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Wong GM, McCray A, Hom K, Teti S, Cohen NT, Gaillard WD, Oluigbo CO. Outcomes of stereoelectroencephalography following failed epilepsy surgery in children. Childs Nerv Syst 2024:10.1007/s00381-024-06420-w. [PMID: 38652142 DOI: 10.1007/s00381-024-06420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Stereoelectroencephalography (SEEG) is valuable for delineating the seizure onset zone (SOZ) in pharmacoresistant epilepsy when non-invasive presurgical techniques are inconclusive. Secondary epilepsy surgery after initial failure is challenging and there is limited research on SEEG following failed epilepsy surgery in children. OBJECTIVE The objective of this manuscript is to present the outcomes of children who underwent SEEG after failed epilepsy surgery. METHODS In this single-institution retrospective study, demographics, previous surgery data, SEEG characteristics, management, and follow-up were analyzed for pediatric patients who underwent SEEG after unsuccessful epilepsy surgery between August 2016 and February 2023. RESULTS Fifty three patients underwent SEEG investigation during this period. Of this, 13 patients were identified who had unsuccessful initial epilepsy surgery (24%). Of these 13 patients, six patients (46%) experienced unsuccessful resective epilepsy surgery that targeted the temporal lobe, six patients (46%) underwent surgery involving the frontal lobe, and one patient (8%) had laser interstitial thermal therapy (LITT) of the right insula. SEEG in two thirds of patients (4/6) with initial failed temporal resections revealed expanded SOZ to include the insula. All 13 patients (100%) had a subsequent surgery after SEEG which was either LITT (54%) or surgical resection (46%). After the subsequent surgery, a favorable outcome (Engel class I/II) was achieved by eight patients (62%), while five patients experienced an unfavorable outcome (Engel class III/IV, 38%). Of the six patients with secondary surgical resection, four patients (67%) had favorable outcomes, while of the seven patients with LITT, two patients (29%) had favorable outcomes (Engel I/II). Average follow-up after the subsequent surgery was 37 months ±23 months. CONCLUSION SEEG following initial failed resective epilepsy surgery may help guide next steps at identifying residual epileptogenic cortex and is associated with favorable seizure control outcomes.
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Affiliation(s)
- Georgia M Wong
- Department of Neurological Surgery, Georgetown University School of Medicine, Washington, DC, USA.
| | - Ashley McCray
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Kara Hom
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
| | - Saige Teti
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Nathan T Cohen
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - William D Gaillard
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA.
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Yasuda S, Yano H, Ikegame Y, Kumagai M, Iwama T, Shinoda J, Izumo T. Posttraumatic epilepsy in chronic disorders of consciousness due to severe traumatic brain injury after traffic accidents. Seizure 2024; 117:222-228. [PMID: 38503099 DOI: 10.1016/j.seizure.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE To evaluate the clinical state of posttraumatic epilepsy (PTE) in patients with chronic disorders of consciousness (CDC) due to severe traumatic brain injury (STBI) after traffic accidents and clarify the risk factors for seizure occurrence in such patients. METHODS Two hundred ninety-three patients with CDC due to STBI (mean age at admission [±standard deviation]: 36.4 ± 17.9 years; men: 71.7 %; mean duration of injury to admission: 416 ± 732 days; mean hospitalization time: 899 ± 319 days) were enrolled in this study. We retrospectively investigated the relationship between seizure conditions (type and frequency) and clinical data, including age, sex, pathological types of brain injury, with/without surgical intervention, degree of CDC, and administration of antiseizure medications (ASMs). RESULTS Overall, 52.9 % (n = 155/293) and 64.2 % of the patients (n = 183/of 285 patients surviving at discharge) were administered ASMs at admission and discharge, respectively. One hundred thirty-two patients (45.1 %) experienced epileptic seizures during hospitalization, and the mean seizure frequency was 4.0 ± 0.4 times per year. In multivariate analysis, significant and independent risk factors of seizure occurrence were revealed to be male sex, high National Agency for Automotive Safety and Victims' Aid score, hypoxic encephalopathy, and history of the neurosurgical operations. CONCLUSION The high prevalence of PTE in patients with CDC due to STBI, and the significant and independent risk factors for seizure occurrence in the chronic clinical phase were revealed. We expect that this study will aid toward improving clinical assessment and management of epileptic seizures in the population.
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Affiliation(s)
- Shoji Yasuda
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan; Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.
| | - Hirohito Yano
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan; Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Yuka Ikegame
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan
| | - Morio Kumagai
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Jun Shinoda
- Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo 505-0034, Japan; Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo 505-0034, Japan; Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
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Chiarello D, Cognolato E, Francione S, Nobile G, Bosisio L, Barbagallo G, Pacetti M, Tortora D, Cantalupo G, Nobili L, Consales A. Negative MRI and a seizure onset zone close to eloquent areas in FCD type II: Application of MRg-LiTT after a SEEG re-evaluation in pediatric patients with a previous failed surgery. Epilepsy Behav 2024; 153:109694. [PMID: 38401416 DOI: 10.1016/j.yebeh.2024.109694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Negative MRI and an epileptogenic zone (EZ) adjacent to eloquent areas are two main issues that can be encountered during pre-surgical evaluation for epilepsy surgery. Focal Cortical Dysplasia type II (FCD type II) is the most common aetiology underlying a negative MRI. The objective of this study is to present three cases of pediatric patients exhibiting negative MRI and a seizure onset zone close to eloquent areas, who previously underwent traditional open surgery or SEEG-guided radiofrequency thermocoagulations (RF-TC). After seizure seizure recrudescence, pre-surgical SEEG was re-evaluated and Magnetic Resonance-guided laser interstitial thermal therapy (MRg-LiTT) was performed. We discuss the SEEG patterns, the planning of laser probes trajectories and the outcomes one year after the procedure. METHODS Pediatric patients who underwent SEEG followed by MRg-LiTT for drug-resistant epilepsy associated with FCD type II at our Centre were included. Pre-surgical videoEEG (vEEG), stereoEEG (sEEG), and MRI were reviewed. Post-procedure clinical outcome (measured by Engel score) and complications rates were evaluated. RESULTS Three patients underwent 3 MRg-LiTT procedures from January 2022 to June 2022. Epileptogenic zone was previously studied via SEEG in all the patients. All the three patients pre-surgical MRI was deemed negative. Mean age at seizure onset was 47 months (21-96 months), mean age at MRg-LiTT was 12 years (10 years 10 months - 12 years 9 months). Engel class Ia outcome was achieved in patients #2 and #3, Engel class Ib in patient #1. Mean follow-up length was of 17 months (13 months - 20 months). Complications occurred in one patient (patient #2, extradural hematoma). CONCLUSIONS The combined use of SEEG and MRg-LiTT in complex cases can lead to good outcomes both as a rescue therapy after failed surgery, but also as an alternative to open surgery after a successful SEEG-guided Radiofrequency Thermocoagulation (RF-TC). Specific SEEG patterns and a previous good outcome from RF-TC can be predictors of a favourable outcome.
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Affiliation(s)
- D Chiarello
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital, Milan, Italy; Neurology of Epilepsy and Movement Disorder Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Italy
| | - E Cognolato
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3).
| | - S Francione
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital, Milan, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - G Nobile
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - L Bosisio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - G Barbagallo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - M Pacetti
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - D Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - G Cantalupo
- Child Neuropsychiatry Unit, University Hospital of Verona (full member of the European Reference Network EpiCARE), Verona, Italy; Center for Research on Epilepsy in Pediatric age (CREP), University Hospital of Verona, Verona, Italy; Innovation Biomedicine section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - L Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3).
| | - A Consales
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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Wu Y, Zhang Z, Liang P, Li L, Zou B, Wang D, Dong X, Tang H, Qiu H, Zhai X. Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040785. [PMID: 37109743 PMCID: PMC10146799 DOI: 10.3390/medicina59040785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/08/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: After failed epilepsy surgery, patients often revert to an antiseizure medication (ASM) ASM regimen, which can be adjusted or optimized in three ways: increasing the dose, alternative therapy, and combination therapy. It is unclear which type of antiseizure medication adjustment method can improve outcomes. Materials and Methods: Children who underwent failed epileptic resection surgery at the Department of Neurosurgery, Children's Hospital of Chongqing Medical University between January 2015 and December 2021 were included in this cohort, who were reviewed for whether they underwent adjustment of ASM with increased dose, alternative therapy, or combination therapy. The seizure outcome and quality of life (QoL) were assessed. Two-tailed Fisher exact test and Mann-Whitney U test were used for statistical analysis. Results: Sixty-three children with failed surgery were included for further analysis, with a median follow-up time of 53 months. The median seizure recurrence time was 4 months. At the last follow-up, 36.5% (n = 23) of patients achieved seizure freedom, 41.3% (n = 26) achieved seizure remission, and 61.9% (n = 39) had a good QoL. None of the three types of ASM adjustment improved children's outcomes, whether considered in terms of seizure-free rate, seizure remission rate, or QoL. Early recurrences were significantly associated with decreased probability of seizure freedom (p = 0.02), seizure remission (p = 0.02), and a good QoL (p = 0.01). Conclusions: Children who underwent failed epilepsy surgery remains some potential for late seizure remission from ASM. Yet adjusting ASM regimen does not increase the probability of seizure remission nor does it improve the QoL. Clinicians should complete evaluations and consider the need for other antiepileptic treatment as soon as possible after surgery failed, especially when dealing with children with an early recurrence.
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Affiliation(s)
- Yuxin Wu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Zaiyu Zhang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Ping Liang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Lusheng Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Bin Zou
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Difei Wang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Xinyu Dong
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Haotian Tang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Hanli Qiu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Xuan Zhai
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
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Jirsa V, Wang H, Triebkorn P, Hashemi M, Jha J, Gonzalez-Martinez J, Guye M, Makhalova J, Bartolomei F. Personalised virtual brain models in epilepsy. Lancet Neurol 2023; 22:443-454. [PMID: 36972720 DOI: 10.1016/s1474-4422(23)00008-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023]
Abstract
Individuals with drug-resistant focal epilepsy are candidates for surgical treatment as a curative option. Before surgery can take place, the patient must have a presurgical evaluation to establish whether and how surgical treatment might stop their seizures without causing neurological deficits. Virtual brains are a new digital modelling technology that map the brain network of a person with epilepsy, using data derived from MRI. This technique produces a computer simulation of seizures and brain imaging signals, such as those that would be recorded with intracranial EEG. When combined with machine learning, virtual brains can be used to estimate the extent and organisation of the epileptogenic zone (ie, the brain regions related to seizure generation and the spatiotemporal dynamics during seizure onset). Virtual brains could, in the future, be used for clinical decision making, to improve precision in localisation of seizure activity, and for surgical planning, but at the moment these models have some limitations, such as low spatial resolution. As evidence accumulates in support of the predictive power of personalised virtual brain models, and as methods are tested in clinical trials, virtual brains might inform clinical practice in the near future.
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Affiliation(s)
- Viktor Jirsa
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France.
| | - Huifang Wang
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | - Paul Triebkorn
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | - Meysam Hashemi
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | - Jayant Jha
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | | | - Maxime Guye
- Centre National de la Recherche Scientifique, Center for Magnetic Resonance in Biology and Medicine, Aix Marseille Université, Marseille, France; Centre d'Exploration Métabolique par Résonance Magnétique, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France
| | - Julia Makhalova
- Centre National de la Recherche Scientifique, Center for Magnetic Resonance in Biology and Medicine, Aix Marseille Université, Marseille, France; Centre d'Exploration Métabolique par Résonance Magnétique, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France; Epileptology and Clinical Neurophysiology Department, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France
| | - Fabrice Bartolomei
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France; Epileptology and Clinical Neurophysiology Department, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France
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Feng T, Yang Y, Wei P, Wang C, Fan X, Wang K, Zhang H, Shan Y, Zhao G. The role of the orbitofrontal cortex and insula for prognosis of mesial temporal lobe epilepsy. Epilepsy Behav 2023; 138:109003. [PMID: 36470059 DOI: 10.1016/j.yebeh.2022.109003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE We investigated the network between the medial temporal lobe (MTL) and extratemporal structures in patients with mesial temporal lobe epilepsy (MTLE) in order to explain the recurrence of MTLE after surgery. This study contributes to our current understanding of MTLE with stereotactic electroencephalography (SEEG). METHODS We conducted a retrospective study of SEEG in 20 patients with MTLE in order to observe and analyze the intensity of interictal high-frequency oscillations (HFOs), as well as the dynamic course of coherence connectivity values of the MTL and extratemporal structures during the initial phase of the seizure. The results correlated with the patient prognosis. RESULTS First, the presence of HFOs was observed during the interictal period in all 20 patients; these were localized to the MTL in 17 patients and the orbitofrontal cortex in seven patients and the insula in six patients. The better the prognosis, the greater the localization of the HFOs concentration in the MTL structures (p < 0.05). Second, significantly enhanced connectivity of MTL structures with the orbitofrontal cortex and insula was observed in most patients with MTLE, before and after the seizure onset (p < 0.05). Finally, the connectivity between extratemporal structures, such as the orbitofrontal cortex and insula, and MTL structures was significantly stronger in patients who had a worse prognosis than in other patients, before and after seizure onset (p < 0.05). INTERPRETATION The epileptogenic network in recurrent MTLE is not limited to MTL structures but is also associated with the orbitofrontal cortex and insula. This can be used as a potential indicator for predicting the prognosis of patients after surgery, providing an important avenue for future clinical evaluation.
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Affiliation(s)
- Tao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yanfeng Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Changming Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Kailiang Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Huaqiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China.
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China; Institute for Brain Disorder, Beijing, China.
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Devisetty R, MB A, Jyothirmai S, Ajai R, Pillai A, Kumar A, Gopinath S, Parasuram H. Localizing epileptogenic network from SEEG using non-linear correlation, mutual information and graph theory analysis. Proc Inst Mech Eng H 2022; 236:1783-1796. [DOI: 10.1177/09544119221134991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The key challenge in epilepsy surgery is precise localization and removal of the epileptogenic zone (EZ) from the brain. Localization of the epileptogenic network by visual analysis of intracranial EEG is extremely difficult. In this retrospective study, we used interictal connectivity and graph theory analysis on intracranial EEG to better delineate the epileptogenic zone. Patients who underwent surgery for drug-refractory mesial temporal and neocortical epilepsy were included. Computational measures, such as h2 nonlinear correlation and mutual information, were used to estimate the interdependency of intracranial EEGs. We observed that the Out-Degree, Out-Strength, and Betweenness centrality (graph properties) were the best predictors of EZ. From the results, we also found that graph properties with a normalized value above 0.75 were found to be a useful measure to localize the EZ with a sensitivity of 87.88 and a specificity of 87.13. Our results also validate that frequently occurring types of interictal fast discharges (IFD) with connectivity measures and graph properties can better localize the EZ. We foresee graph theory analysis of interictal intracranial EEG data can help precise localization of EZ for cortical resection as well as in minimally invasive radiofrequency ablation of epileptogenic hubs. Further, prospective validation is required for clinical use.
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Affiliation(s)
- Rohith Devisetty
- Department of Electronics and Communication Engineering, Amrita Vishwa Vidyapeetham, Amritapuri, India
| | - Amsitha MB
- Department of Electronics and Communication Engineering, Amrita Vishwa Vidyapeetham, Amritapuri, India
| | - Sasi Jyothirmai
- Department of Electronics and Communication Engineering, Amrita Vishwa Vidyapeetham, Amritapuri, India
| | - Remya Ajai
- Department of Electronics and Communication Engineering, Amrita Vishwa Vidyapeetham, Amritapuri, India
| | - Ashok Pillai
- Amrita Advanced Centre for Epilepsy (AACE), Amrita Institute of Medical Sciences, Kochi, Kerala, India
- Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Anand Kumar
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
- Amrita Mind Brain Center, Amrita Vishwa Vidyapeetham, Amritapuri Campus, Kollam, Kerala, India
| | - Siby Gopinath
- Amrita Advanced Centre for Epilepsy (AACE), Amrita Institute of Medical Sciences, Kochi, Kerala, India
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
- Amrita Mind Brain Center, Amrita Vishwa Vidyapeetham, Amritapuri Campus, Kollam, Kerala, India
| | - Harilal Parasuram
- Amrita Advanced Centre for Epilepsy (AACE), Amrita Institute of Medical Sciences, Kochi, Kerala, India
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
- Amrita Mind Brain Center, Amrita Vishwa Vidyapeetham, Amritapuri Campus, Kollam, Kerala, India
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Gadot R, Korst G, Shofty B, Gavvala JR, Sheth SA. Thalamic stereoelectroencephalography in epilepsy surgery: a scoping literature review. J Neurosurg 2022; 137:1210-1225. [PMID: 35276641 DOI: 10.3171/2022.1.jns212613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (sEEG) is a well-established surgical method for defining the epileptogenic network. Traditionally reserved for identifying discrete cortical regions for resection or ablation, sEEG in current practice is also used for identifying more broadly involved subcortical epileptic network components, driven by the availability of brain-based neuromodulation strategies. In particular, sEEG investigations including thalamic nuclei are becoming more frequent in parallel with the increase in therapeutic strategies involving thalamic targets such as deep brain stimulation (DBS) and responsive neurostimulation (RNS). The objective to this study was to evaluate existing evidence and trends regarding the purpose, techniques, and relevant electrographic findings of thalamic sEEG. METHODS MEDLINE and Embase databases were systematically queried for eligible peer-reviewed studies involving sEEG electrode implantation into thalamic nuclei of patients with epilepsy. Available data were abstracted concerning preoperative workup and purpose for implanting the thalamus, thalamic targets and trajectories, and electrophysiological methodology and findings. RESULTS sEEG investigations have included thalamic targets for both basic and clinical research purposes. Medial pulvinar, dorsomedial, anterior, and centromedian nuclei have been the most frequently studied. Few studies have reported any complications with thalamic sEEG implantation, and no studies have reported long-term complications. Various methods have been utilized to characterize thalamic activity in epileptic disorders including evoked potentials, power spectrograms, synchronization indices, and the epileptogenicity index. Thalamic intracranial recordings are beginning to be used to guide neuromodulation strategies including RNS and DBS, as well as to understand complex, network-dependent seizure disorders. CONCLUSIONS Inclusion of thalamic coverage during sEEG evaluation in drug-resistant epilepsy is a growing practice and is amenable to various methods of electrographic data analysis. Further study is required to establish well-defined criteria for thalamic implantation during invasive investigations as well as safety and ethical considerations.
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Affiliation(s)
| | | | | | - Jay R Gavvala
- 2Neurology, Baylor College of Medicine, Houston, Texas
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9
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Wang C, Chen S, Huang L, Yu L. Prediction and control of focal seizure spread: Random walk with restart on heterogeneous brain networks. Phys Rev E 2022; 105:064412. [PMID: 35854502 DOI: 10.1103/physreve.105.064412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
Whole-brain models offer a promising method of predicting seizure spread, which is critical for successful surgical treatment of focal epilepsy. Existing methods are largely based on structural connectome, which ignores the effects of heterogeneity within the regional excitability of brains. In this study we used a whole-brain model to show that heterogeneity in nodal excitability had a significant impact on seizure propagation in the networks and compromised the prediction accuracy with structural connections. We then addressed this problem with an algorithm based on random walk with restart on graphs. We demonstrated that by establishing a relationship between the restarting probability and the excitability for each node, this algorithm could significantly improve the seizure spread prediction accuracy in heterogeneous networks and was more robust against the extent of heterogeneity. We also strategized surgical seizure control as a process to identify and remove the key nodes (connections) responsible for the early spread of seizures from the focal region. Compared to strategies based on structural connections, virtual surgery with a strategy based on a modified random walk with extended restart generated outcomes with a high success rate while maintaining low damage to the brain by removing fewer anatomical connections. These findings may have potential applications in developing personalized surgery strategies for epilepsy.
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Affiliation(s)
- Chen Wang
- School of Physical Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - Sida Chen
- School of Physical Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - Liang Huang
- School of Physical Science and Technology, Lanzhou University, Lanzhou 730000, China
- Lanzhou Center for Theoretical Physics, Key Laboratory of Theoretical Physics of Gansu Province, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Lianchun Yu
- School of Physical Science and Technology, Lanzhou University, Lanzhou 730000, China
- Lanzhou Center for Theoretical Physics, Key Laboratory of Theoretical Physics of Gansu Province, Lanzhou University, Lanzhou, Gansu 730000, China
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10
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Weiss SA, Pastore T, Orosz I, Rubinstein D, Gorniak R, Waldman Z, Fried I, Wu C, Sharan A, Slezak D, Worrell G, Engel J, Sperling MR, Staba RJ. Graph theoretical measures of fast ripples support the epileptic network hypothesis. Brain Commun 2022; 4:fcac101. [PMID: 35620169 PMCID: PMC9128387 DOI: 10.1093/braincomms/fcac101] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/10/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
The epileptic network hypothesis and epileptogenic zone hypothesis are two
theories of ictogenesis. The network hypothesis posits that coordinated activity
among interconnected nodes produces seizures. The epileptogenic zone hypothesis
posits that distinct regions are necessary and sufficient for seizure
generation. High-frequency oscillations, and particularly fast ripples, are
thought to be biomarkers of the epileptogenic zone. We sought to test these
theories by comparing high-frequency oscillation rates and networks in surgical
responders and non-responders, with no appreciable change in seizure frequency
or severity, within a retrospective cohort of 48 patients implanted with
stereo-EEG electrodes. We recorded inter-ictal activity during non-rapid eye
movement sleep and semi-automatically detected and quantified high-frequency
oscillations. Each electrode contact was localized in normalized coordinates. We
found that the accuracy of seizure onset zone electrode contact classification
using high-frequency oscillation rates was not significantly different in
surgical responders and non-responders, suggesting that in non-responders the
epileptogenic zone partially encompassed the seizure onset zone(s)
(P > 0.05). We also found that in the
responders, fast ripple on oscillations exhibited a higher spectral content in
the seizure onset zone compared with the non-seizure onset zone
(P < 1 × 10−5).
By contrast, in the non-responders, fast ripple had a lower spectral content in
the seizure onset zone
(P < 1 × 10−5).
We constructed two different networks of fast ripple with a spectral content
>350 Hz. The first was a rate–distance network that
multiplied the Euclidian distance between fast ripple-generating contacts by the
average rate of fast ripple in the two contacts. The radius of the
rate–distance network, which excluded seizure onset zone nodes,
discriminated non-responders, including patients not offered resection or
responsive neurostimulation due to diffuse multifocal onsets, with an accuracy
of 0.77 [95% confidence interval (CI) 0.56–0.98]. The second fast
ripple network was constructed using the mutual information between the timing
of the events to measure functional connectivity. For most non-responders, this
network had a longer characteristic path length, lower mean local efficiency in
the non-seizure onset zone, and a higher nodal strength among non-seizure onset
zone nodes relative to seizure onset zone nodes. The graphical theoretical
measures from the rate–distance and mutual information networks of 22
non- responsive neurostimulation treated patients was used to train a support
vector machine, which when tested on 13 distinct patients classified
non-responders with an accuracy of 0.92 (95% CI 0.75–1). These
results indicate patients who do not respond to surgery or those not selected
for resection or responsive neurostimulation can be explained by the epileptic
network hypothesis that is a decentralized network consisting of widely
distributed, hyperexcitable fast ripple-generating nodes.
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Affiliation(s)
- Shennan A Weiss
- Dept. of Neurology, State University of New York Downstate, Brooklyn, New York, 11203 USA
- Dept. of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, New York, 11203 USA
- Dept. of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY, USA
| | - Tomas Pastore
- Dept. of Computer Science, University of Buenos Aires, Buenos Aires, Argentina
| | - Iren Orosz
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Daniel Rubinstein
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Richard Gorniak
- Dept. of Neuroradiology, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Zachary Waldman
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Itzhak Fried
- Dept. of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Chengyuan Wu
- Dept. of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Ashwini Sharan
- Dept. of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Diego Slezak
- Dept. of Computer Science, University of Buenos Aires, Buenos Aires, Argentina
| | - Gregory Worrell
- Dept. of Neurology, Mayo Systems Electrophysiology Laboratory (MSEL), USA
- Dept. of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Jerome Engel
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Michael R. Sperling
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Richard J Staba
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
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11
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Jehi L, Morita-Sherman M, Love TE, Bartolomei F, Bingaman W, Braun K, Busch RM, Duncan J, Hader WJ, Luan G, Rolston JD, Schuele S, Tassi L, Vadera S, Sheikh S, Najm I, Arain A, Bingaman J, Diehl B, de Tisi J, Rados M, Van Eijsden P, Wahby S, Wang X, Wiebe S. Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery. Ann Neurol 2021; 90:927-939. [PMID: 34590337 DOI: 10.1002/ana.26238] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim was to compare the outcomes of subdural electrode (SDE) implantations versus stereotactic electroencephalography (SEEG), the 2 predominant methods of intracranial electroencephalography (iEEG) performed in difficult-to-localize drug-resistant focal epilepsy. METHODS The Surgical Therapies Commission of the International League Against Epilepsy created an international registry of iEEG patients implanted between 2005 and 2019 with ≥1 year of follow-up. We used propensity score matching to control exposure selection bias and generate comparable cohorts. Study endpoints were: (1) likelihood of resection after iEEG; (2) seizure freedom at last follow-up; and (3) complications (composite of postoperative infection, symptomatic intracranial hemorrhage, or permanent neurological deficit). RESULTS Ten study sites from 7 countries and 3 continents contributed 2,012 patients, including 1,468 (73%) eligible for analysis (526 SDE and 942 SEEG), of whom 988 (67%) underwent subsequent resection. Propensity score matching improved covariate balance between exposure groups for all analyses. Propensity-matched patients who underwent SDE had higher odds of subsequent resective surgery (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.05, 1.84) and higher odds of complications (OR = 2.24, 95% CI 1.34, 3.74; unadjusted: 9.6% after SDE vs 3.3% after SEEG). Odds of seizure freedom in propensity-matched resected patients were 1.66 times higher (95% CI 1.21, 2.26) for SEEG compared with SDE (unadjusted: 55% seizure free after SEEG-guided resections vs 41% after SDE). INTERPRETATION In comparison to SEEG, SDE evaluations are more likely to lead to brain surgery in patients with drug-resistant epilepsy but have more surgical complications and lower probability of seizure freedom. This comparative-effectiveness study provides the highest feasible evidence level to guide decisions on iEEG. ANN NEUROL 2021.
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Affiliation(s)
- Lara Jehi
- Cleveland Clinic Epilepsy Center, Cleveland, OH
| | | | - Thomas E Love
- Departments of Medicine and Population & Quantitative Health Sciences, CWRU and Population Health Research Institute, The MetroHealth System, and Center for Health Care Research and Policy, CWRU - MetroHealth, Cleveland, OH
| | - Fabrice Bartolomei
- Epileptology Department, Aix Marseille University, APHM, INSERM, INS, Institut National de la Sante et de la Recherche Medicale, Timone Hospital, Marseille, France
| | | | - Kees Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | | | - John Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Walter J Hader
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Guoming Luan
- Department of Neurosurgery, Comprehensive Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; Beijing Key Laboratory of Epilepsy; Epilepsy Institution, Beijing Institute for Brain Disorders, Beijing, China
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Stephan Schuele
- Department of Neurology, Northwestern University, Chicago, IL
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milano, Italy
| | - Sumeet Vadera
- Department of Neurosurgery, University of California, Irvine, CA
| | | | - Imad Najm
- Cleveland Clinic Epilepsy Center, Cleveland, OH
| | - Amir Arain
- Department of Neurology, University of Utah, Salt Lake City, UT
| | | | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Matea Rados
- Department of Child Neurology, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - Pieter Van Eijsden
- Department of Child Neurology, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - Sandra Wahby
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Xiongfei Wang
- Department of Neurosurgery, Comprehensive Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; Beijing Key Laboratory of Epilepsy; Epilepsy Institution, Beijing Institute for Brain Disorders, Beijing, China
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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12
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Stereo-electroencephalography (SEEG) in pediatric epilepsy: Utility in children with and without prior epilepsy surgery failure. Epilepsy Res 2021; 177:106765. [PMID: 34537417 DOI: 10.1016/j.eplepsyres.2021.106765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND When noninvasive modalities fail to adequately localize the seizure onset zone (SOZ) in children with medically refractory epilepsy, invasive interrogation with stereo-electroencephalography (SEEG) or subdural electrodes may be required. Our center utilizes SEEG for invasive monitoring in a carefully selected population of children, many of whom have seizures despite a prior surgical resection. We describe the cohort of patients who underwent SEEG in the first 5 years of its employment in our institution, almost half of which had a history of a failed epilepsy surgery. METHODS We retrospectively reviewed the records of the first 44 consecutive children who underwent SEEG at Nicklaus Children's Hospital (Miami, Florida), a large, level 4 epilepsy referral center. Patient demographic, clinical, radiographic, and electrophysiological information was collected prospectively. Student's t-test was used for sampling of means and analysis of variance (ANOVA) for evaluation of variance beyond 2 means; chi-square test of independence was used to assess the relationship between categorical variables. RESULTS There were 44 patients in this cohort, of whom 17 (38.6 %) were male. The mean age of seizure onset was 6.2 years. Twenty-one patients (47.7 %) had previously failed an epilepsy surgery. Patients with a history of prior epilepsy surgery failure were older at SEEG implantation (17.6 vs. 13.7 years; p = 0.043), were more likely to have SEEG for identification of resection margins (9 vs. 4; p = 0.034), and had fewer electrodes placed (5.9 vs. 7.5; p = 0.016). No difference was seen in complication rates between groups with only 3/297 electrodes placed associated with complications, all of which were minor. Post-SEEG, 29 (65.9 %) patients underwent focal resection, 7 patients had VNS insertion, 3 underwent RNS placement, and 5 had no further intervention. The majority of patients that underwent resection in both groups experienced an improvement in seizures (Engel class I-III), reported by 13/15 (86.7 %) in those naive to surgery and 10/14 (71.4 %) in those with prior surgical failure. Seizure-freedom was much lower in those with prior epilepsy surgery, seen in only 4/14 (28.6 %) versus 8/15 (53.3 %). CONCLUSION Our data supports current literature on SEEG as a safe and effective method of electrophysiological evaluation in children naive to surgery and adds that it is a safe technique in children with a history of failed epilepsy surgery. There was no difference in complication rates, which were <1 % in both groups. A favorable outcome was seen in the majority of patients in both groups; the seizure freedom rate, however, was much lower in those with prior epilepsy surgery.
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13
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The UK experience of stereoelectroencephalography in children: An analysis of factors predicting the identification of a seizure-onset zone and subsequent seizure freedom. Epilepsia 2021; 62:1883-1896. [PMID: 34165813 DOI: 10.1111/epi.16954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is being used more frequently in the pre-surgical evaluation of children with focal epilepsy. It has been shown to be safe in children, but there are no multicenter studies assessing the rates and factors associated with the identification of a putative seizure-onset zone (SOZ) and subsequent seizure freedom following SEEG-guided epilepsy surgery. METHODS Multicenter retrospective cohort study of all children undergoing SEEG at six of seven UK Children's Epilepsy Surgery Service centers from 2014 to 2019. Demographics, noninvasive evaluation, SEEG, and operative factors were analyzed to identify variables associated with the identification of a putative SOZ and subsequent seizure freedom following SEEG-guided epilepsy surgery. RESULTS One hundred thirty-five patients underwent 139 SEEG explorations using a total of 1767 electrodes. A putative SOZ was identified in 117 patients (85.7%); odds of successfully finding an SOZ were 6.4 times greater for non-motor seizures compared to motor seizures (p = 0.02) and 3.6 times more if four or more seizures were recorded during SEEG (p = 0.03). Of 100 patients undergoing surgical treatment, 47 (47.0%) had an Engel class I outcome at a median follow-up of 1.3 years; the only factor associated with outcome was indication for SEEG (p = 0.03); an indication of "recurrence following surgery/treatment" had a 5.9 times lower odds of achieving seizure freedom (p = 0.002) compared to the "lesion negative" cohort, whereas other indications ("lesion positive, define extent," "lesion positive, discordant noninvasive investigations" and "multiple lesions") were not statistically significantly different. SIGNIFICANCE This large nationally representative cohort illustrates that SEEG-guided surgery can still achieve high rates of seizure freedom. Seizure semiology and the number of seizures recorded during SEEG are important factors in the identification of a putative SOZ, and the indication for SEEG is an important factor in postoperative outcomes.
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14
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Martini ML, Valliani AA, Sun C, Costa AB, Zhao S, Panov F, Ghatan S, Rajan K, Oermann EK. Deep anomaly detection of seizures with paired stereoelectroencephalography and video recordings. Sci Rep 2021; 11:7482. [PMID: 33820942 PMCID: PMC8021582 DOI: 10.1038/s41598-021-86891-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/16/2021] [Indexed: 01/30/2023] Open
Abstract
Real-time seizure detection is a resource intensive process as it requires continuous monitoring of patients on stereoelectroencephalography. This study improves real-time seizure detection in drug resistant epilepsy (DRE) patients by developing patient-specific deep learning models that utilize a novel self-supervised dynamic thresholding approach. Deep neural networks were constructed on over 2000 h of high-resolution, multichannel SEEG and video recordings from 14 DRE patients. Consensus labels from a panel of epileptologists were used to evaluate model efficacy. Self-supervised dynamic thresholding exhibited improvements in positive predictive value (PPV; difference: 39.0%; 95% CI 4.5–73.5%; Wilcoxon–Mann–Whitney test; N = 14; p = 0.03) with similar sensitivity (difference: 14.3%; 95% CI − 21.7 to 50.3%; Wilcoxon–Mann–Whitney test; N = 14; p = 0.42) compared to static thresholds. In some models, training on as little as 10 min of SEEG data yielded robust detection. Cross-testing experiments reduced PPV (difference: 56.5%; 95% CI 25.8–87.3%; Wilcoxon–Mann–Whitney test; N = 14; p = 0.002), while multimodal detection significantly improved sensitivity (difference: 25.0%; 95% CI 0.2–49.9%; Wilcoxon–Mann–Whitney test; N = 14; p < 0.05). Self-supervised dynamic thresholding improved the efficacy of real-time seizure predictions. Multimodal models demonstrated potential to improve detection. These findings are promising for future deployment in epilepsy monitoring units to enable real-time seizure detection without annotated data and only minimal training time in individual patients.
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Affiliation(s)
- Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Aly A Valliani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Claire Sun
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Neurosciences, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Anthony B Costa
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Shan Zhao
- Department of Anesthesiology, Icahn School of Medicine At Mount Sinai, New York, NY, 10029, USA
| | - Fedor Panov
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Saadi Ghatan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Kanaka Rajan
- Department of Neurosciences, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA.
| | - Eric Karl Oermann
- Department of Neurosurgery, New York University Langone Medical Center, New York University, Skirball, Suite 8S, 530 First Avenue, New York, NY, 10016, USA. .,Department of Radiology, New York University Langone Medical Center, New York, NY, 10016, USA. .,NYU Center for Data Science, New York University, New York, NY, 10011, USA.
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15
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San-Juan D, Rodríguez-Méndez DA. Epilepsy as a disease affecting neural networks: A neurophysiological perspective. Neurologia 2020; 38:S0213-4853(20)30213-9. [PMID: 32912747 DOI: 10.1016/j.nrl.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/09/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The brain is a series of networks of functionally and anatomically connected, bilaterally represented structures; in epilepsy, activity of any part of the brain affects activity in the other parts. This is relevant for understanding the pathophysiology, diagnosis, and prognosis of the disease. OBJECTIVE In this study, we present a state-of-the-art review of the neurophysiological view of epilepsy as a disease affecting neural networks. RESULTS We describe the basic and advanced principles of epilepsy as a disease affecting neural networks, based on the use of different clinical and mathematical techniques from a neurophysiological perspective, and signal the limitations of these findings in the clinical context. CONCLUSIONS Epilepsy is a disease affecting complex neural networks. Understanding these will enable better management and prognostic confidence.
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Affiliation(s)
- D San-Juan
- Departamento de Investigación Clínica, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México.
| | - D A Rodríguez-Méndez
- Facultad de Ciencias, Universidad Autónoma del Estado de México, Toluca de Lerdo, México
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16
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Sun K, Liu Z, Li Y, Wang L, Tang Z, Wang S, Zhou X, Shao L, Sun C, Liu X, Jiang T, Wang Y, Tian J. Radiomics Analysis of Postoperative Epilepsy Seizures in Low-Grade Gliomas Using Preoperative MR Images. Front Oncol 2020; 10:1096. [PMID: 32733804 PMCID: PMC7360821 DOI: 10.3389/fonc.2020.01096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/02/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose: The present study aimed to evaluate the performance of radiomics features in the preoperative prediction of epileptic seizure following surgery in patients with LGG. Methods: This retrospective study collected 130 patients with LGG. Radiomics features were extracted from the T2-weighted MR images obtained before surgery. Multivariable Cox-regression with two nested leave-one-out cross validation (LOOCV) loops was applied to predict the prognosis, and elastic net was used in each LOOCV loop to select the predictive features. Logistic models were then built with the selected features to predict epileptic seizures at two time points. Student's t-tests were then used to compare the logistic model predicted probabilities of developing epilepsy in the epilepsy and non-epilepsy groups. The t-test was used to identify features that differentiated patients with early-onset epilepsy from their late-onset counterparts. Results: Seventeen features were selected with the two nested LOOCV loops. The index of concordance (C-index) of the Cox model was 0.683, and the logistic model predicted probabilities of seizure were significantly different between the epilepsy and non-epilepsy groups at each time point. Moreover, one feature was found to be significantly different between the patients with early- or late-onset epilepsy. Conclusion: A total of 17 radiomics features were correlated with postoperative epileptic seizures in patients with LGG and one feature was a significant predictor of the time of epilepsy onset.
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Affiliation(s)
- Kai Sun
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China
| | - Yiming Li
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhenchao Tang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China
| | - Shuo Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China
| | - Xuezhi Zhou
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China
| | - Lizhi Shao
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,School of Computer Science and Engineering, Southeast University, Nanjing, China
| | - Caixia Sun
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Key Laboratory of Intelligent Medical Image Analysis and Precise Diagnosis of Guizhou Province, School of Computer Science and Technology, Guizhou University, Guiyang, China
| | - Xing Liu
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yinyan Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Tian
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China.,University of Chinese Academy of Science, Beijing, China
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17
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Peedicail JS, Almohawes A, Hader W, Starreveld Y, Singh S, Josephson CB, Murphy W, Federico P, Wiebe S, Pillay N, Agha‐Khani Y, Jette N, Avendano R, Hanna S. Outcomes of stereoelectroencephalography exploration at an epilepsy surgery center. Acta Neurol Scand 2020; 141:463-472. [PMID: 32057089 DOI: 10.1111/ane.13229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/13/2019] [Accepted: 02/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Epilepsy surgery is offered in resistant focal epilepsy. Non-invasive investigations like scalp video EEG monitoring (SVEM) help delineate epileptogenic zone. Complex cases may require intracranial video EEG monitoring (IVEM). Stereoelectroencephalography (SEEG)-based intracerebral electrode implantation has better spatial resolution, lower morbidity, better tolerance, and superiority in sampling deep structures. Our objectives were to assess IVEM using SEEG with regard to reasoning behind implantation, course, surgical interventions, and outcomes. MATERIALS AND METHODS Seventy-two admissions for SEEG from January 2014 to December 2018 were included in the study. Demographic and clinical data were retrospectively collected. RESULTS The cohort comprised of 69 adults of which 34 (47%) had lesional MRI. Reasons for SEEG considering all cases included non-localizing ictal onset (76%), ictal-interictal discordance (21%), discordant semiology (17%), proximity to eloquent cortex (33%), nuclear imaging discordance (34%), and discordance with neuropsychology (19%). Among lesional cases, additional reasons included SVEM discordance (68%) and dual or multiple pathology (47%). Forty-eight patients (67%) were offered resective surgery, and 41 underwent it. Twenty-three (56%) had at least one year post-surgical follow-up of which 14 (61%) had Engels class I outcome. Of the remaining 23 who were continued on medical management, 4 (17%) became seizure-free and 12 (51%) had reduction in seizure frequency. CONCLUSION SEEG monitoring is an important and safe tool for presurgical evaluation with good surgical and non-surgical outcomes. Whether seizure freedom following non-surgical management could be related to SEEG implantation, medication change, or natural course needs to be determined.
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Affiliation(s)
- Joseph Samuel Peedicail
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Amal Almohawes
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Walter Hader
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Yves Starreveld
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Shaily Singh
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Colin Bruce Josephson
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - William Murphy
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Paolo Federico
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Samuel Wiebe
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Neelan Pillay
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Yahya Agha‐Khani
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Nathalie Jette
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Rey Avendano
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Salma Hanna
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
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Yardi R, Morita-Sherman ME, Fitzgerald Z, Punia V, Bena J, Morrison S, Najm I, Bingaman W, Jehi L. Long-term outcomes of reoperations in epilepsy surgery. Epilepsia 2020; 61:465-478. [PMID: 32108946 DOI: 10.1111/epi.16452] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze longitudinal seizure outcomes following epilepsy surgery, including reoperations, in patients with intractable focal epilepsy. METHODS Clinicoradiological characteristics of patients who underwent epilepsy surgery from 1995 to 2016 with follow-up of ≥1 year were reviewed. In patients undergoing reoperations, the latest resection was considered the index surgery. The primary outcome was complete seizure freedom (Engel I) at last follow-up. Potentially significant outcome variables were first identified using univariate analyses and then fit in multivariate Cox proportional hazards models. RESULTS Of 898 patients fulfilling study criteria, 110 had reoperations; 92 had one resection prior to the index surgery and 18 patients had two or more prior resective surgeries. Two years after the index surgery, 69% of patients with no prior surgeries had an Engel score of I, as opposed to only 42% of those with one prior surgery, and 33% of those with two or more prior resections (P < .001). Among surgical outcome predictors, the number of prior epilepsy surgeries, female sex, lesional initial magnetic resonance imaging, no prior history of generalization, and pathology correlated with better seizure outcomes on univariate analysis. However, only sex (P = .011), history of generalization (P = .016), and number of prior surgeries (P = .002) remained statistically significant in the multivariate model. SIGNIFICANCE Although long-term seizure control is possible in patients with failed prior epilepsy surgery, the chances of success diminish with every subsequent resection. Outcome is additionally determined by inherent biological markers (sex and secondary generalization tendency), rather than traditional outcome predictors, supporting a hypothesis of "surgical refractoriness."
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Affiliation(s)
- Ruta Yardi
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Vineet Punia
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | - James Bena
- Quantitative Health Sciences, Cleveland, Ohio
| | | | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | | | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
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19
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Chen Y, Huang T, Sun Y, Liao J, Cao D, Li L, Xiang K, Lin C, Li C, Chen Q. Surface-Based Registration of MR Scan versus Refined Anatomy-Based Registration of CT Scan: Effect on the Accuracy of SEEG Electrodes Implantation Performed in Prone Position under Frameless Neuronavigation. Stereotact Funct Neurosurg 2020; 98:73-79. [PMID: 32036377 DOI: 10.1159/000505713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/31/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Stereoelectroencephalography (SEEG) refers to a commonly used diagnostic procedure to localise and define the epileptogenic zone of refractory focal epilepsies, by means of minimally invasive operation techniques without large craniotomies. OBJECTIVE This study aimed to investigate the influence of different registration methods on the accuracy of SEEG electrode implantation under neuronavigation for paediatric patients with refractory epilepsy. METHODS The clinical data of 18 paediatric patients with refractory epilepsy were retrospectively analysed. The SEEG electrodes were implanted under optical neuronavigation while the patients were in the prone position. Patients were divided into two groups on the basis of the surface-based registration of MR scan method and refined anatomy-based registration of CT scan. Registration time, accuracy, and the differences between electrode placement and preoperative planned position were analysed. RESULTS Thirty-six electrodes in 7 patients were placed under surface-based registration of MR scan, and 45 electrodes in 11 patients were placed under refined anatomy-based registration of CT scan. The registration time of surface-based registration of MR scan and refined anatomy-based registration of CT scan was 45 ± 12 min and 10 ± 4 min. In addition, the mean registration error, the error of insertion point, and target error were 3.6 ± 0.7 mm, 2.7 ± 0.7 mm, and 3.1 ± 0.5 mm in the surface-based registration of MR scan group, and 1.1 ± 0.3 mm, 1.5 ± 0.5 mm, and 2.2 ± 0.6 mm in the refined anatomy-based registration of CT scan group. The differences between the two registration methods were statistically significant. CONCLUSIONS The refined anatomy-based registration of CT scan method can improve the registration efficiency and electrode placement accuracy, and thereby can be considered as the preferred registration method in the application of SEEG electrode implantation under neuronavigation for treatment of paediatric intractable epilepsy.
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Affiliation(s)
- Yan Chen
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Tieshuan Huang
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Yang Sun
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianxiang Liao
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Dezhi Cao
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Lin Li
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Kui Xiang
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Chun Lin
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Cong Li
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Qian Chen
- Neurosurgery Department, Shenzhen Children's Hospital, Shenzhen, China,
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20
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The Widespread Network Effects of Focal Epilepsy. J Neurosci 2019; 38:8107-8109. [PMID: 30232147 DOI: 10.1523/jneurosci.1471-18.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 01/20/2023] Open
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21
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Liu W, Tian S, Zhang J, Huang P, Wang T, Deng Y, Liu X, Miao F, Sun B, Zhan S. Utility of stereo-electroencephalography recording guided by magnetoencephalography in the surgical treatment of epilepsy patients with negative magnetic resonance imaging results. Int J Neurosci 2019; 129:1045-1052. [PMID: 31215295 DOI: 10.1080/00207454.2019.1634066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: It is challenging for neurosurgeons to perform surgeries on patients without detectable structural lesions. Therefore, this retrospective study aimed to explore the outcome of stereo-electroencephalography (SEEG) in suspicious areas guided by magnetoencephalography (MEG)-magnetic resonance imaging (MRI) reconstruction in MRI-negative epilepsy patients. Methods: This study included 47 patients with negative-MRI epilepsy. Seizure outcome at 24 months was assessed using a modified Engel's classification. Accordingly, class I and II were considered favorable outcomes, whereas classes III and IV were unfavorable. Furthermore, patients were classified into a consistent group if the results of MEG and SEEG indicated the same area of the brain. The relationship between surgical outcome and the concordance of MEG and SEEG was analyzed. Results: A complete seizure-free condition was achieved in 22 (47%) patients. Sex, handedness, age and duration of illness were not significantly associated with seizure-free outcome (p = .187 [Pearson chi-squared test]). The number of patients with favorable outcome (Engle I and II) was as high as 68% at the time of follow-up. Furthermore, more seizure-free patients were found in the SEEG and MEG consistent group. Conclusions: SEEG is a valuable tool in the pre-evaluation for resective epilepsy surgery, particularly in negative-MRI epilepsy patients; MEG greatly facilitates localization for SEEG electrode implantation. However, none of these tools are absolutely sensitive and reliable; therefore, collecting as much information as possible is necessary to achieve satisfactory results in epilepsy surgery.
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Affiliation(s)
- Wei Liu
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shuaiwei Tian
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jing Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Peng Huang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Tao Wang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yulei Deng
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xiaoying Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Fei Miao
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Bomin Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shikun Zhan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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22
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Mo JJ, Hu WH, Zhang C, Wang X, Liu C, Zhao BT, Zhou JJ, Zhang K. Value of stereo-electroencephalogram in reoperation of patients with pharmacoresistant epilepsy: a single center, retrospective study. Br J Neurosurg 2018; 32:663-670. [PMID: 30317876 DOI: 10.1080/02688697.2018.1506095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jia-Jie Mo
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Chao Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Bao-Tian Zhao
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jun-Jian Zhou
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
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