT to detect and localize the ictal MEG onset, and compared these methods with the ictal onset zone (IOZ) derived from chronic intracranial electroencephalography. The surgical resection areas and outcomes were also evaluated.Results
GMFT detected and localized the ictal MEG onset in all patients, whereas ECD estimation showed localized ECDs in only 2. The delineation of GMFT was concordant with the IOZ at the gyral-unit level in 10 of 12 patients (83.3%). The detectability and precision of delineation of ictal MEG activity by GMFT were significantly superior to those of ECD (p < 0.05 and p < 0.01, respectively). Complete resection of the IOZ in the concordant group provided seizure freedom in 3 patients, whereas seizures remained in 9 patients who had incomplete resections.Conclusions
Because of its higher spatial resolution, GMFT of ictal MEG is superior to conventional ECD estimation in patients with neocortical epilepsy.Significance
Ictal MEG study is a useful tool to estimate the seizure onset in patients with neocortical epilepsy. 相似文献10.
Mamede de Carvalho Artiom Poliakov Cristiano Tavares Michael Swash 《Clinical neurophysiology》2017,128(11):2200-2204
Objective
We studied motor unit recruitment to test a new method to identify motor unit firing rate (FR) variability.Methods
We studied 68 ALS patients, with and without upper neuron signs (UMN) in lower limbs, 24 patients with primary lateral sclerosis (PLS), 13 patients with spinal cord lesion and 39 normal subjects. All recordings were made from tibialis anterior muscles of normal strength. Subjects performed a very slight contraction in order to activate 2 motor units in each recording. 5–7 motor unit pairs were recorded in each subject. Mean consecutive differences (MCD) were calculated for each pair of potentials. The mean MCD for each muscle was estimated as the mean from the total number of pairs recorded. A p value < 0.01 was accepted as significant.Results
MCD of FR frequency was less in the subjects with spinal cord lesion and PLS. In addition, the FR frequency of the 1st motor unit in a pair of units was markedly reduced in PLS, and in subjects with spinal cord lesions.Conclusion
These results support a lower threshold and reduced FR fluctuation in spinal motor neurons of spastic patients.Significance
This method can be developed for detection of UMN lesions. 相似文献11.
F. Fürbass S. Kampusch E. Kaniusas J. Koren S. Pirker R. Hopfengärtner H. Stefan T. Kluge C. Baumgartner 《Clinical neurophysiology》2017,128(8):1466-1472
Objective
This study investigated sensitivity and false detection rate of a multimodal automatic seizure detection algorithm and the applicability to reduced electrode montages for long-term seizure documentation in epilepsy patients.Methods
An automatic seizure detection algorithm based on EEG, EMG, and ECG signals was developed. EEG/ECG recordings of 92 patients from two epilepsy monitoring units including 494 seizures were used to assess detection performance. EMG data were extracted by bandpass filtering of EEG signals. Sensitivity and false detection rate were evaluated for each signal modality and for reduced electrode montages.Results
All focal seizures evolving to bilateral tonic-clonic (BTCS, n = 50) and 89% of focal seizures (FS, n = 139) were detected. Average sensitivity in temporal lobe epilepsy (TLE) patients was 94% and 74% in extratemporal lobe epilepsy (XTLE) patients. Overall detection sensitivity was 86%. Average false detection rate was 12.8 false detections in 24 h (FD/24 h) for TLE and 22 FD/24 h in XTLE patients. Utilization of 8 frontal and temporal electrodes reduced average sensitivity from 86% to 81%.Conclusion
Our automatic multimodal seizure detection algorithm shows high sensitivity with full and reduced electrode montages.Significance
Evaluation of different signal modalities and electrode montages paces the way for semi-automatic seizure documentation systems. 相似文献12.
Anneleen Dereymaeker Amir H. Ansari Katrien Jansen Perumpillichira J. Cherian Jan Vervisch Paul Govaert Leen De Wispelaere Charlotte Dielman Vladimir Matic Alexander Caicedo Dorado Maarten De Vos Sabine Van Huffel Gunnar Naulaers 《Clinical neurophysiology》2017,128(9):1737-1745
Objective
To assess interrater agreement based on majority voting in visual scoring of neonatal seizures.Methods
An online platform was designed based on a multicentre seizure EEG-database. Consensus decision based on ‘majority voting’ and interrater agreement was estimated using Fleiss’ Kappa. The influences of different factors on agreement were determined.Results
1919 Events extracted from 280 h EEG of 71 neonates were reviewed by 4 raters. Majority voting was applied to assign a seizure/non-seizure classification. 44% of events were classified with high, 36% with moderate, and 20% with poor agreement, resulting in a Kappa value of 0.39. 68% of events were labelled as seizures, and in 46%, all raters were convinced about electrographic seizures. The most common seizure duration was <30 s. Raters agreed best for seizures lasting 60–120 s. There was a significant difference in electrographic characteristics of seizures versus dubious events, with seizures having longer duration, higher power and amplitude.Conclusions
There is a wide variability in identifying rhythmic ictal and non-ictal EEG events, and only the most robust ictal patterns are consistently agreed upon. Database composition and electrographic characteristics are important factors that influence interrater agreement.Significance
The use of well-described databases and input of different experts will improve neonatal EEG interpretation and help to develop uniform seizure definitions, useful for evidence-based studies of seizure recognition and management. 相似文献13.
Anne Weissbach Tobias Bäumer Peter P. Pramstaller Norbert Brüggemann Vera Tadic Robert Chen Christine Klein Alexander Münchau 《Clinical neurophysiology》2017,128(1):275-280
Objectives
Mutations in the Parkin and PINK1 gene account for the majority of autosomal recessive early-onset Parkinson cases. There is increasing evidence that clinically asymptomatic subjects with single heterozygous mutations have a latent nigrostriatal dopaminergic deficit and could be taken as in vivo model of pre-symptomatic phase of Parkinsonism.Methods
We charted premotor–motor excitability changes as compensatory mechanisms for subcortical dopamine depletions using transcranial magnetic stimulation by applying magnetic resonance-navigated premotor–motor cortex conditioning in 15 asymptomatic, heterozygous Parkin and PINK1 mutation carriers (2 female; mean age 53 ± 8 years) and 16 age- and sex-matched controls (5 female; mean age 57 ± 9 years). Participants were examined at baseline and after acute l-dopa challenge.Results
There were l-dopa and group specific effects during premotor–motor conditioning at an interstimulus interval of 6 ms indicating a normalisation of premotor–motor interactions in heterozygous Parkin and PINK1 mutation carriers after l-dopa intake. Non-physiologically high conditioned MEP amplitudes at this interval in mutation carriers decreased after l-dopa intake but increased in controls.Conclusion
Premotor–motor excitability changes are part of the cortical reorganization in asymptomatic heterozygous Parkin- and PINK1 mutation carriers.Significance
These subjects offer opportunities to delineate motor network adaptation in pre-symptomatic Parkinsonism. 相似文献14.
I.C. Zibrandtsen P. Kidmose C.B. Christensen T.W. Kjaer 《Clinical neurophysiology》2017,128(12):2454-2461
Objective
Ear-EEG is recording of electroencephalography from a small device in the ear. This is the first study to compare ictal and interictal abnormalities recorded with ear-EEG and simultaneous scalp-EEG in an epilepsy monitoring unit.Methods
We recorded and compared simultaneous ear-EEG and scalp-EEG from 15 patients with suspected temporal lobe epilepsy. EEGs were compared visually by independent neurophysiologists. Correlation and time-frequency analysis was used to quantify the similarity between ear and scalp electrodes. Spike-averages were used to assess similarity of interictal spikes.Results
There were no differences in sensitivity or specificity for seizure detection. Mean correlation coefficient between ear-EEG and nearest scalp electrode was above 0.6 with a statistically significant decreasing trend with increasing distance away from the ear. Ictal morphology and frequency dynamics can be observed from visual inspection and time-frequency analysis. Spike averages derived from ear-EEG electrodes yield a recognizable spike appearance.Conclusions
Our results suggest that ear-EEG can reliably detect electroencephalographic patterns associated with focal temporal lobe seizures. Interictal spike morphology from sufficiently large temporal spike sources can be sampled using ear-EEG.Significance
Ear-EEG is likely to become an important tool in clinical epilepsy monitoring and diagnosis. 相似文献15.
Introduction
Fukuyama congenital muscular dystrophy (FCMD), caused by fukutin mutations, is the most common form of Japanese CMD. We followed a Japanese CMD sibship without fukutin mutation, and herein identified new FKRP mutations causing MDC1C rarely reported in Oriental countries.Patients
Two affected siblings, individuals 1 (I-1, male) and 2 (I-2, female), were born uneventfully to unaffected, non-consanguineous parents. Severe hypotonia was soon apparent and serum CK levels were elevated: I-1: 1025 IU/L (normal range <130 IU/L) and I-2: 5350 IU/L. I-1 had neither shown head control, nor said any words until he died of pneumonia at the age of 23 months. I-2 learned to sit at 4 years and 10 months and spoke sentences at 6 years and 5 months. She had received respiratory support since 9 years of age and died at 22 years. Both showed a low-density area in the cerebral white matter on CT. MRI of I-2 revealed diffuse hyperintensity in the cerebral white matter on T2-WI, polymicrogyria over the frontal and parietal lobes, and disorganized folia and cysts in the cerebellum.Methods and results
Next generation and Sanger sequencing were performed for I-2. Heterozygous FKRP mutations were identified in exon 4: c.1167_1168delGC, p.Gly391Leufs172 and c.501_502GT>CC, p.Arg167Ser, p.Cys168Arg.Discussion
Recently, fukutin and FKRP were identified as sequentially acting ribitol 5-phosphate transferases involved in the post-translational modification of α-dystroglycan. This may explain the clinical similarities between the two disorders. 相似文献16.
Hyun Woo Kim Zhejiu Quan Young-Beom Kim Eunji Cheong Heung Dong Kim Minjung Cho Jiho Jang Young Rang Yoo Joon Soo Lee Ji Hun Kim Yang In Kim Dae-Sung Kim Hoon-Chul Kang 《Brain & development》2018,40(4):287-298
Background
We investigated how two distinct mutations in SCN1A differentially affect electrophysiological properties of the patient-derived GABAergic neurons and clinical severities in two Dravet syndrome (DS) patients.Materials and Methods
We established induced pluripotent stem cells from two DS patients with different mutations in SCN1A and subsequently differentiated them into forebrain GABAergic neurons. Functionality of differentiated GABAergic neurons was examined by electrophysiological recordings.Results
DS-1 patient had a missense mutation, c.4261G?>?T [GenBank: NM_006920.4] and DS-2 patient had a nonsense frameshift mutation, c.3576_3580 del TCAAA [GenBank: NM_006920.4]. Clinically, contrary to our expectations, DS-1 patient had more severe symptoms including frequency of seizure episodes and the extent of intellectual ability penetration than DS-2 patient. Electrophysiologic recordings showed significantly lower sodium current density and reduced action potential frequency at strong current injection (>60?pA) in GABAergic neurons derived from both. Intriguingly, unique genetic alterations of SCN1A differentially impacted electrophysiological impairment of the neurons, and the impairment’s extent corresponded with the symptomatic severity of the donor from which the iPSCs were derived.Conclusion
Our results suggest the possibility that patient-derived iPSCs may provide a reliable in vitro system that reflects clinical severities in individuals with DS. 相似文献17.
Vasileios Kokkinos Andreas M. Koupparis Michalis Koutroumanidis George K. Kostopoulos 《Clinical neurophysiology》2017,128(9):1553-1562
Objective
This work investigates the spatial distribution in time of generalized ictal spikes in the typical absences of childhood absence epilepsy (CAE).Methods
We studied twelve children with CAE, who had more than two typical absences during their routine video-EEG. Seizures were identified, and ictal spikes were marked over the maximum electronegative peak, clustered, waveform-averaged and spatiotemporaly analyzed in 2D electrode space.Results
Consistency of spatiotemporal patterns of ictal spikes was high between the absences of the same child, but low between children. Three main discharge patterns were identified: of anterio-posterior propagation, of posterio-anterior propagation and confined to the frontal/prefrontal regions. In 4 patients, the propagation patterns transformed during the seizure into either a lateralized diminished or a non-lateralized reverse direction form. Most spikes originated fronto-temporaly, all maximized over the frontal/prefrontal electrodes and mostly decayed prefrontaly. In 4 patients, lateralized propagation patterns were identified.Conclusions
Ictal spike propagation patterns suggest that epileptogenic CAE networks are personalized, interconnect distal areas in the brain – not the entire cortex – with a tendency to generate bilateral symmetrical discharges, sometimes unsuccessfully. The transformation of propagation patterns during the seizure indicates the existence of dynamic interplay within epileptogenic networks.Significance
Our results support the revised concept of ictogenesis of ILAE definition in genetic (also known as idiopathic) generalized epilepsies. Understanding the focal features in CAE avoids misdiagnosis as focal epilepsy and inappropriate treatment. 相似文献18.
Objective
The discontinuation of antiepileptic drugs (AEDs) is an important treatment decision for epilepsy patients who have been seizure-free for 2 years or longer. Some patients experience seizures relapse after AED withdrawal. The prognostic value of electroencephalograms (EEGs) for seizure relapse following AED withdrawal is controversial. To our knowledge, this is the first meta-analysis to address whether EEG data can be used to guide the discontinuation of AEDs.Method
We performed a meta-analysis of cohort studies that reported original EEG data from before AED withdrawal and recurrence after AED-withdrawal. The quality of each study was assessed using the Newcastle–Ottawa Scale.Results
Fifteen studies including a total of 2349 participants were included in this meta-analysis. This meta-analysis of 15 studies demonstrates that an abnormal electroencephalogram was a predictor of the risk of relapse. Additionally, paroxysmal, slowing, spike and wave activities on electroencephalograms were associated with increased risk of relapse.Conclusion
We reveal that abnormal EEG records, particularly paroxysmal abnormalities, before AED withdrawal predicted a high risk of relapse. Slowing and spike and wave activities also exhibited moderate predictive values.Significance
Our findings suggest that, EEGs might be an important prognostic tool for antiepileptic drug reduction. 相似文献19.
Simon Podnar Stayko Sarafov Ivailo Tournev Gregor Omejec Janez Zidar 《Clinical neurophysiology》2017,128(4):505-511
Objective
To systematically study peripheral nerve morphology in patients with transthyretin (TTR) amyloidosis and TTR gene mutation carriers using high-resolution ultrasonography (US).Methods
In this prospective cross-sectional study we took a structured history, performed neurological examination, and measured peripheral nerve cross-sectional areas (CSAs) bilaterally at 28 standard locations using US. Demographic and US findings were compared to controls.Results
Peripheral nerve CSAs were significantly larger in 33 patients with familial amyloid polyneuropathy (FAP) compared to 50 controls, most dramatically at the common entrapment sites (median nerve at the wrist, ulnar nerve at the elbow), and in the proximal nerve segments (median nerve in the upper arm, sciatic nerve in the thigh). Findings in 21 asymptomatic TTR gene mutation carriers were less marked compared to controls, with CSAs being larger only in the median nerve in the upper arm. Nerve CSAs correlated with abnormalities on nerve conduction studies.Conclusion
Using US, we confirmed previous pathohistological and imaging reports in FAP of the most pronounced peripheral nerve thickening in the proximal limb segments.Significance
Similar to US findings in diabetic and vasculitic neuropathies these predominantly proximal locations of nerve thickening may be attributed to ischaemic nerve damage caused by poor perfusion in the watershed zones along proximal limb segments. 相似文献20.
Jiao Xue Ping Qian Hui Li Haipo Yang Xiaoyan Liu Yuehua Zhang Zhixian Yang 《Clinical neurophysiology》2017,128(1):220-226