INNV-38. RATE OF EEG IN GLIOMA PATIENTS: SHOULD THIS BE PART OF STANDARD OF CARE FOR NEW BRAIN TUMOR PATIENTS?

Abstract Current guidelines recommend antiepileptic drug (AED) therapy for glioma patients only in patients who have experienced a seizure. There is no current recommendation in regards to performing EEG monitoring in glioma patients. Thus, typically only clinical seizures have prompted AED therapy in glioma patients. Our purpose was to investigate the rate of EEG monitoring in glioma patients entered into our glioma registry, along with seizure and AED rates. Using our glioma registry to date, of 167 glioma patients, 119 patients had EEGs performed during their clinical course. Of those 119 patients, 104 glioma patients had either clinical or electrographic seizure activity and all 104 were on AEDs. This observation indicates that baseline eeg monitoring might be considered in all newly diagnosed glioma patients to reduce seizure incidence, potentially, starting AED prophylaxis if epileptiform activity is seen on EEG prior to clinical seizure activity to potentially reduce morbidity and healthcare costs related to clinical seizure activity. This warrants further prospective study.

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EEG Suppression Associated with Apneic Episodes in a Neonate

Case Reports in Neurological Medicine ◽

10.1155/2012/250801 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Evonne Low ◽

Eugene M. Dempsey ◽

C. Anthony Ryan ◽

Janet M. Rennie ◽

Geraldine B. Boylan

Keyword(s):

Heart Rate ◽

Oxygen Saturation ◽

Preterm Neonate ◽

Seizure Activity ◽

Baseline Heart Rate ◽

Eeg Monitoring ◽

Oxygen Saturation Level ◽

Electrographic Seizure ◽

Eeg Activity ◽

Equivalent Age

We describe the EEG findings from an ex-preterm neonate at term equivalent age who presented with intermittent but prolonged apneic episodes which were presumed to be seizures. A total of 8 apneic episodes were captured (duration 23–376 seconds) during EEG monitoring. The baseline EEG activity was appropriate for corrected gestational age and no electrographic seizure activity was recorded. The average baseline heart rate was 168 beats per minute (bpm) and the baseline oxygen saturation level was in the mid-nineties. Periods of complete EEG suppression lasting 68 and 179 seconds, respectively, were recorded during 2 of these 8 apneic episodes. Both episodes were accompanied by bradycardia less than 70 bpm and oxygen saturation levels of less than 20%. Short but severe episodes of apnea can cause complete EEG suppression in the neonate.

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Seizure Forecasting Using a Novel Sub-Scalp Ultra-Long Term EEG Monitoring System

Frontiers in Neurology ◽

10.3389/fneur.2021.713794 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rachel E. Stirling ◽

Matias I. Maturana ◽

Philippa J. Karoly ◽

Ewan S. Nurse ◽

Kate McCutcheon ◽

...

Keyword(s):

Seizure Activity ◽

Characteristic Curve ◽

Epileptiform Activity ◽

Machine Learning Algorithms ◽

Eeg Monitoring ◽

Accurate Identification ◽

Patient Reported ◽

Diagnostic Management ◽

Eeg Recordings ◽

Brain Data

Accurate identification of seizure activity, both clinical and subclinical, has important implications in the management of epilepsy. Accurate recognition of seizure activity is essential for diagnostic, management and forecasting purposes, but patient-reported seizures have been shown to be unreliable. Earlier work has revealed accurate capture of electrographic seizures and forecasting is possible with an implantable intracranial device, but less invasive electroencephalography (EEG) recording systems would be optimal. Here, we present preliminary results of seizure detection and forecasting with a minimally invasive sub-scalp device that continuously records EEG. Five participants with refractory epilepsy who experience at least two clinically identifiable seizures monthly have been implanted with sub-scalp devices (Minder®), providing two channels of data from both hemispheres of the brain. Data is continuously captured via a behind-the-ear system, which also powers the device, and transferred wirelessly to a mobile phone, from where it is accessible remotely via cloud storage. EEG recordings from the sub-scalp device were compared to data recorded from a conventional system during a 1-week ambulatory video-EEG monitoring session. Suspect epileptiform activity (EA) was detected using machine learning algorithms and reviewed by trained neurophysiologists. Seizure forecasting was demonstrated retrospectively by utilizing cycles in EA and previous seizure times. The procedures and devices were well-tolerated and no significant complications have been reported. Seizures were accurately identified on the sub-scalp system, as visually confirmed by periods of concurrent conventional scalp EEG recordings. The data acquired also allowed seizure forecasting to be successfully undertaken. The area under the receiver operating characteristic curve (AUC score) achieved (0.88), which is comparable to the best score in recent, state-of-the-art forecasting work using intracranial EEG.

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Seizure Forecasting Using a Novel Sub-Scalp Ultra-Long Term EEG Monitoring System

10.1101/2021.05.09.21256558 ◽

2021 ◽

Author(s):

Rachel E Stirling ◽

Philippa J Karoly ◽

Matias Maturana ◽

Ewan S Nurse ◽

Kate McCutcheon ◽

...

Keyword(s):

Seizure Activity ◽

Characteristic Curve ◽

Epileptiform Activity ◽

Machine Learning Algorithms ◽

Eeg Monitoring ◽

Accurate Identification ◽

Patient Reported ◽

Diagnostic Management ◽

Eeg Recordings ◽

Brain Data

Accurate identification of seizure activity, both clinical and subclinical, has important implications in the management of epilepsy. Accurate recognition of seizure activity is essential for diagnostic, management and forecasting purposes, but patient-reported seizures have been shown to be unreliable. Earlier work has revealed accurate capture of electrographic seizures and forecasting is possible with an implantable intracranial device, but less invasive electroencephalography (EEG) recording systems would be optimal. Here, we present preliminary results of seizure detection and forecasting with a minimally invasive sub-scalp device that continuously records EEG. Five participants with refractory epilepsy who experience at least two clinically identifiable seizures monthly have been implanted with sub-scalp devices (Minder TM), providing two channels of data from both hemispheres of the brain. Data is continuously captured via a behind-the-ear system, which also powers the device, and transferred wirelessly to a mobile phone, from where it is accessible remotely via cloud storage. EEG recordings from the sub-scalp device were compared to data recorded from a conventional system during a 1-week ambulatory video-EEG monitoring session. Suspect epileptiform activity (EA) was detected using machine learning algorithms and reviewed by trained neurophysiologists. Seizure forecasting was demonstrated retrospectively by utilising cycles in EA and previous seizure times. The procedures and devices were well tolerated and no significant complications have been reported. Seizures were accurately identified on the sub-scalp system, as confirmed by periods of concurrent conventional scalp EEG recordings. The data acquired also allowed seizure forecasting to be successfully undertaken. The area under the receiver operating characteristic curve (AUC score) achieved (0.88) is comparable to the best score in recent, state-of-the-art forecasting work using intracranial EEG.

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Succinic Semialdehyde Dehydrogenase Deficiency: Review of the Natural History Study

Journal of Child Neurology ◽

10.1177/0883073820981262 ◽

2021 ◽

pp. 088307382098126

Author(s):

Phillip L. Pearl ◽

Melissa L. DiBacco ◽

Christos Papadelis ◽

Thomas Opladen ◽

Ellen Hanson ◽

...

Keyword(s):

Natural History ◽

Psychiatric Symptoms ◽

Epileptiform Activity ◽

Laboratory Data ◽

Standard Of Care ◽

Succinic Semialdehyde ◽

Succinic Semialdehyde Dehydrogenase ◽

Natural History Study ◽

Semialdehyde Dehydrogenase ◽

Verbal Score

Objective: The SSADHD Natural History Study was initiated in 2019 to define the natural course and identify biomarkers correlating with severity. Methods: The study is conducted by 4 institutions: BCH (US clinical), WSU (bioanalytical core), USF (biostatistical core), and Heidelberg (iNTD), with support from the family advocacy group (SSADH Association). Recruitment goals were to study 20 patients on-site at BCH, 10 with iNTD, and 25 as a standard-of care cohort. Results: At this half-way point of this longitudinal study, 28 subjects have been recruited (57% female, mean 9 years, range 18 months–40 years). Epilepsy is present in half and increases in incidence and severity, as do psychiatric symptoms, in adolescence and adulthood. The average Full Scale IQ (FSIQ) was 53 (Verbal score of 56, Non Verbal score of 49), and half scored as having ASD. Although there was no correlation between gene variant and phenotypic severity, there were extreme cases of lowest functioning in one individual and highest in another that may have genotype-phenotype correlation. The most common EEG finding was mild background slowing with rare epileptiform activity, whereas high-density EEG and magnetoencephalography showed reduction in the gamma frequency band consistent with GABAergic dysfunction. MR spectroscopy showed elevations in the GABA/NAA ratio in all regions studied with no crossover between subjects and controls. Conclusions: The SSADH Natural History Study is providing a unique opportunity to study the complex pathophysiology longitudinally and derive electrophysiologic, neuroimaging, and laboratory data for correlation and to serve as biomarkers for clinical trials and prognostic assessments in this ultra-rare inherited disorder of GABA metabolism.

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Temporal bone chondroblastoma with secondary aneurysmal bone cyst presenting as an intracranial mass with clinical seizure activity

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2010.11.004 ◽

2011 ◽

Vol 18 (6) ◽

pp. 857-860 ◽

Cited By ~ 7

Author(s):

Christopher J. Stapleton ◽

Brian P. Walcott ◽

Katy R. Linskey ◽

Kristopher T. Kahle ◽

Brian V. Nahed ◽

...

Keyword(s):

Temporal Bone ◽

Aneurysmal Bone Cyst ◽

Seizure Activity ◽

Bone Cyst ◽

Intracranial Mass ◽

Clinical Seizure ◽

Secondary Aneurysmal Bone Cyst

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Impact of an ICU EEG monitoring pathway on timeliness of therapeutic intervention and electrographic seizure termination

Epilepsia ◽

10.1111/epi.13354 ◽

2016 ◽

Vol 57 (5) ◽

pp. 786-795 ◽

Cited By ~ 22

Author(s):

Ryan P. Williams ◽

Brenda Banwell ◽

Robert A. Berg ◽

Dennis J. Dlugos ◽

Maureen Donnelly ◽

...

Keyword(s):

Therapeutic Intervention ◽

Eeg Monitoring ◽

Electrographic Seizure ◽

Seizure Termination

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Epileptiform Discharges With In-Vivo-Like Features in Slices of Rat Piriform Cortex With Longitudinal Association Fibers

Journal of Neurophysiology ◽

10.1152/jn.2001.86.5.2445 ◽

2001 ◽

Vol 86 (5) ◽

pp. 2445-2460 ◽

Cited By ~ 28

Author(s):

Rezan Demir ◽

Lewis B. Haberly ◽

Meyer B. Jackson

Keyword(s):

Seizure Activity ◽

Epileptiform Activity ◽

Piriform Cortex ◽

Brain Slices ◽

Epileptiform Discharges ◽

Local Circuitry ◽

Association Fibers ◽

Discharge Propagation

Brain slices serve as useful models for the investigation of epilepsy. However, the preparation of brain slices disrupts circuitry and severs axons, thus complicating efforts to relate epileptiform activity in vitro to seizure activity in vivo. This issue is relevant to studies in transverse slices of the piriform cortex (PC), the preparation of which disrupts extensive rostrocaudal fiber systems. In these slices, epileptiform discharges propagate slowly and in a wavelike manner, whereas such discharges in vivo propagate more rapidly and jump abruptly between layers. The objective of the present study was to identify fiber systems responsible for these differences. PC slices were prepared by cutting along three different nearly orthogonal planes (transverse, parasagittal, and longitudinal), and epileptiform discharges were imaged with a voltage-sensitive fluorescent dye. Interictal-like epileptiform activity was enabled by either a kindling-like induction process or disinhibition with bicuculline. The pattern of discharge onset was very similar in slices cut in different planes. As described previously in transverse PC slices, discharges were initiated in the endopiriform nucleus (En) and adjoining regions in a two-stage process, starting with low-amplitude “plateau activity” at one site and leading to an accelerating depolarization and discharge onset at another nearby site. The similar pattern of onset in slices of various orientations indicates that the local circuitry and neuronal properties in and around the En, rather than long-range fibers, assume dominant roles in the initiation of epileptiform activity. Subtle variations in the onset site indicate that interneurons can fine tune the site of discharge onset. In contrast to the mode of onset, discharge propagation showed striking variations. In longitudinal slices, where rostrocaudal association fibers are best preserved, discharge propagation resembled in vivo seizure activity in the following respects: propagation was as rapid as in vivo and about two to three times faster than in other slices; discharges jumped abruptly between the En and PC; and discharges had large amplitudes in superficial layers of the PC. Cuts in longitudinal slices that partially separated the PC from the En eliminated these unique features. These results help clarify why epileptiform activity differs between in vitro and in vivo experiments and suggest that rostrocaudal pyramidal cell association fibers play a major role in the propagation of discharges in the intact brain. The longitudinal PC slice, which best preserves these fibers, is ideally suited for the study their role.

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Implementing a Multidisciplinary Approach to Enhance Compliance With Guideline-Recommended Prechemotherapy Pneumococcal Vaccination in a Military-Based Medical Oncology Practice

Journal of Oncology Practice ◽

10.1200/jop.2016.015602 ◽

2017 ◽

Vol 13 (11) ◽

pp. e966-e971 ◽

Cited By ~ 1

Author(s):

Wilfred Delacruz ◽

Sandra Terrazzino ◽

Michael Osswald ◽

Casey Payne ◽

Brian Haney

Keyword(s):

Pneumococcal Vaccination ◽

Standard Of Care ◽

Baseline Period ◽

Community Acquired Pneumonia ◽

Vaccination Rates ◽

Patients With Cancer ◽

Single Person ◽

Increased Risk ◽

Oncology Practice ◽

Current Guidelines

Purpose: Patients with cancer are at increased risk for invasive pneumococcal disease, including community-acquired pneumonia. Current Advisory Committee on Immunization Practices and National Cancer Comprehensive Network guidelines recommend pneumococcal vaccination for immunocompromised patients, including patients with cancer. Methods: We conducted a quality improvement (QI) project to enhance compliance with pneumococcal vaccination in patients before their chemotherapy. Baseline pneumococcal vaccination rates were gathered from July 2013 to June 2014. We reviewed the current guidelines for pneumococcal vaccinations in patients with cancer with physicians and encouraged them to prescribe the pneumococcal vaccination to patients before therapy. We also recruited our clinic nurse practitioner, who meets all patients for chemotherapy teaching, to prescribe the vaccine to patients younger than 65 years of age. Results: During the baseline period, of the 110 patients younger than 65 years who received chemotherapy, seven (6.4%) received the pneumococcal vaccine. Of the 90 patients (median age, 60 years; range, 20 to 86 years) who received chemotherapy during the study period, 58 were younger than 65 years, of whom three patients were already vaccinated before their diagnosis. Twenty-five (45.5%) patients were vaccinated through our QI project. We have improved our compliance with pneumococcal vaccination by 39% ( P < .001). Conclusion: We have improved compliance with pneumococcal vaccination in patients with cancer receiving chemotherapy in our clinic through a QI project. We found that screening is best accomplished by a single person who is able to screen all patients. This practice is now a standard of care in our clinic.

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The Agitated Psychotic Patient: Guidelines to Ensure Staff and Patient Safety

Journal of the American Psychiatric Nurses Association ◽

10.1067/mpn.2002.127080 ◽

2002 ◽

Vol 8 (4_suppl) ◽

pp. S2-S8 ◽

Cited By ~ 6

Author(s):

Mary C. Murphy

Keyword(s):

Behavior Management ◽

Large Scale ◽

Standard Of Care ◽

Healthcare Organizations ◽

Current Recommendation ◽

Oral Formulations ◽

Large Numbers ◽

Assaultive Behavior ◽

Patient Guidelines ◽

Verbal Intervention

Patient-perpetrated violence is a serious problem that affects large numbers of nursing and healthcare staff. Incidents of assaultive behavior can lead to patient and staff injury, loss of productivity, and increased stress and burnout among healthcare professionals. The use of restraints for aggressive or assaultive behavior is governed by guidelines of the Joint Commission on Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services. Guidelines for dealing with the acutely agitated patient have recently been published by an expert consensus panel. All three sources agree that the use of nonphysical forms of behavior management (e.g., verbal intervention or show of force) is the appropriate first-line strategy. If medication is required, the current recommendation is the use of oral forms rather than intramuscular (IM) preparations, such as haloperidol and lorazepam, which have been the standard of care for many years. The primary disadvantages of injectables are the potential for injury and trauma to the patient, which is of special relevance for patients with paranoia, confusion, or previous assaults. Recent results suggest that oral formulations of atypical antipsychotics (e.g., risperidone) in combination with oral benzodiazepines (e.g., lorazepam) are as effective as similar IM treatments (e.g., haloperidol) in reducing psychotic agitation. Although additional large-scale studies are needed, early findings suggest that these oral formulations offer a less traumatic form of treatment than conventional IM drugs. For patients who will not accept oral medication, IM formulations of newer drugs are under investigation. These drugs (e.g., olanzapine, ziprasidone) may offer lower risk of side effects compared with older medications like haloperidol.

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