title: Is ictal cognitive dysfunction predictable?
abstract: OBJECTIVE
  Accurate prediction of electrographic seizure onset may reduce injuries and improve quality of life in pharmaco-resistant epileptics. However, because sub-clinical, far out-number clinical seizures, indiscriminate issuance of warnings may have a paralyzing effect on these patients. This study investigates the predictability of ictal cognitive dysfunction.
  
  
  METHODS
  Latency and percentage of correct responses to a reaction time test triggered by automated seizure detections were compared to those obtained inter-ictally in 14 subjects undergoing surgery evaluation. Since accurate prediction of seizures is elusive, early detection was used, as it indirectly but reliably investigates for the existence of a cognitive pre-ictal state.
  
  
  RESULTS
  Significant differences between ictal and inter-ictal cognitive performance were not uncovered until late into the temporal evolution of "focal" seizures.
  
  
  CONCLUSIONS
  These observations suggest that cognitive dysfunction is unpredictable in seizures originating from discrete cortical regions, as the transition into unawareness seems abrupt.
  
  
  CONCLUSIONS
  Prediction of electrographic seizure onsets with worthwhile accuracy would likely result in large numbers of daily warnings, the great majority for sub-clinical seizures. This outcome would considerably increase, without safety justification, patients' psychological burden inherent to each forecast, thus further diminishing quality of life.
authors.affiliation: Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, United States. Electronic address: iosorio@kumc.edu.
authors.forename: Ivan
authors.initials: I
authors.lastname: Osorio
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology*; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D004569:Electroencephalography / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012640:Seizures / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
keywords: Clinical; Cognitive; Ictal; Inter-ictal; Pre-ictal; Prediction; Quality of life; Seizures; Sub-clinical; Warning