Electroencephalogram (EEG) is the primary tool in investigation of the brain science. It is necessary to carry out a deepgoing study into the characteristics and information hidden in EEGs to meet the needs of the clinical research. In this paper, we present a wavelet-nonlinear dynamic methodology for analysis of nonlinear characteristic of EEGs and delta, theta, alpha, and beta sub-bands. We therefore studied the effectiveness of correlation dimension (CD), largest Lyapunov exponen, and approximate entropy (ApEn) in differentiation between the interictal EEG and ictal EEG based on statistical significance of the differences. The results showed that the nonlinear dynamic characteristic of EEG and EEG subbands could be used as effective identification statistics in detecting seizures.
ObjectiveTo investigate the role of amygdala volume index(AVI) in surgcial evaluation in patients with mesial temporal lobe epilepsy (mTLE), including clinical features, etiologies and surgical outcome. MethodsThirty six patients were diagnosed as mTLE after surgical evaluation including clinical manifestations, video-electroencephalogram (VEEG) and magnetic resonance imaging (MRI) at the Second Affiliated Hospital of Zhejiang University between March 2013 and March 2016. Bilateral amygdala AVI was then calculated from amygdala volumes on MRI, which were measured with region of interest (ROI) analysis. All patients were treated surgically. Etiologies of mTLE were further confirmed by the histopathology of the resected tissue. ResultsAmong the 35 patients, there is a strong correlation between AVI on the lesion side and age of onset (R =-0.389, P = 0.019) as well as age of surgery (R =-0.357, P = 0.032). No obvious relation can be seen between AVI and gender, history of febrile convulsion, duration of epilepsy, secondary generalized seizure, side of lesion, presurgical seizure frequency and electrode implantation. There is no significant difference in AVI among the five etiologies. At follow-up, thirty patients (80.5%) reached seizure-free, AVI on the lesion side is nota predictor of surgical failure (P > 0.05). ConclusionAVI plays a role in etiology evaluation in patients with mesial temporal lobe epilepsy. Moreover, a larger AVI on the lesion side is correlated with an earlier age of onset. There is limited value of amygdala volume insurgical outcome prediction of patients with mTLE.
ObjectiveTo explore the advantages and disadvantages of using two intracranial EEG (iEEG) monitoring methods—Subdural ectrodes electroencephalography (SDEG)and Stereoelectroencephalography (SEEG), in patients with “difficult to locate” Intractable Epilepsy. MethodsRetrospectively analyzed the data of 60 patients with SDEG monitoring (49 cases) and SEEG monitoring (11 cases) from January 2010 to December 2018 in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical. Observe and statistically compare the differences in the evaluation results of epileptic zones, surgical efficacy and related complications of the two groups of patients, and review the relevant literature. ResultsThe results showed that the two groups of SDEG and SEEG had no significant difference in the positive rate and surgical resection rate of epileptogenic zones, but the bilateral implantation rate of SEEG (5/11, 45.5%) was higher than that of SDEG (18/49, 36.7%). At present, there was no significant difference in the postoperative outcome among patients with epileptic zones resected after SDEG and SEEG monitoring (P>0.05). However, due to the limitation of the number of SEEG cases, it is not yet possible to conclude that the two effects were the same. There was a statistically significant difference in the total incidence of serious complications of bleeding or infection between the two groups (SDEG 20 cases vs. SEEG 1 case, P<0.05). There was a statistically significant difference in the total incidence of significant headache or cerebral edema between the two groups (SDEG 26 cases vs. SEEG 2 cases, P<0.05). There was a statistically significant difference in the incidence of cerebrospinal fluid leakage, subcutaneous fluid incision, and poor healing of incision after epileptic resection (SDEG 14 cases vs. SEEG 0 case, P<0.05); there were no significant differences in dysfunction of speech, muscle strength between the two groups (P>0.05). ConclusionSEEG has fewer complications than SDEG, SEEG is safer than SDEG. The two kinds of iEEG monitoring methods have advantages in the localization of epileptogenic zones and the differentiation of functional areas. The effective combination of the two methods in the future may be more conducive to the location of epileptic zones and functional areas.
ObjectiveTo explore the strategy and outcome of surgery for the treatment of encephalomalacia with secondary intractable epilepsy. MethodsDuring the period of July 2009 and June 2015, 21 cases of encephalomalacia with secondary intractable epilepsy were performed operation. Among them there were 16 males and 5 females. Their ages ranged from 4 to 34 years, with their illness duration from 3 to 14 years. According to the results of MRI and video-EEG monitoring, all the patients were performed operation under the monitoring of ECoG. And the outcome was graded by Engle scales for analysis. ResultsECoG monitoring after the resection of encephalomalacia showed that there was still abnormal discharge. Enlarged cortical resection was performed in 10 cases, and cortical coagulation in 3、anterior temporal lobectomy + resection of the hippocampus and amygdala in 4、additional callosotomy in 4. The post-operative follow-up of 1~7 years showed that Grade Ⅰ was observed in 10 cases、Grade Ⅱ in 5 cases、Grade Ⅲ in 3 cases and Grade Ⅳ in 3 cases.The total surgical effectiveness was 85.7%. ConclusionTo the patients of encephalomalacia with secondary intractable epilepsy, the epileptic lesion should be resected besides the resection of encephalomalacia. And the surgical effectiveness is satisfactory.
ObjectiveTo explore the clinical features and surgical treatment effects of the temporal lobe epilepsy with hippocampal sclerosis.MethodsForty two patients diagnosed as temporal lobe epilepsy with hippocampal sclerosis and underwent protemporal lobectomy in Wuhan Brain Hospital from Jan. 2012 to Dec. 2018 were collected, which included 30 males and 12 females, with the age between 9 to 60 years. Their disease duration ranged from 3 to 10 years. The clinical manifestations showed complex partial seizure in 18 cases, partial-secondary –generalized seizure in 4 cases, and generalized tonic-clonic seizure in 20 cases. Based on their results of clinical manifestations, combined with MRI and VEEG results, all the patients underwent anterior temporal lobectomy (including the most parts of the hippocampus and amydala).ResultsThe postoperative pathology confirmed the diagnosis of hippocampal sclerosis. The follow-up of more than 1 year showed seizure-free in 38 cases, and significant improvement in 4 cases.ConclusionsTo the patients of temporal lobe epilepsy with hippocampal sclerosis, anterior temporal lobectomy should be performed (including the most parts of the hippocampus and amydala) if the VEEG monitoring results show that there are epileptic discharges in the ipsilateral temporal lobe. And the postoperative curative result is satisfactory.
As a common disease in nervous system, epilepsy is possessed of characteristics of high incidence, suddenness and recurrent seizures. Timely prediction with corresponding rescues and treatments can be regarded as effective countermeasure to epilepsy emergencies, while most accidental injuries can thus be avoided. Currently, how to use electroencephalogram (EEG) signals to predict seizure is becoming a highlight topic in epilepsy researches. In spite of significant progress that made, more efforts are still to be made before clinical applications. This paper reviews past epilepsy studies, including research records and critical technologies. Contributions of machine learning (ML) and deep learning (DL) on seizure predictions have been emphasized. Since feature selection and model generalization limit prediction ratings of conventional ML measures, DL based seizure predictions predominate future epilepsy studies. Consequently, more exploration may be vitally important for promoting clinical applications of epileptic seizure prediction.
ObjectiveTo observe the clinical efficacy of Xiao’er kang xian capsule added to anti-seizure medications (ASMs) in the treatment of children with refractory epilepsy and its influence on serum neuron-specific enolase (NSE) and cludter of differentiation 19+ (CD19+) levels. Methods A total of 60 children with refractory epilepsy were selected from the pediatric outpatient department and ward of Guangdong Provincial People's Hospital from February 2021 to June 2023. The study subjects were divided into two groups by numerical random method,with 30 cases in each group. The children with Xiao’er kang xian capsule added to the original treatment were the treatment group and the children without Xiao’er kang xian capsule added to the original treatment were the control group. The frequency, duration, EEG characteristics, adverse reactions and changes in serum NSE and CD19+ levels of the two groups were compared after treatment. Results Self-control before and after treatment in the treatment group: the frequency and duration of seizures were significantly reduced, with statistical difference (P<0.05). EEG discharge index in awake period and sleep period were significantly decreased, with statistical difference (P<0.05). After 6 months of treatment, comparison between the two groups of children: the seizure frequency of children in the treatment group was significantly decreased compared with the control group (P=0.03). There was a statistical difference (P<0.05), and the seizure duration in the treatment group was less than that in the control group (P=0.863), the clinical effective rate of treatment group 83.33% was higher than that of control group 63.33% (P=0.08), the effective rate of EEG in treatment group 80% was higher than that of control group 60% (P=0.091), serum NSE and CD19+ in treatment group were lower than that of control group, with no statistical difference (P>0.05). After 12 months of treatment, the frequency and duration of seizures in the treatment group were significantly decreased (P<0.05). The clinical efficacy and effectiveness of treatment group were significantly higher than that of control group (P=0.038). The incidence of adverse reactions in both groups was 16.67% (P>0.05). The effective rate of EEG in treatment group was significantly higher than that in control group (P=0.053). Serum NSE and CD19+ in treatment group were significantly lower than those in control group (P<0.05). ConclusionFor children with refractory epilepsy, the addition of Xiao’er kang xian capsule on the basis of the original treatment has obvious effect low adverse reaction and high safety. NSE and CD19+ can be used as monitoring indicators for the influence of the disease and prognosis evaluation during the treatment of children with epilepsy.
Objectives To investigate the changes of serum monoamine neurotransmitters and myocardial enzymes in patients with refractory epilepsy (RE), and the possible effects on the cardiovascular system, which would contribute to provide help and guidance to the early warming and prevention to the sudden unexpected death in epilepsy (SUDEP). Methods We collected sixty patients with RE who admitted to Neurological department of First Hospital of Jilin University from December 2015 to December 2016. According to the exclusion criteria, we selected thirty-two patients into the study. The study included 21 males and 11 females patients. Epinephrine (EPI), norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), creatine kinase isoenzyme (CKMB), lactate dehydrogenase (LDH) and hydroxybutyrate dehydrogenase (HBDH) were measured in peri-ictal period and the interictal period in the patients. All the data were analyzed by SPSS17.0 statistical software. Results ① Thirty two patients were eligiblefor this study and the maleto female ratio is 21:11; The age ranged from 15 to 85 years old, with the average age of 50.9±17.6 years old. Twelve (37.5%) were older than 60 years old and 20 (62.5%) were under 60 years old. The epilepsy history ranged from 1 year to 14 years, with an average of 3.75±3.12 years; ② Comparing the levels of monoamine neurotransmitters in peri-ictal period and the interictal period in the patients with RE, we found that the level of EPI and LDH was significantly lower than that in interictal period, while the levels of NE and DA were significantly increased; ③ The results showed that EPI, NE and DA levels in patients under 60 were higher than over 60; ④ Patients were divided into four groups according to the etiology of the disease: idiopathic epilepsy group (10 cases, 31.25%), post-encephalitic epilepsy group (7 cases, 21.88%), post-stroke epilepsy group (9 cases, 28.12%) and epilepsy after brain injury group (6 cases, 18.75%). The results showed that the levels of EPI, NE and DA in the post-strokeepilepsy group were significantly lower than those in the other three groups. The level of CKMB in the idiopathic epilepsy group was higher than that in post-stroke epilepsy and epilepsy induced by brain injury patients. Conclusions RE patients have a higher level of serum NE and DA interictal period, suggesting that seizures may increase sympathetic nervous excitability. The patients under 60 years-old with RE release more catecholamines than young patients, suggesting that the latterwith intractable epilepsy may have higher sympathetic nerve excitability. And it may be associated with the higher incidence of SUDEP in young patients. Post-stroke epilepsyrelease less catecholamine than others, suggesting that the sympathetic nervous excitability is relatively low, and it may have relatively little damage to heart.
ObjectiveTo analyze the clinical efficacy and safety of rapamycin in the treatment of Tuberous sclerosis complex ( TSC ) complicated with refractory epilepsy, and to provide scientific basis for the clinical treatment of this disease.MethodsRetrospective analysis was performed on 22 children with TSC complicated with refractory epilepsy admitted to Henan People's Hospital from 2017 to 2019, including 11 males and 11 females who met the inclusion criteria, with an average age of (27.91±36.92) months. They were treated with antiepileptic drugs and rapamycin at the same time, and followed up for at least 1 year.To observe the change of seizure frequency before and after treatment with rapamycin.ResultsThe mean reduction rate of seizure frequency in children with tuberous sclerosis complicated with refractory epilepsy was 52.1% 6 months after the addition of rapamycin, and 51.2% 12 months after the addition of rapamycin. The number of seizure-free days could be maintained. The difference before and after the addition of rapamycin was statistically significant (P<0.05).ConclusionThe addition of rapamycin in the treatment of TSC complicated with refractory epilepsy can reduce the frequency of seizure and increase the number of days without seizure, and the adverse reactions are mild/moderate. Rapamycin has certain safety in children with regular follow-up.
ObjectiveTo summarize clinical electrophysiological features and efficacy of some of Anti-epileptic drugs(AEDs) of Juvenile myoclonic epilepsy (JME). MethodsClinical electrophysiological information of 101 outpatients with JME observed at Xuanwu Hospital from Jul. 2001 to Sep. 2014 was retrospectively analyzed, including the seizure types, trigger factors, electroencephalogram. We followed some of these patients and compared the efficacy between different AEDs. Result According to different seizure types, there are four subtypes: Myoclonus (MJ) only 11.88%, MJ+generalized tonic-clonic seizure(GTCS) 75.24%, MJ+GTCS+Absence(Abs) 11.88%, MJ+Abs 1.00%. Patients with typical ictal generalized poly-spike and waves (PSW) or spike and waves (SW) or spikes account for 96.80%. And 75.00% of patients have no MJ and 91.80% have no GTCS with valproic acid monotherapy. 65.00% and 88.24% of patients were seizure free of MJ and GTCS recpectively. But the difference of efficacy between these two drugs have no statistically significance. Sleep deprivation was the primary trigger factors, accounting for 16.83%. ConclusionJME has clinical heterogeinety, clinicians should fully understand the whole condition of JME individual, including their clinical manifestation, EEG features, reaction to AEDs, trigger factors, habitual patterns and so on, in order to help making individualized therapy.