Electromagnetic source imaging in presurgical workup of patients with epilepsy: A prospective study.

Objective: To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy.

Methods: We prospectively recorded magnetoencephalography (MEG) simultaneously with EEG and performed EMSI, comprising electric source imaging, magnetic source imaging, and analysis of combined MEG-EEG datasets, using 2 different software packages. As reference standard for irritative zone (IZ) and seizure onset zone (SOZ), we used intracranial recordings and for localization accuracy, outcome 1 year after operation.

Patient-reported outcome (PRO) measure-based algorithm for clinical decision support in epilepsy outpatient follow-up: a test-retest reliability study.

Objectives: Patient-reported outcome (PRO) measures have been used in epilepsy outpatient clinics in Denmark since 2011. The patients' self-reported PRO data are used by clinicians as a decision aid to support whether a patient needs contact with the outpatient clinic or not based on a PRO algorithm. Validity and reliability are fundamental to any PRO measurement used at the individual level in clinical practice.

Modified automatic R-peak detection algorithm for patients with epilepsy using a portable electrocardiogram recorder.

Earlier studies have shown that short term heart rate variability (HRV) analysis of ECG seems promising for detection of epileptic seizures. A precise and accurate automatic R-peak detection algorithm is a necessity in a real-time, continuous measurement of HRV, in a portable ECG device. We used the portable CE marked ePatch® heart monitor to record the ECG of 14 patients, who were enrolled in the videoEEG long term monitoring unit for clinical workup of epilepsy.

Effect of patient-initiated versus fixed-interval telePRO-based outpatient follow-up: study protocol for a pragmatic randomised controlled study.

Background: The traditional system of routine outpatient follow-up of chronic disease in secondary care may involve a waste of resources if patients are well. The use of patient-reported outcomes (PRO) could support more flexible, cost-saving follow-up activities. AmbuFlex is a PRO system used in outpatient follow-up in the Central Denmark Region.

Added diagnostic value of magnetoencephalography (MEG) in patients suspected for epilepsy, where previous, extensive EEG workup was unrevealing.

Objective: To elucidate the possible additional diagnostic yield of MEG in the workup of patients with suspected epilepsy, where repeated EEGs, including sleep-recordings failed to identify abnormalities.

Methods: Fifty-two consecutive patients with clinical suspicion of epilepsy and at least three normal EEGs, including sleep-EEG, were prospectively analyzed. The reference standard was inferred from the diagnosis obtained from the medical charts, after at least one-year follow-up.

Comparing maximum autonomic activity of psychogenic non-epileptic seizures and epileptic seizures using heart rate variability.

Purpose: The semiology of psychogenic non-epileptic seizures (PNES) can resemble epileptic seizures, and differentiation between epileptic seizures with no EEG-correlate and PNES can be challenging even for trained experts. Therefore, there has been a search for a quantitative measure, other than EEG and semiology that could distinguish PNES from epileptic seizures. We used ECG to measure heart rate variability (HRV) in order to compare maximum autonomic activity of epileptic seizures and PNES.

AmbuFlex: tele-patient-reported outcomes (telePRO) as the basis for follow-up in chronic and malignant diseases.

Purpose: A tele-patient-reported outcome (telePRO) model includes outpatients' reports of symptoms and health status from home before or instead of visiting the outpatient clinic. In the generic PRO system, AmbuFlex, telePRO is used to decide whether a patient needs an outpatient visit and is thus a tool for better symptom assessment, more patient-centred care, and more efficient use of resources. Specific PROs are developed for each patient group.

Visualizing spikes in source-space: Rapid and efficient evaluation of magnetoencephalography.

Objective: Reviewing magnetoencephalography (MEG) recordings is time-consuming: signals from the 306 MEG-sensors are typically reviewed divided into six arrays of 51 sensors each, thus browsing each recording six times in order to evaluate all signals. A novel method of reconstructing the MEG signals in source-space was developed using a source-montage of 29 brain-regions and two spatial components to remove magnetocardiographic (MKG) artefacts. Our objective was to evaluate the accuracy of reviewing MEG in source-space.

Long-term mortality in children and young adults with epilepsy--A population-based cohort study.

Purpose: Epilepsy is associated with an increased mortality. This study estimates the effects of co-morbid disorders on short-term and long-term mortality and presents cause-specific mortality for children and young adults with epilepsy.

Methods: We established a population-based cohort of 1,855,946 children born in Denmark from 1977 to 2006.

Exploring the capability of wireless near infrared spectroscopy as a portable seizure detection device for epilepsy patients.

Purpose: Near infrared spectroscopy (NIRS) has proved useful in measuring significant hemodynamic changes in the brain during epileptic seizures. The advance of NIRS-technology into wireless and portable devices raises the possibility of using the NIRS-technology for portable seizure detection.

Methods: This study used NIRS to measure changes in oxygenated (HbO), deoxygenated (HbR), and total hemoglobin (HbT) at left and right side of the frontal lobe in 33 patients with epilepsy undergoing long-term video-EEG monitoring.

Using Lorenz plot and Cardiac Sympathetic Index of heart rate variability for detecting seizures for patients with epilepsy.

Tachycardia is often seen during epileptic seizures, but it also occurs during physical exercise. In order to assess whether focal epileptic seizures can be detected by short term moving window Heart Rate Variability (HRV) analysis, we modified the geometric HRV method, Lorenz plot, to consist of only 30, 50 or 100 R-R intervals per analyzed window. From each window we calculated the longitudinal (L) and transverse (T) variability of Lorenz plot to retrieve the Cardiac Sympathetic Index (CSI) as (L/T) and "Modified CSI" (described in methods), and compared the maximum during the patient's epileptic seizures with that during the patient's own exercise and non-seizure sessions as control.

Detection of epileptic seizures with a modified heart rate variability algorithm based on Lorenz plot.

Purpose: In order to assess whether focal epileptic seizures can be detected and distinguished from exercise we evaluated four different heart rate variability (HRV) methods with short term moving window analysis of 30, 50 or 100 R-R intervals or seconds per analyzed window.

Methods: The four methods consisted of: (1) reciprocal high frequency power based on Fast Fourier Transformation, (2) Cardiac Sympathetic Index (CSI), (3) Modified CSI both based on Lorenz plot, and (4) heart rate differential method. Seventeen patients (12 males, 5 females; age 20-55) had 47 seizures (including three secondary generalized tonic-clonic (sGTC)), which were analyzed during their long term video-EEG monitoring of 1-5 days duration.

Epidemiology of epilepsy in adults: implementing the ILAE classification and terminology into population-based epidemiologic studies.

The new proposal for Revised Terminology for Organization of Seizures and Epilepsies published in 2010 poses challenges to all fields of epilepsy including epidemiology. We describe efforts to incorporate the new terminology and classification into population-based health registers in Denmark in order to provide the background for assessment of the quality of epilepsy care, epidemiologic studies of epilepsy, and clinical trials in adults.

Lack of interaction between sertraline and lamotrigine in psychiatric patients: a retrospective study.

Introduction: This study evaluates the pharmacokinetic interaction between sertraline and lamotrigine in psychiatric patients.

Methods: We identifi ed patients with at least 1 measurement of trough lamotrigine plasma concentration (at steady-state) during lamotrigine therapy and compared dose and plasma concentrations between patients who received lamotrigine with sertraline and patients who received lamotrigine without sertraline.

Results: The dose corrected concentration of lamotrigine in patients receiving lamotrigine in combination with sertraline was 60.

Detection of epileptic-seizures by means of power spectrum analysis of heart rate variability: a pilot study.

Objective: To investigate whether epileptic seizures could be predicted or detected by means of spectral analysis of heart rate variability (HRV).

Methods: Six patients with temporal lobe epilepsy (4 females, 2 males) participated in the prospective pilot study while enrolled for video/EEG monitoring (24 h/day, 2-4 days). ECG was continuously recorded and 30 min seizure-sessions (25-30 min pre-seizure to 30 sec-5 min post-seizure onset) and 30 min non-seizure-sessions (day- and night sessions for each patient, as control) were chosen for further HRV-analysis.

[Epilepsy treatment by vagus nerve stimulation].

Epilepsy is a common neurological disorder, and between one fourth and one third of the patients do not obtain seizure freedom after treatment with antiepileptic drugs. If the epileptic seizures in such patients have severe consequences, the patients should be assessed for epilepsy surgery. In case epilepsy surgery is not feasible, vagus nerve stimulation (VNS) should be offered.

Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study.

Background: The risk of epilepsy shortly after traumatic brain injury is high, but how long this high risk lasts is unknown. We aimed to assess the risk of epilepsy up to 10 years or longer after traumatic brain injury, taking into account sex, age, severity, and family history.

Methods: We identified 1 605 216 people born in Denmark (1977-2002) from the Civil Registration System.

Incidence and prevalence of epilepsy in Denmark.

Purpose: To estimate the occurrence of epilepsy in Denmark between 1977 and 2002, taking gender, age, and secular trends into consideration.

Methods: We used the Danish Civil Registration System to identify all persons born in Denmark and the Danish National Hospital Register to identify persons registered with epilepsy between 1977 and 2002.

Results: Between 1977 and 2002 the average incidence of epilepsy was 68.

Validation of epilepsy diagnoses in the Danish National Hospital Register.

Purpose: To validate the diagnosis of epilepsy in the Danish National Hospital Register.

Methods: We randomly selected 200 patients registered with epilepsy in the Danish National Hospital Register between 1977 and 2002 and validated the diagnosis according to the guidelines developed by the International League Against Epilepsy.

Results: We reviewed the medical records of 188 (94%) persons from 57 departments at 41 hospitals.

Oral contraceptives induce lamotrigine metabolism: evidence from a double-blind, placebo-controlled trial.

Purpose: This study evaluates the effect of oral contraceptives on lamotrigine (LTG) plasma concentrations and urine excretion of LTG metabolites in a double-blind, placebo-controlled, crossover study in patients with epilepsy.

Methods: Women with epilepsy, treated with LTG in monotherapy and taking combination-type oral contraceptives, were randomized to treatment with placebo or a standard combination-type contraceptive pill. The dose-corrected trough plasma concentration of LTG and the ratio of N-2-glucuronide/unchanged LTG on urine after 21 days of concomitant placebo treatment was analyzed versus those after 21 days of concomitant treatment with the oral contraceptive pill.

The long-term risk of epilepsy after febrile seizures in susceptible subgroups.

A family history of seizures, preexisting brain damage, or birth complications may modify the long-term risk of epilepsy after febrile seizures. The authors evaluated the association between febrile seizures and epilepsy in a population-based cohort of 1.54 million persons born in Denmark (1978-2002), including 49,857 persons with febrile seizures and 16,481 persons with epilepsy.

Oxcarbazepine concentrations during pregnancy: a retrospective study in patients with epilepsy.

We assessed the concentration of the oxcarbazepine metabolite 10-hydroxycarbazepine (MHD) in nine pregnancies among seven women before, during, and after pregnancy. The mean dose-corrected concentration of MHD was decreased during pregnancy (analysis of variance, p = 0.0016), being 72% (SD = 13%) in the first trimester, 74% (SD = 17%) in the second trimester, 64% (SD = 6%) in the third trimester, and 108% (SD = 18%) after pregnancy vs the dose-corrected concentration before pregnancy.

Gender differences in epilepsy.

Purpose: The aim of this study was to look at gender differences in unselected populations of patients with epilepsy classified according to the 1989 International League Against Epilepsy (ILAE) criteria.

Methods: Data were obtained from two sources: (a) the EpiBase database at the outpatient clinic at the Department of Neurology, Aarhus University Hospital, Denmark, confined to adults with epilepsy (n=2,170), and (b) the Danish Twin Registry (n=318).

Results: In localization-related epilepsy, no overall gender difference was found in either the EpiBase population (n=1,511; w=750 (50%), m=761 (50%); p=0.