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ID 84 – EEG monitoring of sleep is important in the detection of dementia-associated epilepsy
Abstracts / Clinical Neurophysiology 127 (2016) e18–e132
operating room before and immediately after the PPTg targeting (group II). Results: After PPTg targeting, the scalp tibial nerve SEP amplitudes were decreased of 42% and 74% in Group I and Group II patients, respectively. SEP amplitudes recovered within 10 days. Median nerve SEPs were not affected by implantation. Conclusions: Tibial nerve SEP amplitude decrease after PPTg targeting was probably due to microlesions in the lateral part of the medial lemniscus including fibers originating from lower limb. The quick recover demonstrates that a partial neurapraxic block of the nerve conduction is likely to occur. Key message: Our results suggest that the stereotactic procedure for targeting the PPTg represents a safe trajectory. doi:10.1016/j.clinph.2015.11.338
ID 84 – EEG monitoring of sleep is important in the detection of dementia-associated epilepsy—A. Horváth a,b, A. Kovács a,b, } cs a, G. Barcs a, A. Kamondi a,c (a National Institute of Clinical A. Szu Neurosciences, Budapest, Hungary, b Semmelweis University School of PhD Studies, János Szentágothai Doctoral School of Neurosciences, Budapest, Hungary, c Semmelweis University Department of Neurology, Budapest, Hungary) Objective: Major neurocognitive disorders represent a huge medical and social challenge. Neurocognitive disorders, especially Alzheimer’s disease (AD) are frequently associated with epilepsy. Epileptic seizures and interictal epileptic activity have important impact on the cognitive performance of AD patients and on the progression of the disease. Accurate detection of epilepsy is difficult in AD. Methods: In the framework of Alzheimer–Epilepsy Project of the National Brain Research Program of Hungary (KTIA_NAP_13-12013-0001), we performed 48 h-long EEG monitoring in 5 AD patients suffering from epilepsy. We analyzed the distribution of occurrence of ictal and interictal epileptiform EEG activity during wakefulness, non-REM sleep and REM sleep. Results: We found significantly higher preponderance of epileptiform EEG discharges during non-REM sleep periods compared to wakefulness. The sleep pattern of all patients was severely disturbed. Conclusions: Long-term EEG with sleep studies appear necessary for the correct diagnosis of epilepsy in AD. We assume that epileptiform activity in slow-wave sleep as well as the disruption of the physiologic sleep pattern may have an impact on the impaired memory functions in AD. Further investigations are required to enlighten this important association. Key message: EEG monitoring of sleep is necessary for the accurate diagnosis of dementia-associated epilepsy. doi:10.1016/j.clinph.2015.11.339
ID 97 – Correlations between intraoperative microelectrode recording, microstimulation and macrostimulation with optimal post-operative programming of deep brain stimulation— V. Fernández, L. Romero, T. Muñoz, I. López, S. Giacometti, O. Fernández, M. Arraez (Instituto de Neurociencias Clínicas, Hospital Regional Universitario de Málaga ‘‘Carlos Haya”, Málaga, Spain)
e101
Introduction: Microelectrode recording (MER) is a means of analyzing the electrical activity of the brain, and assessing whether we have found the target for the deep brain stimulator (DBS) electrode. However, no evidence exists that microelectrode recording improves patient outcomes. DBS electrical pulses should activate the intended target structure alone without spreading electrical current to adjacent neural structures which would result in adverse effects being recorded. Intraoperative microstimulation (mSTIM) can test this aspect quite precisely but it is not always performed. Objective: Asses the influence of MER and mSTIM over optimal post-operative programming of DBS. Material and methods: Prospective transversal study of 15 patients with Parkinson disease who underwent a MRI navigated DBS surgery of bilateral STN, with MER, mSTIM and macrostimulation (MSTIM). Results: The overall outcome in these patients was satisfactory after an optimal DBS programming was established. The chosen optimal position of electrodes was correlated with MER results and type of stimulation (monopolar/bipolar) or intensity was guided by mSTIM. MSTIM was only able to predict adverse effects that would be encountered with high intensities. Discussion: Through the use of intraoperative MER, with mSTIM, neurologist can assure for optimal post-operative programming of the DBS. doi:10.1016/j.clinph.2015.11.340
ID 115 – Near infrared spectroscopy as a seizure detection technology for patients with epilepsy—J. Jeppesen a, S. Beniczky a,b, P. Johansen c, P. Sidenius d, A. Fuglsang-Frederiksen a (a Department of Neurophysiology, Aarhus University Hospital, Denmark, b Department of Clinical Neurophysiology, Danish Epilepsy Centre, Denmark, c Department of Engineering, Aarhus University, Denmark, d Department of Neurology, Aarhus University Hospital, Denmark) Objective: Near Infrared Spectroscopy (NIRS) has proved useful in measuring significant hemodynamic changes in the brain during epileptic seizures. The advance of NIRS-technology into wireless and portable devices raises the possibility of using the NIRStechnology for portable seizure detection. Methods: This study used NIRS to measure changes in oxygenated (HbO), deoxygenated (HbR), and total hemoglobin (HbT) at left and right side of the frontal lobe in 15 epilepsy patients (34 focal seizures) undergoing long-term video-EEG monitoring. Twelve parameters consisting of maximum increase and decrease changes of HbO, HbR and HbT during seizures (1-min before- to 3-min after seizureonset) for left and right side, were compared with the patients’ own non-seizure periods (a 2-h period and a 30-min exercise-period). In both non-seizure periods a four minutes moving windows with maximum overlapping were applied to find non-seizure maxima of the twelve parameters. Results: When analyzing the twelve parameters separately the positive seizure detection was in range of 6–24%. Conclusion: NIRS did not seem to be a suitable technology for generic seizure detection given the device, settings, and methods used in this study. Key message: There are still several challenges to overcome before the NIRS-technology can be used as home-monitoring seizure detection device. doi:10.1016/j.clinph.2015.11.341
operating room before and immediately after the PPTg targeting (group II). Results: After PPTg targeting, the scalp tibial nerve SEP amplitudes were decreased of 42% and 74% in Group I and Group II patients, respectively. SEP amplitudes recovered within 10 days. Median nerve SEPs were not affected by implantation. Conclusions: Tibial nerve SEP amplitude decrease after PPTg targeting was probably due to microlesions in the lateral part of the medial lemniscus including fibers originating from lower limb. The quick recover demonstrates that a partial neurapraxic block of the nerve conduction is likely to occur. Key message: Our results suggest that the stereotactic procedure for targeting the PPTg represents a safe trajectory. doi:10.1016/j.clinph.2015.11.338
ID 84 – EEG monitoring of sleep is important in the detection of dementia-associated epilepsy—A. Horváth a,b, A. Kovács a,b, } cs a, G. Barcs a, A. Kamondi a,c (a National Institute of Clinical A. Szu Neurosciences, Budapest, Hungary, b Semmelweis University School of PhD Studies, János Szentágothai Doctoral School of Neurosciences, Budapest, Hungary, c Semmelweis University Department of Neurology, Budapest, Hungary) Objective: Major neurocognitive disorders represent a huge medical and social challenge. Neurocognitive disorders, especially Alzheimer’s disease (AD) are frequently associated with epilepsy. Epileptic seizures and interictal epileptic activity have important impact on the cognitive performance of AD patients and on the progression of the disease. Accurate detection of epilepsy is difficult in AD. Methods: In the framework of Alzheimer–Epilepsy Project of the National Brain Research Program of Hungary (KTIA_NAP_13-12013-0001), we performed 48 h-long EEG monitoring in 5 AD patients suffering from epilepsy. We analyzed the distribution of occurrence of ictal and interictal epileptiform EEG activity during wakefulness, non-REM sleep and REM sleep. Results: We found significantly higher preponderance of epileptiform EEG discharges during non-REM sleep periods compared to wakefulness. The sleep pattern of all patients was severely disturbed. Conclusions: Long-term EEG with sleep studies appear necessary for the correct diagnosis of epilepsy in AD. We assume that epileptiform activity in slow-wave sleep as well as the disruption of the physiologic sleep pattern may have an impact on the impaired memory functions in AD. Further investigations are required to enlighten this important association. Key message: EEG monitoring of sleep is necessary for the accurate diagnosis of dementia-associated epilepsy. doi:10.1016/j.clinph.2015.11.339
ID 97 – Correlations between intraoperative microelectrode recording, microstimulation and macrostimulation with optimal post-operative programming of deep brain stimulation— V. Fernández, L. Romero, T. Muñoz, I. López, S. Giacometti, O. Fernández, M. Arraez (Instituto de Neurociencias Clínicas, Hospital Regional Universitario de Málaga ‘‘Carlos Haya”, Málaga, Spain)
e101
Introduction: Microelectrode recording (MER) is a means of analyzing the electrical activity of the brain, and assessing whether we have found the target for the deep brain stimulator (DBS) electrode. However, no evidence exists that microelectrode recording improves patient outcomes. DBS electrical pulses should activate the intended target structure alone without spreading electrical current to adjacent neural structures which would result in adverse effects being recorded. Intraoperative microstimulation (mSTIM) can test this aspect quite precisely but it is not always performed. Objective: Asses the influence of MER and mSTIM over optimal post-operative programming of DBS. Material and methods: Prospective transversal study of 15 patients with Parkinson disease who underwent a MRI navigated DBS surgery of bilateral STN, with MER, mSTIM and macrostimulation (MSTIM). Results: The overall outcome in these patients was satisfactory after an optimal DBS programming was established. The chosen optimal position of electrodes was correlated with MER results and type of stimulation (monopolar/bipolar) or intensity was guided by mSTIM. MSTIM was only able to predict adverse effects that would be encountered with high intensities. Discussion: Through the use of intraoperative MER, with mSTIM, neurologist can assure for optimal post-operative programming of the DBS. doi:10.1016/j.clinph.2015.11.340
ID 115 – Near infrared spectroscopy as a seizure detection technology for patients with epilepsy—J. Jeppesen a, S. Beniczky a,b, P. Johansen c, P. Sidenius d, A. Fuglsang-Frederiksen a (a Department of Neurophysiology, Aarhus University Hospital, Denmark, b Department of Clinical Neurophysiology, Danish Epilepsy Centre, Denmark, c Department of Engineering, Aarhus University, Denmark, d Department of Neurology, Aarhus University Hospital, Denmark) Objective: Near Infrared Spectroscopy (NIRS) has proved useful in measuring significant hemodynamic changes in the brain during epileptic seizures. The advance of NIRS-technology into wireless and portable devices raises the possibility of using the NIRStechnology for portable seizure detection. Methods: This study used NIRS to measure changes in oxygenated (HbO), deoxygenated (HbR), and total hemoglobin (HbT) at left and right side of the frontal lobe in 15 epilepsy patients (34 focal seizures) undergoing long-term video-EEG monitoring. Twelve parameters consisting of maximum increase and decrease changes of HbO, HbR and HbT during seizures (1-min before- to 3-min after seizureonset) for left and right side, were compared with the patients’ own non-seizure periods (a 2-h period and a 30-min exercise-period). In both non-seizure periods a four minutes moving windows with maximum overlapping were applied to find non-seizure maxima of the twelve parameters. Results: When analyzing the twelve parameters separately the positive seizure detection was in range of 6–24%. Conclusion: NIRS did not seem to be a suitable technology for generic seizure detection given the device, settings, and methods used in this study. Key message: There are still several challenges to overcome before the NIRS-technology can be used as home-monitoring seizure detection device. doi:10.1016/j.clinph.2015.11.341