Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/30888
Title: Paroxysmal fast activity is a biomarker of treatment response in DBS for Lennox-Gastaut syndrome.
Austin Authors: Dalic, Linda J ;Warren, Aaron E L;Spiegel, Chloe;Thevathasan, Wesley;Roten, Annie ;Bulluss, Kristian J ;Archer, John S 
Affiliation: Department of Surgery, University of Melbourne, Parkville, VIC, Australia
Murdoch Children's Research Institute, Parkville, VIC, Australia
Bionics Institute, East Melbourne, VIC, Australia
Department of Medicine, University of Melbourne, and Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
Neurosurgery
Medicine (University of Melbourne)
Neurology
The Florey Institute of Neuroscience and Mental Health
Issue Date: 17-Sep-2022
Date: 2022
Publication information: Epilepsia 2022; 63(12): 3134-3147
Abstract: Epilepsy treatment trials typically rely on seizure diaries to determine seizure frequency, but these are time-consuming and difficult to accurately maintain. Fast, reliable, and objective biomarkers of treatment response are needed, particularly in Lennox-Gastaut syndrome (LGS) where high seizure frequency and co-morbid cognitive and behavioural issues are additional obstacles to accurate diary-keeping. Here, we measured generalised paroxysmal fast activity (GPFA), a key interictal electrographic feature of LGS, and correlated GPFA burden with seizure diaries during a thalamic deep brain stimulation (DBS) treatment trial (ESTEL). GPFA and electrographic seizure counts from intermittent, 24-hour EEGs were compared to 3-monthly diary-recorded seizure counts in 17 young adults with LGS (mean age ±1SD=24.9±6.6) in the ESTEL study, a randomised clinical trial of DBS lasting 12 months (comprising a 3-month baseline and 9 months of post-implantation follow-up). Baseline median seizures measured by diaries was 2.6 (IQR:1.4-5) per day, compared to 284 (IQR:120.5-360) electrographic seizures per day, confirming that diaries capture only a small fraction of seizure burden. Across all patient EEGs, the average number of GPFA discharges per hour of sleep was 138 (IQR:72-258). GPFA duration and frequency, quantified over 2-hour windows of sleep EEG, were significantly associated with diary-recorded seizure counts over 3-month intervals (p<0.001, η²p = 0.30-0.48). For every one GPFA discharge, there were 20-25 diary seizures witnessed over 3 months. There was high between-patient variability in the ratio between diary seizure burden and GPFA burden; however, within individual patients, the ratio was similar over time, such that the percentage change from pre-DBS baseline in seizure diaries strongly correlated with the percentage change in GPFA. When seeking to optimise treatment in patients with LGS, monitoring changes in GPFA may allow rapid titration of treatment parameters, rather than waiting for feedback from seizure diaries.
URI: https://ahro.austin.org.au/austinjspui/handle/1/30888
DOI: 10.1111/epi.17414
ORCID: https://orcid.org/0000-0001-8335-1348
https://orcid.org/0000-0002-3939-3847
Journal: Epilepsia
PubMed URL: 36114808
Type: Journal Article
Subjects: GPFA
LGS
deep brain stimulation
epilepsy
outcome prediction
Appears in Collections:Journal articles

Show full item record

Page view(s)

36
checked on Apr 19, 2024

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.