title: TMS combined with EEG in genetic generalized epilepsy: A phase II diagnostic accuracy study.
abstract: OBJECTIVE
  (A) To develop a TMS-EEG stimulation and data analysis protocol in genetic generalized epilepsy (GGE). (B) To investigate the diagnostic accuracy of TMS-EEG in GGE.
  
  
  METHODS
  Pilot experiments resulted in the development and optimization of a paired-pulse TMS-EEG protocol at rest, during hyperventilation (HV), and post-HV combined with multi-level data analysis. This protocol was applied in 11 controls (C) and 25 GGE patients (P), further dichotomized into responders to antiepileptic drugs (R, n=13) and non-responders (n-R, n=12).Features (n=57) extracted from TMS-EEG responses after multi-level analysis were given to a feature selection scheme and a Bayesian classifier, and the accuracy of assigning participants into the classes P-C and R-nR was computed.
  
  
  RESULTS
  On the basis of the optimal feature subset, the cross-validated accuracy of TMS-EEG for the classification P-C was 0.86 at rest, 0.81 during HV and 0.92 at post-HV, whereas for R-nR the corresponding figures are 0.80, 0.78 and 0.65, respectively. Applying a fusion approach on all conditions resulted in an accuracy of 0.84 for the classification P-C and 0.76 for the classification R-nR.
  
  
  CONCLUSIONS
  TMS-EEG can be used for diagnostic purposes and for assessing the response to antiepileptic drugs.
  
  
  CONCLUSIONS
  TMS-EEG holds significant diagnostic potential in GGE.
authors.affiliation: Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece. Electronic address: kimiskid@auth.gr.
authors.forename: Vasilios K
authors.initials: VK
authors.lastname: Kimiskidis
authors.affiliation: Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece. Electronic address: alkisser@auth.gr.
authors.forename: Alkiviadis
authors.initials: A
authors.lastname: Tsimpiris
authors.affiliation: Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France; Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland. Electronic address: ryvlin@cermep.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ryvlin
authors.affiliation: Kuopio Epilepsy Center, Department of Neurology, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland. Electronic address: reetta.kalviainen@kuh.fi.
authors.forename: Reetta
authors.initials: R
authors.lastname: Kalviainen
authors.affiliation: Clinical Neurophysiology Dpt., Epilepsy, Guys, St Thomas' NHS Foundation Trust, Kings College London, London, UK; Department of Academic Neurosciences, Kings College London, London, UK. Electronic address: Michael.Koutroumanidis@gstt.nhs.uk.
authors.forename: Michalis
authors.initials: M
authors.lastname: Koutroumanidis
authors.affiliation: Department of Basic and Clinical Neuroscience, KCL-IOPP, London, UK; Department of Clinical Neurophysiology, KCH, London, UK; Department of Human Physiology, Universidad Complutense Madrid, Madrid, Spain. Electronic address: Antonio.valentin@kcl.ac.uk.
authors.forename: Antonio
authors.initials: A
authors.lastname: Valentin
authors.affiliation: Artificial Intelligence Information Analysis Lab, Department of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece; Neuroinformatics Group, Department of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: laskaris@aiia.csd.auth.gr.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Laskaris
authors.affiliation: Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece. Electronic address: dkugiu@auth.gr.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Kugiumtzis
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D000068598:Data Accuracy; D004569:Electroencephalography / Q000592:standards*; D004829:Epilepsy, Generalized / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050781:Transcranial Magnetic Stimulation / Q000592:standards*
keywords: Diagnostic accuracy; Generalized epilepsy; Paired-pulse stimulation; Sensitivity; Specificity; TMS–EEG