Publications by authors named "Hina Dave"

10 Publications

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Emergent Admissions to the Epilepsy Monitoring Unit in the Setting of COVID-19 Pandemic-related, State-mandated Restrictions: Clinical Decision Making and Outcomes.

Neurodiagn J 2021 Jun 10:1-9. Epub 2021 Jun 10.

Department of NeurologyUniversity of Texas Southwestern Medical Center, Dallas, Texas.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the state of Texas-limited elective procedures to conserve beds and personal protective equipment (PPE); therefore, between March 22 and May 18, 2020, admission to the epilepsy monitoring unit (EMU) was limited only to urgent and emergent cases. We evaluated clinical characteristics and outcomes of these patients who were admitted to the EMU. Nineteen patients were admitted (one patient twice) with average age of 36.26 years (11 female) and average length of stay 3 days (range: 2-9 days). At least one event was captured on continuous EEG (cEEG) and video monitoring in all 20 admissions (atypical in one). One patient had both epileptic (ES) and psychogenic non-epileptic seizures (PNES) while 10 had PNES and 9 had ES. In 8 of 9 patients with ES, medications were changed, while in 5 patients with PNES, anti-epileptic drugs (AED) were stopped; the remaining 5 were not on medications. Of the 14 patients who had seen an epileptologist pre-admission, 13 (or 93%) had their diagnosis confirmed by EMU stay; a statistically significant finding. While typically an elective admission, in the setting of the COVID-19 pandemic, urgent and emergent EMU admissions were required for increased seizure or event frequency. In the vast majority of patients (13 of 19), admission lead to medication changes to either better control seizures or to change therapeutics as appropriate when PNES was identified.
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http://dx.doi.org/10.1080/21646821.2021.1918512DOI Listing
June 2021

Beyond the Wada: An updated approach to pre-surgical language and memory testing: An updated review of available evaluation techniques and recommended workflow to limit Wada test use to essential clinical cases.

Epilepsy Res 2021 Aug 15;174:106673. Epub 2021 May 15.

Epilepsy Division, Department of Neurology, University of Texas Southwestern Medical Center Dallas. Electronic address:

The Intracarotid amobarbital test (IAT), also called Wada test, is considered the "gold standard" for lateralizing language dominance in the pre-surgical evaluation of patients with epilepsy. In addition, it has been further modified to assess the postoperative risk of amnesia in patients undergoing temporal lobectomy. Since then it has been utilized to lateralize language and assess pre-surgical memory function. Over the years, its popularity has declined due to several limitations and availability of alternative procedures like fMRI and MEG. A survey of its use in the pre-surgical evaluation for epilepsy surgery has not been performed since the 2008 international survey by Baxendale et al. and it was heavily skewed due to data from European and North American countries. Only approximately 12% of the epilepsy centers indicated that they used the Wada test in every patient to assess preoperative memory function and language lateralization before temporal lobectomy. Nowadays, we have many functional mapping tools at our disposal. It has become somewhat unsuitable to have epilepsy patients undergo an invasive test such as the Wada test for the risks associated with it outweigh the benefits. Our objective is to review the Wada Test and alternative methods of assessing language and memory dominance, as it is past its prime and should only be used in specific circumstances.
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http://dx.doi.org/10.1016/j.eplepsyres.2021.106673DOI Listing
August 2021

Non-lesional mesial temporal lobe epilepsy requires bilateral invasive evaluation.

Epilepsy Behav Rep 2021 27;15:100441. Epub 2021 Mar 27.

Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA.

Purpose: Mesial temporal lobe epilepsy (MTLE) usually responds well to surgical treatment, although in non-lesional cases up to 50% of patients experience seizure relapse. The possibility of bilateral independent seizure onset should be considered as a reason for epilepsy surgery failure.

Methods: In a cohort of 177 patients who underwent invasive presurgical evaluation with stereo-tactically placed electrodes in two level four epilepsy centers, 29 had non-lesional MTLE. Invasive evaluation results are described.

Results: Among 29 patients with non-lesional MRI and mesial temporal lobe seizure onset recorded during stereo-EEG (SEEG) evaluation, four patients with unilateral preimplantation hypothesis had independent bilateral mesial temporal seizures on SEEG despite of unilateral non-invasive evaluation data. Three of these patients were treated with bitemporal responsive neurostimulator system (RNS). Independent bilateral mesial temporal seizures have been confirmed on RNS ECoG (electrocorticography). The fourth patient underwent right anterior temporal lobectomy.

Conclusion: We propose that patients with non-lesional mesial temporal lobe epilepsy would benefit from bilateral invasive evaluation of mesial temporal structures to predict those patients who would be at most risk for surgical failure. Neurostimulaiton could be an initial treatment option for patients with independent bitemporal seizure onset.
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http://dx.doi.org/10.1016/j.ebr.2021.100441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058515PMC
March 2021

Personalized EEG Feature Selection for Low-Complexity Seizure Monitoring.

Int J Neural Syst 2021 Mar 22:2150018. Epub 2021 Mar 22.

Department of Neurology and Neurotherapeutic, The University of Texas Southwestern Medical Center, Dallas 75230, USA.

Approximately, one third of patients with epilepsy are refractory to medical therapy and thus can be at high risk of injuries and sudden unexpected death. A low-complexity electroencephalography (EEG)-based seizure monitoring algorithm is critically important for daily use, especially for wearable monitoring platforms. This paper presents a personalized EEG feature selection approach, which is the key to achieve a reliable seizure monitoring with a low computational cost. We advocate a two-step, personalized feature selection strategy to enhance monitoring performances for each patient. In the first step, linear discriminant analysis (LDA) is applied to find a few seizure-indicative channels. Then in the second step, least absolute shrinkage and selection operator (LASSO) method is employed to select a discriminative subset of both frequency and time domain features (spectral powers and entropy). A personalization strategy is further customized to find the best settings (number of channels and features) that yield the highest classification scores for each subject. Experimental results of analyzing [Formula: see text] subjects in CHB-MIT database are quite promising. We have achieved an average F-1 score of [Formula: see text] with excellent sensitivity and specificity using not more than [Formula: see text] features extracted from at most [Formula: see text] channels.
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http://dx.doi.org/10.1142/S0129065721500180DOI Listing
March 2021

Feature Selection Using F-statistic Values for EEG Signal Analysis.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:5963-5966

Electroencephalography (EEG) is a highly complex and non-stationary signal that reflects the cortical electric activity. Feature selection and analysis of EEG for various purposes, such as epileptic seizure detection, are highly in demand. This paper presents an approach to enhance classification performance by selecting discriminative features from a combined feature set consisting of frequency domain and entropy based features. For each EEG channel, nine different features are extracted, including six sub-band spectral powers and three entropy values (sample, permutation and spectral entropy). Features are then ranked across all channels using F-statistic values and selected for SVM classification. Experimentation using CHB-MIT dataset shows that our method achieves average sensitivity, specificity and F-1 score of 92.63%, 99.72% and 91.21%, respectively.
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http://dx.doi.org/10.1109/EMBC44109.2020.9176434DOI Listing
July 2020

Comparison of psychiatric comorbidities and impact on quality of life in patients with epilepsy or psychogenic nonepileptic spells.

Epilepsy Behav 2020 01 20;102:106649. Epub 2019 Nov 20.

Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA. Electronic address:

Objectives: Psychiatric comorbidity is common in people with epilepsy (PWE) and psychogenic nonepileptic spells (PNES). These comorbidities can be detrimental to quality of life (QOL) and are often underdiagnosed and undertreated. Some types of epilepsy, such as focal temporal lobe epilepsy (TLE), have been associated with higher rates of psychiatric comorbidity. This study examined the impact of psychiatric comorbidity on QOL in patients admitted to two level 4 epilepsy monitoring units (EMUs).

Methods: In this prospective observational study, 200 patients admitted to two level 4 EMUs completed standardized surveys including the Quality of Life in Epilepsy (QOLIE-31-P), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire (PHQ-9), and Beck Depression Inventory-II (BDI-II). Hierarchal multiple regression was performed to assess impact on QOL.

Results: Of the 200 participants, 113 had a diagnosis of epilepsy, 36 had a diagnosis of PNES, and 51 were excluded for nondiagnostic evaluation or dual diagnosis. Of those with epilepsy, 65 had TLE, 28 had focal extratemporal lobe epilepsy (ETLE), and 20 had nonfocal epilepsy. Patients with PNES had higher self-reported anxiety and depression levels (GAD-7: p = 0.04, PHQ-9: p < 0.01; BDI-II: p < 0.01) but similar QOL to PWE (p = 0.78). Using hierarchal multiple regression, symptoms of anxiety and depression were significant predictors of lower QOL in PWE but not in patients with PNES. There was no difference in QOL in those with ETLE and TLE.

Conclusions: Our findings suggest that self-reported anxiety and depression symptoms are common in patients admitted to level 4 EMUs regardless of diagnosis and play an important role in predicting QOL in PWE. Our findings emphasize the importance of routinely screening all EMU patients for psychiatric comorbidity.
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http://dx.doi.org/10.1016/j.yebeh.2019.106649DOI Listing
January 2020

Provocative induction of psychogenic nonepileptic seizures: Noninferiority of an induction technique without versus with placebo.

Epilepsia 2018 11 1;59(11):e161-e165. Epub 2018 Oct 1.

Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.

We aim to demonstrate, in a sufficiently powered and standardized study, that the success rate of inducing psychogenic nonepileptic seizures (PNES) without placebo (saline infusion) is noninferior to induction with placebo. The clinical data of 170 consecutive patients with suspected PNES who underwent induction with placebo from January 21, 2009 to March 31, 2013 were pair-matched with 170 consecutive patients with suspected PNES who underwent the same induction technique but without addition of placebo from April 1, 2013 to February 7, 2018 at the same center. The success rates of induction were 79.4% (135/170) without placebo and 73.5% (125/170) with placebo. The difference of these two proportions was 5.9%, with two-sided 95% confidence interval ranging from -3.6% to 15.2%, indicating a non-statistically significant difference. The lower bound of the 95% confidence interval (-3.6%) was above the noninferiority margin (δ = -5%), hence inferring noninferiority of induction without versus with placebo. The greater cumulative induction experiences of the clinician performer (influencing the manner/presentation of induction) may supplant the potential advantage from addition of placebo (the means utilized). Among experienced performers, provocative induction without placebo should be the preferred diagnostic approach, given more ethically acceptable transparency and the noninferior success rate when compared to the same induction technique with placebo.
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http://dx.doi.org/10.1111/epi.14570DOI Listing
November 2018

Propofol-ketamine combination therapy for effective control of super-refractory status epilepticus.

Epilepsy Behav 2015 Nov 6;52(Pt A):264-6. Epub 2015 Nov 6.

Ochsner Medical Center, New Orleans, LA, USA.

Retrospective analysis was conducted of patients with SRSE who were treated simultaneously with propofol and ketamine. Sixty-seven patients were identified from 2012 to 2015, and outcomes documented were resolution and mortality. The duration of combined ketamine and propofol use ranged from 1 to 28 days (mean - 3.6 days). Infusion rates ranged up to 145 and 175 mcg/kg/min. Vasopressors were used in 53 patients (79%), and were given within the first 5 days of the ICU admission in 48 (91%) patients. The overall SRSE resolution rate was 91%, and the overall mortality including patients with anoxic brain injury was 39%. Of the 13 patients with SRSE as a result of anoxic brain injury, SRSE was controlled in 5 (56%). The primary determinant of mortality was family withdrawing care related to the presence of severe medical/neurological diseases.
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http://dx.doi.org/10.1016/j.yebeh.2015.07.040DOI Listing
November 2015

Pyridoxine deficiency in adult patients with status epilepticus.

Epilepsy Behav 2015 Nov 28;52(Pt A):154-8. Epub 2015 Sep 28.

Department of Neurology, Ochsner Medical Center, New Orleans, LA, USA.

An 8-year-old girl treated at our facility for superrefractory status epilepticus was found to have a low pyridoxine level at 5 μg/L. After starting pyridoxine supplementation, improvement in the EEG for a 24-hour period was seen. We decided to look at the pyridoxine levels in adult patients admitted with status epilepticus. We reviewed the records on patients admitted to the neurological ICU for status epilepticus (SE). Eighty-one adult patients were identified with documented pyridoxine levels. For comparison purposes, we looked at pyridoxine levels in outpatients with epilepsy (n=132). Reported normal pyridoxine range is >10 ng/mL. All but six patients admitted for SE had low normal or undetectable pyridoxine levels. A selective pyridoxine deficiency was seen in 94% of patients with status epilepticus (compared to 39.4% in the outpatients) which leads us to believe that there is a relationship between status epilepticus and pyridoxine levels.
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http://dx.doi.org/10.1016/j.yebeh.2015.08.015DOI Listing
November 2015

Safety & pK of IV loading dose of lacosamide in the ICU.

Epilepsy Behav 2015 Aug 23;49:340-2. Epub 2015 Jul 23.

Ochsner Medical Center, New Orleans, LA, USA.

A restrospective review of patients treated in the ICU for refractory status epilepticus who had received an initial IV loading dose of lacosamide (LCS) was performed. A total of 142 patients were identified. The first 34 patients received 400mg which by weight-based measurement ranged from 2 to 11 mg/kg. Higher mg/kg dosing had been used subsequently with doses up to 13 mg/kg. No patient required reduction in rate or cessation of infusion. Initiation of pressor agents was not needed during the infusion of the loading dose. Postinfusion LCS blood levels were drawn, and dosing of 10-12 mg/kg and higher resulted in blood levels above 15 μg/ml while doses of 2-6 mg/kg resulted in levels below 10 μg/ml. We conclude that a weight-based loading dose of 10-12 mg/kg at an infusion rate of 0.4 mg/kg/min is safe and will produce levels of 15 μg/ml and higher. This article is part of a Special Issue entitled "Status Epilepticus".
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http://dx.doi.org/10.1016/j.yebeh.2015.06.032DOI Listing
August 2015