Epilepsy research
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Resective epilepsy surgery in early childhood has become an important treatment option for selected infants and children with epilepsy. We describe experience and clinical outcomes of children under 3 years undergoing epilepsy surgery at Great Ormond Street Hospital (GOSH). ⋯ Epilepsy surgery in children under 3 years of age offers suitable candidates a good chance of significantly improved seizure outcome which compares with rates in older cohorts.
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We describe seizure laterality and temporal seizure patterns in six subjects with bilateral temporal lobe epilepsy (bTLE) implanted with bilateral hippocampal depth electrodes and the NeuroPace RNS™ system over 84 consecutive days. Seizures were disproportionate in laterality in three subjects and disproportionate in time for two subjects. Clustering of seizures did not clearly affect laterality. Some but not all subjects with bTLE displayed nonrandom temporal or lateral clustering of seizures.
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EEG monitoring is important for the early detection of seizures during the course of critical illness. However, the logistics of real time EEG interpretation is challenging for the neurophysiology and critical care medicine teams. This study evaluated factors affecting the utility of digital trend analysis (DTA) for rapid seizure identification in children. ⋯ DTA applied to the raw EEG data does produce a graphic display that facilitates identification of seizures. The actual characteristics of the electrographic seizure may predict which DTA method is better and the overall accuracy of seizure detection may increase when multimodal trending is used simultaneously. Application of DTA alone with display of conventional EEG is beneficial for rapid interpretation of EEG findings regardless of experience.
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Vagus nerve stimulation (VNS) is an established treatment for refractory epilepsy. The ADNS-300 is a new system for VNS that includes a rechargeable stimulus generator and an electrode for combined stimulation and recording. In this feasibility study, three patients were implanted with ADNS-300 for therapeutic VNS. In addition, compound action potentials (CAPs) were recorded to evaluate activation of the vagus nerve in response to VNS. ⋯ This feasibility study demonstrates that the ADNS-300 system can be used for combined therapeutic stimulation (in 3/3 patients) and recording of CAPs in response to VNS (in 2/3 patients) up to three weeks after surgery. Implantation in a larger number of patients will lead to a better understanding of the electrophysiology of the vagus nerve, which in turn could result in more adequate and individualized VNS parameter choice.
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Comparative Study
Patient-specific bivariate-synchrony-based seizure prediction for short prediction horizons.
This paper evaluates the patient-specific seizure prediction performance of pre-ictal changes in bivariate-synchrony between pairs of intracranial electroencephalographic (iEEG) signals within 15min of a seizure in patients with pharmacoresistant focal epilepsy. Prediction horizons under 15min reduce the durations of warning times and should provide adequate time for a seizure control device to intervene. Long-term continuous iEEG was obtained from 6 patients. ⋯ Moreover, there were 9 seizures in each testing set which gives greater power to this cross-validation result, although the cross-validation was performed on the best channel pair selected by within-sample optimization for all seizures of the patient. Further validation with larger datasets from individual patients is needed. Improvements in prediction performance should be achievable through investigations of multivariate synchrony combined with non-linear classification methods.