Seizure symptoms and ambulatory EEG findings: incidence of epileptiform discharges.

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Citation: Epileptic Disorders. 22(6):752-758, 2020 Dec 01.PMID: 33331277Institution: MedStar Union Memorial HospitalForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Electroencephalography/sn [Statistics & Numerical Data] | *Epilepsy/di [Diagnosis] | *Epilepsy/pp [Physiopathology] | *Monitoring, Ambulatory/sn [Statistics & Numerical Data] | *Seizures/di [Diagnosis] | *Seizures/pp [Physiopathology] | Adult | Aged | Epilepsy/ep [Epidemiology] | Female | Humans | Incidence | Male | Middle Aged | Neurophysiological Monitoring/sn [Statistics & Numerical Data] | Practice Guidelines as Topic | Retrospective Studies | Seizures/ep [Epidemiology] | Self Report/sn [Statistics & Numerical Data] | Video RecordingYear: 2020ISSN:
  • 1294-9361
Name of journal: Epileptic disorders : international epilepsy journal with videotapeAbstract: AIMS: Ambulatory video-EEG monitoring has been utilized as a cost-effective alternative to inpatient video-EEG monitoring for non-surgical diagnostic evaluation of symptoms suggestive of epileptic seizures. We aimed to assess incidence of epileptiform discharges in ambulatory video-EEG recordings according to seizure symptom history obtained during clinical evaluation.CONCLUSIONS: Our study shows that the use of ILAE 2017 symptom categories may help guide ambulatory video-EEG studies.METHODS: This was a retrospective cohort study. We queried seizure symptoms from 9,221 consecutive ambulatory video-EEG studies in 35 states over one calendar year. We assessed incidence of epileptiform discharges for each symptom, including symptoms that conformed to a category heading, even if not included in the ILAE 2017 symptom list. We report incidences, odds ratios, and corresponding p values using Fisher's exact test and univariate logistic regression. We applied multivariable logistic regression to generate odds ratios for the six symptom categories that are controlled for the presence of other symptoms.RESULTS: History that included motor symptoms (OR=1.53) or automatisms (OR=1.42) was associated with increased occurrence of epileptiform discharges, whereas history of sensory symptoms (OR=0.76) predicted lack of epileptiform discharges. Patient-reported symptoms that were associated with increased occurrence of epileptiform discharges included lip-smacking, moaning, verbal automatism, aggression, eye-blinking, deja vu, muscle pain, urinary incontinence, choking and jerking. On the other hand, auditory hallucination memory deficits, lightheadedness, syncope, giddiness, fibromyalgia and chronic pain predicted absence of epileptiform discharges. The majority of epileptiform discharges consisted only of interictal sharp waves or spikes.All authors: Al Bunni H, Ali NY, Alnobani A, Aziz S, Chen H, Fares A, Hussain FM, Iqbal T, Khan FA, Khan MT, Koubeissi M, Slater JD, Syed AU, Syed TUOriginally published: Epileptic Disorders. 2020 Dec 16Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-12-31
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Journal Article MedStar Authors Catalog Article 33331277 Available 33331277

AIMS: Ambulatory video-EEG monitoring has been utilized as a cost-effective alternative to inpatient video-EEG monitoring for non-surgical diagnostic evaluation of symptoms suggestive of epileptic seizures. We aimed to assess incidence of epileptiform discharges in ambulatory video-EEG recordings according to seizure symptom history obtained during clinical evaluation.

CONCLUSIONS: Our study shows that the use of ILAE 2017 symptom categories may help guide ambulatory video-EEG studies.

METHODS: This was a retrospective cohort study. We queried seizure symptoms from 9,221 consecutive ambulatory video-EEG studies in 35 states over one calendar year. We assessed incidence of epileptiform discharges for each symptom, including symptoms that conformed to a category heading, even if not included in the ILAE 2017 symptom list. We report incidences, odds ratios, and corresponding p values using Fisher's exact test and univariate logistic regression. We applied multivariable logistic regression to generate odds ratios for the six symptom categories that are controlled for the presence of other symptoms.

RESULTS: History that included motor symptoms (OR=1.53) or automatisms (OR=1.42) was associated with increased occurrence of epileptiform discharges, whereas history of sensory symptoms (OR=0.76) predicted lack of epileptiform discharges. Patient-reported symptoms that were associated with increased occurrence of epileptiform discharges included lip-smacking, moaning, verbal automatism, aggression, eye-blinking, deja vu, muscle pain, urinary incontinence, choking and jerking. On the other hand, auditory hallucination memory deficits, lightheadedness, syncope, giddiness, fibromyalgia and chronic pain predicted absence of epileptiform discharges. The majority of epileptiform discharges consisted only of interictal sharp waves or spikes.

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