Ivan Osorio1. 1. Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, United States. Electronic address: iosorio@kumc.edu.
Abstract
OBJECTIVE: Accurate prediction of electrographic seizure onset may reduce injuries and improve quality of life in pharmaco-resistant epileptics. However, because sub-clinical, far out-number clinical seizures, indiscriminate issuance of warnings may have a paralyzing effect on these patients. This study investigates the predictability of ictal cognitive dysfunction. METHODS: Latency and percentage of correct responses to a reaction time test triggered by automated seizure detections were compared to those obtained inter-ictally in 14 subjects undergoing surgery evaluation. Since accurate prediction of seizures is elusive, early detection was used, as it indirectly but reliably investigates for the existence of a cognitive pre-ictal state. RESULTS: Significant differences between ictal and inter-ictal cognitive performance were not uncovered until late into the temporal evolution of "focal" seizures. CONCLUSIONS: These observations suggest that cognitive dysfunction is unpredictable in seizures originating from discrete cortical regions, as the transition into unawareness seems abrupt. SIGNIFICANCE: Prediction of electrographic seizure onsets with worthwhile accuracy would likely result in large numbers of daily warnings, the great majority for sub-clinical seizures. This outcome would considerably increase, without safety justification, patients' psychological burden inherent to each forecast, thus further diminishing quality of life.
OBJECTIVE: Accurate prediction of electrographic seizure onset may reduce injuries and improve quality of life in pharmaco-resistant epileptics. However, because sub-clinical, far out-number clinical seizures, indiscriminate issuance of warnings may have a paralyzing effect on these patients. This study investigates the predictability of ictal cognitive dysfunction. METHODS: Latency and percentage of correct responses to a reaction time test triggered by automated seizure detections were compared to those obtained inter-ictally in 14 subjects undergoing surgery evaluation. Since accurate prediction of seizures is elusive, early detection was used, as it indirectly but reliably investigates for the existence of a cognitive pre-ictal state. RESULTS: Significant differences between ictal and inter-ictal cognitive performance were not uncovered until late into the temporal evolution of "focal" seizures. CONCLUSIONS: These observations suggest that cognitive dysfunction is unpredictable in seizures originating from discrete cortical regions, as the transition into unawareness seems abrupt. SIGNIFICANCE: Prediction of electrographic seizure onsets with worthwhile accuracy would likely result in large numbers of daily warnings, the great majority for sub-clinical seizures. This outcome would considerably increase, without safety justification, patients' psychological burden inherent to each forecast, thus further diminishing quality of life.
Authors: Joana Berger-Estilita; Katharina Steck; Christian Vetter; Kathleen Seidel; Vladimir Krejci; Darren Hight; Heiko Kaiser Journal: Medicine (Baltimore) Date: 2019-11 Impact factor: 1.817