Current practices in long-term video-EEG monitoring services: A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery

Kobulashvili, Teia; Höfler, Julia; Dobesberger, Judith; Ernst, Florian; Ryvlin, Philippe; Cross, J. Helen; Braun, Kees P.J.; Dimova, Petia; Francione, Stefano; Hečimović, Hrvoje; Helmstaedter, C.; Kimiskidis, Vasilios Κ.; Lossius, Morten I.; Malmgren, Kristina; Marusič, Petr; Steinhoff, Bernhard J.; Boon, Paul; Craiu, Dana; Delanty, Norman; Fabó, Dániel; Gil‐Nagel, Antonio; Guekht, Alla; Hirsch, Édouard; Kälviäinen, Reetta; Mameniškienė, Rūta; Özkara, Çiğdem; Seeck, Margitta; Rubboli, Guido; Kršek, Pavel; Rheims, Sylvain; Trinka, Eugen

doi:10.1016/j.seizure.2016.03.009

Cited by 73 publications

(71 citation statements)

References 23 publications

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“…Patient safety with the goal of reducing the risks and consequences of seizures including seizure‐related injuries, cardiac arrhythmias, and, in rare cases, sudden unexpected death in epilepsy (SUDEP) is of critical importance during VEM . Although there is consensus that patient safety can be optimized by continuous surveillance through trained personnel, according to several surveys, constant observation is available in only 56%‐80% of EMUs . Therefore, automatic on‐line EEG seizure detection and warning systems could significantly improve patient safety.…”

Section: Indications For Scalp‐eeg–based Seizure Detectionmentioning

confidence: 99%

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Seizure detection using scalp‐EEG

2018

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Scalp electroencephalography (EEG)-based seizure-detection algorithms applied in a clinical setting should detect a broad range of different seizures with high sensitivity and selectivity and should be easy to use with identical parameter settings for all patients. Available algorithms provide sensitivities between 75% and 90%. EEG seizure patterns with short duration, low amplitude, circumscribed focal activity, high frequency, and unusual morphology as well as EEG seizure patterns obscured by artifacts are generally difficult to detect. Therefore, detection algorithms generally perform worse on seizures of extratemporal origin as compared to those of temporal lobe origin. Specificity (false-positive alarms) varies between 0.1 and 5 per hour. Low false-positive alarm rates are of critical importance for acceptance of algorithms in a clinical setting. Reasons for false-positive alarms include physiological and pathological interictal EEG activities as well as various artifacts. To achieve a stable, reproducible performance (especially concerning specificity), algorithms need to be tested and validated on a large amount of EEG data comprising a complete temporal assessment of all interictal EEG. Patient-specific algorithms can further improve sensitivity and specificity but need parameter adjustments and training for individual patients. Seizure alarm systems need to provide on-line calculation with short detection delays in the order of few seconds. Scalp-EEG-based seizure detection systems can be helpful in an everyday clinical setting in the epilepsy monitoring unit, but at the current stage cannot replace continuous supervision of patients and complete visual review of the acquired data by specially trained personnel. In an outpatient setting, application of scalp-EEG-based seizure-detection systems is limited because patients won't tolerate wearing widespread EEG electrode arrays for long periods in everyday life. Recently developed subcutaneous EEG electrodes may offer a solution in this respect.

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Section: Indications For Scalp‐eeg–based Seizure Detectionmentioning

confidence: 99%

“…Therefore, automatic on‐line EEG seizure detection and warning systems could significantly improve patient safety. However, such systems are used in only 15%‐19% of EMUs …”

Section: Indications For Scalp‐eeg–based Seizure Detectionmentioning

confidence: 99%

Seizure detection using scalp‐EEG

2018

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“…The primary objective is to improve the quality, accessibility, and consistency of presurgical diagnostic approaches in patients with drug‐resistant focal epilepsy across Europe. One aim of this network is to describe the requirements and the structure of epilepsy surgical centers and of current practice in brain imaging, source localization procedures, electroencephalography (EEG) monitoring, and, the focus if the present report, the neuropsychological assessment and outcome monitoring in patients with drug‐resistant epilepsy.…”

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confidence: 99%

Current standards of neuropsychological assessment in epilepsy surgery centers across Europe

et al. 2017

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We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe.

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“…In addition, some patients cluster from alternate sides, with most or all seizures arising from one side for weeks to months, only to switch to the other side at other times . In addition to the short time window permissible with typical scalp or intracranial recordings in the EMU, withdrawal of antiseizure medications, sleep deprivation, anesthesia, stress, and the postoperative setting could alter normal patterns of seizures and even trigger seizures that otherwise would not occur . Thus, limitations in the data provided by the typical presurgical evaluation may lead to a faulty conclusion about a patient's laterality, especially in patients with possible bitemporal epilepsy.…”

Section: Introductionmentioning

confidence: 99%

Mesial temporal resection following long‐term ambulatory intracranial EEG monitoring with a direct brain‐responsive neurostimulation system

et al. 2020

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Objective To describe seizure outcomes in patients with medically refractory epilepsy who had evidence of bilateral mesial temporal lobe (MTL) seizure onsets and underwent MTL resection based on chronic ambulatory intracranial EEG (ICEEG) data from a direct brain‐responsive neurostimulator (RNS) system. Methods We retrospectively identified all patients at 17 epilepsy centers with MTL epilepsy who were treated with the RNS System using bilateral MTL leads, and in whom an MTL resection was subsequently performed. Presumed lateralization based on routine presurgical approaches was compared to lateralization determined by RNS System chronic ambulatory ICEEG recordings. The primary outcome was frequency of disabling seizures at last 3‐month follow‐up after MTL resection compared to seizure frequency 3 months before MTL resection. Results We identified 157 patients treated with the RNS System with bilateral MTL leads due to presumed bitemporal epilepsy. Twenty‐five patients (16%) subsequently had an MTL resection informed by chronic ambulatory ICEEG (mean = 42 months ICEEG); follow‐up was available for 24 patients. After MTL resection, the median reduction in disabling seizures at last follow‐up was 100% (mean: 94%; range: 50%‐100%). Nine patients (38%) had exclusively unilateral electrographic seizures recorded by chronic ambulatory ICEEG and all were seizure‐free at last follow‐up after MTL resection; eight of nine continued RNS System treatment. Fifteen patients (62%) had bilateral MTL electrographic seizures, had an MTL resection on the more active side, continued RNS System treatment, and achieved a median clinical seizure reduction of 100% (mean: 90%; range: 50%‐100%) at last follow‐up, with eight of fifteen seizure‐free. For those with more than 1 year of follow‐up (N = 21), 15 patients (71%) were seizure‐free during the most recent year, including all eight patients with unilateral onsets and 7 of 13 patients (54%) with bilateral onsets. Significance Chronic ambulatory ICEEG data provide information about lateralization of MTL seizures and can identify additional patients who may benefit from MTL resection.

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Current practices in long-term video-EEG monitoring services: A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery

Abstract: This study shows a considerable diversity in the organization and practice patterns across European epilepsy monitoring units. The collected data may contribute to the development and implementation of evidence-based recommended practices in LTM services across Europe.

Cited by 73 publications

References 23 publications

Seizure detection using scalp‐EEG

Seizure detection using scalp‐EEG

Current standards of neuropsychological assessment in epilepsy surgery centers across Europe

Mesial temporal resection following long‐term ambulatory intracranial EEG monitoring with a direct brain‐responsive neurostimulation system

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