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Koren J, Gritsch G, Pirker S, Herta J, Perko H, Kluge T, Baumgartner C. Automatic ictal onset source localization in presurgical epilepsy evaluation. Clin Neurophysiol 2018; 129:1291-1299. [PMID: 29680731 DOI: 10.1016/j.clinph.2018.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/07/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To test the diagnostic accuracy of a new automatic algorithm for ictal onset source localization (IOSL) during routine presurgical epilepsy evaluation following STARD (Standards for Reporting of Diagnostic Accuracy) criteria. METHODS We included 28 consecutive patients with refractory focal epilepsy (25 patients with temporal lobe epilepsy (TLE) and 3 with extratemporal epilepsy) who underwent resective epilepsy surgery. Ictal EEG patterns were analyzed with a novel automatic IOSL algorithm. IOSL source localizations on a sublobar level were validated by comparison with actual resection sites and seizure free outcome 2 years after surgery. RESULTS Sensitivity of IOSL was 92.3% (TLE: 92.3%); specificity 60% (TLE: 50%); positive predictive value 66.7% (TLE: 66.7%); and negative predictive value 90% (TLE: 85.7%). The likelihood ratio was more than ten times higher for concordant IOSL results as compared to discordant results (p = 0.013). CONCLUSIONS We demonstrated the clinical feasibility of our IOSL approach yielding reasonable high performance measures on a sublobar level. SIGNIFICANCE Our IOSL method may contribute to a correct localization of the seizure onset zone in temporal lobe epilepsy and can readily be used in standard epilepsy monitoring settings. Further studies are needed for validation in extratemporal epilepsy.
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Affiliation(s)
- Johannes Koren
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Neurological Department, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | - Gerhard Gritsch
- Austrian Institute of Technology GmbH (AIT), Safety & Security Department, Vienna, Austria
| | - Susanne Pirker
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Neurological Department, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | - Johannes Herta
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Hannes Perko
- Austrian Institute of Technology GmbH (AIT), Safety & Security Department, Vienna, Austria
| | - Tilmann Kluge
- Austrian Institute of Technology GmbH (AIT), Safety & Security Department, Vienna, Austria
| | - Christoph Baumgartner
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Neurological Department, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria; Department of Epileptology and Clinical Neurophysiology, Sigmund Freud University, Vienna, Austria.
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Jedynak M, Pons AJ, Garcia-Ojalvo J, Goodfellow M. Temporally correlated fluctuations drive epileptiform dynamics. Neuroimage 2017; 146:188-196. [PMID: 27865920 PMCID: PMC5353705 DOI: 10.1016/j.neuroimage.2016.11.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/17/2016] [Accepted: 11/13/2016] [Indexed: 12/27/2022] Open
Abstract
Macroscopic models of brain networks typically incorporate assumptions regarding the characteristics of afferent noise, which is used to represent input from distal brain regions or ongoing fluctuations in non-modelled parts of the brain. Such inputs are often modelled by Gaussian white noise which has a flat power spectrum. In contrast, macroscopic fluctuations in the brain typically follow a 1/fb spectrum. It is therefore important to understand the effect on brain dynamics of deviations from the assumption of white noise. In particular, we wish to understand the role that noise might play in eliciting aberrant rhythms in the epileptic brain. To address this question we study the response of a neural mass model to driving by stochastic, temporally correlated input. We characterise the model in terms of whether it generates "healthy" or "epileptiform" dynamics and observe which of these dynamics predominate under different choices of temporal correlation and amplitude of an Ornstein-Uhlenbeck process. We find that certain temporal correlations are prone to eliciting epileptiform dynamics, and that these correlations produce noise with maximal power in the δ and θ bands. Crucially, these are rhythms that are found to be enhanced prior to seizures in humans and animal models of epilepsy. In order to understand why these rhythms can generate epileptiform dynamics, we analyse the response of the model to sinusoidal driving and explain how the bifurcation structure of the model gives rise to these findings. Our results provide insight into how ongoing fluctuations in brain dynamics can facilitate the onset and propagation of epileptiform rhythms in brain networks. Furthermore, we highlight the need to combine large-scale models with noise of a variety of different types in order to understand brain (dys-)function.
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Affiliation(s)
- Maciej Jedynak
- Departament de Física i Enginyeria Nuclear, Universitat Politècnica de Catalunya, Terrassa, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.
| | - Antonio J Pons
- Departament de Física i Enginyeria Nuclear, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Jordi Garcia-Ojalvo
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Marc Goodfellow
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK; Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, UK; EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, UK
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Valentín A, Selway RP, Amarouche M, Mundil N, Ughratdar I, Ayoubian L, Martín-López D, Kazi F, Dar T, Jiménez-Jiménez D, Hughes E, Alarcón G. Intracranial stimulation for children with epilepsy. Eur J Paediatr Neurol 2017; 21:223-231. [PMID: 27840024 DOI: 10.1016/j.ejpn.2016.10.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/19/2016] [Accepted: 10/24/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To evaluate the efficacy of intracranial stimulation to treat refractory epilepsy in children. METHODS This is a retrospective analysis of a pilot study on all 8 children who had intracranial electrical stimulation for the investigation and treatment of refractory epilepsy at King's College Hospital between 2014 and 2015. Five children (one with temporal lobe epilepsy and four with frontal lobe epilepsy) had subacute cortical stimulation (SCS) for a period of 20-161 h during intracranial video-telemetry. Efficacy of stimulation was evaluated by counting interictal discharges and seizures. Two children had thalamic deep brain stimulation (DBS) of the centromedian nucleus (one with idiopathic generalized epilepsy, one with presumed symptomatic generalized epilepsy), and one child on the anterior nucleus (right fronto-temporal epilepsy). The incidence of interictal discharges was evaluated visually and quantified automatically. RESULTS Among the three children with DBS, two had >60% improvement in seizure frequency and severity and one had no improvement. Among the five children with SCS, four showed improvement in seizure frequency (>50%) and one chid did not show improvement. Procedures were well tolerated by children. CONCLUSION Cortical and thalamic stimulation appear to be effective and well tolerated in children with refractory epilepsy. SCS can be used to identify the focus and predict the effects of resective surgery or chronic cortical stimulation. Further larger studies are necessary.
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Affiliation(s)
- Antonio Valentín
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK.
| | - Richard P Selway
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Meriem Amarouche
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Nilesh Mundil
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Ismail Ughratdar
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Leila Ayoubian
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - David Martín-López
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, Kingston Hospital NHS FT, London, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Farhana Kazi
- Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Talib Dar
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Diego Jiménez-Jiménez
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| | - Elaine Hughes
- Department of Paediatric Neurosciences, King's College Hospital NHS Trust, London, UK; Department of Paediatric Neurology, Evelina Children's Hospital, London, UK
| | - Gonzalo Alarcón
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Comprehensive Epilepsy Center, Neuroscience Institute, Academic Health Systems Hamad Medical Corporation, Doha, Qatar
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Depth versus subdural temporal electrodes revisited: Impact on surgical outcome after resective surgery for epilepsy. Clin Neurophysiol 2016; 128:418-423. [PMID: 28160747 DOI: 10.1016/j.clinph.2016.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 11/23/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study retrospectively the impact of electrode modality (subdural or depth electrodes) during presurgical assessment on surgical outcome after temporal lobectomy. METHODS The study included 17 patients assessed with depth electrodes and 57 with bitemporal subdural strips. RESULTS MRI showed a larger proportion of bilateral pathology in patients undergoing depth recordings (29.41% versus 3.5%, p=0.00069). Among the operated patients, those undergoing depth electrode recordings showed better outcome at one year after surgery (11/12 versus 22/33; p=0.046). This difference disappears at longest follow up (10/12 versus 22/33; p=0.138). Moreover, the probability of undergoing surgery and having good outcome after assessment with intracranial recordings is higher for the depth electrode group at one-year follow up (11/17 versus 22/57; p=0.029) but statistical differences decrease to a trend for the longest follow up (10/17 versus 22/57; p=0.069). No other statistical differences were noted between subdural and depth electrodes. Depth electrodes showed lower complication rates than subdural electrodes. CONCLUSION Both depth and subdural electrodes are effective for presurgical assessment of temporal lobe epilepsy. SIGNIFICANCE Assessment with depth electrodes is associated with slightly increased likelihood of surgery and marginally better surgical outcome at one year follow up which disappears for longer follow up periods. Initial assessment with depth electrodes would have avoided a second implantation in 15% of patients.
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Hartl E, Rémi J, Vollmar C, Goc J, Loesch AM, Rominger A, Noachtar S. PET imaging in extratemporal epilepsy requires consideration of electroclinical findings. Epilepsy Res 2016; 125:72-6. [DOI: 10.1016/j.eplepsyres.2016.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/19/2016] [Accepted: 05/25/2016] [Indexed: 11/27/2022]
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Boulogne S, Ryvlin P, Rheims S. Single and paired-pulse electrical stimulation during invasive EEG recordings. Rev Neurol (Paris) 2016; 172:174-81. [PMID: 26993563 DOI: 10.1016/j.neurol.2016.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/11/2016] [Accepted: 02/23/2016] [Indexed: 12/01/2022]
Abstract
Invasive EEG recordings are frequently required during the presurgical exploration of patients with drug-resistant focal epilepsy in order to clarify the epileptic zone location. Intracranial direct electrical stimulations (DES) induce EEG and/or clinical responses that participate in this evaluation. Clinical DES protocols (1Hz and/or 50Hz) trigger massive cortical activation that can elicit seizures, after-discharges or complex clinical signs. In contrast, low-energy (<1Hz) protocols activate more localized cortical regions using single-pulse electrical stimulations (SPES). SPES can elicit two main types of responses. Cortico-cortical evoked potentials (CCEPs) correspond to highly consistent early responses, appearing before 100ms after stimulation, with fixed latency; they are considered physiological and assess the effective connectivity between the recorded regions. Late responses appear after 100ms; they are rare, inconsistent with variable latency and are suggestive of an underlying epileptogenic cortex. Paired-pulse stimulation paradigm associates a conditioning and a test stimulation to induce intracortical inhibition or facilitation by modifying the response amplitude. Largely used in transcranial magnetic stimulation, it has rarely been applied to CCEP although the mechanisms put in place seem highly similar. Low frequency intracerebral stimulations allow analysing brain connectivity and cortical excitability with a high temporal and spatial resolution. The development of new stimulation protocols and the combination with imaging or statistical techniques recently offered promising results.
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Affiliation(s)
- S Boulogne
- Department of Functional Neurology and Epileptology, Hospices civils de Lyon, 59, boulevard Pinel, 69003 Lyon, France; Lyon's Research Neuroscience Center, Inserm U1028/CNRS UMPR 5292, CH Le Vinatier, Bâtiment 452, 95, boulevard Pinel, 69675 Bron, France
| | - P Ryvlin
- Department of clinical neurosciences, CHU Vaudois, 46, rue du Bugnon, 1011 Lausanne, Switzerland
| | - S Rheims
- Department of Functional Neurology and Epileptology, Hospices civils de Lyon, 59, boulevard Pinel, 69003 Lyon, France; Lyon's Research Neuroscience Center, Inserm U1028/CNRS UMPR 5292, CH Le Vinatier, Bâtiment 452, 95, boulevard Pinel, 69675 Bron, France.
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What is the concordance between the seizure onset zone and the irritative zone? A SEEG quantified study. Clin Neurophysiol 2016; 127:1157-1162. [DOI: 10.1016/j.clinph.2015.10.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/30/2015] [Accepted: 10/03/2015] [Indexed: 11/15/2022]
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Jiménez-Jiménez D, Martín-López D, Masood MA, Selway RP, Valentín A, Alarcón G. Prognostic value of the second ictal intracranial pattern for the outcome of epilepsy surgery. Clin Neurophysiol 2015; 127:230-237. [PMID: 26253031 DOI: 10.1016/j.clinph.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 06/24/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the prognostic value of the second ictal pattern (SIP) that follows the first ictal pattern (FIP) seen at seizure onset in order to predict seizure control after epilepsy surgery. METHODS SIPs were analysed in 344 electro-clinical and subclinical seizures recorded with intracranial electrodes in 63 patients. SIPs were classified as (a) electrodecremental event (EDE); (b) fast activity (FA); (c) runs of spikes; (d) spike-wave activity; (e) sharp waves; (f) alpha activity; (g) delta activity and (h) theta activity. Engel surgical outcome scale was used. RESULTS The mean follow-up period was 42.1 months (SD=30.1). EDE was the most common SIP seen (41%), followed by FA (19%), spike-wave activity (18%), alpha activity (8%), sharp-wave activity (8%), delta activity (3%), runs of spikes (2%) and theta activity (2%). EDE as SIP was associated with favourable outcome when compared with FA (p=0.0044) whereas FA was associated with poor outcome when compared with any other pattern (p=0.0389). FA as SIP tends to occur after EDE (75%) whereas EDE tends to evolve from a FIP containing FA (77%). SIP extent was focal in 46% of patients, lobar in 24%, multilobar in 14% and bilateral in 16%. There is a gradual decrease in the proportion of Engel grade I with the extent of SIP. Focal and delayed (in temporal lobe epilepsy) SIPs appear to be associated with better outcome. CONCLUSIONS As SIP, EDE was associated with favourable surgical outcome whereas FA was associated with poor outcome, probably because outcome is dominated by FIP. SIGNIFICANCE EDE as SIP should not discourage surgery. However, FA as SIP should be contemplated with caution. SIP focality and latency can have prognostic value in epilepsy surgery.
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Affiliation(s)
- Diego Jiménez-Jiménez
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador.
| | - David Martín-López
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; West Surrey Clinical Neurophysiology, St Peter's Hospital, Chertsey, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Mojtaba A Masood
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Richard P Selway
- Department of Neurosurgery, King's College Hospital, NHS Trust London, UK
| | - Antonio Valentín
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Gonzalo Alarcón
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Comprehensive Epilepsy Center Neuroscience Institute, Academic Health Systems, Hamad Medical Corporation, Doha, Qatar
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Smart O, Burrell L. Genetic Programming and Frequent Itemset Mining to Identify Feature Selection Patterns of iEEG and fMRI Epilepsy Data. ENGINEERING APPLICATIONS OF ARTIFICIAL INTELLIGENCE 2015; 39:198-214. [PMID: 25580059 PMCID: PMC4285716 DOI: 10.1016/j.engappai.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pattern classification for intracranial electroencephalogram (iEEG) and functional magnetic resonance imaging (fMRI) signals has furthered epilepsy research toward understanding the origin of epileptic seizures and localizing dysfunctional brain tissue for treatment. Prior research has demonstrated that implicitly selecting features with a genetic programming (GP) algorithm more effectively determined the proper features to discern biomarker and non-biomarker interictal iEEG and fMRI activity than conventional feature selection approaches. However for each the iEEG and fMRI modalities, it is still uncertain whether the stochastic properties of indirect feature selection with a GP yield (a) consistent results within a patient data set and (b) features that are specific or universal across multiple patient data sets. We examined the reproducibility of implicitly selecting features to classify interictal activity using a GP algorithm by performing several selection trials and subsequent frequent itemset mining (FIM) for separate iEEG and fMRI epilepsy patient data. We observed within-subject consistency and across-subject variability with some small similarity for selected features, indicating a clear need for patient-specific features and possible need for patient-specific feature selection or/and classification. For the fMRI, using nearest-neighbor classification and 30 GP generations, we obtained over 60% median sensitivity and over 60% median selectivity. For the iEEG, using nearest-neighbor classification and 30 GP generations, we obtained over 65% median sensitivity and over 65% median selectivity except one patient.
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Affiliation(s)
- Otis Smart
- Corresponding author: Otis Smart, PhD, Department of Neurosurgery, Emory University School of Medicine, Woodruff Memorial Research Building, 101 Woodruff Circle, Room 6329, Atlanta, GA 30322, USA, , 404.423.8503 (phone), 404.712.8576 (fax)
| | - Lauren Burrell
- Intelligent Control Systems Laboratory, Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332
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Valentín A, Morris R, Honavar M, Bodi I, Teijeira-Azcona A, Lázaro M, Selway R, Alarcón G, Richardson MP. Single Pulse Electrical Stimulation Identifies Epileptogenicity in a Case With Subcortical Nodular Heterotopia and MRI Negative Epilepsy. Brain Stimul 2015; 8:672-4. [PMID: 25682362 DOI: 10.1016/j.brs.2015.01.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/14/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Antonio Valentín
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK; Department of Clinical Neurophysiology, King's College Hospital, London, UK; Departamento de Fisiología, Universidad Complutense, Madrid, Spain.
| | - Robert Morris
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Mrinalini Honavar
- Department of Clinical Neuropathology, King's College Hospital, London, UK; Department of Anatomic Pathology, USL de Matosinhos, Portugal
| | - Istvan Bodi
- Department of Clinical Neuropathology, King's College Hospital, London, UK; Department of Anatomic Pathology, USL de Matosinhos, Portugal
| | | | - Marian Lázaro
- Department of Clinical Neurophysiology, Guy's and St Thomas Hospital, London, UK
| | - Richard Selway
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Gonzalo Alarcón
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK; Department of Clinical Neurophysiology, King's College Hospital, London, UK; Departamento de Fisiología, Universidad Complutense, Madrid, Spain
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK; Department of Neurology, King's College Hospital, London, UK
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Yang PF, Pei JS, Zhang HJ, Lin Q, Mei Z, Zhong ZH, Tian J, Jia YZ, Chen ZQ, Zheng ZY. Long-term epilepsy surgery outcomes in patients with PET-positive, MRI-negative temporal lobe epilepsy. Epilepsy Behav 2014; 41:91-7. [PMID: 25461196 DOI: 10.1016/j.yebeh.2014.09.054] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
This study compared the long-term efficacy of anterior temporal lobectomy (ATL) for the treatment of medically refractory temporal lobe epilepsy (TLE) in patients who presented with ipsilateral temporal PET hypometabolism and nonlesional magnetic resonance imaging (PET+/MRI-) with that in patients who had mesial temporal sclerosis (MTS) on MRI. We described the electroclinical, MRI, PET, and pathological characteristics and seizure outcome of 28 PET+/MRI--patients without discordant ictal and interictal electroencephalography (EEG) who underwent ATL (2004-2007) for medically refractory partial epilepsy while avoiding intracranial monitoring. The primary outcome was the percentages of Engel Class I outcomes at 2 and 5 years of PET+/MRI--patients compared with those of patients with MTS on MRI; neuropsychological testing was used as the secondary outcome. At 2-year follow-up, 21 (75%) patients in the PET+/MRI--group were in Engel Class I compared with 66 (75.9%) patients with MTS, and at 5-year follow-up, 20 (71.4%) patients in the PET+/MRI--group were in Engel Class I compared with 64 (73.6%) patients in the group with MTS. There were no significant differences between the groups at either time period. We concluded that normal MRI results should not preclude presurgical evaluations in patients with medically refractory TLE, as favorable long-term postoperative seizure outcomes are possible, especially in patients with unilateral anterior interictal epileptiform discharges and ipsilateral temporal PET hypometabolism.
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Affiliation(s)
- Peng-Fan Yang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Jia-Sheng Pei
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Hui-Jian Zhang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Qiao Lin
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhen Mei
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhong-Hui Zhong
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jun Tian
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Yan-Zeng Jia
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zi-Qian Chen
- Department of Neuroradiology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhi-Yong Zheng
- Department of Pathology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
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Nayak D, Valentín A, Selway RP, Alarcón G. Can single pulse electrical stimulation provoke responses similar to spontaneous interictal epileptiform discharges? Clin Neurophysiol 2014; 125:1306-11. [DOI: 10.1016/j.clinph.2013.11.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/21/2013] [Accepted: 11/23/2013] [Indexed: 11/29/2022]
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Jiménez-Jiménez D, Nekkare R, Flores L, Chatzidimou K, Bodi I, Honavar M, Mullatti N, Elwes RDC, Selway RP, Valentín A, Alarcón G. Prognostic value of intracranial seizure onset patterns for surgical outcome of the treatment of epilepsy. Clin Neurophysiol 2014; 126:257-67. [PMID: 25065302 DOI: 10.1016/j.clinph.2014.06.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 05/22/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate if intracranial EEG patterns at seizure onset can predict surgical outcome. METHODS Ictal onset patterns from intracranial EEG were analysed in 373 electro-clinical seizures and subclinical seizures from 69 patients. Seizure onset patterns were classified as: (a) Diffuse electrodecremental (DEE); (b) Focal fast activity (FA); (c) Simultaneous onset of fast activity and diffuse electrodecremental event (FA-DEE); (d) Spikes; (e) Spike-wave activity; (f) Sharp waves; (g) Alpha activity; (h) Delta activity. Presence of preceding epileptiform discharge (PED) was also studied. Engel and ILAE surgical outcome scales were used. RESULTS The mean follow-up period was 42.1 months (SD=30.1). Fast activity was the most common seizure onset pattern seen (33%), followed by (FA-DEE) (20%), DEE (19%), spike-wave activity (12%), sharp-waves (6%), alpha activity (6%), delta activity (3%) and spikes (1%). Preceding epileptiform discharges were present in 75% of patients. FA was associated with favourable outcome (p=0.0083) whereas DEE was associated with poor outcome (p=0.0025). A widespread PED was not associated with poor outcome (p=0.9559). There was no clear association between seizure onset pattern and specific pathology, except possibly between sharp/spike waves and mesial temporal sclerosis. CONCLUSIONS FA activity is associated with favourable outcome. DEE at onset was associated with poor surgical outcome. Widespread/bilateral PEDs were not associated with poor or good outcome. SIGNIFICANCE FA appears to be the best marker for the epileptogenic zone. Surgery should be contemplated with caution if DEE is the first ictal change. However, a widespread/bilateral PED at onset is common and should not discourage surgery.
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Affiliation(s)
- Diego Jiménez-Jiménez
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; Universidad San Francisco de Quito, School of Medicine, Quito, Ecuador
| | - Ramesh Nekkare
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK
| | - Lorena Flores
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK
| | - Katerina Chatzidimou
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK
| | - Istvan Bodi
- Department of Neuropathology, King's College Hospital NHS Trust, London, UK
| | - Mrinalini Honavar
- Department of Neuropathology, King's College Hospital NHS Trust, London, UK; Serviço de Anatomia Patológica, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Nandini Mullatti
- Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Robert D C Elwes
- Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Richard P Selway
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Antonio Valentín
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Gonzalo Alarcón
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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