Pirgit Meritam Larsen1, Stephan Wüstenhagen1, Daniella Terney1, Elena Gardella2, Jørgen Alving1, Harald Aurlien3, Sándor Beniczky4. 1. Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare). 2. Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare); University of Southern Denmark, Denmark. 3. Section for Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, Bergen, Norway. 4. Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare); Department of Clinical Neurophysiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: sbz@filadelfia.dk.
Abstract
OBJECTIVE: To characterize photoparoxysmal EEG response (PPR) using a standardized protocol of intermittent photic stimulation (IPS) and standardized definitions for PPR, classified into six types. METHODS: Using the SCORE system (Standardized Computer-Based Organized Reporting of EEG) we prospectively built a large database of standardized EEG annotations. In this study, we extracted the features related to PPR from the structured dataset consisting of 10,671 EEG recordings with IPS, from 7,188 patients. RESULTS: The standardized IPS protocol elicited PPR in 375 recordings (3.5%), in 288 patients (4%), with a preponderance among young (11-20 years) and female patients (67%). PPR was persistent in patients with multiple recordings. The most frequent type of PPR was activation of preexisting epileptogenic area (58%), followed by generalized-PPR limited to the stimulus train (22%). We could not find any recording with self-sustained posterior response. Seizures were elicited in 27% of patients with PPR, most often myoclonic seizures and absences, in patients with self-sustained generalized PPR. CONCLUSIONS: The most common type of PPR was accentuation of preexisting epileptogenic area. Self-sustained posterior response could not be documented. Self-sustained generalized-PPR had the highest association with seizures. SIGNIFICANCE: Using standardized stimulation protocol and definitions for PPR types, IPS provides high diagnostic yield.
OBJECTIVE: To characterize photoparoxysmal EEG response (PPR) using a standardized protocol of intermittent photic stimulation (IPS) and standardized definitions for PPR, classified into six types. METHODS: Using the SCORE system (Standardized Computer-Based Organized Reporting of EEG) we prospectively built a large database of standardized EEG annotations. In this study, we extracted the features related to PPR from the structured dataset consisting of 10,671 EEG recordings with IPS, from 7,188 patients. RESULTS: The standardized IPS protocol elicited PPR in 375 recordings (3.5%), in 288 patients (4%), with a preponderance among young (11-20 years) and female patients (67%). PPR was persistent in patients with multiple recordings. The most frequent type of PPR was activation of preexisting epileptogenic area (58%), followed by generalized-PPR limited to the stimulus train (22%). We could not find any recording with self-sustained posterior response. Seizures were elicited in 27% of patients with PPR, most often myoclonic seizures and absences, in patients with self-sustained generalized PPR. CONCLUSIONS: The most common type of PPR was accentuation of preexisting epileptogenic area. Self-sustained posterior response could not be documented. Self-sustained generalized-PPR had the highest association with seizures. SIGNIFICANCE: Using standardized stimulation protocol and definitions for PPR types, IPS provides high diagnostic yield.