Literature Monitor

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

Patients with epilepsy are more likely to develop seizure clusters if they have symptomatic generalized epilepsy, an earlier age of onset of their seizures, or if they have status epilepticus, according to a recent review of medical records that looked at over 4000 adult outpatients with epilepsy. The investigators also found that clustering was more common in patients with symptomatic generalized epilepsy than in those with focal epilepsy or idiopathic generalized epilepsy. 

Chen B, Choi H, Hirsh LJ, et al.  Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Res. 2017;133: 98-102.

Post-ictal generalized EEG suppression (PGES) may signal impending sudden unexpected death in epilepsy (SUDEP), according to a recent analysis of 305 seizures that occurred in 17 patients who had definite or probable SUDEP. Researchers found that PGES duration was shorter in patients who died unexpectedly from epilepsy, when compared to living patients. They also found that earlier nursing intervention was linked to shorter seizures after generalized convulsive seizures and may help reduce the risk of SUDEP.

Kang JY, Rabiei AH, Myint L, Nei M. Equivocal significance of post-ictal generalized EEG suppression as a marker of SUDEP risk. Seizure. 2017;48:28-32.

Post-ictal generalized EEG suppression (PGES) may signal impending sudden unexpected death in epilepsy (SUDEP), according to a recent analysis of 305 seizures that occurred in 17 patients who had definite or probable SUDEP. Researchers found that PGES duration was shorter in patients who died unexpectedly from epilepsy, when compared to living patients. They also found that earlier nursing intervention was linked to shorter seizures after generalized convulsive seizures and may help reduce the risk of SUDEP.

Kang JY, Rabiei AH, Myint L, Nei M. Equivocal significance of post-ictal generalized EEG suppression as a marker of SUDEP risk. Seizure. 2017;48:28-32.

Post-ictal generalized EEG suppression (PGES) may signal impending sudden unexpected death in epilepsy (SUDEP), according to a recent analysis of 305 seizures that occurred in 17 patients who had definite or probable SUDEP. Researchers found that PGES duration was shorter in patients who died unexpectedly from epilepsy, when compared to living patients. They also found that earlier nursing intervention was linked to shorter seizures after generalized convulsive seizures and may help reduce the risk of SUDEP.

Kang JY, Rabiei AH, Myint L, Nei M. Equivocal significance of post-ictal generalized EEG suppression as a marker of SUDEP risk. Seizure. 2017;48:28-32.

A new guideline codeveloped by the American Academy of Neurology and the American Epilepsy Society is intended to aid clinicians as they counsel patients about SUDEP. The practice guideline, published in the April 25 issue of Neurology, provides information about SUDEP incidence in different epilepsy populations, data about risk factors, and recommendations for patient care.

“Our guideline brings clarity to the [SUDEP] discussion, giving health care providers practical information they can use to help people with epilepsy reduce their risk,” said Cynthia Harden, MD, Director of Epilepsy Services for the Mount Sinai Health System in New York City.

A panel of experts searched the MEDLINE and Embase databases from the earliest available article to November 2010. An identical search was performed in April 2015 for articles published since November 2010. The keywords for both searches were “SUDEP” and other traditional medical subheadings for epilepsy (eg, “epilepsy/abnormalities,” “epilepsy/drug effects,” or “epilepsy/therapy”).

After reviewing more than 1,000 abstracts, the panel selected 70 relevant articles. The team then conducted a systematic review and developed conclusions using the modified Grading Recommendations Assessment, Development, and Evaluation process. All recommendations were made by consensus.

Incidence rates were based on 12 Class I studies. The systematic review found that SUDEP affects one in 4,500 children with epilepsy per year. Based on these findings, the experts recommend that clinicians inform parents or guardians about this low risk of SUDEP in children (Level B). In addition, the panel recommends that clinicians inform adult patients about the small risk of SUDEP, which typically affects one in 1,000 adults with epilepsy annually (Level B).

The panel also found that generalized tonic-clonic seizures, which involve convulsions and loss of consciousness, are a major risk factor for SUDEP. In addition, they noted that patients who have three or more of these seizures per year have a 15-fold increased risk of SUDEP. To reduce this risk, clinicians are advised to manage epilepsy therapies actively in these patients to reduce seizures (Level B).

The guideline also recommends nocturnal supervision or other nocturnal precautions for patients who experience frequent generalized tonic-clonic seizures and nocturnal seizures (Level C). Furthermore, the presence of an additional person age 10 or older in the bedroom is associated with a decreased SUDEP risk. If individualized epilepsy and psychosocial circumstances permit, such a person should be present, said the panel. Providing nighttime observation might be overly burdensome or intrusive for some patients, the authors added.

Finally, clinicians are advised to inform patients that seizure freedom, especially freedom from generalized tonic-clonic seizures, is strongly associated with a decreased risk of SUDEP (Level B). The panel also analyzed other SUDEP risk factors (eg, lamotrigine use in women, heart rate variability, and male gender), but too little evidence was available to support recommendations.

“Research to identify preventable risk factors should be supported and encouraged so that future clinical trials will be conducted to reduce SUDEP occurrence,” said Dr. Harden.

—Erica Tricarico

Suggested Reading

Harden C, Tomson T, Gloss D, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2017;88(17):1674-1680.

A new guideline codeveloped by the American Academy of Neurology and the American Epilepsy Society is intended to aid clinicians as they counsel patients about SUDEP. The practice guideline, published in the April 25 issue of Neurology, provides information about SUDEP incidence in different epilepsy populations, data about risk factors, and recommendations for patient care.

“Our guideline brings clarity to the [SUDEP] discussion, giving health care providers practical information they can use to help people with epilepsy reduce their risk,” said Cynthia Harden, MD, Director of Epilepsy Services for the Mount Sinai Health System in New York City.

A panel of experts searched the MEDLINE and Embase databases from the earliest available article to November 2010. An identical search was performed in April 2015 for articles published since November 2010. The keywords for both searches were “SUDEP” and other traditional medical subheadings for epilepsy (eg, “epilepsy/abnormalities,” “epilepsy/drug effects,” or “epilepsy/therapy”).

After reviewing more than 1,000 abstracts, the panel selected 70 relevant articles. The team then conducted a systematic review and developed conclusions using the modified Grading Recommendations Assessment, Development, and Evaluation process. All recommendations were made by consensus.

Incidence rates were based on 12 Class I studies. The systematic review found that SUDEP affects one in 4,500 children with epilepsy per year. Based on these findings, the experts recommend that clinicians inform parents or guardians about this low risk of SUDEP in children (Level B). In addition, the panel recommends that clinicians inform adult patients about the small risk of SUDEP, which typically affects one in 1,000 adults with epilepsy annually (Level B).

The panel also found that generalized tonic-clonic seizures, which involve convulsions and loss of consciousness, are a major risk factor for SUDEP. In addition, they noted that patients who have three or more of these seizures per year have a 15-fold increased risk of SUDEP. To reduce this risk, clinicians are advised to manage epilepsy therapies actively in these patients to reduce seizures (Level B).

The guideline also recommends nocturnal supervision or other nocturnal precautions for patients who experience frequent generalized tonic-clonic seizures and nocturnal seizures (Level C). Furthermore, the presence of an additional person age 10 or older in the bedroom is associated with a decreased SUDEP risk. If individualized epilepsy and psychosocial circumstances permit, such a person should be present, said the panel. Providing nighttime observation might be overly burdensome or intrusive for some patients, the authors added.

Finally, clinicians are advised to inform patients that seizure freedom, especially freedom from generalized tonic-clonic seizures, is strongly associated with a decreased risk of SUDEP (Level B). The panel also analyzed other SUDEP risk factors (eg, lamotrigine use in women, heart rate variability, and male gender), but too little evidence was available to support recommendations.

“Research to identify preventable risk factors should be supported and encouraged so that future clinical trials will be conducted to reduce SUDEP occurrence,” said Dr. Harden.

—Erica Tricarico

Suggested Reading

Harden C, Tomson T, Gloss D, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2017;88(17):1674-1680.

A new guideline codeveloped by the American Academy of Neurology and the American Epilepsy Society is intended to aid clinicians as they counsel patients about SUDEP. The practice guideline, published in the April 25 issue of Neurology, provides information about SUDEP incidence in different epilepsy populations, data about risk factors, and recommendations for patient care.

“Our guideline brings clarity to the [SUDEP] discussion, giving health care providers practical information they can use to help people with epilepsy reduce their risk,” said Cynthia Harden, MD, Director of Epilepsy Services for the Mount Sinai Health System in New York City.

A panel of experts searched the MEDLINE and Embase databases from the earliest available article to November 2010. An identical search was performed in April 2015 for articles published since November 2010. The keywords for both searches were “SUDEP” and other traditional medical subheadings for epilepsy (eg, “epilepsy/abnormalities,” “epilepsy/drug effects,” or “epilepsy/therapy”).

After reviewing more than 1,000 abstracts, the panel selected 70 relevant articles. The team then conducted a systematic review and developed conclusions using the modified Grading Recommendations Assessment, Development, and Evaluation process. All recommendations were made by consensus.

Incidence rates were based on 12 Class I studies. The systematic review found that SUDEP affects one in 4,500 children with epilepsy per year. Based on these findings, the experts recommend that clinicians inform parents or guardians about this low risk of SUDEP in children (Level B). In addition, the panel recommends that clinicians inform adult patients about the small risk of SUDEP, which typically affects one in 1,000 adults with epilepsy annually (Level B).

The panel also found that generalized tonic-clonic seizures, which involve convulsions and loss of consciousness, are a major risk factor for SUDEP. In addition, they noted that patients who have three or more of these seizures per year have a 15-fold increased risk of SUDEP. To reduce this risk, clinicians are advised to manage epilepsy therapies actively in these patients to reduce seizures (Level B).

The guideline also recommends nocturnal supervision or other nocturnal precautions for patients who experience frequent generalized tonic-clonic seizures and nocturnal seizures (Level C). Furthermore, the presence of an additional person age 10 or older in the bedroom is associated with a decreased SUDEP risk. If individualized epilepsy and psychosocial circumstances permit, such a person should be present, said the panel. Providing nighttime observation might be overly burdensome or intrusive for some patients, the authors added.

Finally, clinicians are advised to inform patients that seizure freedom, especially freedom from generalized tonic-clonic seizures, is strongly associated with a decreased risk of SUDEP (Level B). The panel also analyzed other SUDEP risk factors (eg, lamotrigine use in women, heart rate variability, and male gender), but too little evidence was available to support recommendations.

“Research to identify preventable risk factors should be supported and encouraged so that future clinical trials will be conducted to reduce SUDEP occurrence,” said Dr. Harden.

—Erica Tricarico

Suggested Reading

Harden C, Tomson T, Gloss D, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2017;88(17):1674-1680.

Contrary to the widespread belief that depressive disorders are more common than anxiety disorders among people with epilepsy, these psychiatric comorbidities appear to have equivalent prevalence, according to research published online ahead of print May 3 in Epilepsia. In addition, variability in the observed prevalence of anxiety disorders in previous studies partly results from the method of diagnosis.

“These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy,” said Amelia J. Scott, a PhD candidate at the University of Sydney.

Comorbid anxiety and depressive disorders are highly prevalent in patients with epilepsy, compared with the general population. The prevalence of anxiety disorders reported in previous studies of people with epilepsy has been highly variable, however. Ms. Scott and colleagues conducted a study to clarify the prevalence of anxiety and depressive disorders in patients with epilepsy and to determine which factors account for the variability in estimates of these disorders’ prevalence.

The investigators searched electronic databases to find studies that reported the prevalence of anxiety and depressive disorders in people with epilepsy until July 2016. Journal articles or dissertations that reported on current diagnoses of anxiety and depressive disorders based on a structured diagnostic interview or a clinician evaluation were included. Clinician evaluations followed the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition or the International Classification of Diseases, Tenth Revision or more recent.

The investigators excluded studies of participants younger than 16. In addition, studies that reported diagnoses of anxiety and depressive disorders using self-report measures and studies that only reported a depression diagnosis or only an anxiety diagnosis were also excluded. Finally, researchers excluded studies if recruitment was based on additional medical comorbidity or on results of prescreening measures of distress.

Extracted data included the prevalence of anxiety and depressive disorders and moderators of interest (eg, method of diagnosis and prevalence of drug-resistant epilepsy). Using these data, Ms. Scott and colleagues conducted a meta-analysis of the overall pooled prevalence of anxiety and depressive disorders.

In all, 27 studies met the inclusion criteria. The pooled prevalence of anxiety disorders was 20.2%, and the pooled prevalence of depressive disorders was 22.9%. Ms. Scott and colleagues also observed that the method of diagnosis significantly affected the observed prevalence of anxiety disorders. The prevalence of anxiety disorders based on unstructured clinician assessment was 8.1%, compared with a prevalence of 27.3% based on a structured clinical interview. No significant moderators of depressive disorder diagnosis were reported, however.

“Future research should aim to improve the detection and management of comorbidities in people with epilepsy, particularly anxiety disorders, which have remained relatively neglected,” said Ms. Scott. “An improvement in our understanding, detection, and management of both anxiety and depressive disorders in people with epilepsy is crucial to improve the quality of life of people with epilepsy.”

—Erica Tricarico

Suggested Reading

Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia. 2017 May 3 [Epub ahead of print].

Contrary to the widespread belief that depressive disorders are more common than anxiety disorders among people with epilepsy, these psychiatric comorbidities appear to have equivalent prevalence, according to research published online ahead of print May 3 in Epilepsia. In addition, variability in the observed prevalence of anxiety disorders in previous studies partly results from the method of diagnosis.

“These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy,” said Amelia J. Scott, a PhD candidate at the University of Sydney.

Comorbid anxiety and depressive disorders are highly prevalent in patients with epilepsy, compared with the general population. The prevalence of anxiety disorders reported in previous studies of people with epilepsy has been highly variable, however. Ms. Scott and colleagues conducted a study to clarify the prevalence of anxiety and depressive disorders in patients with epilepsy and to determine which factors account for the variability in estimates of these disorders’ prevalence.

The investigators searched electronic databases to find studies that reported the prevalence of anxiety and depressive disorders in people with epilepsy until July 2016. Journal articles or dissertations that reported on current diagnoses of anxiety and depressive disorders based on a structured diagnostic interview or a clinician evaluation were included. Clinician evaluations followed the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition or the International Classification of Diseases, Tenth Revision or more recent.

The investigators excluded studies of participants younger than 16. In addition, studies that reported diagnoses of anxiety and depressive disorders using self-report measures and studies that only reported a depression diagnosis or only an anxiety diagnosis were also excluded. Finally, researchers excluded studies if recruitment was based on additional medical comorbidity or on results of prescreening measures of distress.

Extracted data included the prevalence of anxiety and depressive disorders and moderators of interest (eg, method of diagnosis and prevalence of drug-resistant epilepsy). Using these data, Ms. Scott and colleagues conducted a meta-analysis of the overall pooled prevalence of anxiety and depressive disorders.

In all, 27 studies met the inclusion criteria. The pooled prevalence of anxiety disorders was 20.2%, and the pooled prevalence of depressive disorders was 22.9%. Ms. Scott and colleagues also observed that the method of diagnosis significantly affected the observed prevalence of anxiety disorders. The prevalence of anxiety disorders based on unstructured clinician assessment was 8.1%, compared with a prevalence of 27.3% based on a structured clinical interview. No significant moderators of depressive disorder diagnosis were reported, however.

“Future research should aim to improve the detection and management of comorbidities in people with epilepsy, particularly anxiety disorders, which have remained relatively neglected,” said Ms. Scott. “An improvement in our understanding, detection, and management of both anxiety and depressive disorders in people with epilepsy is crucial to improve the quality of life of people with epilepsy.”

—Erica Tricarico

Suggested Reading

Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia. 2017 May 3 [Epub ahead of print].

Contrary to the widespread belief that depressive disorders are more common than anxiety disorders among people with epilepsy, these psychiatric comorbidities appear to have equivalent prevalence, according to research published online ahead of print May 3 in Epilepsia. In addition, variability in the observed prevalence of anxiety disorders in previous studies partly results from the method of diagnosis.

“These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy,” said Amelia J. Scott, a PhD candidate at the University of Sydney.

Comorbid anxiety and depressive disorders are highly prevalent in patients with epilepsy, compared with the general population. The prevalence of anxiety disorders reported in previous studies of people with epilepsy has been highly variable, however. Ms. Scott and colleagues conducted a study to clarify the prevalence of anxiety and depressive disorders in patients with epilepsy and to determine which factors account for the variability in estimates of these disorders’ prevalence.

The investigators searched electronic databases to find studies that reported the prevalence of anxiety and depressive disorders in people with epilepsy until July 2016. Journal articles or dissertations that reported on current diagnoses of anxiety and depressive disorders based on a structured diagnostic interview or a clinician evaluation were included. Clinician evaluations followed the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition or the International Classification of Diseases, Tenth Revision or more recent.

The investigators excluded studies of participants younger than 16. In addition, studies that reported diagnoses of anxiety and depressive disorders using self-report measures and studies that only reported a depression diagnosis or only an anxiety diagnosis were also excluded. Finally, researchers excluded studies if recruitment was based on additional medical comorbidity or on results of prescreening measures of distress.

Extracted data included the prevalence of anxiety and depressive disorders and moderators of interest (eg, method of diagnosis and prevalence of drug-resistant epilepsy). Using these data, Ms. Scott and colleagues conducted a meta-analysis of the overall pooled prevalence of anxiety and depressive disorders.

In all, 27 studies met the inclusion criteria. The pooled prevalence of anxiety disorders was 20.2%, and the pooled prevalence of depressive disorders was 22.9%. Ms. Scott and colleagues also observed that the method of diagnosis significantly affected the observed prevalence of anxiety disorders. The prevalence of anxiety disorders based on unstructured clinician assessment was 8.1%, compared with a prevalence of 27.3% based on a structured clinical interview. No significant moderators of depressive disorder diagnosis were reported, however.

“Future research should aim to improve the detection and management of comorbidities in people with epilepsy, particularly anxiety disorders, which have remained relatively neglected,” said Ms. Scott. “An improvement in our understanding, detection, and management of both anxiety and depressive disorders in people with epilepsy is crucial to improve the quality of life of people with epilepsy.”

—Erica Tricarico

Suggested Reading

Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia. 2017 May 3 [Epub ahead of print].

The risk of sudden unexpected death in epilepsy (SUDEP) in children with epilepsy is very small, affecting about 1 in 4500 individuals.  The risk of SUDEP in adults is a relatively more common, but still rare, occurrence, affecting 1 in 1000 adults, according to a recent review of the evidence published in Neurology. The major risk factor for SUDEP is generalized tonic-clonic seizures (GTCS), which prompted experts to recommend that clinicians should actively monitor patients with GTCS and inform patients of the value of remaining free of GTCS to reduce their risk of SUDEP.

Harden C, Tomson T, Gloss D, et al. Practice guideline summary: sudden unexpected death in epilepsy incidence rates and risk factors. Neurology. 2017;88:1674-1680.

The risk of sudden unexpected death in epilepsy (SUDEP) in children with epilepsy is very small, affecting about 1 in 4500 individuals.  The risk of SUDEP in adults is a relatively more common, but still rare, occurrence, affecting 1 in 1000 adults, according to a recent review of the evidence published in Neurology. The major risk factor for SUDEP is generalized tonic-clonic seizures (GTCS), which prompted experts to recommend that clinicians should actively monitor patients with GTCS and inform patients of the value of remaining free of GTCS to reduce their risk of SUDEP.

Harden C, Tomson T, Gloss D, et al. Practice guideline summary: sudden unexpected death in epilepsy incidence rates and risk factors. Neurology. 2017;88:1674-1680.

The risk of sudden unexpected death in epilepsy (SUDEP) in children with epilepsy is very small, affecting about 1 in 4500 individuals.  The risk of SUDEP in adults is a relatively more common, but still rare, occurrence, affecting 1 in 1000 adults, according to a recent review of the evidence published in Neurology. The major risk factor for SUDEP is generalized tonic-clonic seizures (GTCS), which prompted experts to recommend that clinicians should actively monitor patients with GTCS and inform patients of the value of remaining free of GTCS to reduce their risk of SUDEP.

Harden C, Tomson T, Gloss D, et al. Practice guideline summary: sudden unexpected death in epilepsy incidence rates and risk factors. Neurology. 2017;88:1674-1680.

In order to determine if there are any biomarkers that might help explain why some patients with unilateral temporal lobe epilepsy do well after surgery and some do not, researchers used MRIs to investigate patients and healthy controls. Their analysis revealed a seizure propagation network that suggests a consistent connectivity pattern among patients who remain seizure free for a prolonged period. The seizure free connectivity model was able to differentiate between patients with poor outcomes and those who fared well (P= .0005).

Morgan VL, Englot DJ, Rogers BP, et al. Magnetic resonance imaging connectivity for the prediction of seizure outcome in temporal lobe epilepsy [published online April 27, 2017]. Epilepsia. doi:10.1111/epi.13762.

In order to determine if there are any biomarkers that might help explain why some patients with unilateral temporal lobe epilepsy do well after surgery and some do not, researchers used MRIs to investigate patients and healthy controls. Their analysis revealed a seizure propagation network that suggests a consistent connectivity pattern among patients who remain seizure free for a prolonged period. The seizure free connectivity model was able to differentiate between patients with poor outcomes and those who fared well (P= .0005).

Morgan VL, Englot DJ, Rogers BP, et al. Magnetic resonance imaging connectivity for the prediction of seizure outcome in temporal lobe epilepsy [published online April 27, 2017]. Epilepsia. doi:10.1111/epi.13762.

In order to determine if there are any biomarkers that might help explain why some patients with unilateral temporal lobe epilepsy do well after surgery and some do not, researchers used MRIs to investigate patients and healthy controls. Their analysis revealed a seizure propagation network that suggests a consistent connectivity pattern among patients who remain seizure free for a prolonged period. The seizure free connectivity model was able to differentiate between patients with poor outcomes and those who fared well (P= .0005).

Morgan VL, Englot DJ, Rogers BP, et al. Magnetic resonance imaging connectivity for the prediction of seizure outcome in temporal lobe epilepsy [published online April 27, 2017]. Epilepsia. doi:10.1111/epi.13762.

Although an enlarged amygdala (AE) has been found in patients with temporal lobe epilepsy, a recent analysis found that AE exists among those without epilepsy. The study used high resolution T1-weighted MRI scans and analyzed healthy controls and patients with epilepsy. The investigation revealed that AE was more common in nonlesional localization related epilepsy, when compared with idiopathic generalized epilepsy and healthy controls.

Reyes A, Thesen R, Kuzniecky R, et al. Amygdala enlargement: temporal lobe epilepsy subtype or nonspecific finding? Epilepsy Res. 2017;132:34-40.

Although an enlarged amygdala (AE) has been found in patients with temporal lobe epilepsy, a recent analysis found that AE exists among those without epilepsy. The study used high resolution T1-weighted MRI scans and analyzed healthy controls and patients with epilepsy. The investigation revealed that AE was more common in nonlesional localization related epilepsy, when compared with idiopathic generalized epilepsy and healthy controls.

Reyes A, Thesen R, Kuzniecky R, et al. Amygdala enlargement: temporal lobe epilepsy subtype or nonspecific finding? Epilepsy Res. 2017;132:34-40.

Although an enlarged amygdala (AE) has been found in patients with temporal lobe epilepsy, a recent analysis found that AE exists among those without epilepsy. The study used high resolution T1-weighted MRI scans and analyzed healthy controls and patients with epilepsy. The investigation revealed that AE was more common in nonlesional localization related epilepsy, when compared with idiopathic generalized epilepsy and healthy controls.

Reyes A, Thesen R, Kuzniecky R, et al. Amygdala enlargement: temporal lobe epilepsy subtype or nonspecific finding? Epilepsy Res. 2017;132:34-40.

Length of stay (LOS) may not be the best metric to use when trying to determine the cost effectiveness of invasive monitoring with subdural grid implantation or stereoelectroencephalography, suggests a recent analysis of 76 patients over a 2 year period. Researchers found that as LOS increased a hospital’s profit and contribution margins also increased, while patients maintained a low rate of complications. Investigators concluded that increased LOS does not necessarily result in lower financial gain for institutions. 

Chan AY, Kharrat S. Lundeen K, et al. Length of stay for patients undergoing invasive electrode monitoring with stereoelectroencephalography and subdural grids correlates positively with increased institutional profitability [published online April 20, 2017]. Epilespia. doi:10.1111/epi.13737

Length of stay (LOS) may not be the best metric to use when trying to determine the cost effectiveness of invasive monitoring with subdural grid implantation or stereoelectroencephalography, suggests a recent analysis of 76 patients over a 2 year period. Researchers found that as LOS increased a hospital’s profit and contribution margins also increased, while patients maintained a low rate of complications. Investigators concluded that increased LOS does not necessarily result in lower financial gain for institutions. 

Chan AY, Kharrat S. Lundeen K, et al. Length of stay for patients undergoing invasive electrode monitoring with stereoelectroencephalography and subdural grids correlates positively with increased institutional profitability [published online April 20, 2017]. Epilespia. doi:10.1111/epi.13737

Length of stay (LOS) may not be the best metric to use when trying to determine the cost effectiveness of invasive monitoring with subdural grid implantation or stereoelectroencephalography, suggests a recent analysis of 76 patients over a 2 year period. Researchers found that as LOS increased a hospital’s profit and contribution margins also increased, while patients maintained a low rate of complications. Investigators concluded that increased LOS does not necessarily result in lower financial gain for institutions. 

Chan AY, Kharrat S. Lundeen K, et al. Length of stay for patients undergoing invasive electrode monitoring with stereoelectroencephalography and subdural grids correlates positively with increased institutional profitability [published online April 20, 2017]. Epilespia. doi:10.1111/epi.13737

Death certificates fail to consistently report sudden unexplained death in epilepsy (SUDEP), making it difficult for researchers to study the phenomenon, according to a recent survey sent to medical examiners (MEs). Among 847 responses on 11 case vignettes, MEs did not use the ICD-10 seizure code in 3% to 62% of cases, depending on the specific vignette. Several factors may be responsible for the shortfall, including the complicated nature of SUDEP and uncertain circumstances involved in any individual death.

Atherton DS, Davis GG, Wright C, Devinsky O, Hesdorffer D. A Survey of medical examiner death certification of vignettes on death in epilepsy: gaps in identifying SUDEP [published online April 21, 2017]. Epilepsy Res. doi: http://dx.doi.org/10.1016/j.eplepsyres.2017.04.013.

Death certificates fail to consistently report sudden unexplained death in epilepsy (SUDEP), making it difficult for researchers to study the phenomenon, according to a recent survey sent to medical examiners (MEs). Among 847 responses on 11 case vignettes, MEs did not use the ICD-10 seizure code in 3% to 62% of cases, depending on the specific vignette. Several factors may be responsible for the shortfall, including the complicated nature of SUDEP and uncertain circumstances involved in any individual death.

Atherton DS, Davis GG, Wright C, Devinsky O, Hesdorffer D. A Survey of medical examiner death certification of vignettes on death in epilepsy: gaps in identifying SUDEP [published online April 21, 2017]. Epilepsy Res. doi: http://dx.doi.org/10.1016/j.eplepsyres.2017.04.013.

Death certificates fail to consistently report sudden unexplained death in epilepsy (SUDEP), making it difficult for researchers to study the phenomenon, according to a recent survey sent to medical examiners (MEs). Among 847 responses on 11 case vignettes, MEs did not use the ICD-10 seizure code in 3% to 62% of cases, depending on the specific vignette. Several factors may be responsible for the shortfall, including the complicated nature of SUDEP and uncertain circumstances involved in any individual death.

Atherton DS, Davis GG, Wright C, Devinsky O, Hesdorffer D. A Survey of medical examiner death certification of vignettes on death in epilepsy: gaps in identifying SUDEP [published online April 21, 2017]. Epilepsy Res. doi: http://dx.doi.org/10.1016/j.eplepsyres.2017.04.013.

Brain-responsive neurostimulation may be an effective treatment option for patients with mesial temporal lobe epilepsy, according to a recent study of 111 subjects. When following up for an average of 6.1 years on patients who had the procedure, researchers found it reduced seizures by a median average of 70%. Twenty-nine percent of patients had at least 1 seizure free period that lasted at least 6 months and 15% had at least 1 seizure free period lasting at least 1 year.

Geller EB, Skarpaas TL, Gross RE, et al. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy [published online April 11, 2017]. Epilepsia. doi: 10.1111/epi.13740

Brain-responsive neurostimulation may be an effective treatment option for patients with mesial temporal lobe epilepsy, according to a recent study of 111 subjects. When following up for an average of 6.1 years on patients who had the procedure, researchers found it reduced seizures by a median average of 70%. Twenty-nine percent of patients had at least 1 seizure free period that lasted at least 6 months and 15% had at least 1 seizure free period lasting at least 1 year.

Geller EB, Skarpaas TL, Gross RE, et al. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy [published online April 11, 2017]. Epilepsia. doi: 10.1111/epi.13740

Brain-responsive neurostimulation may be an effective treatment option for patients with mesial temporal lobe epilepsy, according to a recent study of 111 subjects. When following up for an average of 6.1 years on patients who had the procedure, researchers found it reduced seizures by a median average of 70%. Twenty-nine percent of patients had at least 1 seizure free period that lasted at least 6 months and 15% had at least 1 seizure free period lasting at least 1 year.

Geller EB, Skarpaas TL, Gross RE, et al. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy [published online April 11, 2017]. Epilepsia. doi: 10.1111/epi.13740