CLINICAL CORRELATES OF INTRAVENOUS ANESTHETIC DRUG USE

Objective: To determine factors associated with continuous IV anesthetic drug (IVAD) use in nonconvulsive status epilepticus (NCSE). Methods: For this retrospective descriptive cohort study, we included all patients who met clinical and EEG criteria of NCSE from 2009 to 2014 at a tertiary academic medical center. Patients were categorized according to IVAD use. Primary outcome variables were response to treatment and in-hospital death. We used descriptive analyses for baseline characteristics, and primary and secondary outcome variables differences among patients who received IVAD and who did not receive IVAD. Results: Forty-three patients had a total of 45 NCSE episodes. IVAD was used in 69% of the episodes. Patients treated with IVAD were younger (53.1±14.1 vs 64.1±13.3, p=0.0187). The episodes treated with IVAD were associated with more acute neurologic pathology (58% vs 21%, p=0.0236) and more commonly presenteded in comatose patients (39% vs 7%, p=0.0299). Underlying epilepsy was common in both groups (36% in IVAD vs 42% in no-IVAD group). NCSE resolved in 74% of the patients who received IVAD. There were total 13 in-hospital deaths (ten in IVAD users vs three in the no-IVAD group). Only one in-hospital death appeared to be a direct consequence of IVAD. Conclusion: Our findings showed factors such as younger age, acute neurologic pathology and coma at presentation were associated with IVAD use in patients with NCSE. More patients died in IVAD group although this was not statistically significant. There is a need of further studies to determine the effect of IVAD use in NCSE on outcome, and these factors should be controlled in the future outcome and effectiveness studies

Virtual stimulation of the interictal EEG network localizes the EZ as a measure of cortical excitability

Introduction: For patients with drug-resistant epilepsy, successful localization and surgical treatment of the epileptogenic zone (EZ) can bring seizure freedom. However, surgical success rates vary widely because there are currently no clinically validated biomarkers of the EZ. Highly epileptogenic regions often display increased levels of cortical excitability, which can be probed using single-pulse electrical stimulation (SPES), where brief pulses of electrical current are delivered to brain tissue. It has been shown that high-amplitude responses to SPES can localize EZ regions, indicating a decreased threshold of excitability. However, performing extensive SPES in the epilepsy monitoring unit (EMU) is time-consuming. Thus, we built patient-specific in silico dynamical network models from interictal intracranial EEG (iEEG) to test whether virtual stimulation could reveal information about the underlying network to identify highly excitable brain regions similar to physical stimulation of the brain.Methods: We performed virtual stimulation in 69 patients that were evaluated at five centers and assessed for clinical outcome 1 year post surgery. We further investigated differences in observed SPES iEEG responses of 14 patients stratified by surgical outcome.Results: Clinically-labeled EZ cortical regions exhibited higher excitability from virtual stimulation than non-EZ regions with most significant differences in successful patients and little difference in failure patients. These trends were also observed in responses to extensive SPES performed in the EMU. Finally, when excitability was used to predict whether a channel is in the EZ or not, the classifier achieved an accuracy of 91%.Discussion: This study demonstrates how excitability determined via virtual stimulation can capture valuable information about the EZ from interictal intracranial EEG

Efficacy and tolerability of olive oil-based ketogenic diet in children with drug -resistant epilepsy: A single center experience from Turkey

Purpose: Ketogenic diet (KD) is an effective non-pharmacological treatment for drug resistant epilepsy. The aim of this study was to investigate the efficacy, tolerability and complications of olive oil-based KD in epileptic children

The effect of olive oil-based ketogenic diet on serum lipid levels in epileptic children

Ketogenic diet (KD) is one of the most effective therapies for intractable epilepsy. Olive oil is rich in monounsaturated fatty acids and antioxidant molecules and has some beneficial effects on lipid profile, inflammation and oxidant status. The aim of this study was to evaluate the serum lipid levels of children who were receiving olive oil-based KD for intractable seizures at least 1 year. 121 patients (mean age 7.45 +/- A 4.21 years, 57 girls) were enrolled. At baseline and post-treatment 1, 3, 6, and 12 months body mass index-SDS, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride levels were measured. Repeated measure ANOVA with post hoc Bonferroni correction was used for data analysis. The mean duration of KD was 15.4 +/- A 4.1 months. Mean total cholesterol, LDL-cholesterol and triglyceride levels were significantly higher at 1st, 3rd, 6th and 12th months of the KD treatment, compared to pre-treatment levels (p = 0.001), but showed no difference among during-treatment measurements. Mean body mass index-SDS and HDL-cholesterol levels were not different among the baseline and follow-up time points (p = 0.113 and p = 0.067, respectively). No child in this study discontinued the KD because of dyslipidemia. Even if rich in olive oil, high-fat KD causes significant increase in LDL-cholesterol and triglyceride levels. More studies are needed to determine the effect of KD on serum lipids in children using different fat sources in the diet