Ictal quantitative surface electromyography correlates with postictal EEG suppression.
- Arbune AA From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark.
- Conradsen I From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark.
- Cardenas DP From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark.
- Whitmire LE From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark.
- Voyles SR From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark.
- Wolf P From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark.
- Lhatoo S From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark.
- Ryvlin P From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark.
- Beniczky S From the Department of Clinical Neurophysiology (A.A.A., P.W., S.B.), Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurosciences (A.A.A.), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; FORCE Technology (I.C.), Hørsholm, Denmark; Brain Sentinel (D.P.C., L.E.W., S.R.V.), San Antonio, TX; Department of Clinical Medicine (P.W.), Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Center for SUDEP Research (S.L.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Neurology (S.L.), University of Texas Health Sciences Center at Houston; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Department of Clinical Neurophysiology (S.B.), Aarhus University Hospital; and Department of Clinical Medicine (S.B.), Aarhus University, Denmark. sbz@filadelfia.dk.
- 2020-05-14
Published in:
- Neurology. - 2020
Adolescent
Adult
Algorithms
Child
Deltoid Muscle
Electroencephalography
Electromyography
Epilepsy, Tonic-Clonic
Female
Hamstring Muscles
Humans
Male
Middle Aged
Risk Assessment
Seizures
Young Adult
English
OBJECTIVE
To test the hypothesis that neurophysiologic biomarkers of muscle activation during convulsive seizures reveal seizure severity and to determine whether automatically computed surface EMG parameters during seizures can predict postictal generalized EEG suppression (PGES), indicating increased risk for sudden unexpected death in epilepsy. Wearable EMG devices have been clinically validated for automated detection of generalized tonic-clonic seizures. Our goal was to use quantitative EMG measurements for seizure characterization and risk assessment.
METHODS
Quantitative parameters were computed from surface EMGs recorded during convulsive seizures from deltoid and brachial biceps muscles in patients admitted to long-term video-EEG monitoring. Parameters evaluated were the durations of the seizure phases (tonic, clonic), durations of the clonic bursts and silent periods, and the dynamics of their evolution (slope). We compared them with the duration of the PGES.
RESULTS
We found significant correlations between quantitative surface EMG parameters and the duration of PGES (p < 0.001). Stepwise multiple regression analysis identified as independent predictors in deltoid muscle the duration of the clonic phase and in biceps muscle the duration of the tonic-clonic phases, the average silent period, and the slopes of the silent period and clonic bursts. The surface EMG-based algorithm identified seizures at increased risk (PGES ≥20 seconds) with an accuracy of 85%.
CONCLUSIONS
Ictal quantitative surface EMG parameters correlate with PGES and may identify seizures at high risk.
CLASSIFICATION OF EVIDENCE
This study provides Class II evidence that during convulsive seizures, surface EMG parameters are associated with prolonged postictal generalized EEG suppression.
To test the hypothesis that neurophysiologic biomarkers of muscle activation during convulsive seizures reveal seizure severity and to determine whether automatically computed surface EMG parameters during seizures can predict postictal generalized EEG suppression (PGES), indicating increased risk for sudden unexpected death in epilepsy. Wearable EMG devices have been clinically validated for automated detection of generalized tonic-clonic seizures. Our goal was to use quantitative EMG measurements for seizure characterization and risk assessment.
METHODS
Quantitative parameters were computed from surface EMGs recorded during convulsive seizures from deltoid and brachial biceps muscles in patients admitted to long-term video-EEG monitoring. Parameters evaluated were the durations of the seizure phases (tonic, clonic), durations of the clonic bursts and silent periods, and the dynamics of their evolution (slope). We compared them with the duration of the PGES.
RESULTS
We found significant correlations between quantitative surface EMG parameters and the duration of PGES (p < 0.001). Stepwise multiple regression analysis identified as independent predictors in deltoid muscle the duration of the clonic phase and in biceps muscle the duration of the tonic-clonic phases, the average silent period, and the slopes of the silent period and clonic bursts. The surface EMG-based algorithm identified seizures at increased risk (PGES ≥20 seconds) with an accuracy of 85%.
CONCLUSIONS
Ictal quantitative surface EMG parameters correlate with PGES and may identify seizures at high risk.
CLASSIFICATION OF EVIDENCE
This study provides Class II evidence that during convulsive seizures, surface EMG parameters are associated with prolonged postictal generalized EEG suppression.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1212/WNL.0000000000009492
- PMID 32398358
- Persistent URL
- https://sonar.ch/global/documents/945
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