Informed DEcision for cerebrospinal fluid analysis after epiLeptic seizures-the IDEAL-score: A development and validation study

Background: This observational study was done to develop a score based on clinical predictors that enables a guided decision for the necessity of cerebrospinal fluid (CSF) analysis after first unprovoked epileptic seizures and to validate this score in a retrospective patient cohort. Methods: Clinical predictors were identified by two panels of epilepsy experts and selected according to content validity ratios. Based on these predictors a score was created and applied to a cohort of patients with first epileptic seizures. Results: The IDEAL score consists of 9 items (fever, prolonged disturbance of consciousness, headache, imaging results, cognitive dysfunction, status epilepticus, malignancy, autoimmune encephalitis symptoms) that are collected at two different time points ( 3 h [B-score] after hospital admittance). A CSF analysis is recommended, if at least one clinical finding is present, either one of the items evaluated during the acute phase (A-score) or later in the diagnostic process (B-score). In 41 patients (13%) CSF analysis provided essential clues to the cause of the seizure. The combined IDEAL score reached a sensitivity of 98%, a specificity of 53%, a positive predictive value of 24% and a negative predictive value of 99% in this patient cohort. Conclusions: A CSF analysis after first epileptic seizures provided decisive etiological findings in only 13% of all investigated patients. The IDEAL score offers clinicians a simple and easy-to-implement algorithm to assess the necessity of a CSF analysis, and to prevent unnecessary diagnostic procedures

Combined EEG/MEG source reconstruction of epileptic activity using a two-phase spike clustering approach

Summarization: In recent years, several approaches have been introduced for estimating the spike onset zone within the irritative zone in epilepsy diagnosis for presurgical planning. One important direction utilizes source analysis from combined electroencephalography (EEG) and magnetoencephalography (MEG), EMEG, leveraging the benefits from the complementary properties of the two modalities. For EMEG source reconstruction, an average across the annotated epileptic spikes is often used to improve the signal-to-noise-ratio (SNR). In this contribution, we propose a two-phase clustering of interictal spikes with unsupervised learning methods, namely Self Organizing Maps (SOM) and K-means. In addition, we investigate the accuracy of combined EMEG source analysis on the sorted activity, using an individualized (with regard to both geometry and conductivity) six-compartment finite element head model with calibrated skull conductivity and white matter conductivity anisotropy. The results indicate that SOM eliminates the random variations of K-means and stabilizes the clustering efficiency. In terms of source reconstruction accuracy, this study demonstrates that the combined use of modalities reveals activity around two focal cortical dysplasias (FCDs), of one epilepsy patient, one in the right frontal area and one smaller in the left premotor cortex. It is worth mentioning that only EMEG could localize the left premotor FCD, which was then also found in surgery to be the responsible for triggering the epilepsy.Παρουσιάστηκε στο: 19th International Conference on Bioinformatics and Bioengineerin

First epileptic seizure and epilepsies in adulthood. Abridged version ofthe S2k guideline of the German Society for Neurology in cooperationwith the German Society for Epileptology

Holtkamp M, May T, Berkenfeld R, et al. Erster epileptischer Anfall und Epilepsien im Erwachsenenalter. Kurzfassung S2k-Leitlinie der Deutschen Gesellschaft für Neurologie in Zusammenarbeit mit der Deutschen Gesellschaft für Epileptologie. Clinical Epileptology. 2024.The new S2k guideline "First epileptic seizure and epilepsies in adulthood" provides recommendations on clinically relevant issues in five major topics: management of first epileptic seizures, pharmacotherapy, epilepsy surgery, complementary and supportive treatment, and psychosocial aspects. For the topic management of first epileptic seizures, the guideline provides recommendations on identifying the two major differential diagnoses, syncope and psychogenic non-epileptic seizure. The importance of additional examinations such as EEG, MRI and cerebrospinal fluid for syndromic classification and etiological allocation is discussed. Recommendations on neuropsychological and psychiatric screening tests are also given. The topic pharmacotherapy issues recommendations on antiseizure medication in monotherapy for focal, generalized and unclassified epilepsies; patient groups with special challenges such as the aged, women of childbearing potential and people with mental retardation are emphasized. Further issues are indications for measuring serum concentrations of antiseizure medication and possible risks of switching manufacturers. In the topic epilepsy surgery, indications for presurgical assessment and the multiple therapeutic approaches, such as resection, laser ablation, and neurostimulation are presented. Recommendations on postoperative management of patients, including rehabilitation and psychosocial counselling, are given. The topic complementary and supportive therapeutic approaches comprises recommendations on the diagnostics and treatment of common psychiatric comorbidities of epilepsy, such as anxiety disorder, depression and psychosis. Another important issue is the management of psychogenic non-epileptic seizures as a neuropsychiatric differential diagnosis or comorbidity of epileptic seizures. Furthermore, recommendations on the potential role of ketogenic diet and on acupuncture, homeopathy and other complementary approaches are made. The recommendations on psychosocial aspects comprise practical issues, such as fitness to drive a car, training and occupation, medical rehabilitation, sport, transition, patients' self-help, education programs for patients and next of kin, adherence, advise on SUDEP