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Hillebrand A, Holmes N, Sijsma N, O'Neill GC, Tierney TM, Liberton N, Stam AH, van Klink N, Stam CJ, Bowtell R, Brookes MJ, Barnes GR. Non-invasive measurements of ictal and interictal epileptiform activity using optically pumped magnetometers. Sci Rep 2023; 13:4623. [PMID: 36944674 PMCID: PMC10030968 DOI: 10.1038/s41598-023-31111-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
Magneto- and electroencephalography (MEG/EEG) are important techniques for the diagnosis and pre-surgical evaluation of epilepsy. Yet, in current cryogen-based MEG systems the sensors are offset from the scalp, which limits the signal-to-noise ratio (SNR) and thereby the sensitivity to activity from deep structures such as the hippocampus. This effect is amplified in children, for whom adult-sized fixed-helmet systems are typically too big. Moreover, ictal recordings with fixed-helmet systems are problematic because of limited movement tolerance and/or logistical considerations. Optically Pumped Magnetometers (OPMs) can be placed directly on the scalp, thereby improving SNR and enabling recordings during seizures. We aimed to demonstrate the performance of OPMs in a clinical population. Seven patients with challenging cases of epilepsy underwent MEG recordings using a 12-channel OPM-system and a 306-channel cryogen-based whole-head system: three adults with known deep or weak (low SNR) sources of interictal epileptiform discharges (IEDs), along with three children with focal epilepsy and one adult with frequent seizures. The consistency of the recorded IEDs across the two systems was assessed. In one patient the OPMs detected IEDs that were not found with the SQUID-system, and in two patients no IEDs were found with either system. For the other patients the OPM data were remarkably consistent with the data from the cryogenic system, noting that these were recorded in different sessions, with comparable SNRs and IED-yields overall. Importantly, the wearability of OPMs enabled the recording of seizure activity in a patient with hyperkinetic movements during the seizure. The observed ictal onset and semiology were in agreement with previous video- and stereo-EEG recordings. The relatively affordable technology, in combination with reduced running and maintenance costs, means that OPM-based MEG could be used more widely than current MEG systems, and may become an affordable alternative to scalp EEG, with the potential benefits of increased spatial accuracy, reduced sensitivity to volume conduction/field spread, and increased sensitivity to deep sources. Wearable MEG thus provides an unprecedented opportunity for epilepsy, and given its patient-friendliness, we envisage that it will not only be used for presurgical evaluation of epilepsy patients, but also for diagnosis after a first seizure.
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Affiliation(s)
- Arjan Hillebrand
- Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
- Brain Imaging, Amsterdam Neuroscience, Amsterdam, The Netherlands.
- Systems and Network Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Niall Holmes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Ndedi Sijsma
- Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - George C O'Neill
- Wellcome Centre for Human Neuroimaging, Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3AR, UK
| | - Tim M Tierney
- Wellcome Centre for Human Neuroimaging, Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3AR, UK
| | - Niels Liberton
- Department of Medical Technology, 3D Innovation Lab, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anine H Stam
- Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Nicole van Klink
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Brain Imaging, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Neurodegeneration, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Gareth R Barnes
- Wellcome Centre for Human Neuroimaging, Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3AR, UK
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Coleman H, McIntosh A, Wilson SJ. "Do I still have epilepsy?" Epilepsy identity 15-20 years after anterior temporal lobectomy. Epilepsia 2021; 63:402-413. [PMID: 34862797 DOI: 10.1111/epi.17143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/31/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Identity is a multifaceted construct, comprising personal identity (sense of being a unique individual) and social identity (the sense-of-self derived from membership of social groups). Social identity involves explicit identification with a group ("I am …") and implicit behaviors or attitudes associated with group membership. Following successful treatment with surgery, patients with epilepsy can undergo a complex and lasting change in personal identity. To date, there has been no research into postoperative social epilepsy identity (SEI). We sought to examine SEI 15-20 years post-surgery, and the relationship between SEI and satisfaction with surgery, psychosocial improvements, mood, and health-related quality of life (HRQoL). METHODS Thirty-two patients who underwent anterior temporal lobectomy (ATL; 19 female) were recruited, with a median follow-up of 18 years (interquartile range [IQR] = 2.5). Using a novel interactive online program, we collected data on SEI, satisfaction with surgery, and perceived psychosocial improvements, alongside standardized measures of mood (Neurological Disorders Depressio Inventory-Epilepsy; Patient Health Questionnaire-Generalised Anxiety Disorder-7 item) and HRQoL (Quality of Life in Epilepsy-31 item). Non-parametric analyses were used to analyse the data. RESULTS Twenty-five percent of patients were free of disabling seizures since surgery, yet 65% stated they no longer had epilepsy and >90% reported satisfaction with surgery. Explicitly discarding SEI was positively associated with HRQoL at long-term follow-up, over and above seizure outcome. Implicit SEI was expressed as (a) acceptance of epilepsy, (b) a sense of belonging to the epilepsy community, and (c) difficulty disclosing and discussing epilepsy. Difficulty disclosing and discussing epilepsy was associated with increased anxiety and lower HRQoL. SIGNIFICANCE At long-term follow-up, over half of our patients reported an explicit change in SEI, which could promote better HRQoL. In contrast, difficulty with disclosure of epilepsy was associated with increased anxiety and reduced HRQoL, possibly reflecting the ongoing effects of stigma. These findings highlight the importance of understanding changes in patient social identity for promoting long-term well-being after surgery.
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Affiliation(s)
- Honor Coleman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia.,Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Vic., Australia
| | - Anne McIntosh
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Vic., Australia.,Melbourne Brain Centre, Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia.,Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Vic., Australia
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Sinha N, Wang Y, Moreira da Silva N, Miserocchi A, McEvoy AW, de Tisi J, Vos SB, Winston GP, Duncan JS, Taylor PN. Structural Brain Network Abnormalities and the Probability of Seizure Recurrence After Epilepsy Surgery. Neurology 2020; 96:e758-e771. [PMID: 33361262 PMCID: PMC7884990 DOI: 10.1212/wnl.0000000000011315] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 09/24/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed preoperative structural brain networks and clinical characteristics of patients with drug-resistant temporal lobe epilepsy (TLE) to identify correlates of postsurgical seizure recurrences. METHODS We examined data from 51 patients with TLE who underwent anterior temporal lobe resection (ATLR) and 29 healthy controls. For each patient, using the preoperative structural, diffusion, and postoperative structural MRI, we generated 2 networks: presurgery network and surgically spared network. Standardizing these networks with respect to controls, we determined the number of abnormal nodes before surgery and expected to be spared by surgery. We incorporated these 2 abnormality measures and 13 commonly acquired clinical data from each patient into a robust machine learning framework to estimate patient-specific chances of seizures persisting after surgery. RESULTS Patients with more abnormal nodes had a lower chance of complete seizure freedom at 1 year and, even if seizure-free at 1 year, were more likely to relapse within 5 years. The number of abnormal nodes was greater and their locations more widespread in the surgically spared networks of patients with poor outcome than in patients with good outcome. We achieved an area under the curve of 0.84 ± 0.06 and specificity of 0.89 ± 0.09 in predicting unsuccessful seizure outcomes (International League Against Epilepsy [ILAE] 3-5) as opposed to complete seizure freedom (ILAE 1) at 1 year. Moreover, the model-predicted likelihood of seizure relapse was significantly correlated with the grade of surgical outcome at year 1 and associated with relapses up to 5 years after surgery. CONCLUSION Node abnormality offers a personalized, noninvasive marker that can be combined with clinical data to better estimate the chances of seizure freedom at 1 year and subsequent relapse up to 5 years after ATLR. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that node abnormality predicts postsurgical seizure recurrence.
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Affiliation(s)
- Nishant Sinha
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada.
| | - Yujiang Wang
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Nádia Moreira da Silva
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Anna Miserocchi
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Andrew W McEvoy
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Jane de Tisi
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Sjoerd B Vos
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Gavin P Winston
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - John S Duncan
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Peter N Taylor
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
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Gleichgerrcht E, Keller SS, Drane DL, Munsell BC, Davis KA, Kaestner E, Weber B, Krantz S, Vandergrift WA, Edwards JC, McDonald CR, Kuzniecky R, Bonilha L. Temporal Lobe Epilepsy Surgical Outcomes Can Be Inferred Based on Structural Connectome Hubs: A Machine Learning Study. Ann Neurol 2020; 88:970-983. [PMID: 32827235 PMCID: PMC8019146 DOI: 10.1002/ana.25888] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Medial temporal lobe epilepsy (TLE) is the most common form of medication-resistant focal epilepsy in adults. Despite removal of medial temporal structures, more than one-third of patients continue to have disabling seizures postoperatively. Seizure refractoriness implies that extramedial regions are capable of influencing the brain network and generating seizures. We tested whether abnormalities of structural network integration could be associated with surgical outcomes. METHODS Presurgical magnetic resonance images from 121 patients with drug-resistant TLE across 3 independent epilepsy centers were used to train feed-forward neural network models based on tissue volume or graph-theory measures from whole-brain diffusion tensor imaging structural connectomes. An independent dataset of 47 patients with TLE from 3 other epilepsy centers was used to assess the predictive values of each model and regional anatomical contributions toward surgical treatment results. RESULTS The receiver operating characteristic area under the curve based on regional betweenness centrality was 0.88, significantly higher than a random model or models based on gray matter volumes, degree, strength, and clustering coefficient. Nodes most strongly contributing to the predictive models involved the bilateral parahippocampal gyri, as well as the superior temporal gyri. INTERPRETATION Network integration in the medial and lateral temporal regions was related to surgical outcomes. Patients with abnormally integrated structural network nodes were less likely to achieve seizure freedom. These findings are in line with previous observations related to network abnormalities in TLE and expand on the notion of underlying aberrant plasticity. Our findings provide additional information on the mechanisms of surgical refractoriness. ANN NEUROL 2020;88:970-983.
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Affiliation(s)
| | - Simon S. Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Bioology, University of Liverpool, Liverpool, United Kingdom; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Daniel L. Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Brent C. Munsell
- Department of Computer Science, University of North Carolina, Chapel Hill, NC, USA
| | - Kathryn A. Davis
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Erik Kaestner
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University of Bonn
| | - Samantha Krantz
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Jonathan C. Edwards
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Carrie R. McDonald
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Ruben Kuzniecky
- Department of Neurology, Hofstra University / Northwell, NY, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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Coleman H, McIntosh A, Wilson SJ. A patient-centered approach to understanding long-term psychosocial adjustment and meaning-making, 15 to 20 years after epilepsy surgery. Epilepsy Behav 2020; 102:106656. [PMID: 31778879 DOI: 10.1016/j.yebeh.2019.106656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Different psychosocial trajectories have been identified following treatment with epilepsy surgery, as patients adjust to possible changes in seizure frequency and the subsequent impact on their psychosocial functioning. Qualitative research has been key to understanding this adjustment process, particularly in the short-term (2-5 years). Currently, however, there is a lack of qualitative research examining longer-term (>15 years) outcomes, precluding the same rich, detailed understanding of longer-term psychosocial outcomes. Using a grounded theory approach, we explored how patients reflected on and made sense of their adjustment trajectories, 15 to 20 years after surgery. This included the impact of surgery on their sense of self and broader psychosocial functioning. METHODS We recruited 40 adult patients who had undergone anterior temporal lobectomy (ATL) 15 to 20 years ago (24 females; 26 left-sided). Median age at habitual seizure onset was 9.7 years (Interquartile range; IQR = 13.8), and at surgery was 31 years (IQR = 12). Median length of follow-up was 18.4 years (IQR = 4.3). Comprehensive one-on-one interviews (median time = 86 min, IQR = 28) were used to elicit patient experiences of their surgery and subsequent psychosocial outcomes. Data were analyzed using a grounded theory inductive-deductive process. RESULTS Patient narratives revealed a common process of psychosocial change and meaning-making triggered by surgery, which was often perceived as a major turning point in life. Patients reflected on moving through an early postsurgical period (<5 years) of upheaval and psychological disequilibrium. While this period was often remembered as stressful, difficulties were softened and/or reframed in hindsight. Through this process of reframing and meaning-making, patients were able to reestablish equilibrium and a sense of normality. Differences were evident in how patients navigated the process of meaning-making, and the extent to which they felt surgery had changed their self-identity. DISCUSSION We propose a model of postsurgical meaning-making, evident in the narratives of patients who have undergone ATL, providing a new perspective on long-term psychosocial outcomes. This model contributes to our understanding of patient well-being and quality of life, by acknowledging the active role that patients play in seeking to create their own sense of normality after epilepsy surgery.
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Affiliation(s)
- Honor Coleman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia; Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Australia.
| | - Anne McIntosh
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Australia; Department of Neurosciences, Medicine, Nursing and Health Sciences, Monash University, Australia; Melbourne Brain Centre, The Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Australia
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia; Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Australia
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Gleichgerrcht E, Munsell B, Bhatia S, Vandergrift WA, Rorden C, McDonald C, Edwards J, Kuzniecky R, Bonilha L. Deep learning applied to whole-brain connectome to determine seizure control after epilepsy surgery. Epilepsia 2018; 59:1643-1654. [PMID: 30098002 DOI: 10.1111/epi.14528] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/14/2018] [Accepted: 07/15/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We evaluated whether deep learning applied to whole-brain presurgical structural connectomes could be used to predict postoperative seizure outcome more accurately than inference from clinical variables in patients with mesial temporal lobe epilepsy (TLE). METHODS Fifty patients with unilateral TLE were classified either as having persistent disabling seizures (SZ) or becoming seizure-free (SZF) at least 1 year after epilepsy surgery. Their presurgical structural connectomes were reconstructed from whole-brain diffusion tensor imaging. A deep network was trained based on connectome data to classify seizure outcome using 5-fold cross-validation. RESULTS Classification accuracy of our trained neural network showed positive predictive value (PPV; seizure freedom) of 88 ± 7% and mean negative predictive value (NPV; seizure refractoriness) of 79 ± 8%. Conversely, a classification model based on clinical variables alone yielded <50% accuracy. The specific features that contributed to high accuracy classification of the neural network were located not only in the ipsilateral temporal and extratemporal regions, but also in the contralateral hemisphere. SIGNIFICANCE Deep learning demonstrated to be a powerful statistical approach capable of isolating abnormal individualized patterns from complex datasets to provide a highly accurate prediction of seizure outcomes after surgery. Features involved in this predictive model were both ipsilateral and contralateral to the clinical foci and spanned across limbic and extralimbic networks.
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Affiliation(s)
- Ezequiel Gleichgerrcht
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Brent Munsell
- Department of Computer Science, College of Charleston, Charleston, South Carolina
| | - Sonal Bhatia
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - William A Vandergrift
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Carrie McDonald
- Department of Psychology, University of California, San Diego, San Diego, California
| | - Jonathan Edwards
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Ruben Kuzniecky
- Department of Neurology, Hofstra Northwell School of Medicine, Great Neck, New York
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
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Walther K, Dogan Onugoren M, Buchfelder M, Gollwitzer S, Graf W, Kasper BS, Kriwy P, Kurzbuch K, Lang J, Rössler K, Schwab S, Schwarz M, Stefan H, Hamer HM. Psychosocial outcome in epilepsy after extratemporal surgery. Epilepsy Behav 2018; 81:94-100. [PMID: 29454606 DOI: 10.1016/j.yebeh.2018.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Only limited data exist on psychosocial long-term outcome after epilepsy surgery in patients with extratemporal epilepsy. The aim of this study was to investigate psychosocial outcome after extratemporal epilepsy surgery and to assess factors predicting favorable outcome. METHOD Sixty-five out of 104 eligible patients who had undergone extratemporal epilepsy surgery at our epilepsy center between 1990 and 2015 (mean age: 42.2. years; 75% of the resections in the frontal lobe) completed a questionnaire asking about seizure status, employment status, marital and living situation, driving status, depressive symptoms, and quality of life (QOL). Follow-up was on average 9.2years after surgery (range: 1-26years). RESULTS Thirty-eight (58%) patients were free of disabling seizures (Engel class I), and 28 (43%) have not experienced any seizures after surgery (Engel class IA). Employment rate in the primary labor market remained at 45%, but more patients lost employment (14%) than gained employment (8%). Postoperative employment was predicted by preoperative employment (p=.007), seizure freedom (p=.025), older age at seizure onset (p=.018), younger age at follow-up (p=.035), and female gender (p=.048). Seizure-free patients were more likely to be driving; have a partner, particularly in males; and have lower depressive scores. Quality of life at follow-up was best predicted by employment (p=.012), partnership (p=.025), and seizure freedom (p=.025). In contrast, recurrence of seizures and early seizure onset were associated with poor psychosocial outcome, particularly in men. CONCLUSION The study provides support that extratemporal surgery can lead to improved QOL and favorable psychosocial outcome. Seizure freedom is important but not the only determinant of good psychosocial outcome.
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Affiliation(s)
- Katrin Walther
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Müjgan Dogan Onugoren
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stephanie Gollwitzer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Wolfgang Graf
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Burkhard S Kasper
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Peter Kriwy
- Institute of Sociology, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
| | - Katrin Kurzbuch
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Schwarz
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hermann Stefan
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
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Jennum P, Sabers A, Christensen J, Ibsen R, Kjellberg J. Socioeconomic outcome of epilepsy surgery: A controlled national study. Seizure 2016; 42:52-56. [PMID: 27770730 DOI: 10.1016/j.seizure.2016.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 09/25/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Epilepsy surgery has been a standard treatment for refractory epilepsies that cannot be controlled by standard medical treatment. We aimed to evaluate the health and social consequences of resective surgery relative to controls from a study of national data. METHODS Using the Danish National Patient Registry we identified all subjects with an epilepsy diagnosis between 1996 and 2009 and compared them with a group of patients with an epilepsy diagnosis who had had neither epilepsy surgery nor a vagus stimulation diagnosis by the index date, and who were matched by gender, index year for epilepsy diagnosis, and index year for epilepsy surgery. We considered all the health and social information available in the Danish health, medication and social registers. The duration of follow-up was three years. RESULTS 254 epilepsy patients and 989 controls were analyzed. Surgery patients were more severely affected by their disease as indicated by health care use and social impact before the surgical procedure. Patients who underwent epilepsy surgery had a significantly lower costs associated with the use of medication, outpatient services, inpatient admissions, and accident and emergency visits after surgery. The surgical intervention had no significant effects on social status in terms of occupation and educational level. CONCLUSION Although epilepsy surgery was followed by a reduction in inpatient and outpatient health care use, medication and use of accident and emergency facilities, suggesting a positive effect on the epileptic disease, there was no significant effect on social outcome measures.
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Helmstaedter C, Elger CE, Witt JA. The effect of quantitative and qualitative antiepileptic drug changes on cognitive recovery after epilepsy surgery. Seizure 2016; 36:63-69. [DOI: 10.1016/j.seizure.2016.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022] Open
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Bonilha L, Jensen JH, Baker N, Breedlove J, Nesland T, Lin JJ, Drane DL, Saindane AM, Binder JR, Kuzniecky RI. The brain connectome as a personalized biomarker of seizure outcomes after temporal lobectomy. Neurology 2015; 84:1846-53. [PMID: 25854868 DOI: 10.1212/wnl.0000000000001548] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/22/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We examined whether individual neuronal architecture obtained from the brain connectome can be used to estimate the surgical success of anterior temporal lobectomy (ATL) in patients with temporal lobe epilepsy (TLE). METHODS We retrospectively studied 35 consecutive patients with TLE who underwent ATL. The structural brain connectome was reconstructed from all patients using presurgical diffusion MRI. Network links in patients were standardized as Z scores based on connectomes reconstructed from healthy controls. The topography of abnormalities in linkwise elements of the connectome was assessed on subnetworks linking ipsilateral temporal with extratemporal regions. Predictive models were constructed based on the individual prevalence of linkwise Z scores >2 and based on presurgical clinical data. RESULTS Patients were more likely to achieve postsurgical seizure freedom if they exhibited fewer abnormalities within a subnetwork composed of the ipsilateral hippocampus, amygdala, thalamus, superior frontal region, lateral temporal gyri, insula, orbitofrontal cortex, cingulate, and lateral occipital gyrus. Seizure-free surgical outcome was predicted by neural architecture alone with 90% specificity (83% accuracy), and by neural architecture combined with clinical data with 94% specificity (88% accuracy). CONCLUSIONS Individual variations in connectome topography, combined with presurgical clinical data, may be used as biomarkers to better estimate surgical outcomes in patients with TLE.
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Affiliation(s)
- Leonardo Bonilha
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York.
| | - Jens H Jensen
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York
| | - Nathaniel Baker
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York
| | - Jesse Breedlove
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York
| | - Travis Nesland
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York
| | - Jack J Lin
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York
| | - Daniel L Drane
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York
| | - Amit M Saindane
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York
| | - Jeffrey R Binder
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York
| | - Ruben I Kuzniecky
- From the Departments of Neurology (L.B., J.H.J., J.B., T.N.), Radiology and Radiological Science (J.H.J.), and Public Health Sciences (N.B.), Medical University of South Carolina, Charleston; the Department of Neurology (J.J.L.), University of California Irvine; the Departments of Neurology and Pediatrics (D.L.D.) and Radiology (A.M.S.), Emory University, Atlanta, GA; the Department of Neurology (J.R.B.), Medical College of Wisconsin, Milwaukee; and the Comprehensive Epilepsy Center (R.I.K.), New York University, New York
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Mandell JG, Hill KL, Nguyen DTD, Moser KW, Harbaugh RE, McInerney J, Nsubuga BK, Mugamba JK, Johnson D, Warf BC, Boling W, Webb AG, Schiff SJ. Volumetric brain analysis in neurosurgery: Part 3. Volumetric CT analysis as a predictor of seizure outcome following temporal lobectomy. J Neurosurg Pediatr 2015; 15:133-43. [PMID: 25431899 DOI: 10.3171/2014.9.peds12428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The incidence of temporal lobe epilepsy (TLE) due to mesial temporal sclerosis (MTS) can be high in developing countries. Current diagnosis of MTS relies on structural MRI, which is generally unavailable in developing world settings. Given widespread effects on temporal lobe structure beyond hippocampal atrophy in TLE, the authors propose that CT volumetric analysis can be used in patient selection to help predict outcomes following resection. METHODS Ten pediatric patients received preoperative CT scans and temporal resections at the CURE Children's Hospital of Uganda. Engel classification of seizure control was determined 12 months postoperatively. Temporal lobe volumes were measured from CT and from normative MR images using the Cavalieri method. Whole brain and fluid volumes were measured using particle filter segmentation. Linear discrimination analysis (LDA) was used to classify seizure outcome by temporal lobe volumes and normalized brain volume. RESULTS Epilepsy patients showed normal to small brain volumes and small temporal lobes bilaterally. A multivariate measure of the volume of each temporal lobe separated patients who were seizure free (Engel Class IA) from those with incomplete seizure control (Engel Class IB/IIB) with LDA (p<0.01). Temporal lobe volumes also separate normal subjects, patients with Engel Class IA outcomes, and patients with Class IB/IIB outcomes (p<0.01). Additionally, the authors demonstrated that age-normalized whole brain volume, in combination with temporal lobe volumes, may further improve outcome prediction (p<0.01). CONCLUSIONS This study shows strong evidence that temporal lobe and brain volume can be predictive of seizure outcome following temporal lobe resection, and that volumetric CT analysis of the temporal lobe may be feasible in lieu of structural MRI when the latter is unavailable. Furthermore, since the authors' methods are modality independent, these findings suggest that temporal lobe and normative brain volumes may further be useful in the selection of patients for temporal lobe resection when structural MRI is available.
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Yardi R, Irwin A, Kayyali H, Gupta A, Nair D, Gonzalez-Martinez J, Bingaman W, Najm IM, Jehi LE. Reducing versus stopping antiepileptic medications after temporal lobe surgery. Ann Clin Transl Neurol 2014; 1:115-23. [PMID: 25356390 PMCID: PMC4212478 DOI: 10.1002/acn3.35] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/27/2013] [Accepted: 12/30/2013] [Indexed: 02/05/2023] Open
Abstract
Objective To study the safety of antiepileptic drug (AED) withdrawal after temporal lobe epilepsy (TLE) surgery. Methods We reviewed patients who underwent TLE surgery from 1995 to 2011, collecting data on doses, dates of AED initiation, reduction, and discontinuation. Predictors of seizure outcome were defined using Cox-proportional hazard modeling and adjusted for, while comparing longitudinal seizure-freedom in patients for whom AEDs were unchanged after resection as opposed to reduced or stopped. Results A total of 609 patients (86% adults) were analyzed. Follow-up ranged from 0.5 to 16.7 years. Most (64%) had hippocampal sclerosis. Overall, 229 patients had remained on their same baseline AEDs, while 380 patients stopped (127 cases) or reduced (253 cases) their AEDs. Mean timing of the earliest AED change was shorter in patients with recurrent seizures (1.04 years) compared to those seizure-free at last follow-up (1.44 years; P-value 0.03). Whether AEDs were withdrawn 12 or 24 months after surgery, there was a 10–25% higher risk of breakthrough seizures within the subsequent 2 years. However, 70% of patients with seizure recurrence after AED discontinuation reachieved remission, as opposed to 50% of those whose seizures recurred while reducing AEDs (P = 0.0001). Long-term remission rates were similar in both AED discontinuation and “unchanged” groups (82% remission for AEDs withdrawn after 1 year and 90% for AEDs withdrawn after 2 years), while only 65% of patients whose recurrences started during AED reduction achieved a 2-year remission by last follow-up. Interpretation AED withdrawal increases the short-term risk of breakthrough seizures after TLE surgery, and may alter the long-term disease course in some patients.
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Affiliation(s)
- Ruta Yardi
- Epilepsy Center, Neurological Institute, Cleveland Clinic Cleveland, Ohio
| | - Anna Irwin
- Epilepsy Center, Neurological Institute, Cleveland Clinic Cleveland, Ohio
| | - Husam Kayyali
- The Children's Mercy Hospital, University of Missouri Kansas, Missouri
| | - Ajay Gupta
- Epilepsy Center, Neurological Institute, Cleveland Clinic Cleveland, Ohio
| | - Dileep Nair
- Epilepsy Center, Neurological Institute, Cleveland Clinic Cleveland, Ohio
| | | | | | - Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic Cleveland, Ohio
| | - Lara E Jehi
- Epilepsy Center, Neurological Institute, Cleveland Clinic Cleveland, Ohio
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Hanáková P, Brázdil M, Novák Z, Hemza J, Chrastina J, Ošlejšková H, Hermanová M, Pažourková M, Rektor I, Kuba R. Long-term outcome and predictors of resective surgery prognosis in patients with refractory extratemporal epilepsy. Seizure 2013; 23:266-73. [PMID: 24378203 DOI: 10.1016/j.seizure.2013.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE We analyzed the long-term postoperative outcome and possible predictive factors of the outcome in surgically treated patients with refractory extratemporal epilepsy. METHODS We retrospectively analyzed 73 patients who had undergone resective surgery at the Epilepsy Center Brno between 1995 and 2010 and who had reached at least 1 year outcome after the surgery. The average age at surgery was 28.3±11.4 years. Magnetic resonance imaging (MRI) did not reveal any lesion in 24 patients (32.9%). Surgical outcome was assessed annually using Engel's modified classification until 5 years after surgery and at the latest follow-up visit. RESULTS Following the surgery, Engel Class I outcome was found in 52.1% of patients after 1 year, in 55.0% after 5 years, and in 50.7% at the last follow-up visit (average 6.15±3.84 years). Of the patients who reached the 5-year follow-up visit (average of the last follow-up 9.23 years), 37.5% were classified as Engel IA at each follow-up visit. Tumorous etiology and lesions seen in preoperative MRI were associated with significantly better outcome (p=0.035; p<0.01). Postoperatively, 9.6% patients had permanent neurological deficits. CONCLUSION Surgical treatment of refractory extratemporal epilepsy is an effective procedure. The presence of a visible MRI-detected lesion and tumorous etiology is associated with significantly better outcome than the absence of MRI-detected lesion or other etiology.
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Affiliation(s)
- Petra Hanáková
- Epilepsy Center Brno, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Milan Brázdil
- Epilepsy Center Brno, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Zdeněk Novák
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic; Epilepsy Center Brno, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Hemza
- Epilepsy Center Brno, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Chrastina
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic; Epilepsy Center Brno, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Hana Ošlejšková
- Epilepsy Center Brno, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Markéta Hermanová
- Department of Pathology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marta Pažourková
- Department of Radiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivan Rektor
- Epilepsy Center Brno, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Robert Kuba
- Epilepsy Center Brno, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Epilepsy Center Brno, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
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Andersson-Roswall L, Engman E, Samuelsson H, Malmgren K. Psychosocial status 10 years after temporal lobe resection for epilepsy, a longitudinal controlled study. Epilepsy Behav 2013; 28:127-31. [PMID: 23673235 DOI: 10.1016/j.yebeh.2013.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 02/27/2013] [Accepted: 03/02/2013] [Indexed: 11/16/2022]
Abstract
Knowledge about long-term psychosocial outcome of temporal lobe resection (TLR) for epilepsy is limited. The aims of this study were to describe vocational outcome 10 years after TLR and to analyze the effect on the vocational situation by seizures, laterality of resection, verbal memory, and mood. Fifty-one patients were prospectively followed 10 years after TLR. Psychosocial and neuropsychological data were ascertained at baseline and 10 years after surgery and at corresponding time points for 23 controls. Fewer patients worked 10 years post-operatively compared with controls (TLR patients: 61% and controls: 96%). However, seizure-free patients were more likely to retain employment (71%) than patients who had seizures (41%). The odds of working full-time were 9.5 times higher for patients with seizure freedom than for those with continuing seizures. There were no associations between working at 10 years and side of resection or mood, and impairment of verbal memory did not have an influence on vocational outcome.
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Affiliation(s)
- Lena Andersson-Roswall
- Institute of Neuroscience and Physiology, Epilepsy Research Group, University of Gothenburg, Sweden.
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Malter MP, Tschampa HJ, Helmstaedter C, Urbach H, von Lehe M, Becker A, Clusmann H, Elger CE, Bien CG. Outcome after epilepsy surgery in patients with MRI features of bilateral ammon's horn sclerosis. Epilepsy Res 2013; 105:150-7. [DOI: 10.1016/j.eplepsyres.2013.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/17/2012] [Accepted: 02/11/2013] [Indexed: 11/25/2022]
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Long term outcome in patients not initially seizure free after resective epilepsy surgery. Seizure 2011; 20:419-24. [PMID: 21354829 DOI: 10.1016/j.seizure.2011.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 01/14/2011] [Accepted: 01/31/2011] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess the long-term seizure outcome and find predictors of outcome for patients who were not initially seizure free 6 months after epilepsy surgery. METHODS We retrospectively reviewed all adult patients who underwent epilepsy surgery at the Epilepsy Center Bethel, between 1992 and 2003. There were 266 patients included in this analysis. RESULTS Of the 266 patients who were included in this study, the probability of becoming seizure free was 12% (95%CI 8-16%) after 2 years, 19.5% (95%CI 15-24%) after 5 years and 34.7% (95%CI 28-41%) after 10 years. In patients who had auras only, the probability of being seizure free was 18.2% after 2 years, 25.5% after 5 years, and 39.1% after 10 years. In the multiregression analysis, the EEG carried out 2 years after surgery, a psychic aura, the frequency of postoperative focal seizures and hypermotor seizures predicted seizure remission in the long-term outcome. CONCLUSIONS The frequency and type of postoperative seizures are critical determinants for long-term outcome. Seizure semiology may be the clue to a precise diagnosis and long-term prognosis of epilepsy.
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Duncan JS. Selecting patients for epilepsy surgery: synthesis of data. Epilepsy Behav 2011; 20:230-2. [PMID: 20709601 DOI: 10.1016/j.yebeh.2010.06.040] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 06/19/2010] [Indexed: 11/18/2022]
Abstract
The consideration of epilepsy surgery for those with medically refractory seizure disorders requires a well-functioning multidisciplinary team and a systematic approach to investigations, with the aim of advising patients of their chances of being seizure free following surgery, and the risks of any procedure. Investigatory pathways may be outlined that cover most clinical situations, and the indications for invasive EEG studies. It is crucial that patients and their families are given realistic expectations of what may, and may not, be achieved with surgical treatment, and that long-term follow-up is maintained post-operatively.
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Affiliation(s)
- John S Duncan
- UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
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Barragán-Pérez EJ, Heredia-Barragán I, Huerta-Albarran R. Effectiveness of the use of an omega 3 and omega 6 combination(EquazenTM) in paediatric patients with refractory epilepsy. ACTA ACUST UNITED AC 2011. [DOI: 10.1590/s1676-26492011000400007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION: Epilepsy is considered a health problem. 85% of patients are satisfactorily controlled with antiepileptic drugs (AEDs) and 15% have refractory seizures. The combination of omega 3 and omega 6 fatty acids (EquazenTM) can contribute to changes in ionic currents and to stabilization of neurotransmitter's function resulting in cell membrane equilibrium. These changes lead to potential seizure control. OBJECTIVE: To compare efficacy and safety in the treatment of refractory epilepsy with a supplement combining EPA, DHA (omega 3 fatty acids) and GLA (omega 6 fatty acids). METHODS: We reviewed patients from the Neurology Department of the Children's Hospital of Mexico who have refractory epilepsy, evaluating clinical characteristics of seizures, number of seizures and AEDs. 792 mg of EPA, DHA and GLA per day (6 capsules of EquazenTM) were administrated for four weeks in order to assess the frequency of seizures as well as tolerability and probable side effects. RESULTS: The study was conducted with a total of 13 patients with follow-up four weeks after the start of supplementation. We obtained a satisfactory clinical response with ≥ 80% decrease in the daily number of seizures in more than 60% of patient. The mean of number of seizures over all patients was reduced significantly from 26.61±37.2 to 5.92 daily. In addition a significant improvement in the neurocognitive capacity was observedin all patients. CONCLUSION: The co-adjuvant supplementation with EquazenTM may result in a reduction of the number of seizures in refractory epilepsy having in addition significant impact on neurocognitive aspects. To enhance the quality of life of epileptic patient supplementation with a specific combination of EPA, DHA and GLA should be reconsidered.
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American Clinical MEG Society (ACMEGS) Position Statement: The Value of Magnetoencephalography (MEG)/Magnetic Source Imaging (MSI) in Noninvasive Presurgical Evaluation of Patients With Medically Intractable Localization-related Epilepsy. J Clin Neurophysiol 2009; 26:290-3. [DOI: 10.1097/wnp.0b013e3181b49d50] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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