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Eelbode C, Spinelli L, Corniola M, Momjian S, Seeck M, Schaller K, Mégevand P. Implantation and reimplantation of intracranial EEG electrodes in patients considering epilepsy surgery. Epilepsia Open 2023; 8:1622-1627. [PMID: 37873557 PMCID: PMC10690689 DOI: 10.1002/epi4.12846] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
In patients with drug-resistant epilepsy who are considering surgery, intracranial EEG (iEEG) helps delineate the putative epileptogenic zone. In a minority of patients, iEEG fails to identify seizure onsets. In such cases, it might be worthwhile to reimplant more iEEG electrodes. The consequences of such a strategy for the patient are unknown. We matched 12 patients in whom the initially implanted iEEG electrodes did not delineate the seizure onset zone precisely enough to offer resective surgery, and in whom additional iEEG electrodes were implanted during the same inpatient stay, to controls who did not undergo reimplantation. Seven cases and eight controls proceeded to resective surgery. No intracranial infection occurred. One control suffered an intracranial hemorrhage. Three cases and two controls suffered from a post-operative neurological or neuropsychological deficit. We found no difference in post-operative seizure control between cases and controls. Compared to an ILAE score of 5 (ie, stable seizure frequency in the absence of resective surgery), cases showed significant improvement. Reimplantation of iEEG electrodes can offer the possibility of resective epilepsy surgery to patients in whom the initial iEEG investigation was inconclusive, without compromising on the risk of complications or seizure control.
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Affiliation(s)
- Céline Eelbode
- Neurology divisionGeneva University HospitalsGenevaSwitzerland
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
| | - Laurent Spinelli
- Neurology divisionGeneva University HospitalsGenevaSwitzerland
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
| | - Marco Corniola
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
- Neurosurgery DivisionGeneva University HospitalsGenevaSwitzerland
- Neurosurgery DivisionRennes University HospitalRennesFrance
- INSERM UMR 1099 LTSI, University of RennesRennesFrance
| | - Shahan Momjian
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
- Neurosurgery DivisionGeneva University HospitalsGenevaSwitzerland
| | - Margitta Seeck
- Neurology divisionGeneva University HospitalsGenevaSwitzerland
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
| | - Karl Schaller
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
- Neurosurgery DivisionGeneva University HospitalsGenevaSwitzerland
| | - Pierre Mégevand
- Neurology divisionGeneva University HospitalsGenevaSwitzerland
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
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Swarup O, Waxmann A, Chu J, Vogrin S, Lai A, Laing J, Barker J, Seiderer L, Ignatiadis S, Plummer C, Carne R, Seneviratne U, Cook M, Murphy M, D'Souza W. Long-term mood, quality of life, and seizure freedom in intracranial EEG epilepsy surgery. Epilepsy Behav 2021; 123:108241. [PMID: 34450387 DOI: 10.1016/j.yebeh.2021.108241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the long-term outcomes in patients undergoing intracranial EEG (iEEG) evaluation for epilepsy surgery in terms of seizure freedom, mood, and quality of life at St. Vincent's Hospital, Melbourne. METHODS Patients who underwent iEEG between 1999 and 2016 were identified. Patients were retrospectively assessed between 2014 and 2017 by specialist clinic record review and telephone survey with standardized validated questionnaires for: 1) seizure freedom using the Engel classification; 2) Mood using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); 3) Quality-of-life outcomes using the QOLIE-10 questionnaire. Summary statistics and univariate analysis were performed to investigate variables for significance. RESULTS Seventy one patients underwent iEEG surgery: 49 Subdural, 14 Depths, 8 Combination with 62/68 (91.9%) of those still alive, available at last follow-up by telephone survey or medical record review (median of 8.2 years). The estimated epileptogenic zone was 62% temporal and 38% extra-temporal. At last follow-up, 69.4% (43/62) were Engel Class I and 30.6% (19/62) were Engel Class II-IV. Further, a depressive episode (NDDI-E > 15)was observed in 34% (16/47), while a 'better quality of life' (QOLIE-10 score < 25) was noted in 74% (31/42). Quality of life (p < 0.001) but not mood (p = 0.24) was associated with seizure freedom. SIGNIFICANCE Long-term seizure freedom can be observed in patients undergoing complex epilepsy surgery with iEEG evaluation and is associated with good quality of life.
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Affiliation(s)
- Oshi Swarup
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Medicine, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, Victoria 3050, Australia.
| | - Alexandra Waxmann
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Jocelyn Chu
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Simon Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Faculty of Health Arts and Design, Swinburne University of Technology, John St, Hawthorn, Victoria 3122, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Joshua Laing
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - James Barker
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Medicine, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, Victoria 3050, Australia
| | - Linda Seiderer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Sophia Ignatiadis
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Chris Plummer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Faculty of Health Arts and Design, Swinburne University of Technology, John St, Hawthorn, Victoria 3122, Australia
| | - Ross Carne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Neurosciences, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168, Australia
| | - Mark Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Michael Murphy
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
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3
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Kovács S, Tóth M, Janszky J, Dóczi T, Fabó D, Boncz I, Botz L, Zemplényi A. Cost-effectiveness analysis of invasive EEG monitoring in drug-resistant epilepsy. Epilepsy Behav 2021; 114:107488. [PMID: 33257296 DOI: 10.1016/j.yebeh.2020.107488] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Our aim was to determine the cost-effectiveness of two intracranial electroencephalography (iEEG) interventions: 1) stereoelectroencephalography (SEEG) and 2) placement of subdural grid electrodes (SDGs) both followed by resective surgery in patients with drug-resistant, partial-onset epilepsy, compared with medical management (MM) in Hungary from payer's perspective. METHODS The incremental health gains and costs of iEEG interventions have been determined with a combination of a decision tree and prevalence Markov process model over a 30-year time horizon in a cost-utility analysis (CUA). To address the effect of parameter uncertainty on the incremental cost-effectiveness ratio (ICER), deterministic and probabilistic sensitivity analyses were performed. RESULTS Our results showed that both SEEG and SDG interventions represent a more expensive but more effective strategy than MM representing the current standard of care. The total discounted cost of SEEG and SDG were € 32,760 and € 25,028 representing € 18,108 and € 10,375 additional cost compared with MM, respectively. However, they provide an additional 3.931 (in SEEG group) and 3.444 quality-adjusted life years (QALYs; in SDG group), correspondingly. Thus, the ICER of SEEG is € 4607 per QALY gain, while the ICER for SDG is € 3013 per QALY gain, compared with MM. At a cost-effectiveness threshold of € 41,058 per QALY in Hungary, both subtypes of iEEG interventions are cost-effective and provide good value for money. SIGNIFICANCE Because of the high cost of implanting electrodes and monitoring, the invasive EEG for patients with refractory epilepsy is currently not available in the Hungarian national healthcare system. Our study demonstrated that these procedures in Hungary are cost-effective compared with the MM. As a result, the introduction of iEEG interventions to the reimbursement list of the National Health Insurance Fund Administration was initiated.
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Affiliation(s)
- Sándor Kovács
- University of Pécs, Centre for Health Technology Assessment, Pécs, Rákóczi u. 2., H-7623, Hungary; University of Pécs, Faculty of Pharmacy, Division of Pharmacoeconomics, Department of Pharmaceutics, Pécs, Rákóczi u. 2., H-7623, Hungary.
| | - Márton Tóth
- University of Pécs, Medical School, Department of Neurology, Pécs, Rét u. 2., H-7623, Hungary
| | - József Janszky
- University of Pécs, Medical School, Department of Neurology, Pécs, Rét u. 2., H-7623, Hungary; MTA-PTE Clinical Neuroscience MRI Research Group, Pécs, Ifjúság u. 20., H-7624, Hungary
| | - Tamás Dóczi
- MTA-PTE Clinical Neuroscience MRI Research Group, Pécs, Ifjúság u. 20., H-7624, Hungary; University of Pécs, Medical School, Department of Neurosurgery, Pécs, Rét u. 2., H-7623, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Budapest, Amerikai u. 57., H-1145, Hungary
| | - Imre Boncz
- University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, Pécs, Mária u. 5-7., H-7621, Hungary
| | - Lajos Botz
- University of Pécs, Faculty of Pharmacy, Department of Pharmaceutics and Central Clinical Pharmacy, Pécs, Honvéd u. 3., H-7624, Hungary
| | - Antal Zemplényi
- University of Pécs, Centre for Health Technology Assessment, Pécs, Rákóczi u. 2., H-7623, Hungary; University of Pécs, Faculty of Pharmacy, Division of Pharmacoeconomics, Department of Pharmaceutics, Pécs, Rákóczi u. 2., H-7623, Hungary
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Joswig H, Lau JC, Abdallat M, Parrent AG, MacDougall KW, McLachlan RS, Burneo JG, Steven DA. Stereoelectroencephalography Versus Subdural Strip Electrode Implantations: Feasibility, Complications, and Outcomes in 500 Intracranial Monitoring Cases for Drug-Resistant Epilepsy. Neurosurgery 2020; 87:E23-E30. [DOI: 10.1093/neuros/nyaa112] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 02/16/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Both stereoelectroencephalography (SEEG) and subdural strip electrodes (SSE) are used for intracranial electroencephalographic recordings in the invasive investigation of patients with drug-resistant epilepsy.
OBJECTIVE
To compare SEEG and SSE with respect to feasibility, complications, and outcome in this single-center study.
METHODS
Patient characteristics, periprocedural parameters, complications, and outcome were acquired from a pro- and retrospectively managed databank to compare SEEG and SSE cases.
RESULTS
A total of 500 intracranial electroencephalographic monitoring cases in 450 patients were analyzed (145 SEEG and 355 SSE). Both groups were of similar age, gender distribution, and duration of epilepsy. Implantation of each SEEG electrode took 13.9 ± 7.6 min (20 ± 12 min for each SSE; P < .01). Radiation exposure to the patient was 4.3 ± 7.7 s to a dose area product of 14.6 ± 27.9 rad*cm2 for SEEG and 9.4 ± 8.9 s with 21 ± 22.4 rad*cm2 for SSE (P < .01). There was no difference in the length of stay (12.2 ± 7.2 and 12 ± 6.3 d). The complication rate was low in both groups. No infections were seen in SEEG cases (2.3% after SSE). The rate of hemorrhage was 2.8% for SEEG and 1.4% for SSE. Surgical outcome was similar.
CONCLUSION
SEEG allows targeting deeply situated foci with a non-inferior safety profile to SSE and seizure outcome comparable to SSE.
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Affiliation(s)
- Holger Joswig
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
- HMU Health and Medical University Potsdam, Department of Neurosurgery, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Jonathan C Lau
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Mahmoud Abdallat
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Neurosurgery, University of Jordan, Amman, Jordan
| | - Andrew G Parrent
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Keith W MacDougall
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Richard S McLachlan
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - David A Steven
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Surgical outcomes related to invasive EEG monitoring with subdural grids or depth electrodes in adults: A systematic review and meta-analysis. Seizure 2019; 70:12-19. [DOI: 10.1016/j.seizure.2019.06.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 01/05/2023] Open
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Nagahama Y, Schmitt AJ, Nakagawa D, Vesole AS, Kamm J, Kovach CK, Hasan D, Granner M, Dlouhy BJ, Howard MA, Kawasaki H. Intracranial EEG for seizure focus localization: evolving techniques, outcomes, complications, and utility of combining surface and depth electrodes. J Neurosurg 2019; 130:1180-1192. [PMID: 29799342 DOI: 10.3171/2018.1.jns171808] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial electroencephalography (iEEG) provides valuable information that guides clinical decision-making in patients undergoing epilepsy surgery, but it carries technical challenges and risks. The technical approaches used and reported rates of complications vary across institutions and evolve over time with increasing experience. In this report, the authors describe the strategy at the University of Iowa using both surface and depth electrodes and analyze outcomes and complications. METHODS The authors performed a retrospective review and analysis of all patients who underwent craniotomy and electrode implantation from January 2006 through December 2015 at the University of Iowa Hospitals and Clinics. The basic demographic and clinical information was collected, including electrode coverage, monitoring results, outcomes, and complications. The correlations between clinically significant complications with various clinical variables were analyzed using multivariate analysis. The Fisher exact test was used to evaluate a change in the rate of complications over the study period. RESULTS Ninety-one patients (mean age 29 ± 14 years, range 3-62 years), including 22 pediatric patients, underwent iEEG. Subdural surface (grid and/or strip) electrodes were utilized in all patients, and depth electrodes were also placed in 89 (97.8%) patients. The total number of electrode contacts placed per patient averaged 151 ± 58. The duration of invasive monitoring averaged 12.0 ± 5.1 days. In 84 (92.3%) patients, a seizure focus was localized by ictal onset (82 cases) or inferred based on interictal discharges (2 patients). Localization was achieved based on data obtained from surface electrodes alone (29 patients), depth electrodes alone (13 patients), or a combination of both surface and depth electrodes (42 patients). Seventy-two (79.1%) patients ultimately underwent resective surgery. Forty-seven (65.3%) and 18 (25.0%) patients achieved modified Engel class I and II outcomes, respectively. The mean follow-up duration was 3.9 ± 2.9 (range 0.1-10.5) years. Clinically significant complications occurred in 8 patients, including hematoma in 3 (3.3%) patients, infection/osteomyelitis in 3 (3.3%) patients, and edema/compression in 2 (2.2%) patients. One patient developed a permanent neurological deficit (1.1%), and there were no deaths. The hemorrhagic and edema/compression complications correlated significantly with the total number of electrode contacts (p = 0.01), but not with age, a history of prior cranial surgery, laterality, monitoring duration, and the number of each electrode type. The small number of infectious complications precluded multivariate analysis. The number of complications decreased from 5 of 36 cases (13.9%) to 3 of 55 cases (5.5%) during the first and last 5 years, respectively, but this change was not statistically significant (p = 0.26). CONCLUSIONS An iEEG implantation strategy that makes use of both surface and depth electrodes is safe and effective at identifying seizure foci in patients with medically refractory epilepsy. With experience and iterative refinement of technical surgical details, the risk of complications has decreased over time.
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Affiliation(s)
| | - Alan J Schmitt
- 2Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | | | - Adam S Vesole
- 3Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City; and
| | - Janina Kamm
- 2Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | | | | | - Mark Granner
- 2Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | - Brian J Dlouhy
- Departments of1Neurosurgery and
- 4Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Matthew A Howard
- Departments of1Neurosurgery and
- 4Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Steriade C, Martins W, Bulacio J, Morita-Sherman ME, Nair D, Gupta A, Bingaman W, Gonzalez-Martinez J, Najm I, Jehi L. Localization yield and seizure outcome in patients undergoing bilateral SEEG exploration. Epilepsia 2018; 60:107-120. [PMID: 30588603 DOI: 10.1111/epi.14624] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aimed to determine the rates and predictors of resection and seizure freedom after bilateral stereo-electroencephalography (SEEG) implantation. METHODS We reviewed 184 patients who underwent bilateral SEEG implantation (2009-2015). Noninvasive and invasive evaluation findings were collected. Outcomes of interest included subsequent resection and seizure freedom. Statistical analyses employed multivariable logistic regression and proportional hazard modeling. Preoperative and postoperative seizure frequency, severity, and quality of life scales were also compared. RESULTS Following bilateral SEEG implantation, 106 of 184 patients (58%) underwent resection. Single seizure type (P = 0.007), a family history of epilepsy (P = 0.003), 10 or more seizures per month (P = 0.004), lower number of electrodes (P = 0.02), or sentinel electrode placement (P = 0.04) was predictive of undergoing a resection, as were lack of nonlocalized (P < 0.0001) or bilateral (P < 0.0001) ictal-onset zones on SEEG. Twenty-six of 81 patients (32% with follow-up greater than 1 year) remained seizure-free. Predictors of seizure freedom were single seizure type (P = 0.01), short epilepsy duration (P = 0.008), use of 2 or fewer antiepileptic drugs (AEDs) at the time of surgery (P = 0.0006), primary localization hypothesis involving the frontal lobe (P = 0.002), sentinel electrode placement only (P = 0.02), and lack of overlap between ictal-onset zone and eloquent cortex (P = 0.04), along with epilepsy substrate histopathology (P = 0.007). Complete resection of a suspected focal cortical dysplasia showed a trend to increased likelihood of seizure freedom (P = 0.09). The 44 of 55 patients (80%) who underwent resection and experienced seizure recurrence had >50% seizure reduction, as opposed to 26 of 45 patients (58%) who continued medical therapy alone (P = 0.003). Seventy-two percent of patients had a clinically meaningful quality of life improvement (>10% decrease in the Quality of Life in Epilepsy [QOLIE-10] score) at 1 year. SIGNIFICANCE A strong preimplantation hypothesis of a suspected unifocal epilepsy increases the odds of resection and seizure freedom. We discuss a tailored approach, taking into account localization hypothesis and suspected epilepsy etiology in guiding implantation and subsequent surgical strategy.
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Affiliation(s)
- Claude Steriade
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - William Martins
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio.,Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas, Porto Alegre, Brazil
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajay Gupta
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
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Ho AL, Feng AY, Kim LH, Pendharkar AV, Sussman ES, Halpern CH, Grant GA. Stereoelectroencephalography in children: a review. Neurosurg Focus 2018; 45:E7. [DOI: 10.3171/2018.6.focus18226] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Stereoelectroencephalography (SEEG) is an intracranial diagnostic measure that has grown in popularity in the United States as outcomes data have demonstrated its benefits and safety. The main uses of SEEG include 1) exploration of deep cortical/sulcal structures; 2) bilateral recordings; and 3) 3D mapping of epileptogenic zones. While SEEG has gradually been accepted for treatment in adults, there is less consensus on its utility in children. In this literature review, the authors seek to describe the current state of SEEG with a focus on the more recent technology-enabled surgical techniques and demonstrate its efficacy in the pediatric epilepsy population.
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Affiliation(s)
- Allen L. Ho
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | - Austin Y. Feng
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | - Lily H. Kim
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | | | - Eric S. Sussman
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | - Casey H. Halpern
- 1Department of Neurosurgery, Stanford University School of Medicine; and
| | - Gerald A. Grant
- 1Department of Neurosurgery, Stanford University School of Medicine; and
- 2Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital, Stanford, California
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9
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Intracranial Electroencephalographic Monitoring: From Subdural to Depth Electrodes. Can J Neurol Sci 2018; 45:336-338. [DOI: 10.1017/cjn.2018.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAt the London Health Sciences Centre Epilepsy Program, stereotactically implanted depth electrodes have largely replaced subdural electrodes in the presurgical investigation of patients with drug-resistant epilepsy over the past 4 years. The rationale for this paradigm shift was more experience with, and improved surgical techniques for, stereoelectroencephalography, a possible lower-risk profile for depth electrodes, better patient tolerability, shorter operative time, as well as increased recognition of potential surgical targets that are not accessible to subdural electrodes.
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10
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Blount JP. Extratemporal resections in pediatric epilepsy surgery-an overview. Epilepsia 2017; 58 Suppl 1:19-27. [PMID: 28386926 DOI: 10.1111/epi.13680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2016] [Indexed: 11/28/2022]
Abstract
Despite optimized medical treatment, approximately one third of all patients with epilepsy continue to have seizures and by definition have medically resistant epilepsy (MRE). For these patients, surgical disruption of the epileptogenic network may enable freedom or great improvement in control of their seizures. The success of surgery is dependent on accurate localization of the epileptogenic zone and network. Epilepsy arising from regions of cortical dysplasia within the neocortex of the frontal, parietal, and occipital lobes show a propensity for reorganization and progressive decline in seizure freedom and consequent poorer surgical outcome. These procedures often require staged investigation with intracranial electrodes via subdural grids or stereoelectroencephalography (SEEG) and are considered extratemporal resections (ETRs). Central concepts include the following: (1) localization of epileptogenic and eloquent functional regions, (2) safe and effective placement of intracranial electrode arrays, (3) resection of epileptogenic cortex, and (4) avoidance of complications. Each of these concepts is summarized and developed in this summary paper.
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Affiliation(s)
- Jeffrey P Blount
- Pediatric Neurosurgery, Children's of Alabama, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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Yang M, Ma Y, Li W, Shi X, Hou Z, An N, Zhang C, Liu L, Yang H, Zhang D, Liu S. A Retrospective Analysis of Stereoelectroencephalography and Subdural Electroencephalography for Preoperative Evaluation of Intractable Epilepsy. Stereotact Funct Neurosurg 2017; 95:13-20. [DOI: 10.1159/000453275] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 11/07/2016] [Indexed: 11/19/2022]
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12
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Outcome of temporal lobe epilepsy surgery evaluated with bitemporal intracranial electrode recordings. Epilepsy Res 2016; 127:324-330. [DOI: 10.1016/j.eplepsyres.2016.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 11/23/2022]
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13
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Davis MC, Broadwater DR, Mathews WH, Paige AL, DeWolfe JL, Elgavish RA, Riley KO, Ver Hoef LW. Statistical modeling of ICEEG features that determine resection planning. Clin Neurol Neurosurg 2016; 147:18-23. [PMID: 27249656 DOI: 10.1016/j.clineuro.2016.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 02/18/2016] [Accepted: 05/16/2016] [Indexed: 11/26/2022]
Abstract
OBJECT The interpretation of intracranial EEG (ICEEG) recordings is a complex balance of the significance of specific rhythms and their relative timing to seizure onset. Ictal and interictal findings are evaluated in light of findings from cortical stimulation of eloquent cortex to determine the area of resection. PATIENTS AND METHODS Patients with ICEEG electrodes and subsequent surgical resection were retrospectively identified. Only the first 15s of ictal activity, which was divided into five 3-s epochs, was considered. Every electrode in each patient was considered a separate observation in a logistic regression model to predict whether the cortex under a given electrode was included in the planned resection. RESULTS 19 included patients had a total of 37 unique seizures. Recordings from a total of 1306 electrodes were analyzed. The strongest predictors of resection of cortex underlying a given electrode was the presence of low-voltage fast activity in Epoch 1, rhythmic spikes in Epoch 1, interictal paroxysmal fast activity, and low-voltage fast activity in Epoch 2. High-amplitude beta spikes and rhythmic slow waves were also significant predictors in Epoch 1. Interictal spikes had a higher odds ratio of affecting the planned resection if described as "continuous" or "very frequent". The presence of motor or language cortex were the strongest negative predictors of resecting underlying cortex. CONCLUSIONS Here we describe a novel model of ictal and interictal patterns significantly associated with the inclusion of cortex underlying a given ICEEG electrode in the surgical resection plan.
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Affiliation(s)
- Matthew C Davis
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Devin R Broadwater
- University of Alabama at Birmingham School of Medical, Birmingham, AL, United States.
| | - Winn H Mathews
- School of Medicine, University of South Alabama, Mobile, AL, United States
| | - A Lebron Paige
- UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer L DeWolfe
- UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ro A Elgavish
- UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kristen O Riley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lawrence W Ver Hoef
- UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
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Abstract
In the approximately 1% of children affected by epilepsy, pharmacoresistance and early age of seizure onset are strongly correlated with poor cognitive outcomes, depression, anxiety, developmental delay, and impaired activities of daily living. These children often require multiple surgical procedures, including invasive diagnostic procedures with intracranial electrodes to identify the seizure-onset zone. The recent development of minimally invasive surgical techniques, including stereotactic electroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT), and new applications of neurostimulation, such as responsive neurostimulation (RNS), are quickly changing the landscape of the surgical management of pediatric epilepsy. In this review, the authors discuss these various technologies, their current applications, and limitations in the treatment of pediatric drug-resistant epilepsy, as well as areas for future research. The development of minimally invasive diagnostic and ablative surgical techniques together with new paradigms in neurostimulation hold vast potential to improve the efficacy and reduce the morbidity of the surgical management of children with drug-resistant epilepsy.
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Affiliation(s)
- Michael Karsy
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Jian Guan
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Katrina Ducis
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Robert J Bollo
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
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Mullin JP, Sexton D, Al-Omar S, Bingaman W, Gonzalez-Martinez J. Outcomes of Subdural Grid Electrode Monitoring in the Stereoelectroencephalography Era. World Neurosurg 2016; 89:255-8. [PMID: 26893042 DOI: 10.1016/j.wneu.2016.02.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Subdural grid (SDG) electrodes have been the gold standard of invasive monitoring in medically refractory epilepsy; however, in some centers, application of SDGs has been reduced by the progressive application of stereoelectroencephalography (SEEG). This study reviews the efficacy of SDG electrode monitoring after the incorporation of the SEEG methodology at our institution. METHODS We retrospectively reviewed 102 patients undergoing intracranial monitoring via SDG electrodes during the years 2010-2013 at our institution. The series includes all patients who underwent SDG placement after the incorporation of SEEG in our extraoperative invasive monitoring armamentarium. RESULTS Average patient age was 29.9 years old; the series included 31 pediatric patients. There were 49 male patients and 53 female patients. The mean length of follow-up was 21.5 months. The epileptogenic zone was localized in 99 (97%) patients. Surgical resection was performed in 84 patients, and 70% experienced Engel class I freedom from seizures. CONCLUSIONS Invasive monitoring via SDG electrodes continues to be an efficacious option for select patients with medically refractory epilepsy, mainly when the hypothetical epileptogenic zone is anatomically restricted to superficial cortical areas and in close relation with eloquent cortex. This is the first report of epilepsy outcomes after SDG monitoring at a center that also performs SEEG monitoring. Our results suggest a complementary benefit of performing both techniques at 1 institution.
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Affiliation(s)
- Jeffrey P Mullin
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Daniel Sexton
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Soha Al-Omar
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Bingaman
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jorge Gonzalez-Martinez
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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16
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Reduced complications from intracranial grid insertion by using a small grid size and a precise protocol during monitoring. Acta Neurochir (Wien) 2016; 158:395-403; discussion 402-3. [PMID: 26645281 DOI: 10.1007/s00701-015-2647-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND A study of the risk factors associated with complications during intracranial EEG monitoring led to a change in protocol for monitoring and implantation at our centres. We conducted a study to identify any reduction in complications following the changed protocols involving the use of smaller subdural electrode arrays, continuous ICP monitoring, use of a central line, and intake of prophylactic antibiotics and dexamethasone. METHODS We prospectively collected data on patient outcomes between 2005 and 2012 (group B) compared with patients between 1988 and 2004 (group A) before the protocol changes. RESULTS Seventy-one patients in group A and 58 patients in group B underwent intracranial electrode implantation. Complications directly related to grids occurred in 25 % of group A vs. 8.6 % in group B (p < 0.05) and those indirectly related to grids were 11.2 % in group A vs. none in group B. The rate of transient complications requiring no treatment was 12.5 % in group A versus 1.7 % in group B. The rate of transient complications requiring treatment was 10 % in group A and 6.9 % in group B. There were two deaths in group A. The infection rate was higher in group B than group A (5.2 % vs. 2.8 %; p = 0.90). Since 2008 there have been no infective complications. Complications directly related to intracranial EEG monitoring were significantly reduced using the revised protocol (p < 0.05). Regression analysis identifying only the size of the grids (≤4 × 8 grid arrays) implanted was an independent predictor of more complications in group A (P < 0.05). CONCLUSIONS Complication rates following intracranial implantation decreased following the use of a small grid size and adherence to a stringent protocol.
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17
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Falowski SM, DiLorenzo DJ, Shannon LR, Wallace DJ, Devries J, Kellogg RG, Cozzi NP, Fogg LF, Byrne RW. Optimizations and Nuances in Neurosurgical Technique for the Minimization of Complications in Subdural Electrode Placement for Epilepsy Surgery. World Neurosurg 2015; 84:989-97. [DOI: 10.1016/j.wneu.2015.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 01/08/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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18
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Raftopoulos C, Vaz G, Tassigny D, Van Rijckevorsel K. Invasive EEG in refractory epilepsy: insertion of subdural grids through linear craniectomy reduces complications and remains effective. Neurochirurgie 2015; 61:16-21. [PMID: 25592807 DOI: 10.1016/j.neuchi.2014.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/12/2014] [Accepted: 09/03/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate our technique of implanting subdural grids by linear craniectomy under computer-assisted navigation for invasive electroencephalography in medically refractory epilepsy. MATERIAL AND METHOD We report results from our first 38 consecutive patients with medically refractory epilepsy who underwent subdural grids implantation by linear craniectomy. For each case, a preoperative MRI was performed for navigation followed by a postoperative MRI for localization control of the intracranial electrode contacts. A linear skin incision, adapted to the depth and type of subdural electrode (strip or grid) and compatible with possible subsequent therapeutic surgery, was carried out. One or two linear craniectomies (maximal length 6cm, width 1cm) were then drilled with a bevel. The dura mater was incised under microscopic guidance to avoid opening the arachnoid. The required subdural electrodes were then slipped subdurally through each linear craniectomy (letter-box technique). RESULTS Forty-one invasive electroencephalographies were performed with 28 (68%) bilateral. For all invasive electroencephalographies, at least one subdural grid was implanted. Sixty-one subdural grids were implanted in total, 52 with 20 contacts and nine with 32 contacts. No cerebrospinal fluid leakage, no infection, no neurological deficit and no permanent complications were observed. Three subdural grids (5%) were not positioned exactly as planned but this had no consequence for the invasive electroencephalography analysis. CONCLUSION The implantation of 61 consecutive subdural grids for invasive electroencephalography through linear craniectomies was associated with no transient or permanent complications in this population. This letter-box technique appears to be practical and safe without limiting explorative efficacy.
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Affiliation(s)
- C Raftopoulos
- Department of Neurosurgery, University Hospital St-Luc, Université Catholique de Louvain, 10, Avenue Hippocrate, 1200 Brussels, Belgium.
| | - G Vaz
- Department of Neurosurgery, University Hospital St-Luc, Université Catholique de Louvain, 10, Avenue Hippocrate, 1200 Brussels, Belgium
| | - D Tassigny
- Department of Neurosurgery, University Hospital St-Luc, Université Catholique de Louvain, 10, Avenue Hippocrate, 1200 Brussels, Belgium
| | - K Van Rijckevorsel
- Department of Neurology, UCL Center for Refractory Epilepsy, University Hospital St-Luc, Université Catholique de Louvain, 10, Avenue Hippocrate, 1200 Brussels, Belgium
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19
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Garcia Gracia C, Yardi R, Kattan MW, Nair D, Gupta A, Najm I, Bingaman W, Gonzalez-Martinez J, Jehi L. Seizure freedom score: A new simple method to predict success of epilepsy surgery. Epilepsia 2014; 56:359-65. [DOI: 10.1111/epi.12892] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Camilo Garcia Gracia
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Ruta Yardi
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Michael W. Kattan
- Quantitative Health Sciences; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Dileep Nair
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Ajay Gupta
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Imad Najm
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - William Bingaman
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Jorge Gonzalez-Martinez
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
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20
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A History of the Epilepsy Programme at University Hospital (LHSC) & Western University, London, Ontario Canada 1975- 2012. Can J Neurol Sci 2014. [DOI: 10.1017/s0317167100018096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Aghakhani Y, Liu X, Jette N, Wiebe S. Epilepsy surgery in patients with bilateral temporal lobe seizures: A systematic review. Epilepsia 2014; 55:1892-901. [DOI: 10.1111/epi.12856] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Yahya Aghakhani
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
| | - Xiaorong Liu
- Institute of Neuroscience and the Second Affiliated Hospital; Guangzhou Medical University; Guangzhou China
| | - Nathalie Jette
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences; Institute of Public Health and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences; Institute of Public Health and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
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22
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Liu X, Yang Z, Yin Y, Deng X. Increased expression of Notch1 in temporal lobe epilepsy: animal models and clinical evidence. Neural Regen Res 2014; 9:526-33. [PMID: 25206850 PMCID: PMC4153506 DOI: 10.4103/1673-5374.130083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2014] [Indexed: 11/04/2022] Open
Abstract
Temporal lobe epilepsy is associated with astrogliosis. Notch1 signaling can induce astrogliosis in glioma. However, it remains unknown whether Notch1 signaling is involved in the pathogenesis of epilepsy. This study investigated the presence of Notch1, hairy and enhancer of split-1, and glial fibrillary acidic protein in the temporal neocortex and hippocampus of lithium-pilocarpine-treated rats. The presence of Notch1 and hairy and enhancer of split-1 was also explored in brain tissues of patients with intractable temporal lobe epilepsy. Quantitative electroencephalogram analysis and behavioral observations were used as auxiliary measures. Results revealed that the presence of Notch1, hairy and enhancer of split-1, and glial fibrillary acidic protein were enhanced in status epilepticus and vehicle-treated spontaneous recurrent seizures rats, but remain unchanged in the following groups: control, absence of either status epilepticus or spontaneous recurrent seizures, and zileuton-treated spontaneous recurrent seizures. Compared with patient control cases, the presences of Notch1 and hairy and enhancer of split-1 were upregulated in the temporal neocortex of patients with intractable temporal lobe epilepsy. Therefore, these results suggest that Notch1 signaling may play an important role in the onset of temporal lobe epilepsy via astrogliosis. Furthermore, zileuton may be a potential therapeutic strategy for temporal lobe epilepsy by blocking Notch1 signaling.
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Affiliation(s)
- Xijin Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhiyong Yang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yaping Yin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xuejun Deng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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23
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Yang PF, Zhang HJ, Pei JS, Tian J, Lin Q, Mei Z, Zhong ZH, Jia YZ, Chen ZQ, Zheng ZY. Intracranial electroencephalography with subdural and/or depth electrodes in children with epilepsy: techniques, complications, and outcomes. Epilepsy Res 2014; 108:1662-70. [PMID: 25241139 DOI: 10.1016/j.eplepsyres.2014.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
Abstract
Intracranial electroencephalographic monitoring with subdural and/or depth electrodes is widely used for the surgical localization of epileptic foci in patients with intractable partial epilepsy; however, data on safety and surgical outcome with this technique are still inadequate. The aims of this study were to assess the morbidity of intracranial recordings and the surgical outcomes in epileptic children. We retrospectively reviewed the clinical data for 137 children with epilepsy (mean age at implantation: 12.6 ± 3.8 years) who underwent intracranial monitoring with the implantation of strip or grid subdural electrodes and/or intracerebral depth electrodes from September 2004 to September 2011 at a tertiary epilepsy center in China. Complications were classified using five grades of severity (including mortality) and were further classified as either minor or severe. Outcome was classified according to Engel's classification. Regression analysis was performed to identify risk factors for complications. The mean duration of implantation was 5.3 ± 1.3 days. Among the 133 patients who underwent resection, 65 (48.9%) were seizure free (Engel Class I) at last known follow-up, which was >2 years after surgery for all patients. Also, 31 (23.3%) patients had a significant reduction in seizures (Engel Class II). Complications of any type were documented in 29 (21.7%) patients; 15 of these patients had intracranial hematoma. The results of multivariate analysis showed that the only independent risk factor for intracranial hematoma was number of electrode contacts. The most common pathologic diagnosis was focal cortical dysplasia (n=58). Our results showed that intracranial electroencephalographic monitoring in children provides good surgical outcomes and the level of risk is acceptable. When using this technique strategies such as using as few electrode contacts as possible should be adopted to minimize the risk of intracranial hematoma.
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Affiliation(s)
- Peng-Fan Yang
- Department of Neurosurgery, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Hui-Jian Zhang
- Department of Pediatric neurology, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Jia-Sheng Pei
- Department of Neurosurgery, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Jun Tian
- Department of Neurosurgery, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Qiao Lin
- Department of Epileptology, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Zhen Mei
- Department of Epileptology, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Zhong-Hui Zhong
- Department of Epileptology, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Yan-Zeng Jia
- Department of Epileptology, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Zi-Qian Chen
- Department of Neuroradiology, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Zhi-Yong Zheng
- Department of Pathology, Epilepsy Center, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
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Tang Y, Yu X, Zhou B, Lei D, Huang XQ, Tang H, Gong QY, Chen Q, Zhou D. Short-term cognitive changes after surgery in patients with unilateral mesial temporal lobe epilepsy associated with hippocampal sclerosis. J Clin Neurosci 2014; 21:1413-8. [DOI: 10.1016/j.jocn.2013.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 12/03/2013] [Accepted: 12/06/2013] [Indexed: 10/25/2022]
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25
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Tebo CC, Evins AI, Christos PJ, Kwon J, Schwartz TH. Evolution of cranial epilepsy surgery complication rates: a 32-year systematic review and meta-analysis. J Neurosurg 2014; 120:1415-27. [DOI: 10.3171/2014.1.jns131694] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Surgical interventions for medically refractory epilepsy are effective in selected patients, but they are underutilized. There remains a lack of pooled data on complication rates and their changes over a period of multiple decades. The authors performed a systematic review and meta-analysis of reported complications from intracranial epilepsy surgery from 1980 to 2012.
Methods
A literature search was performed to find articles published between 1980 and 2012 that contained at least 2 patients. Patients were divided into 3 groups depending on the procedure they underwent: A) temporal lobectomy with or without amygdalohippocampectomy, B) extratemporal lobar or multilobar resections, or C) invasive electrode placement. Articles were divided into 2 time periods, 1980–1995 and 1996–2012.
Results
Sixty-one articles with a total of 5623 patients met the study's eligibility criteria. Based on the 2 time periods, neurological deficits decreased dramatically from 41.8% to 5.2% in Group A and from 30.2% to 19.5% in Group B. Persistent neurological deficits in these 2 groups decreased from 9.7% to 0.8% and from 9.0% to 3.2%, respectively. Wound infections/meningitis decreased from 2.5% to 1.1% in Group A and from 5.3% to 1.9% in Group B. Persistent neurological deficits were uncommon in Group C, although wound infections/meningitis and hemorrhage/hematoma increased over time from 2.3% to 4.3% and from 1.9% to 4.2%, respectively. These complication rates are additive in patients undergoing implantation followed by resection.
Conclusions
Complication rates have decreased dramatically over the last 30 years, particularly for temporal lobectomy, but they remain an unavoidable consequence of epilepsy surgery. Permanent neurological deficits are rare following epilepsy surgery compared with the long-term risks of intractable epilepsy.
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Affiliation(s)
- Collin C. Tebo
- 1Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, NewYork-Presbyterian Hospital; and
| | - Alexander I. Evins
- 1Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, NewYork-Presbyterian Hospital; and
| | - Paul J. Christos
- 2Department of Public Health, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York
| | - Jennifer Kwon
- 1Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, NewYork-Presbyterian Hospital; and
| | - Theodore H. Schwartz
- 1Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, NewYork-Presbyterian Hospital; and
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26
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Intracranial Telemetry Recording of Intractable Epilepsy at London Health Sciences. Can J Neurol Sci 2012. [DOI: 10.1017/s0317167100018114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Routine EEG telemetry using scalp electrode recordings is carried out in all patients being considered for epilepsy surgery. However this, along with other testing, may not yield sufficient information about the location of seizure onset to allow a decision regarding surgery to be made. Various methods have been developed to implant electrodes for chronic recording closer to the cortical surface from which seizures arise including the use of sphenoidal, foramen ovale, epidural peg, subdural and depth electrodes. This is a review of the last two techniques particularly as utilized at London Health Sciences Centre.
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27
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Mueller CA, Scorzin J, von Lehe M, Fimmers R, Helmstaedter C, Zentner J, Lehmann TN, Meencke HJ, Schulze-Bonhage A, Schramm J. Seizure outcome 1 year after temporal lobe epilepsy: an analysis of MR volumetric and clinical parameters. Acta Neurochir (Wien) 2012; 154:1327-36. [PMID: 22722378 DOI: 10.1007/s00701-012-1407-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/24/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of this work was to determine predictors that may contribute to surgical success or failure. Relevant pre- and postoperative baseline data were analyzed, and temporal structures underwent a volumetric analysis. METHODS A total of 207 patients (107 female) underwent complete evaluation for epilepsy surgery. Prospectively collected data used for this analysis included the clinical and demographic data. Classic prognostic factors (e.g., gender, age at operation, age at epilepsy manifestation, duration of epilepsy, education, side of pathology, intracranial EEG recordings, secondarily generalized tonic-clonic seizures, etiological factors, histology) and a volumetric analysis of 12 temporal lobe subregions were used in a regression analysis to identify possible prognostic factors in surgery for TLE. Primary outcome measure was seizure freedom at 1 year and during the full first year expressed as class I in the ILAE outcome scale. RESULTS In the univariate analysis, we identified one negative predictor for a less favorable seizure outcome: intracranial EEG recordings (p = 0.010), hippocampal sclerosis as histological finding trended toward statistical significance (p = 0.054). No statistical outcome significance was found for preoperative temporal lobe compartment volume loss or postoperative lateral atrophy after mesial resection. CONCLUSIONS Necessity for intracranial EEG recording is an independent factor of not optimal seizure control in the 1-year follow-up. Preoperative temporal lobe volume differences including smaller mesial subcompartments did not correlate with poorer seizure outcome.
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Lazow SP, Thadani VM, Gilbert KL, Morse RP, Bujarski KA, Kulandaivel K, Roth RM, Scott RC, Roberts DW, Jobst BC. Outcome of frontal lobe epilepsy surgery. Epilepsia 2012; 53:1746-55. [DOI: 10.1111/j.1528-1167.2012.03582.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wellmer J, von der Groeben F, Klarmann U, Weber C, Elger CE, Urbach H, Clusmann H, von Lehe M. Risks and benefits of invasive epilepsy surgery workup with implanted subdural and depth electrodes. Epilepsia 2012; 53:1322-32. [DOI: 10.1111/j.1528-1167.2012.03545.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Intracranial electrodes in the presurgical evaluation of epilepsy. Neurol Sci 2012; 33:723-9. [PMID: 22460695 DOI: 10.1007/s10072-012-1020-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
The resection of the epileptogenic area of brain is very important and useful for the treatment of uncontrolled epilepsy, especially for the patients with stereotyped partial seizures. The critical point for successful epilepsy surgery is the precise identification of epileptogenic zone. Actually, we cannot precisely localize the epileptogenic zone in about 25 % of patient with refractory seizures based on the noninvasive examination; thus for these patients, we mainly use the intracranial EEG to localize the epileptogenic zone which could be useful in 10-15 % of surgical candidates. The intracranial electrodes which are most used currently are depth electrodes, subdural strip electrodes, and subdural grid electrodes. The subject of this paper is to discuss and compare the indications, construction, insertion, interpretation, limitations, risks and accuracy of each of these methods.
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Morace R, Di Gennaro G, Picardi A, Quarato PP, Sparano A, Mascia A, Meldolesi GN, Grammaldo LG, De Risi M, Esposito V. Surgery after intracranial investigation with subdural electrodes in patients with drug-resistant focal epilepsy: outcome and complications. Neurosurg Rev 2012; 35:519-26; discussion 526. [DOI: 10.1007/s10143-012-0382-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 11/20/2011] [Indexed: 10/28/2022]
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