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Zanello M, Garnier E, Carron R, Jegou A, Lagarde S, Makhalova J, Medina S, Bénar CG, Bartolomei F, Pizzo F. Stereo-EEG-based ictal functional connectivity in patients with periventricular nodular heterotopia-related epilepsy. Epilepsia 2024; 65:e47-e54. [PMID: 38345420 DOI: 10.1111/epi.17891] [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: 10/17/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 04/16/2024]
Abstract
Nodular heterotopia (NH)-related drug-resistant epilepsy is challenging due to the deep location of the NH and the complexity of the underlying epileptogenic network. Using ictal stereo-electroencephalography (SEEG) and functional connectivity (FC) analyses in 14 patients with NH-related drug-resistant epilepsy, we aimed to determine the leading structure during seizures. For this purpose, we compared node IN and OUT strength between bipolar channels inside the heterotopia and inside gray matter, at the group level and at the individual level. At seizure onset, the channels within NH belonging to the epileptogenic and/or propagation network showed higher node OUT-strength than the channels within the gray matter (p = .03), with higher node OUT-strength than node IN-strength (p = .03). These results are in favor of a "leading" role of NH during seizure onset when involved in the epileptogenic- or propagation-zone network (50% of patients). However, when looking at the individual level, no significant difference between NH and gray matter was found, except for one patient (in two of three seizures). This result confirms the heterogeneity and the complexity of the epileptogenic network organization in NH and the need for SEEG exploration to characterize more precisely patient-specific epileptogenic network organization.
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Affiliation(s)
- Marc Zanello
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, Paris, France
| | - Elodie Garnier
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Romain Carron
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Stereotactic and Functional Neurosurgery, Marseille, France
| | - Aude Jegou
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Stanislas Lagarde
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Julia Makhalova
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- APHM La Timone, CEMEREM, Marseille, France
| | - Samuel Medina
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Christian-G Bénar
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Fabrice Bartolomei
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Francesca Pizzo
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
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Filipescu C, Landré E, Gavaret M, Zanello M, Pallud J. Bilateral periventricular nodular heterotopia: Can SEEG-guided radiofrequency thermocoagulations cure the epilepsy? Epileptic Disord 2024; 26:158-160. [PMID: 37877673 DOI: 10.1002/epd2.20171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Cristina Filipescu
- Neurophysiology and Epileptology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Elisabeth Landré
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Martine Gavaret
- Neurophysiology and Epileptology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Paris-Cité University, Paris, France
| | - Marc Zanello
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Paris-Cité University, Paris, France
| | - Johan Pallud
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Paris-Cité University, Paris, France
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Durica SR, Caruso JP, Podkorytova I, Ding K, Hays R, Lega B, Perven G. Stereo-EEG Evaluation and Surgical Treatment in Patients With Drug-Resistant Focal Epilepsy Associated With Nodular Heterotopia. J Clin Neurophysiol 2023; 40:17-26. [PMID: 34009845 DOI: 10.1097/wnp.0000000000000850] [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: 01/10/2023] Open
Abstract
PURPOSE Nodular heterotopia (NH) is a common cause of drug-resistant epilepsy. Only limited studies detail the treatment of NH with laser interstitial thermal therapy and none analyze the relation between epileptogenicity and NH location. METHODS We retrospectively studied nine patients with drug-resistant epilepsy and NH who underwent stereoelectroencephalography and subsequent epilepsy surgery. Nodular heterotopia in the frontal lobes or along the bodies of the lateral ventricles was classified as anterior NH. Nodular heterotopia in the trigones, temporal or occipital horns, or temporal lobes was classified as posterior NH. Nodular heterotopia in both anterior and posterior locations was classified as diffuse NH. Interictal and ictal stereoelectroencephalography were analyzed, and patients were followed postoperatively to assess outcomes. RESULTS Of the six patients who underwent nine laser interstitial thermal therapy procedures either in isolation or in combination with other surgical therapies, four patients were Engel Ia, one was Engel IIb, and one was Engel IIIa, with an average follow-up of 22.8 months. All patients with posterior NH had interictal epileptiform abnormalities and seizures originating from the posterior NH. None of the patients with anterior NH had epileptiform activity recorded from their NH. CONCLUSION Laser interstitial thermal therapy alone or in combination with other surgical therapies is an effective treatment in those with drug-resistant epilepsy because of NH, even in those with extensive NH and broad seizure onset. We observed a trend suggesting that posterior NH are more likely to be epileptogenic compared with anterior NH and recommend that in patients with anterior NH, alternative epilepsy etiologies and stereoelectroencephalography implantation strategies be considered.
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Affiliation(s)
- Sarah R Durica
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, U.S.A.; and
| | - James P Caruso
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Irina Podkorytova
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Kan Ding
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Ryan Hays
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Bradley Lega
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Ghazala Perven
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
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4
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Alis C, Alis D, Uslu Besli L, Karaarslan E, Sonmezoglu K, Ozkara C, Yeni SN. The analysis of 18 F-FDG PET/MRI, electroencephalography, and semiology in patients with gray matter heterotopia: A pilot study. Acta Neurol Scand 2022; 146:662-670. [PMID: 36102058 DOI: 10.1111/ane.13705] [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: 05/14/2022] [Revised: 07/29/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe 18 F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18 F-FDG PET/MRI) along with semiology and electroencephalography (EEG) in patients with gray matter heterotopia (GMH); to evaluate the concordance between 18 F-FDG PET/MRI and clinical epileptogenic zone (EZ). MATERIALS & METHODS GMH (subcortical heterotopia [SCH] and periventricular nodular heterotopia [PNH]) patients with epilepsy who underwent 18 F-FDG PET/MRI were retrospectively enrolled. Two radiologists evaluated brain MRI, while two nuclear medicine specialists assessed the 18 F-FDG PET. The SUVmax values of visually hypometabolic cortical areas were compared to the contralateral cortex using a SUVmax threshold value of 10%; the SUVmax values of GMH lesions were compared with that of the right precentral gyrus. The cortex or GMH with hypometabolism on 18 F-FDG PET/MRI was considered representative of the EZ. The clinical EZ was identified using EEG and semiology. RESULTS Thirty patients (19 PNH; 11 SCH) with a mean age of 28.46 ± 9.52 years were enrolled. The heterotopic nodules were ametabolic in 3 patients (10%), hypometabolic in 16 (33.33%), isometabolic in 13 (26.66%), and hypermetabolic in 4 (10%). 18 F-FDG PET/MRI demonstrated hypometabolism in the cortex and GMH in 22/30 (73.33%) and 16/30 (53.33%). We could identify a clinical EZ in 18 patients, and 15 out of 18 (83.33%) had concordant 18 F-FDG PET/MRI findings. CONCLUSION Heterotopic nodules in GMH patients show different metabolic patterns on 18 F-FDG PET/MRI, with nearly three-quarters of the patients having cortical hypometabolism. 18 F-FDG PET/ MRI findings are mostly concordant with the clinical EZ.
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Affiliation(s)
- Ceren Alis
- Cerrahpasa School of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Lebriz Uslu Besli
- Cerrahpasa School of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ercan Karaarslan
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Cerrahpasa School of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cigdem Ozkara
- Cerrahpasa School of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seher Naz Yeni
- Cerrahpasa School of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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5
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Moloney PB, Dugan P, Widdess-Walsh P, Devinsky O, Delanty N. Genomics in the Presurgical Epilepsy Evaluation. Epilepsy Res 2022; 184:106951. [DOI: 10.1016/j.eplepsyres.2022.106951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/23/2022] [Accepted: 05/25/2022] [Indexed: 11/03/2022]
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6
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Choi JY, Krishnan B, Hu S, Martinez D, Tang Y, Wang X, Sakaie K, Jones S, Murakami H, Blümcke I, Najm I, Ma D, Wang ZI. Using magnetic resonance fingerprinting to characterize periventricular nodular heterotopias in pharmacoresistant epilepsy. Epilepsia 2022; 63:1225-1237. [PMID: 35343593 PMCID: PMC9081261 DOI: 10.1111/epi.17191] [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: 11/08/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to use a novel magnetic resonance fingerprinting (MRF) technique to examine in vivo tissue property characteristics of periventricular nodular heterotopia (PVNH). These characteristics were further correlated with stereotactic-electroencephalographic (SEEG) ictal onset findings. METHODS We included five patients with PVNH who had SEEG-guided surgery and at least 1 year of seizure freedom or substantial seizure reduction. High-resolution MRF scans were acquired at 3 T, generating three-dimensional quantitative T1 and T2 maps. We assessed the differences between T1 and T2 values from the voxels in the nodules located in the SEEG-defined seizure onset zone (SOZ) and non-SOZ, on -individual and group levels. Receiver operating characteristic analyses were performed to obtain the optimal classification performance. Quantification of SEEG ictal onset signals from the nodules was performed by calculating power spectrum density (PSD). The association between PSD and T1 /T2 values was further assessed at different frequency bands. RESULTS Individual-level analysis showed T1 was significantly higher in SOZ voxels than non-SOZ voxels (p < .05), with an average 73% classification accuracy. Group-level analysis also showed higher T1 was significantly associated with SOZ voxels (p < .001). At the optimal cutoff (normalized T1 of 1.1), a 76% accuracy for classifying SOZ nodules from non-SOZ nodules was achieved. T1 values were significantly associated with ictal onset PSD at the ultraslow, θ, β, γ, and ripple bands (p < .05). T2 values were significantly associated with PSD only at the ultraslow band (p < .05). SIGNIFICANCE Quantitative MRF measures, especially T1 , can provide additional noninvasive information to separate nodules in SOZ and non-SOZ. The T1 and T2 tissue property changes carry electrophysiological underpinnings relevant to the epilepsy, as shown by their significant positive associations with power changes during the SEEG seizure onset. The use of MRF as a supplementary noninvasive tool may improve presurgical evaluation for patients with PVNH and pharmacoresistant epilepsy.
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Affiliation(s)
- Joon Yul Choi
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Balu Krishnan
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Siyuan Hu
- Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - David Martinez
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Yinging Tang
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA.,Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaofeng Wang
- Quantitative Health Science, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ken Sakaie
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroatsu Murakami
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Ingmar Blümcke
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA.,Neuropathology, University of Erlangen, Erlangen, Germany
| | - Imad Najm
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Dan Ma
- Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Zhong Irene Wang
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
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Boulogne S, Pizzo F, Chatard B, Roehri N, Catenoix H, Ostrowsky‐Coste K, Giusiano B, Guenot M, Carron R, Bartolomei F, Rheims S. Functional connectivity and epileptogenicity of nodular heterotopias: A single‐pulse stimulation study. Epilepsia 2022; 63:961-973. [DOI: 10.1111/epi.17168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sébastien Boulogne
- Department of Functional Neurology and Epileptology Hospices Civils de Lyon and University of Lyon Lyon France
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
- Lyon 1 University Villeurbanne France
| | - Francesca Pizzo
- Inserm, INS Institut de Neurosciences des Systèmes Aix Marseille University Marseille France
- Epileptology and Cerebral Rythmology Department Assistance Publique – Hôpitaux de Marseille Marseille France
| | - Benoit Chatard
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
| | - Nicolas Roehri
- Inserm, INS Institut de Neurosciences des Systèmes Aix Marseille University Marseille France
| | - Hélène Catenoix
- Department of Functional Neurology and Epileptology Hospices Civils de Lyon and University of Lyon Lyon France
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
| | - Karine Ostrowsky‐Coste
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
- Epileptology, Sleep Disorders and Functional Pediatric Neurology Hospices Civils de Lyon and University of Lyon Lyon France
| | - Bernard Giusiano
- Inserm, INS Institut de Neurosciences des Systèmes Aix Marseille University Marseille France
- Epileptology and Cerebral Rythmology Department Assistance Publique – Hôpitaux de Marseille Marseille France
| | - Marc Guenot
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
- Department of Functional Neurosurgery Hospices Civils de Lyon and University of Lyon Lyon France
| | - Romain Carron
- Department of Functional Neurosurgery Assistance Publique –Hôpitaux de Marseille Marseille France
| | - Fabrice Bartolomei
- Inserm, INS Institut de Neurosciences des Systèmes Aix Marseille University Marseille France
- Epileptology and Cerebral Rythmology Department Assistance Publique – Hôpitaux de Marseille Marseille France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology Hospices Civils de Lyon and University of Lyon Lyon France
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
- Lyon 1 University Villeurbanne France
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8
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Ravindra VM, Lee S, Gonda D, Patino I, Ruggieri L, Ikeda DS, Curry DJ. Magnetic resonance-guided laser interstitial thermal therapy for pediatric periventricular nodular heterotopia-related epilepsy. J Neurosurg Pediatr 2021; 28:657-662. [PMID: 34560627 DOI: 10.3171/2021.5.peds21171] [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: 03/31/2021] [Accepted: 05/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Periventricular nodular heterotopia (PVNH) is a result of disrupted neuronal migration from the ventricular system and can be a rare cause of refractory focal epilepsy. The goal of this case series was to describe the treatment of pediatric PVNH-related epilepsy with MR-guided laser interstitial thermal ablation. METHODS Patients treated at a single institution with MR-guided laser interstitial thermal therapy (MRgLITT) for PVNH-related epilepsy were identified. Preoperative and postoperative seizure outcomes and procedural information were evaluated. RESULTS Five children with PVNH treated with MRgLITT were reviewed; 1 child was treated twice. Three patients were female; the median age was 10.9 years. Five of 6 treatments were preceded by stereoelectroencephalography phase II monitoring. Three children experienced unilateral PVNH, and 2 had bilateral seizures. The median number of seizures recorded during phase II monitoring was 2; the median number of ablation targets was 2 (range 1-4). All patients experienced a decrease in seizure frequency; 4 patients (80%) had an Engel class ≤ III at the last follow-up (range I-IV). One child experienced right hemianopia posttreatment. CONCLUSIONS This case series investigation has illustrated a novel, minimally invasive approach for treating pediatric PVNH-related epilepsy. Further study of this technique with comparison with other surgical techniques is warranted.
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Affiliation(s)
- Vijay M Ravindra
- 1Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston; and
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Sungho Lee
- 3Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - David Gonda
- 4Department of Neurosurgery, Rady Children's Hospital, University of California, San Diego, California; and
| | - Ilana Patino
- 1Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston; and
| | - Lucia Ruggieri
- 1Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston; and
| | - Daniel S Ikeda
- 5Department of Neurosurgery, US Naval Hospital Okinawa, Okinawa, Japan
| | - Daniel J Curry
- 1Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston; and
- 3Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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9
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Swanson LC, Ahmed R. Epilepsy Syndromes: Current Classifications and Future Directions. Neurosurg Clin N Am 2021; 33:113-134. [PMID: 34801136 DOI: 10.1016/j.nec.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This review describes the clinical presentations and treatment options for commonly recognized epilepsy syndromes in the pediatric age group, based on the 2017 International League Against Epilepsy classification. Structural epilepsies that are amenable to surgical intervention are discussed. Lastly, emerging technologies are reviewed that are expanding our knowledge of underlying epilepsy pathologies and will guide future syndromic classification systems including genetic testing and tissue repositories.
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Affiliation(s)
- Laura C Swanson
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. #18, Chicago, IL 60611, USA
| | - Raheel Ahmed
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, 1675 Highland Avenue #0002, Madison, WI 53705, USA.
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10
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Akkol S, Kucyi A, Hu W, Zhao B, Zhang C, Sava-Segal C, Liu S, Razavi B, Zhang J, Zhang K, Parvizi J. Intracranial Electroencephalography Reveals Selective Responses to Cognitive Stimuli in the Periventricular Heterotopias. J Neurosci 2021; 41:3870-3878. [PMID: 33727335 PMCID: PMC8084321 DOI: 10.1523/jneurosci.2785-20.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/27/2020] [Accepted: 03/06/2021] [Indexed: 11/21/2022] Open
Abstract
Our recent work suggests that non-lesional epileptic brain tissue is capable of generating normal neurophysiological responses during cognitive tasks, which are then seized by ongoing pathologic epileptic activity. Here, we aim to extend the scope of our work to epileptic periventricular heterotopias (PVH) and examine whether the PVH tissue also exhibits normal neurophysiological responses and network-level integration with other non-lesional cortical regions. As part of routine clinical assessment, three adult patients with PVH underwent implantation of intracranial electrodes and participated in experimental cognitive tasks. We obtained simultaneous recordings from PVH and remote cortical sites during rest as well as controlled experimental conditions. In all three subjects (two females), cognitive experimental conditions evoked significant electrophysiological responses in discrete locations within the PVH tissue that were correlated with responses seen in non-epileptic cortical sites. Moreover, the responsive PVH sites exhibited correlated electrophysiological activity with responsive, non-lesional cortical sites during rest conditions. Taken together, our work clearly demonstrates that the PVH tissue may be functionally organized and it may be functionally integrated within cognitively engaged cortical networks despite its anatomic displacement during neurodevelopment.SIGNIFICANCE STATEMENT Periventricular heterotopias (PVH) are developmentally abnormal brain tissues that frequently cause epileptic seizures. In a rare opportunity to obtain direct electrophysiological recordings from PVH, we were able to show that, contrary to common assumptions, PVH functional activity is similar to healthy cortical sites during a well-established cognitive task and exhibits clear resting state connectivity with the responsive cortical regions.
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Affiliation(s)
- Serdar Akkol
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California 94305
| | - Aaron Kucyi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California 94305
- Department of Psychology, Northeastern University, Boston, Massachusetts 02115
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Clara Sava-Segal
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California 94305
| | - Su Liu
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California 94305
| | - Babak Razavi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California 94305
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Josef Parvizi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California 94305
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11
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Khoo HM, Gotman J, Hall JA, Dubeau F. Treatment of Epilepsy Associated with Periventricular Nodular Heterotopia. Curr Neurol Neurosci Rep 2020; 20:59. [PMID: 33123826 DOI: 10.1007/s11910-020-01082-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Epilepsy associated with periventricular nodular heterotopia (PNH), a developmental malformation, is frequently drug-resistant and requires focal therapeutic intervention. Invasive EEG study is usually necessary to delineate the epileptogenic zone, but constructing an accurate hypothesis to define an appropriate electrode implantation scheme and the treatment is challenging. This article reviews recent studies that help understanding the epileptogenicity and potential therapeutic options in PNH. RECENT FINDINGS New noninvasive diagnostic and intracerebral EEG analytic tools demonstrated that cortical hyperexcitability and aberrant connectivity (between nodules and cortices and among nodules) are likely mechanisms causing epilepsy in most patients. The deeply seated PNH, if epileptogenic, are ideal target for stereotactic ablative techniques, which offer concomitant ablation of multiple regions with relatively satisfactory seizure outcome. Advance in diagnostic and analytic tools have enhanced our understanding of the complex epileptogenicity in PNH. Development in stereotactic ablative techniques now offers promising therapeutic options for these patients.
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Affiliation(s)
- Hui Ming Khoo
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-shi, Osaka Prefecture, 565-0871, Japan.
| | - Jean Gotman
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - Jeffery A Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - François Dubeau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
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12
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Laser Interstitial Thermal Therapy for Epileptogenic Periventricular Nodular Heterotopia. World Neurosurg 2020; 138:e892-e897. [DOI: 10.1016/j.wneu.2020.03.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 11/20/2022]
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13
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Abstract
OBJECTIVES Electroencephalography is used in neurocritical care for detection of seizures and assessment of cortical function. Due to limited resolution from scalp electroencephalography, important abnormalities may not be readily detectable. We aimed to identify whether intracranial electroencephalography allows for improved methods of monitoring cortical function in children with severe traumatic brain injury. DESIGN This is a retrospective cohort study from a prospectively collected clinical database. We investigated the occurrence rate of epileptiform abnormalities detected on intracranial electroencephalography when compared with scalp electroencephalography. We also investigated the strength of association of quantitative electroencephalographic parameters and cerebral perfusion pressure between both intracranial and scalp electroencephalography. SETTING This is a single-institution study performed in the Phoenix Children's Hospital PICU. PATIENTS Eleven children with severe traumatic brain injury requiring invasive neuromonitoring underwent implantation of a six-contact intracranial electrode as well as continuous surface electroencephalography. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Visual detection of epileptiform abnormalities was performed by pediatric epileptologists. Association of intracranial and scalp electroencephalography total power, alpha percentage, and alpha-delta power ratio to cerebral perfusion pressure was performed using univariate dynamic structural equations modeling. Demographic data were assessed by retrospective analysis. Intracranial and scalp electroencephalography was performed in 11 children. Three of 11 children had observed epileptiform abnormalities on intracranial electroencephalography. Two patients had epileptiform abnormalities identified exclusively on intracranial electroencephalography, and one patient had seizures initiating on intracranial electroencephalography before arising on scalp electroencephalography. Identification of epileptiform abnormalities was associated with subsequent identification of stroke or malignant cerebral edema. We observed statistically significant positive associations between intracranial alpha-delta power ratio to cerebral perfusion pressure in nine of 11 patients with increased strength of association on intracranial compared with scalp recordings. CONCLUSIONS These findings suggest that intracranial electroencephalography may be useful for detection of secondary insult development in children with traumatic brain injury.
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14
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Nolan RL, Brandmeir N, Tucker ES, Magruder JL, Lee MR, Chen G, Lewis JW. Functional and resting-state characterizations of a periventricular heterotopic nodule associated with epileptogenic activity. Neurosurg Focus 2020; 48:E10. [PMID: 32006947 DOI: 10.3171/2019.11.focus19765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022]
Abstract
The object of this study was to extensively characterize a region of periventricular nodular heterotopia (PVNH) in an epilepsy patient to reveal its possible neurocognitive functional role(s). The authors used 3-T MRI approaches to exhaustively characterize a single, right hemisphere heterotopion in a high-functioning adult male with medically responsive epilepsy, which had manifested during late adolescence. The heterotopion proved to be spectroscopically consistent with a cortical-like composition and was interconnected with nearby ipsilateral cortical fundi, as revealed by fiber tractography (diffusion-weighted imaging) and resting-state functional connectivity MRI (rsfMRI). Moreover, the region of PVNH demonstrated two novel characterizations for a heterotopion. First, functional MRI (fMRI), as distinct from rsfMRI, showed that the heterotopion was significantly modulated while the patient watched animated video scenes of biological motion (i.e., cartoons). Second, rsfMRI, which demonstrated correlated brain activity during a task-negative state, uniquely showed directionality within an interconnected network, receiving positive path effects from patent cortical and cerebellar foci while outputting only negative path effects to specific brain foci.These findings are addressed in the context of the impact on noninvasive presurgical brain mapping strategies for adult and pediatric patient workups, as well as the impact of this study on an understanding of the functional cortical architecture underlying cognition from a neurodiversity and evolutionary perspective.
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Affiliation(s)
| | - Nicholas Brandmeir
- 2Neurosurgery, Rockefeller Neuroscience Institute and Center for Advanced Imaging at West Virginia University
| | | | - John L Magruder
- 3Department of Pediatrics, West Virginia University, Morgantown, West Virginia; and
| | - Mark R Lee
- 2Neurosurgery, Rockefeller Neuroscience Institute and Center for Advanced Imaging at West Virginia University
| | - Gang Chen
- 4Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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15
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Wang D, Wei P, Shan Y, Ren L, Wang Y, Zhao G. Optimized stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of patients with focal epilepsy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:15. [PMID: 32055606 DOI: 10.21037/atm.2019.10.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epilepsy is a severe health disorder affecting people of all ages with high prevalence worldwide. The introduction of new antiepileptic drugs has yielded notable effects in recent decades, yet there are still approximately 30% of patients with seizures refractory to medical therapy. Open surgical resection is widely accepted as a highly effective approach for the treatment of drug-resistant focal epilepsy if the epileptogenic zone can be precisely delineated. However, concerns about the impact of open surgery on brain function have driven considerable interest in less invasive techniques. Clinically, stereoelectroencephalography (SEEG) offers a unique means of exploring the pathophysiologic process and accurately mapping the epileptogenic network in presurgical evaluations for patients with epilepsy because of insufficient information from other noninvasive investigations. Moreover, SEEG-guided radiofrequency thermocoagulation (SEEG-guided RF-TC), which ablates lesions directly through the recording electrodes according to electroclinical evidence, has emerged as a promising, minimally invasive modality with notable preservation of neurocognitive functions. This critical review summarizes the technical details of the parameters and the selection of patients for SEEG-guided RF-TC based on the literature as well as our experiences. With respect to the parameters, the power and duration of RF-TC are discussed. In particular, an optimized SEEG-guided RF-TC modality that integrates more contacts from multiple different electrodes to create a confluent lesioning field is proposed for a more curative effect in comparison to the current protocol of palliative treatment in which RF-TC selectively disrupts critical hubs in the epileptic network through contiguous contacts within the range of a single electrode. Currently, SEEG-guided RF-TC is indicated for a variety of small, deeply seeded and well-demarcated epileptogenic foci, such as deep heterotopic nodules and hypothalamic hamartoma. The efficacy of treating patients with focal cortical dysplasias in the eloquent cortex and with mesial temporal lobe epilepsy associated with hippocampal sclerosis needs to be further determined. Given the small number of patients reported, randomized controlled trials are necessary to compare the efficacy of SEEG-guided RF-TC with conventional methods in the future.
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Affiliation(s)
- Di Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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16
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Khoo HM, von Ellenrieder N, Zazubovits N, Hall JA, Dubeau F, Gotman J. Internodular functional connectivity in heterotopia-related epilepsy. Ann Clin Transl Neurol 2019; 6:1010-1023. [PMID: 31211165 PMCID: PMC6562032 DOI: 10.1002/acn3.769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 11/13/2022] Open
Abstract
Objective A vast network involving the nodules and overlying cortices is believed to be responsible for the epileptogenicity in gray matter heterotopia with multiple nodules, which often associated with difficult‐to‐treat epilepsy. We sought to determine if functional magnetic resonance imaging (fMRI) could detect internodular functional connectivity (FC), and if this connectivity reflects an actual synchronized neuronal activity and partakes in epileptogenicity. Methods We studied 16 epilepsy patients with multiple heterotopic nodules; eight underwent subsequent intracerebral EEG. We examined the internodular FC using fMRI and its correspondence with internodular synchrony of intracerebral interictal activity. We then compared the spreading speed of ictal activity between connected and unconnected nodules; and the FC among possible combinations of nodule pairs in terms of their involvement at seizure onset. Results Seventy nodules were studied: 83% have significant connection to at least one other nodule. Among the 49 pairs studied with intracerebral EEG, (1) synchronized interictal activity is more prevalent in fMRI‐connected pairs (P < 0.05), (2) ictal activity spreads faster between connected pairs (P < 0.0001), and (3) stronger FC was observed between pairs in which both nodules were involved at seizure onset (P < 0.01). Interpretation fMRI could reliably and noninvasively detect the FC between heterotopic nodules. These functional connections correspond to the synchrony of interictal epileptic activity between the nodules and to the ability of nodules to generate synchronous seizure onsets or rapid seizure spread. These findings may help in understanding the complexity of the epileptogenic network in multiple heterotopic nodules and better targeting the likely epileptogenic nodules.
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Affiliation(s)
- Hui Ming Khoo
- Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada.,Department of Neurosurgery Osaka University Graduate School of Medicine Suita Japan
| | | | - Natalja Zazubovits
- Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Jeffery A Hall
- Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - François Dubeau
- Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Jean Gotman
- Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
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17
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Nune G, Arcot Desai S, Razavi B, Agostini MA, Bergey GK, Herekar AA, Hirsch LJ, Lee RW, Rutecki PA, Srinivasan S, Van Ness PC, Tcheng TK, Morrell MJ. Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings. Clin Neurophysiol 2019; 130:1196-1207. [PMID: 31163364 DOI: 10.1016/j.clinph.2019.04.706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/11/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Describe changes in clinical seizure frequency and electrophysiological data recorded in patients with medically-intractable seizures and periventricular nodular heterotopias (PVNH) treated with the RNS® System (NeuroPace, Inc., Mountain View, CA). METHODS Clinical seizures from eight patients (mean follow-up of 10.1 years) were analyzed pre- and post-treatment. Chronic ambulatory electrocorticograms (ECoGs) recorded from PVNHs, hippocampus and neocortex were evaluated to identify the earliest electrographic seizure onset type, pattern of spread, and interictal characteristics. RESULTS Mean reduction in disabling seizures was 85.7 % (n = 8); seven patients had >50% seizure reduction and two were seizure-free in the final year of analysis. Seizure rate showed a progressive reduction over the course of the study with the highest rate of improvement in the first two to three years after implantation. Four of seven patients with one PVNH lead and a second lead in the hippocampus or neocortex had some electrographic seizures first recorded at either lead location, suggesting two foci or seizure propagation patterns. Low voltage fast type activity was the prominent seizure onset pattern. Interictal ECoG power was lower in PVNH than hippocampus. CONCLUSIONS RNS® System treatment substantially reduced clinical seizure frequency in patients with PVNH. Analysis of ictal ECoG records suggests PVNH may be involved in seizure generation. SIGNIFICANCE Chronic ECoG recordings suggest PVNH tissue can actively participate in epileptogenic networks. Direct brain-responsive neurostimulation is a safe and effective treatment option in such patients, progressively reducing seizure rate over a period of years.
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Affiliation(s)
- George Nune
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | | | | | - Mark A Agostini
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Aamr A Herekar
- University of North Texas, Medical City Fort Worth, Fort Worth, TX, USA
| | | | - Ricky W Lee
- Via Christi Epilepsy Center, Wichita, KS, USA
| | - Paul A Rutecki
- University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | | | | | | | - Martha J Morrell
- NeuroPace, Inc., Mountain View, CA, USA; Stanford University, Stanford, CA, USA
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18
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Popescu CE, Mai R, Sara R, Lizio D, Zanni D, Rossetti C, Caobelli F. The Role of FDG-PET in Patients with Epilepsy Related to Periventricular Nodular Heterotopias: Diagnostic Features and Long-Term Outcome. J Neuroimaging 2019; 29:512-520. [PMID: 31006947 DOI: 10.1111/jon.12620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Periventricular nodular heterotopias (PNHs) are frequently associated with drug-resistant epilepsy (DRE). Although magnetic resonance imaging (MRI) can define the morphological features of PNHs, still there is a need to assess their metabolic activity in order to provide useful information on epileptogenicity and long-term outcome. To that end, we investigated the ability of 18 F-FDG PET to identify seizure onset zone in order to assess the metabolic activity of the ectopic neurons and to provide prognostic information on the postsurgical outcome. METHODS Sixteen patients (6 men and 10 women; ranging between 24 and 53 years of age) with PNHs-related DRE were evaluated. All patients underwent clinical evaluation, Stereo-electroencephalogram (SEEG), brain MRI, and 18 F-FDG brain PET/CT. PET images were superimposed on the patient-specific 3-dimensional-brain MRI. The metabolic activity of each nodule and of their cortex was visually and semiquantitatively assessed. The outcome after intervention was assessed in all patients using Engel classification. RESULTS Thirty-one heterotopic sites were identified. Twenty-one of 23 nodules with detectable electric activity on SEEG were identified by PET (91.3%), while 5 of 8 of nodules without electric activity showed no metabolism on PET (62.5%). Overall, the concordance between SEEG and FDG-PET was 26/31 (83.9%). Furthermore, cortical metabolic alterations were depicted, correlating with epileptogenic areas. A favorable postsurgical outcome was reported in 13 patients (81.3%). The presence of a hypometabolic nodule significantly correlated with a worse outcome after surgical therapy (P = .036). CONCLUSIONS In PNHs-related epilepsy, FDG-PET more accurately identifies epileptogenic foci, which aids surgical planning and in postoperative seizure control.
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Affiliation(s)
| | - Roberto Mai
- Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Roberto Sara
- Nuclear Medicine Department, Niguarda Hospital, Milan, Italy
| | | | - Daniela Zanni
- Medical Physics Unit, Niguarda Hospital, Milan, Italy
| | | | - Federico Caobelli
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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19
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Steriade C, Martins W, Bulacio J, Morita-Sherman ME, Nair D, Gupta A, Bingaman W, Gonzalez-Martinez J, Najm I, Jehi L. Localization yield and seizure outcome in patients undergoing bilateral SEEG exploration. Epilepsia 2018; 60:107-120. [PMID: 30588603 DOI: 10.1111/epi.14624] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aimed to determine the rates and predictors of resection and seizure freedom after bilateral stereo-electroencephalography (SEEG) implantation. METHODS We reviewed 184 patients who underwent bilateral SEEG implantation (2009-2015). Noninvasive and invasive evaluation findings were collected. Outcomes of interest included subsequent resection and seizure freedom. Statistical analyses employed multivariable logistic regression and proportional hazard modeling. Preoperative and postoperative seizure frequency, severity, and quality of life scales were also compared. RESULTS Following bilateral SEEG implantation, 106 of 184 patients (58%) underwent resection. Single seizure type (P = 0.007), a family history of epilepsy (P = 0.003), 10 or more seizures per month (P = 0.004), lower number of electrodes (P = 0.02), or sentinel electrode placement (P = 0.04) was predictive of undergoing a resection, as were lack of nonlocalized (P < 0.0001) or bilateral (P < 0.0001) ictal-onset zones on SEEG. Twenty-six of 81 patients (32% with follow-up greater than 1 year) remained seizure-free. Predictors of seizure freedom were single seizure type (P = 0.01), short epilepsy duration (P = 0.008), use of 2 or fewer antiepileptic drugs (AEDs) at the time of surgery (P = 0.0006), primary localization hypothesis involving the frontal lobe (P = 0.002), sentinel electrode placement only (P = 0.02), and lack of overlap between ictal-onset zone and eloquent cortex (P = 0.04), along with epilepsy substrate histopathology (P = 0.007). Complete resection of a suspected focal cortical dysplasia showed a trend to increased likelihood of seizure freedom (P = 0.09). The 44 of 55 patients (80%) who underwent resection and experienced seizure recurrence had >50% seizure reduction, as opposed to 26 of 45 patients (58%) who continued medical therapy alone (P = 0.003). Seventy-two percent of patients had a clinically meaningful quality of life improvement (>10% decrease in the Quality of Life in Epilepsy [QOLIE-10] score) at 1 year. SIGNIFICANCE A strong preimplantation hypothesis of a suspected unifocal epilepsy increases the odds of resection and seizure freedom. We discuss a tailored approach, taking into account localization hypothesis and suspected epilepsy etiology in guiding implantation and subsequent surgical strategy.
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Affiliation(s)
- Claude Steriade
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - William Martins
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio.,Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas, Porto Alegre, Brazil
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajay Gupta
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
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20
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Cvetkovska E, Martins WA, Gonzalez-Martinez J, Taylor K, Li J, Grinenko O, Mosher J, Leahy R, Chauvel P, Nair D. Heterotopia or overlaying cortex: What about in-between? EPILEPSY & BEHAVIOR CASE REPORTS 2018; 11:4-9. [PMID: 30456171 PMCID: PMC6232626 DOI: 10.1016/j.ebcr.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
We describe a patient with unilateral periventricular nodular heterotopia (PNH) and drug-resistant epilepsy, whose SEEG revealed that seizures were arising from the PNH, with the almost simultaneous involvement of heterotopic neurons ("micronodules") scattered within the white matter, and subsequently the overlying cortex. Laser ablation of heterotopic nodules and the adjacent white matter rendered the patient seizure free. This case elucidates that "micronodules" scattered in white matter between heterotopic nodules and overlying cortex might be another contributor in complex epileptogenicity of heterotopia. Detecting patient-specific targets in the epileptic network of heterotopia creates the possibility to disrupt the pathological circuit by minimally invasive procedures.
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Affiliation(s)
- Emilija Cvetkovska
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000, Skopje, Macedonia,Corresponding author at: University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000, Skopje, Macedonia.
| | - William Alves Martins
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,Service of Neurology, Hospital São Lucas, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jorge Gonzalez-Martinez
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,Department of Neurosurgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Ken Taylor
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jian Li
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - Olesya Grinenko
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - John Mosher
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,Department of Neurology, University of Texas, Huston, TX, USA
| | - Richard Leahy
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - Patrick Chauvel
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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21
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Panigrahi M, Vooturi S, Vadapalli R, Somayajula S, Madigubba S, Jayalakshmi S. Predictors of outcome of surgery in adults with mesial lesional temporal lobe epilepsy. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.ijep.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Background We report the clinical characteristics and outcome of epilepsy surgery in adult patients with intractable epilepsy due to isolated lesional temporal lobe epilepsy (TLE).
Methods Retrospective analysis of clinical and outcome characteristics in 47 consecutive adult patients with intractable epilepsy due to isolated lesional TLE who underwent epilepsy surgery from November 2009 to January 2015 was done to predictors of outcome.
Results The mean age at surgery of the study population was 30.74 ± 10.85 years with 20 (43.5%) women. While the average age at onset of epilepsy was 20.12 ± 12.52 years, average duration of epilepsy was 10.78 ± 7.96 years. Favourable Engels outcome was observed in 39 (84.8%) of the patients. Findings on histopathology reported glioma in 24 (52.0%) of the patients. On comparing patients with favourable outcome (n = 39) with those with unfavourable outcome (n = 7), age at surgery was significantly higher in patients with unfavourable outcome (40.14 ± 11.69 years vs 29.05 ± 9.92 years; p = 0.011). Higher percentage of patients with unfavourable outcome scored poor on pre-surgical IQ tests (42.9% vs 7.7%; p = 0.037). On further analysis for predictors of outcome, age at surgery (β = 0.858; 95% CI 0.738–0.997) significantly predicts outcome (β = 1.166; 95% CI 0.931–1.461; p = 0.182), whereas pre-surgical poor IQ showed a trend towards being associated with unfavourable outcome (β = 0.079; 95% CI 0.005–1.287; p = 0.075).
Conclusion Surgery for intractable epilepsy due to isolated lesional TLE has favourable outcome in vast majority (84.8%) of carefully selected patients. Age at surgery predicts outcome in these patients.
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Affiliation(s)
- Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad 03, Telangana, India
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad 03, Telangana, India
| | | | - Shanmukhi Somayajula
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad 03, Telangana, India
| | - Sailaja Madigubba
- Department of Pathology, Krishna Institute of Medical Sciences, Secunderabad 03, Telangana, India
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad 03, Telangana, India
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22
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Stefan H, Schmitt FC. Epileptogenicity and pathology - Under consideration of ablative approaches. Epilepsy Res 2018; 142:109-112. [PMID: 29609992 DOI: 10.1016/j.eplepsyres.2018.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 03/12/2018] [Accepted: 03/25/2018] [Indexed: 11/27/2022]
Abstract
Besides resective epilepsy surgery, minimally invasive ablation using new diagnostic and therapeutic techniques recently became available. Optimal diagnostic approaches for these treatment options are discussed. The pathophysiology of epileptogenic networks differs depending on the lesion-types and location, requiring a differential use of non-invasive or invasive functional studies. In addition to the definition of epileptogenic zones, a challenge for pre-surgical investigation is the determination of three-dimensional epileptic networks to be removed.
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Affiliation(s)
- H Stefan
- Department of Neurology - Biomagnetism, University Hospital Erlangen, 10, Schwabachanlage, 91054 Erlangen, Germany.
| | - F C Schmitt
- Department of Neurology, University Hospital Magdeburg, Germany
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23
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Pizzo F, Roehri N, Catenoix H, Medina S, McGonigal A, Giusiano B, Carron R, Scavarda D, Ostrowsky K, Lepine A, Boulogne S, Scholly J, Hirsch E, Rheims S, Bénar CG, Bartolomei F. Epileptogenic networks in nodular heterotopia: A stereoelectroencephalography study. Epilepsia 2017; 58:2112-2123. [DOI: 10.1111/epi.13919] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Francesca Pizzo
- Inserm; Institut de Neurosciences des Systèmes (INS); Aix Marseille Univ; Marseille France
| | - Nicolas Roehri
- Inserm; Institut de Neurosciences des Systèmes (INS); Aix Marseille Univ; Marseille France
| | - Hélène Catenoix
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon (Lyon University Hospital); Hospital for Neurology and Neurosurgery Pierre Wertheimer; Lyon France
| | - Samuel Medina
- Inserm; Institut de Neurosciences des Systèmes (INS); Aix Marseille Univ; Marseille France
| | - Aileen McGonigal
- Inserm; Institut de Neurosciences des Systèmes (INS); Aix Marseille Univ; Marseille France
- Clinical Neurophysiology; APHM; Timone Hospital; Marseille France
| | - Bernard Giusiano
- Inserm; Institut de Neurosciences des Systèmes (INS); Aix Marseille Univ; Marseille France
| | - Romain Carron
- Inserm; Institut de Neurosciences des Systèmes (INS); Aix Marseille Univ; Marseille France
- Functional and Stereotactic Neurosurgery; APHM; Timone Hospital; Marseille France
| | - Didier Scavarda
- Inserm; Institut de Neurosciences des Systèmes (INS); Aix Marseille Univ; Marseille France
- Functional and Stereotactic Neurosurgery; APHM; Timone Hospital; Marseille France
| | - Karine Ostrowsky
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon (Lyon University Hospital); Hospital for Neurology and Neurosurgery Pierre Wertheimer; Lyon France
| | - Anne Lepine
- Pediatric Neurology Department; Timone Hospital; APHM; Marseille France
| | - Sébastien Boulogne
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon (Lyon University Hospital); Hospital for Neurology and Neurosurgery Pierre Wertheimer; Lyon France
| | - Julia Scholly
- Medical and Surgical Epilepsy Unit; Hautepierre Hospital; University of Strasbourg; Strasbourg France
| | - Edouard Hirsch
- Medical and Surgical Epilepsy Unit; Hautepierre Hospital; University of Strasbourg; Strasbourg France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon (Lyon University Hospital); Hospital for Neurology and Neurosurgery Pierre Wertheimer; Lyon France
| | - Christian-George Bénar
- Inserm; Institut de Neurosciences des Systèmes (INS); Aix Marseille Univ; Marseille France
| | - Fabrice Bartolomei
- Inserm; Institut de Neurosciences des Systèmes (INS); Aix Marseille Univ; Marseille France
- Clinical Neurophysiology; APHM; Timone Hospital; Marseille France
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Mirandola L, Mai RF, Francione S, Pelliccia V, Gozzo F, Sartori I, Nobili L, Cardinale F, Cossu M, Meletti S, Tassi L. Stereo-EEG: Diagnostic and therapeutic tool for periventricular nodular heterotopia epilepsies. Epilepsia 2017; 58:1962-1971. [DOI: 10.1111/epi.13895] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Laura Mirandola
- Department of Biomedical, Metabolic, and Neural Sciences; University of Modena and Reggio Emilia; Modena Italy
| | - Roberto F. Mai
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Stefano Francione
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Veronica Pelliccia
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
- Department of Neuroscience; University of Parma; Parma Italy
| | - Francesca Gozzo
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Ivana Sartori
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Lino Nobili
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | | | - Massimo Cossu
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences; University of Modena and Reggio Emilia; Modena Italy
| | - Laura Tassi
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
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Cossu M, Mirandola L, Tassi L. RF-ablation in periventricular heterotopia-related epilepsy. Epilepsy Res 2017; 142:121-125. [PMID: 28705474 DOI: 10.1016/j.eplepsyres.2017.07.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/24/2017] [Accepted: 07/01/2017] [Indexed: 11/27/2022]
Abstract
Drug-resistant focal epilepsy is a common occurrence in patients with gray matter nodular heterotopia (NH), and surgical treatment is often considered in these cases. NH-related epileptogenicity is sustained by complex networks, which may involve the nodules and extralesional cortex in various combinations. Therefore, invasive EEG is usually required to identify the structures involved in seizure generation. It has been reported that surgery may be effective in cases with unilateral lesions, whereas bilateral cases are not optimal candidates for surgical success. Furthermore, violation of cortical and subcortical structures for approaching deep-seated nodules may result in neurological deficits. For these reasons, selective stereotactic ablation with radiofrequency thermocoagulation (RFTC) has been proposed as an alternative option in these patients. In particular, RFTC may be performed by using the same recording intracerebral electrodes implanted for stereo-electro-encephalo-graphy (SEEG) monitoring, with the advantage of a reliable electro-clinical guide. Excellent results on seizures have been initially reported following coagulation of single, unilateral NH. Subsequent experience has indicated that, basing on the evidence of SEEG recording, promising results may be obtained also in more extended unilateral and bilateral cases. In more complex cases, coagulation of both the nodules and of the involved extralesional cortical structures is often required. In a recently reported series, 67% of patients experienced sustained seizure freedom after the procedure. However, post RFTC seizure outcome in complex cases (NH plus other malformations of cortical development) is not as good as in other patterns of NH. RFTC, especially if guided by SEEG evaluation, should be considered as a first-line treatment option in NH-related epilepsy. Satisfactory results may be obtained also in cases not amenable to traditional surgery. The procedure is safe and does not prevent eventual resective surgery in case of failure in seizure control. For these reasons, in patients undergoing SEEG evaluation, electrode arrangement should be planned with the aim to cover as extensively as possible the heterotopic and extralesional areas, which will presumably be the targets of RFTC.
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Affiliation(s)
- Massimo Cossu
- Epilepsy Surgery Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Laura Mirandola
- Epilepsy Surgery Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Laura Tassi
- Epilepsy Surgery Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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Polster T, Schulz R, Woermann FG, Bernhard MK, Schmitt FC, Büntjen L, Voges J. Thermoablation bei nodulären Heterotopien. ZEITSCHRIFT FUR EPILEPTOLOGIE 2017. [DOI: 10.1007/s10309-017-0107-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Intracranial evaluation and laser ablation for epilepsy with periventricular nodular heterotopia. Seizure 2016; 41:211-6. [DOI: 10.1016/j.seizure.2016.06.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/11/2016] [Accepted: 06/23/2016] [Indexed: 11/13/2022] Open
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Double Inversion Recovery Magnetic Resonance Imaging in Identifying Focal Cortical Dysplasia. Pediatr Neurol 2016; 61:87-93. [PMID: 27241231 DOI: 10.1016/j.pediatrneurol.2016.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/26/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Focal cortical dysplasia is commonly recognized in pediatric epilepsy surgery. Despite characteristic radiographic features, focal cortical dysplasia can be subtle on magnetic resonance imaging. Double inversion recovery acquisition suppresses the white matter signal, which may enhance visualization of abnormal features at the gray-white matter interface. We assessed the ability of double inversion recovery to distinguish focal cortical dysplasia from periventricular nodular heterotopia and normal brain. METHODS Patients with focal cortical dysplasia were identified from our patient database, as was a control group comprising patients with periventricular nodular heterotopia and healthy persons. A senior neuroradiologist reviewed all clinical images and classified them as patients with focal cortical dysplasia (n = 16) or control subjects (periventricular nodular heterotopia, n = 13; normal, n = 20). Four neuroradiologists reviewed the de-identified and randomized double inversion recovery and magnetization prepared rapid acquired gradient echoes (MPRAGE) sequences for each person and scored them as normal, focal cortical dysplasia, or periventricular nodular heterotopia. RESULTS Among individual reviewers, double inversion recovery showed sensitivity from 50% to 88% and specificity from 67% to 91% in detecting focal cortical dysplasia. The sensitivity was notably higher in reviewers with more clinical experience with the technique. Consensus agreement among the three most experienced reviewers gave a sensitivity of 88% (95% confidence interval [CI], 72% to 97%) and specificity of 88% (95% CI, 62% to 98%) for double inversion recovery and sensitivity of 44% (95% CI, 20% to 70%) and specificity of 100% (95% CI, 89% to 100%) for MPRAGE. CONCLUSIONS Double inversion recovery is sensitive for detection of focal cortical dysplasia with experienced users, particularly when there is consensus agreement. The use of two clinically available magnetic resonance imaging acquisitions-double inversion recovery and another sequence with high specificity such as MPRAGE-would be complementary in the evaluation of lesional epilepsy.
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Fallil Z, Pardoe H, Bachman R, Cunningham B, Parulkar I, Shain C, Poduri A, Knowlton R, Kuzniecky R. Phenotypic and imaging features of FLNA-negative patients with bilateral periventricular nodular heterotopia and epilepsy. Epilepsy Behav 2015; 51:321-7. [PMID: 26340046 PMCID: PMC4594191 DOI: 10.1016/j.yebeh.2015.07.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE Periventricular nodular heterotopia (PVNH) is a malformation of cortical development due to impaired neuronal migration resulting in the formation of nodular masses of neurons and glial cells in close proximity to the ventricular walls. We report the clinical characteristics of the largest case series of FLNA-negative patients with seizures and bilateral periventricular heterotopia. METHODS Participants were recruited through the Epilepsy Phenome/Genome Project (EPGP), a multicenter collaborative effort to collect detailed phenotypic data and DNA on a large number of individuals with epilepsy, including a cohort with symptomatic epilepsy related to PVNH. Included subjects had epilepsy, and MRI confirmed bilateral PVNH. Magnetic resonance imaging studies were visually and quantitatively reviewed to investigate the topographic extent of PVNH, symmetry, and laterality. KEY FINDINGS We analyzed data on 71 patients with bilateral PVNH. The incidence of febrile seizures was 16.6%. There was at least one other family member with epilepsy in 36.9% of this population. Developmental delay was present in 21.8%. Focal onset seizures were the most common type of seizure presentation (79.3%). High heterotopia burden was strongly associated with female gender and trigonal nodular localization. There was no evidence for differences in brain volume between PVNH subjects and controls. No relationship was observed between heterotopic volume and gender, developmental delay, location of PVNH, ventricular or cerebellar abnormalities, laterality of seizure onset, age at seizure onset, and duration of epilepsy. SIGNIFICANCE A direct correlation was observed between high heterotopia burden, female gender, and trigonal location in this large cohort of FLNA-negative bilateral PVNH patients with epilepsy. Quantitative MRI measurements indicated that this correlation is based on the diffuse nature of the heterotopic nodules rather than on the total volume of abnormal heterotopic tissue.
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Affiliation(s)
- Zianka Fallil
- NYU Epilepsy Center, Langone Medical Center, New York University, New York, NY, USA
| | - Heath Pardoe
- NYU Epilepsy Center, Langone Medical Center, New York University, New York, NY, USA
| | - Robert Bachman
- NYU Epilepsy Center, Langone Medical Center, New York University, New York, NY, USA
| | - Benjamin Cunningham
- NYU Epilepsy Center, Langone Medical Center, New York University, New York, NY, USA
| | - Isha Parulkar
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Catherine Shain
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | | | - Ruben Kuzniecky
- NYU Epilepsy Center, Langone Medical Center, New York University, New York, NY, USA.
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Shafi MM, Vernet M, Klooster D, Chu CJ, Boric K, Barnard ME, Romatoski K, Westover MB, Christodoulou JA, Gabrieli JDE, Whitfield-Gabrieli S, Pascual-Leone A, Chang BS. Physiological consequences of abnormal connectivity in a developmental epilepsy. Ann Neurol 2015; 77:487-503. [PMID: 25858773 DOI: 10.1002/ana.24343] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/26/2014] [Accepted: 12/07/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Many forms of epilepsy are associated with aberrant neuronal connections, but the relationship between such pathological connectivity and the underlying physiological predisposition to seizures is unclear. We sought to characterize the cortical excitability profile of a developmental form of epilepsy known to have structural and functional connectivity abnormalities. METHODS We employed transcranial magnetic stimulation (TMS) with simultaneous electroencephalographic (EEG) recording in 8 patients with epilepsy from periventricular nodular heterotopia and matched healthy controls. We used connectivity imaging findings to guide TMS targeting and compared the evoked responses to single-pulse stimulation from different cortical regions. RESULTS Heterotopia patients with active epilepsy demonstrated a relatively augmented late cortical response that was greater than that of matched controls. This abnormality was specific to cortical regions with connectivity to subcortical heterotopic gray matter. Topographic mapping of the late response differences showed distributed cortical networks that were not limited to the stimulation site, and source analysis in 1 subject revealed that the generator of abnormal TMS-evoked activity overlapped with the spike and seizure onset zone. INTERPRETATION Our findings indicate that patients with epilepsy from gray matter heterotopia have altered cortical physiology consistent with hyperexcitability, and that this abnormality is specifically linked to the presence of aberrant connectivity. These results support the idea that TMS-EEG could be a useful biomarker in epilepsy in gray matter heterotopia, expand our understanding of circuit mechanisms of epileptogenesis, and have potential implications for therapeutic neuromodulation in similar epileptic conditions associated with deep lesions.
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Affiliation(s)
- Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Comprehensive Epilepsy Center, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Barba C, Parrini E, Coras R, Galuppi A, Craiu D, Kluger G, Parmeggiani A, Pieper T, Schmitt-Mechelke T, Striano P, Giordano F, Blumcke I, Guerrini R. Co-occurring malformations of cortical development and SCN1A gene mutations. Epilepsia 2014; 55:1009-19. [PMID: 24902755 DOI: 10.1111/epi.12658] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report on six patients with SCN1A mutations and malformations of cortical development (MCDs) and describe their clinical course, genetic findings, and electrographic, imaging, and neuropathologic features. METHODS Through our database of epileptic encephalopathies, we identified 120 patients with SCN1A mutations, of which 4 had magnetic resonance imaging (MRI) evidence of MCDs. We collected two further similar observations through the European Task-force for Epilepsy Surgery in Children. RESULTS The study group consisted of five males and one female (mean age 7.4 ± 5.3 years). All patients exhibited electroclinical features consistent with the Dravet syndrome spectrum, cognitive impairment, and autistic features. Sequencing analysis of the SCN1A gene detected two missense, two truncating, and two splice-site mutations. Brain MRI revealed bilateral periventricular nodular heterotopia (PNH) in two patients and focal cortical dysplasia (FCD) in three, and disclosed no macroscopic abnormality in one. In the MRI-negative patient, neuropathologic study of the whole brain performed after sudden unexpected death in epilepsy (SUDEP), revealed multifocal micronodular dysplasia in the left temporal lobe. Two patients with FCD underwent epilepsy surgery. Neuropathology revealed FCD type IA and type IIA. Their seizure outcome was unfavorable. All four patients with FCD exhibited multiple seizure types, which always included complex partial seizures, the area of onset of which co-localized with the region of structural abnormality. SIGNIFICANCE MCDs and SCN1A gene mutations can co-occur. Although epidemiology does not support a causative role for SCN1A mutations, loss or impaired protein function combined with the effect of susceptibility factors and genetic modifiers of the phenotypic expression of SCN1A mutations might play a role. MCDs, particularly FCD, can influence the electroclinical phenotype in patients with SCN1A-related epilepsy. In patients with MCDs and a history of polymorphic seizures precipitated by fever, SCN1A gene testing should be performed before discussing any epilepsy surgery option, due to the possible implications for outcome.
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Affiliation(s)
- Carmen Barba
- Pediatric Neurology Unit and Laboratories, Children's Hospital Meyer-University of Florence, Florence, Italy
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Cossu M, Fuschillo D, Cardinale F, Castana L, Francione S, Nobili L, Lo Russo G. Stereo-EEG-guided radio-frequency thermocoagulations of epileptogenic grey-matter nodular heterotopy. J Neurol Neurosurg Psychiatry 2014; 85:611-7. [PMID: 23853139 DOI: 10.1136/jnnp-2013-305514] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To retrospectively evaluate seizure outcome in a case-series of patients with nodular heterotopy (NH)-related epilepsy treated by stereo-EEG (SEEG)-guided radio-frequency thermocoagulation (RF-THC) of the NH. METHODS Five patients (three male, age 5-33 years) with drug-resistant focal epilepsy presented a single NH at brain MRI. Following video-EEG monitoring, patients underwent SEEG recording to better identify the epileptogenic zone. All patients received RF-THC of the NH, using contiguous contacts of the electrodes employed for recording. The contacts for RF-THC lesions were chosen according to anatomical (intranodular position) and electrical (intranodular ictal low-voltage fast activity) criteria. RESULTS At SEEG recordings, ictal discharge originated from the NH alone in three cases and from the NH and ipsilateral hippocampus in one case. In the remaining case, different sites of ictal onset, including the NH, were identified within the left frontal lobe. No adverse effects related to the RF-THC procedures were observed, apart from a habitual seizure that occurred during coagulation in one patient. Postprocedural sustained seizure freedom was detected in four cases (mean follow-up 33.5 months). In the case with left frontal multifocal ictal activity, RF-THC of the NH provided no benefit on seizures, and the patient is seizure-free after left frontal lobe resection. CONCLUSIONS SEEG-guided RF-THC proved to be a safe and effective option in our small case-series of NH-related focal epilepsy. The indications to this treatment were strictly dependent on findings of intracerebral recording by SEEG, which can define the role of the NH in the generation of the ictal discharge.
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Affiliation(s)
- Massimo Cossu
- Department of Neurosciences, 'C. Munari' Epilepsy Surgery Centre, Ospedale Niguarda Ca' Granda, , Milano, Italy
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Esquenazi Y, Kalamangalam GP, Slater JD, Knowlton RC, Friedman E, Morris SA, Shetty A, Gowda A, Tandon N. Stereotactic laser ablation of epileptogenic periventricular nodular heterotopia. Epilepsy Res 2014; 108:547-54. [PMID: 24518890 DOI: 10.1016/j.eplepsyres.2014.01.009] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/09/2013] [Accepted: 01/14/2014] [Indexed: 11/27/2022]
Abstract
Periventricular nodular heterotopia (PVNH) is a neuronal migrational disorder often associated with pharmacoresistant epilepsy (PRE). Resective surgery for PVNH is limited by its deep location, and the overlying eloquent cortex or white matter. Stereotactic MR guided laser interstitial thermal therapy (MRgLITT) has recently become available for controlled focal ablation, enabling us to target these lesions. We here demonstrate the novel application and techniques for the use of MRgLITT in the management of PVNH epilepsy. Comprehensive presurgical evaluation, including intracranial EEG monitoring in two patients revealed the PVNH to be crucially involved in their PRE. We used MRgLITT to maximally ablate the PVNH in both cases. In the first case, seizure medication adjustment coupled with PVNH ablation, and in the second, PVNH ablation in addition to temporal lobectomy rendered the patient seizure free. A transient visual deficit occurred following ablation in the second patient. MRgLITT is a promising minimally invasive technique for ablation of epileptogenic PVNH, a disease not generally viewed as surgically treatable epilepsy. We also show here the feasibility of applying this technique through multiple trajectories and to create lesions of complex shapes. The broad applicability and long term efficacy of MRgLITT need to be elaborated further.
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Affiliation(s)
- Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Giridhar P Kalamangalam
- Department of Neurology, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Jeremy D Slater
- Department of Neurology, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Robert C Knowlton
- Department of Neurology, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Elliott Friedman
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Saint-Aaron Morris
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | | | | | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA; Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, USA.
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Pseudotemporal Ictal Patterns Compared With Mesial and Neocortical Temporal Ictal Patterns. J Clin Neurophysiol 2013; 30:238-46. [DOI: 10.1097/wnp.0b013e3182872f70] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mandelstam SA, Leventer RJ, Sandow A, McGillivray G, van Kogelenberg M, Guerrini R, Robertson S, Berkovic SF, Jackson GD, Scheffer IE. Bilateral posterior periventricular nodular heterotopia: a recognizable cortical malformation with a spectrum of associated brain abnormalities. AJNR Am J Neuroradiol 2013; 34:432-8. [PMID: 23348762 DOI: 10.3174/ajnr.a3427] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Bilateral posterior PNH is a distinctive complex malformation with imaging features distinguishing it from classic bilateral PNH associated with FLNA mutations. The purpose of this study was to define the imaging features of posterior bilateral periventricular nodular heterotopia and to determine whether associated brain malformations suggest specific subcategories. MATERIALS AND METHODS We identified a cohort of 50 patients (31 females; mean age, 13 years) with bilateral posterior PNH and systematically reviewed and documented associated MR imaging abnormalities. Patients were negative for mutations of FLNA. RESULTS Nodules were often noncontiguous (n = 28) and asymmetric (n = 31). All except 1 patient showed associated developmental brain abnormalities involving a spectrum of posterior structures. A range of posterior fossa abnormalities affected the cerebellum, including cerebellar malformations and posterior fossa cysts (n = 38). Corpus callosum abnormalities (n = 40) ranged from mild dysplasia to agenesis. Posterior white matter volume was decreased (n = 22), and colpocephaly was frequent (n = 26). Most (n = 40) had associated cortical abnormalities ranging from minor to major (polymicrogyria), typically located in the cortex overlying the PNH. Abnormal Sylvian fissure morphology was common (n = 27), and hippocampal abnormalities were frequent (n = 37). Four family cases were identified-2 with concordant malformation patterns and 2 with discordant malformation patterns. CONCLUSIONS The associations of bilateral posterior PNH encompass a range of abnormalities involving brain structures inferior to the Sylvian fissures. We were unable to identify specific subgroups and therefore conceptualize bilateral posterior PNH as a continuum of infrasylvian malformations involving the posterior cerebral and hindbrain structures.
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Pascher B, Kröll J, Mothersill I, Krämer G, Huppertz HJ. Automated morphometric magnetic resonance imaging analysis for the detection of periventricular nodular heterotopia. Epilepsia 2013; 54:305-13. [DOI: 10.1111/epi.12054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wu C, Sperling MR, Falowski SM, Chitale AV, Werner-Wasik M, Evans JJ, Andrews DW, Sharan AD. Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients. EPILEPSY & BEHAVIOR CASE REPORTS 2012; 1:1-6. [PMID: 25688044 PMCID: PMC4150677 DOI: 10.1016/j.ebcr.2012.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 10/06/2012] [Indexed: 11/26/2022]
Abstract
Periventricular heterotopia (PVH) is a neuronal migration disorder characterized by masses of gray matter located along the lateral ventricles that commonly cause epilepsy. The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges. Noninvasive modalities of ablating this epileptogenic focus must therefore be considered. We present a small series of three patients who underwent stereotactic radiosurgery (SRS) for inoperable unilateral dominant hemisphere PVHs in order to illustrate the potential benefits and risks of this treatment modality. A total dose of 37.5–65 Gy resulted in seizure freedom for at least 14 months at the time of their last follow-up, even in patients harboring a second independent epileptic focus. Whether intracranial electrode recording truly offers added value is therefore uncertain. The two patients who received higher radiation doses suffered from symptomatic radiation necrosis and associated cerebral edema, requiring further medical intervention, and persistent monocular visual loss in one patient. While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission. Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.
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Affiliation(s)
- Chengyuan Wu
- Thomas Jefferson University Hospitals, Department of Neurological Surgery, 909 Walnut Street, Third Floor, Philadelphia, PA, USA
| | - Michael R Sperling
- Thomas Jefferson University, Department of Neurology, Philadelphia, PA, USA
| | - Steven M Falowski
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - Ameet V Chitale
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - Maria Werner-Wasik
- Thomas Jefferson University, Department of Radiation Oncology, Philadelphia, PA, USA
| | - James J Evans
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - David W Andrews
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - Ashwini D Sharan
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
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Abstract
Structural abnormalities of the brain are increasingly recognized in patients that suffer from pharmacoresistant focal epilepsies by applying high-resolution imaging techniques. In many of these patients, epilepsy surgery results in control of seizures. Neuropathologically, a broad spectrum of malformations of cortical development (MCD) is observed in respective surgical brain samples. These samples provide a unique basis to further understand underlying pathomechanisms by molecular approaches and develop improved diagnostics and entirely new therapeutic perspectives. Here we provide a comprehensive description of neuropathological findings, available classification systems as well as molecular mechanisms of MCDs. We emphasize the recently published ILEA classification system for focal cortical dysplasias (FCDs), which are now histopathologically distinguished as types I to III. However, this revised classification system represents a major challenge for molecular neuropathologists, as the underlying pathomechanisms in virtually all FCD entities will need to be specified in detail. The fact that only recently, the mammalian target of rapamycin (mTOR)-antagonist Everolimus has been introduced as a treatment of epilepsies in the context of tuberous sclerosis-associated brain lesions is a striking example of a successful translational "bedside to bench and back" approach. Hopefully, the exciting clinico-pathological developments in the field of MCDs will in short term foster further therapeutic breakthroughs for the frequently associated medically refractory epilepsies.
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Affiliation(s)
- Eleonora Aronica
- Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, Amsterdam
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Christodoulou JA, Walker LM, Del Tufo SN, Katzir T, Gabrieli JDE, Whitfield-Gabrieli S, Chang BS. Abnormal structural and functional brain connectivity in gray matter heterotopia. Epilepsia 2012; 53:1024-32. [PMID: 22524972 PMCID: PMC3370071 DOI: 10.1111/j.1528-1167.2012.03466.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Periventricular nodular heterotopia (PNH) is a malformation of cortical development associated with epilepsy and dyslexia. Evidence suggests that heterotopic gray matter can be functional in brain malformations and that connectivity abnormalities may be important in these disorders. We hypothesized that nodular heterotopia develop abnormal connections and systematically investigated the structural and functional connectivity of heterotopia in patients with PNH. METHODS Eleven patients were studied using diffusion tensor tractography and resting-state functional connectivity MRI with bold oxygenation level-dependent (BOLD) imaging. Fiber tracks with a terminus within heterotopic nodules were visualized to determine structural connectivity, and brain regions demonstrating resting-state functional correlations to heterotopic nodules were analyzed. Relationships between these connectivity results and measures of clinical epilepsy and cognitive disability were examined. KEY FINDINGS A majority of heterotopia (69%) showed structural connectivity to discrete regions of overlying cortex, and almost all (96%) showed functional connectivity to these regions (mean peak correlation coefficient 0.61). Heterotopia also demonstrated connectivity to regions of contralateral cortex, other heterotopic nodules, ipsilateral but nonoverlying cortex, and deep gray matter structures or the cerebellum. Patients with the longest durations of epilepsy had a higher degree of abnormal functional connectivity (p = 0.036). SIGNIFICANCE Most heterotopic nodules in PNH are structurally and functionally connected to overlying cortex, and the strength of abnormal connectivity is higher among patients with the longest duration of epilepsy. Along with prior evidence that cortico-cortical tract defects underlie dyslexia in this disorder, the current findings suggest that altered connectivity is likely a critical substrate for neurologic dysfunction in brain malformations.
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Affiliation(s)
- Joanna A. Christodoulou
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA
| | - Linsey M. Walker
- Comprehensive Epilepsy Center, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Stephanie N. Del Tufo
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA
| | - Tami Katzir
- Department of Learning Disabilities, University of Haifa, Haifa, Israel
| | - John D. E. Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA
| | - Bernard S. Chang
- Comprehensive Epilepsy Center, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Affiliation(s)
- Roberto Spreafico
- Department of Research and Diagnostics, IRCCS Foundation Istituto Neurologico C. Besta, Milan, Italy.
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Acar G, Acar F, Oztura I, Baklan B. A case report of surgically treated drug resistant epilepsy associated with subependymal nodular heterotopia. Seizure 2011; 21:223-6. [PMID: 22153995 DOI: 10.1016/j.seizure.2011.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 11/11/2011] [Accepted: 11/13/2011] [Indexed: 10/14/2022] Open
Abstract
Subependymal nodular heterotopia (SNH) is a cortical development malformation that is commonly associated with medically resistant epilepsy. Cases of SNH are challenging to treat surgically because there are typically multiple nodules, which may be involved in epileptogenesis. Moreover, dual pathology may exist in these patients. Here, we present a case with unilateral subependymal heterotopic nodules associated with ipsilateral hippocampal atrophy. Invasive and non-invasive work-ups revealed that the hippocampus was the actual ictal onset zone and that the SNH was not involved. An anterior temporal lobectomy was carried out, and postoperative seizure outcome was class Ia at the end of 2 years. The case demonstrates that SNH may not play a major role in patients with dual pathology. However, direct electroencephalography (EEG) recording from areas of SNH and other possible epileptogenic regions is indispensable in defining the ictal onset zone and avoiding poor surgical outcomes.
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Affiliation(s)
- Göksemin Acar
- Pamukkale University, Department of Neurology, Denizli, Turkey.
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Tschuluun N, Jürgen Wenzel H, Doisy ET, Schwartzkroin PA. Initiation of epileptiform activity in a rat model of periventricular nodular heterotopia. Epilepsia 2011; 52:2304-14. [PMID: 21933177 DOI: 10.1111/j.1528-1167.2011.03264.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Periventricular nodular heterotopia (PNH) is, in humans, often associated with difficult-to-control epilepsy. However, there is considerable controversy about the role of the PNH in seizure generation and spread. To study this issue, we have used a rat model in which injection of methylazoxymethanol (MAM) into pregnant rat dams produces offspring with nodular heterotopia-like brain abnormalities. METHODS Electrophysiologic methods were used to examine the activity of the MAM-induced PNH relative to activity in the neighboring hippocampus and overlying neocortex. Recordings were obtained simultaneously from these three structures in slice preparations from MAM-exposed rats and in intact animals. Bath application or systemic injection of bicuculline was used to induce epileptiform activity. KEY FINDINGS In the in vitro slice, epileptiform discharge was generally initiated in hippocampus. In some cases, independent PNH discharge occurred, but the PNH never "led" discharges in hippocampus or neocortex. Intracellular recordings from PNH neurons confirmed that these cells received synaptic drive from both hippocampus and neocortex, and sent axonal projections to these structures-consistent with anatomic observations of biocytin-injected PNH cells. In intact animal preparations, bicuculline injection resulted in epileptiform discharge in all experiments, with a period of ictal-like electrographic activity typically initiated within 2-3 min after drug injection. In almost all animals, the onset of ictus was seen synchronously across PNH, hippocampal, and neocortical electrodes; in a few cases, the PNH electrode (histologically confirmed) did not participate, but in no case was activity initiated in the PNH electrode. Interictal discharge was also synchronized across all three electrodes; again, the PNH never "led" the other two electrodes, and typically followed (onset several milliseconds after hippocampal/neocortical discharge onset). SIGNIFICANCE These results do not support the hypothesis that the PNH lesion is the primary epileptogenic site, since it does not initiate or lead epileptiform activity that subsequently propagates to other brain regions.
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Affiliation(s)
- Naranzogt Tschuluun
- Department of Neurological Surgery, University of California-Davis, Davis, California 95616, USA
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Schmitt FC, Voges J, Buentjen L, Woermann F, Pannek HW, Skalej M, Heinze HJ, Ebner A. Radiofrequency lesioning for epileptogenic periventricular nodular heterotopia: A rational approach. Epilepsia 2011; 52:e101-5. [DOI: 10.1111/j.1528-1167.2011.03116.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Malformations of Cortical Development and Aberrant Cortical Networks: Epileptogenesis and Functional Organization. J Clin Neurophysiol 2010; 27:372-9. [DOI: 10.1097/wnp.0b013e3181fe0585] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mullin JP, Van Gompel JJ, Lee KH, Meyer FB, Stead M. Surgically treated movement disorders associated with heterotopia: report of 2 cases. J Neurosurg Pediatr 2010; 6:267-72. [PMID: 20809711 DOI: 10.3171/2010.5.peds10220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Heterotopic gray matter has been implicated in epilepsy; however, not much is known regarding heterotopia beyond epilepsy. Here, the authors describe 2 pediatric patients with deep heterotopias contiguous with basal ganglia structures. These heterotopias appear to have manifested as movement disorders. One patient presented with a left-sided myoclonus and choreiform movements associated with a right caudate heterotopia; she experienced vast improvement after resection of periventricular heterotopia. The other patient presented with progressive dystonia and a ballistic movement disorder. Initial bilateral globus pallidus internus stimulation resulted in successful treatment of the dystonia; however, her movement disorder worsened. After an extensive workup, including STATISCOM (statistical ictal SPECT coregistered to MR imaging), the patient underwent cortical stimulation with improvement in her movement disorder. To the best of our knowledge, these cases are the first reported instances of heterotopic gray matter associated with movement disorders. Both patients experienced significant improvements following resection of their heterotopias.
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Affiliation(s)
- Jeffrey P Mullin
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
Electroclinical, MRI, and Neuropathological Study of 10 Patients with Nodular Heterotopia, with Surgical Outcomes Tassi L, Colombo N, Cossu M, Mai R, Francione S, Lo Russo G, Galli C, Bramerio M, Battaglia G, Garbelli R, Meroni A, Spreafico R Brain 2005;128:321–337 We present the results of a retrospective study on 10 patients operated on for intractable epilepsy associated with nodular heterotopia, as identified by high-resolution MRI. Seven patients had unilateral heterotopia, one patient had symmetrical bilateral heterotopia, and two patients had asymmetrical bilateral heterotopia. By stereoelectroencephalogram (SEEG; nine patients), interictal activity within nodules was similar in all cases, and ictal activity never started from nodules alone but from the overlying cortex or simultaneously in nodules and cortex. Excellent outcomes (Engel class Ia, 1987) were achieved in the seven patients with unilateral heterotopia, showing that surgery can be highly beneficial in such cases when the epileptogenic zone is carefully located before surgery by MRI and particularly SEEG. For the bilateral cases, surgical outcomes were Engel IIa (one patient) or Engel IIIa (two patients). Histologic/immunohistochemical studies of resected specimens showed that all nodules had similar microscopic organization, even though their extent and location varied markedly. The overlying cortex was dysplastic in nine patients, but of normal thickness. We suggest that nodule formation may be the result of a dual mechanism: ( 1 ) failure of a stop signal in the germinal periventricular region leading to cell overproduction; and ( 2 ) early transformation of radial glial cells into astrocytes, resulting in defective neuronal migration. The intrinsic interictal epileptiform activity of nodules may be due to an impaired intranodular GABAergic system. The Role of Periventricular Nodular Heterotopia in Epileptogenesis Aghakhani Y, Kinay D, Gotman J, Soualmi L, Andermann F, Olivier A, Dubeau F Brain 2005;128:641–651 A temporal resection in patients with periventricular nodular heterotopia (PNH) and intractable focal seizures yields poor results. To define the role of heterotopic grey matter tissue in epileptogenesis and to improve outcome, we performed stereoencephalography (SEEG) recordings in eight patients with uni- or bilateral PNH and intractable focal epilepsy. The SEEG studies aimed to evaluate the most epileptogenic areas and included the allo- and neocortex and at least one nodule of grey matter. Interictal spiking activity was found in ectopic grey matter in three patients, in the cortex overlying the nodules in five, and in the mesial temporal structures in all. At least one heterotopion was involved at seizure onset in six patients, synchronous with the overlying neocortex or ipsilateral hippocampus. Two patients had their seizures originating in the mesial temporal structures only. Six patients had surgery, and the resected areas included the seizure onset, with follow-up from 1 to 8 years. An amygdalohippocampectomy was performed in two (Engel classes Id and III), an amygdalohippocampectomy plus removal of an adjacent heterotopion in two (class Ia), and a resection of two contiguous nodules plus a small rim of overlying occipital cortex in one patient (class Id). One patient with bilateral PNH had three adjacent nodules resected and an ipsilateral amygdalohippocampectomy, resulting in a reduction of the number of seizures by 25 to 50%. The best predictor of surgical outcome is the presence of a focal epileptic generator; this generator may or may not include the PNH. Invasive recording is required in patients with PNH; it improves localization and is the key to better outcome.
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Saito Y, Sugai K, Nakagawa E, Sakuma H, Komaki H, Sasaki M, Maegaki Y, Ohno K, Sato N, Kaneko Y, Otsuki T. Treatment of epilepsy in severely disabled children with bilateral brain malformations. J Neurol Sci 2009; 277:37-49. [DOI: 10.1016/j.jns.2008.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 10/07/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
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Gurusamy S, Saravanan S, Premnath UK, Sivanandan R. Bilateral Posterior Periventricular Nodular Heterotopia with Cerebellar Hypoplasia, Communicating Hydrocephalus and Bilateral Hippocampal Sclerosis. Neuroradiol J 2009; 22:11-5. [DOI: 10.1177/197140090902200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 01/18/2009] [Indexed: 11/15/2022] Open
Abstract
Heterotopias are foci of grey matter in abnormal locations in the brain and are secondary to arrest of neuronal migration. Bilateral periventricular nodular heterotopias (BPVNH) are a rare form of heterotopic disorders. Many varieties of BPVNH with various associations have been reported in the literature, the commonest being the classical X-linked variety usually associated with filamin A gene (FLNA) mutations. The relationship of other types of BPVNH to this gene is variable. We report a rare variety of this entity – BPVNH with cerebellar hypoplasia, communicating hydrocephalus and bilateral hippocampal sclerosis. An exostosis arising from the left petrous temporal bone was an added finding in our patient.
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Affiliation(s)
| | | | | | - R. Sivanandan
- Diagnostic Radiology, KGS Advanced MR and CT Scan; Madurai, Tamilnadu, India
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Meroni A, Galli C, Bramerio M, Tassi L, Colombo N, Cossu M, Lo Russo G, Garbelli R, Spreafico R. Nodular heterotopia: A neuropathological study of 24 patients undergoing surgery for drug-resistant epilepsy. Epilepsia 2009; 50:116-24. [DOI: 10.1111/j.1528-1167.2008.01717.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tyvaert L, Hawco C, Kobayashi E, LeVan P, Dubeau F, Gotman J. Different structures involved during ictal and interictal epileptic activity in malformations of cortical development: an EEG-fMRI study. ACTA ACUST UNITED AC 2008; 131:2042-60. [PMID: 18669486 DOI: 10.1093/brain/awn145] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Malformations of cortical development (MCDs) are commonly complicated by intractable focal epilepsy. Epileptogenesis in these disorders is not well understood and may depend on the type of MCD. The cellular mechanisms involved in interictal and ictal events are notably different, and could be influenced independently by the type of pathology. We evaluated the relationship between interictal and ictal zones in eight patients with different types of MCD in order to better understand the generation of these activities: four had nodular heterotopia, two focal cortical dysplasia and two subcortical band heterotopia (double-cortex). We used the non-invasive EEG-fMRI technique to record simultaneously all cerebral structures with a high spatio-temporal resolution. We recorded interictal and ictal events during the same session. Ictal events were either electrical only or clinical with minimal motion. BOLD changes were found in the focal cortical dysplasia during interictal and ictal epileptiform events in the two patients with this disorder. Heterotopic and normal cortices were involved in BOLD changes during interictal and ictal events in the two patients with double cortex, but the maximum BOLD response was in the heterotopic band in both patients. Only two of the four patients with nodular heterotopia showed involvement of a nodule during interictal activity. During seizures, although BOLD changes affected the lesion in two patients, the maximum was always in the overlying cortex and never in the heterotopia. For two patients intracranial recordings were available and confirm our findings. The dysplastic cortex and the heterotopic cortex of band heterotopia were involved in interictal and seizure processes. Even if the nodular gray matter heterotopia may have the cellular substrate to produce interictal events, the often abnormal overlying cortex is more likely to be involved during the seizures. The non-invasive BOLD study of interictal and ictal events in MCD patients may help to understand the role of the lesion in epileptogenesis and also determine the potential surgical target.
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Affiliation(s)
- L Tyvaert
- Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, Canada H3A 2B4.
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