Abstract Objective Cannabidiol‐enriched oil (CBDO) is being used increasingly to improve seizure control in adult patients with drug‐resistant epilepsy (DRE), despite the lack of large‐scale studies supporting its efficacy in this patient population. We aimed to assess the effects of add‐on CBDO on seizure frequency as well as on gait, cognitive, affective, and sleep‐quality metrics, and to explore the electrophysiological changes in responder and non‐responder DRE patients treated with add‐on CBDO. Methods We prospectively recruited adult DRE patients who were treated with add‐on CBDO. Patients were evaluated prior to treatment and following 4 weeks of a maintenance daily dose of ≈260 mg CBD and ≈12 mg Δ9‐tetrahydrocannabinol (THC). The outcome measures included seizure response to CBDO (defined as ≥50% decrease in seizures compared to pre‐CBDO baseline), gait testing, Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS), and sleep‐quality questionnaire assessments. Patients underwent electroencephalography (EEG) recording during rest as well as event‐related potentials (ERPs) during visual Go/NoGo task while sitting and while walking. Results Nineteen patients were recruited, of which 16 finished pre‐ and post‐CBDO assessments. Seven patients (43.75%) were responders demonstrating an average reduction of 82.4% in seizures, and nine patients (56.25%) were non‐responders with an average seizure increase of 30.1%. No differences in demographics and clinical parameters were found between responders and non‐responders at baseline. However, responders demonstrated better performance in the dual‐task walking post‐treatment ( p = .015), and correlation between increase in MoCA and seizure reduction ( r = .810, p = .027). Post‐CBDO P300 amplitude was lower during No/Go‐sitting in non‐responders ( p = .028) and during No/Go‐walking in responders ( p = .068). Significance CBDO treatment can reduce seizures in a subset of patients with DRE, but could aggravate seizure control in a minority of patients; yet we found no specific baseline clinical or electrophysiological characteristics that are associated with response to CBDO. However, changes in ERPs in response to treatment could be a promising direction to better identify patients who could benefit from CBDO treatment.
Electroencephalograms (EEGs) are a fundamental evaluation in neurology but require special expertise unavailable in many regions of the world. Artificial intelligence (AI) has a potential for addressing these unmet needs. Previous AI models address only limited aspects of EEG interpretation such as distinguishing abnormal from normal or identifying epileptiform activity. A comprehensive, fully automated interpretation of routine EEG based on AI suitable for clinical practice is needed.
Experiential phenomena (EP), such as illusions and complex hallucinations, are vivid experiences created in one's mind. They can occur spontaneously as epileptic auras or can be elicited by electrical brain stimulation (EBS) in patients undergoing presurgical evaluation for drug-resistant epilepsy. Previous work suggests that EP arise from activation of different nodes within interconnected neural networks mainly in the temporal lobes. Yet, the anatomical extent of these neural networks has not been described and the question of lateralization of EP has not been fully addressed. To this end, an extended number of brain regions in which electrical stimulation elicited EP were studied to test whether there is a lateralization propensity to EP phenomena.
Preoperative localization of seizure onset zones (SOZs) is an evolving field in the treatment of refractory epilepsy. Both magnetic source imaging (MSI), and the more recent EEG-correlated functional MRI (EEG-fMRI), have shown applicability in assisting surgical planning. The purpose of this study was to evaluate the capability of each method and their combination in localizing the seizure onset lobe (SL).
Abstract Background Juvenile myoclonic epilepsy (JME) is characterized by generalized seizures. Nearly 30% of JME patients are drug‐resistant (DR‐JME), indicating a widespread cortical dysfunction. Walking is an important function that necessitates orchestrated coordination of frontocentral cortical regions. However, gait alterations in JME have been scarcely investigated. Our aim was to assess changes in gait and motor‐evoked responses in DR‐JME patients. Methods Twenty‐nine subjects (11 JME drug‐responder, 8 DR‐JME, and 10 healthy controls) underwent a gait analyses during usual walking and dual‐task walking. Later, subjects underwent 64‐channel EEG recordings while performing a simple motor task. We calculated the motor‐evoked current source densities (CSD) at a priori chosen cortical regions. Gait and CSD measures were compared between groups and tasks using mixed model analysis. Results DR‐JME patients demonstrated an altered gait pattern that included slower gait speed ( p = .018), reduced cadence ( p = .003), and smaller arm‐swing amplitude ( p = .011). The DR‐JME group showed higher motor‐evoked CSD in the postcentral gyri compared to responders ( p = .049) and both JME groups showed higher CSD in the superior frontal gyri compared to healthy controls ( p < .011). Moreover, higher CSD in the superior frontal gyri correlated with worse performance in dual‐task walking ( r > |–0.494|, p < .008). Conclusions These alterations in gait and motor‐evoked responses in DRE‐JME patients reflect a more severe dysfunction of motor‐cognitive neural processing in frontocentral regions, leading to poorer gait performance. Further studies are needed to investigate the predictive value of altered gait and cortical motor processing as biomarkers for poor response to treatment in JME and other epilepsy syndromes.
