Changes of interictal epileptiform discharges during medication withdrawal and seizures: A scalp EEG marker of epileptogenicity

Stefano, Pia De; Ménétré, Eric; Vulliémoz, Serge; Mierlo, Pieter van; Seeck, Margitta

doi:10.1016/j.cnp.2022.09.004

Cited by 2 publications

(4 citation statements)

References 34 publications

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“…Only eight studies investigated drug load 57,78,86,94,99 or an exposure response gradient. 75,94,100 These studies 57,78,86,94 were opportunistic, utilizing EEG monitoring units for presurgical assessment.…”

Section: Dose Adjustmentmentioning

confidence: 99%

“…of spikes/s in 1 month and 3 months (RNS system) Supports (M) Tanritanir (2021) 104 No. of spikes/5 min of NREM sleep EEG (visually identified and Persyst version 13) Supports (M) De Stefano (2022) 99 No. of spikes/h per spike cluster in 5-15 days EEG (Epilog PreOp) Supports (M)…”

Section: Automated Detectionmentioning

confidence: 99%

“…75,94,100 These studies 57,78,86,94 were opportunistic, utilizing EEG monitoring units for presurgical assessment. Except for one study, 99 ASM dose adjustments were not decreased or increased in a stepwise protocol, nor were the adjustments repeated to verify results. ASMs with long half-lives or synergistic effects could have influenced results of both the biomarker and seizure outcomes.…”

Section: Dose Adjustmentmentioning

confidence: 99%

“…One low-risk-of-bias study 78 ASM withdrawal. A moderate-risk-of-bias study 99 temporarily and systematically withdrew polytherapy while patients underwent long-term EEG for presurgical evaluation. Spikes were detected using Epilog PreOp (Epilog).…”

Section: T a B L E 4 Studies That Investigated The Association Of Vis...mentioning

confidence: 99%

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Prognostic interictal electroencephalographic biomarkers and models to assess antiseizure medication efficacy for clinical practice: A scoping review

et al. 2023

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Antiseizure medication (ASM) is the primary treatment for epilepsy. In clinical practice, methods to assess ASM efficacy (predict seizure freedom or seizure reduction), during any phase of the drug treatment lifecycle, are limited. This scoping review identifies and appraises prognostic electroencephalographic (EEG) biomarkers and prognostic models that use EEG features, which are associated with seizure outcomes following ASM initiation, dose adjustment, or withdrawal. We also aim to summarize the population and context in which these biomarkers and models were identified and described, to understand how they could be used in clinical practice. Between January 2021 and October 2022, four databases, references, and citations were systematically searched for ASM studies investigating changes to interictal EEG or prognostic models using EEG features and seizure outcomes. Study bias was appraised using modified Quality in Prognosis Studies criteria. Results were synthesized into a qualitative review. Of 875 studies identified, 93 were included. Biomarkers identified were classed as qualitative (visually identified by wave morphology) or quantitative. Qualitative biomarkers include identifying hypsarrhythmia, centrotemporal spikes, interictal epileptiform discharges (IED), classifying the EEG as normal/abnormal/epileptiform, and photoparoxysmal response. Quantitative biomarkers were statistics applied to IED, high‐frequency activity, frequency band power, current source density estimates, pairwise statistical interdependence between EEG channels, and measures of complexity. Prognostic models using EEG features were Cox proportional hazards models and machine learning models. There is promise that some quantitative EEG biomarkers could be used to assess ASM efficacy, but further research is required. There is insufficient evidence to conclude any specific biomarker can be used for a particular population or context to prognosticate ASM efficacy. We identified a potential battery of prognostic EEG biomarkers, which could be combined with prognostic models to assess ASM efficacy. However, many confounders need to be addressed for translation into clinical practice.

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