Anne C. Van Cott

Common data elements in epilepsy research: Development and implementation of the NINDS epilepsy CDE project

The Common Data Element (CDE) Project was initiated in 2006 by the National Institute of Neurological Disorders and Stroke (NINDS) to develop standards for performing funded neuroscience‐related clinical research. CDEs are intended to standardize aspects of data collection; decrease study start‐up time; and provide more complete, comprehensive, and equivalent data across studies within a particular disease area. Therefore, CDEs will simplify data sharing and data aggregation across NINDS‐funded clinical research, and where appropriate, facilitate the development of evidenced‐based guidelines and recommendations. Epilepsy‐specific CDEs were established in nine content areas: (1) Antiepileptic Drugs (AEDs) and Other Antiepileptic Therapies (AETs), (2) Comorbidities, (3) Electrophysiology, (4) Imaging, (5) Neurological Exam, (6) Neuropsychology, (7) Quality of Life, (8) Seizures and Syndromes, and (9) Surgery and Pathology. CDEs were developed as a dynamic resource that will accommodate recommendations based on investigator use, new technologies, and research findings documenting emerging critical disease characteristics. The epilepsy‐specific CDE initiative can be viewed as part of the larger international movement toward “harmonization” of clinical disease characterization and outcome assessment designed to promote communication and research efforts in epilepsy. It will also provide valuable guidance for CDE improvement during further development, refinement, and implementation. This article describes the NINDS CDE Initiative, the process used in developing Epilepsy CDEs, and the benefits of CDEs for the clinical investigator and NINDS.

Epilepsy and EEG in the tElderly

Summary: Seizures are now the third most frequently encountered neurologic problem in the elderly population. The incidence of recurrent unprovoked seizures peaks in older patients. Because of this age‐related increase and the growing elderly population, evaluation and treatment of the elderly patient has received increasing attention. This article focuses on epilepsy, not acute seizures in the elderly. The causes and types of epilepsy older individuals experience are reviewed, along with the diagnostic role of EEG. Treatment options are briefly addressed.

Planned ictal FDG PET imaging for localization of extratemporal epileptic foci

Summary: Purpose: This work demonstrates the feasibility of planned ictal positron emission tomography (PET) with [18F]fluoro‐2‐deoxy‐glucose (FDG) for localization of epileptic activity in patients with frequent partial seizures of extratem‐poral origin.

A psychosocial self-management program for epilepsy: A randomized pilot study in adults

OBJECTIVE The goal of the work described here was to develop and pilot a theoretically based self-management intervention in adults with epilepsy. METHODS A randomized, controlled trial examined intervention effectiveness of a 6-week psychosocial intervention designed to improve self-efficacy and quality of life for 61 adults with diagnosed epilepsy. Measures included the Quality of Life in Epilepsy-89 inventory (QOLIE-89), the Washington Psychosocial Seizure Inventory (WPSI), a locus of control scale (LOC), and the Epilepsy Self-Efficacy Scale-2000 (ESES). Group differences were examined between groups using analysis of covariance. RESULTS There was a significant improvement in the QOLIE-89 Role Limitations-Emotional score in the treatment group at follow-up, but no significant differences in overall quality of life. Strong and significant correlations were observed between outcome measures. CONCLUSION Although the intervention had little effect on improving overall quality of life, we observed promising trends in postintervention group comparisons linking self-efficacy and other psychosocial factors with quality of life. Intervention material can be modified for stage-based behavior change and retested in another study.

Electrographic tachyphylaxis to etomidate and ketamine used for refractory status epilepticus controlled with isoflurane.

Etomidate and ketamine controlled seizures but acute tachyphylaxis occurred. Isoflurane was then used to control seizures.

Stimulus‐Sensitive Seizures in Postanoxic Coma

Summary: Purpose: To describe four patients with stimulus‐sensitive seizures and myoclonus following severe hypoxic‐ischemic injury.

Are psychiatric disorders independent risk factors for new-onset epilepsy in older individuals?

This retrospective study examined whether psychiatric conditions are directly related to epilepsy or, rather, are associated with underlying central nervous system (CNS) disorders linked to subsequent epilepsy. We examined data from a sample of older veterans (>65 years) receiving care from the Veterans Health Administration during fiscal year 2000. We compared individuals with new-onset epilepsy and individuals without epilepsy to examine the extent to which psychiatric disorders were associated with new-onset epilepsy; this analysis controlled for demographic and premorbid neurological risk factors previously associated with new-onset epilepsy. Premorbid psychiatric conditions occurred at higher rates in the epilepsy versus nonepilepsy groups, foremost including depression (17% vs 12%), anxiety (12% vs 8%), psychosis (12% vs 5%), and substance abuse (8% vs 4%). However, in the final model, only psychosis (OR=1.4, CI 1.2-1.6) was significantly associated with epilepsy when controlling for neurological disorders and psychiatric conditions (e.g., stroke, dementia, brain tumor, head injury).

Antiepileptic Drug Monotherapy Exposure and Suicide‐Related Behavior in Older Veterans

To examine the association between antiepileptic drug (AED) receipt and suicide‐related behavior (SRB) in older veterans.

Survey results of Internet and computer usage in veterans with epilepsy.

After our study of a self-management intervention for epilepsy, we gathered data on Internet use and computer availability to assess the feasibility of computer-based interventions in a veteran population. Veterans were asked to complete an anonymous questionnaire that gathered information regarding seizures/epilepsy in addition to demographic data, Internet use, computer availability, and interest in distance education regarding epilepsy. Three hundred twenty-four VA neurology clinic patients completed the survey. One hundred twenty-six self-reported a medical diagnosis of epilepsy and constituted the epilepsy/seizure group. For this group of veterans, the need for remote/distance-based interventions was validated given the majority of veterans traveled long distances (>2 hours). Only 51% of the epilepsy/seizure group had access to the Internet, and less than half (42%) expressed an interest in getting information on epilepsy self-management on their computer, suggesting that Web-based interventions may not be an optimal method for a self-management intervention in this population.

Benign EEG variants.

ABSTRACT. EEG is a valuable tool that assists in the accurate diagnosis of seizure disorders. The precise interpretation of EEG requires an ability to recognize patterns that are benign in nature but may be misinterpreted as indicative of a seizure tendency. This review will summarize benign variants encountered in adult EEGs including: small sharp spikes, wicket spikes, fourteen- and six-hertz positive bursts, six-hertz spike and wave, rhythmic temporal theta bursts of drowsiness, subclinical rhythmic electroencephalographic discharge in adults, and midline theta rhythms. Although most of these patterns are relatively uncommon, it is imperative that the clinical neurophysiologist identifies them as benign variants.