Abstracts

Rationale:
Accurate estimation of seizure localization is a critical component of epilepsy treatment planning, most importantly with regard to presurgical management.  As epileptologists initiate care and begin managing patients, neurologic exams and history-taking are an initial step in establishing patterns in seizure semiology and determining epileptic zone (EZ) and specific regions of interest (ROIs).  Further accurately determining these locations is of paramount importance and is one of the largest factors that can impact management and outcome (Kunieda, T., Kikuchi, T., & Miyamoto, S, 2012).  A multidisciplinary team approach can prove efficacious in accuracy of focal determination as well as increasing the strength in outcome, though it does require the integration multimodal information (Baltuch & Cukiert, 2020).  Synthesizing this information can serve to bolster care provider’s assumptions of EZ onset, as various evaluations and imaging techniques may continue to suggest similar zones; however, with additional assessments can come increasing time investment and increase in procedure invasiveness (e.g., intraoperative electrocorticography, intracranial EEG monitoring; Desai et al., 2011).  Therefore, it may well serve the epilepsy team during their evaluation to utilize and maximize less-invasive procedures when possible to not only assist in strengthening their conceptualization for seizure onset zone, but also possibly minimize the necessity for reliance on more-invasive procedures later in the evaluation process. Neuropsychology and epilepsy have had a longstanding reciprocal relationship with regard to understanding of specific brain functions, though a paradigm shift in the field  with regard to cognitive testing has recently forced practitioners to appreciate the subtleties (and flaws) in making assumptions of localized performances (Blumenfeld, 2002; Baxendale & Thompson, 2010).  Appreciating the complex and integrated functions of brain regions beyond the unidimensional (e.g., temporal lobe epilepsy = memory impairment) necessitates a more in-depth and robust neurocognitive evaluation to evaluate the various subtleties at play with regard to cortical development, neuroplasticity, seizure onset, semiology evolution, and electrophysiological propagation (Hermann et al., 1997; Bell et al., 2001; Hermann et al., 2007; Baxendale and Thompson, 2010; Baxendale et al., 2010; Vlooswijk et al, 2010).
Method:
In an attempt to provide non-invasive guidance for more expansive neurocognitive functioning, The University of Kentucky College of Medicine Department of Neurology’s NAEC Level 4 Epilepsy Center will be piloting the efficacy of a brief bedside ictal onset cognitive estimation task.  The task relies upon patients being presented with stimuli designed to test the integration of several cognitive domains (i.e., verbal and visual memory, language fluency, confrontation naming, object recognition) during a seizure and while undergoing cVEEG (continuous video electroencephalogram) monitoring.  With an anticipated N=10 of adult (age >18yo) patients, the purpose of this pilot study will be to examine the utilization of this task and correlate performance over video with EEG findings, and later correlate estimates based upon task performance with structural findings on neuroimaging and performance on neurocognitive testing.  It can then be evaluated for delivery feasibility by EMU (Epilepsy Monitoring Unit) employees.
Results:
Results pending (pilot investigation).
Conclusion:
Results pending (pilot investigation).
Funding:
:No funding for this pilot study.