Objective
Slowing and frontal spread of the alpha rhythm have been reported in multiple epilepsy syndromes. We investigated whether these phenomena are associated with seizure control.
Methods
We prospectively acquired resting‐state electroencephalogram (
EEG
) in 63 patients with focal and idiopathic generalized epilepsy (
FE
and
IGE
) and 39 age‐ and gender‐matched healthy subjects (HS). Patients were divided into good and poor (≥4 seizures/12 months) seizure control groups based on self‐reports and clinical records. We computed spectral power from 20‐sec
EEG
segments during eyes‐closed wakefulness, free of interictal abnormalities, and quantified power in high‐ and low‐alpha bands. Analysis of covariance and post hoc
t
‐tests were used to assess group differences in alpha‐power shift across all
EEG
channels. Permutation‐based statistics were used to assess the topography of this shift across the whole scalp.
Results
Compared to HS, patients showed a statistically significant shift of spectral power from high‐ to low‐alpha frequencies (effect size
g
= 0.78 [95% confidence interval 0.43, 1.20]). This alpha‐power shift was driven by patients with poor seizure control in both
FE
and
IGE
(
g
= 1.14, [0.65, 1.74]), and occurred over midline frontal and bilateral occipital regions.
IGE
exhibited less alpha power shift compared to
FE
over bilateral frontal regions (
g
= −1.16 [−0.68, −1.74]). There was no interaction between syndrome and seizure control. Effects were independent of antiepileptic drug load, time of day, or subgroup definitions.
Interpretation
Alpha slowing and anteriorization are a robust finding in patients with epilepsy and might represent a generic indicator of seizure liability.
Our findings show that diagnostic HVT for seizure classification and polysomnographies can be carried out safely in the patients' home and poses no security risks for staff. HVT can be effectively integrated into an existing tertiary care service as a routine home or community-based procedure. We hope to encourage other clinical neurophysiology departments and epilepsy centres to take advantage of our experience and consider adopting and implementing HVT, with the aim of a nationwide coverage.
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. Our experience shows that HVET can be highly cost‐effective and is well received by patients. We note limitations related to long‐term electrode attachment and correct camera placing while the patient is unsupervised at home, and concerns related to regulations regarding data privacy for cloud services. We believe that HVET opens significant new opportunities for research, especially in the field of understanding the many influences in seizure occurrence. We speculate that in the future HVET may merge into innovative new multisensor approaches to continuously monitoring people with epilepsy.
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