- Email: [email protected]
Electroencephalogram in idiopathic generalised epilepsies during adulthood
e118
Clinical Neurophysiology Society of Serbia and Montenegro / Clinical Neurophysiology 118 (2007) e117–e127
concerned with the technologies surpassing the limitations of conventional EEG recording and analysis in clinical practice. Results: The database PubMed/Medline accessed on July 30, 2006 contained 96,978 references with the key word ‘‘EEG’’ and 221 references for ‘‘new EEG technology’’. The greatest number of references was concerned with the advancement of already existing technologies – holter EEG, video EEG monitoring, quantitative EEG analysis. Several new technologies have found very useful application in clinical studies, such as geodesic sensor EEG system with photogrammetry that gives capacity for a precise and patient’s comfortable registration of electrical activity from 256 channels, full band EEG – the recording and study of the frequencies range from 0.01 to 300 Hz, and simultaneous co-registration of EEG with fMRI – simultaneous study of epileptic activity in the whole brain. Conclusions: New EEG technologies have significantly enlarged the usefulness of EEG in epileptology and neurology, as well as in cognitive neurosciences and neuropsychopharmacology. doi:10.1016/j.clinph.2006.11.278
Novel applications and paradigms – transcranial magnetic stimulation—T.V. Ilic´ (Military Medical Academy, Belgrade, Serbia) Transcranial magnetic stimulation (TMS) of the brain represents a non-invasive, safe and well-tolerated method for exploring the excitability of the human motor cortex in vivo that is used widely in research and clinical practice. Following initial research mostly directed to single and paired-pulse stimulation, the development of repetitive TMS (rTMS) has brought increasing attention on TMS as a neuroscientific and potential clinical therapeutic tool. Effects of rTMS can outlast the actual stimulation for a considerable amount of time. Areas of intense research are the treatment of affective disorders, motor deficits after stroke, medically intractable epilepsy, movement disorders and intractable deafferentation pain. In addition, to initial experimental protocols that are being used with purpose to induce prolonged, but relatively weak and variable after-effects (facilitation or depression of cortical excitability), recently the novel protocol, so called theta-burst paradigm was established. Low intensity pulses of TMS at 50 Hz for a short duration have produced longer and controllable effect. Expectations are directed toward substantial impact on cognitive research and therapeutic opportunities, either alone or combined with other techniques. Contrary to excellent temporal resolution of TMS, one of the most criticized attributes is the quite poor space resolution that does not allow very precise and restricted stimulation. doi:10.1016/j.clinph.2006.11.279
Amplitude-integrated electroencephalography in newborns with hypoxic–ischemic encephalopathy—D. Osredkar 1, M.C. Toet 2, L.G.M. van Rooij 2, A.C. van Huffelen 2, F. Groenendaal 2, L.S. de Vries 2 (1 University Children’s Hospital, Ljubljana, Slovenia Utrecht, The Netherlands, 2 Wilhelmina Children’s Hospital, Utrecht, The Netherlands)
Purpose: Perinatal cerebral hypoxia–ischemia remains a frequent cause of the chronic handicapping conditions of cerebral palsy, mental retardation, learning disability, and epilepsy. Amplitude-integrated electroencephalographic (aEEG) monitoring of newborns with hypoxic–ischemic encephalopathy (HIE) has been used for assessment of background activity, detection of seizures, evaluation of the effect of anticonvulsive drugs, selection of patients for neuroprotective intervention, and prediction of neurodevelopmental outcome as early as the first hours after birth. The aim of the three presented studies was to further elucidate the role of aEEG in newborns with HIE. Methods and results: The results of the first study on 160 newborns with HIE suggest that newborns who present an initially very abnormal background pattern on aEEG can have a normal outcome when background recovery is seen within 24 h after birth. The results of the second study on 206 newborns with HIE suggest that treatment of neonatal seizures without clinical correlate, as detected with aEEG, can reduce the incidence of postneonatal epilepsy. The results of the third study on 171 newborns with HIE suggest that the time of onset of sleep–wake cycling on aEEG tracing has a predictive value for neurodevelopmental outcome. Conclusions: Continuous aEEG monitoring is a valuable tool for evaluating newborns with HIE. doi:10.1016/j.clinph.2006.11.280
Electroencephalogram in idiopathic generalised epilepsies ˇ arko Martinovic´ (Institute of Mental during adulthood—Z Health, Belgrade, Serbia) Purpose: To determine the importance of electroencephalogram (EEG) during a 3-year prospective follow-up of adults with idiopathic generalised epilepsy (IGE). Method: Adults with various IGE syndromes, defined by the classification of the International League Against Epilepsy, were included in the study. Ictal and interictal EEG patterns and background activity in the group of patients achieving a stable seizure remission were compared with the group without a stable 3-year remission. Results: Atypical EEG findings (lateralized or focal epileptiform and/or slow abnormalities) in 15 patients excluded from the study suggested final recognition of localized or symptomatic epilepsies. Fifty-eight patients (51.7% females), aged 19–52 years (mean 27.9 years at the end of follow-up) fulfilled inclusion criteria. Generalised tonic-clonic seizures, myoclonic seizures and absences occurred in 54, 23 and 16 patients, respectively. The most common syndromes were juvenile myoclonic epilepsy (21 patients) and juvenile absence epilepsy (16 patients). Stable seizure remission was achieved in 32 (55.2%) patients. Atypical EEG abnormalities were recorded in 23 (39.7%) patients and 18 (31%) of them have not achieved any stable seizure remission (p < 0.05). Conclusions: There is a significant association of atypical epileptiform EEG abnormalities with a lack of a stable seizure remission of IGE in adulthood. doi:10.1016/j.clinph.2006.11.281
Clinical Neurophysiology Society of Serbia and Montenegro / Clinical Neurophysiology 118 (2007) e117–e127
concerned with the technologies surpassing the limitations of conventional EEG recording and analysis in clinical practice. Results: The database PubMed/Medline accessed on July 30, 2006 contained 96,978 references with the key word ‘‘EEG’’ and 221 references for ‘‘new EEG technology’’. The greatest number of references was concerned with the advancement of already existing technologies – holter EEG, video EEG monitoring, quantitative EEG analysis. Several new technologies have found very useful application in clinical studies, such as geodesic sensor EEG system with photogrammetry that gives capacity for a precise and patient’s comfortable registration of electrical activity from 256 channels, full band EEG – the recording and study of the frequencies range from 0.01 to 300 Hz, and simultaneous co-registration of EEG with fMRI – simultaneous study of epileptic activity in the whole brain. Conclusions: New EEG technologies have significantly enlarged the usefulness of EEG in epileptology and neurology, as well as in cognitive neurosciences and neuropsychopharmacology. doi:10.1016/j.clinph.2006.11.278
Novel applications and paradigms – transcranial magnetic stimulation—T.V. Ilic´ (Military Medical Academy, Belgrade, Serbia) Transcranial magnetic stimulation (TMS) of the brain represents a non-invasive, safe and well-tolerated method for exploring the excitability of the human motor cortex in vivo that is used widely in research and clinical practice. Following initial research mostly directed to single and paired-pulse stimulation, the development of repetitive TMS (rTMS) has brought increasing attention on TMS as a neuroscientific and potential clinical therapeutic tool. Effects of rTMS can outlast the actual stimulation for a considerable amount of time. Areas of intense research are the treatment of affective disorders, motor deficits after stroke, medically intractable epilepsy, movement disorders and intractable deafferentation pain. In addition, to initial experimental protocols that are being used with purpose to induce prolonged, but relatively weak and variable after-effects (facilitation or depression of cortical excitability), recently the novel protocol, so called theta-burst paradigm was established. Low intensity pulses of TMS at 50 Hz for a short duration have produced longer and controllable effect. Expectations are directed toward substantial impact on cognitive research and therapeutic opportunities, either alone or combined with other techniques. Contrary to excellent temporal resolution of TMS, one of the most criticized attributes is the quite poor space resolution that does not allow very precise and restricted stimulation. doi:10.1016/j.clinph.2006.11.279
Amplitude-integrated electroencephalography in newborns with hypoxic–ischemic encephalopathy—D. Osredkar 1, M.C. Toet 2, L.G.M. van Rooij 2, A.C. van Huffelen 2, F. Groenendaal 2, L.S. de Vries 2 (1 University Children’s Hospital, Ljubljana, Slovenia Utrecht, The Netherlands, 2 Wilhelmina Children’s Hospital, Utrecht, The Netherlands)
Purpose: Perinatal cerebral hypoxia–ischemia remains a frequent cause of the chronic handicapping conditions of cerebral palsy, mental retardation, learning disability, and epilepsy. Amplitude-integrated electroencephalographic (aEEG) monitoring of newborns with hypoxic–ischemic encephalopathy (HIE) has been used for assessment of background activity, detection of seizures, evaluation of the effect of anticonvulsive drugs, selection of patients for neuroprotective intervention, and prediction of neurodevelopmental outcome as early as the first hours after birth. The aim of the three presented studies was to further elucidate the role of aEEG in newborns with HIE. Methods and results: The results of the first study on 160 newborns with HIE suggest that newborns who present an initially very abnormal background pattern on aEEG can have a normal outcome when background recovery is seen within 24 h after birth. The results of the second study on 206 newborns with HIE suggest that treatment of neonatal seizures without clinical correlate, as detected with aEEG, can reduce the incidence of postneonatal epilepsy. The results of the third study on 171 newborns with HIE suggest that the time of onset of sleep–wake cycling on aEEG tracing has a predictive value for neurodevelopmental outcome. Conclusions: Continuous aEEG monitoring is a valuable tool for evaluating newborns with HIE. doi:10.1016/j.clinph.2006.11.280
Electroencephalogram in idiopathic generalised epilepsies ˇ arko Martinovic´ (Institute of Mental during adulthood—Z Health, Belgrade, Serbia) Purpose: To determine the importance of electroencephalogram (EEG) during a 3-year prospective follow-up of adults with idiopathic generalised epilepsy (IGE). Method: Adults with various IGE syndromes, defined by the classification of the International League Against Epilepsy, were included in the study. Ictal and interictal EEG patterns and background activity in the group of patients achieving a stable seizure remission were compared with the group without a stable 3-year remission. Results: Atypical EEG findings (lateralized or focal epileptiform and/or slow abnormalities) in 15 patients excluded from the study suggested final recognition of localized or symptomatic epilepsies. Fifty-eight patients (51.7% females), aged 19–52 years (mean 27.9 years at the end of follow-up) fulfilled inclusion criteria. Generalised tonic-clonic seizures, myoclonic seizures and absences occurred in 54, 23 and 16 patients, respectively. The most common syndromes were juvenile myoclonic epilepsy (21 patients) and juvenile absence epilepsy (16 patients). Stable seizure remission was achieved in 32 (55.2%) patients. Atypical EEG abnormalities were recorded in 23 (39.7%) patients and 18 (31%) of them have not achieved any stable seizure remission (p < 0.05). Conclusions: There is a significant association of atypical epileptiform EEG abnormalities with a lack of a stable seizure remission of IGE in adulthood. doi:10.1016/j.clinph.2006.11.281