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Sheikh SR, McKee ZA, Ghosn S, Jeong KS, Kattan M, Burgess RC, Jehi L, Saab CY. Machine learning algorithm for predicting seizure control after temporal lobe resection using peri-ictal electroencephalography. Sci Rep 2024; 14:21771. [PMID: 39294238 PMCID: PMC11410994 DOI: 10.1038/s41598-024-72249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 09/05/2024] [Indexed: 09/20/2024] Open
Abstract
Brain resection is curative for a subset of patients with drug resistant epilepsy but up to half will fail to achieve sustained seizure freedom in the long term. There is a critical need for accurate prediction tools to identify patients likely to have recurrent postoperative seizures. Results from preclinical models and intracranial EEG in humans suggest that the window of time immediately before and after a seizure ("peri-ictal") represents a unique brain state with implications for clinical outcome prediction. Using a dataset of 294 patients who underwent temporal lobe resection for seizures, we show that machine learning classifiers can make accurate predictions of postoperative seizure outcome using 5 min of peri-ictal scalp EEG data that is part of universal presurgical evaluation (AUC 0.98, out-of-group testing accuracy > 90%). This is the first approach to seizure outcome prediction that employs a routine non-invasive preoperative study (scalp EEG) with accuracy range likely to translate into a clinical tool. Decision curve analysis (DCA) shows that compared to the prevalent clinical-variable based nomogram, use of the EEG-augmented approach could decrease the rate of unsuccessful brain resections by 20%.
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Affiliation(s)
- Shehryar R Sheikh
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA.
- Department of Molecular Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | | | - Samer Ghosn
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Ki-Soo Jeong
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Brown University, Providence, RI, USA
| | - Michael Kattan
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Richard C Burgess
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
- Center for Computational Life Sciences, Cleveland Clinic, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Carl Y Saab
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Brown University, Providence, RI, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Li Y. Out of Sight, Not Yet Out of Reach: Surgical Outcomes in MRI-Negative and Pathology-Negative Epilepsy Patients. Epilepsy Curr 2024; 24:251-253. [PMID: 39309064 PMCID: PMC11412405 DOI: 10.1177/15357597241253413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 09/25/2024] Open
Abstract
Outcome of Epilepsy Surgery in MRI-Negative Patients Without Histopathologic Abnormalities in the Resected Tissue Sanders MW, Van der Wolf I, Jansen FE, Aronica E, Helmstaedter C, Racz A, Surges R, Grote A, Becker AJ, Rheims S, Catenoix H, Duncan JS, De Tisi J, Jacques TS, Cross JH, Kalviainen R, Rauramaa T, Chassoux F, Devaux BC, Di Gennaro G, Esposito V, Bodi I, Honavar M, Bien CG, Cloppenborg T, Coras R, Hamer HM, Marusic P, Kalina A, Pieper T, Kudernatsch M, Hartlieb TS, Von Oertzen TJ, Aichholzer M, Dorfmuller G, Chipaux M, Noachtar S, Kaufmann E, Schulze-Bonhage A, Scheiwe CF, Özkara C, Grunwald T, Koenig K, Guerrini R, Barba C, Buccoliero AM, Giordano F, Rosenow F, Menzler K, Garbelli R, Deleo F, Krsek P, Straka B, Arzimanoglou AA, Toulouse J, Van Paesschen W, Theys T, Pimentel J, Loução De Amorim IM, Specchio N, De Palma L, Feucht M, Scholl T, Roessler K, Toledano Delgado R, Gil-Nagel A, Raicevic S, Ristic AJ, Schijns O, Beckervordersandforth J, San Antonio-Arce V, Rumia J, Blumcke I, Braun KP; as the European Epilepsy Brain Bank Consortium (EEBB). Neurology . 2024;102(4): e208007. doi:10.1212/WNL.0000000000208007 . PMID: 38290094 Background and Objectives: Patients with presumed nonlesional focal epilepsy—based on either MRI or histopathologic findings—have a lower success rate of epilepsy surgery compared with lesional patients. In this study, we aimed to characterize a large group of patients with focal epilepsy who underwent epilepsy surgery despite a normal MRI and had no lesion on histopathology. Determinants of their postoperative seizure outcomes were further studied. Methods: We designed an observational multicenter cohort study of MRI-negative and histopathology-negative patients who were derived from the European Epilepsy Brain Bank and underwent epilepsy surgery between 2000 and 2012 in 34 epilepsy surgery centers within Europe. We collected data on clinical characteristics, presurgical assessment, including genetic testing, surgery characteristics, postoperative outcome, and treatment regimen. Results: Of the 217 included patients, 40% were seizure-free (Engel I) 2 years after surgery and one-third of patients remained seizure-free after 5 years. Temporal lobe surgery (adjusted odds ratio [AOR]: 2.62; 95% CI 1.19-5.76), shorter epilepsy duration (AOR for duration: 0.94; 95% CI 0.89-0.99), and completely normal histopathologic findings—versus nonspecific reactive gliosis—(AOR: 4.69; 95% CI 1.79-11.27) were significantly associated with favorable seizure outcome at 2 years after surgery. Of patients who underwent invasive monitoring, only 35% reached seizure freedom at 2 years. Patients with parietal lobe resections had lowest seizure freedom rates (12.5%). Among temporal lobe surgery patients, there was a trend toward favorable outcome if hippocampectomy was part of the resection strategy (OR: 2.94; 95% CI 0.98-8.80). Genetic testing was only sporadically performed. Discussion: This study shows that seizure freedom can be reached in 40% of nonlesional patients with both normal MRI and histopathology findings. In particular, nonlesional temporal lobe epilepsy should be regarded as a relatively favorable group, with almost half of patients achieving seizure freedom at 2 years after surgery-even more if the hippocampus is resected-compared with only 1 in 5 nonlesional patients who underwent extratemporal surgery. Patients with an electroclinically identified focus, who are nonlesional, will be a promising group for advanced molecular-genetic analysis of brain tissue specimens to identify new brain somatic epilepsy genes or epilepsy-associated molecular pathways.
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Affiliation(s)
- Yi Li
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine
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Patel M, Mittal AK, Joshi V, Agrawal M, Babu Varthya S, Saini L, Saravanan A, Anil A, Rajial T, Panda S, Bhaskar S, Tiwari S, Singh K. Evaluation of Utility of Invasive Electroencephalography for Definitive Surgery in Patients with Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 187:172-183.e2. [PMID: 38649027 DOI: 10.1016/j.wneu.2024.04.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
When noninvasive tests are unable to define the epileptogenic zone in patients, intracranial electroencephalography (iEEG) is a method of localizing the epileptogenic zone. Compared with noninvasive evaluations, it offers more precise information about patterns of epileptiform activity, which results in useful diagnostic information that supports surgical decision-making. The primary aim of the present study was to assess the utility of iEEG for definitive surgery for patients with drug-resistant epilepsy. Online databases such as PubMed, Medline, Embase, Scopus, Cochrane Library, Web of Science, and IEEE Xplore were searched for MeSH terms and free-text keywords. The ROBINS I (risk of bias in non-randomized studies - of interventions) critical appraisal tool was used for quality assessment. The prevalence from different studies was pooled together using the inverse variance heterogeneity method. Egger's regression analysis and funnel plot were used to evaluate publication bias. The systematic review included 18 studies, and the meta-analysis included 10 studies to estimate the prevalence of seizure freedom (Engel class I) in patients undergoing surgery after iEEG. A total of 526 patients were included in the meta-analysis. The follow-up period ranged from 1 to 10 years. The overall pooled estimate of the prevalence of seizure freedom (Engel class I) for patients undergoing surgery after iEEG was 53% (95% confidence interval, 44%-62%). The results additionally demonstrated that 12 studies had a moderate risk of bias and 6 had a low risk. Future studies are crucial to enhance our understanding of iEEG to guide patient choices and unravel their implications.
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Affiliation(s)
- Mamta Patel
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Amit K Mittal
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Vibha Joshi
- Department of CMFM, All India Institute of Medical Sciences, Jodhpur, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Shoban Babu Varthya
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Lokesh Saini
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Aswini Saravanan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhishek Anil
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Tanuja Rajial
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India.
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Qian Z, Lin J, Jiang R, Jean S, Dai Y, Deng D, Tagu PT, Shi L, Song S. Evaluation of MRI post-processing methods combined with PET in detecting focal cortical dysplasia lesions for patients with MRI-negative epilepsy. Seizure 2024; 117:275-283. [PMID: 38579502 DOI: 10.1016/j.seizure.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE Accurate detection of focal cortical dysplasia (FCD) through magnetic resonance imaging (MRI) plays a pivotal role in the preoperative assessment of epilepsy. The integration of multimodal imaging has demonstrated substantial value in both diagnosing FCD and devising effective surgical strategies. This study aimed to enhance MRI post-processing by incorporating positron emission tomography (PET) analysis. We sought to compare the diagnostic efficacy of diverse image post-processing methodologies in patients presenting MRI-negative FCD. METHODS In this retrospective investigation, we assembled a cohort of patients with negative preoperative MRI results. T1-weighted volumetric sequences were subjected to morphometric analysis program (MAP) and composite parametric map (CPM) post-processing techniques. We independently co-registered images derived from various methods with PET scans. The alignment was subsequently evaluated, and its correlation was correlated with postoperative seizure outcomes. RESULTS A total of 41 patients were enrolled in the study. In the PET-MAP(p = 0.0189) and PET-CPM(p = 0.00041) groups, compared with the non-overlap group, the overlap group significantly associated with better postoperative outcomes. In PET(p = 0.234), CPM(p = 0.686) and MAP(p = 0.672), there is no statistical significance between overlap and seizure-free outcomes. The sensitivity of using the CPM alone outperformed the MAP (0.65 vs 0.46). The use of PET-CPM demonstrated superior sensitivity (0.96), positive predictive value (0.83), and negative predictive value (0.91), whereas the MAP displayed superior specificity (0.71). CONCLUSIONS Our findings suggested a superiority in sensitivity of CPM in detecting potential FCD lesions compared to MAP, especially when it is used in combination with PET for diagnosis of MRI-negative epilepsy patients. Moreover, we confirmed the superiority of synergizing metabolic imaging (PET) with quantitative maps derived from structural imaging (MAP or CPM) to enhance the identification of subtle epileptogenic zones (EZs). This study serves to illuminate the potential of integrated multimodal techniques in advancing our capability to pinpoint elusive pathological features in epilepsy cases.
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Affiliation(s)
- Zhe Qian
- Fujian Medical University, Fuzhou, China.
| | - Jiuluan Lin
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Fuzhou, China.
| | - Rifeng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Stéphane Jean
- Department of Neurosurgery, Fuzhou Children's Hospital, Fuzhou, China
| | - Yihai Dai
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Donghuo Deng
- Fujian Medical University Union Hospital, Fuzhou, China.
| | | | - Lin Shi
- BrainNow Research Institute, Guangdong, China.
| | - Shiwei Song
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China.
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Kronlage C, Heide EC, Hagberg GE, Bender B, Scheffler K, Martin P, Focke N. MP2RAGE vs. MPRAGE surface-based morphometry in focal epilepsy. PLoS One 2024; 19:e0296843. [PMID: 38330027 PMCID: PMC10852321 DOI: 10.1371/journal.pone.0296843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024] Open
Abstract
In drug-resistant focal epilepsy, detecting epileptogenic lesions using MRI poses a critical diagnostic challenge. Here, we assessed the utility of MP2RAGE-a T1-weighted sequence with self-bias correcting properties commonly utilized in ultra-high field MRI-for the detection of epileptogenic lesions using a surface-based morphometry pipeline based on FreeSurfer, and compared it to the common approach using T1w MPRAGE, both at 3T. We included data from 32 patients with focal epilepsy (5 MRI-positive, 27 MRI-negative with lobar seizure onset hypotheses) and 94 healthy controls from two epilepsy centres. Surface-based morphological measures and intensities were extracted and evaluated in univariate GLM analyses as well as multivariate unsupervised 'novelty detection' machine learning procedures. The resulting prediction maps were analyzed over a range of possible thresholds using alternative free-response receiver operating characteristic (AFROC) methodology with respect to the concordance with predefined lesion labels or hypotheses on epileptogenic zone location. We found that MP2RAGE performs at least comparable to MPRAGE and that especially analysis of MP2RAGE image intensities may provide additional diagnostic information. Secondly, we demonstrate that unsupervised novelty-detection machine learning approaches may be useful for the detection of epileptogenic lesions (maximum AFROC AUC 0.58) when there is only a limited lesional training set available. Third, we propose a statistical method of assessing lesion localization performance in MRI-negative patients with lobar hypotheses of the epileptogenic zone based on simulation of a random guessing process as null hypothesis. Based on our findings, it appears worthwhile to study similar surface-based morphometry approaches in ultra-high field MRI (≥ 7 T).
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Affiliation(s)
- Cornelius Kronlage
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Ev-Christin Heide
- Clinic of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Gisela E. Hagberg
- High-Field MR Centre, Max-Planck-Institute for Biological Cybernetics, Tuebingen, Germany
- Department for Biomedical Magnetic Resonances, University of Tuebingen, Tuebingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, University of Tuebingen, Tuebingen, Germany
| | - Klaus Scheffler
- High-Field MR Centre, Max-Planck-Institute for Biological Cybernetics, Tuebingen, Germany
- Department for Biomedical Magnetic Resonances, University of Tuebingen, Tuebingen, Germany
| | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Niels Focke
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Clinic of Neurology, University Medical Center Goettingen, Goettingen, Germany
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Lin J, Smith GC, Gliske SV, Zochowski M, Shedden K, Stacey WC. High frequency oscillation network dynamics predict outcome in non-palliative epilepsy surgery. Brain Commun 2024; 6:fcae032. [PMID: 38384998 PMCID: PMC10881100 DOI: 10.1093/braincomms/fcae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
High frequency oscillations are a promising biomarker of outcome in intractable epilepsy. Prior high frequency oscillation work focused on counting high frequency oscillations on individual channels, and it is still unclear how to translate those results into clinical care. We show that high frequency oscillations arise as network discharges that have valuable properties as predictive biomarkers. Here, we develop a tool to predict patient outcome before surgical resection is performed, based on only prospective information. In addition to determining high frequency oscillation rate on every channel, we performed a correlational analysis to evaluate the functional connectivity of high frequency oscillations in 28 patients with intracranial electrodes. We found that high frequency oscillations were often not solitary events on a single channel, but part of a local network discharge. Eigenvector and outcloseness centrality were used to rank channel importance within the connectivity network, then used to compare patient outcome by comparison with the seizure onset zone or a proportion within the proposed resected channels (critical resection percentage). Combining the knowledge of each patient's seizure onset zone resection plan along with our computed high frequency oscillation network centralities and high frequency oscillation rate, we develop a Naïve Bayes model that predicts outcome (positive predictive value: 100%) better than predicting based upon fully resecting the seizure onset zone (positive predictive value: 71%). Surgical margins had a large effect on outcomes: non-palliative patients in whom most of the seizure onset zone was resected ('definitive surgery', ≥ 80% resected) had predictable outcomes, whereas palliative surgeries (<80% resected) were not predictable. These results suggest that the addition of network properties of high frequency oscillations is more accurate in predicting patient outcome than seizure onset zone alone in patients with most of the seizure onset zone removed and offer great promise for informing clinical decisions in surgery for refractory epilepsy.
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Affiliation(s)
- Jack Lin
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
| | - Garnett C Smith
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stephen V Gliske
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Michal Zochowski
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Physics and Biophysics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kerby Shedden
- Department of Statistics and Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - William C Stacey
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Biomedical Engineering, BioInterfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Division of Neurology, Ann Arbor VA Health System, Ann Arbor, MI 48109, USA
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Czarnetzki C, Spinelli L, Huppertz HJ, Schaller K, Momjian S, Lobrinus J, Vargas MI, Garibotto V, Vulliemoz S, Seeck M. Yield of non-invasive imaging in MRI-negative focal epilepsy. J Neurol 2024; 271:995-1003. [PMID: 37907727 PMCID: PMC10827933 DOI: 10.1007/s00415-023-11987-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The absence of MRI-lesion reduces considerably the probability of having an excellent outcome (International League Against Epilepsies [ILAE] class I-II) after epilepsy surgery. Surgical success in magnetic-resonance imaging (MRI)-negative cases relies therefore mainly on non-invasive techniques such as positron-emission tomography (PET), subtraction ictal/inter-ictal single-photon-emission-computed-tomography co-registered to MRI (SISCOM), electric source imaging (ESI) and morphometric MRI analysis (MAP). We were interested in identifying the optimal imaging technique or combination to achieve post-operative class I-II in patients with MRI-negative focal epilepsy. METHODS We identified 168 epileptic patients without MRI lesion. Thirty-three (19.6%) were diagnosed with unifocal epilepsy, underwent surgical resection and follow-up ⩾ 2 years. Sensitivity, specificity, predictive values, and diagnostic odds ratio (OR) were calculated for each technique individually and in combination (after co-registration). RESULTS 23/33 (70%) were free of disabling seizures (75.0% with temporal and 61.5% extratemporal lobe epilepsy). None of the individual modalities presented an OR > 1.5, except ESI if only patients with interictal epileptiform discharges (IEDs) were considered (OR 3.2). On a dual combination, SISCOM with ESI presented the highest outcome (OR = 6). MAP contributed to detecting indistinguishable focal cortical dysplasia in particular in extratemporal epilepsies with a sensitivity of 75%. Concordance of PET, ESI on interictal epileptic discharges, and SISCOM was associated with the highest chance for post-operative seizure control (OR = 11). CONCLUSION If MRI is negative, the chances to benefit from epilepsy surgery are almost as high as in lesional epilepsy, provided that multiple established non-invasive imaging tools are rigorously applied and co-registered together.
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Affiliation(s)
- Christian Czarnetzki
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Laurent Spinelli
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | | | - Karl Schaller
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Shahan Momjian
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Johannes Lobrinus
- Department of Clinical Pathology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Maria-Isabel Vargas
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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Mohsin SN, Grezenko H, Khan S, Eshete FD, Shrestha S, Kamran M, Affaf M, Jama A, Gasim RW, Zubaer Ahmad D, Yadav I, Arif S, K C A, Khaliq AS. Bridging Development and Disruption: Comprehensive Insights into Focal Cortical Dysplasia and Epileptic Management. Cureus 2023; 15:e45996. [PMID: 37900524 PMCID: PMC10601976 DOI: 10.7759/cureus.45996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Focal cortical dysplasia (FCD) is a prominent neurological disorder characterized by disruptions in localized brain cell organization and development. This narrative review delineates the multi-faceted nature of FCD, emphasizing its correlation with drug-resistant epilepsy, predominantly in children and young adults. We explore the historical context of FCD, highlighting its indispensable role in shaping our comprehension of epilepsy and cortical anomalies. The clinical spectrum of FCD is broad, encompassing diverse seizure patterns, cognitive impairments, and associated neuropsychiatric disorders. We underscore the importance of differential diagnosis, with techniques ranging from electroencephalogram (EEG) interpretations to microscopic evaluations, and discuss advanced diagnostic modalities, such as the 3T magnetic resonance imaging (MRI) epilepsy protocols. Therapeutically, while anti-seizure medications are often first-line interventions, surgically refractory cases necessitate more invasive procedures, underscoring the importance of individualized treatment. Furthermore, the review touches upon the prognostic aspects of FCD, highlighting the importance of personalized care regimens, and provides insights into emerging therapeutic avenues, including the potential of the mammalian target of rapamycin (mTOR) pathway. Conclusively, this review accentuates the complex relationship between brain development and epileptogenicity inherent to FCD and underscores the promise of future research in enhancing patient outcomes.
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Affiliation(s)
| | - Han Grezenko
- Translational Neuroscience, Barrow Neurological Institute, Phoenix, USA
| | - Saadia Khan
- Community Medicine, Khyber Girls Medical College, Peshawar, PAK
| | | | - Shraddha Shrestha
- Internal Medicine, Nepal Korea Friendship Municipality Hospital, Bhaktapur, NPL
| | | | - Maryam Affaf
- Internal Medicine, Women's Medical and Dental College, Abbottabad, PAK
| | - Ayat Jama
- Internal Medicine, Nishtar Medical University, Multan, PAK
| | - Rayan W Gasim
- Internal Medicine, University of Khartoum, Khartoum, SDN
| | | | - Indresh Yadav
- Internal Medicine, Samar Hospital and Research Center Pvt. Ltd., Janakpur, NPL
- Internal Medicine, Community Based Medical College, Mymensingh, BGD
| | - Sidra Arif
- Urology, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Anil K C
- Medicine and Surgery, Patan Academy of Health Sciences, Kathmandu, NPL
- Internal Medicine and Neurology, California Institute of Behavioral Neurosciences & Psychology, California, USA
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Všianský V, Brázdil M, Rektor I, Doležalová I, Kočvarová J, Strýček O, Hemza J, Chrastina J, Brichtová E, Horák O, Mužlayová P, Hermanová M, Hendrych M, Pail M. Twenty-five years of epilepsy surgery at a Central European comprehensive epilepsy center-Trends in intervention delay and outcomes. Epilepsia Open 2023; 8:991-1001. [PMID: 37259787 PMCID: PMC10472383 DOI: 10.1002/epi4.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE We analyzed trends in patients' characteristics, outcomes, and waiting times over the last 25 years at our epilepsy surgery center situated in Central Europe to highlight possible areas of improvement in our care for patients with drug-resistant epilepsy. METHODS A total of 704 patients who underwent surgery at the Brno Epilepsy Center were included in the study, 71 of those were children. Patients were separated into three time periods, 1996-2000 (n = 95), 2001-2010 (n = 295) and 2011-2022 (n = 314) based on first evaluation at the center. RESULTS The average duration of epilepsy before surgery in adults remained high over the last 25 years (20.1 years from 1996 to 2000, 21.3 from 2001 to 2010, and 21.3 from 2011 to 2020, P = 0.718). There has been a decrease in rate of surgeries for temporal lobe epilepsy in the most recent time period (67%-70%-52%, P < 0.001). Correspondingly, extratemporal resections have become more frequent with a significant increase in surgeries for focal cortical dysplasia (2%-8%-19%, P < 0.001). For resections, better outcomes (ILAE scores 1a-2) have been achieved in extratemporal lesional (0%-21%-61%, P = 0.01, at least 2-year follow-up) patients. In temporal lesional patients, outcomes remained unchanged (at least 77% success rate). A longer duration of epilepsy predicted a less favorable outcome for resective procedures (P = 0.024) in patients with disease duration of less than 25 years. SIGNIFICANCE The spectrum of epilepsy surgery is shifting toward nonlesional and extratemporal cases. While success rates of extratemporal resections at our center are getting better, the average duration of epilepsy before surgical intervention is still very long and is not improving. This underscores the need for stronger collaboration between epileptologists and outpatient neurologists to ensure prompt and effective treatment for patients with drug-resistant epilepsy.
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Affiliation(s)
- Vít Všianský
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Milan Brázdil
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Ivan Rektor
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Irena Doležalová
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Jitka Kočvarová
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Ondřej Strýček
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Jan Hemza
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Jan Chrastina
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Eva Brichtová
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Ondřej Horák
- Brno Epilepsy Center, Department of Pediatric Neurology, Brno University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Patrícia Mužlayová
- Brno Epilepsy Center, Department of Pediatric Neurology, Brno University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Markéta Hermanová
- Department of Pathology, St. Anne's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Michal Hendrych
- Department of Pathology, St. Anne's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Martin Pail
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
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Asadi-Pooya AA, Brigo F, Lattanzi S, Blumcke I. Adult epilepsy. Lancet 2023; 402:412-424. [PMID: 37459868 DOI: 10.1016/s0140-6736(23)01048-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 07/31/2023]
Abstract
Epilepsy is a common medical condition that affects people of all ages, races, social classes, and geographical regions. Diagnosis of epilepsy remains clinical, and ancillary investigations (electroencephalography, imaging, etc) are of aid to determine the type, cause, and prognosis. Antiseizure medications represent the mainstay of epilepsy treatment: they aim to suppress seizures without adverse events, but they do not affect the underlying predisposition to generate seizures. Currently available antiseizure medications are effective in around two-thirds of patients with epilepsy. Neurosurgical resection is an effective strategy to reach seizure control in selected individuals with drug-resistant focal epilepsy. Non-pharmacological treatments such as palliative surgery (eg, corpus callosotomy), neuromodulation techniques (eg, vagus nerve stimulation), and dietary interventions represent therapeutic options for patients with drug-resistant epilepsy who are not suitable for resective brain surgery.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany; Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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11
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Guo Z, Zhang C, Wang X, Liu C, Zhao B, Mo J, Zheng Z, Shao X, Zhang J, Zhang K, Hu W. Is intracranial electroencephalography mandatory for MRI-negative neocortical epilepsy surgery? J Neurosurg 2023; 138:1720-1730. [PMID: 36242573 DOI: 10.3171/2022.8.jns22995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE MRI-negative focal epilepsy is one of the most challenging cases in surgical epilepsy treatment. Many epilepsy centers recommend intracranial electroencephalography (EEG) for MRI-negative cases, especially neocortical epilepsy. This retrospective study aimed to explore whether intracranial monitoring is mandatory in MRI-negative neocortical epilepsy surgery and the factors that significantly influence the decision on whether to perform intracranial recording. METHODS In this study, consecutive surgical patients with focal MRI-negative neocortical epilepsy were recruited. All patients underwent routine preoperative evaluation according to the dedicated protocol of the authors' epilepsy center to determine the treatment strategy. Patients were divided into two groups according to the surgical strategy, i.e., a direct group and a stereo-EEG (SEEG)-guided group. History of epilepsy, seizure frequency, interictal and ictal EEG data, PET data, PET/MRI coregistration data, neuropathological findings, and surgical outcomes were compared between the two groups. Multivariate analysis was performed to identify factors influencing the decision to perform SEEG monitoring. RESULTS Sixty-four patients were included in this study, 19 and 45 of whom underwent direct and SEEG-guided cortical resection, respectively. At an average follow-up of 3.9 years postoperatively, 56 patients (87.5%) had Engel class I results without permanent neurological deficits. Surgical outcomes were not significantly different between the direct and SEEG-guided groups (94.7% vs 84.4%). PET hypometabolic abnormalities were detected in all patients. There were significant differences between the two groups in the extent of hypometabolism (focal vs nonfocal, p < 0.01) and pathological subtype (focal cortical dysplasia type II vs others, p = 0.03). Multivariate analysis revealed that the extent of hypometabolism (OR 0.01, 95% CI 0.00-0.15; p = 0.001) was the only independent factor affecting the treatment strategy. CONCLUSIONS Careful selection of patients with MRI-negative neocortical epilepsy may yield favorable outcomes after direct cortical resection without intracranial monitoring. PET/MRI coregistration plays an essential role in the preoperative evaluation and subsequent resection of these patients. Intracranial monitoring is not a mandatory requirement for surgery if the focal hypometabolic areas are consistent with the findings of semiology and scalp EEG.
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Affiliation(s)
| | | | - Xiu Wang
- 1Departments of Neurosurgery and
| | | | | | | | - Zhong Zheng
- 4Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Xiaoqiu Shao
- 5Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Jianguo Zhang
- 1Departments of Neurosurgery and
- 3Beijing Key Laboratory of Neurostimulation; and
| | - Kai Zhang
- 1Departments of Neurosurgery and
- 3Beijing Key Laboratory of Neurostimulation; and
| | - Wenhan Hu
- 1Departments of Neurosurgery and
- 3Beijing Key Laboratory of Neurostimulation; and
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12
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Baciu M, O'Sullivan L, Torlay L, Banjac S. New insights for predicting surgery outcome in patients with temporal lobe epilepsy. A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)00884-6. [PMID: 37003897 DOI: 10.1016/j.neurol.2023.02.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/16/2023] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
Resective surgery is the treatment of choice for one-third of adult patients with focal, drug-resistant epilepsy. This procedure is associated with substantial clinical and cognitive risks. In clinical practice, there is no validated model for epilepsy surgery outcome prediction (ESOP). Meta-analyses on ESOP studies assessing prognostic factors report discrepancies in terms of study design. Our review aims to systematically investigate methodological and analytical aspects of studies predicting clinical and cognitive outcomes after temporal lobe epilepsy surgery. A systematic review of ESOP studies published between 2000 and 2022 from three databases (MEDLINE, Web of Science, and PsycINFO) was completed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. It yielded 4867 articles. Among them, 21 corresponded to our inclusion criteria and were therefore retained in the final review. The risk of bias was assessed using A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies (PROBAST). Data extracted from the 21 studies were analyzed using narrative synthesis and descriptive statistics. Our findings show an increase in the use of multimodal datasets and machine learning analyses in recent ESOP studies, although regression remained the most frequently used approach. We also identified a more frequent use of network notions in recent ESOP studies. Nevertheless, several methodological issues were noted, such as small sample sizes, lack of information on the follow-up period, variability in seizure outcome, and the definition of neuropsychological postoperative change. Of 21 studies, only one provided a clinical tool to anticipate the cognitive outcome after epilepsy surgery. We conclude that methodological issues should be overcome before we move towards more complete models to better predict clinical and cognitive outcomes after epilepsy surgery. Recommendations for future studies to harness the possibilities of multimodal datasets and data fusion, are provided. A stronger bridge between fundamental and clinical research may result in developing accessible clinical tools.
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Affiliation(s)
- M Baciu
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L O'Sullivan
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L Torlay
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - S Banjac
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France.
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13
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Zhao B, McGonigal A, Hu W, Zhang C, Wang X, Mo J, Zhao X, Ai L, Shao X, Zhang K, Zhang J. Interictal HFO and FDG-PET correlation predicts surgical outcome following SEEG. Epilepsia 2023; 64:667-677. [PMID: 36510851 DOI: 10.1111/epi.17485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to investigate the quantitative relationship between interictal 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and interictal high-frequency oscillations (HFOs) from stereo-electroencephalography (SEEG) recordings in patients with refractory epilepsy. METHODS We retrospectively included 32 patients. FDG-PET data were quantified through statistical parametric mapping (SPM) t test modeling with normal controls. Interictal SEEG segments with four, 10-min segments were selected randomly. HFO detection and classification procedures were automatically performed. Channel-based HFOs separating ripple (80-250 Hz) and fast ripple (FR; 250-500 Hz) counts were correlated with the surrounding metabolism T score at the individual and group level, respectively. The association was further validated across anatomic seizure origins and sleep vs wake states. We built a joint feature FR × T reflecting the FR and hypometabolism concordance to predict surgical outcomes in 28 patients who underwent surgery. RESULTS We found a negative correlation between interictal FDG-PET and HFOs through the linear mixed-effects model (R2 = .346 and .457 for ripples and FRs, respectively, p < .001); these correlations were generalizable to different epileptogenic-zone lobar localizations and vigilance states. The FR × T inside the resection volume could be used as a predictor for surgical outcomes with an area under the curve of 0.81. SIGNIFICANCE The degree of hypometabolism is associated with HFO generation rate, especially for FRs. This relationship would be meaningful for selection of SEEG candidates and for optimizing SEEG scheme planning. The concordance between FRs and hypometabolism inside the resection volume could provide prognostic information regarding surgical outcome.
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Affiliation(s)
- Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aileen McGonigal
- Epilepsy Unit, Neurosciences Centre, Mater Hospital and Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaobin Zhao
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Ai
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
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14
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Conrad EC, Revell AY, Greenblatt AS, Gallagher RS, Pattnaik AR, Hartmann N, Gugger JJ, Shinohara RT, Litt B, Marsh ED, Davis KA. Spike patterns surrounding sleep and seizures localize the seizure-onset zone in focal epilepsy. Epilepsia 2023; 64:754-768. [PMID: 36484572 PMCID: PMC10045742 DOI: 10.1111/epi.17482] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Interictal spikes help localize seizure generators as part of surgical planning for drug-resistant epilepsy. However, there are often multiple spike populations whose frequencies change over time, influenced by brain state. Understanding state changes in spike rates will improve our ability to use spikes for surgical planning. Our goal was to determine the effect of sleep and seizures on interictal spikes, and to use sleep and seizure-related changes in spikes to localize the seizure-onset zone (SOZ). METHODS We performed a retrospective analysis of intracranial electroencephalography (EEG) data from patients with focal epilepsy. We automatically detected interictal spikes and we classified different time periods as awake or asleep based on the ratio of alpha to delta power, with a secondary analysis using the recently published SleepSEEG algorithm. We analyzed spike rates surrounding sleep and seizures. We developed a model to localize the SOZ using state-dependent spike rates. RESULTS We analyzed data from 101 patients (54 women, age range 16-69). The normalized alpha-delta power ratio accurately classified wake from sleep periods (area under the curve = .90). Spikes were more frequent in sleep than wakefulness and in the post-ictal compared to the pre-ictal state. Patients with temporal lobe epilepsy had a greater wake-to-sleep and pre- to post-ictal spike rate increase compared to patients with extra-temporal epilepsy. A machine-learning classifier incorporating state-dependent spike rates accurately identified the SOZ (area under the curve = .83). Spike rates tended to be higher and better localize the seizure-onset zone in non-rapid eye movement (NREM) sleep than in wake or REM sleep. SIGNIFICANCE The change in spike rates surrounding sleep and seizures differs between temporal and extra-temporal lobe epilepsy. Spikes are more frequent and better localize the SOZ in sleep, particularly in NREM sleep. Quantitative analysis of spikes may provide useful ancillary data to localize the SOZ and improve surgical planning.
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Affiliation(s)
- Erin C. Conrad
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Andrew Y. Revell
- Medical Scientist Training Program, University of Pennsylvania, Philadelphia, PA
| | | | - Ryan S. Gallagher
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Akash R. Pattnaik
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Nicole Hartmann
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - James J. Gugger
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, PA
- Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA
| | - Brian Litt
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Eric D. Marsh
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
- Division of Child Neurology, Department of Biostatistics, University of Pennsylvania, Epidemiology, & Informatics, Philadelphi Department of Biostatistics, University of Pennsylvania, Epidemiology, & Informatics, Philadelphi Pediatric Epilepsy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kathryn A. Davis
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
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15
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Mathon B. Perspectives de la chirurgie de l’épilepsie à l’heure des nouvelles technologies. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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16
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Shamim D, Nwabueze O, Uysal U. Beyond Resection: Neuromodulation and Minimally Invasive Epilepsy Surgery. Noro Psikiyatr Ars 2022; 59:S81-S90. [PMID: 36578991 PMCID: PMC9767135 DOI: 10.29399/npa.28181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Epilepsy is a common neurological disease impacting both patients and healthcare systems. Approximately one third of patients have drug-resistant epilepsy (DRE) and are candidates for surgical options. However, only a small percentage undergo surgical treatment due to factors such as patient misconception/fear of surgery, healthcare disparities in epilepsy care, complex presurgical evaluation, primary care knowledge gap, and lack of systemic structures to allow effective coordination between referring physician and surgical epilepsy centers. Resective surgical treatments are superior to medication management for DRE patients in terms of seizure outcomes but may be less palatable to patients. There have been major advancements in minimally invasive surgeries (MIS) and neuromodulation techniques that may allay these concerns. Both epilepsy MIS and neuromodulation have shown promising seizure outcomes while minimizing complications. Minimally invasive methods include Laser Interstitial Thermal Therapy (LITT), RadioFrequency Ablation (RFA), Stereotactic RadioSurgery (SRS). Neuromodulation methods, which are more palliative, include Vagus Nerve Stimulation (VNS), Deep Brain Stimulation (DBS), and Responsive Neurostimulation System (RNS). This review will discuss the role of these techniques in varied epilepsy subtypes, their effectiveness in improving seizure control, and adverse outcomes.
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Affiliation(s)
- Daniah Shamim
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, USA
| | - Obiefuna Nwabueze
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, USA
| | - Utku Uysal
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, USA,Correspondence Address: Utku Uysal, MS University of Kansas School of Medicine 4000 Cambridge Street Mailstop 1065 Kansas City, KS 66160, USA • E-mail:
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17
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Spinelli L, Baroumand AG, Vulliemoz S, Momjian S, Strobbe G, van Mierlo P, Seeck M. Semiautomatic interictal electric source localization based on long-term electroencephalographic monitoring: A prospective study. Epilepsia 2022; 64:951-961. [PMID: 36346269 DOI: 10.1111/epi.17460] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Electric source imaging (ESI) of interictal epileptiform discharges (IEDs) has shown significant yield in numerous studies; however, its implementation at most centers is labor- and cost-intensive. Semiautomatic ESI analysis (SAEA) has been proposed as an alternative and has previously shown benefit. Computer-assisted automatic spike cluster retrieval, averaging, and source localization are carried out for each cluster and are then reviewed by an expert neurophysiologist, to determine their relevance for the individual case. Here, we examine its yield in a prospective single center study. METHOD Between 2017 and 2022, 122 patients underwent SAEA. Inclusion criteria for the current study were unifocal epilepsy disorder, epilepsy surgery with curative purpose, and postoperative follow-up of 2 years or more. All patients (N=40) had continuous video-electroencephalographic (EEG) monitoring with 37 scalp electrodes, which underwent SAEA. Forty patients matched our inclusion criteria. RESULTS Twenty patients required intracranial monitoring; 13 were magnetic resonance imaging (MRI)-negative. Mean duration of analyzed EEG was 4.3 days (±3.1 days), containing a mean of 12 749 detected IEDs (±22 324). The sensitivity, specificity, and accuracy of SAEA for localizing the epileptogenic focus of the entire group were 74.3%, 80%, and 75%, respectively, leading to an odds ratio (OR) of 11.5 to become seizure-free if the source was included in the resection volume (p < .05). In patients with extratemporal lobe epilepsy, our results indicated an accuracy of 68% (OR=11.7). For MRI-negative patients (n = 13) and patients requiring intracranial EEG (n = 20), we found a similarly high accuracy of 84.6% (OR=19) and 75% (OR = 15.9), respectively. SIGNIFICANCE In this prospective study of SAEA of long-term video-EEG, spanning several days, we found excellent localizing information and a high yield, even in difficult patient groups. This compares favorably to high-density ESI, most likely due to marked improved signal-to-noise ratio of the averaged IEDs. We propose including ESI, or SAEA, in the workup of all patients who are referred for epilepsy surgery.
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Affiliation(s)
- Laurent Spinelli
- EEG and Epilepsy Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Amir G Baroumand
- Medical Image and Signal Processing, Ghent University, Ghent, Belgium.,Epilog, Ghent, Belgium
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Shahan Momjian
- EEG and Epilepsy Unit, University Hospital of Geneva, Geneva, Switzerland
| | | | - Pieter van Mierlo
- Medical Image and Signal Processing, Ghent University, Ghent, Belgium.,Epilog, Ghent, Belgium
| | - Margitta Seeck
- EEG and Epilepsy Unit, University Hospital of Geneva, Geneva, Switzerland
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Functional Connectivity Alterations Based on Hypometabolic Region May Predict Clinical Prognosis of Temporal Lobe Epilepsy: A Simultaneous 18F-FDG PET/fMRI Study. BIOLOGY 2022; 11:biology11081178. [PMID: 36009805 PMCID: PMC9404714 DOI: 10.3390/biology11081178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: Accurate localization of the epileptogenic zone and understanding the related functional connectivity (FC) alterations are critical for the prediction of clinical prognosis in patients with temporal lobe epilepsy (TLE). We aim to localize the hypometabolic region in TLE patients, compare the differences in FC alterations based on hypometabolic region and structural lesion, respectively, and explore their relationships with clinical prognosis. (2) Methods: Thirty-two TLE patients and 26 controls were recruited. Patients underwent 18F-FDG PET/MR scan, surgical treatment, and a 2−3-year follow-up. Visual assessment and voxel-wise analyses were performed to identify hypometabolic regions. ROI-based FC analyses were performed. Relationships between clinical prognosis and FC values were performed by using Pearson correlation analyses and receiver operating characteristic (ROC) analysis. (3) Results: Hypometabolic regions in TLE patients were found in the ipsilateral hippocampus, parahippocampal gyrus, and temporal lobe (p < 0.001). Functional alterations based on hypometabolic regions showed a more extensive whole-brain FC reduction. FC values of these regions negatively correlated with epilepsy duration (p < 0.05), and the ROC curve of them showed significant accuracy in predicting postsurgical outcome. (4) Conclusions: In TLE patients, FC related with hypometabolic region obtained by PET/fMRI may provide value in the prediction of disease progression and seizure-free outcome.
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Lapalme-Remis S, Nguyen DK. Neuroimaging of Epilepsy. Continuum (Minneap Minn) 2022; 28:306-338. [PMID: 35393961 DOI: 10.1212/con.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article provides an overview of imaging modalities, important imaging pathologies, and the role each imaging modality can play in the diagnosis, evaluation, and treatment of epilepsy, including epilepsy surgery. RECENT FINDINGS The Harmonized Neuroimaging of Epilepsy Structural Sequences (HARNESS-MRI) protocol was proposed to standardize MRI imaging for all patients with seizures. The role of 7-Tesla MRI in finding previously occult epileptogenic lesions is under investigation, and the technique is increasingly used. Developing MRI postprocessing techniques can increase the sensitivity of MRI. Improvements in functional imaging techniques such as EEG-functional MRI (fMRI) and magnetic source imaging provide complementary methods of identifying seizure foci. New epileptogenic pathologies such as multinodular and vacuolating neuronal tumors (MVNT) are being discovered, and the importance of others, such as encephaloceles, is better appreciated. SUMMARY Brain imaging is a critical component of the diagnosis and evaluation of patients with epilepsy. Structural imaging modalities such as MRI and CT allow for the identification of a wide variety of potentially epileptogenic lesions. For patients with drug-resistant epilepsy under consideration for resective surgery, both structural and functional neuroimaging may be needed for focus identification and surgical planning for preservation of neurologic function.
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20
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Shu S, Luo S, Cao M, Xu K, Qin L, Zheng L, Xu J, Wang X, Gao JH. Informed MEG/EEG source imaging reveals the locations of interictal spikes missed by SEEG. Neuroimage 2022; 254:119132. [PMID: 35337964 DOI: 10.1016/j.neuroimage.2022.119132] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 02/18/2022] [Accepted: 03/21/2022] [Indexed: 11/19/2022] Open
Abstract
Determining the accurate locations of interictal spikes has been fundamental in the presurgical evaluation of epilepsy surgery. Stereo-electroencephalography (SEEG) is able to directly record cortical activity and localize interictal spikes. However, the main caveat of SEEG techniques is that they have limited spatial sampling (covering <5% of the whole brain), which may lead to missed spikes originating from brain regions that were not covered by SEEG. To address this problem, we propose a SEEG-informed minimum-norm estimates (SIMNE) method by combining SEEG with magnetoencephalography (MEG) or EEG. Specifically, the spike locations determined by SEEG offer as a priori information to guide MEG source reconstruction. Both computer simulations and experiments using data from five epilepsy patients were conducted to evaluate the performance of SIMNE. Our results demonstrate that SIMNE generates more accurate source estimation than a traditional minimum-norm estimates method and reveals the locations of spikes missed by SEEG, which would improve presurgical evaluation of the epileptogenic zone.
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Affiliation(s)
- Su Shu
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871, China; Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Shen Luo
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871, China; Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Miao Cao
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Ke Xu
- Department of Neurosurgery, Sanbo Brain Hospital of Capital Medical University, Beijing 100093, China
| | - Lang Qin
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Li Zheng
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871, China; Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Jing Xu
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; Laboratory of Applied Brain and Cognitive Sciences, College of International Business, Shanghai International Studies University, Shanghai 201620, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital of Capital Medical University, Beijing 100093, China
| | - Jia-Hong Gao
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871, China; Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; McGovern Institute for Brain Research, Peking University, Beijing 100871, China; National Biomedical Imaging Center, Peking University, Beijing 100871, China.
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21
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Wong JK, Deuschl G, Wolke R, Bergman H, Muthuraman M, Groppa S, Sheth SA, Bronte-Stewart HM, Wilkins KB, Petrucci MN, Lambert E, Kehnemouyi Y, Starr PA, Little S, Anso J, Gilron R, Poree L, Kalamangalam GP, Worrell GA, Miller KJ, Schiff ND, Butson CR, Henderson JM, Judy JW, Ramirez-Zamora A, Foote KD, Silburn PA, Li L, Oyama G, Kamo H, Sekimoto S, Hattori N, Giordano JJ, DiEuliis D, Shook JR, Doughtery DD, Widge AS, Mayberg HS, Cha J, Choi K, Heisig S, Obatusin M, Opri E, Kaufman SB, Shirvalkar P, Rozell CJ, Alagapan S, Raike RS, Bokil H, Green D, Okun MS. Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury. Front Hum Neurosci 2022; 16:813387. [PMID: 35308605 PMCID: PMC8931265 DOI: 10.3389/fnhum.2022.813387] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/11/2022] [Indexed: 01/09/2023] Open
Abstract
DBS Think Tank IX was held on August 25-27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging deep brain stimulation (DBS) technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year's meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury.
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Affiliation(s)
- Joshua K. Wong
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Robin Wolke
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Section of Movement Disorders and Neurostimulation, Focus Program Translational Neuroscience, Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Biomedical Statistics and Multimodal Signal Processing Unit, Section of Movement Disorders and Neurostimulation, Focus Program Translational Neuroscience, Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sameer A. Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Helen M. Bronte-Stewart
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Kevin B. Wilkins
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Matthew N. Petrucci
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Emilia Lambert
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Yasmine Kehnemouyi
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Philip A. Starr
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Simon Little
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Juan Anso
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Ro’ee Gilron
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Lawrence Poree
- Department of Anesthesia, University of California, San Francisco, San Francisco, CA, United States
| | - Giridhar P. Kalamangalam
- Department of Neurology, Wilder Center for Epilepsy Research, University of Florida, Gainesville, FL, United States
| | | | - Kai J. Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, NY, United States
| | - Nicholas D. Schiff
- Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, United States
| | - Christopher R. Butson
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jaimie M. Henderson
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Jack W. Judy
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kelly D. Foote
- Department of Neurosurgery, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Peter A. Silburn
- Queensland Brain Institute, University of Queensland and Saint Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Genko Oyama
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hikaru Kamo
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Satoko Sekimoto
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - James J. Giordano
- Neuroethics Studies Program, Department of Neurology, Georgetown University Medical Center, Washington, DC, United States
| | - Diane DiEuliis
- US Department of Defense Fort Lesley J. McNair, National Defense University, Washington, DC, United States
| | - John R. Shook
- Department of Philosophy and Science Education, University of Buffalo, Buffalo, NY, United States
| | - Darin D. Doughtery
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Alik S. Widge
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Helen S. Mayberg
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jungho Cha
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kisueng Choi
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stephen Heisig
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mosadolu Obatusin
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Enrico Opri
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Scott B. Kaufman
- Department of Psychology, Columbia University, New York, NY, United States
| | - Prasad Shirvalkar
- The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States
- Department of Anesthesiology (Pain Management) and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher J. Rozell
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Sankaraleengam Alagapan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Robert S. Raike
- Restorative Therapies Group Implantables, Research and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Hemant Bokil
- Boston Scientific Neuromodulation Corporation, Valencia, CA, United States
| | - David Green
- NeuroPace, Inc., Mountain View, CA, United States
| | - Michael S. Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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22
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Nunez MD, Charupanit K, Sen-Gupta I, Lopour BA, Lin JJ. Beyond rates: time-varying dynamics of high frequency oscillations as a biomarker of the seizure onset zone. J Neural Eng 2022; 19:10.1088/1741-2552/ac520f. [PMID: 35120337 PMCID: PMC9258635 DOI: 10.1088/1741-2552/ac520f] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/04/2022] [Indexed: 11/11/2022]
Abstract
Objective. High frequency oscillations (HFOs) recorded by intracranial electrodes have generated excitement for their potential to help localize epileptic tissue for surgical resection. However, the number of HFOs per minute (i.e. the HFO 'rate') is not stable over the duration of intracranial recordings; for example, the rate of HFOs increases during periods of slow-wave sleep. Moreover, HFOs that are predictive of epileptic tissue may occur in oscillatory patterns due to phase coupling with lower frequencies. Therefore, we sought to further characterize between-seizure (i.e. 'interictal') HFO dynamics both within and outside the seizure onset zone (SOZ).Approach. Using long-term intracranial EEG (mean duration 10.3 h) from 16 patients, we automatically detected HFOs using a new algorithm. We then fit a hierarchical negative binomial model to the HFO counts. To account for differences in HFO dynamics and rates between sleep and wakefulness, we also fit a mixture model to the same data that included the ability to switch between two discrete brain states that were automatically determined during the fitting process. The ability to predict the SOZ by model parameters describing HFO dynamics (i.e. clumping coefficients and coefficients of variation) was assessed using receiver operating characteristic curves.Main results. Parameters that described HFO dynamics were predictive of SOZ. In fact, these parameters were found to be more consistently predictive than HFO rate. Using concurrent scalp EEG in two patients, we show that the model-found brain states corresponded to (1) non-REM sleep and (2) awake and rapid eye movement sleep. However the brain state most likely corresponding to slow-wave sleep in the second model improved SOZ prediction compared to the first model for only some patients.Significance. This work suggests that delineation of SOZ with interictal data can be improved by the inclusion of time-varying HFO dynamics.
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Affiliation(s)
- Michael D. Nunez
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands,Department of Biomedical Engineering, University of California, Irvine CA, USA,Corresponding author (Michael D. Nunez), (Beth A. Lopour)
| | - Krit Charupanit
- Department of Biomedical Engineering, University of California, Irvine CA, USA,Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Indranil Sen-Gupta
- Neurology, University of California Irvine Medical Center, Orange CA, USA
| | - Beth A. Lopour
- Department of Biomedical Engineering, University of California, Irvine CA, USA,Corresponding author (Michael D. Nunez), (Beth A. Lopour)
| | - Jack J. Lin
- Department of Neurology, University of California, Irvine CA, USA
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23
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Schur S, Moreau JT, Khoo HM, Koupparis A, Simard Tremblay E, Myers KA, Osterman B, Rosenblatt B, Farmer JP, Saint-Martin C, Turpin S, Hall J, Olivier A, Bernasconi A, Bernasconi N, Baillet S, Dubeau F, Gotman J, Dudley RWR. New interinstitutional, multimodal presurgical evaluation protocol associated with improved seizure freedom for poorly defined cases of focal epilepsy in children. J Neurosurg Pediatr 2022; 29:74-82. [PMID: 34624842 DOI: 10.3171/2021.6.peds218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In an attempt to improve postsurgical seizure outcomes for poorly defined cases (PDCs) of pediatric focal epilepsy (i.e., those that are not visible or well defined on 3T MRI), the authors modified their presurgical evaluation strategy. Instead of relying on concordance between video-electroencephalography and 3T MRI and using functional imaging and intracranial recording in select cases, the authors systematically used a multimodal, 3-tiered investigation protocol that also involved new collaborations between their hospital, the Montreal Children's Hospital, and the Montreal Neurological Institute. In this study, the authors examined how their new strategy has impacted postsurgical outcomes. They hypothesized that it would improve postsurgical seizure outcomes, with the added benefit of identifying a subset of tests contributing the most. METHODS Chart review was performed for children with PDCs who underwent resection following the new strategy (i.e., new protocol [NP]), and for the same number who underwent treatment previously (i.e., preprotocol [PP]); ≥ 1-year follow-up was required for inclusion. Well-defined, multifocal, and diffuse hemispheric cases were excluded. Preoperative demographics and clinical characteristics, resection volumes, and pathology, as well as seizure outcomes (Engel class Ia vs > Ia) at 1 year postsurgery and last follow-up were reviewed. RESULTS Twenty-two consecutive NP patients were compared with 22 PP patients. There was no difference between the two groups for resection volumes, pathology, or preoperative characteristics, except that the NP group underwent more presurgical evaluation tests (p < 0.001). At 1 year postsurgery, 20 of 22 NP patients and 10 of 22 PP patients were seizure free (OR 11.81, 95% CI 2.00-69.68; p = 0.006). Magnetoencephalography and PET/MRI were associated with improved postsurgical seizure outcomes, but both were highly correlated with the protocol group (i.e., independent test effects could not be demonstrated). CONCLUSIONS A new presurgical evaluation strategy for children with PDCs of focal epilepsy led to improved postsurgical seizure freedom. No individual presurgical evaluation test was independently associated with improved outcome, suggesting that it may be the combined systematic protocol and new interinstitutional collaborations that makes the difference rather than any individual test.
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Affiliation(s)
- Solon Schur
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University
| | - Jeremy T Moreau
- 2McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University.,3Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Hui Ming Khoo
- 4Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | | | | | - Kenneth A Myers
- 6Division of Neurology and Department of Clinical Neurophysiology, Montreal Children's Hospital
| | - Bradley Osterman
- 6Division of Neurology and Department of Clinical Neurophysiology, Montreal Children's Hospital
| | - Bernard Rosenblatt
- 6Division of Neurology and Department of Clinical Neurophysiology, Montreal Children's Hospital
| | - Jean-Pierre Farmer
- 3Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | | | - Sophie Turpin
- 8Division of Nuclear Medicine, Medical Imaging, CHU Ste-Justine and Montreal Children's Hospital; and
| | - Jeff Hall
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University
| | - Andre Olivier
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University
| | - Andrea Bernasconi
- 9Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- 9Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | | | - Francois Dubeau
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University
| | - Jean Gotman
- 5Montreal Neurological Institute, McGill University
| | - Roy W R Dudley
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University.,3Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children's Hospital, Montreal, Quebec, Canada
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24
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-EEG monitoring: A clinical practice guideline of the international league against epilepsy and international federation of clinical neurophysiology. Clin Neurophysiol 2021; 134:111-128. [PMID: 34955428 DOI: 10.1016/j.clinph.2021.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events (see Table S1). For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, WV, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, France.
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich Switzerland.
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Danish Epilepsy Center, Dianalund, Denmark.
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25
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-electroencephalographic monitoring: A clinical practice guideline of the International League Against Epilepsy and International Federation of Clinical Neurophysiology. Epilepsia 2021; 63:290-315. [PMID: 34897662 DOI: 10.1111/epi.16977] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events. For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and to establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, Nancy, France
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich,, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Danish Epilepsy Center, Dianalund, Denmark
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26
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Bouilleret V, Dedeurwaerdere S. What value can TSPO PET bring for epilepsy treatment? Eur J Nucl Med Mol Imaging 2021; 49:221-233. [PMID: 34120191 DOI: 10.1007/s00259-021-05449-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/03/2021] [Indexed: 12/13/2022]
Abstract
Epilepsy is one of the most common neurological disorders and affects both the young and adult populations. The question we asked for this review was how positron emission tomography (PET) imaging with translocator protein (TSPO) radioligands can help inform the epilepsy clinic and the development of future treatments targeting neuroinflammatory processes.Even though the first TSPO PET scans in epilepsy patients were performed over 20 years ago, this imaging modality has not seen wide adoption in the clinic. There is vast scientific evidence from preclinical studies in rodent models of temporal lobe epilepsy which have shown increased levels of TSPO corresponding to neuroinflammatory processes in the brain. These increases peaked sub-acutely (1-2 weeks) after the epileptogenic insult (e.g. status epilepticus) and remained chronically increased, albeit at lower levels. In addition, these studies have shown a correlation between TSPO levels and seizure outcome, pharmacoresistance and behavioural morbidities. Histological assessment points to a complex interplay between different cellular components such as microglial activation, astrogliosis and cell death changing dynamically over time.In epilepsy patients, a highly sensitive biomarker of neuroinflammation would provide value for the optimization of surgical assessment (particularly for extratemporal lobe epilepsy) and support the clinical development path of anti-inflammatory treatments. Clinical studies have shown a systematic increase in asymmetry indices of TSPO PET binding. However, region-based analysis typically does not yield statistical differences and changes are often not restricted to the epileptogenic zone, limiting the ability of this imaging modality to localise pathology for surgery. In this manuscript, we discuss the biological underpinnings of these findings and review for which applications in epilepsy TSPO PET could bring added value.
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Affiliation(s)
- Viviane Bouilleret
- Unité de Neurophysiologie et d'Epileptologie (UNCE), Université Paris-Saclay APHP, 78, Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
- CEA, CNRS, Inserm, BioMaps, Université Paris-Saclay, Orsay, France.
| | - Stefanie Dedeurwaerdere
- Neurosciences Therapeutic Area, Early Solutions, UCB Pharma, Braine-l'Alleud, Belgium
- Experimental Laboratory of Haematology, University of Antwerp, Wilrijk, Belgium
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27
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18F-FDG PET/MR in focal epilepsy: A new step for improving the detection of epileptogenic lesions. Epilepsy Res 2021; 178:106819. [PMID: 34847426 DOI: 10.1016/j.eplepsyres.2021.106819] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/19/2021] [Accepted: 11/15/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Hybrid PET/MR is a promising tool in focal drug-resistant epilepsy, however the additional value for the detection of epileptogenic lesions and surgical decision-making remains to be established. METHODS We retrospectively compared 18F-FDG PET/MR images with those obtained by a previous 18F-FDG PET co-registered with MRI (PET+MR) in 25 consecutive patients (16 females, 13-60 years) investigated for focal drug-resistant epilepsy. Visual analysis was performed by two readers blinded from imaging modalities, asked to assess the technical characteristics (co-registration, quality of images), the confidence in results, the location of PET abnormalities and the presence of a structural lesion on MRI. Clinical impact on surgical strategy and outcome was assessed independently. RESULTS The location of epileptic focus was temporal in 9 patients and extra-temporal in 16 others. MRI was initially considered negative in 21 patients. PET stand-alone demonstrated metabolic abnormalities in 19 cases (76%), and the co-registration with MRI allowed the detection of 4 additional structural lesions. Compared to PET+MR, the PET/MR sensitivity was increased by 13% and new structural lesions (mainly focal cortical dysplasias) were detected in 6 patients (24%). Change of surgical decision-making was substantial for 10 patients (40%), consisting in avoiding invasive monitoring in 6 patients and modifying the planning in 4 others. Seizure-free outcome (follow-up>1 year) was obtained in 12/14 patients who underwent a cortical resection. CONCLUSION Hybrid PET/MR may improve the detection of epileptogenic lesions, allowing to optimize the presurgical work-up and to increase the proportion of successful surgery even in the more complex cases.
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28
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Vogel S, Kaltenhäuser M, Kim C, Müller-Voggel N, Rössler K, Dörfler A, Schwab S, Hamer H, Buchfelder M, Rampp S. MEG Node Degree Differences in Patients with Focal Epilepsy vs. Controls-Influence of Experimental Conditions. Brain Sci 2021; 11:1590. [PMID: 34942895 PMCID: PMC8699109 DOI: 10.3390/brainsci11121590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022] Open
Abstract
Drug-resistant epilepsy can be most limiting for patients, and surgery represents a viable therapy option. With the growing research on the human connectome and the evidence of epilepsy being a network disorder, connectivity analysis may be able to contribute to our understanding of epilepsy and may be potentially developed into clinical applications. In this magnetoencephalographic study, we determined the whole-brain node degree of connectivity levels in patients and controls. Resting-state activity was measured at five frequency bands in 15 healthy controls and 15 patients with focal epilepsy of different etiologies. The whole-brain all-to-all imaginary part of coherence in source space was then calculated. Node degree was determined and parcellated and was used for further statistical evaluation. In comparison to controls, we found a significantly higher overall node degree in patients with lesional and non-lesional epilepsy. Furthermore, we examined the conditions of high/reduced vigilance and open/closed eyes in controls, to analyze whether patient node degree levels can be achieved. We evaluated intraclass-correlation statistics (ICC) to evaluate the reproducibility. Connectivity and specifically node degree analysis could present new tools for one of the most common neurological diseases, with potential applications in epilepsy diagnostics.
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Affiliation(s)
- Stephan Vogel
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
- Friedrich Alexander University Erlangen Nürnberg (FAU), 91054 Erlangen, Germany
| | - Martin Kaltenhäuser
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
| | - Cora Kim
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
| | - Nadia Müller-Voggel
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, 1090 Vienna, Austria;
| | - Arnd Dörfler
- Department of Neuroradiology, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany; (S.S.); (H.H.)
| | - Hajo Hamer
- Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany; (S.S.); (H.H.)
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, 91054 Erlangen, Germany; (M.K.); (C.K.); (N.M.-V.); (M.B.); (S.R.)
- Department of Neurosurgery, University Hospital Halle (Saale), 06120 Halle (Saale), Germany
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29
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Stovall T, Hunt B, Glynn S, Stacey WC, Gliske SV. Interictal high frequency background activity as a biomarker of epileptogenic tissue. Brain Commun 2021; 3:fcab188. [PMID: 34704026 PMCID: PMC8417455 DOI: 10.1093/braincomms/fcab188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 06/17/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
High frequency oscillations (HFOs) are very brief events that are a well-established biomarker of the epileptogenic zone (EZ) but are rare and comprise only a tiny fraction of the total recorded EEG. We hypothesize that the interictal high frequency ‘background’ data, which has received little attention but represents the majority of the EEG record, also may contain additional, novel information for identifying the EZ. We analysed intracranial EEG (30–500 Hz frequency range) acquired from 24 patients who underwent resective surgery. We computed 38 quantitative features based on all usable, interictal data (63–307 h per subject), excluding all detected HFOs. We assessed association between each feature and the seizure onset zone (SOZ) and resected volume (RV) using logistic regression. A pathology score per channel was also created via principle component analysis and logistic regression, using hold-out-one-patient cross-validation to avoid in-sample training. Association of the pathology score with the SOZ and RV was quantified using an asymmetry measure. Many features were associated with the SOZ: 23/38 features had odds ratios >1.3 or <0.7 and 17/38 had odds ratios different than zero with high significance (P < 0.001/39, logistic regression with Bonferroni Correction). The pathology score, the rate of HFOs, and their channel-wise product were each strongly associated with the SOZ [median asymmetry ≥0.44, good surgery outcome patients; median asymmetry ≥0.40, patients with other outcomes; 95% confidence interval (CI) > 0.27 in both cases]. The pathology score and the channel-wise product also had higher asymmetry with respect to the SOZ than the HFO rate alone (median difference in asymmetry ≥0.18, 95% CI >0.05). These results support that the high frequency background data contains useful information for determining the EZ, distinct and complementary to information from detected HFOs. The concordance between the high frequency activity pathology score and the rate of HFOs appears to be a better biomarker of epileptic tissue than either measure alone.
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Affiliation(s)
- Truman Stovall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Brian Hunt
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Simon Glynn
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - William C Stacey
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen V Gliske
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
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30
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Gill RS, Lee HM, Caldairou B, Hong SJ, Barba C, Deleo F, D'Incerti L, Mendes Coelho VC, Lenge M, Semmelroch M, Schrader DV, Bartolomei F, Guye M, Schulze-Bonhage A, Urbach H, Cho KH, Cendes F, Guerrini R, Jackson G, Hogan RE, Bernasconi N, Bernasconi A. Multicenter Validation of a Deep Learning Detection Algorithm for Focal Cortical Dysplasia. Neurology 2021; 97:e1571-e1582. [PMID: 34521691 DOI: 10.1212/wnl.0000000000012698] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To test the hypothesis that a multicenter-validated computer deep learning algorithm detects MRI-negative focal cortical dysplasia (FCD). METHODS We used clinically acquired 3-dimensional (3D) T1-weighted and 3D fluid-attenuated inversion recovery MRI of 148 patients (median age 23 years [range 2-55 years]; 47% female) with histologically verified FCD at 9 centers to train a deep convolutional neural network (CNN) classifier. Images were initially deemed MRI-negative in 51% of patients, in whom intracranial EEG determined the focus. For risk stratification, the CNN incorporated bayesian uncertainty estimation as a measure of confidence. To evaluate performance, detection maps were compared to expert FCD manual labels. Sensitivity was tested in an independent cohort of 23 cases with FCD (13 ± 10 years). Applying the algorithm to 42 healthy controls and 89 controls with temporal lobe epilepsy disease tested specificity. RESULTS Overall sensitivity was 93% (137 of 148 FCD detected) using a leave-one-site-out cross-validation, with an average of 6 false positives per patient. Sensitivity in MRI-negative FCD was 85%. In 73% of patients, the FCD was among the clusters with the highest confidence; in half, it ranked the highest. Sensitivity in the independent cohort was 83% (19 of 23; average of 5 false positives per patient). Specificity was 89% in healthy and disease controls. DISCUSSION This first multicenter-validated deep learning detection algorithm yields the highest sensitivity to date in MRI-negative FCD. By pairing predictions with risk stratification, this classifier may assist clinicians in adjusting hypotheses relative to other tests, increasing diagnostic confidence. Moreover, generalizability across age and MRI hardware makes this approach ideal for presurgical evaluation of MRI-negative epilepsy. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that deep learning on multimodal MRI accurately identifies FCD in patients with epilepsy initially diagnosed as MRI negative.
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Affiliation(s)
- Ravnoor Singh Gill
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Hyo-Min Lee
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Benoit Caldairou
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Seok-Jun Hong
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Carmen Barba
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Francesco Deleo
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Ludovico D'Incerti
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Vanessa Cristina Mendes Coelho
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Matteo Lenge
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Mira Semmelroch
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Dewi Victoria Schrader
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Fabrice Bartolomei
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Maxime Guye
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Andreas Schulze-Bonhage
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Horst Urbach
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Kyoo Ho Cho
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Fernando Cendes
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Renzo Guerrini
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Graeme Jackson
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - R Edward Hogan
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Neda Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO
| | - Andrea Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (R.S.G., H.-M.L., B.C., S.-J.H., N.B., A.B.), Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit and Laboratories (C.B., M.L., R.G.), Children's Hospital A. Meyer-University of Florence, Italy; Epilepsy Unit (F.D.) and Neuroradiology (L.D.), Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurology (V.C.M.C., F.C.), University of Campinas, Brazil; The Florey Institute of Neuroscience and Mental Health and The University of Melbourne (M.S., G.J.), Victoria, Australia; Department of Pediatrics (D.V.S.), British Columbia Children's Hospital, Vancouver, Canada; Aix Marseille University (F.B.), INSERM UMR 1106, Institut de Neurosciences des Systèmes; Aix Marseille University (M.G.), CNRS, CRMBM UMR 7339, Marseille, France; Freiburg Epilepsy Center (A.S.-B., H.U.), Universitätsklinikum Freiburg, Germany; Department of Neurology (K.H.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Neurology (R.E.H.), Washington University School of Medicine, St. Louis, MO.
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Shirozu H, Masuda H, Kameyama S. Long-term seizure outcomes in patients with hypothalamic hamartoma treated by stereotactic radiofrequency thermocoagulation. Epilepsia 2021; 62:2697-2706. [PMID: 34541660 DOI: 10.1111/epi.17071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate long-term seizure outcomes in patients with hypothalamic hamartoma (HH) following stereotactic radiofrequency thermocoagulation (SRT). METHODS A total of 131 patients with HH who underwent SRT and were followed for at least three years after the last SRT were enrolled. Seizure outcomes were evaluated for gelastic seizures (GS) and other types of seizures (nGS) separately using the International League Against Epilepsy classification. Classes 1 and 2 were considered seizure-free. Kaplan-Meier survival analyses were used to estimate the proportion remaining seizure-free after the first and last SRTs. Risk factors relating to outcomes were analyzed by log-rank tests and a multivariate Cox proportional hazards model. RESULTS Reoperation was performed in 34 patients (26.2%). Median total follow-up was 61 (range, 36-202) months. Seizure freedom was obtained in 116 patients (88.6%) for GS and 85 of 108 patients (78.7%) for nGS at the last follow-up. Mean GS-free survival times improved from after the first (64.1 [95%CI 57.3-70.9] months) to after the last SRT (80.2 [95%CI 75.7-84.8] months). About 90% of GS recurrences after the first SRT were found within 6 months, though a few patients recurred more than 2 years after the first SRT. On the other hand, mean nGS-free survival times after the first and last SRTs were not different between after the first SRT (84.4 [95%CI 73.0-90.7] months) and after the last SRT (83.1 [95%CI 74.1-92.0] months). There was no factor related to GS outcomes, but the significant factor for nGS-free survival after the last SRT was multiple previous treatments (p=0.01, hazard ratio=15.65, 95%CI 1.79-137.16). SIGNIFICANCE The last SRT was almost equivalent to achieving complete disconnection of HHs from the hypothalamus according to our strategy. Considering the epileptogenic network, GS outcomes depend on complete disconnection, whereas nGS outcomes are not affected by surgical factors but independency of secondary epileptogenesis.
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Affiliation(s)
- Hiroshi Shirozu
- Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.,Hypothalamic Hamartoma Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan
| | - Hiroshi Masuda
- Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan.,Hypothalamic Hamartoma Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan
| | - Shigeki Kameyama
- Department of Neurosurgery, Niigata Seiro Hospital, Niigata, Japan
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Dimakopoulos V, Mégevand P, Boran E, Momjian S, Seeck M, Vulliémoz S, Sarnthein J. Blinded study: prospectively defined high-frequency oscillations predict seizure outcome in individual patients. Brain Commun 2021; 3:fcab209. [PMID: 34541534 PMCID: PMC8445392 DOI: 10.1093/braincomms/fcab209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/01/2021] [Accepted: 06/14/2020] [Indexed: 11/16/2022] Open
Abstract
Interictal high-frequency oscillations are discussed as biomarkers for epileptogenic brain tissue that should be resected in epilepsy surgery to achieve seizure freedom. The prospective classification of tissue sampled by individual electrode contacts remains a challenge. We have developed an automated, prospective definition of clinically relevant high-frequency oscillations in intracranial EEG from Montreal and tested it in recordings from Zurich. We here validated the algorithm on intracranial EEG that was recorded in an independent epilepsy centre so that the analysis was blinded to seizure outcome. We selected consecutive patients who underwent resective epilepsy surgery in Geneva with post-surgical follow-up > 12 months. We analysed long-term recordings during sleep that we segmented into intervals of 5 min. High-frequency oscillations were defined in the ripple (80–250 Hz) and the fast ripple (250–500 Hz) frequency bands. Contacts with the highest rate of ripples co-occurring with fast ripples designated the relevant area. As a validity criterion, we calculated the test–retest reliability of the high-frequency oscillations area between the 5 min intervals (dwell time ≥50%). If the area was not fully resected and the patient suffered from recurrent seizures, this was classified as a true positive prediction. We included recordings from 16 patients (median age 32 years, range 18–53 years) with stereotactic depth electrodes and/or with subdural electrode grids (median follow-up 27 months, range 12–55 months). For each patient, we included several 5 min intervals (median 17 intervals). The relevant area had high test–retest reliability across intervals (median dwell time 95%). In two patients, the test–retest reliability was too low (dwell time < 50%) so that outcome prediction was not possible. The area was fully included in the resected volume in 2/4 patients who achieved post-operative seizure freedom (specificity 50%) and was not fully included in 9/10 patients with recurrent seizures (sensitivity 90%), leading to an accuracy of 79%. An additional exploratory analysis suggested that high-frequency oscillations were associated with interictal epileptic discharges only in channels within the relevant area and not associated in channels outside the area. We thereby validated the automated procedure to delineate the clinically relevant area in each individual patient of an independently recorded dataset and achieved the same good accuracy as in our previous studies. The reproducibility of our results across datasets is promising for a multicentre study to test the clinical application of high-frequency oscillations to guide epilepsy surgery.
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Affiliation(s)
- Vasileios Dimakopoulos
- Klinik für Neurochirurgie, UniversitätsSpital Zürich, Universität Zürich, Zürich, Switzerland
| | - Pierre Mégevand
- Département des neurosciences fondamentales, Faculté de médecine, Université de Genève, Geneva, Switzerland.,Service de neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Ece Boran
- Klinik für Neurochirurgie, UniversitätsSpital Zürich, Universität Zürich, Zürich, Switzerland
| | - Shahan Momjian
- Service de neurochirurgie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Margitta Seeck
- Service de neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Serge Vulliémoz
- Service de neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Johannes Sarnthein
- Klinik für Neurochirurgie, UniversitätsSpital Zürich, Universität Zürich, Zürich, Switzerland.,Klinisches Neurowissenschaften Zentrum, University Hospital Zurich, Zürich, Switzerland
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33
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Tóth M, Barsi P, Tóth Z, Borbély K, Lückl J, Emri M, Repa I, Janszky J, Dóczi T, Horváth Z, Halász P, Juhos V, Gyimesi C, Bóné B, Kuperczkó D, Horváth R, Nagy F, Kelemen A, Jordán Z, Újvári Á, Hagiwara K, Isnard J, Pál E, Fekésházy A, Fabó D, Vajda Z. The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy. BMC Neurol 2021; 21:363. [PMID: 34537017 PMCID: PMC8449490 DOI: 10.1186/s12883-021-02352-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background When MRI fails to detect a potentially epileptogenic lesion, the chance of a favorable outcome after epilepsy surgery becomes significantly lower (from 60 to 90% to 20–65%). Hybrid FDG-PET/MRI may provide additional information for identifying the epileptogenic zone. We aimed to investigate the possible effect of the introduction of hybrid FDG-PET/MRI into the algorithm of the decision-making in both lesional and non-lesional drug-resistant epileptic patients. Methods In a prospective study of patients suffering from drug-resistant focal epilepsy, 30 nonlesional and 30 lesional cases with discordant presurgical results were evaluated using hybrid FDG-PET/MRI. Results The hybrid imaging revealed morphological lesion in 18 patients and glucose hypometabolism in 29 patients within the nonlesional group. In the MRI positive group, 4 patients were found to be nonlesional, and in 9 patients at least one more epileptogenic lesion was discovered, while in another 17 cases the original lesion was confirmed by means of hybrid FDG-PET/MRI. As to the therapeutic decision-making, these results helped to indicate resective surgery instead of intracranial EEG (iEEG) monitoring in 2 cases, to avoid any further invasive diagnostic procedures in 7 patients, and to refer 21 patients for iEEG in the nonlesional group. Hybrid FDG-PET/MRI has also significantly changed the original therapeutic plans in the lesional group. Prior to the hybrid imaging, a resective surgery was considered in 3 patients, and iEEG was planned in 27 patients. However, 3 patients became eligible for resective surgery, 6 patients proved to be inoperable instead of iEEG, and 18 cases remained candidates for iEEG due to the hybrid FDG-PET/MRI. Two patients remained candidates for resective surgery and one patient became not eligible for any further invasive intervention. Conclusions The results of hybrid FDG-PET/MRI significantly altered the original plans in 19 of 60 cases. The introduction of hybrid FDG-PET/MRI into the presurgical evaluation process had a potential modifying effect on clinical decision-making. Trial registration Trial registry: Scientific Research Ethics Committee of the Medical Research Council of Hungary. Trial registration number: 008899/2016/OTIG. Date of registration: 08 February 2016.
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Affiliation(s)
- Márton Tóth
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary.
| | - Péter Barsi
- Department of Medical Imaging, Semmelweis University, Balassa út 6, Budapest, H-1083, Hungary
| | - Zoltán Tóth
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Katalin Borbély
- PET/CT Ambulance, National Institute of Oncology, Ráth György u.7-9, Budapest, H-1122, Hungary
| | - János Lückl
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Miklós Emri
- MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Imre Repa
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary.,MTA-PTE Clinical Neuroscience MRI Research Group, Ifjúság u. 20, Pécs, H-7624, Hungary
| | - Tamás Dóczi
- MTA-PTE Clinical Neuroscience MRI Research Group, Ifjúság u. 20, Pécs, H-7624, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Zsolt Horváth
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Péter Halász
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Vera Juhos
- Epihope Non-Profit Kft, Szilágyi Erzsébet fasor 17-21, Budapest, 1026, Hungary
| | - Csilla Gyimesi
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Beáta Bóné
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Diána Kuperczkó
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Réka Horváth
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Sándor u. 40, Guba, H-7400, Hungary
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Zsófia Jordán
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Ákos Újvári
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Koichi Hagiwara
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, 3-6-45, Momochihama, Sawara-ku, Fukuoka, 814-0001, Japan
| | - Jean Isnard
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, 59 Boulevard Pinel, 69500, Lyon, France
| | - Endre Pál
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Attila Fekésházy
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Zsolt Vajda
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
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34
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Liu Y, Feig VR, Bao Z. Conjugated Polymer for Implantable Electronics toward Clinical Application. Adv Healthc Mater 2021; 10:e2001916. [PMID: 33899347 DOI: 10.1002/adhm.202001916] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/13/2020] [Indexed: 12/21/2022]
Abstract
Owing to their excellent mechanical flexibility, mixed-conducting electrical property, and extraordinary chemical turnability, conjugated polymers have been demonstrated to be an ideal bioelectronic interface to deliver therapeutic effect in many different chronic diseases. This review article summarizes the latest advances in implantable electronics using conjugated polymers as electroactive materials and identifies remaining challenges and opportunities for developing electronic medicine. Examples of conjugated polymer-based bioelectronic devices are selectively reviewed in human clinical studies or animal studies with the potential for clinical adoption. The unique properties of conjugated polymers are highlighted and exemplified as potential solutions to address the specific challenges in electronic medicine.
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Affiliation(s)
- Yuxin Liu
- Institute of Materials Research and Engineering Agency for Science, Technology and Research Singapore 138634 Singapore
| | - Vivian Rachel Feig
- Division of Gastroenterology, Department of Medicine, Brigham and Women’s Hospital Harvard Medical School Boston MA 02115 USA
| | - Zhenan Bao
- Department of Chemical Engineering Stanford University Stanford CA 94305 USA
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35
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Liu W, Yue Q, Gong Q, Zhou D, Wu X. Regional and remote connectivity patterns in focal extratemporal lobe epilepsy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1128. [PMID: 34430569 PMCID: PMC8350670 DOI: 10.21037/atm-21-1374] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/28/2021] [Indexed: 02/05/2023]
Abstract
Background Focal epilepsy accounts for most epilepsy cases, and frontal lobe epilepsy (FLE) accounts for the largest proportion of cases of extratemporal epilepsy syndrome. The epileptogenic zone is usually not easy to locate, contributing to a lack of imaging studies. The objective of this study was to evaluate functional connectivity patterns to explore the underlying pathological mechanisms of this disorder. Methods Forty-three patients with focal extratemporal epilepsy [mean age ± standard deviation (SD): 29.51±8.04 years, 19 males] and the same number of healthy controls (mean age ± SD: 29.56±8.02 years, 19 males) were recruited to undergo functional magnetic resonance imaging. Mean regional homogeneity (ReHo) was measured, and regions showing significant alterations in ReHo in patients were identified to examine functional connectivity (FC). In particular, FC within the default mode network (DMN) in patients was analyzed. Results Patients with extratemporal lobe epilepsy showed significantly higher ReHo in the bilateral precentral gyrus, and lower ReHo in frontal-cerebellum regions than healthy controls [P<0.05, Gaussian random field (GRF)-corrected]. FC analysis based on regions of interest showed significantly higher connectivity in the frontoparietal-insula region and lowered FC in the frontal-cerebellum regions (P<0.05, GRF-corrected). Altered FC within DMN was also demonstrated (P<0.05, GRF-corrected). Conclusions Analyses of ReHo and FC based on regions of interest suggest epilepsy-related neural networks are located mainly in frontal regions in extratemporal lobe epilepsy. These findings reveal disruptions of interactions and connectivity of large-scale neural networks and frontotemporal-cerebellar regions, suggesting connectivity-based pathophysiology.
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Affiliation(s)
- Wenyu Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Yue
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xintong Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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36
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Adin ME, Spencer DD, Damisah E, Herlopian A, Gerrard JL, Bronen RA. Imaging of Neuromodulation and Surgical Interventions for Epilepsy. AJNR Am J Neuroradiol 2021; 42:1742-1750. [PMID: 34353787 DOI: 10.3174/ajnr.a7222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/30/2021] [Indexed: 11/07/2022]
Abstract
About one-third of epilepsy cases are refractory to medical therapy. During the past decades, the availability of surgical epilepsy interventions has substantially increased as therapeutic options for this group of patients. A wide range of surgical interventions and electrophysiologic neuromodulation techniques are available, including lesional resection, lobar resection, thermoablation, disconnection, multiple subpial transections, vagus nerve stimulation, responsive neurostimulation, and deep brain stimulation. The indications and imaging features of potential complications of the newer surgical interventions may not be widely appreciated, particularly if practitioners are not associated with comprehensive epilepsy centers. In this article, we review a wide range of invasive epilepsy treatment modalities with a particular focus on their postoperative imaging findings and complications. A state-of-the-art treatment algorithm provides context for imaging findings by helping the reader understand how a particular invasive treatment decision is made.
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Affiliation(s)
- M E Adin
- From the Department of Radiology and Biomedical Imaging (M.E.A., R.A.B.)
| | | | | | - A Herlopian
- Neurology (A.H.), Yale School of Medicine, New Haven, Connecticut
| | | | - R A Bronen
- From the Department of Radiology and Biomedical Imaging (M.E.A., R.A.B.)
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Mandge V, Correa DJ, McGinley J, Boro A, Legatt AD, Haut SR. Factors associated with patients not proceeding with proposed resective epilepsy surgery. Seizure 2021; 91:402-408. [PMID: 34303161 DOI: 10.1016/j.seizure.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study evaluated the association between eligible patients not proceeding with resective epilepsy surgery and various demographic, disease-specific, and epilepsy-evaluation variables. METHODS This retrospective case-control study included patients identified as candidates for resective epilepsy surgery at the Montefiore Medical Center between January 1, 2009 and June 30, 2017. Chi-squared, two-tailed, independent sample t-test, Mann-Whitney U test and logistic regression were utilized to identify variables associated with patients not proceeding with surgery. RESULTS Among the 159 potential surgical candidates reviewed over the 8.5-year study period, only 53 ultimately proceeded with surgery (33%). Eighty-seven (55%) out of these 159 patients were identified as appropriate for resective epilepsy surgery during the study period. Thirty-four (39%) of these 87 patients did not proceed with surgery. Variables independently correlated (either positively or negatively) with the patient not proceeding with surgery were: being employed [Odds Ratio (OR) 4.2, 95% confidence interval (CI) 1.12-15.73], temporal lobe lesion on MRI (OR 0.35, 95% CI 0.14-0.84), temporal lobe EEG ictal onsets (OR 0.21, 95% CI 0.07-0.62), and temporal lobe epileptogenic zone (OR 0.19, 95% CI 0.07-0.55). CONCLUSION The novel finding in this study is the association between employment status and whether the patient had epilepsy surgery: employed patients were 4.2 times more likely to not proceed with surgery compared to unemployed patients. In addition, patients with a temporal lobe lesion on MRI, temporal lobe EEG ictal onsets, and/or a temporal epileptogenic zone were more likely to proceed with surgery. Future work will be needed to evaluate these findings prospectively, determine if they generalize to other patient populations, explore the decision whether or not to proceed with epilepsy surgery from a patient-centered perspective, and suggest strategies to reduce barriers to this underutilized treatment.
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Affiliation(s)
- Vishal Mandge
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, United States.
| | - Daniel José Correa
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - John McGinley
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Alexis Boro
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Alan D Legatt
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Sheryl R Haut
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
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Zhao B, Zhang C, Wang X, Wang Y, Liu C, Mo J, Zheng Z, Zhang K, Shao XQ, Hu W, Zhang J. Sulcus-centered resection for focal cortical dysplasia type II: surgical techniques and outcomes. J Neurosurg 2021; 135:266-272. [PMID: 32764170 DOI: 10.3171/2020.5.jns20751] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/14/2020] [Indexed: 11/06/2022]
Abstract
Focal cortical dysplasia type II (FCD II) is a common histopathological substrate of epilepsy surgery. Here, the authors propose a sulcus-centered resection strategy for this malformation, provide technical details, and assess the efficacy and safety of this technique. The main purpose of the sulcus-centered resection is to remove the folded gray matter surrounding a dysplastic sulcus, particularly that at the bottom of the sulcus. The authors also retrospectively reviewed the records of 88 consecutive patients with FCD II treated with resective surgery between January 2015 and December 2018. The demographics, clinical characteristics, electrophysiological recordings, neuroimaging studies, histopathological findings, surgical outcomes, and complications were collected. After the exclusion of diffusely distributed and gyrus-based lesions, 71 patients (30 females, 41 males) who had undergone sulcus-centered resection were included in this study. The mean (± standard deviation) age of the cohort was 17.78 ± 10.54 years (38 pediatric patients, 33 adults). Thirty-five lesions (49%) were demonstrated on MRI; 42 patients (59%) underwent stereo-EEG monitoring before resective surgery; and 37 (52%) and 34 (48%) lesions were histopathologically proven to be FCD IIa and IIb, respectively. At a mean follow-up of 3.34 ± 1.17 years, 64 patients (90%) remained seizure free, and 7 (10%) had permanent neurological deficits including motor weakness, sensory deficits, and visual field deficits. The study findings showed that in carefully selected FCD II cases, sulcus-centered resection is an effective and safe surgical strategy.
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Affiliation(s)
| | | | | | | | | | | | - Zhong Zheng
- 4Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, People's Republic of China
| | - Kai Zhang
- Departments of1Neurosurgery and
- 2Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University
- 3Beijing Key Laboratory of Neurostimulation; and
| | - Xiao-Qiu Shao
- 5Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Wenhan Hu
- Departments of1Neurosurgery and
- 2Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University
- 3Beijing Key Laboratory of Neurostimulation; and
| | - Jianguo Zhang
- Departments of1Neurosurgery and
- 2Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University
- 3Beijing Key Laboratory of Neurostimulation; and
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Surgical outcome and prognostic factors in epilepsy patients with MR-negative focal cortical dysplasia. PLoS One 2021; 16:e0249929. [PMID: 33852634 PMCID: PMC8046256 DOI: 10.1371/journal.pone.0249929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Focal cortical dysplasia (FCD) represents a heterogeneous group of disorders of the cortical formation and is one of the most common causes of epilepsy. Magnetic resonance imaging (MRI) is the modality of choice for detecting structural lesions, and the surgical prognosis in patients with MR lesions is favorable. However, the surgical prognosis of patients with MR-negative FCD is unknown. We aimed to evaluate the long-term surgical outcomes and prognostic factors in MR-negative FCD patients through comprehensive presurgical data. Methods We retrospectively reviewed data from 719 drug-resistant epilepsy patients who underwent resective surgery and selected cases in which surgical specimens were pathologically confirmed as FCD Type I or II. If the epileptogenic focus and surgical specimens were obtained from brain areas with a normal MRI appearance, they were classified as MR-negative FCD. Surgical outcomes were evaluated at 2 and 5 years, and clinical, neurophysiological, and neuroimaging data of MR-negative FCD were compared to those of MR-positive FCD. Results Finally, 47 MR-negative and 34 MR-positive FCD patients were enrolled in the study. The seizure-free rate after surgery (Engel classification I) at postoperative 2 year was 59.5% and 64.7% in the MR-negative and positive FCD groups, respectively (p = 0.81). This rate decreased to 57.5% and 44.4% in the MR-negative and positive FCD groups (p = 0.43) at postoperative 5 years. MR-negative FCD showed a higher proportion of FCD type I (87.2% vs. 50.0%, p = 0.001) than MR-positive FCD. Unilobar cerebral perfusion distribution (odds ratio, OR 5.41) and concordance of interictal epileptiform discharges (OR 5.10) were significantly associated with good surgical outcomes in MR-negative FCD. Conclusion In this study, MR-negative and positive FCD patients had a comparable surgical prognosis, suggesting that comprehensive presurgical evaluations, including multimodal neuroimaging studies, are crucial for obtaining excellent surgical outcomes even in epilepsy patients with MR-negative FCD.
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Davids R, Kowski AB, Meencke H, Oltmanns F, Dehnicke C, Schneider UC, Holtkamp M. Surgery in intractable epilepsy-physicians' recommendations and patients' decisions. Acta Neurol Scand 2021; 143:421-429. [PMID: 33210727 DOI: 10.1111/ane.13377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/29/2020] [Accepted: 11/14/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To identify demographic and clinical variables independently associated with patients' decisions against their physicians' recommendations for resective epilepsy surgery or further scalp video-EEG monitoring (sca-VEM), semi-invasive (sem-)VEM with foramen ovale and/or peg electrodes, and invasive (in-)VEM. METHODS Consecutive patients, who underwent presurgical assessment with at least one sca-VEM between 2010 and 2014, were included into this retrospective analysis. Multivariate analysis was used to identify independent variables associated with patients' decisions. RESULTS Within the study period, 352 patients underwent 544 VEM sessions comprising 451 sca-, 36 sem-, and 57 in-VEMs. Eventually, 96 patients were recommended resective surgery, and 106 were ineligible candidates; 149 patients denied further necessary VEMs; thus, no decision could be made. After sca- or additional sem-VEM, nine out of 51 eligible patients (17.6%) rejected resection. One hundred and ten patients were recommended in-VEM, 52 of those (47.2%) declined. Variables independently associated with rejection of in-VEM comprised intellectual disability (OR 4.721, 95% CI 1.047-21.284), extratemporal focal aware non-motor seizures ("aura") vs. no "aura" (OR 0.338, 95% CI 0.124-0.923), and unilateral or bilateral vs. no MRI lesion (OR 0.248, 95% CI 0.100-0.614 and 0.149, 95% CI 0.027-0.829, respectively). CONCLUSIONS During and after presurgical evaluation, patients with intractable focal epilepsy declined resections and intracranial EEGs, as recommended by their epileptologists, in almost 20% and 50% of cases. This calls for early and thorough counseling of patients on risks and benefits of epilepsy surgery. Future prospective studies should ask patients in depth for specific reasons why they decline their physicians' recommendations.
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Affiliation(s)
- Roman Davids
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg, Charité – Universitätsmedizin Berlin Berlin Germany
| | - Alexander B. Kowski
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg, Charité – Universitätsmedizin Berlin Berlin Germany
| | - Hans‐Joachim Meencke
- Institute for Diagnostics of Epilepsy Evangelisches Krankenhaus Königin Elisabeth Herzberge, Epilepsy‐Center Berlin‐Brandenburg Berlin Germany
| | - Frank Oltmanns
- Institute for Diagnostics of Epilepsy Evangelisches Krankenhaus Königin Elisabeth Herzberge, Epilepsy‐Center Berlin‐Brandenburg Berlin Germany
| | - Christoph Dehnicke
- Institute for Diagnostics of Epilepsy Evangelisches Krankenhaus Königin Elisabeth Herzberge, Epilepsy‐Center Berlin‐Brandenburg Berlin Germany
| | - Ulf C. Schneider
- Department of Neurosurgery Charité – Universitätsmedizin Berlin Berlin Germany
| | - Martin Holtkamp
- Department of Neurology Epilepsy‐Center Berlin‐Brandenburg, Charité – Universitätsmedizin Berlin Berlin Germany
- Institute for Diagnostics of Epilepsy Evangelisches Krankenhaus Königin Elisabeth Herzberge, Epilepsy‐Center Berlin‐Brandenburg Berlin Germany
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Cossu G, González-López P, Pralong E, Kalser J, Messerer M, Daniel RT. Unilateral prefrontal lobotomy for epilepsy: technique and surgical anatomy. Neurosurg Focus 2021; 48:E10. [PMID: 32234977 DOI: 10.3171/2020.1.focus19938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgery for frontal lobe epilepsy remains a challenge because of the variable seizure outcomes after surgery. Disconnective procedures are increasingly applied to isolate the epileptogenic focus and avoid complications related to extensive brain resection. Previously, the authors described the anterior quadrant disconnection procedure to treat large frontal lobe lesions extending up to but not involving the primary motor cortex. In this article, they describe a surgical technique for unilateral disconnection of the prefrontal cortex, while providing an accurate description of the surgical and functional anatomy of this disconnective procedure. METHODS The authors report the surgical treatment of a 5-month-old boy who presented with refractory epilepsy due to extensive cortical dysplasia of the left prefrontal lobe. In addition, with the aim of both describing the subcortical intrinsic anatomy and illustrating the different connections between the prefrontal lobe and the rest of the brain, the authors dissected six human cadaveric brain hemispheres. These dissections were performed from lateral to medial and from medial to lateral to reveal the various tracts sectioned during the three different steps in the surgery, namely the intrafrontal disconnection, anterior callosotomy, and frontobasal disconnection. RESULTS The first step of the dissection involves cutting the U-fibers. During the anterior intrafrontal disconnection, the superior longitudinal fasciculus in the depth of the middle frontal gyrus, the uncinate fasciculus, and the inferior frontooccipital fasciculus in the depth of the inferior frontal gyrus at the level of the anterior insular point are visualized and sectioned, followed by sectioning of the anterior limb of the internal capsule. Once the frontal horn is reached, the anterior callosotomy can be performed to disconnect the genu and the rostrum of the corpus callosum. The intrafrontal disconnection is deepened toward the falx, and at the medial surface, the cingulum is sectioned. The frontobasal disconnection involves cutting the anterior limb of the anterior commissure. CONCLUSIONS This technique allows selective isolation of the epileptogenic focus located in the prefrontal lobe to avoid secondary propagation. Understanding the surface and white matter fiber anatomy is essential to safely perform the procedure and obtain a favorable seizure outcome.
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Affiliation(s)
- Giulia Cossu
- 1Department of Neurosurgery, University Hospital of Lausanne
| | | | - Etienne Pralong
- 1Department of Neurosurgery, University Hospital of Lausanne
| | - Judith Kalser
- 3Department of Pediatrics, Section of Neuro-Pediatrics, University Hospital of Lausanne, Switzerland; and
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Kankirawatana P, Mohamed IS, Lauer J, Aban I, Kim H, Li R, Harrison A, Goyal M, Rozzelle CJ, Knowlton R, Blount JP. Relative contribution of individual versus combined functional imaging studies in predicting seizure freedom in pediatric epilepsy surgery: an area under the curve analysis. Neurosurg Focus 2021; 48:E13. [PMID: 32234993 DOI: 10.3171/2020.1.focus19974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the predictive value and relative contribution of noninvasive presurgical functional imaging modalities based on the authors' institutional experience in pursuing seizure-free surgical outcomes in children with medically refractory epilepsy. METHODS This was a retrospective, single-institution, observational cohort study of pediatric patients who underwent evaluation and surgical treatment for medically refractory partial epilepsy between December 2003 and June 2016. During this interval, 108 children with medically refractory partial epilepsy underwent evaluation for localization and resective epilepsy surgery. Different noninvasive functional imaging modalities, including ictal SPECT, FDG-PET, and magnetoencephalography-magnetic source imaging, were utilized to augment a standardized paradigm (electroencephalography/semiology, MRI, and neuropsychology findings) for localization. Outcomes were evaluated at a minimum of 2 years (mean 7.5 years) utilizing area under the receiver operating characteristic curve analysis. Localizing modalities and other clinical covariates were examined in relation to long-term surgical outcomes. RESULTS There was variation in the contribution of each test, and no single presurgical workup modality could singularly and reliably predict a seizure-free outcome. However, concordance of presurgical modalities yielded a high predictive value. No difference in long-term outcomes between inconclusive (normal or diffusely abnormal) and abnormal focal MRI results were found. Long-term survival analyses revealed a statistically significant association between seizure freedom and patients with focal ictal EEG, early surgical intervention, and no history of generalized convulsions. CONCLUSIONS Comprehensive preoperative evaluation utilizing multiple noninvasive functional imaging modalities is not redundant and can improve pediatric epilepsy surgical outcomes.
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Affiliation(s)
- Pongkiat Kankirawatana
- 1Division of Pediatric Neurology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Ismail S Mohamed
- 1Division of Pediatric Neurology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Jason Lauer
- 2Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Inmaculada Aban
- 3Division of Biostatistics, UAB School of Public Health, The University of Alabama at Birmingham, Alabama
| | - Hyunmi Kim
- 4Division of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Rong Li
- 5Department of Pathology, The University of Alabama at Birmingham, Alabama
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- 1Division of Pediatric Neurology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Monisha Goyal
- 1Division of Pediatric Neurology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Curtis J Rozzelle
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; and
| | - Robert Knowlton
- 7Department of Neurology, University of California, San Francisco, California
| | - Jeffrey P Blount
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; and
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Sharma AA, Nenert R, Mueller C, Maudsley AA, Younger JW, Szaflarski JP. Repeatability and Reproducibility of in-vivo Brain Temperature Measurements. Front Hum Neurosci 2020; 14:598435. [PMID: 33424566 PMCID: PMC7785722 DOI: 10.3389/fnhum.2020.598435] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Magnetic resonance spectroscopic imaging (MRSI) is a neuroimaging technique that may be useful for non-invasive mapping of brain temperature (i.e., thermometry) over a large brain volume. To date, intra-subject reproducibility of MRSI-based brain temperature (MRSI-t) has not been investigated. The objective of this repeated measures MRSI-t study was to establish intra-subject reproducibility and repeatability of brain temperature, as well as typical brain temperature range. Methods: Healthy participants aged 23-46 years (N = 18; 7 females) were scanned at two time points ~12-weeks apart. Volumetric MRSI data were processed by reconstructing metabolite and water images using parametric spectral analysis. Brain temperature was derived using the frequency difference between water and creatine (TCRE) for 47 regions of interest (ROIs) delineated by the modified Automated Anatomical Labeling (AAL) atlas. Reproducibility was measured using the coefficient of variation for repeated measures (COVrep), and repeatability was determined using the standard error of measurement (SEM). For each region, the upper and lower bounds of Minimal Detectable Change (MDC) were established to characterize the typical range of TCRE values. Results: The mean global brain temperature over all subjects was 37.2°C with spatial variations across ROIs. There was a significant main effect for time [F (1, 1,591) = 37.0, p < 0.0001] and for brain region [F (46, 1,591) = 2.66, p < 0.0001]. The time*brain region interaction was not significant [F (46, 1,591) = 0.80, p = 0.83]. Participants' TCRE was stable for each ROI across both time points, with ROIs' COVrep ranging from 0.81 to 3.08% (mean COVrep = 1.92%); majority of ROIs had a COVrep <2.0%. Conclusions: Brain temperature measurements were highly consistent between both time points, indicating high reproducibility and repeatability of MRSI-t. MRSI-t may be a promising diagnostic, prognostic, and therapeutic tool for non-invasively monitoring brain temperature changes in health and disease. However, further studies of healthy participants with larger sample size(s) and numerous repeated acquisitions are imperative for establishing a reference range of typical brain TCRE, as well as the threshold above which TCRE is likely pathological.
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Affiliation(s)
- Ayushe A. Sharma
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, United States
| | - Rodolphe Nenert
- University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, United States
- Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Christina Mueller
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Andrew A. Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jarred W. Younger
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Jerzy P. Szaflarski
- Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, United States
- Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Department of Neurosurgery, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
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Abstract
Nearly 30% of epilepsy patients are refractory to medical therapy. Surgical management of epilepsy is an increasingly viable option for these patients. Although surgery has historically been used as a palliative option, improvements in technology and outcomes show its potential in certain subsets of patients. This article reviews the two main categories of surgical epilepsy treatment-resective surgery and neuromodulation. Resective surgery includes temporal lobe resections, extratemporal resections, laser interstitial thermal therapy, and disconnection procedures. We discuss the three main types of neuromodulation-vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation for epilepsy. The history and indications are explored for each type of treatment. Given the myriad types of resection and neuromodulation techniques, patient selection is reviewed in detail, with a discussion on which patients are most likely to benefit from different treatment strategies. We also discuss outcomes with examples of the pertinent landmark trials and their results. Finally, complications and surgical technique are reviewed. As new indications emerge and patient selection is refined, surgical management will continue to evolve as an adjuvant therapy for epileptic patients.
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Affiliation(s)
- Shahjehan Ahmad
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Cascino GD, Brinkmann BH. Advances in the Surgical Management of Epilepsy: Drug-Resistant Focal Epilepsy in the Adult Patient. Neurol Clin 2020; 39:181-196. [PMID: 33223082 DOI: 10.1016/j.ncl.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pharmacoresistant seizures occur in nearly one-third of people with epilepsy. Medial temporal lobe and lesional epilepsy are the most favorable surgically remediable epileptic syndromes. Successful surgery may render the patient seizure-free, reduce antiseizure drug(s) adverse effects, improve quality of life, and decrease mortality. Surgical management should not be considered a procedure of "last resort." Despite the results of randomized controlled trials, surgery remains an underutilized treatment modality for patients with drug-resistant epilepsy (DRE). Important disparities affect patient referral and selection for surgical treatment. This article discusses the advances in surgical treatment of DRE in adults with focal seizures.
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Affiliation(s)
| | - Benjamin H Brinkmann
- Mayo Clinic, Department of Neurology, 200 First Street Southwest, Rochester, MN 55905, USA
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Mir A, Baradie RA, Alnaim A, Moinuddin A, Khan MI, Jallul T, Otaibi FA, Joseph M, Dossary SA, Bashir S. Utility of single-photon emission computed tomography (SPECT) in presurgical evaluation of children: A single-center experience. Epilepsy Res 2020; 167:106445. [DOI: 10.1016/j.eplepsyres.2020.106445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
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47
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Landazuri P, Shih J, Leuthardt E, Ben-Haim S, Neimat J, Tovar-Spinoza Z, Chiang V, Spencer D, Sun D, Fecci P, Baumgartner J. A prospective multicenter study of laser ablation for drug resistant epilepsy – One year outcomes. Epilepsy Res 2020; 167:106473. [DOI: 10.1016/j.eplepsyres.2020.106473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/21/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
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Scott J, Ren S, Gliske S, Stacey W. Preictal variability of high-frequency oscillation rates in refractory epilepsy. Epilepsia 2020; 61:2521-2533. [PMID: 32944942 PMCID: PMC7722127 DOI: 10.1111/epi.16680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE High-frequency oscillations (HFOs) have shown promising utility in the spatial localization of the seizure onset zone for patients with focal refractory epilepsy. Comparatively few studies have addressed potential temporal variations in HFOs, or their role in the preictal period. Here, we introduce a novel evaluation of the instantaneous HFO rate through interictal and peri-ictal epochs to assess their usefulness in identifying imminent seizure onset. METHODS Utilizing an automated HFO detector, we analyzed intracranial electroencephalographic data from 30 patients with refractory epilepsy undergoing long-term presurgical evaluation. We evaluated HFO rates both as a 30-minute average and as a continuous function of time and used nonparametric statistical methods to compare individual and population-level differences in rate during peri-ictal and interictal periods. RESULTS Mean HFO rate was significantly higher for all epochs in seizure onset zone channels versus other channels. Across the 30 patients of our cohort, we found no statistically significant differences in mean HFO rate during preictal and interictal epochs. For continuous HFO rates in seizure onset zone channels, however, we found significant population-wide increases in preictal trends relative to interictal periods. Using a data-driven analysis, we identified a subset of 11 patients in whom either preictal HFO rates or their continuous trends were significantly increased relative to those of interictal baseline and the rest of the population. SIGNIFICANCE These results corroborate existing findings that HFO rates within epileptic tissue are higher during interictal periods. We show this finding is also present in preictal, ictal, and postictal data, and identify a novel biomarker of preictal state: an upward trend in HFO rate leading into seizures in some patients. Overall, our findings provide preliminary evidence that HFOs can function as a temporal biomarker of seizure onset.
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Affiliation(s)
- Jared Scott
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48105
| | - Sijin Ren
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, 48105
| | - Stephen Gliske
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48105
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48105
| | - William Stacey
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48105
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, 48105
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48105
- BioInterfaces Institute, University of Michigan, Ann Arbor, MI, 48105
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Ye S, Yang L, Lu Y, Kucewicz MT, Brinkmann B, Nelson C, Sohrabpour A, Worrell GA, He B. Contribution of Ictal Source Imaging for Localizing Seizure Onset Zone in Patients With Focal Epilepsy. Neurology 2020; 96:e366-e375. [PMID: 33097598 DOI: 10.1212/wnl.0000000000011109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether seizure onset zone (SOZ) can be localized accurately prior to surgical planning in patients with focal epilepsy, we performed noninvasive EEG recordings and source localization analyses on 39 patients. METHODS In 39 patients with focal epilepsy, we recorded and extracted 138 seizures and 1,325 interictal epileptic discharges using high-density EEG. We investigated a novel approach for directly imaging sources of seizures and interictal spikes from high-density EEG recordings, and rigorously validated it for noninvasive localization of SOZ determined from intracranial EEG findings and surgical resection volume. Conventional source imaging analyses were also performed for comparison. RESULTS Ictal source imaging showed a concordance rate of 95% when compared to intracranial EEG or resection results. The average distance from estimation to seizure onset (intracranial) electrodes is 1.35 cm in patients with concordant results, and 0.74 cm to surgical resection boundary in patients with successful surgery. About 41% of the patients were found to have multiple types of interictal activities; coincidentally, a lower concordance rate and a significantly worse performance in localizing SOZ were observed in these patients. CONCLUSION Noninvasive ictal source imaging with high-density EEG recording can provide highly concordant results with clinical decisions obtained by invasive monitoring or confirmed by resective surgery. By means of direct seizure imaging using high-density scalp EEG recordings, the added value of ictal source imaging is particularly high in patients with complex interictal activity patterns, who may represent the most challenging cases with poor prognosis.
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Affiliation(s)
- Shuai Ye
- From the Department of Biomedical Engineering (S.Y., A.S., B.H.), Carnegie Mellon University, Pittsburgh, PA; Department of Biomedical Engineering (L.Y., Y.L.), University of Minnesota, Minneapolis; Mayo Clinic (M.T.K., B.B., C.N., G.A.W.), Rochester, MN
| | - Lin Yang
- From the Department of Biomedical Engineering (S.Y., A.S., B.H.), Carnegie Mellon University, Pittsburgh, PA; Department of Biomedical Engineering (L.Y., Y.L.), University of Minnesota, Minneapolis; Mayo Clinic (M.T.K., B.B., C.N., G.A.W.), Rochester, MN
| | - Yunfeng Lu
- From the Department of Biomedical Engineering (S.Y., A.S., B.H.), Carnegie Mellon University, Pittsburgh, PA; Department of Biomedical Engineering (L.Y., Y.L.), University of Minnesota, Minneapolis; Mayo Clinic (M.T.K., B.B., C.N., G.A.W.), Rochester, MN
| | - Michal T Kucewicz
- From the Department of Biomedical Engineering (S.Y., A.S., B.H.), Carnegie Mellon University, Pittsburgh, PA; Department of Biomedical Engineering (L.Y., Y.L.), University of Minnesota, Minneapolis; Mayo Clinic (M.T.K., B.B., C.N., G.A.W.), Rochester, MN
| | - Benjamin Brinkmann
- From the Department of Biomedical Engineering (S.Y., A.S., B.H.), Carnegie Mellon University, Pittsburgh, PA; Department of Biomedical Engineering (L.Y., Y.L.), University of Minnesota, Minneapolis; Mayo Clinic (M.T.K., B.B., C.N., G.A.W.), Rochester, MN
| | - Cindy Nelson
- From the Department of Biomedical Engineering (S.Y., A.S., B.H.), Carnegie Mellon University, Pittsburgh, PA; Department of Biomedical Engineering (L.Y., Y.L.), University of Minnesota, Minneapolis; Mayo Clinic (M.T.K., B.B., C.N., G.A.W.), Rochester, MN
| | - Abbas Sohrabpour
- From the Department of Biomedical Engineering (S.Y., A.S., B.H.), Carnegie Mellon University, Pittsburgh, PA; Department of Biomedical Engineering (L.Y., Y.L.), University of Minnesota, Minneapolis; Mayo Clinic (M.T.K., B.B., C.N., G.A.W.), Rochester, MN
| | - Gregory A Worrell
- From the Department of Biomedical Engineering (S.Y., A.S., B.H.), Carnegie Mellon University, Pittsburgh, PA; Department of Biomedical Engineering (L.Y., Y.L.), University of Minnesota, Minneapolis; Mayo Clinic (M.T.K., B.B., C.N., G.A.W.), Rochester, MN
| | - Bin He
- From the Department of Biomedical Engineering (S.Y., A.S., B.H.), Carnegie Mellon University, Pittsburgh, PA; Department of Biomedical Engineering (L.Y., Y.L.), University of Minnesota, Minneapolis; Mayo Clinic (M.T.K., B.B., C.N., G.A.W.), Rochester, MN.
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Gliske SV, Qin Z, Lau K, Alvarado-Rojas C, Salami P, Zelmann R, Stacey WC. Distinguishing false and true positive detections of high frequency oscillations. J Neural Eng 2020; 17:056005. [PMID: 32932244 PMCID: PMC8547344 DOI: 10.1088/1741-2552/abb89b] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective. High frequency oscillations (HFOs) are a promising biomarker of tissue that instigates seizures. However, ambiguous data and random background fluctuations can cause any HFO detector (human or automated) to falsely label non-HFO data as an HFO (a false positive detection). The objective of this paper was to identify quantitative features of HFOs that distinguish between true and false positive detections. Approach. Feature selection was performed using background data in multi-day, interictal intracranial recordings from ten patients. We selected the feature most similar between randomly selected segments of background data and HFOs detected in surrogate background data (false positive detections by construction). We then compared these results with fuzzy clustering of detected HFOs in clinical data to verify the feature’s applicability. We validated the feature is sensitive to false versus true positive HFO detections by using an independent data set (six subjects) scored for HFOs by three human reviewers. Lastly, we compared the effect of redacting putative false positive HFO detections on the distribution of HFOs across channels and their association with seizure onset zone (SOZ) and resected volume (RV). Main results. Of the 15 analyzed features, the analysis selected only skewness of the curvature (skewCurve). The feature was validated in human scored data to be associated with distinguishing true and false positive HFO detections. Automated HFO detections with higher skewCurve were more focal based on entropy measures and had increased localization to both the SOZ and RV. Significance. We identified a quantitative feature of HFOs which helps distinguish between true and false positive detections. Redacting putative false positive HFO detections improves the specificity of HFOs as a biomarker of epileptic tissue.
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Affiliation(s)
- Stephen V Gliske
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, United States of America. Department of Neurology, University of Michigan, Ann Arbor, Michigan, United States of America. Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
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