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Alis C, Isler C, Alis D, Uzan M, Ozkara C. Outcome Predictors of Lesional Posterior Cortex Epilepsy Surgery. World Neurosurg 2023; 172:e483-e489. [PMID: 36690203 DOI: 10.1016/j.wneu.2023.01.055] [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: 10/19/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lesional posterior cortex epilepsy (PCE) is often drug resistant and may benefit from surgical intervention. In this study, we aimed to identify potential predictive factors associated with seizure recurrence after epilepsy surgery in lesional PCE. METHODS We retrospectively reviewed patients with PCE who underwent surgery between 1998 and 2021. They were divided into 2 groups according to seizure outcome; the seizure-free group (group 1) and the non-seizure-free group (group 2). The relationship among clinical factors, electroencephalography (EEG) or cranial magnetic resonance imaging findings, disease, and seizure outcome was investigated. RESULTS A total of 60 patients, with a mean age of 27.26 ± 12.35 years (range, 9-61 years), were included in the study. There were 31 patients (51.66%) in group 1 (Engel class I) and 29 patients (48.33%) in group 2 (13 [21.66%], 10 [16.66%], and 6 [10%] patients in Engel class II, III, and IV, respectively), with a mean follow-up of 8.95 ± 6.96 years (range, 1-24 years). No difference was observed regarding age, gender, age at seizure onset, operation type, treatment gap, and presence of bilateral lesions between the groups (P > 0.05). However, bilateral findings on interictal EEG and gliosis as the underlying disease were predictors of seizure recurrence (P < 0.05). CONCLUSIONS More than half of the patients (including 2 with bilateral magnetic resonance imaging lesions) were seizure free at long-term follow-up. However, patients with bilateral findings on interictal EEG and gliosis were more likely to have recurrent seizures after surgery. Because lesional PCE is almost always drug resistant and has a potential for favorable outcomes, epilepsy surgery should be considered early.
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Affiliation(s)
- Ceren Alis
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Mustafa Uzan
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
| | - Cigdem Ozkara
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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2
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Samanta D, Beal JC, Grinspan ZM. Automated Identification of Surgical Candidates and Estimation of Postoperative Seizure Freedom in Children - A Focused Review. Semin Pediatr Neurol 2021; 39:100914. [PMID: 34620464 PMCID: PMC9082396 DOI: 10.1016/j.spen.2021.100914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022]
Abstract
Surgery is an effective but underused treatment for drug-resistant epilepsy in children. Algorithms to identify surgical candidates and estimate the likelihood of postoperative clinical improvement may be valuable to improve access to epilepsy surgery. We provide a focused review of these approaches. For adults with epilepsy, tools to identify surgical candidates and predict seizure and cognitive outcomes (Ie, Cases for Epilepsy (toolsforepilepsy.com) and Epilepsy Surgery Grading Scale) have been validated and are in use. Analogous tools for children need development. A promising approach is to apply statistical learning tools to clinical datasets, such as electroencephalogram tracings, imaging studies, and the text of clinician notes. Demonstration projects suggest these techniques have the potential to be highly accurate, and await further validation and clinical application.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jules C. Beal
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Zachary M. Grinspan
- Department of Pediatrics, Weill Cornell Medicine, New York, NY.,Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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3
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Kadam R, Arimappamagan A, Bhaskara Rao M, Sadashiva N, Mundlamuri RC, Raghavendra K, Asranna A, Viswanathan LG, Mariyappa N, Kulanthaivelu K, Mangalore S, Nagaraj C, Saini J, Bharath RD, Rajeswaran J, Mahadevan A, Satishchandra P, Sinha S. Posterior Quadrant Disconnection for Childhood Onset Sub-Hemispheric Posterior Head Region Epilepsy: Indications in an Indian Cohort and Outcome. Pediatr Neurosurg 2021; 56:538-548. [PMID: 34649244 DOI: 10.1159/000519202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Posterior quadrant disconnection (PQD) is an under-utilized surgical technique in the management of refractory epilepsy. There is a dearth of data pertinent to post-PQD seizure outcomes. METHODS This retrospective study analyzed patients with drug-resistant childhood-onset epilepsy who underwent PQD at our center from 2009 to 2018. The clinical, imaging, and electrophysiological data were reviewed. The seizure outcome was noted from the latest follow-up in all patients. RESULTS Fifteen patients underwent PQD, with a mean age at onset of epilepsy of 3.3 ± 4.6 years. All patients had seizure onset in childhood with focal onset of seizures, and in addition, 5 had multiple seizure types. All cases underwent presurgical workup with MRI, video-EEG, psychometry, while PET/MEG was done if required. Engel Ia and ILAE I outcomes were considered to be favorable. The histology of the specimen showed 9 patients (60%) had gliosis, 4 (26.7%) had focal cortical dysplasia (FCD), while 1 patient had nodular heterotopia and another had polymicrogyria-pachygyria complex. Postoperative follow-up was available in 14 cases. One patient was lost to follow-up. Mean follow-up duration for the cohort was 45 + 24 months. At last, follow-up (n = 14), 66.7% (10 cases) had favorable outcome (Engel Ia). At the end of 1-year follow-up, up to 73% (n = 11) of the patients were seizure-free. Four patients developed transient hemiparesis after surgery which improved completely by 3-6 months. CONCLUSIONS Gliosis was more common etiology requiring PQD in our series than Western series, where FCD was more common. PQD is a safe and effective surgical modality in childhood-onset epilepsy with posterior head region epileptogenic focus.
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Affiliation(s)
- Raju Kadam
- Departments of Neurosurgery, NIMHANS, Bangalore, India
| | | | | | | | | | | | - Ajay Asranna
- Department of Neurology, NIMHANS, Bangalore, India
| | | | | | | | | | | | | | | | | | | | | | - Sanjib Sinha
- Department of Neurology, NIMHANS, Bangalore, India
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4
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Ueda R, Iwasaki M, Kita Y, Takeichi H, Saito T, Nakagawa E, Sugai K, Okada T, Sasaki M. Improvement of brain function after surgery in infants with posterior quadrant cortical dysplasia. Clin Neurophysiol 2020; 132:332-337. [PMID: 33450555 DOI: 10.1016/j.clinph.2020.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/02/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To reveal whether neurodevelopmental outcome of infants after epilepsy surgery can be quantitatively assessed by electroencephalography (EEG) functional connectivity analysis. METHODS We enrolled 13 infants with posterior quadrant dysplasia aged <2 years who were treated using posterior quadrantectomy and 21 age-matched infants. EEG was performed both before and one year after surgery. Developmental quotient (DQ) was assessed both before and 3 years after surgery. The phase lag index (PLI) of three different pairs of electrodes in the nonsurgical hemisphere, i.e., the anterior short distance (ASD), posterior short distance (PSD), and long distance (LD) pairs, were calculated as indices of brain connectivity. The relationship between the PLI and DQ was evaluated. RESULTS Overall, 77% infants experienced seizure freedom after surgery. The beta- and gamma- range PLI of PSD pairs increased preoperatively. All these pairs normalized postoperatively. Simple linear regression analysis revealed a significant relationship between the postoperative DQ and the postoperative beta-band PLI of ASD pairs. CONCLUSION Preoperative abnormal hyper-connectivity was normalized to the control level after surgery. The postoperative hyperconnectivity was associated with long-term neurodevelopmental improvement. SIGNIFICANCE PLI quantifies neurodevelopmental improvements after posterior quadrantectomy.
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Affiliation(s)
- Riyo Ueda
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan; Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan.
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
| | - Yosuke Kita
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan; Cognitive Brain Research Unit (CBRU), Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, FI-00290 Helsinki, Finland; Mori Arinori Center for Higher Education and Global Mobility, Hitotsubashi University, 2-1, Kunitachi, Tokyo 186-8601, Japan.
| | - Hiroshige Takeichi
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan.
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
| | - Kenji Sugai
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
| | - Takashi Okada
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan.
| | - Masayuki Sasaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
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5
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Pearce K, Dixon L, D'Arco F, Pujar S, Das K, Tahir Z, Tisdall M, Mankad K. Epilepsy surgery in children: what the radiologist needs to know. Neuroradiology 2020; 62:1061-1078. [PMID: 32435887 DOI: 10.1007/s00234-020-02448-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
This review updates the radiologist on current epilepsy surgery practice in children, with a specific focus on the role of imaging in pre-surgical work-up, current and novel surgical techniques, expected post-surgical imaging appearances and important post-operative complications. A comprehensive review of the current and emerging international practices in paediatric epilepsy surgical planning and post-operative imaging is provided with details on case-based radiological findings. A detailed discussion of the pathophysiology and imaging features of different epileptogenic lesions will not be discussed as this is not the objective of this paper. Epilepsy surgery can be an effective method to control seizures in certain children with drug-resistant focal epilepsy. Early surgery in selected appropriate cases can lead to improved cognitive and developmental outcome. Advances in neurosurgical techniques, imaging and neuroanaesthesia have driven a parallel expansion in the array of epilepsy conditions which are potentially treatable with surgery. The range of surgical options is now wide, including minimally invasive ablative procedures for small lesions such as hypothalamic hamartomata, resections for focal lesions like hippocampal sclerosis and complex disconnective surgeries for multilobar conditions like Sturge Weber Syndrome and diffuse cortical malformations. An awareness of the surgical thinking when planning epilepsy surgery in children, and the practical knowledge of the operative steps involved will promote more accurate radiology reporting of the post-operative scan.
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Affiliation(s)
- Kirsten Pearce
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Luke Dixon
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Suresh Pujar
- Department of Neurology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Krishna Das
- Department of Neurology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK.
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Rizzi M, Revay M, d'Orio P, Scarpa P, Mariani V, Pelliccia V, Della Costanza M, Zaniboni M, Castana L, Cardinale F, Lo Russo G, Cossu M. Tailored multilobar disconnective epilepsy surgery in the posterior quadrant. J Neurosurg 2020; 132:1345-1357. [PMID: 31026825 DOI: 10.3171/2019.1.jns183103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical treatment of drug-resistant epilepsy originating from the posterior quadrant (PQ) of the brain often requires large multilobar resections, and disconnective techniques have been advocated to limit the risks associated with extensive tissue removal. Few previous studies have described a tailored temporoparietooccipital (TPO) disconnective approach; only small series with short postoperative follow-ups have been reported. The aim of the present study was to present a tailored approach to multilobar PQ disconnections (MPQDs) for epilepsy and to provide details about selection of patients, presurgical investigations, surgical technique, treatment safety profile, and seizure and cognitive outcome in a large, single-center series of patients with a long-term follow-up. METHODS In this retrospective longitudinal study, the authors searched their prospectively collected database for patients who underwent MPQD for drug-resistant epilepsy in the period of 2005-2017. Tailored MPQDs were a posteriori grouped as follows: type I (classic full TPO disconnection), type II (partial TPO disconnection), type III (full temporooccipital [TO] disconnection), and type IV (partial TO disconnection), according to the disconnection plane in the occipitoparietal area. A bivariate statistical analysis was carried out to identify possible predictors of seizure outcome (Engel class I vs classes II-IV) among several presurgical, surgical, and postsurgical variables. Preoperative and postoperative cognitive profiles were also collected and evaluated. RESULTS Forty-two consecutive patients (29 males, 24 children) met the inclusion criteria. According to the presurgical evaluation (including stereo-electroencephalography in 13 cases), 12 (28.6%), 24 (57.1%), 2 (4.8%), and 4 (9.5%) patients received a type I, II, III, or IV MPQD, respectively. After a mean follow-up of 80.6 months, 76.2% patients were in Engel class I at last contact; at 6 months and 2 and 5 years postoperatively, Engel class I was recorded in 80.9%, 74.5%, and 73.5% of cases, respectively. Factors significantly associated with seizure freedom were the occipital pattern of seizure semiology and the absence of bilateral interictal epileptiform abnormalities at the EEG (p = 0.02). Severe complications occurred in 4.8% of the patients. The available neuropsychological data revealed postsurgical improvement in verbal domains, whereas nonunivocal outcomes were recorded in the other functions. CONCLUSIONS The presented data indicate that the use of careful anatomo-electro-clinical criteria in the presurgical evaluation allows for customizing the extent of surgical disconnections in PQ epilepsies, with excellent results on seizures and an acceptable safety profile.
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Affiliation(s)
- Michele Rizzi
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Martina Revay
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 3Section of Neurosurgery, Department of Neurosciences and of Sense Organs, University of Milan
| | - Piergiorgio d'Orio
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 2Institute of Neuroscience, CNR, Parma
| | - Pina Scarpa
- 4Cognitive Neuropsychology Centre, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Valeria Mariani
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Veronica Pelliccia
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 2Institute of Neuroscience, CNR, Parma
| | - Martina Della Costanza
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 5Clinic of Neurosurgery, Polytechnic University of Marche, Ancona; and
| | - Matteo Zaniboni
- 6Neurological Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Castana
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Francesco Cardinale
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Giorgio Lo Russo
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Massimo Cossu
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
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7
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Wang Y, Zhang C, Wang X, Sang L, Zhou F, Zhang JG, Hu WH, Zhang K. Seizure and cognitive outcomes of posterior quadrantic disconnection: a series of 12 pediatric patients. Br J Neurosurg 2019; 34:677-682. [PMID: 31747787 DOI: 10.1080/02688697.2019.1692785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To evaluate surgical outcomes and cognitive improvements after posterior quadrantic disconnection (PQD) in children who had medically intractable epilepsy and to compare the various characteristics between the acquired group and the developmental group.Method: Between 2015 and 2017, we retrospectively enrolled all pediatric patients who underwent PQD. We used image post-processing techniques for preoperative evaluation. Seizure outcomes and postoperative cognitive improvements were analysed. The patients were divided into the acquired group and the developmental group depending on the pathology; we then compared groups regarding age at onset, surgery, history, and seizure and cognitive outcomes.Results: A total of 12 pediatric patients were enrolled, including 7 acquired patients and 5 developmental patients. After a median 28.9-month follow-up, 11 (91.7%) of 12 patients were seizure free. The image post-processing facilitated a better visualization on preoperative evaluation and helped with detection of the epileptogenic zone. There were significant linear relationships between improvements in IQ and operative age (R2=0.527, p = 0.007) and IQ and epileptic history (R2=0.696, p = 0.001). The median age at seizure onset was 4.86 ± 2.12 years in the acquired group and 2.40 ± 1.14 years in the developmental group (t = 2.344, p = 0.028). Epileptic histories, seizure outcomes and cognitive outcomes were not significantly different between groups.Conclusion: Posterior quadrantic disconnection is an effective epilepsy surgery in selected patients. The use of image post-processing is important for preoperative evaluation. The age at seizure onset and surgery in malformation of cortical development (MCD) patients was earlier; however, the seizure outcome was no better than in acquired pathology patients. Early surgery did not change seizure outcomes but improved cognition.
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Affiliation(s)
- Yao Wang
- 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
| | - Lin Sang
- Epilepsy Center, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Feng Zhou
- Epilepsy Center, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, China, Beijing.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Beijing Key Laboratory of Neurostimulation, China, Beijing.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, China, Beijing
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Kalbhenn T, Cloppenborg T, Wörmann FG, Blümcke I, Coras R, May TW, Polster T, Simon M, Bien CG. Operative posterior disconnection in epilepsy surgery: Experience with 29 patients. Epilepsia 2019; 60:1973-1983. [PMID: 31468520 DOI: 10.1111/epi.16318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE It has been suggested that multilobar epilepsies caused by lesions restricted to the posterior cerebral quadrant (ie, the parietal, temporal, and occipital lobes) can be treated successfully by a procedure termed posterior disconnection. The objective of the present paper was to identify determinants of the epileptological outcome following posterior disconnection surgery. METHODS The authors retrospectively analyzed a series of 29 consecutive patients undergoing posterior disconnection surgery between 2005 and 2017 for the treatment of refractory posterior quadrantic epilepsy. Specifically, all presurgical and postoperative magnetic resonance (MR) studies were reviewed to identify cases with an incomplete disconnection, or the presence of a more widespread pathology involving the whole hemisphere rather than only its posterior quadrant. In addition, we reevaluated all presurgical video-electroencephalography (EEG) reports. RESULTS Seizure-free (International League Against Epilepsy [ILAE] 1) after surgery were 3/3 patients with EEG findings restricted to the posterior quadrant, 0/7 patients who had propagation of epileptic activity to the contralateral frontal lobe, and 11/19 (57.9%) who showed propagation to ipsilateral frontal and/or contralateral posterior. Eleven of 13 (84.6%) patients with purely posterior quadrantic magnetic resonance imaging (MRI) findings (as retrospectively diagnosed by neuroimaging) vs 3/16 (18.8%) cases with additional subtle abnormalities outside the posterior quadrant became seizure-free (P = .001). Eleven of 16 (68.8%) patients with complete disconnections were seizure-free vs only 3/13 (23.0%) cases with leftover temporal lobe tissue with contact to the insula (P = .025, both Fisher's exact test). SIGNIFICANCE A posterior disconnection is a technically demanding but very effective operation for posterior quadrantic epilepsy. Good epileptologic outcomes require not only that the epileptogenic lesion does not extend beyond the confines of the disconnected cerebral volume but also the absence of subtle MRI abnormalities, more widespread than the clear-cut lesion of the posterior quadrant. Hemispheric or contralateral (particularly frontal) propagation of the epileptic activity may also indicate the presence of a hemispheric rather than posterior quadrantic pathology.
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Affiliation(s)
- Thilo Kalbhenn
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | | | | | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Matthias Simon
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Bielefeld, Germany.,Society for Epilepsy Research, Bielefeld, Germany
| | - Christian G Bien
- Epilepsy Center Bethel, Bielefeld, Germany.,Society for Epilepsy Research, Bielefeld, Germany
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9
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Gracia CG, Chagin K, Kattan MW, Ji X, Kattan MG, Crotty L, Najm I, Gonzalez-Martinez J, Bingaman W, Jehi L. Predicting seizure freedom after epilepsy surgery, a challenge in clinical practice. Epilepsy Behav 2019; 95:124-130. [PMID: 31035104 PMCID: PMC6546523 DOI: 10.1016/j.yebeh.2019.03.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/08/2019] [Accepted: 03/27/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to compare the accuracy of clinical judgment in predicting seizure outcome after resective epilepsy surgery relative to two recently published statistical tools [the Epilepsy Surgery Nomogram (ESN) and the modified Seizure-Freedom score (m-SFS)]. METHODS Details of presurgical evaluations of 20 patients who underwent epilepsy surgery were presented to 20 epilepsy experts. The final surgical treatment was also disclosed. The clinicians were asked to predict the likelihood of a good outcome (Engel 1) at 2 and 5 years in each case. The ESN and the m-SFS predictions were calculated with the data provided to the clinicians. The discriminative ability of clinical judgment, ESN, and m-SFS was assessed by calculating a concordance index (C-index). Expert opinion, the m-SFS and the ESN performances were compared using a Receiver Operating Characteristic (ROC) curve analysis. RESULTS The mean age at surgery was 29 years (standard deviation [SD] = 14); 40% were male; 70% were right-handed, and thirteen (65%) had an Engel outcome 1 at 2 and 5 years. The mean C-index for the mean physician's prediction was 0.478 with a variance of 0.012. The ESN had an area under the curve (AUC) of 0.528 and 0.533 for the 2-year and 5-year predictions in comparison with the clinicians' predictions that was 0.476, and 0.466, respectively. For the m-SFS, the AUC at 2 years and 5 years was 0.539 and 0.539, respectively. No statistical difference was noted between the ESN and the clinicians or between m-SFS and the ESN, but there is a moderate statistical difference favoring the m-SFS to the clinicians (p 0.0960 and 0.0514, for 2 and 5 years). SIGNIFICANCE Clinical judgment was not superior to the ESN nor to the m-SFS. Together with the interphysician's prediction variability, our findings reinforce the need for better tools to predict postoperative outcomes.
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Affiliation(s)
- Camilo Garcia Gracia
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, United States of America
| | - Kevin Chagin
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States of America
| | - Michael W Kattan
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States of America
| | - Xinge Ji
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States of America
| | - Madeleine G Kattan
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States of America
| | - Lizzie Crotty
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States of America
| | - Imad Najm
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, United States of America
| | - Jorge Gonzalez-Martinez
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, United States of America
| | - William Bingaman
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, United States of America
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, United States of America.
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Neurosurgical approaches to pediatric epilepsy: Indications, techniques, and outcomes of common surgical procedures. Seizure 2018; 77:76-85. [PMID: 30473268 DOI: 10.1016/j.seizure.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
Epilepsy is a common pediatric neurological condition, and approximately one-third of children with epilepsy are refractory to medical management. For these children neurosurgery may be indicated, but operative success is dependent on complete delineation of the epileptogenic zone. In this review, surgical techniques for pediatric epilepsy are considered. First, potentially-curative operations are discussed and broadly divided into resections and disconnections. Then, two palliative approaches to seizure control are reviewed. Finally, future neurosurgical approaches to epilepsy are considered.
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11
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Shi J, Gao Z, Gao J, Li G, Chen Y. Predictors and outcome surgery for posterior cortex epilepsies. Clin Neurol Neurosurg 2018; 171:124-128. [DOI: 10.1016/j.clineuro.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/02/2018] [Accepted: 06/09/2018] [Indexed: 01/29/2023]
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Harward SC, Chen WC, Rolston JD, Haglund MM, Englot DJ. Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis. Neurosurgery 2018; 82:350-358. [PMID: 28419330 PMCID: PMC5640459 DOI: 10.1093/neuros/nyx158] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Occipital lobe epilepsy (OLE) is an uncommon but debilitating focal epilepsy syndrome with seizures often refractory to medical management. While surgical resection has proven a viable treatment, previous studies examining postoperative seizure freedom rates are limited by small sample size and patient heterogeneity, thus exhibiting significant variability in their results. OBJECTIVE To review the medical literature on OLE so as to investigate rates and predictors of both seizure freedom and visual outcomes following surgery. METHODS We reviewed manuscripts exploring surgical resection for drug-resistant OLE published between January 1990 and June 2015 on PubMed. Seizure freedom rates were analyzed and potential predictors were evaluated with separate meta-analyses. Postoperative visual outcomes were also examined. RESULTS We identified 27 case series comprising 584 patients with greater than 1 yr of follow-up. Postoperative seizure freedom (Engel class I outcome) was observed in 65% of patients, and was significantly predicted by age less than 18 yr (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-2.18), focal lesion on pathological analysis (OR 2.08, 95% CI 1.58-2.89), and abnormal preoperative magnetic resonance imaging (OR 3.24, 95% 2.03-6.55). Of these patients, 175 also had visual outcomes reported with 57% demonstrating some degree of visual decline following surgery. We did not find any relationship between postoperative visual and seizure outcomes. CONCLUSION Surgical resection for OLE is associated with favorable outcomes with nearly two-thirds of patients achieving postoperative seizure freedom. However, patients must be counseled regarding the risk of visual decline following surgery.
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Affiliation(s)
- Stephen C Harward
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - William C Chen
- Department of Neuro-logical Surgery, University of California San Francisco, San Francisco, California
| | - John D Rolston
- Department of Neuro-logical Surgery, University of California San Francisco, San Francisco, California
| | - Michael M Haglund
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Sierra-Marcos A, Fournier-Del Castillo MC, Álvarez-Linera J, Budke M, García-Fernández M, Pérez-Jiménez MA. Functional surgery in pediatric drug-resistant posterior cortex epilepsy: Electro-clinical findings, cognitive and seizure outcome. Seizure 2017; 52:46-52. [PMID: 28963933 DOI: 10.1016/j.seizure.2017.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Epilepsies originated from the occipital, parietal and/or the posterior edge of the temporal lobe are grouped together into posterior cortex epilepsy (PCE). Our objective was firstly to describe electro-clinical and imaging findings in the presurgical evaluation of children with PCE, and secondly to identify potential factors associated with surgical and cognitive outcomes. METHOD From the total of patients referred to the Epilepsy Monitoring Unit of 'Hospital Universitario Niño Jesús' from 2003 to 2016, 55 had drug-resistant PCE. Different variables obtained from the multimodal presurgical work-up were analyzed among patients achieving seizure freedom after surgery (ILAE class 1) and patients with persistent seizures. Categorical variables were compared with Fisheŕs exact test and numeric variables with t-Student for independent samples, and multiple logistic regression were used to analyze predictive values. RESULTS Median duration of epilepsy until surgery was 5 years [3-10 years]. Fifty patients showed lesions in the MRI, and 62.5% had concordant MRI-PET corregistration. 37 (67%) patients were operated (lesionectomy in 21 subjects, tailored resection based on intracranial studies in 16), and 23 (62,2%) reached ILAE class 1, with a mean follow-up period of 3.51 [1-12] years. A lower number of basal seizures and antiepileptic drugs, a well-defined lesion on the MRI, an epileptogenic zone (EZ) restricted to the posterior quadrant and the normalization of postsurgical EEGs were associated with seizure freedom (p<0.05). Additionally, 65% of patients had a long-term improvement of cognitive performances. CONCLUSIONS Epilepsy surgery should be considered in children with drug-resistant PCE, especially in those with a restricted EZ.
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Affiliation(s)
- A Sierra-Marcos
- Epilepsy Unit, Barcelona Medicine and Surgery Institute (IMECBA), Barcelona, Spain; Neurology Department, Hospital CIMA, Barcelona, Spain.
| | - M C Fournier-Del Castillo
- Neuropsychology Section, Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - J Álvarez-Linera
- Neurorradiology Department, Hospital Ruber Internacional, Madrid, Spain
| | - M Budke
- Neurosurgery Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - M García-Fernández
- Epilepsy Monitoring Unit, Clinical Neurophysiology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - M A Pérez-Jiménez
- Epilepsy Monitoring Unit, Clinical Neurophysiology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Liang SL. [Surgery for posterior quadrant epilepsy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:264-267. [PMID: 28302193 PMCID: PMC7390159 DOI: 10.7499/j.issn.1008-8830.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/03/2017] [Indexed: 06/06/2023]
Affiliation(s)
- Shu-Li Liang
- Department of Neurosurgery, General Hospital of People's Liberation Army, Beijing 100853, China
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Ramantani G, Stathi A, Brandt A, Strobl K, Schubert-Bast S, Wiegand G, Korinthenberg R, van Velthoven V, Zentner J, Schulze-Bonhage A, Bast T. Posterior cortex epilepsy surgery in childhood and adolescence: Predictors of long-term seizure outcome. Epilepsia 2017; 58:412-419. [PMID: 28098941 DOI: 10.1111/epi.13654] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to investigate the long-term seizure outcome of children and adolescents who were undergoing epilepsy surgery in the parietooccipital cortex and determine their predictive factors. METHODS We retrospectively analyzed the data of 50 consecutive patients aged 11.1 (mean) ± 5.1 (standard deviation) years at surgery. All patients but one had a magnetic resonance imaging (MRI)-visible lesion. Resections were parietal in 40%, occipital in 32%, and parietooccipital in 28% cases; 24% patients additionally underwent a resection of the posterior border of the temporal lobe. Etiology included focal cortical dysplasia in 44%, benign tumors (dysembryoplastic neuroepithelial tumor, ganglioglioma, angiocentric glioma, and pilocystic astrocytoma) in 32%, peri- or postnatal ischemic lesions in 16%, and tuberous sclerosis in 8% cases. RESULTS At last follow-up (mean 8 years, range 1.5-18 years), 60% patients remained seizure-free (Engel class I): 30% had discontinued and 20% had reduced antiepileptic drugs. Most seizure recurrences (71%) occurred within the first 6 months, and only three patients presented with seizures ≥2 years after surgery. Independent predictors of seizure recurrence included left-sided as well as parietal epileptogenic zones and resections. Longer epilepsy duration to surgery was identified as the only modifiable independent predictor of seizure recurrence. SIGNIFICANCE Our study demonstrates that posterior cortex epilepsy surgery is highly effective in terms of lasting seizure control and antiepileptic drug cessation in selected pediatric candidates. Most importantly, our data supports the early consideration of surgical intervention in children and adolescents with refractory posterior cortex epilepsy.
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Affiliation(s)
| | - Angeliki Stathi
- Epilepsy Center, University Hospital Freiburg, Freiburg, Germany
| | - Armin Brandt
- Epilepsy Center, University Hospital Freiburg, Freiburg, Germany
| | | | - Susanne Schubert-Bast
- Department of Neuropediatrics and Metabolic Disease, University Children's Hospital, Heidelberg, Germany
| | - Gert Wiegand
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Rudolf Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Vera van Velthoven
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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Appel S, Sharan AD, Tracy JI, Evans J, Sperling MR. A comparison of occipital and temporal lobe epilepsies. Acta Neurol Scand 2015; 132:284-90. [PMID: 25809072 DOI: 10.1111/ane.12396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Differentiating between occipital lobe epilepsy (OLE) and temporal lobe epilepsy (TLE) is often challenging. This retrospective case-control study compares OLE to TLE and explores markers that suggest the diagnosis of OLE. METHODS We queried the Jefferson Epilepsy Center surgery database for patients who underwent a resection that involved the occipital lobe. For each patient with OLE, three sequential case-control patients with TLE were matched. Demographic characteristics, symptoms, electrophysiological findings, imaging findings, and surgical outcome were compared. RESULTS Nineteen patients with OLE and 57 patients with TLE were included in the study. Visual symptoms were unique to patients with OLE (8/19) and were not reported by patients with TLE (P < 0.0001). Occipital interictal spikes (IIS) were found only in one-third of the patients with OLE (6/19) and in no patients with TLE (P < 0.0001). IIS in the posterior temporal lobe were found in five of 19 patients with OLE vs one of 57 patients with TLE (P = 0.003). IIS involved more than one lobe of the brain in most patients with OLE (11/19) but only in nine of 57 the TLE group. (P = 0.0003) Multilobar resection was needed in most patients with OLE (15/19), typically including the temporal lobe, but in only one of the patients with TLE (P < 0.0001). CONCLUSION Occipital lobe epilepsy is difficult to identify and may masquerade as temporal lobe epilepsy. Visual symptoms and occipital findings in the EEG suggest the diagnosis of OLE, but absence of these features, does not exclude the diagnosis. When posterior temporal EEG findings or multilobar involvement occurs, the diagnosis of OLE should be considered.
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Affiliation(s)
- S. Appel
- Department of Neurology; Barzilai Medical Center; Ben Gurion University; Ashkelon Israel
- Jefferson Comprehensive Epilepsy Center; Thomas Jefferson University; Philadelphia PA USA
- Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
| | - A. D. Sharan
- Jefferson Comprehensive Epilepsy Center; Thomas Jefferson University; Philadelphia PA USA
- Department of Neurological Surgery; Thomas Jefferson University; Philadelphia PA USA
| | - J. I. Tracy
- Jefferson Comprehensive Epilepsy Center; Thomas Jefferson University; Philadelphia PA USA
- Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
| | - J. Evans
- Jefferson Comprehensive Epilepsy Center; Thomas Jefferson University; Philadelphia PA USA
- Department of Neurological Surgery; Thomas Jefferson University; Philadelphia PA USA
| | - M. R. Sperling
- Jefferson Comprehensive Epilepsy Center; Thomas Jefferson University; Philadelphia PA USA
- Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
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Tamburrini G, Battaglia D, Albamonte E, Contaldo I, Massimi L, Caldarelli M, Di Rocco C. Surgery for posterior quadrantic cortical dysplasia. A review. Childs Nerv Syst 2014; 30:1859-68. [PMID: 25296547 DOI: 10.1007/s00381-014-2449-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Posterior quadrant dysplastic lesions represent 3-15 % of multilobar cortical developmental pathologies, 3-5 % of all the indications to surgery for epilepsy resistant to medical treatment. OBJECTIVE AND METHODS The objective of this study is to review the pertinent literature related to the presurgical clinical, neurophysiological, and neuroradiological evaluation of children affected by posterior quadrant dysplasia in order to discuss the intraoperative management and the different surgical techniques that have been proposed to treat this condition as well as factors related with postsurgical seizure outcome. RESULTS AND CONCLUSIONS Seizures appear most commonly in infants and rapidly progress to a catastrophic course. They are mostly represented by focal seizures and spasms. Surface interictal video-EEG is characterized by background flattening and paroxysmal discharges prevalent on the affected side but not unusually extending to the controlateral hemisphere. The last occasionally shows an independent irritative activity in spite of the absence of further visible structural abnormalities. Most of the patients have visual field or visual attention deficits at diagnosis. Resective as well as disconnective surgical procedures have been proposed for the management of this condition, none of them having shown clear advantages in terms of seizure outcome and complications. Intraoperative electrocorticography (EcoG) and sensorimotor monitoring have been successfully used to improve the localization of the epileptic focus and reduce surgical complication rates. Undistincted lesion borders, independent controlateral ictal or/and interictal EEG activity, and incomplete resections/disconnections are among the main factors that have resulted to be associated with a worse seizure outcome.
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Affiliation(s)
- G Tamburrini
- Pediatric Neurosurgery Unit, Institute of Neurosurgery, Catholic University Medical School, Largo "A. Gemelli", 8, 00168, Rome, Italy,
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Cowie CJ, Cunningham MO. Peritumoral epilepsy: relating form and function for surgical success. Epilepsy Behav 2014; 38:53-61. [PMID: 24894847 PMCID: PMC4265733 DOI: 10.1016/j.yebeh.2014.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 10/28/2022]
Abstract
Seizures are a prominent symptom in patients with both primary and secondary brain tumors. Medical management of seizure control in this patient group is problematic as the mechanisms linking tumorigenesis and epileptogenesis are poorly understood. It is possible that several mechanisms contribute to tumor-associated epileptic zone formation. In this review, we discuss key candidates that may be implicated in peritumoral epileptogenesis and, in so doing, hope to highlight areas for future research. Furthermore, we summarize the current role of antiepileptic medications in this type of epilepsy and examine the changes in surgical practice which may lead to improved seizure rates after tumor surgery. Lastly, we speculate on possible future preoperative and intraoperative considerations for improving seizure control after tumor resection.
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Affiliation(s)
- Christopher J.A. Cowie
- Department of Neurosurgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK,Institute of Neuroscience, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne, UK
| | - Mark O. Cunningham
- Institute of Neuroscience, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne, UK,Corresponding author at: Institute of Neuroscience, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK. Tel.: + 44 191 2088935.
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Losurdo A, Proserpio P, Cardinale F, Gozzo F, Tassi L, Mai R, Francione S, Castana L, Lo Russo G, Casaceli G, Sartori I, Marca GD, Cossu M, Nobili L. Drug-resistant focal sleep related epilepsy: Results and predictors of surgical outcome. Epilepsy Res 2014; 108:953-62. [DOI: 10.1016/j.eplepsyres.2014.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 02/03/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
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20
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Yin S, Feng K, Feng M, Zhang X, Zhang Y. Posterior quadrantic disconnection maintains the activity of isolated temporal-parietal-occipital nerve tissue: neuroprotective measures in the surgical treatment of epilepsy. Neural Regen Res 2014; 9:447-8. [PMID: 25206834 PMCID: PMC4146202 DOI: 10.4103/1673-5374.128259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Shaoya Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Keke Feng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Mei Feng
- Department of Electroneurophysiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xueqing Zhang
- Department of Electroneurophysiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yuqin Zhang
- Department of Pediatric Neurology, Tianjin Children's Hospital, Tianjin, China
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