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Summary: Reduced heart rate variability (HRV) may predispose to sudden unexpected death in epilepsy (SUDEP). We ascertained whether HRV predicts SUDEP in chronic epilepsy using a case–control design and investigated parameters of inter-ictal HRV in 14 patients (7 had died from SUDEP). No HRV parameter was associated with SUDEP. Thus, although altered HRV might be involved in SUDEP, HRV parameters are not clear-cut predictors for SUDEP. [Copyright &y& Elsevier]

We describe two male patients with focal epilepsy in whom transitory episodes of atrial fibrillation (AF) lasting for up to 25h were detected in the context of generalized tonic-clonic seizures (GTCSs). In five of seven previously published cases of transitory AF associated with epileptic seizures, AF was also associated with GTCS, suggesting a pathophysiological link via GTCS-related increase in sympathetic tone and release of catecholamines. Importantly, AF increases the risk of thromboembolic cerebral ischemia, prompting the question of whether antithrombotic preventive treatment should be initiated in people with pharmacoresistant epilepsy and prolonged peri-ictal AF. Furthermore, AF can considerably impair cardiac output and may, via this mechanism, contribute to the risk of sudden unexpected death in epilepsy following GTCS. [ABSTRACT FROM AUTHOR]

Patient-reported seizure frequency is a key measure of modern epileptology regarding both research and individual treatment. Several studies from the last two decades, however, provided unambiguous evidence that patients underreport seizures. Here, we wanted to assess how patients experience the self-monitoring of their seizures and how they evaluate the data quality of their diaries. A novel 10-sided questionnaire addressed the following domains: sociodemographic characteristics, personality, epilepsy, treatment, seizure experience (separately for day and night), and documenting seizures/not documenting seizures, respectively. The survey was distributed to 1100 adult patients from our unit. We finally received N = 170 usable questionnaires (15.3%) indicating the patients’ little interest in this issue. On average, patients estimated to be aware of 5.3 out of 10 daytime seizures (95% CI 4.1–6.5) while relatives/colleagues appear to notice 7.1 (95% CI 6.1–8.1). For nocturnal seizures, patients stated to notice 2.6 out of 10 (95% CI 1.5–3.7) while relatives notice 4.6 (95% CI 3.4–5.8). One-hundred-four patients (61%, 95% CI 54–68%) reported to keep a seizure diary. These patients estimated to document 87% (95% CI 79–95%) of all daytime seizures they were aware of; for perceived nocturnal seizures the documentation rate was 77% (95% CI 67–87%). From this patient-reported data, the rate of documented daytime seizures can be estimated as 62% (95% CI 48–77%) in documenters and 38% (95% CI 26–53%) in the total sample. The respective percentages for documented nocturnal seizures are 35% (95% CI 23–50%) in documenters and 21% (95% CI 12–34%) in the total sample ( Fig. 1 ). In view of the low return rate, our data are even likely to overestimate the average documentation quality. Patients are well aware of the inherent difficulties to provide valid seizure counts and, consistent with many studies, lacking seizure awareness is the main cause of seizure underreporting. Note: First authorship is shared by CH and BB. [ABSTRACT FROM AUTHOR]

Introduction: Video-electroencephalography monitoring (VEM) is the current gold standard for in-hospital epilepsy diagnosis as well as for the diagnostics of many other paroxysmal and recurrent neurological symptoms. Consequently, high-performance VEM systems (VEMS) have become indispensable for performing modern in-hospital differential and presurgical epilepsy diagnostics. As a central diagnostic tool and interface between technology and doctors, VEMS also represent a relevant safety factor in inpatient diagnostics. Recently, complaints about malfunctions of VEMS have been reported repeatedly, some of which hinder the clinical diagnosis of epilepsy patients. Therefore, we investigated the reliability of, customer satisfaction with and potential for improvement of the VEMS used in German epilepsy centres. Materials and Methods: Between December 2020 and January 2021, a survey was conducted among German epilepsy centres. Using a short questionnaire including established business to customer metrics, such as the Net Promoter Score, the Customer Satisfaction Score, the Customer Effort Score and the Things Gone Wrong Metric, the reliability, customer satisfaction and potential for general or specific improvements of VEMS were accessed without aiming to compare individual manufacturers or systems in detail. Results: A total of 16 of 27 contacted epilepsy centres (59%) participated in the survey. Customer satisfaction with VEMS was low with only 13 % of clients that would actively recommend their system to other clinicians or epileptologists. Only 50 % of users were satisfied with the overall performance of their VEMS, and only 18 % were satisfied with the manufacturer's after-sales service. Major software or hardware problems were reported in the diagnostic of approximately every 10th patient. Common problem areas mentioned were the VEMS user interface, the stability of software, a shortage of regular updates and a lack of customer-oriented improvements. The greatest potential for improvement was found in software and hardware stability as well as in customer service. Conclusion: As far as it can reasonably be assessed from this German multicenter survey, the level of satisfaction among German epilepsy centres regarding their VEMS is soberingly low. This unsatisfaction seems to be mainly based on frequent and sometimes serious malfunctions of hardware and software on the one hand and a subjective dissatisfaction with the manufacturer's aftermarket customer service on the other hand. The fact that on average the diagnosis of every 10th patient is hampered by hardware or software problems should be an alarming sign, regardless of the general satisfaction with VEMS. Besides the obvious potential for improvement, there is an urgent need for national and international functional and safety standards for VEMS. [ABSTRACT FROM AUTHOR]

Purpose Epileptic seizures are frequently accompanied by alterations of autonomic function. Previous studies have suggested that especially changes in heart rate (HR) may help to distinguish epileptic from psychogenic, non-epileptic seizures (PNES). Some of these studies may be confounded by various features such as age, gender, state of wakefulness and seizure semiology. Here, we re-assessed periictal HR modulation in temporal lobe seizures (TLES) and PNES adjusted for a number of known confounders. Methods We retrospectively reviewed video-EEG data of people with refractory temporal lobe epilepsy undergoing presurgical assessment and of age- and gender matched patients without known epilepsy presenting with PNES. One seizure per patient was analyzed. HR was assessed with the help of a one-channel ECG lead at different time points (2 min before, during the seizure where HR was highest, immediately after seizure cessation, and 1, 2, 3, 5 and 10 min postictally). Data are given as mean ± SD. Results A total of 189 of patients and seizures were included in the study. Sixty TLES arising from wakefulness (20 men, 34 ± 12 years) and 129 PNES were analyzed. In the PNES group, 60 of the seizures had occurred spontaneously from wakefulness (PNES-S, 20 men, 37 ± 14 years), while 69 were induced by a provocation maneuver (verbal suggestion along with intravenous injection of vitamins; PNES-P, 23 men, 36 ± 14 years). In the PNES-P group, baseline HR was significantly higher as compared to the two other groups ( p < 0.01). In the TLES group, relative HR changes were significantly higher during and shortly after seizure cessation, as compared to the PNES-S group ( p 0.002). During seizures with major motor phenomena (generalized epileptic or psychogenic convulsions), relative HR changes during the seizures were not different ( p = 0.165, convulsive TLES n = 11, convulsive PNES-S n = 36). However, in the first three minutes after seizure cessation, HR was higher in the major motor TLES group ( p values < 0.01, 0.09 and 0.07). Furthermore, non-motor TLES displayed consistently higher relative HR changes during and shortly after seizure cessation up to 2 min postically as compared to the non-motor PNES-S. Conclusions TLES display higher relative HR changes during non-motor seizures as well as shortly after major motor and non-motor seizures, as compared to PNES-S. The setting of a provocation maneuver itself appears to enhance baseline HR. Taken together, our results support the notion that analysis of periictal HR is helpful in the differential diagnosis of epileptic versus psychogenic, non-epileptic seizures. [ABSTRACT FROM AUTHOR]