Electroencephalography (EEG) signal monitoring can be applied for many purposes, such as epileptic seizure detection. To design a reliable, wearable EEG monitoring platform for seizure detection in daily use, this paper presents a two-step approach to select a small subset of discriminative features from a few number of channels. In the first step, linear discriminant analysis (LDA) is applied to choose informative channels which have highly-ranked LDA criterion values. Then in the second step, the least absolute shrinkage and selection operator (LASSO) method is adopted to incrementally add features into selection subset. To determine the best number of channels and features for each subject, a personalization technique is utilized by evaluating the classification result of different feature subsets based on support vector machine (SVM) classifier. Experimentation on CHB-MIT database shows that on average, the proposed method selects approximately 3 channels and 7 features, and yields F-1 score of 81% based on SVM evaluation.
We present two cases of epilepsy with negative scalp EEG and challenging semiologies, the workup undertaken to identify them as cases of insular epilepsy, and subsequent surgical treatment.
Abstract Objective Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (stereo‐EEG) may miss seizure onset elsewhere. We hypothesized that stereo‐EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the 2‐year outcomes of patients who underwent single‐fiber SLAH after stereo‐EEG and evaluated whether stereo‐EEG SOPs predict postoperative seizure freedom. Methods This retrospective five‐center study included patients with or without mesial temporal sclerosis (MTS) who underwent stereo‐EEG followed by single‐fiber SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. An SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was 2‐year Engel I classification or recurrent seizures before then, stratified by SOP category. Results Fifty‐eight patients were included, with a mean follow‐up duration of 39 ± 12 months after SLAH. Overall 1‐, 2‐, and 3‐year Engel I seizure freedom probability was 54%, 36%, and 33%, respectively. Patients with SOPs, including low‐voltage fast activity or low‐frequency repetitive spiking, had a 46% 2‐year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log‐rank test, p = .00015). Significance Patients who underwent SLAH after stereo‐EEG had a low probability of seizure freedom at 2 years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between hippocampal seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.
May 5, 2019April 9, 2019Free AccessSelf-Reported Depression and Anxiety Scores Similar in Patients with Temporal and Extra-Temporal Lobe Epilepsy (P1.5-015)Caroline Abe, Alexander Doyle, David Denny, Munro Cullum, David Montemayor, Jessica Adams, Denise Castillo, Hina Dave, and Kan DingAuthors Info & AffiliationsApril 9, 2019 issue92 (15_supplement)https://doi.org/10.1212/WNL.92.15_supplement.P1.5-015 Letters to the Editor
It is predicted that the current shortfall of neurologists will continue to grow beyond current training rates. It is well documented that medical students often possess stigmatizing beliefs toward neuroscience-based careers. Preclerkship medical education is where many medical students lay the foundation for specialty interests, and at some medical schools, it may be their only direct exposure to neurology. Providing preclerkship students with exp osure to the unique aspects of clinical neuroscience such as procedures is a possible avenue for increasing student interest.
Methods and Curriculum Description
We sought to assess the influence of a procedure workshop on student specialty interest. We organized a hands-on procedure workshop for preclerkship medical students to learn examination skills and procedures used by adult/pediatric neurologists, neurosurgeons, and psychiatrists. Twelve different stations were run by faculty, trainees, and technicians. Attendance was optional, and students were free to move between stations according to their time and interests. Most stations involved some brief education and time for students to practice or take part in the procedure. Attendees completed an exit survey on their retrospective interest in the relevant specialties before attending the workshop, prospective interest after attending the workshop, and the helpfulness of each station in understanding the procedure. Statistical analyses were performed on the survey responses to determine change in specialty interest resulting from the workshop.
Results and Assessment Data
A total of 111 students attended the workshop, and 104 (94%) filled out the postsurvey. Most were from the second-year medical student class. Approximately 41% of the second-year class attended. There was an increase in student interest (d = 0.6346) in the clinical neurosciences by the Fisher exact test (p < 0.0001). Thirty-three attendees (32%) reported an increased interest in the specialties. Of the students who reported having no prior interest in the clinical neuroscience specialties, 82% (18/22) had an increased interest as a result of the workshop.
Discussion and Lessons Learned
A hands-on procedure workshop improved medical student interest in the clinical neurosciences. Although its effect on future specialty choice is unclear, preclerkship experiences such as a procedure workshop may be a useful addition to medical school curricula to foster interest in neurology and the clinical neurosciences.
