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Gates S, Hackman DE, Agarwal N, Zhang W, Barnard P, White JR. Postoperative Neurologic Outcome in Patients Undergoing Resective Surgery for Parietal Lobe Epilepsy: A Systematic Review. Neurology 2024; 102:e209322. [PMID: 38815235 DOI: 10.1212/wnl.0000000000209322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Parietal lobe epilepsy (PLE) surgery can be an effective treatment for selected patients with intractable epilepsy but can be associated with the risk of serious neurologic deficits. We performed a systematic review of the literature to obtain a comprehensive summary of the frequency and types of new postoperative neurologic deficits in patients undergoing PLE resective surgery. METHODS We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published between January 1, 1990, and April 28, 2022. We included studies that reported postoperative neurologic outcome following PLE resective surgery confined to the parietal lobe. We required that studies included ≥5 patients. The data collected included demographic information and specific details of postoperative neurologic deficits. When available, individual patient data were collected. We used the Risk of Bias in Nonrandomized Studies of Interventions tool to assess the risk of bias and Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence. RESULTS Of the 3,461 articles screened, 33 studies met the inclusion criteria. A total of 370 patients were included. One hundred patients (27.0%) had a new deficit noted postoperatively. Approximately half of the patients with deficits experienced only transient deficits. Motor deficits were the most commonly identified deficit. The rates of motor deficits noted after PLE surgery were 5.7%, 3.2%, and 2.2% for transient, long-term, and duration not specified, respectively. Sensory and visual field deficits were also commonly reported. Gerstmann syndrome was noted postoperatively in 4.9% of patients and was almost always transient. Individual patient data added information on parietal lobe subregion postoperative neurologic outcome. DISCUSSION Our systematic review provides a comprehensive summary of the frequency and types of neurologic deficits associated with PLE surgery. A significant percentage of postoperative deficits are transient. In addition to the expected sensory and visual deficits, PLE surgery is associated with a notable risk of motor deficits. The available literature has important deficiencies. Our study highlights gaps in the literature and provides recommendations for future directions. TRIAL REGISTRATION INFORMATION This systematic review was registered on PROSPERO (CRD42022313108, May 26, 2022).
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Affiliation(s)
- Stuart Gates
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Dawn E Hackman
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Nitin Agarwal
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Wenbo Zhang
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Pamela Barnard
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - James R White
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
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Yakimov AM, Timechko EE, Areshkina IG, Usoltseva AA, Yakovleva KD, Kantimirova EA, Utyashev N, Ivin N, Dmitrenko DV. MicroRNAs as Biomarkers of Surgical Outcome in Mesial Temporal Lobe Epilepsy: A Systematic Review. Int J Mol Sci 2023; 24:ijms24065694. [PMID: 36982768 PMCID: PMC10052204 DOI: 10.3390/ijms24065694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Mesial temporal lobe epilepsy is the most common type of epilepsy. For most patients suffering from TLE, the only treatment option is surgery. However, there is a high possibility of relapse. Invasive EEG as a method for predicting the outcome of surgical treatment is a very complex and invasive manipulation, so the search for outcome biomarkers is an urgent task. MicroRNAs as potential biomarkers of surgical outcome are the subject of this study. For this study, a systematic search for publications in databases such as PubMed, Springer, Web of Science, Scopus, ScienceDirect, and MDPI was carried out. The following keywords were used: temporal lobe epilepsy, microRNA, biomarkers, surgery, and outcome. Three microRNAs were studied as prognostic biomarkers of surgical outcome: miR-27a-3p, miR-328-3p, and miR-654-3p. According to the results of the study, only miR-654-3p showed a good ability to discriminate between patients with poor and good surgical outcomes. MiR-654-3p is involved in the following biological pathways: ATP-binding cassette drug transporters, glutamate transporter SLC7A11, and TP53. A specific target for miR-654-3p is GLRA2, the glycine receptor subunit. MicroRNAs, which are diagnostic biomarkers of TLE, and epileptogenesis, miR-134-5p, MiR-30a, miRs-143, etc., can be considered as potential biomarkers of surgical outcome, as they can be indicators of early and late relapses. These microRNAs are involved in the processes characteristic of epilepsy: oxidative stress and apoptosis. The study of miRNAs as potential predictive biomarkers of surgical outcome is an urgent task and should be continued. However, when studying miRNA expression profiles, it is important to take into account and note a number of factors, such as the type of sample under study, the time of sampling for the study, the type and duration of the disease, and the type of antiepileptic treatment. Without taking into account all these factors, it is impossible to assess the influence and involvement of miRNAs in epileptic processes.
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Affiliation(s)
- Alexey M. Yakimov
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Elena E. Timechko
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
- Correspondence: (E.E.T.); (D.V.D.)
| | - Irina G. Areshkina
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Anna A. Usoltseva
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Kristina D. Yakovleva
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Elena A. Kantimirova
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Nikita Utyashev
- Federal State Budgetary Institution “National Medical and Surgical Center Named after N.I. Pirogov”, 105203 Moscow, Russia
| | - Nikita Ivin
- Federal State Budgetary Institution “National Medical and Surgical Center Named after N.I. Pirogov”, 105203 Moscow, Russia
| | - Diana V. Dmitrenko
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
- Correspondence: (E.E.T.); (D.V.D.)
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Yossofzai O, Fallah A, Maniquis C, Wang S, Ragheb J, Weil AG, Brunette-Clement T, Andrade A, Ibrahim GM, Mitsakakis N, Widjaja E. Development and validation of machine learning models for prediction of seizure outcome after pediatric epilepsy surgery. Epilepsia 2022; 63:1956-1969. [PMID: 35661152 DOI: 10.1111/epi.17320] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is substantial variability in reported seizure outcome following pediatric epilepsy surgery, and lack of individualized predictive tools that could evaluate the probability of seizure freedom postsurgery. The aim of this study was to develop and validate a supervised machine learning (ML) model for predicting seizure freedom after pediatric epilepsy surgery. METHODS This is a multicenter retrospective study of children who underwent epilepsy surgery at five pediatric epilepsy centers in North America. Clinical information, diagnostic investigations, and surgical characteristics were collected, and used as features to predict seizure-free outcome 1 year after surgery. The dataset was split randomly into 80% training and 20% testing data. Thirty-five combinations of five feature sets with seven ML classifiers were assessed on the training cohort using 10-fold cross-validation for model development. The performance of the optimal combination of ML classifier and feature set was evaluated in the testing cohort, and compared with logistic regression, a classical statistical approach. RESULTS Of the 801 patients included, 61.3% were seizure-free 1 year postsurgery. During model development, the best combination was XGBoost ML algorithm with five features from the univariate feature set, including number of antiseizure medications, magnetic resonance imaging lesion, age at seizure onset, video-electroencephalography concordance, and surgery type, with a mean area under the curve (AUC) of .73 (95% confidence interval [CI] = .69-.77). The combination of XGBoost and univariate feature set was then evaluated on the testing cohort and achieved an AUC of .74 (95% CI = .66-.82; sensitivity = .87, 95% CI = .81-.94; specificity = .58, 95% CI = .47-.71). The XGBoost model outperformed the logistic regression model (AUC = .72, 95% CI = .63-.80; sensitivity = .72, 95% CI = .63-.82; specificity = .66, 95% CI = .53-.77) in the testing cohort (p = .005). SIGNIFICANCE This study identified important features and validated an ML algorithm, XGBoost, for predicting the probability of seizure freedom after pediatric epilepsy surgery. Improved prognostication of epilepsy surgery is critical for presurgical counseling and will inform treatment decisions.
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Affiliation(s)
- Omar Yossofzai
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Aria Fallah
- Department of Neurosurgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Cassia Maniquis
- Department of Neurosurgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Shelly Wang
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, USA
| | - John Ragheb
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Alexander G Weil
- Department of Neurosurgery, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | | | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George M Ibrahim
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Barkley AS, Sullivan LT, Gibson AW, Zalewski K, Mac Donald CL, Barber JK, Hakimian S, Ko AL, Ojemann JG, Hauptman JS. Acute Postoperative Seizures and Engel Class Outcome at 1 Year Postselective Laser Amygdalohippocampal Ablation for Mesial Temporal Lobe Epilepsy. Neurosurgery 2022; 91:347-354. [PMID: 35506941 DOI: 10.1227/neu.0000000000002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND MRI-guided laser interstitial thermal therapy (MRgLITT) for mesial temporal lobe epilepsy is a safe, minimally invasive alternative to traditional surgical approaches. Prognostic factors associated with efficacy are debated; preoperative epilepsy duration and semiology seem to be important variables. OBJECTIVE To determine whether acute postoperative seizure (APOS) after MRgLITT for mesial temporal lobe epilepsy is associated with seizure freedom/Engel class outcome at 1 year. METHODS A single-institution retrospective study including adults undergoing first time MRgLITT for mesial temporal lobe epilepsy (2010-2019) with ≥1-year follow-up. Preoperative data included sex, epilepsy duration, number of antiepileptics attempted, weekly seizure frequency, seizure semiology, and radiographically verified anatomic lesion at seizure focus. Postoperative data included clinical detection of APOS within 7 days postoperatively, and immediate amygdala, hippocampal, entorhinal, and parahippocampal residual volumes determined using quantitative imaging postprocessing. Primary outcome was seizure freedom/Engel classification 1 year postoperatively. RESULTS Of 116 patients, 53% (n = 61) were female, with an average epilepsy duration of 21 (±14) years, average 6 failed antiepileptics (±3), and weekly seizure frequency of 5. APOS was associated with worse Engel class (P = .010), conferring 6.3 times greater odds of having no improvement vs achieving seizure freedom at 1 year. Residual amygdala, hippocampal, entorhinal, and parahippocampal volumes were not statistically significant prognostic factors. CONCLUSION APOS was associated with a lower chance of seizure freedom at 1 year post-MRgLITT for mesial temporal lobe epilepsy. Amygdala, hippocampal, entorhinal, and parahippocampal residual volumes after ablation were not significant prognostic factors.
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Affiliation(s)
- Ariana S Barkley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Liam T Sullivan
- Department of Biology, University of Washington, Seattle, Washington, USA
| | - Alec W Gibson
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kody Zalewski
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Jason K Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Shahin Hakimian
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Andrew L Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
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5
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Kim W, Shen MY, Provenzano FA, Lowenstein DB, McBrian DK, Mandel AM, Sands TT, Riviello JJ, McKhann GM, Feldstein NA, Akman CI. The role of stereo-electroencephalography to localize the epileptogenic zone in children with nonlesional brain magnetic resonance imaging. Epilepsy Res 2022; 179:106828. [PMID: 34920378 DOI: 10.1016/j.eplepsyres.2021.106828] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to assess the clinical outcome and outcome predictive factors in pediatric epilepsy patients evaluated with stereo-electroencephalography (SEEG). METHODS Thirty-eight patients who underwent SEEG implantation at the Pediatric Epilepsy Center in New York Presbyterian Hospital between June 2014 and December 2019 were enrolled for retrospective chart review. Postoperative seizure outcomes were evaluated in patients with at least 12-months follow up. Meta-analysis was conducted via electronic literature search of data reported from 2000 to 2020 to evaluate significant surgical outcome predictors for SEEG evaluation in the pediatric population. RESULTS In the current case series of 25 postsurgical patients with long-term follow up, 16 patients (64.0%) were seizure free. An additional 7 patients (28.0%) showed significant seizure improvement and 2 patients (8.0%) showed no change in seizure activity. Patients with nonlesional magnetic resonance imaging (MRI) achieved seizure freedom in 50% (5/10) of cases. By comparison, 73% (11/15) of patients with lesional MRI achieved seizure freedom. Out of 12 studies, 158 pediatric patients were identified for inclusion in a meta-analysis of the effectiveness of SEEG. Seizure freedom was reported 54.4% (n = 86/158) of patients at last follow up. Among patients with nonlesional MRI, 45% (n = 24) achieved seizure freedom compared with patients with lesional MRI findings (61.2%, n:= 60) (p = 0.02). The risk for seizure recurrence was 2.15 times higher [95% confidence interval [CI] 1.06-4.37, p = 0.033] in patients diagnosed with nonlesional focal epilepsy compared to those with lesional epilepsy [ 1.49 (95% CI 1.06-2.114, p = 0.021]. CONCLUSION Evaluation by SEEG implantation in pediatric epilepsy is effective in localizing the epileptogenic zone with favorable outcome. Presence of a non-lesional brain MRI was associated with lower chances of seizure freedom. Further research is warranted to improve the efficacy of SEEG in localizing the epileptogenic zone in pediatric patients with non-lesional brain MRI.
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Affiliation(s)
- Woojoong Kim
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Min Y Shen
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Frank A Provenzano
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, USA
| | - Daniel B Lowenstein
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Danielle K McBrian
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Arthur M Mandel
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Tristan T Sands
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - James J Riviello
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York, USA
| | - Neil A Feldstein
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York, USA
| | - Cigdem I Akman
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA.
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Starnes K, Depositario-Cabacar D, Wong-Kisiel L. Presurgical Evaluation Strategies for Intractable Epilepsy of Childhood. Semin Pediatr Neurol 2021; 39:100915. [PMID: 34620457 DOI: 10.1016/j.spen.2021.100915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
For children who continue to experience seizures despite treatment with antiseizure medications, epilepsy surgery can be considered. The goals of the presurgical evaluation are to determine the best surgical approach to render a good outcome. In patients with drug resistant focal epilepsy, the epileptogenic zone defines the minimal brain volume which must be resected for surgical success and to delineate the relationship of this region with functional cortex. A number of noninvasive tools for these tasks have emerged over the past decade, and existing technologies have been revised and improved. In this review, we examine the recent published evidence for these techniques, specifically as applied to the pediatric population. Discussed herein are the diagnostic value of methods such as video electroencephalography, magnetic resonance imaging, and supportive neuroimaging techniques including single photon emission tomography, photon emission tomography, and magnetoencephalography. Functional testing including functional magnetic resonance imaging, electrical stimulation mapping, and transcranial magnetic stimulation are considered in the context of pediatric epilepsy. The application of emerging techniques to preoperative testing such as source localization, image post-processing, and artificial intelligence is covered. We summarize the relative value of presurgical testing based on patient characteristics, including lesional or nonlesional MRI, temporal or extratemporal epilepsy, and other factors relevant in pediatric epilepsy such as pathological substrate and age.
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Affiliation(s)
| | | | - Lily Wong-Kisiel
- Department of Neurology and Pediatrics, Mayo Clinic, Rochester, MN.
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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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8
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Liu Y, Chen G, Chen J, Zhou J, Su L, Zhao T, Zhang G. Individualized stereoelectroencephalography evaluation and navigated resection in medically refractory pediatric epilepsy. Epilepsy Behav 2020; 112:107398. [PMID: 32891888 DOI: 10.1016/j.yebeh.2020.107398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 11/25/2022]
Abstract
Pediatric patients frequently require invasive exploration with intracranial electrodes to achieve high-resolution delineation of the epileptogenic zones (EZ). We intend to discuss the efficacy and safety of stereoelectroencephalophraphy (SEEG) monitoring in pediatric patients with difficulty to localize the EZ. We retrospectively analyzed presurgical findings, SEEG data, resections, and outcomes of a series of 72 consecutive pediatric patients (<18 yrs) who had medically refractory epilepsy and received SEEG recording between January 2015 and September 2019. There were 20 girls and 52 boys with a mean age of 10.13 ± 4.11 years old (range: 1.8-18 years). Twenty-seven patients (37.5%) had nonlesional magnetic resonance imagings (MRIs). In total, 744 electrodes were implanted for an average of 10.33 ± 2.53 (range: 3-18) electrodes per patient. Twenty-eight explorations were unilateral (17 left and 11 right), and 44 explorations were bilateral (12 of which was predominately one side). The average monitoring period in days for the SEEG was 8.99 ± 5.79 (range: 3-25) days. The EZ could be located in 67 (94.4%) patients for the initial implantation according to SEEG monitoring. Lobectomy was performed in 12 patients (17.9%), of those anterior temporal lobectomy (ATL) was performed in 8 cases (11.9%) and insular plus was 2 cases (3.0%), multilobectomy resections in 15 cases (22.4%), tailored cortical resections in 37 cases (55.2%), and corpus callosotomy plus in 2 cases (3.0%). The average follow-up was 18.1 ± 7.53 months (range: 6-54). Forty-three of 67 patients (64.2%) were Engel class I, 12 patients (17.9%) were Engel class II, 10 patients (14.9%) were Engel class III, and an additional 2 patients (3.0%) were Engel class IV. In the SEEG implantation series, no child experienced serious or permanent morbidity. One patient (1.4%) experienced symptomatic intracranial hemorrhage (ICH), and 3 patients (4.2%) experienced asymptomatic ICH. There were no postimplantation infections or other postoperative complications associated with the SEEG. Several common complications related to resection surgery were included in this series with zero mortality. Of the 6 patients in whom we performed a second surgery, 4 of them subsequently became seizure-free (66.7%) after undergoing the second resection with SEEG evaluation. Stereoelectroencephalophraphy is a safe and efficient methodology to identify the EZ in particularly complex cases of focal medically refractory epilepsy for pediatric patients, even in infancy and early childhood. Seizure outcomes of SEEG-guided resection surgery are desirable. We recommend SEEG evaluations and even a more aggressive resection in certain pediatric patients who failed initial resection with realistic chances to benefit from reoperation.
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Affiliation(s)
- Yaoling Liu
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Guoqiang Chen
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Jianwei Chen
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Junjian Zhou
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Lanmei Su
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Tong Zhao
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China
| | - Guangming Zhang
- Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China.
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Bellamkonda N, Phillips HW, Chen JS, Tucker AM, Maniquis C, Mathern GW, Fallah A. Epilepsy surgery for Rasmussen encephalitis: the UCLA experience. J Neurosurg Pediatr 2020; 26:389-397. [PMID: 32679562 DOI: 10.3171/2020.4.peds2098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rasmussen encephalitis (RE) is a rare inflammatory neurological disorder typically involving one hemisphere and resulting in drug-resistant epilepsy and progressive neurological decline. Here, the authors present seizure outcomes in children who underwent epilepsy surgery for RE at a single institution. METHODS The records of consecutive patients who had undergone epilepsy surgery for RE at the UCLA Mattel Children's Hospital between 1982 and 2018 were retrospectively reviewed. Basic demographic information, seizure history, procedural notes, and postoperative seizure and functional outcome data were analyzed. RESULTS The cohort included 44 patients, 41 of whom had sufficient data for analysis. Seizure freedom was achieved in 68%, 48%, and 22% of the patients at 1, 5, and 10 years, respectively. The median time to the first seizure for those who experienced seizure recurrence after surgery was 39 weeks (IQR 11-355 weeks). Anatomical hemispherectomy, as compared to functional hemispherectomy, was independently associated with a longer time to postoperative seizure recurrence (HR 0.078, p = 0.03). There was no statistically significant difference in postoperative seizure recurrence between patients with complete hemispherectomy and those who had less-than-hemispheric surgery. Following surgery, 68% of the patients could ambulate and 84% could speak regardless of operative intervention. CONCLUSIONS A large proportion of RE patients will have seizure relapse after surgery, though patients with anatomical hemispherectomies may have a longer time to postoperative seizure recurrence. Overall, the long-term data in this study suggest that hemispheric surgery can be seen as palliative treatment for seizures rather than a cure for RE.
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Affiliation(s)
| | | | - Jia-Shu Chen
- Departments of1Neurosurgery
- 4Department of Neuroscience, Brown University, Providence, Rhode Island; and
| | - Alexander M Tucker
- 5Department of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | | | - Gary W Mathern
- Departments of1Neurosurgery
- 3Psychiatry and Biobehavioral Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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10
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Kaufmann E, Bartolomei F, Boon P, Chabardes S, Colon AJ, Eross L, Fabó D, Gonçalves-Ferreira A, Imbach LL, Van Paesschen W, Peltola J, Rego R, Theys T, Voges B. European Expert Opinion on ANT-DBS therapy for patients with drug-resistant epilepsy (a Delphi consensus). Seizure 2020; 81:201-209. [PMID: 32861153 DOI: 10.1016/j.seizure.2020.08.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/23/2020] [Accepted: 08/13/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Although deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) represents an established third-line therapy for patients with drug-resistant focal epilepsy, guiding reports on practical treatment principles remain scarce. METHODS An Expert Panel (EP) of 10 European neurologists and 4 neurosurgeons was assembled to share their experience with ANT-DBS therapy. The process included a review of the current literature, which served as a basis for an online survey completed by the EP prior to and following a face-to-face meeting (Delphi method). An agreement level of ≥71 % was considered as consensus. RESULTS Out of 86 reviewed studies, 46 (53 %) were selected to extract information on the most reported criteria for patient selection, management, and outcome. The Delphi process yielded EP consensus on 4 parameters for selection of good candidates and patient management as well as 7 reasons of concern for this therapy. Since it was not possible to give strict device programming advice due to low levels of evidence, the experts shared their clinical practice: all of them start with monopolar stimulation, 79 % using the cycling mode. Most (93 %) EP members set the initial stimulation frequency and pulse width according to the SANTE parameters, while there is more variability in the amplitudes used. Further agreement was achieved on a list of 7 patient outcome parameters to be monitored during the follow-up. CONCLUSIONS Although current evidence is too low for definite practical guidelines, this EP report could support the selection and management of patients with ANT-DBS.
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Affiliation(s)
- Elisabeth Kaufmann
- Epilepsy Center, Department of Neurology, University Hospital, LMU Munich, Munich, Germany.
| | - Fabrice Bartolomei
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France; APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Paul Boon
- Reference Center for Refractory Epilepsy, Ghent University Hospital Belgium - Academic Center for Epileptology, Heeze-Maastricht, the Netherlands
| | - Stéphan Chabardes
- Department of Neurosurgery-Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Department of Neurosurgery, Grenoble Alpes University Hospital, Grenoble, France; Grenoble Institute of Neurosciences GIN-INSERM U1216/CEA/UGA, Grenoble, France; Grenoble Alpes University, Grenoble, France
| | - Albert J Colon
- Academic Centre for Epileptology, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands; Academic Centre for Epileptology, Kempenhaeghe, Heeze, the Netherlands
| | - Loránd Eross
- Faculty of Information Technology and Bionics, Péter Pázmány Catholic University, Budapest, Hungary; Department of Functional Neurosurgery, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Dániel Fabó
- Epilepsy Centrum, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Antonio Gonçalves-Ferreira
- Department of Neurosurgery, University Hospital Santa Maria, Faculdade Medicina Lisboa, Lisbon, Portugal
| | - Lukas L Imbach
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wim Van Paesschen
- Department of Neurology, UZ Leuven, Leuven, Belgium; Laboratory for Epilepsy Research, KU Leuven, Leuven, Belgium
| | - Jukka Peltola
- Department of Neurology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Ricardo Rego
- Department of Neurophysiology, Hospital De São João, Porto, Portugal
| | - Tom Theys
- Laboratory for Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Berthold Voges
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany
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11
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Novak V, Maulisova A, Jezdik P, Benova B, Belohlavkova A, Liby P, Tichy M, Krsek P. Generalized quasiperiodic epileptiform activity in sleep is associated with cognitive impairment in children with drug-resistant focal lesional epilepsy. Epilepsia 2019; 60:2263-2276. [PMID: 31612465 DOI: 10.1111/epi.16362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the impact of generalized quasiperiodic epileptiform discharges ("hurdles") observed in non-rapid eye movement (NREM) sleep on cognitive function in children with intractable focal epilepsy. "Hurdles" pattern does not meet the criteria of the electrical status epilepticus in slow-wave sleep (ESES). METHODS In a retrospective analysis, 24 patients with "hurdles" and their 24 peers matched for demographic and epilepsy-related variables were compared in terms of neuropsychological domains and electroencephalography (EEG)-derived quantifiers. Both "hurdles" and controls were children between 2 and 19 years of age who had intractable focal epilepsy evaluated as candidates of resective epilepsy surgery. RESULTS Full-scale intelligence quotient/developmental quotient (FSIQ/DQ) (P = .002) and visuoconstructional skills (P = .004) were significantly lower in children with "hurdles" compared to controls. Patients with "hurdles" presented with higher interictal spike indexes in sleep (P < .001, median difference -0.9, 95% confidence interval [CI] -1.4, -0.6) and wakefulness (P < .001, median difference -0.3, 95% CI -0.5, -1). Relative time of sleep spindles in NREM sleep was significantly reduced (P < .001, median difference 0.1, 95% CI 0.0, 0.1) in the "hurdles" group. The time proportion of sleep spindles represented a significant positive (P = .008) and spike index of generalized spikes in sleep a significant negative explanatory variable (P = .004) of FSIQ/DQ scores. The proportion of seizure-free patients 2 years after epilepsy surgery did not differ significantly between the two groups (P = .19). SIGNIFICANCE Although the "hurdles" pattern does not fulfill the criteria of ESES, it is associated with a pronounced cognitive dysfunction. Disturbed sleep structure marked by reduced sleep spindles and generalized spiking in sleep is associated with worse cognitive performance. Despite having a generalized nature, we did not find a lower probability of postsurgical seizure freedom in patients with "hurdles" pattern.
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Affiliation(s)
- Vilem Novak
- Department of Paediatric Neurology, Ostrava Faculty Hospital, Ostrava, Czech Republic.,Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Alice Maulisova
- Department of Clinical Psychology, Motol University Hospital, Prague, Czech Republic
| | - Petr Jezdik
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University of Prague, Prague, Czech Republic
| | - Barbora Benova
- Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Anezka Belohlavkova
- Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Petr Liby
- Department of Neurosurgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague 5, Czech Republic
| | - Michal Tichy
- Department of Neurosurgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague 5, Czech Republic
| | - Pavel Krsek
- Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
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12
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Abstract
BACKGROUND This is an updated version of the original Cochrane review, published in 2015.Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary between at least 20% and up to 70%. If the epileptogenic zone can be located, surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.Secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence, and to identify the factors that correlate with remission of seizures postoperatively. SEARCH METHODS For the latest update, we searched the following databases on 11 March 2019: Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to March 08, 2019), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) that included at least 30 participants in a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), with an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome related to postoperative seizure control. Cohort studies or case series were included in the previous version of this review. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportions of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RRs) and 95% confidence intervals (95% CIs). MAIN RESULTS We identified 182 studies with a total of 16,855 included participants investigating outcomes of surgery for epilepsy. Nine studies were RCTs (including two that randomised participants to surgery or medical treatment (99 participants included in the two trials received medical treatment)). Risk of bias in these RCTs was unclear or high. Most of the remaining 173 non-randomised studies followed a retrospective design. We assessed study quality using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses, we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across domains.In terms of freedom from seizures, two RCTs found surgery (n = 97) to be superior to medical treatment (n = 99); four found no statistically significant differences between anterior temporal lobectomy (ATL) with or without corpus callosotomy (n = 60), between subtemporal or transsylvian approach to selective amygdalohippocampectomy (SAH) (n = 47); between ATL, SAH and parahippocampectomy (n = 43) or between 2.5 cm and 3.5 cm ATL resection (n = 207). One RCT found total hippocampectomy to be superior to partial hippocampectomy (n = 70) and one found ATL to be superior to stereotactic radiosurgery (n = 58); and another provided data to show that for Lennox-Gastaut syndrome, no significant differences in seizure outcomes were evident between those treated with resection of the epileptogenic zone and those treated with resection of the epileptogenic zone plus corpus callosotomy (n = 43). We judged evidence from the nine RCTs to be of moderate to very low quality due to lack of information reported about the randomised trial design and the restricted study populations.Of the 16,756 participants included in this review who underwent a surgical procedure, 10,696 (64%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to recording of adverse events to be very poor.In total, 120 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography, history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection, and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation, and presence of postoperative discharges were prognostic factors of outcome.Twenty-nine studies reported multi-variable models of prognostic factors, and showed that the direction of association of factors with outcomes was generally the same as that found in univariate analyses.We observed variability in many of our analyses, likely due to small study sizes with unbalanced group sizes and variation in the definition of seizure outcome, the definition of prognostic factors, and the influence of the site of surgery AUTHORS' CONCLUSIONS: Study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcomes. Future research should be of high quality, follow a prospective design, be appropriately powered, and focus on specific issues related to diagnostic tools, the site-specific surgical approach, and other issues such as extent of resection. Researchers should investigate prognostic factors related to the outcome of surgery via multi-variable statistical regression modelling, where variables are selected for modelling according to clinical relevance, and all numerical results of the prognostic models are fully reported. Journal editors should not accept papers for which study authors did not record adverse events from a medical intervention. Researchers have achieved improvements in cancer care over the past three to four decades by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Sarah J Nevitt
- University of LiverpoolDepartment of BiostatisticsBlock F, Waterhouse Building1‐5 Brownlow HillLiverpoolUKL69 3GL
| | - Jennifer Cotton
- The Clatterbridge Cancer Centre NHS Foundation TrustWirralUK
| | - Sacha Gandhi
- NHS Ayrshire and ArranDepartment of General SurgeryAyrUKKA6 6DX
| | - Jennifer Weston
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolMerseysideUKL9 7LJ
| | - Ajay Sudan
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Roberto Ramirez
- Royal Manchester Children's HospitalHospital RoadPendleburyManchesterUKM27 4HA
| | - Richard Newton
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
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13
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Tomlinson SB, Buch VP, Armstrong D, Kennedy BC. Stereoelectroencephalography in Pediatric Epilepsy Surgery. J Korean Neurosurg Soc 2019; 62:302-312. [PMID: 31085956 PMCID: PMC6514312 DOI: 10.3340/jkns.2019.0015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 12/25/2022] Open
Abstract
Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).
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Affiliation(s)
- Samuel B Tomlinson
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Vivek P Buch
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dallas Armstrong
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin C Kennedy
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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14
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Belohlavkova A, Jezdik P, Jahodova A, Kudr M, Benova B, Maulisova A, Liby P, Vaculik M, Lesko R, Kyncl M, Zamecnik J, Tichy M, Komarek V, Krsek P. Evolution of pediatric epilepsy surgery program over 2000-2017: Improvement of care? Eur J Paediatr Neurol 2019; 23:456-465. [PMID: 31023627 DOI: 10.1016/j.ejpn.2019.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/22/2019] [Accepted: 04/08/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE We assessed trends in spectrum of candidates, diagnostic algorithm, therapeutic approach and outcome of a pediatric epilepsy surgery program between 2000 and 2017. METHODS All pediatric patients who underwent curative epilepsy surgery in Motol Epilepsy Center during selected period (n = 233) were included in the study and divided into two groups according to time of the surgery (developing program 2000-2010: n = 86, established program 2011-2017: n = 147). Differences in presurgical, surgical and outcome variables between the groups were statistically analyzed. RESULTS A total of 264 resections or hemispheric disconnections were performed (including 31 reoperations). In the later epoch median age of candidates decreased. Median duration of disease shortened in patients with temporal lobe epilepsy. Number of patients with non-localizing MRI findings (subtle or multiple lesions) rose, as well as those with epileptogenic zone adjacent to eloquent cortex. There was a trend towards one-step procedures guided by multimodal neuroimaging and intraoperative electrophysiology; long-term invasive EEG was performed in fewer patients. Subdural electrodes for long-term invasive monitoring were almost completely replaced by stereo-EEG. The number of focal resections and hemispherotomies rose over time. Surgeries were more often regarded complete. Histopathological findings of resected tissue documented developing spectrum of candidates. 82.0% of all children were seizure-free two years after surgery; major complications occurred in 4.6% procedures; both groups did not significantly differ in these parameters. CONCLUSION In the established pediatric epilepsy surgery program, our patients underwent epilepsy surgery at younger age and suffered from more complex structural pathology. Outcomes and including complication rate remained stable.
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Affiliation(s)
- Anezka Belohlavkova
- Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Petr Jezdik
- Faculty of Electrical Engineering, Department of Circuit Theory, Czech Technical University in Prague, Technicka 2, 166 27 Prague, Czech Republic
| | - Alena Jahodova
- Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Martin Kudr
- Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Barbora Benova
- Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Alice Maulisova
- Department of Psychology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Petr Liby
- Department of Neurosurgery, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Miroslav Vaculik
- Department of Neurosurgery, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Robert Lesko
- Department of Neurosurgery, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Martin Kyncl
- Department of Radiology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Michal Tichy
- Department of Neurosurgery, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Vladimir Komarek
- Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Pavel Krsek
- Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
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15
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Outcome after individualized stereoelectroencephalography (sEEG) implantation and navigated resection in patients with lesional and non-lesional focal epilepsy. J Neurol 2019; 266:910-920. [PMID: 30701313 DOI: 10.1007/s00415-019-09213-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Refined localization of the epileptogenic zone (EZ) in patients with pharmacoresistant focal epilepsy proceeding to resective surgery might improve postoperative outcome. We here report seizure outcome after stereo EEG (sEEG) evaluation with individually planned stereotactically implanted depth electrodes and subsequent tailored resection. METHODS A cohort of consecutive patients with pharmacoresistant focal epilepsy, evaluated with a non-invasive evaluation protocol and invasive monitoring with personalized, stereotactically implanted depth electrodes for sEEG was analyzed. Co-registration of post-implantation CT scan to presurgical MRI data was used for 3D reconstructions of the patients' brain surface and mapping of neurophysiology data. Individual multimodal 3D maps of the EZ were used to guide subsequent tailored resections. The outcome was rated according to the Engel classification. RESULTS Out of 914 patients who underwent non-invasive presurgical evaluation, 85 underwent sEEG, and 70 were included in the outcome analysis. Median follow-up was 31.5 months. Seizure-free outcome (Engel class I A-C, ILAE class 1-2) was achieved in 83% of the study cohort. Patients exhibiting lesional and non-lesional (n = 42, 86% vs. n = 28, 79%), temporal and extratemporal (n = 45, 80% vs. n = 25, 84%), and right- and left-hemispheric epilepsy (n = 44, 82% vs. n = 26, 85%) did similarly well. This remains also true for those with an EZ adjacent to or distant from eloquent cortex (n = 21, 86% vs. n = 49, 82%). Surgical outcome was independent of resected tissue volume. CONCLUSION Favourable post-surgical outcome can be achieved in patients with resistant focal epilepsy, using individualized sEEG evaluation and tailored navigated resection, even in patients with non-lesional or extratemporal focal epilepsy.
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16
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Kogias E, Schmeiser B, Doostkam S, Brandt A, Hammen T, Zentner J, Ramantani G. Multilobar Resections for 3T MRI-Negative Epilepsy: Worth the Trouble? World Neurosurg 2018; 123:e338-e347. [PMID: 30502474 DOI: 10.1016/j.wneu.2018.11.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Multilobar resection in magnetic resonance imaging (MRI)-negative drug-resistant epilepsy warrants attention because they account for up to one third of MRI-negative epilepsy surgery. Despite their high prevalence, data are sparse, and the risk/benefit ratio continues to be debated. The present study investigated the postoperative seizure outcomes in this especially challenging subgroup. METHODS We retrospectively analyzed the data of 4 consecutive patients with 3T MRI-negative findings and drug-resistant focal epilepsy who had undergone multilobar epilepsy surgery at our institution. RESULTS The mean age at first surgery was 28.5 years (range, 14-48); 1 patient required 2 consecutive reoperations. The final resection was in the frontotemporal and temporo-parieto-occipital regions in 2 patients each. Histopathological examination revealed mild malformations of cortical development in 2 patients and focal cortical dysplasia type Ia and type IIa in 1 patient each. At the last follow-up examination (median, 3.3 years; range, 1-11), 2 patients were completely seizure free (Engel class Ia), 1 patient had experienced some disabling seizures after surgery but had been free of disabling seizures for 2 years at the last follow-up examination (Engel class Ic), and 1 patient had experienced worthwhile improvement (Engel class IIb) and had been seizure free for 1 year at the last follow-up examination. No surgical complications developed. CONCLUSIONS Our results have demonstrated that multilobar epilepsy surgery is effective for lasting seizure control for selected 3T MRI-negative candidates, leading to favorable outcomes for all 4 of our patients. Comprehensive multimodal preoperative evaluation is a prerequisite for postoperative success. Reevaluation should be considered for patients with seizure recurrence, because reoperation could be especially beneficial for selected patients who have not responded to an initially limited resection.
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Affiliation(s)
- Evangelos Kogias
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Barbara Schmeiser
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Soroush Doostkam
- Institute of Neuropathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Armin Brandt
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Thilo Hammen
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Georgia Ramantani
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland.
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17
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Neurosurgical approaches to pediatric epilepsy: Indications, techniques, and outcomes of common surgical procedures. Seizure 2018; 77:76-85. [PMID: 30473268 DOI: 10.1016/j.seizure.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
Epilepsy is a common pediatric neurological condition, and approximately one-third of children with epilepsy are refractory to medical management. For these children neurosurgery may be indicated, but operative success is dependent on complete delineation of the epileptogenic zone. In this review, surgical techniques for pediatric epilepsy are considered. First, potentially-curative operations are discussed and broadly divided into resections and disconnections. Then, two palliative approaches to seizure control are reviewed. Finally, future neurosurgical approaches to epilepsy are considered.
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18
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Goldstein HE, Youngerman BE, Shao B, Akman CI, Mandel AM, McBrian DK, Riviello JJ, Sheth SA, McKhann GM, Feldstein NA. Safety and efficacy of stereoelectroencephalography in pediatric focal epilepsy: a single-center experience. J Neurosurg Pediatr 2018; 22:444-452. [PMID: 30028270 DOI: 10.3171/2018.5.peds1856] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with medically refractory localization-related epilepsy (LRE) may be candidates for surgical intervention if the seizure onset zone (SOZ) can be well localized. Stereoelectroencephalography (SEEG) offers an attractive alternative to subdural grid and strip electrode implantation for seizure lateralization and localization; yet there are few series reporting the safety and efficacy of SEEG in pediatric patients. METHODS The authors review their initial 3-year consecutive experience with SEEG in pediatric patients with LRE. SEEG coverage, SOZ localization, complications, and preliminary seizure outcomes following subsequent surgical treatments are assessed. RESULTS Twenty-five pediatric patients underwent 30 SEEG implantations, with a total of 342 electrodes placed. Ten had prior resections or ablations. Seven had no MRI abnormalities, and 8 had multiple lesions on MRI. Based on preimplantation hypotheses, 7 investigations were extratemporal (ET), 1 was only temporal-limbic (TL), and 22 were combined ET/TL investigations. Fourteen patients underwent bilateral investigations. On average, patients were monitored for 8 days postimplant (range 3-19 days). Nearly all patients were discharged home on the day following electrode explantation. There were no major complications. Minor complications included 1 electrode deflection into the subdural space, resulting in a minor asymptomatic extraaxial hemorrhage; and 1 in-house and 1 delayed electrode superficial scalp infection, both treated with local wound care and oral antibiotics. SEEG localized the hypothetical SOZ in 23 of 25 patients (92%). To date, 18 patients have undergone definitive surgical intervention. In 2 patients, SEEG localized the SOZ near eloquent cortex and subdural grids were used to further delineate the seizure focus relative to mapped motor function just prior to resection. At last follow-up (average 21 months), 8 of 15 patients with at least 6 months of follow-up (53%) were Engel class I, and an additional 6 patients (40%) were Engel class II or III. Only 1 patient was Engel class IV. CONCLUSIONS SEEG is a safe and effective technique for invasive SOZ localization in medically refractory LRE in the pediatric population. SEEG permits bilateral and multilobar investigations while avoiding large craniotomies. It is conducive to deep, 3D, and perilesional investigations, particularly in cases of prior resections. Patients who are not found to have focally localizable seizures are spared craniotomies.
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Affiliation(s)
- Hannah E Goldstein
- 1Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York
| | - Brett E Youngerman
- 1Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York
| | - Belinda Shao
- 2Division of Pediatric Neurosurgery, Department of Neurological Surgery, Children's Hospital of New York, Columbia-Presbyterian, New York
| | - Cigdem I Akman
- 3Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, New York; and
| | - Arthur M Mandel
- 3Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, New York; and
| | - Danielle K McBrian
- 3Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, New York; and
| | - James J Riviello
- 4Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas
| | - Sameer A Sheth
- 1Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York
| | - Guy M McKhann
- 1Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York
| | - Neil A Feldstein
- 2Division of Pediatric Neurosurgery, Department of Neurological Surgery, Children's Hospital of New York, Columbia-Presbyterian, New York
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19
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Kadish NE, Bast T, Reuner G, Wagner K, Mayer H, Schubert-Bast S, Wiegand G, Strobl K, Brandt A, Korinthenberg R, van Velthoven V, Schulze-Bonhage A, Zentner J, Ramantani G. Epilepsy Surgery in the First 3 Years of Life: Predictors of Seizure Freedom and Cognitive Development. Neurosurgery 2018; 84:E368-E377. [DOI: 10.1093/neuros/nyy376] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/18/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Navah Ester Kadish
- Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
- Department of Medical Psychology and Medical Sociology, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Thomas Bast
- Epilepsy Centre Kork, Kehl-Kork, Germany
- Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Gitta Reuner
- Section Neuropediatrics and Inborn Errors of Metabolism, University Children's Hospital, Heidelberg, Germany
| | | | - Hans Mayer
- Epilepsy Centre Kork, Kehl-Kork, Germany
| | - Susanne Schubert-Bast
- Section Neuropediatrics and Inborn Errors of Metabolism, University Children's Hospital, Heidelberg, Germany
- Department of Neuropediatrics, Goethe- University, Frankfurt am Main, Germany
| | - Gert Wiegand
- Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | | | - Armin Brandt
- Epilepsy Centre, University Hospital Freiburg, Germany
| | - Rudolf Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, Department of Paediatrics and Adolescent Medicine, University Hospital Freiburg, Germany
| | | | | | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Germany
| | - Georgia Ramantani
- Medical Faculty, University of Freiburg, Freiburg, Germany
- Epilepsy Centre, University Hospital Freiburg, Germany
- Department of Neuropediatrics, University Children's Hospital Zürich, Switzerland
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20
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Tatum W, Rubboli G, Kaplan P, Mirsatari S, Radhakrishnan K, Gloss D, Caboclo L, Drislane F, Koutroumanidis M, Schomer D, Kasteleijn-Nolst Trenite D, Cook M, Beniczky S. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clin Neurophysiol 2018; 129:1056-1082. [DOI: 10.1016/j.clinph.2018.01.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 12/20/2022]
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21
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Maillard LG, Tassi L, Bartolomei F, Catenoix H, Dubeau F, Szurhaj W, Kahane P, Nica A, Marusic P, Mindruta I, Chassoux F, Ramantani G. Stereoelectroencephalography and surgical outcome in polymicrogyria-related epilepsy: A multicentric study. Ann Neurol 2017; 82:781-794. [PMID: 29059488 DOI: 10.1002/ana.25081] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to (1) assess the concordance between various polymicrogyria (PMG) types and the associated epileptogenic zone (EZ), as defined by stereoelectroencephalography (SEEG), and (2) determine the postsurgical seizure outcome in PMG-related drug-resistant epilepsy. METHODS We retrospectively analyzed 58 cases: 49 had SEEG and 39 corticectomy or hemispherotomy. RESULTS Mean age at SEEG or surgery was 28.3 years (range, 2-50). PMG was bilateral in 9 (16%) patients and unilateral in 49, including 17 (29%) unilobar, 12 (21%) multilobar, 15 (26%) perisylvian, and only 5 (9%) hemispheric. Twenty-eight (48%) patients additionally had schizencephaly, heterotopia, or focal cortical dysplasia. The SEEG-determined EZ was fully concordant with the PMG in only 8 (16%) cases, partially concordant in 74%, and discordant in 10%. The EZ included remote cortical areas in 21 (43%) cases and was primarily localized in those in 5 (10%), all related to the mesial temporal structures. All but 1 PMG patient with corticectomy or hemispherotomy had a unilateral PMG. At last follow-up (mean, 4.6 years; range, 1-16), 28 (72%) patients remained seizure free. Shorter epilepsy duration to surgery was an independent predictor of seizure freedom. INTERPRETATION PMG-related drug-resistant epilepsy warrants a comprehensive presurgical evaluation, including SEEG investigations in most cases, given that the EZ may only partially overlap with the PMG or include solely remote cortical areas. Seizure freedom is feasible in a large proportion of patients. PMG extent should not deter from exploring the possibility of epilepsy surgery. Our data support the early consideration of epilepsy surgery in this patient group. Ann Neurol 2017;82:781-794.
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Affiliation(s)
- Louis Georges Maillard
- Research Center for Automatic Control of Nancy (CRAN), University of Lorraine, CNRS, UMR 7039, Vandoeuvre, France.,Department of Neurology, Central University Hospital (CHU) Nancy, Nancy, France.,Medical Faculty, University of Lorraine, Nancy, France
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Fabrice Bartolomei
- Aix Marseille University, Institute of Systems Neuroscience, Marseille, France.,AP-HM, Hospital de la Timone, Department of Clinical Neurophysiology, Marseille, France
| | - Hélène Catenoix
- Functional Neurology and Epileptology Department, Pierre Wertheimer Neurological Hospital, Lyon, France
| | - François Dubeau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada
| | - William Szurhaj
- Epilepsy Unit, Lille University Medical Centre, Lille, France.,INSERM U1171, University of Lille, France
| | - Philippe Kahane
- Department of Neurology, Central University Hospital, Grenoble, France.,INSERM U1216, Grenoble Neuroscience Institute, Grenoble, France.,University Grenoble Alpes, Grenoble, France
| | - Anca Nica
- Neurology Department, CHU, Rennes, France.,INSERM, U1099, Rennes, France
| | - Petr Marusic
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Ioana Mindruta
- Department of Neurology, University Emergency Hospital, Bucharest, Romania.,Department of Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Georgia Ramantani
- Research Center for Automatic Control of Nancy (CRAN), University of Lorraine, CNRS, UMR 7039, Vandoeuvre, France.,Child Neurology, University Children's Hospital, Zurich, Switzerland.,Swiss Epilepsy Center, Zurich, Switzerland
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22
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Ramantani G, Kadish NE, Mayer H, Anastasopoulos C, Wagner K, Reuner G, Strobl K, Schubert-Bast S, Wiegand G, Brandt A, Korinthenberg R, Mader I, van Velthoven V, Zentner J, Schulze-Bonhage A, Bast T. Frontal Lobe Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom, Overall Cognitive and Adaptive Functioning. Neurosurgery 2017; 83:93-103. [DOI: 10.1093/neuros/nyx340] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/16/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Although frontal lobe resections account for one-third of intralobar resections in pediatric epilepsy surgery, there is a dearth of information regarding long-term seizure freedom, overall cognitive and adaptive functioning.
OBJECTIVE
To identify outcome predictors and define the appropriate timing for surgery.
METHODS
We retrospectively analyzed the data of 75 consecutive patients aged 10.0 ± 4.9 yr at surgery that had an 8.1 yr mean follow-up.
RESULTS
Etiology comprised focal cortical dysplasia (FCD) in 71% and benign tumors in 16% cases. All patients but one had a magnetic resonance imaging-visible lesion. At last follow-up, 63% patients remained seizure-free and 37% had discontinued antiepileptic drugs. Presurgical predictors of seizure freedom were a shorter epilepsy duration, strictly regional epileptic discharges in electroencephalography (EEG), and an epileptogenic zone and/or lesion distant from eloquent cortex. Postsurgical predictors were the completeness of resection and the lack of early postoperative seizures or epileptic discharges in EEG. Higher presurgical overall cognitive and adaptive functioning was related to later epilepsy onset and to a sublobar epileptogenic zone and/or lesion. Following surgery, scores remained stable in the majority of patients. Postsurgical gains were determined by higher presurgical performance and tumors vs FCD.
CONCLUSION
Our findings highlight the favorable long-term outcomes following frontal lobe epilepsy surgery in childhood and adolescence and underline the importance of early surgical intervention in selected candidates. Early postsurgical relapses and epileptic discharges in EEG constitute key markers of treatment failure and should prompt timely reevaluation. Postsurgical overall cognitive and adaptive functioning is stable in most patients, whereas those with benign tumors have higher chances of improvement.
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Affiliation(s)
| | - Navah Ester Kadish
- Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Hans Mayer
- Epilepsy Centre Kork, Kehl-Kork, Germany
| | - Constantin Anastasopoulos
- Division of Neuropediatrics and Muscular Disorders, University Children's Hospital, Freiburg, Germany
| | - Kathrin Wagner
- Epilepsy Centre, University Hospital Freiburg, Freiburg, Germany
| | - Gitta Reuner
- Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany
| | | | - Susanne Schubert-Bast
- Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany
| | - Gert Wiegand
- Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Armin Brandt
- Epilepsy Centre, University Hospital Freiburg, Freiburg, Germany
| | - Rudolf Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, University Children's Hospital, Freiburg, Germany
| | - Irina Mader
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
| | - Vera van Velthoven
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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23
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Ramantani G, Stathi A, Brandt A, Strobl K, Schubert-Bast S, Wiegand G, Korinthenberg R, van Velthoven V, Zentner J, Schulze-Bonhage A, Bast T. Posterior cortex epilepsy surgery in childhood and adolescence: Predictors of long-term seizure outcome. Epilepsia 2017; 58:412-419. [PMID: 28098941 DOI: 10.1111/epi.13654] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to investigate the long-term seizure outcome of children and adolescents who were undergoing epilepsy surgery in the parietooccipital cortex and determine their predictive factors. METHODS We retrospectively analyzed the data of 50 consecutive patients aged 11.1 (mean) ± 5.1 (standard deviation) years at surgery. All patients but one had a magnetic resonance imaging (MRI)-visible lesion. Resections were parietal in 40%, occipital in 32%, and parietooccipital in 28% cases; 24% patients additionally underwent a resection of the posterior border of the temporal lobe. Etiology included focal cortical dysplasia in 44%, benign tumors (dysembryoplastic neuroepithelial tumor, ganglioglioma, angiocentric glioma, and pilocystic astrocytoma) in 32%, peri- or postnatal ischemic lesions in 16%, and tuberous sclerosis in 8% cases. RESULTS At last follow-up (mean 8 years, range 1.5-18 years), 60% patients remained seizure-free (Engel class I): 30% had discontinued and 20% had reduced antiepileptic drugs. Most seizure recurrences (71%) occurred within the first 6 months, and only three patients presented with seizures ≥2 years after surgery. Independent predictors of seizure recurrence included left-sided as well as parietal epileptogenic zones and resections. Longer epilepsy duration to surgery was identified as the only modifiable independent predictor of seizure recurrence. SIGNIFICANCE Our study demonstrates that posterior cortex epilepsy surgery is highly effective in terms of lasting seizure control and antiepileptic drug cessation in selected pediatric candidates. Most importantly, our data supports the early consideration of surgical intervention in children and adolescents with refractory posterior cortex epilepsy.
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Affiliation(s)
| | - Angeliki Stathi
- Epilepsy Center, University Hospital Freiburg, Freiburg, Germany
| | - Armin Brandt
- Epilepsy Center, University Hospital Freiburg, Freiburg, Germany
| | | | - Susanne Schubert-Bast
- Department of Neuropediatrics and Metabolic Disease, University Children's Hospital, Heidelberg, Germany
| | - Gert Wiegand
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Rudolf Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Vera van Velthoven
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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24
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Epilepsy surgery in the posterior part of the brain. Epilepsy Behav 2016; 64:273-282. [PMID: 27788449 DOI: 10.1016/j.yebeh.2016.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/21/2022]
Abstract
Posterior cortex epilepsy surgery is rarely performed and is associated with a high number of surgical failures, partly because accurate localization of the epileptogenic zone in the posterior part of the brain is extremely difficult. We present the characteristics as well as the surgical outcome and its determinants of a cohort of 208 consecutive patients (adults/children: 125/83) operated on for drug-resistant posterior cortex epilepsy at the "Claudio Munari" Epilepsy Surgery Centre, Milan between May 1996 and May 2013 (mean postsurgical follow-up: 9.6years). In addition, we highlight the differences in anatomoelectroclinical features and outcome between (i) patients who necessitated an invasive preoperative evaluation and those who proceeded directly to surgery and (ii) adults and children. Mean age at epilepsy onset was 6.8years (91.4% with onset before 14years of age). A high seizure frequency was reported by 51% of subjects, interictal and ictal EEG features were localizing in 16% and 28% of cases, and 86% of patients had a positive, judged as more or less informative, MRI. Invasive presurgical evaluation by stereoelectroencephalography was performed in 54% of patients; explorations may schematically be grouped in three main implantation patterns. Globally, 70% of subjects achieved seizure freedom, and further, 10% achieved Engel class II, with the patients operated on in childhood achieving significantly better postsurgical results in terms of seizure freedom and drug discontinuation. Duration of epilepsy represented the most consistent predictor of surgical outcome, with early surgery being correlated with higher chances of surgical success. Therefore, we recommend an early surgical referral in cases of pharmacoresistant posterior cortex seizures. Furthermore, we suggest that surgical failure might be predicted very early, namely within the first 6 postoperative months. We conclude that surgical management of posterior cortex epilepsy may attain excellent results.
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25
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Acute postoperative seizures as predictors of seizure outcomes after epilepsy surgery. Epilepsy Res 2016; 127:119-125. [DOI: 10.1016/j.eplepsyres.2016.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 08/14/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022]
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26
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Cao K, Liu M, Wang C, Liu Q, Yang K, Tao L, Guo X. Five-Year Long-Term Prognosis of Epileptic Children After Hemispheric Surgery: A Systematic Review and Meta-analysis. Medicine (Baltimore) 2016; 95:e3743. [PMID: 27281073 PMCID: PMC4907651 DOI: 10.1097/md.0000000000003743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/13/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022] Open
Abstract
To estimate children's long-term seizure outcomes after hemispheric surgery and the associated predictors.A systematic review of 4 databases and a meta-analysis were performed from January 1, 1995 to August 31, 2015. The databases included PubMed, Embase, Science Direct, and Web of Science; patients were classified into the Engel Class I group and the Engel Class II to IV group, according to their seizure outcomes. Nine potential predictors were then stratified across the groups and estimated using the Wilcoxon rank-sum test for continuous variables and the Chi-squared test for categorical variables.The search yielded 15 retrospective studies, with a total sample size of 380. Five years after surgery, 268 (0.71, 95% confidence interval [CI]: 0.64-0.78) children were seizure free; the seizure onset age in the Engel Class I group was significantly higher than that of the Engel Class II to IV group (standardized mean difference [SMD] = 0.26, 95% CI: 0.03-0.49, P = 0.028); specifically, when predicting the positive long-term outcomes, the odds ratio for late onset age (≥3.6 months, median value of the Engel Class II-IV group) versus early onset age was 2.65 (95% CI: 1.454-4.836, z = 3.18, P = 0.001). The abnormal magnetic resonance imaging (MRI) findings were more predictive for positive seizure outcomes than the normal findings (odds ratio [OR] = 4.60, 95% CI: 1.27-16.62, P = 0.02).Following hemispheric surgery, the long-term prognosis of children with epilepsy was good. Late seizure onset (age ≥ 3.6 months) and abnormal MRI findings were positive predictors for long-term seizure control in children.
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Affiliation(s)
- Kai Cao
- From the Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University (KC, CW, QL, KY, LT, XG); Beijing Municipal Key Laboratory of Clinical Epidemiology (KC, CW, QL, KY, LT, XG); Beijing Key Laboratory of Environment Toxicology (ML); School of Public Health, Capital Medical University (ML); and Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Laboratory (KC), Beijing, China
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27
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Abstract
Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20-30% of children with recurrent seizures have drug-resistant epilepsy (DRE). For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal-seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each.
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Affiliation(s)
- Jian Guan
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Michael Karsy
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Katrina Ducis
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Robert J Bollo
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
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28
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Abstract
Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70-80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60-75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions. Approximately 20-50% of patients with meningioma and 20-35% of those with brain metastases also suffer from seizures. After tumor resection, approximately 60-90% are rendered seizure-free, with most favorable seizure outcomes seen in individuals with glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack of generalized seizures are common predictors of a favorable seizure outcome. With regard to anticonvulsant medication selection, evidence-based guidelines for the treatment of focal epilepsy should be followed, and individual patient factors should also be considered, including patient age, sex, organ dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly forms an essential part of glioma treatment, enzyme-inducing anticonvulsants should be avoided when possible. Seizure freedom is the ultimate goal in the treatment of brain tumor patients with epilepsy, given the adverse effects of seizures on quality of life.
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Affiliation(s)
- Dario J Englot
- UCSF Comprehensive Epilepsy Center, University of California San Francisco, San Francisco, California, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Edward F Chang
- UCSF Comprehensive Epilepsy Center, University of California San Francisco, San Francisco, California, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Charles J Vecht
- Service Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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Giulioni M, Martinoni M, Marucci G. Commentary on Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia 2015; 56:1176-7. [PMID: 26149795 DOI: 10.1111/epi.13005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Marco Giulioni
- IRCCS Institute of Neurological Sciences, Section of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | - Matteo Martinoni
- IRCCS Institute of Neurological Sciences, Section of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Gianluca Marucci
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Section of Pathology "Marcello Malpighi", Bellaria Hospital, Bologna, Italy
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Abstract
BACKGROUND Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary according to the age of the participants and which focal epilepsies are included, but have been reported as at least 20% and in some studies up to 70%. If the epileptogenic zone can be located surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.The secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence and to identify the factors that correlate to remission of seizures postoperatively. SEARCH METHODS We searched the Cochrane Epilepsy Group Specialised Register (June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 6), MEDLINE (Ovid) (2001 to 4 July 2013), ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for relevant trials up to 4 July 2013. SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs), cohort studies or case series, with either a prospective and/or retrospective design, including at least 30 participants, a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome relating to postoperative seizure control. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportion of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RR) and 95% confidence intervals. MAIN RESULTS We identified 177 studies (16,253 participants) investigating the outcome of surgery for epilepsy. Four studies were RCTs (including one that randomised participants to surgery or medical treatment). The risk of bias in the RCTs was unclear or high, limiting our confidence in the evidence that addressed the primary review objective. Most of the remaining 173 non-randomised studies had a retrospective design; they were of variable size, were conducted in a range of countries, recruited a wide demographic range of participants, used a wide range of surgical techniques and used different scales used to measure outcomes. We performed quality assessment using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across the domains.In terms of freedom from seizures, one RCT found surgery to be superior to medical treatment, two RCTs found no statistically significant difference between anterior temporal lobectomy (ATL) with or without corpus callosotomy or between 2.5 cm or 3.5 cm ATL resection, and one RCT found total hippocampectomy to be superior to partial hippocampectomy. We judged the evidence from the four RCTs to be of moderate to very low quality due to the lack of information reported about the randomised trial design and the restricted study populations.Of the 16,253 participants included in this review, 10,518 (65%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to the recording of adverse events to be very poor.In total, 118 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: an abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography (EEG), history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation or presence of postoperative discharges were prognostic factors of outcome. We observed variability between studies for many of our analyses, likely due to the small study sizes with unbalanced group sizes, variation in the definition of seizure outcome, definition of the prognostic factor and the influence of the site of surgery, all of which we observed to be related to postoperative seizure outcome. Twenty-nine studies reported multivariable models of prognostic factors and the direction of association of factors with outcome was generally the same as found in the univariate analyses. However, due to the different multivariable analysis approaches and selective reporting of results, meaningful comparison of multivariate analysis with univariate meta-analysis is difficult. AUTHORS' CONCLUSIONS The study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcome. Future research should be of high quality, have a prospective design, be appropriately powered and focus on specific issues related to diagnostic tools, the site-specific surgical approach and other issues such as the extent of resection. Prognostic factors related to the outcome of surgery should be investigated via multivariable statistical regression modelling, where variables are selected for modelling according to clinical relevance and all numerical results of the prognostic models are fully reported. Protocols should include pre- and postoperative measures of speech and language function, cognition and social functioning along with a mental state assessment. Journal editors should not accept papers where adverse events from a medical intervention are not recorded. Improvements in the development of cancer care over the past three to four decades have been achieved by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Department of Paediatric Neurology, Royal Manchester Children's Hospital, Hathersage Road, Manchester, UK, M13 0JH
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Mathon B, Bédos-Ulvin L, Baulac M, Dupont S, Navarro V, Carpentier A, Cornu P, Clemenceau S. Évolution des idées et des techniques, et perspectives d’avenir en chirurgie de l’épilepsie. Rev Neurol (Paris) 2015; 171:141-56. [DOI: 10.1016/j.neurol.2014.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/10/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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Di Gennaro G, Casciato S, Quarato PP, Mascia A, D’Aniello A, Grammaldo LG, De Risi M, Meldolesi GN, Romigi A, Esposito V, Picardi A. Acute postoperative seizures and long-term seizure outcome after surgery for hippocampal sclerosis. Seizure 2015; 24:59-62. [DOI: 10.1016/j.seizure.2014.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/31/2014] [Accepted: 08/19/2014] [Indexed: 11/25/2022] Open
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Shin JH, Jung NY, Kim SP, Son EI. Emerging surgical strategies of intractable frontal lobe epilepsy with cortical dysplasia in terms of extent of resection. J Korean Neurosurg Soc 2014; 56:248-53. [PMID: 25368769 PMCID: PMC4217063 DOI: 10.3340/jkns.2014.56.3.248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/24/2014] [Accepted: 09/18/2014] [Indexed: 11/27/2022] Open
Abstract
Objective Cortical dysplasia (CD) is one of the common causes of epilepsy surgery. However, surgical outcome still remains poor, especially with frontal lobe epilepsy (FLE), despite the advancement of neuroimaging techniques and expansion of surgical indications. The aim of this study was to focus on surgical strategies in terms of extent of resection to improve surgical outcome in the cases of FLE with CD. Methods A total of 11 patients of FLE were selected among 67 patients who were proven pathologically as CD, out of a total of 726 epilepsy surgery series since 1992. This study categorized surgical groups into three according to the extent of resection : 1) focal corticectomy, 2) regional corticectomy, and 3) partial functional lobectomy, based on the preoperative evaluation, in particular, ictal scalp EEG onset and/or intracranial recordings, and the lesions in high-resolution MRI. Surgical outcome was assessed following Engel's classification system. Results Focal corticectomy was performed in 5 patients and regional corticectomy in another set of 5 patients. Only 1 patient underwent partial functional lobectomy. Types I and II CD were detected with the same frequency (45.45% each) and postoperative outcome was fully satisfactory (91%). Conclusion The strategy of epilepsy surgery is to focus on the different characteristics of each individual, considering the extent of real resection, which is based on the focal ictal onset consistent with neuroimaging, especially in the practical point of view of neurosurgery.
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Affiliation(s)
- Jung-Hoon Shin
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Na-Young Jung
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Pyo Kim
- Department of Pathology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Eun-Ik Son
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Kenney D, Wirrell E. Patient considerations in the management of focal seizures in children and adolescents. Adolesc Health Med Ther 2014; 5:49-65. [PMID: 24808722 PMCID: PMC3986281 DOI: 10.2147/ahmt.s44316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Focal epilepsy accounts for approximately one-half to two-thirds of new-onset epilepsy in children. Etiologies are diverse, and range from benign epilepsy syndromes with normal neuroimaging and almost certain remission to focal malformations of cortical development or hippocampal sclerosis with intractable seizures persisting lifelong. Other important etiologies in children include pre-, peri-, or postnatal brain injury, low-grade neoplasms, vascular lesions, and neuroimmunological disorders. Cognitive, behavioral, and psychiatric comorbidities are commonly seen and must be addressed in addition to seizure control. Given the diverse nature of focal epilepsies in children and adolescents, investigations and treatments must be individualized. First-line therapy consists of prophylactic antiepileptic drugs; however, prognosis is poor after failure of two to three drugs for lack of efficacy. Refractory cases should be referred for an epilepsy surgery workup. Dietary treatments and neurostimulation may be considered in refractory cases who are not good candidates for surgery.
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Affiliation(s)
- Daniel Kenney
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Elaine Wirrell
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Erba G, Messina P, Pupillo E, Beghi E. Acceptance of epilepsy surgery in the pediatric age - what the parents think and what the doctors can do. Epilepsy Behav 2013; 29:112-20. [PMID: 23939035 DOI: 10.1016/j.yebeh.2013.05.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/30/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
Epilepsy surgery (ES) in pediatrics is safe and effective but can be underutilized. Possible barriers could be parental resistance and doctor inertia. We surveyed 138 parents of pediatric patients with epilepsy and found that 25.2% were opposed to this treatment. However, upon completing the questionnaire that contained factual information about ES, 50.4% of the responders stated that they had become more favorable vs. 3.3% more contrary and 46.3% unchanged. Parents of prepubescent patients were most receptive (p=0.0343) and more likely to shift to a more favorable attitude. Thus, pediatric neurologists should not hesitate to discuss ES as soon as indicated, providing all necessary information to increase acceptance. However, among 60 child neurologists surveyed, 60% did not fully comply with guidelines or follow accepted standards of practice, indicating that they may not be apt to provide proper parental guidance. We conclude that education of both practicing neurologists and parents is needed to facilitate the process.
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Affiliation(s)
- Giuseppe Erba
- Strong Epilepsy Center, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Di Gennaro G, D’Aniello A, De Risi M, Quarato PP, Mascia A, Grammaldo LG, Meldolesi GN, Esposito V, Fabi E, Picardi A. Prognostic significance of acute postoperative seizures in extra-temporal lobe epilepsy surgery. Clin Neurophysiol 2013; 124:1536-40. [DOI: 10.1016/j.clinph.2013.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
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Englot DJ, Breshears JD, Sun PP, Chang EF, Auguste KI. Seizure outcomes after resective surgery for extra-temporal lobe epilepsy in pediatric patients. J Neurosurg Pediatr 2013; 12:126-33. [PMID: 23768201 DOI: 10.3171/2013.5.peds1336] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults, seizures in children are more often extratemporal in origin. Extra-temporal lobe epilepsy (ETLE) in pediatric patients is often medically refractory, leading to significantly diminished quality of life. Seizure outcomes after resective surgery for pediatric ETLE vary tremendously in the literature, given diverse patient and epilepsy characteristics and small sample sizes. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after resective surgery for ETLE, excluding hemispherectomy. Thirty-six studies were examined. These 36 studies included 1259 pediatric patients who underwent resective surgery for ETLE. Seizure freedom (Engel Class I outcome) was achieved in 704 (56%) of these 1259 patients postoperatively, and 555 patients (44%) continued to have seizures (Engel Class II-IV outcome). Shorter epilepsy duration (≤ 7 years, the median value in this study) was more predictive of seizure freedom than longer (> 7 years) seizure history (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.07-2.14), suggesting that earlier intervention may be beneficial. Also, lesional epilepsy was associated with better seizure outcomes than nonlesional epilepsy (OR 1.34, 95% CI 1.19-1.49). Other predictors of seizure freedom included an absence of generalized seizures (OR 1.61, 95% CI 1.18-2.35) and localizing ictal electroencephalographic findings (OR 1.55, 95% CI 1.24-1.93). In conclusion, seizure outcomes after resective surgery for pediatric ETLE are less favorable than those associated with temporal lobectomy, but seizure freedom may be more common with earlier intervention and lesional epilepsy etiology. Children with continued debilitating seizures despite failure of multiple medication trials should be referred to a comprehensive pediatric epilepsy center for further medical and surgical evaluation.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA.
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Najm I, Jehi L, Palmini A, Gonzalez-Martinez J, Paglioli E, Bingaman W. Temporal patterns and mechanisms of epilepsy surgery failure. Epilepsia 2013; 54:772-82. [DOI: 10.1111/epi.12152] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Imad Najm
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland; Ohio; U.S.A
| | - Lara Jehi
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland; Ohio; U.S.A
| | - Andre Palmini
- Porto Alegre Epilepsy Surgery Program; Neurology and Neurosurgery Services; Hospital São Lucas; Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS); Porto Alegre; Brazil
| | | | - Eliseu Paglioli
- Porto Alegre Epilepsy Surgery Program; Neurology and Neurosurgery Services; Hospital São Lucas; Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS); Porto Alegre; Brazil
| | - William Bingaman
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland; Ohio; U.S.A
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