Literature Monitor

Measuring mammillary body volume among patients with mesial temporal lobe epilepsy after laser interstitial thermal therapy may help determine how effective the ablative procedure is, according to a recent study published in Epilepsy Research.

• Investigators reviewed pre- and post-laser interstitial thermal therapy data with the help of magnetic resonance imaging, looking at the axial and coronal planes.
• Patient demographics, clinical semiology, and localization of seizures were considered.
• From 2012 to 2015, 20 patients were available for complete analysis, of which 13 were found to be free of seizures at the end of one year.
• Among patients who remained free of seizures, ipsilaterial mammillary body volume dropped by 34.6% on average, compared to 8.4% in patients who continued to have seizures after laser treatment, suggesting that mammillary body volume may be a useful marker to evaluate the benefits of ablation.

Grewala SS, Guptab V, Vibhute P, Shih JJ, Tatum WO, Wharen RE. Mammillary body changes and seizure outcome after laser interstitial thermal therapy of the mesial temporal lobe.  Epilepsy Res. 2018;141:19-22.

Measuring mammillary body volume among patients with mesial temporal lobe epilepsy after laser interstitial thermal therapy may help determine how effective the ablative procedure is, according to a recent study published in Epilepsy Research.

• Investigators reviewed pre- and post-laser interstitial thermal therapy data with the help of magnetic resonance imaging, looking at the axial and coronal planes.
• Patient demographics, clinical semiology, and localization of seizures were considered.
• From 2012 to 2015, 20 patients were available for complete analysis, of which 13 were found to be free of seizures at the end of one year.
• Among patients who remained free of seizures, ipsilaterial mammillary body volume dropped by 34.6% on average, compared to 8.4% in patients who continued to have seizures after laser treatment, suggesting that mammillary body volume may be a useful marker to evaluate the benefits of ablation.

Grewala SS, Guptab V, Vibhute P, Shih JJ, Tatum WO, Wharen RE. Mammillary body changes and seizure outcome after laser interstitial thermal therapy of the mesial temporal lobe.  Epilepsy Res. 2018;141:19-22.

Measuring mammillary body volume among patients with mesial temporal lobe epilepsy after laser interstitial thermal therapy may help determine how effective the ablative procedure is, according to a recent study published in Epilepsy Research.

• Investigators reviewed pre- and post-laser interstitial thermal therapy data with the help of magnetic resonance imaging, looking at the axial and coronal planes.
• Patient demographics, clinical semiology, and localization of seizures were considered.
• From 2012 to 2015, 20 patients were available for complete analysis, of which 13 were found to be free of seizures at the end of one year.
• Among patients who remained free of seizures, ipsilaterial mammillary body volume dropped by 34.6% on average, compared to 8.4% in patients who continued to have seizures after laser treatment, suggesting that mammillary body volume may be a useful marker to evaluate the benefits of ablation.

Grewala SS, Guptab V, Vibhute P, Shih JJ, Tatum WO, Wharen RE. Mammillary body changes and seizure outcome after laser interstitial thermal therapy of the mesial temporal lobe.  Epilepsy Res. 2018;141:19-22.

Differences in the perivascular spaces in the brain may serve as a biomarker for patients with epilepsy, assisting clinicians in determining the impact of the disorder, according to a comparison of MRI images from healthy controls and patients.

• Researchers used 7T magnetic resonance imaging to evaluate the brains of 21 patients with epilepsy and 17 healthy controls.
• Perivascular spaces were marked with the use of Osirix image analysis software.
• Investigators calculated the asymmetry index for each region of the brain and reported a maximum asymmetry index for patients and controls.
• Significant differences were found in the maximum asymmetry index between patients with epilepsy and controls (P=.016).
• In nearly 3 of 4 patients (72%), the area or lobe of the brain that displayed the maximum perivascular space asymmetry was also the area that contained the suspected area for the onset of seizures.

Feldman RE, Rutland JW, Fields MC, et al. Quantification of perivascular spaces at 7T: A potential MRI biomarker for epilepsy. Seizure. 2018;54:11-18.

Differences in the perivascular spaces in the brain may serve as a biomarker for patients with epilepsy, assisting clinicians in determining the impact of the disorder, according to a comparison of MRI images from healthy controls and patients.

• Researchers used 7T magnetic resonance imaging to evaluate the brains of 21 patients with epilepsy and 17 healthy controls.
• Perivascular spaces were marked with the use of Osirix image analysis software.
• Investigators calculated the asymmetry index for each region of the brain and reported a maximum asymmetry index for patients and controls.
• Significant differences were found in the maximum asymmetry index between patients with epilepsy and controls (P=.016).
• In nearly 3 of 4 patients (72%), the area or lobe of the brain that displayed the maximum perivascular space asymmetry was also the area that contained the suspected area for the onset of seizures.

Feldman RE, Rutland JW, Fields MC, et al. Quantification of perivascular spaces at 7T: A potential MRI biomarker for epilepsy. Seizure. 2018;54:11-18.

Differences in the perivascular spaces in the brain may serve as a biomarker for patients with epilepsy, assisting clinicians in determining the impact of the disorder, according to a comparison of MRI images from healthy controls and patients.

• Researchers used 7T magnetic resonance imaging to evaluate the brains of 21 patients with epilepsy and 17 healthy controls.
• Perivascular spaces were marked with the use of Osirix image analysis software.
• Investigators calculated the asymmetry index for each region of the brain and reported a maximum asymmetry index for patients and controls.
• Significant differences were found in the maximum asymmetry index between patients with epilepsy and controls (P=.016).
• In nearly 3 of 4 patients (72%), the area or lobe of the brain that displayed the maximum perivascular space asymmetry was also the area that contained the suspected area for the onset of seizures.

Feldman RE, Rutland JW, Fields MC, et al. Quantification of perivascular spaces at 7T: A potential MRI biomarker for epilepsy. Seizure. 2018;54:11-18.

Treating the psychological consequences of epilepsy can help improve patients’ health-related quality of life according to a recent Cochrane Library review.

• To arrive at that conclusion, researchers analyzed 24 randomized controlled trials that included 2439 patients, and narrowed down the review to 9 studies and 468 patients that included outcomes for quality of life.
• The 9 studies specifically looked at Quality of Life in Epilepsy-31 (QOLIE-31) outcomes, which were combined into a meta-analysis.
• Total scores for QOLIE-31 improved by 5.68 points (P<.0001), and subscores, which included metrics for emotional well being, energy/fatigue, and overall quality of life, improved as well.
• Reviewers categorized the quality of evidence supporting psychological treatment for patients with epilepsy as moderate, taking into account possible bias in 8 of 9 studies.

Michaelis R, Tang V, Wagner JL, et al. Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life. Epilepsia. 2018;59(2):315-332.

Treating the psychological consequences of epilepsy can help improve patients’ health-related quality of life according to a recent Cochrane Library review.

• To arrive at that conclusion, researchers analyzed 24 randomized controlled trials that included 2439 patients, and narrowed down the review to 9 studies and 468 patients that included outcomes for quality of life.
• The 9 studies specifically looked at Quality of Life in Epilepsy-31 (QOLIE-31) outcomes, which were combined into a meta-analysis.
• Total scores for QOLIE-31 improved by 5.68 points (P<.0001), and subscores, which included metrics for emotional well being, energy/fatigue, and overall quality of life, improved as well.
• Reviewers categorized the quality of evidence supporting psychological treatment for patients with epilepsy as moderate, taking into account possible bias in 8 of 9 studies.

Michaelis R, Tang V, Wagner JL, et al. Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life. Epilepsia. 2018;59(2):315-332.

Treating the psychological consequences of epilepsy can help improve patients’ health-related quality of life according to a recent Cochrane Library review.

• To arrive at that conclusion, researchers analyzed 24 randomized controlled trials that included 2439 patients, and narrowed down the review to 9 studies and 468 patients that included outcomes for quality of life.
• The 9 studies specifically looked at Quality of Life in Epilepsy-31 (QOLIE-31) outcomes, which were combined into a meta-analysis.
• Total scores for QOLIE-31 improved by 5.68 points (P<.0001), and subscores, which included metrics for emotional well being, energy/fatigue, and overall quality of life, improved as well.
• Reviewers categorized the quality of evidence supporting psychological treatment for patients with epilepsy as moderate, taking into account possible bias in 8 of 9 studies.

Michaelis R, Tang V, Wagner JL, et al. Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life. Epilepsia. 2018;59(2):315-332.

Levetiracetam may be a superior initial treatment for infants with nonsyndromic epilepsy, a multicenter, prospective, observational study has shown.

“Our findings suggest that levetiracetam has superior effectiveness compared with phenobarbital as initial monotherapy for nonsyndromic epilepsy in infants,” wrote Zachary Grinspan, MD, director of the pediatric epilepsy program at Cornell University, New York, and his colleagues. “We estimate that for every 100 infants with epilepsy treated with levetiracetam instead of phenobarbital, 44 infants would be free from monotherapy failure instead of 16.”

To evaluate the effectiveness of levetiracetam vs. phenobarbital, Dr. Grinspan and his colleagues developed the Early Life Epilepsy Study, a multicenter, prospective, observational investigation of 155 children with nonsyndromic epilepsy. Patient information for this study was obtained from medical records and was collected from March 1, 2012, through April 30, 2015. All of the patients in the study were observed in the first 3 years of life.

Of the 155 children included in the analysis for this study, 117 were treated with levetiracetam and 38 with phenobarbital. There were some differences between the groups. Children treated with levetiracetam were, on average, 2 months older at seizure onset than were those in the phenobarbital group (5.2 months vs. 3.0 months; P less than .001). Infants treated with levetiracetam also tended to begin treatment further from the time of their first seizure and exhibited less developmental delay at the time of epilepsy diagnosis. There were some other differences of possible clinical importance (developmental structural brain abnormalities, head circumference) that did not reach statistical significance.

Freedom from monotherapy failure was greater in the levetiracetam group (47 [40.2%] vs. 6 [15.8%]; P = .01; odds ratio, 3.6; 95% confidence interval, 1.5-10). Overall, the researchers concluded that levetiracetam was superior to phenobarbital for nonsyndromic epilepsy in pediatric patients (OR, 4.2; 95% CI, 1.1-16; number needed to treat, 3.5 [95% CI, 1.7-60]).

Outcome information was missing for more infants treated with levetiracetam than for those treated with phenobarbital, which could have skewed the analyses, Dr. Grinspan and his associates said. The nature of nonsyndromic epilepsy also makes it difficult to study because of the intricate genetic interactions that can influence the disorder.

Although this study provides information that could potentially benefit infantile epilepsy patients, the investigators said that more work must be done on the topic.

“A prospective clinical trial is needed. Levetiracetam and phenobarbital are both commonly used for infantile-onset epilepsy, indicating community equipoise regarding their relative effectiveness,” they wrote. “However, the effect size in our analysis was surprisingly large (number needed to treat, 3.5), suggesting that a change in practice could meaningfully improve outcomes.”

The investigators reported receiving grants and fees and consulting with a range of institutions, and the complete list can be found on the JAMA Pediatrics website. This study was funded by the Pediatric Epilepsy Research Foundation.

[email protected]

SOURCE: Grinspan Z et al. JAMA Pediatr. 2018 Feb 12. doi: 10.1001/jamapediatrics.2017.5211.

Levetiracetam may be a superior initial treatment for infants with nonsyndromic epilepsy, a multicenter, prospective, observational study has shown.

“Our findings suggest that levetiracetam has superior effectiveness compared with phenobarbital as initial monotherapy for nonsyndromic epilepsy in infants,” wrote Zachary Grinspan, MD, director of the pediatric epilepsy program at Cornell University, New York, and his colleagues. “We estimate that for every 100 infants with epilepsy treated with levetiracetam instead of phenobarbital, 44 infants would be free from monotherapy failure instead of 16.”

To evaluate the effectiveness of levetiracetam vs. phenobarbital, Dr. Grinspan and his colleagues developed the Early Life Epilepsy Study, a multicenter, prospective, observational investigation of 155 children with nonsyndromic epilepsy. Patient information for this study was obtained from medical records and was collected from March 1, 2012, through April 30, 2015. All of the patients in the study were observed in the first 3 years of life.

Of the 155 children included in the analysis for this study, 117 were treated with levetiracetam and 38 with phenobarbital. There were some differences between the groups. Children treated with levetiracetam were, on average, 2 months older at seizure onset than were those in the phenobarbital group (5.2 months vs. 3.0 months; P less than .001). Infants treated with levetiracetam also tended to begin treatment further from the time of their first seizure and exhibited less developmental delay at the time of epilepsy diagnosis. There were some other differences of possible clinical importance (developmental structural brain abnormalities, head circumference) that did not reach statistical significance.

Freedom from monotherapy failure was greater in the levetiracetam group (47 [40.2%] vs. 6 [15.8%]; P = .01; odds ratio, 3.6; 95% confidence interval, 1.5-10). Overall, the researchers concluded that levetiracetam was superior to phenobarbital for nonsyndromic epilepsy in pediatric patients (OR, 4.2; 95% CI, 1.1-16; number needed to treat, 3.5 [95% CI, 1.7-60]).

Outcome information was missing for more infants treated with levetiracetam than for those treated with phenobarbital, which could have skewed the analyses, Dr. Grinspan and his associates said. The nature of nonsyndromic epilepsy also makes it difficult to study because of the intricate genetic interactions that can influence the disorder.

Although this study provides information that could potentially benefit infantile epilepsy patients, the investigators said that more work must be done on the topic.

“A prospective clinical trial is needed. Levetiracetam and phenobarbital are both commonly used for infantile-onset epilepsy, indicating community equipoise regarding their relative effectiveness,” they wrote. “However, the effect size in our analysis was surprisingly large (number needed to treat, 3.5), suggesting that a change in practice could meaningfully improve outcomes.”

The investigators reported receiving grants and fees and consulting with a range of institutions, and the complete list can be found on the JAMA Pediatrics website. This study was funded by the Pediatric Epilepsy Research Foundation.

[email protected]

SOURCE: Grinspan Z et al. JAMA Pediatr. 2018 Feb 12. doi: 10.1001/jamapediatrics.2017.5211.

Levetiracetam may be a superior initial treatment for infants with nonsyndromic epilepsy, a multicenter, prospective, observational study has shown.

“Our findings suggest that levetiracetam has superior effectiveness compared with phenobarbital as initial monotherapy for nonsyndromic epilepsy in infants,” wrote Zachary Grinspan, MD, director of the pediatric epilepsy program at Cornell University, New York, and his colleagues. “We estimate that for every 100 infants with epilepsy treated with levetiracetam instead of phenobarbital, 44 infants would be free from monotherapy failure instead of 16.”

To evaluate the effectiveness of levetiracetam vs. phenobarbital, Dr. Grinspan and his colleagues developed the Early Life Epilepsy Study, a multicenter, prospective, observational investigation of 155 children with nonsyndromic epilepsy. Patient information for this study was obtained from medical records and was collected from March 1, 2012, through April 30, 2015. All of the patients in the study were observed in the first 3 years of life.

Of the 155 children included in the analysis for this study, 117 were treated with levetiracetam and 38 with phenobarbital. There were some differences between the groups. Children treated with levetiracetam were, on average, 2 months older at seizure onset than were those in the phenobarbital group (5.2 months vs. 3.0 months; P less than .001). Infants treated with levetiracetam also tended to begin treatment further from the time of their first seizure and exhibited less developmental delay at the time of epilepsy diagnosis. There were some other differences of possible clinical importance (developmental structural brain abnormalities, head circumference) that did not reach statistical significance.

Freedom from monotherapy failure was greater in the levetiracetam group (47 [40.2%] vs. 6 [15.8%]; P = .01; odds ratio, 3.6; 95% confidence interval, 1.5-10). Overall, the researchers concluded that levetiracetam was superior to phenobarbital for nonsyndromic epilepsy in pediatric patients (OR, 4.2; 95% CI, 1.1-16; number needed to treat, 3.5 [95% CI, 1.7-60]).

Outcome information was missing for more infants treated with levetiracetam than for those treated with phenobarbital, which could have skewed the analyses, Dr. Grinspan and his associates said. The nature of nonsyndromic epilepsy also makes it difficult to study because of the intricate genetic interactions that can influence the disorder.

Although this study provides information that could potentially benefit infantile epilepsy patients, the investigators said that more work must be done on the topic.

“A prospective clinical trial is needed. Levetiracetam and phenobarbital are both commonly used for infantile-onset epilepsy, indicating community equipoise regarding their relative effectiveness,” they wrote. “However, the effect size in our analysis was surprisingly large (number needed to treat, 3.5), suggesting that a change in practice could meaningfully improve outcomes.”

The investigators reported receiving grants and fees and consulting with a range of institutions, and the complete list can be found on the JAMA Pediatrics website. This study was funded by the Pediatric Epilepsy Research Foundation.

[email protected]

SOURCE: Grinspan Z et al. JAMA Pediatr. 2018 Feb 12. doi: 10.1001/jamapediatrics.2017.5211.

The ability of a patient to focus over time is often impaired among children with epilepsy, and intraindividual variability may be an important way to measure such attentional problems according to a study published in Epilepsy & Behavior.

• Intraindividual variability, a measure of changes in an individual’s transient behavioral performance, has been identified in both pediatric and adult patients with epilepsy.
• Srnka et al evaluated intraindividual variability in 144 patients who had just been diagnosed with epilepsy, using the Connors Continuous Performance Task-II as a metric.
• The children with epilepsy were between the ages of 8 and 18 years and were compared to 82 healthy children.
• The researchers found a large difference in variability between the two groups, with an effect size difference of 0.68.
• They also discovered that intraindividual variability predicted intellectual functioning and academic achievement.

Srnka K, Seidenberg M, Hermann B, Jones J. Intraindividual variability in attentional vigilance in children with epilepsy.  Epilepsy Behav. 2018;79:42-45.

The ability of a patient to focus over time is often impaired among children with epilepsy, and intraindividual variability may be an important way to measure such attentional problems according to a study published in Epilepsy & Behavior.

• Intraindividual variability, a measure of changes in an individual’s transient behavioral performance, has been identified in both pediatric and adult patients with epilepsy.
• Srnka et al evaluated intraindividual variability in 144 patients who had just been diagnosed with epilepsy, using the Connors Continuous Performance Task-II as a metric.
• The children with epilepsy were between the ages of 8 and 18 years and were compared to 82 healthy children.
• The researchers found a large difference in variability between the two groups, with an effect size difference of 0.68.
• They also discovered that intraindividual variability predicted intellectual functioning and academic achievement.

Srnka K, Seidenberg M, Hermann B, Jones J. Intraindividual variability in attentional vigilance in children with epilepsy.  Epilepsy Behav. 2018;79:42-45.

The ability of a patient to focus over time is often impaired among children with epilepsy, and intraindividual variability may be an important way to measure such attentional problems according to a study published in Epilepsy & Behavior.

• Intraindividual variability, a measure of changes in an individual’s transient behavioral performance, has been identified in both pediatric and adult patients with epilepsy.
• Srnka et al evaluated intraindividual variability in 144 patients who had just been diagnosed with epilepsy, using the Connors Continuous Performance Task-II as a metric.
• The children with epilepsy were between the ages of 8 and 18 years and were compared to 82 healthy children.
• The researchers found a large difference in variability between the two groups, with an effect size difference of 0.68.
• They also discovered that intraindividual variability predicted intellectual functioning and academic achievement.

Srnka K, Seidenberg M, Hermann B, Jones J. Intraindividual variability in attentional vigilance in children with epilepsy.  Epilepsy Behav. 2018;79:42-45.

Magnetoencephalography (MEG) may play an important role in the presurgical workup of patients with nonlesional refractory focal epilepsy suggests a recent observational study.

• Investigators observed 31 patients at an academic epilepsy center to determine if MEG would have had an impact on patient care; (they were unable to analyze the MEG early enough to influence the decision-making process).
• Had the test been integrated into the presurgical workup, 68% of patients would have received different management initially.
• MEG would have reduced the number of patients who received intracranial electrodes.
• MEG would also have led to the position of the electrodes being changed or provided adequate evidence to justify the use of an intracranial electrode.
• The results of the MEG studies would have let surgeons do direct surgery with no need for intracranial electrodes in 2 of 11 patients.
• 6 patients fared poorly after surgery, but MEG would have changed their outcomes in 3 of these patients by modifying the resection margin.

Mohamed IS, Bout hillier A, Bérubé A, et al. The clinical impact of integration of magnetoencephalography in the presurgical workup for refractory nonlesional epilepsy. Epilepsy Behav. 2018;79:34-41.

Magnetoencephalography (MEG) may play an important role in the presurgical workup of patients with nonlesional refractory focal epilepsy suggests a recent observational study.

• Investigators observed 31 patients at an academic epilepsy center to determine if MEG would have had an impact on patient care; (they were unable to analyze the MEG early enough to influence the decision-making process).
• Had the test been integrated into the presurgical workup, 68% of patients would have received different management initially.
• MEG would have reduced the number of patients who received intracranial electrodes.
• MEG would also have led to the position of the electrodes being changed or provided adequate evidence to justify the use of an intracranial electrode.
• The results of the MEG studies would have let surgeons do direct surgery with no need for intracranial electrodes in 2 of 11 patients.
• 6 patients fared poorly after surgery, but MEG would have changed their outcomes in 3 of these patients by modifying the resection margin.

Mohamed IS, Bout hillier A, Bérubé A, et al. The clinical impact of integration of magnetoencephalography in the presurgical workup for refractory nonlesional epilepsy. Epilepsy Behav. 2018;79:34-41.

Magnetoencephalography (MEG) may play an important role in the presurgical workup of patients with nonlesional refractory focal epilepsy suggests a recent observational study.

• Investigators observed 31 patients at an academic epilepsy center to determine if MEG would have had an impact on patient care; (they were unable to analyze the MEG early enough to influence the decision-making process).
• Had the test been integrated into the presurgical workup, 68% of patients would have received different management initially.
• MEG would have reduced the number of patients who received intracranial electrodes.
• MEG would also have led to the position of the electrodes being changed or provided adequate evidence to justify the use of an intracranial electrode.
• The results of the MEG studies would have let surgeons do direct surgery with no need for intracranial electrodes in 2 of 11 patients.
• 6 patients fared poorly after surgery, but MEG would have changed their outcomes in 3 of these patients by modifying the resection margin.

Mohamed IS, Bout hillier A, Bérubé A, et al. The clinical impact of integration of magnetoencephalography in the presurgical workup for refractory nonlesional epilepsy. Epilepsy Behav. 2018;79:34-41.

Electrocorticographic (ECoG) high-γ modulation (HGM) can serve as a specific way to localize language preoperatively, when compared with electrical stimulation mapping (ESM), which is considered the gold standard, according to a recent meta-analysis. But the same analysis concluded that it was not sensitive enough when compared with ESM.

• The meta-analysis reviewed several metrics for diagnostic validity, including area under the summary receiver operating characteristic (SROC) curve, diagnostic odds ratio, and pooled estimates of sensitivity and specificity.
• To determine language mapping, the most common task used was overt picture naming.
• ECoG was analyzed at 50 to 400 Hz, with different studies using different bandwidths.
• Among the studies that looked at ESM, there were wide variations in pulse duration, train duration, and maximum current.
• The pooled diagnostic odds ratio was 6.44 and the AUC was 0.77, making HGM a fairly reliable way to ascertain electrodes overlying ESM cortical language sites.

Aryaa R, Horn PS, Crone NE, et al. ECoG high-gamma modulation versus electrical stimulation for presurgical language mapping. Epilepsy Behav. 2018;79:26-33.

Electrocorticographic (ECoG) high-γ modulation (HGM) can serve as a specific way to localize language preoperatively, when compared with electrical stimulation mapping (ESM), which is considered the gold standard, according to a recent meta-analysis. But the same analysis concluded that it was not sensitive enough when compared with ESM.

• The meta-analysis reviewed several metrics for diagnostic validity, including area under the summary receiver operating characteristic (SROC) curve, diagnostic odds ratio, and pooled estimates of sensitivity and specificity.
• To determine language mapping, the most common task used was overt picture naming.
• ECoG was analyzed at 50 to 400 Hz, with different studies using different bandwidths.
• Among the studies that looked at ESM, there were wide variations in pulse duration, train duration, and maximum current.
• The pooled diagnostic odds ratio was 6.44 and the AUC was 0.77, making HGM a fairly reliable way to ascertain electrodes overlying ESM cortical language sites.

Aryaa R, Horn PS, Crone NE, et al. ECoG high-gamma modulation versus electrical stimulation for presurgical language mapping. Epilepsy Behav. 2018;79:26-33.

Electrocorticographic (ECoG) high-γ modulation (HGM) can serve as a specific way to localize language preoperatively, when compared with electrical stimulation mapping (ESM), which is considered the gold standard, according to a recent meta-analysis. But the same analysis concluded that it was not sensitive enough when compared with ESM.

• The meta-analysis reviewed several metrics for diagnostic validity, including area under the summary receiver operating characteristic (SROC) curve, diagnostic odds ratio, and pooled estimates of sensitivity and specificity.
• To determine language mapping, the most common task used was overt picture naming.
• ECoG was analyzed at 50 to 400 Hz, with different studies using different bandwidths.
• Among the studies that looked at ESM, there were wide variations in pulse duration, train duration, and maximum current.
• The pooled diagnostic odds ratio was 6.44 and the AUC was 0.77, making HGM a fairly reliable way to ascertain electrodes overlying ESM cortical language sites.

Aryaa R, Horn PS, Crone NE, et al. ECoG high-gamma modulation versus electrical stimulation for presurgical language mapping. Epilepsy Behav. 2018;79:26-33.

Clinical trials that evaluate experimental treatment for patients with epilepsy often produce large placebo effects, but a recent database analysis suggests that what appears like a placebo effect may in fact result from the natural variability in patients’ response to treatment.

• Researchers conducted clinical trial simulations using data from sources including a large patient-managed seizure tracking diary database called SeizureTracker.com, a clinical trial that looked at transcranial magnetic stimulation, and a seizure diary dataset called NeuroVista, which tracks longitudinal intracranial monitoring.
• The analysis measured 50% responder rates and median percentage change.
• The clinical trial simulations were performed in 2 directions; it measured outcomes with time running forward and in reverse, ie, moving backwards from baseline through titration, to treatment.
• The analysis found that temporal reversal didn’t prevent large 50% responder rates, suggesting that what appears to be a placebo effect in clinical trials is in fact normal variability in the way patients respond to active treatment.

A multi-dataset time-reversal approach to clinical trial placebo response and the relationship to natural variability in epilepsy. Seizure. 2017; 53:31-36. DOI: http://dx.doi.org/10.1016/j.seizure.2017.10.016.

Clinical trials that evaluate experimental treatment for patients with epilepsy often produce large placebo effects, but a recent database analysis suggests that what appears like a placebo effect may in fact result from the natural variability in patients’ response to treatment.

• Researchers conducted clinical trial simulations using data from sources including a large patient-managed seizure tracking diary database called SeizureTracker.com, a clinical trial that looked at transcranial magnetic stimulation, and a seizure diary dataset called NeuroVista, which tracks longitudinal intracranial monitoring.
• The analysis measured 50% responder rates and median percentage change.
• The clinical trial simulations were performed in 2 directions; it measured outcomes with time running forward and in reverse, ie, moving backwards from baseline through titration, to treatment.
• The analysis found that temporal reversal didn’t prevent large 50% responder rates, suggesting that what appears to be a placebo effect in clinical trials is in fact normal variability in the way patients respond to active treatment.

A multi-dataset time-reversal approach to clinical trial placebo response and the relationship to natural variability in epilepsy. Seizure. 2017; 53:31-36. DOI: http://dx.doi.org/10.1016/j.seizure.2017.10.016.

Clinical trials that evaluate experimental treatment for patients with epilepsy often produce large placebo effects, but a recent database analysis suggests that what appears like a placebo effect may in fact result from the natural variability in patients’ response to treatment.

• Researchers conducted clinical trial simulations using data from sources including a large patient-managed seizure tracking diary database called SeizureTracker.com, a clinical trial that looked at transcranial magnetic stimulation, and a seizure diary dataset called NeuroVista, which tracks longitudinal intracranial monitoring.
• The analysis measured 50% responder rates and median percentage change.
• The clinical trial simulations were performed in 2 directions; it measured outcomes with time running forward and in reverse, ie, moving backwards from baseline through titration, to treatment.
• The analysis found that temporal reversal didn’t prevent large 50% responder rates, suggesting that what appears to be a placebo effect in clinical trials is in fact normal variability in the way patients respond to active treatment.

A multi-dataset time-reversal approach to clinical trial placebo response and the relationship to natural variability in epilepsy. Seizure. 2017; 53:31-36. DOI: http://dx.doi.org/10.1016/j.seizure.2017.10.016.

Ictal electroencephalography (EEG) does not appear to help determine the best approach to surgery in pediatric patients if magnetic resonance imaging (MRI) findings and other presurgical data have pinpointed the epileptogenic focus, according to retrospective analysis that included 115 children.

• Investigators looked at children with epilepsy who had surgical resection based on a lesion that was identified by MRI and corroborated by other presurgical findings.
• Ictal video EEG findings were divided into 2 groups; ictal EEG findings were labeled “positive” if the identified location of the lesion agreed with the location indicated by the MRI, or “negative” if results were discordant with the MRI findings.
• The analysis found no differences in seizure-free outcomes when negative and positive EEGs were compared.
• A positive ictal EEG was not linked with better clinical outcomes regardless of the surgical site or the pathology of the lesion.
• EEGs had limited predictive value, which prompted researchers to question whether they are worth doing if MRI findings and related presurgical data confirm the location of the epileptogenic site.

MRI supersedes ictal EEG when other presurgical data are concordant. Seizure. 2017; 53:18-22. DOI: http://dx.doi.org/10.1016/j.seizure.2017.10.013.

Ictal electroencephalography (EEG) does not appear to help determine the best approach to surgery in pediatric patients if magnetic resonance imaging (MRI) findings and other presurgical data have pinpointed the epileptogenic focus, according to retrospective analysis that included 115 children.

• Investigators looked at children with epilepsy who had surgical resection based on a lesion that was identified by MRI and corroborated by other presurgical findings.
• Ictal video EEG findings were divided into 2 groups; ictal EEG findings were labeled “positive” if the identified location of the lesion agreed with the location indicated by the MRI, or “negative” if results were discordant with the MRI findings.
• The analysis found no differences in seizure-free outcomes when negative and positive EEGs were compared.
• A positive ictal EEG was not linked with better clinical outcomes regardless of the surgical site or the pathology of the lesion.
• EEGs had limited predictive value, which prompted researchers to question whether they are worth doing if MRI findings and related presurgical data confirm the location of the epileptogenic site.

MRI supersedes ictal EEG when other presurgical data are concordant. Seizure. 2017; 53:18-22. DOI: http://dx.doi.org/10.1016/j.seizure.2017.10.013.

Ictal electroencephalography (EEG) does not appear to help determine the best approach to surgery in pediatric patients if magnetic resonance imaging (MRI) findings and other presurgical data have pinpointed the epileptogenic focus, according to retrospective analysis that included 115 children.

• Investigators looked at children with epilepsy who had surgical resection based on a lesion that was identified by MRI and corroborated by other presurgical findings.
• Ictal video EEG findings were divided into 2 groups; ictal EEG findings were labeled “positive” if the identified location of the lesion agreed with the location indicated by the MRI, or “negative” if results were discordant with the MRI findings.
• The analysis found no differences in seizure-free outcomes when negative and positive EEGs were compared.
• A positive ictal EEG was not linked with better clinical outcomes regardless of the surgical site or the pathology of the lesion.
• EEGs had limited predictive value, which prompted researchers to question whether they are worth doing if MRI findings and related presurgical data confirm the location of the epileptogenic site.

MRI supersedes ictal EEG when other presurgical data are concordant. Seizure. 2017; 53:18-22. DOI: http://dx.doi.org/10.1016/j.seizure.2017.10.013.

Telling the difference between epilepsy and psychogenic non-epileptic seizures (PNES) has always been a challenge, especially in low-resource clinical settings in which video-electroencephalography (EEG) monitoring is not available. Patient questionnaires may help differentiate the 2 conditions, suggests a recent study.

• Investigators gave adult patients and eyewitnesses questionnaires that discussed subjective experiences and vulnerabilities, including signs, symptoms, and risk factors.
• They also calculated specificity and sensitivity for each measured variable, comparing the responses of patients and eyewitnesses to the final diagnosis.
• The study generated 28 useful patient questionnaires, including 17 from patients who had PNES and 11 who had epileptic seizures.
• The analysis uncovered 7 variables that had both high sensitivity and specificity scores, and 5 of these markers were found to be statistically significant diagnostic predictors.
• The most indicative items on the questionnaires included head injury, physical abuse, chronic fatigue, heart racing, and tingling or numbness.
• The analysis also yielded 16 useful eyewitness questionnaires, which found side-to-side head movements and closed eyes as statistically significant markers.

​Patients’ and caregivers’ contributions for differentiating epileptic from psychogenic nonepileptic seizures. Value and limitations of self-reporting questionnaires: A pilot study. Seizure. 2017;53:66-71. DOI: http://dx.doi.org/10.1016/j.seizure.2017.11.001.

Telling the difference between epilepsy and psychogenic non-epileptic seizures (PNES) has always been a challenge, especially in low-resource clinical settings in which video-electroencephalography (EEG) monitoring is not available. Patient questionnaires may help differentiate the 2 conditions, suggests a recent study.

• Investigators gave adult patients and eyewitnesses questionnaires that discussed subjective experiences and vulnerabilities, including signs, symptoms, and risk factors.
• They also calculated specificity and sensitivity for each measured variable, comparing the responses of patients and eyewitnesses to the final diagnosis.
• The study generated 28 useful patient questionnaires, including 17 from patients who had PNES and 11 who had epileptic seizures.
• The analysis uncovered 7 variables that had both high sensitivity and specificity scores, and 5 of these markers were found to be statistically significant diagnostic predictors.
• The most indicative items on the questionnaires included head injury, physical abuse, chronic fatigue, heart racing, and tingling or numbness.
• The analysis also yielded 16 useful eyewitness questionnaires, which found side-to-side head movements and closed eyes as statistically significant markers.

​Patients’ and caregivers’ contributions for differentiating epileptic from psychogenic nonepileptic seizures. Value and limitations of self-reporting questionnaires: A pilot study. Seizure. 2017;53:66-71. DOI: http://dx.doi.org/10.1016/j.seizure.2017.11.001.

Telling the difference between epilepsy and psychogenic non-epileptic seizures (PNES) has always been a challenge, especially in low-resource clinical settings in which video-electroencephalography (EEG) monitoring is not available. Patient questionnaires may help differentiate the 2 conditions, suggests a recent study.

• Investigators gave adult patients and eyewitnesses questionnaires that discussed subjective experiences and vulnerabilities, including signs, symptoms, and risk factors.
• They also calculated specificity and sensitivity for each measured variable, comparing the responses of patients and eyewitnesses to the final diagnosis.
• The study generated 28 useful patient questionnaires, including 17 from patients who had PNES and 11 who had epileptic seizures.
• The analysis uncovered 7 variables that had both high sensitivity and specificity scores, and 5 of these markers were found to be statistically significant diagnostic predictors.
• The most indicative items on the questionnaires included head injury, physical abuse, chronic fatigue, heart racing, and tingling or numbness.
• The analysis also yielded 16 useful eyewitness questionnaires, which found side-to-side head movements and closed eyes as statistically significant markers.

​Patients’ and caregivers’ contributions for differentiating epileptic from psychogenic nonepileptic seizures. Value and limitations of self-reporting questionnaires: A pilot study. Seizure. 2017;53:66-71. DOI: http://dx.doi.org/10.1016/j.seizure.2017.11.001.