PubMed · 13923039
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K TUKEL. 1962. [On epilepsy].. https://pubmed.ncbi.nlm.nih.gov/13923039/
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OBJECTIVES: The Standards of Practice Committee of the American Sleep Disorders Association has supported the use of actigraphy in the assessment of sleep disorders. Pollak et al disagree. The objective of this paper is to identify and critically evaluate several theoretic and methodologic issues that are central to these divergent views regarding the valid use of actigraphy for sleep assessment. DESIGN: Critical review, analysis, and comment. SETTING: N/A. PATIENTS/PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: N/A. CONCLUSIONS: (1) Coefficients of the validity of actigraphy exceed those associated with common medical tests and the best psychological tests. (2) Reasons why actigraphy should be held to a substantially higher empirical standard than common medical tests and the best psychological tests have yet to be advanced. (3) Differences between actigraphy and polysomnography are not random and can be reduced. (3a) Sleep onset is a gradual rather than a discrete process. Actigraphy keys on an earlier phase of the sleep-onset process than does polysomnography, resulting in systematic rather than random differences. (3b) A sleep switch device can be used to substantially increase the accuracy of sleep-onset times. (3c) The residual unreliability of polysomnographic data explains a portion of the differences between actigraphy and polysomnography. Actigraphy cannot be expected to agree more completely with polysomnography than polysomnography does with itself. (4) Complete agreement between actigraphy and polysomnography has been presumed, but achieving such a limit is theoretically impossible. Some lower maximum agreement limit should be identified. (5) Conclusions that actigraphy is not an accurate sleep-wake indicator and that it is inappropriate to infer sleep from actigraphy data are not supported by the findings. Conclusions reached, including caveats, by the Standards of Practice Committee remain supported.
Temporal lobe epilepsy (TLE) is the most common type of refractory epilepsy. The mechanisms of epileptogenesis and seizure semiology of the mesial and neocortical temporal lobe epilepsy are discussed. The evaluation and selection of patients for TLE surgery requires team work: the different clinical aspects of neuropsychological evaluation, magnetic resonance and functional imaging (positron emission tomography, single photon emission computed tomography and magnetoenephalography) are reviewed. In our programme of epilepsy surgery at Kuopio University Hospital, Finland, we have performed 230 temporal resections from 1988 until 2002. Preoperative diagnostic EEG-videotelemetry often required intracranial monitoring and it has proved to be safe and efficient. The indications and technique for tailored temporal lobe resection with amygdalohippocampectomy used in our institution, as well as the complications, are described. Our analysis of outcome after temporal lobe surgery included 140 consecutive adult patients between 1988 and 1999; one year after the operation in unilateral TLE the Engel I-II outcome was observed in 68% of the patients. Outcome of surgery improved significantly after introduction of the standardised MR imaging protocol from 1993; 74% of patients with unilateral TLE achieved Engel I-II outcome.
OBJECTIVE: To assess whether MEG is superior to scalp-EEG in the localization of interictal epileptiform activity and to stress the 'con' part in this controversy. METHODS: Advantages and disadvantages of the two techniques were systematically reviewed. RESULTS: While MEG and EEG complement each other for the detection of interictal epileptiform discharges, EEG offers the advantage of long-term recording significantly increasing its diagnostic yield which is not feasible with MEG. Localization accuracies of EEG and MEG are comparable once inaccuracies for the solution of the forward problem are eliminated. MEG may be more sensitive for the detection of neocortical spike sources. EEG and MEG source localizations show comparable agreement with invasive electrical recordings, can clarify the spatial relationship between the irritative zone and structural lesions, guide the placement of invasive electrodes and attribute epileptic activity to lobar subcompartments in temporal lobe epilepsy and to a lesser extent in extratemporal epilepsy. CONCLUSIONS: A clear superiority of MEG over EEG for the localization of interictal epileptiform activity cannot be derived from the studies presently available. SIGNIFICANCE: The combination of EEG and MEG provides information for the localization of interictal epileptiform activity which cannot be obtained with either technique alone.