When do psychogenic nonepileptic seizures occur on a video/EEG telemetry unit?

To maximize the efficiency of diagnostic video/EEG telemetry, we retrospectively studied the occurrence of clinical events during admission in 254 patients. One hundred fifty-nine patients had psychogenic nonepileptic seizures (PNES) and 95 had epileptic seizures (ES). Twenty-five with PNES and none with ES had an event before or during electrode placement (P<0.

Hemodynamic correlates of epileptiform discharges: an EEG-fMRI study of 63 patients with focal epilepsy.

Using continuous EEG-correlated fMRI, we investigated the Blood Oxygen Level Dependent (BOLD) signal correlates of interictal epileptic discharges (IEDs) in 63 consecutively recruited patients with focal epilepsy. Semi-automated spike detection and advanced modeling strategies are introduced to account for different EEG event types, and to minimize false activations from uncontrolled motion. We show that: (1) significant hemodynamic correlates were detectable in over 68% of patients in whom discharges were captured and were highly, but not entirely, concordant with site(s) of presumed seizure generation where known; (2) deactivations were less concordant and may non-specifically reflect the consequential or downstream effects of IEDs on brain activity; (3) a striking pattern of retrosplenial deactivation was observed in 7 cases mainly with focal discharges; (4) the basic hemodynamic response to IEDs is physiological; (5) incorporating information about different types of IEDs, their durations and saturation effects resulted in more powerful models for the detection of fMRI correlates; (6) focal activations were more likely when there was good electroclinical localization, frequent stereotyped spikes, less head motion and less background EEG abnormality, but were also seen in patients in whom the electroclinical focus localization was uncertain.

EEG-fMRI of idiopathic and secondarily generalized epilepsies.

We used simultaneous EEG and functional MRI (EEG-fMRI) to study generalized spike wave activity (GSW) in idiopathic and secondary generalized epilepsy (SGE). Recent studies have demonstrated thalamic and cortical fMRI signal changes in association with GSW in idiopathic generalized epilepsy (IGE). We report on a large cohort of patients that included both IGE and SGE, and give a functional interpretation of our findings.

EEG/functional MRI in epilepsy: The Queen Square Experience.

The recording of EEG during functional MRI scanning (EEG/fMRI) has opened up new dimensions in brain research. The simultaneous recording of EEG activity and its temparospatial haemodynamic correlates is a powerful tool in the non-invasive mapping of normal and pathological brain function. The technological constraints imposed by having a conductor (the EEG) within the magnetic environment of the MRI scanner have been sufficiently overcome for high quality EEG recording during MRI.

Mapping of spikes, slow waves, and motor tasks in a patient with malformation of cortical development using simultaneous EEG and fMRI.

We report on the simultaneous and continuous acquisition of EEG and functional MRI data in a patient with a left hemiparesis and focal epilepsy secondary to malformation of cortical development in the right hemisphere. EEG-triggered fMRI localization was previously demonstrated in this patient. In the experiments reported here, 322 spikes maximum at electrode C4 and 126 focal slow waves were identified offline.

EEG quality during simultaneous functional MRI of interictal epileptiform discharges.

This article concerns the evaluation of the quality of interictal epileptiform EEG discharges recorded throughout simultaneous echo planar imaging (EPI). BOLD (blood oxygen level dependent) functional MRI (fMRI) images were acquired continuously on a patient with intractable epilepsy. EEG was sampled simultaneously, during and after imaging, with removal of pulse and imaging artifacts by subtraction of channel-specific running averages.

Functional magnetic resonance imaging of human absence seizures.

We studied a patient with idiopathic generalized epilepsy and frequent absences, using electroencephalogram-correlated functional magnetic resonance imaging. Four prolonged runs of generalized spike-wave discharge occurred during a 35-minute experiment. Time-locked activation was observed bilaterally within the thalami in conjunction with widespread but symmetrical cortical deactivation with a frontal maximum.

Simultaneous EEG-Correlated Ictal fMRI.

The ability to continuously acquire simultaneous EEG and fMRI data during seizures presents a formidable challenge both clinically and technically. Published ictal fMRI reports have so far been unable to benefit from simultaneous electrographic recordings and remain largely assumptive. Unique findings from a Continuous EEG-correlated fMRI experiment are presented in which a focal subclinical seizure was captured in its entirety.

Role of functional magnetic resonance imaging in the evaluation of patients with malformations caused by cortical development.

As functional MR imaging (fMRI) continues to offer unparalleled advantages in probing neural activity, diagnostic applications continue to flourish. The evaluation of malformations caused by abnormalities of cortical development is an area in which fMRI has an emerging role and potential to provide new insights into epileptogenesis through multimodal integration with electroencephalagraphy. The clinical impact, however, is just beginning to be felt as new data emerge.