The role of outpatient ambulatory electroencephalography in the diagnosis and management of adults with epilepsy or nonepileptic attack disorder: A systematic literature review

Lawley, Andrew; Evans, Shaun; Manfredonia, Francesco; Cavanna, Andrea E.

doi:10.1016/j.yebeh.2015.09.032

Cited by 34 publications

(20 citation statements)

References 32 publications

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“…Our study confirms on a larger scale results of previous studies [2,5] of AVEM utility for non-urgent and non-surgical evaluation of events.…”

Section: Discussionsupporting

confidence: 90%

“…Likewise, we only included inpatient VEM referrals that study investigators at the two collaborating epilepsy centers opined were referred for diagnostic evaluation of events. Based on prior AVEM outcome literature [2,3], we a priori defined primary outcome measure of our study as composite percentage of VEM recordings that captured at least one pushbutton event on video-camera or demonstrated epileptiform activity on EEG tracings. With expert opinion that varied as to how to optimally define a clinically meaningful VEM outcome, we defined 12 secondary outcome measures ( Fig.…”

Section: Outcome and Clinical Utility Variablesmentioning

confidence: 99%

“…Prospective AVEM outcome studies have lessened these concerns [2], finding that only 1/101 (< 1.0%) [3] and 1/41 (2.4%) [4] AVEM recordings were un-interpretable, due to artifact, that ambulatory and inpatient VEM were statistically indifferent in their capacity to capture patient events on video (74% ambulatory, 62% inpatient) [4], and that in side-by-side comparison ambulatory and inpatient VEM were overall equally likely to generate results that meaningfully impact clinical decision-making in non-urgent and non-surgical cases (73% ambulatory, 73% inpatient) [4]. However, these and other published AVEM outcome studies [5,6] are limited to single-center investigations with no greater than 502 subjects.…”

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confidence: 99%

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Outcome of ambulatory video-EEG monitoring in a ˜10,000 patient nationwide cohort

Syed

LaFrance

Loddenkemper

et al. 2019

Seizure

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We evaluate outcome of in-home diagnostic ambulatory video-EEG monitoring (AVEM) performed on a nationwide cohort of patients over one calendar year, and we compare our findings with outcomes of inpatient adult and pediatric VEM performed during the same year at two academic epilepsy centers. Methods: This is a retrospective cohort study. We obtained AVEM outcome data from an independent ambulatory-EEG testing facility. Inpatient VEM data from a 4-bed adult epilepsy center and an 8-bed pediatric epilepsy center were also included. Primary outcome measure was composite percentage of VEM records with epileptiform activity on EEG tracings or at least one video-recorded pushbutton event. We assessed patient-reported symptoms documented in AVEM event diaries. Results: Of 9221 AVEM recordings performed across 28 states, 62.5% attained primary outcome. At least one patient-activated pushbutton event was captured on video in 54% of AVEM recordings (53.6% in adults, 56.1% in children). Epileptiform activity was reported in 1657 (18.0%) AVEM recordings (1473 [88.9%] only interictal, 9 [0.5%] only ictal, 175 [10.6%] both interictal and ictal). Most common patient-reported symptomatology during AVEM pushbutton events was behavioral/autonomic/emotional in adults and children. Compared to AVEM, inpatient VEM captured more confirmed representative events in adult and pediatric samples. Conclusions: AVEM is useful for non-urgent diagnostic evaluation of events. 1. Introduction Despite cost, accessibility, and convenience advantages of diagnostic ambulatory video-EEG monitoring (AVEM) over inpatient VEM, some clinicians tend to favor inpatient VEM even when inpatient level-of-care may not be medically needed, mainly because of two

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“…Our study confirms on a larger scale results of previous studies [2,5] of AVEM utility for non-urgent and non-surgical evaluation of events.…”

Section: Discussionsupporting

confidence: 90%

Section: Outcome and Clinical Utility Variablesmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Outcome of ambulatory video-EEG monitoring in a ˜10,000 patient nationwide cohort

Syed

LaFrance

Loddenkemper

et al. 2019

Seizure

View full text Add to dashboard Cite

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“…Outpatient device testing may also provide more generalizable false-positive data, especially for inertial devices, as patients may perform more frequent and varied ambulatory movements [67]. While outpatient ambulatory trials face challenges in study design and administration, and often lack a performance benchmark, they may be necessary to evaluate SDD utility for ASM clinical trials [68][69][70]. In fact, SDDs that have received 510(k) clearance have only been approved for use during "periods of rest" [8,9], further underscoring the need for this stage of testing.…”

Section: Streamlining Testing: a Device Validation Frameworkmentioning

confidence: 99%

Seizure detection devices for use in antiseizure medication clinical trials: A systematic review

Kurada

Srinivasan

Hammond

et al. 2019

Seizure

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This study characterizes the current capabilities of seizure detection device (SDD) technology and evaluates the fitness of these devices for use in anti-seizure medication (ASM) clinical trials. Methods: Through a systematic literature review, 36 wireless SDDs featured in published device validation studies were identified. Each device's seizure detection capabilities that addressed ASM clinical trial primary endpoint measurement needs were cataloged. Results: The two most common types of seizures targeted by ASMs in clinical trials are generalized tonic-clonic (GTC) seizures and focal with impaired awareness (FIA) seizures. The Brain Sentinel SPEAC achieved the highest performance for the detection of GTC seizures (F 1-score = 0.95). A non-commercial wireless EEG device achieved the highest performance for the detection of FIA seizures (F 1-score = 0.88). Discussion: A preliminary assessment of device capabilities for measuring selected ASM clinical trial secondary endpoints was performed. The need to address key limitations in validation studies is highlighted in order to support future assessments of SDD fitness for ASM clinical trial use. In tandem, a stepwise framework to streamline device testing is put forth. These suggestions provide a starting point for establishing SDD reporting requirements before device integration into ASM clinical trials. We conducted a systematic literature review, following PRISMA

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“…The electroencephalogram (EEG), which is generated from electrodes placed upon specific areas over the scalp and the aggregation of postsynaptic potentials with amplification, acts as a footprint of cortical function [ 16 ]. Owing to its simplicity and portable nature, the EEG has been widely utilized for detecting and characterizing seizure in various settings, guiding therapeutic decisions during neurosurgery or anesthesia, and for prognostication in neuropsychiatric illnesses [ 16 – 18 ]. Quantitative EEG analysis, an objective summary of the visual EEG tracings, further allows clinicians to evaluate alterations in cortical activities earlier, and its findings are found to correlate strongly with clinical progression in many neurological diseases [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Frail phenotype is associated with distinct quantitative electroencephalographic findings among end-stage renal disease patients: an observational study

et al. 2017

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BackgroundFrailty is prevalent among patients with end-stage renal disease (ESRD) and is associated with an increased risk of cognitive impairment. However, apart from its influence on cognition, it is currently unknown whether frailty affects subtler cerebral function in patients with ESRD.MethodsPatients with ESRD were prospectively enrolled, with clinical features and laboratory data recorded. The severity of frailty among these patients with ESRD was ascertained using the previously validated simple FRAIL scale, and was categorized as none-to-mild and moderate-to-severe frailty. All participants underwent quantitative electroencephalography (EEG), with band powers documented following the generation of the delta to alpha ratio (DAR) and delta/theta to alpha/beta ratio (DTABR). EEG results were then compared between groups of different levels of frailty.ResultsIn this cohort, (mean age: 68.9 ± 10.4 years, 37% male, 3.4 ± 3 years of dialysis), 20, 60, 40, 17, and 6% patients exhibited positivity in the fatigue, resistance, ambulation, illness, and loss-of-body-weight domains, respectively, with 45.7% being none to mildly frail and 54.3% being moderately to severely frail. Those with mild frailty had a significantly higher delta power compared to those with more severe frailty, involving all topographic sites. Patients with ESRD and severe frailty had significantly lower global, left frontal, left temporo-occipital, and right temporo-occipital DAR and DTABR, except in the right frontal area, and tended to have central accentuation of alpha, beta, and theta power, and more homogeneous DTABR and DAR distribution compared to the findings in those with mild frailty.ConclusionsFrailty in patients with ESRD can have subtler neurophysiological influences, presenting as altered EEG findings, which warrant our attention.

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The role of outpatient ambulatory electroencephalography in the diagnosis and management of adults with epilepsy or nonepileptic attack disorder: A systematic literature review

Cited by 34 publications

References 32 publications

Outcome of ambulatory video-EEG monitoring in a ˜10,000 patient nationwide cohort

Outcome of ambulatory video-EEG monitoring in a ˜10,000 patient nationwide cohort

Seizure detection devices for use in antiseizure medication clinical trials: A systematic review

Frail phenotype is associated with distinct quantitative electroencephalographic findings among end-stage renal disease patients: an observational study

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