The circadian distribution of interictal epileptiform EEG activity

Silva, António Martins da; Aarts, J.H.P; Binnie, C. D.; Laxminarayan, Ramanan; Silva, F.H Lopes Da; Meijer, J. W. A.; Nagelkerke, Nico

doi:10.1016/0013-4694(84)90195-0

Cited by 66 publications

(21 citation statements)

References 16 publications

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“…Because spontaneous variability in IED frequency between recordings may be substantial, longer recordings may improve the ability to distinguish true improvement from expected variation (Camfield et al 1995; Martins da Silva et al 1984). Long term EEG monitoring for this cohort was not feasible at the time the data was collected, and in practice, evaluation of patients initiating the KD would be limited to routine outpatient EEG recordings.…”

Section: Discussionmentioning

confidence: 99%

Early EEG improvement after ketogenic diet initiation

et al. 2011

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Purpose-This study examines electroencephalographic (EEG) changes in children with medication resistant epilepsy treated with the ketogenic diet (KD). Methods-RoutineEEGs were obtained prior to KD initiation, then one month and three months later. Changes in EEG background slowing and frequency of interictal epileptiform discharges (IEDs) were evaluated using power spectrum analysis and manual determination of spike index. KD responders were compared to non-responders to determine if baseline or early EEG characteristics predicted treatment response (>50% seizure reduction) at three months.Results-Thirty-seven patients were evaluated. No differences in baseline EEG features were found between responder groups. Frequency of IEDs declined in 65% of patients as early as one month, by a median of 13.6% (IQR 2-33). Those with a ten percent or greater improvement in IED frequency at one month were greater than six times more likely to be KD responders (OR 6.5 95% CI 0.85 to 75. p=0.03). Qualitative and quantitative measures of EEG background slowing improved in the whole cohort, but did not predict responder status.Conclusion-Baseline predictors of KD response remain elusive. Most patients experienced a reduction in IEDs and improvement in EEG background slowing after KD initiation. Reduction of IEDs at one month strongly predicted KD responder status at three months.

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Section: Discussionmentioning

confidence: 99%

Early EEG improvement after ketogenic diet initiation

et al. 2011

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“…The reports addressing the relationship between PHT blood levels and IEDs frequency have given controversial results, since while some authors have described a positive correlation between higher PHT levels and IEDs rate improvement [22,23], others did not confirm such a link [17,24].…”

Section: Phenytoinmentioning

confidence: 93%

Effects of antiepileptic drugs on interictal epileptiform discharges in focal epilepsies: an update on current evidence

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Bonanni

et al. 2015

Expert Review of Neurotherapeutics

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Interictal epileptiform discharges (IEDs), occurring in the electroencephalograms (EEG) of patients with focal epilepsy, are crucial for diagnosis, while their relationship with seizure severity and recurrence is controversial. The effects of antiepileptic drugs (AEDs) on IEDs are even more debated. In general, it is currently believed by experts in the field that most of the classical AEDs do not significantly affect IEDs occurrence in these patients, and that monitoring their EEG effects during treatment is useless. In this review, we update the existing literature on the effects of classical and newer AEDs on focal IEDs, emphasizing the scarcity of data concerning the latter. We also discuss potential limits of available clinical and experimental data and future perspectives.

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“…Sleep induction, achieved either by medication qr sleep deprivation, is a widely used method of EEG activation in clinical practice, because the frequency and extent of interictal epileptiform discharges (IEDs) .in the EEGs of people with epilepsy are generally increased in sleep (1)(2)(3). With a single waking EEG study, epileptiform discharges are detected in -50% of all patients with epilepsy (43).…”

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Predictive Value of Interictal Epileptiform Discharges During Non‐REM Sleep on Scalp EEG Recordings for the Lateralization of Epileptogenesis

et al. 1998

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Summary:Purpose: EEG recording during sleep is widely used in the assessment of epilepsy, particularly in candidates for surgery, yet the diagnostic value of this procedure is not well established. We evaluated the predictive reliability of interictal epileptiform discharges (IEDs) for localization in presurgical patients with temporal lobe epilepsy (TLE) during non-REM sleep.Methods: Preoperative scalp EEG recordings with waking and sleep states were assessed in 83 patients with TLE in whom localization of the epileptogenic zone was subsequently confirmed by successful surgical treatment (patient seizure-free >1Results: The accuracy of EEG recordings for prediction of lateralization significantly changed from 5 1.8% during waking to 78.3% during sleep. After exclusion of patients who showed year). no discharges, the predictive value changed from 74.1 to 86.7%. However, in patients in whom the waking scalp EEG lateralized incorrectly, no improvement in reliability was achieved by sleep recording.Conclusions: Our results suggest that IEDs occurring in non-REM sleep provide more accurate information for lateralization of epileptogenesis than do those occurring during waking. This gain of diagnostic information was obtained in patients who showed either bilateral or no discharges in waking records, because unilateral discharges arising de novo in sleep were always correctly lateralizing. On the other hand, in patients who showed unilateral discharges in the awake state, whether ipsilateral or contralateral to the epileptogenic zone, the findings were generally unchanged during sleep. Key Words: Epilepsy-Electroencephalogram-Interictal discharge-Sleep.Sleep induction, achieved either by medication qr sleep deprivation, is a widely used method of EEG activation in clinical practice, because the frequency and extent of interictal epileptiform discharges (IEDs) .in the EEGs of people with epilepsy are generally increased in sleep (1-3). With a single waking EEG study, epileptiform discharges are detected in -50% of all patients with epilepsy (43). During sleep, epileptiform discharges appear in -80% (5).The region of IEDs does not always indicate the site of seizure onset (6). Patients with intractable epilepsy often show epileptiform discharges in regions more extensive than, and not necessarily contiguous to, the epileptogenic zone. Long duration of the illness and Iiigh seizure frequency may cause more complex pathophysiological phenomena, such as mirror foci or secondary epileptogenesis (7). Interictal or even ictal discharges in scalp recordings are variously estimated to have 6 6 9 5 % predictive reliability for the lateralization of epileptogenesis (8-12). Therefore, an increase in interictal discharges in sleep would not necessarily provide more reliable information for the localization and lateralization of epileptogenesis. However, few studies have addressed the localizing significance of epileptiform discharges in sleep.Some researchers believe that the localization of the epileptogenic zone by discharges in...

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The circadian distribution of interictal epileptiform EEG activity

Cited by 66 publications

References 16 publications

Early EEG improvement after ketogenic diet initiation

Early EEG improvement after ketogenic diet initiation

Effects of antiepileptic drugs on interictal epileptiform discharges in focal epilepsies: an update on current evidence

Predictive Value of Interictal Epileptiform Discharges During Non‐REM Sleep on Scalp EEG Recordings for the Lateralization of Epileptogenesis

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