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Jha R, Mj Chua M, Nawabi N, Cash SS, Rolston JD, Cole AJ. Foramen ovale electrode investigation in the era of SEEG: Results and a reappraisal. Epilepsy Res 2024; 205:107401. [PMID: 38981170 DOI: 10.1016/j.eplepsyres.2024.107401] [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: 03/20/2024] [Revised: 05/31/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Patients with medication-resistant disabling epilepsy should be considered for potential epilepsy surgery. If noninvasive techniques are unable to identify the location of the seizure onset zone (SOZ), it becomes necessary to consider intracranial investigations. Stereo-electroencephalography (SEEG) is currently the preferred method for such monitoring, however foramen ovale (FO) electrodes offer a less invasive alternative that may be suitable in certain situations. Previous studies have demonstrated the effectiveness of FO electrodes in suspected mesial temporal epilepsy, nevertheless, increased experience with FO electrode use could further enhance their safety and efficacy. Therefore, we conducted an analysis of recent FO electrode investigations to assess their utility in surgical decision making, post resection outcomes, and complication rates. METHODS We conducted a retrospective analysis of 61 patients who underwent FO placement at Mass General Brigham between 2009 and 2020. Patient and seizure characteristics, preoperative investigation data, and seizures outcomes were collected. In addition, identified predictors of FO utility using logistic regression. RESULTS A total of 61 patients were identified. FO evaluation localized the SOZ in 56 % of patients. Complications were encountered in 1.6 % of patients. Subsequent surgical resection was pursued by 49 % of patients, with 56 % becoming seizure free, and 67 % having favorable seizure outcomes at last follow-up. Multivariate analysis identified younger patients with a higher number of preoperative ASMs as more likely to undergo subsequent treatment, however, these features were not predictive features of SOZ localization, seizure freedom, or favorable seizure outcomes. In patients with bitemporal or cross-over onsets on scalp EEG, FO was able to identify the SOZ in 79 %, whereas in patients with discordant or unclear onset, the rates were 71 % and 45 %, respectively. CONCLUSION In a contemporary cohort, FO electrode placement had a low complication rate and a high utility primarily in cases of unclear laterality of mesial temporal onsets or discordance between scalp EEG and other pre-FO investigation data in cases of suspected mesial temporal onsets.
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Affiliation(s)
- Rohan Jha
- Harvard Medical School, Boston, MA, USA
| | - Melissa Mj Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Noah Nawabi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John D Rolston
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J Cole
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Miron G, Dehnicke C, Meencke HJ, Onken J, Holtkamp M. Presurgical video-EEG monitoring with foramen ovale and epidural peg electrodes: a 25-year perspective. J Neurol 2022; 269:5474-5486. [PMID: 35705881 PMCID: PMC9468058 DOI: 10.1007/s00415-022-11208-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
Background Epilepsy surgery cases are becoming more complex and increasingly require invasive video-EEG monitoring (VEM) with intracranial subdural or intracerebral electrodes, exposing patients to substantial risks. We assessed the utility and safety of using foramen ovale (FO) and epidural peg electrodes (FOP) as a next step diagnostic approach following scalp VEM. Methods We analyzed clinical, electrophysiological, and imaging characteristics of 180 consecutive patients that underwent FOP VEM between 1996 and 2021. Multivariate logistic regression was used to assess predictors of clinical and electrophysiological outcomes. Results FOP VEM allowed for immediate resection recommendation in 36 patients (20.0%) and excluded this option in 85 (47.2%). Fifty-nine (32.8%) patients required additional invasive EEG investigations; however, only eight with bilateral recordings. FOP VEM identified the ictal onset in 137 patients, compared to 96 during prior scalp VEM, p = .004. Predictors for determination of ictal onset were temporal lobe epilepsy (OR 2.9, p = .03) and lesional imaging (OR 3.1, p = .01). Predictors for surgery recommendation were temporal lobe epilepsy (OR 6.8, p < .001), FO seizure onset (OR 6.1, p = .002), and unilateral interictal epileptic activity (OR 3.8, p = .02). One-year postsurgical seizure freedom (53.3% of patients) was predicted by FO ictal onset (OR 5.8, p = .01). Two patients experienced intracerebral bleeding without persisting neurologic sequelae. Conclusion FOP VEM adds clinically significant electrophysiological information leading to treatment decisions in two-thirds of cases with a good benefit–risk profile. Predictors identified for electrophysiological and clinical outcome can assist in optimally selecting patients for this safe diagnostic approach. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11208-6.
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Affiliation(s)
- Gadi Miron
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany.
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Christoph Dehnicke
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Heinz-Joachim Meencke
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Abdi-Sargezeh B, Valentin A, Alarcon G, Martin-Lopez D, Sanei S. Higher-order tensor decomposition based scalp-to-intracranial EEG projection for detection of interictal epileptiform discharges. J Neural Eng 2021; 18. [PMID: 34818640 DOI: 10.1088/1741-2552/ac3cc4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/24/2021] [Indexed: 11/12/2022]
Abstract
Objective.Interictal epileptiform discharges (IEDs) occur between two seizures onsets. IEDs are mainly captured by intracranial recordings and are often invisible over the scalp. This study proposes a model based on tensor factorization to map the time-frequency (TF) features of scalp EEG (sEEG) to the TF features of intracranial EEG (iEEG) in order to detect IEDs from over the scalp with high sensitivity.Approach.Continuous wavelet transform is employed to extract the TF features. Time, frequency, and channel modes of IED segments from iEEG recordings are concatenated into a four-way tensor. Tucker and CANDECOMP/PARAFAC decomposition techniques are employed to decompose the tensor into temporal, spectral, spatial, and segmental factors. Finally, TF features of both IED and non-IED segments from scalp recordings are projected onto the temporal components for classification.Main results.The model performance is obtained in two different approaches: within- and between-subject classification approaches. Our proposed method is compared with four other methods, namely a tensor-based spatial component analysis method, TF-based method, linear regression mapping model, and asymmetric-symmetric autoencoder mapping model followed by convolutional neural networks. Our proposed method outperforms all these methods in both within- and between-subject classification approaches by respectively achieving 84.2% and 72.6% accuracy values.Significance.The findings show that mapping sEEG to iEEG improves the performance of the scalp-based IED detection model. Furthermore, the tensor-based mapping model outperforms the autoencoder- and regression-based mapping models.
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Affiliation(s)
- Bahman Abdi-Sargezeh
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Antonio Valentin
- Department of Clinical Neuroscience, King's College London, London, United Kingdom
| | - Gonzalo Alarcon
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | | | - Saeid Sanei
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
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Abdi-Sargezeh B, Valentin A, Alarcon G, Sanei S. Incorporating Uncertainty in Data Labeling into Automatic Detection of Interictal Epileptiform Discharges from Concurrent Scalp-EEG via Multi-way Analysis. Int J Neural Syst 2021; 31:2150019. [PMID: 33775232 DOI: 10.1142/s0129065721500192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Interictal epileptiform discharges (IEDs) are elicited from an epileptic brain, whereas they can also be due to other neurological abnormalities. The diversity in their morphologies, their strengths, and their sources within the brain cause a great deal of uncertainty in their labeling by clinicians. The aim of this study is therefore to exploit and incorporate this uncertainty (the probability of the waveform being an IED) in the IED detection system which combines spatial component analysis (SCA) with the IED probabilities referred to as SCA-IEDP-based method. For comparison, we also propose and study SCA-based method in which probability of the waveform being an IED is ignored. The proposed models are employed to detect IEDs in two different classification approaches: (1) subject-dependent and (2) subject-independent classification approaches. The proposed methods are compared with two other state-of-the-art methods namely, time-frequency features and tensor factorization methods. The proposed SCA-IEDP model has achieved superior performance in comparison with the traditional SCA and other competing methods. It achieved 79.9% and 63.4% accuracy values in subject-dependent and subject-independent classification approaches, respectively. This shows that considering the IED probabilities in designing an IED detection system can boost its performance.
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Affiliation(s)
| | - Antonio Valentin
- Department of Clinical Neuroscience, King's College London, London, UK
| | - Gonzalo Alarcon
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - Saeid Sanei
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
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Bick SK, Dolatshahi MS, Grannan BL, Cole AJ, Hoch DB, Eskandar EN. Preoperative MRI findings and prediction of diagnostic utility of foramen ovale electrodes. J Neurosurg 2020; 132:692-699. [PMID: 30849762 DOI: 10.3171/2018.12.jns182093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Foramen ovale electrodes (FOEs) are a minimally invasive method to localize mesial temporal seizures in cases in which noninvasive methods are inconclusive. The objective of this study was to identify factors predicting the ability of FOEs to yield a diagnosis in order to determine optimal candidates for this procedure. METHODS All cases of diagnostic investigations performed with FOEs at the authors' institution between 2005 and 2017 were reviewed. FOE investigation was defined as diagnostic if it led to a treatment decision. Demographic and clinical variables for diagnostic and nondiagnostic investigations were compared using a Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables. RESULTS Ninety-three patients underwent investigations performed with FOEs during the study period and were included in the study. FOE investigation was diagnostic in 75.3% of cases. Of patients who underwent anterior temporal lobectomy following diagnostic FOE evaluation, 75.9% were Engel class I at last follow-up (average 40.1 months). When the diagnostic and nondiagnostic FOE groups were compared, patients who had diagnostic investigations were more likely to be male (57.1% male vs 26.1% in the nondiagnostic group, p = 0.015). They were also more likely to have temporal lesions on preoperative MRI (p = 0.018). CONCLUSIONS FOEs are a useful, minimally invasive diagnostic modality resulting in a treatment decision in 75% of cases. Male patients and patients with temporal lesions on MRI may be most likely to benefit from FOE investigation.
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Affiliation(s)
| | | | | | - Andrew J Cole
- 2Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel B Hoch
- 2Neurology, Massachusetts General Hospital, Boston, Massachusetts
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Abou Jaoude M, Jing J, Sun H, Jacobs CS, Pellerin KR, Westover MB, Cash SS, Lam AD. Detection of mesial temporal lobe epileptiform discharges on intracranial electrodes using deep learning. Clin Neurophysiol 2020; 131:133-141. [PMID: 31760212 PMCID: PMC6879011 DOI: 10.1016/j.clinph.2019.09.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/10/2019] [Accepted: 09/16/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Develop a high-performing algorithm to detect mesial temporal lobe (mTL) epileptiform discharges on intracranial electrode recordings. METHODS An epileptologist annotated 13,959 epileptiform discharges from a dataset of intracranial EEG recordings from 46 epilepsy patients. Using this dataset, we trained a convolutional neural network (CNN) to recognize mTL epileptiform discharges from a single intracranial bipolar channel. The CNN outputs from multiple bipolar channel inputs were averaged to generate the final detector output. Algorithm performance was estimated using a nested 5-fold cross-validation. RESULTS On the receiver-operating characteristic curve, our algorithm achieved an area under the curve (AUC) of 0.996 and a partial AUC (for specificity > 0.9) of 0.981. AUC on a precision-recall curve was 0.807. A sensitivity of 84% was attained at a false positive rate of 1 per minute. 35.9% of the false positive detections corresponded to epileptiform discharges that were missed during expert annotation. CONCLUSIONS Using deep learning, we developed a high-performing, patient non-specific algorithm for detection of mTL epileptiform discharges on intracranial electrodes. SIGNIFICANCE Our algorithm has many potential applications for understanding the impact of mTL epileptiform discharges in epilepsy and on cognition, and for developing therapies to specifically reduce mTL epileptiform activity.
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Affiliation(s)
- Maurice Abou Jaoude
- Epilepsy Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jin Jing
- Epilepsy Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Haoqi Sun
- Epilepsy Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Claire S Jacobs
- Epilepsy Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kyle R Pellerin
- Epilepsy Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M Brandon Westover
- Epilepsy Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Epilepsy Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alice D Lam
- Epilepsy Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland. Acta Neurochir (Wien) 2018; 160:3-22. [PMID: 29134341 PMCID: PMC5735218 DOI: 10.1007/s00701-017-3357-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/06/2017] [Indexed: 11/14/2022]
Abstract
Background The predecessor of today’s Department of Neurosurgery, UniversitätsSpital Zürich (USZ), was founded 80 years ago as the first independent Swiss clinic dedicated to neurosurgical patient care. On the occasion of this anniversary, we aimed to highlight the history of neurosurgery as a specialty at the USZ, and to put it into the historical context of Swiss and European Neurosurgery. Method A literature review was conducted and we searched the archives of the USZ and the city of Zurich, as well as those of Swiss journals to extract relevant published articles, books, historical reports and pictures. The USZ Department of Medical History, the Museum of Medical History and the Swiss National Library were contacted to provide source material. To further verify the content, (emeritus) faculty from the USZ and external experts on the history of Swiss neurosurgery reviewed the manuscript. Results Surgeries of the head and spine had occasionally been conducted in Zurich by the general surgeons, Rudolf Ulrich Krönlein and Paul Clairmont, before an independent neurosurgical clinic was founded by Hugo Krayenbühl on 6 July 1937. This was the first Swiss department dedicated to neurosurgical patient care. Besides providing high-quality medicine for both the local and wider population, the department was chaired by eminent leaders of neurosurgery, who influenced the scientific and clinical neurosurgery of their time. As such, it has long been regarded as one of the top teaching and research hospitals in Switzerland and in Europe. Conclusions On the occasion of its 80th anniversary, we have performed an in-depth review of its development, successes and challenges, with a special focus on the early decades. Reflecting on the past, we have identified common denominators of success in neurosurgery that remain valid today. Electronic supplementary material The online version of this article (10.1007/s00701-017-3357-z) contains supplementary material, which is available to authorised users.
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Patel SH, Halpern CH, Shepherd TM, Timpone VM. Electrical stimulation and monitoring devices of the CNS: An imaging review. J Neuroradiol 2017; 44:175-184. [DOI: 10.1016/j.neurad.2016.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/12/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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Shah AK, Mittal S. Invasive electroencephalography monitoring: Indications and presurgical planning. Ann Indian Acad Neurol 2014; 17:S89-94. [PMID: 24791095 PMCID: PMC4001224 DOI: 10.4103/0972-2327.128668] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 12/01/2013] [Accepted: 12/01/2013] [Indexed: 11/24/2022] Open
Abstract
Electroencephalography (EEG) remains a “gold standard” for defining seizures; hence identification of epileptogenic zone for surgical treatment of epilepsy requires precise electrographic localization of the seizures. Routine scalp EEG recording is not sufficient in many instances, such as extratemporal lobe epilepsy or non-lesional temporal lobe epilepsy. In these individuals EEG recording from proximity of the seizure focus is necessary, which can be achieved by placing electrodes on the surface or in the substance of the brain. As this process requires invasive procedures (usually necessitating surgical intervention) EEG obtained via these electrodes is defined as invasive electroencephalography (iEEG). As only limited areas of the brain can be covered by these electrodes in an individual, precise targeting of the presumed seizure onset location is crucial. The presurgical planning includes where to place electrodes, which type of the electrodes to choose and planned duration of the intracranial recording. Though there are general principles that guide such endeavor, each center does it slightly differently depending upon the various technologies available to them and expertise and preferences of the epilepsy surgery team. Here we describe our approach to iEEG recording. We briefly describe the background, types of iEEG recording and rationale for each, various electrode types, and scenarios where iEEG might be useful. We also describe planning of iEEG recording once the need has been established as well as our decision making process of deciding about location of electrode placement, type of electrodes to use, length of recording, choice of arrays, mapping of eloquent cortex and finally surgical planning and decisions.
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Affiliation(s)
- Aashit K Shah
- Department of Neurology, Detroit, Michigan, USA ; Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA ; Detroit Medical Center, Detroit, Michigan, USA ; Karmanos Cancer Institute, Detroit, Michigan, USA
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Sheth SA, Aronson JP, Shafi MM, Phillips HW, Velez-Ruiz N, Walcott BP, Kwon CS, Mian MK, Dykstra AR, Cole A, Eskandar EN. Utility of foramen ovale electrodes in mesial temporal lobe epilepsy. Epilepsia 2014; 55:713-724. [DOI: 10.1111/epi.12571] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Sameer A. Sheth
- Department of Neurosurgery; Columbia University Medical Center; New York Presbyterian Hospital; New York New York U.S.A
| | - Joshua P. Aronson
- Department of Neurosurgery; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - Mouhsin M. Shafi
- Division of Epilepsy; Department of Neurology; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts U.S.A
| | - H. Wesley Phillips
- Department of Neurosurgery; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - Naymee Velez-Ruiz
- Department of Neurology; Emory University School of Medicine; Atlanta Georgia U.S.A
| | - Brian P. Walcott
- Department of Neurosurgery; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - Churl-Su Kwon
- Department of Neurosurgery; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - Matthew K. Mian
- Department of Neurosurgery; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - Andrew R. Dykstra
- Department of Neurology; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - Andrew Cole
- Department of Neurology; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - Emad N. Eskandar
- Department of Neurosurgery; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
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