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Moshref R, Burneo JG, Steven DA, Mirsattari SM, Jones ML, Lau J, MacDougall KW, Andrade A, de Ribaurpierre S, Suller Marti A. Vagus nerve stimulation in lesional and Non-Lesional Drug-Resistant focal onset epilepsies. Epilepsy Behav 2024; 159:109948. [PMID: 39096795 DOI: 10.1016/j.yebeh.2024.109948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE Drug-resistant epilepsy (DRE) affects one-third of patients with focal epilepsy. A large portion of patients are not candidates for epilepsy surgery, thus alternative options, such as vagus nerve stimulation (VNS), are proposed. Our objective is to study the effect of vagus nerve stimulation on lesional versus non-lesional epilepsies. METHODS This is a retrospective cohort study in a single center in London, Ontario, which includes patients with DRE implanted with VNS, implanted between 1997-2018 and the date of analysis is December 2023. PARTICIPANTS Patients implanted with VNS were classified by lesional (VNS-L) and non-lesional (VNS-NL) based on their MRI head findings. We further subdivided the VNS groups into patients with VNS alone versus those who also had additional epilepsy surgeries. RESULTS A total of 29 patients were enrolled in the VNS-L, compared to 29 in the VNS-NL. The median age of the patients in the study was 31.8 years, 29.31 % were men (N = 17). 41.4 % (n = 12) of the patients were VNS responders (≥50 % seizure reduction) in the VNS-L group compared to 62.0 % (n = 18) in the VNS-NL group (p = 0.03). When other epilepsy surgeries were combined with VNS in the VNS-L group, the median rate of seizure reduction was greater (72.4 (IQR 97.17-45.88) than the VNS-NL group 53.9 (IQR 92.22-27.92); p = 0.27). CONCLUSIONS VNS is a therapeutic option for patients with lesional epilepsy, with slightly inferior results compared to patients with non-lesional epilepsy. Patients implanted with VNS showed higher seizure reduction rates if they had previous epilepsy surgeries. This study demonstrates that VNS in lesional epilepsies can be an effective treatment.
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Affiliation(s)
- Rana Moshref
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neuroepidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - David A Steven
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Michelle-Lee Jones
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Jonathan Lau
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Keith W MacDougall
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Andrea Andrade
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Sandrine de Ribaurpierre
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Ana Suller Marti
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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Jeno M, Zimmerman MB, Shandley S, Wong-Kisiel L, Singh RK, McNamara N, Fedak Romanowski E, Grinspan ZM, Eschbach K, Alexander A, McGoldrick P, Wolf S, Nangia S, Bolton J, Olaya J, Shrey DW, Karia S, Karakas C, Tatachar P, Ostendorf AP, Gedela S, Javarayee P, Reddy S, Manuel CM, Gonzalez-Giraldo E, Sullivan J, Coryell J, Depositario-Cabacar DFT, Hauptman JS, Samanta D, Armstrong D, Perry MS, Marashly A, Ciliberto M. Pediatric Palliative Epilepsy Surgery: A Report From the Pediatric Epilepsy Research Consortium (PERC) Surgery Database. Pediatr Neurol 2024; 157:70-78. [PMID: 38897096 DOI: 10.1016/j.pediatrneurol.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/12/2024] [Accepted: 04/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Epilepsy surgery is an underutilized resource for children with drug-resistant epilepsy. Palliative and definitive surgical options can reduce seizure burden and improve quality of life. Palliative epilepsy surgery is often seen as a "last resort" compared to definitive surgical options. We compare patient characteristics between palliative and definitive epilepsy surgical patients and present palliative surgical outcomes from the Pediatric Epilepsy Research Consortium surgical database. METHODS The Pediatric Epilepsy Research Consortium Epilepsy Surgery database is a prospective registry of patients aged 0-18 years undergoing evaluation for epilepsy surgery at 20 pediatric epilepsy centers. We included all children with completed surgical therapy characterized as definitive or palliative. Demographics, epilepsy type, age of onset, age at referral, etiology of epilepsy, treatment history, time-to-referral/evaluation, number of failed anti-seizure medications (ASMs), imaging results, type of surgery, and postoperative outcome were acquired. RESULTS Six hundred forty patients undergoing epilepsy surgery were identified. Patients undergoing palliative procedures were younger at seizure onset (median: 2.1 vs 4 years, P= 0.0008), failed more ASM trials before referral for presurgical evaluation (P=<0.0001), and had longer duration of epilepsy before referral for surgery (P=<0.0001). During presurgical evaluation, patients undergoing palliative surgery had shorter median duration of video-EEG data collected (P=0.007) but number of cases where ictal data were acquired was similar between groups. The most commonly performed palliative procedure was corpus callosotmy (31%), followed by lobectomy (21%) and neuromodulation (82% responsive neurostimulation vs 18% deep brain stimulation). Palliative patients were further categorized into traditionally palliative procedures vs traditionally definitive procedures. The majority of palliative patients had 50% reduction or better in seizure burden. Seizure free outcomes were significantly higher among those with traditional definitive surgeries, 41% (95% confidence interval: 26% to 57%) compared with traditional palliative surgeries and 9% (95% confidence interval: 2% to 17%). Rate of seizure freedom was 46% at 24 months or greater of follow-up in the traditional definitive group. CONCLUSIONS Patients receiving palliative epilepsy surgery trialed more ASMs, were referred later after becoming drug resistant, and had longer gaps between drug resistance and epilepsy surgery compared with patients undergoing definitive epilepsy surgery. The extent of surgical evaluation is impacted if surgery is thought to be palliative. A majority of palliative surgery patients achieved >50% seizure reduction at follow-up, both in groups that received traditionally palliative and traditionally definitive surgical procedures. Palliative surgical patients can achieve greater seizure control and should be referred to an epilepsy surgery center promptly after failing two appropriate anti-seizure medications.
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Affiliation(s)
- Mary Jeno
- Division of Pediatric Neurology, Department of Neurology, University of San Francisco Benioff Children's Hospital Oakland, Oakland, California.
| | | | - Sabrina Shandley
- Neurosciences Research Center, Cook Children's Medical Center, Fort Worth, Texas
| | - Lily Wong-Kisiel
- Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Rani Kaur Singh
- Department of Pediatrics, Atrium Health-Levine Childrens Hospital, Wake Forest University School of Medicine, Charlotte, North Carolina
| | - Nancy McNamara
- Michigan Medicine Pediatric Neurology, CS Mott Children's Hospital, Ann Arbor, Michigan
| | - Erin Fedak Romanowski
- Michigan Medicine Pediatric Neurology, CS Mott Children's Hospital, Ann Arbor, Michigan; Division of Pediatric Neurology, Department of Pediatrics, University of Michigan Health, Ann Arbor, Michigan
| | - Zachary M Grinspan
- Department of Pediatrics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Krista Eschbach
- Department of Pediatrics, Section of Neurology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Allyson Alexander
- Department of Neurosurgery, Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Patricia McGoldrick
- BCHP Neurology at Hawthorne, Boston Children's Health Physicians of New York and Connecticut, Valhalla, New York
| | - Steven Wolf
- Neurology at Hawthorne, Boston Children's Health Physicians of New York and Connecticut, Valhalla, New York
| | | | - Jeffrey Bolton
- Department of Neurology, Boston Children's, Boston, Massachusetts
| | - Joffre Olaya
- Department of Pediatrics, UC Irvine Children's Hospital of Orange County, Orange, California
| | - Daniel W Shrey
- Department of Pediatrics, UC Irvine Children's Hospital of Orange County, Orange, California
| | - Samir Karia
- Department of Neurology, Norton Neuroscience Institute and Children's Medical Center, University of Louisville, Louisville, Kentucky
| | - Cemal Karakas
- Division of Child Neurology, Department of Neurology, Norton Neuroscience Institute and Children's Medical Center, University of Louisville, Louisville, Kentucky
| | - Priyamvada Tatachar
- Division of Neurology - Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adam P Ostendorf
- Associate Division Chief of Research, Inpatient Epilepsy and Epilepsy Surgery Program, Neurology Division, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Satyanarayana Gedela
- Department of Neurology, Nemours Children's Health, Nemours Children's Hospital, Orlando, Florida
| | - Pradeep Javarayee
- Division of Child Neurology, Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shilpa Reddy
- Division of Pediatric Neurology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad McNair Manuel
- Department Pediatric Neurology, Our Lady of the Lake Health, Baton Rouge, Louisiana
| | - Ernesto Gonzalez-Giraldo
- Department of Neurology, Division of Epilepsy, University of California-San Francisco, San Francisco, California
| | - Joseph Sullivan
- Department of Neurology, Division of Epilepsy, University of California-San Francisco, San Francisco, California; Benioff Children's Hospital Pediatric Epilepsy Center of Excellence, University of California San Francisco, San Francisco, California
| | - Jason Coryell
- Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, Oregon
| | | | - Jason Scott Hauptman
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Debopam Samanta
- Child Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dallas Armstrong
- Department of Pediatrics and Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Scott Perry
- Neurosciences Research Center, Cook Children's Medical Center, Fort Worth, Texas; Jane and John Justin Institute for Mind Health at Cook Children's Medical Center, Fort Worth, Texas
| | - Ahmad Marashly
- Neurology Department, Epilepsy Division, The Johns Hopkins University, Baltimore, Maryland
| | - Michael Ciliberto
- Department of Biostatistics, University of Iowa, Iowa City, Iowa; Child Neurology, Department of Pediatrics, University of Iowa, Iowa City, Iowa
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Scotti-Degnan C, Riisen A, Flynn T. The role of psychology and neuropsychology in pediatric epilepsy surgery evaluation. Curr Probl Pediatr Adolesc Health Care 2024; 54:101592. [PMID: 38555234 DOI: 10.1016/j.cppeds.2024.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Epilepsy is one of the most common neurological problems affecting 470,000 children in the United States. While most youth will achieve seizure freedom using medication, up to a third will continue to have seizures and are therefore considered to have drug-resistant epilepsy (DRE). Children and adolescents with epilepsy are at higher risk of behavioral, cognitive, and emotional disorders. Youth with DRE are at even greater risk of behavioral and emotional problems impacting quality of life and may need to pursue surgical interventions, including resective surgery or device implantation. Due to advances in the evaluation of candidates and surgical options, epilepsy surgery is more effective and has become second-line treatment for youth with DRE. This paper highlights the importance of exploring, assessing, and treating psychological and neuropsychological factors throughout the three phases of the epilepsy surgery process and ways pediatricians can support youth and families.
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Affiliation(s)
- Carinna Scotti-Degnan
- The Children's Hospital of Philadelphia, Assistant Professor, Department of Psychiatry, Associated Faculty of the Perelman School of Medicine at the University of Pennsylvania, United States.
| | - Amanda Riisen
- The Children's Hospital of Philadelphia, Assistant Professor, Department of Psychiatry, Associated Faculty of the Perelman School of Medicine at the University of Pennsylvania, United States.
| | - Thomas Flynn
- The Children's Hospital of Philadelphia, Section Chief, Neuropsychology & Assessment, United States.
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4
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Englot DJ. Epilepsy surgery is not palliative. Epilepsia 2024; 65:281-282. [PMID: 37914404 DOI: 10.1111/epi.17815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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5
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Singh RK, Eschbach K, Samanta D, Perry MS, Liu G, Alexander AL, Wong-Kisiel L, Ostendorf A, Tatachar P, Reddy SB, McCormack MJ, Manuel CM, Gonzalez-Giraldo E, Numis AL, Wolf S, Karia S, Karakas C, Olaya J, Shrey D, Auguste KI, Depositario-Cabacar D. Responsive Neurostimulation in Drug-Resistant Pediatric Epilepsy: Findings From the Epilepsy Surgery Subgroup of the Pediatric Epilepsy Research Consortium. Pediatr Neurol 2023; 143:106-112. [PMID: 37084698 DOI: 10.1016/j.pediatrneurol.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/22/2023] [Accepted: 03/02/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Responsive neurostimulation (RNS), a closed-loop intracranial electrical stimulation system, is a palliative surgical option for patients with drug-resistant epilepsy (DRE). RNS is approved by the US Food and Drug Administration for patients aged ≥18 years with pharmacoresistant partial seizures. The published experience of RNS in children is limited. METHODS This is a combined prospective and retrospective study of patients aged ≤18 years undergoing RNS placement. Patients were identified from the multicenter Pediatric Epilepsy Research Consortium Surgery Registry from January 2018 to December 2021, and additional data relevant to this study were retrospectively collected and analyzed. RESULTS Fifty-six patients received RNS during the study period. The mean age at implantation was 14.9 years; the mean duration of epilepsy, 8.1 years; and the mean number of previously trialed antiseizure medications, 4.2. Five patients (9%) previously trialed dietary therapy, and 19 patients (34%) underwent prior surgery. Most patients (70%) underwent invasive electroencephalography evaluation before RNS implantation. Complications occurred in three patients (5.3%) including malpositioned leads or transient weakness. Follow-up (mean 11.7 months) was available for 55 patients (one lost), and four were seizure-free with RNS off. Outcome analysis of stimulation efficacy was available for 51 patients: 33 patients (65%) were responders (≥50% reduction in seizure frequency), including five patients (10%) who were seizure free at follow-up. CONCLUSIONS For young patients with focal DRE who are not candidates for surgical resection, neuromodulation should be considered. Although RNS is off-label for patients aged <18 years, this multicenter study suggests that it is a safe and effective palliative option for children with focal DRE.
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Affiliation(s)
- Rani K Singh
- Department of Pediatrics, Atrium Health-Levine Children's Hospital, Charlotte, North Carolina; Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Krista Eschbach
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Debopam Samanta
- Child Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Alaska
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Neurosciences Center, Cook Children's Medical Center, Ft Worth, Texas
| | - Gang Liu
- Department of Pediatrics, Atrium Health-Levine Children's Hospital, Charlotte, North Carolina
| | - Allyson L Alexander
- Department of Neurosurgery, School of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado
| | | | - Adam Ostendorf
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | | | - Shilpa B Reddy
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael J McCormack
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad M Manuel
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Adam L Numis
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Steven Wolf
- Department of Pediatrics, Boston Children's Health Physicians, New York, New York
| | - Samir Karia
- Division of Child Neurology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Cemal Karakas
- Division of Child Neurology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Joffre Olaya
- Department of Neurosurgery, Children's Hospital Orange County, Orange, California
| | - Daniel Shrey
- Department of Neurosciences, Children's Hospital Orange County, Orange, California
| | - Kurtis I Auguste
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
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Shelyagin IS, Akimova PO, Stefanov SZ, Sufianov RA. Predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy. SECHENOV MEDICAL JOURNAL 2023. [DOI: 10.47093/2218-7332.2022.13.3.24-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Aim. To identify predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy in a multivariate model.Materials and methods. Aretrospective study included 69 patients with drug-resistant temporal lobe epilepsy who underwent microsurgical anterior temporal lobectomy. The study included 31 (45%) men and 38 (55%) women. The median age was 28 (21; 36). Surgical treatment outcomes were assessed at 6, 12, 36, and 60 months after surgical intervention according to the Engel Epilepsy Surgery Outcome Scale. Logistic regression equations were calculated, a ROC curve was constructed, and odds ratio (OR) with 95% confidence interval (CI), sensitivity, specificity, area under the ROC curve (AUC) were calculated.Results. In all assessed time periods, 88.3–93.0% of patients had outcomes consistent with Engel classes I and II. The distribution of patients by outcome classes did not change statistically significantly over the entire follow-up period. There were the following predictors of high efficacy of surgical treatment at 6 months after surgery: relatively shorter duration of active disease course (OR 0.719, 95%, CI: 0.437–0.966, p < 0.05), absence of status epilepticus (OR 0.048, 95% CI: 0.002–0.472, p < 0.05), absence of subdominant foci of irritative activity (OR 0.123, 95% CI: 0.012–0.845, p < 0.01), presence of mesial temporal sclerosis (OR 1008, 95% CI: 21.59–1310851, p < 0.01), a relatively longer resection margin on the temporal lobe (OR 637.32, 95% CI: 5.43–1960062, p < 0.05), lateralization of epileptogenic zone in subdominant hemisphere (OR 0.103, 95% CI 0.004–0.937, p = 0.0532). AUC was 0.957 (0.917–0.997), p < 0.0001; sensitivity 87.5%, and specificity 82.8%.Conclusion. Independent predictors of the efficacy of microsurgical anterior temporal lobectomy in patients with drug-resistant temporal lobe epilepsy are the following: shorter duration of active disease course, absence of status epilepticus in the history, absence of subdominant foci, presence of mesial temporal sclerosis, a relatively longer resection margin on the temporal lobe, and lateralization of the epileptogenic zone in the temporal lobe of the subdominant hemisphere.
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Affiliation(s)
- I. S. Shelyagin
- Tyumen State Medical University; Federal Centre of Neurosurgery
| | | | | | - R. A. Sufianov
- Sechenov First Moscow State Medical University (Sechenov University)
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Coorg R, Seto ES. Invasive Epilepsy Monitoring: The Switch from Subdural Electrodes to Stereoelectroencephalography. JOURNAL OF PEDIATRIC EPILEPSY 2023. [DOI: 10.1055/s-0042-1760105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractStereoelectroencephalography (SEEG) has experienced an explosion in use due to a shifting understanding of epileptic networks and wider application of minimally invasive epilepsy surgery techniques. Both subdural electrode (SDE) monitoring and SEEG serve important roles in defining the epileptogenic zone, limiting functional deficits, and formulating the most effective surgical plan. Strengths of SEEG include the ability to sample difficult to reach, deep structures of the brain without a craniotomy and without disrupting the dura. SEEG is complementary to minimally invasive epilepsy treatment options and may reduce the treatment gap in patients who are hesitant about craniotomy and surgical resection. Understanding the strengths and limitations of SDE monitoring and SEEG allows epileptologists to choose the best modality of invasive monitoring for each patient living with drug-resistant seizures.
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Affiliation(s)
- Rohini Coorg
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas, United States
| | - Elaine S. Seto
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas, United States
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8
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Riviello JJ, Curry DJ, Weiner HL. An Introduction to Minimally Invasive Pediatric Epilepsy Surgery. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1759876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThe field of minimally invasive surgery has evolved over the past 50 years, including neurosurgery, with an evolution to “minimally invasive neurosurgery” when feasible. Epilepsy surgery has followed this trend, with a transition from standard neurosurgical techniques to minimally invasive techniques in all phases of neurosurgical involvement. These include the diagnostic intracranial electroencephalogram with a subdural exploration to stereoelectroencephalography, the actual resection from an open craniotomy to a less destructive technique, or the multiple modalities of neuromodulation instead of a destructive surgery.The influence of these minimally invasive techniques has resulted in a change in the overall philosophy of pediatric epilepsy surgery. The expectations of what is considered “successful” epilepsy surgery has changed from total seizure control, in other words, a “cure,” to palliative epilepsy surgery with a decrease in the targeted seizures, especially “disabling seizures.” This has led to an overall greater acceptance of epilepsy surgery. This article summarizes the major reasons behind the explosion of minimally invasive pediatric epilepsy surgery, which are amplified in the subsequent articles. Some of this chapter includes the authors' opinions.
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Affiliation(s)
- James J. Riviello
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, Unites States
- Department of Neurology, Texas Children's Hospital, Houston, Texas, Unites States
| | - Daniel J. Curry
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, Unites States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, Unites States
| | - Howard L. Weiner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, Unites States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, Unites States
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Huang S, Chen R, Chen H, Si G. Abnormal electroencephalogram (EEG) after drug withdrawal is a risk factor for epilepsy recurrence in children: a systematic review and meta-analysis. Transl Pediatr 2022; 11:947-953. [PMID: 35800270 PMCID: PMC9253940 DOI: 10.21037/tp-22-206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The relationship between abnormal electroencephalogram (EEG) and epilepsy recurrence after antiepileptic drug (AED) withdrawal has been controversial. We aimed to explore the relationship between abnormal EEG after AED withdrawal and the risk of epilepsy recurrence in children. METHODS Literature retrieval was performed using the PubMed, EMBASE, Medline, CENTRAL, and China National Knowledge Infrastructure (CNKI) databases. Included literatures were subjects of pediatric epilepsy patients who discontinued medication. The recurrence rate of epilepsy in patients with normal and abnormal EEG after AED withdrawal was observed. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of literatures. The Chi-square test was used to test heterogeneity. If heterogeneity between the articles existed, a random-effects model was used; otherwise, fixed-effects models were used. Subgroup analysis was used to explore the causes of heterogeneity. The odds ratio (OR) and 95% confidence interval (CI) were calculated using the Mantel-Haenszel statistical method. OR was not adjusted for other factors. RESULTS A total of 843 articles were retrieved. Nine studies were included, with a total of 1,663 patients, including 1,299 patients with normal EEG and 364 patients with abnormal EEG. Compared with the normal EEG patients, the OR of recurrence rate after AEDs withdrawal was 3.02 (P=0.0003), with heterogeneity (P<0.0001). The funnel plot indicated that there was no publication bias among the studies. The not partial seizure group analysis showed OR =1.70 (P=0.003) and no heterogeneity (P=0.70) in patients with abnormal EEG compared to those with normal EEG. In the partial seizures subgroup, the OR of the recurrence rate after AED withdrawal was 8.08 (P<0.00001) compared with the normal EEG patients, and there was no heterogeneity (P=0.29). The funnel chart shows that the partial seizures type subgroup analysis revealed positive results, while the not partial seizure group analysis reported negative results, indicating publication bias. CONCLUSIONS The risk of epilepsy recurrence is higher in children with abnormal EEG after AED withdrawal, regardless of seizure type. For pediatric epilepsy patients with abnormal EEG after AED withdrawal, a more cautious discontinuation regimen, closer follow-up and monitoring are required.
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Affiliation(s)
- Shanwen Huang
- Department of Pediatrics, Haikou Maternal and Child Health Hospital, Haikou, China
| | - Ruipeng Chen
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Hao Chen
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Gang Si
- Department of Pharmacy, Haikou Maternal and Child Health Hospital, Haikou, China
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