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Zhang Y, Lv Y, You H, Dou W, Hou B, Shi L, Zuo Z, Mao W, Feng F. Study of the hippocampal internal architecture in temporal lobe epilepsy using 7 T and 3 T MRI. Seizure 2019; 71:116-123. [DOI: 10.1016/j.seizure.2019.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/08/2019] [Accepted: 06/18/2019] [Indexed: 11/28/2022] Open
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202
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Klein P, Tyrlikova I. No prevention or cure of epilepsy as yet. Neuropharmacology 2019; 168:107762. [PMID: 31499048 DOI: 10.1016/j.neuropharm.2019.107762] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/02/2019] [Accepted: 09/05/2019] [Indexed: 12/29/2022]
Abstract
Approximately 20% of all epilepsy is caused by acute acquired injury such as traumatic brain injury, stroke and CNS infection. The known onset of the injury which triggers the epileptogenic process, early presentation to medical care, and a latency between the injury and the development of clinical epilepsy present an opportunity to intervene with treatment to prevent epilepsy. No such treatment exists and yet there has been remarkably little clinical research during the last 20 years to try to develop such treatment. We review possible reasons for this, possible ways to rectify the situations and note some of the ways currently under way to do so. Resective surgical treatment can achieve "cure" in some patients but is sparsely utilized. In certain "self-limiting" syndromes of childhood and adolescence epilepsy remits spontaneously. In a proportion of patients who become seizure free on medications or with dietary treatment, seizure freedom persists when treatment is discontinued. We discuss these situations which can be considered "cures"; and note that at present we have little understanding of mechanism of such cures, and cannot therefore translate them into a treatment paradigm targeting a "cure" of epilepsy. This article is part of the special issue entitled 'New Epilepsy Therapies for the 21st Century - From Antiseizure Drugs to Prevention, Modification and Cure of Epilepsy'.
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Affiliation(s)
- Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA.
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203
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Kalbhenn T, Cloppenborg T, Wörmann FG, Blümcke I, Coras R, May TW, Polster T, Simon M, Bien CG. Operative posterior disconnection in epilepsy surgery: Experience with 29 patients. Epilepsia 2019; 60:1973-1983. [PMID: 31468520 DOI: 10.1111/epi.16318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE It has been suggested that multilobar epilepsies caused by lesions restricted to the posterior cerebral quadrant (ie, the parietal, temporal, and occipital lobes) can be treated successfully by a procedure termed posterior disconnection. The objective of the present paper was to identify determinants of the epileptological outcome following posterior disconnection surgery. METHODS The authors retrospectively analyzed a series of 29 consecutive patients undergoing posterior disconnection surgery between 2005 and 2017 for the treatment of refractory posterior quadrantic epilepsy. Specifically, all presurgical and postoperative magnetic resonance (MR) studies were reviewed to identify cases with an incomplete disconnection, or the presence of a more widespread pathology involving the whole hemisphere rather than only its posterior quadrant. In addition, we reevaluated all presurgical video-electroencephalography (EEG) reports. RESULTS Seizure-free (International League Against Epilepsy [ILAE] 1) after surgery were 3/3 patients with EEG findings restricted to the posterior quadrant, 0/7 patients who had propagation of epileptic activity to the contralateral frontal lobe, and 11/19 (57.9%) who showed propagation to ipsilateral frontal and/or contralateral posterior. Eleven of 13 (84.6%) patients with purely posterior quadrantic magnetic resonance imaging (MRI) findings (as retrospectively diagnosed by neuroimaging) vs 3/16 (18.8%) cases with additional subtle abnormalities outside the posterior quadrant became seizure-free (P = .001). Eleven of 16 (68.8%) patients with complete disconnections were seizure-free vs only 3/13 (23.0%) cases with leftover temporal lobe tissue with contact to the insula (P = .025, both Fisher's exact test). SIGNIFICANCE A posterior disconnection is a technically demanding but very effective operation for posterior quadrantic epilepsy. Good epileptologic outcomes require not only that the epileptogenic lesion does not extend beyond the confines of the disconnected cerebral volume but also the absence of subtle MRI abnormalities, more widespread than the clear-cut lesion of the posterior quadrant. Hemispheric or contralateral (particularly frontal) propagation of the epileptic activity may also indicate the presence of a hemispheric rather than posterior quadrantic pathology.
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Affiliation(s)
- Thilo Kalbhenn
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | | | | | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Matthias Simon
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Bielefeld, Germany.,Society for Epilepsy Research, Bielefeld, Germany
| | - Christian G Bien
- Epilepsy Center Bethel, Bielefeld, Germany.,Society for Epilepsy Research, Bielefeld, Germany
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Sheikh S, Thompson N, Bingaman W, Gonzalez‐Martinez J, Najm I, Jehi L. (Re)Defining success in epilepsy surgery: The importance of relative seizure reduction in patient‐reported quality of life. Epilepsia 2019; 60:2078-2085. [DOI: 10.1111/epi.16327] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Shehryar Sheikh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Ohio
| | - Nic Thompson
- Quantitative Health Sciences Cleveland Clinic Cleveland Ohio
| | - William Bingaman
- Neurosurgery Cleveland Clinic Cleveland Ohio
- Epilepsy Center Cleveland Clinic Cleveland Ohio
| | | | - Imad Najm
- Epilepsy Center Cleveland Clinic Cleveland Ohio
| | - Lara Jehi
- Epilepsy Center Cleveland Clinic Cleveland Ohio
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Cardinale F, Rizzi M, Vignati E, Cossu M, Castana L, d’Orio P, Revay M, Costanza MD, Tassi L, Mai R, Sartori I, Nobili L, Gozzo F, Pelliccia V, Mariani V, Lo Russo G, Francione S. Stereoelectroencephalography: retrospective analysis of 742 procedures in a single centre. Brain 2019; 142:2688-2704. [DOI: 10.1093/brain/awz196] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractThis retrospective description of a surgical series is aimed at reporting on indications, methodology, results on seizures, outcome predictors and complications from a 20-year stereoelectroencephalography (SEEG) activity performed at a single epilepsy surgery centre. Prospectively collected data from a consecutive series of 742 SEEG procedures carried out on 713 patients were reviewed and described. Long-term seizure outcome of SEEG-guided resections was defined as a binomial variable: absence (ILAE classes 1–2) or recurrence (ILAE classes 3–6) of disabling seizures. Predictors of seizure outcome were analysed by preliminary uni/bivariate analyses followed by multivariate logistic regression. Furthermore, results on seizures of these subjects were compared with those obtained in 1128 patients operated on after only non-invasive evaluation. Survival analyses were also carried out, limited to patients with a minimum follow-up of 10 years. Resective surgery has been indicated for 570 patients (79.9%). Two-hundred and seventy-nine of 470 patients operated on (59.4%) were free of disabling seizures at least 2 years after resective surgery. Negative magnetic resonance and post-surgical lesion remnant were significant risk factors for seizure recurrence, while type II focal cortical dysplasia, balloon cells, glioneuronal tumours, hippocampal sclerosis, older age at epilepsy onset and periventricular nodular heterotopy were significantly associated with seizure freedom. Twenty-five of 153 patients who underwent radio-frequency thermal coagulation (16.3%) were optimal responders. Thirteen of 742 (1.8%) procedures were complicated by unexpected events, including three (0.4%) major complications and one fatality (0.1%). In conclusion, SEEG is a safe and efficient methodology for invasive definition of the epileptogenic zone in the most challenging patients. Despite the progressive increase of MRI-negative cases, the proportion of seizure-free patients did not decrease throughout the years.
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Affiliation(s)
- Francesco Cardinale
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Michele Rizzi
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Elena Vignati
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Massimo Cossu
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Laura Castana
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Piergiorgio d’Orio
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Neuroscience Institute, CNR, Parma, Italy
| | - Martina Revay
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Neurosurgery Residency Program, University of Milan, Milan, Italy
| | - Martina Della Costanza
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Neurosurgery Unit, Polytechnic, University of Marche, Ancona, Italy
| | - Laura Tassi
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Roberto Mai
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Ivana Sartori
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS ‘G. Gaslini’ Institute, DINOGMI, University of Genoa, Genoa, Italy
| | - Francesca Gozzo
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Veronica Pelliccia
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Department of Neuroscience, University of Parma, Parma, Italy
| | - Valeria Mariani
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giorgio Lo Russo
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Stefano Francione
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
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Lee MH, O'Hara NB, Motoi H, Luat AF, Juhász C, Sood S, Asano E, Jeong JW. Novel diffusion tractography methodology using Kalman filter prediction to improve preoperative benefit-risk analysis in pediatric epilepsy surgery. J Neurosurg Pediatr 2019; 24:293-305. [PMID: 31277057 PMCID: PMC9080971 DOI: 10.3171/2019.4.peds1994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study the authors investigated the clinical reliability of diffusion weighted imaging maximum a posteriori probability (DWI-MAP) analysis with Kalman filter prediction in pediatric epilepsy surgery. This approach can yield a suggested resection margin as a dynamic variable based on preoperative DWI-MAP pathways. The authors sought to determine how well the suggested margin would have maximized occurrence of postoperative seizure freedom (benefit) and minimized occurrence of postoperative neurological deficits (risk). METHODS The study included 77 pediatric patients with drug-resistant focal epilepsy (age 10.0 ± 4.9 years) who underwent resection of their presumed epileptogenic zone. In preoperative DWI tractography from the resected hemisphere, 9 axonal pathways, Ci=1-9, were identified using DWI-MAP as follows: C1-3 supporting face, hand, and leg motor areas; C4 connecting Broca's and Wernicke's areas; C5-8 connecting Broca's, Wernicke's, parietal, and premotor areas; and C9 connecting the occipital lobe and lateral geniculate nucleus. For each Ci, the resection margin, di, was measured by the minimal Euclidean distance between the voxels of Ci and the resection boundary determined by spatially coregistered postoperative MRI. If Ci was resected, di was assumed to be negative (calculated as -1 × average Euclidean distance between every voxel inside the resected Ci volume, ri). Kalman filter prediction was then used to estimate an optimal resection margin, d*i, to balance benefit and risk by approximating the relationship between di and ri. Finally, the authors defined the preservation zone of Ci that can balance the probability of benefit and risk by expanding the cortical area of Ci up to d*i on the 3D cortical surface. RESULTS In the whole group (n = 77), nonresection of the preoperative preservation zone (i.e., actual resection margin d*i greater than the Kalman filter-defined d*i) accurately predicted the absence of postoperative motor (d*1-3: 0.93 at seizure-free probability of 0.80), language (d*4-8: 0.91 at seizure-free probability of 0.81), and visual deficits (d*9: 0.90 at seizure-free probability of 0.75), suggesting that the preservation of preoperative Ci within d*i supports a balance between postoperative functional deficit and seizure freedom. The subsequent subgroup analyses found that preservation of preoperative Ci =1-4,9 within d*i =1-4,9 may provide accurate deficit predictions independent of age and seizure frequency, suggesting that the DWI-based surgical margin can be effective for surgical planning even in young children and across a range of epilepsy severity. CONCLUSIONS Integrating DWI-MAP analysis with Kalman filter prediction may help guide epilepsy surgery by visualizing the margins of the eloquent white matter pathways to be preserved.
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Affiliation(s)
- Min-Hee Lee
- Departments of1Pediatrics
- 5Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Nolan B O'Hara
- 4Translational Neuroscience Program, Wayne State University School of Medicine, Detroit; and
- 5Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | | | | | - Csaba Juhász
- Departments of1Pediatrics
- 2Neurology, and
- 3Neurosurgery, and
- 4Translational Neuroscience Program, Wayne State University School of Medicine, Detroit; and
- 5Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | | | - Eishi Asano
- Departments of1Pediatrics
- 2Neurology, and
- 4Translational Neuroscience Program, Wayne State University School of Medicine, Detroit; and
| | - Jeong-Won Jeong
- Departments of1Pediatrics
- 2Neurology, and
- 4Translational Neuroscience Program, Wayne State University School of Medicine, Detroit; and
- 5Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
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Malmgren K, Krýsl D. Epilepsy: Long-term outcomes in MRI-negative patients with epilepsy. Nat Rev Neurol 2019; 13:132-133. [PMID: 28252006 DOI: 10.1038/nrneurol.2017.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Sahlgrenska University Hospital, Blå Stråket 7, 413 45 Gothenburg, Sweden
| | - David Krýsl
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Sahlgrenska University Hospital, Blå Stråket 7, 413 45 Gothenburg, Sweden
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Sato Y, Ochi A, Mizutani T, Otsubo H. Low entropy of interictal gamma oscillations is a biomarker of the seizure onset zone in focal cortical dysplasia type II. Epilepsy Behav 2019; 96:155-159. [PMID: 31150993 DOI: 10.1016/j.yebeh.2019.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Dynamic changes in the regularity of interictal gamma oscillations (GOs, 30-70 Hz) on intracranial electroencephalography (EEG) reflect focal ictogenesis with epileptogenic neuronal synchronization in focal cortical dysplasia (FCD). We investigated whether the regularity of interictal GOs is a biomarker of the seizure onset zone (SOZ) using multiscale entropy analysis. METHODS We quantified the regularity of interictal GOs using intracranial EEG data from 1164 electrodes in 13 patients with FCD who were seizure-free postoperatively. The regularity of interictal GOs was quantified as entropy values. Low entropy represents high regularity. We standardized entropy values using Z values for each SOZ, resection area (RA), and the region outside the RA. The cutoff Z values, sensitivity, and specificity for detecting each area were calculated using area under the receiver operating characteristics curves (AUCs). RESULTS Low Z values represent higher regularity of GOs. The cutoff Z value of ≤-2.09 for the SOZ had a sensitivity of 100% and specificity of 97.1% (AUC = 0.992 ± 0.002). The cutoff Z value of ≤-0.12 for the RA had a sensitivity of 54.2% and specificity of 73.8% (AUC = 0.673 ± 0.019). The cutoff Z value of ≥-0.11 for the region outside the RA had a sensitivity of 73.8% and specificity of 54.2% (AUC = 0.673 ± 0.019). CONCLUSIONS Low entropy of interictal GOs was a reliable biomarker for the SOZ. Maintained high entropy of interictal GOs may be an auxiliary biomarker for nonepileptogenic regions. SIGNIFICANCE Low entropy of interictal GOs may be a biomarker for the SOZ in FCD type II.
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Affiliation(s)
- Yosuke Sato
- Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tohru Mizutani
- Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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209
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Conte F, Van Paesschen W, Legros B, Depondt C. The Epilepsy Surgery Grading Scale: Validation in an independent population with drug-resistant focal epilepsy. Epilepsia 2019; 60:e78-e82. [PMID: 31247119 DOI: 10.1111/epi.16096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
The Epilepsy Surgery Grading Scale (ESGS) is a simple tool that predicts a patient's likelihood of progressing to resective surgery and becoming seizure-free. The aim of our study was to validate the ESGS in an independent patient cohort. We retrospectively calculated the ESGS score for adult patients with drug-resistant focal epilepsy undergoing presurgical evaluation at two reference centers for drug-resistant epilepsy in Belgium. We classified patients into ESGS grade 1 (most favorable), grade 2 (intermediate), and grade 3 (least favorable). We assessed progression to surgery and postsurgical seizure freedom. A total of 238 patients underwent presurgical evaluation (presurgical cohort), of whom 140 progressed to surgery (surgical cohort). In the presurgical cohort, we observed significant differences in rates of surgery and in rates of seizure freedom between grades 1, 2, and 3. In the surgical cohort, we observed significant differences in rates of seizure freedom between grades 1 and 2 and between grades 1 and 3. We confirm the usefulness of the ESGS for the prognostic stratification of patients with drug-resistant focal epilepsy undergoing presurgical evaluation. Our results support the use of the ESGS in the decision process of presurgical evaluation in clinical practice.
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Affiliation(s)
| | - Wim Van Paesschen
- Department of Neurology, Gasthuisberg University Hospital, Leuven, Belgium
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210
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Abstract
BACKGROUND This is an updated version of the original Cochrane review, published in 2015.Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary between at least 20% and up to 70%. If the epileptogenic zone can be located, surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.Secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence, and to identify the factors that correlate with remission of seizures postoperatively. SEARCH METHODS For the latest update, we searched the following databases on 11 March 2019: Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to March 08, 2019), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) that included at least 30 participants in a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), with an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome related to postoperative seizure control. Cohort studies or case series were included in the previous version of this review. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportions of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RRs) and 95% confidence intervals (95% CIs). MAIN RESULTS We identified 182 studies with a total of 16,855 included participants investigating outcomes of surgery for epilepsy. Nine studies were RCTs (including two that randomised participants to surgery or medical treatment (99 participants included in the two trials received medical treatment)). Risk of bias in these RCTs was unclear or high. Most of the remaining 173 non-randomised studies followed a retrospective design. We assessed study quality using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses, we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across domains.In terms of freedom from seizures, two RCTs found surgery (n = 97) to be superior to medical treatment (n = 99); four found no statistically significant differences between anterior temporal lobectomy (ATL) with or without corpus callosotomy (n = 60), between subtemporal or transsylvian approach to selective amygdalohippocampectomy (SAH) (n = 47); between ATL, SAH and parahippocampectomy (n = 43) or between 2.5 cm and 3.5 cm ATL resection (n = 207). One RCT found total hippocampectomy to be superior to partial hippocampectomy (n = 70) and one found ATL to be superior to stereotactic radiosurgery (n = 58); and another provided data to show that for Lennox-Gastaut syndrome, no significant differences in seizure outcomes were evident between those treated with resection of the epileptogenic zone and those treated with resection of the epileptogenic zone plus corpus callosotomy (n = 43). We judged evidence from the nine RCTs to be of moderate to very low quality due to lack of information reported about the randomised trial design and the restricted study populations.Of the 16,756 participants included in this review who underwent a surgical procedure, 10,696 (64%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to recording of adverse events to be very poor.In total, 120 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography, history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection, and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation, and presence of postoperative discharges were prognostic factors of outcome.Twenty-nine studies reported multi-variable models of prognostic factors, and showed that the direction of association of factors with outcomes was generally the same as that found in univariate analyses.We observed variability in many of our analyses, likely due to small study sizes with unbalanced group sizes and variation in the definition of seizure outcome, the definition of prognostic factors, and the influence of the site of surgery AUTHORS' CONCLUSIONS: Study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcomes. Future research should be of high quality, follow a prospective design, be appropriately powered, and focus on specific issues related to diagnostic tools, the site-specific surgical approach, and other issues such as extent of resection. Researchers should investigate prognostic factors related to the outcome of surgery via multi-variable statistical regression modelling, where variables are selected for modelling according to clinical relevance, and all numerical results of the prognostic models are fully reported. Journal editors should not accept papers for which study authors did not record adverse events from a medical intervention. Researchers have achieved improvements in cancer care over the past three to four decades by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Sarah J Nevitt
- University of LiverpoolDepartment of BiostatisticsBlock F, Waterhouse Building1‐5 Brownlow HillLiverpoolUKL69 3GL
| | - Jennifer Cotton
- The Clatterbridge Cancer Centre NHS Foundation TrustWirralUK
| | - Sacha Gandhi
- NHS Ayrshire and ArranDepartment of General SurgeryAyrUKKA6 6DX
| | - Jennifer Weston
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolMerseysideUKL9 7LJ
| | - Ajay Sudan
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Roberto Ramirez
- Royal Manchester Children's HospitalHospital RoadPendleburyManchesterUKM27 4HA
| | - Richard Newton
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
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Fujimoto A, Ichikawa N, Sato K, Nishimura M, Enoki H, Okanishi T. Inclusion of general physicians in the multidisciplinary treatment team for epilepsy may lead to an economic benefit. Epilepsy Behav 2019; 95:56-60. [PMID: 31026783 DOI: 10.1016/j.yebeh.2019.03.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this study was to compare epileptic seizure control and economic impact in patients with epilepsy between when they were seen by general physicians (GPs) versus epilepsy specialists. METHOD We began distributing a booklet we named the "Epi Passport" to patients with epilepsy in December 2014 to share information within the regional epilepsy network of GPs, epilepsy specialists, and patients (Gep). We compared seizure control and household income levels before and after the introduction of this booklet. RESULTS There was no significant difference in seizure control between patients who saw specialists or GPs (P = 0.215). Significant increases in household income were seen among 134 patients (36.6%) in the post-Epi Passport period who were primarily seen by GPs (P < 0.001). However, 35 patients (9.6%) showed a decrease in income between periods, and 197 patients (53.8%) showed no change. Age of 20-39 years old was significantly associated with increases in household income (P = 0.0287). CONCLUSION After the introduction of the Epi Passport, about one-third of the patients with epilepsy who were mainly seen by GPs in their community showed an increase in household income. There was no difference in seizure control among those who saw a GP or a specialist. Inclusion of GPs in the multidisciplinary treatment team for epilepsy may lead to increased patient income because of the fact that patients can manage their epilepsy in their community using their GP.
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Affiliation(s)
- Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan.
| | - Naoki Ichikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan
| | - Mitsuyo Nishimura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Japan
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Analysis for the Association Between Corpus Callosum Thickness and Corpus Callosotomy Outcomes for Patients With Epileptic Spasms or Tonic Spasms. Pediatr Neurol 2019; 95:79-83. [PMID: 30819564 DOI: 10.1016/j.pediatrneurol.2019.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This retrospective study is designed to determine whether the thickness of the corpus callosum can predict corpus callosotomy outcome in pediatric patients with epileptic or tonic spasms. METHODS We retrospectively studied 25 patients (18 boys) with intractable childhood-onset epileptic or tonic spasms who underwent corpus callosotomy between March 2008 and January 2017. Seizure outcomes were classified as favorable (class I and II of Engel's outcome classification) or unfavorable (class III and IV of Engel's outcome classification) at 12 months postoperatively. We measured the corpus callosum area on the midline and maximum cerebral area on the para-midline in sagittal magnetic resonance images just before surgery. We statistically analyzed the associations between surgical outcomes and corpus callosum area, corpus callosum area/maximum cerebral area (corpus callosum/cerebrum ratio), or age at magnetic resonance imaging just before surgery, using univariate and multivariate logistic regression analyses. RESULTS Age at surgery ranged from six to 237 months (mean: 119). Main seizure types were epileptic spasms in 17 patients and tonic spasms in eight. Favorable outcomes occurred in 10 (40%) patients and unfavorable outcomes in 15 (60%). Both corpus callosum area and corpus callosum/cerebrum ratio did not show significant associations with the outcomes in the univariate and multivariate analyses. The 95% confidence intervals of corpus callosum/cerebrum ratio strongly overlapped between the favorable and unfavorable outcome groups. CONCLUSIONS Our data failed to support that corpus callosum thickness on the sagittal image is associated with corpus callosotomy outcomes in pediatric patients with epileptic spasms or tonic spasms.
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213
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Cajigas I, Kanner AM, Ribot R, Casabella AM, Mahavadi A, Jermakowicz W, Sur S, Millan C, Saporta A, Lowe M, Velez-Ruiz N, Rey G, Ibrahim GM, Ivan ME, Jagid JR. Magnetic Resonance–Guided Laser Interstitial Thermal Therapy for Mesial Temporal Epilepsy: A Case Series Analysis of Outcomes and Complications at 2-Year Follow-Up. World Neurosurg 2019; 126:e1121-e1129. [DOI: 10.1016/j.wneu.2019.03.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 11/29/2022]
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Arya R, Mangano FT, Horn PS, Kaul SK, Kaul SK, Roth C, Leach JL, Turner M, Holland KD, Greiner HM. Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter? J Neurosurg Pediatr 2019; 24:200-208. [PMID: 31151097 DOI: 10.3171/2019.4.peds18677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is emerging data that adults with temporal lobe epilepsy (TLE) without a discrete lesion on brain MRI have surgical outcomes comparable to those with hippocampal sclerosis (HS). However, pediatric TLE is different from its adult counterpart. In this study, the authors investigated if the presence of a potentially epileptogenic lesion on presurgical brain MRI influences the long-term seizure outcomes after pediatric temporal lobectomy. METHODS Children who underwent temporal lobectomy between 2007 and 2015 and had at least 1 year of seizure outcomes data were identified. These were classified into lesional and MRI-negative groups based on whether an epilepsy-protocol brain MRI showed a lesion sufficiently specific to guide surgical decisions. These patients were also categorized into pure TLE and temporal plus epilepsies based on the neurophysiological localization of the seizure-onset zone. Seizure outcomes at each follow-up visit were incorporated into a repeated-measures generalized linear mixed model (GLMM) with MRI status as a grouping variable. Clinical variables were incorporated into GLMM as covariates. RESULTS One hundred nine patients (44 females) were included, aged 5 to 21 years, and were classified as lesional (73%), MRI negative (27%), pure TLE (56%), and temporal plus (44%). After a mean follow-up of 3.2 years (range 1.2-8.8 years), 66% of the patients were seizure free for ≥ 1 year at last follow-up. GLMM analysis revealed that lesional patients were more likely to be seizure free over the long term compared to MRI-negative patients for the overall cohort (OR 2.58, p < 0.0001) and for temporal plus epilepsies (OR 1.85, p = 0.0052). The effect of MRI lesion was not significant for pure TLE (OR 2.64, p = 0.0635). Concordance of ictal electroencephalography (OR 3.46, p < 0.0001), magnetoencephalography (OR 4.26, p < 0.0001), and later age of seizure onset (OR 1.05, p = 0.0091) were associated with a higher likelihood of seizure freedom. The most common histological findings included cortical dysplasia types 1B and 2A, HS (40% with dual pathology), and tuberous sclerosis. CONCLUSIONS A lesion on presurgical brain MRI is an important determinant of long-term seizure freedom after pediatric temporal lobectomy. Pediatric TLE is heterogeneous regarding etiologies and organization of seizure-onset zones with many patients qualifying for temporal plus nosology. The presence of an MRI lesion determined seizure outcomes in patients with temporal plus epilepsies. However, pure TLE had comparable surgical seizure outcomes for lesional and MRI-negative groups.
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Affiliation(s)
- Ravindra Arya
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.,2Department of Pediatrics, University of Cincinnati College of Medicine
| | | | - Paul S Horn
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Sabrina K Kaul
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Serena K Kaul
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Celie Roth
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - James L Leach
- 4Division of Pediatric Neuro-radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michele Turner
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Katherine D Holland
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.,2Department of Pediatrics, University of Cincinnati College of Medicine
| | - Hansel M Greiner
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.,2Department of Pediatrics, University of Cincinnati College of Medicine
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Chen J, Chen X, Huang C, Zhu H, Hou Z, An N, Liu SY, Yang H, Zhang CQ. Predictors of seizure recurrence in patients with surgery for focal cortical dysplasia: pairwise and network meta-analysis and trial sequential analysis. Childs Nerv Syst 2019; 35:753-767. [PMID: 30911833 DOI: 10.1007/s00381-019-04124-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/05/2019] [Indexed: 12/17/2022]
Abstract
OBJECT The aim of this study was to determine the predictors of seizure recurrence in surgery for focal cortical dysplasia (FCD) by conducting a meta-analysis. METHODS Publications that met the pre-stated inclusion criteria were selected from PubMed and CNKI databases. Two authors extracted data independently about prognostic factors, surgical outcome, and clinical characteristics of participants. A fixed-effects model was used to calculate the summary of odds ratio (OR) with 95% confidence interval (CI). RESULTS Forty-eight studies were included in our meta-analysis. Three predictors of seizure recurrence (Engel class III/IV)-histological FCD type I, incomplete resection, and extratemporal location were determined; combined OR with 95% CI were 1.94 (95%CI 1.53-2.46), 12.06 (95%CI 7.32-19.88), and 1.91 (95%CI 1.06-3.44), respectively. Trial sequential analysis revealed that the outcomes had a sufficient sample size to reach firm conclusions. Furthermore, seizure location was not substantially modified by geographic region, while histological FCD type I and incomplete resection showed a significant association with seizure recurrence in different continents except Asia for incomplete resection. Sensitivity analyses restricted to studies for each variable yielded robust results. Little evidence of publication bias was observed. Meanwhile, the difference in the standard for outcome failed to influence the results for prognosis. Network meta-analysis including 13 trials comparing subtypes of FCD found the FCD IIb had the lowest seizure recurrence rate. CONCLUSIONS This meta-analysis suggests that histological FCD type I, incomplete resection, and extratemporal location are recurrence factors in patients with epilepsy surgery for FCD. In addition, FCD IIb is associated with the highest rates of postoperative seizure control among the subtypes of FCD, type I and type II.
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Affiliation(s)
- Jie Chen
- Department of Neurosurgery, Chongqing University CancerHospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China
| | - Xin Chen
- Department of Neurosurgery, General Hospital of the People's Liberation Army Chengdu Military Region, Chengdu, 610083, Sichuan, China
| | - Chen Huang
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, 77030, USA
| | - He Zhu
- Department of Internal Medicine St. Luke's Hospital, Chesterfield, MO, 63017, USA
| | - Zhi Hou
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Ning An
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Shi-Yong Liu
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Hui Yang
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Chun-Qing Zhang
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.
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Tomlinson SB, Wong JN, Conrad EC, Kennedy BC, Marsh ED. Reproducibility of interictal spike propagation in children with refractory epilepsy. Epilepsia 2019; 60:898-910. [PMID: 31006860 PMCID: PMC6488404 DOI: 10.1111/epi.14720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/11/2019] [Accepted: 03/13/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Interictal spikes are a characteristic feature of invasive electroencephalography (EEG) recordings in children with refractory epilepsy. Spikes frequently co-occur across multiple brain regions with discernable latencies, suggesting that spikes can propagate through distributed neural networks. The purpose of this study was to examine the long-term reproducibility of spike propagation patterns over hours to days of interictal recording. METHODS Twelve children (mean age 13.1 years) were retrospectively studied. A mean ± standard deviation (SD) of 47.2 ± 40.1 hours of interictal EEG recordings were examined per patient (range 17.5-166.5 hours). Interictal recordings were divided into 30-minute segments. Networks were extracted based on the frequency of spike coactivation between pairs of electrodes. For each 30-minute segment, electrodes were assigned a "Degree Preference (DP)" based on the tendency to appear upstream or downstream within propagation sequences. The consistency of DPs across segments ("DP-Stability") was quantified using the Spearman rank correlation. RESULTS Regions exhibited highly stable preferences to appear upstream, intermediate, or downstream in spike propagation sequences. Across networks, the mean ± SD DP-Stability was 0.88 ± 0.07, indicating that propagation patterns observed in 30-minute segments were representative of the patterns observed in the full interictal window. At the group level, regions involved in seizure generation appeared more upstream in spike propagation sequences. SIGNIFICANCE Interictal spike propagation is a highly reproducible output of epileptic networks. These findings shed new light on the spatiotemporal dynamics that may constrain the network mechanisms of refractory epilepsy.
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Affiliation(s)
- Samuel B. Tomlinson
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Jeremy N. Wong
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Erin C. Conrad
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Benjamin C. Kennedy
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Eric D. Marsh
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
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Popescu CE, Mai R, Sara R, Lizio D, Zanni D, Rossetti C, Caobelli F. The Role of FDG-PET in Patients with Epilepsy Related to Periventricular Nodular Heterotopias: Diagnostic Features and Long-Term Outcome. J Neuroimaging 2019; 29:512-520. [PMID: 31006947 DOI: 10.1111/jon.12620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Periventricular nodular heterotopias (PNHs) are frequently associated with drug-resistant epilepsy (DRE). Although magnetic resonance imaging (MRI) can define the morphological features of PNHs, still there is a need to assess their metabolic activity in order to provide useful information on epileptogenicity and long-term outcome. To that end, we investigated the ability of 18 F-FDG PET to identify seizure onset zone in order to assess the metabolic activity of the ectopic neurons and to provide prognostic information on the postsurgical outcome. METHODS Sixteen patients (6 men and 10 women; ranging between 24 and 53 years of age) with PNHs-related DRE were evaluated. All patients underwent clinical evaluation, Stereo-electroencephalogram (SEEG), brain MRI, and 18 F-FDG brain PET/CT. PET images were superimposed on the patient-specific 3-dimensional-brain MRI. The metabolic activity of each nodule and of their cortex was visually and semiquantitatively assessed. The outcome after intervention was assessed in all patients using Engel classification. RESULTS Thirty-one heterotopic sites were identified. Twenty-one of 23 nodules with detectable electric activity on SEEG were identified by PET (91.3%), while 5 of 8 of nodules without electric activity showed no metabolism on PET (62.5%). Overall, the concordance between SEEG and FDG-PET was 26/31 (83.9%). Furthermore, cortical metabolic alterations were depicted, correlating with epileptogenic areas. A favorable postsurgical outcome was reported in 13 patients (81.3%). The presence of a hypometabolic nodule significantly correlated with a worse outcome after surgical therapy (P = .036). CONCLUSIONS In PNHs-related epilepsy, FDG-PET more accurately identifies epileptogenic foci, which aids surgical planning and in postoperative seizure control.
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Affiliation(s)
| | - Roberto Mai
- Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Roberto Sara
- Nuclear Medicine Department, Niguarda Hospital, Milan, Italy
| | | | - Daniela Zanni
- Medical Physics Unit, Niguarda Hospital, Milan, Italy
| | | | - Federico Caobelli
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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218
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He X, Zhai F, Guan Y, Zhou J, Li T, Luan G. Surgical outcomes and prognostic factors of drug-resistant epilepsy secondary to encephalomalacia. Epilepsia 2019; 60:948-957. [PMID: 30980678 DOI: 10.1111/epi.14733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/06/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate long-term outcomes and prognostic factors in patients who underwent surgical resection for drug-resistant epilepsy secondary to encephalomalacia. METHODS A total of 143 patients with drug-resistant epilepsy who underwent surgical resection with a follow-up of at least 5 years were included. Seizure outcomes were evaluated based on the International League Against Epilepsy classification. Univariate analysis and a multivariate logistic regression model in a backward fashion were used to identify the potential predictors of seizure outcomes. RESULTS Three months after surgery, 102 of 143 (71.3%) patients had achieved favorable seizure outcomes. Five years after surgery, 107 of 143 (74.8%) patients had achieved favorable seizure outcomes. Changes in the postoperative seizure status were observed in 22 of 143 (15.4%) patients during follow-up, but the difference in the seizure-free rate between 3 months and 5 years after surgery was not significant. Univariate and multivariate analyses revealed that only a monthly seizure frequency of >30 seizures (odds ratio = 3.42, 95% confidence interval = 1.19-9.76) and bilateral ictal onset rhythms (odds ratio = 4.46, 95% confidence interval = 1.61-12.39) were independent predictors of unfavorable seizure outcomes. SIGNIFICANCE Surgical resection is an effective treatment for patients with drug-resistant epilepsy secondary to encephalomalacia. Knowledge of the predictors of seizure outcomes may help during preoperative counseling and selection of optimal candidates for epilepsy surgery among patients with drug-resistant epilepsy secondary to encephalomalacia.
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Affiliation(s)
- Xinghui He
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Guoming Luan
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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219
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Zanello M, Meyer B, Still M, Goodden JR, Colle H, Schichor C, Bello L, Wager M, Smits A, Rydenhag B, Tate M, Metellus P, Hamer PDW, Spena G, Capelle L, Mandonnet E, Robles SG, Sarubbo S, Martino González J, Fontaine D, Reyns N, Krieg SM, Huberfeld G, Wostrack M, Colle D, Robert E, Noens B, Muller P, Yusupov N, Rossi M, Conti Nibali M, Papagno C, Visser V, Baaijen H, Galbarritu L, Chioffi F, Bucheli C, Roux A, Dezamis E, Duffau H, Pallud J. Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers. Seizure 2019; 69:31-40. [PMID: 30959423 DOI: 10.1016/j.seizure.2019.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/02/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The practical management of cavernous angioma located within eloquent brain area before, during and after surgical resection is poorly documented. We assessed the practical pre-operative, intra-operative, and post-operative management of cavernous angioma located within eloquent brain area. METHOD An online survey composed of 61 items was sent to 26 centers to establish a multicenter international retrospective cohort of adult patients who underwent a surgical resection as the first-line treatment of a supratentorial cavernous angioma located within or close to eloquent brain area. RESULTS 272 patients from 19 centers (mean 13.6 ± 16.7 per center) from eight countries were included. The pre-operative management varied significantly between centers and countries regarding the pre-operative functional assessment, the pre-operative epileptological assessment, the first given antiepileptic drug, and the time to surgery. The intra-operative environment varied significantly between centers and countries regarding the use of imaging systems, the use of functional mapping with direct electrostimulations, the extent of resection of the hemosiderin rim, the realization of a post-operative functional assessment, and the time to post-operative functional assessment. The present survey found a post-operative improvement, as compared to pre-operative evaluations, of the functional status, the ability to work, and the seizure control. CONCLUSIONS We observed a variety of practice between centers and countries regarding the management of cavernous angioma located within eloquent regions. Multicentric prospective studies are required to solve relevant questions regarding the management of cavernous angioma-related seizures, the timing of surgery, and the optimal extent of hemosiderin rim resection.
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Affiliation(s)
- Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich School of Medicine, Munich, Germany
| | - Megan Still
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - John R Goodden
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Henry Colle
- Department of Neurosurgery, St Lucas Hospital, Gand, Belgium
| | - Christian Schichor
- Neurosurgical Clinic, University of Munich - Campus Grosshadern, Munich, Germany
| | - Lorenzo Bello
- Department of Neurosurgery, Humanitas Hospital, Milan, Italy
| | - Michel Wager
- Department of Neurosurgery, La Milétrie University Hospital, 86021 Poitiers, France
| | - Anja Smits
- Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
| | - Bertil Rydenhag
- Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
| | - Matthew Tate
- Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, USA
| | - Philippe Metellus
- Department of Neurosurgery, Clairval Private Hospital, Marseille, France
| | - Philip De Witt Hamer
- Department of Neurosurgery, VU University Medical Center, Amsterdam, Netherlands
| | | | - Laurent Capelle
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Santiago Gil Robles
- Department of Neurosurgery, Hospital Universitario Quironsalud, Madrid, Spain
| | - Silvio Sarubbo
- Department of Neurosurgery, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Juan Martino González
- Department of Neurosurgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Denys Fontaine
- Department of Neurosurgery, Nice University Hospital, Nice, France
| | - Nicolas Reyns
- Department of Neurosurgery, Roger-Salengro University Hospital, Lille, France
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University of Munich School of Medicine, Munich, Germany
| | - Gilles Huberfeld
- Department of Neurophysiology, Pitié-Salpêtrière Hospital, UPMC, Sorbonne Université, Paris, France; Infantile Epilepsy and Brain Plasticity, INSERM U1129 Paris Descartes University, PRES Sorbonne, Paris, France; Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, Paris, France
| | - Maria Wostrack
- Department of Neurosurgery, Technical University of Munich School of Medicine, Munich, Germany
| | - David Colle
- Department of Neurosurgery, St Lucas Hospital, Gand, Belgium
| | - Erik Robert
- Department of Neurosurgery, St Lucas Hospital, Gand, Belgium
| | - Bonny Noens
- Department of Neurosurgery, St Lucas Hospital, Gand, Belgium
| | - Peter Muller
- Department of Neurosurgery, St Lucas Hospital, Gand, Belgium
| | - Natan Yusupov
- Neurosurgical Clinic, University of Munich - Campus Grosshadern, Munich, Germany
| | - Marco Rossi
- Department of Neurosurgery, Humanitas Hospital, Milan, Italy
| | | | | | - Victoria Visser
- Department of Neurosurgery, VU University Medical Center, Amsterdam, Netherlands
| | - Hans Baaijen
- Department of Neurosurgery, VU University Medical Center, Amsterdam, Netherlands
| | - Lara Galbarritu
- Department of Neurosurgery, Hospital Universitario Quironsalud, Madrid, Spain
| | - Franco Chioffi
- Department of Neurosurgery, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Carlos Bucheli
- Department of Neurosurgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Hugues Duffau
- Neurosurgery Department, Hôpital Gui-de-Chauliac, Montpellier University Medical Center, 34000 Montpellier, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France.
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Ahmed R, Rubinger L, Go C, Drake JM, Rutka JT, Carter Snead O, Widjaja E. Utility of additional dedicated high-resolution 3T MRI in children with medically refractory focal epilepsy. Epilepsy Res 2019; 143:113-119. [PMID: 29398181 DOI: 10.1016/j.eplepsyres.2018.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 11/28/2017] [Accepted: 01/02/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE In patients with medically refractory epilepsy and normal magnetic resonance imaging (MRI), high-resolution dedicated MRI may identify cryptic lesions. The aim of this study was to assess improvement in lesion detection and its impact on clinical management, using additional high-resolution dedicated 3T MRI in children with medically refractory epilepsy who had normal 3T epilepsy protocol MRI. MATERIALS AND METHODS Children who had resective epilepsy surgery and suspected focal cortical dysplasia (FCD) or normal 3T epilepsy protocol MRI were included. Those with other diagnosis on MRI including tumor and hippocampal sclerosis were excluded. Patients who had normal MRI on 3T epilepsy protocol underwent dedicated high-resolution 3T MRI through the epileptogenic zone, guided by video EEG, Magnetoencephalography and FDG-PET data. RESULTS 101 patients with at least 1 year follow-up were included. Twenty-nine of 44 (66%) patients who had normal epilepsy protocol MRI had a lesion identified on dedicated high-resolution MRI. The addition of dedicated high-resolution MRI to standard epilepsy protocol increased sensitivity from 53.1% (95%CI: 40%-66%) to 85.9% (95%CI: 75%-93%). Identified lesions were concordant to surgical resection in all patients and guided depth/strip electrode insertion in 20/25 (80%) patients who underwent staged resection. Dedicated MRI detected small deep seated lesions in 10/20 (50%), and guided depth electrodes placement, without which it would not be feasible, as the lobar location of epileptogenic zone from other non-invasive tests were not sufficiently precise. CONCLUSION Patients with non-lesional epilepsy on standard epilepsy protocol MR may benefit from high-resolution dedicated MRI to aid identification of an underlying lesion, which could impact surgical management and improve seizure control.
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Affiliation(s)
- Raheel Ahmed
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Luc Rubinger
- Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Cristina Go
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - James M Drake
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Elysa Widjaja
- Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
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Watila MM, Xiao F, Keezer MR, Miserocchi A, Winkler AS, McEvoy AW, Sander JW. Epilepsy surgery in low- and middle-income countries: A scoping review. Epilepsy Behav 2019; 92:311-326. [PMID: 30738248 DOI: 10.1016/j.yebeh.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Epilepsy surgery is an important treatment option for people with drug-resistant epilepsy. Surgical procedures for epilepsy are underutilized worldwide, but it is far worse in low- and middle-income countries (LMIC), and it is less clear as to what extent people with drug-resistant epilepsy receive such treatment at all. Here, we review the existing evidence for the availability and outcome of epilepsy surgery in LMIC and discuss some challenges and priority. METHODS We used an accepted six-stage methodological framework for scoping reviews as a guide. We searched PubMed, Embase, Global Health Archives, Index Medicus for South East Asia Region (IMSEAR), Index Medicus for Eastern Mediterranean Region (IMEMR), Latin American & Caribbean Health Sciences Literature (LILACS), African Journal Online (AJOL), and African Index Medicus (AIM) to identify the relevant literature. RESULTS We retrieved 148 articles on epilepsy surgery from 31 countries representing 22% of the 143 LMIC. Epilepsy surgery appears established in some of these centers in Asia and Latin America while some are in their embryonic stage reporting procedures in a small cohort performed mostly by motivated neurosurgeons. The commonest surgical procedure reported was temporal lobectomies. The postoperative seizure-free rates and quality of life (QOL) are comparable with those in the high-income countries (HIC). Some models have shown that epilepsy surgery can be performed within a resource-limited setting through collaboration with international partners and through the use of information and communications technology (ICT). The cost of surgery is a fraction of what is available in HIC. CONCLUSION This review has demonstrated the availability of epilepsy surgery in a few LMIC. The information available is inadequate to make any reasonable conclusion of its existence as routine practice. Collaborations with international partners can provide an opportunity to bring high-quality academic training and technological transfer directly to surgeons working in these regions and should be encouraged.
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Affiliation(s)
- Musa M Watila
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria
| | - Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Magnetic Resonance Imaging Unit, Epilepsy Society, Gerrards Cross, UK
| | - Mark R Keezer
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, Québec H2L 4M1, Canada; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Andrea S Winkler
- Centre for Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Center for Global Health, Department of Neurology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands.
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Awake craniotomies for epileptic gliomas: intraoperative and postoperative seizure control and prognostic factors. J Neurooncol 2019; 142:577-586. [DOI: 10.1007/s11060-019-03131-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
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Thomschewski A, Hincapié AS, Frauscher B. Localization of the Epileptogenic Zone Using High Frequency Oscillations. Front Neurol 2019; 10:94. [PMID: 30804887 PMCID: PMC6378911 DOI: 10.3389/fneur.2019.00094] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/23/2019] [Indexed: 01/22/2023] Open
Abstract
For patients with drug-resistant focal epilepsy, surgery is the therapy of choice in order to achieve seizure freedom. Epilepsy surgery foremost requires the identification of the epileptogenic zone (EZ), defined as the brain area indispensable for seizure generation. The current gold standard for identification of the EZ is the seizure-onset zone (SOZ). The fact, however that surgical outcomes are unfavorable in 40-50% of well-selected patients, suggests that the SOZ is a suboptimal biomarker of the EZ, and that new biomarkers resulting in better postsurgical outcomes are needed. Research of recent years suggested that high-frequency oscillations (HFOs) are a promising biomarker of the EZ, with a potential to improve surgical success in patients with drug-resistant epilepsy without the need to record seizures. Nonetheless, in order to establish HFOs as a clinical biomarker, the following issues need to be addressed. First, evidence on HFOs as a clinically relevant biomarker stems predominantly from retrospective assessments with visual marking, leading to problems of reproducibility and reliability. Prospective assessments of the use of HFOs for surgery planning using automatic detection of HFOs are needed in order to determine their clinical value. Second, disentangling physiologic from pathologic HFOs is still an unsolved issue. Considering the appearance and the topographic location of presumed physiologic HFOs could be immanent for the interpretation of HFO findings in a clinical context. Third, recording HFOs non-invasively via scalp electroencephalography (EEG) and magnetoencephalography (MEG) is highly desirable, as it would provide us with the possibility to translate the use of HFOs to the scalp in a large number of patients. This article reviews the literature regarding these three issues. The first part of the article focuses on the clinical value of invasively recorded HFOs in localizing the EZ, the detection of HFOs, as well as their separation from physiologic HFOs. The second part of the article focuses on the current state of the literature regarding non-invasively recorded HFOs with emphasis on findings and technical considerations regarding their localization.
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Affiliation(s)
- Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria,Department of Psychology, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Ana-Sofía Hincapié
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Birgit Frauscher
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada,*Correspondence: Birgit Frauscher
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Mouthaan BE, Rados M, Boon P, Carrette E, Diehl B, Jung J, Kimiskidis V, Kobulashvili T, Kuchukhidze G, Larsson PG, Leitinger M, Ryvlin P, Rugg-Gunn F, Seeck M, Vulliémoz S, Huiskamp G, Leijten FSS, Van Eijsden P, Trinka E, Braun KPJ. Diagnostic accuracy of interictal source imaging in presurgical epilepsy evaluation: A systematic review from the E-PILEPSY consortium. Clin Neurophysiol 2019; 130:845-855. [PMID: 30824202 DOI: 10.1016/j.clinph.2018.12.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/16/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Interictal high resolution (HR-) electric source imaging (ESI) and magnetic source imaging (MSI) are non-invasive tools to aid epileptogenic zone localization in epilepsy surgery candidates. We carried out a systematic review on the diagnostic accuracy and quality of evidence of these modalities. METHODS Embase, Pubmed and the Cochrane database were searched on 13 February 2017. Diagnostic accuracy studies taking post-surgical seizure outcome as reference standard were selected. Quality appraisal was based on the QUADAS-2 framework. RESULTS Eleven studies were included: eight MSI (n = 267), three HR-ESI (n = 127) studies. None was free from bias. This mostly involved: selection of operated patients only, interference of source imaging with surgical decision, and exclusion of indeterminate results. Summary sensitivity and specificity estimates were 82% (95% CI: 75-88%) and 53% (95% CI: 37-68%) for overall source imaging, with no statistical difference between MSI and HR-ESI. Specificity is higher when partially concordant results were included as non-concordant (p < 0.05). Inclusion of indeterminate test results as non-concordant lowered sensitivity (p < 0.05). CONCLUSIONS Source imaging has a relatively high sensitivity but low specificity for identification of the epileptogenic zone. SIGNIFICANCE We need higher quality studies allowing unbiased test evaluation to determine the added value and diagnostic accuracy of source imaging in the presurgical workup of refractory focal epilepsy.
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Affiliation(s)
- Brian E Mouthaan
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Matea Rados
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Paul Boon
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium
| | - Evelien Carrette
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium
| | - Beate Diehl
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Department of Clinical and Experimental Epilepsy, University College, London, UK
| | - Julien Jung
- Department of Functional Neurology and Epileptology, Institute of Epilepsies (IDEE), Hospices Civils de Lyon, Lyon, France
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Teia Kobulashvili
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Pål G Larsson
- Department of Neurosurgery, Clinic of Surgery and Neuroscience, Oslo University Hospital, Norway
| | - Markus Leitinger
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Fergus Rugg-Gunn
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Department of Clinical and Experimental Epilepsy, University College, London, UK
| | - Margitta Seeck
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Switzerland
| | - Serge Vulliémoz
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Switzerland
| | - Geertjan Huiskamp
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Frans S S Leijten
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Pieter Van Eijsden
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria; Institute of Public Health, Medical Decision Making and HTA, UMIT, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Kees P J Braun
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
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Xu C, Yu T, Zhang G, Rajah GB, Wang Y, Li Y. Concordance between the interictal focal EEG pattern and MRI lesions as a predictor of a favorable surgical outcome in patients with epileptic spasms: a Chinese study. J Neurosurg Pediatr 2019; 23:422-431. [PMID: 30717039 DOI: 10.3171/2018.10.peds18380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the electro-clinical features, etiology, treatment, and postsurgical seizure outcomes in patients with intractable epileptic spasms (ESs). METHODS The authors retrospectively studied the medical records of all patients who had presented with medically intractable ESs and had undergone surgery in the period between October 2009 and August 2015. The interictal electroencephalography (EEG) pattern, MRI studies, magnetoencephalography findings, and postsurgical seizure outcomes were compared. RESULTS Twenty-six patients, 12 boys and 14 girls (age range 3-22 years), were eligible for study inclusion. Of these 26 patients, 84.6% (22) presented with multiple seizure types including partial seizures (PSs) independent of the ESs (30.8%); ESs followed by tonic seizures (30.8%); myoclonic seizures (19.2%); tonic seizures (19.2%); ESs followed by PSs (19.2%); focal seizures with secondary generalization (15.4%); atypical absence (11.5%); PSs followed by ESs (7.7%); and myoclonic followed by tonic seizures (7.7%). Seventeen patients underwent multilobar resection and 9 underwent unilobar resection. At the last follow-up (mean 36.6 months), 42.3% of patients were seizure free (outcome classification [OC] 1), 23.1% had > 50% reduction in seizure frequency (OC2-OC4), and 34.6% had < 50% reduction in seizure frequency or no improvement (OC5 and OC6). Predictors of favorable outcomes included an interictal focal EEG pattern and concordance between interictal EEG and MRI-demonstrated lesions (p = 0.001 and 0.004, respectively). CONCLUSIONS A favorable surgical outcome is achievable in a highly select group of patients with ESs secondary to structural lesions. Interictal EEG can help in identifying patients with the potential for favorable resective outcomes.
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Affiliation(s)
- Cuiping Xu
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
| | - Tao Yu
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
| | - Guojun Zhang
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
| | - Gary B Rajah
- 3Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Yuping Wang
- 4Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Yongjie Li
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
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226
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Mo JJ, Zhang JG, Li WL, Chen C, Zhou NJ, Hu WH, Zhang C, Wang Y, Wang X, Liu C, Zhao BT, Zhou JJ, Zhang K. Clinical Value of Machine Learning in the Automated Detection of Focal Cortical Dysplasia Using Quantitative Multimodal Surface-Based Features. Front Neurosci 2019; 12:1008. [PMID: 30686974 PMCID: PMC6336916 DOI: 10.3389/fnins.2018.01008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/14/2018] [Indexed: 01/18/2023] Open
Abstract
Objective: To automatically detect focal cortical dysplasia (FCD) lesion by combining quantitative multimodal surface-based features with machine learning and to assess its clinical value. Methods: Neuroimaging data and clinical information for 74 participants (40 with histologically proven FCD type II) was retrospectively included. The morphology, intensity and function-based features characterizing FCD lesions were calculated vertex-wise on each cortical surface and fed to an artificial neural network. The classifier performance was quantitatively and qualitatively assessed by performing statistical analysis and conventional visual analysis. Results: The accuracy, sensitivity, specificity of the neural network classifier based on multimodal surface-based features were 70.5%, 70.0%, and 69.9%, respectively, which outperformed the unimodal classifier. There was no significant difference in the detection rate of FCD subtypes (Pearson’s Chi-Square = 0.001, p = 0.970). Cohen’s kappa score between automated detection outcomes and post-surgical resection region was 0.385 (considered as fair). Conclusion: Automated machine learning with multimodal surface features can provide objective and intelligent detection of FCD lesion in pre-surgical evaluation and can assist the surgical strategy. Furthermore, the optimal parameters, appropriate surface features and efficient algorithm are worth exploring.
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Affiliation(s)
- Jia-Jie Mo
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Ling Li
- Department of Functional Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chao Chen
- Key Laboratory of Complex System Control Theory and Application, Tianjin University of Technology, Tianjin, China
| | - Na-Jing Zhou
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China
| | - Wen-Han Hu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yao Wang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bao-Tian Zhao
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun-Jian Zhou
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Neuroradiological findings in patients with “non-lesional” focal epilepsy revealed by research protocol. Clin Radiol 2019; 74:78.e1-78.e11. [DOI: 10.1016/j.crad.2018.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/26/2018] [Indexed: 11/21/2022]
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228
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Gröppel G, Dorfer C, Samueli S, Dressler A, Mühlebner A, Prayer D, Czech T, Feucht M. Single stage epilepsy surgery in children and adolescents with focal cortical dysplasia type II – Prognostic value of the intraoperative electrocorticogram. Clin Neurophysiol 2019; 130:20-24. [DOI: 10.1016/j.clinph.2018.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/12/2018] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
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Wanigasinghe J, Arambepola C, Murugupillai R, Chang T. Age, sex and ethnic differentials in the prevalence and control of epilepsy among Sri Lankan children: a population-based study. BMJ Paediatr Open 2019; 3:e000430. [PMID: 31321319 PMCID: PMC6598552 DOI: 10.1136/bmjpo-2018-000430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/03/2019] [Accepted: 04/11/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of childhood epilepsy in Sri Lanka by different age groups (0-5, 6-10 and 11-16 years), sex and ethnicity, and to describe the types and outcomes of epilepsy. DESIGN AND PATIENTS A population-based, cross-sectional study was conducted in the district considered to be ethnically most balanced in Sri Lanka. A door-to-door survey was performed in the 0-5 year age group (60 geographically defined areas as clusters; 19 children per cluster), and a school-based survey in the 6-16 year age group (150 classes as clusters; 25 children per cluster). The screened children with epilepsy were reviewed individually for confirmation of the diagnosis of epilepsy, typing of the underlying epilepsy syndrome and assessment of control. The same group of children were re-evaluated 1 year later to reconfirm the syndromic diagnosis and to assess the stability of control of epilepsy. RESULTS The overall prevalence of childhood epilepsy was 5.7 per 10 000 children aged 0-16 years (95% CI: 38 to 87). It was higher with younger ages (73.4 per 10 000 children aged 0-5 years; 55.1 per 10 000 children aged 6-10 years and 50.4 per 10 000 children aged 11-16 years). A male dominance was noted in both age groups. In each age group, the prevalence was highest in children of Sinhalese ethnicity. Symptomatic focal epilepsy was the single most common group of epilepsy in both age groups. Majority of children remained well controlled on medications. CONCLUSION The findings indicate a relatively high burden of epilepsy among children in Sri Lanka, however, these were comparable to the burden of disease reported from other countries in the region.
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Affiliation(s)
- Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Roshini Murugupillai
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University, Sri Lanka, Batticaloa, Sri Lanka
| | - Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Abstract
PURPOSE It has been challenging to detect early changes preceding seizure onset in patients with epilepsy. This study investigated the preictal discharges (PIDs) by intracranial electroencephalogram of 11 seizures from 7 patients with mesial temporal lobe epilepsy. METHODS The EEG segments consisting of 30 seconds before ictal onset and 5 seconds after ictal onset were selected for analysis. After PID detection, the amplitude and interval were measured. According to the timing of PID onset, the 30-second period preceding seizure onset was divided into two stages: before PID stage and PID stage. The autocorrelation coefficients during the two stages were calculated and compared. RESULTS Preictal discharge amplitude progressively increased, while PID interval gradually decreased toward seizure onset. The autocorrelation coefficients of PID channels were significantly higher during PID stage than before PID stage. There was an overlap between channels with PIDs and seizure onset channels (80.77%). CONCLUSIONS Preictal discharges emerge prior to ictal event, with a dynamic change and a spatial correlation with seizure onset zone. These findings deepen our understanding of seizure generation and help early prediction and localization of seizure onset zone.
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231
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Mansouri A, Taslimi S, Abbasian A, Badhiwala JH, Akbar MA, Alotaibi NM, Almenawer SA, Weil AG, Fallah A, Carmant L, Ibrahim GM. Surgical outcomes for medically intractable epilepsy in low- and middle-income countries: a systematic review and meta-analysis. J Neurosurg 2018; 131:1068-1078. [PMID: 30497170 DOI: 10.3171/2018.5.jns18599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/29/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs). METHODS The MEDLINE and Embase databases were searched without publication date restriction. This search was supplemented by a manual screen of key epilepsy and neurosurgical journals (January 2005 to December 2016). Studies that reported outcomes for at least 10 patients of any age undergoing surgery for MIE in LMICs over a defined follow-up period were included. A meta-analysis with a random-effects model was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. Pooled estimates of seizure freedom and favorable seizure outcomes following anterior temporal lobectomy with or without amygdalohippocampectomy (ATL ± AH) were reported. RESULTS Twenty studies were selected, of which 16 were from Asian centers. The average age at surgery in all studies was less than 30 years, and the average preoperative duration of epilepsy ranged from 3 to 16.1 years. Mesial temporal sclerosis accounted for 437 of 951 described pathologies, and 1294 of the 1773 procedures were ATL ± AH. Based on 7 studies (646 patients) the pooled seizure freedom estimate following ATL ± AH was 68% (95% CI 55%-82%). Based on 8 studies (1096 patients), the pooled estimate for favorable seizure outcomes was 79% (95% CI 74%-85%). CONCLUSIONS Surgery for MIE in LMICs shows a high percentage of seizure freedom and favorable outcomes. These findings call for a concerted global effort to improve timely access to surgery for MIE patients in these regions, including investments aimed at refining existing and establishing additional centers.
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Affiliation(s)
- Alireza Mansouri
- 1Department of Neuro-Oncology, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Aria Fallah
- 6Department of Neurosurgery, Mattel Children's Hospital, David Geffen School of Medicine at University of California Los Angeles, California; and
| | - Lionel Carmant
- 7Division of Neurology, CHU Sainte-Justine Hospital, University of Montreal, Quebec, Canada
- 8Clinique d'Epilepsie de Port-au-Prince, Haiti
| | - George M Ibrahim
- 9Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario
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Chandra PS, Subianto H, Bajaj J, Girishan S, Doddamani R, Ramanujam B, Chouhan MS, Garg A, Tripathi M, Bal CS, Sarkar C, Dwivedi R, Sapra S, Tripathi M. Endoscope-assisted (with robotic guidance and using a hybrid technique) interhemispheric transcallosal hemispherotomy: a comparative study with open hemispherotomy to evaluate efficacy, complications, and outcome. J Neurosurg Pediatr 2018; 23:187-197. [PMID: 30497135 DOI: 10.3171/2018.8.peds18131] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/09/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEndoscope-assisted hemispherotomy (EH) has emerged as a good alternative option for hemispheric pathologies with drug-resistant epilepsy.METHODSThis was a prospective observational study. Parameters measured included primary outcome measures (frequency, severity of seizures) and secondary outcomes (cognition, behavior, and quality of life). Blood loss, operating time, complications, and hospital stay were also taken into account. A comparison was made between the open hemispherotomy (OH) and endoscopic techniques performed by the senior author.RESULTSOf 59 cases (42 males), 27 underwent OH (8 periinsular, the rest vertical) and 32 received EH. The mean age was 8.65 ± 5.41 years (EH: 8.6 ± 5.3 years; OH: 8.6 ± 5.7 years). Seizure frequency per day was 7 ± 5.9 (EH: 7.3 ± 4.6; OH: 15.0 ± 6.2). Duration of disease (years since first episode) was 3.92 ± 1.24 years (EH: 5.2 ± 4.3; OH: 5.8 ± 4.5 years). Number of antiepileptic drugs per patient was 3.9 ± 1.2 (EH: 4.2 ± 1.2; OH: 3.8 ± 0.98). Values for the foregoing variables are expressed as the mean ± SD. Pathologies included the following: postinfarct encephalomalacia in 19 (EH: 11); Rasmussen's syndrome in 14 (EH: 7); hemimegalencephaly in 12 (EH: 7); hemispheric cortical dysplasia in 7 (EH: 4); postencephalitis sequelae in 6 (EH: 2); and Sturge-Weber syndrome in 1 (EH: 1). The mean follow-up was 40.16 ± 17.3 months. Thirty-nine of 49 (79.6%) had favorable outcomes (International League Against Epilepsy class I and II): in EH the total was 19/23 (82.6%) and in OH it was 20/26 (76.9%). There was no difference in the primary outcome between EH and OH (p = 0.15). Significant improvement was seen in the behavioral/quality of life performance, but not in IQ scores in both EH and OH (p < 0.01, no intergroup difference). Blood loss (p = 0.02) and hospital stay (p = 0.049) were less in EH.CONCLUSIONSEH was as effective as the open procedure in terms of primary and secondary outcomes. It also resulted in less blood loss and a shorter postoperative hospital stay.
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Affiliation(s)
- P Sarat Chandra
- Departments of1Neurosurgery.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | - Heri Subianto
- Departments of1Neurosurgery.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | - Jitin Bajaj
- Departments of1Neurosurgery.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | - Shabari Girishan
- Departments of1Neurosurgery.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | | | - Bhargavi Ramanujam
- 2Neurology.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | | | | | | | | | | | | | - Savita Sapra
- 8Pediatric Neuropsychology, All India Institute of Medical Sciences, New Delhi
| | - Manjari Tripathi
- 2Neurology.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
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Tsai ML, Chen CL, Hsieh KLC, Miser JS, Chang H, Liu YL, Wong TT. Seizure characteristics are related to tumor pathology in children with brain tumors. Epilepsy Res 2018; 147:15-21. [DOI: 10.1016/j.eplepsyres.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/01/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022]
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234
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Conte F, Legros B, Van Paesschen W, Avbersek A, Muglia P, Depondt C. Long-term seizure outcomes in patients with drug resistant epilepsy. Seizure 2018; 62:74-78. [DOI: 10.1016/j.seizure.2018.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 01/26/2023] Open
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Abstract
The World Health Organization classifies diffuse low-grade gliomas (DLGGs) are highly epileptogenic primary brain tumors; epileptic seizures occur in more than 90% of cases. Epileptic seizures and drug resistance progress during the course of DLGGs. The glioma-related epileptogenic mechanisms are multifactorial; epileptogenic foci lie within the infiltrated peritumoral neocortex. A short seizure duration before surgery and a large extent of resection are the main predictors of postoperative seizure control in DLGGs. A supratotal resection of a DLGG can improve postoperative seizure control. Epileptic seizure at diagnosis positively affects DLGGs malignant transformation and overall survival.
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Affiliation(s)
- Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, 1 rue Cabanis, Paris Cedex 14 75674, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; French Glioma Study Group, Réseau d'Etude des Gliomes, REG, Groland, France; Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France.
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
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Prognostic factors determining poor postsurgical outcomes of mesial temporal lobe epilepsy. PLoS One 2018; 13:e0206095. [PMID: 30339697 PMCID: PMC6195284 DOI: 10.1371/journal.pone.0206095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/06/2018] [Indexed: 01/12/2023] Open
Abstract
Objectives To investigate the long-term postoperative outcomes and predictive factors associated with poor surgical outcomes in mesial temporal lobe epilepsy (MTLE). Materials and methods We enrolled patients with MTLE who underwent resective surgery at single university-affiliated hospital. Surgical outcomes were determined using a modified Engel classification at the 2nd and 5th years after surgery and the last time of follow-up. Results The mean duration of follow-up after surgery was 7.6 ± 3.7 years (range, 5.0–21.0 years). 334 of 400 patients (83.5%) were seizure-free at the 5th postoperative year. Significant predictive factors of a poor outcome at the 5th year were a history of generalized tonic clonic (GTC) seizures (odds ratio, OR; 2.318), bi-temporal interictal epileptiform discharge (IED) (OR; 3.107), bilateral hippocampal sclerosis (HS) (OR; 5.471), unilateral HS and combined extra-hippocampal lesion (OR; 5.029), and bi-temporal hypometabolism (BTH) (OR; 4.438). Bi-temporal IED (hazard ratio, HR; 2.186), BTH (HR; 2.043), bilateral HS (HR; 2.541) and unilateral HS and combined extra-hippocampal lesion (HR; 2.75) were independently associated with seizure recurrence. We performed a subgroup analysis of 208 patients with unilateral HS, and their independent predictors of a poor outcome at the 5th year were BTH (OR; 5.838) and tailored hippocampal resection (OR; 11.053). Conclusion This study demonstrates that 16.5% of MTLE patients had poor long-term outcomes after surgery. Bilateral involvement in electrophysiological and imaging studies predicts poor surgical outcomes in MTLE patients.
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Mo JJ, Hu WH, Zhang C, Wang X, Liu C, Zhao BT, Zhou JJ, Zhang K. Value of stereo-electroencephalogram in reoperation of patients with pharmacoresistant epilepsy: a single center, retrospective study. Br J Neurosurg 2018; 32:663-670. [PMID: 30317876 DOI: 10.1080/02688697.2018.1506095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jia-Jie Mo
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Chao Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Bao-Tian Zhao
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jun-Jian Zhou
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
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Gollwitzer S, Hopfengärtner R, Rössler K, Müller T, Olmes DG, Lang J, Köhn J, Onugoren MD, Heyne J, Schwab S, Hamer HM. Afterdischarges elicited by cortical electric stimulation in humans: When do they occur and what do they mean? Epilepsy Behav 2018; 87:173-179. [PMID: 30269940 DOI: 10.1016/j.yebeh.2018.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/09/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Afterdischarges (ADs) are a common and unwanted byproduct of direct cortical stimulation during invasive electroencephalography (EEG) recordings. Brief pulse stimulation (BPS) can sometimes terminate ADs. This study investigated AD characteristics and their relevance for emergence of stimulation seizures. In addition, AD response to BPS was analyzed. MATERIAL AND METHODS Invasive EEG recordings including mapping with direct cortical stimulation in patients with refractory epilepsy at the Erlangen Epilepsy Center were retrospectively reviewed. Afterdischarge defined as stimulation-induced rhythmic epileptiform discharges of more than a two-second duration were analyzed regarding incidence, localization, duration, propagation pattern, morphology, and seizure emergence. In addition, the influence of AD characteristics and stimulation settings on BPS success rate was studied. RESULTS A number of 4261 stimulation trials in 20 patients were investigated. Afterdischarge occurred in 518 trials (14.2%) and lasted 12.4 s (standard deviation [SD]: 8.6 s) on average. We elicited ADs in the seizure onset zone (SOZ) (n = 64; 19.4%), the irritative zone (n = 105, 20.0%), and outside the irritative area (n = 222, 12.5%). Rhythmic spikes (30.5%) and spike-wave complexes (30.3%) represented predominant morphologies. Afterdischarge morphology in the SOZ and hippocampus differed from other areas with polyspikes and sequential spikes being the most common types there (p = 0.0005; p < 0.0001 respectively). Hippocampal ADs were particularly frequent (n = 50, 38.2%) and long-lasting (mean: 16.6, SD: 8.3 s). Brief pulse stimulation was applied in 18.1% of the AD trials (n = 94) and was successful in 37.4% (n = 40). Success rates were highest when BPS was delivered within 9.5 s (p = 0.0048) and in ADs of spike-wave morphology (p = 0.0004). Fifteen clinical seizures emerged from ADs (3.55%), mostly evolving from sequential spikes. Afterdischarges in patients with stimulation seizures appeared more widespread (p < 0.0001) and lasted longer (mean duration 7.0 s) than in those without (mean duration 21.0 s, p = 0.0054). CONCLUSION Afterdischarges appear in the epileptogenic and nonepileptogenic cortex. Duration and propagation patterns can help to quantify the risk of stimulation seizures, with sequential spikes being most susceptible to seizure elucidation. The hippocampus is highly sensitive to AD release. Brief pulse stimulation is a safe and efficacious way to terminate ADs, especially when delivered quickly after AD onset.
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Affiliation(s)
- Stephanie Gollwitzer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
| | - Rüdiger Hopfengärtner
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Tamara Müller
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - David Gerhard Olmes
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Johannes Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Julia Köhn
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Müjgan Dogan Onugoren
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Jana Heyne
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Schwab
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Hajo Martinus Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
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Zhang B, Feng X, Peng F, Wang L, Guo EK, Zhang Y, Liu P, Wu Z, Liu A. Seizure predictors and outcome after Onyx embolization in patients with brain arteriovenous malformations. Interv Neuroradiol 2018; 25:124-131. [PMID: 30269666 DOI: 10.1177/1591019918801290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Brain arteriovenous malformation (bAVM)-related epilepsy can significantly affect patient quality of life. We aimed to identify the factors associated with seizures occurrence and evaluate the long-term outcome following Onyx embolization in bAVM patients. METHODS Between July 2014 and July 2016, 239 consecutive patients underwent treatment for bAVMs in our institute and were respectively analyzed. Demographics, seizure status and bAVM morphologic characteristics were recorded. Modified Engel classification was used to evaluate the long-term seizure outcomes. RESULTS Of 239 bAVM patients, 68 (28.5%) initially presented with seizures. Seizure occurrence was associated with cerebral hemorrhage history, frontal-temporal location and arterial borderzone location. Of the 37 patients who presented with initial seizures and were treated with Onyx embolization, 23 (62.2%) were treated with antiepileptic drugs (AEDs) before Onyx embolization. At the last follow-up visit, 19 (51.4%) of the 37 patients reached modified Engel class I outcome. Of the 23 patients who had ever been treated with AEDs, 12 (52.2%) were still taking AEDs at the last follow-up visit. Single-factor analysis showed that arterial borderzone location was significantly correlated with higher modified Engel class outcome ( p = 0.046). CONCLUSION Patients with bAVM hemorrhage history, frontal-temporal location and arterial borderzone location were associated with seizure occurrence. Seizure-free status was not obtained in AVM patients with arterial borderzone after embolization, though it may have benefits in other ways. The seizure-free mechanism of bAVM with Onyx embolization is worth further study.
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Affiliation(s)
- Baorui Zhang
- 1 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,2 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Feng
- 1 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,2 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Peng
- 1 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,2 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Luyao Wang
- 1 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,2 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Er Kang Guo
- 1 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,2 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yupeng Zhang
- 1 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,2 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- 1 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,2 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongxue Wu
- 1 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,2 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aihua Liu
- 1 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,2 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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240
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Postoperative seizure outcome and timing interval to start antiepileptic drug withdrawal: A retrospective observational study of non-neoplastic drug resistant epilepsy. Sci Rep 2018; 8:13782. [PMID: 30213952 PMCID: PMC6137227 DOI: 10.1038/s41598-018-31092-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/16/2018] [Indexed: 02/05/2023] Open
Abstract
This study aimed to investigate the impact of timing interval to start AED withdraw (TIW) after surgery on the seizure outcome in non-neoplastic drug resistant epilepsy (DRE). TIW were divided into three groups (respectively,<1 year, 1-<2 years, and ≥2 years). The seizure outcome at the different time points after starting AED withdrawal were compared among three groups. Other factors that related to seizure recurrence and TIW were included into the multiple analysis to investigate the predictors of seizure-free. Altogether, 205 patients were involved in the study. 102 individuals (50%) had seizure recurrence and 127 (62%) had seizure-free at the final follow up. 115 of them have attempted AED reduction and had not seizure recurrence before AED reduction. The rate of seizure-free had no significant difference among people with different TIW. Multiple analysis indicated that temporal surgery is a favorable predictor of seizure-free at the first year after starting AED withdrawal, and preoperative secondary generalized seizures is an unfavorable predictor of seizure-free at the final follow up. In patients with non-neoplastic DRE, TIW is not the mainly influence factor on seizure outcome, however, preoperative secondary generalized seizures and extra-temporal surgery are negatively associated with seizure-free.
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241
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Jalloh I, Cho N, Nga VD, Whitney R, Jain P, Al-Mehmadi S, Yau I, Okura H, Widjaja E, Otsubo H, Ochi A, Donner E, McCoy B, Drake J, Go C, Rutka JT. The role of surgery in refractory epilepsy secondary to polymicrogyria in the pediatric population. Epilepsia 2018; 59:1982-1996. [DOI: 10.1111/epi.14556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Ibrahim Jalloh
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
| | - Newton Cho
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
| | - Vincent D.W. Nga
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
- Division of Neurosurgery; National University Hospital; Singapore City Singapore
| | - Robyn Whitney
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Puneet Jain
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
- Division of Pediatric Neurology; Department of Pediatrics; BLK Super Speciality Hospital; New Delhi India
| | - Sameer Al-Mehmadi
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Ivanna Yau
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Hidehiro Okura
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
- Department of Neurosurgery; Juntendo University School of Medicine; Tokyo Japan
| | - Elysa Widjaja
- Division of Diagnostic Imaging; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Hiroshi Otsubo
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Ayako Ochi
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Elizabeth Donner
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Blathnaid McCoy
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - James Drake
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
| | - Cristina Go
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - James T. Rutka
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
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242
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Unusual ictal propagation patterns suggesting poor prognosis after temporal lobe epilepsy surgery: Switch of lateralization and bilateral asynchrony. Epilepsy Behav 2018; 86:31-36. [PMID: 30071374 DOI: 10.1016/j.yebeh.2018.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to investigate unusual ictal propagation patterns in patients with drug-resistant temporal lobe epilepsy (TLE) and reveal their electrophysiological, neuroimaging, and prognostic properties after surgery. METHODS Among 248 patients with TLE who underwent scalp video-electroencephalographic (EEG) monitoring, 24 patients with 'switch of lateralization' or 'bilateral asynchrony' in at least one of their seizures (9.3%) were analyzed retrospectively. The postoperative outcome was determined in 16 patients who had undergone epilepsy surgery. RESULTS All but 5 of the included patients had hippocampal sclerosis (HS) as their magnetic resonance imaging (MRI) findings. Twelve out of 16 patients (75%) who had surgery were seizure-free for at least 1 year. Nine out of 12 patients (75%) with good outcome had unilateral interictal EEG discharges in temporal regions whereas 3 out of 4 patients with poor outcome had bilateral temporal interictal spiking (p = 0.018). CONCLUSION Unusual ictal propagation patterns are not always related to poor prognosis after surgery in patients with TLE. Patients with unilateral interictal spiking in the temporal region tend to have good outcome despite these unusual patterns. These patterns can also be seen in patients with TLE with other etiologies besides the well-known HS in MRI.
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243
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Fujimoto A, Okanishi T, Kanai S, Sato K, Itamura S, Baba S, Nishimura M, Masui T, Enoki H. Double match of 18F-fluorodeoxyglucose-PET and iomazenil-SPECT improves outcomes of focus resection surgery. Acta Neurochir (Wien) 2018; 160:1875-1882. [PMID: 29858947 DOI: 10.1007/s00701-018-3573-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND When the results of electroencephalography (EEG), magnetic resonance imaging (MRI), and seizure semiology are discordant or no structural lesion is evident on MRI, single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are important examinations for lateralization or localization of epileptic regions. We hypothesized that the concordance between interictal 2-[18F]fluoro-2-deoxy-D-glucose (18FDG)-PET and iomazenil (IMZ)-SPECT could suggest the epileptogenic lobe in patients with non-lesional findings on MRI. METHOD Fifty-nine patients (31 females, 28 males; mean age, 29 years; median age, 27 years; range, 7-56 years) underwent subdural electrode implantation followed by focus resection. All patients underwent 18FDG-PET, IMZ-SPECT, and focus resection surgery. Follow-up was continued for ≥ 2 years. We evaluated surgical outcomes as seizure-free or not and analyzed correlations between outcomes and concordances of low-uptake lobes on PET, SPECT, or both PET and SPECT to the resection lobes. We used uni- and multivariate logistic regression analyses. RESULTS In univariate analyses, all three concordances correlated significantly with seizure-free outcomes (PET, p = 0.017; SPECT, p = 0.030; both PET and SPECT, p = 0.006). In multivariate analysis, concordance between resection and low-uptake lobes in both PET and SPECT correlated significantly with seizure-free outcomes (p = 0.004). The odds ratio was 6.0. CONCLUSION Concordance between interictal 18FDG-PET and IMZ-SPECT suggested that the epileptogenic lobe is six times better than each examination alone among patients with non-lesional findings on MRI. IMZ-SPECT and 18FDG-PET are complementary examinations in the assessment of localization-related epilepsy.
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244
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Motoi H, Miyakoshi M, Abel TJ, Jeong JW, Nakai Y, Sugiura A, Luat AF, Agarwal R, Sood S, Asano E. Phase-amplitude coupling between interictal high-frequency activity and slow waves in epilepsy surgery. Epilepsia 2018; 59:1954-1965. [PMID: 30146766 DOI: 10.1111/epi.14544] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/19/2018] [Accepted: 07/26/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We hypothesized that the modulation index (MI), a summary measure of the strength of phase-amplitude coupling between high-frequency activity (>150 Hz) and the phase of slow waves (3-4 Hz), would serve as a useful interictal biomarker for epilepsy presurgical evaluation. METHODS We investigated 123 patients who underwent focal cortical resection following extraoperative electrocorticography recording and had at least 1 year of postoperative follow-up. We examined whether consideration of MI would improve the prediction of postoperative seizure outcome. MI was measured at each intracranial electrode site during interictal slow-wave sleep. We compared the accuracy of prediction of patients achieving International League Against Epilepsy class 1 outcome between the full multivariate logistic regression model incorporating MI in addition to conventional clinical, seizure onset zone (SOZ), and neuroimaging variables, and the reduced logistic regression model incorporating all variables other than MI. RESULTS Ninety patients had class 1 outcome at the time of most recent follow-up (mean follow-up = 5.7 years). The full model had a noteworthy outcome predictive ability, as reflected by regression model fit R2 of 0.409 and area under the curve (AUC) of receiver operating characteristic plot of 0.838. Incomplete resection of SOZ (P < 0.001), larger number of antiepileptic drugs at the time of surgery (P = 0.007), and larger MI in nonresected tissues relative to that in resected tissue (P = 0.020) were independently associated with a reduced probability of class 1 outcome. The reduced model had a lower predictive ability as reflected by R2 of 0.266 and AUC of 0.767. Anatomical variability in MI existed among nonepileptic electrode sites, defined as those unaffected by magnetic resonance imaging lesion, SOZ, or interictal spike discharges. With MI adjusted for anatomical variability, the full model yielded the outcome predictive ability of R2 of 0.422, AUC of 0.844, and sensitivity/specificity of 0.86/0.76. SIGNIFICANCE MI during interictal recording may provide useful information for the prediction of postoperative seizure outcome.
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Affiliation(s)
- Hirotaka Motoi
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Makoto Miyakoshi
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, California
| | - Taylor J Abel
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeong-Won Jeong
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan.,Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Yasuo Nakai
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Ayaka Sugiura
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Aimee F Luat
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan.,Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Rajkumar Agarwal
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan.,Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Sandeep Sood
- Department of Neurosurgery, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Eishi Asano
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan.,Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan
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245
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Shi J, Gao Z, Gao J, Li G, Chen Y. Predictors and outcome surgery for posterior cortex epilepsies. Clin Neurol Neurosurg 2018; 171:124-128. [DOI: 10.1016/j.clineuro.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/02/2018] [Accepted: 06/09/2018] [Indexed: 01/29/2023]
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246
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Nagy G, Stokes SS, Erőss LG, Bhattacharyya D, Yianni J, Rowe JG, Kemeny AA, Radatz MWR. Contemporary radiosurgery of cerebral cavernous malformations: Part 2. Treatment outcome for hemispheric lesions. J Neurosurg 2018; 130:1826-1834. [PMID: 30052157 DOI: 10.3171/2018.2.jns171267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 02/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The role of radiosurgery (RS) in treating superficial cavernous malformations (CMs) is insufficiently studied in part because of the disappointing results of early experimental attempts as compared to the mostly safe and effective microsurgery. Nonetheless, because of lesion- or treatment-specific factors, a therapeutic alternative may be required. In this study, the authors aimed to assess the safety of RS in treating superficial CMs and to analyze its long-term effect on hemorrhage rates and epilepsy control. METHODS The authors conducted a retrospective analysis of 96 patients with 109 CMs located in the cerebral or cerebellar hemispheres and treated with RS between 1995 and 2014. A median of 15 Gy (range 10-25 Gy) was given to the 50% prescription isodose level, lesion volume was 604 mm3 (4-8300 mm3), and the prescription isodose volume was 638.5 mm3 (4-9500 mm3). Outcomes were compared to those of 206 deep-seated lesions reported on in another study. Ninety-five patients had available follow-up, which was a median of 7 years (1-21 years). Median patient age was 42 years (0.5-77) at presentation and 45 (3-80) at treatment. Seventy-one CMs presented with symptomatic hemorrhage, and 52 caused seizures. RESULTS In the nonhemorrhagic group (37 lesions), one bleed occurred during the follow-up period, for an annual bleed rate of 0.4% per lesion. The lifetime annual bleed rate of CMs having a single hemorrhage prior to treatment was 2.5%. The rebleed rate in the single-bleed group decreased from 1.8% within the first 2 years after RS to 0.7% thereafter. The pretreatment rebleed rate for lesions having multiple bleeds prior to RS was 14.15%, which fell to 3.85% for the first 2 years after RS and declined to 1.3% thereafter. Multivariate analysis showed younger age, deep lesion location, and multiple pretreatment hemorrhages as significant predictors of posttreatment hemorrhage.Pretreatment hemorrhages led to permanent deficits in 41.4% of the cases with a single bleed and in 46.1% of cases with multiple bleeds. Only mild (modified Rankin Scale score 1) and a low rate of permanent neurological deficits were caused either by posttreatment hemorrhages (4.3%) or by radiation (2%).The rate of improvement in epilepsy was 84.9% after RS in patients with at least one seizure prior to treatment, not depending on the presence of hemorrhage or the time interval between presentation and treatment. Favorable outcome occurred in 81% of patients whose seizures were not controlled with antiepileptic medication prior to RS. CONCLUSIONS Radiosurgery for superficial CMs is safe and appears to be effective, offering a real treatment alternative to surgery for selected patients. Given their relatively benign natural history, superficial CMs require further study to verify the long-term benefit of RS over the lesions' natural history.
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Affiliation(s)
- Gábor Nagy
- 1National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Loránd G Erőss
- 1National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Debapriya Bhattacharyya
- 2Department of Neurosurgery, and
- 3National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital; and
- 4Thornbury Radiosurgery Centre, Sheffield, United Kingdom
| | - John Yianni
- 2Department of Neurosurgery, and
- 3National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital; and
- 4Thornbury Radiosurgery Centre, Sheffield, United Kingdom
| | - Jeremy G Rowe
- 2Department of Neurosurgery, and
- 3National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital; and
- 4Thornbury Radiosurgery Centre, Sheffield, United Kingdom
| | | | - Matthias W R Radatz
- 2Department of Neurosurgery, and
- 3National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital; and
- 4Thornbury Radiosurgery Centre, Sheffield, United Kingdom
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247
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Markoula S, Chaudhary UJ, Perani S, De Ciantis A, Yadee T, Duncan JS, Diehl B, McEvoy AW, Lemieux L. The impact of mapping interictal discharges using EEG-fMRI on the epilepsy presurgical clinical decision making process: A prospective study. Seizure 2018; 61:30-37. [PMID: 30059825 DOI: 10.1016/j.seizure.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/27/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE We set out to establish the clinical utility of EEG-correlated fMRI as part of the presurgical evaluation, by measuring prospectively its effects on the clinical decision. METHODS Patients with refractory extra-temporal focal epilepsy, referred for presurgical evaluation were recruited in a period of 18 months. The EEG-fMRI based localization was presented during a multi-disciplinary meeting after the team had defined the presumed RESULTS: Sixteen patients (six women), with a median age of 28 years, were recruited. Interpretable EEG-fMRI results were available in 13: interictal epileptic discharges (IEDs) were recorded in eleven patients and seizures were recorded in two patients. In three patients, no epileptic activity was captured during EEG-fMRI acquisition and in two of those an IED topographic map correlation was performed (between EEG recorded inside the scanner and long-term video EEG monitoring). EEG-fMRI results presentation had no impact on the initial clinical decision in three patients (23%) of the thirteen and resulted in a modification of the initial surgical plan in ten patients (77%) of the thirteen finally presented in MDT; in eight patients the impact was on the planned placement of invasive electrodes and in two patients the EEG-fMRI led to additional non-invasive tests before proceeding further with surgery. CONCLUSION The study is a prospective observational cohort study specifically designed to assess the impact of EEG-fMRI on the clinical decision making process, suggesting a significant influence of EEG-fMRI on epilepsy surgery planning.
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Affiliation(s)
- Sofia Markoula
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK; Neurology Department, University Hospital of Ioannina, Ioannina, Greece.
| | - Umair J Chaudhary
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK; Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Suejen Perani
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Alessio De Ciantis
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| | - Tinonkorn Yadee
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
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Technical Modification of Amygdalo-Hippocampectomy in Temporal Lobe Epilepsy Surgery to Further Reduce Severe Neurological Complications: A Clinical-Anatomical Study. World Neurosurg 2018. [DOI: 10.1016/j.wneu.2018.02.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kreilkamp BAK, Weber B, Elkommos SB, Richardson MP, Keller SS. Hippocampal subfield segmentation in temporal lobe epilepsy: Relation to outcomes. Acta Neurol Scand 2018; 137:598-608. [PMID: 29572865 PMCID: PMC5969077 DOI: 10.1111/ane.12926] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/24/2022]
Abstract
Objective To investigate the clinical and surgical outcome correlates of preoperative hippocampal subfield volumes in patients with refractory temporal lobe epilepsy (TLE) using a new magnetic resonance imaging (MRI) multisequence segmentation technique. Methods We recruited 106 patients with TLE and hippocampal sclerosis (HS) who underwent conventional T1‐weighted and T2 short TI inversion recovery MRI. An automated hippocampal segmentation algorithm was used to identify twelve subfields in each hippocampus. A total of 76 patients underwent amygdalohippocampectomy and postoperative seizure outcome assessment using the standardized ILAE classification. Semiquantitative hippocampal internal architecture (HIA) ratings were correlated with hippocampal subfield volumes. Results Patients with left TLE had smaller volumes of the contralateral presubiculum and hippocampus‐amygdala transition area compared to those with right TLE. Patients with right TLE had reduced contralateral hippocampal tail volumes and improved outcomes. In all patients, there were no significant relationships between hippocampal subfield volumes and clinical variables such as duration and age at onset of epilepsy. There were no significant differences in any hippocampal subfield volumes between patients who were rendered seizure free and those with persistent postoperative seizure symptoms. Ipsilateral but not contralateral HIA ratings were significantly correlated with gross hippocampal and subfield volumes. Conclusions Our results suggest that ipsilateral hippocampal subfield volumes are not related to the chronicity/severity of TLE. We did not find any hippocampal subfield volume or HIA rating differences in patients with optimal and unfavorable outcomes. In patients with TLE and HS, sophisticated analysis of hippocampal architecture on MRI may have limited value for prediction of postoperative outcome.
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Affiliation(s)
- B. A. K. Kreilkamp
- Department of Molecular and Clinical Pharmacology; Institute of Translational Medicine; University of Liverpool; Liverpool UK
- Department of Neuroradiology; The Walton Centre NHS Foundation Trust; Liverpool UK
| | - B. Weber
- Department of Epileptology; University of Bonn; Bonn Germany
- Center for Economics and Neuroscience; University of Bonn; Bonn Germany
- Department of NeuroCognition/Imaging; Life& Brain Research Center; Bonn Germany
| | - S. B. Elkommos
- Department of Molecular and Clinical Sciences; St George's, University of London; London UK
| | - M. P. Richardson
- Department of Basic and Clinical Neuroscience; Institute of Psychiatry, Psychology & Neuroscience; King's College London; London UK
- Engineering and Physical Sciences Research Council Centre for Predictive Modelling in Healthcare; University of Exeter; Exeter UK
| | - S. S. Keller
- Department of Molecular and Clinical Pharmacology; Institute of Translational Medicine; University of Liverpool; Liverpool UK
- Department of Neuroradiology; The Walton Centre NHS Foundation Trust; Liverpool UK
- Department of Basic and Clinical Neuroscience; Institute of Psychiatry, Psychology & Neuroscience; King's College London; London UK
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Impact of resective epilepsy surgery on health-related quality of life in children with and without low intellectual ability. Epilepsy Behav 2018; 83:131-136. [PMID: 29705622 DOI: 10.1016/j.yebeh.2018.03.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The current study examined pre- and postoperative health-related quality of life (HRQL) across children with and without low intellectual ability. We also aimed to clarify the literature on postsurgical change by assessing domain-specific HRQL pre- and postoperatively in children with drug-resistant epilepsy. METHOD All patients (n=111) underwent resective epilepsy surgery between 1996 and 2016 at the Hospital for Sick Children in Toronto, comparing baseline and 1-year follow-up HRQL with the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-76). At the group-level, postsurgical change in HRQL was examined through linear mixed-effects modeling. Clinically important change in HRQL at the individual level was quantified using a standard error of measurement (SEM)-based criterion, and estimates were stratified by intellectual ability. RESULTS Children with epilepsy and low intellectual ability had lower overall HRQL compared with those with normal intelligence (b=-10.45, SE=4.89, p=.035). No differences in change in HRQL related to intellectual level were found. In the broader sample, significant postoperative improvements were found for HRQL related to physical activity (b=8.28, SE=1.79, p<.001), social activity (b=15.81, SE=2.76, p<.001), and behavior (b=4.34, SE=1.35, p=.001). Postoperative improvements in physical and social HRQL were associated with better seizure control (p=.011). Conversely, cognitive and emotional domains of HRQL did not improve one year postoperatively, even in the presence of improved seizure control. SIGNIFICANCE Results suggest that children with low intellectual ability can expect to achieve similar improvements in HRQL after epilepsy surgery compared with those with normal intelligence. Further, while overall HRQL is shown to improve in children following epilepsy surgery, domain-specific change is nuanced and has important implications for health practitioners aiming to monitor treatment progress of patients.
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