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Effects of Botulinum Toxin Injection on Reducing Myogenic Artifacts During Video-Eeg Monitoring: A Longitudinal Study Publisher Pubmed



Ghelichnia B1 ; Balali P1 ; Farahmand G2 ; Shafiee Sabet M3 ; Feizi S4 ; Pourghaz B1 ; Jameie M1, 5 ; Tafakhori A1
Authors
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Authors Affiliations
  1. 1. Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Neurology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Ziaian Hospital, Department of Family Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Neuroscience Research Center Iran, University of Medical Sciences, Tehran, Iran

Source: Neurodiagnostic Journal Published:2022


Abstract

Medically refractory seizures affect one-third of patients with epilepsy (PwE), for whom epilepsy surgery is considered. Video electroencephalography (vEEG) monitoring is a fundamental tool for pre-operative seizure localization. Facial and cranial myogenic artifacts can obscure vEEG findings, thus interfering with seizure localization. Studies have shown the beneficial effects of botulinum toxin type A (BTX-A) injection into cranial muscles for reducing myogenic artifacts. This longitudinal study aimed to assess the effects of BTX-A injection on these artifacts. Twenty-two patients with medically refractory hypermotor seizures with daily seizure frequency and undetermined epilepsy localization were included in this study and underwent Dysport® injection (200 units) into the frontotemporal region. vEEG recordings were performed at baseline (one week before the injection), and at three days and six days post-injection. Before and after the injection, the amplitudes of myogenic artifacts were compared during various states (ictal, blinking, chewing, bruxism, head lateralization, scowling, talking, and yawning). BTX-A injection significantly reduced the amplitudes of EEG myogenic artifacts, except during blinking (day three) and talking (days three and six). On day six, significant reduction in EEG myogenic artifacts were noted during blinking, chewing, and bruxism for the greatest number of patients (95.5%, 90.9%, 81.8%), while significant reductions in EEG myogenic artifacts during talking, head lateralization, and ictal phase were associated with the least number of patients (22.7%, 36.3%, and 40.9%). Therefore, BTX-A injection could be a convenient method for filtering myogenic contamination, improving EEG interpretation, and facilitating seizure localization in patients with medically refractory seizures. © 2022 ASET–The Neurodiagnostic Society.