Diagnostic Methods

Date: 31 0 8 2003

Report By: John S Duncan

Commission Members

John S Duncan (Chair), Tom Henry (Secretary), Robert Fisher , Ian Mothersill , Fernando Lopes da Silva, Marilyn Jonesgotman

The Commission met on 10 December 2002 in Seattle , and will meet on 11 Octob er 2003 in Lisbon .

Narrative   

The DMC has subcommissions, as follows:

Neuroimaging (Chair: Tom Henry )

Definitions of epilepsy (Chair: Robert Fisher )

Video description of Seizures (Chair: Ian Mothersill )

Neurophysiology (Chair: Fernando Lopes da Silva)

Neuropsychology (Chair: Marilyn Jonesgotman)

Each subcommission has agreed objectives to pursue over the next 3 years, in the form of producing guidelines and consensus statements that relate to their areas of expertise, and the organization of teaching skills workshops, in order to disseminate best practice.

Three one-day skills workshops will occur at the 25 th IEC in Tunis Lisbon on Saturday 11 October 2003 , covering Neuroimaging, Neuropsychology and Neurophysiology. US$ 20,000 of external sponsorship has been obtained and everything is in place for very successful workshops.

Subcommission reports

Neuroimaging

Chair: T Henry ( USA )

Secretary: F Cendes ( Brazil )

Members: R Bronen (USA), J S Duncan (UK), C Chiron (France), W Gaillard (USA), R Kuzniecky (USA), I Savic (Sweden), P Satishchandra (India)

Neuroimaging Subcommission Objectives

1. Recommendations on neuroimaging of children with epilepsy.
2. Recommendations on the standardization of imaging formats between centers.
3. Review of the current situation on neuroimaging in animal models of epilepsy.
4. Review of the current situation on neuroimaging and the biology of the epilepsies including development, neuroprotection, plasticity and genetics.
5. Planning and presentation of the Imaging Skills Workshop at the International Epilepsy Congress in 2003.

Progress towards Objectives

The greatest progress has been made in the fifth objective. The Workshop agenda and planning have been completed, for the Workshop on 11 October 2003 in Lisbon.

Drs. Chiron and Gaillard agreed to take on the first objective. Dr. Gaillard will present a draft of recommendations for imaging children at the Subcommission meeting on 11 October 2003.

Subcommission members agreed that it would be desirable to recruit other participants, probably basic scientists who are not active in the ILAE, to assist us in the third and fourth objectives. Dr. Henry will present candidates for discussion at the Subcommission meeting on 11 October 2003.

Most of the Subcommission members consider the second objective problematic, owing to the principal role that neuroradiologists hold in determination of imaging formats, and the considerable independence of various national and center-specific organizations in technical aspects of imaging. Dr. Bronen is working on opinions as to what if anything would be desirable to review systematically.

DEFINITION OF EPILEPSY

Chair: R Fisher ( USA )

Secretary: W Emde Boas ( Netherlands )

Members:

Warren Blume ( London , Canada )

Christian Elger ( Bonn , Germany )

Pierre Jallon ( Lausanne , Switzerland )

Pierre Bill ( Durban , South Africa )

Sucheta Joshi (Bombay/USA)

Pierre Genton ( Centre St Paul , Marseilles , France )

Objectives

1. Document on definitions of epilepsy and of seizures.

Progress towards Objectives

Dr Fisher and colleagues have developed a detailed draft of this Subcommission's position statement. This draft has undergone recent further revision. The subcommittee plans to meet in Lisbon to agree on wording of the definitions. The plan is to prepare the document as a position paper, with review by the DMC and ILAE Executive Committee, followed by submission to Epilepsia within one year.

NEUROPSYCHOLOGY

Chair: M Jonesgotman (Montreal , Canada )

Secretary: Mary Lou Smith (Ontario , Canada)

Members:

Gail Risse ( Minnesota , USA )

Michael Westerveld ( Connecticut , USA )

Susan Bookheimer ( California , USA )

Sally Baxendale ( London , UK )

Anna Rita Giovagnoli ( Milan , Italy )

Tatia Lee ( Hong Kong )

Michael Saling ( Melbourne , Australia )

Objectives

1. Recommendations on minimum standards for neuropsychological assessment prior to epilepsy surgery.
2. Neuropsychology for epilepsy skills workshop at ILAE meeting in 2003.

Progress towards Objectives

Members of this Subcommission met in Seattle on 8 December 2002. The Neuropsychology Skills Workshop for the Lisbon IEC has been prepared.

Topics being reviewed with the intent to write documents are:

Identify reliable neuropsychological localizing tasks.

• Find standard expression of performance. Examples of tests that assess these functions could be provided. The emphasis should be placed on the logic behind an assessment rather than a particular battery of tests.
• Determine our role in Quality of Life issues
• Define the interface of functional neuroimaging with neuropsychological assessment.
• Define the current role of the intracarotid amytal procedure in presurgical evaluation.

VIDEO CLASSIFICATION OF SEIZURES 

Chair: I Mothersill ( Zurich , Switzerland )

Secretary: P Hilfiker ( Zurich , Switzerland )

Members: T Grunwald ( Bonn , Germany ), A Ebner ( Bethel , Germany ), W van Emde Boas ( Amsterdam , Netherlands ), J Alving ( Denmark ), W Blume ( London , Canada )

Objectives:

1. Dissemination of "Signs of Epileptic seizures CD" (Completed)

2. Production of Nonepileptic attacks CD

Progress towards Objectives:

After many meetings and contacts with Aventis and Nihon Kohden a contract was agreed . Nihon Kohden have purchased (as a first batch) 100 copies of the CD-Rom "Signs of Epileptic Seizures" to distribute among their customers.

At first we assumed this would be followed up later with more but this will not be the case as to our surprise Aventis have decided to take all copies for distribution. This means that the disseminaton of "Signs of Epileptic Seizures" is finally completed.

Depending on how the reaction is from these two companies we will decide in the future as to whether or not we produce more copies.

The next project "Non-Epileptic attacks" is still waiting for sponsorship. A preview CD will be prepared for Lisbon

Due to the advances in DVD technology the next production will probably be combined, with from signs to seizures, i.e. which sign occurs in which seizure type and then comparing the e pileptic seizures to non- epileptic attacks that could cause diagnostic difficulties.

NEUROPHYSIOLOGY

Chair: F Lopes Da Silva (Netherlands)

Secretary: G Battaglia (Italy)

Members: Jean Gotman (Canada), Brian Litt (USA), Bernard Renault (France), Klaus Lennertz ( Germany), Dimitri Velis (Netherlands), Sylvia Kochen (Argentin ) , Perrine Plouin France)

Objectives

1. Recommendations for Standardization of digital EEG format for intersite transmission.
2. Neurophysiology skills workshop at ILAE Tunis, October 2003 meeting.

Progress towards Objectives

A Neurophysiology skills workshop for Lisbon on 11 October 2003 , has been designed and the didactic materials are being prepared in digital format (power-point presentations in a CD).

Regarding the Recommendations for Standardization of digital EEG format, a discussion among sub-committee members has led to enlarg ing the scope of this issue to account for more general recommendations regarding the requirements for long-term recordings in epilepsy. A position paper on this issue is being prepared.

John S Duncan