Effects of Interictal Epileptiform Discharges on Cognition

2018 ◽  
Vol 07 (03) ◽  
pp. 082-088 ◽  
Author(s):  
Aag Jennekens-Schinkel ◽  
Joost Meekes
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Cognitive Deficit ◽  
Single Case ◽  
Careful Monitoring ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Single Case Designs ◽  
Lower Intelligence ◽  
Electroencephalogram Eeg

AbstractInterictal epileptiform discharges (IEDs) are brief events (typically < 1 second, although some authors use a cutoff of up to 3 seconds) in the electroencephalogram (EEG), which are not accompanied by any overt change in behavior or consciousness. IEDs are associated with both chronic cognitive deficits and transient cognitive impairment (TCI). Higher IED load correlates with lower intelligence quotient (IQ) and poorer performance on tests of memory and executive function. TCI has mainly been observed during tasks that place high demands on attention, visuomotor speed, and working memory. There is evidence that IEDs may also directly interfere with episodic memory. Despite the evidence for associations between IEDs and cognitive dysfunction, there is currently scant evidence that IEDs, in fact, cause chronic cognitive deficit in humans. Although causality appears likely in the case of TCI, even here the conditions under which IEDs affect cognition are unclear. The evidence in favor of treating IEDs with medication is very limited. Attempts to treat IEDs should only be made when it is clear that cognitive impairment interferes with activities or participation. Such attempts require strong single-case designs and careful monitoring of both the EEG and cognitive function to establish the efficacy of treatment in individual patients.

scholarly journals Interictal epileptiform discharges have an independent association with cognitive impairment in children with lesional epilepsy

Epilepsia ◽  
2016 ◽  
Vol 57 (9) ◽  
pp. 1436-1442 ◽  
Author(s):  
Jennifer M. Glennon ◽  
Louise Weiss-Croft ◽  
Sue Harrison ◽  
J. Helen Cross ◽  
Stewart G. Boyd ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Independent Association

scholarly journals Automated Inter-Ictal Epileptiform Discharge Detection from Routine EEG

2021 ◽  
Author(s):  
Duong Nhu ◽  
Mubeen Janmohamed ◽  
Lubna Shakhatreh ◽  
Ofer Gonen ◽  
Patrick Kwan ◽  
...  
Keyword(s):  
Royal Melbourne Hospital ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Model Variant ◽  
Eeg Recordings ◽  
Generalized Epilepsy ◽  
Electroencephalogram Eeg ◽  
Health Hospital ◽  
Epilepsy Monitoring

Epilepsy is the most common neurological disorder. The diagnosis commonly requires manual visual electroencephalogram (EEG) analysis which is time-consuming. Deep learning has shown promising performance in detecting interictal epileptiform discharges (IED) and may improve the quality of epilepsy monitoring. However, most of the datasets in the literature are small (n≤100) and collected from single clinical centre, limiting the generalization across different devices and settings. To better automate IED detection, we cross-evaluated a Resnet architecture on 2 sets of routine EEG recordings from patients with idiopathic generalized epilepsy collected at the Alfred Health Hospital and Royal Melbourne Hospital (RMH). We split these EEG recordings into 2s windows with or without IED and evaluated different model variants in terms of how well they classified these windows. The results from our experiment showed that the architecture generalized well across different datasets with an AUC score of 0.894 (95% CI, 0.881–0.907) when trained on Alfred’s dataset and tested on RMH’s dataset, and 0.857 (95% CI, 0.847–0.867) vice versa. In addition, we compared our best model variant with Persyst and observed that the model was comparable.

scholarly journals A STUDY ON COMPARATIVE YIELDS OF STANDARD SHORT TERM ELECTROENCEPHALOGRAM AND LONG TERM ELECTROENCEPHALOGRAM RECORDING IN SUSPECTED EPILEPSY PATIENTS

2021 ◽  
Vol 71 (5) ◽  
pp. 1727-31
Author(s):  
Saima Shafait ◽  
Wasim Alamgir ◽  
Imran Ahmad ◽  
Saeed Arif ◽  
Jahanzeb Liaqat ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Extended Period ◽  
Final Analysis ◽  
Epileptiform Discharge ◽  
Military Hospital ◽  
Recording Time ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Interictal Epileptiform Discharge ◽  
Electroencephalogram Eeg

Objective: To compare the yield of interictal epileptiform discharges on prolonged (1-2 hours) electroencephalogram (EEG) as compared to standard routine (30 minutes) electroencephalogram (EEG). Study Design: Comparative observational study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi from Oct 2019 to Sep 2020. Methodology: A total of 364 outdoor patients with suspected epilepsy were recruited for the study. Out of these 55 electroencephalograms were excluded after applying exclusion criteria and 309 were included for final analysis. Electro-encephalograms were recorded using a 10-20 international system of electrode placement. The duration of each standard electroencephalogram was 30 minutes. It was followed by recording for an extended period of 60 minutes at least. The time to the appearance of the first abnormal interictal epileptiform discharge was noted. For analytical purposes, epileptiform discharges were classified as “early” if they appeared within the first 30 minutes and as “late” if appeared afterward. All electro-encephalograms were evaluated independently by two neurologists. Results: A total of 309 electroencephalograms were included for final analysis. Interictal epileptiform discharges were seen in 48 (15.6%) recordings. The mean time to appearance of first interictal epileptiform discharge was 14.6 ± 19.09 minutes. In 36 (11.7%) cases, discharges appeared early (within the first 30 minutes) whereas in the remaining 12 (3.9%) cases, discharges appeared late. This translates into a 33% increase in the diagnostic yield of electroencephalogram with an extended period of recording. Conclusion: Extending the electroencephalogram recording time results in a significantly better diagnostic yield of outdoor electroencephalogram.

How Long Should Routine EEG Be Recorded to Get Relevant Information?

2017 ◽  
Vol 49 (5) ◽  
pp. 335-341
Author(s):  
Hannah Doudoux ◽  
Kristina Skaare ◽  
Thomas Geay ◽  
Philippe Kahane ◽  
Jean L. Bosson ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Relevant Information ◽  
The Other ◽  
Neurologic Manifestation ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Eeg Abnormalities ◽  
Eeg Recordings ◽  
Time Required ◽  
Over Time

Objective. The optimal duration of routine EEG (rEEG) has not been determined on a clinical basis. This study aims to determine the time required to obtain relevant information during rEEG with respect to the clinical request. Method. All rEEGs performed over 3 months in unselected patients older than 14 years in an academic hospital were analyzed retrospectively. The latency required to obtain relevant information was determined for each rEEG by 2 independent readers blinded to the clinical data. EEG final diagnoses and latencies were analyzed with respect to the main clinical requests: subacute cognitive impairment, spells, transient focal neurologic manifestation or patients referred by epileptologists. Results. From 430 rEEGs performed in the targeted period, 364 were analyzed: 92% of the pathological rEEGs were provided within the first 10 minutes of recording. Slowing background activity was diagnosed from the beginning, whereas interictal epileptiform discharges were recorded over time. Moreover, the time elapsed to demonstrate a pattern differed significantly in the clinical groups: in patients with subacute cognitive impairment, EEG abnormalities appeared within the first 10 minutes, whereas in the other groups, data could be provided over time. Conclusion. Patients with subacute cognitive impairment differed from those in the other groups significantly in the elapsed time required to obtain relevant information during rEEG, suggesting that 10-minute EEG recordings could be sufficient, arguing in favor of individualized rEEG. However, this conclusion does not apply to intensive care unit patients.

scholarly journals Prospective evaluation of interrater agreement between EEG technologists and neurophysiologists

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Isabelle Beuchat ◽  
Senubia Alloussi ◽  
Philipp S. Reif ◽  
Nora Sterlepper ◽  
Felix Rosenow ◽  
...  
Keyword(s):  
Interrater Agreement ◽  
Prospective Evaluation ◽  
False Negatives ◽  
Predictive Values ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Eeg Recordings ◽  
Taking Action ◽  
Electroencephalogram Eeg ◽  
Eeg Pattern

AbstractWe aim to prospectively investigate, in a large and heterogeneous population, the electroencephalogram (EEG)-reading performances of EEG technologists. A total of 8 EEG technologists and 5 certified neurophysiologists independently analyzed 20-min EEG recordings. Interrater agreement (IRA) for predefined EEG pattern identification between EEG technologists and neurophysiologits was assessed using percentage of agreement (PA) and Gwet-AC1. Among 1528 EEG recordings, the PA [95% confidence interval] and interrater agreement (IRA, AC1) values were as follows: status epilepticus (SE) and seizures, 97% [96–98%], AC1 kappa = 0.97; interictal epileptiform discharges, 78% [76–80%], AC1 = 0.63; and conclusion dichotomized as “normal” versus “pathological”, 83.6% [82–86%], AC1 = 0.71. EEG technologists identified SE and seizures with 99% [98–99%] negative predictive value, whereas the positive predictive values (PPVs) were 48% [34–62%] and 35% [20–53%], respectively. The PPV for normal EEGs was 72% [68–76%]. SE and seizure detection were impaired in poorly cooperating patients (SE and seizures; p < 0.001), intubated and older patients (SE; p < 0.001), and confirmed epilepsy patients (seizures; p = 0.004). EEG technologists identified ictal features with few false negatives but high false positives, and identified normal EEGs with good PPV. The absence of ictal features reported by EEG technologists can be reassuring; however, EEG traces should be reviewed by neurophysiologists before taking action.

Characterizing EEG Cortical Dynamics and Connectivity with Responses to Single Pulse Electrical Stimulation (SPES)

2018 ◽  
Vol 28 (06) ◽  
pp. 1750057 ◽  
Author(s):  
Gonzalo Alarcón ◽  
Diego Jiménez-Jiménez ◽  
Antonio Valentín ◽  
David Martín-López
Keyword(s):  
Electrical Stimulation ◽  
Single Pulse ◽  
Oscillatory Behavior ◽  
Temporal Lobectomy ◽  
Dynamic Interactions ◽  
Cortical Dynamics ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
System Equations ◽  
Electroencephalogram Eeg

Objectives: To model cortical connections in order to characterize their oscillatory behavior and role in the generation of spontaneous electroencephalogram (EEG). Methods: We studied averaged responses to single pulse electrical stimulation (SPES) from the non-epileptogenic hemisphere of five patients assessed with intracranial EEG who became seizure free after contralateral temporal lobectomy. Second-order control system equations were modified to characterize the systems generating a given response. SPES responses were modeled as responses to a unit step input. EEG power spectrum was calculated on the 20[Formula: see text]s preceding SPES. Results: 121 channels showed responses to 32 stimulation sites. A single system could model the response in 41.3% and two systems were required in 58.7%. Peaks in the frequency response of the models tended to occur within the frequency range of most activity on the spontaneous EEG. Discrepancies were noted between activity predicted by models and activity recorded in the spontaneous EEG. These discrepancies could be explained by the existence of alpha rhythm or interictal epileptiform discharges. Conclusions: Cortical interactions shown by SPES can be described as control systems which can predict cortical oscillatory behavior. The method is unique as it describes connectivity as well as dynamic interactions.

Cognitive Deficits in Chronic Alcoholics

1977 ◽  
Vol 40 (3) ◽  
pp. 719-724 ◽  
Author(s):  
Peter Ornstein
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Inpatient Treatment ◽  
Cognitive Deficit ◽  
Significant Gain ◽  
Chronic Alcoholic ◽  
Drinking Behaviors ◽  
Visual Organization ◽  
Degree Of Recovery

The degree of cognitive deficit in chronic alcoholic males at onset of inpatient treatment and degree of recovery at discharge, plus a possible relationship between the latter and post-hospital drinking behaviors were assessed. 330 patients were classified as abstaining, improved, unimproved, or unclassified on the basis of their drinking behaviors during the first 3 mo. following discharge. The Hooper Visual Organization Test and the Shipley-Hartford were administered at admission and discharge as measures of cognitive impairment. All four groups showed significant improvement on the Hooper as well as on their Shipley Conceptual Quotient scores at discharge, but only the abstainers showed a significant gain in vocabulary scores. The results suggest a cognitive deficit consistent with mild organicity.

scholarly journals Reiterating the role of corpus callosum in generalization of interictal and ictal epileptiform discharges: a case report with post-callosotomy intracranial electroencephalography in Lennox–Gastaut syndrome

2021 ◽  
Vol 13 (3) ◽  
pp. 249-253
Author(s):  
S. Gopinath ◽  
A. Pillai ◽  
A. G. Diwan ◽  
J. V. Pattisapu ◽  
K. Radhakrishnan
Keyword(s):  
Corpus Callosum ◽  
Epileptic Encephalopathy ◽  
Drop Attacks ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Eeg Abnormalities ◽  
Before And After ◽  
Intracranial Electroencephalography ◽  
Electroencephalogram Eeg

Lennox–Gastaut syndrome (LGS) is an epileptic encephalopathy characterized by delayed mental development and intractable multiple seizure types, predominantly tonic. Drop attacks are the commonest and the most disabling type of seizures. Resective surgery is often not possible in LGS as the electroencephalogram (EEG) abnormalities are usually multifocal and generalized, and magnetic resonance image is often either normal or multilesional. We report a case of LGS with bilateral parieto-occipital gliosis where EEG before and after callosotomy demonstrated synchronized bilateral interictal epileptiform discharges and ictal discharges becoming desynchronized and running down. This phenomenon emphasizes the role of the corpus callosum in secondary bilateral synchrony.

Cognitive Enhancement in Epilepsy

2017 ◽  
Author(s):  
Beth A. Leeman-Markowski ◽  
Kimford J. Meador
Keyword(s):  
Quality Of Life ◽  
Cognitive Deficits ◽  
Cognitive Enhancement ◽  
Psychiatric Disease ◽  
Epilepsy Syndrome ◽  
Surgical Interventions ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Underlying Mechanisms

Cognitive deficits, including attention, language, and memory dysfunction, are common in the setting of epilepsy and can greatly impair quality of life. Cognitive dysfunction in epilepsy is often multifactorial and may relate to the underlying etiology or epilepsy syndrome, comorbid psychiatric disease, interictal epileptiform discharges, effects of seizures, antiepileptic drugs, and surgical interventions. Studies have addressed the prevention of impairment and, less commonly, methods for cognitive enhancement. This chapter examines the possible underlying mechanisms of cognitive deficits in epilepsy, methods for prevention of dysfunction, issues in study design, and data regarding cognitive enhancement.

scholarly journals Specificity of Cognitive Impairment in Neurological Disease: A Methodological Critique of Parkinson’s Disease

1991 ◽  
Vol 4 (2) ◽  
pp. 89-102 ◽  
Author(s):  
H. J. Sagar
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Cognitive Deficit ◽  
Cross Sectional Study ◽  
Cognitive Disorder ◽  
Cross Sectional ◽  
Motor Disability ◽  
Patient Groups

Multiple cognitive deficits have been recognized in many neurological disorders but the specificity of the findings and the relationship to the underlying neuropathology remain obscure. Definitions of dementia have been proposed based on symptom profiles of the cognitive disorder and qualitative differences have been claimed between dementias of different aetiology. Some conditions have been claimed to show patterns of cognitive deficit that are distinguished from dementia and related to specific neuropathology or psychological processes, e.g. frontal lobe deficits in Parkinson's disease. Sometimes, a relationship has been established between certain cognitive deficits and particular neurochemical deficits which has led to the notion of specific drug treatment, e.g. cholinergic deficits and memory failure in Alzheimer's disease. However, these conclusions are often potentially flawed by methodological inadequacies. This critique presents some methodological issues relevant to the study of brain-behaviour and drug-behaviour relationships in syndromes of multiple cognitive deficit, using Parkinson's disease as the model. The following recommendations are made: rigid diagnostic criteria; representative patient groups; avoidance of arbitrary quantitative criteria to limit definitions of dementia; matching of groups for overall level of cognitive impairment in the search for qualitative cognitive differences related to neuropathology or effects of particular drugs; the use of suitable controls in patient groups, neuropsychological tests and treatment regimes; the use of specific quantitative tests of cognition, affect and motor disability; and longitudinal, compared with cross-sectional, study design.

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