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Kellogg MA, Ernst LD, Spencer DC, Datta P, Klein E, Bhati MT, Shivacharan RS, Nho YH, Barbosa DAN, Halpern CH, Raslan A. Dual Treatment of Refractory Focal Epilepsy and Obsessive-Compulsive Disorder With Intracranial Responsive Neurostimulation. Neurol Clin Pract 2024; 14:e200318. [PMID: 38846467 PMCID: PMC11152646 DOI: 10.1212/cpj.0000000000200318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/02/2024] [Indexed: 06/09/2024]
Abstract
Purpose of the Review Intracranial neurostimulation is a well-established treatment of neurologic conditions such as drug-resistant epilepsy (DRE) and movement disorders, and there is emerging evidence for using deep brain stimulation to treat obsessive-compulsive disorder (OCD) and depression. Nearly all published reports of intracranial neurostimulation have focused on implanting a single device to treat a single condition. The purpose of this review was to educate neurology clinicians on the background literature informing dual treatment of 2 comorbid neuropsychiatric conditions epilepsy and OCD, discuss ethical and logistical challenges to dual neuropsychiatric treatment with a single device, and demonstrate the promise and pitfalls of this approach through discussion of the first-in-human closed-looped responsive neurostimulator (RNS) implanted to treat both DRE (on-label) and OCD (off-label). Recent Findings We report the first implantation of an intracranial closed-loop neurostimulation device (the RNS system) with the primary goal of treating DRE and a secondary exploratory goal of managing treatment-refractory OCD. The RNS system detects electrophysiologic activity and delivers electrical stimulation through 1 or 2 electrodes implanted into a patient's seizure-onset zones (SOZs). In this case report, we describe a patient with treatment-refractory epilepsy and OCD where the first lead was implanted in the right superior temporal gyrus to target the most active SOZ based on stereotactic EEG (sEEG) recordings and semiology. The second lead was implanted to target the right anterior peri-insular region (a secondary SOZ on sEEG) with the distal-most contacts in the right nucleus accumbens, a putative target for OCD neurostimulation treatment. The RNS system was programmed to detect and record the unique electrophysiologic signature of both the patient's seizures and compulsions and then deliver tailored electrical pulses to disrupt the pathologic circuitry. Summary Dual treatment of refractory focal epilepsy and OCD with an intracranial closed-loop neurostimulation device is feasible, safe, and potentially effective. However, there are logistical challenges and ethical considerations to this novel approach to treatment, which require complex care coordination by a large multidisciplinary team.
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Affiliation(s)
- Marissa A Kellogg
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Lia D Ernst
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - David C Spencer
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Proleta Datta
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Eran Klein
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Mahendra T Bhati
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Rajat S Shivacharan
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Young-Hoon Nho
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Daniel A N Barbosa
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Casey H Halpern
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Ahmed Raslan
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
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Liu Q, Cai Y, Mao Z, Chen W, Chen B, Chen W, Zhang C, Lu Y, Xu J, He D. SEEG-RFTC in patients with refractory focal epilepsy: real-world outcomes from 121 cases. Ann Clin Transl Neurol 2024. [PMID: 38968332 DOI: 10.1002/acn3.52117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE Radiofrequency thermocoagulation (RFTC) has emerged as an effective and safe treatment method for patients with refractory focal epilepsy, when stereo-electroencephalography (SEEG) is implanted. Although real-world research results are still limited, a considerable number of patients have shown favorable outcomes with this less invasive method. This study aims to describe the outcomes and predictive factors of SEEG-RFTC in real-world research. METHODS A retrospective observational study was conducted on patients in the authors' epilepsy center. In total, 121 patients who underwent RFTC were included in the study. Post-RFTC outcomes were evaluated using the seizure-free rate and response rate (seizure frequency reduction more than 50%). Predictive factors influencing post-RFTC outcome were considered by comparing different variables. RESULTS The mean follow-up period was 18.3 months. Eighty-two patients (67.8%) were responders and 54 (44.6%) were seizure free. In 36 patients with malformation of cortical development, the seizure-free rate and the response rate were 69.44% and 83.33%, respectively. In 20 patients with hippocampal sclerosis, 19 patients were responders and 14 (70%) patients were seizure free at the last follow-up. The MRI feature and etiology of epilepsy are correlated with the outcome. MR-positive is a predictive factor for seizure freedom (p < 0.01) and responders (p < 0.01). Other factors have no predictive value for post-RFTC outcome. INTERPRETATION SEEG-RFTC is a safe procedure and yields favorable outcomes in numerous cases of focal DRE. The MRI feature and etiology of epilepsy are correlated with the seizure-free rate and response rate. And MRI positivity is the predictor for good RFTC outcome.
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Affiliation(s)
- Qiangqiang Liu
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Yanqing Cai
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Ziyu Mao
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Wenze Chen
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Bin Chen
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Wenzhen Chen
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Chencheng Zhang
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Yong Lu
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Jiwen Xu
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Dake He
- Department of Children Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
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Bustros S, Kaur M, Ritchey E, Szaflarski JP, McGwin GJ, Riley KO, Bentley JN, Memon AA, Jaisani Z. Non-lesional epilepsy does not necessarily convey poor outcomes after invasive monitoring followed by resection or thermal ablation. Neurol Res 2024; 46:653-661. [PMID: 38602305 DOI: 10.1080/01616412.2024.2340879] [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: 03/08/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE We aimed to compare outcomes including seizure-free status at the last follow-up in adult patients with medically refractory focal epilepsy identified as lesional vs. non-lesional based on their magnetic resonance imaging (MRI) findings who underwent invasive evaluation followed by subsequent resection or thermal ablation (LiTT). METHODS We identified 88 adult patients who underwent intracranial monitoring between 2014 and 2021. Of those, 40 received resection or LiTT, and they were dichotomized based on MRI findings, as lesional (N = 28) and non-lesional (N = 12). Patient demographics, seizure characteristics, non-invasive interventions, intracranial monitoring, and surgical variables were compared between the groups. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification, and postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Statistical analyses employed Fisher's exact test to compare categorical variables, while a t-test was used for continuous variables. RESULTS There were no differences in baseline characteristics between groups except for more often noted PET abnormality in the lesional group (p = 0.0003). 64% of the lesional group and 57% of the non-lesional group received surgical resection or LiTT (p = 0.78). At the last follow-up, 78.5% of the patients with lesional MRI findings achieved Engel I outcomes compared to 66.7% of non-lesional patients (p = 0.45). Kaplan-Meier curves did not show a significant difference in seizure-free duration between both groups after surgical intervention (p = 0.49). SIGNIFICANCE In our sample, the absence of lesion on brain MRI was not associated with worse seizure outcomes in adult patients who underwent invasive intracranial monitoring followed by resection or thermal ablation.
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Affiliation(s)
- Stephanie Bustros
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Manmeet Kaur
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Elizabeth Ritchey
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Gerald Jr McGwin
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - J Nicole Bentley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Adeel A Memon
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - Zeenat Jaisani
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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Dickey AS, Reddy V, Pedersen NP, Krafty RT. Bayesian Estimation Improves Prediction of Outcomes after Epilepsy Surgery. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.21.24309313. [PMID: 38947027 PMCID: PMC11213074 DOI: 10.1101/2024.06.21.24309313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Low power is a problem in many fields, as underpowered studies that find a statistically significant result will exaggerate the magnitude of the observed effect size. We quantified the statistical power and magnitude error of studies of epilepsy surgery outcomes. The median power across all studies was 14%. Studies with a median sample size or less (n<=56) and a statistically significant result exaggerated the true effect size by a factor of 5.4 (median odds ratio 9.3 vs. median true odds ratio 1.7), while the Bayesian estimate of the odds ratio only exaggerated the true effect size by a factor of 1.6 (2.7 vs. 1.7). We conclude that Bayesian estimation of odds ratio attenuates the exaggeration of significant effect sizes in underpowered studies. This approach could help improve patient counseling about the chance of seizure freedom after epilepsy surgery.
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Affiliation(s)
- Adam S Dickey
- Division of Epilepsy, Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA
| | - Vineet Reddy
- Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road BC-71, Boca Raton, FL 33431
| | - Nigel P Pedersen
- Division of Epilepsy, Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA
- Division of Epilepsy, Department of Neurology, UC Davis Health System, 3160 Folsom Blvd., Suite 2100, Sacramento, CA 95816
- College of Medicine and Public Health, Flinders University, GPO Box 2100 Adelaide SA 5001, Australia
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA
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Courtney MR, Antonic-Baker A, Chen Z, Sinclair B, Nicolo JP, Neal A, Marotta C, Bunyamin J, Law M, Kwan P, O'Brien TJ, Vivash L. Association of Localizing 18F-FDG-PET Hypometabolism and Outcome Following Epilepsy Surgery: Systematic Review and Meta-Analysis. Neurology 2024; 102:e209304. [PMID: 38626375 DOI: 10.1212/wnl.0000000000209304] [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: 04/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although commonly used in the evaluation of patients for epilepsy surgery, the association between the detection of localizing 18fluorine fluorodeoxyglucose PET (18F-FDG-PET) hypometabolism and epilepsy surgery outcome is uncertain. We conducted a systematic review and meta-analysis to determine whether localizing 18F-FDG-PET hypometabolism is associated with favorable outcome after epilepsy surgery. METHODS A systematic literature search was undertaken. Eligible publications included evaluation with 18F-FDG-PET before epilepsy surgery, with ≥10 participants, and those that reported surgical outcome at ≥12 months. Random-effects meta-analysis was used to calculate the odds of achieving a favorable outcome, defined as Engel class I, International League Against Epilepsy class 1-2, or seizure-free, with localizing 18F-FDG-PET hypometabolism, defined as concordant with the epilepsy surgery resection zone. Meta-regression was used to characterize sources of heterogeneity. RESULTS The database search identified 8,916 studies, of which 98 were included (total patients n = 4,104). Localizing 18F-FDG-PET hypometabolism was associated with favorable outcome after epilepsy surgery for all patients with odds ratio (OR) 2.68 (95% CI 2.08-3.45). Subgroup analysis yielded similar findings for those with (OR 2.64, 95% CI 1.54-4.52) and without epileptogenic lesion detected on MRI (OR 2.49, 95% CI 1.80-3.44). Concordance with EEG (OR 2.34, 95% CI 1.43-3.83), MRI (OR 1.69, 95% CI 1.19-2.40), and triple concordance with both (OR 2.20, 95% CI 1.32-3.64) was associated with higher odds of favorable outcome. By contrast, diffuse 18F-FDG-PET hypometabolism was associated with worse outcomes compared with focal hypometabolism (OR 0.34, 95% CI 0.22-0.54). DISCUSSION Localizing 18F-FDG-PET hypometabolism is associated with favorable outcome after epilepsy surgery, irrespective of the presence of an epileptogenic lesion on MRI. The extent of 18F-FDG-PET hypometabolism provides additional information, with diffuse hypometabolism associated with worse surgical outcome than focal 18F-FDG-PET hypometabolism. These findings support the incorporation of 18F-FDG-PET into routine noninvasive investigations for patients being evaluated for epilepsy surgery to improve epileptogenic zone localization and to aid patient selection for surgery.
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Affiliation(s)
- Merran R Courtney
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Zhibin Chen
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Benjamin Sinclair
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - John-Paul Nicolo
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Andrew Neal
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Cassandra Marotta
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Jacob Bunyamin
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Meng Law
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Patrick Kwan
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Terence J O'Brien
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Lucy Vivash
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
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Drexler R, Ricklefs FL, Ben-Haim S, Rada A, Wörmann F, Cloppenborg T, Bien CG, Simon M, Kalbhenn T, Colon A, Rijkers K, Schijns O, Borger V, Surges R, Vatter H, Rizzi M, de Curtis M, Didato G, Castelli N, Carpentier A, Mathon B, Yasuda CL, Cendes F, Chandra PS, Tripathi M, Clusmann H, Delev D, Guenot M, Haegelen C, Catenoix H, Lang J, Hamer H, Brandner S, Walther K, Hauptmann JS, Jeffree RL, Kegele J, Weinbrenner E, Naros G, Velz J, Krayenbühl N, Onken J, Schneider UC, Holtkamp M, Rössler K, Spyrantis A, Strzelczyk A, Rosenow F, Stodieck S, Alonso-Vanegas MA, Wellmer J, Wehner T, Dührsen L, Gempt J, Sauvigny T. Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases. Epilepsia 2024; 65:1333-1345. [PMID: 38400789 DOI: 10.1111/epi.17923] [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: 10/04/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Benchmarking has been proposed to reflect surgical quality and represents the highest standard reference values for desirable results. We sought to determine benchmark outcomes in patients after surgery for drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS This retrospective multicenter study included patients who underwent MTLE surgery at 19 expert centers on five continents. Benchmarks were defined for 15 endpoints covering surgery and epilepsy outcome at discharge, 1 year after surgery, and the last available follow-up. Patients were risk-stratified by applying outcome-relevant comorbidities, and benchmarks were calculated for low-risk ("benchmark") cases. Respective measures were derived from the median value at each center, and the 75th percentile was considered the benchmark cutoff. RESULTS A total of 1119 patients with a mean age (range) of 36.7 (1-74) years and a male-to-female ratio of 1:1.1 were included. Most patients (59.2%) underwent anterior temporal lobe resection with amygdalohippocampectomy. The overall rate of complications or neurological deficits was 14.4%, with no in-hospital death. After risk stratification, 377 (33.7%) benchmark cases of 1119 patients were identified, representing 13.6%-72.9% of cases per center and leaving 742 patients in the high-risk cohort. Benchmark cutoffs for any complication, clinically apparent stroke, and reoperation rate at discharge were ≤24.6%, ≤.5%, and ≤3.9%, respectively. A favorable seizure outcome (defined as International League Against Epilepsy class I and II) was reached in 83.6% at 1 year and 79.0% at the last follow-up in benchmark cases, leading to benchmark cutoffs of ≥75.2% (1-year follow-up) and ≥69.5% (mean follow-up of 39.0 months). SIGNIFICANCE This study presents internationally applicable benchmark outcomes for the efficacy and safety of MTLE surgery. It may allow for comparison between centers, patient registries, and novel surgical and interventional techniques.
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Affiliation(s)
- Richard Drexler
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franz L Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California, San Diego, San Diego, California, USA
| | - Anna Rada
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Friedrich Wörmann
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Thomas Cloppenborg
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Matthias Simon
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
- Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, Bielefeld, Germany
| | - Thilo Kalbhenn
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
- Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, Bielefeld, Germany
| | - Albert Colon
- Department of Epileptology, Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands
- ACE Work Group Epilepsy Surgery Kempenhaeghe/Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Kim Rijkers
- ACE Work Group Epilepsy Surgery Kempenhaeghe/Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Neurosurgery, Academic Center for Epileptology UMC/Maastricht University Medical Center+, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Olaf Schijns
- ACE Work Group Epilepsy Surgery Kempenhaeghe/Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Neurosurgery, Academic Center for Epileptology UMC/Maastricht University Medical Center+, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Michele Rizzi
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco de Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nicoló Castelli
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Bertrand Mathon
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Poodipedi Sarat Chandra
- Department of Neurosurgery and Neurology, AIIMS, and MEG Resource Facility, New Delhi, India
| | - Manjari Tripathi
- Department of Neurosurgery and Neurology, AIIMS, and MEG Resource Facility, New Delhi, India
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Daniel Delev
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marc Guenot
- Department of Functional Neurosurgery, Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Claire Haegelen
- Department of Functional Neurosurgery, Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Hélène Catenoix
- Department of Neurology, Hospices Civils de Lyon, Lyon, France
| | - Johannes Lang
- Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hajo Hamer
- Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Brandner
- Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katrin Walther
- Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jason S Hauptmann
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Rosalind L Jeffree
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Josua Kegele
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Eliane Weinbrenner
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Georgios Naros
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Julia Velz
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Onken
- Institute for Diagnostics of Epilepsy, Epilepsy Center Berlin-Brandenburg, Berlin, Germany
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf C Schneider
- Department of Neurosurgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Martin Holtkamp
- Institute for Diagnostics of Epilepsy, Epilepsy Center Berlin-Brandenburg, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Andrea Spyrantis
- Department of Neurosurgery and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurosurgery and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurosurgery and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Stefan Stodieck
- Department of Neurology and Epileptology, Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany
| | - Mario A Alonso-Vanegas
- National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez", Mexico City, Mexico
| | - Jörg Wellmer
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Tim Wehner
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Gempt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bu J, Yin H, Ren N, Zhu H, Xu H, Zhang R, Zhang S. Structural and functional changes in the default mode network in drug-resistant epilepsy. Epilepsy Behav 2024; 151:109593. [PMID: 38157823 DOI: 10.1016/j.yebeh.2023.109593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/25/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To investigate brain network properties and connectivity abnormalities of the default mode network (DMN) in drug-resistant epilepsy (DRE). The study was based on probabilistic fiber tracking and functional connectivity (FC) analysis, to explore the structural and functional connectivity patterns change between frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE). METHODS A total of 33 DRE patients (18 TLE and 15 FLE) and 30 healthy controls (HCs) were recruited. The volume fraction of the septal brain region of the DMN in DRE was calculated using FreeSurfer. The FC analysis was performed using Data Processing and Analysis for Brain Imaging in MATLAB. The structural connections between brain regions of the DMN were calculated based on probabilistic fiber tracking. RESULTS The left precuneus (PCUN) volumes in epilepsy groups were lower than that in HCs. Compared with FLE, TLE showed reduced FC between the left hippocampus (HIP) and PCUN/medial frontal gyrus, and between the right inferior parietal lobule (IPL) and right superior temporal gyrus. Compared with HCs, FLE showed increased FCs between the right IPL and occipital lobe, and between the left superior frontal gyrus (SFG) and bilateral superior temporal gyrus. In terms of structural connectivity, TLE exhibited increased connectivity strength between the left SFG and left PCUN, and showed reduced connection strength between the left HIP and left posterior cingulate gyrus/left PCUN, when compared with the FLE. CONCLUSIONS TLE and FLE patients showed structural and functional changes in the DMN. Compared with FLE patients, the TLE patients showed reduced structural and functional connection strengths between the left HIP and PCUN. These alterations in connection strengths holds promise for the identification of TLE and FLE.
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Affiliation(s)
- Jinxin Bu
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Hangxing Yin
- Department of Neurology, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Nanxiao Ren
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Haitao Zhu
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Honghao Xu
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Rui Zhang
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China.
| | - Shugang Zhang
- Department of Neurology, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China.
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8
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Bettegazzi B, Cattaneo S, Simonato M, Zucchini S, Soukupova M. Viral Vector-Based Gene Therapy for Epilepsy: What Does the Future Hold? Mol Diagn Ther 2024; 28:5-13. [PMID: 38103141 PMCID: PMC10786988 DOI: 10.1007/s40291-023-00687-6] [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] [Accepted: 11/12/2023] [Indexed: 12/17/2023]
Abstract
In recent years, many pre-clinical studies have tested gene therapy approaches as possible treatments for epilepsy, following the idea that they may provide an alternative to conventional pharmacological and surgical options. Multiple gene therapy approaches have been developed, including those based on anti-sense oligonucleotides, RNA interference, and viral vectors. In this opinion article, we focus on translational issues related to viral vector-mediated gene therapy for epilepsy. Research has advanced dramatically in addressing issues like viral vector optimization, target identification, strategies of gene expression, editing or regulation, and safety. Some of these pre-clinically validated potential gene therapies are now being tested in clinical trials, in patients with genetic or focal forms of drug-resistant epilepsy. Here, we discuss the ongoing translational research and the advancements that are needed and expected in the near future. We then describe the clinical trials in the pipeline and the further challenges that will need to be addressed at the clinical and economic levels. Our optimistic view is that all these issues and challenges can be overcome, and that gene therapy approaches for epilepsy will soon become a clinical reality.
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Affiliation(s)
| | - Stefano Cattaneo
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, via Fossato di Mortara 70, 44121, Ferrara, Italy
| | - Michele Simonato
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, via Fossato di Mortara 70, 44121, Ferrara, Italy
| | - Silvia Zucchini
- Department of Neuroscience and Rehabilitation, University of Ferrara, via Fossato di Mortara 70, 44121, Ferrara, Italy.
- Laboratory of Technologies for Advanced Therapy (LTTA), Technopole of Ferrara, Ferrara, Italy.
| | - Marie Soukupova
- Department of Neuroscience and Rehabilitation, University of Ferrara, via Fossato di Mortara 70, 44121, Ferrara, Italy
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9
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Wang Z, Li Y, He Z, Li S, Huang K, Shi X, Sun X, Ruan R, Cui C, Wang R, Wang L, Lv S, Zhang C, Liu Z, Yang H, Yang X, Liu S. Predictive model for epileptogenic tubers from all tubers in patients with tuberous sclerosis complex based on 18F-FDG PET: an 8-year single-centre study. BMC Med 2023; 21:500. [PMID: 38110931 PMCID: PMC10729377 DOI: 10.1186/s12916-023-03121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/19/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND More than half of patients with tuberous sclerosis complex (TSC) suffer from drug-resistant epilepsy (DRE), and resection surgery is the most effective way to control intractable epilepsy. Precise preoperative localization of epileptogenic tubers among all cortical tubers determines the surgical outcomes and patient prognosis. Models for preoperatively predicting epileptogenic tubers using 18F-FDG PET images are still lacking, however. We developed noninvasive predictive models for clinicians to predict the epileptogenic tubers and the outcome (seizure freedom or no seizure freedom) of cortical tubers based on 18F-FDG PET images. METHODS Forty-three consecutive TSC patients with DRE were enrolled, and 235 cortical tubers were selected as the training set. Quantitative indices of cortical tubers on 18F-FDG PET were extracted, and logistic regression analysis was performed to select those with the most important predictive capacity. Machine learning models, including logistic regression (LR), linear discriminant analysis (LDA), and artificial neural network (ANN) models, were established based on the selected predictive indices to identify epileptogenic tubers from multiple cortical tubers. A discriminating nomogram was constructed and found to be clinically practical according to decision curve analysis (DCA) and clinical impact curve (CIC). Furthermore, testing sets were created based on new PET images of 32 tubers from 7 patients, and follow-up outcome data from the cortical tubers were collected 1, 3, and 5 years after the operation to verify the reliability of the predictive model. The predictive performance was determined by using receiver operating characteristic (ROC) analysis. RESULTS PET quantitative indices including SUVmean, SUVmax, volume, total lesion glycolysis (TLG), third quartile, upper adjacent and standard added metabolism activity (SAM) were associated with the epileptogenic tubers. The SUVmean, SUVmax, volume and TLG values were different between epileptogenic and non-epileptogenic tubers and were associated with the clinical characteristics of epileptogenic tubers. The LR model achieved the better performance in predicting epileptogenic tubers (AUC = 0.7706; 95% CI 0.70-0.83) than the LDA (AUC = 0.7506; 95% CI 0.68-0.82) and ANN models (AUC = 0.7425; 95% CI 0.67-0.82) and also demonstrated good calibration (Hosmer‒Lemeshow goodness-of-fit p value = 0.7). In addition, DCA and CIC confirmed the clinical utility of the nomogram constructed to predict epileptogenic tubers based on quantitative indices. Intriguingly, the LR model exhibited good performance in predicting epileptogenic tubers in the testing set (AUC = 0.8502; 95% CI 0.71-0.99) and the long-term outcomes of cortical tubers (1-year outcomes: AUC = 0.7805, 95% CI 0.71-0.85; 3-year outcomes: AUC = 0.8066, 95% CI 0.74-0.87; 5-year outcomes: AUC = 0.8172, 95% CI 0.75-0.87). CONCLUSIONS The 18F-FDG PET image-based LR model can be used to noninvasively identify epileptogenic tubers and predict the long-term outcomes of cortical tubers in TSC patients.
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Affiliation(s)
- Zhongke Wang
- Department of Neurosurgery, Armed Police Hospital of Chongqing, Chongqing, China
| | - Yang Li
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zeng He
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shujing Li
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Kaixuan Huang
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xianjun Shi
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiaoqin Sun
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ruotong Ruan
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Chun Cui
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ruodan Wang
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Wang
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shengqing Lv
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chunqing Zhang
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China
- Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing, China
| | - Zhonghong Liu
- Department of Neurosurgery, Armed Police Hospital of Chongqing, Chongqing, China
| | - Hui Yang
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China.
- Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing, China.
| | - Xiaolin Yang
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China.
| | - Shiyong Liu
- Department of Neurosurgery, Comprehensive Epilepsy Center, Xinqiao Hospital, Army Medical University, Chongqing, China.
- Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing, China.
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Panebianco M, Bresnahan R, Marson AG. Lamotrigine add-on therapy for drug-resistant focal epilepsy. Cochrane Database Syst Rev 2023; 12:CD001909. [PMID: 38078494 PMCID: PMC10712213 DOI: 10.1002/14651858.cd001909.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND This is an updated version of a Cochrane Review last updated in 2020. Epilepsy is a common neurological disorder, affecting 0.5% to 1% of the population. In nearly 30% of cases, epilepsy is resistant to currently available drugs. Pharmacological treatment remains the first choice to control epilepsy. Lamotrigine is a second-generation antiseizure medication. When used as an add-on (in combination with other antiseizure medications), lamotrigine can reduce seizures, but with some adverse effects. OBJECTIVES To evaluate the benefits and harms of add-on lamotrigine, compared with add-on placebo or no add-on treatment in people with drug-resistant focal epilepsy. SEARCH METHODS For this update, we searched the Cochrane Register of Studies (CRS Web) and MEDLINE (Ovid) on 3 October 2022 with no language restrictions. CRS Web includes randomised and quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialised Registers of Cochrane Review Groups, including Epilepsy. SELECTION CRITERIA We included randomised controlled trials (RCTs) that investigated add-on lamotrigine versus add-on placebo or no add-on treatment in people of any age with drug-resistant focal epilepsy. We used data from the first period of eligible cross-over trials. DATA COLLECTION AND ANALYSIS For this update, two review authors independently selected trials and extracted data. Our primary outcome was 50% or greater reduction in seizure frequency. Our secondary outcomes were treatment withdrawal, adverse effects, cognitive effects, and quality of life. Primary analyses were by intention-to-treat. We performed sensitivity best- and worse-case analyses to account for missing outcome data. We calculated pooled risk ratios (RRs) with 95% confidence intervals (95% Cls) for dichotomous outcomes. MAIN RESULTS We identified no new studies for this update, so the results and conclusions of the review are unchanged. We included five parallel-group studies in adults or children, eight cross-over studies in adults or children, and one parallel study with a responder-enriched design in infants. In total, these 14 studies enroled 1806 eligible participants (38 infants, 199 children, 1569 adults). Baseline phases ranged from four to 12 weeks and treatment phases ranged from eight to 36 weeks. We rated 11 studies (1243 participants) at low overall risk of bias and three (697 participants) at unclear overall risk of bias due to lack of information on study design. Four studies (563 participants) reported effective blinding. Lamotrigine compared with placebo probably increases the likelihood of achieving 50% or greater reduction in seizure frequency (RR 1.80, 95% CI 1.45 to 2.23; 12 trials, 1322 participants (adults and children); moderate-certainty evidence). There is probably little or no difference in risk of treatment withdrawal for any reason among people treated with lamotrigine versus people treated with placebo (RR 1.11, 95% CI 0.91 to 1.37; 14 trials; 1806 participants; moderate-certainty evidence). Lamotrigine compared with placebo is probably associated with a greater risk of ataxia (RR 3.34, 99% Cl 2.01 to 5.55; 12 trials; 1525 participants; moderate-certainty evidence), dizziness (RR 1.76, 99% Cl 1.28 to 2.43; 13 trials; 1768 participants; moderate-certainty evidence), nausea (RR 1.81, 99% CI 1.22 to 2.68; 12 studies, 1486 participants; moderate-certainty evidence), and diplopia (RR 3.79, 99% Cl 2.15 to 6.68; 3 trials, 944 participants; moderate-certainty evidence). There is probably little or no difference in the risk of fatigue between lamotrigine and placebo (RR 0.82, 99% CI 0.55 to 1.22; 12 studies, 1552 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS Lamotrigine as an add-on treatment for drug-resistant focal seizures is probably effective for reducing seizure frequency. Certain adverse effects (ataxia, dizziness, diplopia, and nausea) are probably more likely to occur with lamotrigine compared with placebo. There is probably little or no difference in the number of people who withdraw from treatment with lamotrigine versus placebo. The trials were of relatively short duration and provided no long-term evidence. In addition, some trials had few participants. Further trials are needed to assess the long-term effects of lamotrigine and to compare lamotrigine with other add-on drugs.
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Affiliation(s)
- Mariangela Panebianco
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Rebecca Bresnahan
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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11
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Luan C, Miller J, Sollars C, Peng J, Singh J. Stereo-Electroencephalography-Recorded Interictal Epileptiform Discharges: Activation Pattern and Its Relationship With Surgical Outcome. Cureus 2023; 15:e41337. [PMID: 37546108 PMCID: PMC10397415 DOI: 10.7759/cureus.41337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/08/2023] Open
Abstract
Background Patients with drug-resistant epilepsy commonly undergo stereo-electroencephalography (SEEG) intracranial monitoring for surgical evaluation. Our current practice of defining the epileptogenic zone relies heavily on recognizing the seizure onset zone (SOZ), but the clinical significance of interictal epileptiform discharges (IEDs) is not well established. Methodology We retrospectively identified adult patients who underwent SEEG between January 2019 and May 2022. To study IED activation patterns, we classified IEDs as leading spikes (involved within the SOZ) and distant spikes (outside the SOZ). We calculated each patient's total number of brain subregions generating distant spikes. We correlated them with epilepsy type, duration, and surgical outcome (Engel I: good outcome and Engel II-IV: poor outcome). Results A total of 22 patients were identified during the study period, and 16 underwent surgical intervention (ablation or resection) with one-year post-surgery follow-up. The most common IED morphology was a single spike or sharp followed by periodic spikes or sharps. We found that 87% (n = 19/22) of leading spikes were activated during the first 24 hours of SEEG monitoring, whereas no activation pattern was observed for distant spikes. We found that a higher number of subregions generating distant spikes were associated with poor surgical outcomes (p = 0.002). However, we did not find any significant association between the number of subregions generating distant spikes with epilepsy duration (p = 0.67), temporal or extratemporal-onset epilepsy (p = 0.58), or the presence of an MRI lesion (p = 0.62). Conclusions IEDs involved within the SOZ were found to be activated during the first 24 hours of SEEG monitoring, which could aid in recognizing the pathological spikes and targeted mapping of the irritative zone. We also observed that a higher number of brain subregions generating IEDs outside the SOZ were associated with poor surgical outcomes, but this observation needs to be further studied with larger sample size prospective studies.
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Affiliation(s)
- Cindy Luan
- Neurology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Jacob Miller
- Biomedical Engineering, The Ohio State University College of Medicine, Columbus, USA
| | - Caleb Sollars
- Neurodiagnostic EEG Lab, The Ohio State University College of Medicine, Columbus, USA
| | - Juan Peng
- Biomedical Informatics, The Ohio State University College of Medicine, Columbus, USA
| | - Jaysingh Singh
- Neurology, The Ohio State University Wexner Medical Center, Columbus, USA
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12
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Hassanzadeh E, Hornak A, Hassanzadeh M, Warfield SK, Pearl PL, Bolton J, Suarez R, Stone S, Stufflebeam S, Ailion AS. Comparison of fMRI language laterality with and without sedation in pediatric epilepsy. Neuroimage Clin 2023; 38:103448. [PMID: 37285796 PMCID: PMC10250119 DOI: 10.1016/j.nicl.2023.103448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/07/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
Functional MRI is an essential component of presurgical language mapping. In clinical settings, young children may be sedated for the MRI with the functional stimuli presented passively. Research has found that sedation changes language activation in healthy adults and children. However, there is limited research comparing sedated and unsedated functional MRI in pediatric epilepsy patients. We compared language activation patterns in children with epilepsy who received sedation for functional MRI to the ones who did not. We retrospectively identified the patients with focal epilepsy who underwent presurgical functional MRI including Auditory Descriptive Decision Task at Boston Children's Hospital from 2014 to 2022. Patients were divided into sedated and awake groups, based on their sedation status during functional MRI. Auditory Descriptive Decision Task stimuli were presented passively to the sedated group per clinical protocol. We extracted language activation maps contrasted against a control task (reverse speech) in the Frontal and Temporal language regions and calculated separate language laterality indexes for each region. We considered positive laterality indexes as left dominant, negative laterality indexes as right dominant, and absolute laterality indexes <0.2 as bilateral. We defined 2 language patterns: typical (i.e., primarily left-sided) and atypical. Typical pattern required at least one left dominant region (either frontal or temporal) and no right dominant region. We then compared the language patterns between the sedated and awake groups. Seventy patients met the inclusion criteria, 25 sedated, and 45 awake. Using the Auditory Descriptive Decision Task paradigm, when adjusted for age, handedness, gender, and laterality of lesion in a weighted logistic regression model, the odds of the atypical pattern were 13.2 times higher in the sedated group compared to the awake group (Confidence Interval: 2.55-68.41, p-value < 0.01). Sedation may alter language activation patterns in pediatric epilepsy patients. Language patterns on sedated functional MRI with passive tasks may not represent language networks during wakefulness, sedation may differentially suppress some networks, or require a different task or method of analysis to capture the awake language network. Given the critical surgical implication of these findings, additional studies are needed to better understand how sedation impacts the functional MRI blood oxygenation level-dependent signal. Consistent with current practice, sedated functional MRI should be interpreted with greater caution and requires additional validation as well as research on post-surgical language outcomes.
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Affiliation(s)
- Elmira Hassanzadeh
- Neuroradiology, Massachusetts General Hospital, Harvard Medical School, 02116, USA.
| | - Alena Hornak
- Neurology, Boston Children's Hospital, Harvard Medical School, 02116, USA
| | | | - Simon K Warfield
- Radiology, Boston Children's Hospital, Harvard Medical School, 02116, USA
| | - Phillip L Pearl
- Neurology, Boston Children's Hospital, Harvard Medical School, 02116, USA
| | - Jeffrey Bolton
- Neurology, Boston Children's Hospital, Harvard Medical School, 02116, USA
| | - Ralph Suarez
- Radiology, Boston Children's Hospital, Harvard Medical School, 02116, USA
| | - Scellig Stone
- Neurosurgery, Boston Children's Hospital, Harvard Medical School, 02116, USA
| | - Steve Stufflebeam
- Neuroradiology, Massachusetts General Hospital, Harvard Medical School, 02116, USA
| | - Alyssa S Ailion
- Neurology, Boston Children's Hospital, Harvard Medical School, 02116, USA
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13
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Meng Q, Liu Y, Ren Y, Wu H, Zhang J, Li H, Dong S, Jing J, Liu X, Du C, Zhang H. Multivariate analysis of seizure outcomes after resective surgery for focal epilepsy: a single-center study on 833 patients. Neurosurg Rev 2023; 46:89. [PMID: 37071225 DOI: 10.1007/s10143-023-01988-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
The predictors of seizure outcomes after resective surgery for focal epilepsy, for an update on the features of good and poor outcomes, are investigated. A retrospective study of patients with focal epilepsy undergoing resective surgery from March 2011 to April 2019 was performed. There were 3 groups according to the seizure outcomes: seizure freedom, seizure improvement, and no improvement. Predictors of seizure outcomes were identified by multivariate logistic regression analysis. Of all 833 patients, 561 (67.3%) patients remained seizure-free at the last follow-up, 203 (24.4%) patients had seizure improvement, and 69 (8.3%) had no improvement. The mean follow-up duration was 5.2 years (range: 2.7 to 9.6). Predictors of better outcomes included epilepsy duration < 5 years, localized discharge, no. of antiepileptic drugs at surgery < 3, and temporal lobe resection. However, predictors of worse outcomes included intracranial hemorrhage in infancy, interictal abnormal discharge, intracranial electrode monitoring, and acute postoperative seizure. Our study suggests that resective surgery for focal epilepsy has satisfactory outcomes. Short epilepsy duration, localized discharge, and temporal lobe resection are positive predictors of seizure freedom. Patients with these predictors are intensively recommended for surgery.
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Affiliation(s)
- Qiang Meng
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Yong Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Yutao Ren
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hao Wu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiale Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Huanfa Li
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Shan Dong
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Jiangpeng Jing
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Xiaofang Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Changwang Du
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Hua Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China.
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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14
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Steinbrenner M, Tito T, Dehnicke C, Holtkamp M. Predictors and reasons for epilepsy patients to decline surgery: a prospective study. J Neurol 2023; 270:2302-2307. [PMID: 36473975 PMCID: PMC10025225 DOI: 10.1007/s00415-022-11510-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients with drug-resistant focal epilepsy, resective surgery is the most successful treatment option to achieve seizure freedom. However, a surprisingly high rate of patients declines their physicians' recommendation to undergo removal of the seizure focus or-if necessary-further video-EEG monitoring (VEM). METHODS In this prospective study, consecutive patients in presurgical assessment with at least one scalp VEM between 2016 and 2018 were included. We assessed both epilepsy-related and psychosocial variables as well as decision-making of physicians and patients, including reasons for decline in the latter. RESULTS Out of 116 patients with a total of 165 VEM, 20 patients were eventually found to be ineligible for resection, 51 declined, and 45 agreed on recommendations for resection or further VEM diagnostics. Patients most frequently declined due to general fear of brain surgery (n = 30, 59%) and currently lower seizure frequency (n = 11, 22%). An independent predictor of patients' decline was less epilepsy-related fear (OR 0.43; p = 0.02) assessed in a standardised questionnaire. CONCLUSION Half of the patients potentially eligible for resective surgery decline the operation or further VEM procedures. Patients who decline are more fearful of brain surgery than of ongoing disabling seizures. More insight is needed to improve counselling of patients.
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Affiliation(s)
- Mirja Steinbrenner
- Department of Neurology and Experimental Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Tabea Tito
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Christoph Dehnicke
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology and Experimental Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
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15
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Seyama G, Iida K, Kagawa K, Katagiri M, Okamura A, Morioka H, Horie N. Hippocampal volumetry to determine the resection side in patients with intractable non-lesional bilateral temporal lobe epilepsy. Sci Rep 2023; 13:3153. [PMID: 36823240 PMCID: PMC9950135 DOI: 10.1038/s41598-023-30151-8] [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: 12/13/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
Bilateral Temporal lobe epilepsy (BTLE) cases may result in poor surgical outcomes due to the difficulty in determining/localizing the epileptogenic zone. In this study, we investigated whether hippocampal volume (HV) would be useful for the determination of the best resection side in BTLE. Eighteen cases of BTLE determined by a scalp video electroencephalogram (SVEEG) underwent resection via intracranial electroencephalography (IVEEG). Patients with lesions or semiologically determined focus lateralization were excluded. In addition to SVEEG, an epilepsy protocol magnetic resonance imaging (MRI) including hippocampus fluid-attenuated inversion recovery (FLAIR) and HV, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), single-photon emission computed tomography with 123I-iomazenil (IMZ-SPECT), and magnetoencephalography (MEG) were performed for the preoperative evaluation of the lateralization. The resection side was determined based on the IVEEG results, and the seizure outcome at two years postoperatively was classified as either a well-controlled seizure outcome (Engel class I), or residual (classes II-V). We used a Fisher's exact test to compare the concordance between the determination of the epileptic focus by each modality and the resected side where patients achieved a well-controlled seizure outcome. Seizures were well controlled in 9/18 patients after surgery. Eight out of 11 patients (72.7%), in whom the HV results (strongly atrophic side) and the resection side were matched, had well-controlled seizure outcomes (P = 0.0498). The concordance of other presurgical evaluations with the resection side was not significantly related to a well-controlled seizure outcome. HV may be a useful method to determine the optimal resection side of the epileptic focus/foci in cases of suspected BTLE.
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Affiliation(s)
- Go Seyama
- grid.257022.00000 0000 8711 3200Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan ,grid.470097.d0000 0004 0618 7953Epilepsy Center, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Koji Iida
- Epilepsy Center, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kota Kagawa
- grid.257022.00000 0000 8711 3200Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan ,grid.470097.d0000 0004 0618 7953Epilepsy Center, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Masaya Katagiri
- grid.257022.00000 0000 8711 3200Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan ,grid.470097.d0000 0004 0618 7953Epilepsy Center, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Akitake Okamura
- Department of Neurosurgery, Takanobashi Central Hospital, 2-4-16 Kokutaiji-chou, Naka-ku, Hiroshima, 730-0042 Japan
| | - Hiromi Morioka
- Department of Neurosurgery, Mazda Hospital, 2-15 Aosakiminami, Futyuu-chou, Aki-gun, Hiroshima, 735-8585 Japan
| | - Nobutaka Horie
- grid.257022.00000 0000 8711 3200Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
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16
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Barba C, Blumcke I, Winawer MR, Hartlieb T, Kang HC, Grisotto L, Chipaux M, Bien CG, Heřmanovská B, Porter BE, Lidov HGW, Cetica V, Woermann FG, Lopez-Rivera JA, Canoll PD, Mader I, D'Incerti L, Baldassari S, Yang E, Gaballa A, Vogel H, Straka B, Macconi L, Polster T, Grant GA, Krsková L, Shin HJ, Ko A, Crino PB, Krsek P, Lee JH, Lal D, Baulac S, Poduri A, Guerrini R. Clinical Features, Neuropathology, and Surgical Outcome in Patients With Refractory Epilepsy and Brain Somatic Variants in the SLC35A2 Gene. Neurology 2023; 100:e528-e542. [PMID: 36307217 PMCID: PMC9931085 DOI: 10.1212/wnl.0000000000201471] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The SLC35A2 gene, located at chromosome Xp11.23, encodes for a uridine diphosphate-galactose transporter. We describe clinical, genetic, neuroimaging, EEG, and histopathologic findings and assess possible predictors of postoperative seizure and cognitive outcome in 47 patients with refractory epilepsy and brain somatic SLC35A2 gene variants. METHODS This is a retrospective multicenter study where we performed a descriptive analysis and classical hypothesis testing. We included the variables of interest significantly associated with the outcomes in the generalized linear models. RESULTS Two main phenotypes were associated with brain somatic SLC35A2 variants: (1) early epileptic encephalopathy (EE, 39 patients) with epileptic spasms as the predominant seizure type and moderate to severe intellectual disability and (2) drug-resistant focal epilepsy (DR-FE, 8 patients) associated with normal/borderline cognitive function and specific neuropsychological deficits. Brain MRI was abnormal in all patients with EE and in 50% of those with DR-FE. Histopathology review identified mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy in 44/47 patients and was inconclusive in 3. The 47 patients harbored 42 distinct mosaic SLC35A2 variants, including 14 (33.3%) missense, 13 (30.9%) frameshift, 10 (23.8%) nonsense, 4 (9.5%) in-frame deletions/duplications, and 1 (2.4%) splicing variant. Variant allele frequencies (VAFs) ranged from 1.4% to 52.6% (mean VAF: 17.3 ± 13.5). At last follow-up (35.5 ± 21.5 months), 30 patients (63.8%) were in Engel Class I, of which 26 (55.3%) were in Class IA. Cognitive performances remained unchanged in most patients after surgery. Regression analyses showed that the probability of achieving both Engel Class IA and Class I outcomes, adjusted by age at seizure onset, was lower when the duration of epilepsy increased and higher when postoperative EEG was normal or improved. Lower brain VAF was associated with improved postoperative cognitive outcome in the analysis of associations, but this finding was not confirmed in regression analyses. DISCUSSION Brain somatic SLC35A2 gene variants are associated with 2 main clinical phenotypes, EE and DR-FE, and a histopathologic diagnosis of MOGHE. Additional studies will be needed to delineate any possible correlation between specific genetic variants, mutational load in the epileptogenic tissue, and surgical outcomes.
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Affiliation(s)
- Carmen Barba
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Ingmar Blumcke
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Melodie R Winawer
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Till Hartlieb
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Hoon-Chul Kang
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Laura Grisotto
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Mathilde Chipaux
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Christian G Bien
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Barbora Heřmanovská
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Brenda E Porter
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Hart G W Lidov
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Valentina Cetica
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Friedrich G Woermann
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Javier A Lopez-Rivera
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Peter D Canoll
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Irina Mader
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Ludovico D'Incerti
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Sara Baldassari
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Edward Yang
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Ahmed Gaballa
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Hannes Vogel
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Barbora Straka
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Letizia Macconi
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Tilman Polster
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Gerald A Grant
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Lenka Krsková
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Hui Jin Shin
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Ara Ko
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Peter B Crino
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Pavel Krsek
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Jeong Ho Lee
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Dennis Lal
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Stéphanie Baulac
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Annapurna Poduri
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Renzo Guerrini
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
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Shelyagin IS, Akimova PO, Stefanov SZ, Sufianov RA. Predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy. SECHENOV MEDICAL JOURNAL 2023. [DOI: 10.47093/2218-7332.2022.13.3.24-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Aim. To identify predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy in a multivariate model.Materials and methods. Aretrospective study included 69 patients with drug-resistant temporal lobe epilepsy who underwent microsurgical anterior temporal lobectomy. The study included 31 (45%) men and 38 (55%) women. The median age was 28 (21; 36). Surgical treatment outcomes were assessed at 6, 12, 36, and 60 months after surgical intervention according to the Engel Epilepsy Surgery Outcome Scale. Logistic regression equations were calculated, a ROC curve was constructed, and odds ratio (OR) with 95% confidence interval (CI), sensitivity, specificity, area under the ROC curve (AUC) were calculated.Results. In all assessed time periods, 88.3–93.0% of patients had outcomes consistent with Engel classes I and II. The distribution of patients by outcome classes did not change statistically significantly over the entire follow-up period. There were the following predictors of high efficacy of surgical treatment at 6 months after surgery: relatively shorter duration of active disease course (OR 0.719, 95%, CI: 0.437–0.966, p < 0.05), absence of status epilepticus (OR 0.048, 95% CI: 0.002–0.472, p < 0.05), absence of subdominant foci of irritative activity (OR 0.123, 95% CI: 0.012–0.845, p < 0.01), presence of mesial temporal sclerosis (OR 1008, 95% CI: 21.59–1310851, p < 0.01), a relatively longer resection margin on the temporal lobe (OR 637.32, 95% CI: 5.43–1960062, p < 0.05), lateralization of epileptogenic zone in subdominant hemisphere (OR 0.103, 95% CI 0.004–0.937, p = 0.0532). AUC was 0.957 (0.917–0.997), p < 0.0001; sensitivity 87.5%, and specificity 82.8%.Conclusion. Independent predictors of the efficacy of microsurgical anterior temporal lobectomy in patients with drug-resistant temporal lobe epilepsy are the following: shorter duration of active disease course, absence of status epilepticus in the history, absence of subdominant foci, presence of mesial temporal sclerosis, a relatively longer resection margin on the temporal lobe, and lateralization of the epileptogenic zone in the temporal lobe of the subdominant hemisphere.
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Affiliation(s)
- I. S. Shelyagin
- Tyumen State Medical University; Federal Centre of Neurosurgery
| | | | | | - R. A. Sufianov
- Sechenov First Moscow State Medical University (Sechenov University)
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Lemoine É, Neves Briard J, Rioux B, Podbielski R, Nauche B, Toffa D, Keezer M, Lesage F, Nguyen DK, Bou Assi E. Computer-assisted analysis of routine electroencephalogram to identify hidden biomarkers of epilepsy: protocol for a systematic review. BMJ Open 2023; 13:e066932. [PMID: 36693684 PMCID: PMC9884857 DOI: 10.1136/bmjopen-2022-066932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The diagnosis of epilepsy frequently relies on the visual interpretation of the electroencephalogram (EEG) by a neurologist. The hallmark of epilepsy on EEG is the interictal epileptiform discharge (IED). This marker lacks sensitivity: it is only captured in a small percentage of 30 min routine EEGs in patients with epilepsy. In the past three decades, there has been growing interest in the use of computational methods to analyse the EEG without relying on the detection of IEDs, but none have made it to the clinical practice. We aim to review the diagnostic accuracy of quantitative methods applied to ambulatory EEG analysis to guide the diagnosis and management of epilepsy. METHODS AND ANALYSIS The protocol complies with the recommendations for systematic reviews of diagnostic test accuracy by Cochrane. We will search MEDLINE, EMBASE, EBM reviews, IEEE Explore along with grey literature for articles, conference papers and conference abstracts published after 1961. We will include observational studies that present a computational method to analyse the EEG for the diagnosis of epilepsy in adults or children without relying on the identification of IEDs or seizures. The reference standard is the diagnosis of epilepsy by a physician. We will report the estimated pooled sensitivity and specificity, and receiver operating characteristic area under the curve (ROC AUC) for each marker. If possible, we will perform a meta-analysis of the sensitivity and specificity and ROC AUC for each individual marker. We will assess the risk of bias using an adapted QUADAS-2 tool. We will also describe the algorithms used for signal processing, feature extraction and predictive modelling, and comment on the reproducibility of the different studies. ETHICS AND DISSEMINATION Ethical approval was not required. Findings will be disseminated through peer-reviewed publication and presented at conferences related to this field. PROSPERO REGISTRATION NUMBER CRD42022292261.
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Affiliation(s)
- Émile Lemoine
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- Institute of Biomedical Engineering, Ecole Polytechnique de Montreal, Montreal, Québec, Canada
| | - Joel Neves Briard
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Bastien Rioux
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Renata Podbielski
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Bénédicte Nauche
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Denahin Toffa
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Mark Keezer
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Frédéric Lesage
- Institute of Biomedical Engineering, Ecole Polytechnique de Montreal, Montreal, Québec, Canada
| | - Dang K Nguyen
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Elie Bou Assi
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
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Neligan A, Adan G, Nevitt SJ, Pullen A, Sander JW, Bonnett L, Marson AG. Prognosis of adults and children following a first unprovoked seizure. Cochrane Database Syst Rev 2023; 1:CD013847. [PMID: 36688481 PMCID: PMC9869434 DOI: 10.1002/14651858.cd013847.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Epilepsy is clinically defined as two or more unprovoked epileptic seizures more than 24 hours apart. Given that, a diagnosis of epilepsy can be associated with significant morbidity and mortality, it is imperative that clinicians (and people with seizures and their relatives) have access to accurate and reliable prognostic estimates, to guide clinical practice on the risks of developing further unprovoked seizures (and by definition, a diagnosis of epilepsy) following single unprovoked epileptic seizure. OBJECTIVES 1. To provide an accurate estimate of the proportion of individuals going on to have further unprovoked seizures at subsequent time points following a single unprovoked epileptic seizure (or cluster of epileptic seizures within a 24-hour period, or a first episode of status epilepticus), of any seizure type (overall prognosis). 2. To evaluate the mortality rate following a first unprovoked epileptic seizure. SEARCH METHODS We searched the following databases on 19 September 2019 and again on 30 March 2021, with no language restrictions. The Cochrane Register of Studies (CRS Web), MEDLINE Ovid (1946 to March 29, 2021), SCOPUS (1823 onwards), ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). CRS Web includes randomized or quasi-randomized, controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialized Registers of Cochrane Review Groups including Epilepsy. In MEDLINE (Ovid) the coverage end date always lags a few days behind the search date. SELECTION CRITERIA We included studies, both retrospective and prospective, of all age groups (except those in the neonatal period (< 1 month of age)), of people with a single unprovoked seizure, followed up for a minimum of six months, with no upper limit of follow-up, with the study end point being seizure recurrence, death, or loss to follow-up. To be included, studies must have included at least 30 participants. We excluded studies that involved people with seizures that occur as a result of an acute precipitant or provoking factor, or in close temporal proximity to an acute neurological insult, since these are not considered epileptic in aetiology (acute symptomatic seizures). We also excluded people with situational seizures, such as febrile convulsions. DATA COLLECTION AND ANALYSIS Two review authors conducted the initial screening of titles and abstracts identified through the electronic searches, and removed non-relevant articles. We obtained the full-text articles of all remaining potentially relevant studies, or those whose relevance could not be determined from the abstract alone and two authors independently assessed for eligibility. All disagreements were resolved through discussion with no need to defer to a third review author. We extracted data from included studies using a data extraction form based on the checklist for critical appraisal and data extraction for systematicreviews of prediction modelling studies (CHARMS). Two review authors then appraised the included studies, using a standardised approach based on the quality in prognostic studies (QUIPS) tool, which was adapted for overall prognosis (seizure recurrence). We conducted a meta-analysis using Review Manager 2014, with a random-effects generic inverse variance meta-analysis model, which accounted for any between-study heterogeneity in the prognostic effect. We then summarised the meta-analysis by the pooled estimate (the average prognostic factor effect), its 95% confidence interval (CI), the estimates of I² and Tau² (heterogeneity), and a 95% prediction interval for the prognostic effect in a single population at three various time points, 6 months, 12 months and 24 months. Subgroup analysis was performed according to the ages of the cohorts included; studies involving all ages, studies that recruited adult only and those that were purely paediatric. MAIN RESULTS Fifty-eight studies (involving 54 cohorts), with a total of 12,160 participants (median 147, range 31 to 1443), met the inclusion criteria for the review. Of the 58 studies, 26 studies were paediatric studies, 16 were adult and the remaining 16 studies were a combination of paediatric and adult populations. Most included studies had a cohort study design with two case-control studies and one nested case-control study. Thirty-two studies (29 cohorts) reported a prospective longitudinal design whilst 15 studies had a retrospective design whilst the remaining studies were randomised controlled trials. Nine of the studies included presented mortality data following a first unprovoked seizure. For a mortality study to be included, a proportional mortality ratio (PMR) or a standardised mortality ratio (SMR) had to be given at a specific time point following a first unprovoked seizure. To be included in the meta-analysis a study had to present clear seizure recurrence data at 6 months, 12 months or 24 months. Forty-six studies were included in the meta-analysis, of which 23 were paediatric, 13 were adult, and 10 were a combination of paediatric and adult populations. A meta-analysis was performed at three time points; six months, one year and two years for all ages combined, paediatric and adult studies, respectively. We found an estimated overall seizure recurrence of all included studies at six months of 27% (95% CI 24% to 31%), 36% (95% CI 33% to 40%) at one year and 43% (95% CI 37% to 44%) at two years, with slightly lower estimates for adult subgroup analysis and slightly higher estimates for paediatric subgroup analysis. It was not possible to provide a summary estimate of the risk of seizure recurrence beyond these time points as most of the included studies were of short follow-up and too few studies presented recurrence rates at a single time point beyond two years. The evidence presented was found to be of moderate certainty. AUTHORS' CONCLUSIONS Despite the limitations of the data (moderate-certainty of evidence), mainly relating to clinical and methodological heterogeneity we have provided summary estimates for the likely risk of seizure recurrence at six months, one year and two years for both children and adults. This provides information that is likely to be useful for the clinician counselling patients (or their parents) on the probable risk of further seizures in the short-term whilst acknowledging the paucity of long-term recurrence data, particularly beyond 10 years.
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Affiliation(s)
- Aidan Neligan
- Homerton University Hospital, NHS Foundation Trust, London, UK
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Guleed Adan
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sarah J Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Laura Bonnett
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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Zhang S, Luo Y, Zhao Y, Zhu F, Jiang X, Wang X, Mo T, Zeng H. Prognostic analysis in children with focal cortical dysplasia II undergoing epilepsy surgery: Clinical and radiological factors. Front Neurol 2023; 14:1123429. [PMID: 36949857 PMCID: PMC10025379 DOI: 10.3389/fneur.2023.1123429] [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: 12/14/2022] [Accepted: 02/06/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the value of clinical profiles and radiological findings in assessing postsurgical outcomes in children with focal cortical dysplasia (FCD) II while exploring prognostic predictors of this disease. METHODS We retrospectively reviewed 50 patients with postoperative pathologically confirmed FCD II from January 2016 to June 2021. The clinical profiles and preoperative radiological findings were measured and analyzed. The patients were classified into four classes based on the Engel Class Outcome System at the last follow-up. For the analysis, the patients were divided into two categories based on Engel I and Engel II-IV, namely, seizure-free and non-seizure-free groups. Qualitative and quantitative factors were subsequently compared by groups using comparative statistics. Receiver operating characteristic (ROC) curves were used to identify the predictors of prognosis in children with FCD II. RESULTS Thirty-seven patients (74%) had Engel class I outcomes. The minimum postsurgical follow-up was 1 year. At the epilepsy onset, patients who attained seizure freedom were older and less likely to have no apparent lesions on the preoperative MRI ("MRI-negative"). The non-seizure-free group exhibited a higher gray matter signal intensity ratio (GR) on 3D T1-MPRAGE images (p = 0.006), with a lower GR on T2WI images (p = 0.003) and FLAIR images (p = 0.032). The ROC curve indicated that the model that combined the GR value of all MRI sequences (AUC, 0.87; 95% CI, 0.77-0.97; p < 0.001; 86% sensitivity, 85% specificity) was able to predict prognosis accurately. CONCLUSION A lower age at the onset or the MRI-negative finding of FCD lesions suggests a poor prognosis for children with FCD II. The model consisting of GR values from three MRI sequences facilitates the prognostic assessment of FCD II patients with subtle MRI abnormalities to prevent worse outcomes.
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Affiliation(s)
- Siqi Zhang
- Shantou University Medical College, Shantou University, Shantou, China
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yi Luo
- Shantou University Medical College, Shantou University, Shantou, China
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yilin Zhao
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Fengjun Zhu
- Department of Epilepsy Surgical Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Xianping Jiang
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaoyu Wang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Tong Mo
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
- *Correspondence: Hongwu Zeng
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Gleichgerrcht E, Dumitru M, Hartmann DA, Munsell BC, Kuzniecky R, Bonilha L, Sameni R. Seizure forecasting using machine learning models trained by seizure diaries. Physiol Meas 2022; 43:10.1088/1361-6579/aca6ca. [PMID: 36541513 PMCID: PMC9940727 DOI: 10.1088/1361-6579/aca6ca] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
Objectives.People with refractory epilepsy are overwhelmed by the uncertainty of their next seizures. Accurate prediction of future seizures could greatly improve the quality of life for these patients. New evidence suggests that seizure occurrences can have cyclical patterns for some patients. Even though these cyclicalities are not intuitive, they can be identified by machine learning (ML), to identify patients with predictable vs unpredictable seizure patterns.Approach.Self-reported seizure logs of 153 patients from the Human Epilepsy Project with more than three reported seizures (totaling 8337 seizures) were used to obtain inter-seizure interval time-series for training and evaluation of the forecasting models. Two classes of prediction methods were studied: (1) statistical approaches using Bayesian fusion of population-wise and individual-wise seizure patterns; and (2) ML-based algorithms including least squares, least absolute shrinkage and selection operator, support vector machine (SVM) regression, and long short-term memory regression. Leave-one-person-out cross-validation was used for training and evaluation, by training on seizure diaries of all except one subject and testing on the left-out subject.Main results.The leading forecasting models were the SVM regression and a statistical model that combined the median of population-wise seizure time-intervals with a test subject's prior seizure intervals. SVM was able to forecast 50%, 70%, 81%, 84%, and 87% of seizures of unseen subjects within 0, 1, 2, 3 to 4 d of mean absolute forecasting error, respectively. The subject-wise performances show that patients with more frequent seizures were generally better predicted.Significance.ML models can leverage non-random patterns within self-reported seizure diaries to forecast future seizures. While diary-based seizure forecasting alone is only one of many aspects of clinical care of patients with epilepsy, studying the level of predictability across seizures and patients paves the path towards a better understanding of predictable vs unpredictable seizures on individualized and population-wise bases.
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Affiliation(s)
| | - Mircea Dumitru
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA
| | - David A. Hartmann
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA
| | - Brent C. Munsell
- Department of Computer Science, University of North Carolina, Chapel Hill, NC
| | | | - Leonardo Bonilha
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA
| | - Reza Sameni
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA
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DeFelipe J, DeFelipe-Oroquieta J, Furcila D, Muñoz-Alegre M, Maestú F, Sola RG, Blázquez-Llorca L, Armañanzas R, Kastanaskaute A, Alonso-Nanclares L, Rockland KS, Arellano JI. Neuroanatomical and psychological considerations in temporal lobe epilepsy. Front Neuroanat 2022; 16:995286. [PMID: 36590377 PMCID: PMC9794593 DOI: 10.3389/fnana.2022.995286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/11/2022] [Indexed: 01/03/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy and is associated with a variety of structural and psychological alterations. Recently, there has been renewed interest in using brain tissue resected during epilepsy surgery, in particular 'non-epileptic' brain samples with normal histology that can be found alongside epileptic tissue in the same epileptic patients - with the aim being to study the normal human brain organization using a variety of methods. An important limitation is that different medical characteristics of the patients may modify the brain tissue. Thus, to better determine how 'normal' the resected tissue is, it is fundamental to know certain clinical, anatomical and psychological characteristics of the patients. Unfortunately, this information is frequently not fully available for the patient from which the resected tissue has been obtained - or is not fully appreciated by the neuroscientists analyzing the brain samples, who are not necessarily experts in epilepsy. In order to present the full picture of TLE in a way that would be accessible to multiple communities (e.g., basic researchers in neuroscience, neurologists, neurosurgeons and psychologists), we have reviewed 34 TLE patients, who were selected due to the availability of detailed clinical, anatomical, and psychological information for each of the patients. Our aim was to convey the full complexity of the disorder, its putative anatomical substrates, and the wide range of individual variability, with a view toward: (1) emphasizing the importance of considering critical patient information when using brain samples for basic research and (2) gaining a better understanding of normal and abnormal brain functioning. In agreement with a large number of previous reports, this study (1) reinforces the notion of substantial individual variability among epileptic patients, and (2) highlights the common but overlooked psychopathological alterations that occur even in patients who become "seizure-free" after surgery. The first point is based on pre- and post-surgical comparisons of patients with hippocampal sclerosis and patients with normal-looking hippocampus in neuropsychological evaluations. The second emerges from our extensive battery of personality and projective tests, in a two-way comparison of these two types of patients with regard to pre- and post-surgical performance.
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Affiliation(s)
- Javier DeFelipe
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain,*Correspondence: Javier DeFelipe,
| | - Jesús DeFelipe-Oroquieta
- Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Facultad de Educación, Universidad Camilo José Cela, Madrid, Spain
| | - Diana Furcila
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Mar Muñoz-Alegre
- Facultad de Educación y Psicología, Universidad Francisco de Vitoria, Madrid, Spain
| | - Fernando Maestú
- Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain,Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain
| | - Rafael G. Sola
- Cátedra UAM de “Innovación en Neurocirugía”, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lidia Blázquez-Llorca
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Sección Departamental de Anatomía y Embriología, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Rubén Armañanzas
- Institute of Data Science and Artificial Intelligence, Universidad de Navarra, Pamplona, Spain,Tecnun School of Engineering, Universidad de Navarra, Donostia-San Sebastian, Spain
| | - Asta Kastanaskaute
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Lidia Alonso-Nanclares
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Kathleen S. Rockland
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States
| | - Jon I. Arellano
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States
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Hebel JM, Holtkamp M. Epilepsy surgery in older patients – English Version. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00481-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Shaaban S, Kakisaka Y, Belal T, Jin K, Osawa S, Tominaga T, Elmenshawi I, Nakasato N. Distribution of postictal slowing has an additional yield to interictal epileptiform discharge in predicting surgical outcomes in temporal lobe epilepsy. Epilepsia Open 2022; 7:802-809. [PMID: 36225084 PMCID: PMC9712469 DOI: 10.1002/epi4.12660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/07/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate whether the slowing of bilateral postictal scalp electroencephalography (EEG) after focal impaired awareness seizures is associated with poor seizure outcomes after temporal lobe epilepsy (TLE) surgery. METHODS This retrospective cohort study was conducted in the Department of Epileptology, Tohoku University Hospital from 2010 to 2020. The study included 42 patients with TLE who underwent a detailed presurgical evaluation and sequential resective surgery for the unilateral probable epileptogenic temporal lobe with 1 year or more of follow-up. We reviewed the interictal epileptiform distribution and those of the ictal and postictal epochs of the first focal impaired awareness seizure recorded in presurgical scalp EEG. We classified patients either with postoperative seizure-free status (Engel I) as group A or those with seizure persistence (Engel II-IV) as group B. RESULTS Of 42 patients, 29 (69%) were classified into group A. Compared with group B, group A had a lower number of bilateral postictal polymorphic delta activity (PPDA) (10.3%: 61.5%) and bilateral interictal epileptiform discharges (IEDs) (13.8%: 69.2%) (P = 0.003, P = 0.001, respectively). A combined analysis of bilateral PPDA and IEDs per individual patient showed significantly more frequent seizure persistence after surgery (P < 0.0001) than a single analysis of bilateral IEDs or PPDA alone (P = 0.001). The regression analysis revealed that bilaterally distributed PPDA or IEDs had 13.50 or 13.72 times higher odds of persisting seizures within 1 year of surgery (95% confidence interval: 1.90-95.88; 2.12-88.87, respectively) (P = 0.009, 0.006). SIGNIFICANCE The results of this study revealed that the bilateral distribution of PPDA was associated with poor postoperative seizure outcomes in patients with TLE, as well as bilateral IEDs. Additionally, the concomitant bilateral distribution of interictal and postictal changes is a strong indicator of poor surgical outcomes.
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Affiliation(s)
- Sally Shaaban
- Department of EpileptologyTohoku University Graduate School of MedicineSendaiMiyagiJapan,Department of Neurology, Mansoura faculty of medicineMansouraDakahliaEgypt
| | - Yosuke Kakisaka
- Department of EpileptologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Tamer Belal
- Department of Neurology, Mansoura faculty of medicineMansouraDakahliaEgypt
| | - Kazutaka Jin
- Department of EpileptologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Shin‐ichiro Osawa
- Department of EpileptologyTohoku University Graduate School of MedicineSendaiMiyagiJapan,Department of NeurosurgeryTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Teiji Tominaga
- Department of EpileptologyTohoku University Graduate School of MedicineSendaiMiyagiJapan,Department of NeurosurgeryTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Ibrahim Elmenshawi
- Department of Neurology, Mansoura faculty of medicineMansouraDakahliaEgypt
| | - Nobukazu Nakasato
- Department of EpileptologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
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Courtney MR, Antonic-Baker A, Sinclair B, Nicolo JP, Neal A, Law M, Kwan P, O'Brien TJ, Vivash L. 18F-FDG-PET hypometabolism as a predictor of favourable outcome in epilepsy surgery: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e065440. [PMID: 36202585 PMCID: PMC9540844 DOI: 10.1136/bmjopen-2022-065440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A substantial proportion of patients who undergo surgery for drug resistant focal epilepsy do not become seizure free. While some factors, such as the detection of hippocampal sclerosis or a resectable lesion on MRI and electroencephalogram-MRI concordance, can predict favourable outcomes in epilepsy surgery, the prognostic value of the detection of focal hypometabolism with 18F-fluorodeoxyglucose positive emission tomography (18F-FDG-PET) hypometabolism is uncertain. We propose a protocol for a systematic review and meta-analysis to examine whether localisation with 18F-FDG-PET hypometabolism predicts favourable outcomes in epilepsy surgery. METHODS AND ANALYSIS A systematic literature search of Medline, Embase and Web of Science will be undertaken. Publications which include evaluation with 18F-FDG-PET prior to surgery for drug resistant focal epilepsy, and which report ≥12 months of postoperative surgical outcome data will be included. Non-human, non-English language publications, publications with fewer than 10 participants and unpublished data will be excluded. Screening and full-text review of publications for inclusion will be undertaken by two independent investigators, with discrepancies resolved by consensus or a third investigator. Data will be extracted and pooled using random effects meta-analysis, with heterogeneity quantified using the I2 analysis. ETHICS AND DISSEMINATION Ethics approval is not required. Once complete, the systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022324823.
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Affiliation(s)
- Merran R Courtney
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Benjamin Sinclair
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - John-Paul Nicolo
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Neal
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Meng Law
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Bsat S, Najjar M, Nawfal O, Farhat S, Chanbour H, Beydoun A. Standardized reporting of complications of epilepsy surgery and invasive monitoring: A single-center retrospective study. Epilepsy Behav 2022; 134:108844. [PMID: 35853316 DOI: 10.1016/j.yebeh.2022.108844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Monitoring adverse effects related to epilepsy surgery is essential for quality control and for counseling patients prior to the procedure. The aim of this study was to analyze the rates of complications related to epilepsy surgery following invasive monitoring and to classify them according to the recently proposed protocol by the E-pilepsy consortium. METHODS This is a retrospective study of collected data extracted from our routinely updated epilepsy surgery database which consisted of 173 surgical procedures: 89 surgeries for insertion of subdural grids, strips, and/or depth electrodes, and 84 resective surgeries. According to the protocol, complications were defined as unexpected postoperative adverse events and were stratified into transient (lasting less than 6 months) and permanent deficits (lasting 6 months or longer). In addition, we reported patients with postoperative psychiatric disturbances and calculated the rates of transient and permanent postoperative sequelae which were defined as expected postoperative deficits deemed inherent to the surgical procedure. RESULTS Six potentially life-threatening complications requiring acceleration of the planned resective surgery occurred during invasive monitoring. Following resective surgery, 12 transient sequelae (8 motor deficits, three language deficits, and one transient dyscalculia) and 10 permanent sequelae (5 mild memory disturbances, four visual field cuts, and one contralateral dysesthesia) occurred. In addition, 7 patients experienced transient motor complications. Four permanent postoperative neurological complications (4.8%) occurred: motor deficits in three patients and a partial peripheral facial palsy in one. Finally, five patients developed de novo psychiatric disturbances (transient in four and permanent in one). CONCLUSIONS This is the first study to classify complications of epilepsy surgery according to the E-pilepsy consortium protocol. Our findings demonstrate that epilepsy surgery following invasive monitoring is safe and associated with low morbidity when performed in specialized centers. Monitoring these complications according to a unified definition and using a multidimensional protocol will allow for a direct comparison across epilepsy surgery centers, will provide the epileptologists and surgeons with objective percentages to share with their patients and will help in identifying risk factors and improving the safety of epilepsy surgery.
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Affiliation(s)
- Shadi Bsat
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Marwan Najjar
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Omar Nawfal
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Sahar Farhat
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Hani Chanbour
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
| | - Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
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Na JH, Jung DE, Kang HJ, Kang HC, Kim HD. Treatment strategies for Lennox-Gastaut syndrome: outcomes of multimodal treatment approaches. Ther Adv Neurol Disord 2022; 15:17562864221108012. [PMID: 35958038 PMCID: PMC9358332 DOI: 10.1177/17562864221108012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Multimodal treatment approaches are often considered for patients with Lennox-Gastaut syndrome (LGS). Creating an algorithm that can guide healthcare providers in selecting treatment options for patients with LGS remains a challenge. Herein, we assessed the long-term seizure-free and neurodevelopmental outcomes of stepwise multimodal treatment in patients with LGS. Objective Herein, we assess the long-term seizure-free and neurodevelopmental outcomes of stepwise multimodal treatment in patients with LGS. Methods We retrospectively examined the data of 371 patients with LGS who underwent stepwise multimodal treatment, including antiseizure medication (ASM) therapy, dietary therapy (DT), resective epilepsy surgery (R-ES), and palliative epilepsy surgery (P-ES). The seizure-free outcome was considered to be the effect of the final treatment according to the treatment algorithm, and the percentage of patients who remained seizure-free in each treatment group was calculated. ASM treatment, DT, R-ES, and P-ES were applied to 371 (100%), 201 (54.2%), 112 (30.2%), and 115 (31.0%) patients with LGS, respectively. We evaluated the stepwise multimodal treatment outcomes in these patients. Results One hundred sixty-eight patients (45.3%) remained seizure-free for at least 1 year (seizure-free-for-1-year group), 61 of whom (16.5%) remained seizure-free for more than 5 years (remained-seizure-free group). Among the patients treated with ASM therapy, DT, R-ES, and P-ES, 41 (11.1%), 53 (14.3%), 56 (15.1%), and 29 (7.8%), respectively, remained seizure-free for 1 year. In addition, 15 (4.1%), 15 (4.1%), 19 (5.1%), and 12 (3.2%) patients in the ASM, DT, R-ES, and P-ES treatment groups, respectively, remained seizure-free for more than 5 years. Both the seizure-free-for-1-year and remained-seizure-free groups showed significant improvement in electroencephalography findings and neurodevelopmental status following treatment. Conclusion This study provides an update on the long-term seizure outcomes and neurodevelopmental improvements in a large cohort of patients with LGS following comprehensive multimodal treatment. We emphasize that the active combination of multiple ASMs, DT, and surgical treatment could provide long-term seizure-free outcomes and significant neurological benefits to patients with LGS.
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Affiliation(s)
- Ji-Hoon Na
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Da Eun Jung
- Department of Pediatrics, Ajou Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hee Jung Kang
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
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Huang R, Zhou X, Chen G, Su L, Liu Z, Zhou P, Weng J, Min Y. Advances of functional nanomaterials for magnetic resonance imaging and biomedical engineering applications. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2022; 14:e1800. [PMID: 35445588 DOI: 10.1002/wnan.1800] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/12/2022]
Abstract
Functional nanomaterials have been widely used in biomedical fields due to their good biocompatibility, excellent physicochemical properties, easy surface modification, and easy regulation of size and morphology. Functional nanomaterials for magnetic resonance imaging (MRI) can target specific sites in vivo and more easily detect disease-related specific biomarkers at the molecular and cellular levels than traditional contrast agents, achieving a broad application prospect in MRI. This review focuses on the basic principles of MRI, the classification, synthesis and surface modification methods of contrast agents, and their clinical applications to provide guidance for designing novel contrast agents and optimizing the contrast effect. Furthermore, the latest biomedical advances of functional nanomaterials in medical diagnosis and disease detection, disease treatment, the combination of diagnosis and treatment (theranostics), multi-model imaging and nanozyme are also summarized and discussed. Finally, the bright application prospects of functional nanomaterials in biomedicine are emphasized and the urgent need to achieve significant breakthroughs in the industrial transformation and the clinical translation is proposed. This article is categorized under: Nanotechnology Approaches to Biology > Nanoscale Systems in Biology Diagnostic Tools > Diagnostic Nanodevices Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.
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Affiliation(s)
- Ruijie Huang
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Xingyu Zhou
- Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Guiyuan Chen
- Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Lanhong Su
- Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Zhaoji Liu
- Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Peijie Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jianping Weng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yuanzeng Min
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Department of Chemistry, University of Science and Technology of China, Hefei, China
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Pereira Dalio MTR, Velasco TR, Feitosa IDF, Assirati Junior JA, Carlotti Junior CG, Leite JP, Dos Santos AC, Alexandre V, Nakano FN, Saute RL, Wichert-Ana L, Sakamoto AC. Long-Term Outcome of Temporal Lobe Epilepsy Surgery in 621 Patients With Hippocampal Sclerosis: Clinical and Surgical Prognostic Factors. Front Neurol 2022; 13:833293. [PMID: 35547380 PMCID: PMC9084624 DOI: 10.3389/fneur.2022.833293] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy and is frequently drug-resistant (DR) to antiseizure medication (ASM), corresponding to approximately one-third of the cases. When left inadequately treated, it can worsen the quality of life, cognitive deficits, and risk of death. The standard treatment for drug-resistant TLE is the surgical removal of the structures involved, with good long-term outcome rates of 60–70 % and a low rate of adverse effects. The goal of successful treatment is sustained seizure freedom. In our study, we evaluated sustained long-term (up to 23 years) surgical outcomes in 621 patients with DR-TLE associated with hippocampal sclerosis, who underwent a temporal lobectomy. We analyzed the main predictive factors that influence the surgical outcome related to seizure control, through a longitudinal and retrospective study, using a multivariable regression model. We found that 73.6% of the patients were free from disabling seizures (Engel Class I), maintained over time in 65% of patients followed up to 23 years after surgery. We found that four independent variables predicted seizure outcomes. The presence of dysmnesic and olfactory aura predicted a less favorable outcome. The history of febrile seizure and the surgical technique predicted a good outcome. Regarding the type of surgical technique, the standard anteromesial temporal lobectomy (ATL) led to significantly better outcomes (78.6% Engel Class I) when compared to the selective amygdalohippocampectomy via subtemporal approach (67.2% Engel Class I; p = 0.002), suggesting that the neuronal networks involved in the epileptogenic zone may be beyond mesial temporal structures. The multivariable regression model with the above-mentioned predictor variables revealed an ExpB = 3.627 (N = 621, p < 0.001), indicating that the model was able to distinguish between patients with a seizure-free. We conclude that epilepsy surgery is a safe procedure, with low rates of postoperative complications and good long-term results.
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Affiliation(s)
- Marina Teixeira Ramalho Pereira Dalio
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - Tonicarlo Rodrigues Velasco
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - Izabela Dayany Franca Feitosa
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - João Alberto Assirati Junior
- Department of Surgery and Neurosurgery, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - Carlos Gilberto Carlotti Junior
- Department of Surgery and Neurosurgery, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - João Pereira Leite
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - Antonio Carlos Dos Santos
- Department of Radiology, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - Veriano Alexandre
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - Frederico Nakane Nakano
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - Ricardo Lutzky Saute
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - Lauro Wichert-Ana
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
| | - Americo Ceiki Sakamoto
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Hospital of Clinics of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), Ribeirão Preto, Brazil
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Alim-Marvasti A, Vakharia VN, Duncan JS. Multimodal prognostic features of seizure freedom in epilepsy surgery. J Neurol Neurosurg Psychiatry 2022; 93:499-508. [PMID: 35246493 PMCID: PMC9016256 DOI: 10.1136/jnnp-2021-327119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Accurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models. METHODS We searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: 'clinical', 'imaging', 'neurophysiology', 'multimodal concordance', 'genetic', 'surgical technique' and 'pathology'. We propose a structural causal model based on these features. RESULTS We found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons. SIGNIFICANCE Seizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models. PROSPERO REGISTRATION NUMBER CRD42021185232.
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Affiliation(s)
- Ali Alim-Marvasti
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK .,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vejay Niranjan Vakharia
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK
| | - John Sidney Duncan
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK
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Singh A, Woelfle R, Chepesiuk R, Southward C, Antflick J, Cowan K, Hum K, Ng M, Burneo JG, Suller Marti A. Canadian epilepsy priority-setting partnership: Toward a new national research agenda. Epilepsy Behav 2022; 130:108673. [PMID: 35367726 DOI: 10.1016/j.yebeh.2022.108673] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Health research agendas are often set by researchers or by industry and may not reflect the needs and priorities of end users. This priority-setting partnership (PSP) for epilepsy was undertaken to identify the most pressing unanswered questions about epilepsy and seizures from the perspective of people with epilepsy (PWE) and their care providers. METHODS Using the methodology developed by the James Lind Alliance (JLA), evidence uncertainties were gathered via online surveys from stakeholders across Canada. Submissions were formed into summary questions and checked against existing evidence to determine if they were true uncertainties. Verified uncertainties were then ranked by patients, caregivers, and healthcare providers and a final workshop was held to reach a consensus on the top 10 priorities. RESULTS The final top 10 list reflects the priority areas of focus for research as identified by the Canadian epilepsy community, including genetic markers for diagnosis and treatment, concerns about living with the long-term effects of epilepsy, and addressing knowledge gaps in etiology and treatment approaches. CONCLUSION This project represents the first systematic evidence of patient- and clinician-centered research priorities for epilepsy. The results of this priority-setting exercise provide an opportunity for researchers and funding agencies to align their agendas with the values and needs of the epilepsy community in order to improve clinical outcomes and quality of life (QOL) for PWE.
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Affiliation(s)
- Amaya Singh
- EpLink - The Epilepsy Research Program of the Ontario Brain Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.
| | - Rebecca Woelfle
- EpLink - The Epilepsy Research Program of the Ontario Brain Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Katherine Cowan
- The James Lind Alliance, The Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Kathryn Hum
- EpLink - The Epilepsy Research Program of the Ontario Brain Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Marcus Ng
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neuroepidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ana Suller Marti
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Paediatrics Department, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neurosciences Program, Western University, London, Ontario, Canada
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Mo J, Zhang J, Hu W, Shao X, Sang L, Zheng Z, Zhang C, Wang Y, Wang X, Liu C, Zhao B, Zhang K. Neuroimaging gradient alterations and epileptogenic prediction in focal cortical dysplasia Ⅲa. J Neural Eng 2022; 19. [PMID: 35405671 DOI: 10.1088/1741-2552/ac6628] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/10/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Focal cortical dysplasia Type Ⅲa (FCD Ⅲa) is a highly prevalent temporal lobe epilepsy but the seizure outcomes are not satisfactory after epilepsy surgery. Hence, quantitative neuroimaging, epileptogenic alterations, as well as their values in guiding surgery are worth exploring. METHODS We examined 69 patients with pathologically verified FCD Ⅲa using multimodal neuroimaging and stereoelectroencephalography (SEEG). Among them, 18 received postoperative imaging which showed the extent of surgical resection and 9 underwent SEEG implantation. We also explored neuroimaging gradient alterations along with the distance to the temporal pole. Subsequently, the machine learning regression model was employed to predict whole-brain epileptogenicity. Lastly, the correlation between neuroimaging or epileptogenicity and surgical cavities was assessed. RESULTS FCD Ⅲa displayed neuroimaging gradient alterations on the temporal neocortex, morphology-signal intensity decoupling, low similarity of intra-morphological features and high similarity of intra-signal intensity features. The support vector regression model was successfully applied at the whole-brain level to calculate the continuous epileptogenic value at each vertex (mean-squared error = 13.8 ± 9.8). CONCLUSION Our study investigated the neuroimaging gradient alterations and epileptogenicity of FCD Ⅲa, along with their potential values in guiding suitable resection range and in predicting postoperative seizure outcomes. The conclusions from this study may facilitate an accurate presurgical examination of FCD Ⅲa. However, further investigation including a larger cohort is necessary to confirm the results.
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Affiliation(s)
- Jiajie Mo
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Jianguo Zhang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Wenhan Hu
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Xiaoqiu Shao
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Lin Sang
- Peking University First Hospital Fengtai Hospital, No. 99 South 4th Fengtai Road, Fengtai District, Beijing, 100070, CHINA
| | - Zhong Zheng
- Peking University First Hospital Fengtai Hospital, No. 99 South 4th Fengtai Road, Fengtai District, Beijing, 100070, CHINA
| | - Chao Zhang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Yao Wang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Xiu Wang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Chang Liu
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Baotian Zhao
- Beijing Tiantan Hospital, , Beijing, 100070, CHINA
| | - Kai Zhang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
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Zhu Z, Zhang Z, Gao X, Feng L, Chen D, Yang Z, Hu S. Individual Brain Metabolic Connectome Indicator Based on Jensen-Shannon Divergence Similarity Estimation Predicts Seizure Outcomes of Temporal Lobe Epilepsy. Front Cell Dev Biol 2022; 9:803800. [PMID: 35310541 PMCID: PMC8926031 DOI: 10.3389/fcell.2021.803800] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/15/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: We aimed to use an individual metabolic connectome method, the Jensen-Shannon Divergence Similarity Estimation (JSSE), to characterize the aberrant connectivity patterns and topological alterations of the individual-level brain metabolic connectome and predict the long-term surgical outcomes in temporal lobe epilepsy (TLE). Methods: A total of 128 patients with TLE (63 females, 65 males; 25.07 ± 12.01 years) who underwent Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) imaging were enrolled. Patients were classified either as experiencing seizure recurrence (SZR) or seizure free (SZF) at least 1 year after surgery. Each individual’s metabolic brain network was ascertained using the proposed JSSE method. We compared the similarity and difference in the JSSE network and its topological measurements between the two groups. The two groups were then classified by combining the information from connection and topological metrics, which was conducted by the multiple kernel support vector machine. The validation was performed using the nested leave-one-out cross-validation strategy to confirm the performance of the methods. Results: With a median follow-up of 33 months, 50% of patients achieved SZF. No relevant differences in clinical features were found between the two groups except age at onset. The proposed JSSE method showed marked degree reductions in IFGoperc.R, ROL. R, IPL. R, and SMG. R; and betweenness reductions in ORBsup.R and IOG. R; meanwhile, it found increases in the degree analysis of CAL. L and PCL. L, and in the betweenness analysis of PreCG.R, IOG. R, PoCG.R, PCL. L and PCL.R. Exploring consensus significant metabolic connections, we observed that the most involved metabolic motor networks were the INS-TPOmid.L, MTG. R-SMG. R, and MTG. R-IPL.R pathways between the two groups, and yielded another detailed individual pathological connectivity in the PHG. R-CAU.L, PHG. R-HIP.L, TPOmid.L-LING.R, TPOmid.L-DCG.R, MOG. R-MTG.R, MOG. R-ANG.R, and IPL. R-IFGoperc.L pathways. These aberrant functional network measures exhibited ideal classification performance in predicting SZF individuals from SZR ones at a sensitivity of 75.00%, a specificity of 92.79%, and an accuracy of 83.59%. Conclusion: The JSSE method indicator can identify abnormal brain networks in predicting an individual’s long-term surgical outcome of TLE, thus potentially constituting a clinically applicable imaging biomarker. The results highlight the biological meaning of the estimated individual brain metabolic connectome.
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Affiliation(s)
- Zehua Zhu
- Department of Nuclear Medicine, XiangYa Hospital, Changsha, China
| | - Zhimin Zhang
- Department of Blood Transfusion, XiangYa Hospital, Changsha, China
| | - Xin Gao
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Dengming Chen
- Department of Nuclear Medicine, XiangYa Hospital, Changsha, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, XiangYa Hospital, Changsha, China.,Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, China
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Prantzalos K, Zhang J, Shafiabadi N, Fernandez-BacaVaca G, Sahoo SS. Epilepsy-Connect: An Integrated Knowledgebase for Characterizing Alterations in Consciousness State of Pharmacoresistant Epilepsy Patients. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:1019-1028. [PMID: 35308974 PMCID: PMC8861706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Alterations in consciousness state are a defining characteristic of focal epileptic seizures. Consequently, understanding the complex changes in neurocognitive networks which underpin seizure-induced alterations in consciousness state is important for advancement in seizure classification. Comprehension of these changes are complicated by a lack of data standardization; however, the use of a common terminological system or ontology in a patient registry minimizes this issue. In this paper, we introduce an integrated knowledgebase called Epilepsy-Connect to improve the understanding of changes in consciousness states during focal seizures of pharmacoresistant epilepsy patients. This registry catalogues over 809 seizures from 70 patients at University Hospital's Epilepsy Center who were undergoing stereotactic electroencephalography (SEEG) monitoring as part of an evaluation for surgical intervention. Although Epilepsy-Connect focuses on consciousness states, it aims to enable users to leverage data from an informatics platform to analyze epilepsy data in a streamlined manner. Epilepsy-Connect is available at https://bmhinformatics.case.edu/Epilepsyconnect/login/.
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Affiliation(s)
- Katrina Prantzalos
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jianzhe Zhang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nassim Shafiabadi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Satya S Sahoo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Nagarajan L, Ghosh S, Dyke J, Lee S, Silberstein J, Azmanov D, Richard W. Epilepsy surgery in PCDH 19 related developmental and epileptic encephalopathy: A case report. Epilepsy Behav Rep 2022; 19:100560. [PMID: 35856042 PMCID: PMC9287778 DOI: 10.1016/j.ebr.2022.100560] [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: 04/22/2022] [Revised: 06/26/2022] [Accepted: 07/03/2022] [Indexed: 12/03/2022] Open
Abstract
PCDH19 pathogenic variants may be associated with DEE in females. Epilepsy Surgery may be an option for PCDH19 related drug-resistant epilepsy.
We report a female child with PCDH19 related developmental and epileptic encephalopathy with drug-resistant seizures, cognitive and language impairment, autism spectrum disorder and sleep dysfunction. Her seizures, which started at 10 months of age, were resistant to multiple anti-seizure medications. Developmental stagnation followed by regression occurred after the onset of recurrent seizures. Her ictal EEGS suggested left temporal lobe origin for her recorded seizures. MRI upon expert re-review showed a subtle abnormality in the left temporal lobe. In view of the severe nature and frequency of her seizures, a left temporal lobectomy was undertaken at the age of 2 years and 3 months. Though her seizure outcome was Engel class 3, her seizure frequency and severity were significantly reduced. She has been seizure-free for 10 months at her last outpatient assessment when she was 4 years and 8 months of age (2 years and 5 months after epilepsy surgery). However she recently had an admission for COVID19 infection, with a breakthrough cluster of seizures. Her developmental trajectory changed, though she is making good progress with her cognitive and language skills.
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Affiliation(s)
- Lakshmi Nagarajan
- Children’s Neuroscience Service, Dept of Neurology, Perth Children’s Hospital, Nedlands, WA 6009, Australia
- School of Medicine, University of Western Australia, WA 6009, Australia
- Corresponding author at: Children’s Neuroscience Service, Dept of Neurology, Perth Children’s Hospital, Nedlands, WA 6009, Australia.
| | - Soumya Ghosh
- Children’s Neuroscience Service, Dept of Neurology, Perth Children’s Hospital, Nedlands, WA 6009, Australia
- Perron Institute for Neurological and Translational Science, University of Western Australia. WA 6009, Australia
| | - Jason Dyke
- School of Medicine, University of Western Australia, WA 6009, Australia
- PathWest Neuropathology, Royal Perth Hospital, Victoria Street, Perth, WA 6000, Australia
| | - Sharon Lee
- School of Medicine, University of Western Australia, WA 6009, Australia
- Dept of Neurosurgery, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Jonathan Silberstein
- Children’s Neuroscience Service, Dept of Neurology, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Dimitar Azmanov
- Dept of Neurosurgery, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | - Warne Richard
- WA State Wide Neurosurgery Service, WA 6009, Australia
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Ka A, Taher A, D'Souza S, Barnes EH, Gupta S, Troedson C, Wade F, Teo O, Dale RC, Wong C, Bleasel AF, Dexter M, Kothur K, Gill D. Predictors of longitudinal seizure outcomes after epilepsy surgery in childhood. Epilepsy Behav Rep 2022; 19:100561. [PMID: 35899185 PMCID: PMC9309686 DOI: 10.1016/j.ebr.2022.100561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 10/31/2022] Open
Abstract
Long term seizure outcome in children following epilepsy surgery is favorable. Histopathology is an independent determinant of long-term seizure outcome. Long-term seizure outcome remains stable in children with tumours and FCD type 2b, whereas seizure freedom declines with time in children with other types of FCD and cortical malformations. Children with moderate to severe developmental disability and younger age of seizure onset have higher seizure recurrence reflecting broader epileptic networks.
There is a paucity of data on longitudinal seizure outcome of children undergoing epilepsy surgery. All children (n = 132) who underwent resective epilepsy surgery from January 1998 to December 2015 were identified. Relevant clinical, neurophysiological, imaging, surgical and seizure outcome data were extracted. Multivariable logistic regression analysis and Kaplan-Meier survival with Cox proportional hazard modelling were performed. The mean age at surgery was 7.8 years (range 0.2–17.9). 71% were seizure-free at a mean follow up of 5.3 ± 2.7 years. Of those who were seizure-free, 65 patients were able to completely wean off anti- seizure medications successfully. Using survival analysis, the probability of Engel Class I outcome at one year after surgery was 81% (95% confidence interval [CI] 87%–75%). This dropped to 73% at two years (95% CI 81%–65%), 58% at five years (95% CI 67.8%–48%), and 47% at ten years. Proportional hazard modelling showed that the presence of moderate to severe developmental disability (HR 6.5; p = 0.02) and lack of complete resection (HR 0.4; p = 0.02) maintain association as negative predictors of seizure-free outcome. Our study demonstrates favorable long-term seizure control following pediatric epilepsy surgery and highlights important predictors of seizure outcome guiding case selection and counseling of expectations prior to surgery.
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Li H, Ji S, Dong B, Chen L. Seizure control after epilepsy surgery in early childhood: A systematic review and meta-analysis. Epilepsy Behav 2021; 125:108369. [PMID: 34731717 DOI: 10.1016/j.yebeh.2021.108369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/15/2021] [Accepted: 09/25/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This meta-analysis aimed to determine the main factors influencing surgical outcomes in children <3 years old with refractory epilepsy. METHODS The PubMed and Cochrane database were systematically searched for epilepsy surgery outcomes from December 1, 1991, to March 30, 2021, using the following search terms: "Epilepsy surgery OR Seizure operation" AND "under three years" OR "first three years" OR "early childhood" OR "infancy OR infants." Seizure onset, duration of epilepsy, magnetic resonance imaging findings, age at the time of surgery, surgical methods, resection extent, and pathological findings were considered potential moderators of differences in seizure outcomes. The fixed-effects models, combined effect sizes, and 95% confidence intervals (CI) were used to calculate the influence of potential factors on seizure outcomes. RESULTS Thirty two studies (559 cases) were included in the meta-analysis. The significant factors that correlated with a lower seizure control rate were frontal lobectomy (odds ratio [OR]: 0.33, 95% CI: 0.12-0.91; p = 0.03) and malformation of cortical development (MCD) (OR, 0.38; 95% CI: 0.24-0.62; p < 0.01). A higher seizure control rate was observed in children with tumors (92.86%) and Sturge-Weber syndrome (SWS, 91.43%). Frontal lobe epilepsy induced by MCD was related to the worst postoperative efficacy (OR, 0.26; 95% CI: 0.13-0.53; p < 0.01). SIGNIFICANCE The results of our meta-analyses revealed that pathology and surgical location play critical roles in the outcome of epilepsy surgery in children <3 years old. Clarification of the etiology of epilepsy before surgery is critical for better postoperative outcomes.
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Affiliation(s)
- Hua Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
| | - Shuming Ji
- Department of Clinical Research Management, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
| | - Bosi Dong
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China; Department of Clinical Research Management, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China.
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Wang X, Deng D, Zhou C, Li H, Guan X, Fang L, Cai Q, Wang W, Zhou Q. Focal Cortical Dysplasia Type Ⅲ Related Medically Refractory Epilepsy: MRI Findings and Potential Predictors of Surgery Outcome. Diagnostics (Basel) 2021; 11:diagnostics11122225. [PMID: 34943462 PMCID: PMC8699898 DOI: 10.3390/diagnostics11122225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
This study aims to explore the relationship between neuropathologic and the post-surgical prognosis of focal cortical dysplasia (FCD) typed-Ⅲ-related medically refractory epilepsy. A total of 266 patients with FCD typed-Ⅲ-related medically refractory epilepsy were retrospectively studied. Presurgical clinical data, type of surgery, and postsurgical seizure outcome were analyzed. The minimum post-surgical follow-up was 1 year. A total of 266 patients of FCD type Ⅲ were included in this study and the median follow-up time was 30 months (range, 12~48 months). Age at onset ranged from 1.0 years to 58.0 years, with a median age of 12.5 years. The number of patients under 12 years old was 133 (50%) in patients with FCD type Ⅲ. A history of febrile seizures was present in 42 (15.8%) cases. In the entire postoperative period, 179 (67.3%) patients were seizure-free. Factors with p < 0.15 in univariate analysis, such as age of onset of epilepsy (p = 0.145), duration of epilepsy (p = 0.004), febrile seizures (p = 0.150), being MRI-negative (p = 0.056), seizure type (p = 0.145) and incomplete resection, were included in multivariate analysis. Multivariate analyses revealed that MRI-negative findings of FCD (OR 0.34, 95% CI 0.45-0.81, p = 0.015) and incomplete resection (OR 0.12, 95% CI 0.05-0.29, p < 0.001) are independent predictors of unfavorable seizure outcomes. MRI-negative finding of FCD lesions and incomplete resection were the most important predictive factors for poor seizure outcome in patients with FCD type Ⅲ.
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Affiliation(s)
- Xiaozhuan Wang
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Dabiao Deng
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou 510510, China
| | - Chengqian Zhou
- Department of Psychiatry and Behavioral Science, School of Medicine, John Hopkins University, Baltimore, MD 21278, USA;
| | - Honglin Li
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Xueqin Guan
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Liguang Fang
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Qinxin Cai
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Wensheng Wang
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou 510510, China
- Correspondence: (W.W.); (Q.Z.)
| | - Quan Zhou
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
- Correspondence: (W.W.); (Q.Z.)
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Krylov VV, Gekht AB, Trifonov IS, Lebedeva AV, Rider FK, Kaimovsky IL, Sinkin MV, Kordonskaya OO, Magomedsultanov AI, Navruzov RA, Yakovlev AA, Grigorieva EV, Mamulashvili GV. [Long-term postoperative outcomes in patients with drug-resistant epilepsy]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:6-13. [PMID: 34713998 DOI: 10.17116/neiro2021850516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epilepsy surgery is effective in 30-82% of patients with drug-resistant epilepsy. However, risk factors of unfavorable outcomes after epilepsy surgery require further study. OBJECTIVE To evaluate risk factors of favorable and unfavorable long-term postoperative outcomes in patients with drug-resistant epilepsy. MATERIAL AND METHODS Postoperative outcomes in a large cohort of patients with epilepsy are reported for the first time in the Russian Federation. There were 271 patients with drug-resistant scheduled for surgery. Preoperative examination and surgical treatment were carried out between January 1, 2014 and December 12, 2019 at the Evdokimov Moscow State University of Medicine and Dentistry and Sklifosovsky Research Institute for Emergency Care. We used Engel grading system to assess postoperative outcomes after 12, 24, 48 and 60 months. We distinguished favorable (Engel I-II) and unfavorable (Engel III-IV) outcomes and analyzed the factors influencing postoperative results in these patients. RESULTS There were 319 surgical procedures in 271 patients (217 primary resections, implantation of vagus nerve stimulator in 31 patients, 9 redo resections and 8 radiosurgical procedures). Focal cortical dysplasia (FCD) was found in 162 (60%) patients, «dual pathology» - in 118 (44%) cases. In 12 months after surgery, favorable outcomes (Engel l-II) were observed in 69% of patients (n=148), after 24 months - in 71% (n=127) of patients. Postoperative complications occurred in 6 (1.9%) patients. There was no mortality. The earlier onset of epilepsy (p=0.01), multifocal (p=0.002) and bilateral lesions (p=0.0038) were the most significant risk factors of unfavorable postoperative outcomes. CONCLUSION Surgical resection is effective approach for drug-resistant epilepsy.
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Affiliation(s)
- V V Krylov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A B Gekht
- Solovyov Scientific and Practical Psychoneurological Center, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - I S Trifonov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Lebedeva
- Solovyov Scientific and Practical Psychoneurological Center, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - F K Rider
- Solovyov Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - I L Kaimovsky
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Solovyov Scientific and Practical Psychoneurological Center, Moscow, Russia.,Buyanov Moscow City Clinical Hospital, Moscow, Russia
| | - M V Sinkin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - O O Kordonskaya
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia.,Federal Center for Brain and Neurotechnologies, Moscow, Russia
| | | | - R A Navruzov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A A Yakovlev
- Solovyov Scientific and Practical Psychoneurological Center, Moscow, Russia.,Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
| | - E V Grigorieva
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - G V Mamulashvili
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Asada R, Hamamoto Y, Yu Y, Mizuno S, Chambers JK, Uchida K, Hasegawa D. Ventrolateral temporal lobectomy in normal dogs as a counterpart to human anterior temporal lobectomy: a preliminary study on the surgical procedure and complications. J Vet Med Sci 2021; 83:1513-1520. [PMID: 34408102 PMCID: PMC8569885 DOI: 10.1292/jvms.21-0127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anterior temporal lobectomy (ATL) is a surgical procedure for drug-resistant mesial temporal lobe epilepsy that is commonly performed in human medicine. The purpose of this study was to determine whether ATL-like surgery, i.e., removal of the amygdala and hippocampal head, is possible in dogs, and to investigate its safety and postoperative complications. Eight healthy beagles underwent ATL-like surgery and were observed for 3 months postoperatively. Samples from the surgically resected tissues and postmortem brain were evaluated pathologically. The surgical survival rate was 62.5%. The major postoperative complications were visual impairment, temporal muscle atrophy on the operative side, and a postoperative acute symptomatic seizure. Due to the anatomical differences between dogs and humans, the surgically resected area to approach the medial temporal structures in dogs was the ventrolateral part of the temporal lobe. Therefore, the ATL-like surgery described in this study was named "ventrolateral temporal lobectomy" (VTL). This study is the first report of temporal lobectomy including amygdalohippocampectomy in veterinary medicine and demonstrates its feasibility. Although it requires some degree of skill, VTL could be a treatment option for canine drug-resistant epilepsy and lesions in the mesial temporal lobe.
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Affiliation(s)
- Rikako Asada
- Laboratory of Veterinary Radiology, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan
| | - Yuji Hamamoto
- Laboratory of Veterinary Radiology, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan.,Research Center for Animal Life Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan
| | - Yoshihiko Yu
- Laboratory of Veterinary Radiology, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan.,Research Center for Animal Life Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan
| | - Satoshi Mizuno
- Laboratory of Veterinary Radiology, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan
| | - James K Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Daisuke Hasegawa
- Laboratory of Veterinary Radiology, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan.,Research Center for Animal Life Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan
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Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in 2014. Epilepsy is a common neurological condition characterised by recurrent seizures. Pharmacological treatment remains the first choice to control epilepsy. Sulthiame (STM) is widely used as an antiepileptic drug in Europe and Israel. In this review, we have presented a summary of evidence for the use of STM as monotherapy in epilepsy. OBJECTIVES To assess the efficacy and side effect profile of STM as monotherapy when compared with placebo or another antiepileptic drug for people with epilepsy. SEARCH METHODS We searched the following databases on 13 April 2020: the Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to 10 April 2020). CRS Web includes randomised or quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, the Cochrane Central Register of Controlled Trials (CENTRAL), and the specialised registers of Cochrane Review Groups including Cochrane Epilepsy. We imposed no language restrictions. We contacted the manufacturers of STM and researchers in the field to ask about ongoing and unpublished studies. SELECTION CRITERIA Randomised controlled monotherapy trials of STM in people of any age with epilepsy of any aetiology. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. Two review authors independently selected trials for inclusion and extracted the relevant data. We assessed the following outcomes: treatment withdrawal; seizure-free at six months; adverse effects; and quality of life scoring. We conducted the primary analyses by intention-to-treat where possible, and presented a narrative analysis of the data. MAIN RESULTS We included four studies involving a total of 355 participants: three studies (209 participants) with a diagnosis of benign epilepsy of childhood with centrotemporal spikes (BECTS), and one study (146 participants) with a diagnosis of generalised tonic-clonic seizures (GTCS). STM was given as monotherapy compared with placebo and with levetiracetam in the BECTS studies, and compared with phenytoin in the GTCS study. An English translation of the full text of one of the BECTS studies could not be found, and analysis of this study was based solely on the English translation of the abstract. For the primary outcome, the total number of dropouts caused either by seizure recurrence or adverse reaction was significantly higher in the levetiracetam treatment arm compared to the STM treatment arm (RR 0.32, 95% Cl 0.10 to 1.03; 1 study, 43 participants; low-certainty evidence). For the secondary outcomes for this comparison, results for seizure freedom were inconclusive (RR 1.12, 95% Cl 0.88 to 1.44; 1 study, 43 participants; low-certainty evidence). Reporting of adverse effects was incomplete. Participants receiving STM were significantly less likely to develop gingival hyperplasia than participants receiving phenytoin in the GTCS study (RR 0.03, 95% CI 0.00 to 0.58; 1 study, 146 participants; low-certainty evidence). No further statistically significant adverse events were noted when STM was compared with phenytoin or placebo. The most common adverse events were related to behavioural disturbances when STM was compared with levetiracetam (RR 0.95, 95% Cl 0.59 to 1.55; 1 study, 43 participants; low-certainty evidence), with the same incidence in both groups. No data were reported for quality of life. Overall, we assessed one study at high risk of bias and one study at unclear bias across the seven domains, mainly due to lack of information regarding study design. Only one trial reported effective methods for blinding. The risk of bias assessments for the other two studies ranged from low to high. We rated the overall certainty of the evidence for the outcomes as low using the GRADE approach. AUTHORS' CONCLUSIONS This review provides insufficient information to inform clinical practice. Small sample sizes, poor methodological quality, and lack of data on important outcome measures precluded any meaningful conclusions regarding the efficacy and tolerability of sulthiame as monotherapy in epilepsy. More trials, recruiting larger populations, over longer periods, are needed to determine whether sulthiame has a clinical use.
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Affiliation(s)
| | - Mariangela Panebianco
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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42
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Benevides ML, Costa Nunes J, Guarnieri R, Melo H, Lunardi M, Neves Linhares M, Kupek E, Wolf P, Lin K, Walz R. Anxiety and depressive symptoms long after mesial temporal epilepsy surgery: A prospective study. Epilepsy Behav 2021; 118:107936. [PMID: 33839452 DOI: 10.1016/j.yebeh.2021.107936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anxiety and depressive symptoms are prevalent in patients with refractory mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) before and after anterior temporal lobectomy (ATL). AIMS (1) To follow the levels of anxiety and depressive symptoms long-term after ATL among patients with refractory MTLE-HS; (2) To identify pre- and postsurgical variables associated with the levels of anxiety and depressive symptoms after surgery. METHODS We compared the levels of anxiety and depressive symptoms determined by the Hospital Anxiety and Depression Scale (HADS) before and long after ATL (mean 104 months, range 70-130) in 41 consecutive patients refractory MTLE-HS. The last follow-up was between September 2018 and March 2020. We also determined pre- and postsurgical variables independently associated with the HADS scores after surgery. RESULTS The scores of HADS and its subdomains related to anxiety and depression decreased significantly (p < 0.01) after ATL. After multiple linear regressions, the HADS-Anxiety scores before surgery (B = 0.47, CI 95% 0.20 to 0.75, p = 0.001) and at follow-up after surgery (B = 0.07, CI 0.00 to 0.14, p = 0.05) remain independently and positively associated with HADS-Anxiety scores after surgery. The HADS-Depression scores after surgery were independently positively associated with HADS-Depression scores before surgery (B = 0.39, CI 95% 0.10 to 0.76, p = 0.01) and worse seizure control after surgery (B = 1.55, CI 95% 0.23 to 2.87, p = 0.02). CONCLUSION Anxiety and depressive symptoms in patients with MTLE-HS significantly improved after ATL. Presurgical levels of anxiety and depressive symptoms, respectively, were positively associated with the postsurgical levels of those symptoms. Length of follow-up is associated with anxiety, and worse seizure control is associated with depressive symptoms after ATL. The results have implications for the surgical management of MTLE-HS patients.
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Affiliation(s)
- Maria Luiza Benevides
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil.
| | - Jean Costa Nunes
- Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Division of Neuropathology, HU, UFSC, Florianópolis, SC, Brazil; Neurodiagnostic Brasil - Diagnósticos em Neuropatologia, Florianópolis, SC, Brazil; Psychiatry Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil
| | - Ricardo Guarnieri
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil
| | - Hiago Melo
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil
| | - Mariana Lunardi
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Marcelo Neves Linhares
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Neurosurgery Division, Surgery Department, HU, UFSC, Florianópolis, Brazil; Neurosurgery Service, Governador Celso Ramos Hospital, Florianópolis, Brazil
| | - Emil Kupek
- Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Departament of Public Health, UFSC, Florianópolis, SC, Brazil
| | - Peter Wolf
- Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
| | - Kátia Lin
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil; Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
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Tantawi M, Miao J, Matias C, Skidmore CT, Sperling MR, Sharan AD, Wu C. Gray Matter Sampling Differences Between Subdural Electrodes and Stereoelectroencephalography Electrodes. Front Neurol 2021; 12:669406. [PMID: 33986721 PMCID: PMC8110924 DOI: 10.3389/fneur.2021.669406] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Stereoelectroencephalography (SEEG) has seen a recent increase in popularity in North America; however, concerns regarding the spatial sampling capabilities of SEEG remain. We aimed to quantify and compare the spatial sampling of subdural electrode (SDE) and SEEG implants. Methods: Patients with drug-resistant epilepsy who underwent invasive monitoring were included in this retrospective case-control study. Ten SEEG cases were compared with ten matched SDE cases based on clinical presentation and pre-implantation hypothesis. To quantify gray matter sampling, MR and CT images were coregistered and a 2.5mm radius sphere was superimposed over the center of each electrode contact. The estimated recording volume of gray matter was defined as the cortical voxels within these spherical models. Paired t-tests were performed to compare volumes and locations of SDE and SEEG recording. A Ripley's K-function analysis was performed to quantify differences in spatial distributions. Results: The average recording volume of gray matter by each individual contact was similar between the two modalities. SEEG implants sampled an average of 20% more total gray matter, consisted of an average of 17% more electrode contacts, and had 77% more of their contacts covering gray matter within sulci. Insular coverage was only achieved with SEEG. SEEG implants generally consist of discrete areas of dense local coverage scattered across the brain; while SDE implants cover relatively contiguous areas with lower density recording. Significance: Average recording volumes per electrode contact are similar for SEEG and SDE, but SEEG may allow for greater overall volumes of recording as more electrodes can be routinely implanted. The primary difference lies in the location and distribution of gray matter than can be sampled. The selection between SEEG and SDE implantation depends on sampling needs of the invasive implant.
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Affiliation(s)
- Mohamed Tantawi
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States.,Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jingya Miao
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States.,Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Caio Matias
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States.,Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ashwini D Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chengyuan Wu
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States.,Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
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44
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Consales A, Casciato S, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, de Palma L, Morano A, Vatti G, Villani F, Zamponi N, Tassi L, Di Gennaro G, Marras CE. The surgical treatment of epilepsy. Neurol Sci 2021; 42:2249-2260. [PMID: 33797619 DOI: 10.1007/s10072-021-05198-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/16/2021] [Indexed: 01/07/2023]
Abstract
In 2009, the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) conducted an overview about the techniques used for the pre-surgical evaluation and the surgical treatment of epilepsies. The recognition that, in selected cases, surgery can be considered the first-line approach, suggested that the experience gained by the main Italian referral centers should be pooled in order to provide a handy source of reference. In light of the progress made over these past years, some parts of that first report have accordingly been updated. The present revision aims to harmonize the general principles regulating the patient selection and the pre-surgical work-up, as well as to expand the use of epilepsy surgery, that still represents an underutilized resource, regrettably. The objective of this contribution is drawing up a methodological framework within which to integrate the experiences of each group in this complex and dynamic sector of the neurosciences.
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Affiliation(s)
- Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giancarlo Di Gennaro
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy.
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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Kohlhase K, Zöllner JP, Tandon N, Strzelczyk A, Rosenow F. Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta-analysis of outcomes. Epilepsia 2021; 62:831-845. [PMID: 33656182 DOI: 10.1111/epi.16846] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023]
Abstract
Magnetic resonance-guided laser interstitial laser therapy (MRgLITT) and radiofrequency ablation (RFA) represent two minimally invasive methods for the treatment of drug-refractory mesial temporal lobe epilepsy (mTLE). We performed a systematic review and a meta-analysis to compare outcomes and complications between MRgLITT, RFA, and conventional surgical approaches to the temporal lobe (i.e., anterior temporal lobe resection [ATL] or selective amygdalohippocampectomy [sAHE]). Forty-three studies (13 MRgLITT, 6 RFA, and 24 surgery studies) involved 554, 123, 1504, and 1326 patients treated by MRgLITT, RFA, ATL, or sAHE, respectively. Engel Class I (Engel-I) outcomes were achieved after MRgLITT in 57% (315/554, range = 33.3%-67.4%), RFA in 44% (54/123, range = 0%-67.2%), ATL in 69% (1032/1504, range = 40%-92.9%), and sAHE in 66% (887/1326, range = 21.4%-93.3%). Meta-analysis revealed no significant difference in seizure outcome between MRgLITT and RFA (Q = 2.74, p = .098), whereas ATL and sAHE were both superior to MRgLITT (ATL: Q = 8.92, p = .002; sAHE: Q = 4.33, p = .037) and RFA (ATL: Q = 6.42, p = .0113; sAHE: Q = 5.04, p = .0247), with better outcome in patients at follow-up of 60 months or more. Mesial hippocampal sclerosis (mTLE + hippocampal sclerosis) was associated with significantly better outcome after MRgLITT (Engel-I outcome in 64%; Q = 8.55, p = .0035). The rate of major complications was 3.8% for MRgLITT, 3.7% for RFA, 10.9% for ATL, and 7.4% for sAHE; the differences did not show statistical significance. Neuropsychological deficits occurred after all procedures, with left-sided surgeries having a higher rate of verbal memory impairment. Lateral functions such as naming or object recognition may be more preserved in MRgLITT. Thermal therapies are effective techniques but show a significantly lower rate of Engel-I outcome in comparison to ATL and sAHE. Between MRgLITT and RFA there were no significant differences in Engel-I outcome, whereby the success of treatment seems to depend on the approach used (e.g., occipital approach). MRgLITT shows a similar rate of complications compared to RFA, whereas patients undergoing MRgLITT may experience fewer major complications compared to ATL or sAHE and might have a more beneficial neuropsychological outcome.
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Affiliation(s)
- Konstantin Kohlhase
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
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Adan G, Neligan A, Nevitt SJ, Pullen A, Sander JW, Marson AG. Prognostic factors predicting an unprovoked seizure recurrence in children and adults following a first unprovoked seizure. Hippokratia 2021. [DOI: 10.1002/14651858.cd013848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Guleed Adan
- Department of Molecular and Clinical Pharmacology; Institute of Translational Medicine, University of Liverpool; Liverpool UK
- The Walton Centre NHS Foundation Trust; Liverpool UK
| | - Aidan Neligan
- Homerton University Hospital, NHS Foundation Trust; London UK
- Department of Clinical and Experimental Epilepsy; UCL Queen Square Institute of Neurology; London UK
| | - Sarah J Nevitt
- Department of Health Data Science; University of Liverpool; Liverpool UK
| | | | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy; UCL Queen Square Institute of Neurology; London UK
- National Hospital for Neurology and Neurosurgery; London UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology; Institute of Translational Medicine, University of Liverpool; Liverpool UK
- The Walton Centre NHS Foundation Trust; Liverpool UK
- Liverpool Health Partners; Liverpool UK
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47
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Neligan A, Adan G, Nevitt SJ, Pullen A, Sander JW, Marson AG. Prognosis of adults and children following a first unprovoked seizure. Hippokratia 2021. [DOI: 10.1002/14651858.cd013847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aidan Neligan
- Homerton University Hospital, NHS Foundation Trust; London UK
- Department of Clinical and Experimental Epilepsy; UCL Queen Square Institute of Neurology; London UK
| | - Guleed Adan
- Department of Molecular and Clinical Pharmacology; Institute of Translational Medicine, University of Liverpool; Liverpool UK
- The Walton Centre NHS Foundation Trust; Liverpool UK
| | - Sarah J Nevitt
- Department of Health Data Science; University of Liverpool; Liverpool UK
| | | | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy; UCL Queen Square Institute of Neurology; London UK
- National Hospital for Neurology and Neurosurgery; London UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology; Institute of Translational Medicine, University of Liverpool; Liverpool UK
- The Walton Centre NHS Foundation Trust; Liverpool UK
- Liverpool Health Partners; Liverpool UK
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Panebianco M, Al-Bachari S, Hutton JL, Marson AG. Gabapentin add-on treatment for drug-resistant focal epilepsy. Cochrane Database Syst Rev 2021; 1:CD001415. [PMID: 33434292 PMCID: PMC8094401 DOI: 10.1002/14651858.cd001415.pub4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is an updated version of the Cochrane Review previously published in 2018. Epilepsy is a common neurological disorder characterised by recurrent seizures. Most people with epilepsy have a good prognosis and their seizures are well controlled by a single antiepileptic drug, but up to 30% develop drug-resistant epilepsy, especially people with focal seizures. In this review, we summarised the evidence from randomised controlled trials (RCTs) of gabapentin, when used as an add-on treatment for drug-resistant focal epilepsy. OBJECTIVES To evaluate the efficacy and tolerability of gabapentin when used as an add-on treatment for people with drug-resistant focal epilepsy. SEARCH METHODS For the latest update, we searched the Cochrane Register of Studies (CRS Web) and MEDLINE (Ovid) on 11 August 2020. CRS Web includes randomised or quasi-randomised, controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialised Registers of Cochrane Review Groups including Epilepsy. We imposed no language restrictions. SELECTION CRITERIA Randomised, placebo-controlled, double-blind, add-on trials of gabapentin in people with drug-resistant focal epilepsy. We also included trials using an active drug control group or comparing different doses of gabapentin. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion and extracted the relevant data. We assessed the following outcomes: seizure frequency, seizure freedom, treatment withdrawal (any reason) and adverse effects. Primary analyses were intention-to-treat. We also undertook sensitivity best-case and worst-case analyses. We estimated summary risk ratios (RR) for each outcome and evaluated dose-response in regression models. MAIN RESULTS We identified no new studies for this update, therefore, the results and conclusions are unchanged. In the previous update of this review, we combined data from six trials in meta-analyses of 1206 randomised participants. The overall risk ratio (RR) for reduction in seizure frequency of 50% or more compared to placebo was 1.89 (95% confidence interval (CI) 1.40 to 2.55; 6 studies, 1206 participants; moderate-certainty evidence). Dose regression analysis (for trials in adults) showed increasing efficacy with increasing dose, with 25.3% (95% CI 19.3 to 32.3) of people responding to gabapentin 1800 mg compared to 9.7% on placebo, a 15.5% increase in response rate (95% CI 8.5 to 22.5). The RR for treatment withdrawal compared to placebo was 1.05 (95% CI 0.74 to 1.49; 6 trials, 1206 participants; moderate-certainty evidence). Adverse effects were significantly associated with gabapentin compared to placebo. RRs were as follows: ataxia 2.01 (99% CI 0.98 to 4.11; 3 studies, 787 participants; low-certainty evidence), dizziness 2.43 (99% CI 1.44 to 4.12; 6 studies, 1206 participants; moderate-certainty evidence), fatigue 1.95 (99% CI 0.99 to 3.82; 5 studies, 1161 participants; low-certainty evidence) and somnolence 1.93 (99% CI 1.22 to 3.06; 6 studies, 1206 participants; moderate-certainty evidence). There was no evidence of a difference for the adverse effects of headache (RR 0.79, 99% CI 0.46 to 1.35; 6 studies, 1206 participants; moderate-certainty evidence) or nausea (RR 0.95, 99% CI 0.52 to 1.73; 4 trials, 1034 participants; moderate-certainty evidence). Overall, the studies were at low to unclear risk of bias due to information on each risk of bias domain not being available. We judged the overall certainty of the evidence (using the GRADE approach) as low to moderate due to potential attrition bias resulting from missing outcome data and imprecise results with wide CIs. AUTHORS' CONCLUSIONS Gabapentin has efficacy as an add-on treatment in people with drug-resistant focal epilepsy, and seems to be fairly well-tolerated. However, the trials reviewed were of relatively short duration and provide no evidence for the long-term efficacy of gabapentin beyond a three-month period. The results cannot be extrapolated to monotherapy or to people with other epilepsy types. Further trials are needed to assess the long-term effects of gabapentin, and to compare gabapentin with other add-on drugs.
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Affiliation(s)
- Mariangela Panebianco
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Jane L Hutton
- Department of Statistics, University of Warwick, Coventry, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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Tang Y, Liao G, Li J, Long T, Li Y, Feng L, Chen D, Tang B, Hu S. FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy. Front Med (Lausanne) 2020; 7:605002. [PMID: 33425950 PMCID: PMC7793721 DOI: 10.3389/fmed.2020.605002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: Metabolic abnormality in the extratemporal area on fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is not an uncommon finding in drug-resistant temporal lobe epilepsy (TLE), however the correlation between extratemporal metabolic abnormalities and surgical long-term prognosis has not been fully elucidated. We aim to investigate FDG-PET extratemporal metabolic profiles predictive of failure in surgery for TLE patients. Methods: Eighty-two patients with unilateral TLE (48 female, 34 male; 25.6 ± 10.6 years old; 37 left TLE, 45 right TLE) and 30 healthy age-matched controls were enrolled. Patients were classified either as experiencing seizure-recurrence (SZR, Engel class II through IV) or seizure-free (SZF, Engel class I) at least 1 year after surgery. Regional cerebral metabolism was evaluated by FDG-PET with statistical parametric mapping (SPM12). Abnormal metabolic profiles and patterns on FDG-PET in SZR group were evaluated and compared with those of healthy control and SZF subjects on SPM12. Volume and intensity as well as special brain areas of abnormal metabolism in temporal and extratemporal regions were quantified and visualized. Results: With a median follow-up of 1.5 years, 60% of patients achieved Engel class I (SZF). SZR was associated with left TLE and widespread hypometabolism in FDG-PET visual assessment (both p < 0.05). All patients had hypometabolism in the ipsilateral temporal lobe but SZR was not correlated with volume or intensity of temporal hypometabolism (median, 1,456 vs. 1,040 mm3; p > 0.05). SZR was correlated with extratemporal metabolic abnormalities that differed according to lateralization: in right TLE, SZR exhibited larger volume in extratemporal areas compared to SZF (median, 11,060 vs. 2,112 mm3; p < 0.05). Surgical failure was characterized by Cingulum_Ant_R/L, Frontal_Inf_Orb_R abnormal metabolism in extratemporal regions. In left TLE, SZR presented a larger involvement of extratemporal areas similar to right TLE but with no significant (median, 5,873 vs. 3,464 mm3; p > 0.05), Cingulum_Ant_ R/L, Parietal_Inf_L, Postcentral_L, and Precuneus_R involved metabolic abnormalities were correlated with SZR. Conclusions: Extratemporal metabolic profiles detected by FDG-PET may indicate a prominent cause of TLE surgery failure and should be considered in predictive models for epilepsy surgery. Seizure control after surgery might be improved by investigating extratemporal areas as candidates for resection or neuromodulation.
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Affiliation(s)
- Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Guang Liao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Tingting Long
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yulai Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Dengming Chen
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, China
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Cramer SW, McGovern RA, Wang SG, Chen CC, Park MC. Resective epilepsy surgery: assessment of randomized controlled trials. Neurosurg Rev 2020; 44:2059-2067. [PMID: 33169227 DOI: 10.1007/s10143-020-01432-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
Epilepsy is the most common form of chronic neurologic disease. Here, we review the available randomized controlled trials (RCTs) that examined the efficacy of resective epilepsy surgery in select patients suffering from medically intractable epilepsy (defined as persistent epilepsy despite two or more antiepileptic drugs [AEDs]). Three RCTs (two adult RCTs and one pediatric RCT) consistently supported the efficacy of resective surgery as treatment for epilepsy with semiology localized to the mesial temporal lobe. In these studies, 58-100% of the patients who underwent resective surgery achieved seizure freedom, in comparison to 0-13% of medically treated patients. In another RCT, the likelihood of seizure freedom after resective surgery was independent of the surgical approach (transSylvian [64%] versus subtemporal [62%]). Two other RCTs demonstrated that hippocampal resection is essential to optimize seizure control. But, no significant gain in seizure control was achieved beyond removing 2.5 cm of the hippocampus. Across RCTs, minor complications (deficit lasting < 3 months) and major complications (deficit > 3 months) ranged 2-5% and 5-11% respectively. However, nonincapacitating superior subquadrantic visual-field defects (not typically considered a minor or major complication) were noted in up to 55% of the surgical cohort. The available RCTs provide compelling support for resective surgery as a treatment for mesial temporal lobe epilepsy and offer insights toward optimal surgical strategy.
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Affiliation(s)
- Samuel W Cramer
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA.
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA.,Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA
| | - Sonya G Wang
- Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA.,Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA
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