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Manokaran RK, Ochi A, Weiss S, Yau I, Sharma R, Otsubo H, Ibrahim GM, Donner EJ, Jain P. Stimulation-Induced Seizures in Children Undergoing Stereo-EEG Evaluation. J Clin Neurophysiol 2024:00004691-990000000-00127. [PMID: 38376953 DOI: 10.1097/wnp.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
PURPOSE This study reports our center's initial experience with the use of low-frequency stimulation in provoking stimulation-induced seizures (SIS) in children with drug-resistant epilepsy undergoing stereo-EEG evaluations. METHODS This retrospective study enrolled children aged 2 to 18 years with drug-resistant focal epilepsy who underwent stereo-EEG evaluation and extraoperative direct electrical cortical stimulation to elicit seizures. The low-frequency stimulation parameters consisted of biphasic square waveforms at frequency of 1 Hz, pulse width 1 millisecond, current 1 to 3 mA, and train duration of 20 seconds. Various epilepsy-related, imaging, neurophysiology, and surgery-related variables were collected and summarized. RESULTS Fourteen children (mean age 13 years; 57.1% girls) were included, 10 of whom had unilateral stereo-EEG coverage. Cortical stimulation for provoking seizures was performed after a median of 5 days after electrode implantation. The median number of electrode-contacts stimulated per patient was 42. Four patients (28.6%) experienced habitual SIS (all extratemporal). The etiology in three patients was focal cortical dysplasia. Interictal high-frequency oscillations at electrode-contacts provoking SIS were observed in three cases (75%). Two of these individuals (50%) had class 1 International League Against Epilepsy seizure outcome at last follow-up, after the resection of the brain regions generating SIS. CONCLUSIONS Low-frequency (1-Hz) stimulation could provoke habitual SIS in nearly one-fourth of children with focal epilepsy undergoing stereo-EEG monitoring. This study provides a limited pediatric experience with the low-frequency cortical stimulation and SIS.
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Affiliation(s)
- Ranjith Kumar Manokaran
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Zhao XM, Wan HJ, Shao XQ, Zhang JG, Meng FG, Hu WH, Zhang C, Wang X, Mo JJ, Tao XR, Zhang K, Qiao H. Associated factors with stimulation induced seizures and the relevance with surgical outcomes. Clin Neurol Neurosurg 2023; 232:107865. [PMID: 37480785 DOI: 10.1016/j.clineuro.2023.107865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/11/2023] [Accepted: 06/25/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE To analyze the associated factors with stimulation-induced seizures (SIS) and the relevant factors in predicting surgical outcomes. METHODS We analyzed 80 consecutive epilepsy patients explored by stereo-electroencephalography with routine electrical stimulation mapping (ESM). If seizures induced by ESM, patients were classified as SIS-positive (SIS-P); otherwise, SIS-negative (SIS-N). Patients received radical surgery were further classified as favorable (Engel I) and unfavorable (Engel II-IV) groups. RESULTS Of the 80 patients included, we identified 44 (55.0%) and 36(45.0%) patients in the SIS-P and SIS-N groups, respectively. Multivariate analysis revealed that the seizure onset pattern (SOP) of preceding repetitive epileptiform discharges following LVFA (PRED→LVFA) (OR 3.319, 95% CI 1.200-9.183, P = 0.021) and pathology of focal cortical dysplasia (FCD) type II (OR 3.943, 95% CI 1.093-14.226, P = 0.036) were independent factors influencing whether the electrical stimulation can induce a seizure. Among the patients received radical surgery, there were 55 and 15 patients in the favorable and unfavorable groups separately. Multivariate analysis revealed that the SOP of PRED→LVFA induced seizures by stimulation (OR 11.409, 95% CI 1.182-110.161, P = 0.035) and bilateral implantation (OR 0.048, 95% CI 0.005-0.497, P = 0.011) were independent factors affecting surgical outcomes. The previous epilepsy surgery had a trend to be a negative factor with SIS (OR 0.156, 95% CI 0.028-0.880, P = 0.035) and surgical outcomes (OR 0.253, 95% CI 0.053-1.219, P = 0.087). CONCLUSION ESM is a highly valuable method for localizing the seizure onset zone. The SOP of PRED→LVFA and FCD type II were associated with elicitation of SIS by ESM, whereas a previous epilepsy surgery showed a negative association. Furthermore, the SOP of PRED→LVFA together with SIS in the same patient predicted favorable surgical outcomes, whereas bilateral electrode implantation predicted unfavorable outcomes.
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Affiliation(s)
- Xue-Min Zhao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hui-Juan Wan
- Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fan-Gang Meng
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia-Jie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Rong Tao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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Medina-Pizarro M, Spencer DD, Damisah EC. Recent advances in epilepsy surgery. Curr Opin Neurol 2023; 36:95-101. [PMID: 36762633 DOI: 10.1097/wco.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW Technological innovations in the preoperative evaluation, surgical techniques and outcome prediction in epilepsy surgery have grown exponentially over the last decade. This review highlights and emphasizes relevant updates in techniques and diagnostic tools, discussing their context within standard practice at comprehensive epilepsy centres. RECENT FINDINGS High-resolution structural imaging has set an unprecedented opportunity to detect previously unrecognized subtle abnormalities. Machine learning and computer science are impacting the methodologies to analyse presurgical and surgical outcome data, building more accurate prediction models to tailor treatment strategies. Robotic-assisted placement of depth electrodes has increased the safety and ability to sample epileptogenic nodes within deep structures, improving our understanding of the seizure networks in drug-resistant epilepsy. The current available minimally invasive techniques are reasonable surgical alternatives to ablate or disrupt epileptogenic regions, although their sustained efficacy is still an active area of research. SUMMARY Epilepsy surgery is still underutilized worldwide. Every patient who continues with seizures despite adequate trials of two well selected and tolerated antiseizure medications should be evaluated for surgical candidacy. Collaboration between academic epilepsy centres is of paramount importance to answer long-standing questions in epilepsy surgery regarding the understanding of spatio-temporal dynamics in epileptogenic networks and its impact on surgical outcomes.
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Oliveira LPD, Pérez-Enríquez C, Barguilla A, Langohr K, Conesa G, Infante N, Principe A, Rocamora R. Stereo-electroencephalography-guided radiofrequency thermocoagulation in patients with MRI-negative focal epilepsy. J Neurosurg 2023; 138:837-846. [PMID: 35962969 DOI: 10.3171/2022.6.jns22733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/13/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Coupled with stereo-electroencephalography (SEEG), radiofrequency thermocoagulation (RFTC) has emerged as a therapeutic alternative for patients with refractory focal epilepsy, with proven safe but highly variable results across studies. The authors aimed to describe the outcomes and safety of SEEG-RFTC, focusing on patients with MRI-negative epilepsy. METHODS A retrospective observational study was conducted on patients evaluated by SEEG in the authors' center. Of 84 total cases, 55 underwent RFTC, with 31 MRI-negative epilepsies that were ultimately included in the study. The primary outcome was freedom from disabling seizures at last follow-up. Secondary outcomes were reduction in seizure frequency (RFTC response = seizure frequency reduction > 50%), peri-interventional complications, and neuropsychological outcomes. Potential factors influencing post-RFTC outcome were considered by comparing different variables between responders and nonresponders. RESULTS The mean follow-up period was 30.9 months (range 7.1-69.8 months). Three patients underwent subsequent resection/laser interstitial thermal therapy within the 1st year after RFTC failure. All other patients completed a minimum follow-up period of 1 year. Fourteen patients (45.2%) showed at least a 50% reduction in seizure frequency (responders), and 8 were seizure free (25.8% of the whole cohort). One case showed a permanent complication not directly related to thermolesions. Most patients (76%) showed no significant cognitive decline. Electrically elicited seizures (EESs) were observed in all seizure-free patients and were more frequent in responders (p = 0.038). All patients who were seizure free at the 6-month visit maintained their status during long-term follow-up. CONCLUSIONS SEEG-RFTC is a safe procedure and leads to a good response in many cases of MRI-negative focal epilepsies. One-quarter of the patients were seizure free and almost one-half were responders at the last follow-up. Although these results are still far from those achieved through conventional resection, a nonnegligible proportion of patients may benefit from this one-stage and much less invasive approach. Factors associated with seizure outcome remain to be elucidated; however, responders were significantly more frequent among patients with EESs, and achieving 6 months of seizure freedom appears to predict a good long-term response. In addition, the positive predictive value of RFTC response may be a valuable factor in the decision to proceed to subsequent surgery.
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Affiliation(s)
- Luísa Panadés-de Oliveira
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar.,2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM)
| | - Carmen Pérez-Enríquez
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar.,2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM)
| | - Ainara Barguilla
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar
| | - Klaus Langohr
- 3Department of Statistics and Operations Research, Universitat Politècnica de Catalunya BarcelonaTech.,4Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, IMIM
| | - Gerardo Conesa
- 2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM).,5Department of Neurosurgery, Hospital del Mar; and
| | | | - Alessandro Principe
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar.,2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM).,6Biomedical Engineering, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Rodrigo Rocamora
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar.,2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM).,6Biomedical Engineering, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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