A Neuromorphic Spiking Neural Network Detects Epileptic High Frequency Oscillations in the Scalp EEG

Background: Interictal High Frequency Oscillations (HFO) are measurable in scalp EEG. This has aroused interest in investigating their potential as biomarkers of epileptogenesis, seizure propensity, disease severity, and treatment response. The demand for therapy monitoring in epilepsy has kindled interest in compact wearable electronic devices for long- term EEG recording. Spiking neural networks (SNN) have been shown to be optimal architectures for being embedded in compact low-power signal processing hardware. Methods: We analyzed 20 scalp EEG recordings from 11 patients with pediatric focal lesional epilepsy. We designed a custom SNN to detect events of interest (EoI) in the 80-250 Hz ripple band and reject artifacts in the 500-900 Hz band. Results: We identified the optimal SNN parameters to automatically detect EoI and reject artifacts. The occurrence of HFO thus detected was associated with active epilepsy with 80% accuracy. The HFO rate mirrored the decrease in seizure frequency in 8 patients (p = 0.0047). Overall, the HFO rate correlated with seizure frequency (rho = 0.83, p < 0.0001, Spearman’s correlation).Conclusions: The fully automated SNN detected clinically relevant HFO in the scalp EEG. This is a further step towards non-invasive epilepsy monitoring with a low-power wearable device.

Epidemiology and Pathophysiology of Epilepsy

About 10% of people in the United States have 1 seizure in their lifetime; less than 4% have recurrent seizures or epilepsy. Currently, more than 3.4 million people in the United States have active epilepsy, making it one of the most common neurologic disorders. Seizures can develop at any age, but the most common times are during childhood and after age 60 years. The greatest incidence is in elderly patients. Acute symptomatic seizures (also called provoked seizures or reactive seizures) result from new and active insults to the central nervous system.

Epidemiology of Epilepsy in Nigeria

BackgroundWe determined the prevalence, incidence, and risk factors for epilepsy in Nigeria.MethodsWe conducted a door-to-door survey to identify cases of epilepsy in 3 regions. We estimated age-standardized prevalence adjusted for nonresponse and sensitivity and the 1-year retrospective incidence for active epilepsy. To assess potential risk factors, we conducted a case-control study by collecting sociodemographic and risk factor data. We estimated odds ratios using logistic regression analysis and corresponding population attributable fractions (PAFs).ResultsWe screened 42,427 persons (age ≥6 years), of whom 254 had confirmed active epilepsy. The pooled prevalence of active epilepsy per 1,000 was 9.8 (95% confidence interval [CI] 8.6–11.1), 17.7 (14.2–20.6) in Gwandu, 4.8 (3.4–6.6) in Afikpo, and 3.3 (2.0–5.1) in Ijebu-Jesa. The pooled incidence per 100,000 was 101.3 (95% CI 57.9–167.6), 201.2 (105.0–358.9) in Gwandu, 27.6 (3.3–128.0) in Afikpo, and 23.9 (3.2–157.0) in Ijebu-Jesa. Children's significant risk factors included febrile seizures, meningitis, poor perinatal care, open defecation, measles, and family history in first-degree relatives. In adults, head injury, poor perinatal care, febrile seizures, family history in second-degree relatives, and consanguinity were significant. Gwandu had more significant risk factors. The PAF for the important factors in children was 74.0% (71.0%–76.0%) and in adults was 79.0% (75.0%–81.0%).ConclusionThis work suggests varied epidemiologic numbers, which may be explained by differences in risk factors and population structure in the different regions. These variations should differentially determine and drive prevention and health care responses.

Quality of life and its predictors in adults with tuberous sclerosis complex (TSC): a multicentre cohort study from Germany

Background Tuberous sclerosis complex (TSC) is a monogenetic, multisystemic disease characterised by the formation of benign tumours that can affect almost all organs, caused by pathogenic variations in TSC1 or TSC2. In this multicentre study from Germany, we investigated the influence of sociodemographic, clinical, and therapeutic factors on quality of life (QoL) among individuals with TSC. Methods We assessed sociodemographic and clinical characteristics and QoL among adults with TSC throughout Germany using a validated, three-month, retrospective questionnaire. We examined predictors of health-related QoL (HRQoL) using multiple linear regression analysis and compared the QoL among patients with TSC with QoL among patients with other chronic neurological disorders. Results We enrolled 121 adults with TSC (mean age: 31.0 ± 10.5 years; range: 18–61 years, 45.5% [n = 55] women). Unemployment, a higher grade of disability, a higher number of organ manifestations, the presence of neuropsychiatric manifestations or active epilepsy, and a higher burden of therapy-related adverse events were associated with worse QoL, as measured by two QoL instruments (EuroQoL-5 dimensions [EQ-5D] and Quality of Life in Epilepsy Patients [QOLIE-31]). Neuropsychiatric and structural nervous system manifestations, the number of affected organs, and therapy-related adverse events were also associated with higher depression, as measured by the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). In multiple regression analysis, more severe therapy-related adverse events (large effect, p < 0.001), active epilepsy (large effect, p < 0.001), and neuropsychiatric manifestations (medium effect, p = 0.003) were independently associated with worse HRQoL, explaining 65% of the variance (p < 0.001). The HRQoL among patients with active TSC-associated epilepsy was worse than that among patients with drug-refractory mesial temporal lobe epilepsy (p < 0.001), and the generic QoL among patients with more than three TSC organ manifestations was similar to those of patients with severe migraine and uncontrolled asthma. Conclusions Active epilepsy, neuropsychiatric manifestations (such as anxiety and depression), and therapy-related adverse events are important independent predictors of worse quality of life among adults with TSC. Generic quality of life in TSC with several manifestations is similar to uncontrolled severe chronic diseases and significantly negatively correlates with TSC severity. Trial registration DRKS, DRKS00016045. Registered 01 March 2019.

Pre- and Postictal Changes in the Innate Immune System: Cause or Effect?

<b><i>Introduction:</i></b> Recent studies have shown that inflammatory processes might play a role in epileptogenesis. Their role in ictogenesis is much less clear. The aim of this study was to investigate peri-ictal changes of the innate immune system by analyzing changes of immune cells, as well as pro- and anti-inflammatory cytokines. <b><i>Methods:</i></b> Patients with active epilepsy admitted for video-EEG monitoring for presurgical evaluation were included. Blood was sampled every 20 min for 5 h on 3 consecutive days until a seizure occurred. After a seizure, additional samples were drawn immediately, as well as 1 and 24 h later. To analyze the different populations of peripheral blood mononuclear cells, all samples underwent FACS for CD3, CD4, CD8, CD56, CD14, CD16, and CD19. For cytokine analysis, we used a custom bead-based multiplex immunoassay for IFN-γ, IL-1β, IL-1RA, IL-4, IL-6, IL-10, IL-12, IL-17, MCP-1, MIP-1α, and TNFα. <b><i>Results:</i></b> Fourteen patients with focal seizures during the sampling period were included. Natural killer (NK) cells showed a negative correlation (<i>ρ</i> = −0.3362, <i>p</i> = 0.0195) before seizure onset and an immediate increase to 1.95-fold afterward. T helper (<i>T</i>_H) and B cells decreased by 2 and 8%, respectively, in the immediate postictal interval. Nonclassical and intermediate monocytes decreased not until 1 day after the seizures, and cytotoxic T (<i>T</i>_C) cells showed a long-lasting postictal increase by 4%. IL-10 and MCP-1 increased significantly after seizures, and IL-12 decreased in the postictal phase. <b><i>Discussion/Conclusion:</i></b> Our study argues for a role of the innate immune system in the pre- and postictal phases. NK cells might be involved in preictal changes or be altered as an epiphenomenon in the immediate preictal interval.

Clinical Profile and Prediction of Response to Treatment in Childhood Epilepsy - A Single-Centre Experience from Eastern India

BACKGROUND Though epilepsy remains a significant problem for children and adolescents in our country, studies delineating the clinical profile and response to treatment in childhood epilepsy are lacking. The current study was carried out for obtaining a baseline profile and to predict the response to treatment in childhood epilepsy in India that may be helpful in planning management strategies from a public health point of view. METHODS Patients with clinical suggestion of active epilepsy (N = 141) from one month to 12 years, were enrolled into the study over a period of 1 year (February 2010 to January 2011) from the out-patient department and epilepsy clinic of Bangur Institute of Neurology. Detailed history was taken along with neurological examination. Electroencephalography (EEG) and neuroimaging (MRI / CT scan) were done on all patients. Each patient included in the study was kept in followup for a period of 6 months and their response to the treatment was recorded. RESULTS About 48.9 % (N = 69) patients had localisation related epilepsy while the rest had generalised epilepsy. Of those with generalised epilepsy, generalised tonicclonic seizures (GTCS) was by far the most common type. Of those with focal EEG activity, the highest proportion (50 %), were localised to the temporal lobe. Symptomatic aetiology accounted for 59.6 % (N = 84) of the patients. 20.6 % (N = 29) had poor response to treatment at 6 months follow-up. Abnormal neuroimaging (OR = 6.708) and abnormal EEG (OR = 6.357) were effective factors in predicting poor response to treatment. CONCLUSIONS Our study highlights the need to link specialised epilepsy services with primary health centres for early detection and treatment. EEG is an essential cost-effective modality in determining seizure localisation and response to treatment. KEYWORDS Paediatric, Epilepsy, Clinical Profile, Response to Treatment

Neurocysticercosis in patients with active epilepsy in the tea garden community of Assam, Northeast India

Neurocysticercosis is a significant cause of epilepsy in the tropics. The present cross-sectional survey was conducted in the socioeconomically backward tea garden community of Assam to gauge the prevalence of neurocysticercosis in patients with active epilepsy and to determine the associated risk factors. In a door to door survey, a total of 1028 individuals from every fifth household of the study Teagarden were enrolled to identify self-reported seizure cases, followed by a neurological examination to confirm the diagnosis of active epilepsy. Patients with active epilepsy underwent clinical, epidemiological, neuroimaging (contrast-enhanced computerized tomography) and immunological evaluations to establish the diagnosis of neurocysticercosis. Clinically confirmed 53 (5.16%) active epilepsy were identified; 45 agreed to further assessment for neurocysticercosis and 19 (42.2%) cases fulfilled either definitive or probable diagnostic criteria for neurocysticercosis. Patients with epilepsy due to neurocysticercosis were more likely to suffer from taeniasis (20.0% vs 0.0%), rear pigs (57.9% vs 15.4%) or have pigs in their neighbourhood (78.9% vs 53.8%) relative to epileptic patients without neurocysticercosis. Rearing pigs (aOR 14.35, 95% CI: 3.98–51.75) or having pigs in the neighbourhood (aOR 12.34, 95% CI: 2.53–60.31) were independent risk factors of neurocysticercosis. In this community, the prevalence of taeniasis (adult worm infection) was 6.6% based on microscopy. The study reports a high prevalence of active epilepsy in the tea garden community of Assam and neurocysticercosis as its primary cause. The high prevalence of taeniasis is also a significant concern.

How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries

New-onset refractory status epilepticus (NORSE) is a rare clinical presentation of refractory status epilepticus (RSE) that occurs in people without active epilepsy or preexisting neurologic disorder. Febrile infection-related epilepsy syndrome (FIRES) is a subcategory of NORSE. New-onset refractory status epilepticus/FIRES are becoming increasingly recognized; however, information pertaining to disease course, clinical outcomes, and survivorship remains limited, and mortality and morbidity are variable, but often high. The objective of the NORSE/FIRES Family Registry is to (1) provide an easily accessible and internationally available multilingual registry into which survivors or NORSE/FIRES surrogates or family members of people affected by NORSE/FIRES or their physicians can enter data in a systematic and rigorous research study from anywhere in the world where internet is available; and (2) to examine past medical history, outcomes, and quality of life for people affected by NORSE/FIRES.

Neuroimaging Patterns and Function in Cerebral Palsy—Application of an MRI Classification

Background: Cerebral palsy (CP) is a disorder of movement and posture and every child with CP has a unique composition of neurological symptoms, motor severity, and associated impairments, constituting the functional profile. Although not part of the CP definition, magnetic resonance imaging (MRI) sheds light on the localization, nature, and severity of brain compromise. The MRI classification system (MRICS), developed by the Surveillance of Cerebral Palsy in Europe (SCPE), describes typical MRI patterns associated with specific timing of vulnerability in different areas of the brain. The classification has proven to be reliable and easy to use.Aims: The aim of this study is to apply the MRICS on a large dataset and describe the functional profile associated with the different MRI patterns of the MRICS.Materials and Methods: Data on children with CP born in 1999–2009 with a post-neonatal MRI from 20 European registers in the JRC-SCPE Central Registry was included. The CP classification and the MRICS was applied, and The Gross Motor Function Classification (GMFCS) and the Bimanual Fine Motor Function (BFMF) classification were used. The following associated impairments were documented: intellectual impairment, active epilepsy, visual impairment, and hearing impairment. An impairment index was used to characterize severity of impairment load.Results: The study included 3,818 children with post-neonatal MRI. Distribution of CP type, motor, and associated impairments differed by neuroimaging patterns. Functional profiles associated with neuroimaging patterns were described, and the impairment index showed that bilateral findings were associated with a more severe outcome both regarding motor impairment and associated impairments than unilateral compromise. The results from this study, particularly the differences in functional severity regarding uni- and bilateral brain compromise, may support counseling and service planning of support of children with CP.