Abeer J. Hani

American Clinical Neurophysiology Society Guideline 2: Guidelines for Standard Electrode Position Nomenclature

This revision to the EEG Guidelines is an update incorporating current electroencephalography technology and practice and was previously published as Guideline 5. While the 10-10 system of electrode position nomenclature has been accepted internationally for almost two decades, it has not been used universally. The reasons for this and clinical scenarios when the 10-10 system provides additional localizing information are discussed in this revision. In addition, situations in which AF1/2, AF5/6, PO1/2 and PO5/6 electrode positions may be utilized for EEG recording are discussed.

American Clinical Neurophysiology Society Guideline 3: A Proposal for Standard Montages to Be Used in Clinical EEG

This revision to the EEG Guidelines is an update incorporating current electroencephalography technology and practice and was previously published as Guideline 6. A discussion of methodology for the appropriate selection of reference electrodes is added. In addition, montages are added to assist with localization of abnormal activity in mesial frontal and anterior temporal regions.

Genetics of Pediatric Epilepsy

As the genetic etiologies of an expanding number of epilepsy syndromes are revealed, the complexity of the phenotype genotype correlation increases. As our review will show, multiple gene mutations cause different epilepsy syndromes, making identification of the specific mutation increasingly more important for prognostication and often more directed treatment. Examples of that include the need to avoid specific drugs in Dravet syndrome and the ongoing investigations of the potential use of new directed therapies such as retigabine in KCNQ2-related epilepsies, quinidine in KCNT1-related epilepsies, and memantine in GRIN2A-related epilepsies.

Impact of C-reactive protein test results on evidence-based decision-making in cases of bacterial infection

BackgroundC-reactive protein (CRP) is widely used to detect bacterial infection in children. We investigated the impact of CRP test results on decision-making and summarized the evidence base (EB) of CRP testing.MethodsWe collected information from the hospital records of 91 neonates with suspected sepsis and of 152 febrile children with suspected infection on the number of ordered CRP tests, the number of EB-CRP tests, and the impact of the test results on decision-making. CRP diagnostic accuracy studies focusing on pediatric infections were reviewed critically. The main outcomes were the proportion of CRP tests that were EB and the proportion of tests that affected decision-making. A secondary outcome was the overall one-year expenditure on CRP testing.ResultsThe current EB for CRP testing in pediatric infections is weak and suggests that CRP is of low diagnostic value. Approximately 54.8% of tests performed for suspected neonatal sepsis and 28% of tests performed for other infections were EB; however, the results of only 12.9% of neonatal sepsis tests and of 29.9% of tests on children with other infections informed decision-making. The one-year overall cost for CRP testing and related health care was

Epilepsy surgery in a developing country (Lebanon): ten years experience and predictors of outcome

26,715.9.ConclusionsThe routine ordering of CRP for children with infections is based on weak evidence. The impact of the CRP test results on decision-making is rather small, and CRP ordering may contribute to unnecessary health care expenditures. Better quality research is needed to definitively determine the diagnostic accuracy of CRP levels in children with infections.

Current and Emerging Therapies of Severe Epileptic Encephalopathies

We present our 10-year experience and preoperative predictors of outcome in 93 adults and children who underwent epilepsy surgery at the American University of Beirut. Presurgical evaluation included video-EEG monitoring, MRI, neuropsychological assessment with invasive monitoring, and other tests (PET, SPECT, Wada). Surgeries included temporal (54%), extratemporal (22%), and multilobar resections (13%), hemispherectomy (4%), vagal nerve stimulation (6%), and corpus callosotomy (1%). Mesial temporal sclerosiswas the mostcommonaetiology (37%). After resective surgery, 70% had Engel class I, 9% class II, 14% class III, and 7% class IV. The number of antiepileptic drugs before surgery was the only preoperative factor associated with Engel class I (p=0.005). Despite the presence of financial and philanthropic aid, many patients could not be operated on for financial reasons. We conclude that advanced epilepsy presurgical workups, surgical procedures, and favourable outcomes, comparable to those of developed countries, are achievable in developing countries, but that issues of financial coverage remain to be addressed.

Early Treatment of Convulsive Status Epilepticus

In this article, we review the treatment options for the pediatric epileptic encephalopathies and provide an update on the new and emerging therapies targeted at the underlying pathophysiology of many of these syndromes. We illustrate how the identification of the specific genetic and autoimmune causes has made possible the evaluation and development of novel, better targeted therapies, as and at times, avoidance of potentially offending agents.

Autoimmune, Infectious, and Metabolic NCSE/NCS

The management of convulsive status epilepticus (CSE) consists of simultaneous termination of the status epilepticus (SE) and determination and management of the underlying etiology. The operational definition of CSE is seizure activity lasting for more than 5 min or recurrent seizure activity with no recovery in between. Management of SE consists of stabilizing the patient along with early administration of abortive therapy and initiation of the workup for an underlying etiology. Early treatment of SE often starts with the use of benzodiazepines, best administered via parenteral route, based on recommendations by the American Epilepsy Society, Neurocritical Care Society, and the European Federation of Neurological Societies. Various formulations of midazolam, diazepam, and lorazepam have been investigated for out-of-hospital treatment of CSE. Subsequent second-line therapy consists of parenteral anti-seizure drugs (ASD) including phenytoin, phenobarbital, valproic acid, levetiracetam, and lacosamide. Evidence supporting the use of many of these ASDs is still lacking or being evaluated.

Epilepsy surgery in a developing country (Lebanon)

The role of autoimmune etiologies in the genesis of epilepsy and encephalitis has been recently discovered. Historically, infectious and to a lesser degree metabolic etiologies have also been implicated in convulsive and nonconvulsive seizures (NCS) and status epilepticus (SE). With the recent advances in and recommendations for continuous EEG (cEEG) monitoring, NCS and nonconvulsive SE (NCSE) are being increasingly detected in these conditions. It is imperative to diagnose abnormal movements that are associated with such disease states and to differentiate between epileptic and nonepileptic events. Hence, cEEG monitoring serves a vital role in spell characterization and identification of seizures and SE.

American Clinical Neurophysiology Society Guideline 1: Minimum Technical Requirements for Performing Clinical Electroencephalography.

We present our 10-year experience and preoperative predictors of outcome in 93 adults and children who underwent epilepsy surgery at the American University of Beirut. Presurgical evaluation included video-EEG monitoring, MRI, neuropsychological assessment with invasive monitoring, and other tests (PET, SPECT, Wada). Surgeries included temporal (54%), extratemporal (22%), and multilobar resections (13%), hemispherectomy (4%), vagal nerve stimulation (6%), and corpus callosotomy (1%). Mesial temporal sclerosiswas the mostcommonaetiology (37%). After resective surgery, 70% had Engel class I, 9% class II, 14% class III, and 7% class IV. The number of antiepileptic drugs before surgery was the only preoperative factor associated with Engel class I (p=0.005). Despite the presence of financial and philanthropic aid, many patients could not be operated on for financial reasons. We conclude that advanced epilepsy presurgical workups, surgical procedures, and favourable outcomes, comparable to those of developed countries, are achievable in developing countries, but that issues of financial coverage remain to be addressed.