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Wu H, Liao K, Tan Z, Zeng C, Wu B, Zhou Z, Zhou H, Tang Y, Gong J, Ye W, Ling X, Guo Q, Xu H. A PET-based radiomics nomogram for individualized predictions of seizure outcomes after temporal lobe epilepsy surgery. Seizure 2024; 119:17-27. [PMID: 38768522 DOI: 10.1016/j.seizure.2024.04.021] [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: 12/06/2023] [Revised: 03/26/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE To establish and validate a novel nomogram based on clinical characteristics and [18F]FDG PET radiomics for the prediction of postsurgical seizure freedom in patients with temporal lobe epilepsy (TLE). PATIENTS AND METHODS 234 patients with drug-refractory TLE patients were included with a median follow-up time of 24 months after surgery. The correlation coefficient redundancy analysis and LASSO Cox regression were used to characterize risk factors. The Cox model was conducted to develop a Clinic-PET nomogram to predict the relapse status in the training set (n = 171). The nomogram's performance was estimated through discrimination, calibration, and clinical utility. The prognostic prediction model was validated in the test set (n = 63). RESULTS Eight radiomics features were selected to assess the radiomics score (radscore) of the operation side (Lat_radscore) and the asymmetric index (AI) of the radiomics score (AI_radscore). AI_radscor, Lat_radscor, secondarily generalized seizures (SGS), and duration between seizure onset and surgery (Durmon) were significant predictors of seizure-free outcomes. The final model had a C-index of 0.68 (95 %CI: 0.59-0.77) for complete freedom from seizures and time-dependent AUROC was 0.65 at 12 months, 0.65 at 36 months, and 0.59 at 60 months in the test set. A web application derived from the primary predictive model was displayed for economic and efficient use. CONCLUSIONS A PET-based radiomics nomogram is clinically promising for predicting seizure outcomes after temporal lobe epilepsy surgery.
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Affiliation(s)
- Huanhua Wu
- The Affiliated Shunde Hospital of Jinan University, Foshan, Guangdong Province 528305, PR China
| | - Kai Liao
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University & Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, PR China
| | - Zhiqiang Tan
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University & Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, PR China
| | - Chunyuan Zeng
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University & Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, PR China
| | - Biao Wu
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University & Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, PR China
| | - Ziqing Zhou
- Department of Nuclear Medicine, Nanhai District People's Hospital of Foshan, Foshan, Guangdong Province, 528225, PR China
| | - Hailing Zhou
- Department of Radiology, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong Province, 524045, PR China
| | - Yongjin Tang
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University & Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, PR China
| | - Jian Gong
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University & Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, PR China
| | - Weijian Ye
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University & Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, PR China
| | - Xueying Ling
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University & Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, PR China.
| | - Qiang Guo
- Epilepsy Center, Guangdong 999 Brain Hospital, Affiliated Brain Hospital of Jinan University, Guangzhou, Guangdong Province 510510, PR China.
| | - Hao Xu
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University & Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, PR China.
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Meng Q, Liu Y, Ren Y, Wu H, Zhang J, Li H, Dong S, Jing J, Liu X, Du C, Zhang H. Multivariate analysis of seizure outcomes after resective surgery for focal epilepsy: a single-center study on 833 patients. Neurosurg Rev 2023; 46:89. [PMID: 37071225 DOI: 10.1007/s10143-023-01988-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
The predictors of seizure outcomes after resective surgery for focal epilepsy, for an update on the features of good and poor outcomes, are investigated. A retrospective study of patients with focal epilepsy undergoing resective surgery from March 2011 to April 2019 was performed. There were 3 groups according to the seizure outcomes: seizure freedom, seizure improvement, and no improvement. Predictors of seizure outcomes were identified by multivariate logistic regression analysis. Of all 833 patients, 561 (67.3%) patients remained seizure-free at the last follow-up, 203 (24.4%) patients had seizure improvement, and 69 (8.3%) had no improvement. The mean follow-up duration was 5.2 years (range: 2.7 to 9.6). Predictors of better outcomes included epilepsy duration < 5 years, localized discharge, no. of antiepileptic drugs at surgery < 3, and temporal lobe resection. However, predictors of worse outcomes included intracranial hemorrhage in infancy, interictal abnormal discharge, intracranial electrode monitoring, and acute postoperative seizure. Our study suggests that resective surgery for focal epilepsy has satisfactory outcomes. Short epilepsy duration, localized discharge, and temporal lobe resection are positive predictors of seizure freedom. Patients with these predictors are intensively recommended for surgery.
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Affiliation(s)
- Qiang Meng
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Yong Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Yutao Ren
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hao Wu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiale Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Huanfa Li
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Shan Dong
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Jiangpeng Jing
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Xiaofang Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Changwang Du
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Hua Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China.
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Baciu M, O'Sullivan L, Torlay L, Banjac S. New insights for predicting surgery outcome in patients with temporal lobe epilepsy. A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)00884-6. [PMID: 37003897 DOI: 10.1016/j.neurol.2023.02.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/16/2023] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
Resective surgery is the treatment of choice for one-third of adult patients with focal, drug-resistant epilepsy. This procedure is associated with substantial clinical and cognitive risks. In clinical practice, there is no validated model for epilepsy surgery outcome prediction (ESOP). Meta-analyses on ESOP studies assessing prognostic factors report discrepancies in terms of study design. Our review aims to systematically investigate methodological and analytical aspects of studies predicting clinical and cognitive outcomes after temporal lobe epilepsy surgery. A systematic review of ESOP studies published between 2000 and 2022 from three databases (MEDLINE, Web of Science, and PsycINFO) was completed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. It yielded 4867 articles. Among them, 21 corresponded to our inclusion criteria and were therefore retained in the final review. The risk of bias was assessed using A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies (PROBAST). Data extracted from the 21 studies were analyzed using narrative synthesis and descriptive statistics. Our findings show an increase in the use of multimodal datasets and machine learning analyses in recent ESOP studies, although regression remained the most frequently used approach. We also identified a more frequent use of network notions in recent ESOP studies. Nevertheless, several methodological issues were noted, such as small sample sizes, lack of information on the follow-up period, variability in seizure outcome, and the definition of neuropsychological postoperative change. Of 21 studies, only one provided a clinical tool to anticipate the cognitive outcome after epilepsy surgery. We conclude that methodological issues should be overcome before we move towards more complete models to better predict clinical and cognitive outcomes after epilepsy surgery. Recommendations for future studies to harness the possibilities of multimodal datasets and data fusion, are provided. A stronger bridge between fundamental and clinical research may result in developing accessible clinical tools.
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Affiliation(s)
- M Baciu
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L O'Sullivan
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L Torlay
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - S Banjac
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France.
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4
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Yossofzai O, Fallah A, Maniquis C, Wang S, Ragheb J, Weil AG, Brunette-Clement T, Andrade A, Ibrahim GM, Mitsakakis N, Widjaja E. Development and validation of machine learning models for prediction of seizure outcome after pediatric epilepsy surgery. Epilepsia 2022; 63:1956-1969. [PMID: 35661152 DOI: 10.1111/epi.17320] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is substantial variability in reported seizure outcome following pediatric epilepsy surgery, and lack of individualized predictive tools that could evaluate the probability of seizure freedom postsurgery. The aim of this study was to develop and validate a supervised machine learning (ML) model for predicting seizure freedom after pediatric epilepsy surgery. METHODS This is a multicenter retrospective study of children who underwent epilepsy surgery at five pediatric epilepsy centers in North America. Clinical information, diagnostic investigations, and surgical characteristics were collected, and used as features to predict seizure-free outcome 1 year after surgery. The dataset was split randomly into 80% training and 20% testing data. Thirty-five combinations of five feature sets with seven ML classifiers were assessed on the training cohort using 10-fold cross-validation for model development. The performance of the optimal combination of ML classifier and feature set was evaluated in the testing cohort, and compared with logistic regression, a classical statistical approach. RESULTS Of the 801 patients included, 61.3% were seizure-free 1 year postsurgery. During model development, the best combination was XGBoost ML algorithm with five features from the univariate feature set, including number of antiseizure medications, magnetic resonance imaging lesion, age at seizure onset, video-electroencephalography concordance, and surgery type, with a mean area under the curve (AUC) of .73 (95% confidence interval [CI] = .69-.77). The combination of XGBoost and univariate feature set was then evaluated on the testing cohort and achieved an AUC of .74 (95% CI = .66-.82; sensitivity = .87, 95% CI = .81-.94; specificity = .58, 95% CI = .47-.71). The XGBoost model outperformed the logistic regression model (AUC = .72, 95% CI = .63-.80; sensitivity = .72, 95% CI = .63-.82; specificity = .66, 95% CI = .53-.77) in the testing cohort (p = .005). SIGNIFICANCE This study identified important features and validated an ML algorithm, XGBoost, for predicting the probability of seizure freedom after pediatric epilepsy surgery. Improved prognostication of epilepsy surgery is critical for presurgical counseling and will inform treatment decisions.
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Affiliation(s)
- Omar Yossofzai
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Aria Fallah
- Department of Neurosurgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Cassia Maniquis
- Department of Neurosurgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Shelly Wang
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, USA
| | - John Ragheb
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Alexander G Weil
- Department of Neurosurgery, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | | | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George M Ibrahim
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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5
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Zhu Z, Zhang Z, Gao X, Feng L, Chen D, Yang Z, Hu S. Individual Brain Metabolic Connectome Indicator Based on Jensen-Shannon Divergence Similarity Estimation Predicts Seizure Outcomes of Temporal Lobe Epilepsy. Front Cell Dev Biol 2022; 9:803800. [PMID: 35310541 PMCID: PMC8926031 DOI: 10.3389/fcell.2021.803800] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/15/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: We aimed to use an individual metabolic connectome method, the Jensen-Shannon Divergence Similarity Estimation (JSSE), to characterize the aberrant connectivity patterns and topological alterations of the individual-level brain metabolic connectome and predict the long-term surgical outcomes in temporal lobe epilepsy (TLE). Methods: A total of 128 patients with TLE (63 females, 65 males; 25.07 ± 12.01 years) who underwent Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) imaging were enrolled. Patients were classified either as experiencing seizure recurrence (SZR) or seizure free (SZF) at least 1 year after surgery. Each individual's metabolic brain network was ascertained using the proposed JSSE method. We compared the similarity and difference in the JSSE network and its topological measurements between the two groups. The two groups were then classified by combining the information from connection and topological metrics, which was conducted by the multiple kernel support vector machine. The validation was performed using the nested leave-one-out cross-validation strategy to confirm the performance of the methods. Results: With a median follow-up of 33 months, 50% of patients achieved SZF. No relevant differences in clinical features were found between the two groups except age at onset. The proposed JSSE method showed marked degree reductions in IFGoperc.R, ROL. R, IPL. R, and SMG. R; and betweenness reductions in ORBsup.R and IOG. R; meanwhile, it found increases in the degree analysis of CAL. L and PCL. L, and in the betweenness analysis of PreCG.R, IOG. R, PoCG.R, PCL. L and PCL.R. Exploring consensus significant metabolic connections, we observed that the most involved metabolic motor networks were the INS-TPOmid.L, MTG. R-SMG. R, and MTG. R-IPL.R pathways between the two groups, and yielded another detailed individual pathological connectivity in the PHG. R-CAU.L, PHG. R-HIP.L, TPOmid.L-LING.R, TPOmid.L-DCG.R, MOG. R-MTG.R, MOG. R-ANG.R, and IPL. R-IFGoperc.L pathways. These aberrant functional network measures exhibited ideal classification performance in predicting SZF individuals from SZR ones at a sensitivity of 75.00%, a specificity of 92.79%, and an accuracy of 83.59%. Conclusion: The JSSE method indicator can identify abnormal brain networks in predicting an individual's long-term surgical outcome of TLE, thus potentially constituting a clinically applicable imaging biomarker. The results highlight the biological meaning of the estimated individual brain metabolic connectome.
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Affiliation(s)
- Zehua Zhu
- Department of Nuclear Medicine, XiangYa Hospital, Changsha, China
| | - Zhimin Zhang
- Department of Blood Transfusion, XiangYa Hospital, Changsha, China
| | - Xin Gao
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Dengming Chen
- Department of Nuclear Medicine, XiangYa Hospital, Changsha, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, XiangYa Hospital, Changsha, China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, China
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Integrating Optimized Multiscale Entropy Model with Machine Learning for the Localization of Epileptogenic Hemisphere in Temporal Lobe Epilepsy Using Resting-State fMRI. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1834123. [PMID: 34745491 PMCID: PMC8566056 DOI: 10.1155/2021/1834123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
The bottleneck associated with the validation of the parameters of the entropy model has limited the application of this model to modern functional imaging technologies such as the resting-state functional magnetic resonance imaging (rfMRI). In this study, an optimization algorithm that could choose the parameters of the multiscale entropy (MSE) model was developed, while the optimized effectiveness for localizing the epileptogenic hemisphere was validated through the classification rate with a supervised machine learning method. The rfMRI data of 20 mesial temporal lobe epilepsy patients with positive indicators (the indicators of epileptogenic hemisphere in clinic) in the hippocampal formation on either left or right hemisphere (equally divided into two groups) on the structural MRI were collected and preprocessed. Then, three parameters in the MSE model were statistically optimized by both receiver operating characteristic (ROC) curve and the area under the ROC curve value in the sensitivity analysis, and the intergroup significance of optimized entropy values was utilized to confirm the biomarked brain areas sensitive to the epileptogenic hemisphere. Finally, the optimized entropy values of these biomarked brain areas were regarded as the feature vectors input for a support vector machine to classify the epileptogenic hemisphere, and the classification effectiveness was cross-validated. Nine biomarked brain areas were confirmed by the optimized entropy values, including medial superior frontal gyrus and superior parietal gyrus (p < .01). The mean classification accuracy was greater than 90%. It can be concluded that combination of the optimized MSE model with the machine learning model can accurately confirm the epileptogenic hemisphere by rfMRI. With the powerful information interaction capabilities of 5G communication, the epilepsy side-fixing algorithm that requires computing power can be integrated into a cloud platform. The demand side only needs to upload patient data to the service platform to realize the preoperative assessment of epilepsy.
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7
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Fitzgerald Z, Morita-Sherman M, Hogue O, Joseph B, Alvim MKM, Yasuda CL, Vegh D, Nair D, Burgess R, Bingaman W, Najm I, Kattan MW, Blumcke I, Worrell G, Brinkmann BH, Cendes F, Jehi L. Improving the prediction of epilepsy surgery outcomes using basic scalp EEG findings. Epilepsia 2021; 62:2439-2450. [PMID: 34338324 PMCID: PMC8488002 DOI: 10.1111/epi.17024] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/15/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the role of scalp electroencephalography (EEG; ictal and interictal patterns) in predicting resective epilepsy surgery outcomes. We use the data to further develop a nomogram to predict seizure freedom. METHODS We retrospectively reviewed the scalp EEG findings and clinical data of patients who underwent surgical resection at three epilepsy centers. Using both EEG and clinical variables categorized into 13 isolated candidate predictors and 6 interaction terms, we built a multivariable Cox proportional hazards model to predict seizure freedom 2 years after surgery. Harrell's step-down procedure was used to sequentially eliminate the least-informative variables from the model until the change in the concordance index (c-index) with variable removal was less than 0.01. We created a separate model using only clinical variables. Discrimination of the two models was compared to evaluate the role of scalp EEG in seizure-freedom prediction. RESULTS Four hundred seventy patient records were analyzed. Following internal validation, the full Clinical + EEG model achieved an optimism-corrected c-index of 0.65, whereas the c-index of the model without EEG data was 0.59. The presence of focal to bilateral tonic-clonic seizures (FBTCS), high preoperative seizure frequency, absence of hippocampal sclerosis, and presence of nonlocalizable seizures predicted worse outcome. The presence of FBTCS had the largest impact for predicting outcome. The analysis of the models' interactions showed that in patients with unilateral interictal epileptiform discharges (IEDs), temporal lobe surgery cases had a better outcome. In cases with bilateral IEDs, abnormal magnetic resonance imaging (MRI) predicted worse outcomes, and in cases without IEDs, patients with extratemporal epilepsy and abnormal MRI had better outcomes. SIGNIFICANCE This study highlights the value of scalp EEG, particularly the significance of IEDs, in predicting surgical outcome. The nomogram delivers an individualized prediction of postoperative outcome, and provides a unique assessment of the relationship between the outcome and preoperative findings.
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Affiliation(s)
| | | | - Olivia Hogue
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Boney Joseph
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Deborah Vegh
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Richard Burgess
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Bingaman
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael W. Kattan
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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8
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González-Ortiz S, Medrano S, Capellades J, Vilas M, Mestre A, Serrano L, Conesa G, Pérez-Enríquez C, Arumi M, Bargalló N, Delgado-Martinez I, Rocamora R. Voxel-based morphometry for the evaluation of patients with pharmacoresistant epilepsy with apparently normal MRI. J Neuroimaging 2021; 31:560-568. [PMID: 33817887 DOI: 10.1111/jon.12849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance imaging (MRI) is essential in the diagnosis of pharmacoresistant epilepsy (PRE), because patients with lesions detected by MRI have a better prognosis after surgery. Focal cortical dysplasia (FCD) is one of the most frequent etiologies of PRE but can be difficult to identify by MRI. Voxel-based morphometric analysis programs, like the Morphometric Analysis Program (MAP), have been developed to help improve MRI detection. Our objective was to evaluate the clinical usefulness of MAP in patients with PRE and an apparently normal MRI. METHODS We studied 70 patients with focal PRE and a nonlesional MRI. The 3DT1 sequence was processed with MAP, obtaining three z-score maps. Patients were classified as MAP+ if one or more z-score maps showed a suspicious area of brightness, and MAP- if the z-score maps did not show any suspicious areas. For MAP+ cases, a second-look MRI was performed with a dedicated inspection based on the MAP findings. The MAP results were correlated with the epileptogenic zone. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS Thirty-one percent of patients were classified as MAP+ and 69% were MAP-. Results showed a sensitivity of 0.57, specificity of 0.8, PPV of 0.91, and NPV of 0.35. In 19% of patients, an FCD was found in the second-look MRI after MAP. CONCLUSIONS MAP was helpful in the detection of lesions in PRE patients with a nonlesional MRI, which could have important repercussions for the clinical management and postoperative prognosis of these patients.
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Affiliation(s)
- Sofía González-Ortiz
- Radiology Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | | | - Marta Vilas
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Antoni Mestre
- Nuclear Medicine Department, Hospital Trueta, Girona, Spain
| | - Laura Serrano
- Neurosurgery Department, Hospital del Mar, Barcelona, Spain
| | - Gerardo Conesa
- Neurosurgery Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Carmen Pérez-Enríquez
- Neurology Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Montserrat Arumi
- Anatomic Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Nuria Bargalló
- Centre de Diagnosi per la Imatge, Hospital Clínic, Barcelona, Spain
| | - Ignacio Delgado-Martinez
- Neurosurgery Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Rodrigo Rocamora
- Neurology Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
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9
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Jackson HN, Gadgil N, Pan IW, Clarke DF, Wagner KM, Cronkite CA, Lam S. Sociodemographic Factors in Pediatric Epilepsy Surgery. Pediatr Neurol 2020; 107:71-76. [PMID: 32284204 DOI: 10.1016/j.pediatrneurol.2019.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite documented efficacy of surgical treatment in carefully selected patients, surgery is delayed and/or underutilized in both adult and children with focal onset epilepsy. The reasons for surgical delay are often assumed or theorized, and studies have predominantly targeted the adult population. To focus on a more targeted pediatric population and to determine identifiable reasons for intervention, this study aimed to investigate time to epilepsy surgery among pediatric patients with medically intractable epilepsy associated with focal cortical dysplasia and to identify sociodemographic and clinical associations in time to epilepsy surgery. METHODS We reviewed 96 consecutive pediatric patients who underwent surgery for medically intractable epilepsy with a diagnosis of focal cortical dysplasia. Descriptive statistics, univariate and multivariate analyses were conducted to study the association of sociodemographic variables of patients with focal cortical dysplasia and time to epilepsy surgery and postoperative seizure control. RESULTS We identified that non-white patients on average had a longer duration of epilepsy before surgery and traveled shorter distances for care. Non-white patients were more likely to have government-funded insurance. Patients who traveled the shortest distance to the surgical center underwent epilepsy surgery at an older age. CONCLUSIONS Sociodemographic factors of travel distance, insurance, and race influenced time to epilepsy surgery for children with focal cortical dysplasia. Further research is warranted to target barriers in access to subspecialty care and develop ways to identify earlier the patients who may benefit from evaluation and deployment of surgical intervention.
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Affiliation(s)
- Hudin N Jackson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Nisha Gadgil
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - I-Wen Pan
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas
| | - Dave F Clarke
- Division of Pediatric Neurology, Department of Neurology, Dell Medical School University of Texas at Austin, Austin, Texas
| | - Kathryn M Wagner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Sandi Lam
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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10
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Alarcón G, Bird Pedersen M, Juárez-Torrejón N, Martín-López D, Ughratdar I, Selway RP, Valentín A. The Single Word Auditory Comprehension (SWAC) test: A simple method to identify receptive language areas with electrical stimulation. Epilepsy Behav 2019; 90:266-272. [PMID: 30442560 DOI: 10.1016/j.yebeh.2018.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Resective surgery for medically refractory epilepsy in proximity to speech receptive areas requires balancing adequate resection of the epileptogenic zone for optimal seizure control with preservation of function. We develop a simple test (Single Word Auditory Comprehension or SWAC) to localize speech receptive areas by evaluating patients' ability to comprehend a single word. METHODS Patients were studied during presurgical or intraoperative assessment for epilepsy with intracranial electrodes. They were asked to listen to a common word (target word) and to describe what it meant without saying the target word. Electrical stimulation (trains of biphasic 2-ms pulses, 50 Hz for 3 s) was delivered while the patient listened to the target word, not while the patient explained the meaning of the word. In six patients, SWAC test was carried out during extraoperative chronic recordings, and in one patient in the operating theater under local anesthesia. RESULTS Among the 7 patients where the test identified deficits, 6 underwent resection (4 temporal, 1 supramarginal, and 1 occipital). Two patients showed temporary minor speech deficits after resection. No patient showed permanent speech deficits after resection. CONCLUSION/SIGNIFICANCE The SWAC test is reliable, simple and fast to implement, and suitable for intraoperating mapping. It could be used as a simple initial test to identify receptive language areas where more complex additional tests can be performed.
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Affiliation(s)
- Gonzalo Alarcón
- Comprehensive Epilepsy Center, Neuroscience Institute, Academic Health Systems, Hamad Medical Corporation, Doha, Qatar; Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; Weill Cornell Medicine, Doha, Qatar; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Marie Bird Pedersen
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | | | - David Martín-López
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Ismail Ughratdar
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Richard P Selway
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Antonio Valentín
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK.
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11
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Alarcón G, Jiménez-Jiménez D, Valentín A, Martín-López D. Characterizing EEG Cortical Dynamics and Connectivity with Responses to Single Pulse Electrical Stimulation (SPES). Int J Neural Syst 2018; 28:1750057. [DOI: 10.1142/s0129065717500575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: To model cortical connections in order to characterize their oscillatory behavior and role in the generation of spontaneous electroencephalogram (EEG). Methods: We studied averaged responses to single pulse electrical stimulation (SPES) from the non-epileptogenic hemisphere of five patients assessed with intracranial EEG who became seizure free after contralateral temporal lobectomy. Second-order control system equations were modified to characterize the systems generating a given response. SPES responses were modeled as responses to a unit step input. EEG power spectrum was calculated on the 20[Formula: see text]s preceding SPES. Results: 121 channels showed responses to 32 stimulation sites. A single system could model the response in 41.3% and two systems were required in 58.7%. Peaks in the frequency response of the models tended to occur within the frequency range of most activity on the spontaneous EEG. Discrepancies were noted between activity predicted by models and activity recorded in the spontaneous EEG. These discrepancies could be explained by the existence of alpha rhythm or interictal epileptiform discharges. Conclusions: Cortical interactions shown by SPES can be described as control systems which can predict cortical oscillatory behavior. The method is unique as it describes connectivity as well as dynamic interactions.
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Affiliation(s)
- Gonzalo Alarcón
- Comprehensive Epilepsy Center Neuroscience Institute, Academic Health Systems, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Neuroscience, King’s College London, Institute of Psychiatry, Psychology and Neuroscience London, UK
- Department of Clinical Neurophysiology, King’s College Hospital NHS FT, London, UK
- Weill Cornell Medical College, Doha, Qatar
| | - Diego Jiménez-Jiménez
- Department of Clinical Neuroscience, King’s College London, Institute of Psychiatry, Psychology and Neuroscience London, UK
- Department of Clinical Neurophysiology, King’s College Hospital NHS FT, London, UK
- Universidad San Francisco de Quito, School of Medicine, Quito, Ecuador
| | - Antonio Valentín
- Department of Clinical Neuroscience, King’s College London, Institute of Psychiatry, Psychology and Neuroscience London, UK
- Department of Clinical Neurophysiology, King’s College Hospital NHS FT, London, UK
- Weill Cornell Medical College, Doha, Qatar
| | - David Martín-López
- Department of Clinical Neuroscience, King’s College London, Institute of Psychiatry, Psychology and Neuroscience London, UK
- Weill Cornell Medical College, Doha, Qatar
- Department of Clinical Neurophysiology, Kingston Hospital NHS FT, London, UK
- Department of Clinical Neurophysiology, St George’s University Hospitals NHS FT, London, UK
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12
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Shah AK, Fuerst D, Mittal S. Intraoperative hippocampal electrocorticography frequently captures electrographic seizures and correlates with hippocampal pathology. Clin Neurophysiol 2018; 129:717-723. [PMID: 29438820 DOI: 10.1016/j.clinph.2018.01.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 12/05/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Relationship between electrographic seizures on hippocampal electrocorticography (IH-ECoG) and presence/type of hippocampal pathology remains unclear. METHODS IH-ECoG was recorded for 10-20 min from the ventricular surface of the hippocampus following removal of the temporal neocortex in 40 consecutive patients. Correlation between intraoperative hippocampal seizures and preoperative MRI, hippocampal histopathology, and EEG from invasive monitoring was determined. RESULTS IH-ECoG captured electrographic seizures in 15/40 patients (in 8/23 with abnormal hippocampal signal on MRI and 7/17 patients without MRI abnormality). Hippocampal neuronal loss was observed in 22/40 (Group 1), while 18/40 had no significant neuronal loss (Group 2). In Group 1, 4/22 had seizures on IH-ECoG, while 11/18 had electrographic seizures in Group 2. In 24/40 patients who underwent prolonged extraoperative intracranial EEG (IC-EEG) recording, hippocampal seizures were captured in 14. Of these, 7 also had seizures during IH-ECoG. In 10/24 IC-EEG patients without seizures, 3 had seizures on IH-ECoG. CONCLUSIONS IH-ECoG frequently captures spontaneous electrographic seizures. These are more likely to occur in patients with pathologic processes that do not disrupt/infiltrate hippocampus compared to patients with intractable epilepsy associated with disrupted hippocampal architecture. SIGNIFICANCE Intraoperative hippocampal seizures may result from deafferentation from the temporal neocortex and disinhibition of the perforant pathway.
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Affiliation(s)
- Aashit K Shah
- Department of Neurology, Wayne State University, Detroit, MI, USA; Comprehensive Epilepsy Center, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Darren Fuerst
- Comprehensive Epilepsy Center, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Sandeep Mittal
- Comprehensive Epilepsy Center, Detroit Medical Center, Wayne State University, Detroit, MI, USA; Department of Neurosurgery, Wayne State University, Detroit, MI, USA; Department of Oncology, Wayne State University, Detroit, MI, USA; Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
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13
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Choi SA, Kim SY, Kim H, Kim WJ, Kim H, Hwang H, Choi JE, Lim BC, Chae JH, Chong S, Lee JY, Phi JH, Kim SK, Wang KC, Kim KJ. Surgical outcome and predictive factors of epilepsy surgery in pediatric isolated focal cortical dysplasia. Epilepsy Res 2017; 139:54-59. [PMID: 29197666 DOI: 10.1016/j.eplepsyres.2017.11.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/26/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is a common cause of medically intractable epilepsy in children. Epilepsy surgery has been a valuable treatment option to achieve seizure freedom in these intractable epilepsy patients. We aimed to present long-term surgical outcome, in relation to pathological severity, and to assess predictive factors of epilepsy surgery in pediatric isolated FCD. METHODS We retrospectively analyzed the data of 58 children and adolescents, with FCD International League Against Epilepsy (ILAE) task force classification types I and II, who underwent resective epilepsy surgery and were followed for at least 2 years after surgery. RESULTS The mean age at epilepsy onset was 4.3 years (0-14.2 years), and mean age at epilepsy surgery was 9.4 years (0.4-17.5 years). The mean duration of postoperative follow-up was 5.1±2.6 years (2-12.4 years). Of 58 patients, 62% of patients achieved Engel class I at 2 years postoperatively, 58% at 5 years postoperatively, and 53% at the last follow up. Forty eight percent of our cohort successfully discontinued antiepileptic medication. Of 30 patients with seizure recurrence, 83% of seizures recurred within 2 years after surgery. We observed that FCD type IIb was significantly associated with a better surgical outcome. At fifth postoperative year, 88% of FCD IIb patients were seizure free compared with 21% of type I and 57% of type IIa patients (P=0.043). By multivariate analysis, lesion on MRI (P=0.02) and complete resection (P<0.01) were the most important predictive factors for a seizure-free outcome. SIGNIFICANCE Epilepsy surgery is highly effective; more than half of medically intractable epilepsy patients achieved seizure freedom after surgery. In addition, we found significant difference in surgical outcomes according to the ILAE task force classification. Lesion on MRI and complete resection were the most important predictive factors for favorable seizure outcome in isolated FCD patients.
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Affiliation(s)
- Sun Ah Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyuna Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ji Eun Choi
- Department of Pediatrics, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Byung Chan Lim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sangjoon Chong
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Ki Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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14
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Fedele T, Burnos S, Boran E, Krayenbühl N, Hilfiker P, Grunwald T, Sarnthein J. Resection of high frequency oscillations predicts seizure outcome in the individual patient. Sci Rep 2017; 7:13836. [PMID: 29062105 PMCID: PMC5653833 DOI: 10.1038/s41598-017-13064-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/13/2017] [Indexed: 11/10/2022] Open
Abstract
High frequency oscillations (HFOs) are recognized as biomarkers for epileptogenic brain tissue. A remaining challenge for epilepsy surgery is the prospective classification of tissue sampled by individual electrode contacts. We analysed long-term invasive recordings of 20 consecutive patients who subsequently underwent epilepsy surgery. HFOs were defined prospectively by a previously validated, automated algorithm in the ripple (80–250 Hz) and the fast ripple (FR, 250–500 Hz) frequency band. Contacts with the highest rate of ripples co-occurring with FR over several five-minute time intervals designated the HFO area. The HFO area was fully included in the resected area in all 13 patients who achieved seizure freedom (specificity 100%) and in 3 patients where seizures reoccurred (negative predictive value 81%). The HFO area was only partially resected in 4 patients suffering from recurrent seizures (positive predictive value 100%, sensitivity 57%). Thus, the resection of the prospectively defined HFO area proved to be highly specific and reproducible in 13/13 patients with seizure freedom, while it may have improved the outcome in 4/7 patients with recurrent seizures. We thus validated the clinical relevance of the HFO area in the individual patient with an automated procedure. This is a prerequisite before HFOs can guide surgical treatment in multicentre studies.
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Affiliation(s)
- Tommaso Fedele
- University Hospital Zurich, Neurosurgery Department, Zurich, Switzerland.
| | - Sergey Burnos
- University Hospital Zurich, Neurosurgery Department, Zurich, Switzerland.,ETH Zurich, Institute of Neuroinformatics, Zurich, Switzerland
| | - Ece Boran
- University Hospital Zurich, Neurosurgery Department, Zurich, Switzerland
| | - Niklaus Krayenbühl
- University Hospital Zurich, Neurosurgery Department, Zurich, Switzerland
| | | | | | - Johannes Sarnthein
- University Hospital Zurich, Neurosurgery Department, Zurich, Switzerland.,University of Zurich, Zurich Neuroscience Centre, Zurich, Switzerland
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15
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Wang Y, Trevelyan AJ, Valentin A, Alarcon G, Taylor PN, Kaiser M. Mechanisms underlying different onset patterns of focal seizures. PLoS Comput Biol 2017; 13:e1005475. [PMID: 28472032 PMCID: PMC5417416 DOI: 10.1371/journal.pcbi.1005475] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/23/2017] [Indexed: 02/07/2023] Open
Abstract
Focal seizures are episodes of pathological brain activity that appear to arise from a localised area of the brain. The onset patterns of focal seizure activity have been studied intensively, and they have largely been distinguished into two types-low amplitude fast oscillations (LAF), or high amplitude spikes (HAS). Here we explore whether these two patterns arise from fundamentally different mechanisms. Here, we use a previously established computational model of neocortical tissue, and validate it as an adequate model using clinical recordings of focal seizures. We then reproduce the two onset patterns in their most defining properties and investigate the possible mechanisms underlying the different focal seizure onset patterns in the model. We show that the two patterns are associated with different mechanisms at the spatial scale of a single ECoG electrode. The LAF onset is initiated by independent patches of localised activity, which slowly invade the surrounding tissue and coalesce over time. In contrast, the HAS onset is a global, systemic transition to a coexisting seizure state triggered by a local event. We find that such a global transition is enabled by an increase in the excitability of the "healthy" surrounding tissue, which by itself does not generate seizures, but can support seizure activity when incited. In our simulations, the difference in surrounding tissue excitability also offers a simple explanation of the clinically reported difference in surgical outcomes. Finally, we demonstrate in the model how changes in tissue excitability could be elucidated, in principle, using active stimulation. Taken together, our modelling results suggest that the excitability of the tissue surrounding the seizure core may play a determining role in the seizure onset pattern, as well as in the surgical outcome.
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Affiliation(s)
- Yujiang Wang
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
| | - Andrew J Trevelyan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Gonzalo Alarcon
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Comprehensive Epilepsy Center, Neuroscience Institute, Academic Health Systems, Hamad Medical Corporation, Doha, Qatar
| | - Peter N Taylor
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
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16
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Depth versus subdural temporal electrodes revisited: Impact on surgical outcome after resective surgery for epilepsy. Clin Neurophysiol 2016; 128:418-423. [PMID: 28160747 DOI: 10.1016/j.clinph.2016.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 11/23/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study retrospectively the impact of electrode modality (subdural or depth electrodes) during presurgical assessment on surgical outcome after temporal lobectomy. METHODS The study included 17 patients assessed with depth electrodes and 57 with bitemporal subdural strips. RESULTS MRI showed a larger proportion of bilateral pathology in patients undergoing depth recordings (29.41% versus 3.5%, p=0.00069). Among the operated patients, those undergoing depth electrode recordings showed better outcome at one year after surgery (11/12 versus 22/33; p=0.046). This difference disappears at longest follow up (10/12 versus 22/33; p=0.138). Moreover, the probability of undergoing surgery and having good outcome after assessment with intracranial recordings is higher for the depth electrode group at one-year follow up (11/17 versus 22/57; p=0.029) but statistical differences decrease to a trend for the longest follow up (10/17 versus 22/57; p=0.069). No other statistical differences were noted between subdural and depth electrodes. Depth electrodes showed lower complication rates than subdural electrodes. CONCLUSION Both depth and subdural electrodes are effective for presurgical assessment of temporal lobe epilepsy. SIGNIFICANCE Assessment with depth electrodes is associated with slightly increased likelihood of surgery and marginally better surgical outcome at one year follow up which disappears for longer follow up periods. Initial assessment with depth electrodes would have avoided a second implantation in 15% of patients.
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17
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Hirfanoglu T, Serdaroglu A, Kurt G, Erdem A, Capraz I, Bilir E, Vural O, Ucar M, Oner AY, Onal B, Akdemir O, Atay O, Arhan E, Aydin K. Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center. Epilepsy Behav 2016; 63:67-72. [PMID: 27566969 DOI: 10.1016/j.yebeh.2016.07.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/14/2016] [Accepted: 07/28/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study aimed to investigate the efficacy of resective surgery in children with focal lesional epilepsy by evaluating the predictive value of pre- and postsurgical factors in terms of seizure freedom. METHODS This study included 61 children aged between 2 and 18years who were admitted to the pediatric video-EEG unit for presurgical workup. Each patient was evaluated with a detailed history, video-EEG, neuroimaging, and postsurgical outcomes according to Engel classification to predict postsurgical seizure freedom. All the possible factors including history, etiology, presurgical evaluation, surgical procedures, and postsurgical results were analyzed for their predictive value for postoperative seizure freedom. RESULTS Of the 61 patients, 75% were diagnosed as having temporal lobe epilepsy (TLE), and 25% were diagnosed with extra-TLE. Two years after the surgery, 78.6% were seizure-free, of which 89% had TLE, and 50% had extra-TLE (p<0.05). Patients were more likely to have a favorable outcome for seizure freedom if they had rare seizure frequency, focal EEG findings, and focal seizures; had a temporal epileptogenic zone; or had TLE and hippocampal sclerosis. On the other hand, patients were more likely to have unfavorable results for seizure freedom if they had younger age of seizure onset, frequent seizures before the surgery, a frontal or multilobar epileptogenic zone, secondarily generalized seizures, extra-TLE with frontal lobe surgery, or focal cortical dysplasia. SIGNIFICANCE Resective surgery is one of the most effective treatment methods in children with intractable epilepsy. A history of young age of seizure onset, frequent seizures before surgery, secondarily generalized seizures, a multilobar epileptogenic zone, frontal lobe surgery, and focal cortical dysplasia (FCD) are the most important predictive factors indicating that a patient would continue having seizures after surgery. On the other hand, focal seizure semiologies, temporal lobe localization, and hippocampal sclerosis indicate that a patient would have better results in terms of seizure freedom.
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Affiliation(s)
- Tugba Hirfanoglu
- Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey
| | - Ayse Serdaroglu
- Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey
| | - Gokhan Kurt
- Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey
| | - Atilla Erdem
- Ankara University School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Irem Capraz
- Department of Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey
| | - Erhan Bilir
- Department of Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey
| | - Ozge Vural
- Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey
| | - Murat Ucar
- Department of Radiology, Gazi University School of Medicine, Ankara, Turkey
| | - Ali Yusuf Oner
- Department of Radiology, Gazi University School of Medicine, Ankara, Turkey
| | - Baran Onal
- Department of Radiology, Gazi University School of Medicine, Ankara, Turkey
| | - Ozgur Akdemir
- Department of Nuclear Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Ozlem Atay
- Department of Nuclear Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Ebru Arhan
- Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey
| | - Kursad Aydin
- Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey
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Yang Z, Choupan J, Reutens D, Hocking J. Lateralization of Temporal Lobe Epilepsy Based on Resting-State Functional Magnetic Resonance Imaging and Machine Learning. Front Neurol 2015; 6:184. [PMID: 26379618 PMCID: PMC4553409 DOI: 10.3389/fneur.2015.00184] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/10/2015] [Indexed: 11/13/2022] Open
Abstract
Lateralization of temporal lobe epilepsy (TLE) is critical for successful outcome of surgery to relieve seizures. TLE affects brain regions beyond the temporal lobes and has been associated with aberrant brain networks, based on evidence from functional magnetic resonance imaging. We present here a machine learning-based method for determining the laterality of TLE, using features extracted from resting-state functional connectivity of the brain. A comprehensive feature space was constructed to include network properties within local brain regions, between brain regions, and across the whole network. Feature selection was performed based on random forest and a support vector machine was employed to train a linear model to predict the laterality of TLE on unseen patients. A leave-one-patient-out cross validation was carried out on 12 patients and a prediction accuracy of 83% was achieved. The importance of selected features was analyzed to demonstrate the contribution of resting-state connectivity attributes at voxel, region, and network levels to TLE lateralization.
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Affiliation(s)
- Zhengyi Yang
- School of Information Technology and Electrical Engineering, The University of Queensland , Brisbane, QLD , Australia ; Centre for Advanced Imaging, The University of Queensland , Brisbane, QLD , Australia
| | - Jeiran Choupan
- Centre for Advanced Imaging, The University of Queensland , Brisbane, QLD , Australia ; Queensland Brain Institute, The University of Queensland , Brisbane, QLD , Australia
| | - David Reutens
- Centre for Advanced Imaging, The University of Queensland , Brisbane, QLD , Australia
| | - Julia Hocking
- School of Psychology and Counselling, Queensland University of Technology , Brisbane, QLD , Australia
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Jiménez-Jiménez D, Martín-López D, Masood MA, Selway RP, Valentín A, Alarcón G. Prognostic value of the second ictal intracranial pattern for the outcome of epilepsy surgery. Clin Neurophysiol 2015; 127:230-237. [PMID: 26253031 DOI: 10.1016/j.clinph.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 06/24/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the prognostic value of the second ictal pattern (SIP) that follows the first ictal pattern (FIP) seen at seizure onset in order to predict seizure control after epilepsy surgery. METHODS SIPs were analysed in 344 electro-clinical and subclinical seizures recorded with intracranial electrodes in 63 patients. SIPs were classified as (a) electrodecremental event (EDE); (b) fast activity (FA); (c) runs of spikes; (d) spike-wave activity; (e) sharp waves; (f) alpha activity; (g) delta activity and (h) theta activity. Engel surgical outcome scale was used. RESULTS The mean follow-up period was 42.1 months (SD=30.1). EDE was the most common SIP seen (41%), followed by FA (19%), spike-wave activity (18%), alpha activity (8%), sharp-wave activity (8%), delta activity (3%), runs of spikes (2%) and theta activity (2%). EDE as SIP was associated with favourable outcome when compared with FA (p=0.0044) whereas FA was associated with poor outcome when compared with any other pattern (p=0.0389). FA as SIP tends to occur after EDE (75%) whereas EDE tends to evolve from a FIP containing FA (77%). SIP extent was focal in 46% of patients, lobar in 24%, multilobar in 14% and bilateral in 16%. There is a gradual decrease in the proportion of Engel grade I with the extent of SIP. Focal and delayed (in temporal lobe epilepsy) SIPs appear to be associated with better outcome. CONCLUSIONS As SIP, EDE was associated with favourable surgical outcome whereas FA was associated with poor outcome, probably because outcome is dominated by FIP. SIGNIFICANCE EDE as SIP should not discourage surgery. However, FA as SIP should be contemplated with caution. SIP focality and latency can have prognostic value in epilepsy surgery.
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Affiliation(s)
- Diego Jiménez-Jiménez
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador.
| | - David Martín-López
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; West Surrey Clinical Neurophysiology, St Peter's Hospital, Chertsey, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Mojtaba A Masood
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Richard P Selway
- Department of Neurosurgery, King's College Hospital, NHS Trust London, UK
| | - Antonio Valentín
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Gonzalo Alarcón
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Comprehensive Epilepsy Center Neuroscience Institute, Academic Health Systems, Hamad Medical Corporation, Doha, Qatar
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Lamberink HJ, Boshuisen K, van Rijen PC, Gosselaar PH, Braun KPJ. Changing profiles of pediatric epilepsy surgery candidates over time: A nationwide single-center experience from 1990 to 2011. Epilepsia 2015; 56:717-25. [DOI: 10.1111/epi.12974] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Herm J. Lamberink
- Department of (Child) Neurology and Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Kim Boshuisen
- Department of (Child) Neurology and Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Peter C. van Rijen
- Department of (Child) Neurology and Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Peter H. Gosselaar
- Department of (Child) Neurology and Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Kees P. J. Braun
- Department of (Child) Neurology and Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
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Development and validation of nomograms to provide individualised predictions of seizure outcomes after epilepsy surgery: a retrospective analysis. Lancet Neurol 2015; 14:283-90. [DOI: 10.1016/s1474-4422(14)70325-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Yang PF, Pei JS, Zhang HJ, Lin Q, Mei Z, Zhong ZH, Tian J, Jia YZ, Chen ZQ, Zheng ZY. Long-term epilepsy surgery outcomes in patients with PET-positive, MRI-negative temporal lobe epilepsy. Epilepsy Behav 2014; 41:91-7. [PMID: 25461196 DOI: 10.1016/j.yebeh.2014.09.054] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
This study compared the long-term efficacy of anterior temporal lobectomy (ATL) for the treatment of medically refractory temporal lobe epilepsy (TLE) in patients who presented with ipsilateral temporal PET hypometabolism and nonlesional magnetic resonance imaging (PET+/MRI-) with that in patients who had mesial temporal sclerosis (MTS) on MRI. We described the electroclinical, MRI, PET, and pathological characteristics and seizure outcome of 28 PET+/MRI--patients without discordant ictal and interictal electroencephalography (EEG) who underwent ATL (2004-2007) for medically refractory partial epilepsy while avoiding intracranial monitoring. The primary outcome was the percentages of Engel Class I outcomes at 2 and 5 years of PET+/MRI--patients compared with those of patients with MTS on MRI; neuropsychological testing was used as the secondary outcome. At 2-year follow-up, 21 (75%) patients in the PET+/MRI--group were in Engel Class I compared with 66 (75.9%) patients with MTS, and at 5-year follow-up, 20 (71.4%) patients in the PET+/MRI--group were in Engel Class I compared with 64 (73.6%) patients in the group with MTS. There were no significant differences between the groups at either time period. We concluded that normal MRI results should not preclude presurgical evaluations in patients with medically refractory TLE, as favorable long-term postoperative seizure outcomes are possible, especially in patients with unilateral anterior interictal epileptiform discharges and ipsilateral temporal PET hypometabolism.
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Affiliation(s)
- Peng-Fan Yang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Jia-Sheng Pei
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Hui-Jian Zhang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Qiao Lin
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhen Mei
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhong-Hui Zhong
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jun Tian
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Yan-Zeng Jia
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zi-Qian Chen
- Department of Neuroradiology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhi-Yong Zheng
- Department of Pathology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
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Amini E, Rezaei M, Mohamed Ibrahim N, Golpich M, Ghasemi R, Mohamed Z, Raymond AA, Dargahi L, Ahmadiani A. A Molecular Approach to Epilepsy Management: from Current Therapeutic Methods to Preconditioning Efforts. Mol Neurobiol 2014; 52:492-513. [PMID: 25195699 DOI: 10.1007/s12035-014-8876-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/25/2014] [Indexed: 01/16/2023]
Abstract
Epilepsy is the most common and chronic neurological disorder characterized by recurrent unprovoked seizures. The key aim in treating patients with epilepsy is the suppression of seizures. An understanding of focal changes that are involved in epileptogenesis may therefore provide novel approaches for optimal treatment of the seizure. Although the actual pathogenesis of epilepsy is still uncertain, recently growing lines of evidence declare that microglia and astrocyte activation, oxidative stress and reactive oxygen species (ROS) production, mitochondria dysfunction, and damage of blood-brain barrier (BBB) are involved in its pathogenesis. Impaired GABAergic function in the brain is probably the most accepted hypothesis regarding the pathogenesis of epilepsy. Clinical neuroimaging of patients and experimental modeling have demonstrated that seizures may induce neuronal apoptosis. Apoptosis signaling pathways are involved in the pathogenesis of several types of epilepsy such as temporal lobe epilepsy (TLE). The quality of life of patients is seriously affected by treatment-related problems and also by unpredictability of epileptic seizures. Moreover, the available antiepileptic drugs (AED) are not significantly effective to prevent epileptogenesis. Thus, novel therapies that are proficient to control seizure in people who are suffering from epilepsy are needed. The preconditioning method promises to serve as an alternative therapeutic approach because this strategy has demonstrated the capability to curtail epileptogenesis. For this reason, understanding of molecular mechanisms underlying brain tolerance induced by preconditioning is crucial to delineate new neuroprotective ways against seizure damage and epileptogenesis. In this review, we summarize the work to date on the pathogenesis of epilepsy and discuss recent therapeutic strategies in the treatment of epilepsy. We will highlight that novel therapy targeting such as preconditioning process holds great promise. In addition, we will also highlight the role of gene reprogramming and mitochondrial biogenesis in the preconditioning-mediated neuroprotective events.
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Affiliation(s)
- Elham Amini
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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Alarcón G. What is the use of a single shoe? On the dual nature of neuronal networks. Clin Neurophysiol 2014; 125:1715-6. [DOI: 10.1016/j.clinph.2014.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/08/2014] [Accepted: 02/11/2014] [Indexed: 11/25/2022]
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Jiménez-Jiménez D, Nekkare R, Flores L, Chatzidimou K, Bodi I, Honavar M, Mullatti N, Elwes RDC, Selway RP, Valentín A, Alarcón G. Prognostic value of intracranial seizure onset patterns for surgical outcome of the treatment of epilepsy. Clin Neurophysiol 2014; 126:257-67. [PMID: 25065302 DOI: 10.1016/j.clinph.2014.06.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 05/22/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate if intracranial EEG patterns at seizure onset can predict surgical outcome. METHODS Ictal onset patterns from intracranial EEG were analysed in 373 electro-clinical seizures and subclinical seizures from 69 patients. Seizure onset patterns were classified as: (a) Diffuse electrodecremental (DEE); (b) Focal fast activity (FA); (c) Simultaneous onset of fast activity and diffuse electrodecremental event (FA-DEE); (d) Spikes; (e) Spike-wave activity; (f) Sharp waves; (g) Alpha activity; (h) Delta activity. Presence of preceding epileptiform discharge (PED) was also studied. Engel and ILAE surgical outcome scales were used. RESULTS The mean follow-up period was 42.1 months (SD=30.1). Fast activity was the most common seizure onset pattern seen (33%), followed by (FA-DEE) (20%), DEE (19%), spike-wave activity (12%), sharp-waves (6%), alpha activity (6%), delta activity (3%) and spikes (1%). Preceding epileptiform discharges were present in 75% of patients. FA was associated with favourable outcome (p=0.0083) whereas DEE was associated with poor outcome (p=0.0025). A widespread PED was not associated with poor outcome (p=0.9559). There was no clear association between seizure onset pattern and specific pathology, except possibly between sharp/spike waves and mesial temporal sclerosis. CONCLUSIONS FA activity is associated with favourable outcome. DEE at onset was associated with poor surgical outcome. Widespread/bilateral PEDs were not associated with poor or good outcome. SIGNIFICANCE FA appears to be the best marker for the epileptogenic zone. Surgery should be contemplated with caution if DEE is the first ictal change. However, a widespread/bilateral PED at onset is common and should not discourage surgery.
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Affiliation(s)
- Diego Jiménez-Jiménez
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; Universidad San Francisco de Quito, School of Medicine, Quito, Ecuador
| | - Ramesh Nekkare
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK
| | - Lorena Flores
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK
| | - Katerina Chatzidimou
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK
| | - Istvan Bodi
- Department of Neuropathology, King's College Hospital NHS Trust, London, UK
| | - Mrinalini Honavar
- Department of Neuropathology, King's College Hospital NHS Trust, London, UK; Serviço de Anatomia Patológica, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Nandini Mullatti
- Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Robert D C Elwes
- Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Richard P Selway
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Antonio Valentín
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Gonzalo Alarcón
- Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK; Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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