Children with generalized seizures are often excluded as epilepsy surgery candidates. This prospe... more Children with generalized seizures are often excluded as epilepsy surgery candidates. This prospective study was conducted to evaluate the utility of magnetoencephalography (MEG) to refine the location of the "irritative zone" in children with single lesions on magnetic resonance imaging (MRI) but with generalized ictal electroencephalographic (EEG) findings. Patients admitted with refractory epilepsy with imaging studies showing focal or hemispheric abnormalities but scalp video EEG showing generalized or multiregional epileptiform abnormalities were included. Patients were encouraged into natural sleep, and simultaneous whole-head MEG/EEG was recorded. Source localization of epileptic spikes on MEG was carried out while blinded to other results. Acceptable dipoles were classified into 3 groups: focal, hemispheric clusters, and single focal cluster with additional widespread dipoles. Nine patients (4 female, 5 males; ages 10 months to 15 years) were included. Two had foca...
Objective. To unveil current medical and psychosocial conditions of patients with West syndrome i... more Objective. To unveil current medical and psychosocial conditions of patients with West syndrome in Japan.Methods. A cross‐sectional analysis was performed in patients with West syndrome registered in the Rare Epilepsy Syndrome Registry (RES‐R) of Japan. Furthermore, new‐onset patients registered in the RES‐R were observed prospectively and their outcomes after one and two years of follow‐up were compared with data at onset.Results. For the cross‐sectional study, 303 patients with West syndrome were included. Seizures (such as spasms, tonic seizures and focal seizures) occurred daily in 69.3% of the patients at registration. Seizure frequency of less than one per year was observed in cases of unknown etiology (22.6%), genetic etiology (23.8%) and malformation of cortical development (MCD; 19.1%). Neurological findings were absent in 37.0%, but a high rate of abnormality was seen in patients with Aicardi syndrome, hypoxic‐ischemic encephalopathy (HIE), genetic etiology and MCD other t...
Objective. To examine the current medical and psychosocial status of patients with epilepsy, aimi... more Objective. To examine the current medical and psychosocial status of patients with epilepsy, aiming to facilitate appropriate application of the Intractable/Rare Diseases Act of Japan.Methods. By analysing the cross‐sectional data of patients registered in the tertiary hospital‐based Epilepsy Syndrome Registry of Japan, we investigated the proportion of patients who met the severity criteria as defined by the Act (seizure frequency of at least once a month, or presence of intellectual/neurological/psychiatric symptoms, or both) and whether there are candidate syndrome/diseases to be added to the existing list in the Act.Results. In total, 2,209 patients were registered. After excluding self‐limited/idiopathic epilepsies, 1,851 of 2,110 patients (87.7%) met the severity criteria. The patients were classified into eight main epilepsy syndromes (594 patients), 20 groups based on aetiology (1,078 patients), and three groups without known aetiology (427 patients). Most of the groups clas...
BACKGROUND: Recovery time after corpus callosotomy (CC) is known to be longer in elderly than in ... more BACKGROUND: Recovery time after corpus callosotomy (CC) is known to be longer in elderly than in younger patients. OBJECTIVE: To evaluate the relationship between patient age and recovery time of activities of daily living (ADL) after 1-stage complete CC. METHODS: This study included 41 patients (22 women; aged 13 months-34 years, median 7 years) who underwent 1-stage complete CC for medically intractable seizures with drop attacks, infantile spasms, and/or bilaterally synchronized electroencephalographic discharges between August 2009 and April 2019. The timing of restart of competence in 5 ADL categories and surgical outcomes were recorded. RESULTS: Patients (1) restarted speech at 2.2 ± 1.3 (mean ± 2 standard deviations; range 1-5) days, (2) restarted replying with their own name on request at 5.5 ± 8.6 (2-33) days, (3) restarted oral intake at 1.6 ± 1.7 (1-11) days, (5) discontinued intravenous feeding at 6.0 ± 3.0 (2-16) days, and (5) restarted ambulation or wheelchair movement at 5.8 ± 3.4 (2-10) days. Younger patients showed significantly (P < .0223) earlier recovery of ambulation or wheelchair movement, but no age difference was found in the other 4 ADL categories. Overall seizure freedom was achieved in 5 patients, excellent (>80%) seizure reduction in 11, good (50%-80%) seizure reduction in 5, and poor (<50%) seizure reduction in 20. CONCLUSION: Early ADL recovery after 1-stage complete CC is favorable in both young and adult patients. These findings, with good surgical outcomes, will encourage more positive consideration of 1-stage complete CC in both pediatric and adult patients.
Objective: Analysis of the electroencephalogram (EEG) for epileptic spike and seizure detection o... more Objective: Analysis of the electroencephalogram (EEG) for epileptic spike and seizure detection or brain-computer interfaces can be severely hampered by the presence of artifacts. The aim of this study is to describe and evaluate a fast automatic algorithm for ongoing correction of artifacts in continuous EEG recordings, which can be applied offline and online. Methods: The automatic algorithm for ongoing correction of artifacts is based on fast blind source separation. It uses a sliding window technique with overlapping epochs and features in the spatial, temporal and frequency domain to detect and correct ocular, cardiac, muscle and powerline artifacts. Results: The approach was validated in an independent evaluation study on publicly available continuous EEG data with 2035 marked artifacts. Validation confirmed that 88% of the artifacts could be removed successfully (ocular: 81%, cardiac: 84%, muscle: 98%, powerline: 100%). It outperformed state-of-the-art algorithms both in terms of artifact reduction rates and computation time. Conclusions: Fast ongoing artifact correction successfully removed a good proportion of artifacts, while preserving most of the EEG signals. Significance: The presented algorithm may be useful for ongoing correction of artifacts, e.g., in online systems for epileptic spike and seizure detection or braincomputer interfaces.
• A validation study of the Japanese version of the problem gambling severity index (PGSI) in a n... more • A validation study of the Japanese version of the problem gambling severity index (PGSI) in a nationwide community sample. • The Japanese version of PGSI had excellent internal consistency and moderate test-retest reliability. • We demonstrated the PGSI had good criterion validity using the diagnosis of gambling disorder in DSM-5 as a reference standard.
BACKGROUND Acceptance of disability (AOD) is a key concept in rehabilitation psychology that enha... more BACKGROUND Acceptance of disability (AOD) is a key concept in rehabilitation psychology that enhances psychosocial adjustment of individuals with disability. However, the impact of AOD on well-being has never been examined for patients with epilepsy. The present study investigated whether AOD affects quality of life (QOL) in patients with epilepsy in the presence of other multiple aspects of epilepsy based on the biopsychosocial model. METHODS We retrospectively reviewed 151 consecutive patients with epilepsy (77 men, aged 18-74 years) who underwent comprehensive assessment including long-term video-EEG monitoring, neuroimaging studies, and neuropsychological and psychosocial assessment in our epilepsy monitoring unit. Data were obtained from medical records and self-reported questionnaires. The outcome variable was QOL. Predictive variables included demographic characteristics, seizure-related variables (i.e., duration of epilepsy, seizure frequency, and number of antiepileptic drugs), psychological factors (i.e., AOD, depression, and self-stigma), and social factors (i.e., social support and education level). Acceptance of disability was measured by the Adaptation of Disability Scale-Revised (ADS-R), which we translated into Japanese with the original author's approval, and examined its internal consistency reliability. Data were analyzed using four hierarchical multiple regression analysis models. RESULTS The mean ADS-R score was 80 (range 45-115). The predictors accounted for 42% of the variance in QOL (R2 = 0.45, ΔR2 = 0.42, F[8, 141] = 14.47, p = 0.00). Higher AOD (p < 0.01), higher social support (p < 0.01), and lower depression scores (p = 0.02) were found to contribute significantly to higher overall QOL. CONCLUSION The present study revealed AOD as an important psychological concept, in addition to social support and depression as previously reported, to improve the QOL of patients with epilepsy. Acceptance of disability should be incorporated in the intervention to increase QOL of patients with epilepsy.
The influence of sleep on interictal epileptiform discharges is well known, yet its impact on ict... more The influence of sleep on interictal epileptiform discharges is well known, yet its impact on ictal EEG changes is not fully investigated. We report three patients with posterior quadrant epilepsy showing focal ictal EEG onset during NREM sleep, but not during wakefulness. Materials and methods: Three patients with posterior quadrant epilepsy (three men; 25, 41, and 44 years) were included in the present study. They underwent 4-day video-EEG monitoring in our epilepsy monitoring unit. Scalp EEG was performed using the 10-20 system with additional anterior temporal electrodes. Sleep stages were scored based on the American Academy of Sleep Medicine criteria. Habitual seizures were recorded both during wakefulness and sleep. Ictal EEG recordings and neuroimaging studies (i.e., MR imaging and FDG-PET) were reviewed. Results: All three patients were diagnosed as neocortical epilepsy arising from temporo-parieto-occipital lobe. In patient 1 (25 year-old right-handed male), complex partial seizures with automatism were recorded. Ictal EEG changes started with rhythmic beta activity in the left posterior temporal region during NREM sleep, but not during wakefulness. MRI showed focal cerebral defect after the resection of traumatic lesion in the left parietal lobe. In patient 2 (41 year-old right-handed male), complex partial seizures were recorded. Ictal EEG changes started with rhythmic beta activity in the left temporo-occipital region during NREM sleep, but not during wakefulness. Neither MRI nor FDG-PET showed abnormalities. In patient 3 (44 year-old right-handed male), complex partial seizures with vocalization were recorded. Ictal EEG changes started with rhythmic beta activity in the left temporo-occipital region during NREM sleep, but not during wakefulness. MRI showed focal atrophic lesion in the left parieto-occipital lobe. Conclusion: Ictal EEG findings of neocortical epilepsy arising from temporo-parieto-occipital lobe may be susceptible to sleep. Seizures during NREM sleep can elicit focal EEG onset and have higher detectability and localization accuracy than those during wakefulness.
Children with generalized seizures are often excluded as epilepsy surgery candidates. This prospe... more Children with generalized seizures are often excluded as epilepsy surgery candidates. This prospective study was conducted to evaluate the utility of magnetoencephalography (MEG) to refine the location of the "irritative zone" in children with single lesions on magnetic resonance imaging (MRI) but with generalized ictal electroencephalographic (EEG) findings. Patients admitted with refractory epilepsy with imaging studies showing focal or hemispheric abnormalities but scalp video EEG showing generalized or multiregional epileptiform abnormalities were included. Patients were encouraged into natural sleep, and simultaneous whole-head MEG/EEG was recorded. Source localization of epileptic spikes on MEG was carried out while blinded to other results. Acceptable dipoles were classified into 3 groups: focal, hemispheric clusters, and single focal cluster with additional widespread dipoles. Nine patients (4 female, 5 males; ages 10 months to 15 years) were included. Two had foca...
Objective. To unveil current medical and psychosocial conditions of patients with West syndrome i... more Objective. To unveil current medical and psychosocial conditions of patients with West syndrome in Japan.Methods. A cross‐sectional analysis was performed in patients with West syndrome registered in the Rare Epilepsy Syndrome Registry (RES‐R) of Japan. Furthermore, new‐onset patients registered in the RES‐R were observed prospectively and their outcomes after one and two years of follow‐up were compared with data at onset.Results. For the cross‐sectional study, 303 patients with West syndrome were included. Seizures (such as spasms, tonic seizures and focal seizures) occurred daily in 69.3% of the patients at registration. Seizure frequency of less than one per year was observed in cases of unknown etiology (22.6%), genetic etiology (23.8%) and malformation of cortical development (MCD; 19.1%). Neurological findings were absent in 37.0%, but a high rate of abnormality was seen in patients with Aicardi syndrome, hypoxic‐ischemic encephalopathy (HIE), genetic etiology and MCD other t...
Objective. To examine the current medical and psychosocial status of patients with epilepsy, aimi... more Objective. To examine the current medical and psychosocial status of patients with epilepsy, aiming to facilitate appropriate application of the Intractable/Rare Diseases Act of Japan.Methods. By analysing the cross‐sectional data of patients registered in the tertiary hospital‐based Epilepsy Syndrome Registry of Japan, we investigated the proportion of patients who met the severity criteria as defined by the Act (seizure frequency of at least once a month, or presence of intellectual/neurological/psychiatric symptoms, or both) and whether there are candidate syndrome/diseases to be added to the existing list in the Act.Results. In total, 2,209 patients were registered. After excluding self‐limited/idiopathic epilepsies, 1,851 of 2,110 patients (87.7%) met the severity criteria. The patients were classified into eight main epilepsy syndromes (594 patients), 20 groups based on aetiology (1,078 patients), and three groups without known aetiology (427 patients). Most of the groups clas...
BACKGROUND: Recovery time after corpus callosotomy (CC) is known to be longer in elderly than in ... more BACKGROUND: Recovery time after corpus callosotomy (CC) is known to be longer in elderly than in younger patients. OBJECTIVE: To evaluate the relationship between patient age and recovery time of activities of daily living (ADL) after 1-stage complete CC. METHODS: This study included 41 patients (22 women; aged 13 months-34 years, median 7 years) who underwent 1-stage complete CC for medically intractable seizures with drop attacks, infantile spasms, and/or bilaterally synchronized electroencephalographic discharges between August 2009 and April 2019. The timing of restart of competence in 5 ADL categories and surgical outcomes were recorded. RESULTS: Patients (1) restarted speech at 2.2 ± 1.3 (mean ± 2 standard deviations; range 1-5) days, (2) restarted replying with their own name on request at 5.5 ± 8.6 (2-33) days, (3) restarted oral intake at 1.6 ± 1.7 (1-11) days, (5) discontinued intravenous feeding at 6.0 ± 3.0 (2-16) days, and (5) restarted ambulation or wheelchair movement at 5.8 ± 3.4 (2-10) days. Younger patients showed significantly (P &lt; .0223) earlier recovery of ambulation or wheelchair movement, but no age difference was found in the other 4 ADL categories. Overall seizure freedom was achieved in 5 patients, excellent (&gt;80%) seizure reduction in 11, good (50%-80%) seizure reduction in 5, and poor (&lt;50%) seizure reduction in 20. CONCLUSION: Early ADL recovery after 1-stage complete CC is favorable in both young and adult patients. These findings, with good surgical outcomes, will encourage more positive consideration of 1-stage complete CC in both pediatric and adult patients.
Objective: Analysis of the electroencephalogram (EEG) for epileptic spike and seizure detection o... more Objective: Analysis of the electroencephalogram (EEG) for epileptic spike and seizure detection or brain-computer interfaces can be severely hampered by the presence of artifacts. The aim of this study is to describe and evaluate a fast automatic algorithm for ongoing correction of artifacts in continuous EEG recordings, which can be applied offline and online. Methods: The automatic algorithm for ongoing correction of artifacts is based on fast blind source separation. It uses a sliding window technique with overlapping epochs and features in the spatial, temporal and frequency domain to detect and correct ocular, cardiac, muscle and powerline artifacts. Results: The approach was validated in an independent evaluation study on publicly available continuous EEG data with 2035 marked artifacts. Validation confirmed that 88% of the artifacts could be removed successfully (ocular: 81%, cardiac: 84%, muscle: 98%, powerline: 100%). It outperformed state-of-the-art algorithms both in terms of artifact reduction rates and computation time. Conclusions: Fast ongoing artifact correction successfully removed a good proportion of artifacts, while preserving most of the EEG signals. Significance: The presented algorithm may be useful for ongoing correction of artifacts, e.g., in online systems for epileptic spike and seizure detection or braincomputer interfaces.
• A validation study of the Japanese version of the problem gambling severity index (PGSI) in a n... more • A validation study of the Japanese version of the problem gambling severity index (PGSI) in a nationwide community sample. • The Japanese version of PGSI had excellent internal consistency and moderate test-retest reliability. • We demonstrated the PGSI had good criterion validity using the diagnosis of gambling disorder in DSM-5 as a reference standard.
BACKGROUND Acceptance of disability (AOD) is a key concept in rehabilitation psychology that enha... more BACKGROUND Acceptance of disability (AOD) is a key concept in rehabilitation psychology that enhances psychosocial adjustment of individuals with disability. However, the impact of AOD on well-being has never been examined for patients with epilepsy. The present study investigated whether AOD affects quality of life (QOL) in patients with epilepsy in the presence of other multiple aspects of epilepsy based on the biopsychosocial model. METHODS We retrospectively reviewed 151 consecutive patients with epilepsy (77 men, aged 18-74 years) who underwent comprehensive assessment including long-term video-EEG monitoring, neuroimaging studies, and neuropsychological and psychosocial assessment in our epilepsy monitoring unit. Data were obtained from medical records and self-reported questionnaires. The outcome variable was QOL. Predictive variables included demographic characteristics, seizure-related variables (i.e., duration of epilepsy, seizure frequency, and number of antiepileptic drugs), psychological factors (i.e., AOD, depression, and self-stigma), and social factors (i.e., social support and education level). Acceptance of disability was measured by the Adaptation of Disability Scale-Revised (ADS-R), which we translated into Japanese with the original author's approval, and examined its internal consistency reliability. Data were analyzed using four hierarchical multiple regression analysis models. RESULTS The mean ADS-R score was 80 (range 45-115). The predictors accounted for 42% of the variance in QOL (R2 = 0.45, ΔR2 = 0.42, F[8, 141] = 14.47, p = 0.00). Higher AOD (p < 0.01), higher social support (p < 0.01), and lower depression scores (p = 0.02) were found to contribute significantly to higher overall QOL. CONCLUSION The present study revealed AOD as an important psychological concept, in addition to social support and depression as previously reported, to improve the QOL of patients with epilepsy. Acceptance of disability should be incorporated in the intervention to increase QOL of patients with epilepsy.
The influence of sleep on interictal epileptiform discharges is well known, yet its impact on ict... more The influence of sleep on interictal epileptiform discharges is well known, yet its impact on ictal EEG changes is not fully investigated. We report three patients with posterior quadrant epilepsy showing focal ictal EEG onset during NREM sleep, but not during wakefulness. Materials and methods: Three patients with posterior quadrant epilepsy (three men; 25, 41, and 44 years) were included in the present study. They underwent 4-day video-EEG monitoring in our epilepsy monitoring unit. Scalp EEG was performed using the 10-20 system with additional anterior temporal electrodes. Sleep stages were scored based on the American Academy of Sleep Medicine criteria. Habitual seizures were recorded both during wakefulness and sleep. Ictal EEG recordings and neuroimaging studies (i.e., MR imaging and FDG-PET) were reviewed. Results: All three patients were diagnosed as neocortical epilepsy arising from temporo-parieto-occipital lobe. In patient 1 (25 year-old right-handed male), complex partial seizures with automatism were recorded. Ictal EEG changes started with rhythmic beta activity in the left posterior temporal region during NREM sleep, but not during wakefulness. MRI showed focal cerebral defect after the resection of traumatic lesion in the left parietal lobe. In patient 2 (41 year-old right-handed male), complex partial seizures were recorded. Ictal EEG changes started with rhythmic beta activity in the left temporo-occipital region during NREM sleep, but not during wakefulness. Neither MRI nor FDG-PET showed abnormalities. In patient 3 (44 year-old right-handed male), complex partial seizures with vocalization were recorded. Ictal EEG changes started with rhythmic beta activity in the left temporo-occipital region during NREM sleep, but not during wakefulness. MRI showed focal atrophic lesion in the left parieto-occipital lobe. Conclusion: Ictal EEG findings of neocortical epilepsy arising from temporo-parieto-occipital lobe may be susceptible to sleep. Seizures during NREM sleep can elicit focal EEG onset and have higher detectability and localization accuracy than those during wakefulness.
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Papers by Kazutaka Jin