The brain-heart connection: Value of concurrent ECG and EEG recordings in epilepsy management.

Concurrent electrocardiogram (ECG) and electroencephalogram (EEG) recording both ictally and interictally has significant value in the comprehensive management of epilepsy. This review highlights the diagnostic utility of simultaneous ECG and EEG monitoring in differentiating between epileptic and cardiac events, detecting cardiac abnormalities, and identifying autonomic dysfunction. The critical role of this combined approach to defining the mechanisms underlying cardiac morbidity and sudden cardiac death in patients with epilepsy and in guiding therapeutic interventions is underscored.

The unforeseen future: Impacts of the COVID-19 pandemic on home video-EEG telemetry.

The coronavirus disease 2019 (COVID-19) pandemic had widespread impact on health care systems globally-particularly services arranged around elective admission and attendance such as epilepsy monitoring units and home video-EEG telemetry (HVET). Here, we review the ongoing impacts of the pandemic on HVET services among several different providers who used different initial models of HVET. We discuss the features of HVET that led to success in providing continued diagnostic services to patients with epilepsy and related disorders and through retrospective audit of our services demonstrate the high diagnostic yield of HVET.

How much time is enough? Establishing an optimal duration of recording for ambulatory video EEG.

Objective: Ambulatory video EEG allows for extended recording of EEG in the comfort of a patient's home. However, the optimal duration of recording to capture clinical events is yet to be established. The current study uses retrospective analyses to identify an optimal recording duration for at-home video EEG.

Seizure symptoms and ambulatory EEG findings: incidence of epileptiform discharges.

Aims: Ambulatory video-EEG monitoring has been utilized as a cost-effective alternative to inpatient video-EEG monitoring for non-surgical diagnostic evaluation of symptoms suggestive of epileptic seizures. We aimed to assess incidence of epileptiform discharges in ambulatory video-EEG recordings according to seizure symptom history obtained during clinical evaluation.

Methods: This was a retrospective cohort study.

Past, Present and Future of Home video-electroencephalographic telemetry: A review of the development of in-home video-electroencephalographic recordings.

Video-electroencephalographic (EEG) monitoring is an essential tool in epileptology, conventionally carried out in a hospital epilepsy monitoring unit. Due to high costs and long waiting times for hospital admission, coupled with technological advances, several centers have developed and implemented video-EEG monitoring in the patient's home (home video-EEG telemetry [HVET]). Here, we review the history and current status of three general approaches to HVET: (1) supervised HVET, which entails setting up video-EEG in the patient's home with daily visiting technologist support; (2) mobile HVET (also termed ambulatory video-EEG), which entails attaching electrodes in a health care facility, supplying the patient and carers with the hardware and instructions, and then asking the patient and carer to set up recording at home without technologist support; and (3) cloud-based HVET, which adds to either of the previous models continuous streaming of video-EEG from the home to the health care provider, with the option to review data in near real time, troubleshoot hardware remotely, and interact remotely with the patient.

The real-world economic impact of home-based video electroencephalography: the payer perspective.

Electroencephalography (EEG) is an established method to evaluate and manage epilepsy; video EEG (VEEG) has significantly improved its diagnostic value. This study compared healthcare costs and diagnostic-related outcomes associated with outpatient vs inpatient VEEG among patients with epilepsy in the US. This study used Truven MarketScan Commercial and Medicare Supplemental claims databases.

A Continuous Clustering Algorithm for Detection of Local Sleep in Humans.

Objective: Research in animal models has shown that many EEG sleep features reflect local conditions, which is a consequence of relative inactivity of neuronal clusters. In humans, the authors previously reported that focal sleep patterns appear on the cortex during the wake state and suggested that this underlies the condition described as drowsiness. The focal changes at individual electrodes appeared as a combination of increased instantaneous amplitude in the delta band and decreased instantaneous frequency in the theta-alpha band during non-REM sleep, with the opposite occurring during the wake state, permitting their categorization as "active" and "inactive.

Outcome of ambulatory video-EEG monitoring in a ˜10,000 patient nationwide cohort.

Purpose: We evaluate outcome of in-home diagnostic ambulatory video-EEG monitoring (AVEM) performed on a nationwide cohort of patients over one calendar year, and we compare our findings with outcomes of inpatient adult and pediatric VEM performed during the same year at two academic epilepsy centers.

Methods: This is a retrospective cohort study. We obtained AVEM outcome data from an independent ambulatory-EEG testing facility.

Analysis of Morbidity and Outcomes Associated With Use of Subdural Grids vs Stereoelectroencephalography in Patients With Intractable Epilepsy.

Importance: A major change has occurred in the evaluation of epilepsy with the availability of robotic stereoelectroencephalography (SEEG) for seizure localization. However, the comparative morbidity and outcomes of this minimally invasive procedure relative to traditional subdural electrode (SDE) implantation are unknown.

Objective: To perform a comparative analysis of the relative efficacy, procedural morbidity, and epilepsy outcomes consequent to SEEG and SDE in similar patient populations and performed by a single surgeon at 1 center.

Laser ablation for mesial temporal lobe epilepsy: Surgical and cognitive outcomes with and without mesial temporal sclerosis.

Objectives: Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique for focal epilepsy. A major appeal of LITT is that it may result in fewer cognitive deficits, especially when targeting dominant hemisphere mesial temporal lobe (MTL) epilepsy. To evaluate this, as well as to determine seizure outcomes following LITT, we evaluated the relationships between ablation volumes and surgical or cognitive outcomes in 43 consecutive patients undergoing LITT for MTL epilepsy.

Efficacy of antiepileptic drugs in the adjunctive treatment of refractory partial-onset seizures: Meta-analysis of pivotal trials.

Objective: In the absence of randomized clinical trials (RCTs) assessing the relative efficacy of antiepileptic drugs (AEDs), meta-analyses are useful resources for informing treatment choices. This meta-analysis assesses the relative efficacy and tolerability of AEDs for adjunctive treatment of refractory partial onset seizures (POS).

Methods: A systematic literature review was conducted to identify pivotal AED trials serving as the basis for US Food and Drug Administration (FDA) approval.

A simple clinical score for prediction of nonepileptic seizures.

Psychogenic nonepileptic seizures (PNES), often mistaken for epilepsy in community practice, require inpatient video-EEG (VEEG) monitoring for diagnostic confirmation. We developed a simple score designed for use in an outpatient setting to predict the subsequent VEEG diagnosis of PNES. We retrospectively compared fifty-five consecutive patients with VEEG-proven PNES (N=55) with a group of randomly selected patients with VEEG-proven epilepsy (N=55).

Focal Changes to Human Electrocorticography With Drowsiness: A Novel Measure of Local Sleep.

Drowsiness may be defined as the progressive loss of cortical processing efficiency that occurs with time passing while awake. This loss of cortical processing efficiency is reflected in focal changes to the electroencephalogram, including islands of increased delta power concurrent with drop-offs in neuronal activity (i.e.

Surgical Resection for Epilepsy Following Cerebral Gunshot Wounds.

Objective: The surgical management of epilepsy after penetrating gunshot wounds (GSWs) to the head has not been described in the modern era. Given the extensive damage to the cranium and cortex from such injuries, the safety and efficacy of surgical intervention are unclear. We report surgical strategy and outcomes after resection for medically refractory epilepsy following GSWs in 4 patients.

A unified statistical model for the human electrocorticogram.

Objective: Extracellular field potentials (ECFs) generated in the cerebral cortex span a vast range of spatiotemporal scales. The process(es) leading to this large dynamic range remain debatable. Here we propose a novel statistical description of the amplitude spectrum of the human electrocorticogram (ECoG).

Reactivation of visual-evoked activity in human cortical networks.

In the absence of sensory input, neuronal networks are far from being silent. Whether spontaneous changes in ongoing activity reflect previous sensory experience or stochastic fluctuations in brain activity is not well understood. Here we demonstrate reactivation of stimulus-evoked activity that is distributed across large areas in the human brain.

Automatic Vagus Nerve Stimulation Triggered by Ictal Tachycardia: Clinical Outcomes and Device Performance--The U.S. E-37 Trial.

Objectives: The Automatic Stimulation Mode (AutoStim) feature of the Model 106 Vagus Nerve Stimulation (VNS) Therapy System stimulates the left vagus nerve on detecting tachycardia. This study evaluates performance, safety of the AutoStim feature during a 3-5-day Epilepsy Monitoring Unit (EMU) stay and long- term clinical outcomes of the device stimulating in all modes.

Materials And Methods: The E-37 protocol (NCT01846741) was a prospective, unblinded, U.

Periodic Lateralized Epileptiform Discharges and Afterdischarges: Common Dynamic Mechanisms.

Purpose: No neurophysiological hypothesis currently exists addressing how and why periodic lateralized epileptiform discharges (PLEDs) arise in certain types of brain disease. Based on spectral analysis of clinical scalp EEG traces, the authors formulated a general mechanism for the emergence of PLEDs.

Methods: The authors retrospectively analyzed spectra of PLED time series and control EEG segments from the opposite hemisphere in 25 hospitalized neurological patients.

An interictal EEG spectral metric for temporal lobe epilepsy lateralization.

Objective: Visually-obvious abnormalities in the resting baseline EEG--slowing, spiking and high-frequency oscillations (HFOs)--are cardinal, though incompletely understood, features of the seizure onset zone in focal epilepsy. We hypothesized that evidence of cortical network dysfunction in temporal lobe epilepsy (TLE) would persist in the absence of visually-classifiable abnormalities in the baseline EEG recorded within the conventional passband, and that metrics of such dysfunction could serve as a lateralizing diagnostic in TLE.

Methods: Epochs of resting EEG without significant abnormalities in light sleep over several days were compared between a group of 10 patients with proven TLE and 10 subjects without epilepsy.

Stereotactic laser ablation of epileptogenic periventricular nodular heterotopia.

Periventricular nodular heterotopia (PVNH) is a neuronal migrational disorder often associated with pharmacoresistant epilepsy (PRE). Resective surgery for PVNH is limited by its deep location, and the overlying eloquent cortex or white matter. Stereotactic MR guided laser interstitial thermal therapy (MRgLITT) has recently become available for controlled focal ablation, enabling us to target these lesions.

Dynamic mechanisms underlying afterdischarge: a human subdural recording study.

Objective: No synoptic understanding exists of how and why afterdischarges (ADs) occur following electrical stimulation of the cerebral cortex. Based on human observations, we formulated a general mechanism for the emergence of ADs.

Methods: We retrospectively analysed spectra of AD time-series and control segments of the resting electrocorticogram (ECoG) in 15 epilepsy patients who underwent cortical stimulation mapping.

Characterization of interictal epileptiform discharges with time-resolved cortical current maps using the helmholtz-hodge decomposition.

Source estimates performed using a single equivalent current dipole (ECD) model for interictal epileptiform discharges (IEDs) which appear unifocal have proven highly accurate in neocortical epilepsies, falling within millimeters of that demonstrated by electrocorticography. Despite this success, the single ECD solution is limited, best describing sources which are temporally stable. Adapted from the field of optics, optical flow analysis of distributed source models of MEG or EEG data has been proposed as a means to estimate the current motion field of cortical activity, or "cortical flow.

Quality assessment of electroencephalography obtained from a "dry electrode" system.

This study examines the difference in application times for routine electroencephalography (EEG) utilizing traditional electrodes and a "dry electrode" headset. The primary outcome measure was the time to interpretable EEG (TIE). A secondary outcome measure of recording quality and interpretability was obtained from EEG sample review by two blinded clinical neurophysiologists.