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- The prevalence of post-therapy epilepsy in patients treated for high-grade glial tumors: a systematic review and meta-analysisPublication . Ferreira, Marta Pereira; Carvalho, Ruben Lopes; Soares, Joana Isabel; Casalta‑Lopes, João; Borges, Daniel Filipe; Borges, Daniel Filipe; Soares, Joana I.Gliomas are the most prevalent type of primary brain tumor of the adult central nervous system. High-grade gliomas (HGG) are the most common type of glioma. Epilepsy is often the first clinical manifestation of HGG. Since epilepsy leads to increased morbidity and mortality rates, seizure control is one of the main therapeutic goals for patients with glioma-related epilepsy. Post-therapy epilepsy is observed in a significant percentage of patients, hence, this work aimed to quantify the prevalence of post-therapy epilepsy after HGG treatment. Our search was conducted across PubMed®, EMBASE®, Web of Science™, Cochrane Library, Sicelo and Scopus, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This review included articles published in Portuguese or English that evaluate adult patients with newly diagnosed HGG, who were treated with at least surgery or radiation. Thirty-six studies reporting on 4036 HGG patients were included in our meta-analysis. The mean age ranged from 44 to 73 years. Glioblastoma was the most commonly observed HGG, representing 77,8% of all glioma patients. The pre-treatment seizure frequency was observed in 21,2%. All patients underwent surgery as the main therapy, and 1842 patients received standard adjuvant therapy. We also observed a pooled prevalence of post-therapy seizures of 25.5% (95% confidence interval of [19.9%; 31.1%]). Substantial heterogeneity in all assessed variables was observed. Conducting larger prospective studies with suitable epilepsy diagnostic methods would help provide a more precise estimate of the number of HGG patients who develop post-therapy epilepsy.
- Post-Therapy Epilepsy Prevalence in Patients with High-Grade Gliomas: a systematic review and meta-analysisPublication . Borges, Daniel Filipe; Soares, Joana I.; Casalta-Lopes, João; Ferreira, Marta Pereira; Carvalho, RubenHigh-grade gliomas are the most common type of malignant glioma. Seizures are frequently the first clinical manifestation of high-grade gliomas. Seizure-control is one of the main goals of treatment due to the impact in quality of life of these patients. Besides it impacts in morbidity and mortality rates there is a lack of evidence in the prevalence of post- therapy epilepsy. Our main goal was to evaluate the prevalence of epilepsy after the end of high-grade gliomas treatment. Our search was conducted across PubMed®️, EMBASE®️, Web of Science™️, Cochrane Library, Sicelo and Scopus, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all studies conducted on adults with newly diagnosed high-grade gliomas, who were treated with at least surgery or radiotherapy, and assessed for long-term side-effects (accounting for seizures) and published in Portuguese or English. Thirty-six studies were included in the meta-analysis, encompassing a total of 4036 patients with high-grade gliomas. Patient’s mean age ranged from 44 to 73 years, with a diagnosis of glioblastoma in 77,8% of all patients. Pretreatment seizures were observed in 21,2% of all cases. Surgery was the main treatment for all studies, with 1842 patients undergoing adjuvant therapy. Our meta-analysis identified a pooled prevalence of post-therapy seizures of 25.5%, with a 95% confidence interval of [19.9%;31.1%] (Z=8.90, p<.001). A significant heterogeneity between studies was observed (I2=96%, Q(35)=784, p<.001) with no significant asymmetry in funnel plot analysis (Z=1.27, p=.20). High-grade gliomas are a recognized trigger for seizures. A high heterogeneity in all the evaluated variables was observed. To minimize the diversity of results, a larger prospective studies using appropriate epilepsy diagnostic techniques would be beneficial to have a more exact number of the high-grade glial patients that develop post-therapy epilepsy.
- Sleep stage detection: a clinical validation study of a custom-built single-channel in-ear EEG sensorPublication . Borges, Daniel Filipe; Soares, Joana I.; Silva, Heloísa; Felgueiras, João; Batista, Carla; Ferreira, Simão; Rocha, Nuno; Leal, AlbertoIntroduction:Sleep is vital for health. It has regenerative and protective functions, and its disruption reduces the quality of life and increases susceptibility to disease. During sleep, there is a cyclicity of distinct phases that are studied using polysomnography (PSG), a costly and technically demanding method that compromises the quality of natural sleep. The search for simpler devices for recording biological signals at home addresses some of these issues. Objective: To clinically validate a custom-built single-channel in-ear EEG sensor for sleep classification by assessing various sleep metrics and staging decisions with simultaneously recorded PSG. Methods: Prospective cross-sectional study with 28 participants, divided into two groups: healthy volunteers and clinical patients. In both groups, PSG, individual in-ear EEG- with two different electrode configurations- and actigraphic recordings (only in the healthy group) were performed simultaneously for a whole night. Statistical analysis focussed on the four main sleep metrics: TRT (total recording time), TST (total sleep time), SE (sleep efficiency), SL (sleep latency) and the 5-class classifications (wakefulness, N1, N2, N3 and REM sleep). This included correlation analyses between methods and Bland-Altman plots, Cohen’s K coefficient, and confusion matrices aiming 30-second epoch-wise agreement with an automatic sleep classification algorithm using visual sleep classification by an ERSR-certified human expert as the gold standard according to current AASM guidelines. Results: The analysed sleep data comprised 30960 epochs. The correlation analysis revealed strong positive correlations (0.90) for all variables for the in-ear sensor. The Bland-Altman plots show a high level of agreement and consistency (+- 1.87 SD), with minimal bias between methods. The average kappa values (0.75) and the confusion matrices with each method's sensitivity and specificity also show a very high level of concordance.Conclusions: In both groups, the in-ear EEG sensor showed strong correlation, agreement and reliability with the gold standard, supporting accurate sleep classification.