Approximately 8% to 10% of the population will experience a seizure during their lifetime. Only about 2% to 3% of patients go on to develop epilepsy. Understanding the underlying etiology leading to ...an accurate diagnosis is necessary to ensure appropriate treatment and that patients with low risk for recurrence are not treated unnecessarily.
Patients can present with new-onset seizure for a variety of reasons such as acute symptomatic seizures due to acute brain injury or metabolic derangements, or unprovoked seizures that are the initial manifestation of epilepsy. A patient history and physical examination may identify features more consistent with an epileptic event and laboratory studies and brain imaging can identify an acute insult contributing to the presentation. Patients diagnosed with first-time unprovoked seizure require electroencephalography and epilepsy protocol-specific magnetic resonance imaging of the brain, which includes thin-cut coronal slices to determine risk of recurrence and the need for long-term treatment. In patients who meet the criteria for diagnosis of epilepsy, a carefully selected antiepileptic medication with consideration of comorbidities, adverse effect profile, and type of epilepsy is essential along with appropriate counseling.
Approximately 3% of the population will develop epilepsy but 2 to 3 times as many patients will experience a single seizure or seizure-like event. A diagnosis of epilepsy has significant medical, social, and emotional consequences. A careful patient history and physical examination, electroencephalography, and brain imaging are necessary to separate patients with acute symptomatic seizures, single unprovoked seizures, and nonepileptic events from those with new-onset epilepsy.
The COVID-19 pandemic impacted clinical practice, education, and research in Neurophysiology/Epilepsy. Although there is published literature on clinical impact, its educational impact is not well ...described. A national survey of Clinical Neurophysiology (CNP) and Epilepsy fellowship programs was conducted to assess the impact of COVID-19 on fellowship education.
A list of accredited Clinical Neurophysiology and Epilepsy fellowship programs was obtained from the Accreditation Council for Graduate Medical Education. Program directors at individual locations were contacted to complete a brief survey about the program and impact of COVID-19. Fellows from responding programs were subsequently invited to share their perceptions about the impact of the pandemic on their training.
From 176 programs, 40 PDs responded (22.7%). From these 40 programs, fellows from 26 completed surveys (65.0% response). There was a reduction in EEG and epilepsy monitoring unit volumes post-COVID-19, with a trend of change for EMG, whereas continuous EEG volumes were mostly unchanged. The impact of the pandemic on training was rated as moderate to severe (≥50%) by 30.0% of PDs and 49.0% of trainees. In remarkable agreement, 20.0% of PDs and 20.4% of fellows believed that additional fellowship training was needed before graduation. Lack of fellow satisfaction was correlated with the perceived impact of the pandemic on education ( p = 0.008).
This survey revealed a considerable impact on EEG/EMG clinical volume because of COVID-19, although continuous EEG was not as impacted. More fellows than PDs believed that training was considerably impacted by COVID-19, but a similar number thought that additional training was needed. It was unclear from this study whether the fellows' perception of educational impact was solely because of the pandemic or in addition to preexisting training deficiencies in the training programs.
To better understand the EEG education provided to adult neurology residents by surveying program directors of adult neurology residency programs in the United States.
An online survey focused on ...characteristics of neurology residency programs and their EEG teaching systems was distributed to the 161 adult neurology residency program directors listed in the Accreditation Council for Graduate Medical Education website at the time of the study.
Forty-seven (29%) out of the 161 program directors completed the survey. Most of the participating programs (89%) were academic. The mean number of 1-month EEG rotations required to graduate was 1.7 (range 0-4, median 1.75). EEG rotations involved the inpatient and outpatient setting in 91% and 70% of programs, respectively. The average number of EEGs read during a typical EEG rotation varied from more than 40, in about one-third of programs, to 0-10, in about 14% of programs. There was significant variability in the requirements for successful completion of EEG rotations, and most program directors (64%) reported not utilizing objective measures to assess EEG milestones. The most commonly used educational methods were didactics throughout the year (95%) and EEG teaching during EEG rotations (93%). The most commonly reported barriers to EEG education were insufficient EEG exposure (32%) and ineffective didactics (11%); possible solutions are summarized.
Our study identified a lack of consistency in teaching and evaluating residents during residency and presented EEG education barriers alongside possible solutions. We encourage program directors across the country to re-evaluate their EEG teaching systems in order to optimize EEG education.
Objectives
Disability in patients with epilepsy (PWEs) is multifactorial: beyond seizure frequency/severity, PWEs are prone to a range of neuropsychiatric, cognitive, and somatic comorbidities that ...significantly affect quality of life. Here, we explored how variations in seizure severity and the burden of self‐reported somatic/neuropsychiatric symptoms correlate with disruptions to 24 h activity patterns (rest‐activity rhythms RARs), determined through wrist accelerometry/actigraphy.
Methods
Multiday wrist‐actigraphy recordings were obtained from 59 adult patients with focal epilepsy (44% male, ages 18–72), who contemporaneously responded to validated psychometric instruments to measure anxiety, depression, sleepiness, and somatic symptoms. We conducted a similar in silico psychometric‐actigraphic correlation in a publicly available data set of 1747 Hispanic subjects (35% male, ages 18–65) from the Study of Latinos (SOL) Sueño Ancillary Study. RARs were analyzed via a sigmoidally‐transformed cosine model (quantifying amplitude, steepness, acrophase, and robustness) and nonparametric measures to estimate RAR stability, fragmentation, and sleep.
Results
Compared with matched SOL subjects, RARs from PWE subjects featured a significantly lower amplitude, a wider rest phase, and significantly more total daily sleep. Within PWEs, similar RAR distortions were associated with seizure intractability and/or anticonvulsant polytherapy, whereas high anxiety, depression, and somatic symptom scores were associated with lower RAR robustness and acrophase delay. We applied the SOL data set to train logistic regression models to dichotomously classify subjective anxiety, depression, and sleepiness symptoms using demographic and RAR parameters. When tested on PWEs, these models predicted prevalent anxiety and depression symptom burden (accuracy ~70%) but failed to predict subjective sleepiness.
Significance
Together these results demonstrate that RAR features may encode prevalent depression and anxiety symptoms in patients with focal epilepsy, potentially offering wearable‐derived endpoints to adjunct clinical care and drug/device trials. With larger PWE‐specific actigraphic‐psychometric data sets, we may identify RAR signatures that may more precisely correlate with varying seizure frequency, the burden of anticonvulsant therapy, and prevalent mood/anxiety symptoms.
Neuromodulation through implantable pulse generators (IPGs) represents an important treatment approach for neurological disorders. While the field has observed the success of state-of-the-art ...interventions, such as deep brain stimulation (DBS) or responsive neurostimulation (RNS), implantable systems face various technical challenges, including the restriction of recording from a limited number of brain sites, power management, and limited external access to the assessed neural data in a continuous fashion. To the best of our knowledge, for the first time in this study, we investigated the feasibility of recording human intracranial EEG (iEEG) using a benchtop version of the Brain Interchange (BIC) unit of CorTec, which is a portable, wireless, and externally powered implant with sensing and stimulation capabilities. We developed a MATLAB/SIMULINK-based rapid prototyping environment and a graphical user interface (GUI) to acquire and visualize the iEEG captured from all 32 channels of the BIC unit. We recorded prolonged iEEG (~ 24 h) from three human subjects with externalized depth leads using the BIC and commercially available clinical amplifiers simultaneously in the epilepsy monitoring unit (EMU). The iEEG signal quality of both streams was compared, and the results demonstrated a comparable power spectral density (PSD) in all the systems in the low-frequency band (< 80 Hz). However, notable differences were primarily observed above 100 Hz, where the clinical amplifiers were associated with lower noise floor (BIC-17 dB vs. clinical amplifiers < - 25 dB). We employed an established spike detector to assess and compare the spike rates in each iEEG stream. We observed over 90% conformity between the spikes rates and their spatial distribution captured with BIC and clinical systems. Additionally, we quantified the packet loss characteristic in the iEEG signal during the wireless data transfer and conducted a series of simulations to compare the performance of different interpolation methods for recovering the missing packets in signals at different frequency bands. We noted that simple linear interpolation has the potential to recover the signal and reduce the noise floor with modest packet loss levels reaching up to 10%. Overall, our results indicate that while tethered clinical amplifiers exhibited noticeably better noise floor above 80 Hz, epileptic spikes can still be detected successfully in the iEEG recorded with the externally powered wireless BIC unit opening the road for future closed-loop neuromodulation applications with continuous access to brain activity.
Accurately recognizing artifacts on electroencephalogram (EEG) is necessary to prevent EEG misinterpretation and epilepsy misdiagnosis. EEG artifacts generated by neurostimula-tion devices can be ...identified based on their unique spatial and frequency properties'. VNS and RNS artifacts display an electrical interferencelike "spiky" morphology with a distribution that is incompatible with a cerebral source and frequencies that mirror stimulation settings. DBS artifact features diffuse electrical interference with a relatively monomorphic appearance, and its frequency can vary depending on intermittent versus continuous neurostimulation - indicated for epilepsy and movement disorders, respectively.
The effects of brain stimulation on memory formation in humans have shown conflicting results in previous studies. We hypothesized that direct cortical stimulation using an implanted responsive ...neurostimulation (RNS) system will improve memory.
To evaluate whether direct cortical stimulation using RNS improves memory as measured with recall scores of a list-learning task.
During outpatient visits, a list-learning task (Hopkins Verbal Learning Test-Revised) was administered to 17 patients with RNS implants. Patients were read a list of 12 semantically related words and asked to recall the list after 3 different learning trials. True or sham stimulations were performed for every third word presented for immediate recall. Most patients had frontotemporal network stimulation-one patient each had insular and parietal stimulations. After a 20-min delay, they were asked to recall the list again, first freely and then through a "yes/no" recognition paradigm. A crossover design was used in which half the patients had true stimulation during the initial visit and half had sham stimulation-followed by crossover to the other group at the next visit.
The Hopkins Verbal Learning Test-Revised delayed recall raw score was higher for the stimulation condition compared with the nonstimulation condition (paired t -test, P = .04, effect size d = 0.627).
Verbal memory improves by direct cortical stimulation during a list-learning task. The RNS system can be effectively used in memory research using direct cortical stimulation. This study has implications in the development of neurostimulation devices for cognitive enhancement in conditions such as epilepsy, dementia, and traumatic brain injury.
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