1
|
Kim J, Kang JK, Lee SA, Hong SH. Combined Depth and Subdural Electrodes for Lateralization of the Ictal Onset Zone in Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis. Brain Sci 2023; 13:1547. [PMID: 38002507 PMCID: PMC10669380 DOI: 10.3390/brainsci13111547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Objective: This study aimed to explore the efficacy of conventional invasive techniques in confirming unilateral seizure onset localization in mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and to investigate the association between electrode type and intracranial electroencephalography (EEG) pattern. (2) Methods: This retrospective study encompasses patients diagnosed with MTLE-HS who underwent an invasive study prior to an anterior temporal lobectomy (ATL). Intracranial EEG features were assessed for 99 seizure events from 25 selected patients who achieved seizure remission with ATL after an invasive study using bilateral combined depth and subdural electrodes. Their findings were compared to those of 21 seizure events in eight patients who exhibited suboptimal seizure outcomes. (3) Results: For the distribution of electrodes that recorded the ictal onset, hippocampal depth electrodes recorded 96% of all seizure events, while subdural electrodes recorded 52%. Among the seizures recorded in subdural electrodes, 49% were localized in medial electrodes, with only 8% occurring in lateral electrodes. The initiation of seizures exclusively detected in hippocampal depth electrodes was associated with successful seizure remission, whereas those solely recorded in the lateral strip electrodes were often linked to refractory seizures after ATL. (4) Conclusions: These findings emphasize the importance of employing a combination of depth and subdural electrodes in invasive studies for patients with MTLE-HS to enhance the accuracy of lateralization. This also cautions against sole reliance on subdural electrodes without depth electrodes, which could lead to inaccurate localization.
Collapse
Affiliation(s)
- Junhyung Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Joong Koo Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea (S.A.L.)
- Ace Neurology Clinic, Seoul 05616, Republic of Korea
| | - Sang Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea (S.A.L.)
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| |
Collapse
|
2
|
Pawar SU, Ravat SH, Muzumdar DP, Sankhe SS, Chheda AH, Manglunia AS, Maldar AN. Does Tc-99m ECD ictal brain SPECT have incremental value in localization of epileptogenic zone and predicting postoperative seizure freedom in cases with discordant video electroencephalogram and MRI findings? Nucl Med Commun 2020; 41:858-870. [PMID: 32796473 DOI: 10.1097/mnm.0000000000001240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Localization of epileptogenic focus in drug-refractory epilepsy using Tc-99m ethylene cystine dimer (ECD) brain single photon emission computed tomography (SPECT) is less studied in patients with discordant findings on video electroencephalogram (VEEG) and MRI. The study was done to evaluate brain SPECT for epileptogenic focus localization and postoperative seizure freedom. METHODS Epilepsy patients with discordant VEEG and MRI findings underwent brain SPECT at ictal and interictal phases. Various groups unilateral/bilateral mesial temporal sclerosis (MTS), solitary and multifocal lesional, nonlesional epilepsy were studied for localization of epileptogenic focus and postoperative seizure freedom (>2 years) using Engels classification. Reasons for nonoperability was evaluated in nonoperated group. RESULTS SPECT could localize epileptogenic focus in 49/67 (73.13%) and guided surgery in 19/33 (57.57%) patients in operated group. SPECT was useful in 12 (46.12%) of unilateral (2)/bilateral (10) MTS. Postoperative seizure freedom of Engels Class I and II in 22 (66.67%), III in six (18.2%) and IV in one patient based on SPECT findings (P = 0.0086). Overall sensitivity and specificity were 79.3% and 85.7%, respectively. SPECT could localize epileptogenic focus in 23/34 (67.64%) patients in nonoperated group; 10 (29.41%) patients refused for surgery and no epileptogenic focus was localized in the rest of 14 (41.2%). CONCLUSION Ictal SPECT showed incremental value and was found necessary for epileptogenic focus localization and subsequent surgery in unilateral/bilateral MTS in this study. Seizure freedom in patients undergoing epilepsy surgery based on ictal SPECT assistance was comparable to the surgical group not requiring ictal SPECT.
Collapse
Affiliation(s)
| | | | | | - Shilpa Sushilkumar Sankhe
- Radiology, Comprehensive Epilepsy Care Centre, Seth G S Medical College and KEM Hospital, Mumbai, India
| | | | | | | |
Collapse
|
3
|
Forthoffer N, Kleitz C, Bilger M, Brissart H. Depression could modulate neuropsychological status in epilepsy. Rev Neurol (Paris) 2020; 176:456-467. [PMID: 32414531 DOI: 10.1016/j.neurol.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022]
Abstract
While cognition and depression have often been studied in patients with epilepsy, only a few studies have so far attempted to link these two domains, and more specifically to investigate the specific impact of depression on cognition in epilepsy. In this review, we performed an extensive search of the literature database to provide a better understanding of this subject. Using several inclusion criteria (adult population, quantitative depression/neuropsychological assessment, statistical analyses of the impact of depression on cognitive scores, patients with epilepsy (PWE) and no other neurological disease, and studies including at least 20 patients), we identified 20 articles (out of 712 search results) that investigated both depression and cognition in PWE. Their results were summarized using a narrative and descriptive approach. This review highlights a variable impact of depression on cognition in PWE, depending on the laterality of the seizure onset zone, the type of epilepsy and the surgical context. We emphasize the need for a systematic depression assessment in these patients, especially since depressed PWE will benefit from prompt and appropriate care to help them avoid cognitive decline, particularly in a surgical context.
Collapse
Affiliation(s)
- N Forthoffer
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, 54000 Nancy, France; LNCA, UMR 7364, CNRS et Université de Strasbourg, Strasbourg, France.
| | - C Kleitz
- Service de Neurologie, Hôpital Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - M Bilger
- Service de Neurologie, Hôpital Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - H Brissart
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, 54000 Nancy, France; CRAN, UMR 7039, CNRS et Université de Lorraine, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
4
|
Sen A, Dugan P, Perucca P, Costello D, Choi H, Bazil C, Radtke R, Andrade D, Depondt C, Heavin S, Adcock J, Pickrell WO, McGinty RN, Nascimento F, Smith P, Rees MI, Kwan P, O'Brien TJ, Goldstein D, Delanty N. The phenotype of bilateral hippocampal sclerosis and its management in "real life" clinical settings. Epilepsia 2018; 59:1410-1420. [PMID: 29901232 DOI: 10.1111/epi.14436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is little detailed phenotypic characterization of bilateral hippocampal sclerosis (HS). We therefore conducted a multicenter review of people with pharmacoresistant epilepsy and bilateral HS to better determine their clinical characteristics. METHODS Databases from 11 EPIGEN centers were searched. For identified cases, clinicians reviewed the medical notes, imaging, and electroencephalographic (EEG), video-EEG, and neuropsychometric data. Data were irretrievably anonymized, and a single database was populated to capture all phenotypic information. These data were compared with phenotyped cases of unilateral HS from the same centers. RESULTS In total, 96 patients with pharmacoresistant epilepsy and bilateral HS were identified (43 female, 53 male; age range = 8-80 years). Twenty-five percent had experienced febrile convulsions, and 27% of patients had experienced status epilepticus. The mean number of previously tried antiepileptic drugs was 5.32, and the average number of currently prescribed medications was 2.99; 44.8% of patients had cognitive difficulties, and 47.9% had psychiatric comorbidity; 35.4% (34/96) of patients continued with long-term medical therapy alone, another 4 being seizure-free on medication. Sixteen patients proceeded to, or were awaiting, neurostimulation, and 11 underwent surgical resection. One patient was rendered seizure-free postresection, with an improvement in seizures for 3 other cases. By comparison, of 201 patients with unilateral HS, a significantly higher number (44.3%) had febrile convulsions and only 11.4% had experienced status epilepticus. Importantly, 41.8% (84/201) of patients with unilateral HS had focal aware seizures, whereas such seizures were less frequently observed in people with bilateral HS, and were never observed exclusively (P = .002; Fisher's exact test). SIGNIFICANCE The current work describes the phenotypic spectrum of people with pharmacoresistant epilepsy and bilateral HS, highlights salient clinical differences from patients with unilateral HS, and provides a large platform from which to develop further studies, both epidemiological and genomic, to better understand etiopathogenesis and optimal treatment regimes in this condition.
Collapse
Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, National Institute for Health Research Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
| | - Patricia Dugan
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Piero Perucca
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Departments of Neuroscience and Neurology, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Daniel Costello
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
| | - Hyunmi Choi
- Comprehensive Epilepsy Center, Neurological Institute of New York, New York, NY, USA
| | - Carl Bazil
- Comprehensive Epilepsy Center, Neurological Institute of New York, New York, NY, USA
| | - Rod Radtke
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | | | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sinead Heavin
- FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jane Adcock
- Oxford Epilepsy Research Group, National Institute for Health Research Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
| | - W Owen Pickrell
- Neurology Research Group, Institute of Life Science, Swansea University Medical School, Swansea, UK
| | - Ronan N McGinty
- Oxford Epilepsy Research Group, National Institute for Health Research Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK.,Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
| | | | - Philip Smith
- Department of Neurology, University of Wales, Cardiff, UK
| | - Mark I Rees
- Neurology Research Group, Institute of Life Science, Swansea University Medical School, Swansea, UK
| | - Patrick Kwan
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Departments of Neuroscience and Neurology, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia.,Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Terence J O'Brien
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Departments of Neuroscience and Neurology, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - David Goldstein
- Institute for Genomic Medicine, Columbia University Medical Center, New York, NY, USA
| | - Norman Delanty
- FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|