Clinical value of subclinical seizures in children with focal epilepsy

Velkey, Ábel; Siegler, Zsuzsanna; Jánszky, J.; Duray, Borbála; Fogarasi, András

doi:10.1016/j.eplepsyres.2011.03.001

Cited by 14 publications

(21 citation statements)

References 15 publications

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“…Our study is consistent with the study by Velkey et al, 6 where they included 59 pediatric patients with SCSs on scalp VEEG; in 85% of these patients, SCSs had additional diagnostic value, notably assisting localization of the seizure-onset zone in 31 patients (53%). Being seizure-free is a most practical gold standard to confirm the localization value of any noninvasive technique.…”

Section: Discussionsupporting

confidence: 91%

“…[3][4][5][6] The common practice for VEEG monitoring is to capture typical CS episodes with associated signs or symptoms, 12,13 while the value of SCS localization is not well established. SCS episodes are commonly recorded during scalp VEEG monitoring but their localization significance is still unclear.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] The common practice for VEEG monitoring is to capture typical CS episodes with associated signs or symptoms, 12,13 while the value of SCS localization is not well established. 5,6 In addition, to clarify the localization role of SCSs, efforts are needed in general to understand and manage SCSs in patients with epilepsy. Under these scenarios, SCSs may provide additional information when they are present.…”

Section: Discussionmentioning

confidence: 99%

“…1 Although the localization values of clinical seizures (CSs) and interictal epileptiform discharges have been well established, 2 the clinical significance of SCSs is still debated. 1,[3][4][5][6]8,9 In addition, comparison between the localization value of CSs and SCSs was not always possible, because not all included patients had both SCSs and CSs. 1,[7][8][9] One common limitation of the prior studies was that the included patients did not all have surgery or postoperative seizure outcome.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence, clinical characteristics, and localization value of SCSs were explored in prior studies based on scalp video-electroencephalography (VEEG) 3-6 and invasive EEG. 1,3,5,6,8,9 Due to these limitations, it's still unclear whether (or to what extent) SCS localization information should be considered for presurgical evaluation purpose. 1,[3][4][5][6]8,9 In addition, comparison between the localization value of CSs and SCSs was not always possible, because not all included patients had both SCSs and CSs.…”

Section: Introductionmentioning

confidence: 99%

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Localization value of subclinical seizures on scalp video‐EEG in epilepsy presurgical evaluation

Wang

Tang

et al. 2019

Epilepsia

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Objective:To evaluate the localization value and prognostic significance of subclinical seizures (SCSs) on scalp video-electroencephalography monitoring (VEEG) in comparison to clinical seizures (CSs) in patients who had epilepsy surgery. Methods: We included 123 consecutive patients who had SCSs and CSs during scalp-VEEG evaluation. All patients had subsequent epilepsy surgery and at least 1-year follow-up. Concordance between SCSs and CSs was summarized into five categories: complete, partial, overlapping, no concordance, or indeterminate. Using the same scheme, we analyzed the relationship between resection and SCS/CS localizations. The concordance measures, along with demographic, electroclinical, and other presurgical evaluation data, were evaluated for their associations with postoperative seizure outcome. Results: Sixty-nine patients (56.1%) had seizure-free outcome at 1-year follow-up.In 68 patients (55.3%), the localizations of SCSs and CSs were completely concordant. Multivariate logistic analysis showed that complete SCS/CS concordance was independently associated with seizure-free outcome at 1-year (P = .020) and 2-year follow-up (P = .040). In the temporal lobe epilepsy (TLE) seizure-free group, SCS localization was completely contained within the resection in 44.4% and CS localization was completely contained within the resection in 41.7%; in the extratemporal lobe epilepsy (ETLE) seizure-free group, SCS localization was completely contained within the resection in 54.5% and CS localization was completely contained within the resection in 57.6%. Significance: Complete concordance between CS and SCS localization is a positive prognostic factor for 1-year and 2-year postoperative seizure-free outcome.Localization value of SCSs on scalp VEEG is similar to that of CSs for TLE and ETLE. Although SCSs cannot replace CSs, localization information from SCSs should not be ignored. K E Y W O R D Sclinical seizures, epilepsy surgery, subclinical seizures, video-EEG monitoring (VEEG) 2478 | WANG et Al.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] The common practice for VEEG monitoring is to capture typical CS episodes with associated signs or symptoms, 12,13 while the value of SCS localization is not well established. 5,6 In addition, to clarify the localization role of SCSs, efforts are needed in general to understand and manage SCSs in patients with epilepsy. Under these scenarios, SCSs may provide additional information when they are present.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Localization value of subclinical seizures on scalp video‐EEG in epilepsy presurgical evaluation

Wang

Tang

et al. 2019

Epilepsia

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Simulating clinical trials with and without intracranial EEG data

et al. 2017

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OBJECTIVE It is currently unknown if knowledge of clinically silent (electrographic) seizures improves the statistical efficiency of clinical trials. METHODS Using data obtained from 10 patients with chronically implanted subdural electrodes over an average of 1 year, a Monte Carlo bootstrapping simulation study was performed to estimate the statistical power of running a clinical trial based on A) patient reported seizures with intracranial EEG (icEEG) confirmation, B) all patient reported events, or C) all icEEG confirmed seizures. A “drug” was modeled as having 10%, 20%, 30%, 40% and 50% efficacy in 1000 simulated trials each. Outcomes were represented as percentage of trials that achieved p<0.05 using Fisher Exact test for 50%-responder rates (RR50), and Wilcoxon Rank Sum test for median percentage change (MPC). RESULTS At each simulated drug strength, the MPC method showed higher power than RR50. As drug strength increased, statistical power increased. For all cases except RR50 with drug of 10% efficacy, using patient reported events (with or without icEEG confirmation) was not as statistically powerful as using all available intracranially confirmed seizures (p<0.001). SIGNIFICANCE This study demonstrated using simulation that additional accuracy in seizure detection using chronically implanted icEEG improves statistical power of clinical trials. Newer invasive and noninvasive seizure detection devices may have the potential to provide greater statistical efficiency, accelerate drug discovery and lower trial costs.

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Clinical Characteristics and Prognostic Significance of Subclinical Seizures in Focal Epilepsy: A Retrospective Study

Chen

Yang

et al. 2022

Neurol Ther

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Introduction The aim was to evaluate the clinical characteristics and prognostic significance of subclinical seizures (SCSs) on scalp video-electroencephalogram (VEEG) monitoring with or without intracranial electroencephalogram (IEEG) monitoring in patients who had epilepsy surgery. Methods We reviewed 286 epileptic patients who underwent subsequent epilepsy surgery during scalp-VEEG evaluation with or without IEEG monitoring between 2013 and 2020, with a minimum follow-up of 1 year. The prevalence and clinical characteristics of SCSs, as well as their prognostic significance, were analyzed. Results A total of 286 patients were enrolled for analysis, and 80 patients had IEEG implanted. SCSs were recorded in 9.79% of the patients based on VEEG and 50% based on IEEG. In the VEEG group ( n = 286), younger seizure onset ( P = 0.004) was associated with the presence of s-SCSs (SCSs detected on scalp VEEG). In the IEEG group ( n = 80), temporal lobe epilepsy ( P = 0.015) was associated with the presence of i-SCSs (SCSs detected on IEEG). Of 286 patients, 208 (72.73%) were seizure-free in the VEEG group, and 56 0f 80 patients (70%) were seizure-free in the IEEG group through the last follow-up. In the VEEG group, the presence of s-SCSs did not affect seizure outcome; predictors of seizure recurrence were longer epilepsy duration ( P = 0.003, OR 1.003, 95% CI 1.001–1.005), history of focal to bilateral tonic–clonic seizure ( P = 0.027, OR 1.665, 95% CI 1.060–2.613), nonspecific pathology ( P = 0.018, OR 2.184, 95% CI 1.145–4.163), and incomplete resection ( P = 0.004, OR 2.705, 95% CI 1.372–5.332). In the IEEG group, i-SCSs were significantly associated with seizure outcome ( P = 0.028, OR 0.371, 95% CI 0.153–0.898). Conclusion The rate of SCSs captured on IEEG monitoring was higher than that on VEEG monitoring during presurgical evaluation. SCSs detected on VEEG monitoring were associated with younger seizure onset. SCSs detected on IEEG monitoring were associated with temporal lobe epilepsy and also predicted surgical outcomes in focal epilepsy. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00342-y.

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Clinical value of subclinical seizures in children with focal epilepsy

Cited by 14 publications

References 15 publications

Localization value of subclinical seizures on scalp video‐EEG in epilepsy presurgical evaluation

Localization value of subclinical seizures on scalp video‐EEG in epilepsy presurgical evaluation

Simulating clinical trials with and without intracranial EEG data

Clinical Characteristics and Prognostic Significance of Subclinical Seizures in Focal Epilepsy: A Retrospective Study

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