Publications by authors named "Philippe Ryvlin"

234 Publications

Interpreting deep learning models for epileptic seizure detection on EEG signals.

Artif Intell Med 2021 07 1;117:102084. Epub 2021 May 1.

Embedded Systems Laboratory (ESL), EPFL, Lausanne, Switzerland.

While Deep Learning (DL) is often considered the state-of-the art for Artificial Intel-ligence-based medical decision support, it remains sparsely implemented in clinical practice and poorly trusted by clinicians due to insufficient interpretability of neural network models. We have approached this issue in the context of online detection of epileptic seizures by developing a DL model from EEG signals, and associating certain properties of the model behavior with the expert medical knowledge. This has conditioned the preparation of the input signals, the network architecture, and the post-processing of the output in line with the domain knowledge. Specifically, we focused the discussion on three main aspects: (1) how to aggregate the classification results on signal segments provided by the DL model into a larger time scale, at the seizure-level; (2) what are the relevant frequency patterns learned in the first convolutional layer of different models, and their relation with the delta, theta, alpha, beta and gamma frequency bands on which the visual interpretation of EEG is based; and (3) the identification of the signal waveforms with larger contribution towards the ictal class, according to the activation differences highlighted using the DeepLIFT method. Results show that the kernel size in the first layer determines the interpretability of the extracted features and the sensitivity of the trained models, even though the final performance is very similar after post-processing. Also, we found that amplitude is the main feature leading to an ictal prediction, suggesting that a larger patient population would be required to learn more complex frequency patterns. Still, our methodology was successfully able to generalize patient inter-variability for the majority of the studied population with a classification F1-score of 0.873 and detecting 90% of the seizures.
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http://dx.doi.org/10.1016/j.artmed.2021.102084DOI Listing
July 2021

Letter to the Editor. No need to change the nomenclature of stereoelectroencephalography.

J Neurosurg Pediatr 2021 May 21:1-2. Epub 2021 May 21.

4Le Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

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http://dx.doi.org/10.3171/2021.2.PEDS2168DOI Listing
May 2021

Discriminating cognitive motor dissociation from disorders of consciousness using structural MRI.

Neuroimage Clin 2021 29;30:102651. Epub 2021 Mar 29.

Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address:

An accurate evaluation and detection of awareness after a severe brain injury is crucial to a patient's diagnosis, therapy, and end-of-life decisions. Misdiagnosis is frequent as behavior-based assessments often overlook subtle signs of consciousness. This study aimed to identify brain MRI characteristics of patients with residual consciousness after a severe brain injury and to develop a simple MRI-based scoring system according to the findings. We retrieved data from 128 patients and split them into a development or validation set. Structural brain MRIs were qualitatively assessed for lesions in 18 brain regions. We used logistic regression and support vector machine algorithms to first identify the most relevant brain regions predicting a patient's outcome in the development set. We next built a diagnostic MRI-based score and estimated its optimal diagnostic cut-off point. The classifiers were then tested on the validation set and their performance compared using the receiver operating characteristic curve. Relevant brain regions predicting negative outcome highly overlapped between both classifiers and included the left mesencephalon, right basal ganglia, right thalamus, right parietal cortex, and left frontal cortex. The support vector machine classifier showed higher accuracy (0.93, 95% CI: 0.81-0.96) and specificity (0.97, 95% CI: 0.85-1) than logistic regression (accuracy: 0.87, 95% CI: 0.73 - 0.95; specificity: 0.90, 95% CI: 0.75-0.97), but equal sensitivity (0.67, 95% CI: 0.24-0.94 and 0.22-0.96, respectively) for distinguishing patients with and without residual consciousness. The novel MRI-based score assessing brain lesions in patients with disorders of consciousness accurately detects patients with residual consciousness. It could complement valuably behavioral evaluation as it is time-efficient and requires only conventional MRI.
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http://dx.doi.org/10.1016/j.nicl.2021.102651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056460PMC
March 2021

Need of guidance in disabling and chronic migraine identification in the primary care setting, results from the european MyLife anamnesis survey.

BMC Fam Pract 2021 Mar 20;22(1):54. Epub 2021 Mar 20.

Barts Health NHS Trust, London, UK.

Background: Migraine affects 80.8 million people in Western Europe and is the first cause of disability among people between ages 15 and 49 worldwide. Despite being a highly prevalent and disabling condition, migraine remains under-diagnosed and poorly managed.

Methods: An international, online survey was conducted among 201 general practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain and the UK) who are experienced in the management of headache disorders.

Results: The majority of GPs (82%) did not refer patients with chronic migraine (CM) to migraine specialists. Among those patients, the participants estimated that around 55% received preventive medication. Some differences between countries were observed regarding referral rate and prescription of preventive treatment. Most GPs (87%) reported a lack of training or the need to be updated on CM management. Accordingly, 95% of GPs considered that a migraine anamnesis guide could be of use. Overall, more than 95% of GPs favoured the use of a patient diary, a validated diagnostic tool and a validated scale to assess impact of migraine on patients' daily life. Similarly, 96% of the GPs considered that the inclusion of warning features (red flags) in an anamnesis guide would be useful and 90% favoured inclusion of referral recommendations.

Conclusions: The results from this survey indicate that more education on diagnosis and management of CM is needed in primary care. Better knowledge on the recognition and management of migraine in primary care would improve both prognosis and diagnosis and reduce impact of migraine on patients' lives, healthcare utilization and societal burden.
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http://dx.doi.org/10.1186/s12875-021-01402-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980340PMC
March 2021

Automated seizure detection using wearable devices: A clinical practice guideline of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology.

Clin Neurophysiol 2021 May 5;132(5):1173-1184. Epub 2021 Mar 5.

Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.

The objective of this clinical practice guideline (CPG) is to provide recommendations for healthcare personnel working with patients with epilepsy, on the use of wearable devices for automated seizure detection in patients with epilepsy, in outpatient, ambulatory settings. The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology developed the CPG according to the methodology proposed by the ILAE Epilepsy Guidelines Working Group. We reviewed the published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and evaluated the evidence and formulated the recommendations following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We found high level of evidence for the accuracy of automated detection of generalized tonic-clonic seizures (GTCS) and focal-to-bilateral tonic-clonic seizures (FBTCS) and recommend use of wearable automated seizure detection devices for selected patients when accurate detection of GTCS and FBTCS is recommended as a clinical adjunct. We also found moderate level of evidence for seizure types without GTCs or FBTCs. However, it was uncertain whether the detected alarms resulted in meaningful clinical outcomes for the patients. We recommend using clinically validated devices for automated detection of GTCS and FBTCS, especially in unsupervised patients, where alarms can result in rapid intervention (weak/conditional recommendation). At present, we do not recommend clinical use of the currently available devices for other seizure types (weak/conditional recommendation). Further research and development are needed to improve the performance of automated seizure detection and to document their accuracy and clinical utility.
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http://dx.doi.org/10.1016/j.clinph.2020.12.009DOI Listing
May 2021

Automated seizure detection using wearable devices: A clinical practice guideline of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology.

Epilepsia 2021 Mar;62(3):632-646

Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.

The objective of this clinical practice guideline (CPG) is to provide recommendations for healthcare personnel working with patients with epilepsy on the use of wearable devices for automated seizure detection in patients with epilepsy, in outpatient, ambulatory settings. The Working Group of the International League Against Epilepsy (ILAE) and the International Federation of Clinical Neurophysiology (IFCN) developed the CPG according to the methodology proposed by the ILAE Epilepsy Guidelines Working Group. We reviewed the published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and evaluated the evidence and formulated the recommendations following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We found high level of evidence for the accuracy of automated detection of generalized tonic-clonic seizures (GTCS) and focal-to-bilateral tonic-clonic seizures (FBTCS) and recommend the use of wearable automated seizure detection devices for selected patients when accurate detection of GTCS and FBTCS is recommended as a clinical adjunct. We also found a moderate level of evidence for seizure types without GTCS or FBTCS. However, it was uncertain whether the detected alarms resulted in meaningful clinical outcomes for the patients. We recommend using clinically validated devices for automated detection of GTCS and FBTCS, especially in unsupervised patients, where alarms can result in rapid intervention (weak/conditional recommendation). At present, we do not recommend clinical use of the currently available devices for other seizure types (weak/conditional recommendation). Further research and development are needed to improve the performance of automated seizure detection and to document their accuracy and clinical utility.
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http://dx.doi.org/10.1111/epi.16818DOI Listing
March 2021

Insular seizures and epilepsies: Ictal semiology and minimal invasive surgery.

Curr Opin Neurol 2021 Apr;34(2):153-165

Division of Neurology, Centre Hospitalier Université de Montréal, Montreal, Québec, Canada.

Purpose Of Review: The increased identification of seizures with insular ictal onset, promoted by the international development of stereo-electroencephalography (SEEG), has led to the recent description of larger cohorts of patients with insular or insulo-opercular epilepsies than those previously available. These new series have consolidated and extended our knowledge of the rich ictal semiology and diverse anatomo-clinical correlations that characterized insular seizures. In parallel, some experiences have been gained in the surgical treatment of insular epilepsies using minimal invasive procedures.

Recent Findings: The large majority of patients present with auras (mostly somatosensory and laryngeal) and motor signs (predominantly elementary and orofacial), an underlying focal cortical dysplasia, and an excellent postoperative seizure outcome. Many other subjective and objective ictal signs, known to occur in other forms of epilepsies, are also observed and clustered in five patterns, reflecting the functional anatomy of the insula and its overlying opercula, as well as preferential propagation pathways to frontal or temporal brain regions. A nocturnal predominance of seizure is frequently reported, whereas secondary generalization is infrequent. Some rare ictal signs are highly suggestive of an insular origin, including somatic pain, reflex seizures, choking spells, and vomiting. Minimal invasive surgical techniques have been applied to the treatment of insular epilepsies, including Magnetic Resonance Imaging-guided laser ablation (laser interstitial thermal therapy (LITT)), radiofrequency thermocoagulation (RFTC), gamma knife radiosurgery, and responsive neurostimulation. Rates of seizure freedom (about 50%) appear lower than that reported with open-surgery (about 80%) with yet a significant proportion of transient neurological deficit for LITT and RFTC.

Summary: Significant progress has been made in the identification and surgical treatment of insular and insulo-opercular epilepsies, including more precise anatomo-clinical correlations to optimally plan SEEG investigations, and experience in using minimal invasive surgery to reduce peri-operative morbidity.
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http://dx.doi.org/10.1097/WCO.0000000000000907DOI Listing
April 2021

Editorial: Seizure and developmental disorders 2020.

Authors:
Philippe Ryvlin

Curr Opin Neurol 2021 Apr;34(2):151-152

Department of Clinical Neurosciences, CHUV, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.

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http://dx.doi.org/10.1097/WCO.0000000000000908DOI Listing
April 2021

Identifying patients with epilepsy at high risk of cardiac death: signs, risk factors and initial management of high risk of cardiac death.

Epileptic Disord 2021 Feb;23(1):17-39

Stichting Epilepsie Instellingen Nederland - SEIN, Achterweg 5, 2103 SW, Heemstede, The Netherlands, NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK, Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.

People with epilepsy have a three-fold increased risk of dying prematurely, and a significant proportion is due to sudden cardiac death or acute myocardial infarctions. The causes of increased cardiovascular morbidity and mortality in epilepsy are manifold and include acute or remote effects of epileptic seizures, the longstanding epilepsy itself or antiseizure treatments. Seizure-related cardiac arrhythmias are common and comprise bradyarrhythmia and asystole, atrial fibrillation and ventricular tachycardia. The most frequent clinically relevant seizure-related arrhythmia is ictal asystole that may require implantation of a cardiac pacemaker, whereas seizure-related ventricular tachycardias are only rarely reported. Takotsubo cardiomyopathy and myocardial infarction are rare complications and predominantly described in association with tonic-clonic seizures. Epilepsy-related cardiac complications include a disturbed cardiac autonomic nervous system and acquired dysfunction of the heart (recently defined as 'epileptic heart'), probably contributing to the abnormalities of cardiac repolarisation and elevated risk of sudden cardiac death in people with epilepsy. If successful, the use of antiseizure medication prevents seizure-related cardiac arrhythmias and remote cardiac complications. However, enzyme-inducing antiseizure medications have a negative impact on cardiovascular risk factors, which may further be aggravated by weight gain linked to specific antiseizure drugs. Given the severe consequences of cardiac risks, the aim of this educational review is to explain the many facets of cardiac complications and their underlying causes, and to enable the reader to recognize and manage these risks with the goal to mitigate the cardiac risks in people with epilepsy. Features of syncope are explained in detail, as syncope of all origins can be mistaken as epileptic seizures in people with or without epilepsy, and ictal syncope (i.e. seizure-induced syncope) can easily be ignored.
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http://dx.doi.org/10.1684/epd.2021.1254DOI Listing
February 2021

Asymmetric high-order anatomical brain connectivity sculpts effective connectivity.

Netw Neurosci 2020 1;4(3):871-890. Epub 2020 Sep 1.

Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, London, United Kingdom.

Bridging the gap between symmetric, direct white matter brain connectivity and neural dynamics that are often asymmetric and polysynaptic may offer insights into brain architecture, but this remains an unresolved challenge in neuroscience. Here, we used the graph Laplacian matrix to simulate symmetric and asymmetric high-order diffusion processes akin to particles spreading through white matter pathways. The simulated indirect structural connectivity outperformed direct as well as absent anatomical information in sculpting effective connectivity, a measure of causal and directed brain dynamics. Crucially, an asymmetric diffusion process determined by the sensitivity of the network nodes to their afferents best predicted effective connectivity. The outcome is consistent with brain regions adapting to maintain their sensitivity to inputs within a dynamic range. Asymmetric network communication models offer a promising perspective for understanding the relationship between structural and functional brain connectomes, both in normalcy and neuropsychiatric conditions.
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http://dx.doi.org/10.1162/netn_a_00150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888488PMC
September 2020

Relation between coffee consumption and risk of seizure-related respiratory dysfunction in patients with drug-resistant focal epilepsy.

Epilepsia 2021 Mar 14;62(3):765-777. Epub 2021 Feb 14.

Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.

Objective: Caffeine is an antagonist of the adenosine pathway, which is involved in regulation of breathing. Extracellular concentrations of adenosine are increased in the immediate aftermath of a seizure. Seizure-related overstimulation of adenosine receptors might promote peri-ictal apnea. However, the relation between caffeine consumption and risk of seizure-related respiratory dysfunction in patients with drug-resistant focal epilepsy remains unknown.

Methods: We performed a cross-sectional analysis of data collected in patients included in the SAVE study in Lyon's epilepsy monitoring unit at the Adult Epilepsy Department of the Lyon University Hospital between February 2016 and October 2018. The video-electroencephalographic recordings of 156 patients with drug-resistant focal epilepsy included in the study were reviewed to identify those with ≥1 focal seizure (FS), valid pulse oximetry (SpO ) measurement, and information about usual coffee consumption. This latter was collected at inclusion using a standardized self-questionnaire and further classified into four groups: none, rare (≤3 cups/week), moderate (4 cups/week to 3 cups/day), and high (≥4 cups/day). Peri-ictal hypoxemia (PIH) was defined as SpO < 90% for at least 5 s occurring during the ictal period, the post-ictal period, or both.

Results: Ninety patients fulfilled inclusion criteria, and 323 seizures were analyzed. Both the level of usual coffee consumption (p = .033) and the level of antiepileptic drug withdrawal (p = .004) were independent risk factors for occurrence of PIH. In comparison with FS in patients with no coffee consumption, risk of PIH was four times lower in FS in patients with moderate consumption (odds ratio [OR] = .25, 95% confidence interval [CI] = .07-.91, p = .036) and six times lower in FS in patients with high coffee consumption (OR = .16, 95% CI = .04-.66, p = .011). However, when PIH occurred, its duration was longer in patients with moderate or high consumption than in those with no coffee consumption (p = .042).

Significance: Coffee consumption may be a protective factor for seizure-related respiratory dysfunction, with a dose-dependent effect.
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http://dx.doi.org/10.1111/epi.16837DOI Listing
March 2021

Current clinical practice in disabling and chronic migraine in the primary care setting: results from the European My-LIFE anamnesis survey.

BMC Neurol 2021 Jan 4;21(1). Epub 2021 Jan 4.

Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.

Background: Migraine is a prevalent and disabling headache disorder that affects more than 1.04 billion individuals world-wide. It can result in reduction in quality of life, increased disability, and high socio-economic burden. Nevertheless, and despite the availability of evidence-based national and international guidelines, the management of migraine patients often remains suboptimal, especially for chronic migraine (CM) patients.

Methods: My-LIFE anamnesis project surveyed 201 General practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain, and the UK) with the aim of understanding chronic migraine (CM) patients' management in the primary care setting.

Results: In our survey, GPs diagnosed episodic migraine (EM) more often than CM (87% vs 61%, p < 0.001). We found that many CM patients were not properly managed or referred to specialists, in contrast to guidelines recommendations. The main tools used by primary-care physicians included clinical interview, anamnesis guide, and patient diary. Tools used at the first visit differed from those used at follow-up visits. Up to 82% of GPs reported being responsible for management of patients diagnosed with disabling or CM and did not refer them to a specialist. Even when the GP had reported referring CM patients to a specialist, 97% of them were responsible for their follow-up. Moreover, the treatment prescribed, both acute and preventive, was not in accordance with local and international recommendations. GPs reported that they evaluated the efficacy of the treatment prescribed mainly through patient perception, and the frequency of follow-up visits was not clearly established in the primary care setting. These results suggest that CM is underdiagnosed and undertreated; thereby its management is suboptimal in the primary care.

Conclusions: There is a need of guidance in the primary care setting to both leverage the management of CM patients and earlier referral to specialists, when appropriate.
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http://dx.doi.org/10.1186/s12883-020-02014-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780632PMC
January 2021

EpilepsyGAN: Synthetic Epileptic Brain Activities With Privacy Preservation.

IEEE Trans Biomed Eng 2021 Aug 16;68(8):2435-2446. Epub 2021 Jul 16.

Epilepsy is a chronic neurological disorder affecting more than 65 million people worldwide and manifested by recurrent unprovoked seizures. The unpredictability of seizures not only degrades the quality of life of the patients, but it can also be life-threatening. Modern systems monitoring electroencephalography (EEG) signals are being currently developed with the view to detect epileptic seizures in order to alert caregivers and reduce the impact of seizures on patients' quality of life. Such seizure detection systems employ state-of-the-art machine learning algorithms that require a large amount of labeled personal data for training. However, acquiring EEG signals during epileptic seizures is a costly and time-consuming process for medical experts and patients. Furthermore, this data often contains sensitive personal information, presenting privacy concerns. In this work, we generate synthetic seizure-like brain electrical activities, i.e., EEG signals, that can be used to train seizure detection algorithms, alleviating the need for sensitive recorded data. Our experiments show that the synthetic seizure data generated with our GAN model succeeds at preserving the privacy of the patients without producing any degradation in performance during seizure monitoring.
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http://dx.doi.org/10.1109/TBME.2020.3042574DOI Listing
August 2021

Association of Peri-ictal Brainstem Posturing With Seizure Severity and Breathing Compromise in Patients With Generalized Convulsive Seizures.

Neurology 2021 01 2;96(3):e352-e365. Epub 2020 Dec 2.

From the NINDS Center for SUDEP Research (L.V., N.L., S.O., M.O.-U., S.T., M.R.S.R., R.K.S., D.F., M.N., C.S., L.A., B.K.G., J.S.H., S.S., J.O., R.M.H., B.D., L.M.B., O.D., G.B.R., P.R., G.-Q.Z., S.D.L.) and Department of Neurology (L.V., N.L., J.P.H., S.O., M.O.-U., S.T., M.R.S.R., N.J.H., J.S.H., G.-Q.Z., S.D.L.), McGovern Medical School, and Biostatistics and Epidemiology Research Design Core (L.Z., G.B.R.), Division of Clinical and Translational Sciences, University of Texas Health Science Center at Houston; Departament de Medicina (L.V.), Universitat Autonoma de Barcelona, Spain; University of Iowa Carver College of Medicine (R.K.S., B.K.G.), Iowa City; NYU Langone School of Medicine (D.F., O.D.), New York; Sidney Kimmel Medical College (M.N.), Thomas Jefferson University, Philadelphia, PA; Division of Pulmonary (K.S.), Critical Care and Sleep Medicine, University Hospitals Medical Center, Cleveland, OH; Institute of Neurology (C.S., L.A., B.D.), University College London, UK; Case Western Reserve University (N.S., X.Z., V.R.-M.), Cleveland, OH; Feinberg School of Medicine (S.S.), Northwestern University, Chicago, IL; Department of Neurobiology and the Brain Research Institute (J.O., R.M.H.), University of California, Los Angeles; Department of Neurology (L.M.B.), Columbia University, New York, NY; and Department of Clinical Neuroscience (P.R.), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Objective: To analyze the association between peri-ictal brainstem posturing semiologies with postictal generalized electroencephalographic suppression (PGES) and breathing dysfunction in generalized convulsive seizures (GCS).

Methods: In this prospective, multicenter analysis of GCS, ictal brainstem semiology was classified as (1) decerebration (bilateral symmetric tonic arm extension), (2) decortication (bilateral symmetric tonic arm flexion only), (3) hemi-decerebration (unilateral tonic arm extension with contralateral flexion) and (4) absence of ictal tonic phase. Postictal posturing was also assessed. Respiration was monitored with thoracoabdominal belts, video, and pulse oximetry.

Results: Two hundred ninety-five seizures (180 patients) were analyzed. Ictal decerebration was observed in 122 of 295 (41.4%), decortication in 47 of 295 (15.9%), and hemi-decerebration in 28 of 295 (9.5%) seizures. Tonic phase was absent in 98 of 295 (33.2%) seizures. Postictal posturing occurred in 18 of 295 (6.1%) seizures. PGES risk increased with ictal decerebration (odds ratio [OR] 14.79, 95% confidence interval [CI] 6.18-35.39, < 0.001), decortication (OR 11.26, 95% CI 2.96-42.93, < 0.001), or hemi-decerebration (OR 48.56, 95% CI 6.07-388.78, < 0.001). Ictal decerebration was associated with longer PGES ( = 0.011). Postictal posturing was associated with postconvulsive central apnea (PCCA) ( = 0.004), longer hypoxemia ( < 0.001), and Spo recovery ( = 0.035).

Conclusions: Ictal brainstem semiology is associated with increased PGES risk. Ictal decerebration is associated with longer PGES. Postictal posturing is associated with a 6-fold increased risk of PCCA, longer hypoxemia, and Spo recovery. Peri-ictal brainstem posturing may be a surrogate biomarker for GCS severity identifiable without in-hospital monitoring.

Classification Of Evidence: This study provides Class III evidence that peri-ictal brainstem posturing is associated with the GCS with more prolonged PGES and more severe breathing dysfunction.
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http://dx.doi.org/10.1212/WNL.0000000000011274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884980PMC
January 2021

Seizure detection and mobile health devices in epilepsy: Recent developments and future perspectives.

Epilepsia 2020 11 23;61 Suppl 1:S1-S2. Epub 2020 Oct 23.

Department of Clinical Neurophysiology, Aarhus University Hospital and Danish Epilepsy Center, Dianalund, Denmark.

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http://dx.doi.org/10.1111/epi.16702DOI Listing
November 2020

Medical Informatics Platform (MIP): A Pilot Study Across Clinical Italian Cohorts.

Front Neurol 2020 23;11:1021. Epub 2020 Sep 23.

Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.

With the shift of research focus to personalized medicine in Alzheimer's Dementia (AD), there is an urgent need for tools that are capable of quantifying a patient's risk using diagnostic biomarkers. The Medical Informatics Platform (MIP) is a distributed e-infrastructure federating large amounts of data coupled with machine-learning (ML) algorithms and statistical models to define the biological signature of the disease. The present study assessed (i) the accuracy of two ML algorithms, i.e., supervised Gradient Boosting (GB) and semi-unsupervised 3C strategy (Categorize, Cluster, Classify-CCC) implemented in the MIP and (ii) their contribution over the standard diagnostic workup. We examined individuals coming from the MIP installed across 3 Italian memory clinics, including subjects with Normal Cognition (CN, = 432), Mild Cognitive Impairment (MCI, = 456), and AD ( = 451). The GB classifier was applied to best discriminate the three diagnostic classes in 1,339 subjects, and the CCC strategy was used to refine the classical disease categories. Four dementia experts provided their diagnostic confidence (DC) of MCI conversion on an independent cohort of 38 patients. DC was based on clinical, neuropsychological, CSF, and structural MRI information and again with addition of the outcome from the MIP tools. The GB algorithm provided a classification accuracy of 85% in a nested 10-fold cross-validation for CN vs. MCI vs. AD discrimination. Accuracy increased to 95% in the holdout validation, with the omission of each Italian clinical cohort out in turn. CCC identified five homogeneous clusters of subjects and 36 biomarkers that represented the disease fingerprint. In the DC assessment, CCC defined six clusters in the MCI population used to train the algorithm and 29 biomarkers to improve patients staging. GB and CCC showed a significant impact, evaluated as +5.99% of increment on physicians' DC. The influence of MIP on DC was rated from "slight" to "significant" in 80% of the cases. GB provided fair results in classification of CN, MCI, and AD. CCC identified homogeneous and promising classes of subjects via its semi-unsupervised approach. We measured the effect of the MIP on the physician's DC. Our results pave the way for the establishment of a new paradigm for ML discrimination of patients who will or will not convert to AD, a clinical priority for neurology.
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http://dx.doi.org/10.3389/fneur.2020.01021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538836PMC
September 2020

Somatosensory phenomena elicited by electrical stimulation of hippocampus: Insight into the ictal network.

Epilepsy Behav Rep 2020 31;14:100387. Epub 2020 Aug 31.

Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.

Up to 11% of patients with mesial temporal lobe epilepsy experience somatosensory auras, although these structures do not have any somatosensory physiological representation. We present the case of a patient with left mesial temporal lobe epilepsy who had somatosensory auras on the right side of the body. Stereo-EEG recording demonstrated seizure onset in the left mesial temporal structures, with propagation to the sensory cortices, when the patient experienced the somatosensory aura. Direct electrical stimulation of both the left amygdala and the hippocampus elicited the patient's habitual, somatosensory aura, with afterdischarges propagating to sensory cortices. These unusual responses to cortical stimulation suggest that in patients with epilepsy, aberrant neural networks are established, which have an essential role in ictogenesis.
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http://dx.doi.org/10.1016/j.ebr.2020.100387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501419PMC
August 2020

Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19?

Front Neurol 2020 25;11:880. Epub 2020 Aug 25.

Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland.

Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties.
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http://dx.doi.org/10.3389/fneur.2020.00880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477378PMC
August 2020

Standard procedures for the diagnostic pathway of sleep-related epilepsies and comorbid sleep disorders: A European Academy of Neurology, European Sleep Research Society and International League against Epilepsy-Europe consensus review.

J Sleep Res 2020 12 21;29(6):e13184. Epub 2020 Sep 21.

IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.

Background: Some epilepsy syndromes (sleep-related epilepsies [SRE]) have a strong link with sleep. Comorbid sleep disorders are common in patients with SRE and can exert a negative impact on seizure control and quality of life.

Purposes: To define the standard procedures for the diagnostic pathway of patients with possible SRE (scenario 1) and the general management of patients with SRE and comorbidity with sleep disorders (scenario 2).

Methods: The project was conducted under the auspices of the European Academy of Neurology (EAN), the European Sleep Research Society (ESRS) and the International League against Epilepsy (ILAE) Europe. The framework of the document entailed the following phases: conception of the clinical scenarios; literature review; statements regarding the standard procedures. For literature search a step-wise approach starting from systematic reviews to primary studies was applied. Published studies were identified from the National Library of Medicine's MEDLINE database and Cochrane Library.

Results: Scenario 1: despite a low quality of evidence, recommendations on anamnestic evaluation, tools for capturing the event at home or in the laboratory are provided for specific SRE. Scenario 2: Early diagnosis and treatment of sleep disorders (especially respiratory disorders) in patients with SRE are likely to be beneficial for seizures control.

Conclusions: Definitive procedures for evaluating patients with SRE are lacking. We provide advice that could be of help for standardising and improving the diagnostic approach of specific SRE. The importance of identifying and treating specific sleep disorders for the management and outcome of patients with SRE is underlined.
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http://dx.doi.org/10.1111/jsr.13184DOI Listing
December 2020

Sudden death in epilepsy: There is room for intracranial pressure.

Brain Behav 2020 11 19;10(11):e01838. Epub 2020 Sep 19.

Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.

Introduction: Sudden unexpected death in patients with epilepsy (SUDEP) remains a poorly understood entity, and it is unclear whether the same pathomechanisms underlie all sudden deaths occurring in patients with epilepsy. One aspect not included in current models of SUDEP is the role of increased intracranial pressure (ICP) which can be observed immediately upon seizure activity in neurosurgical practice.

Methods: We conducted a systematic review of the occurrence of edema in patients with epilepsy reported to have died of sudden death who underwent brain autopsy or postmortem brain imaging and discuss how increased ICP may contribute to clinical features of SUDEP.

Results: 19 eligible studies comprising a total of 623 patients were identified. Edema-mostly mild or moderate-was reported in 17% of cases and 74% of studies. 1% (n = 6) of the overall cases were clearly identified as having Dravet syndrome or an SCN1A mutation. In these patients, edema was found in 4 (67%) of cases.

Conclusion: Edema is regularly found in patients with epilepsy classified to have died from SUDEP. We argue that seizures preceding SUDEP may in certain cases elicit acute edema which may represent an additional contributing factor in the cascade of events leading to sudden death of patients with epilepsy. Furthermore, we hypothesize that mild edema may especially progress to severe edema in patients with sodium channel mutations which may represent an important mechanism to investigate in the context of understanding the significantly elevated risk of SUDEP in patients with SCN1A mutations.
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http://dx.doi.org/10.1002/brb3.1838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667321PMC
November 2020

Neural correlates of verbal working memory in children with epilepsy with centro-temporal spikes.

Neuroimage Clin 2020 20;28:102392. Epub 2020 Aug 20.

Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.

Background: Previous functional magnetic resonance imaging (fMRI) studies have identified brain systems underlying different components of working memory (WM) in healthy subjects. The aim of this study was to compare the functional integrity of these neural networks in children with self-limited childhood epilepsy with centro-temporal spikes (ECTS) as compared to healthy controls, using a verbal working memory task (WMT).

Methods: Functional MRI of WM in seventeen 6-to-13 year-old children, diagnosed with ECTS, and 17 sex- and age-matched healthy controls were conducted at 3 T. To estimate BOLD responses during the maintenance of low, medium, and high WMT loads, we used a Sternberg verbal WMT. Neuropsychological testing prior to scanning and behavioral data during scanning were also acquired.

Results: Behavioral performances during WMT, in particular accuracy and response time, were poorer in children with ECTS than in controls. Increased WM load was associated with increased BOLD signal in all subjects, with significant clusters detected in frontal and parietal regions, predominantly in the left hemisphere. However, under the high load condition, patients showed reduced activation in the frontal, temporal and parietal regions as compared to controls. In brain regions where WM-triggered BOLD activation differed between groups, this activation correlated with neuropsychological performances in healthy controls but not in patients with ECTS, further suggesting WM network dysfunction in the latter.

Conclusion: Children with ECTS differ from healthy controls in how they control WM processes during tasks with increasing difficulty level, notably for high WM load where patients demonstrate both reduced BOLD activation and behavioral performances.
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http://dx.doi.org/10.1016/j.nicl.2020.102392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495114PMC
June 2021

Big data in epilepsy: Clinical and research considerations. Report from the Epilepsy Big Data Task Force of the International League Against Epilepsy.

Epilepsia 2020 09 7;61(9):1869-1883. Epub 2020 Aug 7.

Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.

Epilepsy is a heterogeneous condition with disparate etiologies and phenotypic and genotypic characteristics. Clinical and research aspects are accordingly varied, ranging from epidemiological to molecular, spanning clinical trials and outcomes, gene and drug discovery, imaging, electroencephalography, pathology, epilepsy surgery, digital technologies, and numerous others. Epilepsy data are collected in the terabytes and petabytes, pushing the limits of current capabilities. Modern computing firepower and advances in machine and deep learning, pioneered in other diseases, open up exciting possibilities for epilepsy too. However, without carefully designed approaches to acquiring, standardizing, curating, and making available such data, there is a risk of failure. Thus, careful construction of relevant ontologies, with intimate stakeholder inputs, provides the requisite scaffolding for more ambitious big data undertakings, such as an epilepsy data commons. In this review, we assess the clinical and research epilepsy landscapes in the big data arena, current challenges, and future directions, and make the case for a systematic approach to epilepsy big data.
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http://dx.doi.org/10.1111/epi.16633DOI Listing
September 2020

Brain circuits signaling the absence of emotion in body language.

Proc Natl Acad Sci U S A 2020 08 6;117(34):20868-20873. Epub 2020 Aug 6.

Department of Psychiatry and Psychotherapy, University of Tübingen Medical School, 72076 Tübingen, Germany.

Adaptive social behavior and mental well-being depend on not only recognizing emotional expressions but also, inferring the absence of emotion. While the neurobiology underwriting the perception of emotions is well studied, the mechanisms for detecting a lack of emotional content in social signals remain largely unknown. Here, using cutting-edge analyses of effective brain connectivity, we uncover the brain networks differentiating neutral and emotional body language. The data indicate greater activation of the right amygdala and midline cerebellar vermis to nonemotional as opposed to emotional body language. Most important, the effective connectivity between the amygdala and insula predicts people's ability to recognize the absence of emotion. These conclusions extend substantially current concepts of emotion perception by suggesting engagement of limbic effective connectivity in recognizing the lack of emotion in body language reading. Furthermore, the outcome may advance the understanding of overly emotional interpretation of social signals in depression or schizophrenia by providing the missing link between body language reading and limbic pathways. The study thus opens an avenue for multidisciplinary research on social cognition and the underlying cerebrocerebellar networks, ranging from animal models to patients with neuropsychiatric conditions.
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http://dx.doi.org/10.1073/pnas.2007141117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456113PMC
August 2020

Early discrimination of cognitive motor dissociation from disorders of consciousness: pitfalls and clues.

J Neurol 2021 Jan 4;268(1):178-188. Epub 2020 Aug 4.

Acute Neuro-rehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Bâtiment Champ de l'Air, Rue du Bugnon 21, 1011, Lausanne, Switzerland.

Bedside assessment of consciousness and awareness after a severe brain injury might be hampered by confounding clinical factors (i.e., pitfalls) interfering with the production of behavioral or motor responses to external stimuli. Despite the use of validated clinical scales, a high misdiagnosis rate is indeed observed. We retrospectively analyzed a cohort of 49 patients with severe brain injury admitted to an acute neuro-rehabilitation program. Patients' behavior was assessed using the Motor Behavior Tool and Coma Recovery Scale Revised. All patients underwent systematic assessment for pitfalls including polyneuropathy and/or myopathy and/or myelopathy, major cranial nerve palsies, non-convulsive status epilepticus, aphasia (expressive or comprehensive), cortical blindness, thalamic involvement and frontal akinetic syndrome. A high prevalence (75%) of pitfalls potentially interfering with sensory afference (polyneuropathy, myopathy, myelopathy, and sensory aphasia), motor efference (polyneuropathy, myopathy, motor aphasia, and frontal akinetic syndrome), and intrinsic brain activity (thalamic involvement and epilepsy) was found. Nonetheless, the motor behavior tool identified residual cognition (i.e. a cognitive motor dissociation condition) regardless of the presence of these pitfalls in 70% of the patients diagnosed as unresponsive using the Coma Recovery Scale Revised. On one hand, pitfalls might contribute to misdiagnosis. On the other, it could be argued that they are clues for diagnosing cognitive motor dissociation rather than true disorders of consciousness given their prominent effect on the sensory-motor input-output balance.
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http://dx.doi.org/10.1007/s00415-020-10125-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815538PMC
January 2021

A European questionnaire survey on epilepsy monitoring units' current practice for postoperative psychogenic nonepileptic seizures' detection.

Epilepsy Behav 2020 11 31;112:107355. Epub 2020 Jul 31.

National Institute of Psychiatry and Neurology, Department of Neurology, University of Pécs, Budapest, Hungary.

Background: In cases undergoing epilepsy surgery, postoperative psychogenic nonepileptic seizures (PNES) may be underdiagnosed complicating the assessment of postsurgical seizures' outcome and the clinical management. We conducted a survey to investigate the current practices in the European epilepsy monitoring units (EMUs) and the data that EMUs could provide to retrospectively detect cases with postoperative PNES and to assess the feasibility of a subsequent postoperative PNES research project for cases with postoperative PNES.

Methods: We developed and distributed a questionnaire survey to 57 EMUs. Questions addressed the number of patients undergoing epilepsy surgery, the performance of systematic preoperative and postoperative psychiatric evaluation, the recording of sexual or other abuse, the follow-up period of patients undergoing epilepsy surgery, the performance of video-electroencephalogram (EEG) and postoperative psychiatric assessment in suspected postoperative cases with PNES, the existence of electronic databases to allow extraction of cases with postoperative PNES, the data that these bases could provide, and EMUs' interest to participate in a retrospective postoperative PNES project.

Results: Twenty EMUs completed the questionnaire sheet. The number of patients operated every year/per center is 26.7 ( ± 19.1), and systematic preoperative and postoperative psychiatric evaluation is performed in 75% and 50% of the EMUs accordingly. Sexual or other abuse is systematically recorded in one-third of the centers, and the mean follow-up period after epilepsy surgery is 10.5 ± 7.5 years. In suspected postoperative PNES, video-EEG is performed in 85% and psychiatric assessment in 95% of the centers. An electronic database to allow extraction of patients with PNES after epilepsy surgery is used in 75% of the EMUs, and all EMUs that sent the sheet completed expressed their interest to participate in a retrospective postoperative PNES project.

Conclusion: Postoperative PNES is an underestimated and not well-studied entity. This is a European survey to assess the type of data that the EMUs surgical cohorts could provide to retrospectively detect postoperative PNES. In cases with suspected PNES, most EMUs perform video-EEG and psychiatric assessment, and most EMUs use an electronic database to allow extraction of patients developing PNES.
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http://dx.doi.org/10.1016/j.yebeh.2020.107355DOI Listing
November 2020

Machine learning and wearable devices of the future.

Epilepsia 2021 Mar 26;62 Suppl 2:S116-S124. Epub 2020 Jul 26.

The Graeme Clark Institute, The University of Melbourne, Melbourne, Vic., Australia.

Machine learning (ML) is increasingly recognized as a useful tool in healthcare applications, including epilepsy. One of the most important applications of ML in epilepsy is seizure detection and prediction, using wearable devices (WDs). However, not all currently available algorithms implemented in WDs are using ML. In this review, we summarize the state of the art of using WDs and ML in epilepsy, and we outline future development in these domains. There is published evidence for reliable detection of epileptic seizures using implanted electroencephalography (EEG) electrodes and wearable, non-EEG devices. Application of ML using the data recorded with WDs from a large number of patients could change radically the way we diagnose and manage patients with epilepsy.
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http://dx.doi.org/10.1111/epi.16555DOI Listing
March 2021

Biomarkers of seizure severity derived from wearable devices.

Epilepsia 2020 11 10;61 Suppl 1:S61-S66. Epub 2020 Jun 10.

Department of Clinical Neurosciences, Vaud University Hospital Center, Lausanne, Switzerland.

Besides triggering alarms, wearable seizure detection devices record a variety of biosignals that represent biomarkers of seizure severity. There is a need for automated seizure characterization, to identify high-risk seizures. Wearable devices can automatically identify seizure types with the highest associated morbidity and mortality (generalized tonic-clonic seizures), quantify their duration and frequency, and provide data on postictal position and immobility, autonomic changes derived from electrocardiography/heart rate variability, electrodermal activity, respiration, and oxygen saturation. In this review, we summarize how these biosignals reflect seizure severity, and how they can be monitored in the ambulatory outpatient setting using wearable devices. Multimodal recording of these biosignals will provide valuable information for individual risk assessment, as well as insights into the mechanisms and prevention of sudden unexpected death in epilepsy.
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http://dx.doi.org/10.1111/epi.16492DOI Listing
November 2020

Noninvasive detection of focal seizures in ambulatory patients.

Epilepsia 2020 11 2;61 Suppl 1:S47-S54. Epub 2020 Jun 2.

Department of Clinical Neurosciences, Vaud University Hospital, Lausanne, Switzerland.

Reliably detecting focal seizures without secondary generalization during daily life activities, chronically, using convenient portable or wearable devices, would offer patients with active epilepsy a number of potential benefits, such as providing more reliable seizure count to optimize treatment and seizure forecasting, and triggering alarms to promote safeguarding interventions. However, no generic solution is currently available to reach these objectives. A number of biosignals are sensitive to specific forms of focal seizures, in particular heart rate and its variability for seizures affecting the neurovegetative system, and accelerometry for those responsible for prominent motor activity. However, most studies demonstrate high rates of false detection or poor sensitivity, with only a minority of patients benefiting from acceptable levels of accuracy. To tackle this challenging issue, several lines of technological progress are envisioned, including multimodal biosensing with cross-modal analytics, a combination of embedded and distributed self-aware machine learning, and ultra-low-power design to enable appropriate autonomy of such sophisticated portable solutions.
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http://dx.doi.org/10.1111/epi.16538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754288PMC
November 2020

Peri-ictal heart rate variability parameters as surrogate markers of seizure severity.

Epilepsia 2020 11 21;61 Suppl 1:S55-S60. Epub 2020 May 21.

Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark.

This study aims at defining objective parameters reflecting the severity of peri-ictal autonomic changes and their relation to post-ictal generalized electroencephalography (EEG) suppression (PGES), with the view that such changes could be detected by wearable seizure detection systems and prove useful to assess the risk of sudden unexpected death in epilepsy (SUDEP). To this purpose, we assessed peri-ictal changes in heart rate variability (HRV) and correlated them with seizure duration, intensity of electromyography-based ictal muscle activity, and presence and duration of post-ictal generalized EEG suppression (PGES). We evaluated 75 motor seizures from 40 patients, including 61 generalized tonic-clonic seizures (GTCS) and 14 other major motor seizure types. For all major motor seizures, HRV measurements demonstrated a significantly decreased parasympathetic activity and increased sympathetic activity in the post-ictal period. The post-ictal increased sympathetic activity was significantly higher for GTCS as compared with non-GTCS. The degree of peri-ictal decreased parasympathetic activity and increased sympathetic activity was associated with longer PGES (>20 s), longer seizure duration, and greater intensity of ictal muscle activity. Mean post-ictal heart rate (HR) was an independent predictor of PGES duration, seizure duration, and intensity of ictal muscle contraction. Our results indicate that peri-ictal changes in HRV are potential biomarkers of major motor seizure severity.
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http://dx.doi.org/10.1111/epi.16491DOI Listing
November 2020

Ictal quantitative surface electromyography correlates with postictal EEG suppression.

Neurology 2020 06 12;94(24):e2567-e2576. Epub 2020 May 12.

From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark.

Objective: To test the hypothesis that neurophysiologic biomarkers of muscle activation during convulsive seizures reveal seizure severity and to determine whether automatically computed surface EMG parameters during seizures can predict postictal generalized EEG suppression (PGES), indicating increased risk for sudden unexpected death in epilepsy. Wearable EMG devices have been clinically validated for automated detection of generalized tonic-clonic seizures. Our goal was to use quantitative EMG measurements for seizure characterization and risk assessment.

Methods: Quantitative parameters were computed from surface EMGs recorded during convulsive seizures from deltoid and brachial biceps muscles in patients admitted to long-term video-EEG monitoring. Parameters evaluated were the durations of the seizure phases (tonic, clonic), durations of the clonic bursts and silent periods, and the dynamics of their evolution (slope). We compared them with the duration of the PGES.

Results: We found significant correlations between quantitative surface EMG parameters and the duration of PGES ( < 0.001). Stepwise multiple regression analysis identified as independent predictors in deltoid muscle the duration of the clonic phase and in biceps muscle the duration of the tonic-clonic phases, the average silent period, and the slopes of the silent period and clonic bursts. The surface EMG-based algorithm identified seizures at increased risk (PGES ≥20 seconds) with an accuracy of 85%.

Conclusions: Ictal quantitative surface EMG parameters correlate with PGES and may identify seizures at high risk.

Classification Of Evidence: This study provides Class II evidence that during convulsive seizures, surface EMG parameters are associated with prolonged postictal generalized EEG suppression.
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http://dx.doi.org/10.1212/WNL.0000000000009492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455333PMC
June 2020
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