Electrocorticographic events from long-term ambulatory brain recordings can potentially supplement seizure diaries
Electrocorticographic events from long-term ambulatory brain recordings can potentially supplement seizure diaries
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DOI：
10.1016/j.eplepsyres.2020.106302
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发表时间：
2020-03-01
影响因子：
2.2
通讯作者：
Morrell, Martha J.
中科院分区：
文献类型：
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作者：
Quigg, Mark;Skarpaas, Tara L.;Morrell, Martha J.
目的：确定通过脑反应性神经刺激系统连续皮层电图监测检测到的癫痫样事件来补充患者维护的癫痫日记的可行性。方法：对一项脑反应性神经刺激（RNS（R）系统）随机对照试验的数据进行回顾性分析，该试验用于辅助治疗 191 名受试者的医学上难治性局灶性癫痫发作。使用互相关和 Logistic 广义估计方程模型评估日记报告的癫痫发作每日计数与设备记录的“长癫痫样事件”(LE)（电图癫痫发作 (ES) 的替代指标）之间的长期（>= 3 个月）对应关系。结果：在检测设置保持不变的 124 名患者中，日记报告的癫痫发作和 LE 在数日内显着共同变化，在54 名患者 (44%) 的 LE 通常为 ES（高一致性患者）。检测到 LE 的天数多于患者报告癫痫发作的天数（阳性预测值 (PPV)：34%）。在没有 LE 的日子里，通常没有日记报告的癫痫发作（阴性预测值 (NPV)：90%）。在 LE 和 ES 高度一致性的患者中，PPV 和 NPV 均稍高，分别为 43% (35-52%) 和 93% (95% CI: 86-97%)。结论：虽然 LE 的数量大大超过日记报告的癫痫发作数量，但 LE 和日记癫痫发作之间的高度跨日相关性和强 NPV 表明 RNS (R) 系统记录的 LE 可能通过提供相对癫痫发作负担的客观生物标志物来潜在地补充癫痫日记。
Purpose: To determine the feasibility of using epileptiform events detected by continuous electrocorticographic monitoring via a brain-responsive neurostimulation system to supplement patient-maintained seizure diaries.Methods: Data were retrospectively analyzed from a randomized controlled trial of brain-responsive neurostimulation (RNS (R) System) for adjunctive treatment of medically intractable focal onset seizures in 191 subjects. The long-term (>= 3 months) correspondence between daily counts of diary-reported seizures and device-recorded "long epileptiform events" (LEs), a proxy for electrographic seizures (ESs), was assessed using cross-correlation and logistic generalized estimating equation models.Results: Diary-reported seizures and LEs significantly co-varied across days in 124 patients whose detection settings were held constant, with a significantly higher correlation in 54 patients (44 %) whose LEs were usually ESs (high concordance patients). There were more days in which LEs were detected than days in which patients reported a seizure (positive predictive value (PPV): 34 %). On days when there were no LEs, there were typically no diary-reported seizures (negative predictive value (NPV): 90 %). In patients with a high concordance between LEs and ESs, the PPV and NPV were both slightly higher, 43 % (35-52 %) and 93 % (95 % CI: 86-97 %) respectively.Conclusion: Although LEs can substantially outnumber diary reported seizures, the high across-day correlation and strong NPV between LEs and diary seizures suggests that LEs recorded by the RNS (R) System could potentially supplement seizure diaries by providing an objective biomarker for relative seizure burden.