Wendyl Jude D'Souza

Wendyl Jude D'Souza
St. Vincent's Hospital Melbourne · Department of General Medicine

MBChB, MPH, FRACP, PhD

About

183
Publications
34,320
Reads
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3,804
Citations
Additional affiliations
February 2001 - present
University of Melbourne
Position
  • Associate Professor of Neuroepidemiology and Health Services Research
January 2001 - present
St. Vincent's Hospital Melbourne
Position
  • Consultant Neurologist
January 2000 - present
St. Vincent's Hospital Melbourne
Position
  • Associate Professor of Epidemiology & Health Services Research

Publications

Publications (183)
Article
Importance: Cannabidiol has shown efficacy in randomized clinical trials for drug-resistant epilepsy in specific syndromes that predominantly affect children. However, high-level evidence for the efficacy and safety of cannabidiol in the most common form of drug-resistant epilepsy in adults, focal epilepsy, is lacking. Objective: To investigate...
Article
Purpose Functional seizures (FS) are heterogenous, with no agreed way to subdivide them. One FS subtype frequently observed during EEG is those whose seizures are provoked by hyperventilation. We wished to see whether this subtype might reflect a different seizure mechanism. Methods We analysed the video-EEG/ECGs of all patients with FS from two h...
Article
Background Focal semiologies have been described in idiopathic generalized epilepsies (IGE) and generalized-onset bilateral tonic-clonic seizures (GBTCS). These focal signs may lead to wrong diagnosis and inappropriate choice of antiseizure medications. We sought to investigate the differences in focal semiologic features between GBTCS and focal-on...
Article
Objectives: Autoimmune encephalitis (AE) is a neurological disorder caused by autoimmune attack on cerebral proteins. Experts currently recommend staged immunotherapeutic management, with first-line immunotherapy followed by second-line immunotherapy if response to first-line therapy is inadequate. Meta-analysis of the evidence base may provide hi...
Article
Purpose: To investigate the effectiveness, safety and tolerability of perampanel (PER) in treating myoclonic seizures in clinical practice, using data from the PERaMpanel pooled analysIs of effecTiveness and tolerability (PERMIT) study. Methods: PERMIT was a pooled analysis of 44 real-world studies from 17 countries, in which patients with focal an...
Article
Full-text available
Objective: Long-term electroencephalogram (EEG) recordings can aid diagnosis and management of various neurological conditions such as epilepsy. In this study we characterize the safety and stability of a clinical grade ring electrode arrays by analyzing EEG recordings, fluoroscopy, and computed tomography (CT) imaging with long-term implantation...
Article
Objective: To evaluate the prevalence and biomarkers of drug-resistant epilepsy (DRE) in patients with autoimmune encephalitis (AIE). Methods: Sixty-nine patients with AIE were recruited retrospectively and electroencephalographies (EEGs) were reviewed using a standard reporting proforma. Associations between EEG biomarkers and DRE development a...
Article
Full-text available
The PER a M panel pooled analys I s of effec T iveness and tolerability (PERMIT) study was a pooled analysis of data from 44 real-world studies from 17 countries, in which people with epilepsy (PWE; focal and generalized) were treated with perampanel (PER). Retention and effectiveness were assessed after 3, 6, and 12 months, and at the last visit (...
Article
Background: Despite the rapid increase in research examining outcomes in Autoimmune Encephalitis (AE) patients, there are few cohort studies examining cognitive outcomes in this population. Methods: This retrospective observational study collected psychometric data from 59 patients across six secondary and tertiary referral centres in metropolit...
Article
Full-text available
Objective Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality. Although lots of effort has been made in identifying clinical risk factors for SUDEP in the literature, there are few validated methods to predict individual SUDEP risk. Prolonged postictal EEG suppression (PGES) is a potential SUDEP biomarker,...
Article
Objective To evaluate the utility of electroencephalography (EEG) changes as diagnostic and prognostic biomarkers in acute autoimmune encephalitis (AIE). Methods One hundred and thirty-one patients with AIE were recruited retrospectively across 7 hospitals. Clinical data were collected during admission and at 12 months. EEGs were reviewed using a...
Article
Full-text available
Objective: To investigate the factor structure of the verbal paired-associates (VPA) subtest in the WMS-III using a theoretically driven model of semantic processing previously found to be well-fitting for the WMS-IV version of the test. Method: Archival data were used from 267 heterogeneous neurosciences patients and 223 seizure disorder patien...
Article
Full-text available
Objective New-onset seizures affect up to 10% of people over their lifetime, however, their health economic impact has not been well-studied. This prospective multicentre study will collect patient reported outcome measures (PROMs) from adults with new-onset seizures seen in six Seizure Clinics across Melbourne, Australia and The University of Colo...
Article
Full-text available
This article describes source data from a systematic review and meta-analysis of electroencephalography (EEG) and magnetoencephalography (MEG) studies investigating functional connectivity in idiopathic generalized epilepsy. Data selection, analysis and reporting was performed according to PRISMA guidelines. Eligible studies for review were identif...
Article
Outcomes of status epilepticus have not substantially changed over the last decade. Given onset is most often in the community, early termination strategies that are implementable outside of hospitals are of public health importance. This 10-year retrospective single-centre cohort study aimed to determine whether pre-hospital benzodiazepine adminis...
Article
Electroencephalography (EEG) has long been used as a versatile and noninvasive diagnostic tool in epilepsy. With the advent of digital EEG, more advanced applications of EEG have emerged. Compared with technologically advanced practice in focal epilepsies, the utilization of EEG in idiopathic generalized epilepsy (IGE) has been lagging, often restr...
Poster
Understanding how medication shortages is associated with patient behaviour in the form of brand switching.
Article
For idiopathic generalized epilepsies (IGE), brain network analysis is emerging as a biomarker for potential use in clinical care. To determine whether people with IGE show alterations in resting-state brain connectivity compared to healthy controls, and to quantify these differences, we conducted a systematic review and meta-analysis of EEG and ma...
Article
Objective We compared heart rate variability (HRV) in sudden unexpected death in epilepsy (SUDEP) cases and living epilepsy controls. Methods This international, multicenter, retrospective, nested case-control study examined patients admitted for video-EEG monitoring (VEM) between January 1, 2003 and December 31, 2014, and subsequently died of SUD...
Article
Objectives To determine the long-term outcomes in patients undergoing intracranial EEG (iEEG) evaluation for epilepsy surgery in terms of seizure freedom, mood, and quality of life at St. Vincent’s Hospital, Melbourne. Methods Patients who underwent iEEG between 1999 and 2016 were identified. Patients were retrospectively assessed between 2014 and...
Article
Full-text available
Background: Circadian and multiday rhythms are found across many biological systems, including cardiology, endocrinology, neurology, and immunology. In people with epilepsy, epileptic brain activity and seizure occurrence have been found to follow circadian, weekly, and monthly rhythms. Understanding the relationship between these cycles of brain...
Conference Paper
Objectives To demonstrate proof of concept/feasibility of a novel digital platform using real-time capture of patient-reported outcomes for real-world research involving patients with epilepsy. Methods The phone app collects multi-faceted patient-reported outcomes including seizure frequency, medication side effects, mood, anxiety, quality of life...
Article
Full-text available
Accurate identification of seizure activity, both clinical and subclinical, has important implications in the management of epilepsy. Accurate recognition of seizure activity is essential for diagnostic, management and forecasting purposes, but patient-reported seizures have been shown to be unreliable. Earlier work has revealed accurate capture of...
Article
Full-text available
Objective To explore the impact of psychiatric comorbidities on all-cause mortality in adults with epilepsy from a cohort of patients admitted for video-electroencephalogram monitoring (VEM) over two decades. Methods A retrospective medical records audit was conducted on 2709 adults admitted for VEM and diagnosed with epilepsy at three Victorian c...
Article
Full-text available
The unpredictability of epileptic seizures exposes people with epilepsy to potential physical harm, restricts day-to-day activities, and impacts mental well-being. Accurate seizure forecasters would reduce the uncertainty associated with seizures but need to be feasible and accessible in the long-term. Wearable devices are perfect candidates to dev...
Article
Purpose To explore the efficacy and tolerability of adjuvant perampanel (PER) and their associated risk factors in late add-on drug-resistant epilepsy. Method Retrospective multicenter ‘real-world’ observational study. Consecutively identified patients commenced on PER, with mixed epilepsy syndromes, from nine Australian epilepsy centers. Primary...
Article
Full-text available
Background While the effects of prolonged sleep deprivation (≥24 h) on seizure occurrence has been thoroughly explored, little is known about the effects of day-to-day variations in the duration and quality of sleep on seizure probability. A better understanding of the interaction between sleep and seizures may help to improve seizure management....
Preprint
Full-text available
The unpredictability of epileptic seizures exposes people with epilepsy to potential physical harm, restricts day-to-day activities, and impacts mental well-being. Accurate seizure forecasters would reduce the uncertainty associated with seizures but need to be feasible and accessible in the long-term. Wearable devices are perfect candidates to dev...
Article
Full-text available
Objectives This study aimed to identify a well-fitting and theoretically justified item-level latent factor structure for the Wechsler Memory Scales (WMS)-IV verbal paired associates (VerbalPA) subtest to facilitate the ease and accuracy of score interpretations for patients with lateralized temporal lobe epilepsy (TLE). Methods Archival data were...
Preprint
Accurate identification of seizure activity, both clinical and subclinical, has important implications in the management of epilepsy. Accurate recognition of seizure activity is essential for diagnostic, management and forecasting purposes, but patient-reported seizures have been shown to be unreliable. Earlier work has revealed accurate capture of...
Preprint
Full-text available
Background While the effects of prolonged sleep deprivation (≥24 hours) on seizure occurrence has been thoroughly explored, little is known about the effects of day-to-day variations in the duration and quality of sleep on seizure probability. A better understanding of the interaction between sleep and seizures may help to improve seizure managemen...
Article
Objective Bilateral tonic-clonic seizures are encountered in both focal and generalized epilepsies. We reviewed the literature regarding the presence of focal signs in generalized-onset tonic-clonic seizures (GOTCS) and the utility of semiology in differentiating those from focal to bilateral tonic-clonic seizures (FBTCS). Methods We conducted a c...
Article
Objective To examine the prognostic value of CSF abnormalities in seropositive autoimmune encephalitis (AE). Methods We retrospectively studied 57 cases of seropositive AE. Primary outcomes were mortality and modified Rankin Scale, while secondary outcomes were first line treatment failure, ICU admission and relapse. Regression analysis was perfor...
Article
Full-text available
Objective To examine the utility of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) as biomarkers of prognosis in seropositive autoimmune encephalitis (AE). Methods In this multicenter study, we retrospectively analyzed 57 cases of seropositive AE with hospital admissions between January 2008 and Ju...
Article
Objective To determine the utility of high-frequency activity (HFA) and epileptiform spikes as biomarkers for epilepsy, we examined the variability in their rates and locations using long-term ambulatory intracranial EEG (iEEG) recordings. Methods This study used continuous iEEG recordings obtained over an average of 1.4 years from 15 patients wit...
Preprint
Full-text available
Circadian and multiday rhythms are found across many biological systems, including cardiology, endocrinology, neurology and immunology. In people with epilepsy, epileptic brain activity and seizure occurrence have been found to follow circadian, weekly and monthly rhythms. Understanding the relationship between these cycles of brain excitability an...
Article
Psychosis of epilepsy (POE) can be a devastating condition, and its neurobiological basis remains unclear. In a previous study, we identified reduced posterior hippocampal volumes in patients with POE. The hippocampus can be further subdivided into anatomically and functionally distinct subfields that, along with the hippocampal fissure, have been...
Article
Full-text available
The International League Against Epilepsy (ILAE) groups seizures into "focal", "generalized" and "unknown" based on whether the seizure onset is confined to a brain region in one hemisphere, arises in several brain region simultaneously, or is not known, respectively. This separation fails to account for the rich diversity of clinically and experim...
Article
Objective To investigate the hypothesis that patients diagnosed with psychogenic nonepileptic seizures (PNES) on video-EEG monitoring (VEM) have increased mortality by comparison to the general population. Methods This retrospective cohort study included patients evaluated in VEM units of 3 tertiary hospitals in Melbourne, Australia, between Janua...
Article
Full-text available
The human brain has the capacity to rapidly change state, and in epilepsy these state changes can be catastrophic, resulting in loss of consciousness, injury and even death. Theoretical interpretations considering the brain as a dynamical system suggest that prior to a seizure, recorded brain signals may exhibit critical slowing down, a warning sig...
Article
Full-text available
Background A clinical feasibility study was undertaken at a single center of long-term intra-cerebroventricular drug delivery of the anti-seizure medication valproic acid, into the cerebrospinal fluid (CSF) in order to treat drug resistant focal seizures, using an implantable infusion system. The primary objective was to establish the dose range of...
Preprint
Full-text available
Objective To assess the variability in the rates and locations of high-frequency activity (HFA) and epileptiform spikes after electrode implantation, and to examine the long-term patterns of HFA using ambulatory intracranial EEG (iEEG) recordings. Methods Continuous iEEG recordings obtained over an average of 1.4 years from 15 patients with drug-r...
Article
Objective: The objective of this study was to evaluate the efficacy and tolerability of perampanel (PER) in late adjunctive treatment of focal epilepsy. We assessed outcomes 1) according to patients' clinical profiles and the broad mechanism of action (MoA) of concomitant antiepileptic drugs (AEDs) and 2) the effects of PER on adverse events, irri...
Article
Objective To investigate the impact of sleep onset and offset on the rate of epileptiform discharges (ED) in idiopathic generalized epilepsies (IGE). Methods We studied the temporal distribution of EDs with mixed-effects Poisson regression modeling in a cohort of patients diagnosed with IGE who underwent 24-hour ambulatory electroencephalography (...
Article
Full-text available
Objective: This study aimed to explore the quality of life (QoL) of adult patients with epilepsy (PwE) in Australia and its relationship with comorbidities and adverse events (AEs) from antiepileptic drugs (AEDs). Methods: Cross-sectional surveys were completed by PwE, or carer proxies, recruited via the online pharmacy application MedAdvisor an...
Article
The quality of fMRI data impacts functional connectivity measures and consequently, the decisions that clinicians and researchers make regarding functional connectivity interpretation. The present study used resting state fMRI to investigate resting state network connectivity in a sample of patients with Juvenile Absence Epilepsy. Single-subject ma...
Article
Full-text available
Epilepsy diagnosis can be costly, time-consuming, and not uncommonly inaccurate. The reference standard diagnostic monitoring is continuous video-electroencephalography (EEG) monitoring, ideally capturing all events or concordant interictal discharges. Automating EEG data review would save time and resources, thus enabling more people to receive re...
Preprint
Full-text available
The human brain has the capacity to rapidly change state, and in epilepsy these state changes can be catastrophic, resulting in loss of consciousness, injury and even death. Theoretical interpretations considering the brain as a dynamical system would suggest that prior to a seizure recorded brain signals may exhibit critical slowing, a warning sig...
Article
Objective: The objective of this study was to evaluate the current evidence regarding the effect of antiepileptic drugs (AEDs) on epileptiform discharge (ED) burden in genetic generalized epilepsy (GGE). Methods: We conducted a comprehensive literature search of PubMed, Embase, PsycINFO, and the Web of Science Core Collection databases using the...
Article
Introduction This analysis explored relationships between memory/cognitive issues, quality of life (QoL), and employment among patients with epilepsy (PwE) in Australia. Methods Cross-sectional surveys were completed by PwE, or caregiver proxies, recruited via the online pharmacy application MedAdvisor and Australian PwE Facebook groups from May–A...
Article
Introduction This study explored the impact of specific types of comorbidities and adverse events (AEs) from antiepileptic drugs (AEDs) on quality of life (QoL) among adult patients with epilepsy (PwE) in Australia. Methods Cross-sectional surveys were completed by PwE, or caregiver proxies, recruited via the online pharmacy application MedAdvisor...
Preprint
Full-text available
Epilepsy diagnosis can be costly, time-consuming and not uncommonly inaccurate. The reference standard diagnostic monitoring is continuous video-EEG monitoring, ideally capturing all events or concordant interictal discharges. Automating EEG data review would save time and resources, thus enabling more people to receive reference standard monitorin...
Article
Objective: Psychosis of epilepsy (POE) occurs more frequently in temporal lobe epilepsy, raising the question as to whether abnormalities of the hippocampus are aetiologically important. Despite decades of investigation, it is unclear whether hippocampal volume is reduced in POE, perhaps due to small sample sizes and methodological limitations of...
Article
Full-text available
Although recent structural connectivity studies of traumatic brain injury (TBI) have used graph theory to evaluate alterations in global integration and functional segregation, pooled analysis is needed to examine the robust patterns of change in graph metrics across studies. Following a systematic search, 15 studies met the inclusion criteria for...
Article
Full-text available
Objectives: To assess associations between occupation and motor neuron disease (MND). Methods: We conducted a population-based case-control study with cases (n=321) recruited through the New Zealand Motor Neurone Disease Association and hospital discharge data. Controls (n=605) were recruited from the Electoral Roll. Information on personal and...
Article
Objective There remains a paucity of knowledge regarding specific epilepsy‐related risk factors for accidents and injuries in people with epilepsy. Injury studies in people with epilepsy are overrepresented, with tertiary based populations that are prone to bias from severe disease. This study aims to assess the contribution of epilepsy‐related ris...
Article
Objective psychosis of epilepsy (POE) occurs more frequently in temporal lobe epilepsy, raising the question as to whether abnormalities of the hippocampus are aetiologically important. Despite decades of investigation, it is unclear whether hippocampal volume is reduced in POE, perhaps due to small sample sizes and methodological limitations of pa...
Chapter
Ambulatory electroencephalography (aEEG) is a technique of continuous EEG recording while ensuring maximum mobility of the patient in a more naturalistic setting. The initial technological drawbacks of aEEG have been circumvented by incorporating digital and computer technology. Some of the current devices provide the facility of synchronous video...