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Biomedical subjects

J Gotman

Publications and source records attributed to J Gotman.

At least 73 records · Page 4Linked to original sources
PubMed1995

Frequency of the electroencephalographic discharge in seizures of focal and widespread onset in intracerebral recordings.

The information provided by the EEG during an epileptic seizure is of critical importance in the localization of an epileptic focus. Localizing information is usually provided by the region of onset, by the predominance of the discharge during the seizure, and by postictal slow waves. In patients with intracerebral electrodes, we investigated another aspect of the discharge: its highest frequency. We divided seizures into those with a focal onset and those with a regional onset. Results indicated clearly that fast frequencies (15-30 Hz) were much more frequent during seizures of focal onset than during seizures of widespread onset. Highest frequencies were not necessarily observed at the onset of focal seizures but could be observed at any time during a seizure of focal onset. High frequencies appear to characterize small epileptogenic zones (EZ). Our results may be helpful in the interpretation of intracerebral EEGs when large brain areas remain unexplored and one is often uncertain of the extent of an EZ.

Amygdala↗
PubMed1995

A seizure warning system for long-term epilepsy monitoring.

We developed a system to provide a warning early in the development of a seizure with a reasonably low false alarm rate. Such a warning will improve the close observation of seizures and interaction between observers and patients early in the seizure, even in seizures having no obvious clinical manifestation. The system relies on the availability of the EEG recording of one sample seizure, which is used as a template for subsequent detection. We evaluated the performance in 24 seizure types from scalp and intracerebral recordings. It yielded a 100% detection rate and a false alarm rate averaging one false alarm every 5 hours. The warning signal was given, on average, 9.6 seconds after EEG seizure onset. The system will be useful in improving the clinical observation of seizures and may allow ictal SPECT scans to be more widely performed.

Electroencephalography↗
PubMed1993

Graphic representation of the EEG during epileptic seizures.

In seizures starting gradually, careful examination of the background is required to determine the time and region of onset. We propose a method for displaying EEG variables which characterize seizure onset: changes in amplitude and in average frequency compared to background. These variables are displayed topographically for each EEG channel so that 1 or 2 min of EEG may be viewed on a standard screen, thus representing pre-ictal and ictal periods. We evaluated the ability of this display to indicate seizure onset, by comparing the times and regions of seizure onset indicated by traditional EEG and by the display. The comparison was performed on 30 seizures from scalp recordings and 49 seizures from depth recordings. Seizures were selected for having a gradual onset with no or minimal artefact. Onset times from traditional EEG and the computer method, examined independently, coincided (within 3 sec) in 77% of scalp seizures and 63% of depth seizures. In 14% of seizures the computer display indicated an onset more than 3 sec earlier than visual examination; upon reexamination, however, this onset was thought to be possibly correct. This quantitative display, which in practice should be used with traditional EEG, may thus be useful for computer-assisted seizure interpretation and for a condensed representation of seizures.

Brain↗
PubMed1993

Improvement in seizure detection performance by automatic adaptation to the EEG of each patient.

An important problem in the use of automatic seizure detection during long-term epilepsy monitoring is that false detections can be very frequent, often because a paroxysmal but non-epileptiform pattern occurs repeatedly in a particular patient. We therefore introduce a method to reduce such patient-specific false seizure detections. The program "learns" about the false detections occurring in the first day of a prolonged monitoring session and attempts to eliminate similar patterns occurring during the remainder of the session. This method was evaluated in 20 patients having particularly high false detection rates. Seventy EEG sessions from 10 patients with scalp electrodes and 64 sessions from 10 patients with depth electrodes, covering a total of 2600 h were used in the evaluation. False detections were reduced by 61% (50% in scalp recordings and 71% in depth recordings), with only a 5% probability of losing true seizures. The average false detection rate in these patients fell from 3.25/h to 1.26/h. This significant reduction in false detections could also lead to lower detection thresholds and consequently to the detection of more true seizures.

Automation↗
PubMed1992

State dependent spike detection: validation.

We present a formal validation of the method of state dependent spike detection; its principle and initial results were given in Gotman and Wang (1991). The method utilizes different procedures for elimination of non-epileptic transients according to state (active or quiet wakefulness, sleep stages); it also varies detection sensitivity according to state. Twenty new 100 min recordings were obtained from 20 unselected patients, covering active wakefulness, quiet wakefulness and various sleep stages. Results indicated that, while the total number of detections was reduced by 15%, true detections increased by 39% and false detections decreased by 60%. This significant improvement is due to the fact that wave morphology is now considered within its spatial context and particularly within a wide temporal context.

Adolescent↗
PubMed1992

Intracranial EEG study of brain structures affected by internal carotid injection of amobarbital.

Hippocampal function, considered critical in memory processing, is supposedly tested in the intracarotid sodium amobarbital (ISA) procedure; however, since the hippocampus is not completely irrigated by the internal carotid artery, some believe the procedure may be invalid for memory testing. We quantified delta activity in intracerebral EEGs during ISA tests. There was increased delta in ipsilateral structures as follows: amygdala (6.4 minutes), anterior hippocampus (7.2), middle hippocampus (7.4), temporal neocortex (9.1), frontal lobe (8.4), central/parietal area (11.0), and occipital lobe (9.7). Contralateral structures usually (> 64%) showed increased delta lasting 4 to 5 minutes. The ipsilateral hippocampus had delta waves in over 90% of injections. We conclude that the hippocampus is clearly affected by the ISA injection. We argue that the slow waves may not be caused by a direct effect of the drug, but rather by a functional deafferentation due to the profound inactivation of structures surrounding the hippocampus. Similarly, slow waves contralateral to injection may be caused by sudden removal of neuronal input from the regions receiving the amobarbital.

Amobarbital↗
PubMed1991

State-dependent spike detection: concepts and preliminary results.

In traditional methods of spike detection, spikes are defined in absolute terms (duration, amplitude) or relative to a few seconds of background. These methods result in many false positive detections during long-term epilepsy monitoring because of numerous artefacts and non-epileptic transients. To reduce significantly false detection, we propose to render spike detection sensitive to the state of the EEG. We thus defined 5 states (active wakefulness, quiet wakefulness, desynchronized EEG, phasic EEG and slow EEG) and designed a method for automatic state classification. We then designed procedures for identification of non-epileptic transients (eye blinks, EMG, alpha, spindles, vertex sharp waves). These procedures are to be applied only in the state in which they are likely to occur (e.g., eye blinks in wakefulness). We present preliminary results from 14 recordings each lasting 100 min, which indicate a state classification reliability of 85-90%, reduction in false detection of 65-90% if state classification were perfect; true spikes lost as a result of these procedures were under 5%. These results are encouraging and validate the concept of a spike detection system which analyses a wide temporal and spatial context before deciding the significance of a wave form.

Blinking↗
PubMed1991

Effects of seizures and carbamazepine on interictal spiking in amygdala kindled cats.

We examined the influence of seizures and carbamazepine (CBZ) on spiking rates in kindled cats. In the first experiment, spiking rates were measured before and after seizures, with and without CBZ. CBZ was administered immediately after seizures in order not to affect them. Spiking rates were measured over 9 h during the different sleep stages. In a second experiment, CBZ was administered before and after seizures so as to affect seizure strength and thus measure its effect on spiking. Results confirmed earlier findings of a large increase in spiking following a stage 6 seizure in fully kindled animals. We also established that: (1) repeated daily seizures caused a further increase in spiking until a ceiling was reached; (2) increased spiking was not a direct effect of postictal alterations in sleep stages; (3) CBZ, despite its effectiveness as an anticonvulsant, did not reduce spiking but rather increased it; (4) postictal increases in spiking were related to seizure 'strength'. These findings support the hypothesis that spiking rates are primarily influenced by seizure occurrence, as was found in patients with temporal lobe seizures, and that anticonvulsants act differently on seizures and spikes. This emphasizes the possibility of distinct pathophysiological mechanisms for interictal spikes and seizures.

Action Potentials↗
PubMed1991

Relationships between interictal spiking and seizures: human and experimental evidence.

Epileptic seizures of focal origin often occur unpredictably as do interictal spikes. It is often assumed that spikes increase prior to seizures of focal origin and that antiepileptic medication affects spikes and seizures in a parallel fashion. We review evidence that this assumption is invalid and that there is a clear dissociation between spikes and seizures: increases in spiking before seizures have not been clearly documented; decreases in antiepileptic medication do not result directly in increased spiking; seizures are often followed by long-lasting increases in spiking; finally, seizures are no more likely when spikes are frequent than when spikes are rare. It therefore appears that spikes and seizures are two quite distinct phenomena, both originating in the epileptic focus but varying over time differently from what is most often believed.

Anticonvulsants↗
PubMed1991

Interictal spiking during wakefulness and sleep and the localization of foci in temporal lobe epilepsy.

We examined variations in interictal spiking during sleep and wakefulness to assess differences in reliability for localizing epileptic foci. Forty patients were studied prospectively. Spikes were assessed for rates, field, and appearance of new foci. Final localization was determined by surgery, electrocorticography, and seizure onset. Comparison of interictal EEG foci with final localization was made. In 39 patients, slow-wave sleep activated spiking compared with wakefulness. Most patients showed maximal spiking in sleep stages 3 or 4. Restriction of field in rapid eye movement (REM) sleep and wakefulness, and extension of field in slow-wave sleep occurred. New foci appeared in non-rapid eye movement sleep in 53% of patients. Similar but not identical spiking rates, foci, and field distributions were seen in wakefulness and REM sleep. All REM foci were unilateral. Our findings suggest that localization of the primary epileptogenic area is more reliable in REM sleep than in wakefulness, and in wakefulness more than in slow-wave sleep.

Action Potentials↗
PubMed1990

Automatic seizure detection: improvements and evaluation.

Improvements to an existing automatic seizure detection program are described. They are aimed at taking into account a larger temporal context and thus improving the specificity of the detections. Results were evaluated on 293 recordings from 49 patients, totaling 5303 h of 16-channel recording. They showed that 24% of the 244 seizures recorded were missed by the automatic detection; in 41% of the seizures, the patient alarm was not pressed but the computer made detections. The false detection rate was of the order of 1 false detection per hour of recording. Conclusions are: (1) automatic seizure detection must be used in conjunction with a patient alarm button since some seizures, having poorly defined EEG activity, are not detected; (2) the automatic detection allowed capture of many seizures, clinical and subclinical, for which the alarm was not pressed; (3) the low false detection rate indicates that lower detection threshold could be used, yielding better seizure detection.

Adolescent↗
PubMed1990

Quantitative EEG analysis of carbamazepine effects on amygdaloid kindled seizures in cats.

We studied the effects of carbamazepine (CBZ) on seizure behaviour and electroencephalographic (EEG) activity in 6 amygdala kindled cats. CBZ reduced the behavioural severity of kindled seizures and prolonged the earlier seizure stages (latency to stage 4). These effects were not always paralleled by a reduction in the duration of seizure activity. EEG activity paradoxically increased in amplitude during early and mid-seizure, then fell in late seizure after CBZ. CBZ also caused an overall decrease in EEG coherence during mid and late seizure. These observations represent a first attempt to use quantitative EEG analysis to investigate the effects of anticonvulsants on electrographic seizure activity. The duration of postictal EEG suppression was reduced after CBZ treatment. The results support the view that CBZ has a major effect on limiting the spread of seizure discharges.

Administration, Oral↗
PubMed1990

Can slow waves in the electrocorticogram (ECoG) help localize epileptic foci?

In patients operated for medically refractory epilepsy, ECoGs are often performed to help further localize the epileptogenic focus. During the necessarily short recording, spikes may be rare or absent, or may be only a partial representation of the epileptic activity. The usefulness of background abnormality in localizing the focus in ECoGs was therefore determined. The relationships of MRI, CT, and pathological findings with ECoG background were also noted. The ECoGs of 40 patients were recorded. Delta activity was evaluated by spectral analysis. In 22 ECoGs, maximum delta activity coincided spatially with maximum spiking or was adjacent to it. The region of maximum delta activity rarely coincided with CT, MRI and pathological findings. Although the relationship between delta activity and spiking was much stronger than expected by chance, it may not be sufficient to allow the use of delta activity to localize a focus in individual cases.

Action Potentials↗
PubMed1990

Asymmetry in delta activity in patients with focal epilepsy.

The localization of epileptogenic foci usually relies on multiple factors. The validity of background EEG abnormalities in lateralizing or localizing the focus was examined. Asymmetries in delta activity were measured by comparing EEGs of epileptic subjects to that of control subjects. The relationships of MRI, CT and pathological findings with delta asymmetries were also noted. In only 2 of 22 patients, delta activity showed no asymmetry. In 17 patients, delta asymmetries correlated with the side of the focus, and in the remaining 3 patients, predominant delta activity was observed in the hemisphere contralateral to the focus. The analysis of the relationship between delta activity and lesions observed on the CT scan was inconclusive. The area exhibiting predominant delta activity frequently coincided with the regions showing solitary discrete lesions on MRI scans. The results suggest that slow wave abnormalities, when measured by comparison to a control population, can be useful in lateralizing the epileptogenic focus.

Adult↗
PubMed1990

Changes in seizure activity following anticonvulsant drug withdrawal.

We retrospectively studied the effects of changing antiepileptic drug levels on patterns of seizure discharge in 8 patients investigated with intracerebral electrodes during presurgical evaluation. We compared seizures recorded at high levels of medication to seizures recorded at low levels for changes in seizure duration, duration from unilateral onset to contralateral spread, inter- and intrahemispheric coherence, and morphology of EEG discharges. Seizures were more frequent with low medication, as was secondary generalization. Reduction in medication did not affect the morphology of discharges at onset, duration to contralateral spread, and coherence between EEG discharges. Seizures of similar type (eg, complex partial seizures without secondary generalization) were not longer with low than with high medication. Whereas medication clearly affects seizure frequency and generalization, it has little effect on the pattern of early parts of seizures. In particular, we found no evidence that seizure discharges become bilateral or generalized more quickly when medication is reduced.

Anticonvulsants↗
PubMed1989

Interictal spiking increases after seizures but does not after decrease in medication.

In patients with focal epilepsy, EEG spike rate fluctuates considerably over time. We had previously shown that seizure occurrence played an important role in these fluctuations. We undertook this study to confirm this finding with better control of critical variables such as state of alertness and spike quantification, and to assess the spatial extent of the changes. Background activity changes and antiepileptic drug levels were also examined in relation to spiking. Spike discharge rate increased in the hours and days following seizures in widespread brain regions including, but not restricted to, the seizure focus. Spike rate did not change systematically before seizures. Postictal changes in background activity did not parallel spike fluctuations. Decreased antiepileptic drug levels did not cause increased spike rate. These results indicate that, following seizures, there is activation of interictal spiking which is not paralleled by changes in background activity. It is most often widespread and not necessarily most prominent at the site of seizure onset.

Adult↗