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Xu X, Yu X, Kang G, Mao Z, Cui Z, Pan L, Zong R, Tang Y, Wan M, Ling Z. Role of High-Frequency Oscillation in Locating an Epileptogenic Zone for Radiofrequency Thermocoagulation. Front Hum Neurosci 2021; 15:699556. [PMID: 34630056 PMCID: PMC8497699 DOI: 10.3389/fnhum.2021.699556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Radiofrequency thermocoagulation (RFTC) has been proposed as a first-line surgical treatment option for patients with drug-resistant focal epilepsy (DRE) that is associated with gray matter nodular heterotopia (GMNH). Excellent results on seizures have been reported following unilateral RFTC performed on ictal high-frequency-discharge, fast-rhythm, and low-voltage initiation areas. Complex cases (GMNH plus other malformations of cortical development) do not have good outcomes with RFTC. Yet, there is little research studying the effect of high-frequency oscillation in locating epileptogenic zones for thermocoagulation on unilateral, DRE with bilateral GMNH. We present a case of DRE with bilateral GMNH, treated using RFTC on unilateral GMNH and the overlying cortex, guided by stereotactic electroencephalogram (SEGG), and followed up for 69 months. Twenty-four-hour EGG recordings, seizure frequency, post-RFTC MRI, and neuropsychological tests were performed once yearly. To date, this patient is seizure-free, the electroencephalogram is normal, neuropsychological problems have not been found, and the trace of RFTC has been clearly identified on MRI. His dosage of antiepileptic medication has, furthermore, been significantly reduced. It is concluded that RFTC on unilateral DRE with bilateral GMNH may achieve good long-term effects, lasting up to, and perhaps longer than, 69 months. Ictal high-frequency oscillation (fast ripple) inside the heterotopia and the overlying cortex may be the key to this successful effect.
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Affiliation(s)
- Xin Xu
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Xingguang Yu
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Guixia Kang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, Beijing University of Posts and Telecommunications, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Zhiqiang Cui
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Longsheng Pan
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Rui Zong
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Yuan Tang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, Beijing University of Posts and Telecommunications, Beijing, China
| | - Ming Wan
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Zhipei Ling
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
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Cvetkovska E, Martins WA, Gonzalez-Martinez J, Taylor K, Li J, Grinenko O, Mosher J, Leahy R, Chauvel P, Nair D. Heterotopia or overlaying cortex: What about in-between? EPILEPSY & BEHAVIOR CASE REPORTS 2018; 11:4-9. [PMID: 30456171 PMCID: PMC6232626 DOI: 10.1016/j.ebcr.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
We describe a patient with unilateral periventricular nodular heterotopia (PNH) and drug-resistant epilepsy, whose SEEG revealed that seizures were arising from the PNH, with the almost simultaneous involvement of heterotopic neurons ("micronodules") scattered within the white matter, and subsequently the overlying cortex. Laser ablation of heterotopic nodules and the adjacent white matter rendered the patient seizure free. This case elucidates that "micronodules" scattered in white matter between heterotopic nodules and overlying cortex might be another contributor in complex epileptogenicity of heterotopia. Detecting patient-specific targets in the epileptic network of heterotopia creates the possibility to disrupt the pathological circuit by minimally invasive procedures.
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Affiliation(s)
- Emilija Cvetkovska
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000, Skopje, Macedonia,Corresponding author at: University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000, Skopje, Macedonia.
| | - William Alves Martins
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,Service of Neurology, Hospital São Lucas, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jorge Gonzalez-Martinez
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,Department of Neurosurgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Ken Taylor
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jian Li
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - Olesya Grinenko
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - John Mosher
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA,Department of Neurology, University of Texas, Huston, TX, USA
| | - Richard Leahy
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - Patrick Chauvel
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Suh BS, Ko KH, Lee KH, Sung TJ. A Case of Wolf-Hirschhorn Syndrome with Periventricular Nodular Heterotopia Presenting with Status Epilepticus. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.4.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Bong Sul Suh
- Department of Pediatrics, Hallym University Medical Center, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Keun Hyeok Ko
- Department of Pediatrics, Hallym University Medical Center, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Kon Hee Lee
- Department of Pediatrics, Hallym University Medical Center, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Tae-Jung Sung
- Department of Pediatrics, Hallym University Medical Center, Kangnam Sacred Heart Hospital, Seoul, Korea
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Kim H, Mansi T, Bernasconi N. Disentangling hippocampal shape anomalies in epilepsy. Front Neurol 2013; 4:131. [PMID: 24062718 PMCID: PMC3769634 DOI: 10.3389/fneur.2013.00131] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/26/2013] [Indexed: 11/13/2022] Open
Abstract
Drug-resistant temporal lobe epilepsy (TLE) and epileptic syndromes related to malformations of cortical development (MCD) are associated with complex hippocampal morphology. The contribution of volume and position to the overall hippocampal shape in these conditions has not been studied. We propose a surface-based framework to localize volume changes through measurement of Jacobian determinants, and quantify fine-scale position and curvature through a medial axis model. We applied our methodology to T1-weighted 3D volumetric MRI of 88 patients with TLE and 78 patients with MCD, including focal cortical dysplasia (FCD, n = 29), heterotopia (HET, n = 40), and polymicrogyria (PMG, n = 19). Patients were compared to 46 age- and sex-matched healthy controls. Surface-based analysis of volume in TLE revealed severe ipsilateral atrophy mainly along the rostro-caudal extent of the hippocampal CA1 subfield. In MCD, patterns of volume changes included bilateral CA1 atrophy in HET and FCD, and left dentate hypertrophy in all three groups. The analysis of curvature revealed medial bending of the posterior hippocampus in TLE, whereas in MCD there was a supero-medial shift of the hippocampal body. Albeit hippocampal shape anomalies in TLE and MCD result from a combination of volume and positional changes, their nature and distribution suggest different pathogenic mechanisms.
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Affiliation(s)
- Hosung Kim
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University , Montreal, QC , Canada
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