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Reduction of EEG Myogenic Artifact with Botulinum Toxin during Video‐EEG Monitoring
Author(s) -
Grant Arthur C.,
Hermanowicz Neal
Publication year - 2007
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2006.00930.x
Subject(s) - ictal , artifact (error) , electroencephalography , scalp , botulinum toxin , epilepsy , medicine , anesthesia , psychology , audiology , surgery , neuroscience
Summary: Purpose: To determine whether EEG myogenic artifact during video‐EEG monitoring (VEM) is reduced with targeted scalp botulinum toxin (BTX‐A) injections. Methods: Twelve consecutive patients scheduled for presurgical VEM were treated 2–3 weeks before admission with subcutaneous BTX‐A injections at specific EEG electrode locations. On the basis of clinical data available before VEM, four subjects were treated unilaterally (group 1) and eight bilaterally (group 2). BTX‐A efficacy was assessed quantitatively in group 1 subjects by comparing high‐frequency (20–100 Hz) power at homologous “treated” and “untreated” electrodes during voluntary forceful jaw closure. The clinical impact of BTX‐A treatment was assessed by determining whether ≥5 of the first 10 s of each ictal recording was obscured by muscle artifact, and whether residual myogenic artifact on BTX‐A–“treated” electrodes rendered these ictal EEG segments impossible to interpret. Results: BTX‐A treatment reduced high‐frequency power by a mean of 53% at electrodes T3/T4 and 52% at electrodes F7/F8. None of 49 ictal EEGs had ≥5 of the first 10 s obscured by myogenic artifact, and all of these ictal epochs were interpretable. Adverse events were limited to two subjects who complained of transient difficulty chewing tough foods. Conclusions: Scalp‐muscle BTX‐A treatment before VEM significantly reduces myogenic artifact in subsequent EEG recordings, including ictal EEG. The clinical utility of this technique for improved or more‐rapid seizure localization will be determined only by large, blinded, prospective trials.