Bashir Shihabuddin

Non-invasive detection and identification of brain activity patterns in the developing fetus

OBJECTIVE Utilizing a MEG-based device specifically designed to study the fetus, we investigated the presence of salient patterns in spontaneous fetal brain activity. METHODS We performed 91 MEG recordings from 30 fetuses at various gestational ages. The tracings were evaluated and compared to the well-established electroencephalographic (EEG) features in premature infants. Also, we looked at the correlation of the gestational age (GA) on the occurrence of these patterns and complexes. RESULTS We were able to identify specific patterns and track changes in fetal brain activity starting at 28 weeks of gestation. The patterns and trends were similar to the established EEG features in premature infants at comparable ages. Of the 30 fetuses, 18 (60%) had at least one recording with discontinuity, 7 (23%) had sharp transients, and 8 (27%) had delta brush activity. Further there was a decrease in the presence of discontinuous patterns after 35 weeks. CONCLUSIONS We have shown that fetal spontaneous brain activity features can be recorded and identified using MEG technique. The observation of more discontinuity at early gestational ages is consistent with the overall pattern of maturation seen in EEGs of premature infants. SIGNIFICANCE With refinements, this method can aid in understanding the maturation process of fetal brain activity and further develop as a tool for fetal neurological evaluation.

Epilepsy and the Impact of an Epileptology Clinic for Patients with Mental Retardation and Associated Disabilities in an Institutional Setting

Summary:  Purpose: Epilepsy is a common problem in institutionalized patients with multiple handicaps. Limited data exist on the characteristics of epilepsy in this patient population and the impact of systematic evaluation by an epilepsy service.

Orbito-frontal epilepsy masquerading as temporal lobe epilepsy—a case report

Temporal lobectomy fails to control seizures in a considerable percentage of patients who do not have hippocampal sclerosis. One theoretical reason for failure of surgery is that some of these patients may in fact have extratemporal epilepsy. We present a 28-year-old woman with clinical and scalp electroencephalogram (EEG) evidence of right temporal lobe epilepsy (TLE) supported by functional imaging with interictal positron emission tomography (PET) and ictal single-photon emission computerized tomography (SPECT). An invasive EEG monitoring was prompted by the discovery of a small right orbito-frontal lesion on MRI. Monitoring documented seizure onset at the lesion, with rapid right temporal involvement. The patient was almost seizure-free after a lesionectomy. The index of suspicion of orbito-frontal epilepsy should be high in patients with apparent TLE when the scalp EEG and neuroimaging data are not congruent, or if temporal lobe pathology cannot be identified on structural imaging.

Methadone induced Torsades de Pointes mimicking seizures in clinical presentation

Torsades de Pointes (TdP) has been associated with high dose methadone use. This usually presents clinically with palpitations, dizziness and syncope. We report a case of methadoneinduced TdP with an unusual clinical presentation mimicking convulsive seizures. This case highlights the importance of being aware of methadone-induced TdP and the possible atypical clinical manifestations of this condition.

Predictive Value of Electrocorticography in Patients With Mesial Temporal Lobe Epilepsy Undergoing Selective Amygdalohippocampectomy

Purpose: The utility of intraoperative electrocorticography has been reported in predicting seizure outcome in patients with mesial temporal lobe epilepsy due to mesial temporal sclerosis (MTS) undergoing standard temporal lobectomy. Three studies reported the predictive outcome in patients with MTS undergoing selective amygdalohippocampectomy (sAHE). We evaluate the predictive value of the intraoperative electrocorticography in postoperative outcome in patients with mesial temporal lobe epilepsy secondary to MTS undergoing sAHE. Methods: Retrospective analysis of 36 consecutive patients with mesial temporal lobe epilepsy undergoing sAHE between 2001 and 2012. A single neurosurgeon performed the sAHE. Preresection and postresection spikes were recorded in all patients and interpreted by two epileptologists. Long-term postoperative seizure freedom was correlated with intraoperative electrocorticography findings. Results: Ten patients had normal brain MRI (G1), whereas 26 had MTS (G2). All patients had MTS on histopathology. Mean duration of postoperative follow-up was 21.3 and 24.4 months for G1 and G2, respectively. In G1, 4/10 (40%) had resolution of spikes after sAHE, with 2/4 (50%) seizure free at last follow-up. Spikes were persistent in 6/10 (60%), with 5/6 (83%) seizure free at last follow-up (P value = 0.5). In G2, 7/26 (27%) had postresection resolution of spikes, with 5/7 (71%) seizure free at last follow-up. Spikes were persistent in 19/26 (73%), with 13/19 (68%) seizure free at last follow-up (P value = 0.62). The difference between the two arms of G1 and G2 was statistically insignificant. Conclusions: Postresection intraoperative electrocorticography has limited value in predicting postoperative seizure freedom in patients with mesial temporal lobe epilepsy secondary to MTS undergoing sAHE.

Seizures in Subdural Hematoma

Subdural hemorrhage (SDH) or hematoma is a common neurological condition that often complicates traumatic brain injury. It usually occurs when the bridging veins between the dura and arachnoid maters rupture allowing blood to accumulate in the subdural space. SDH is divided into acute, subacute, or chronic forms based on the time of head injury and clinical presentation. It is often surgically evacuated especially if the presentation is acute. SDH can be associated with different neurological signs and symptoms including seizures. There is an increased risk of seizures in the 1st week after SDH, and this risk may persist for some time after surgical decompression. Seizures can be partial or generalized in type, and status epilepticus can occur in these patients. The electroencephalogram (EEG) findings in SDH include focal and generalized slowing patterns and epileptiform discharges. Some of these patients benefit from continuous video-EEG monitoring which allows the identification of subtle or subclinical seizures and certain electrographic patterns that require treatment. Antiepileptic drugs (AEDs) are used whenever clinical seizures occur or prophylactically during the 1st week following an acute SDH. AEDs are often used prophylactically in chronic SDH, but this practice is controversial.

FC25.1 Non-invasive measurement of spontaneous fetal brain activity using magnetoencephalography

total of 226 neurons recorded in the rest conditions for 30–60 s were analyzed in terms of physiological characteristics. A mean firing rate was 30 ± 19 Hz (11–98 Hz). Movement related cells were observed in 96 neurons (42.4%) and showed tonic or irregular firing pattern. Three types of single unit were distinguished by the pattern of discharge: irregular (mean firing rate 28.5 ± 11.8 Hz, 58.3%), tonic (48.8 ± 15.9 Hz, 18.1%) and oscillatory (23.8 ± 13.1 Hz, 23.6%). Conclusion: The somatotopy and physiological characteristics of STN in this study were consistent with the previous studies in the human and monkeys.