A subgaleal electrode array for neurostimulation allows the recording of relevant information in closed loop applications

Dümpelmann, Matthias; Reinacher, Peter C.; Kravalis, Kristina; Jagschies, Lasse; Tittelbach, Michael; Coenen, Volker A.; Schulze‐Bonhage, Andreas

doi:10.1016/j.jneumeth.2021.109295

Cited by 9 publications

(6 citation statements)

References 12 publications

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“…Even information important for surgical decisions may need monitoring periods well beyond standard in‐hospital video‐EEG monitoring, as has been shown for the question of unilateral vs bilateral onset in temporal lobe epilepsy when using bitemporal recordings with an implantable device 14,30 . Recent new brain stimulation devices may extend such options for long‐term monitoring as well 18,27 . Progress in the development of ambulatory long‐term monitoring using new technologies will thus be complementary and crucial to overcome the limitations of in‐hospital assessment as reported here considering both available health care resources and the social constraints imposed on patients during hospitalization.…”

Section: Discussionmentioning

confidence: 91%

“…14,30 Recent new brain stimulation devices may extend such options for long-term monitoring as well. 18,27 Progress in the development of ambulatory long-term monitoring using new technologies will thus be complementary and crucial to overcome the limitations of in-hospital assessment as reported here considering both available health care resources and the social constraints imposed on patients during hospitalization. (See also Baud et This retrospective analysis is limited by relying on the inclusion criterion of diagnosis of epilepsy as based on information from the individual's patient history with documented seizures, one seizure and additional biomarkers of the presence of epilepsy increasing the risk for further seizures beyond 60%, or based on an established epilepsy syndrome.…”

Section: Key Pointsmentioning

confidence: 99%

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Diagnostic yield and limitations of in‐hospital documentation in patients with epilepsy

et al. 2022

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ObjectiveTo determine the diagnostic yield of in‐hospital video–electroencephalography (EEG) monitoring to document seizures in patients with epilepsy.MethodsRetrospective analysis of electronic seizure documentation at the University Hospital Freiburg (UKF) and at King's College London (KCL). Statistical assessment of the role of the duration of monitoring, and subanalyses on presurgical patient groups and patients undergoing reduction of antiseizure medication.ResultsOf more than 4800 patients with epilepsy undergoing in‐hospital recordings at the two institutions since 2005, seizures with documented for 43% (KCL) and 73% (UKF).. Duration of monitoring was highly significantly associated with seizure recordings (p < .0001), and presurgical patients as well as patients with drug reduction had a significantly higher diagnostic yield (p < .0001). Recordings with a duration of >5 days lead to additional new seizure documentation in only less than 10% of patients.SignificanceThere is a need for the development of new ambulatory monitoring strategies to document seizures for diagnostic and monitoring purposes for a relevant subgroup of patients with epilepsy in whom in‐hospital monitoring fails to document seizures.

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Section: Discussionmentioning

confidence: 91%

Section: Key Pointsmentioning

confidence: 99%

Diagnostic yield and limitations of in‐hospital documentation in patients with epilepsy

et al. 2022

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“…Beyond the documentation of seizures, a differentiation of seizure severity and clinical versus subclinical electrographic events may also be of interest for closed-loop applications under development. 20 In our dataset, obtained using gold standard conditions for the assessment of electroclinical correlations, a set of predefined features successfully classified electrographic seizures in clinical or subclinical events in the absence of video data during long-term EEG monitoring in focal epilepsies. As shown in Table 1, duration served as the most effective paradigm to categorize electrographic events as subclinical or clinical, with a classification accuracy of >74%.…”

Section: Discussionmentioning

confidence: 99%

“…By definition, electrographic ictal events have a similar appearance to ictal patterns during seizures 18 ; a distinction may thus pose particular problems. Beyond the documentation of seizures, a differentiation of seizure severity and clinical versus subclinical electrographic events may also be of interest for closed‐loop applications under development 20 …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, scalp electrodes rather than subcutaneous recordings were used to distinguish clinical and subclinical events. The similarity of signals acquired with scalp and subcutaneous electrodes, 37 on the other hand, suggests that the results from scalp two‐channel recordings in principle can be extrapolated to recordings obtained subcutaneously 20 . We did not perform an analysis limited to two contralateral channels only; however, as 75% of clinical seizures showed an involvement of contralateral electrodes in comparison to 33% of subclinical seizures in our study, the implantation of subcutaneous electrodes in the contralateral temporal side may be superior in differentiating clinical from subclinical seizures.…”

Section: Discussionmentioning

confidence: 99%

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Differentiation of subclinical and clinical electrographic events in long‐term electroencephalographic recordings

2022

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ObjectiveWith the advent of ultra‐long‐term recordings for monitoring of epilepsies, the interpretation of results of isolated electroencephalographic (EEG) recordings covering only selected brain regions attracts considerable interest. In this context, the question arises of whether detected ictal EEG patterns correspond to clinically manifest seizures or rather to purely electrographic events, that is, subclinical events.MethodsEEG patterns from 268 clinical seizures and 252 subclinical electrographic events from 50 patients undergoing video‐EEG monitoring were analyzed. Features extracted included predominant frequency band, duration, association with rhythmic muscle artifacts, spatial extent, and propagation patterns. Classification using logistic regression was performed based on data from the whole dataset of 10–20 system EEG recordings and from a subset of two temporal electrode contacts.ResultsCorrect separation of clinically manifest and purely electrographic events based on 10–20 system EEG recordings was possible in up to 83.8% of events, depending on the combination of features included. Correct classification based on two‐channel recordings was only slightly inferior, achieving 78.6% accuracy; 74.4% and 74.8%, respectively, of events could be correctly classified when using duration alone with either electrode set, although classification accuracies were lower for some subgroups of seizures, particularly focal aware seizures and epileptic arousals.SignificanceA correct classification of subclinical versus clinical EEG events was possible in 74%–83% of events based on full EEG recordings, and in 74%–78% when considering only a subset of two electrodes, matching the channel number available from new implantable diagnostic devices. This is a promising outcome, suggesting that ultra‐long‐term low‐channel EEG recordings may provide sufficient information for objective seizure diaries. Intraindividual optimization using high numbers of ictal events may further improve separation, provided that supervised learning with external validation is feasible.

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Intracranial and epicranial focus stimulation—concepts and approval status

Schulze‐Bonhage

2023

Clin Epileptol

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A subgaleal electrode array for neurostimulation allows the recording of relevant information in closed loop applications

Cited by 9 publications

References 12 publications

Diagnostic yield and limitations of in‐hospital documentation in patients with epilepsy

Diagnostic yield and limitations of in‐hospital documentation in patients with epilepsy

Differentiation of subclinical and clinical electrographic events in long‐term electroencephalographic recordings

Intracranial and epicranial focus stimulation—concepts and approval status

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