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Ramantani G, Wirrell E. Epilepsy surgery in developmental and epileptic encephalopathies. Epilepsy Behav 2024; 159:109985. [PMID: 39181112 DOI: 10.1016/j.yebeh.2024.109985] [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: 08/03/2024] [Accepted: 08/04/2024] [Indexed: 08/27/2024]
Abstract
Developmental and epileptic encephalopathies (DEEs) present significant treatment challenges due to frequent, drug-resistant seizures and comorbidities that impact quality of life. DEEs include both developmental encephalopathy from underlying pathology and epileptic encephalopathy where seizures exacerbate cognitive and behavioral impairments. Classification by syndrome and etiology is essential for therapy and prognosis, with common syndromes like infantile epileptic spasms syndrome and Dravet syndrome having specific first-line treatments. Etiologies are predominantly genetic, structural, or combined, with targeted therapies increasingly available. Surgery aims to improve seizure control but also may improve development, if the epileptic encephalopathy can be ameliorated. Timely intervention can reduce seizures and epileptiform discharges, maximizing developmental potential and allowing reduction in antiseizure medication. In cases requiring extensive resections, new deficits may be offset by developmental gains. Studies indicate that parents are generally willing to accept some deficits for significant seizure reduction.
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Affiliation(s)
- Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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Ramantani G. Epilepsy Surgery: Bridging the Gap with Minimally Invasive Techniques. Neuropediatrics 2024; 55:277-278. [PMID: 39250915 DOI: 10.1055/s-0044-1789235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Affiliation(s)
- Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
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Stefanos-Yakoub I, Wingeier K, Held U, Latal B, Wirrell E, Smith ML, Ramantani G. Long-term intellectual and developmental outcomes after pediatric epilepsy surgery: A systematic review and meta-analysis. Epilepsia 2024; 65:251-265. [PMID: 38031640 DOI: 10.1111/epi.17834] [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: 07/27/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
In addition to the primary aim of seizure freedom, a key secondary aim of pediatric epilepsy surgery is to stabilize and, potentially, optimize cognitive development. Although the efficacy of surgical treatment for seizure control has been established, the long-term intellectual and developmental trajectories are yet to be delineated. We conducted a systematic review and meta-analysis of studies reporting pre- and postsurgical intelligence or developmental quotients (IQ/DQ) of children with focal lesional epilepsy aged ≤18 years at epilepsy surgery and assessed at >2 years after surgery. We determined the IQ/DQ change and conducted a random-effects meta-analysis and meta-regression to assess its determinants. We included 15 studies reporting on 341 patients. The weighted mean age at surgery was 7.1 years (range = .3-13.8). The weighted mean postsurgical follow-up duration was 5.6 years (range = 2.7-12.8). The overall estimate of the mean presurgical IQ/DQ was 60 (95% confidence interval [CI] = 47-73), the postsurgical IQ/DQ was 61 (95% CI = 48-73), and the change was +.94 IQ/DQ (95% CI = -1.70 to 3.58, p = .486). Children with presurgical IQ/DQ ≥ 70 showed a tendency for higher gains than those with presurgical IQ/DQ < 70 (p = .059). Higher gains were determined by cessation of antiseizure medication (ASM; p = .041), not just seizure freedom. Our findings indicate, on average, stabilization of intellectual and developmental functioning at long-term follow-up after epilepsy surgery. Once seizure freedom has been achieved, ASM cessation enables the optimization of intellectual and developmental trajectories in affected children.
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Affiliation(s)
- Ilona Stefanos-Yakoub
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kevin Wingeier
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga; Neurosciences and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Ramantani G, Cserpan D, Tisdall M, Otte WM, Dorfmüller G, Cross JH, van Schooneveld M, van Eijsden P, Nees F, Reuner G, Krayenbühl N, Zentner J, Bulteau C, Braun KPJ. Determinants of Functional Outcome after Pediatric Hemispherotomy. Ann Neurol 2024; 95:377-387. [PMID: 37962290 DOI: 10.1002/ana.26830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE We aimed to evaluate determinants of functional outcome after pediatric hemispherotomy in a large and recent multicenter cohort. METHODS We retrospectively investigated the functional outcomes of 455 children who underwent hemispherotomy at 5 epilepsy centers in 2000-2016. We identified determinants of unaided walking, voluntary grasping with the hemiplegic hand, and speaking through Bayesian multivariable regression modeling using missing data imputation. RESULTS Seventy-five percent of children were seizure-free, and 44% stopped antiseizure medication at a 5.1-year mean follow-up (range = 1-17.1). Seventy-seven percent of children could walk unaided, 8% could grasp voluntarily, and 68% could speak at the last follow-up. Children were unlikely to walk when they had contralateral magnetic resonance imaging (MRI) abnormalities (40/73, p = 0.04), recurrent seizures following hemispherotomy (62/109, p = 0.04), and moderately (50/61, p = 0.03) or severely impaired (127/199, p = 0.001) postsurgical intellectual functioning, but were likely to walk when they were older at outcome determination (p = 0.01). Children were unlikely to grasp voluntarily with the hand contralateral to surgery when they had Rasmussen encephalitis (0/61, p = 0.001) or Sturge-Weber syndrome (0/32, p = 0.007). Children were unlikely to speak when they had contralateral MRI abnormalities (30/69, p = 0.002) and longer epilepsy duration (p = 0.01), but likely to speak when they had Sturge-Weber syndrome (29/35, p = 0.01), were older at surgery (p = 0.04), and were older at outcome determination (p < 0.001). INTERPRETATION Etiology and bilaterality of structural brain abnormalities were key determinants of functional outcome after hemispherotomy. Longer epilepsy duration affected language outcomes. Not surprisingly, walking and talking ability increased with older age at outcome evaluation. ANN NEUROL 2024;95:377-387.
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Affiliation(s)
- Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dorottya Cserpan
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Willem M Otte
- Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
| | - Georg Dorfmüller
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Member of European Reference Network EpiCARE, Paris, France
| | - J Helen Cross
- Department of Neurology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, Great Ormond Street and University College London National Institute for Health and Care Research Biomedical Research Centre Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Monique van Schooneveld
- Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
| | - Pieter van Eijsden
- Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
| | - Frauke Nees
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Gitta Reuner
- Institute of Education Studies, Faculty of Behavioral and Cultural Studies, University of Heidelberg, Heidelberg, Germany
| | - Niklaus Krayenbühl
- Department of Neurosurgery, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Josef Zentner
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christine Bulteau
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Member of European Reference Network EpiCARE, Paris, France
- University of Paris, MC2Lab, Institute of Psychology, Boulogne-Billancourt, France
| | - Kees P J Braun
- Department of Child Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Member of European Reference Network EpiCARE, Utrecht, the Netherlands
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Stefanos-Yakoub I, Wingeier K, Cserpan D, Gennari AG, Latal B, Reuner G, Ramantani G. Lesion Extent Negatively Impacts Intellectual Skills in Pediatric Focal Epilepsy. Pediatr Neurol 2023; 145:67-73. [PMID: 37285765 DOI: 10.1016/j.pediatrneurol.2023.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/08/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cognitive development in children and adolescents with focal lesional epilepsy is determined by the underlying epileptogenic lesion, in addition to epilepsy itself. However, the impact of lesion-related variables on intelligence quotient (IQ) and developmental quotient (DQ) remains largely unexplored. Here, we aimed to determine the effect of lesion-related predictors and their relation with epilepsy-related predictors of intellectual functioning. METHODS We retrospectively analyzed data from children with focal lesional epilepsy who underwent standardized cognitive evaluation yielding IQ/DQ in our institution. RESULTS We included 50 consecutive patients aged 0.5 to 17.5 years (mean, 9.3; S.D., 4.9) at cognitive assessment. Epilepsy duration was 0 to 15.5 years (mean, 3.8; S.D., 4.1). Of the total cohort, 30 (60%) patients had unilobar lesions, seven (14%) multilobar, 10 (20%) hemispheric, and three (6%) bilateral. Etiology was congenital in 32 (64%) cases, acquired in 14 (28%), and progressive in four (8%). For patients with unilobar lesions, the mean IQ/DQ was 97.1 ± 15.7, for multilobar 98.9 ± 20.2, for hemispheric 76.1 ± 20.5, and for bilateral 76.3 ± 4.5. Larger lesion extent, earlier epilepsy onset, and longer epilepsy duration correlated with lower IQ/DQ in the univariate analysis, whereas only lesion extent and epilepsy duration contributed significantly to the explanatory model in the multivariable analysis. CONCLUSIONS The present study demonstrates that lesion extent and epilepsy duration are important risk factors for intellectual impairment in pediatric patients with focal lesional epilepsy. These findings are useful for family counseling and the early consideration of interventions that may limit the duration of epilepsy.
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Affiliation(s)
- Ilona Stefanos-Yakoub
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kevin Wingeier
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Dorottya Cserpan
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Antonio Giulio Gennari
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland; MR Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Gitta Reuner
- Faculty of Behavioral and Cultural Studies, Institute of Education Studies, University of Heidelberg, Heidelberg, Germany
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
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Ramantani G, Bulteau C, Cserpan D, Otte WM, Dorfmüller G, Cross JH, Zentner J, Tisdall M, Braun KPJ. Not surgical technique, but etiology, contralateral MRI, prior surgery, and side of surgery determine seizure outcome after pediatric hemispherotomy. Epilepsia 2023; 64:1214-1224. [PMID: 36869851 DOI: 10.1111/epi.17574] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE We aimed to assess determinants of seizure outcome following pediatric hemispherotomy in a contemporary cohort. METHODS We retrospectively analyzed the seizure outcomes of 457 children who underwent hemispheric surgery in five European epilepsy centers between 2000 and 2016. We identified variables related to seizure outcome through multivariable regression modeling with missing data imputation and optimal group matching, and we further investigated the role of surgical technique by Bayes factor (BF) analysis. RESULTS One hundred seventy seven children (39%) underwent vertical and 280 children (61%) underwent lateral hemispherotomy. Three hundred forty-four children (75%) achieved seizure freedom at a mean follow-up of 5.1 years (range 1 to 17.1). We identified acquired etiology other than stroke (odds ratio [OR] 4.4, 95% confidence interval (CI) 1.1-18.0), hemimegalencephaly (OR 2.8, 95% CI 1.1-7.3), contralateral magnetic resonance imaging (MRI) findings (OR 5.5, 95% CI 2.7-11.1), prior resective surgery (OR 5.0, 95% CI 1.8-14.0), and left hemispherotomy (OR 2.3, 95% CI 1.3-3.9) as significant determinants of seizure recurrence. We found no evidence of an impact of the hemispherotomy technique on seizure outcome (the BF for a model including the hemispherotomy technique over the null model was 1.1), with comparable overall major complication rates for different approaches. SIGNIFICANCE Knowledge about the independent determinants of seizure outcome following pediatric hemispherotomy will improve the counseling of patients and families. In contrast to previous reports, we found no statistically relevant difference in seizure-freedom rates between the vertical and horizontal hemispherotomy techniques when accounting for different clinical features between groups.
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Affiliation(s)
- Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christine Bulteau
- Member of ERN EpiCare, Department of Pediatric Neurosurgery, Hospital Fondation Adolphe de Rothschild, Paris, France
| | - Dorottya Cserpan
- Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Willem M Otte
- Member of ERN EpiCare, Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands
| | - Georg Dorfmüller
- Member of ERN EpiCare, Department of Pediatric Neurosurgery, Hospital Fondation Adolphe de Rothschild, Paris, France
| | - J Helen Cross
- Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street & UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Josef Zentner
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kees P J Braun
- Member of ERN EpiCare, Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands
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Gennari AG, Cserpan D, Stefanos-Yakoub I, Kottke R, O’Gorman Tuura R, Ramantani G. Diffusion tensor imaging discriminates focal cortical dysplasia from normal brain parenchyma and differentiates between focal cortical dysplasia types. Insights Imaging 2023; 14:36. [PMID: 36826756 PMCID: PMC9958211 DOI: 10.1186/s13244-023-01368-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/29/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES Although diffusion tensor imaging (DTI) may facilitate the identification of cytoarchitectural changes associated with focal cortical dysplasia (FCD), the predominant aetiology of paediatric structural epilepsy, its potential has thus far remained unexplored in this population. Here, we investigated whether DTI indices can differentiate FCD from contralateral brain parenchyma (CBP) and whether clinical features affect these indices. METHODS In this single-centre, retrospective study, we considered children and adolescents with FCD-associated epilepsy who underwent brain magnetic resonance (MRI), including DTI. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, and radial diffusivity, were calculated in both FCD and CBP. The DTI indices best discriminating between FCD and CBP were subsequently used to assess the link between DTI and selected clinical and lesion-related parameters. RESULTS We enrolled 32 patients (20 male; median age at MRI 4 years), including 15 with histologically confirmed FCD. FA values were lower (p = 0.03), whereas MD values were higher in FCD than in CBP (p = 0.04). The difference in FA values between FCD and CBP was more pronounced for a positive vs. negative history of status epilepticus (p = 0.004). Among histologically confirmed cases, the difference in FA values between FCD and CBP was more pronounced for type IIb versus type I FCD (p = 0.03). CONCLUSIONS FA and MD discriminate between FCD and CBP, while FA differentiates between FCD types. Status epilepticus increases differences in FA, potentially reflecting changes induced in the brain. Our findings support the potential of DTI to serve as a non-invasive biomarker to characterise FCD in the paediatric population.
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Affiliation(s)
- Antonio Giulio Gennari
- Department of Neuropediatrics, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,MR-Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Dorottya Cserpan
- grid.412341.10000 0001 0726 4330Department of Neuropediatrics, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Ilona Stefanos-Yakoub
- grid.412341.10000 0001 0726 4330Department of Neuropediatrics, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Raimund Kottke
- grid.412341.10000 0001 0726 4330Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Ruth O’Gorman Tuura
- grid.412341.10000 0001 0726 4330MR-Research Centre, University Children’s Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland ,grid.412341.10000 0001 0726 4330Children’s Research Centre, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Georgia Ramantani
- grid.412341.10000 0001 0726 4330Department of Neuropediatrics, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland ,grid.412341.10000 0001 0726 4330Children’s Research Centre, University Children’s Hospital Zurich, Zurich, Switzerland
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Scalp HFO rates decrease after successful epilepsy surgery and are not impacted by the skull defect resulting from craniotomy. Sci Rep 2022; 12:1301. [PMID: 35079091 PMCID: PMC8789862 DOI: 10.1038/s41598-022-05373-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
Epilepsy surgery can achieve seizure freedom in selected pediatric candidates, but reliable postsurgical predictors of seizure freedom are missing. High frequency oscillations (HFO) in scalp EEG are a new and promising biomarker of treatment response. However, it is unclear if the skull defect resulting from craniotomy interferes with HFO detection in postsurgical recordings. We considered 14 children with focal lesional epilepsy who underwent presurgical evaluation, epilepsy surgery, and postsurgical follow-up of ≥ 1 year. We identified the nearest EEG electrodes to the skull defect in the postsurgical MRI. We applied a previously validated automated HFO detector to determine HFO rates in presurgical and postsurgical EEG. Overall, HFO rates showed a positive correlation with seizure frequency (p < 0.001). HFO rates in channels over the HFO area decreased following successful epilepsy surgery, irrespective of their proximity to the skull defect (p = 0.005). HFO rates in channels outside the HFO area but near the skull defect showed no increase following surgery (p = 0.091) and did not differ from their contralateral channels (p = 0.726). Our observations show that the skull defect does not interfere with postsurgical HFO detection. This supports the notion that scalp HFO can predict postsurgical seizure freedom and thus guide therapy management in focal lesional epilepsy.
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Marashly A, Karia S, Zonjy B. Epilepsy Surgery: Special Circumstances. Semin Pediatr Neurol 2021; 39:100921. [PMID: 34620459 DOI: 10.1016/j.spen.2021.100921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
Epilepsy surgery has proven to be very effective in treating refractory focal epilepsies in children, producing seizure freedom or partial seizure control well beyond any other medical or dietary therapies. While surgery is mostly utilized in certain clinical phenotypes, either based on the location such as temporal lobe epilepsy, or based on the presence of known epileptogenic lesions such as focal cortical dysplasia, tumors or hemimegalencephaly, there is a growing body of evidence to support the role of surgery in other patients' cohorts that were classically not thought of as surgical candidates. These include patients with rare genetic disorders, electrical status epilepticus in sleep, status epilepticus and the very young patients. Furthermore, epilepsy surgery is not considered as a "last resort" as seizure and cognitive outcomes of surgery are considerably better when done earlier rather than later in relation to the time of onset of epilepsy and age of surgery especially in the context of known focal cortical dysplasia. This article examines the accumulating evidence of the utility of epilepsy surgery in these special circumstances.
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Affiliation(s)
- Ahmad Marashly
- Assistant Professor, University of Washington/Seattle Children's Hospital, Seattle, WA.
| | - Samir Karia
- Associate Professor, Univeristy of Louisville, Luisiville, KY
| | - Bilal Zonjy
- Assistant Professor, University of Washington/Seattle Children's Hospital, Seattle, WA
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Cserpan D, Boran E, Lo Biundo SP, Rosch R, Sarnthein J, Ramantani G. Scalp high-frequency oscillation rates are higher in younger children. Brain Commun 2021; 3:fcab052. [PMID: 33870193 PMCID: PMC8042248 DOI: 10.1093/braincomms/fcab052] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/30/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Abstract
High-frequency oscillations in scalp EEG are promising non-invasive biomarkers of epileptogenicity. However, it is unclear how high-frequency oscillations are impacted by age in the paediatric population. We prospectively recorded whole-night scalp EEG in 30 children and adolescents with focal or generalized epilepsy. We used an automated and clinically validated high-frequency oscillation detector to determine ripple rates (80-250 Hz) in bipolar channels. Children < 7 years had higher high-frequency oscillation rates (P = 0.021) when compared with older children. The median test-retest reliability of high-frequency oscillation rates reached 100% (iqr 50) for a data interval duration of 10 min. Scalp high-frequency oscillation frequency decreased with age (r = -0.558, P = 0.002), whereas scalp high-frequency oscillation duration and amplitude were unaffected. The signal-to-noise ratio improved with age (r = 0.37, P = 0.048), and the background ripple band activity decreased with age (r = -0.463, P = 0.011). We characterize the relationship of scalp high-frequency oscillation features and age in paediatric patients. EEG intervals of ≥ 10 min duration are required for reliable measurements of high-frequency oscillation rates. This study is a further step towards establishing scalp high-frequency oscillations as a valid epileptogenicity biomarker in this vulnerable age group.
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Affiliation(s)
- Dorottya Cserpan
- Department of Neuropediatrics, University Children's Hospital Zurich, 8032 Zurich, Switzerland,Department of Neurosurgery, University Hospital Zurich, 8006 Zurich, Switzerland
| | - Ece Boran
- Department of Neurosurgery, University Hospital Zurich, 8006 Zurich, Switzerland
| | - Santo Pietro Lo Biundo
- Department of Neuropediatrics, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Richard Rosch
- Department of Neuropediatrics, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Johannes Sarnthein
- Department of Neurosurgery, University Hospital Zurich, 8006 Zurich, Switzerland,University of Zurich, 8006 Zurich, Switzerland,Klinisches Neurozentrum Zurich, University Hospital Zurich, 8006 Zurich, Switzerland
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, 8032 Zurich, Switzerland,University of Zurich, 8006 Zurich, Switzerland,Children’s Research Centre, University Children's Hospital Zurich, 8032 Zurich, Switzerland,Correspondence to: Georgia Ramantani, MD, PhD Department of Neuropediatrics, University Children's Hospital Zurich Steinwiesstrasse 75, 8032 Zurich, Switzerland. E-mail:
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Kogias E, Bast T, Schubert-Bast S, Wiegand G, Brandt A, Strobl K, Korinthenberg R, Schulze-Bonhage A, Zentner J, Ramantani G. Multilobar Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom. Neurosurgery 2020; 88:174-182. [PMID: 32814942 DOI: 10.1093/neuros/nyaa368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although multilobar resections correspond to one-fifth of pediatric epilepsy surgery, there are little data on long-term seizure control. OBJECTIVE To investigate the long-term seizure outcomes of children and adolescents undergoing multilobar epilepsy surgery and identify their predictors. METHODS In this retrospective study, we considered 69 consecutive patients that underwent multilobar epilepsy surgery at the age of 10.0 ± 5.0 yr (mean ± SD). The magnetic resonance imaging revealed a lesion in all but 2 cases. Resections were temporo-parieto(-occipital) in 30%, temporo-occipital in 41%, parieto-occipital in 16%, and fronto-(temporo)-parietal in 13% cases. Etiologies were determined as focal cortical dysplasia in 67%, perinatal or postnatal ischemic lesions in 23%, and benign tumors in 10% of cases. RESULTS At last follow-up of median 9 yr (range 2.8-14.8), 48% patients were seizure free; 33% were off antiepileptic drugs. 10% of patients, all with dysplastic etiology, required reoperations: 4 of 7 achieved seizure freedom. Seizure recurrence occurred mostly (80%) within the first 6 mo. Among presurgical variables, only an epileptogenic zone far from eloquent cortex independently correlated with significantly higher rates of seizure arrest in multivariate analysis. Among postsurgical variables, the absence of residual lesion and of acute postsurgical seizures was independently associated with significantly higher rates of seizure freedom. CONCLUSION Our study demonstrates that multilobar epilepsy surgery is effective regarding long-term seizure freedom and antiepileptic drug withdrawal in selected pediatric candidates. Epileptogenic zones-and lesions-localized distant from eloquent cortex and, thus, fully resectable predispose for seizure control. Acute postsurgical seizures are critical markers of seizure recurrence that should lead to prompt reevaluation.
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Affiliation(s)
- Evangelos Kogias
- Department of Neurosurgery, University Hospital Freiburg, Freiburg im Breisgau, Germany.,Medical Faculty, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Bast
- Medical Faculty, University of Freiburg, Freiburg im Breisgau, Germany.,Epilepsy Center Kork, Kehl-Kork, Germany
| | - Susanne Schubert-Bast
- Department of General Pediatrics, University Children's Hospital Heidelberg, Heidelberg, Germany.,Department of Neuropediatrics, University Children's Hospital Frankfurt, Frankfurt, Germany.,Epilepsy Center Frankfurt Rhine-Main, Frankfurt am Main, Germany
| | - Gert Wiegand
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Armin Brandt
- Epilepsy Center, University Hospital Freiburg, Freiburg im Breisgau, Germany
| | - Karl Strobl
- Medical Faculty, University of Freiburg, Freiburg im Breisgau, Germany
| | - Rudolf Korinthenberg
- Department of Neuropediatrics and Muscular Disorders, University Children's Hospital Freiburg, Freiburg im Breisgau, Germany
| | | | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Freiburg im Breisgau, Germany
| | - Georgia Ramantani
- Medical Faculty, University of Freiburg, Freiburg im Breisgau, Germany.,Epilepsy Center, University Hospital Freiburg, Freiburg im Breisgau, Germany.,Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
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