Epilepsy in the developing world

Carpio, Arturo; Hauser, W. Allen

doi:10.1007/s11910-009-0048-z

Cited by 88 publications

(80 citation statements)

References 52 publications

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“…A morphological classification based on the viability and location of the parasite in the CNS has been proposed: active, when the parasite is alive; transitional or degenerative, if it is in the colloidal or granular-nodular phase; or inactive, if there is evidence of its death [2][3][4] . Seizures are the main symptom in transitional parenchymal cysts 1,5 . However, these images are not pathognomonic of NC: (1) a single enhanced lesion on CT or hyperintense lesion on MRI is a common finding in patients with newly identified seizures in endemic countries; these patients, who are mainly children and young adults, have some benign and transitory clinical manifestations, predominantly focal seizures or focal seizures with secondary generalization; occasionally, they have Todd's paresis or focal neurological deficits 6 ; (2) these lesions may be seen in CNS tuberculosis and in other inflammatory pathological conditions 1 .…”

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“…Seizures are the most common clinical manifestation of NC. Carpio and Romo emphasize that it is essential to distinguish between seizures and epilepsy in relation to neurocysticercosis 1,5 . Acute symptomatic seizures may result from transitional or degenerating cysts, but are ultimately a consequence of the acute inflammatory response (seizures, not epilepsy).…”

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confidence: 99%

“…Acute symptomatic seizures may result from transitional or degenerating cysts, but are ultimately a consequence of the acute inflammatory response (seizures, not epilepsy). In contrast, a patient with seizures who has viable cysts and/or inactive, non-inflamed calcified cysts may be categorized as having unprovoked or remote seizures (epilepsy) 1,5 . This difference is often difficult to assess.…”

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confidence: 99%

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“…It is estimated that 0.5-1.5% of the general population has epilepsy, and approximately 5% of people experience one or more seizures during their lifetime 1 . Epilepsy is one of the most prevalent neurological conditions worldwide, mainly in developing countries 1,2 .…”

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“…Epilepsy is one of the most prevalent neurological conditions worldwide, mainly in developing countries 1,2 . Proper treatment depends on the correct diagnosis.…”

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Syncope in patients with drug-resistant epilepsy without apparent cardiovascular disease

Alves-Leon

Pinto

Andraus

et al. 2013

Arq. Neuro-Psiquiatr.

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Epilepsy and syncope are clinical conditions with high prevalence rates in the general population, and the differential diagnosis between them is difficult. Objective: To assess the frequency of syncope in patients diagnosed with drug-resistant epilepsy (DRE) without apparent heart disease, to investigate the relationship between clinical and electroencephalographic (EEG) changes, and to verify the role of the inclination test (IT (n=9), with a significant prevalence in women. Vasovagal syncope (VVS) was the most frequent diagnosis. Conclusion: We found a significant association between syncope and the presence of autonomic symptoms (p=0.005). The IT plays an important role in the differential diagnosis of patients with DRE presenting with autonomic symptoms, regardless of EEG results and brain magnetic resonance imaging (MRI) abnormalities.Keywords: drug-resistant epilepsy, epilepsy, inclination test, syncope, pseudoseizures. RESUMOEpilepsia e síncope são condições clínicas com alta prevalência na população geral e, às vezes, o diagnóstico diferencial entre elas é difícil. Objetivo: Investigar a frequência de síncope em pacientes diagnosticados com epilepsia fármaco resistente (EFR), sem doença cardíaca aparente; investigar a relação entre alterações clínicas e eletrencefalográficas; verificar o papel do teste de inclinação (TI). Método: Estudo aberto prospectivo, realizado de 2004 a 2006, incluindo 35 pacientes consecutivos do Programa de Epilepsias do Hospital Universitário Clementino Fraga Filho, diagnosticados com EFR, sem doença cardíaca aparente. Resultados: A frequência de síncope foi de 25,7% (n=9), com prevalência significativa em mulheres. Síncope vasovagal (SVV) foi o diagnóstico mais frequente. Conclusão: Encontramos uma significativa associação entre síncope e a presença de sintomas autonômicos (p=0,005). O TI tem importante papel no diagnóstico diferencial de pacientes com diagnóstico de EFR que apresentam sintomas autonômicos, a despeito de alterações eletrencefalográficas e de ressonância magnética do crânio.Palavras-chave: epilepsia fármaco-resistente, epilepsia, teste de inclinação, pseudocrises.

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Interrater Reliability of Experts in Identifying Interictal Epileptiform Discharges in Electroencephalograms

et al. 2020

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The validity of using electroencephalograms (EEGs) to diagnose epilepsy requires reliable detection of interictal epileptiform discharges (IEDs). Prior interrater reliability (IRR) studies are limited by small samples and selection bias.OBJECTIVE To assess the reliability of experts in detecting IEDs in routine EEGs. DESIGN, SETTING, AND PARTICIPANTSThis prospective analysis conducted in 2 phases included as participants physicians with at least 1 year of subspecialty training in clinical neurophysiology. In phase 1, 9 experts independently identified candidate IEDs in 991 EEGs (1 expert per EEG) reported in the medical record to contain at least 1 IED, yielding 87 636 candidate IEDs. In phase 2, the candidate IEDs were clustered into groups with distinct morphological features, yielding 12 602 clusters, and a representative candidate IED was selected from each cluster. We added 660 waveforms (11 random samples each from 60 randomly selected EEGs reported as being free of IEDs) as negative controls. Eight experts independently scored all 13 262 candidates as IEDs or non-IEDs. The 1051 EEGs in the study were recorded at the Massachusetts General Hospital between 2012 and 2016.MAIN OUTCOMES AND MEASURES Primary outcome measures were percentage of agreement (PA) and beyond-chance agreement (Gwet κ) for individual IEDs (IED-wise IRR) and for whether an EEG contained any IEDs (EEG-wise IRR). Secondary outcomes were the correlations between numbers of IEDs marked by experts across cases, calibration of expert scoring to group consensus, and receiver operating characteristic analysis of how well multivariate logistic regression models may account for differences in the IED scoring behavior between experts. RESULTS Among the 1051 EEGs assessed in the study, 540 (51.4%) were those of females and 511 (48.6%) were those of males. In phase 1, 9 experts each marked potential IEDs in a median of 65 (interquartile range [IQR], 28-332) EEGs. The total number of IED candidates marked was 87 636. Expert IRR for the 13 262 individually annotated IED candidates was fair, with the mean PA being 72.4% (95% CI, 67.0%-77.8%) and mean κ being 48.7% (95% CI, 37.3%-60.1%). The EEG-wise IRR was substantial, with the mean PA being 80.9% (95% CI, 76.2%-85.7%) and mean κ being 69.4% (95% CI, 60.3%-78.5%). A statistical model based on waveform morphological features, when provided with individualized thresholds, explained the median binary scores of all experts with a high degree of accuracy of 80% (range, 73%-88%).CONCLUSIONS AND RELEVANCE This study's findings suggest that experts can identify whether EEGs contain IEDs with substantial reliability. Lower reliability regarding individual IEDs may be largely explained by various experts applying different thresholds to a common underlying statistical model.

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Epilepsy in the developing world

Cited by 88 publications

References 52 publications

Neurocysticercosis: still some unanswered questions

Neurocysticercosis: still some unanswered questions

Syncope in patients with drug-resistant epilepsy without apparent cardiovascular disease

Interrater Reliability of Experts in Identifying Interictal Epileptiform Discharges in Electroencephalograms

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