The hypothesis of the functional disintegration of the brain due to the persistence of benign epileptiform patterns on the electroencephalogram

In this work, we have analyzed the results of observation of 200 children aged from 3 to 15 years old, who had various neuropsychiatric disorders in combination with benign childhood epileptiform patterns on the electroencephalogram. A hypothesis has been put forward about functional disorders of the developing nervous system with prolonged persistence of benign focal epileptiform discharge of childhood on electroencephalogram, mainly in slow-wave sleep. The possibilities of therapeutic correction of these disorders are discussed.

A STUDY ON COMPARATIVE YIELDS OF STANDARD SHORT TERM ELECTROENCEPHALOGRAM AND LONG TERM ELECTROENCEPHALOGRAM RECORDING IN SUSPECTED EPILEPSY PATIENTS

Objective: To compare the yield of interictal epileptiform discharges on prolonged (1-2 hours) electroencephalogram (EEG) as compared to standard routine (30 minutes) electroencephalogram (EEG). Study Design: Comparative observational study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi from Oct 2019 to Sep 2020. Methodology: A total of 364 outdoor patients with suspected epilepsy were recruited for the study. Out of these 55 electroencephalograms were excluded after applying exclusion criteria and 309 were included for final analysis. Electro-encephalograms were recorded using a 10-20 international system of electrode placement. The duration of each standard electroencephalogram was 30 minutes. It was followed by recording for an extended period of 60 minutes at least. The time to the appearance of the first abnormal interictal epileptiform discharge was noted. For analytical purposes, epileptiform discharges were classified as “early” if they appeared within the first 30 minutes and as “late” if appeared afterward. All electro-encephalograms were evaluated independently by two neurologists. Results: A total of 309 electroencephalograms were included for final analysis. Interictal epileptiform discharges were seen in 48 (15.6%) recordings. The mean time to appearance of first interictal epileptiform discharge was 14.6 ± 19.09 minutes. In 36 (11.7%) cases, discharges appeared early (within the first 30 minutes) whereas in the remaining 12 (3.9%) cases, discharges appeared late. This translates into a 33% increase in the diagnostic yield of electroencephalogram with an extended period of recording. Conclusion: Extending the electroencephalogram recording time results in a significantly better diagnostic yield of outdoor electroencephalogram.

A Review of Network and Computer Analysis of Epileptiform Discharge Free EEG to Characterize and Detect Epilepsy

Objectives. There is emerging evidence that network/computer analysis of epileptiform discharge free electroencephalograms (EEGs) can be used to detect epilepsy, improve diagnosis and resource use. Such methods are automated and can be performed on shorter recordings of EEG. We assess the evidence and its strength in the area of seizure detection from network/computer analysis of epileptiform discharge free EEG. Methods. A scoping review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance was conducted with a literature search of Embase, Medline and PsychINFO. Predesigned inclusion/exclusion criteria were applied to selected articles. Results. The initial search found 3398 articles. After duplicate removal and screening, 591 abstracts were reviewed, 64 articles were selected and read leading to 20 articles meeting the requisite inclusion/exclusion criteria. These were 9 reports and 2 cross-sectional studies using network analysis to compare and/or classify EEG. One review of 17 reports and 10 cross-sectional studies only aimed to classify the EEGs. One cross-sectional study discussed EEG abnormalities associated with autism. Conclusions. Epileptiform discharge free EEG features derived from network/computer analysis differ significantly between people with and without epilepsy. Diagnostic algorithms report high accuracies and could be clinically useful. There is a lack of such research within the intellectual disability (ID) and/or autism populations, where epilepsy is more prevalent and there are additional diagnostic challenges.

Effects of sodium valproate combined with levetiracetam in treatment of children epilepsy and its influences on serum S-100 and high mobility group box-1

Objective: To explore the effects of sodium valproate combined with levetiracetam in the treatment of children epilepsy, and its influences on serum S-100 and high mobility group box-1 (HMGB-1) in children with epilepsy.Methods: A total of 160 children who were diagnosed as epilepsy in Baogang Hospital of Inner Mongolia from July 2016 to October 2018 were selected as research objects. They were randomly divided into the study group (n = 80) and the control group (n = 80) by the random number table method, i.e., they were treated with sodium valproate combined with levetiracetam and sodium valproate alone, respectively. After 16 weeks of treatment, the effective rates of epileptic seizure treatment and the improvement of epileptiform discharge were evaluated, and chi-square test was used for statistical comparison. The related indicators, including serum tumor necrosis factor- (TNF-), hypersensitive C-reactive protein (hs-CRP), homocysteine (Hcy), haematocrit (HCT), erythrocyte sedimentation rate (ESR), serum S-100 and HMGB-1, were measured before and after treatment. Paired t-test was used for the comparison in the above indicators within a group before and after treatment; group t-test was used for the comparison between two groups. Chi-square test was used for the comparison in the rate of adverse reactions during treatment between two groups. The study was approved by Ethics Committee of Baogang Hospital (Approval No.: BG201606073), and all children’s guardians were required to sign informed consent forms for clinical study. There were no statistically significant differences between two groups in general clinical data (p > .05), such as sex constituent ratio, age, the course of disease, the frequency of epileptic seizure per year before treatment, the incidence of epileptiform discharge before treatment and the constituent ratio of types of epileptic seizure, etc.Results: 1) After treatment, the effective rates of epileptic seizure treatment and the improvement of epileptiform discharge in the study group were 92.5% (74/80) and 85.0% (68/80) respectively, which were both significantly higher than those in the control group [68.8% (55/80) and 58.8% (47/80)], and the differences were statistically significant (2 = 14.444, 13.635; p < .001). 2) In the study group, the levels of serum TNF-, hs-CRP and Hcy, as well as HCT and ESR after treatment were (53.1 ± 14.0) pg/ml, (5.0 ± 2.5) mg/L, (12.5 ± 3.1) μmol/L, (38.1 ± 5.1)% and (3.0 ± 0.5) mm/h respectively, which were all significantly lower than those [(107.9 ± 17.8) pg/ml, (10.1 ± 2.5) mg/L, (42.2 ± 5.8) μmol/L, (45.3 ± 4.5)% and (5.2 ± 0.6) mm/h] before treatment, and all the differences were statistically significant (t = 21.644, 12.902, 40.393, 9.468, 25.194; p < .001). In the control group, the levels of serum TNF-, hs-CRP and Hcy, as well as HCT and ESR after treatment were (60.6 ± 17.8) pg/ml, (8.2 ± 2.2) mg/L, (15.2 ± 3.1) μmol/L, (40.2 ± 3.4)% and (4.5 ± 0.6) mm/h respectively, which were all significantly lower than those [(112.4 ± 14.3) pg/ml, (9.3 ± 3.8) mg/L, (41.1 ± 2.8) μmol/L, (44.6 ± 5.5)% and (5.4 ± 0.8) mm/h] before treatment, and all the differences were statistically significant (t = 20.292, 2.241, 55.456, 3.320, 8.050; p < .05). After treatment, the above indicators in the study group were all significantly lower than those in the control group, and all the differences were statistically significant (t = 2.962, 8.595, 5.508, 3.064, 17.178; p < .05). 3) In the study group, the levels of serum S-100 and HMGB-1 after treatment were (0.65 ± 0.38) μg/L and (5.3 ± 2.4) μg/L respectively, which were significantly lower than those [(0.91 ± 0.32) μg/L and (8.1 ± 2.0) μg/L] before treatment, and the differences were statistically significant (t = 4.681, 8.020; p < .001). In the control group, the levels of serum S-100 and HMGB-1 after treatment were (0.78 ± 0.27) μg/L and (6.4 ± 2.2) μg/L respectively, which were significantly lower than those [(0.88 ± 0.25) μg/L and (7.9 ± 1.7) μg/L] before treatment, and the differences were statistically significant (t = 2.431, p = .016; t = 4.826, p < .001). After treatment, the levels of serum S-100 and HMGB-1 in the study group were significantly lower than those in the control group, and the differences were statistically significant (t = 2.495, p = .014; t = 2.840, p = .005). 4) There was no significant difference between two groups in the rate of adverse reactions, such as nausea, vomiting, poor appetite, dizziness, drowsiness, hepatic and renal injury during treatment (p > .05).Conclusions: The efficacy of sodium valproate combined with levetiracetam is obviously better than that of sodium valproate alone in the treatment of children epilepsy. The children patients’ serum S-100 and HMGB-1 are more significantly reduced, resulting in a lower rate of adverse reactions, which has a certain clinical value.