Literature Monitor

Developmental encephalopathic epilepsies (DEEs) are responsible for a disproportionate number of cases of drug resistance, early deaths, and disability, according to researchers from Northwestern-Feinberg School of Medicine and Yale School of Medicine.

• An analysis of 613 pediatric patients from the Connecticut Study of Epilepsy allowed researchers to classify patients into specific epilepsy syndromes and to reclassify them over a period of 9 years.
• Among these children, 58 were found to have DEEs (9.4%).
• DEEs were more resistant to drug therapy than other epilepsies (71% vs 18%), more likely to cause intellectual disability (84% vs 11%), and more likely to cause death (21% vs <1%).
• The analysis also revealed changes from the initial epilepsy diagnosis over time, eg, Lennox-Gastaut syndrome was initially diagnosed in only 4 children but by the end of 9 years, 22 had received the diagnosis.

Berg AT, Levy SR, Testa FM. Evolution and course of early life developmental encephalopathic epilepsies: Focus on Lennox‐Gastaut syndrome. Epilepsia. 2018;59:2096-2105.

Developmental encephalopathic epilepsies (DEEs) are responsible for a disproportionate number of cases of drug resistance, early deaths, and disability, according to researchers from Northwestern-Feinberg School of Medicine and Yale School of Medicine.

• An analysis of 613 pediatric patients from the Connecticut Study of Epilepsy allowed researchers to classify patients into specific epilepsy syndromes and to reclassify them over a period of 9 years.
• Among these children, 58 were found to have DEEs (9.4%).
• DEEs were more resistant to drug therapy than other epilepsies (71% vs 18%), more likely to cause intellectual disability (84% vs 11%), and more likely to cause death (21% vs <1%).
• The analysis also revealed changes from the initial epilepsy diagnosis over time, eg, Lennox-Gastaut syndrome was initially diagnosed in only 4 children but by the end of 9 years, 22 had received the diagnosis.

Berg AT, Levy SR, Testa FM. Evolution and course of early life developmental encephalopathic epilepsies: Focus on Lennox‐Gastaut syndrome. Epilepsia. 2018;59:2096-2105.

Developmental encephalopathic epilepsies (DEEs) are responsible for a disproportionate number of cases of drug resistance, early deaths, and disability, according to researchers from Northwestern-Feinberg School of Medicine and Yale School of Medicine.

• An analysis of 613 pediatric patients from the Connecticut Study of Epilepsy allowed researchers to classify patients into specific epilepsy syndromes and to reclassify them over a period of 9 years.
• Among these children, 58 were found to have DEEs (9.4%).
• DEEs were more resistant to drug therapy than other epilepsies (71% vs 18%), more likely to cause intellectual disability (84% vs 11%), and more likely to cause death (21% vs <1%).
• The analysis also revealed changes from the initial epilepsy diagnosis over time, eg, Lennox-Gastaut syndrome was initially diagnosed in only 4 children but by the end of 9 years, 22 had received the diagnosis.

Berg AT, Levy SR, Testa FM. Evolution and course of early life developmental encephalopathic epilepsies: Focus on Lennox‐Gastaut syndrome. Epilepsia. 2018;59:2096-2105.

Analyzing infraslow amplitude modulations may help clinicians better understand changes in intracranial EEG readings over the long-term and help researchers develop better algorithms to forecast the onset of seizures, according to a report published in Epilepsia.

• Investigators from Yale-New Haven Hospital collected intracranial EEG readings from 13 adult patients with medically refractory epilepsy.
• To derive infraslow envelope correlations, they estimated magnitude-squared coherence at <0.15 Hz of EEG frequency band power time series for all electrode contact pairs.
• Infraslow envelope magnitude-squared coherence increased significantly after patients had their antiepileptic drugs tapered; it also increased at night and decreased during the day.

Joshi RB, Duckrow RB, Goncharova II, et al. Seizure susceptibility and infraslow modulatory activity in the intracranial electroencephalogram. Epilepsia. 2018;59:2075-2085.

Analyzing infraslow amplitude modulations may help clinicians better understand changes in intracranial EEG readings over the long-term and help researchers develop better algorithms to forecast the onset of seizures, according to a report published in Epilepsia.

• Investigators from Yale-New Haven Hospital collected intracranial EEG readings from 13 adult patients with medically refractory epilepsy.
• To derive infraslow envelope correlations, they estimated magnitude-squared coherence at <0.15 Hz of EEG frequency band power time series for all electrode contact pairs.
• Infraslow envelope magnitude-squared coherence increased significantly after patients had their antiepileptic drugs tapered; it also increased at night and decreased during the day.

Joshi RB, Duckrow RB, Goncharova II, et al. Seizure susceptibility and infraslow modulatory activity in the intracranial electroencephalogram. Epilepsia. 2018;59:2075-2085.

Analyzing infraslow amplitude modulations may help clinicians better understand changes in intracranial EEG readings over the long-term and help researchers develop better algorithms to forecast the onset of seizures, according to a report published in Epilepsia.

• Investigators from Yale-New Haven Hospital collected intracranial EEG readings from 13 adult patients with medically refractory epilepsy.
• To derive infraslow envelope correlations, they estimated magnitude-squared coherence at <0.15 Hz of EEG frequency band power time series for all electrode contact pairs.
• Infraslow envelope magnitude-squared coherence increased significantly after patients had their antiepileptic drugs tapered; it also increased at night and decreased during the day.

Joshi RB, Duckrow RB, Goncharova II, et al. Seizure susceptibility and infraslow modulatory activity in the intracranial electroencephalogram. Epilepsia. 2018;59:2075-2085.

Diagnosing psychogenic nonepileptic seizures (PNES) can prove challenging; using provocative induction is one way to detect the disorder. A recent experiment suggests that inducing seizures without the use of a placebo is just as effective as inducing them with one.

• Researchers compared 170 patients suspected of having PNES who underwent provocative induction plus placebo to 170 patients who underwent the same induction procedure without a saline solution placebo.
• Induction triggered a seizure in 79.4% of patients without the help of the placebo, compared to 73.5% with placebo, a non-significant difference.
• Investigators postulated that the greater success rate in the non-placebo group may have resulted from the greater cumulative induction experience of clinicians, which may have influenced the manner and presentation of how the induction was presented.
• The study concluded that experienced clinicians should opt for non-placebo based provocative induction.

Chen DK, Dave H, Gadelmola, K et al. Provocative induction of psychogenic nonepileptic seizures: Noninferiority of an induction technique without versus with placebo.  Epilepsia. 2018; 59:e161-e165.

Diagnosing psychogenic nonepileptic seizures (PNES) can prove challenging; using provocative induction is one way to detect the disorder. A recent experiment suggests that inducing seizures without the use of a placebo is just as effective as inducing them with one.

• Researchers compared 170 patients suspected of having PNES who underwent provocative induction plus placebo to 170 patients who underwent the same induction procedure without a saline solution placebo.
• Induction triggered a seizure in 79.4% of patients without the help of the placebo, compared to 73.5% with placebo, a non-significant difference.
• Investigators postulated that the greater success rate in the non-placebo group may have resulted from the greater cumulative induction experience of clinicians, which may have influenced the manner and presentation of how the induction was presented.
• The study concluded that experienced clinicians should opt for non-placebo based provocative induction.

Chen DK, Dave H, Gadelmola, K et al. Provocative induction of psychogenic nonepileptic seizures: Noninferiority of an induction technique without versus with placebo.  Epilepsia. 2018; 59:e161-e165.

Diagnosing psychogenic nonepileptic seizures (PNES) can prove challenging; using provocative induction is one way to detect the disorder. A recent experiment suggests that inducing seizures without the use of a placebo is just as effective as inducing them with one.

• Researchers compared 170 patients suspected of having PNES who underwent provocative induction plus placebo to 170 patients who underwent the same induction procedure without a saline solution placebo.
• Induction triggered a seizure in 79.4% of patients without the help of the placebo, compared to 73.5% with placebo, a non-significant difference.
• Investigators postulated that the greater success rate in the non-placebo group may have resulted from the greater cumulative induction experience of clinicians, which may have influenced the manner and presentation of how the induction was presented.
• The study concluded that experienced clinicians should opt for non-placebo based provocative induction.

Chen DK, Dave H, Gadelmola, K et al. Provocative induction of psychogenic nonepileptic seizures: Noninferiority of an induction technique without versus with placebo.  Epilepsia. 2018; 59:e161-e165.

A community-based program that helps patients with epilepsy self-manage their condition and related psychiatric problems has proven effective in reducing the severity of depression according to a study published in Epilepsy and Behavior.

• Community Targeted Self-Management for Epilepsy and Mental Illness (C-TIME), a behavioral program, consisted of ten 60 to 90-minute sessions conducted over 12 weeks.
• The program included outreach and engagement efforts to help patients suffering from both epilepsy and mental health conditions.
• Thirty patients were enrolled in the program; four months after participating in C-TIME, 66% of the enrolled patients were available for outcome evaluation.
• Researchers reported significant reduction in depression severity, and more than 90% of the group said they were satisfied with results.

Sajatovic M, Needham K, Colón-Zimmermann K, et al. The Community-targeted Self-management of Epilepsy and Mental Illness (C-TIME) initiative: A research, community, and healthcare administration partnership to reduce epilepsy burden [published online ahead of print October 29, 2018]. Epilepsy Behav.  https://doi.org/10.1016/j.yebeh.2018.10.004

A community-based program that helps patients with epilepsy self-manage their condition and related psychiatric problems has proven effective in reducing the severity of depression according to a study published in Epilepsy and Behavior.

• Community Targeted Self-Management for Epilepsy and Mental Illness (C-TIME), a behavioral program, consisted of ten 60 to 90-minute sessions conducted over 12 weeks.
• The program included outreach and engagement efforts to help patients suffering from both epilepsy and mental health conditions.
• Thirty patients were enrolled in the program; four months after participating in C-TIME, 66% of the enrolled patients were available for outcome evaluation.
• Researchers reported significant reduction in depression severity, and more than 90% of the group said they were satisfied with results.

Sajatovic M, Needham K, Colón-Zimmermann K, et al. The Community-targeted Self-management of Epilepsy and Mental Illness (C-TIME) initiative: A research, community, and healthcare administration partnership to reduce epilepsy burden [published online ahead of print October 29, 2018]. Epilepsy Behav.  https://doi.org/10.1016/j.yebeh.2018.10.004

A community-based program that helps patients with epilepsy self-manage their condition and related psychiatric problems has proven effective in reducing the severity of depression according to a study published in Epilepsy and Behavior.

• Community Targeted Self-Management for Epilepsy and Mental Illness (C-TIME), a behavioral program, consisted of ten 60 to 90-minute sessions conducted over 12 weeks.
• The program included outreach and engagement efforts to help patients suffering from both epilepsy and mental health conditions.
• Thirty patients were enrolled in the program; four months after participating in C-TIME, 66% of the enrolled patients were available for outcome evaluation.
• Researchers reported significant reduction in depression severity, and more than 90% of the group said they were satisfied with results.

Sajatovic M, Needham K, Colón-Zimmermann K, et al. The Community-targeted Self-management of Epilepsy and Mental Illness (C-TIME) initiative: A research, community, and healthcare administration partnership to reduce epilepsy burden [published online ahead of print October 29, 2018]. Epilepsy Behav.  https://doi.org/10.1016/j.yebeh.2018.10.004

The Epilepsy Foundation, working with a pharmaceutical company, has launched an educational initiative to locate communities most in need of professional and consumer education. The program emphasizes the value of tailored and innovative approaches to reach underserved populations to improve their self-management skills for epilepsy.

• A data analysis conducted by The Connectors Project found 4 states in need of help: Michigan, Oklahoma, Nevada, and West Virginia, all of which have rural and/or underserved communities.
• The Foundation launched outreach and awareness programs in these states, as well as digital and in-person education for clinicians, patients, and families.
• The initiatives were designed to fill critical gaps in patients’ ability to self-manage epilepsy and gaps in their ability to get access to quality professional care.

Owens S, Sirven JI, Shafer PO, et al. Innovative approaches reaching underserved and rural communities to improve epilepsy care: A review of the methodology of the Connectors Project [published online ahead of print October 31, 2018]. Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2018.09.029

The Epilepsy Foundation, working with a pharmaceutical company, has launched an educational initiative to locate communities most in need of professional and consumer education. The program emphasizes the value of tailored and innovative approaches to reach underserved populations to improve their self-management skills for epilepsy.

• A data analysis conducted by The Connectors Project found 4 states in need of help: Michigan, Oklahoma, Nevada, and West Virginia, all of which have rural and/or underserved communities.
• The Foundation launched outreach and awareness programs in these states, as well as digital and in-person education for clinicians, patients, and families.
• The initiatives were designed to fill critical gaps in patients’ ability to self-manage epilepsy and gaps in their ability to get access to quality professional care.

Owens S, Sirven JI, Shafer PO, et al. Innovative approaches reaching underserved and rural communities to improve epilepsy care: A review of the methodology of the Connectors Project [published online ahead of print October 31, 2018]. Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2018.09.029

The Epilepsy Foundation, working with a pharmaceutical company, has launched an educational initiative to locate communities most in need of professional and consumer education. The program emphasizes the value of tailored and innovative approaches to reach underserved populations to improve their self-management skills for epilepsy.

• A data analysis conducted by The Connectors Project found 4 states in need of help: Michigan, Oklahoma, Nevada, and West Virginia, all of which have rural and/or underserved communities.
• The Foundation launched outreach and awareness programs in these states, as well as digital and in-person education for clinicians, patients, and families.
• The initiatives were designed to fill critical gaps in patients’ ability to self-manage epilepsy and gaps in their ability to get access to quality professional care.

Owens S, Sirven JI, Shafer PO, et al. Innovative approaches reaching underserved and rural communities to improve epilepsy care: A review of the methodology of the Connectors Project [published online ahead of print October 31, 2018]. Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2018.09.029

Giving neurologists the tools to diagnose and treat common psychiatric disorders can help meet the mental health needs of adults with epilepsy whose psychiatric comorbidities are being ignored, according to investigators from Wake Forest School of Medicine and Johns Hopkins University.

• There is a high prevalence of psychiatric disorders among adults with epilepsy.
• These comorbidities are often overlooked because patients have limited access to mental health services.
• Heidi Munger Clary and Jay Salpekar suggest that letting neurologists diagnose and manage common conditions like mood and anxiety disorders will help address this dilemma.
• The researchers suggest that validated screeners could help neurologists who do not have expertise in psychiatry to manage depression and anxiety.
• With such assistance, adult neurologists could be trained to effectively use selective serotonin reupdate inhibitors (SSRIs).

Munger Clary HM, Salpekar JA. Should adult neurologists play a role in the management of the most common psychiatric comorbidities? Practical considerations [published online ahead of print November 22, 2018]. Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2018.10.020

Giving neurologists the tools to diagnose and treat common psychiatric disorders can help meet the mental health needs of adults with epilepsy whose psychiatric comorbidities are being ignored, according to investigators from Wake Forest School of Medicine and Johns Hopkins University.

• There is a high prevalence of psychiatric disorders among adults with epilepsy.
• These comorbidities are often overlooked because patients have limited access to mental health services.
• Heidi Munger Clary and Jay Salpekar suggest that letting neurologists diagnose and manage common conditions like mood and anxiety disorders will help address this dilemma.
• The researchers suggest that validated screeners could help neurologists who do not have expertise in psychiatry to manage depression and anxiety.
• With such assistance, adult neurologists could be trained to effectively use selective serotonin reupdate inhibitors (SSRIs).

Munger Clary HM, Salpekar JA. Should adult neurologists play a role in the management of the most common psychiatric comorbidities? Practical considerations [published online ahead of print November 22, 2018]. Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2018.10.020

Giving neurologists the tools to diagnose and treat common psychiatric disorders can help meet the mental health needs of adults with epilepsy whose psychiatric comorbidities are being ignored, according to investigators from Wake Forest School of Medicine and Johns Hopkins University.

• There is a high prevalence of psychiatric disorders among adults with epilepsy.
• These comorbidities are often overlooked because patients have limited access to mental health services.
• Heidi Munger Clary and Jay Salpekar suggest that letting neurologists diagnose and manage common conditions like mood and anxiety disorders will help address this dilemma.
• The researchers suggest that validated screeners could help neurologists who do not have expertise in psychiatry to manage depression and anxiety.
• With such assistance, adult neurologists could be trained to effectively use selective serotonin reupdate inhibitors (SSRIs).

Munger Clary HM, Salpekar JA. Should adult neurologists play a role in the management of the most common psychiatric comorbidities? Practical considerations [published online ahead of print November 22, 2018]. Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2018.10.020

Two clinical parameters measurable at seizure onset appear to predict a return to baseline after prolonged status epilepticus (SE), based on a study of patients who presented to a single, tertiary academic medical center over a 12-year period.

Absence of nonconvulsive SE with coma and a decreasing Charlson Comorbidity Index were the only independent predictors for return to baseline in patients with SE duration greater than 48 hours, the researchers found. However, the research fell short of developing a model for identifying patients at risk for prolonged SE.

“These findings are of great clinical importance, as up to now, clinicians have had no reliable prediction tools to direct decisions regarding the level of care with progressive SE duration. Early and reliable identification of patients with potential favorable outcome despite having SE for several days is of utmost clinical importance, as this insight may urge clinicians to intensify treatment rather than consider care withdrawal as systemic and neurologic sequelae increase, and chances of SE termination decrease over time,” first author Raoul C. Sutter, MD, of University Hospital Basel (Switzerland), and his colleagues wrote about their findings in Epilepsia.

The researchers identified 467 adult patients with prolonged SE at University Hospital Basel during 2005-2016 – excluding those with SE as a consequence of hypoxic‐ischemic brain injury – who had a median age of 66.7 years and median SE duration of 1 day. While 11.8% of patients died in the hospital and 12.4% at 30 days after SE onset, 40.9% made a complete neurologic and functional recovery to their premorbid status.

There were significant differences in in-hospital outcomes between patients with different SE durations. For example, rates of returning to baseline differed significantly at 55.6% of those with a SE duration of 0-12 hours, 36.8% with 12-24 hours’ duration, 34.6% with 24-48 hours’ duration, and 25.5% with more than 48 hours.

A multivariable regression model identified absence of nonconvulsive SE with coma and a decreasing Charlson Comorbidity Index as the only independent predictors for return to baseline in patients with SE duration greater than 48 hours, and both remained significant predictors after adjustment for use of anesthetics and vasopressors. These predictors of a return to baseline after prolonged SE remained significant after excluding patients who died. This two-variable prediction model had an area under the receiver operating curve (AUROC) of 0.82, “indicating good discrimination,” and an AUROC of 0.76 following cross-validation.

The investigators also sought to develop a model to identify patients at risk for prolonged SE, but the model showed relatively poor discriminative ability with AUROCs of just 0.67-0.72 for predicting no termination of SE within 12, 24, or 48 hours. “Our attempt to generate a highly reliable prediction model for early recognition of patients at increased risk for developing prolonged SE failed, as demonstrated by the rather small AUROC and the fact that sensitivity analyses after exclusion of patients who died revealed inconsistent association of the identified predictors,” they wrote.

Prior reports identified younger age, absence of acute brain lesions at presentation, and the absence of multiple concomitant medical problems as factors associated with favorable outcome after prolonged SE, but “none of the studies performed multivariable regression models and generated or tested predictions models in this context,” they noted.

The authors cautioned that “although internal cross-validation of the final prediction model indicated adequate performance [based on an AUROC of 0.76], further external validation of our prediction model is warranted before our prediction model can be implemented and used for decision making in daily clinical practice.”

Some authors reported receiving research, travel, and/or personal grants or speaker fees from companies marketing antiepileptic drugs, such as UCB, Eisai, and GlaxoSmithKline.

[email protected]

SOURCE: Sutter RC et al. Epilepsia. 2018 Nov 22. doi: 10.1111/epi.14603

Two clinical parameters measurable at seizure onset appear to predict a return to baseline after prolonged status epilepticus (SE), based on a study of patients who presented to a single, tertiary academic medical center over a 12-year period.

Absence of nonconvulsive SE with coma and a decreasing Charlson Comorbidity Index were the only independent predictors for return to baseline in patients with SE duration greater than 48 hours, the researchers found. However, the research fell short of developing a model for identifying patients at risk for prolonged SE.

“These findings are of great clinical importance, as up to now, clinicians have had no reliable prediction tools to direct decisions regarding the level of care with progressive SE duration. Early and reliable identification of patients with potential favorable outcome despite having SE for several days is of utmost clinical importance, as this insight may urge clinicians to intensify treatment rather than consider care withdrawal as systemic and neurologic sequelae increase, and chances of SE termination decrease over time,” first author Raoul C. Sutter, MD, of University Hospital Basel (Switzerland), and his colleagues wrote about their findings in Epilepsia.

The researchers identified 467 adult patients with prolonged SE at University Hospital Basel during 2005-2016 – excluding those with SE as a consequence of hypoxic‐ischemic brain injury – who had a median age of 66.7 years and median SE duration of 1 day. While 11.8% of patients died in the hospital and 12.4% at 30 days after SE onset, 40.9% made a complete neurologic and functional recovery to their premorbid status.

There were significant differences in in-hospital outcomes between patients with different SE durations. For example, rates of returning to baseline differed significantly at 55.6% of those with a SE duration of 0-12 hours, 36.8% with 12-24 hours’ duration, 34.6% with 24-48 hours’ duration, and 25.5% with more than 48 hours.

A multivariable regression model identified absence of nonconvulsive SE with coma and a decreasing Charlson Comorbidity Index as the only independent predictors for return to baseline in patients with SE duration greater than 48 hours, and both remained significant predictors after adjustment for use of anesthetics and vasopressors. These predictors of a return to baseline after prolonged SE remained significant after excluding patients who died. This two-variable prediction model had an area under the receiver operating curve (AUROC) of 0.82, “indicating good discrimination,” and an AUROC of 0.76 following cross-validation.

The investigators also sought to develop a model to identify patients at risk for prolonged SE, but the model showed relatively poor discriminative ability with AUROCs of just 0.67-0.72 for predicting no termination of SE within 12, 24, or 48 hours. “Our attempt to generate a highly reliable prediction model for early recognition of patients at increased risk for developing prolonged SE failed, as demonstrated by the rather small AUROC and the fact that sensitivity analyses after exclusion of patients who died revealed inconsistent association of the identified predictors,” they wrote.

Prior reports identified younger age, absence of acute brain lesions at presentation, and the absence of multiple concomitant medical problems as factors associated with favorable outcome after prolonged SE, but “none of the studies performed multivariable regression models and generated or tested predictions models in this context,” they noted.

The authors cautioned that “although internal cross-validation of the final prediction model indicated adequate performance [based on an AUROC of 0.76], further external validation of our prediction model is warranted before our prediction model can be implemented and used for decision making in daily clinical practice.”

Some authors reported receiving research, travel, and/or personal grants or speaker fees from companies marketing antiepileptic drugs, such as UCB, Eisai, and GlaxoSmithKline.

[email protected]

SOURCE: Sutter RC et al. Epilepsia. 2018 Nov 22. doi: 10.1111/epi.14603

Two clinical parameters measurable at seizure onset appear to predict a return to baseline after prolonged status epilepticus (SE), based on a study of patients who presented to a single, tertiary academic medical center over a 12-year period.

Absence of nonconvulsive SE with coma and a decreasing Charlson Comorbidity Index were the only independent predictors for return to baseline in patients with SE duration greater than 48 hours, the researchers found. However, the research fell short of developing a model for identifying patients at risk for prolonged SE.

“These findings are of great clinical importance, as up to now, clinicians have had no reliable prediction tools to direct decisions regarding the level of care with progressive SE duration. Early and reliable identification of patients with potential favorable outcome despite having SE for several days is of utmost clinical importance, as this insight may urge clinicians to intensify treatment rather than consider care withdrawal as systemic and neurologic sequelae increase, and chances of SE termination decrease over time,” first author Raoul C. Sutter, MD, of University Hospital Basel (Switzerland), and his colleagues wrote about their findings in Epilepsia.

The researchers identified 467 adult patients with prolonged SE at University Hospital Basel during 2005-2016 – excluding those with SE as a consequence of hypoxic‐ischemic brain injury – who had a median age of 66.7 years and median SE duration of 1 day. While 11.8% of patients died in the hospital and 12.4% at 30 days after SE onset, 40.9% made a complete neurologic and functional recovery to their premorbid status.

There were significant differences in in-hospital outcomes between patients with different SE durations. For example, rates of returning to baseline differed significantly at 55.6% of those with a SE duration of 0-12 hours, 36.8% with 12-24 hours’ duration, 34.6% with 24-48 hours’ duration, and 25.5% with more than 48 hours.

A multivariable regression model identified absence of nonconvulsive SE with coma and a decreasing Charlson Comorbidity Index as the only independent predictors for return to baseline in patients with SE duration greater than 48 hours, and both remained significant predictors after adjustment for use of anesthetics and vasopressors. These predictors of a return to baseline after prolonged SE remained significant after excluding patients who died. This two-variable prediction model had an area under the receiver operating curve (AUROC) of 0.82, “indicating good discrimination,” and an AUROC of 0.76 following cross-validation.

The investigators also sought to develop a model to identify patients at risk for prolonged SE, but the model showed relatively poor discriminative ability with AUROCs of just 0.67-0.72 for predicting no termination of SE within 12, 24, or 48 hours. “Our attempt to generate a highly reliable prediction model for early recognition of patients at increased risk for developing prolonged SE failed, as demonstrated by the rather small AUROC and the fact that sensitivity analyses after exclusion of patients who died revealed inconsistent association of the identified predictors,” they wrote.

Prior reports identified younger age, absence of acute brain lesions at presentation, and the absence of multiple concomitant medical problems as factors associated with favorable outcome after prolonged SE, but “none of the studies performed multivariable regression models and generated or tested predictions models in this context,” they noted.

The authors cautioned that “although internal cross-validation of the final prediction model indicated adequate performance [based on an AUROC of 0.76], further external validation of our prediction model is warranted before our prediction model can be implemented and used for decision making in daily clinical practice.”

Some authors reported receiving research, travel, and/or personal grants or speaker fees from companies marketing antiepileptic drugs, such as UCB, Eisai, and GlaxoSmithKline.

[email protected]

SOURCE: Sutter RC et al. Epilepsia. 2018 Nov 22. doi: 10.1111/epi.14603

Although ambulatory EEGs (aEEGs) can help distinguish epileptic attacks from non-epileptic attacks, they have their limitations. A recent retrospective review of EEG procedure notes from the Stanford Comprehensive Epilepsy Center has found that they rarely yield useful information beyond 24 hours duration.

• Stanford researchers analyzed 358 adult aEEG readings from 2010 to 2017 and found epileptiform discharges or epileptic seizures in 101 of the readings (28%).
• The analysis compared detection rates for 20-30 hours, 30-50 hours, and 50-76 hours and found little difference.
• Epilepsy seizures were observed in 11%, 7%, and 10% respectively for the 3 duration periods.
• An analysis of the epileptiform abnormalities revealed no significant differences in detection rates for the 3 duration periods.
• Among aEEGs that were ordered to characterize suspected events, however, 72 hours was the best option because it generated a higher rate of capture.

Kuo J, Lee-Messer C, Le S. Optimal recording duration of ambulatory EEG (aEEG). Epilepsy Res. 2018;149:9-12.

Although ambulatory EEGs (aEEGs) can help distinguish epileptic attacks from non-epileptic attacks, they have their limitations. A recent retrospective review of EEG procedure notes from the Stanford Comprehensive Epilepsy Center has found that they rarely yield useful information beyond 24 hours duration.

• Stanford researchers analyzed 358 adult aEEG readings from 2010 to 2017 and found epileptiform discharges or epileptic seizures in 101 of the readings (28%).
• The analysis compared detection rates for 20-30 hours, 30-50 hours, and 50-76 hours and found little difference.
• Epilepsy seizures were observed in 11%, 7%, and 10% respectively for the 3 duration periods.
• An analysis of the epileptiform abnormalities revealed no significant differences in detection rates for the 3 duration periods.
• Among aEEGs that were ordered to characterize suspected events, however, 72 hours was the best option because it generated a higher rate of capture.

Kuo J, Lee-Messer C, Le S. Optimal recording duration of ambulatory EEG (aEEG). Epilepsy Res. 2018;149:9-12.

Although ambulatory EEGs (aEEGs) can help distinguish epileptic attacks from non-epileptic attacks, they have their limitations. A recent retrospective review of EEG procedure notes from the Stanford Comprehensive Epilepsy Center has found that they rarely yield useful information beyond 24 hours duration.

• Stanford researchers analyzed 358 adult aEEG readings from 2010 to 2017 and found epileptiform discharges or epileptic seizures in 101 of the readings (28%).
• The analysis compared detection rates for 20-30 hours, 30-50 hours, and 50-76 hours and found little difference.
• Epilepsy seizures were observed in 11%, 7%, and 10% respectively for the 3 duration periods.
• An analysis of the epileptiform abnormalities revealed no significant differences in detection rates for the 3 duration periods.
• Among aEEGs that were ordered to characterize suspected events, however, 72 hours was the best option because it generated a higher rate of capture.

Kuo J, Lee-Messer C, Le S. Optimal recording duration of ambulatory EEG (aEEG). Epilepsy Res. 2018;149:9-12.

Trying to predict morbidity and mortality among patients with status epilepticus has proven difficult, and the 2 scoring metrics designed to accomplish that feat have significant shortcomings, according to a retrospective analysis of status epilepticus patients conducted at the Ohio State University Wexner Medical Center.

• Investigators reviewed the records of 46 affected patients admitted to the hospital’s neuro-critical care unit.
• Data from the status epilepticus Severity Score (STESS) and Epidemiology-based Mortality Score in Status Epilepticus (EMSE) were analyzed.
• Sensitivity of EMSE was 100% and sensitivity of STESS was 90%.
• The specificity of both metrics was wanting, however: EMSE, 28.6% and STESS, 42.9%.
• Researchers concluded that both scoring systems may help predict clinical outcomes in status epilepticus patients who have few co-existing conditions but are less valuable in populations with several medical problems.

Yechoor A, Adeli A, Hafeez S. External validation of the epidemiology-based mortality score in status epilepticus in an American intensive care population. Epilepsy Res. 2018;148:32-36.

Trying to predict morbidity and mortality among patients with status epilepticus has proven difficult, and the 2 scoring metrics designed to accomplish that feat have significant shortcomings, according to a retrospective analysis of status epilepticus patients conducted at the Ohio State University Wexner Medical Center.

• Investigators reviewed the records of 46 affected patients admitted to the hospital’s neuro-critical care unit.
• Data from the status epilepticus Severity Score (STESS) and Epidemiology-based Mortality Score in Status Epilepticus (EMSE) were analyzed.
• Sensitivity of EMSE was 100% and sensitivity of STESS was 90%.
• The specificity of both metrics was wanting, however: EMSE, 28.6% and STESS, 42.9%.
• Researchers concluded that both scoring systems may help predict clinical outcomes in status epilepticus patients who have few co-existing conditions but are less valuable in populations with several medical problems.

Yechoor A, Adeli A, Hafeez S. External validation of the epidemiology-based mortality score in status epilepticus in an American intensive care population. Epilepsy Res. 2018;148:32-36.

Trying to predict morbidity and mortality among patients with status epilepticus has proven difficult, and the 2 scoring metrics designed to accomplish that feat have significant shortcomings, according to a retrospective analysis of status epilepticus patients conducted at the Ohio State University Wexner Medical Center.

• Investigators reviewed the records of 46 affected patients admitted to the hospital’s neuro-critical care unit.
• Data from the status epilepticus Severity Score (STESS) and Epidemiology-based Mortality Score in Status Epilepticus (EMSE) were analyzed.
• Sensitivity of EMSE was 100% and sensitivity of STESS was 90%.
• The specificity of both metrics was wanting, however: EMSE, 28.6% and STESS, 42.9%.
• Researchers concluded that both scoring systems may help predict clinical outcomes in status epilepticus patients who have few co-existing conditions but are less valuable in populations with several medical problems.

Yechoor A, Adeli A, Hafeez S. External validation of the epidemiology-based mortality score in status epilepticus in an American intensive care population. Epilepsy Res. 2018;148:32-36.

Among children who have had surgical resection of epileptic lesions, it may be wise to continue postoperative invasive monitoring, suggests this investigation of 71 patients published in Epilepsy Research.

• A retrospective analysis of 5 patients with MRI-negative epilepsy and 66 patients with MRI-identified neocortical lesions, post-resection invasive monitoring yielded positive outcomes in 86%.
• In 55 of 71 patients, post-resection monitoring resulted in additional resections.
• Postop monitoring detected clinical seizures at the resection margins, subclinical seizures and interictal discharges at the resection margins, and both clinical and subclinical seizures that indicated a new epileptogenic focus.

Hidalgo ET, Frankel HG, Rodriguez C, et al. Invasive monitoring after resection of epileptogenic neocortical lesions in multi-staged epilepsy surgery in children. Epilepsy Res. 2018; 148:48-54.   

Among children who have had surgical resection of epileptic lesions, it may be wise to continue postoperative invasive monitoring, suggests this investigation of 71 patients published in Epilepsy Research.

• A retrospective analysis of 5 patients with MRI-negative epilepsy and 66 patients with MRI-identified neocortical lesions, post-resection invasive monitoring yielded positive outcomes in 86%.
• In 55 of 71 patients, post-resection monitoring resulted in additional resections.
• Postop monitoring detected clinical seizures at the resection margins, subclinical seizures and interictal discharges at the resection margins, and both clinical and subclinical seizures that indicated a new epileptogenic focus.

Hidalgo ET, Frankel HG, Rodriguez C, et al. Invasive monitoring after resection of epileptogenic neocortical lesions in multi-staged epilepsy surgery in children. Epilepsy Res. 2018; 148:48-54.   

Among children who have had surgical resection of epileptic lesions, it may be wise to continue postoperative invasive monitoring, suggests this investigation of 71 patients published in Epilepsy Research.

• A retrospective analysis of 5 patients with MRI-negative epilepsy and 66 patients with MRI-identified neocortical lesions, post-resection invasive monitoring yielded positive outcomes in 86%.
• In 55 of 71 patients, post-resection monitoring resulted in additional resections.
• Postop monitoring detected clinical seizures at the resection margins, subclinical seizures and interictal discharges at the resection margins, and both clinical and subclinical seizures that indicated a new epileptogenic focus.

Hidalgo ET, Frankel HG, Rodriguez C, et al. Invasive monitoring after resection of epileptogenic neocortical lesions in multi-staged epilepsy surgery in children. Epilepsy Res. 2018; 148:48-54.