Abstracts

Rationale: Video-EEG monitoring (VEM) is a common method used to obtain a definitive diagnosis in patients with epilepsy that is often performed over several days. Smartphones are commonly used in everyday life and function as a telephone but also serve as information sharing portals and communication terminals. Popular features include a wide range of work-related, social and recreational functions. Electronically “texting” messages between cellular phones are a common form of communication. We report a unique EEG phenomenon in patients with paroxysmal neurological events undergoing video-EEG monitoring (VEM).Methods: Two epilepsy centers analyzed 131 patients using personal electronic devices (PEDs) in the epilepsy monitoring unit (EMU). A texting rhythm (TR) that was defined as a reproducible, stimulus-evoked, time-locked, generalized frontocentral monomorphic burst of 5-6 Hz theta consistently induced by active text messaging. An independent prospective and retrospective cohort were analyzed and compared between two sites inclucing Florida and Illinois. We assessed age, gender, diagnosis, epilepsy classification, MRI and EEG to compare patients with a TR. Analysis was performed using Pearson’s chi-square and Fisher’s Exact Test. Significance judged at p < 0.05.Results: We identified 24/98 evaluable patients with a TR at one center and 7/31 in another for an overall prevalence in 31/129 of 24.0%. The waveform prevalence was similar at both centers independent of location. A TR was highly specific to active texting (p< 0.0001). A similar waveform during independent cognitive, speech/language, motor activation and audio cellular telephone use was absent (p<0.0001). It appeared to be increased in patients with epilepsy in one cohort (p= 0.03) and generalized seizures in the other (p= 0.025). Age, gender, epilepsy type, MRI results, and EEG lateralization in patients with focal epileptic seizures (ES) did not bear a relationship to the presence of a TR in either arm of the study (p= NS).Conclusions: The TR is a novel and specific waveform time-locked to text messaging and linked to active use of smartphones. It provides objective evidence of an alteration in routine neurophysiologic function potentially interfering with tasks that require full attention (e.g. driving). Epileptologists should also be aware of the TR to separate it from an abnormality in epilepsy patients undergoing VEM. We believe that the TR reflects the neural coding seen during non-auditory communication measurable by EEG. Additional research may help identify the significance of this unique cognitive-visual-motor network that is technology-related and task-specific.