TMS-EEG: first steps towards a clinical application in epilepsy

Abstract

1) A parameter that is robust only when using a very strict measuring protocol, cannot be used in clinical practice2) Complete understanding of the TEP is not necessary for clinical utility 3) A silent TMS coil is required for optimal N100/P180 evaluation 4) Defining TMS as a non-invasive technique is inexplicable5) The search for significant differences has nothing to do with clinically relevant findings 6) Progress would be faster if scientists would share more with each other 7) Technology develops faster than our ability to adequately use it 8) There is an important task for the Technical Physician in the medical device industry 9) Life is what happens to us, while we are making other plans (Allen Saunders)Esther ter Braack 6 June 2018 StellingenBehorende bij het proefschrift TMS-EEG: first steps towards a clinical application in epilepsy 1) Een meetrespons die alleen robuust is met een zeer sterk gecontroleerd meetprotocol, is niet bruikbaar in de klinische praktijk 2) Volledig begrip van de TEP is niet vereist voor klinisch gebruik 3) Een stille TMS spoel is nodig voor optimale N100/P180 evaluatie 4) TMS definiëren als een niet-invasieve techniek is niet uit te leggen 5) De zoektocht naar significante verschillen heeft niets te maken met klinisch relevante resultaten 6) De vooruitgang zou sneller gaan als wetenschappers meer met elkaar zouden delen 7) Technologie ontwikkelt zich sneller dan ons vermogen om deze adequaat te gebruiken 8) Er ligt een belangrijke taak voor de Technisch Geneeskundige in de medische technologie industrie 9) Het leven is wat ons overkomt, terwijl we andere plannen maken (Allen Saunders)Esther ter Braack 6 juni 2018 In all patients, evaluation of AED success is based on the absence or recurrence of the seizures, so during this trial and error based process additional seizures may occur. It can take up to several months to either achieve an effective dosage and/or combination of AEDs, meaning that the patient becomes seizure free; or conclude that the patient suffers from refractory epilepsy. Hence, a major challenge is to shorten the time needed to evaluate the success of AEDs on a single subject level. TMS-EEG: FIRST STEPS TOWARDS A CLINICAL APPLICATION IN EPILEPSY ESTHER M. TER BRAACKIn patients with only one seizure, and a normal EEG and MRI, uncertainty remains. A seizure is a traumatic experience, and an epilepsy diagnosis has potential serious consequences, such as the loss of a driving licence or the need for career changes.Currently there is only one option in these patients: wait if a second seizure occurs. The estimated probability of seizure recurrence in patients with a normal EEG is 27.4% (Krumholz et al. 2007). This means that more than a quarter of these patients do have epilepsy, but the definite diagnosis is made only at a later stage. Therefore, another major challenge is to improve the diagnostic process in patients who present with a single seizure and a normal EEG and MRI scan.When we consider these two major challenges, namely improving diagnostics and short...