Clinical Neurophysiology: EEG–Video Monitoring

1 Elaine C. Wirrell, and 2 Christina Cheung ( 1 Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada ; and 2 Faculty of Medicine, Queens University, Kingston, ON, Canada ) Rationale: Adolescent perception of physical and social impact of chronic illness was assessed to determine a) is there greater prejudice toward epilepsy than other chronic disease, b) do adolescents with chronic disease have less prejudice towards similarly affected peers with all, or just their specific chronic disease. Methods: Cohort study. Setting: Outpatient clinics of a tertiary care pediatric hospital. Participants: Cognitively normal teens aged 13–18 without chronic disease (n = 41) and with epilepsy (n = 32), asthma (n = 38), diabetes (n = 21) and migraine (n = 17). Main Outcome Measures: Perceived physical and social impact of 8 chronic diseases (epilepsy, asthma, diabetes, Down's syndrome, arthritis, migraine, leukemia, HIV infection). Results: Epilepsy was perceived to have more adverse physical impact than all chronic illnesses except Down's syndrome. The perception was that it more frequently caused mental handicap, injured the afflicted individual and bystanders and led to death. Epilepsy was also perceived to have more negative social impact particularly on behavior, honesty, popularity, adeptness at sports and fun. Significantly more adolescents' expressed reluctance to befriend peers with epilepsy both from their own and their perceived parental perspectives. Having a chronic disease did not generally alter adolescents' perceptions of peers with chronic disease. However cases with epilepsy ranked this disease to have less social impact than teens with other chronic diseases. Conclusions: Adolescents consider epilepsy to have a greater physical and social impact than most chronic diseases. Educational efforts should focus on the “normality” of most persons with epilepsy, and emphasize the low risk of injury when proper first aide is followed. 1 Tonicarlo R. Velasco, 1 Veriano Alexandre Jr., 1 Marino M. Bianchin, 1 Roger Walz, 1 Charles L. Dalmagro, 1 Regina M.F. Fernandes, 1 Juliana S. Lage, and 1 Americo C. Sakamoto ( 1 Neurology, CIREP, Ribeirao Preto, Sao Paulo, Brazil ) Rationale: Fourteen and six positive spiking is an electroencephalographic phenomenon first described by Gibbs and Gibbs in 1951 as bursts of arch‐shaped surface positive waves at 14 & 6 Hz seen during drowsiness in the posterior temporal leads. It was originally associated with headache, head trauma, epilepsy, behavioral disorders, vomiting and dizziness. However, it can be accepted as a pattern appearing in normal children and adolescents. Here we describe a series of patients with unilateral temporal lobe epilepsy (MTLE) which revealed 14 and 6 Hz positive spikes during video‐EEG. We analyze the relative frequency and lateralization value of this EEG pattern. Methods: Video‐EEG analysis. Electrodes were placed over the scalp according to the international 10–20 system, added to temporal electrodes positioned according to the 10–10 system and sphenoidal electrodes. 14 and 6 Hz positive spikes definition. The EEG was visually assessed by a board‐certified electroencephalographer (TRV) for the presence of 14 & 6 Hz positive spikes, defined as arch shaped waves at 13–17 and/or 5–7 Hz seen generally over the posterior temporal region. The sharp peaks of its component need to be positive in respect to other regions. Side of epileptogenic temporal lobe (TL). The side of epileptogenic TL was defined by high resolution MRI, ictal SPECT, and neuropsychological examination, and ictal video‐EEG. The ictal onset zone (IOZ) was assessed on ictal video‐EEG by two investigators, and when the results were discordant, they were reviewed together to achieve agreement about the localization and lateralization of seizure onset. When the IOZ could not be localized noninvasively, intracranial EEG recordings were performed. Results: From 359 patients examined, 22 had 14 & 6 Hz positive spikes (6,12%). The localization of EEG pattern was in the lateral posterior temporal leads, with maximum amplitude in the T5‐T6 and P7‐P8 electrodes. In the temporal lobe the mesio‐basal region discloses the minimum amplitude (sphenoidal electrodes). In one patient with foramen ovale electrode, we observed high amplitude 14 and 6 Hz positive spikes, probably related to intracranial positioning of electrodes than due to mesio‐basal origin. In 21 patients, 14 and 6 Hz positive spikes were lateralized contralateral to the side of MTLE (p < 0.01). Conclusions: Our findings indicate that 14 & 6 Hz positive spikes are uncommon. The high frequency of lateralized pattern in patients with unilateral MTLE and the fact that occurred consistently in the TL contralateral to the side of hipocampal sclerosis is in agreement with the theory that 14 & 6 Hz positive spikes can be a normal EEG pattern and suggest that the origin of 14 & 6 Hz positive spikes locate in temporal lobe. Although uncommon, the EEG pattern is a reliable method for lateralization of epileptogenic temporal lobe. (Supported by Fapesp, CAPES and CnPq.) 1 Amir M. Arain, and 1 Bassel W. Abou‐Khalil ( 1 Neurology, Vanderbilt University Medical Center, Nashville, TN ) Rationale: Hyperventilation (HV) is used routinely to provoke absence seizures, but is less effective for precipitation of partial seizures. Hyperventilation may also be effective in precipitating nonepileptic seizures. This study was undertaken to determine the effectiveness of hyperventilation in consecutive patients undergoing prolonged video EEG monitoring. Methods: We prospectively used hyperventilation in consecutive patients admitted to our epilepsy monitoring unit for long‐term video‐EEG monitoring. Patients underwent 3 min of hyperventilation on a daily basis (1–6 days). We excluded children younger than 12 and mentally retarded individuals. Results: We evaluated 56 consecutive patients. Their ages ranged from 12 to 85 years. 36 (66%) had localization‐related epilepsy, 19 (34%) had nonepileptic spells, and one had both partial onset seizures and nonepileptic seizures. Events were activated in 5 patients with epilepsy (2 auras, 2 complex partial seizures and 1 secondarily generalized tonic clonic seizure), and in 9 patients with nonepileptic seizures (all were nonepileptic events). The patient with both epileptic and nonepileptic seizures had a nonepileptic spell activated. Spontaneous and activated epileptic seizures did not differ in their clinical characteristics. Conclusions: Voluntary HV is effective in inducing seizures as well as nonepileptic spells during monitoring. The effectiveness of HV in localization‐related epilepsy was higher than expected, possibly due to increased seizure tendency from medication withdrawal. This study suggests that daily HV may be effective in shortening the duration of video‐EEG monitoring, both in patients with epilepsy and those with nonepileptic seizures. 1 Adriana C. Bermeo, 1 Dileep R. Nair, 1 Prakash Kotagal, 1 Mark Bej, 1 Imad Najm, and 1 Hans O. Lüders ( 1 Neurology, Cleveland Clinic Foundation, Cleveland, OH ) Rationale: We studied the changes related to cardiac rhythm in patients with generalized tonic‐clonic seizures (GTCS) as it relates to episodes of apnea and during the motor and premotor phase of the seizure. Methods: Patients in the epilepsy monitoring unit were recruited if they experienced a GTCS. We assessed the heart rate as well as the oxygen saturation in 24 GTCS experienced in 18

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