Diagnostic Yield of Five Minutes Compared to Three Minutes Hyperventilation During Electroencephalography in Children

2021 ◽  
pp. 155005942110582
Author(s):  
Nivetha Vasudevan ◽  
Ranjith Kumar Manokaran ◽  
Saji James
Keyword(s):  
Adverse Events ◽  
Diagnostic Yield ◽  
Paediatric Population ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Ictal Eeg ◽  
Eeg Abnormalities

Purpose: To investigate whether hyperventilation (HV) for 5 minutes increases the diagnostic yield of electroencephalography (EEG) compared to 3 minutes HV and to determine whether performing HV for 5 minutes is feasible and safe in children. Methods: Data were evaluated from 579 children aged less than 18 years, referred to EEG for epilepsy evaluation. Occurrence of seizures, HV induced interictal epileptiform discharges precipitation and potentiation and adverse events if any were noted during the first 3 minutes and last 2 minutes of HV separately. Results: 398 children (68.7%) completed 5 minutes HV. Seizures were precipitated during the first 3 minutes of HV in 2 children, and during the last 2 minutes in one more child. Inter-ictal EEG abnormalities were precipitated in the first 3 minutes of HV in 31 children, and during the last 2 min in 4 more children. All 398 children completed HV during the last 2 minutes successfully and no adverse events occurred during the last 2 minutes of HV. Conclusion: 33.33% of seizures and 11.5% of inter-ictal EEG abnormalities triggered by HV occurred during the last 2 min of HV. This finding supports the utility of prolonged hyperventilation for 5 minutes. Prolonged HV for 5 minutes increases the diagnostic yield of EEG in paediatric population and it is safe and feasible.

scholarly journals Interictal discharges spread along local recurrent networks between tubers and surrounding cortex

2019 ◽  
Author(s):  
S Tumpa ◽  
R Thornton ◽  
M Tisdall ◽  
T Baldeweg ◽  
KJ Friston ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Epilepsy Surgery ◽  
Local Network ◽  
Neural Mass Model ◽  
Model Parameters ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Eeg Abnormalities ◽  
Neural Mass ◽  
Interictal Discharges

AbstractThe presence of interictal epileptiform discharges on electroencephalography (EEG) may indicate increased epileptic seizure risk and on invasive EEG are the signature of the irritative zone. In highly epileptogenic lesions – such as cortical tubers in tuberous sclerosis – these discharges can be recorded with intracranial stereotactic EEG as part of the evaluation for epilepsy surgery. Yet the network mechanisms that underwrite the generation and spread of these discharges remain poorly understood, limiting their current diagnostic use.Here, we investigate the dynamics of interictal epileptiform discharges using a combination of quantitative analysis of invasive EEG recordings and mesoscale neural mass modelling of cortical dynamics. We first characterise spatially organised local dynamics of discharges recorded from 36 separate tubers in 8 patients with tuberous sclerosis. We characterise these dynamics with a set of competing explanatory network models using dynamic causal modelling. Bayesian model comparison of plausible network architectures suggests that the recurrent coupling between neuronal populations within – and adjacent to – the tuber core explains the travelling wave dynamics observed in these patient recordings.Our results – based on interictal activity – unify competing theories about the pathological organisation of epileptic foci and surrounding cortex in patients with tuberous sclerosis. Coupled oscillator dynamics have previously been used to describe ictal activity, where fast travelling ictal discharges are commonly observed within the recruited seizure network. The interictal data analysed here add the insight that this functional architecture is already established in the interictal state. This links observations of interictal EEG abnormalities directly to pathological network coupling in epilepsy, with possible implications for epilepsy surgery approaches in tuberous sclerosis.Significance StatementInterictal epileptiform discharges (IEDs) are clinically important markers of an epileptic brain. Here we link local IED spread to network coupling through a combination of clinical recordings in paediatric patients with tuberous sclerosis complex, quantitative EEG analysis of interictal discharges spread, and Bayesian inference on coupled neural mass model parameters. We show that the kinds of interictal discharges seen in our patients require recurrent local network coupling extending beyond the putative seizure focus and that in fact only those recurrent coupled networks can support seizure-like and interictal dynamics when run in simulation. Our findings provide a novel integrated perspective on emergent epileptic dynamics in human patients.

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.

scholarly journals Congruence and Discrepancy of Interictal and Ictal EEG With MRI Lesions in Pediatric Epilepsies

2020 ◽  
Vol 51 (6) ◽  
pp. 412-419
Author(s):  
Jan Rémi ◽  
Sophie Shen ◽  
Moritz Tacke ◽  
Philipp Probst ◽  
Lucia Gerstl ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Epilepsy ◽  
Resonance Imaging ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Ictal Eeg ◽  
Magnetic Resonance Imaging Mri ◽  
Surface Eeg ◽  
Frontal Lesions ◽  
Video Eeg

Purpose. To evaluate the congruence or discrepancy of the localization of magnetic resonance imaging (MRI) lesions with interictal epileptiform discharges (IEDs) or epileptic seizure patterns (ESPs) in surface EEG in lesional pediatric epilepsy patients. Methods. We retrospectively analyzed presurgical MRI and video-EEG monitoring findings of patients up to age 18 years. Localization of MRI lesions were compared with ictal and interictal noninvasive EEG findings of patients with frontal, temporal, parietal, or occipital lesions. Results. A total of 71 patients were included. Localization of ESPs showed better congruence with MRI in patients with frontal lesions (n = 21, 77.5%) than in patients with temporal lesions (n = 24; 40.7%) ( P = .009). No significant IED distribution differences between MRI localizations could be found. Conclusions. MRI lesions and EEG findings are rarely fully congruent. Congruence of MRI lesions and ESPs was highest in children with frontal lesions. This is in contrast to adults, in whom temporal lesions showed the highest congruency with the EEG localization of ESP. Lesional pediatric patients should be acknowledged as surgical candidates despite incongruent findings of interictal and ictal surface EEG.

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 Standardization and quality assurance in clinical electroencephalography

2020 ◽  
Author(s):  
Laura Craciun
Keyword(s):  
Adverse Events ◽  
Diagnostic Yield ◽  
Sleep Eeg ◽  
Monitoring Methods ◽  
Large Area ◽  
Psychogenic Nonepileptic Seizures ◽  
Eeg Abnormalities ◽  
Interictal Eeg ◽  
Eeg Recordings ◽  
Level Of Significance

Objectives: Our objectives were to address some key issues- to determine the minimal efficient duration of the standard and sleep EEG recordings, to assess the diagnostic yield of hyperventilation (HV) and to assess whether injuries occur more often in an Epilepsy Monitoring Unit (EMU) where portable EEG amplifiers are used, and where patients can freely move within a large area during the monitoring. Methods: For the first part of the study, we have reviewed 1005 EEG recordings and determined the shortest recording duration necessary to identify interictal EEG abnormalities. In order to assess the diagnostic yield of 5 min HV compared to 3 min HV, data were evaluated from 1084 consecutive patients, from three European centers, referred to EEG on suspicion of epilepsy. Seizures and interictal EEG abnormalities precipitated during the first 3 min and during the last 2 min of the HV period (totally 5 min) were determined. For the last part of our study, patients were monitored at the Danish Epilepsy Center. Adverse events (AEs) including injuries, were prospectively noted, as part of the safety policy of the hospital. Other data were retrospectively extracted from the electronic database, for a 5-year period (Jan 2012–Dec 2016). Results: Standard, awake recordings shorter than 20 min yielded a significantly lower incidence of abnormal findings as compared to longer recordings. Although there was an increase in the diagnostic yield from 30 to 180 min recording duration, this failed to reach the level of significance. For sleep recordings, there was no significant increase in the diagnostic yield beyond 30 min. 877 (81%) completed 5 min HV. Seizures were precipitated during the first 3 min of HV in 21 patients, and during the last 2 min in four more patients. Interictal EEG abnormalities were precipitated in the first 3 min of HV in 16 patients, and during the last 2 min in 7 more patients. Psychogenic nonepileptic seizures occurred in eight patients during the first 3 min of HV and in two more patients during the last 2 min. No adverse events occurred during the last 2 min of HV. 976 patients were admitted to the EMU. Falls occurred in 19 patients (1.9%) but none of them resulted in injury. The rate of AEs were similar or lower than previously reported by other centers, where the mobility of the patients had been restricted during monitoring. Conclusions: Our results provide evidence for recommending at least 20 min recording duration for standard awake EEGs and 30 min for sleep EEG recordings. 16% of seizures and 30% of interictal EEG abnormalities triggered by HV occurred during the last 2 min of HV, suggesting the clinical usefulness of prolonged hyperventilation for 5 min. The vast majority of patients (99%) who are able to hyperventilate for 3 min can complete 5 min HV, without additional adverse events. In an EMU specially designed for this purpose, where patients are under continuous surveillance by personnel dedicated to the EMU, injuries can be avoided even when the mobility of the patients is not restricted.

scholarly journals D.05 SREDA-like temporal EEG seizure pattern in LGI1-antibody mediated encephalitis

2016 ◽  
Vol 43 (S2) ◽  
pp. S14-S14
Author(s):  
C Steriade ◽  
S Mirsattari ◽  
BJ Murray ◽  
R Wennberg
Keyword(s):  
Clinical Features ◽  
Temporal Lobe ◽  
Limbic Encephalitis ◽  
Cognitive Symptoms ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Eeg Abnormalities ◽  
Eeg Data ◽  
Temporal Lobe Seizures ◽  
Eeg Recordings

Background: Leucine-rich glioma inactived-1 (LGI1) antibodies are associated with limbic encephalitis and distinctive seizure types, which are typically immunotherapy-responsive. While nonspecific EEG abnormalities are commonly seen, specific EEG characteristics are not currently understood to be useful for suspecting the clinical diagnosis. Based on initial observations in two patients, we analyzed the EEG recordings in a larger series of patients and describe a novel ictal pattern that can suggest the diagnosis of LGI1-antibody mediated encephalitis, even in the absence of common clinical features. Methods: Clinical and EEG data were collected in nine patients with LGI1 antibodies. Results: Psychiatric and cognitive symptoms were common, as were tonic seizures associated with EEG electrodecremental events (often with the so-called faciobrachial dystonic semiology). A rarity or absence of interictal epileptiform discharges contrasted with frequent subclinical temporal lobe seizures in some patients, which at times showed characteristics similar to subclinical rhythmic electrographic discharges of adults (SREDA), including sensitivity to hyperventilation. Conclusions: LGI1-antibody mediated encephalitis may be associated with tonic seizures and corresponding electrodecremental events, as well as an unusual SREDA-like pattern of frequent subclinical temporal lobe seizures, which may be triggered by hyperventilation, all in the setting of rare interictal epileptiform discharges.

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.

Diagnostic yield of seizure recordings and neuroimaging in patients with focal epilepsy without interictal epileptiform discharges

2020 ◽  
Vol 112 ◽  
pp. 107468
Author(s):  
Minori Suzuki ◽  
Kazutaka Jin ◽  
Yu Kitazawa ◽  
Mayu Fujikawa ◽  
Yosuke Kakisaka ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Diagnostic Yield ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges

scholarly journals Polysomnographic Findings in Fragile X Syndrome Children with EEG Abnormalities

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Marco Carotenuto ◽  
Michele Roccella ◽  
Francesco Pisani ◽  
Sara Matricardi ◽  
Alberto Verrotti ◽  
...  
Keyword(s):  
Fragile X Syndrome ◽  
Sleep Disturbances ◽  
Fragile X ◽  
Genetic Syndrome ◽  
Sharp Waves ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Excitatory Pathways ◽  
Eeg Abnormalities ◽  
Recorded Data

Fragile X syndrome (FXS) is a genetic syndrome with intellectual disability due to the loss of expression of the FMR1 gene located on chromosome X (Xq27.3). This mutation can suppress the fragile X mental retardation protein (FMRP) with an impact on synaptic functioning and neuronal plasticity. Among associated sign and symptoms of this genetic condition, sleep disturbances have been already described, but few polysomnographic reports in pediatric age have been reported. This multicenter case-control study is aimed at assessing the sleep macrostructure and at analyzing the presence of EEG abnormalities in a cohort of FXS children. We enrolled children with FXS and, as controls, children with typical development. All subjects underwent at least 1 overnight polysomnographic recording (PSG). All recorded data obtained from patients and controls were compared. In children with FXS, all PSG-recorded parameters resulted pathological values compared to those obtained from controls, and in FXS children only, we recorded interictal epileptiform discharges (IEDs), as diffuse or focal spikes and sharp waves, usually singles or in brief runs with intermittent or occasional incidence. A possible link between IEDs and alterations in the circadian sleep-wake cycle may suggest a common dysregulation of the balance between inhibitory and excitatory pathways in these patients. The alteration in sleep pattern in children with FXS may negatively impact the neuropsychological and behavioral functioning, adding increasing burn of the disease on the overall management of these patients. In this regard, treating physicians have to early detect sleep disturbances in their patients for tailored management, in order to prevent adjunctive comorbidities.

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