Meeting Special Needs: A practical guide to support children with Epilepsy

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There is, however, no doubt that the analysis of neuronal oscillations is still open to considerable progress. All current methods face the same difficulties: For example, the presence of noise and multiple oscillations might destroy the discernibility of spectral peaks representing rhythmic activity. Often, the methods are optimized for a particular database and the detection is limited by investigator experience, inducing possible bias, low interrater reliability, and problems with reproducibility. This should include an adapted display of the detection results to allow visual checking of detections, as a gold standard for automatic detection is still missing.

The cooperation between research centers, adopting common analysis procedures combined with the sharing of wide bandwidth data, will help to standardize automated detection strategies of HFOs. A specific reason for this interest is that it might help us understand and distinguish physiologic and epileptic HFOs. A DC amplifier or an AC amplifier with long time constant, that is, 10 s, can be used to record slow shifts as long as the following three conditions are carefully considered from the methodologic point of view: 1 the kind of metals used for electrodes, 2 the size of the recording surface, and 3 the input impedance of the amplifier.

Therefore, for intracranial electrodes, the only polarizable metals are available, such as platinum, stainless steel, and gold. Because the capacitance is proportional to the electrode surface area Fig. To minimize imbalance of electrode potentials, use of a system reference made of platinum is recommended, even if employed as a surface or scalp electrode such as a mastoid electrode. Peaks of VHFOs were visually identified on a computer screen, and the frequency, amplitude, and duration were measured.

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Because the amplitude of VHFOs are very low and duration is very short, magnification of the horizontal time and vertical amplitude axes is essential for visual detection. VHFOs were considered true if the frequencies of the oscillations at both filter settings were the same. Waveforms of VHFOs are not typical sinusoidal waves, and fluctuations in frequency and amplitude for individual peaks appear in waveforms.

Interictally, VHFOs appear intermittently, followed by spikes. Combined recording of both HFOs and other rhythms, especially of DC shifts and delta rhythms, depends on how bandpass filter and sampling rate are set for appropriate wideband EEG recording. Coupling with other rhythms could be applicable for both ictal and interictal activities. Ictal activity was described earlier. For interictal activity, as opposed to ictal DC shifts of long duration, rather short, fragmented slow activity of delta frequency or slower activity has been observed.

Especially slow waves of sleep show coupling with presumed epileptic HFOs on the slope of the slow wave and with presumed physiologic HFOs after the peak of the slow wave. An example is the modulation index, which reflects the strength of coupling between amplitude of HFOs and the phase of slow waves. HFOs are novel electromagnetic biomarkers for epileptogenic brain tissue, and we are standing at the threshold of a change in clinical practice and basic understanding of epilepsy. The 2nd international workshop on High Frequency Oscillations in Epilepsy held in Freiburg, Germany, included a teaching workshop.

This kind of teaching needs to be repeated and extended to increase comprehension. Meanwhile, software producers are currently extending the capabilities by building in HFO filters and analysis methods. Despite the existence of a couple of publications describing and evaluating automatic detection algorithms, only a few publications focus on the application of the detector. Their application should be encouraged despite their limitations as complements to visual HFO assessment and to open new opportunities, where visual HFO analysis is not feasible due to its extreme time demands, like in multichannel recordings.

Electrode sensor diversity is increasing and preclinical research demands for higher channel counts and smaller dimensions continue to drive development. Recording devices can be developed with a focus on low noise and artifacts.


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The number of patients is still relatively low, so the economic drive is low for companies to go beyond small evolutionary development steps. Public incentives are needed to initiate public—private partnerships to help disruptive technologies come to the market for new therapies. Other authors have no potential conflicts of interest to disclose.

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Please review our Terms and Conditions of Use and check box below to share full-text version of article. Summary Objective Technology for localizing epileptogenic brain regions plays a central role in surgical planning. Results We emphasize the importance of low noise recording to minimize artifacts. Figure 1 Open in figure viewer PowerPoint. Examples of HFOs recorded with different recording methods. What can be seen are ripples and fast ripples that precede the cortical surface ripples and fast ripples slightly and very HFOs that can be recognized on one depth electrode channel.

C Intraoperative electrocorticography showing a spike, a ripple, and a fast ripple. A sharp wave and a ripple can be recognized. Evoked sensorimotor responses Evoked sensorimotor responses. HF, high frequency. Figure 2 Open in figure viewer PowerPoint. Influence of the size of recording electrodes on spatial resolution and recording properties transfer function. Small electrodes allow for recording of small nerve cell ensembles right but result in high impedance magnitude Z.

Large electrode sites left exhibit large capacitive and small resistive values, which results in lower impedance at low frequencies and a low cutoff frequency from which signal attenuation is constant. Figure 3 Open in figure viewer PowerPoint. Examples of grid and depth electrodes. Grid arrays A — F and depth electrodes G — H.

Main advances in the development of grids focus on higher spatial sampling, which requires new solutions for wiring and amplification. Figure 4 Open in figure viewer PowerPoint. The essence of different automated HFO detectors: A Broadband electrophysiologic recording of brain activity. B First detector stage consisting either of filtering the recordings to the HFO frequency bands or performing time—frequency analysis on the broadband recordings.

C Feature extraction, for example, based on higher signal amplitudes during the oscillation in the filtered recordings, spectral profiles, or computer vision approaches applied to time—frequency analysis. D Wide range of classification approaches: From simple thresholding to modern machine learning approaches. This special issue of Progress in Neurobiology is dedicated to the meeting held at the Montreal Neurological Institute, Canada.

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Crossref Google Scholar. Crossref PubMed Google Scholar. Citing Literature. Volume 58 , Issue 8 August Pages Figures References Related Information. Close Figure Viewer. This propensity to suicide is attributed to several factors, the most obvious being that people with epilepsy live under very difficult psychosocial circumstances.

Many adults struggle to keep a job, and young people face misunderstanding and even bullying from peers at school. The resulting isolation, coupled with the unpredictability and lack of control inherent to a seizure disorder, make it no surprise that anxiety and depression feature prominently in epilepsy. But epilepsy itself is also believed to contribute to mood disorders, likely because seizures — as well as head traumas that might result from them — damage brain tissue.

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The longer a person has had epilepsy and the more severe the problem, the higher the risk of suicide. Finally, the availability of prescription medications provides patients with a means to harm themselves. The most common suicide method among people with epilepsy is overdosing on antiepileptic drugs.

A: First, I regularly screen all my patients with epilepsy for suicide risk — every six months is appropriate, and more often if the patient is deemed at elevated risk. I recommend the Ask Suicide Screening Questions ASQ tool, which takes only 10 minutes to administer and has been validated for teens and adults with epilepsy.

Meeting Special Needs: A Practical Guide to Support Children with Epilepsy

Developed by the National Institute of Mental Health, it is available free online. Individuals deemed at imminent risk of suicide are immediately referred for additional assessment. For those deemed at low immediate risk but who express thoughts of anxiety or depression and have considered suicide in the past, I help develop coping strategies: What are things they can do to feel better when they are low?

Together we come up with a list, which might include things like meditation exercises, taking a walk or watching a movie. We also discuss next steps if such techniques prove inadequate. It is important to screen for mood disorders, depression and anxiety in people with epilepsy, as these are the more likely causes of increased suicidality in this population. The use of antidepressant medications is another hot topic. Many doctors are uncomfortable adding mood-altering drugs to antiepileptic medications, so they wishfully think, along with their patients, that depression will lift once epilepsy is brought under control.