Factors influencing seizure induction in patients with intracranial EEG recording.

Objective: To shorten inpatient epilepsy monitoring unit (EMU) stays during epilepsy surgery evaluation, physicians utilize techniques to induce seizures including antiseizure medication (ASM) reduction, sleep deprivation, and chemical stimulation. We assessed the relative efficacy of these techniques.

Methods: We reviewed data from patients admitted for intracranial video-EEG (electroencephalography) evaluation at a single center.

Interictal Epileptiform Discharge Detection Using Multi-Head Deep Convolutional Neural Network.

Interictal epileptiform discharges (IEDs) are intermittent electrophysiological events that occur in patients with epilepsy between seizures. Automated detection of IEDs helps clinician to identify cortical irritations and relations to seizure recurrence. It also reduces the necessity of visual inspection by physicians interpreting the EEG.

SEEG-based epileptic seizure network modeling and analysis for pre-surgery evaluation.

Stereo-electroencephalography is a minimally invasive technique for patients with refractory epilepsy pursuing surgery to reduce or control seizures. Electrodes are implanted based on pre-surgery evaluations and can collect deep brain activities for surgery decisions. This paper presents a methodology to analyze stereo-electroencephalography and assist clinicians by recommending the optimal surgical option and target areas for focal epilepsy patients.

Seizure onset patterns predict outcome after stereo-electroencephalography-guided laser amygdalohippocampotomy.

Objective: Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (stereo-EEG) may miss seizure onset elsewhere. We hypothesized that stereo-EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control.

Single center outcomes of intracranial evaluation and surgical intervention in the elderly population.

Objective: The object of this case series is to report the effectiveness and complication rates of presurgical evaluation and surgical treatment among elderly epilepsy patients in our clinic.

Methods: We reviewed patients charts from 2016 to 2020 and identified patients over the age of 55 years of age who underwent intracranial EEG, resection, and device placement. We compared the complications and post-intervention outcomes of 14 different patients.

A randomized phase 2b efficacy study in patients with seizure episodes with a predictable pattern using Staccato® alprazolam for rapid seizure termination.

Objective: Alprazolam administered via the Staccato® breath-actuated device is delivered into the deep lung for rapid systemic exposure and is a potential therapy for rapid epileptic seizure termination (REST). We conducted an inpatient study (ENGAGE-E-001 [NCT03478982]) in patients with stereotypic seizure episodes with prolonged or repetitive seizures to determine whether Staccato alprazolam rapidly terminates seizures in a small observed population after administration under direct supervision.

Methods: Adult patients with established diagnosis of focal and/or generalized epilepsy with a documented history of seizure episodes with a predictable pattern were enrolled.

Emergency department visits and readmissions in patients with psychogenic nonepileptic seizures (PNES) at a safety net hospital.

Introduction: Readmissions and emergency department (ED) visits after an index admission have been become a quality measure due to associations with poor outcomes and increased healthcare costs. Readmissions and ED encounters have been studied in a variety of conditions including epilepsy but have not been examined exclusively in psychogenic nonepileptic seizures (PNES). In this study we examined the rate of readmissions and ED visits after a discharge from an Epilepsy Monitoring Unit (EMU) in a safety net hospital.

Emergent Admissions to the Epilepsy Monitoring Unit in the Setting of COVID-19 Pandemic-related, State-mandated Restrictions: Clinical Decision Making and Outcomes.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the state of Texas-limited elective procedures to conserve beds and personal protective equipment (PPE); therefore, between March 22 and May 18, 2020, admission to the epilepsy monitoring unit (EMU) was limited only to urgent and emergent cases. We evaluated clinical characteristics and outcomes of these patients who were admitted to the EMU. Nineteen patients were admitted (one patient twice) with average age of 36.

Beyond the Wada: An updated approach to pre-surgical language and memory testing: An updated review of available evaluation techniques and recommended workflow to limit Wada test use to essential clinical cases.

The Intracarotid amobarbital test (IAT), also called Wada test, is considered the "gold standard" for lateralizing language dominance in the pre-surgical evaluation of patients with epilepsy. In addition, it has been further modified to assess the postoperative risk of amnesia in patients undergoing temporal lobectomy. Since then it has been utilized to lateralize language and assess pre-surgical memory function.

Non-lesional mesial temporal lobe epilepsy requires bilateral invasive evaluation.

Purpose: Mesial temporal lobe epilepsy (MTLE) usually responds well to surgical treatment, although in non-lesional cases up to 50% of patients experience seizure relapse. The possibility of bilateral independent seizure onset should be considered as a reason for epilepsy surgery failure.

Methods: In a cohort of 177 patients who underwent invasive presurgical evaluation with stereo-tactically placed electrodes in two level four epilepsy centers, 29 had non-lesional MTLE.

Personalized EEG Feature Selection for Low-Complexity Seizure Monitoring.

Approximately, one third of patients with epilepsy are refractory to medical therapy and thus can be at high risk of injuries and sudden unexpected death. A low-complexity electroencephalography (EEG)-based seizure monitoring algorithm is critically important for daily use, especially for wearable monitoring platforms. This paper presents a personalized EEG feature selection approach, which is the key to achieve a reliable seizure monitoring with a low computational cost.

Feature Selection Using F-statistic Values for EEG Signal Analysis.

Electroencephalography (EEG) is a highly complex and non-stationary signal that reflects the cortical electric activity. Feature selection and analysis of EEG for various purposes, such as epileptic seizure detection, are highly in demand. This paper presents an approach to enhance classification performance by selecting discriminative features from a combined feature set consisting of frequency domain and entropy based features.

Comparison of psychiatric comorbidities and impact on quality of life in patients with epilepsy or psychogenic nonepileptic spells.

Objectives: Psychiatric comorbidity is common in people with epilepsy (PWE) and psychogenic nonepileptic spells (PNES). These comorbidities can be detrimental to quality of life (QOL) and are often underdiagnosed and undertreated. Some types of epilepsy, such as focal temporal lobe epilepsy (TLE), have been associated with higher rates of psychiatric comorbidity.

Provocative induction of psychogenic nonepileptic seizures: Noninferiority of an induction technique without versus with placebo.

We aim to demonstrate, in a sufficiently powered and standardized study, that the success rate of inducing psychogenic nonepileptic seizures (PNES) without placebo (saline infusion) is noninferior to induction with placebo. The clinical data of 170 consecutive patients with suspected PNES who underwent induction with placebo from January 21, 2009 to March 31, 2013 were pair-matched with 170 consecutive patients with suspected PNES who underwent the same induction technique but without addition of placebo from April 1, 2013 to February 7, 2018 at the same center. The success rates of induction were 79.

Propofol-ketamine combination therapy for effective control of super-refractory status epilepticus.

Retrospective analysis was conducted of patients with SRSE who were treated simultaneously with propofol and ketamine. Sixty-seven patients were identified from 2012 to 2015, and outcomes documented were resolution and mortality. The duration of combined ketamine and propofol use ranged from 1 to 28 days (mean - 3.

Pyridoxine deficiency in adult patients with status epilepticus.

An 8-year-old girl treated at our facility for superrefractory status epilepticus was found to have a low pyridoxine level at 5 μg/L. After starting pyridoxine supplementation, improvement in the EEG for a 24-hour period was seen. We decided to look at the pyridoxine levels in adult patients admitted with status epilepticus.

Safety & pK of IV loading dose of lacosamide in the ICU.

A restrospective review of patients treated in the ICU for refractory status epilepticus who had received an initial IV loading dose of lacosamide (LCS) was performed. A total of 142 patients were identified. The first 34 patients received 400mg which by weight-based measurement ranged from 2 to 11 mg/kg.