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Hao G, Yan H, Wang X, Gao R, Xue Y, Zhang X, Ni D, Shu W, Qiao L, He L, Yu T. The role of magnetoencephalography in preoperative localization and postoperative outcome prediction in patients with posterior cortical epilepsy. CNS Neurosci Ther 2024; 30:e14602. [PMID: 38332652 PMCID: PMC10853654 DOI: 10.1111/cns.14602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/16/2023] [Accepted: 01/01/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE We aimed to explore the value of magnetoencephalography in the presurgical evaluation of patients with posterior cortex epilepsy. METHODS A total of 39 patients with posterior cortex epilepsy (PCE) and intact magnetoencephalography (MEG) images were reviewed from August 2019 to July 2022. MEG dipole clusters were classified into single clusters, multiple clusters, and scatter dipoles based on tightness criteria. The association of the surgical outcome with MEG dipole classifications was evaluated using Fisher's exact tests. RESULTS Among the 39 cases, there were 24 cases of single clusters (61.5%), nine cases of multiple clusters (23.1%), and six cases of scattered dipoles (15.4%). Patients with single dipole clusters were more likely to become seizure-free. Among single dipole cluster cases (n = 24), complete MEG dipole resection yielded a more favorable surgical outcome than incomplete resection (83.3% vs. 16.7%, p = 0.007). Patients with concordant MRI and MEG findings achieved a significantly more favorable surgical outcome than discordant patients (66.7% vs. 33.3%, p = 0.044), especially in single dipole cluster patients (87.5% vs. 25.0%, p = 0.005). SIGNIFICANCE MEG can provide additional valuable information regarding surgical candidate selection, epileptogenic zone localization, electrode implantation schedule, and final surgical planning in patients with posterior cortex epilepsy.
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Affiliation(s)
- Guiliang Hao
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Hao Yan
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xueyuan Wang
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Runshi Gao
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Yansong Xue
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xiating Zhang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Duanyu Ni
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Wei Shu
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Liang Qiao
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Liu He
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Tao Yu
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
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2
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Geller AS, Teale P, Kronberg E, Ebersole JS. Magnetoencephalography for Epilepsy Presurgical Evaluation. Curr Neurol Neurosci Rep 2024; 24:35-46. [PMID: 38148387 DOI: 10.1007/s11910-023-01328-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE OF THE REVIEW Magnetoencephalography (MEG) is a functional neuroimaging technique that records neurophysiology data with millisecond temporal resolution and localizes it with subcentimeter accuracy. Its capability to provide high resolution in both of these domains makes it a powerful tool both in basic neuroscience as well as clinical applications. In neurology, it has proven useful in its ability to record and localize epileptiform activity. Epilepsy workup typically begins with scalp electroencephalography (EEG), but in many situations, EEG-based localization of the epileptogenic zone is inadequate. The complementary sensitivity of MEG can be crucial in such cases, and MEG has been adopted at many centers as an important resource in building a surgical hypothesis. In this paper, we review recent work evaluating the extent of MEG influence of presurgical evaluations, novel analyses of MEG data employed in surgical workup, and new MEG instrumentation that will likely affect the field of clinical MEG. RECENT FINDINGS MEG consistently contributes to presurgical evaluation and these contributions often change the plan for epilepsy surgery. Extensive work has been done to develop new analytic methods for localizing the source of epileptiform activity with MEG. Systems using optically pumped magnetometry (OPM) have been successfully deployed to record and localize epileptiform activity. MEG remains an important noninvasive tool for epilepsy presurgical evaluation. Continued improvements in analytic methodology will likely increase the diagnostic yield of the test. Novel instrumentation with OPM may contribute to this as well, and may increase accessibility of MEG by decreasing cost.
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Affiliation(s)
- Aaron S Geller
- Department of Neurology, CU Anschutz Medical School, Aurora, CO, USA.
| | - Peter Teale
- Department of Neurology, CU Anschutz Medical School, Aurora, CO, USA
| | - Eugene Kronberg
- Department of Neurology, CU Anschutz Medical School, Aurora, CO, USA
| | - John S Ebersole
- Department of Neurology, Atlantic Neuroscience Institute, Summit, NJ, USA
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3
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Laohathai C, Ebersole JS, Mosher JC, Bagić AI, Sumida A, Von Allmen G, Funke ME. Practical Fundamentals of Clinical MEG Interpretation in Epilepsy. Front Neurol 2021; 12:722986. [PMID: 34721261 PMCID: PMC8551575 DOI: 10.3389/fneur.2021.722986] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
Magnetoencephalography (MEG) is a neurophysiologic test that offers a functional localization of epileptic sources in patients considered for epilepsy surgery. The understanding of clinical MEG concepts, and the interpretation of these clinical studies, are very involving processes that demand both clinical and procedural expertise. One of the major obstacles in acquiring necessary proficiency is the scarcity of fundamental clinical literature. To fill this knowledge gap, this review aims to explain the basic practical concepts of clinical MEG relevant to epilepsy with an emphasis on single equivalent dipole (sECD), which is one the most clinically validated and ubiquitously used source localization method, and illustrate and explain the regional topology and source dynamics relevant for clinical interpretation of MEG-EEG.
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Affiliation(s)
- Christopher Laohathai
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, United States
- Department of Neurology, Saint Louis University, Saint Louis, MO, United States
| | - John S. Ebersole
- Northeast Regional Epilepsy Group, Atlantic Health Neuroscience Institute, Summit, NJ, United States
| | - John C. Mosher
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, United States
| | - Anto I. Bagić
- University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), Department of Neurology, University of Pittsburgh Medical Center, Pittsburg, PA, United States
| | - Ai Sumida
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, United States
| | - Gretchen Von Allmen
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, United States
| | - Michael E. Funke
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, United States
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4
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Castagno S, D'Arco F, Tahir MZ, Battey H, Eltze C, Moeller F, Tisdall M. Seizure outcomes of large volume temporo-parieto-occipital and frontal surgery in children with drug-resistant epilepsy. Epilepsy Res 2021; 177:106769. [PMID: 34560348 DOI: 10.1016/j.eplepsyres.2021.106769] [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: 01/29/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In this study, we investigate the seizure outcomes of temporo-parieto-occipital (TPO) and frontal disconnections or resections in children with drug-resistant epilepsy (DRE) in order to determine factors which may predict surgical results. METHODS Children with DRE, who underwent either TPO or frontal disconnection or resection at Great Ormond Street Hospital for Children between 2000 and 2017, were identified from a prospectively collated operative database. Demographic data, age at surgery, type of surgery, scalp EEGs and operative histopathology were collected. Magnetic resonance imaging (MRI) was assessed to determine completeness of disconnection and presence of radiological lesion beyond the disconnection margins. Seizure outcome at 6, 12, and 24 months post-surgery was assessed using the Engel Scale (ES). Logistic regression was used to identify relationships between data variables and seizure outcome. RESULTS 46 children (males = 28, females = 18; age range 0.5-16.6 years) who underwent TPO (n = 32, including a re-do disconnection) or frontal disconnection or resection (n = 15) were identified. Patients in the TPO treatment group had more favourable seizure outcomes than those in the frontal treatment group (ES I-II in 56 %vs 47 % at 6 months, 52 % vs 46 % at 12 months). Presence of the lesion beyond disconnection boundaries and older age at the time of surgery were associated with poorer seizure outcome. Gender, surgery type, completeness of disconnection, scalp EEG findings and underlying pathology were not related to seizure outcome, but subgroup numbers were small. CONCLUSIONS Both TPO and frontal disconnection are effective treatments for selected children with posterior multi-lobar or diffuse frontal lobe epilepsy. Confinement of the MRI lesion within the disconnection margins and a younger age at surgery are associated with favourable seizure outcomes. Further studies are required to elucidate these findings.
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Affiliation(s)
| | - Felice D'Arco
- Great Ormond Street Hospital, Department of Radiology, London, WC1N 3JH, United Kingdom
| | - M Zubair Tahir
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
| | - Heather Battey
- Imperial College London, Department of Mathematics, London, SW7 2AZ, United Kingdom
| | - Christin Eltze
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Friederike Moeller
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Martin Tisdall
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
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5
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Watkins MW, Shah EG, Funke ME, Garcia-Tarodo S, Shah MN, Tandon N, Maestu F, Laohathai C, Sandberg DI, Lankford J, Thompson S, Mosher J, Von Allmen G. Indications for Inpatient Magnetoencephalography in Children - An Institution's Experience. Front Hum Neurosci 2021; 15:667777. [PMID: 34149382 PMCID: PMC8213217 DOI: 10.3389/fnhum.2021.667777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Magnetoencephalography (MEG) is recognized as a valuable non-invasive clinical method for localization of the epileptogenic zone and critical functional areas, as part of a pre-surgical evaluation for patients with pharmaco-resistant epilepsy. MEG is also useful in localizing functional areas as part of pre-surgical planning for tumor resection. MEG is usually performed in an outpatient setting, as one part of an evaluation that can include a variety of other testing modalities including 3-Tesla MRI and inpatient video-electroencephalography monitoring. In some clinical circumstances, however, completion of the MEG as an inpatient can provide crucial ictal or interictal localization data during an ongoing inpatient evaluation, in order to expedite medical or surgical planning. Despite well-established clinical indications for performing MEG in general, there are no current reports that discuss indications or considerations for completion of MEG on an inpatient basis. We conducted a retrospective institutional review of all pediatric MEGs performed between January 2012 and December 2020, and identified 34 cases where MEG was completed as an inpatient. We then reviewed all relevant medical records to determine clinical history, all associated diagnostic procedures, and subsequent treatment plans including epilepsy surgery and post-surgical outcomes. In doing so, we were able to identify five indications for completing the MEG on an inpatient basis: (1) super-refractory status epilepticus (SRSE), (2) intractable epilepsy with frequent electroclinical seizures, and/or frequent or repeated episodes of status epilepticus, (3) intractable epilepsy with infrequent epileptiform discharges on EEG or outpatient MEG, or other special circumstances necessitating inpatient monitoring for successful and safe MEG data acquisition, (4) MEG mapping of eloquent cortex or interictal spike localization in the setting of tumor resection or other urgent neurosurgical intervention, and (5) international or long-distance patients, where outpatient MEG is not possible or practical. MEG contributed to surgical decision-making in the majority of our cases (32 of 34). Our clinical experience suggests that MEG should be considered on an inpatient basis in certain clinical circumstances, where MEG data can provide essential information regarding the localization of epileptogenic activity or eloquent cortex, and be used to develop a treatment plan for surgical management of children with complicated or intractable epilepsy.
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Affiliation(s)
- Michael W Watkins
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - Ekta G Shah
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - Michael E Funke
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Department of Neurology, McGovern Medical School, Houston, TX, United States
| | - Stephanie Garcia-Tarodo
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Pediatric Neurology Unit, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Manish N Shah
- Department of Neurosurgery, McGovern Medical School, Houston, TX, United States.,Division of Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School, Houston, TX, United States
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School, Houston, TX, United States
| | - Fernando Maestu
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Universidad Complutense and Universidad Politecnica de Madrid, Madrid, Spain.,Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Christopher Laohathai
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - David I Sandberg
- Department of Neurosurgery, McGovern Medical School, Houston, TX, United States.,Division of Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School, Houston, TX, United States
| | - Jeremy Lankford
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - Stephen Thompson
- Department of Neurology, McGovern Medical School, Houston, TX, United States
| | - John Mosher
- Department of Neurology, McGovern Medical School, Houston, TX, United States
| | - Gretchen Von Allmen
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Department of Neurology, McGovern Medical School, Houston, TX, United States
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Abstract
INTRODUCTION Focal cortical dysplasias (FCDs) represent the most common etiology in pediatric drug-resistant focal epilepsies undergoing surgical treatment. The localization, extent and histopathological features of FCDs are considerably variable. Somatic mosaic mutations of genes that encode proteins in the PI3K-AKTmTOR pathway, which also includes the tuberous sclerosis associated genes TSC1 and TSC2, have been implicated in FCD type II in a substantial subset of patients. Surgery is the principal therapeutic option for FCD-related epilepsy. Advanced neurophysiological and neuroimaging techniques have improved surgical outcome and reduced the risk of postsurgical deficits. Pharmacological MTOR inhibitors are being tested in clinical trials and might represent an example of personalized treatment of epilepsy based on the known mechanisms of disease, used alone or in combination with surgery. AREAS COVERED This review will critically analyze the advances in the diagnosis and treatment of FCDs, with a special focus on the novel therapeutic options prompted by a better understanding of their pathophysiology. EXPERT OPINION Focal cortical dysplasia is a main cause of drug-resistant epilepsy, especially in children. Novel, personalized approaches are needed to more effectively treat FCD-related epilepsy and its cognitive consequences.
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Affiliation(s)
- Renzo Guerrini
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
| | - Carmen Barba
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
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7
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Stefan H, Rampp S. Interictal and Ictal MEG in presurgical evaluation for epilepsy surgery. ACTA EPILEPTOLOGICA 2020. [DOI: 10.1186/s42494-020-00020-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractAlthough presurgical evaluation of patients with pharamacoresistent focal epilepsies provides essential information for successful epilepsy surgery, there is still a need for further improvement. Developments of noninvasive electrophysiological recording and analysis techniques offer additional information based on interictal and ictal epileptic activities. In this review, we provide an overview on the application of ictal magnetoencephalography (MEG). The results of a literature research for published interictal/ictal MEG findings and experiences with own cases are demonstrated and discussed. Ictal MEG may provide added value in comparison to interictal recordings. The results may be more focal and closer to the invasively determined seizure onset zone. In some patients without clear interictal findings, ictal MEG could provide correct localization. Novel recording and analysis techniques facilitate ictal recordings. However, extended recording durations, movement and artifacts still represent practical limitations. Ictal MEG may provide added value regarding the localization of the seizure onset zone but depends on the selection of patients and the application of optimal analysis techniques.
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8
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Zimmern V. Why Brain Criticality Is Clinically Relevant: A Scoping Review. Front Neural Circuits 2020; 14:54. [PMID: 32982698 PMCID: PMC7479292 DOI: 10.3389/fncir.2020.00054] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/23/2020] [Indexed: 12/13/2022] Open
Abstract
The past 25 years have seen a strong increase in the number of publications related to criticality in different areas of neuroscience. The potential of criticality to explain various brain properties, including optimal information processing, has made it an increasingly exciting area of investigation for neuroscientists. Recent reviews on this topic, sometimes termed brain criticality, make brief mention of clinical applications of these findings to several neurological disorders such as epilepsy, neurodegenerative disease, and neonatal hypoxia. Other clinicallyrelevant domains - including anesthesia, sleep medicine, developmental-behavioral pediatrics, and psychiatry - are seldom discussed in review papers of brain criticality. Thorough assessments of these application areas and their relevance for clinicians have also yet to be published. In this scoping review, studies of brain criticality involving human data of all ages are evaluated for their current and future clinical relevance. To make the results of these studies understandable to a more clinical audience, a review of the key concepts behind criticality (e.g., phase transitions, long-range temporal correlation, self-organized criticality, power laws, branching processes) precedes the discussion of human clinical studies. Open questions and forthcoming areas of investigation are also considered.
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Affiliation(s)
- Vincent Zimmern
- Division of Child Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
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9
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Pellegrino G, Xu M, Alkuwaiti A, Porras-Bettancourt M, Abbas G, Lina JM, Grova C, Kobayashi E. Effects of Independent Component Analysis on Magnetoencephalography Source Localization in Pre-surgical Frontal Lobe Epilepsy Patients. Front Neurol 2020; 11:479. [PMID: 32582009 PMCID: PMC7280485 DOI: 10.3389/fneur.2020.00479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/01/2020] [Indexed: 01/18/2023] Open
Abstract
Objective: Magnetoencephalography source imaging (MSI) of interictal epileptiform discharges (IED) is a useful presurgical tool in the evaluation of drug-resistant frontal lobe epilepsy (FLE) patients. Yet, failures in MSI can arise related to artifacts and to interference of background activity. Independent component analysis (ICA) is a popular denoising procedure but its clinical application remains challenging, as the selection of multiple independent components (IC) is controversial, operator dependent, and time consuming. We evaluated whether selecting only one IC of interest based on its similarity with the average IED field improves MSI in FLE. Methods: MSI was performed with the equivalent current dipole (ECD) technique and two distributed magnetic source imaging (dMSI) approaches: minimum norm estimate (MNE) and coherent Maximum Entropy on the Mean (cMEM). MSI accuracy was evaluated under three conditions: (1) ICA of continuous data (Cont_ICA), (2) ICA at the time of IED (IED_ICA), and (3) without ICA (No_ICA). Localization performance was quantitatively measured as actual distance of the source maximum in relation to the focus (Dmin), and spatial dispersion (SD) for dMSI. Results: After ICA, ECD Dmin did not change significantly (p > 0.200). For both dMSI techniques, ICA application worsened the source localization accuracy. We observed a worsening of both MNE Dmin (p < 0.05, consistently) and MNE SD (p < 0.001, consistently) for both ICA approaches. A similar behaviour was observed for cMEM, for which, however, Cont_ICA seemed less detrimental. Conclusion: We demonstrated that a simplified ICA approach selecting one IC of interest in combination with distributed magnetic source imaging can be detrimental. More complex approaches may provide better results but would be rather difficult to apply in real-world clinical setting. In a broader perspective, caution should be taken in applying ICA for source localization of interictal activity. To ensure optimal and useful results, effort should focus on acquiring good quality data, minimizing artifacts, and determining optimal candidacy for MEG, rather than counting on data cleaning techniques.
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Affiliation(s)
- Giovanni Pellegrino
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Min Xu
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Abdulla Alkuwaiti
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Manuel Porras-Bettancourt
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Ghada Abbas
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Jean-Marc Lina
- Multimodal Functional Imaging Laboratory, Biomedical Engineering Department, McGill University, Montreal, QC, Canada.,Département de Génie Électrique, École de Technologie Supérieure, Montreal, QC, Canada.,Centre de Recherches Mathematiques, Univeristé de Montréal, Montreal, QC, Canada
| | - Christophe Grova
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Multimodal Functional Imaging Laboratory, Biomedical Engineering Department, McGill University, Montreal, QC, Canada.,Département de Génie Électrique, École de Technologie Supérieure, Montreal, QC, Canada.,Physics Department and PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Eliane Kobayashi
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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Pellegrino G, Hedrich T, Porras-Bettancourt M, Lina JM, Aydin Ü, Hall J, Grova C, Kobayashi E. Accuracy and spatial properties of distributed magnetic source imaging techniques in the investigation of focal epilepsy patients. Hum Brain Mapp 2020; 41:3019-3033. [PMID: 32386115 PMCID: PMC7336148 DOI: 10.1002/hbm.24994] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/18/2020] [Accepted: 03/11/2020] [Indexed: 02/03/2023] Open
Abstract
Source localization of interictal epileptiform discharges (IEDs) is clinically useful in the presurgical workup of epilepsy patients. We aimed to compare the performance of four different distributed magnetic source imaging (dMSI) approaches: Minimum norm estimate (MNE), dynamic statistical parametric mapping (dSPM), standardized low-resolution electromagnetic tomography (sLORETA), and coherent maximum entropy on the mean (cMEM). We also evaluated whether a simple average of maps obtained from multiple inverse solutions (Ave) can improve localization accuracy. We analyzed dMSI of 206 IEDs derived from magnetoencephalography recordings in 28 focal epilepsy patients who had a well-defined focus determined through intracranial EEG (iEEG), epileptogenic MRI lesions or surgical resection. dMSI accuracy and spatial properties were quantitatively estimated as: (a) distance from the epilepsy focus, (b) reproducibility, (c) spatial dispersion (SD), (d) map extension, and (e) effect of thresholding on map properties. Clinical performance was excellent for all methods (median distance from the focus MNE = 2.4 mm; sLORETA = 3.5 mm; cMEM = 3.5 mm; dSPM = 6.8 mm, Ave = 0 mm). Ave showed the lowest distance between the map maximum and epilepsy focus (Dmin lower than cMEM, MNE, and dSPM, p = .021, p = .008, p < .001, respectively). cMEM showed the best spatial features, with lowest SD outside the focus (SD lower than all other methods, p < .001 consistently) and high contrast between the generator and surrounding regions. The average map Ave provided the best localization accuracy, whereas cMEM exhibited the lowest amount of spurious distant activity. dMSI techniques have the potential to significantly improve identification of iEEG targets and to guide surgical planning, especially when multiple methods are combined.
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Affiliation(s)
- Giovanni Pellegrino
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,IRCCS Fondazione San Camillo Hospital, Venice, Italy.,Department of Multimodal Functional Imaging Lab, Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Tanguy Hedrich
- Department of Multimodal Functional Imaging Lab, Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Manuel Porras-Bettancourt
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jean-Marc Lina
- Departement de Genie Electrique, Ecole de Technologie Superieure, Montreal, Quebec, Canada.,Centre de Recherches Mathematiques, Montréal, Quebec, Canada
| | - Ümit Aydin
- Physics Department and PERFORM Centre, Concordia University, Montreal, Quebec, Canada
| | - Jeffery Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Christophe Grova
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Department of Multimodal Functional Imaging Lab, Biomedical Engineering, McGill University, Montreal, Quebec, Canada.,Centre de Recherches Mathematiques, Montréal, Quebec, Canada.,Physics Department and PERFORM Centre, Concordia University, Montreal, Quebec, Canada
| | - Eliane Kobayashi
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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11
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He X, Zhou J, Teng P, Wang X, Guan Y, Zhai F, Li T, Luan G. The impact of MEG results on surgical outcomes in patients with drug-resistant epilepsy associated with focal encephalomalacia: a single-center experience. J Neurol 2019; 267:812-822. [PMID: 31773245 DOI: 10.1007/s00415-019-09638-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the impact of magnetoencephalography (MEG) results on surgical outcomes in patients with drug-resistant epilepsy secondary to encephalomalacia. METHODS We retrospectively reviewed 121 patients with drug-resistant epilepsy associated with encephalomalacia who underwent MEG followed by resection surgery. Patients were subdivided into concordant MEG group and dis-concordant MEG group for analysis based on whether the MEG results were in concordance with epileptogenic zones or not. RESULTS 121 patients were included in the present study. The MEG spike sources of 73 (60.33%) patients were in concordance with epileptogenic zones while the MEG spike sources of the other 48 (39.67%) were in dis-concordance with epileptogenic zones. Favorable seizure outcomes were achieved in 79.45% (58 of 73) of patients with concordant MEG results while only 62.50% (30 of 48) of patients with dis-concordant MEG results were seizure free with a follow-up of 2-10 years. The differences of seizure-free rate between patients with concordant MEG results and dis-concordant MEG results were statistically significant. For patients with concordant MEG results, bilateral lesions on MRI are the only independent predictor of unfavorable seizure outcomes. For patients with discordant MEG results, duration of seizures is the only independent predictor of unfavorable seizure outcomes. CONCLUSIONS Concordant MEG results are associated with favorable seizure outcomes. Bilateral lesions on MRI independently predict unfavorable seizure outcomes in patients with concordant MEG results while longer seizure durations independently predict unfavorable seizure outcomes in patients with dis-concordant MEG results.
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Affiliation(s)
- Xinghui He
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Beijing Sanbo Brain Hospital, Capital Medical University, Xiangshan Yikesong 50, Haidian District, Beijing, 100093, China
| | - Jian Zhou
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Beijing Sanbo Brain Hospital, Capital Medical University, Xiangshan Yikesong 50, Haidian District, Beijing, 100093, China
| | - Pengfei Teng
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Beijing Sanbo Brain Hospital, Capital Medical University, Xiangshan Yikesong 50, Haidian District, Beijing, 100093, China
| | - Xiongfei Wang
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Beijing Sanbo Brain Hospital, Capital Medical University, Xiangshan Yikesong 50, Haidian District, Beijing, 100093, China
| | - Yuguang Guan
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Beijing Sanbo Brain Hospital, Capital Medical University, Xiangshan Yikesong 50, Haidian District, Beijing, 100093, China
| | - Feng Zhai
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Beijing Sanbo Brain Hospital, Capital Medical University, Xiangshan Yikesong 50, Haidian District, Beijing, 100093, China
| | - Tianfu Li
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Guoming Luan
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China. .,Department of Neurosurgery, Epilepsy Center, Beijing Sanbo Brain Hospital, Capital Medical University, Xiangshan Yikesong 50, Haidian District, Beijing, 100093, China. .,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.
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12
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Carrette E, Stefan H. Evidence for the Role of Magnetic Source Imaging in the Presurgical Evaluation of Refractory Epilepsy Patients. Front Neurol 2019; 10:933. [PMID: 31551904 PMCID: PMC6746885 DOI: 10.3389/fneur.2019.00933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/12/2019] [Indexed: 12/03/2022] Open
Abstract
Magnetoencephalography (MEG) in the field of epilepsy has multiple advantages; just like electroencephalography (EEG), MEG is able to measure the epilepsy specific information (i.e., the brain activity reflecting seizures and/or interictal epileptiform discharges) directly, non-invasively and with a very high temporal resolution (millisecond-range). In addition MEG has a unique sensitivity for tangential sources, resulting in a full picture of the brain activity when combined with EEG. It accurately allows to perform source imaging of focal epileptic activity and functional cortex and shows a specific high sensitivity for a source in the neocortex. In this paper the current evidence and practice for using magnetic source imaging of focal interictal and ictal epileptic activity during the presurgical evaluation of drug resistant patients is being reviewed.
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Affiliation(s)
- Evelien Carrette
- Reference Centre for Refractory Epilepsy, Ghent University Hospital, Ghent, Belgium
| | - Hermann Stefan
- Department of Neurology-Biomagnetism, University Hospital Erlangen, Erlangen, Germany
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13
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Rampp S, Stefan H, Wu X, Kaltenhäuser M, Maess B, Schmitt FC, Wolters CH, Hamer H, Kasper BS, Schwab S, Doerfler A, Blümcke I, Rössler K, Buchfelder M. Magnetoencephalography for epileptic focus localization in a series of 1000 cases. Brain 2019; 142:3059-3071. [PMID: 31373622 DOI: 10.1093/brain/awz231] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 02/05/2023] Open
Abstract
Abstract
The aim of epilepsy surgery in patients with focal, pharmacoresistant epilepsies is to remove the complete epileptogenic zone to achieve long-term seizure freedom. In addition to a spectrum of diagnostic methods, magnetoencephalography focus localization is used for planning of epilepsy surgery. We present results from a retrospective observational cohort study of 1000 patients, evaluated using magnetoencephalography at the University Hospital Erlangen over the time span of 28 years. One thousand consecutive cases were included in the study, evaluated at the University Hospital Erlangen between 1990 and 2018. All patients underwent magnetoencephalography as part of clinical workup for epilepsy surgery. Of these, 405 underwent epilepsy surgery after magnetoencephalography, with postsurgical follow-ups of up to 20 years. Sensitivity for interictal epileptic activity was evaluated, in addition to concordance of localization with the consensus of presurgical workup on a lobar level. We evaluate magnetoencephalography characteristics of patients who underwent epilepsy surgery versus patients who did not proceed to surgery. In operated patients, resection of magnetoencephalography localizations were related to postsurgical seizure outcomes, including long-term results after several years. In comparison, association of lesionectomy with seizure outcomes was analysed. Measures of diagnostic accuracy were calculated for magnetoencephalography resection and lesionectomy. Sensitivity for interictal epileptic activity was 72% with significant differences between temporal and extra-temporal lobe epilepsy. Magnetoencephalography was concordant with the presurgical consensus in 51% and showed additional or more focal involvement in an additional 32%. Patients who proceeded to surgery showed a significantly higher percentage of monofocal magnetoencephalography results. Complete magnetoencephalography resection was associated with significantly higher chances to achieve seizure freedom in the short and long-term. Diagnostic accuracy was significant in temporal and extra-temporal lobe cases, but was significantly higher in extra-temporal lobe epilepsy (diagnostic odds ratios of 4.4 and 41.6). Odds ratios were also higher in non-lesional versus lesional cases (42.0 versus 6.2). The results show that magnetoencephalography provides non-redundant information, which significantly contributes to patient selection, focus localization and ultimately long-term seizure freedom after epilepsy surgery. Specifically in extra-temporal lobe epilepsy and non-lesional cases, magnetoencephalography provides excellent accuracy.
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Affiliation(s)
- Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Germany
- Department of Neurosurgery, University Hospital Halle (Saale), Germany
| | - Hermann Stefan
- Department of Neurology, University Hospital Erlangen, Germany
| | - Xintong Wu
- Department of Neurosurgery, University Hospital Erlangen, Germany
- Department of Neurology, West China Hospital, Sichuan University, Sichuan, China
| | | | - Burkhard Maess
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Carsten H Wolters
- Institute for Biomagnetism and Biosignalanalysis, University Münster, Germany
| | - Hajo Hamer
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Germany
| | - Burkhard S Kasper
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Germany
| | - Arndt Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Germany
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14
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Mouthaan BE, Rados M, Boon P, Carrette E, Diehl B, Jung J, Kimiskidis V, Kobulashvili T, Kuchukhidze G, Larsson PG, Leitinger M, Ryvlin P, Rugg-Gunn F, Seeck M, Vulliémoz S, Huiskamp G, Leijten FSS, Van Eijsden P, Trinka E, Braun KPJ. Diagnostic accuracy of interictal source imaging in presurgical epilepsy evaluation: A systematic review from the E-PILEPSY consortium. Clin Neurophysiol 2019; 130:845-855. [PMID: 30824202 DOI: 10.1016/j.clinph.2018.12.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/16/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Interictal high resolution (HR-) electric source imaging (ESI) and magnetic source imaging (MSI) are non-invasive tools to aid epileptogenic zone localization in epilepsy surgery candidates. We carried out a systematic review on the diagnostic accuracy and quality of evidence of these modalities. METHODS Embase, Pubmed and the Cochrane database were searched on 13 February 2017. Diagnostic accuracy studies taking post-surgical seizure outcome as reference standard were selected. Quality appraisal was based on the QUADAS-2 framework. RESULTS Eleven studies were included: eight MSI (n = 267), three HR-ESI (n = 127) studies. None was free from bias. This mostly involved: selection of operated patients only, interference of source imaging with surgical decision, and exclusion of indeterminate results. Summary sensitivity and specificity estimates were 82% (95% CI: 75-88%) and 53% (95% CI: 37-68%) for overall source imaging, with no statistical difference between MSI and HR-ESI. Specificity is higher when partially concordant results were included as non-concordant (p < 0.05). Inclusion of indeterminate test results as non-concordant lowered sensitivity (p < 0.05). CONCLUSIONS Source imaging has a relatively high sensitivity but low specificity for identification of the epileptogenic zone. SIGNIFICANCE We need higher quality studies allowing unbiased test evaluation to determine the added value and diagnostic accuracy of source imaging in the presurgical workup of refractory focal epilepsy.
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Affiliation(s)
- Brian E Mouthaan
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Matea Rados
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Paul Boon
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium
| | - Evelien Carrette
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium
| | - Beate Diehl
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Department of Clinical and Experimental Epilepsy, University College, London, UK
| | - Julien Jung
- Department of Functional Neurology and Epileptology, Institute of Epilepsies (IDEE), Hospices Civils de Lyon, Lyon, France
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Teia Kobulashvili
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Pål G Larsson
- Department of Neurosurgery, Clinic of Surgery and Neuroscience, Oslo University Hospital, Norway
| | - Markus Leitinger
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Fergus Rugg-Gunn
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Department of Clinical and Experimental Epilepsy, University College, London, UK
| | - Margitta Seeck
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Switzerland
| | - Serge Vulliémoz
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Switzerland
| | - Geertjan Huiskamp
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Frans S S Leijten
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Pieter Van Eijsden
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria; Institute of Public Health, Medical Decision Making and HTA, UMIT, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Kees P J Braun
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
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15
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Abstract
Cingulate epilepsy manifests with a broad range of semiologic features and seizure types. Key clinical features may elucidate ictal involvement of certain subregions of the cingulate gyrus. Ictal and interictal electroencephalogram findings in cingulate epilepsy vary and are often poorly localized, adding to the diagnostic challenge of identifying the seizure onset zone for presurgical cases, particularly in the absence of a lesion on imaging. Recent advances in multimodal imaging techniques may contribute to ictal localization and further our understanding of neural and epileptic pathways involving the cingulate gyrus. Beyond medication and surgical resection, new techniques including stereotactic laser ablation, responsive neurostimulation, and deep brain stimulation offer additional approaches for the treatment of cingulate epilepsy.
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16
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Kasper BS, Rössler K, Hamer HM, Dörfler A, Blümcke I, Coras R, Roesch J, Mennecke A, Wellmer J, Sommer B, Lorber B, Lang JD, Graf W, Stefan H, Schwab S, Buchfelder M, Rampp S. Coregistrating magnetic source and magnetic resonance imaging for epilepsy surgery in focal cortical dysplasia. Neuroimage Clin 2018; 19:487-496. [PMID: 29984157 PMCID: PMC6029564 DOI: 10.1016/j.nicl.2018.04.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/18/2018] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
Abstract
Background Epilepsy surgery for focal cortical dysplasia type II (FCD II) offers good chances for seizure freedom, but remains a challenge with respect to lesion detection, defining the epileptogenic zone and the optimal resection strategy. Integrating results from magnetic source imaging from magnetoencephalography (MEG) with magnetic resonance imaging (MRI) including MRI postprocessing may be useful for optimizing these goals. Methods We here present data from 21 adult FCD II patients, investigated during a 10 year period and evaluated including magnetic source imaging. 16 patients had epilepsy surgery, i.e. histopathologically verified FCD II, and a long follow up. We present our analysis of epileptogenic zones including MEG in relation to structural data according to MRI data and relate these results to surgical outcomes. Results FCD II in our cohort was characterized by high MEG yield and localization accuracy and MEG showed impact on surgical success-rates. MEG source localizations were detected in 95.2% of patients and were as close as 12.3 ± 8,1 mm to the MRI-lesion. After a mean follow up of >3 years, we saw >80% Engel I outcomes, with more favourable outcomes when the MEG source was completely resected (Fishers exact test 0,033). Conclusion We argue for a high value of conducting a combined MEG-MRI approach in the presurgical workup and the resection strategy in patients with FCD II related epilepsy.
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Affiliation(s)
- Burkhard S Kasper
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Karl Rössler
- Department of Neurosurgery, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Arnd Dörfler
- Department of Neuroradiology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Ingmar Blümcke
- Department of Neuropathology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Roland Coras
- Department of Neuropathology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Julie Roesch
- Department of Neuroradiology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Angelika Mennecke
- Department of Neuroradiology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Jörg Wellmer
- Ruhr-Epileptology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, Germany.
| | - Björn Sommer
- Department of Neurosurgery, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Bogdan Lorber
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia.
| | - Johannes D Lang
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Wolfgang Graf
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Hermann Stefan
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Stefan Schwab
- Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Stefan Rampp
- Department of Neurosurgery, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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17
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Stefan H, Schmitt FC. Epileptogenicity and pathology - Under consideration of ablative approaches. Epilepsy Res 2018; 142:109-112. [PMID: 29609992 DOI: 10.1016/j.eplepsyres.2018.03.019] [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: 05/19/2017] [Revised: 03/12/2018] [Accepted: 03/25/2018] [Indexed: 11/27/2022]
Abstract
Besides resective epilepsy surgery, minimally invasive ablation using new diagnostic and therapeutic techniques recently became available. Optimal diagnostic approaches for these treatment options are discussed. The pathophysiology of epileptogenic networks differs depending on the lesion-types and location, requiring a differential use of non-invasive or invasive functional studies. In addition to the definition of epileptogenic zones, a challenge for pre-surgical investigation is the determination of three-dimensional epileptic networks to be removed.
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Affiliation(s)
- H Stefan
- Department of Neurology - Biomagnetism, University Hospital Erlangen, 10, Schwabachanlage, 91054 Erlangen, Germany.
| | - F C Schmitt
- Department of Neurology, University Hospital Magdeburg, Germany
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18
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Feyissa AM, Britton JW, Van Gompel J, Lagerlund TL, So E, Wong-Kisiel LC, Cascino GC, Brinkman BH, Nelson CL, Watson R, Worrell GA. High density scalp EEG in frontal lobe epilepsy. Epilepsy Res 2017; 129:157-161. [PMID: 28073096 DOI: 10.1016/j.eplepsyres.2016.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/27/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Localization of seizures in frontal lobe epilepsy using the 10-20 system scalp EEG is often challenging because neocortical seizure can spread rapidly, significant muscle artifact, and the suboptimal spatial resolution for seizure generators involving mesial frontal lobe cortex. Our aim in this study was to determine the value of visual interpretation of 76 channel high density EEG (hdEEG) monitoring (10-10 system) in patients with suspected frontal lobe epilepsy, and to evaluate concordance with MRI, subtraction ictal SPECT co-registered to MRI (SISCOM), conventional EEG, and intracranial EEG (iEEG). METHODS We performed a retrospective cohort study of 14 consecutive patients who underwent hdEEG monitoring for suspected frontal lobe seizures. The gold standard for localization was considered to be iEEG. Concordance of hdEEG findings with MRI, subtraction ictal SPECT co-registered to MRI (SISCOM), conventional 10-20 EEG, and iEEG as well as correlation of hdEEG localization with surgical outcome were examined. RESULTS hdEEG localization was concordant with iEEG in 12/14 and was superior to conventional EEG 3/14 (p<0.01) and SISCOM 3/12 (p<0.01). hdEEG correctly lateralized seizure onset in 14/14 cases, compared to 9/14 (p=0.04) cases with conventional EEG. Seven patients underwent surgical resection, of whom five were seizure free. CONCLUSIONS hdEEG monitoring should be considered in patients with suspected frontal epilepsy requiring localization of epileptogenic brain. hdEEG may assist in developing a hypothesis for iEEG monitoring and could potentially augment EEG source localization.
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Affiliation(s)
- Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, United States.
| | - Jeffrey W Britton
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - Jamie Van Gompel
- Departments of Neurological Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - Terrance L Lagerlund
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - Elson So
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - Lilly C Wong-Kisiel
- Division of Child and Adolescent Neurology, Mayo Clinic Children's Center, 200 First Street SW, Rochester, MN, 55905, United States.
| | - Gregory C Cascino
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - Benjamin H Brinkman
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - Cindy L Nelson
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - Robert Watson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - Gregory A Worrell
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
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19
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Stefan H, Trinka E. Magnetoencephalography (MEG): Past, current and future perspectives for improved differentiation and treatment of epilepsies. Seizure 2017; 44:121-124. [DOI: 10.1016/j.seizure.2016.10.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/25/2016] [Indexed: 01/23/2023] Open
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20
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Schönherr M, Stefan H, Hamer HM, Rössler K, Buchfelder M, Rampp S. The delta between postoperative seizure freedom and persistence: Automatically detected focal slow waves after epilepsy surgery. Neuroimage Clin 2016; 13:256-263. [PMID: 28018852 PMCID: PMC5167245 DOI: 10.1016/j.nicl.2016.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/03/2016] [Accepted: 12/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In this study, we use a novel automated method for localization and quantitative comparison of magnetoencephalographic (MEG) delta activity in patients with and without recurrent seizures after epilepsy surgery as well as healthy controls. METHODS We identified the generators of delta activity by source location in frequency domain between 1 and 4 Hz in spontaneous MEG data. Comparison with healthy control subjects by z-transform emphasized relative changes of activation in patients. The individual results were compared to spike localizations and statistical group analysis was performed. Additionally, MEG results were compared to 1-4 Hz activity in invasive EEG (iEEG) in two patients, in whom this data was available. RESULTS Patients with recurrent seizures exhibited significantly increased focal MEG delta activity both in comparison to healthy controls and seizure free patients. This slow activity showed a correlation to interictal epileptic activity and was not explained by consequences of the resection alone. In two patients with iEEG, iEEG analysis was concordant with the MEG findings. SIGNIFICANCE The quantity of delta activity could be used as a diagnostic marker for recurrent seizures. The close relation to epileptic spike localizations and the resection volume of patients with successful second surgery imply involvement in seizure recurrence. This initial evidence suggests a potential application in the planning of second epilepsy surgery.
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Affiliation(s)
- Margit Schönherr
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hermann Stefan
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hajo M. Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
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21
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Magnetoencephalography-guided surgery in frontal lobe epilepsy using neuronavigation and intraoperative MR imaging. Epilepsy Res 2016; 126:26-36. [DOI: 10.1016/j.eplepsyres.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/01/2016] [Accepted: 06/24/2016] [Indexed: 11/17/2022]
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22
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Yin S, Jin W, Li Q, Feng M, Feng K, Shao H, Zhang X, Wang S. Complete prefrontal lobe isolation surgery for recurrent epilepsy: A case report. Exp Ther Med 2016; 12:3029-3034. [PMID: 27882111 DOI: 10.3892/etm.2016.3714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/22/2016] [Indexed: 01/30/2023] Open
Abstract
Epileptogenic focus resection is less effective for the treatment of frontal lobe epilepsy compared with temporal lobe epilepsy. However, there is currently a lack of effective therapeutic options for patients with frontal lobe epilepsy who are unsuitable for epileptogenic focus resection (such patients with epileptogenic foci in one frontal lobe in which the precise epileptic foci cannot be determined), or who experience recurrent epilepsy following epileptogenic focus resection. The present study reports a patient with frontal lobe epilepsy who underwent successful frontal lobe isolation surgery following a previous unsuccessful epileptogenic focus resection surgery. To ensure complete isolation of the prefrontal lobe, the surgery included division of the anterior commissure and the anterior part of the corpus callosum. The patient was followed-up for 16 months. Although the follow-up electroencephalogram presented a number of sharp waves on the affected side, the patient did not experience any seizures. The results suggest that prefrontal lobe isolation is an effective method of treating frontal lobe epilepsy, as division of the anterior commissure and the anterior part of the corpus callosum ensures disconnection of the prefrontal lobe from other regions of the brain.
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Affiliation(s)
- Shaoya Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
| | - Weipeng Jin
- Department of Neurosurgery, Second Affiliated Hospital, Tianjin Medical University, Tianjin 300211, P.R. China
| | - Qingyun Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
| | - Mei Feng
- Department of Nerve Electrophysiology, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
| | - Keke Feng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
| | - Hui Shao
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
| | - Xueqing Zhang
- Department of Nerve Electrophysiology, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
| | - Shimin Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
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23
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Okanishi T, Akiyama T, Mayo E, Honda Y, Ueda-Kawada C, Nakajima M, Homma Y, Ochi A, Go C, Widjaja E, Chuang SH, Rutka JT, Drake J, Snead OC, Otsubo H. Magnetoencephalography spike sources interrelate the extensive epileptogenic zone of tuberous sclerosis complex. Epilepsy Res 2016; 127:302-310. [PMID: 27693986 DOI: 10.1016/j.eplepsyres.2016.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/16/2016] [Accepted: 09/05/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We hypothesized that the extensive epileptic network in patients with tuberous sclerosis complex (TSC) manifests as clustered and scattered distributions of magnetoencephalography spike sources (MEGSS). METHODS We retrospectively analyzed pre-surgical MEG in 15 patients with TSC. We performed single moving dipole analysis to localize and classify clustered and scattered MEGSS. We compared the number of electrodes within the resected area (RA) and the proportions of clustered and scattered MEGSS within RA with the seizure outcome. RESULTS The number of electrodes within RA ranged from 29 to 83 (mean=51). The MEGSS were distributed over multiple lobes (3-8; mean=5.9) and bilaterally in 14 patients. Clusters of MEGSS ranged from 1 to 4 (mean=1.4). The number of MEGSS ranged in total from 28 to 139 (mean=70); in the clusters, 10-128 (mean=49); and in the scatters, 0-45 (mean=21). Four patients achieved an Engel class I surgical outcome, four, a class II outcome; five, a class III outcome; and two, a class IV outcome. The proportion of MEGSS ranged in total from 0 to 92% (mean=57%) within RA; 0-100% (mean=67%) in the resection hemisphere; 0-100% (mean=63%) in the clusters; and 0-81% (mean=28%) in the scatters. Univariate ordinal logistic regression analyses showed that the proportion of scattered MEGSS within RA (p=0.049) significantly correlated with seizure outcomes. Multivariate analyses using three covariates (number of electrodes, proportions of clustered and scattered MEGSS within RA) showed that only the proportion of scattered MEGSS within RA significantly correlated with seizure outcomes (p=0.016). SIGNIFICANCE MEG data showed a wide distribution of multilobar MEGSS in patients with TSC. The seizure outcome was not related to the clustered MEGSS within RA, since the grids were essentially planned to cover and resect the clustered MEGSS surrounding tubers. The maximal possible resection of scattered MEGSS correlated with improved seizure outcome in TSC. Some parts of the epileptogenic zone disrupted by multiple tubers did not have a sufficiently large area to produce clustered MEGSS. Although the wide distribution of scattered MEGSS is not interpreted as epileptogenic, they might be interrelated with clustered MEGSS to project a complex epilepsy network and be part of the extensive epileptogenic zones found in TSC.
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Affiliation(s)
- Tohru Okanishi
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada.
| | - Tomoyuki Akiyama
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada; Department of Child Neurology, Okayama University Hospital, PO Box 700, 0914 Okayama, Japan
| | - Ellen Mayo
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Yasunori Honda
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Chihiro Ueda-Kawada
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Midori Nakajima
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei-Hamamatsu General Hospital, PO Box 430, 8558, Hamamatsu, Shizuoka, Japan
| | - Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Cristina Go
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Division of Diagnostic Imaging, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Sylvester H Chuang
- Division of Diagnostic Imaging, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - James Drake
- Division of Neurosurgery, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, PO Box M5G, 1X8, Toronto, Ontario, Canada
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24
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Nakajima M, Widjaja E, Baba S, Sato Y, Yoshida R, Tabei M, Okazaki A, Sakuma S, Holowka SA, Ochi A, Snead OC, Rutka JT, Drake JM, Shiraishi H, Doesburg S, Otsubo H. Remote MEG dipoles in focal cortical dysplasia at bottom of sulcus. Epilepsia 2016; 57:1169-78. [DOI: 10.1111/epi.13399] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Midori Nakajima
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
- Department of Pediatrics; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Elysa Widjaja
- Diagnostic Imaging; The Hospital for Sick Children; Toronto Ontario Canada
| | - Shiro Baba
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Yosuke Sato
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Ryuhei Yoshida
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Maya Tabei
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Ayaka Okazaki
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Satoru Sakuma
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
| | | | - Ayako Ochi
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
| | - O. Carter Snead
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
| | - James T. Rutka
- Division of Neurosurgery; The Hospital for Sick Children; Toronto Ontario Canada
| | - James M. Drake
- Division of Neurosurgery; The Hospital for Sick Children; Toronto Ontario Canada
| | - Hideaki Shiraishi
- Department of Pediatrics; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Sam Doesburg
- Department of Biomedical Physiology and Kinesiology; Simon Fraser University; Burnaby British Columbia Canada
| | - Hiroshi Otsubo
- Division of Neurology; The Hospital for Sick Children; Toronto Ontario Canada
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25
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Pellegrino G, Hedrich T, Chowdhury R, Hall JA, Lina JM, Dubeau F, Kobayashi E, Grova C. Source localization of the seizure onset zone from ictal EEG/MEG data. Hum Brain Mapp 2016; 37:2528-46. [PMID: 27059157 DOI: 10.1002/hbm.23191] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Surgical treatment of drug-resistant epilepsy relies on the identification of the seizure onset zone (SOZ) and often requires intracranial EEG (iEEG). We have developed a new approach for non-invasive magnetic and electric source imaging of the SOZ (MSI-SOZ and ESI-SOZ) from ictal magnetoencephalography (MEG) and EEG recordings, using wavelet-based Maximum Entropy on the Mean (wMEM) method. We compared the performance of MSI-SOZ and ESI-SOZ with interictal spike source localization (MSI-spikes and ESI-spikes) and clinical localization of the SOZ (i.e., based on iEEG or lesion topography, denoted as clinical-SOZ). METHODS A total of 46 MEG or EEG seizures from 13 patients were analyzed. wMEM was applied around seizure onset, centered on the frequency band showing the strongest power change. Principal component analysis applied to spatiotemporal reconstructed wMEM sources (0.4-1 s around seizure onset) identified the main spatial pattern of ictal oscillations. Qualitative sublobar concordance and quantitative measures of distance and spatial overlaps were estimated to compare MSI/ESI-SOZ with MSI/ESI-Spikes and clinical-SOZ. RESULTS MSI/ESI-SOZ were concordant with clinical-SOZ in 81% of seizures (MSI 90%, ESI 64%). MSI-SOZ was more accurate and identified sources closer to the clinical-SOZ (P = 0.012) and to MSI-Spikes (P = 0.040) as compared with ESI-SOZ. MSI/ESI-SOZ and MSI/ESI-Spikes did not differ in terms of concordance and distance from the clinical-SOZ. CONCLUSIONS wMEM allows non-invasive localization of the SOZ from ictal MEG and EEG. MSI-SOZ performs better than ESI-SOZ. MSI/ESI-SOZ can provide important additional information to MSI/ESI-Spikes during presurgical evaluation. Hum Brain Mapp 37:2528-2546, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Giovanni Pellegrino
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montreal, Québec, Canada.,Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Tanguy Hedrich
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montreal, Québec, Canada
| | - Rasheda Chowdhury
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montreal, Québec, Canada
| | - Jeffery A Hall
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Jean-Marc Lina
- Département de Génie Electrique, École de Technologie Supérieure, Montreal, Québec, Canada.,Centre De Recherches En Mathématiques, Montreal, Québec, Canada.,Centre D'etudes Avancées En Médecine Du Sommeil, Centre De Recherche De L'hôpital Sacré-Coeur De Montréal, Montreal, Québec, Canada
| | - Francois Dubeau
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Eliane Kobayashi
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Christophe Grova
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montreal, Québec, Canada.,Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada.,Centre De Recherches En Mathématiques, Montreal, Québec, Canada.,Physics Department and PERFORM Centre, Concordia University, Montreal, Québec, Canada
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26
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Guerrini R, Duchowny M, Jayakar P, Krsek P, Kahane P, Tassi L, Melani F, Polster T, Andre VM, Cepeda C, Krueger DA, Cross JH, Spreafico R, Cosottini M, Gotman J, Chassoux F, Ryvlin P, Bartolomei F, Bernasconi A, Stefan H, Miller I, Devaux B, Najm I, Giordano F, Vonck K, Barba C, Blumcke I. Diagnostic methods and treatment options for focal cortical dysplasia. Epilepsia 2015; 56:1669-86. [DOI: 10.1111/epi.13200] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Renzo Guerrini
- Pediatric Neurology and Neurogenetics Unit and Laboratories; Children's Hospital Meyer-University of Florence; Florence Italy
- IRCCS Stella Maris Foundation; Pisa Italy
| | - Michael Duchowny
- Neuroscience Program and the Comprehensive Epilepsy Center; Miami Children's Hospital; Miami Florida U.S.A
| | - Prasanna Jayakar
- Department of Neurology; Miami Children's Hospital; Miami Florida U.S.A
| | - Pavel Krsek
- Department of Pediatric Neurology; 2nd Faculty of Medicine; Motol University Hospital; Charles University; Prague Czech Republic
| | - Philippe Kahane
- INSERM U836; University of Grenoble Alpes, GIN; Grenoble; France
- Epilepsy Unit; Michallon Hospital; Grenoble France
| | - Laura Tassi
- Epilepsy Surgery Center; Niguarda Hospital; Milan Italy
| | - Federico Melani
- Pediatric Neurology and Neurogenetics Unit and Laboratories; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Tilman Polster
- Department of Child Neurology; Bethel Epilepsy Center; Bielefeld Germany
| | | | - Carlos Cepeda
- Intellectual and Developmental Disabilities Research Center; David Geffen School of Medicine; University of California at Los Angeles; Los Angeles California U.S.A
| | - Darcy A. Krueger
- Division of Neurology; Department of Pediatrics; Cincinnati Children's Hospital Medical Center; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - J. Helen Cross
- UCL-Institute of Child Health; Great Ormond Street Hospital for Children NHS Foundation Trust; London United Kingdom
- Young Epilepsy; Lingfield United Kingdom
| | - Roberto Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit; Neurological InstituteC. Besta”; Milan Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery; University of Pisa; Pisa Italy
| | - Jean Gotman
- Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec Canada
| | | | - Philippe Ryvlin
- Department of Clinical Neurosciences; CHUV; Lausanne Switzerland
- Translational and Integrative Group in Epilepsy Research (TIGER) and Institute for Epilepsies (IDEE); Lyon's Neuroscience Center; INSERM U1028; CNRS 5292; UCBL; Le Vinatier Hospital; Bron; Lyon France
| | - Fabrice Bartolomei
- Faculty of Medicine; INSERM, U1106; Institute of Neurosciences of Systems; Marseille France
- Faculty of Medicine; Aix Marseille University; Marseille France
- Clinical Neurophysiology Unit; Department of Clinical Neurosciences; CHU Timone; Marseille France
- Henri-Gastaut Hospital; Saint-Paul Center; Marseille France
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory; McConnell Brain Imaging Center; Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec Canada
| | - Hermann Stefan
- Epilepsy Center Erlangen (ZEE); University Erlangen-Nürnberg; Erlangen Germany
| | - Ian Miller
- Department of Neurology and Comprehensive Epilepsy Program; Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
| | | | - Imad Najm
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland OH U.S.A
| | - Flavio Giordano
- Pediatric Neurosurgery Unit; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Kristl Vonck
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology; Department of Neurology; Ghent University; Ghent Belgium
| | - Carmen Barba
- Pediatric Neurology and Neurogenetics Unit and Laboratories; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Ingmar Blumcke
- Department of Neuropathology; University Hospital Erlangen; Erlangen Germany
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27
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Dimitriadis SI. Predictive value of MEG using gradient magnetic field topography (GMFT) for seizure outcome following anterior corpus callosotomy (ACC) in patients with drop attacks. Clin Neurophysiol 2015; 127:12-14. [PMID: 26168716 DOI: 10.1016/j.clinph.2015.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Stavros I Dimitriadis
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK; Cardiff University Brain Research Imaging Center (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK; Artificial Intelligence and Information Analysis Laboratory, Department of Informatics, Aristotle University, 54124 Thessaloniki, Greece; NeuroInformatics Group, AUTH, Thessaloniki, Greece.
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28
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Englot DJ, Nagarajan SS, Imber BS, Raygor KP, Honma SM, Mizuiri D, Mantle M, Knowlton RC, Kirsch HE, Chang EF. Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery. Epilepsia 2015; 56:949-58. [PMID: 25921215 DOI: 10.1111/epi.13002] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The efficacy of epilepsy surgery depends critically upon successful localization of the epileptogenic zone. Magnetoencephalography (MEG) enables noninvasive detection of interictal spike activity in epilepsy, which can then be localized in three dimensions using magnetic source imaging (MSI) techniques. However, the clinical value of MEG in the presurgical epilepsy evaluation is not fully understood, as studies to date are limited by either a lack of long-term seizure outcomes or small sample size. METHODS We performed a retrospective cohort study of patients with focal epilepsy who received MEG for interictal spike mapping followed by surgical resection at our institution. RESULTS We studied 132 surgical patients, with mean postoperative follow-up of 3.6 years (minimum 1 year). Dipole source modeling was successful in 103 patients (78%), whereas no interictal spikes were seen in others. Among patients with successful dipole modeling, MEG findings were concordant with and specific to the following: (1) the region of resection in 66% of patients, (2) invasive electrocorticography (ECoG) findings in 67% of individuals, and (3) the magnetic resonance imaging (MRI) abnormality in 74% of cases. MEG showed discordant lateralization in ~5% of cases. After surgery, 70% of all patients achieved seizure freedom (Engel class I outcome). Whereas 85% of patients with concordant and specific MEG findings became seizure-free, this outcome was achieved by only 37% of individuals with MEG findings that were nonspecific to or discordant with the region of resection (χ(2) = 26.4, p < 0.001). MEG reliability was comparable in patients with or without localized scalp electroencephalography (EEG), and overall, localizing MEG findings predicted seizure freedom with an odds ratio of 5.11 (95% confidence interval [CI] 2.23-11.8). SIGNIFICANCE MEG is a valuable tool for noninvasive interictal spike mapping in epilepsy surgery, including patients with nonlocalized findings receiving long-term EEG monitoring, and localization of the epileptogenic zone using MEG is associated with improved seizure outcomes.
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Affiliation(s)
- Dario J Englot
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, San Francisco, California, U.S.A.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, U.S.A.,Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A
| | - Srikantan S Nagarajan
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, San Francisco, California, U.S.A.,Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A
| | - Brandon S Imber
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, San Francisco, California, U.S.A.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Kunal P Raygor
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, San Francisco, California, U.S.A.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Susanne M Honma
- Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A
| | - Danielle Mizuiri
- Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A
| | - Mary Mantle
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, San Francisco, California, U.S.A.,Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A
| | - Robert C Knowlton
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, San Francisco, California, U.S.A.,Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A.,Department of Neurology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Heidi E Kirsch
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, San Francisco, California, U.S.A.,Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A.,Department of Neurology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Edward F Chang
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, San Francisco, California, U.S.A.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, U.S.A.,Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, U.S.A
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29
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Rampp S. Direct current shifts, high frequency oscillations and the epileptogenic zone. Clin Neurophysiol 2014; 126:2-4. [PMID: 25022792 DOI: 10.1016/j.clinph.2014.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Stefan Rampp
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany; Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, In der Schornau 23-25, 44892 Bochum, Germany.
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