Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

Pensel, Max Christian; Schnuerch, Martin; Elger, Christian E.; Surges, Rainer

doi:10.1111/epi.16454

Cited by 7 publications

(16 citation statements)

References 25 publications

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“…Specifically, it is well‐known that AED changes and withdrawal can change the severity and evolutions of seizures. For example, bilateral tonic–clonic seizures are more prevalent when AED levels are reduced (Pensel et al, 2020). AEDs have further been shown to impact inter‐ and peri‐ictal brain activity (Badawy, Macdonell, Jackson, & Berkovic, 2009; Meisel et al, 2015), making it an important feature to consider.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, it is wellknown that AED changes and withdrawal can change the severity and evolutions of seizures. For example, bilateral tonic-clonic seizures are more prevalent when AED levels are reduced (Pensel et al, 2020).…”

Section: Residuementioning

confidence: 99%

“…Importantly, epilepsy is not a static disorder; electrographic seizure and epileptiform activities have been shown to fluctuate over hours to years in both intensity and spatial distribution. Specifically, while seizures often share common features in the same patient (Burns et al, 2014; Kramer et al, 2010; Schevon et al, 2012; Schindler et al, 2011; Truccolo et al, 2011; Wagner et al, 2015), electrographic seizure activity may change in terms of duration (Cook et al, 2016), spatial spread (Karthick, Tanaka, Khoo, & Gotman, 2018; Marciani & Gotman, 1986; Naftulin et al, 2018; Pensel, Schnuerch, Elger, & Surges, 2020), spectral properties (Alarcon, Binnie, Elwes, & Polkey, 1995) from one seizure to the next. Our recent study (Schroeder et al, 2020) has additionally shown that the seizure EEG spatio‐temporal evolution from seizure start to seizure termination (or short: 'seizure evolution') also changes from one seizure to the next in the same patient.…”

Section: Introductionmentioning

confidence: 99%

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Fluctuations in EEG band power at subject‐specific timescales over minutes to days explain changes in seizure evolutions

Panagiotopoulou

Papasavvas

Schroeder

et al. 2022

Human Brain Mapping

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Epilepsy is recognised as a dynamic disease, where both seizure susceptibility and seizure characteristics themselves change over time. Specifically, we recently quantified the variable electrographic spatio‐temporal seizure evolutions that exist within individual patients. This variability appears to follow subject‐specific circadian, or longer, timescale modulations. It is therefore important to know whether continuously recorded interictaliEEG features can capture signatures of these modulations over different timescales. In this study, we analyse continuous intracranial electroencephalographic (iEEG) recordings from video‐telemetry units and find fluctuations in iEEG band power over timescales ranging from minutes up to 12 days. As expected and in agreement with previous studies, we find that all subjects show a circadian fluctuation in their iEEG band power. We additionally detect other fluctuations of similar magnitude on subject‐specific timescales. Importantly, we find that a combination of these fluctuations on different timescales can explain changes in seizure evolutions in most subjects above chance level. These results suggest that subject‐specific fluctuations in iEEG band power over timescales of minutes to days may serve as markers of seizure modulating processes. We hope that future study can link these detected fluctuations to their biological driver(s). There is a critical need to better understand seizure modulating processes, as this will enable the development of novel treatment strategies that could minimise the seizure spread, duration or severity and therefore the clinical impact of seizures.

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Section: Discussionmentioning

confidence: 99%

Section: Residuementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fluctuations in EEG band power at subject‐specific timescales over minutes to days explain changes in seizure evolutions

Panagiotopoulou

Papasavvas

Schroeder

et al. 2022

Human Brain Mapping

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“…It is also well-known that AED changes and withdrawal can change the severity and dynamics of seizures. For example, bilateral tonic-clonic seizures are more prevalent when AED levels are reduced [37]. We were unable to include this information in the current study, but future studies may wish to investigate AED levels as additional potential explanatory variables for seizure dissimilarity.…”

Section: Discussionmentioning

confidence: 95%

Fluctuations in EEG band power at subject-specific timescales over minutes to days explain changes in seizure evolutions

Panagiotopoulou¹,

Papasavvas²,

Schroeder³

et al. 2020

Preprint

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Epilepsy is recognised as a dynamic disease, where seizures and their features change over time. Specifically, we recently demonstrated that seizures themselves change in terms of their evolution. However, the underpinning modulators of seizure evolution remain unclear.In this work, we analyse continuous (interictal) intracranial Electroencephalographic (iEEG) recordings, and elucidate fluctuations in iEEG band power over different timescales (ranging from minutes to days).We find that all patients show an approximately circadian fluctuation in their EEG band power, but also many other fluctuations on patient-specific timescales. Importantly, we find that a combination of fluctuations on different timescales can explain the changes in seizure evolution in most patients above chance-level.We interpret these results as evidence that seizure modulating factors exist, and they vary over time (patient-specifically). These time-varying modulating factors can be captured in fluctuations of EEG band power, and future work should link them to the exact biological time-varying processes.

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“…In case of ASM tapering, a distinction can be made between taper dose and taper rate. Two studies have shown in multivariate analyses that taper dose affected the risk of an adverse event more so than taper rate (8,9).…”

Section: Factors That Determine the Risk Of Adverse Eventsmentioning

confidence: 99%

Yield and risk associated with prolonged presurgical video‐EEG monitoring: a systematic review

Griethuysen¹,

Asch²,

Otte³

et al. 2022

Epileptic Disorders

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Presurgical long-term video-EEG monitoring (LT-VEEG) is an important part of the presurgical evaluation in patients with focal epilepsy. Multiple seizures need to be recorded, often in limited time and with the need to taper anti seizure medication (ASM). The aim of this study was to systematically study the yield -in terms of success -and risks of presurgical LT-VEEG, and to identify all previously reported contributing variables. MethodsA systematic review of the databases of PubMed Medline, Embase, Cochrane Central, and the Cochrane Database of Systematic Reviews were searched following the Preferred Reporting Items for Systematic Reviews (PRISMA) guideline. Publications about presurgical LT-VEEG reporting on variables contributing to yield and risk were included. Study characteristics of all included studies were extracted following a standardized template. Within these articles, studies presenting multivariable analyses of factors contributing to the risk of adverse events or the succes of LT-VEEGwere identified. Results 3We found 36 articles reporting on LT-VEEG, including 4.703 presurgical patients, both children and adults. Presurgical LT-VEEG monitoring has an average yield of 85%. Adverse events occurred with an averaged total event rate of 17%, but the type of included events was variable among studies. Factors reported to independently contribute to successful LT-VEEG were: baseline seizure frequency, shorter interval since most recent seizure, extra-temporal lobe epilepsy, ASM reduction not needed. Factors independently contributing to the occurrence of adverse event were: ASM tapering, history of status epilepticus, history of focal to bilateral tonic clonic seizures, psychiatric comorbidity, and ASM taper rate. ConclusionThis study reveals that data on factors contributing to yield and risk of adverse events is significant variable and often with inadequate statistics. Future research is warrented to develop guidelines for ASM withdrawal during presurgical video-EEG monitoring, taking predefined factors for success and risks of adverse events into account.

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Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

Cited by 7 publications

References 25 publications

Fluctuations in EEG band power at subject‐specific timescales over minutes to days explain changes in seizure evolutions

Fluctuations in EEG band power at subject‐specific timescales over minutes to days explain changes in seizure evolutions

Fluctuations in EEG band power at subject-specific timescales over minutes to days explain changes in seizure evolutions

Yield and risk associated with prolonged presurgical video‐EEG monitoring: a systematic review

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