The clinical value of EEG monitoring and silver nanoparticles to detect the levels of serum Nesfatin-1, S100β and neuron-specific enolase in evaluating the severity and prognosis of epilepsy

This study aimed to explore the clinical value of electroencephalogram (EEG) monitoring and the use of silver nanoparticles to detect serum levels of Nesfatin-1, S100β and Neuron-specific enolase (NSE) in assessing the severity and prognosis of epilepsy. A total of 54 epilepsy patients treated at our hospital from June 2017 to June 2019 were selected as the epilepsy group, and 54 healthy subjects were selected as the control group. EEG and serum levels of Nesfatin-1, S100β, and NSE in epilepsy patients without seizure and within 1 hour of seizure were ascertained and compared. The Liverpool Seizure Severity Scale (LSSS) score was used to evaluate the severity of epilepsy in patients, and the correlation between EEG findings and serum Nesfatin-1, S100β , and NSE levels was analyzed. ROC analysis was also conducted on the levels of the three factors. The patients were followed up for 1 year, the mortality rate was calculated, and the levels of Nesfatin-1, S100β, and NSE in deceased and non-deceased patients were compared. There were 50 cases (92.6%) with EEG abnormalities in the epilepsy group and 31 cases (57.4%) with epileptic EEGs in the epileptic non-seizure group. There was a significant difference in the proportion of abnormal EEGs between the two groups of epilepsy patients (P <0.05); the biomarker (Nesfatin-1, S100β, and NSE) serum levels were higher in both the non-seizure group and epileptic group than the control group, and the levels in the seizure group were higher than those in the non-seizure group (P < 0.05); seizures in patients with epilepsy were positively correlated with EEG abnormalities and biomarker serum levels. There was, however, no significant correlation between EEG abnormalities and biomarker serum levels. ROC analysis of epilepsy patients and their serum levels of Nesfatin-1, S100β and NSE showed that the area under the curve corresponding to each index was 0.850, 0.881, and 0.868, respectively (P < 0.05). With regards to deceased patients, the proportion with an abnormal EEG was 100% (15/15), which was higher than 41.0% (16/39) of non-deceased patients. Serum levels of biomarkers were also significantly higher than those in non-deceased patients (P < 0.05). Changes in EEG and biomarker serum levels were closely related to the severity of epilepsy. The proportion of patients with abnormal EEGs during seizure periods was higher, and the expression of serum Nesfatin-1, S100β and NSE was also increased, which means they can be used as markers of epilepsy and have an impact on its prognosis

Evaluation of electroencephalographic changes in patients with the new onset suspicious seizure movements

Background: Abnormal EEG is a predictor of seizure relapse. Obtaining data related to the diagnosis and outcome of the first seizures is necessary for improving care for these patients, whereas data for these studies is scarce and is limited to a few a few centres. The aim was evaluation of the EEG changes in patients with first suspicious movements of seizure.Methods: All of the patients with first suspicious movements of seizure referred to Alavi hospital of Ardabil from March 2019 to March 2020 enrolled in this study. Data including age, gender, etiology of the seizure, seizure type and EEG changes gathered. Collected data were analyzed by statistical methods in SPSS version 21.Results: 71 patients were studied. Based on the seizure type, 50 (70.4%) patients had motor, 10 (14.1%) patients had nonmotor and 11 (15.5%) patients had focal seizures type impaired awareness. EEG findings were normal in 46 patients (64.8%). There were slowing waves and epileptic discharge in 12 (16.9%) and 13 (18.3%) patients, respectively. Abnormal EEGs recorded in routine modality in 16 patients (64%), H. V. modality in 2 patients (8%), Ph. S. modality in 2 patients (8%) and both routine and excitatory modalities in 5 (20%) patients.Conclusions: There was not a significant relationship between EEG findings and age, gender, seizure etiology and seizure type. Also there was not a significant relationship between abnormal waves in different modalities and type and etiology of the seizures.

COMPARISON OF VARIOUS EEG ELECTRODE PLACEMENT SYSTEMS TO DETECT EPILEPTIFORM ABNORMALITIES IN INFANTS

Background: Technical difficulties in placement of whole 10-20 electrode system is not uncommon in neonates and infants. Apart from the full channel many centers uses the modified and amplitude integrated EEG montages to identify seizures. Objective: Efficacy of standard, modified and amplitude integrated EEG electrode placement in infants to detect epileptiform abnormalities. Methods: All routine EEGs from June 2015 to April 2018 were taken. Age ≤ 2years at the time of recoding was the inclusion criteria. Digital EEG was performed according to standard 10-20 electrode placement system in all patients. Abnormal EEGs were reanalyzed in different montages like A) 21 electrodes- full channel, B) 10 electrodes- modified long distance and C)4 electrodes- (centro/parietal) respectively. Inter ictal epileptiform discharges (IEDs), seizures, periodic complexes and non-specific dysfunctions were tabulated in all patients. Full channel montages are considered bench mark for the analysis Results: A total 129 EEGs analyzed. A) Full channel standard 21 electrodes montages could identify IEDs in 35, non-specific electrophysiological dysfunction in 9 and burst-suppression pattern in 2 EEGs. B) Modified electrode placement consists of 10 electrodes could identify IEDs only in 26 EEGs and non-specific electro physiological dysfunction in 6 EEGs. A total of 28 nonconvulsive seizures (NCS) recorded in 6 patients; 20 numbers of NCS (71.4%) seen in modified electrode placement (B) and only 16 (57.1%) seen in centro/parietal electrode placement (C).. Conclusion: Standard EEG electrode placement has higher yield in detecting epileptiform abnormalities.

Utility of Routine EEG in emergency room and inpatient service

Background:The most important indication for electroencephalograms (EEGs) is the investigation of epileptic and non-epileptic seizures. However, it is unclear whether EEG in the emergency room (ER) can be useful in managing other conditions. Our objective was to investigate the usefulness of EEGs in the ER.Methods:We performed ab observational, descriptive, retrospective study based on clinical records between 2018 and 2019. We evaluated patients admitted to our ER or hospital wards who underwent an EEG. We defined the EEG results as useful when they prompted changes in antiepileptic drug (AED) treatment or clinical management.Results:We gathered information from 236 patients with a mean age of 59.23 (SD±22.6), of whom 47.9% were women. In patients with seizures, 18.2% were generalized, 27.1% were focal, and 18.6% were unknown.Overall, 25.8% of the EEGs were abnormal. However, in patients with a history of predisposing conditions for epileptic seizures or encephalopathies, the tracing was abnormal in 47.5%. The most frequent alteration on the abnormal EEGs was generalized slowing (18.2%).The EEG was useful in 76.7% of patients: AEDs changed in 8.4%, and clinical management changed in 76.2% of patients. The usefulness of EEGs associated with acute ischemic lesions on CT (p=0.023) and with the diagnosis of vasovagal syncope (p=0.022).Conclusions:Routine EEG is useful in the ER, even in patients with a normal CT or MR brain image, as it helps determine clinical management or AED changes.

A 9-month retrospective evaluation of the aetiology and management of patients presenting with encephalitis/meningoencephalitis at a South London hospital

Encephalitis causes high morbidity and mortality. An incidence of 4.3 cases of encephalitis/100 000 population has been reported in the UK. We performed a retrospective evaluation of the diagnosis and management of adults admitted to hospital with a clinical diagnosis of encephalitis/meningoencephalitis. Clinical, laboratory and radiological data were collated from electronic records. Thirty-six patients, median age 55 years and 24 (67%) male were included. The aetiology was confirmed over nine months in 25 (69%) of whom 16 were infections (six viral, seven bacterial, two parasitic and one viral and parasitic co-infection); 7 autoimmune; 1 metabolic and 1 neoplastic. Of 24 patients with fever, 15 (63%) had an infection. The median time to computed topography, magnetic resonance imaging and electroencephalography (EEG) was 1, 8 and 3 days respectively. Neuroimaging was abnormal in 25 (69%) and 17 (89%) had abnormal EEGs. Only 19 (53%) received aciclovir treatment. Six (17%) made good recoveries, 16 (44%) had moderate disability, 8 (22%) severe disability and 6 (17%) died. Outcomes were worse for those with an infectious cause. In summary, a diagnosis was made in 69.4% of patients admitted with encephalitis/meningoencephalitis. Autoimmune causes are important to consider at an early stage due to a successful response to treatment. Only 53% of patients received aciclovir on admission. Neuroimaging and EEG studies were delayed. The results of this work resulted in further developing the clinical algorithm for managing these patients.

Melatonin versus chloral hydrate as the sedating agent in performing electroencephalogram in paediatric patients

Electroencephalography (EEG) is a valuable tool in the diagnosis of epilepsy. The attainment of a high quality EEG requires patient's co-operation which is particularly difficult in children. Chloral hydrate has been used as a sedating agent in EEGs but it has potential serious adverse effects and anti-epileptic activity. Melatonin is used increasingly in different investigations as a safe alternative. Our study is to compare their effectiveness as sedating agents in performing EEGs and the detection rate of abnormal EEGs. This is a retrospective study performed in a regional hospital in Hong Kong. One hundred and ninety two EEG studies were included from December 2010 to July 2014. One hundred and two children were given chloral hydrate (50 mg/Kg) in the first half of the period and 90 children were given melatonin (3 mg for =< 5 years or 6 mg for >= 5 year) in the later half. The two groups are compared with Pearson's Chi-squared test with Yates’ continuity correction. The successful rate in sedation was similar between the two groups while the pick up rate of abnormal EEGs was 52.56% in the melatonin group and 21.57% in the chloral hydrate group (p < 0.05). Subgroup analysis among patients with epilepsy or mental retardation and intellectual disability shared same findings with higher detection rate of abnormal EEGs in the melatonin group. No side effect was documented in the study. Compare with chloral hydrate, melatonin is a safe and effective alternative and probably has less interference with the electrographic activity.

P.075 The trend of electroencephalograph findings after starting anti-epileptic drugs during seizure assessment in children

Background: Few studies have explored the effects of anti-epileptic drugs (AEDs) on electroencephalograph (EEG) findings during the assessment of seizure management. Although a patient may reach seizure freedom, EEG results may continue to be abnormal. Further information is required to understand the trend of EEG findings during seizure treatment. Methods: This is a retrospective study based on chart reviews. Patients who had epilepsy evaluations at the Royal University Hospital in Saskatoon between January 2012 and December 2015, were selected. The relationships among time of initiating AEDs, EEG findings, and seizure outcome on follow-ups, have been evaluated. Results: 151 patients had first seizure clinic assessments, in which 75 patients had an EEG before starting AEDs. Among the 75 patients, 54 (72%) had abnormal EEGs. From those, 38 (70.3%) patient’s EEGs became normal and 16 (29.7%) patients continued to have abnormal EEGs after the introduction of AEDs. The seizure freedom was 81.5% among those who had normal EEG on follow-up, and 43.7% of those who continued to have abnormal EEGs. Conclusions: Although patients with normal EEGs after starting AEDs may encounter a higher chance of seizure freedom, the seizure free patients with abnormal EEGs indicate that EEG is not completely sufficient in predicting seizure status.

Diagnostic Challenges for the Neurologist

The diagnosis of psychogenic nonepileptic seizures (PNES) can be challenging for the neurologist. This chapter aims to help navigate such challenges and is organized into three sections: suspecting the diagnosis, establishing the diagnosis, and delivering the diagnosis of PNES. Often these patients present to an epilepsy center with a long-standing history of refractory “epilepsy,” have tried multiple antiepileptic drugs to no avail, and have had “abnormal EEGs.” Therefore, a clear history about the seizures needs to be obtained by the neurologist. The patient needs to be evaluated using gold standard testing: long-term video-EEG monitoring. Challenges that can arise during monitoring include unsuccessful recording of habitual events, and events established as PNES yet with EEG evidence of interictal epileptic discharges. If a typical event has not been captured, the neurologist needs to navigate this situation by either attempting to provoke an event on EEG, remonitoring the patient with long-term video-EEG, or asking the patient’s family to capture an event on video, to get closer to the correct diagnosis. Once the diagnosis is established, there are challenges in delivering the diagnosis, especially if patients have carried a diagnosis of epilepsy for many years.

Electroencephalogram abnormalities in full term infants with history of severe asphyxia

ingtool used to determine developmental and electrical problemsin the brain. A history of severe asphyxia is a risk factor for thesebrain problems in infants.Objective To evaluate the prevalence of abnormal EEGs infull term neonates and to assess for an association with severeasphyxia, hypoxic ischemic encephalopathy (HIE), and spontaneousdelivery.Methods This cross-sectional study was conducted at thePediatric Outpatient Department of Sanglah Hospital, Denpasar,from November 2013 to January 2014. Subjects were fullterminfants aged 1 month who were delivered and/or hospitalized atSanglah Hospital. All subjects underwent EEG. The EEGs wereinterpreted by a pediatric neurology consultant, twice, with aweek interval between readings. Clinical data were obtainedfrom medical records. Association between abnormal ECG andsevere asphyxia were analyzed by Chi-square and multivariablelogistic analyses.Results Of 55 subjects, 27 had a history of severe asphyxia and 28were vigorous babies. Forty percent (22/55) of subjects had abnormalEEG findings, 19/22 of these subjects having history of severeasphyxia, 15/22 had history of hypoxic-ischemic encephalopathy(HIE), and 20/22 were delievered vaginally. There were strongcorrelations between the prevalence of abnormal EEG and historyof severe asphyxia, HIE, and spontaneous delivery.Conclusion Prevalence of abnormal EEG among full-term neonatesreferred to neurology/growth development clinic is around40%, with most of them having a history of severe asphyxia. AbnormalEEG is significantly associated to severe asphyxia, HIE, andspontaneous delivery.