scholarly journals P.095 The many clinical facets of pediatric occipital spikes and the predictive value of consistent EEG dipole

2021 ◽  
Vol 48 (s3) ◽  
pp. S46-S46
Author(s):  
AN Datta ◽  
L Wallbank ◽  
J Micallef ◽  
PK Wong
Keyword(s):  
Febrile Seizures ◽  
Clinical Settings ◽  
Clinical Predictors ◽  
Seizure Onset ◽  
Study Objective ◽  
Epileptiform Discharges ◽  
Symptomatic Epilepsy ◽  
Neuro Imaging ◽  
The Many ◽  
Occipital Spikes

Background: Pediatric occipital epileptiform discharges (OEDS) occur in various clinical settings, including benign and symptomatic epilepsies. The study objective is to determine electro-clinical predictors for aetiology and prognosis in children with OEDs. Methods: 205 patients with OEDs were classified into seizure groups: symptomatic (n=98), idiopathic focal (IF) (n=57), idiopathic generalized (IG) (n=18), no-seizures (n=27) and febrile seizures (n=5). Results: The median age of seizure onset was 3 years (range: 0-19). There was more EEG background slowing (P<0.05) in the symptomatic; photosensitivity (P<0.0001) and GSW (P<0.0001) in IG; and presence of consistent EEG spike dipole in IF group. The symptomatic had more DD (P< 0.0001), autism (P <0.019), and school difficulties (P<0.001) than the IF and IG groups, but not different from the no-seizure group. Conclusions: OEDs with consistent dipole spike is predictive of IF epilepsy. In contrast to frontal and temporal lobe epilepsy, only 30% with symptomatic epilepsy had occipital-predominant neuro-imaging abnormalities. Notably, neuro-psychiatric co-morbidities were similar between the symptomatic and no-seizure group.

Pediatric Occipital Spikes at a Single Center Over 26 Years and the Significance of Tangential Dipole

2021 ◽  
pp. 088307382098404
Author(s):  
Anita N. Datta ◽  
Laura Wallbank ◽  
Johann Micallef ◽  
Peter K. H. Wong
Keyword(s):  
Eye Movements ◽  
Visual Analysis ◽  
Clinical Settings ◽  
Single Center ◽  
Treatment Resistant ◽  
Clinical Predictors ◽  
Seizure Onset ◽  
Study Objective ◽  
Epileptiform Discharges ◽  
Occipital Spikes

Background: Pediatric occipital epileptiform discharges occur in various clinical settings, including self-limited and treatment-resistant epilepsies. The study objective is to determine electro-clinical predictors for prognosis in children with occipital epileptiform discharges. Methods: 205 patients with occipital epileptiform discharges were classified into seizure groups: self-limited occipital (SLO) (n = 57), including Panayiotopoulos and Gastaut syndrome; non-self-limited occipital (non-SLO) (n = 98), including various seizure etiologies; genetic-generalized (n = 18); febrile (n = 5); and no-seizure (n = 27) groups. Electro-clinical features of the SLO and non-SLO were compared, as this is of most clinical relevance. Results: The median age of seizure onset was 3 years (range: 0-19). Occipital epileptiform discharges with frontal/central positivity were present in both groups, but more common in the SLO than non-SLO groups; 21/57 (36.8%) and 19/98 (19.4%), respectively ( P < .022). However, when occipital epileptiform discharges with tangential dipoles ( P < .048) were accompanied by abnormal ictal eye movements ( P < .037), they were predictive of SLO epilepsy. Conclusions: In our cohort, occipital epileptiform discharges with tangential dipole detected by visual analysis and abnormal ictal eye movements were predictive of SLO epilepsy.

scholarly journals Electroencephalographic Features of Temporal Lobe Epilepsy

2010 ◽  
Vol 37 (4) ◽  
pp. 439-448 ◽  
Author(s):  
Mohammed M. Jan ◽  
Mark Sadler ◽  
Susan R. Rahey
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Surgical Management ◽  
Temporal Lobe ◽  
Seizure Onset ◽  
Resective Surgery ◽  
Accurate Localization ◽  
Epileptiform Discharges ◽  
Ictal Eeg ◽  
Temporal Lobe Seizures ◽  
Eeg Recordings

Electroencephalography (EEG) is an important tool for diagnosing, lateralizing and localizing temporal lobe seizures. In this paper, we review the EEG characteristics of temporal lobe epilepsy (TLE). Several “non-standard” electrodes may be needed to further evaluate the EEG localization, Ictal EEG recording is a major component of preoperative protocols for surgical consideration. Various ictal rhythms have been described including background attenuation, start-stop-start phenomenon, irregular 2-5 Hz lateralized activity, and 5-10 Hz sinusoidal waves or repetitive epileptiform discharges. The postictal EEG can also provide valuable lateralizing information. Postictal delta can be lateralized in 60% of patients with TLE and is concordant with the side of seizure onset in most patients. When patients are being considered for resective surgery, invasive EEG recordings may be needed. Accurate localization of the seizure onset in these patients is required for successful surgical management.

To begin …

2010 ◽  
Author(s):  
Stavros Prineas ◽  
Andrew F Smith
Keyword(s):  
Human Dimensions ◽  
Pain Clinic ◽  
Clinical Settings ◽  
Hospital Administrators ◽  
High Dependency ◽  
The World ◽  
Theatre Staff ◽  
Anaesthetic Assessment ◽  
The Many ◽  
Labour Suite

Communication is an innately fascinating and, on occasions, a somewhat mysterious topic. At its heart, it is the means of expressing, both to ourselves and to others, how we perceive the world and how we influence the world around us. It is a tool for exchanging information and meaning, but also a way to connect with others. While obviously a means to an end, it is also an end in itself—without the ability to share with others, life would be greatly impoverished. The many human dimensions of communication— the practical, the social, the linguistic, the lyrical, the subliminal, its ability to soothe and to injure, to inform, to entertain, to terrify—are what make this topic so challenging. Anaesthesia has come a very long way since the 1840s. The advent of safer and more selective drugs, coupled with ever more sophisticated technology, has made the practice of anaesthesia safer, yet also more complicated. The patients that we treat are often older, have multiple co-morbidities, and are undergoing procedures that would have been unthinkable 20 years ago. Yet with the increasingly complex workload have come the additional pressures of time and resource allocation. Patients are admitted on the day of surgery, leaving minimal time for anaesthetic assessment. Anaesthetists are frequently busy, isolated and unavailable when working in theatre, or find themselves working at multiple sites with little opportunity for interaction with colleagues. Similarly, theatre staff rarely work in the same operating room with the same team on a regular basis. The hospital administrators are under constant pressure as they strain to contain costs and reduce length of stay, while wards are increasingly understaffed and overworked. In the midst of all this, patients are left wondering who is actually caring for them, and if anyone is listening to their concerns. Anaesthetists play a crucial role in multi-professional teams in a wide variety of clinical settings of which theatre is only one. There is the high dependency unit (HDU), the labour suite, paediatrics, the chronic pain clinic—to name but a few. In almost every aspect of anaesthetic clinical practice the ability to communicate effectively is a vital component of patient care.

scholarly journals Biomarkers for Selection of Therapy for Adenocarcinoma of the Lung

2017 ◽  
Vol 13 (4) ◽  
pp. 221-227 ◽  
Author(s):  
Eric H. Bernicker ◽  
Ross A. Miller ◽  
Phillip T. Cagle
Keyword(s):  
Kinase Inhibitors ◽  
Cytotoxic Chemotherapy ◽  
Driver Mutations ◽  
Molecular Testing ◽  
Small Cell Lung ◽  
Clinical Predictors ◽  
Adenocarcinoma Of The Lung ◽  
The Many ◽  
Work Up ◽  
Selection Of

To suggest that the discovery of targetable driver mutations in many patients with advanced adenocarcinoma of the lung has completely transformed the work-up and therapeutic options for this disease would not be hyperbole. Although not curative, small-molecule tyrosine kinase inhibitors directed at oncogene-addicted tumors have led to significantly improved response rates compared with cytotoxic chemotherapy, with often manageable toxicities and better tolerance. However, the absence of reliable clinical predictors has made molecular testing essential to ensure that patients receive the proper medical management. We outline the many recent advances with regard to diagnosis and treatment of oncogene-addicted advanced nonsquamous non–small-cell lung cancer.

scholarly journals Kurtosis-Based Detection of Intracranial High-Frequency Oscillations for the Identification of the Seizure Onset Zone

2018 ◽  
Vol 28 (07) ◽  
pp. 1850001 ◽  
Author(s):  
Lucia Rita Quitadamo ◽  
Roberto Mai ◽  
Francesca Gozzo ◽  
Veronica Pelliccia ◽  
Francesco Cardinale ◽  
...  
Keyword(s):  
High Frequency ◽  
Computational Time ◽  
Seizure Onset ◽  
Time Frequency ◽  
High Frequency Oscillations ◽  
Epileptiform Discharges ◽  
Seizure Onset Zone ◽  
Potential Biomarker ◽  
Eeg Data

Pathological High-Frequency Oscillations (HFOs) have been recently proposed as potential biomarker of the seizure onset zone (SOZ) and have shown superior accuracy to interictal epileptiform discharges in delineating its anatomical boundaries. Characterization of HFOs is still in its infancy and this is reflected in the heterogeneity of analysis and reporting methods across studies and in clinical practice. The clinical approach to HFOs identification and quantification usually still relies on visual inspection of EEG data. In this study, we developed a pipeline for the detection and analysis of HFOs. This includes preliminary selection of the most informative channels exploiting statistical properties of the pre-ictal and ictal intracranial EEG (iEEG) time series based on spectral kurtosis, followed by wavelet-based characterization of the time–frequency properties of the signal. We performed a preliminary validation analyzing EEG data in the ripple frequency band (80–250 Hz) from six patients with drug-resistant epilepsy who underwent pre-surgical evaluation with stereo-EEG (SEEG) followed by surgical resection of pathologic brain areas, who had at least two-year positive post-surgical outcome. In this series, kurtosis-driven selection and wavelet-based detection of HFOs had average sensitivity of 81.94% and average specificity of 96.03% in identifying the HFO area which overlapped with the SOZ as defined by clinical presurgical workup. Furthermore, the kurtosis-based channel selection resulted in an average reduction in computational time of 66.60%.

scholarly journals Temporal Lobe Epilepsy Semiology

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Robert D. G. Blair
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Focal Epilepsy ◽  
Intractable Epilepsy ◽  
Febrile Seizures ◽  
Mesial Temporal Sclerosis ◽  
Careful Study ◽  
Seizure Onset ◽  
Seizure Semiology ◽  
Seizure Onset Zone

Epilepsy represents a multifaceted group of disorders divided into two broad categories, partial and generalized, based on the seizure onset zone. The identification of the neuroanatomic site of seizure onset depends on delineation of seizure semiology by a careful history together with video-EEG, and a variety of neuroimaging technologies such as MRI, fMRI, FDG-PET, MEG, or invasive intracranial EEG recording. Temporal lobe epilepsy (TLE) is the commonest form of focal epilepsy and represents almost 2/3 of cases of intractable epilepsy managed surgically. A history of febrile seizures (especially complex febrile seizures) is common in TLE and is frequently associated with mesial temporal sclerosis (the commonest form of TLE). Seizure auras occur in many TLE patients and often exhibit features that are relatively specific for TLE but few are of lateralizing value. Automatisms, however, often have lateralizing significance. Careful study of seizure semiology remains invaluable in addressing the search for the seizure onset zone.

The Role of Expert Systems in Improving the Test Requesting Patterns of Clinicians

1993 ◽  
Vol 30 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Margaret Peters ◽  
P M G Broughton
Keyword(s):  
Expert Systems ◽  
Clinical Chemistry ◽  
Clinical Settings ◽  
Out Of Hours ◽  
Laboratory Staff ◽  
Testing Strategies ◽  
Laboratory Utilization ◽  
The Many ◽  
Clinical Chemistry Tests

The many strategies proposed for influencing the test requesting patterns of clinicians have had only limited success, largely because they are labour intensive and depend on motivation and commitment. Clinical protocols which have been locally agreed between laboratory staff and clinicians are potentially one of the more successful strategies, but detailed study of their application in different clinical settings has been limited by practical problems. Expert systems offer a way of implementing locally agreed protocols and, consequently, of assisting the identification, audit and refinement of laboratory testing strategies. Where these systems have been applied in specialist units they have resulted in savings in time by both clinical and laboratory staff, and an overall reduction in the number of clinical chemistry tests done within and out of hours. These systems offer promise as a method of improving laboratory utilization.

scholarly journals P.024 Stimulus-Induced Rhythmic, Periodic or Ictal Discharges (SIRPIDs): associated factors and prognostic implications

2016 ◽  
Vol 43 (S2) ◽  
pp. S27-S27
Author(s):  
S Braksick ◽  
D Burkholder ◽  
T Spyridoula ◽  
L Martineau ◽  
J Mandrekar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Demographic Data ◽  
Clinical Predictors ◽  
Epileptiform Discharges ◽  
Electrographic Seizures ◽  
Alteration Of Consciousness ◽  
Prognostic Implications ◽  
Antiepileptic Medications

Background: SIRPIDS were first described in 2004 in patients admitted in an intensive care unit. Despite few studies attempting to better characterize SIRPIDS, their pathophysiology and clinical implication remain uncertain. Methods: Adult patients hospitalized in an intensive care unit with alteration of consciousness who underwent EEG recording in three separate centers were included in this retrospective study. Demographic data and EEG findings were noted. Characteristics of SIRPIDS were documented. The main outcome measures included the incidence of SIRPIDS, association of SIRPIDS with mortality and other EEG characteristics, EEG and clinical predictors of mortality. Results: 416 patients were included and SIRPIDs were identified in 43 patients (10.3%). The proportion of patients with SIRPIDs was not significantly different across the three sites (p=0.3351). Anoxia (p=0.0009), antiepileptic medications (p=0.0109), electrographic seizures (p=0.0259), triphasic waves (p=0.0012) and epileptiform discharges (p=0.0242) were independently associated with the presence of SIRPIDs. Older age (p=0.0050), anoxia (p=<0.0001) and absence of EEG reactivity (p<0.0001), but not SIRPIDs (p=0.1668), were independently associated with in-hospital mortality. Conclusions: In critically ill patients undergoing EEG, SIRPIDs occurred in 10% and were associated with other electrographic abnormalities previously reported to indicate poor prognosis. SIRPIDs were not independently associated with in-hospital mortality.

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