EEG analysis – automatic spike detection

In the diagnosis and treatment of epilepsy, an electroencephalography (EEG) is one of the main tools. However visual inspection of EEG is very time consuming. Automatic extraction of important EEG features saves not only a lot of time for neurologist, but also enables a whole new level for EEG analysis, by using data mining methods. In this work we present and analyse methods to extract some of these features of EEG – drowsiness score and centrotemporal spikes. For spike detection, a method based on morphological filters is used. Also a database design is proposed in order to allow easy EEG analysis and provide data accessibility for data mining algorithms developed in the future

Electroencephalogram spike detection and classification by diagnosis with convolutional neural network

This work presents convolutional neural network (CNN) based methodology for electroencephalogram (EEG) classification by diagnosis: benign childhood epilepsy with centrotemporal spikes (rolandic epilepsy) (Group I) and structural focal epilepsy (Group II). Manual classification of these groups is sometimes difficult, especially, when no clinical record is available, thus presenting a need for an algorithm for automatic classification. The presented algorithm has the following steps: (i) EEG spike detection by morphological filter based algorithm; (ii) classification of EEG spikes using preprocessed EEG signal data from all channels in the vicinity of the spike detected; (iii) majority rule classifier application to all EEG spikes from a single patient. Classification based on majority rule allows us to achieve 80% average accuracy (despite the fact that from a single spike one would obtain only 58% accuracy).&nbsp

Behavioral Problems in Children with Benign Childhood Epilepsy With Centrotemporal Spikes Treated and Untreated with Antiepileptic Drugs

The aim of this study was to investigate behavioral problems in two groups of children with benign childhood epilepsy with centrotemporal spikes (BECTS), i.e., those treated with antiepileptic drugs and those not treated in order to identify the factors associated with behavioral problems. Material and Methods. In total, 20 newly diagnosed untreated, 23 treated patients with BECTS, and 20 patients with acute/subacute peripheral nervous system disorders as a comparison group (aged 6–11 years) were examined. The evaluation was performed using the Lithuanian version of the Child Behavior Checklist (CBCL). Schooling parameters, clinical parameters, EEG parameters, and their relation to the results of the CBCL were also investigated. Results. The treated patients with BECTS had significantly higher scores in the subscales of Social Problems, Anxious/Depressed, Aggressive Behavior, and Attention Problems compared with the scores of the patients with peripheral nervous system disorders. A significant relationship was established between the scores of native language grades and Attention Problems; grades in mathematics and treatment duration; and age when the first seizure occurred and Delinquent Behavior in the group of treated patients. The duration of epilepsy was positively correlated with the scores in the subscales of Withdrawn and Delinquent Behavior. The presence of additional extrarolandic focus and spread of focal specific discharges to the centrofrontotemporal and centroparietotemporal areas were related to higher scores in Social Problems, Attention Problems, and Delinquent Behavior in the group of the treated patients with BECTS. Conclusions. Children with BECTS, especially those treated and with a longer epilepsy course, were found to be at risk of behavioral problems. Lower grades were associated with a longer disease course and medications. The presence of extrarolandic discharges was related to higher CBCL scores in the group of the treated patients with BECTS

Associations between EEG data, sleep, behavioural disorders and clinical characteristics in Rolandic epilepsy

Although patients with benign Rolandic epilepsy (RE) exhibit a benign course of the disease, some of them display sleep and behavioural problems. Seventy five patients with RE, aged 6–11 years, were included in this study. The patients were divided into two subgroups according to the presence of seizures over the preceding 6 months. The comparison group comprised 32 patients without epilepsy and with similar characteristics in terms of age and sex. All patients underwent evaluation of sleep (Sleep Disturbance Scale for Children) and behaviour (Lithuanian version of Child Behaviour Checklist). We examined the sleep and behavioural problems in correlation with the clinical data, EEG data, and simple visual-motor reaction time data. We automatically and manually analysed EEG in the collaboration with Vilnius University Faculty of Mathematics and Informatics. Only patients who had had seizures over the preceding 6 months displayed significantly higher scores for sleep problems (disorders of excessive daytime sleepiness, disorders of sleep breathing, and disorders of sleep-wake transition, longer sleep onset latency), and behavioural problems (social problems, thought problems, attention problems, and aggressive behavior) than the patients of the comparison group. Behavioural problems were associated with the longer epilepsy duration, more frequent and more severe seizures, sleep problems and sleep EEG data (spike frequency >35/min and spike focus, spreading to the other than centrotemporal zones). Wake EEG spike frequency >17 spikes/min was related to the longer simple reaction time. Behavioural problems and EEG data (sleep spike frequency >37 spikes/min and spike focus, spreading to the other than centrotemporal zones) were related to the more difficult to treat RE. A method of morphological filter had 88.0% accuracy, compared to the manually calculated EEG data

Case report: Guillain-Barré syndrome and possible association with Lyme disease

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating or axon-damaging polyneuropathy. It is characterized by sensory, motor and reflex disorder, damaged cranial nerves, autonomic disorders, and, less frequently, damage to the central nervous system. This is a life-threatening condition that urges patients to seek emergency treatment for progressive pain, paralysis and/or respiratory distress that can cause death in the absence of timely treatment. Early diagnosis and treatment of this condition are very important in preventing fatal outcome. Although many infections are associated with the etiology of GBS, correlation with Lyme disease is determined very rarely. Lyme disease is a tick-borne Borrelia burgdorferi infection that can cause lesions of multiple organ systems: usually the skin, joints, nervous system, and the heart. This case report presents an 8-year-old boy who was admitted to the hospital because of progressive weakness in the extremities, meningeal signs, bilateral facial nerve paresis, and areflexia. The patient was diagnosed with GBS and Lyme disease; and symptoms of the patient gradually disappeared following the treatment with intravenous immunoglobulin and ceftriaxone. Although the diagnosis of GBS was definite, the diagnosis of Lyme disease was complicated by a variety of circumstances which we analyse in this article. We also discuss a possible connection between the two pathologies

Etiopathogenesis, symptoms, diagnosis and treatment of neuroblastoma

Neuroblastoma characterizes a spectrum of neoplastic diseases of neural crest-derived sympathoadrenal cells and manifests mostly in early childhood. Although neuroblastoma is classified as a very rare pathology, it is the most common malignancy in children under one year of age. The aim of this article is to review and describe the etiopathogenesis, clinical manifestations, diagnosis and treatment of neuroblastoma. The literature search was accomplished by using the PubMed database. The exact ethiopathogenesis of neuroblastoma is not known, but is thought to be the result of a defect in the differentiation of neural crest stem cells. Over the past decade, more and more information about the interaction and influence of oncogenetic and transcriptional factors on tumor initiation has been available, most notably mutations in the MYCN, PHOX2B, and ALK genes, cytogenetic factors such as gain of chromosomes 2p; 17q gain; 1p loss of heterozygosity; 11q loss. Despite the rising number of major identifying factors influencing neuroblastoma formation, there is not a single one of them that is present in all cases of neuroblastoma, so a multifactorial etiology is considered, thus explaining the heterogeneous expression of the disease. The tumor can develop anywhere in the sympathetic nervous system and the most often clinical presentation is abdominal or back pain, sweating, constipation and diarrhea. The prognosis of the disease depends on the degree of tumor differentiation, but there is also a chance of spontaneous regression. Radiologic imaging plays an important role in diagnosis of neuroblastoma and is used to determine both the localization of the tumour and prognosis, however the diagnosis is confirmed by histological examination of the tumor biopsy. Treatment of neuroblastoma is complicated by unequal response to treatment, it is prescribed depending on the risk group of the tumor. A choice to observe can be made for infants because of the possibility of spontaneous regression. In the case of low-risk disease, surgery is the standard treatment. In the case of moderate-risk diseases, treatment of choice is chemotherapy, combined with surgical treatment if necessary, and in the case of high-risk disease, both chemotherapy and surgery are used in combination with radiotherapy

Anti-N-methyl-d-aspartate receptor encephalitis and positive human herpesvirus-7 deoxyribonucleic acid in cerebrospinal fluid: a case report

Background: Anti-N-methyl-d-aspartate receptor encephalitis is a neuroautoimmune syndrome typically presenting with seizures, psychiatric symptoms, and autonomic dysfunction. Human herpesvirus-7 is often found with human herpesvirus-6 and infects leukocytes such as T-cells, monocytes–macrophages, epithelial cells, and central nervous system cells. The pathogenicity of human herpesvirus-7 is unclear. Cases of anti-N-methyl-d-aspartate receptor encephalitis with human herpesvirus-7 present in cerebrospinal fluid have been documented, but the clinical significance of this finding remains unclear. Case presentation: An 11-year-old Caucasian boy was admitted to hospital after a generalized tonic–clonic seizure. Generalized tonic seizures repeated three more times during the day of hospitalization. Blood tests showed minor ongoing inflammation, while brain computed tomography yielded normal results. Brain magnetic resonance imaging showed hyperintense focal alterations in both temporal lobes, hippocampi, and at the base of the right frontal lobe. Positive anti-N-methyl-d-aspartate receptor antibodies were found in both serum and cerebrospinal fluid. Positive novel coronavirus 2 (severe acute respiratory syndrome coronavirus 2) immunoglobulin G antibodies were found in serum. Polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 was negative. Furthermore, positive human herpesvirus-7 deoxyribonucleic acid was found in cerebrospinal fluid. The patient was treated with acyclovir, human immunoglobulin, and methylprednisolone. The seizures did not repeat, and no psychiatric symptoms were present. The patient made a full recovery. Conclusions: We present a pediatric case of anti-N-methyl-d-aspartate receptor encephalitis with atypical clinical presentation. The role of human herpesvirus-7 in neurological disorders remains unclear in immunocompetent patients

Behavioral problems in children with benign childhood epilepsy with centrotemporal spikes treated and untreated with antiepileptic drugs

The aim of this study was to investigate behavioral problems in two groups of children with benign childhood epilepsy with centrotemporal spikes (BECTS), i.e. those treated with antiepileptic drugs and those not treated in order to identify the factors associated with behavioral problems. Material and Methods. In total, 20 newly diagnosed untreated, 23 treated patients with BECTS, and 20 patients with acute/subacute peripheral nervous system disorders as a comparison group (aged 6-11 years) were examined. The evaluation was performed using the Lithuanian version of the Child Behavior Checklist (CBCL). Schooling parameters, clinical parameters, EEG parameters, and their relation to the results of the CBCL were also investigated. Results. The treated patients with BECTS had significantly higher scores in the subscales of Social Problems, Anxious/Depressed, Aggressive Behavior, and Attention Problems compared with the scores of the patients with peripheral nervous system disorders. A significant relationship was established between the scores of native language grades and Attention Problems; grades in mathematics and treatment duration; and age when the first seizure occurred and Delinquent Behavior in the group of treated patients. The duration of epilepsy was positively correlated with the scores in the subscales of Withdrawn and Delinquent Behavior. The presence of additional extrarolandic focus and spread of focal specific discharges to the centrofrontotemporal and centroparietotemporal areas were related to higher scores in Social Problems, Attention Problems, and Delinquent Behavior in the group of the treated patients with BECTS. Children with BECTS, especially those treated and with a longer epilepsy course, were found to be at risk of behavioral problems. Lower grades were associated with a longer disease course and medications. The presence of extrarolandic discharges was related to higher CBCL scores in the group of the treated patients with BECTS