EEG recording after sleep deprivation in a series of patients with juvenile myoclonic epilepsy

Seizures in Juvenile Myoclonic Epilepsy (JME) are dependent on the sleep-wake cycle and precipitant factors, among which sleep deprivation (SD) is one of the most important. Still an under diagnosed syndrome, misinterpretation of the EEGs contributes to diagnostic delay. Despite this, a quantitative EEG investigation of SD effects has not been performed. We investigated the effect of SD on EEGs in 41 patients, aged 16-50 yr. (mean 25.4), who had not yet had syndromic diagnosis after a mean delay of 8.2 yr. Two EEG recordings separated by a 48-hour interval were taken at 7 a.m. preceded by a period of 6 hours of sleep (routine EEG) and after SD (sleep-deprived EEG). The same protocol was followed and included a rest wakefulness recording, photic stimulation, hyperventilation and a post-hyperventilation period. The EEGs were analyzed as to the effect of SD on the number, duration, morphology, localization and predominance of abnormalities in the different stages. A discharge index (DI) was calculated. Out of the 41 patients, 4 presented both normal EEG recordings. In 37 (90.2%) there were epileptiform discharges (ED). The number of patients with ED ascended from 26 (70.3%) in the routine EEG to 32 (86.5%) in the sleep-deprived exam. The presence of generalized spike-wave and multispike-wave increased from 20 (54.1%) and 13 (35.1%) in the first EEG to 29 (78.4%) and 19 (51.4%) in the second, respectively (p<0.05 and p<0.01). As to localization, the number of generalized, bilateral and synchronous ED increased from 21 (56.8%) to 30 (81.1%) (p<0.01). The DI also increased; while 8 patients (21.6%) presented greater rate in the routine EEG, 25 (67.6%) did so in the sleep-deprived EEG mainly during somnolence and sleep (p<0.01). Moreover, the paroxysms were also longer in the sleep-deprived EEG. Sleep-deprived EEG is a powerful tool in JME and can contribute significantly to the syndromic characterization of this syndrome.

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Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation

Clinical Neurophysiology ◽

10.1016/j.clinph.2014.10.015 ◽

2015 ◽

Vol 126 (8) ◽

pp. 1493-1497 ◽

Cited By ~ 11

Author(s):

Greta Gustafsson ◽

Anders Broström ◽

Martin Ulander ◽

Magnus Vrethem ◽

Eva Svanborg

Keyword(s):

Sleep Deprivation ◽

Epileptiform Discharges ◽

Eeg Recordings

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Video-EEG Recordings in Idiopathic Generalized Epilepsy, including Juvenile Myoclonic Epilepsy

Epilepsia ◽

10.1111/j.1528-1167.2006.00484_7.x ◽

2006 ◽

Vol 47 (3) ◽

pp. 664-664

Author(s):

Leanne Casaubon ◽

Richard Wennberg

Keyword(s):

Juvenile Myoclonic Epilepsy ◽

Myoclonic Epilepsy ◽

Idiopathic Generalized Epilepsy ◽

Eeg Recordings ◽

Generalized Epilepsy ◽

Video Eeg

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Effects of sleep deprivation on cortical excitability in patients affected by juvenile myoclonic epilepsy: a combined transcranial magnetic stimulation and EEG study

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.2004.041137 ◽

2006 ◽

Vol 77 (1) ◽

pp. 56-60 ◽

Cited By ~ 67

Author(s):

P Manganotti

Keyword(s):

Transcranial Magnetic Stimulation ◽

Sleep Deprivation ◽

Magnetic Stimulation ◽

Cortical Excitability ◽

Juvenile Myoclonic Epilepsy ◽

Myoclonic Epilepsy

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Source localization of epileptiform discharges in juvenile myoclonic epilepsy (JME) using magnetoencephalography (MEG)

Epilepsy Research ◽

10.1016/j.eplepsyres.2016.11.019 ◽

2017 ◽

Vol 129 ◽

pp. 67-73 ◽

Cited By ~ 2

Author(s):

Veeranna Gadad ◽

Sanjib Sinha ◽

Narayanan Mariyappa ◽

Ganne Chaithanya ◽

Velmurugan Jayabal ◽

...

Keyword(s):

Source Localization ◽

Juvenile Myoclonic Epilepsy ◽

Myoclonic Epilepsy ◽

Epileptiform Discharges

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P275 The extent and characteristics of diagnostic delay in axSpA: a systematic review

Rheumatology ◽

10.1093/rheumatology/keaa111.268 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Charles A Hay ◽

Sarah Ryan ◽

Jon Packham ◽

Christian D Mallen ◽

James A Prior

Keyword(s):

Systematic Review ◽

Back Pain ◽

Chronic Back Pain ◽

Lumbar Disc ◽

Diagnostic Delay ◽

Cross Sectional ◽

Mean Delay ◽

Median Delay ◽

Number Of Patients

Abstract Background Axial spondyloarthritis (axSpA) is an inflammatory arthritis predominantly affecting the spine. It is characterised by chronic back pain, stiffness and fatigue. As axSpA progresses it can cause disability, reduction in quality-of-life, depression and impacts on work. Prompt diagnosis is important, but symptoms associated with axSpA are common in the general population resulting in diagnostic delay. The reported diagnostic delay for axSpA varies in the literature, ranging from five to fifteen years. The aim of this review was to ascertain the extent of axSpA diagnostic delay and report on axSpA characteristics associated with diagnostic delay. Methods A systematic review was conducted to identify articles reporting diagnostic delay in axSpA. Inclusion criteria were studies including adult axSpA populations, cohort, cross-sectional or case-control design and reporting a median time-period of delay from axSpA symptom onset to final axSpA diagnosis (studies reporting mean delay were excluded due to skewness of data). Data was also extracted which related to delay as a result of specific axSpA characteristics. Narrative synthesis was used to report our findings. Results 9,848 articles were initially identified. After title, abstract and full-text review, 15 articles reported median diagnostic delay. Of these, 2 were from the UK, 2 from Germany, and 1 each from India, Norway, France, USA, Iran, Turkey, China and Italy. Combined, the total number of participants across eligible papers was 10,661. Though median delay ranged from ≤1 to 8 years, the majority (60%) of articles reported a median delay of between 2-5 years. Regarding the role of specific axSpA characteristics on delay, the most noted causes for delay were lack of extra-articular axSpA symptoms (5.9 vs. 8.7 years of delay for patients with and without extra-articular symptoms respectively) and misdiagnosis. Common misdiagnoses were lumbar disc herniation, rheumatoid arthritis and mechanical back pain (MBP), with the latter being significantly associated with delayed diagnosis (OR 2.83(95% CI 1.16-6.87)). Finally, delay is far from uniform, with a UK study reporting that 30.3% of patients are diagnosed within 2 years, 21% in 3-5 years, 19.9% in 6-10 years, 19.2% after 11-20 years and 9.6% after 20 years. Conclusion Though diagnostic delay of axSpA is considerable, affecting long term outcomes in a large number of patients, it is not as long as previously reported by using mean delay, which is more affected by bias (long term delays in small numbers of individuals) than median delay. Further research into the specific barriers and facilitators of delay is required to help reduce this delay in the future. Disclosures C.A. Hay None. S. Ryan None. J. Packham None. C.D. Mallen None. J.A. Prior None.

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Effect of Wrist Tapping on Interhemispheric Coherence in Patients with Juvenile Myoclonic Epilepsy

International Journal of Biomedicine ◽

10.21103/article11(1)_oa12 ◽

2021 ◽

Vol 11 (1) ◽

pp. 73-77

Author(s):

Ekaterina Narodova ◽

Natalia Shnayder ◽

Vladislav Karnaukhov ◽

Olesya Bogomolova ◽

Kirill Petrov ◽

...

Keyword(s):

Healthy Volunteers ◽

Epileptic Seizures ◽

Juvenile Myoclonic Epilepsy ◽

Myoclonic Epilepsy ◽

Control Group ◽

Alpha Band ◽

Epileptiform Discharges ◽

Interhemispheric Coherence ◽

Before And After ◽

The Brain

The aim of this study was to assess the dynamics of interhemispheric coherence (IC) as an indicator of integration of different areas of the brain and their participation in the performance of certain functions before and after wrist tapping (WT), using the author's method in juvenile myoclonic epilepsy (JME). Methods and Results: The study included 81 subjects of working age, including 51 clinically healthy volunteers (median age of 39[21;56] years) and 30 patients (median age of 27[23;38] years) with JME. Analysis of IC in the electrode pairs Fp1-Fp2, F3-F4, C3-C4, T3-T4 was performed using a computer encephalographic complex. A coherent EEG analysis was used to identify and evaluate the relationships between different areas of the brain. Based on the change in the coherence coefficients (CCs), the level of integrative activity of brain structures was quantified. In healthy volunteers, before and after WT, we observed a statistically significant decrease in CCs for the beta-1 band in the pairs Fp1-Fp2, F3-F4, and C3-C4 (P<0.05), while in the pair T3-T4, changes in CCs were not statistically significant (P>0.05). At the same time, a statistically significant decrease in CCs in the alpha band was found only in the frontal regions in the pairs Fp1-Fp2 and F3-F4 (P<0.05). No statistically significant changes were found in all the studied pairs in the theta band. When comparing CCs in JME patients in beta–1 and theta bands, before and after WT, we did not find statistically significant changes in CCs in all the studied electrode pairs. However, in the alpha band, we found a statistically significant decrease in CCs in the frontal region in the F3-F4 (P=0.0038) and C3-C4 electrode pairs (P=0.034). The results of the study of interhemispheric integration showed statistically significant differences between patients with JME and the control group. Conclusion: WT according to the author's method does not provoke the occurrence of interictal epileptiform discharges on the EEG and epileptic seizures in patients with JME. Coherent analysis showed positive changes in interhemispheric integrations of neurons in the beta–1 and alpha frequency ranges, mainly in the anterior hemispheres.

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