Mary Fitzsimons

Gender and the integration of acoustic dimensions of prosody: implications for clinical studies.

This study was conducted to detect the existence of a relationship between spectral and temporal prosodic cues and to examine gender differences in any such relationship. The rationale for the investigation was to gain a greater understanding of normal prosody and the requirements for control groups in clinical studies of prosody. Ten male and 10 female speakers with no known speech or neurological deficits participated in the study. They performed a reading task which involved delivering 10 sentences first with a declarative and then repeated with an interrogative intonation (20 sentences per speaker). Intrasubject and intersubject analyses of the speech data revealed a dependence of pitch on duration that differed between male and female speakers. Significant differences between the genders were also found in speech rate, pitch range, and pitch slope. The findings suggest that an integrated treatment of acoustic cues may provide a more invariant feature of normal prosody against which clinical groups may be compared. The data also imply that in clinical studies of the production of prosody gender should be carefully controlled.

Widespread cortical morphologic changes in juvenile myoclonic epilepsy: Evidence from structural MRI

Purpose:  Atypical morphology of the surface of the cerebral cortex may be related to abnormal cortical folding (gyrification) and therefore may indicate underlying malformations of cortical development (MCDs). Using magnetic resonance imaging (MRI)–based analysis, we examined cortical morphology in patients with juvenile myoclonic epilepsy (JME).

Cerebral Cortical Gyrification: A Preliminary Investigation in Temporal Lobe Epilepsy

Summary:  Purpose: To introduce a measure of global cortical folding in epilepsy by using stereology. Subtle developmental abnormalities associated with temporal lobe epilepsy may encompass brain morphologic changes such as an aberrant degree of cortical folding.

Improved patient specific seizure detection during pre-surgical evaluation

OBJECTIVE There is considerable interest in improved off-line automated seizure detection methods that will decrease the workload of EEG monitoring units. Subject-specific approaches have been demonstrated to perform better than subject-independent ones. However, for pre-surgical diagnostics, the traditional method of obtaining a priori data to train subject-specific classifiers is not practical. We present an alternative method that works by adapting the threshold of a subject-independent to a specific subject based on feedback from the user. METHODS A subject-independent quadratic discriminant classifier incorporating modified features based partially on the Gotman algorithm was first built. It was then used to derive subject-specific classifiers by determining subject-specific posterior probability thresholds via user interaction. The two schemes were tested on 529 h of intracranial EEG containing 63 seizures from 15 subjects undergoing pre-surgical evaluation. To provide comparison, the standard Gotman algorithm was implemented and optimised for this dataset by tuning the detection thresholds. RESULTS Compared to the tuned Gotman algorithm, the subject-independent scheme reduced the false positive rate by 51% (0.23 to 0.11 h(-1)) while increasing sensitivity from 53% to 62%. The subject-specific scheme further improved sensitivity to 78%, but with a small increase in false positive rate to 0.18 h(-1). CONCLUSIONS The results suggest that a subject-independent classifier scheme with modified features is useful for reducing false positive rate, while subject adaptation further enhances performance by improving sensitivity. The results also suggest that the proposed subject-adapted classifier scheme approximates the performance of the subject-specific Gotman algorithm. SIGNIFICANCE The proposed method could potentially increase the productivity of offline EEG analysis. The approach could also be generalised to enhance the performance of other subject independent algorithms.

The Irish epilepsy surgery experience: Long-term follow-up

AIM To assess the long-term seizure outcome of Irish patients who underwent resective surgery for refractory epilepsy since 1975. We also wished to determine the impact of pathology and surgical technique (with particular reference to neocorticectomy) on seizure outcome. METHODS A retrospective review of medical notes, radiological and histopathological records, was undertaken between 1975 and 2005. Missing data was supplemented by telephone calls to patients. One hundred and ninety-nine patients suited the criteria for inclusion and had at least 1-year follow-up (1-24 years, mean 7.0 years). Engels criteria were used to classify seizure outcome at 1, 2, 5, 10, 15 and >15 years follow-up. RESULTS The percentage of patients seizure free at 2, 5, 10, 15 and >15 years were, 56.6%, 41.4%, 44%, 25% and 31.3%, respectively. Of patients with a pathologically confirmed diagnosis of mesial temporal sclerosis, 55.6% were seizure free at 10 years. Equivalent figures for tumour were 62.5%, for cortical dysplasia, 34.8%, for those without any demonstrable pathologic abnormality, 50%, for dual pathology, 50% and for all others, 33.3%. Of those with 10 years or greater follow-up only 20% of neocorticectomy patients were in Engel class 1, compared with an average of 58.5% for the other surgical techniques. CONCLUSION Seizure freedom rates for Irish Patients were comparable to other large retrospective studies. Patients who underwent selective procedures tended to do better than those undergoing lobar resections, in keeping with international trends. The surgical technique unique to the Irish cohort, temporal necocorticectomy, had the worst long-term outcome.

Evidence-based models of care for people with epilepsy.

Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

An international survey of long-term video/EEG services.

To determine current practices in the provision of video-EEG services, the authors conducted an international survey by post. The aim of the survey was to evaluate, by reference to other centres, how and why certain things are done, be assured that their own center is providing a quality service, identify weaknesses in their service, and from this, set improvement goals and objectives. A purposive sampling method was used by sending questionnaires to 78 hospitals where it was believed a long-term video-EEG monitoring service existed. Completed survey questionnaires were returned from 42 centers. Although the survey mechanism may have resulted in self-selection bias, evaluation of the responses provides information on patient management, staffing levels, equipment, and equipment management. Ultimately, these data may aid in identifying a minimum set of requirements for the provision of a video-EEG telemetry service.

Regional increase of cerebral cortex thickness in juvenile myoclonic epilepsy.

The goal of this study was to characterize cerebral cortex thickness patterns in juvenile myoclonic epilepsy (JME). Surface‐based morphometry (SBM) was applied to process brain magnetic resonance images acquired from 24 patients with JME and 40 healthy controls and quantify cerebral cortex thickness. Differences in cortical thickness between patients and controls were determined using generalized linear model (covariates: age and gender). In patients with JME, thickness increase was detected bilaterally within localized regions in the orbitofrontal and mesial frontal cortices. Such thickness patterns coexisted with significant bilateral reduction in thalamic volume. These findings confirm that the underlying mechanisms in JME are related to aberrant corticothalamic structure and indicate that frontal cortex abnormalities are possibly linked to regional increase in cerebral cortical thickness.

The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.

Assessing the quality of epilepsy care with an electronic patient record

PURPOSE The American Academy of Neurology (AAN) quality indicators for epilepsy are designed to monitor quality, identify gaps, and ultimately drive improvements in clinical care. Appreciation of electronic patient records (EPR) to support such performance management is growing. This study aimed to demonstrate the use of an epilepsy-specific EPR in applying the AAN measures to objectively monitor clinical performance. METHOD A sample of out-patient clinics at Beaumont Hospital, Dublin was benchmarked against 4 of the AAN quality indicators. RESULTS 88% (142/160) of clinical encounters met the requirement to explicitly document seizure type and seizure frequency at each visit; aetiology or epilepsy syndrome was documented/updated for 58% (93/160); evidence of counselling about antiepileptic drug side effects was present in 34% (54/160) of records; counselling for women of childbearing potential was documented in 33% (18/57) of relevant records. CONCLUSION The EPR makes performance monitoring efficient and objective. Results suggest either failure to carryout recommended clinical tasks or poor documentation. Whichever is the case, a baseline is provided against which improvement goals can be set.