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1.
Myrto Stylianou Nicholas Murphy Luis R. Peraza Sara Graziadio Ruth Cromarty Alison Killen John T. O&#x; Brien Alan J. Thomas Fiona E.N. LeBeau John-Paul Taylor 《Clinical neurophysiology》2018,129(6):1209-1220
Objective
We investigated for quantitative EEG (QEEG) differences between Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) patients and healthy controls, and for QEEG signatures of cognitive fluctuations (CFs) in DLB.Methods
We analysed eyes-closed, resting state EEGs from 18 AD, 17 DLB and 17 PDD patients with mild dementia, and 21 age-matched controls. Measures included spectral power, dominant frequency (DF), frequency prevalence (FP), and temporal DF variability (DFV), within defined EEG frequency bands and cortical regions.Results
DLB and PDD patients showed a leftward shift in the power spectrum and DF. AD patients showed greater DFV compared to the other groups. In DLB patients only, greater DFV and EEG slowing were correlated with CFs, measured by the clinician assessment of fluctuations (CAF) scale. The diagnostic accuracy of the QEEG measures was 94% (90.4–97.9%), with 92.26% (80.4–100%) sensitivity and 83.3% (73.6–93%) specificity.Conclusion
Although greater DFV was only shown in the AD group, within the DLB group a positive DFV – CF correlation was found. QEEG measures could classify DLB and AD patients with high sensitivity and specificity.Significance
The findings add to an expanding literature suggesting that EEG is a viable diagnostic and symptom biomarker in dementia, particularly DLB. 相似文献2.
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3.
Pan Gong Jiao Xue Ping Qian Haipo Yang Xiaoyan Liu Lixin Cai Kaigui Bian Zhixian Yang 《Brain & development》2018,40(4):299-310
Objective
To investigate high-frequency oscillations (HFOs) in epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS) with different etiologies.Methods
Twenty-one CSWS patients treated with methylprednisolone were divided into structural group and genetic/unknown group. Comparisons were made between the two etiological groups: selected clinical variables including gender, age parameters, seizure frequencies and antiepileptic drugs; distribution of HFOs in pre-methylprednisolone electroencephalography (EEG) and percentage changes of HFOs and spikes after methylprednisolone treatment.Results
There were 7 patients (33%) in structural group and 14 patients (68%) in genetic/unknown group. No significant difference was found between the two groups regarding selected clinical variables. HFOs were found in 12 patients in pre-methylprednisolone EEG. The distribution of HFOs was focal and accordant with lesions in 5 of structural group, and it was also focal but in different brain regions in 7 of genetic/unknown group. The percentage reduction of total HFOs and spikes was 81% (158/195) and 19% (1956/10,037) in structural group, while 98% (315/323) and 55% (6658/12,258) in genetic/unknown group after methylprednisolone treatment.Conclusion
The etiologies had no distinct correlation with some clinical characteristics in CSWS. HFOs recorded on scalp EEG might not only be used as makers of seizure-onset zone (SOZ), but also have association with functional disruption of brain networks. Both HFOs and spikes reduced more in genetic/unknown patients than that in structural patients after methylprednisolone treatment and HFOs were more sensitive to treatment than spikes. 相似文献4.
Christopher M. Ruzas Peter E. DeWitt Kimberly S. Bennett Kevin E. Chapman Nicole Harlaar Tellen D. Bennett 《Neurocritical care》2017,26(2):256-266
Background
Traumatic brain injury (TBI) causes substantial morbidity and mortality in US children. Post-traumatic seizures (PTS) occur in 11–42% of children with severe TBI and are associated with unfavorable outcome. Electroencephalographic (EEG) monitoring may be used to detect PTS and antiepileptic drugs (AEDs) may be used to treat PTS, but national rates of EEG and AED use are not known. The purpose of this study was to describe the frequency and timing of EEG and AED use in children hospitalized after severe TBI.Methods
Retrospective cohort study of 2165 children at 30 hospitals in a probabilistically linked dataset from the National Trauma Data Bank (NTDB) and the Pediatric Health Information Systems (PHIS) database, 2007–2010. We included children (age <18 years old at admission) with linked NTDB and PHIS records, severe (Emergency Department [ED] Glasgow Coma Scale [GCS] <8) TBI, hospital length of stay >24 h, and non-missing disposition. The primary outcomes were EEG and AED use.Results
Overall, 31.8% of the cohort had EEG monitoring. Of those, 21.8% were monitored on the first hospital day. The median duration of EEG monitoring was 2.0 (IQR 1.0, 4.0) days. AEDs were prescribed to 52.0% of the cohort, of whom 61.8% received an AED on the first hospital day. The median duration of AED use was 8.0 (IQR 4.0, 17.0) days. EEG monitoring and AED use were more frequent in children with known risk factors for PTS. EEG monitoring and AED use were not related to hospital TBI volume.Conclusion
EEG use is relatively uncommon in children with severe TBI, but AEDs are frequently prescribed. EEG monitoring and AED use are more common in children with known risk factors for PTS.5.
Vasilios K. Kimiskidis Alkiviadis Tsimpiris Philippe Ryvlin Reetta Kalviainen Michalis Koutroumanidis Antonio Valentin Nikolaos Laskaris Dimitris Kugiumtzis 《Clinical neurophysiology》2017,128(2):367-381
Objectives
(A) To develop a TMS–EEG stimulation and data analysis protocol in genetic generalized epilepsy (GGE). (B) To investigate the diagnostic accuracy of TMS–EEG in GGE.Methods
Pilot experiments resulted in the development and optimization of a paired-pulse TMS–EEG protocol at rest, during hyperventilation (HV), and post-HV combined with multi-level data analysis. This protocol was applied in 11 controls (C) and 25 GGE patients (P), further dichotomized into responders to antiepileptic drugs (R, n = 13) and non-responders (n-R, n = 12).Features (n = 57) extracted from TMS–EEG responses after multi-level analysis were given to a feature selection scheme and a Bayesian classifier, and the accuracy of assigning participants into the classes P-C and R-nR was computed.Results
On the basis of the optimal feature subset, the cross-validated accuracy of TMS–EEG for the classification P-C was 0.86 at rest, 0.81 during HV and 0.92 at post-HV, whereas for R-nR the corresponding figures are 0.80, 0.78 and 0.65, respectively. Applying a fusion approach on all conditions resulted in an accuracy of 0.84 for the classification P-C and 0.76 for the classification R-nR.Conclusion
TMS–EEG can be used for diagnostic purposes and for assessing the response to antiepileptic drugs.Significance
TMS–EEG holds significant diagnostic potential in GGE. 相似文献6.
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7.
Niraj K. Sharma Carlos Pedreira Maria Centeno Umair J. Chaudhary Tim Wehner Lucas G.S. França Tinonkorn Yadee Teresa Murta Marco Leite Sjoerd B. Vos Sebastien Ourselin Beate Diehl Louis Lemieux 《Clinical neurophysiology》2017,128(7):1246-1254
Objective
To validate the application of an automated neuronal spike classification algorithm, Wave_clus (WC), on interictal epileptiform discharges (IED) obtained from human intracranial EEG (icEEG) data.Method
Five 10-min segments of icEEG recorded in 5 patients were used. WC and three expert EEG reviewers independently classified one hundred IED events into IED classes or non-IEDs. First, we determined whether WC-human agreement variability falls within inter-reviewer agreement variability by calculating the variation of information for each classifier pair and quantifying the overlap between all WC-reviewer and all reviewer-reviewer pairs. Second, we compared WC and EEG reviewers’ spike identification and individual spike class labels visually and quantitatively.Results
The overlap between all WC-human pairs and all human pairs was >80% for 3/5 patients and >58% for the other 2 patients demonstrating WC falling within inter-human variation. The average sensitivity of spike marking for WC was 91% and >87% for all three EEG reviewers. Finally, there was a strong visual and quantitative similarity between WC and EEG reviewers.Conclusions
WC performance is indistinguishable to that of EEG reviewers’ suggesting it could be a valid clinical tool for the assessment of IEDs.Significance
WC can be used to provide quantitative analysis of epileptic spikes. 相似文献8.
Srikanth Muppidi Babak Razavi Mitchell G. Miglis Safwan Jaradeh 《Clinical neurophysiology》2018,129(4):783-786
Objective
To assess electroencephalography (EEG) changes during tilt table testing in syncope and other orthostatic syndromes.Methods
We retrospectively reviewed consecutive tilt table studies with simultaneous EEG from April 2014 to May 2016 at our center. All patients had video EEG during tilt table. All patients had at least 10?min of head up tilt unless they had syncope or did not tolerate the study. Video EEG was interpreted by epileptologists.Results
Eighty-seven patients met the inclusion criteria. Mean age was 45?years, and 55 were women. Seven patients (～8%) had syncope during tilt table, 11 patients (～12%) had significant neurogenic orthostatic hypotension and a separate group of 11 patients (～12%) had significant orthostatic tachycardia. Valsalva responses were abnormal in 7 of the 11 patients with orthostatic hypotension, suggesting an underlying neurogenic orthostatic hypotension. Visually discernable EEG changes were seen in only 3 patients (～43%) who had syncope and in 1 patient (～9%) with orthostatic tachycardia.Conclusions
Qualitative EEG analysis based on visual inspection during tilt table study revealed abnormalities in less than half the patients with syncope and a very small fraction with orthostatic tachycardia.Significance
Routine qualitative EEG recording might not be clinically useful during tilt table studies. 相似文献9.
Johan B. Arends Inge van der Linden Saskia C. Ebus Mariëtte H. Debeij Boudewijn W. Gunning Machiel J. Zwarts 《Clinical neurophysiology》2017,128(4):661-666
Objective
Diagnostic value and efficacy of re-interpretation of previous EEGs in 100 patients admitted to a tertiary epilepsy center with EEG results conflicting with the clinical diagnosis after the first visit.Methods
EEGs were reclassified. A matched control group was included to assess the efficiency of the re-interpretation process. Efficacy was assessed by questionnaires and costs as number of technician hours needed.Results
In 85 patients the previous EEG conclusion was known. In 43 the conclusion was altered. In 23 the epileptic activity changed from positive to negative (17) or the reverse (6). In 15 the focus changed (7 originally classified as generalized epileptic activity). In 5 the syndrome changed. 57% of the re-interpretation group needed no extra EEG afterwards.96% of the re-interpretations were considered useful by requesting and 72% by not involved neurologists.The average time per EEG technologist per patient was 8,81 h in controls and 5,40 in the re-interpretation group.Conclusions
In 43 from the 85 patients (51%) re-interpretation of ‘controversial’ EEGs led to a different opinion. The re-interpretations were useful and less time consuming, compared to new EEGs in controls.Significance
Re-interpretation of ‘controversial’ EEGs is useful and cost effective. 相似文献10.
Eila Sonkajärvi Seppo Rytky Seppo Alahuhta Kalervo Suominen Timo Kumpulainen Pasi Ohtonen Elina Karvonen Ville Jäntti 《Clinical neurophysiology》2018,129(3):638-645
Objectives
The aim of the study was to compare the EEG findings and haemodynamic parameters of adult male patients while undergoing mask induction with sevoflurane anaesthesia with either controlled hyperventilation (CH) or spontaneous breathing (SB).Methods
Twenty male patients, aged 23–52 (mean 42) years were anaesthetized randomly with either spontaneous breathing or mild controlled hyperventilation via mask. EEG was recorded using a full 10–20 electrode set.Results
Anaesthesia induction with high inhaled concentrations of sevoflurane produced several epileptiform and periodic EEG patterns. CH doubled the amount of these EEG patterns compared to SB. Higher heart rate was recorded in the CH group.Conclusions
We describe a high incidence of paroxysmal EEG activity: epileptiform and generalized periodic discharges (GPDs) during rapid sevoflurane in nitrous oxide-oxygen mask induction in hyperventilated male patients. However these activities have no effect to the heart rate or the mean arterial pressure.Significance
The monitoring of GPDs and burst suppression patterns during rapid anaesthesia induction with sevoflurane provides possibility to study the effects of volatile anaesthetics in the healthy brain. In order to analyse the different sources of EEG patterns a wide-band multichannel EEG recording is necessary. 相似文献11.
Danilo Bernardo Hiroki Nariai Shaun A. Hussain Raman Sankar Noriko Salamon Darcy A. Krueger Mustafa Sahin Hope Northrup E. Martina Bebin Joyce Y. Wu 《Clinical neurophysiology》2018,129(7):1458-1466
Objectives
We aim to establish that interictal fast ripples (FR; 250–500?Hz) are detectable on scalp EEG, and to investigate their association to epilepsy.Methods
Scalp EEG recordings of a subset of children with tuberous sclerosis complex (TSC)-associated epilepsy from two large multicenter observational TSC studies were analyzed and compared to control children without epilepsy or any other brain-based diagnoses. FR were identified both by human visual review and compared with semi-automated review utilizing a deep learning-based FR detector.Results
Seven out of 7 children with TSC-associated epilepsy had scalp FR compared to 0 out of 4 children in the control group (p?=?0.003). The automatic detector has a sensitivity of 98% and false positive rate with average of 11.2 false positives per minute.Conclusions
Non-invasive detection of interictal scalp FR was feasible, by both visual and semi-automatic detection. Interictal scalp FR occurred exclusively in children with TSC-associated epilepsy and were absent in controls without epilepsy. The proposed detector achieves high sensitivity of FR detection; however, expert review of the results to reduce false positives is advised.Significance
Interictal FR are detectable on scalp EEG and may potentially serve as a biomarker of epilepsy in children with TSC. 相似文献12.
Naoum P. Issa Shasha Wu Sandra Rose Vernon L. Towle Peter C. Warnke James X. Tao 《Clinical neurophysiology》2018,129(9):1796-1803
Objective
Mesial temporal lobe epilepsy (mTLE) is the most common type of focal epilepsy, but often lacks scalp EEG correlates. We ask if hippocampal epileptiform discharges that are characteristic of mTLE are associated with small sharp spikes (SSS) recorded on scalp EEG. SSS are considered benign waveforms, so are not currently used as markers of epilepsy.Methods
To determine if there is a relationship between SSS and hippocampal discharges, simultaneous scalp and hippocampal depth electrode EEGs were recorded from 27 patients being evaluated for possible mTLE. Scalp EEG waveforms were assessed at the time of hippocampal discharges identified on intracranial hippocampal depth electrodes.Results
15 of 27 patients had SSS on scalp EEG that were time locked to hippocampal epileptiform discharges measured intracranially. These hippocampal spikes tended to have overlying high frequency oscillations and to co-localize with a seizure onset zone, suggesting that they were pathological discharges.Conclusions
There is a tight coupling between a subset of pathological hippocampal discharges and SSS.Significance
SSS can be scalp EEG markers of mTLE rather than normal EEG variants. 相似文献13.
Carla Bentes Ana Rita Peralta Pedro Viana Hugo Martins Carlos Morgado Carlos Casimiro Ana Catarina Franco Ana Catarina Fonseca Ruth Geraldes Patrícia Canhão Teresa Pinho e Melo Teresa Paiva José M. Ferro 《Clinical neurophysiology》2018,129(8):1680-1687
Objective
To identify the most accurate quantitative electroencephalographic (qEEG) predictor(s) of unfavorable post-ischemic stroke outcome, and its discriminative capacity compared to already known demographic, clinical and imaging prognostic markers.Methods
Prospective cohort of 151 consecutive anterior circulation ischemic stroke patients followed for 12?months. EEG was recorded within 72?h and at discharge or 7?days post-stroke. QEEG (global band power, symmetry, affected/unaffected hemisphere and time changes) indices were calculated from mean Fast Fourier Transform and analyzed as predictors of unfavorable outcome (mRS?≥?3), at discharge and 12?months poststroke, before and after adjustment for age, admission NIHSS and ASPECTS.Results
Higher delta, lower alpha and beta relative powers (RP) predicted outcome. Indices with higher discriminative capacity were delta-theta to alpha-beta ratio (DTABR) and alpha RP. Outcome models including either of these and other clinical/imaging stroke outcome predictors were superior to models without qEEG data. In models with qEEG indices, infarct size was not a significant outcome predictor.Conclusions
DTAABR and alpha RP are the best qEEG indices and superior to ASPECTS in post-stroke outcome prediction. They improve the discriminative capacity of already known clinical and imaging stroke outcome predictors, both at discharge and 12?months after stroke.Significance
qEEG indices are independent predictors of stroke outcome. 相似文献14.
Brian Nils Lundstrom Christian Meisel Jamie Van Gompel Matt Stead Greg Worrell 《Clinical neurophysiology》2018,129(5):909-919
Objectives
To develop quantitative measures for estimating seizure probability, we examine intracranial EEG data from patient groups with three qualitative seizure probabilities: patients with drug resistant focal epilepsy (high), these patients during cortical stimulation (intermediate), and patients who have no history of seizures (low).Methods
Patients with focal epilepsy were implanted with subdural electrodes during presurgical evaluation. Patients without seizures were implanted during treatment with motor cortex stimulation for atypical facial pain.Results
The rate and amplitude of spikes correlate with qualitative seizure probability across patient groups and with proximity to the seizure onset zone in focal epilepsy patients. Spikes occur earlier during the negative oscillation of underlying slow activity (0.5–2?Hz) when seizure probability is increased. Similarly, coupling between slow and fast activity is increased.Conclusions
There is likely a continuum of sharply contoured activity between non-epileptiform and epileptiform. Characteristics of spiking and how spikes relate to slow activity can be combined to predict seizure onset zones.Significance
Intracranial EEG data from patients without seizures represent a unique comparison group and highlight changes seen in spiking and slow wave activity with increased seizure probability. Slow wave activity and related physiology are an important potential biomarker for estimating seizure probability. 相似文献15.
Birgit Frauscher Sweta Joshi Nicolas von Ellenrieder Dang Khoa Nguyen François Dubeau Jean Gotman 《Clinical neurophysiology》2018,129(8):1526-1533
Objective
Ponto-geniculo-occipital (PGO) waves occurring along the visual axis are one of the hallmarks of REM sleep in experimental animals. In humans, direct evidence is scarce. There is no systematic study of PGO waves in the primary visual cortex.Methods
Eleven epilepsy patients undergoing combined intracranial EEG/polysomnography had 71 channels recording physiological EEG activity from various cortical areas; seven channels recorded from the primary visual cortex. An equal number of 4-s phasic and tonic REM segments were selected. Patterns consistent with PGO waves were visually analyzed in both states in the primary visual cortex. Spectral analysis compared activity in the primary visual cortex with the remaining cortical areas.Results
Visual inspection revealed an increase in sharply contoured theta waves (duration: 150–250?ms) in the primary visual cortex during phasic as compared to tonic REM sleep. Spectral analysis confirmed a 32% increase in mean absolute theta power during phasic versus tonic REM sleep (p corrected?=?0.014).Conclusion
No classical PGO waves, but sharply contoured theta waves were found in the human primary visual cortex during phasic as opposed to tonic REM sleep.Significance
This research suggests that sharply contoured theta waves are the human correlate of PGO waves described in experimental animal models. 相似文献16.
Elham Bagheri Justin Dauwels Brian C. Dean Chad G. Waters M. Brandon Westover Jonathan J. Halford 《Clinical neurophysiology》2017,128(10):1994-2005
Objective
The presence of interictal epileptiform discharges (IED) in the electroencephalogram (EEG) is a key finding in the medical workup of a patient with suspected epilepsy. However, inter-rater agreement (IRA) regarding the presence of IED is imperfect, leading to incorrect and delayed diagnoses. An improved understanding of which IED attributes mediate expert IRA might help in developing automatic methods for IED detection able to emulate the abilities of experts. Therefore, using a set of IED scored by a large number of experts, we set out to determine which attributes of IED predict expert agreement regarding the presence of IED.Methods
IED were annotated on a 5-point scale by 18 clinical neurophysiologists within 200 30-s EEG segments from recordings of 200 patients. 5538 signal analysis features were extracted from the waveforms, including wavelet coefficients, morphological features, signal energy, nonlinear energy operator response, electrode location, and spectrogram features. Feature selection was performed by applying elastic net regression and support vector regression (SVR) was applied to predict expert opinion, with and without the feature selection procedure and with and without several types of signal normalization.Results
Multiple types of features were useful for predicting expert annotations, but particular types of wavelet features performed best. Local EEG normalization also enhanced best model performance. As the size of the group of EEGers used to train the models was increased, the performance of the models leveled off at a group size of around 11.Conclusions
The features that best predict inter-rater agreement among experts regarding the presence of IED are wavelet features, using locally standardized EEG. Our models for predicting expert opinion based on EEGer’s scores perform best with a large group of EEGers (more than 10).Significance
By examining a large group of EEG signal analysis features we found that wavelet features with certain wavelet basis functions performed best to identify IEDs. Local normalization also improves predictability, suggesting the importance of IED morphology over amplitude-based features. Although most IED detection studies in the past have used opinion from three or fewer experts, our study suggests a “wisdom of the crowd” effect, such that pooling over a larger number of expert opinions produces a better correlation between expert opinion and objectively quantifiable features of the EEG. 相似文献17.
Sahar F. Zafar Eva N. Postma Siddharth Biswal Emily J. Boyle Sophia Bechek Kathryn O&#x;Connor Apeksha Shenoy Jennifer Kim Mouhsin S. Shafi Aman B. Patel Eric S. Rosenthal M. Brandon Westover 《Clinical neurophysiology》2018,129(11):2219-2227
Objective
To quantify the burden of epileptiform abnormalities (EAs) including seizures, periodic and rhythmic activity, and sporadic discharges in patients with aneurysmal subarachnoid hemorrhage (aSAH), and assess the effect of EA burden and treatment on outcomes.Methods
Retrospective analysis of 136 high-grade aSAH patients. EAs were defined using the American Clinical Neurophysiology Society nomenclature. Burden was defined as prevalence of <1%, 1–9%, 10–49%, 50–89%, and >90% for each 18–24 hour epoch. Our outcome measure was 3-month Glasgow Outcome Score.Results
47.8% patients had EAs. After adjusting for clinical covariates EA burden on first day of recording and maximum daily burden were associated with worse outcomes. Patients with higher EA burden were more likely to be treated with anti-epileptic drugs (AEDs) beyond the standard prophylactic protocol. There was no difference in outcomes between patients continued on AEDs beyond standard prophylaxis compared to those who were not.Conclusions
Higher burden of EAs in aSAH independently predicts worse outcome. Although nearly half of these patients received treatment, our data suggest current AED management practices may not influence outcome.Significance
EA burden predicts worse outcomes and may serve as a target for prospective interventional controlled studies to directly assess the impact of AEDs, and create evidence-based treatment protocols. 相似文献18.
Giulia Varotto Silvana Franceschetti Davide Caputo Elisa Visani Laura Canafoglia Elena Freri Francesca Ragona Giuliano Avanzini Ferruccio Panzica 《Clinical neurophysiology》2018,129(11):2372-2379
Objective
To investigate the changes in EEG connectivity in children with the typical presentation of benign epilepsy with centro-temporal spikes (BECTS).Methods
We compared awake and spindle-sleep EEG recordings obtained by a standard electrode array in patients with lateralised (10 Right, 9 Left-BECTS) or bilateral spikes (10 MF-BECTS) and in 17 age-matched controls. We analysed EEG activity using partial directed coherence, an estimator of connectivity based on the multivariate autoregressive models and calculated in- and out-degrees, strength, clustering coefficient and betweenness centrality.Results
In comparison with the controls, the awake EEG recordings of the patients with lateralised BECTS showed a minimal increase in out-degrees on F4 and F3. The greater differences, found during sleep, included significant reductions in both in- and out-degrees and strength in all of the patient groups, but in T4 or T3 showing increased out-degrees and strength in Right and Left-BECTS. Betweenness centrality was significantly reduced on C3 and C4 in the patients with MF-BECTS.Conclusions
Our observations suggest that the main finding in BECTS patients is widely reduced local connectivity.Significance
The network changes in BECTS can be interpreted as a permissive condition occurring in a developmental window that predisposes to seizure generation during spindle-sleep. 相似文献19.
Zhichuan Li Lanyan Fang Wenlei Jiang Myong-Jin Kim Liang Zhao 《Current neurology and neuroscience reports》2017,17(11):82
Purpose of Review
This review summarizes the current FDA practice in developing risk- and evidence-based product-specific bioequivalence guidances for antiepileptic drugs (AEDs).Recent Findings
FDA’s product-specific guidance (PSG) for AEDs takes into account the therapeutic index of each AED product. Several PSGs for AEDs recommend fully replicated studies and a reference-scaled average bioequivalence (RS-ABE) approach that permit the simultaneous equivalence comparison of the mean and within-subject variability of the test and reference products.Summary
The PSGs for AEDs published by FDA reflect the agency’s current thinking on the bioequivalence studies and approval standards for generics of AEDs. Bioequivalence between brand and generic AED products demonstrated in controlled studies with epilepsy patients provides strong scientific support for the soundness of FDA bioequivalence standards.20.
Jiao Xue Ping Qian Hui Li Haipo Yang Xiaoyan Liu Yuehua Zhang Zhixian Yang 《Clinical neurophysiology》2017,128(1):220-226