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• Small sharp spikes (SSSs) are more commonly seen in temporal lobe epilepsy (TLE) than in extra-TLE. • Low-amplitude temporal spikes may be morphologically misdiagnosed as SSSs in TLE. • Simultaneous magnetoencephalography is useful to identify epileptiform discharges mimicking SSSs in TLE. To determine whether magnetoencephalography (MEG) can identify epileptiform discharges mimicking small sharp spikes (SSSs) on scalp electroencephalography (EEG) in patients with temporal lobe epilepsy (TLE). We retrospectively reviewed simultaneous scalp EEG and MEG recordings of 83 consecutive patients with TLE and 49 with extra-TLE (ETLE). SSSs in scalp EEG were detected in 15 (18.1%) of 83 TLE patients compared to only two (4.1%) of 49 ETLE patients (p = 0.029). Five of the 15 TLE patients had MEG spikes with concurrent SSSs in EEG, but neither of the 2 ETLE patients. Three of these 5 TLE patients had additional interictal epileptiform discharges (IEDs) in EEG and MEG. Equivalent current dipoles (ECDs) of MEG spikes with concurrent SSSs and IEDs showed no difference in temporal lobe localization and horizontal orientation, whereas ECD moments were smaller in MEG spikes with concurrent SSSs than those with IEDs. SSSs were more common in TLE than in ETLE. At least some morphologically diagnosed SSSs are true but low-amplitude epileptiform discharges in TLE which can be identified with simultaneous MEG. Simultaneous MEG is useful to identify epileptiform discharges mimicking SSSs in patients with TLE. [ABSTRACT FROM AUTHOR]

• Twenty-three patients with mesial temporal lobe epilepsy with pathologically confirmed hippocampal sclerosis were reviewed. • Ictal EEG findings of the initial delta and delayed theta/alpha pattern suggest purely hippocampal epileptogenicity. • Patients with this pattern are likely to become seizure-free after selective amygdalohippocampectomy. To determine whether the ictal scalp EEG findings suggest purely hippocampal epileptogenicity in patients with mesial temporal lobe epilepsy (mTLE) associated with hippocampal sclerosis (HS). Twenty-three patients with mTLE with pathologically confirmed HS were divided into 12 with epileptogenicity only in the hippocampus (HS only group) and 11 with epileptogenicity in both the hippocampus and temporal neocortex or other locations (HS plus group), based on the combination of surgical procedures, postoperative outcome, and pathological findings. Sixteen underwent selective amygdalohippocampectomy (SelAH) and 7 received anterior temporal lobectomy. Ictal scalp EEG findings of 79 focal impaired awareness seizures were compared between the HS only and HS plus groups. We focused on the 1–4 Hz rhythmic delta activity at ictal onset followed by 5–9 Hz rhythmic theta/alpha activity 10–30 s after the onset in the temporal region. The initial delta and delayed theta/alpha (ID-DT) pattern was observed in 8 of 12 patients in the HS only group, but in none of 11 patients in the HS plus group (p < 0.01). ID-DT pattern on ictal EEG suggests purely hippocampal epileptogenicity in mTLE with HS. Patients with the ID-DT pattern are likely to become seizure-free after SelAH. [ABSTRACT FROM AUTHOR]

Sudden death in the bathtub occurs relatively frequently in Japan, particularly among elderly people. We hypothesize that sudden death in epilepsy occurring in the bathtub (SDEPB) can be distinguished from sudden death in nonepilepsy occurring in the bathtub (SDnonEPB), but is identical to sudden unexpected death in epilepsy (SUDEP). Tokyo Medical Examiner's Office conducts postmortem examinations for all sudden and unexpected deaths in Tokyo. Clinical, social, and autopsy findings of 43 SDEPB were compared with 76 SDnonEPB, 50 SUDEP outside the bathtub, and Japanese forensic autopsy data as controls. Extension of the leg(s) outside the bathtub was seen in 33% of SDEPB, but none of SDnonEPB. Sitting position was seen less frequently in SDEPB (37%) than in SDnonEPB (64%). Lung weight and pleural effusion volume were significantly lower in SDEPB than in SDnonEPB. Age at death in SDEPB was significantly younger than that in SDnonEPB. Sudden death in epilepsy occurring in the bathtub showed no differences in lung weight and pleural effusion volume from SUDEP. Living with family was more frequent in SDEPB (73%) than in SUDEP (48%). Few antiepileptic drugs, infrequent seizures, and low rate of mental retardation were identical between SDEPB and SUDEP. Lung weight was significantly heavier in all three groups than in age- and sex- matched autopsy controls. Leg extension outside the bathtub, lower lung weight, and absence of pleural effusion distinguish SDEPB from SDnonEPB in elderly people. Sudden death in epilepsy occurring in the bathtub may represent a form of SUDEP occurring in the bathtub, rather than drowning despite submergence in the bathtub at discovery. Conditions for bathing require careful attention from physicians and relatives, even for patients with epilepsy with few medications and infrequent seizures, and without mental retardation. • Clinical, social, and autopsy findings of SDEPB were compared with SDnonEPB and SUDEP. • Leg extension outside the bathtub and seated position distinguish SDEPB from SDnonEPB. • SDEPB shows no differences in lung weight and pleural effusion volume from SUDEP. • Few antiepileptic drugs and infrequent seizures are identical between SDEPB and SUDEP. • SDEPB may represent a form of SUDEP occurring in the bathtub, rather than drowning. [ABSTRACT FROM AUTHOR]

Highlights • PER-induced body weight gain was analyzed to determine correlations with ID dose and serum concentration. • Mild to moderate ID patients gained more body weight than no ID patients. • Body weight gain was minimum in severe to profound ID patients, probably due to caregivers' control of food intake. • Higher PER serum concentration was linearly correlated with more weight gain, especially in patients with lower intellect. Abstract Background Body weight (BW) gain may be induced by perampanel (PER) administration, similar to the well-known adverse effects of valproic acid and gabapentin. Intellectual disability (ID) and serum PER concentration may be risk factors of BW gain. Purpose This study investigated how ID and serum PER concentration are associated with PER-induced BW gain. Methods Subjects were 76 patients with epilepsy (41 men, aged 16–70 years). All patients were divided by intelligence quotient (IQ) into no ID (IQ ≥ 70, n = 24), mild to moderate ID (70 > IQ ≥35, n = 31), and severe to profound ID (IQ < 35, n = 21) groups. BW was measured before and 2, 4, 6, and 12 months after initiation of PER treatment, and serum PER concentration at 12 months. Results BW gains in the mild to moderate ID group at 4, 6, and 12 months were significantly (p < 0.05) higher than in the no ID and in the severe to profound ID groups. At 12 months, BW gain was associated with serum PER concentrations in the no ID (p = 0.034) and the mild to moderate ID (p = 0.001) groups but not in the severe to profound ID group. Multiple linear regression analysis found BW gain at 12 months was positively correlated with the mild to moderate ID group (β = 0.373, p = 0.002) and serum PER concentration (β = 0.241, p = 0.047). Conclusions The mild to moderate ID group gained more BW than the no ID group, suggesting that PER-induced food intake was greater due to weaker behavioral control in the mild to moderate ID group. The present study suggests a linear correlation between serum PER concentration and BW change. [ABSTRACT FROM AUTHOR]

Background To evaluate whether a teleconference-based lecture provides similar understanding of seizure semiology to a face-to-face lecture for physicians. Methods Subjects were 66 physicians consisting of adult and pediatric neurologists, neurosurgeons, psychiatrists, and general practitioners. All attended the 30-minute lecture to introduce various types of seizure semiology using video-clips by one of the authors (Yo.K.) and then joined the comprehensive case conference which discussed three cases in 1.5 h. Group A received the lecture and conference using a teleconference system (N = 43) and Group B attended in person (N = 23) for geographical reasons. After the conference, 32 subjects (23 in Group A and nine in Group B) scored their own post-lecture understanding of seizure semiology using the four-point Likert scale from 1 (not at all) to 4 (very well) as well as the estimated pre-lecture score. Data was analyzed to assess whether their understanding was improved after the lecture. Results No significant difference was found in improvement of understanding after the lecture between Group A (43%) and Group B (22%; p  = 0.42). Pre-lecture score of subjects with improved understanding was significantly lower (2.3 +/- 0.2) than those without improvement (3.7 +/- 0.1) ( p < 0.05). Significance Teleconference-based lectures can be a useful tool to educate seizure semiology for physicians, especially at the inexperienced level, by overcoming geographical limitations. [ABSTRACT FROM AUTHOR]

Purpose Predictive factors of higher drug load for seizure freedom were investigated in idiopathic generalized epilepsy (IGE), focusing on the difference between juvenile myoclonic epilepsy (JME) and other types of IGE (non-JME IGE). Methods Twelve patients with JME and 12 patients with non-JME IGE, who achieved seizure freedom for 1 year or longer with appropriate antiepileptic drugs (AEDs) after video electroencephalography monitoring, were reviewed retrospectively. The sum of prescribed daily dose/defined daily dose ratio of all prescribed AEDs at the final visit was defined as total AED load. Patients requiring total AED load >1 were classified into the higher AED load group. Clinical background and the presence of interictal focal epileptiform abnormalities (FEAs) were compared between the higher and lower AED load groups. Results Higher AED load group of patients with JME had interictal FEAs and family history of epilepsy more frequently than the lower AED load group ( p  = 0.03 and p  = 0.03). Similar comparison of patients with non-JME IGE showed no significant differences. Conclusions The presence of interictal FEAs and a family history of epilepsy are significantly associated variables for higher AED load for seizure freedom in patients with JME, but not in patients with non-JME IGE. [ABSTRACT FROM AUTHOR]

• Preoperative dSPM of language MEG signals showed right-shifted lateralization in the supramarginal gyrus in left mesial TLE. • Right shift in supramarginal gyrus was correlated with postoperative verbal memory increase in HS+ group of left mesial TLE. • Regional language lateralization in dSPM of MEG signals may be useful to predict postoperative verbal memory in left HS+ group. To clarify whether preoperative language magnetoencephalography (MEG) predicts postoperative verbal memory (VM) changes in left mesial temporal lobe epilepsy (LMTLE). We reviewed 18 right-handed patients with LMTLE who underwent anterior temporal lobectomy or selective amygdala hippocampectomy, 12 with (HS+) and 6 without hippocampal sclerosis (HS−). Patients underwent neuropsychological assessment before and after surgery. MEG was measured with an auditory verbal learning task in patients preoperatively and in 15 right-handed controls. Dynamic statistical parametric mapping (dSPM) was used for source imaging of task-related activity. Language laterality index (LI) was calculated by z-score of dSPM in language-related regions. LI in the region of HS+ and HS− was compared to controls. The correlation between LI and postoperative VM change was assessed in HS+ and HS−. Preoperative LI in supramarginal gyrus showed greater right-shifted lateralization in both HS+ and HS− than in controls. Right-shifted LI in supramarginal gyrus was correlated with postoperative VM increase in HS+ (p = 0.019), but not in HS−. Right-shifted language lateralization in dSPM of MEG signals may predict favorable VM outcome in HS+ of LMTLE. Findings warrant further investigation of the relation between regional language laterality index and postoperative verbal memory changes. [ABSTRACT FROM AUTHOR]

Objective Intellectual disability (ID) is associated with weight gain caused by antiepileptic drugs such as valproic acid. The present study analyzed the relationship between ID and weight loss caused by topiramate (TPM). Methods Seventy-eight patients with epilepsy (35 women, aged 18 to 70 years) were enrolled in this prospective study. Body weight was measured before and 1, 6, 12, and 18 months after initiation of TPM treatment. Both patients and caregivers were provided information about TPM-related weight loss. The patients were divided into the group with no or mild ID (intelligence quotient > 50) and the group with moderate to profound ID (intelligence quotient ≤ 50). Results Body weight of both groups significantly decreased until 6 months but stabilized after 12 months. Weight loss at 6, 12, and 18 months was significantly greater in the group with no or mild ID than in the group with moderate to profound ID. Body weight change at 18 months was correlated with intellectual levels ( β = 0.274, p = 0.011) and baseline body mass index ( β = − 0.322, p = 0.002) by multiple linear regression analysis. Conclusions The present study suggests that the pattern of weight loss during TPM administration differs according to intellectual levels. Patients with ID maintained their body weight. Weight loss due to TPM might be weakened by caregiver control of food intake or inactivity. [ABSTRACT FROM AUTHOR]

To investigate whether seizure lateralization affects sleep macrostructure in patients with left and right temporal lobe epilepsy (TLE), as rapid eye movement (REM) sleep is shorter in patients with right hemispheric cerebral infarction than with left. We retrospectively analyzed data from 16 patients with TLE (6 men and 10 women aged 34.9 ± 11.4 years) who underwent polysomnography as well as long-term video electroencephalography. Ten patients were diagnosed with left TLE and six patients with right TLE. Sleep stages and respiratory events were scored based on the American Academy of Sleep Medicine criteria. Sleep and respiratory parameters were compared between the patient groups. Percentage of REM stage sleep was significantly (p < 0.05) lower in patients with left TLE (median 8.8 %, interquartile range 5.5-13.8 %) than in patients with right TLE (median 17.0 %, interquartile range 14.1-18.3 %). The other parameters showed no significant differences. Shorter REM sleep in patients with left TLE sharply contrasts with the previous report of shorter REM sleep in patients with right cerebral infarction. Laterality of the irritative epileptic focus versus destructive lesion may have different effects on the sleep macrostructures. [ABSTRACT FROM AUTHOR]

• Newer displaced older anti-seizure medications during 2015–2018. • Newer anti-seizure medications are widely prescribed in adult patients with epilepsy. • This trend is more apparent in patients with newly diagnosed epilepsy. • These trends are also apparent in the subgroup of patients with focal epilepsy. • Newer anti-seizure medications may increase the treatment options for epilepsy. To investigate whether newer anti-seizure medications (ASMs) are widely prescribed for a range of adult patients in Japan, including patients with previously and newly diagnosed epilepsy, or with focal and generalized epilepsies. A retrospective cohort study was conducted using the Japanese insurance claims database including 8.4 million people to identify adults (≥16 years of age) with epilepsy diagnosis code identified between January 2015 and December 2018. Patients were included in the prevalent population if epilepsy was already diagnosed at baseline, and in the incident population if prior baseline data for at least 12 months included no epilepsy diagnosis code or ASM prescription. Patients were followed up from the month when the initial oral ASM was prescribed for up to 4 years until the end of 2019 as long as at least one ASM was prescribed. Proportions of prescribed oral ASMs were analyzed by population with epilepsy (prevalent vs. incident) and classification (focal vs. generalized). Anti-seizure medications were classified into older vs. newer ASMs according to the date of approval before and after 1990, respectively. A total of 24,691 patients fulfilled the eligibility criteria for the analysis. Of these, 21,046 and 3,645 were included in the prevalent and incident populations, respectively. The proportion of older ASMs significantly decreased, whereas the proportion of newer ASMs significantly increased (p < 0.0001) during the study period. This trend was more apparent in the population with incident epilepsy than in that with prevalent epilepsy, and was also apparent in the subgroup of focal epilepsy, but not in that of generalized epilepsy. Levetiracetam was the most frequently prescribed of the newer ASMs. Newer ASMs became more widely prescribed throughout the study period in populations with both prevalent and incident epilepsies, as well as the subpopulation with focal epilepsy. The advantages of newer ASMs such as better safety profiles may have led to the increasing proportions of prescriptions and newer ASMs may increase the treatment options for patients. [ABSTRACT FROM AUTHOR]

Objective Small focal cortical dysplasia (FCD) may be ambiguous or overlooked on magnetic resonance (MR) imaging. Source localization of EEG and magnetoencephalography (MEG) spikes was evaluated to confirm the diagnosis of small FCD. Methods This study included 6 epilepsy patients with a single small lesion on MR imaging suggesting FCD within a single gyrus among 181 consecutive epilepsy patients admitted to our epilepsy monitoring unit over 27 months. Stereotypical interictal spikes were detected on simultaneous EEG and MEG recordings and the onset-related source of averaged spikes was estimated. Results All 6 patients had unique clinical characteristics as follows: leg sensori-motor seizures in 5 patients and eye version in 1 patient; a small MR imaging lesion suggesting FCD in the dorsal peri-rolandic region, which had been overlooked until our evaluation; and both EEG and MEG dipoles were estimated adjacent to the MR imaging lesion. Conclusions Source localization of EEG and MEG spikes can confirm the diagnosis of FCD based on a single small MR imaging lesion, which was overlooked by previous examination of MR images. Significance Examination of MR images should be based on spike source localization as well as seizure semiology to identify subtle MR imaging abnormalities. [ABSTRACT FROM AUTHOR]

Highlights: [•] Patients with implanted medical devices (e.g. VNS) can routinely undergo satisfactory MEG recording. [•] Artifacts can be removed from MEG data and epileptic spikes can be localized by filtering with spatiotemporal signal space separation (tSSS). [•] The effect of spatiotemporal signal space separation (tSSS) on dipole fitting is to either improve the statistical parameters of the fit (44%) or to make a source localization possible when otherwise no fit could have been made (28%). [ABSTRACT FROM AUTHOR]

Identification and accurate localization of seizure foci is vital in patients with medically-intractable focal epilepsy, who may be candidates for potentially curative resective epilepsy surgery. We present a patient with difficult-to-control seizures associated with an occult focal cortical dysplasia residing within the deeper left parietal operculum and underlying posterior insula, which was not detected by conventional MRI analysis. Propagated activities from this deeper generator produced misleading EEG patterns both on surface and subdural electrode recordings suggesting initial activation of the perirolandic and mesial frontal regions. However, careful spatio-temporal analysis of stereotyped interictal activities recorded during MEG, using sequential dipole modeling, revealed a consistent pattern of epileptic propagation originating from the deeper source and propagating within few milliseconds to the dorsal convexity. In this instance, careful dissection of noninvasive investigations (interictal MEG along with ictal SPECT findings) allowed clinicians to dismiss the inaccurate and misleading findings of the traditional 'gold-standard' intracranial EEG. In fact, this multimodal noninvasive approach uncovered a subtle dysplastic lesion, resection of which rendered the patient seizure-free. This case highlights the potential benefits of dynamic analysis of interictal MEG in the appropriate clinical context. Pathways of interictal spike propagation may help elucidate essential neural networks underlying focal epilepsy. Hum Brain Mapp, 2012. © 2012 Wiley Periodicals, Inc [ABSTRACT FROM AUTHOR]

The article discusses the role of musicogenic epilepsy (ME) propagation in revealing interconnections in superior temporal cortex. It mentions ME as an intriguing epilepsy syndrome that affects a single individual among a million. It also focuses on the case study of a patient with non-lesion ME that revealed interconnections within the superior temporal cortex.

Summary: Objective: To better understand the process of ictal propagation in epilepsy by using cortico-cortical evoked potential (CCEP), which reveals the brain networks. Methods: Intracranial EEG recordings of 11 seizures from 11 patients with pharmacoresistant focal epilepsy were studied to identify the propagation sites and times. Six patients had a history of secondary generalization (Gen (+) group) and five patients did not (Gen (−) group). Thereafter repetitive 1Hz bipolar electrical stimuli were applied to the ictal onset zones and CCEPs were recorded by averaging electrocorticograms. Results: The propagation of contiguous spread was significantly faster than non-contiguous spread (p =0.033). In four patients, CCEP amplitudes were significantly larger in the ictal propagation area than out of the propagation area. However, the distribution of CCEP responses was not necessarily consistent with the ictal propagation area as a whole. Furthermore, the ictal propagation areas out of CCEP-positive areas were significantly broader in Gen (+) group than Gen (−) group (p =0.017). Conclusion: The present findings suggest that contiguous spread is faster than non-contiguous spread, which can be explained by the enhancement of excitability around the ictal onset area. Furthermore, there is a group of fibers that is “closed” during the seizures and secondary generalization might be more associated with the impairment of cortical inhibition over the broad cortical area rather than direct connection. [Copyright &y& Elsevier]

To assess neuromagnetic spike localization as an indication for extended lesionectomy of cavernoma. Electroencephalography (EEG) and magnetoencephalography (MEG) was simultaneously recorded in 17 patients (8 men, mean age 29.7 years) with single cavernoma. The location of the equivalent current dipole (ECD) of the interictal spikes was correlated with the lesion shown by magnetic resonance imaging. Preoperative ECD localization was classified into four types: perilesional, adjacent to the cavernoma only (n = 6); mirror, adjacent to the lesion and at the contralateral homologous site (n = 5); remote, mainly at a remote site in the ipsilateral hemisphere (n = 3); and no spikes (n = 3). The spikes were detected by only MEG in two of five “mirror” and all three “remote” patients. In the mirror group, contralateral spikes were synchronized with the ipsilateral spikes, or also occurred independently. Two “perilesional” and two “mirror” patients became seizure-free and spike-free after extended lesionectomy. In contrast, the other two “mirror” patients had residual seizures and spikes after pure lesionectomy. The detectability of mirror and remote spikes was higher by MEG than by EEG, whereas the detectability of perilesional spikes was similar by MEG and EEG. Therefore, the use of both EEG and MEG will provide the maximum information about spike distribution and propagation. Residual seizures and spikes after pure lesionectomy, but not after extended lesionectomy, in the “mirror” patients suggest the importance of resection of the perilesional irritable zone. Extended resection of the irritable cortex surrounding cavernoma is recommended for better seizure control, particularly in “mirror” patients. [ABSTRACT FROM AUTHOR]

Repeated routine electroencephalography (EEG) or even long-term video-EEG monitoring (VEM) does not always record interictal epileptiform discharges (IEDs) in some patients with epilepsy. The present study investigated whether focal seizures detected by VEM and focal abnormalities on neuroimaging are useful for the diagnosis of patients with focal epilepsy without IEDs. We retrospectively reviewed 409 consecutive patients with focal epilepsy (207 men, aged 9 to 76 years) who underwent 4- or 5-day VEM, magnetic resonance imaging (MRI), and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis to identify patients without IEDs. The occurrence of focal seizures during VEM and the presence of focal abnormalities on neuroimaging were investigated in those patients. The occurrence rate of seizures during VEM was investigated in patients with daily, weekly, monthly, and yearly seizure frequency based on history-taking. Ninety-five (23.2%) of 409 patients with focal epilepsy did not have IEDs. Fifty-five (57.9%) of the 95 patients had focal seizures during VEM. Fifty-four patients (56.8%) showed focal abnormalities compatible with seizure semiology on neuroimaging investigations. Neither seizure recordings nor neuroimaging abnormalities were seen in 16 (16.8%) of the 95 patients. The occurrence rate of seizures during VEM depended on the seizure frequency at history-taking. However, 28 (45.9%) of 61 patients with monthly and yearly seizure frequency had focal seizures during 4- or 5-day VEM with seizure induction. Video-EEG monitoring can detect focal seizures in patients with focal epilepsy but no IEDs. Comprehensive assessment including VEM and neuroimaging study is important for the diagnosis. • One-fourth of patients with focal epilepsy did not have IEDs during 4- or 5-day VEM. • Six-tenths of patients without IEDs had epileptic seizures during 4- or 5-day VEM. • Five-sixths of patients without IEDs had seizures and/or neuroimaging abnormalities. • Half of patients with one or fewer seizures per month had seizures during VEM. • Comprehensive evaluation is important for diagnosis of focal epilepsy without IEDs. [ABSTRACT FROM AUTHOR]

Epilepsy is a network disease. The primary somatosensory cortex (S1) is usually considered to be intact, but could be subclinically disturbed based on abnormal functional connectivity in patients with temporal lobe epilepsy (TLE). We aimed to investigate if the S1 of TLE is abnormally modulated. Somatosensory evoked magnetic fields (SEFs) evoked by median nerve stimulation were recorded in each hemisphere of 15 TLE patients and 28 normal subjects. All responses were separately averaged in the awake state and light sleep using background magnetoencephalography. Latency and strength of the equivalent current dipole (ECD) was compared between the groups for the first (M1) and second peaks. Latencies showed no significant differences between the groups in either wakefulness or light sleep. ECD strengths were significantly lower in TLE patients than in controls only during wakefulness. The reduction of M1 ECD strength in the awake state is significantly correlated with duration of epilepsy. SEFs of TLE patients showed pure ECD strength reduction without latency delay. The phenomenon occurred exclusively during wakefulness, suggesting that a wakefulness-specific modulator of S1 is abnormal in TLE. Repetitive seizures may gradually insult the modulator of S1 distant from the epileptogenic network. [ABSTRACT FROM AUTHOR]

• This clinical practice guideline identified standards with recommendations summarized in Table S1. • Limited high-level evidence addressing standards for LTVEM exist, and further research is needed. • Selected topics for utility of LTVEM exist, although comprehensive criteria addressing minimum standards for performance are needed. • Clinicians, hospital administrators, and insurers benefit from establishing standards for inpatient video-EEG monitoring applied to patient management. The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events (see Table S1). For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and establish its clinical utility. [ABSTRACT FROM AUTHOR]

Summary: The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long‐term video‐electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using the PRISMA (Preferred Reporting Items for Systematic Review and Meta‐Analysis) statement. We found limited high‐level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events. For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long‐term outcome effects of LTVEM and to establish its clinical utility. [ABSTRACT FROM AUTHOR]

Background: The classical Wada test (cWada), performed by injecting a short-acting anesthetic through the intracarotid route, helps determine language dominance. In the cWada, adverse effects are observed in 10–30% of trials, hindering accurate assessments. In this study, we assessed the effectiveness of the super-selective Wada test (ssWada), a more selective approach for anesthetic infusion into the middle cerebral artery (MCA). Methods: We retrospectively examined the data of 17 patients with epilepsy who underwent ssWada via anesthetic injection into one M1 segment of the MCA and at least one contralateral trial. Results: The ssWada identified 12 patients with left language dominance, 3 with right language dominance, and 2 with bilateral language distribution. Nine trials on the language dominant side resulted in global aphasia for patients with left- or right language dominance. Of the 13 trials conducted on the non-dominant language side, 12 revealed intact language function and one resulted in confusion. Among these, the outcomes of global aphasia or no language impairment were confirmed in the contralateral trials. Among the 22 trials of unilateral M1 injections in patients with unilateral language dominance, 21 (95.5%) showed either global aphasia or no language impairment, indicating language dominance. Conclusions: The ssWada yields clear results, with a high rate of over 90% in determining the language dominant hemisphere with few side effects. [ABSTRACT FROM AUTHOR]

• A fast automatic algorithm for ongoing correction of artifacts in EEG is described and evaluated. • It outperformed state-of-the-art algorithms in terms of artifact reduction rates and computation time. • It may be used to remove artifacts in online epileptic spike and seizure detection or brain-computer interfaces. Analysis of the electroencephalogram (EEG) for epileptic spike and seizure detection or brain-computer interfaces can be severely hampered by the presence of artifacts. The aim of this study is to describe and evaluate a fast automatic algorithm for ongoing correction of artifacts in continuous EEG recordings, which can be applied offline and online. The automatic algorithm for ongoing correction of artifacts is based on fast blind source separation. It uses a sliding window technique with overlapping epochs and features in the spatial, temporal and frequency domain to detect and correct ocular, cardiac, muscle and powerline artifacts. The approach was validated in an independent evaluation study on publicly available continuous EEG data with 2035 marked artifacts. Validation confirmed that 88% of the artifacts could be removed successfully (ocular: 81%, cardiac: 84%, muscle: 98%, powerline: 100%). It outperformed state-of-the-art algorithms both in terms of artifact reduction rates and computation time. Fast ongoing artifact correction successfully removed a good proportion of artifacts, while preserving most of the EEG signals. The presented algorithm may be useful for ongoing correction of artifacts, e.g., in online systems for epileptic spike and seizure detection or brain-computer interfaces. [ABSTRACT FROM AUTHOR]

Background: The classical Wada test (cWada), performed by injecting a short-acting anesthetic through the intracarotid route, helps determine language dominance. In the cWada, adverse effects are observed in 10–30% of trials, hindering accurate assessments. In this study, we assessed the effectiveness of the super-selective Wada test (ssWada), a more selective approach for anesthetic infusion into the middle cerebral artery (MCA). Methods: We retrospectively examined the data of 17 patients with epilepsy who underwent ssWada via anesthetic injection into one M1 segment of the MCA and at least one contralateral trial. Results: The ssWada identified 12 patients with left language dominance, 3 with right language dominance, and 2 with bilateral language distribution. Nine trials on the language dominant side resulted in global aphasia for patients with left- or right language dominance. Of the 13 trials conducted on the non-dominant language side, 12 revealed intact language function and one resulted in confusion. Among these, the outcomes of global aphasia or no language impairment were confirmed in the contralateral trials. Among the 22 trials of unilateral M1 injections in patients with unilateral language dominance, 21 (95.5%) showed either global aphasia or no language impairment, indicating language dominance. Conclusions: The ssWada yields clear results, with a high rate of over 90% in determining the language dominant hemisphere with few side effects. [ABSTRACT FROM AUTHOR]

The article presents case study of a 23-year-old female who was diagnosed with emotion-triggered neurocardiogenic syncope. Topics discussed include observation of convulsive syncope with the help of Video electroencephalography (EEG) with simultaneous electrocardiography (ECG) monitoring; information on Neurocardiac syncope (NCS) which is a form of neurally mediated syncope (NMS); and determination of cardioinhibitory mechanism as the cause of neurocardiogenic syncope.

• Effect of acceptance of disability on QOL was investigated in patients with epilepsy. • Hierarchical regression analysis was used for a multifactorial model to predict QOL. • Psychological and social factors outweighed medical factors in determining QOL. • Acceptance of epilepsy is a new assessment and intervention target in epilepsy care. Acceptance of disability (AOD) is a key concept in rehabilitation psychology that enhances psychosocial adjustment of individuals with disability. However, the impact of AOD on well-being has never been examined for patients with epilepsy. The present study investigated whether AOD affects quality of life (QOL) in patients with epilepsy in the presence of other multiple aspects of epilepsy based on the biopsychosocial model. We retrospectively reviewed 151 consecutive patients with epilepsy (77 men, aged 18–74 years) who underwent comprehensive assessment including long-term video-EEG monitoring, neuroimaging studies, and neuropsychological and psychosocial assessment in our epilepsy monitoring unit. Data were obtained from medical records and self-reported questionnaires. The outcome variable was QOL. Predictive variables included demographic characteristics, seizure-related variables (i.e., duration of epilepsy, seizure frequency, and number of antiepileptic drugs), psychological factors (i.e., AOD, depression, and self-stigma), and social factors (i.e., social support and education level). Acceptance of disability was measured by the Adaptation of Disability Scale-Revised (ADS-R), which we translated into Japanese with the original author's approval, and examined its internal consistency reliability. Data were analyzed using four hierarchical multiple regression analysis models. The mean ADS-R score was 80 (range 45–115). The predictors accounted for 42% of the variance in QOL (R 2 = 0.45, Δ R 2 = 0.42, F [8, 141] = 14.47, p = 0.00). Higher AOD (p < 0.01), higher social support (p < 0.01), and lower depression scores (p = 0.02) were found to contribute significantly to higher overall QOL. The present study revealed AOD as an important psychological concept, in addition to social support and depression as previously reported, to improve the QOL of patients with epilepsy. Acceptance of disability should be incorporated in the intervention to increase QOL of patients with epilepsy. [ABSTRACT FROM AUTHOR]

Generalized epilepsy and tremor phenotypes have been reported in some genetic disorders. Among them benign adult familial myoclonus epilepsy (BAFME) has been confirmed as a clearly defined clinical and genetic entity. On the other hand, non-progressive tremor and generalized epilepsy phenotypes have also been reported in patients with DHDDS variants. Case presentation. We report on a long term follow-up of patient with de novo missense variant of DHDDS , who revealed non progressive nature. This 18-year-old woman presented non-progressive tremor since her early infancy. She had rare seizures. Her tremor was considered as cortical myoclonic tremor with giant somatosensory evoked potentials. In patients with early onset, non-progressive tremor and rare generalized epilepsy phenotypes, DHDDS variants may be considered in the genetic differential diagnosis. [ABSTRACT FROM AUTHOR]

• The odyssey plot visualized the referral process and the cause of the surgical delay. • Non-epileptologist referral delay was the most serious cause of overall delay. • Patient delay was the longest in cases developed with -focal-aware seizures (FAS). • Non-epileptologists overlooked FAS in 82% and hippocampal sclerosis (HS) in 86%. The "odyssey plot" was used to visualize referral delays in epilepsy surgery. Participants were 36 patients (19 males; 13–67 years, median 27 years) with mesial temporal lobe epilepsy with hippocampal sclerosis (HS) who underwent resection surgery. The "referral odyssey plot" included five clinical episodes: seizure onset (T1), first visits to a non-epileptologist (T2) and to an epileptologist (T3), first admission to our epilepsy monitoring unit (EMU) (T4), and resection surgery (T5). For each patient, we identified the first seizure type: the physician who first diagnosed focal aware seizure (FAS), focal impaired awareness seizure (FIAS), focal to bilateral tonic-clonic seizure (FBTCS), and radiologically suspected HS. Within the overall delay (T1-T5, median 18 years; interquartile range [IQR] 14), non-epileptologist's delay (T2-T3, 11.5 years; IQR 12.25) was far (p < 0.0001) longer than patient's (T1-T2, 0 year; IQR 2.25), epileptologist's (T3-T4, 1 year; IQR 4), or after-EMU delay (T4-T5, 1 year; IQR 1). FAS onset cases had significantly longer T1-T2 (N = 5, median 7 years; IQR 6) than FIAS (N = 22, 0 year; IQR 1, p < 0.005) or FBTCS onset cases (N = 9, 0 year; IQR 0, p < 0.001). FAS was correctly diagnosed first by non-epileptologists in 17.9%, by out-patient epileptologists in 35.7%, and at the EMU in 46.4%. FIAS was correctly diagnosed first by non-epileptologists in 94.4% and by out-patient epileptologists in 5.6%. Non-epileptologists diagnosed FBTCS in all cases. HS was diagnosed by non-epileptologists in 13.9%, by out-patient epileptologists in 47.2%, and at the EMU in 38.9%. Early referral to epileptologists is most critical for early surgery. Early utilization of the EMU is highly recommended because FAS is often overlooked by outpatient epileptologists. The odyssey plot will be useful to improve the healthcare system for other types of epilepsy. [ABSTRACT FROM AUTHOR]

Purpose: Conventional volumetric analysis could not detect ipsilateral atrophy of the mammillary body in patients with unilateral hippocampal sclerosis. By using thin-slice-reconstructed volumetric analysis, we investigated whether the mammillary body volume is smaller on the hippocampal sclerosis side than in healthy subjects or the non-hippocampal sclerosis side. Methods: This retrospective study included 45 patients with unilateral hippocampal sclerosis and 30 healthy subjects. Three-dimensional T1WI of 1 mm thicknesses were oversampled to a thickness of 0.2 mm (thin-slice-reconstructed images), and the mammillary bodies were segmented manually to determine mammillary body volume on each side. Mammillary body volumes on the hippocampal sclerosis side were compared with those in healthy subjects or the non-hippocampal sclerosis side. Results: In patients with right hippocampal sclerosis, right mammillary body volume was both significantly smaller than that in healthy subjects (30.3 ± 10.3 vs. 43.3 ± 8.07 mm3, P < 0.001) and significantly smaller than the left mammillary body volume in each patient (30.3 ± 10.3 vs. 41.4 ± 10.1 mm3, P < 0.001). Similarly, in patients with left hippocampal sclerosis, left mammillary body volume was both significantly smaller than that in healthy subjects (37.7 ± 11.2 vs. 47.0 ± 8.65 mm3, P < 0.001) and significantly smaller than right mammillary body volume in each patient (37.7 ± 11.2 vs. 42.5 ± 7.78 mm3, P = 0.044). Conclusions: In this study, thin-slice-reconstructed volumetric analysis showed that, in patients with unilateral hippocampal sclerosis, mammillary body volume on the hippocampal sclerosis side is smaller than that in healthy subjects and the non-hippocampal sclerosis side. [ABSTRACT FROM AUTHOR]

Object The use of T2 relaxometry was investigated to detect non-sclerotic epileptogenic abnormality of the hippocampus in presurgical evaluation of temporal lobe epilepsy (TLE). Methods This prospective study included 30 patients who underwent hippocampectomy as part of surgical treatment of refractory TLE. Ten patients had structural epileptogenic lesions in the extra-hippocampal temporal lobe. Twelve patients underwent intracranial electroencephalography (iEEG) study before surgery. Visual assessment of atrophy and increased T2 signal intensity, volumetry, and T2 relaxometry of hippocampus were performed pre-operatively using 3 T magnetic resonance imaging, and compared with the neuropathological findings and iEEG findings. Magnetic resonance imaging of 30 age- and sex-matched healthy controls was used to establish normal values, which were defined as z score within 2. Results Visual assessment, volumetry, and T2 relaxometry detected hippocampal abnormalities on the surgical side in 16 (53%), 16 (53%), and 26 (87%) patients, respectively. Hippocampal volume loss was always associated with prolonged T2 relaxation time, and supported by histopathological diagnosis of HS in all cases except one. Hippocampal abnormality was detected only by T2 relaxometry in nine patients (30%). Pathological diagnosis of these cases included mild HS in one, microdysgenesis in one, and granule cell pathology in three. Four patients with normal hippocampal volume and T2 relaxation time had no HS or granule cell pathology. Prolonged T2 relaxation time was associated with medial temporal seizure onset in iEEG (p < 0.05). Conclusions T2 relaxometry improves the detection of non-sclerotic epileptogenic abnormality of the hippocampus. [ABSTRACT FROM AUTHOR]

• Japanese version of Epilepsy Stigma Scale (ESS-J) was developed. • Japanese version of the ESS consists of 10 items with 2 subscales: enacted and felt stigma. • Japanese version of the ESS has sound internal consistency, and construct and concurrent validity. • Japanese version of the ESS is a useful tool for clinical interpretation and quality-of-life research. Self-stigma is considered to have immensely negative influences on the living and psychological states in patients with epilepsy. Understanding the stigma experienced by patients with epilepsy is essential considering its negative impact on their treatment and quality of life (QOL). However, few sufficiently validated self-report instruments are available to evaluate self-stigma in patients with epilepsy. The Epilepsy Stigma Scale (ESS) is one of the most commonly used self-reported questionnaires available to evaluate self-stigma in patients with epilepsy. The present study translated the ESS into Japanese to validate the Japanese version of the ESS (ESS-J) in Japanese adults with epilepsy. The study included 338 patients with epilepsy (166 men, aged 18–75 years) who underwent comprehensive assessment including long-term video-electroencephalography monitoring, neuroimaging studies, and neuropsychological and psychosocial assessments in the Tohoku University Hospital Epilepsy Monitoring Unit. This study consisted of two phases: (1) translation of the ESS into Japanese using the back-translation technique; and (2) statistical analysis of the ESS-J to evaluate the factor structure, reliability, and validity. The 2-factor model achieved acceptable fit to the data: χ 2 = 161.27, df = 34, p < 0.01, comparative fit index = 0.929, root mean square error of approximation = 0.105, standardized root mean squared residual = 0.047, Akaike's information criterion = 203.27 and, Bayesian information criterion = 283.56. These two subscales were named enacted stigma and felt stigma based on the theoretical model of self-stigma. We found the ESS-J to have acceptable internal consistency as follows: enacted (7 items; α = 0.88) and felt stigma subscale (3 items; α = 0.82). The concurrent validity was confirmed by adequate correlation with other related instruments. Both enacted and felt stigma had positive and moderate correlations with depression as measured by the Neurological Disorders Depression Inventory for Epilepsy (r = 0.44, p < 0.01; r = 0.41, p < 0.01, respectively) and with anxiety as measured by the Generalized Anxiety Disorder -7 (r = 0.48, p < 0.01; r = 0.38, p < 0.01, respectively). The ESS-J demonstrated acceptable validity and reliability. The present study provided preliminary evidence about the psychometric properties of the ESS-J, indicating the reliable factorial structure, adequate internal consistency, and satisfactory construct and concurrent validity. Measurement of the two types of self-stigma may offer a useful tool for clinical interpretation of patients' psychological state throughout epilepsy care, and as one of the patient-reported outcomes in QOL research. [ABSTRACT FROM AUTHOR]

Purpose This study was aimed to determine what preoperative profiles were associated with seizure remission after corpus callosotomy and whether such seizure outcome was associated with the postoperative developmental outcome. Methods This retrospective study included 26 consecutive patients with childhood onset epilepsy who underwent one-stage total corpus callosotomy at our institution and were followed up for a minimum of 1 year. The age at surgery ranged from 13 months to 32 years (median 6 years). The association between postoperative seizure freedom and preoperative profiles, post-operative developmental gains was examined. Results Five patients achieved seizure freedom (Engel class I), and 10 patients achieved worthwhile reduction of seizures (class III), whereas the remaining patients had a class IV outcome. All five seizure-free patients had “lack of abnormal magnetic resonance imaging findings”, “lack of proven etiology of seizures”, and underwent “surgery at age 6 years or younger”. These three factors were associated with seizure freedom ( p < 0.05, Fisher exact test). Post-operative gains in developmental quotient were significantly better in patients with seizure freedom than in those without ( p < 0.05, Mann Whitney U test). Conclusion Our study replicated the notion that seizure remission can be achieved after total corpus callosotomy in subsets of patients with medically-uncontrolled epilepsy, and suggested that a better developmental outcome can be expected in patients benefiting from seizure freedom. [ABSTRACT FROM AUTHOR]

Purpose: Hemispheric epileptogenic lesions such as hemimegalencephaly often manifest as intractable epilepsy in early infancy. Hemispherotomy is the treatment of choice for controlling intractable hemispheric epilepsy. Less invasive procedures are desirable for surgery on infants with low body weight. This study compared our experience with interhemispheric vertical hemispherotomy (IVH) and peri-insular lateral hemispherotomy (PIH). Methods: Thirteen consecutive patients underwent hemispherotomy for treatment of intractable epilepsy in our institution between 2001 and 2012. The etiology of epilepsy included hemimegalencephaly in 7 patients and cortical dysplasia in 3. PIH was performed on the first 5 patients and IVH on the last 8 patients. In the latter procedure, complete section of the corpus callosum was first performed via the interhemispheric approach. After removing part of the cingulate gyrus, section of the descending fibers was performed anterolaterally to the thalamus. Clinical characteristics, duration of operation and amount of blood transfusion were compared between the PIH and IVH groups. Results: There was no difference in age at surgery, body weight and age of epilepsy onset between the two groups. No surgery-related death was observed. No patients required shunt operation. One patient who underwent IVH required reoperation for incomplete disconnection. The amount of intraoperative blood transfusion was smaller and the total duration of operation was shorter in the IVH group than in the PIH group. Conclusion: The interhemispheric approach minimizes cortical resection and may be less invasive than PIH. IVH is advantageous for treating infants with low body weight. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Cerebral amyloid angiopathy-related inflammation is a rare treatable encephalopathy in the elderly. Although cerebral amyloid angiopathy-related inflammation often manifests as seizures, the details have not been well documented. We describe a 70-year-old man with disseminated cerebral amyloid angiopathy-related inflammation manifesting as secondary non-convulsive status epilepticus, whose ictal electroencephalogram showed periodic lateralized epileptiform discharges. The cerebral microbleeds were disseminated, but rather obscure in the region where the magnetic resonance imaging and electroencephalogram abnormalities were prominent. The symptoms ameliorated after the administration of corticosteroids in combination with an antiepileptic drug. Cerebral amyloid angiopathy-related inflammation should be taken into consideration when elderly patients present with progressive mental and cognitive decline with disseminated cortical and subcortical lesions. As some cerebral amyloid angiopathy-related inflammation patients might manifest as non-convulsive seizure, electroencephalograms are necessary for deciding the therapeutic strategy. [ABSTRACT FROM AUTHOR]

Highlights: [•] Inter-hemispheric coherence is decreased during the final stage of corpus callosotomy and the effect is maximized after sectioning is completed. [•] Various patterns of coherence decrease suggest individual variations in the participation of the corpus callosum in the genesis of bilateral synchrony. [•] Intra-operative monitoring of inter-hemispheric EEG coherence with wavelet transform coherence and trend analysis techniques is useful to estimate the physiological completeness of callosal sectioning. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the utility of a temporally-extended signal space separation algorithm (tSSS) for patients with vagal nerve stimulator (VNS). Methods: We evaluated median nerve somatosensory evoked responses (SER) of magnetoencephalography (MEG) in 27 VNS patients (48 sides) with/without tSSS processing. We classified SER dipoles as ‘acceptable’ if: (A) the location of the dipole was in the expected location in the central sulcus, and (B) the goodness of fit value (GOF) was greater than 80%. We evaluated (1) the number of sides which produced acceptable dipoles in each dataset (i.e. with/without tSSS processing), and in cases where the both data produced reliable dipoles, (2) compared their GOFs and the 95% confidence volumes (CV) (mm3). Statistical differences in the GOF and CV between with/without tSSS conditions were determined by paired t test. Results: Only 11 (23%) responses had reliable dipoles without tSSS processing, while all 48 (100%) had acceptable dipoles under tSSS processing. Additionally, the latter group had significantly higher GOF (increased by 7% on average) and lower CV (mean decrease of 200mm3) than the former (p <0.01). Conclusions: Processing with tSSS quantitatively improves dipole fitting of known sources in VNS patients. Significance: This algorithm permits satisfactory MEG testing in the relatively commonly encountered epilepsy patient with VNS. [Copyright &y& Elsevier]

Purpose: To investigate the utility of magnetic source imaging (MSI) and ictal single photon emission computed tomography (SPECT), each compared with intracranial electroencephalography (EEG) (ICEEG), to localize the epileptogenic zone (EZ) and predict epilepsy surgery outcome in patients with nonlesional neocortical focal epilepsy. Methods: Studied were 14 consecutive patients with nonlesional neocortical epilepsy who underwent presurgical evaluation including ICEEG, positive MSI, and localizing subtraction Ictal SPECT coregistered to MRI (SISCOM) analysis. Follow-up after epilepsy surgery was ≥24 months. ICEEG, MSI, and SPECT results were classified using a sublobar classification. Key Findings: Of 14 patients, 6 (42.9%) became seizure-free after surgery. Sublobar ICEEG focus was completely resected in 11 patients; 5 (45.5%) of them became seizure- free. Concordance of ICEEG and MSI and complete focus resection was found in 5 (35.7%) patients; 80% of them became seizure-free. Sublobar ICEEG-MSI concordance and complete focus resection significantly increased the chance of seizure freedom after epilepsy surgery (p = 0.038). In contrast, of the 6 patients (42.9%) with concordant ICEEG and SISCOM and complete focus resection, only 66.7% became seizure-free (p = 0.138). Assuming concordant results, the additive value to ICEEG alone for localizing the EZ is higher with ICEEG-MSI (odds ratio 14) compared to ICEEG-SISCOM (odds ratio 6). Significance: This study shows that combination of MSI and/or SISCOM with ICEEG is useful in the presurgical evaluation of patients with nonlesional neocortical epilepsy. Concordant test results of either MSI or SISCOM with ICEEG provide useful additive information for that provided by ICEEG alone to localize the EZ in this most challenging group of patients. When sublobar concordance with ICEEG is observed, MSI is more advantageous compared to SISCOM in predicting seizure-free epilepsy surgery outcome. [ABSTRACT FROM AUTHOR]

Summary: Objective: To clarify the clinical and neurophysiological profiles of fronto-parietal opercular epilepsy in which epileptic spikes are detected with magnetoencephalography (MEG) but not with scalp electroencephalography (EEG). Methods: Four patients presented with epileptic spikes localized to the fronto-parietal opercular cortex, which were only appreciated following MEG recordings. Results: In all cases, seizure semiology suggested early activation of the operculum and lower peri-rolandic cortex consistent with the somatotopic organization of this region, i.e. tingling sensation involving the throat and hemi-face or contralateral upper limb, and spasms of the neck and throat. MEG spikes were localized in the fronto-parietal operculum. Three of the four patients underwent invasive electrocorticography and/or stereo-EEG recordings, and spikes were confirmed to arise from the estimated area of MEG dipole localization. Two patients remained seizure-free for over 1 year after resection of the epileptogenic region; the other patient declined resective surgery due to proximity to the language cortex. Conclusion: This study demonstrates the usefulness of MEG in localizing spikes arising from within the fronto-parietal opercular regions, and implies that MEG may provide localizing information in patients with symptoms suggestive of opercular epilepsy, even if scalp EEG recordings fail to disclose any epileptogenic activities. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the utility of magnetic source imaging (MSI) for localizing the epileptogenic zone (EZ) and predicting epilepsy surgery outcome in non-lesional neocortical focal epilepsy (NLNE) patients. Methods: Data from 18 consecutive patients with NLNE who underwent presurgical evaluation including intracranial electroencephalography (ICEEG) and MSI were studied. Follow-up after epilepsy surgery was ≥24months. Intracranial electroencephalography and MSI results were classified using a sublobar classification. Results: Sublobar ICEEG focus was completely resected in 15 patients; seizure-free rate was 60%. Eight patients showed sublobar-concordant ICEEG/MSI results and complete resection of both regions; seizure-free rate was 87.5%. Seizure-free rate in cases not matching these criteria was only 30% (p=0.013). Conclusions: Magnetoencephalography is a useful tool to localize the EZ and determine the site of surgical resection in NLNE patients. When sublobar concordance with ICEEG is observed, MSI increases the predictive value for a seizure-free epilepsy surgery outcome in these patients. [Copyright &y& Elsevier]

A novel antiepileptic drug, levetiracetam, has been reported to cause several psychiatric adverse effects in spite of its effectiveness on epilepsy. However, a possible relationship between levetiracetam and obsessive-compulsive behavior has only been reported in a few studies with adult epilepsy patients. We treated a pediatric patient with epilepsy without past or family history of psychiatric disorder. Levetiracetam was started to control generalized tonic-clonic seizure. Two months after initiation of levetiracetam with favorable seizure control, she started to show an obsessive-compulsive behavior such as repetitive checking of her back, pants, and chair. Based on the course of its appearance, levetiracetam administration was identified as a possible cause. After termination of levetiracetam, her obsessive-compulsive behavior completely disappeared with reappearance of seizures. This case provides clear evidence that levetiracetam may cause obsessive-compulsive behavior even in a pediatric epilepsy patient without psychiatric background, possibly mediated by modulation of the glutamate system by levetiracetam. [ABSTRACT FROM PUBLISHER]

Unilateral cerebral cortical encephalitis (UCCE) with myelin oligodendrocyte glycoprotein (MOG)-antibody comprises a new spectrum of disease entities generally presenting seizures. Here, we report a case of a young adult with anti-MOG antibody-associated UCCE who only presented persistent left pulsatile headache. Neurological examination revealed no deficits. Brain MRI showed a fluid-attenuated inversion recovery hyperintense lesion along the swollen left cerebral cortex. The patient was positive for anti-MOG antibodies. We diagnosed him with anti-MOG antibody-associated UCCE. Immediately after the administration of high-dose IV methylprednisolone, the headache diminished. Anti-MOG antibody-associated UCCE is a new differential diagnosis in patients with unilateral chronic pulsatile headache. Unlabelled Image • Anti-MOG antibody-associated unilateral cortical encephalitis can cause headache. • Afebrile unilateral chronic pulsatile headache might be characteristic. • FLAIR image of brain MRI is useful to diagnose this disease. [ABSTRACT FROM AUTHOR]

It is difficult to distinguish epileptic high-frequency oscillations (HFOs) from physiological ones. We hypothesized that sleep stages affect the occurrence of epileptic and physiological HFOs differently and that rapid eye movement (REM) sleep HFOs are more specific to epileptogenicity. Thirteen patients with drug-resistant epilepsy underwent extraoperative intracranial EEG monitoring. Interictal HFOs were detected semi-automatically on EEGs taken during different sleep stages. The z-score of the HFO occurrence rate was calculated from the baseline rate obtained from non-epileptogenic areas. Electrodes showing HFOs at a higher z-score during REM than non-REM sleep were labeled “REM-dominant HFO” electrodes. The correlation between areas of surgical resection and REM-dominant HFO electrodes was associated with postoperative seizure freedom. The rate of HFO occurrence was significantly lower during REM sleep than during non-REM sleep. Of 1071 electrodes, 107 were defined as REM-dominant HFO electrodes. Inclusion of these electrodes in surgical resection was associated with postoperative freedom from seizures. Sleep stage influenced the occurrence of HFOs. The rate of HFO occurrence was lower during REM sleep than during non-REM sleep. Cortical areas exhibiting a less suppressive effect of REM sleep on HFOs are a specific marker of the epileptogenic zone. [ABSTRACT FROM AUTHOR]