Diagnostic Methods

Commission Members

Aims

The DMC subcommissions are 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 Jones Gotman). 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.

Definition of Epilepsy

Chair: R. Fisher (Stanford, USA), W. Emde Boas (Netherlands), Warren Blume (London, Canada), Christian Elger (Bonn, Germany), Pierre Genton (Marseille, France), Jerome Engel, Jr. (Los Angeles, USA), Phillip Lee (London, UK).

Objectives

1. Document on definitions of epilepsy and of seizures.

Neuropsychology

Chair: M. Jones Gotman (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.

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.

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 (Argentina), Perrine Plouin (France).

Objectives

1. Recommendations for standardization of digital EEG format for intersite transmission.

Achievements prior to July 2003

Each subcommission agreed on objectives to pursue over the next 4 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.

Commission Activities July 31, 2003 to June 30, 2004

Three one-day skills workshops were held at the 25th IEC in Lisbon on Saturday 11 October 2003, covering Neuroimaging, Neuropsychology and Neuro-physiology. US $20,000 of external sponsorship was obtained and the workshops were a success. Attendance was lower than previously because the advertising of the workshops in the conference materials was poor and many potential attendees did not know of their existence until afterwards.

Neuroimaging progress towards objectives. C. Chiron and G. Gaillard have drafted recommendations for imaging children. 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. T. Henry is working on this area. The second objective is problematic, owing to the principal role that neuroradiologists hold in determination of imaging formats, and the considerable independence of various national and center-specific organisations in technical aspects of imaging. R. Bronen is working on opinions as to what if anything would be desirable to review systematically.

Definition of Epilepsy

Progress towards objectives. R. Fisher and colleagues have agreed upon definitions for the terms “epileptic seizures” and “epilepsy.” A paper has been written and submitted to the ILAE Executive Committee.

Neuropsychology

Progress towards objectives. Topics being reviewed with the intent to write documents are:

1. Identify reliable neuropsychological localizing tasks.
2. 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.
3. Determine our role in Quality of Life issues
4. Define the interface of functional neuroimaging with neuropsychological assessment.
5. Define the current role of the intracarotid amytal procedure in presurgical evaluation.

Video Classification of Seizures

Progress towards objectives. Nihon Kohden and Aventis have purchased and distributed copies of the CD-ROM “Signs of Epileptic Seizures” to distribute among their customers. The disseminaton of “Signs of Epileptic Seizures” is finally completed.

The next project “Non-Epileptic Attacks” is still waiting for sponsorship. 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 epileptic seizures to non-epileptic attacks that could cause diagnostic difficulties.

Neurophysiology

Progress towards objectives. Regarding the recommendations for standardization of digital EEG format, a discussion among subcommittee members has led to enlarging 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.

Upcoming Activities

We have set up an integrated Diagnostic Methods workshop for the 26th IEC in Paris, to be held on Saturday, 27 August 2005. In addition, the
subcommissions are working on completing their objectives.

John S. Duncan
Chair