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Mitsumatsu T, Ito Y, Maki Y, Yamamoto H, Sawamura F, Ishizaki T, Maesawa S, Bagarinao E, Nakata T, Kidokoro H, Saito R, Natsume J. Epileptic foci and networks in children with epilepsy after acute encephalopathy with biphasic seizures and late reduced diffusion. Brain Dev 2024; 46:302-307. [PMID: 39089917 DOI: 10.1016/j.braindev.2024.07.003] [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: 03/08/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) develops along with status epilepticus and widespread subcortical white matter edema. We aimed to evaluate the epileptic foci and networks in two patients with epilepsy after AESD using simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI). METHODS Statistically significant blood oxygen level-dependent (BOLD) responses related to interictal epileptiform discharges (IEDs) were analyzed using an event-related design of hemodynamic response functions with multiple peaks. RESULTS Patient 1 developed focal seizures at age 10 years, one year after AESD onset. Positive BOLD changes were observed in the bilateral frontotemporal lobes, left parietal lobe, and left insula. BOLD changes were also observed in the subcortical structures. Patient 2 developed epileptic spasms at age two years, one month after AESD onset. Following total corpus callosotomy (CC) at age three years, the epileptic spasms resolved, and neurodevelopmental improvement was observed. Before CC, positive BOLD changes were observed bilaterally in the frontotemporal lobes. BOLD changes were also observed in the subcortical structures. After CC, the positive BOLD changes were localized in the temporal lobe ipsilateral to the IEDs, and the negative BOLD changes were mainly in the cortex and subcortical structures of the hemisphere ipsilateral to IEDs. CONCLUSION EEG-fMRI revealed multiple epileptic foci and extensive epileptic networks, including subcortical structures in two cases with post-AESD epilepsy. CC may be effective in disconnecting the bilaterally synchronous epileptic networks of epileptic spasms after AESD, and pre-and post-operative changes in EEG-fMRI may reflect improvements in epileptic symptoms.
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Affiliation(s)
- Takamasa Mitsumatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain & Mind Research Center, Nagoya University, Nagoya, Japan
| | - Yuji Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain & Mind Research Center, Nagoya University, Nagoya, Japan.
| | - Yuki Maki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain & Mind Research Center, Nagoya University, Nagoya, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain & Mind Research Center, Nagoya University, Nagoya, Japan
| | - Fumi Sawamura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain & Mind Research Center, Nagoya University, Nagoya, Japan
| | - Tomotaka Ishizaki
- Brain & Mind Research Center, Nagoya University, Nagoya, Japan; Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Maesawa
- Brain & Mind Research Center, Nagoya University, Nagoya, Japan; Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Neurosurgery, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Epifanio Bagarinao
- Brain & Mind Research Center, Nagoya University, Nagoya, Japan; Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiko Nakata
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain & Mind Research Center, Nagoya University, Nagoya, Japan
| | - Ryuta Saito
- Brain & Mind Research Center, Nagoya University, Nagoya, Japan; Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain & Mind Research Center, Nagoya University, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Sun S, Tian M, Lin X, Zhao P. Disturbed white matter integrity on diffusion tensor imaging in young children with epilepsy. Clin Radiol 2024; 79:e119-e126. [PMID: 37940443 DOI: 10.1016/j.crad.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
AIM To evaluate whether abnormalities in white matter (WM) integrity are present in young children with epilepsy. MATERIALS AND METHODS Twelve children (3-6 years old) with epilepsy and six matched healthy controls were recruited for brain diffusion tensor imaging (DTI). Track-based spatial statistics (TBSS) was used to analyse and compare DTI indices of mean diffusivity (MD), fractional anisotropy (FA), axial and radial diffusivity (AD/RD) between patients and controls, and correlations between clinical variables and DTI parameters were analysed. RESULTS Compared with controls, patients showed increased FA in the left superior corona radiata and increased AD in the bilateral superior corona radiata. In children with generalised epilepsy, FA was increased in the left external capsule, while AD was decreased in the body of the corpus callosum, the left external capsule and the left superior longitudinal fasciculus. In those with focal epilepsy, FA was increased in the genu and body of the corpus callosum, and RD was decreased in the genu of the corpus callosum and left external capsule. Compared with partial epilepsy, generalised epilepsy was associated with increased FA in the right anterior corona radiata and decreased RD in the right anterior corona radiata and the genu and body of the corpus callosum. No significant correlations were observed between clinical variables and DTI parameters. CONCLUSIONS The results of this study indicate that the microstructure of the white matter is disturbed by epileptic discharges and a compensatory response occurs during early brain development.
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Affiliation(s)
- S Sun
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - M Tian
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - X Lin
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - P Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Kosugi K, Iijima K, Yokosako S, Takayama Y, Kimura Y, Kaneko Y, Sumitomo N, Saito T, Nakagawa E, Sato N, Iwasaki M. Low EEG Gamma Entropy and Glucose Hypometabolism After Corpus Callosotomy Predicts Seizure Outcome After Subsequent Surgery. Front Neurol 2022; 13:831126. [PMID: 35401399 PMCID: PMC8989433 DOI: 10.3389/fneur.2022.831126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with generalized epilepsy who had lateralized EEG abnormalities after corpus callosotomy (CC) occasionally undergo subsequent surgeries to control intractable epilepsy.ObjectivesThis study evaluated retrospectively the combination of EEG multiscale entropy (MSE) and FDG-PET for identifying lateralization of the epileptogenic zone after CC.MethodsThis study included 14 patients with pharmacoresistant epilepsy who underwent curative epilepsy surgery after CC. Interictal scalp EEG and FDG-PET obtained after CC were investigated to determine (1) whether the MSE calculated from the EEG and FDG-PET findings was lateralized to the surgical side, and (2) whether the lateralization was associated with seizure outcomes.ResultsSeizure reduction rate was higher in patients with lateralized findings to the surgical side than those without (MSE: p < 0.05, FDG-PET: p < 0.05, both: p < 0.01). Seizure free rate was higher in patients with lateralized findings in both MSE and FDG-PET than in those without (p < 0.05).ConclusionsThis study demonstrated that patients with lateralization of MSE and FDG-PET to the surgical side had better seizure outcomes. The combination of MSE and conventional FDG-PET may help to select surgical candidates for additional surgery after CC with good postoperative seizure outcomes.
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Affiliation(s)
- Kenzo Kosugi
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Suguru Yokosako
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuiko Kimura
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuu Kaneko
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
- *Correspondence: Masaki Iwasaki
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Long R, Wang Y, Chen L, Deng D, Mei L, Mou J, Tang G, Han F, Kemp GJ, Gong Q, Qiu L. Abnormalities of Cerebral White Matter Microstructure in Children With New-Onset, Untreated Idiopathic-Generalized Epilepsy. Front Neurol 2021; 12:744723. [PMID: 34917014 PMCID: PMC8669567 DOI: 10.3389/fneur.2021.744723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/01/2021] [Indexed: 02/05/2023] Open
Abstract
Despite evidence for microstructural brain alterations in epilepsy patients, little is known about how these develop with age and the progress of the disease. The aim of this study was to investigate microstructural abnormalities of the white matter (WM) in children with new-onset, untreated idiopathic-generalized epilepsy (IGE) using the MRI technique of diffusion tensor imaging (DTI). The study was approved by the institutional review board, and all individuals or their parents gave signed informed consent. In total, 45 patients with IGE (age 5-18 years, male: female 26:19) and 32 healthy controls (HCs; age 5-18 years, male: female 21:11) were included. Voxel-based analysis (VBA) was used to compare patients and controls, and Pearson correlation analysis was used to investigate relationships between altered DTI metrics and clinical parameters. Compared with controls, patients with IGE showed increased mean diffusivity (MD) in the left splenium of the corpus callosum, increased fractional anisotropy (FA) in the right WM of the superior and middle frontal gyri, increased axial diffusivity (AD) in the WM of right corona radiata and left occipital lobe, and decreased AD in the WM of the left thalamus and the right middle cerebellar peduncle. There was no correlation between the altered diffusion parameters and clinical measures. Our study demonstrated several distinct microstructural impairments in children with new-onset, untreated IGE, of which altered AD might be the most sensitive marker of dysmyelination. The increased FA in the IGE group might suggest an initiating or compensatory mechanism that is activated prior to cognitive decline in these children.
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Affiliation(s)
- Ran Long
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yuting Wang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Radiology, The Second People's Hospital of Yibin, Yibin, China
| | - Lizhou Chen
- Huaxi Magnetic Resonance Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Dingmei Deng
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lan Mei
- Department of Radiology, The Second People's Hospital of Yibin, Yibin, China
| | - Jingping Mou
- Department of Radiology, The Second People's Hospital of Yibin, Yibin, China
| | - Guangcai Tang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fugang Han
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Graham John Kemp
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Qiyong Gong
- Huaxi Magnetic Resonance Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lihua Qiu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Radiology, The Second People's Hospital of Yibin, Yibin, China
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Yokosako S, Muraoka N, Watanabe S, Kosugi K, Takayama Y, Iijima K, Kimura Y, Kaneko Y, Sumitomo N, Saito T, Nakagawa E, Iwasaki M. Corpus callosotomy in pediatric patients with non-lesional epileptic encephalopathy with electrical status epilepticus during sleep. Epilepsy Behav Rep 2021; 16:100463. [PMID: 34195590 PMCID: PMC8239855 DOI: 10.1016/j.ebr.2021.100463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022] Open
Abstract
Corpus callosotomy (CC) was performed in 3 pediatric patients with refractory epileptic encephalopathy with ESES. IQ was improved after CC with complete resolution of ESES in one patient. Developmental regression ceased after CC with worthwhile seizure reduction and temporary improvement of ESES in 2 patients. Epileptiform discharges disappeared or became lateralized after CC.
Epileptic encephalopathy with electrical status epilepticus during sleep (ESES) is often refractory to medical treatment and leads to poor cognitive outcomes. Corpus callosotomy may be an effective treatment option for drug-resistant ESES with no focal etiology. We retrospectively identified three patients who underwent corpus callosotomy for drug-resistant ESES in our institution. Electroencephalography (EEG) findings and cognitive functions were evaluated before surgery, at 3 months, 6 months, 1 year, and 2 years after surgery. Age at surgery was 6 years 10 months, 7 years 9 months, and 8 years 4 months, respectively. Period between the diagnosis of ESES and surgery ranged from 7 to 25 months. All patients had no obvious structural abnormalities and presented with cognitive decline despite multiple antiseizure medications and steroid therapies. One patient showed complete resolution of ESES and an improvement of intelligence quotient after surgery. Epileptiform EEG was lateralized to one hemisphere after surgery and spike wave index (SWI) was decreased with moderate improvement in development and seizures in the other 2 patients. SWI re-exacerbated from 6 months after surgery, but without subsequent developmental regression in these 2 patients. Corpus callosotomy may become an important treatment option for drug-resistant ESES in patients with no structural abnormalities.
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Affiliation(s)
- Suguru Yokosako
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Norihiro Muraoka
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Shiena Watanabe
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yuiko Kimura
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yu Kaneko
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Corresponding author.
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Honda R, Baba H, Adachi K, Koshimoto R, Ono T, Toda K, Tanaka S, Baba S, Yamasaki K, Yatsuhashi H. Developmental outcome after corpus callosotomy for infants and young children with drug-resistant epilepsy. Epilepsy Behav 2021; 117:107799. [PMID: 33610103 DOI: 10.1016/j.yebeh.2021.107799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/26/2020] [Accepted: 01/10/2021] [Indexed: 12/21/2022]
Abstract
AIM To examine the developmental and seizure outcomes after corpus callosotomy (CC) in early childhood. METHODS We retrospectively identified 106 patients who underwent CC for drug-resistant epilepsy before the age of 6 years, at the Nagasaki Medical Center, between July 2002 and July 2016. Patients' developmental outcomes were evaluated one year after CC using the Kinder Infant Development Scale. RESULTS The mean preoperative developmental quotient (DQ) was 25.0 (standard deviation [SD], 20.8), and the mean difference between preoperative DQ and one-year postoperative DQ was -1.6 points (SD, 11.6). However, 42.5% of patients had a mean DQ increase of 6.5 points (SD, 6.4), one year after CC from that before surgery. Factors related to the improvement in postoperative DQ were 'low preoperative DQ', 'developmental gain 1 month postoperatively', and 'postoperative seizure-free state'. Approximately 21.7% of patients were seizure-free 1 year after CC. INTERPRETATION Performing CC, in infancy and early childhood for patients with drug-resistant epilepsy and severe developmental impairment, was associated with improved development in 42.5% of patients. Remission of seizures, even if only for a short period, contributed to developmental improvement. From a developmental perspective, CC for drug-resistant epilepsy in early childhood is an effective treatment.
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Affiliation(s)
- Ryoko Honda
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan; Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Hiroshi Baba
- Department of Neurosurgery, Nishiisahaya Hospital, Nagasaki, Japan; Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kohei Adachi
- Department of Comprehensive Community Care Services, Nagasaki Junshin Catholic University, Japan
| | - Rika Koshimoto
- Psychological Counselling Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Tomonori Ono
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Keisuke Toda
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan; Department of Neurosurgery, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Shigeki Tanaka
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Shiro Baba
- Department of Neurosurgery, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazumi Yamasaki
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hiroshi Yatsuhashi
- Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan; Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
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Höller Y, Nardone R. Quantitative EEG biomarkers for epilepsy and their relation to chemical biomarkers. Adv Clin Chem 2020; 102:271-336. [PMID: 34044912 DOI: 10.1016/bs.acc.2020.08.004] [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] [Indexed: 02/01/2023]
Abstract
The electroencephalogram (EEG) is the most important method to diagnose epilepsy. In clinical settings, it is evaluated by experts who identify patterns visually. Quantitative EEG is the application of digital signal processing to clinical recordings in order to automatize diagnostic procedures, and to make patterns visible that are hidden to the human eye. The EEG is related to chemical biomarkers, as electrical activity is based on chemical signals. The most well-known chemical biomarkers are blood laboratory tests to identify seizures after they have happened. However, research on chemical biomarkers is much less extensive than research on quantitative EEG, and combined studies are rarely published, but highly warranted. Quantitative EEG is as old as the EEG itself, but still, the methods are not yet standard in clinical practice. The most evident application is an automation of manual work, but also a quantitative description and localization of interictal epileptiform events as well as seizures can reveal important hints for diagnosis and contribute to presurgical evaluation. In addition, the assessment of network characteristics and entropy measures were found to reveal important insights into epileptic brain activity. Application scenarios of quantitative EEG in epilepsy include seizure prediction, pharmaco-EEG, treatment monitoring, evaluation of cognition, and neurofeedback. The main challenges to quantitative EEG are poor reliability and poor generalizability of measures, as well as the need for individualization of procedures. A main hindrance for quantitative EEG to enter clinical routine is also that training is not yet part of standard curricula for clinical neurophysiologists.
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Affiliation(s)
- Yvonne Höller
- Faculty of Psychology, University of Akureyri, Akureyri, Iceland.
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
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Okanishi T, Fujimoto A, Okanari K, Baba S, Ichikawa N, Nishimura M, Enoki H. Corpus callosotomy for drug-resistant spasms associated with tuberous sclerosis complex. Epilepsy Behav 2019; 98:228-232. [PMID: 31394351 DOI: 10.1016/j.yebeh.2019.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/01/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Corpus callosotomy (CC) has recently been adopted for the treatment of drug-resistant epileptic spasms and tonic spasms. In the present study, we investigated CC outcomes among patients with drug-resistant epileptic spasms or tonic spasms associated with tuberous sclerosis complex (TSC). METHODS We retrospectively collected data from seven patients (3 women, 4 men) with diagnosed TSC and who were treated using CC at Seirei Hamamatsu General Hospital in Japan. All patients had experienced drug-resistant epileptic spasms (<3 s of muscular contraction) or tonic spasms (>3 s) prior to CC, which were confirmed via video-electroencephalogram monitoring. RESULTS All patients exhibited multiple bilateral cortical tubers on brain magnetic resonance imaging. The main seizure types were epileptic spasms in four, tonic spasms in one, and both seizure types in two patients. Patients underwent total CC between the ages of 25 months and 21.5 years. Additional resection or disconnection was performed in two patients. The follow-up period after CC ranged between 9 months and 3.5 years. Three patients achieved remission from spasms following CC alone. Two other patients became free from spasms several months after CC but required an additional focus disconnection or medical treatment. The remaining two patients continued to show spasms or asymmetrical tonic seizures. CONCLUSION Total CC resulted in freedom from drug-resistant epileptic or tonic spasms in several patients with TSC. Stepwise progression from CC to additional resection or disconnection surgery may aid in the treatment of spasms secondary to TSC.
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Affiliation(s)
- Tohru Okanishi
- Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan.
| | - Ayataka Fujimoto
- Epilepsy and Surgery, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan
| | - Kazuo Okanari
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu 879-5503, Japan
| | - Shimpei Baba
- Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan
| | - Naoki Ichikawa
- Epilepsy and Surgery, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan
| | - Mitsuyo Nishimura
- Division of Clinical Laboratory, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan
| | - Hideo Enoki
- Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan
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Analysis for the Association Between Corpus Callosum Thickness and Corpus Callosotomy Outcomes for Patients With Epileptic Spasms or Tonic Spasms. Pediatr Neurol 2019; 95:79-83. [PMID: 30819564 DOI: 10.1016/j.pediatrneurol.2019.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This retrospective study is designed to determine whether the thickness of the corpus callosum can predict corpus callosotomy outcome in pediatric patients with epileptic or tonic spasms. METHODS We retrospectively studied 25 patients (18 boys) with intractable childhood-onset epileptic or tonic spasms who underwent corpus callosotomy between March 2008 and January 2017. Seizure outcomes were classified as favorable (class I and II of Engel's outcome classification) or unfavorable (class III and IV of Engel's outcome classification) at 12 months postoperatively. We measured the corpus callosum area on the midline and maximum cerebral area on the para-midline in sagittal magnetic resonance images just before surgery. We statistically analyzed the associations between surgical outcomes and corpus callosum area, corpus callosum area/maximum cerebral area (corpus callosum/cerebrum ratio), or age at magnetic resonance imaging just before surgery, using univariate and multivariate logistic regression analyses. RESULTS Age at surgery ranged from six to 237 months (mean: 119). Main seizure types were epileptic spasms in 17 patients and tonic spasms in eight. Favorable outcomes occurred in 10 (40%) patients and unfavorable outcomes in 15 (60%). Both corpus callosum area and corpus callosum/cerebrum ratio did not show significant associations with the outcomes in the univariate and multivariate analyses. The 95% confidence intervals of corpus callosum/cerebrum ratio strongly overlapped between the favorable and unfavorable outcome groups. CONCLUSIONS Our data failed to support that corpus callosum thickness on the sagittal image is associated with corpus callosotomy outcomes in pediatric patients with epileptic spasms or tonic spasms.
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Liu G, Lyu G, Yang N, Chen B, Yang J, Hu Y, Lei Y, Xia J, Lin F, Fan G. Abnormalities of diffusional kurtosis imaging and regional homogeneity in idiopathic generalized epilepsy with generalized tonic-clonic seizures. Exp Ther Med 2019; 17:603-612. [PMID: 30651841 PMCID: PMC6307453 DOI: 10.3892/etm.2018.7018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 12/15/2017] [Indexed: 11/05/2022] Open
Abstract
Neuroimaging techniques have been used to investigate idiopathic generalized epilepsy with generalized tonic-clonic seizures (IGE-GTCS) and different studies employing these methods have produced varying results. However, there have been few studies exploring diffusional kurtosis imaging (DKI) and regional homogeneity (ReHo) techniques in patients with IGE-GTCS. In the current study, resting-state functional magnetic resonance imaging (fMRI) and DKI data were collected from 28 patients with IGE-GTCS and 28 healthy controls. The ReHo method and tract-based spatial statistical (TBSS) analysis were performed to compare differences between the groups. Compared with healthy controls, patients with IGE-GTCS exhibited markedly increased ReHo in the bilateral putamen, the thalamus, right pallidum, right supplementary motor area and the bilateral paracentral lobules. Compared with healthy controls, patients with IGE-GTCS also exhibited markedly decreased ReHo in the posterior cingulate/precuneus, left angular gyrus and dorsolateral prefrontal cortex. In patients with IGE-GTCS, DKI revealed lower fractional anisotropy in the left anterior/superior corona radiata, left superior longitudinal fasciculus and genu/body of the corpus callosum. Higher mean diffusivity was detected in the bilateral anterior corona radiata, left superior corona radiata, left cingulum, and genu/body/splenium of the corpus callosum. Furthermore, reduced mean kurtosis values were identified over the bilateral superior/posterior corona radiate, left anterior corona radiata, right superior longitudinal fasciculus, left posterior thalamic radiation and the genu/body/splenium of the corpus callosum. Therefore, the results of the current study revealed abnormalities in spontaneous activity in the gray and white matter tracts in patients with IGE-GTCS. These results suggest that novel MRI technology may be useful to help determine the pathogenesis of IGE-GTCS.
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Affiliation(s)
- Guohao Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Guiwen Lyu
- Department of Radiology, The Second People's Hospital of Shenzhen, Shenzhen, Guangdong 518035, P.R. China
| | - Na Yang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Boyu Chen
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yiwen Hu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yi Lei
- Department of Radiology, The Second People's Hospital of Shenzhen, Shenzhen, Guangdong 518035, P.R. China
| | - Jun Xia
- Department of Radiology, The Second People's Hospital of Shenzhen, Shenzhen, Guangdong 518035, P.R. China
| | - Fan Lin
- Department of Radiology, The Second People's Hospital of Shenzhen, Shenzhen, Guangdong 518035, P.R. China
| | - Guoguang Fan
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Liang JG, Lee D, Youn SE, Kim HD, Kim NY. Electroencephalography Network Effects of Corpus Callosotomy in Patients with Lennox-Gastaut Syndrome. Front Neurol 2017; 8:456. [PMID: 28928710 PMCID: PMC5591410 DOI: 10.3389/fneur.2017.00456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the functional network effects of corpus callosotomy (CC), a well-recognized palliative surgical therapy for patients with Lennox-Gastaut syndrome (LGS). Specifically, we sought to gain insight into the effects of CC on LGS remission, based on brain networks in LGS by calculating network metrics and evaluating by network measures before and after surgery. METHODS Electroencephalographic recordings made during preoperative and 3-month postoperative states in 14 patients with LGS who had undergone successful CC were retrospectively analyzed. First, undirected correlation matrices were constituted for the mathematical expression of functional networks. Then, we plotted these networks to analyze the effects of CC on connectivity. In addition, conventional local and global network measures were applied to evaluate differences in network topology between preoperative and postoperative states. RESULTS In the preoperative state, hubs were mainly distributed around the paramedian regions. After CC, the hubs moved from the paramedian regions to the dual-hemisphere and even the lateral regions. Thus, the general connectivity state became more homogeneous, which was verified by network plots and statistical analysis of local measures. The results of global network measures indicated a decreased clustering coefficient in the delta band, decreased characteristic path length in both the delta and gamma bands, and increased global efficiency in the gamma band. CONCLUSION Our results showed a consistent variation in the global brain network that converted to a small-world topology with an optimal balance of functional integration and segregation of the network. Such changes were positively correlated with satisfactory surgery results, which could be interpreted as being indicative of LGS recovery process after CC. For patients with refractory LGS along with no focal epileptogenic zone findings, which were not suitable for the resective surgical therapy, our results verified that CC could work as an effective surgical treatment option.
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Affiliation(s)
- Jun-Ge Liang
- RFIC Center, Kwangwoon University, Seoul, South Korea
| | - Dongpyo Lee
- Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Song Ee Youn
- Department of Pediatrics, Padiatric Epilepsy Clinic, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Heung Dong Kim
- Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, South Korea.,Department of Pediatrics, Padiatric Epilepsy Clinic, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Nam-Young Kim
- RFIC Center, Kwangwoon University, Seoul, South Korea
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Kagawa K, Iida K, Hashizume A, Katagiri M, Baba S, Kurisu K, Otsubo H. Magnetoencephalography using gradient magnetic field topography (GMFT) can predict successful anterior corpus callosotomy in patients with drop attacks. Clin Neurophysiol 2016; 127:221-229. [DOI: 10.1016/j.clinph.2015.04.292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/21/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
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Dimitriadis SI. Predictive value of MEG using gradient magnetic field topography (GMFT) for seizure outcome following anterior corpus callosotomy (ACC) in patients with drop attacks. Clin Neurophysiol 2015; 127:12-14. [PMID: 26168716 DOI: 10.1016/j.clinph.2015.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Stavros I Dimitriadis
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK; Cardiff University Brain Research Imaging Center (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK; Artificial Intelligence and Information Analysis Laboratory, Department of Informatics, Aristotle University, 54124 Thessaloniki, Greece; NeuroInformatics Group, AUTH, Thessaloniki, Greece.
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Yang PF, Lin Q, Mei Z, Chen ZQ, Zhang HJ, Pei JS, Tian J, Jia YZ, Zhong ZH. Outcome after anterior callosal section that spares the splenium in pediatric patients with drop attacks. Epilepsy Behav 2014; 36:47-52. [PMID: 24857808 DOI: 10.1016/j.yebeh.2014.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
We report on the efficacy and safety of extended, one-stage anterior callosal section that spares the splenium, which is performed in a large series of pediatric patients with drop attacks. Twenty-nine pediatric patients with drop attacks were studied (19 males and 10 females; mean age: 9.9 years). As presurgical factors, the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, electroencephalograph abnormalities, magnetic resonance imaging abnormalities, and (18)fluorodeoxyglucose positron emission tomography abnormalities were analyzed. All patients had multiple seizure types, including drop attacks, atypical absence seizures, complex partial seizures, tonic seizures, and generalized tonic-clonic seizures. All patients were developmentally impaired and had electroencephalograph results showing marked secondary bilateral synchrony. All patients received an extended, one-stage callosal section, leaving only the splenium intact. The mean follow-up time was 5.2 years. Seizure outcome (cessation of seizures or ≥ 90% seizure reduction) was achieved in 79.3% of patients with drop attacks. The families assessed the overall daily function as improved in 62.1% of the patients, unchanged in 24.1%, and worse in 13.8%. Family satisfaction with callosotomy was achieved in 82.8% of the patients. The majority of the patients had some degree of a transient acute postoperative disconnection syndrome that disappeared within 3 weeks. Postoperatively, patients showed a consistent increase in attention levels. We conclude that extended callosal sectioning that leaves the splenium intact should be considered a good palliative surgical option for pediatric patients with drop attacks and that diminishment of epileptic discharge synchrony is a good prognostic sign following callosotomy. We also found that the postoperative increase in attention levels was as useful as seizure control in improving the quality of life of these patients.
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Affiliation(s)
- Peng-Fan Yang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Qiao Lin
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhen Mei
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zi-Qian Chen
- Department of Medical Imaging, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Hui-Jian Zhang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jia-Sheng Pei
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jun Tian
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Yan-Zeng Jia
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhong-Hui Zhong
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
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15
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Griessenauer CJ, Bilal M, Kankirawatana P, Kulbersh B, Shane Tubbs R, Rozzelle C. Lymphatic malformation of the tongue with coexisting intractable epilepsy treated with corpus callosotomy: A case report. Clin Neurol Neurosurg 2014; 117:68-70. [DOI: 10.1016/j.clineuro.2013.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/13/2013] [Accepted: 11/29/2013] [Indexed: 11/28/2022]
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16
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Okumura E, Iwasaki M, Sakuraba R, Itabashi I, Osawa SI, Jin K, Itabashi H, Kato K, Kanno A, Tominaga T, Nakasato N. Time-varying inter-hemispheric coherence during corpus callosotomy. Clin Neurophysiol 2013; 124:2091-100. [DOI: 10.1016/j.clinph.2013.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/28/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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17
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Cordelli DM, Garavelli L, Savasta S, Guerra A, Pellicciari A, Giordano L, Bonetti S, Cecconi I, Wischmeijer A, Seri M, Rosato S, Gelmini C, Della Giustina E, Ferrari AR, Zanotta N, Epifanio R, Grioni D, Malbora B, Mammi I, Mari F, Buoni S, Mostardini R, Grosso S, Pantaleoni C, Doz M, Poch-Olivé ML, Rivieri F, Sorge G, Simonte G, Licata F, Tarani L, Terazzi E, Mazzanti L, Cerruti Mainardi P, Boni A, Faravelli F, Grasso M, Bianchi P, Zollino M, Franzoni E. Epilepsy in Mowat-Wilson syndrome: delineation of the electroclinical phenotype. Am J Med Genet A 2013; 161A:273-84. [PMID: 23322667 DOI: 10.1002/ajmg.a.35717] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 09/20/2012] [Indexed: 12/26/2022]
Abstract
Mowat-Wilson syndrome (MWS) is a genetic disease caused by heterozygous mutations or deletions of the ZEB2 gene and is characterized by distinctive facial features, epilepsy, moderate to severe intellectual disability, corpus callosum abnormalities and other congenital malformations. Epilepsy is considered a main manifestation of the syndrome, with a prevalence of about 70-75%. In order to delineate the electroclinical phenotype of epilepsy in MWS, we investigated epilepsy onset and evolution, including seizure types, EEG features, and response to anti-epileptic therapies in 22 patients with genetically confirmed MWS. Onset of seizures occurred at a median age of 14.5 months (range: 1-108 months). The main seizure types were focal and atypical absence seizures. In all patients the first seizure was a focal seizure, often precipitated by fever. The semiology was variable, including hypomotor, versive, or focal clonic manifestations; frequency ranged from daily to sporadic. Focal seizures were more frequent during drowsiness and sleep. In 13 patients, atypical absence seizures appeared later in the course of the disease, usually after the age of 4 years. Epilepsy was usually quite difficult to treat: seizure freedom was achieved in nine out of the 20 treated patients. At epilepsy onset, the EEGs were normal or showed only mild slowing of background activity. During follow-up, irregular, diffuse frontally dominant and occasionally asymmetric spike and waves discharges were seen in most patients. Sleep markedly activated these abnormalities, resulting in continuous or near-to-continuous spike and wave activity during slow wave sleep. Slowing of background activity and poverty of physiological sleep features were seen in most patients. Our data suggest that a distinct electroclinical phenotype, characterized by focal and atypical absence seizures, often preceded by febrile seizures, and age-dependent EEG changes, can be recognized in most patients with MWS.
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Affiliation(s)
- Duccio Maria Cordelli
- Child Neurology and Psychiatry Unit, S Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
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Kim JH, Suh SI, Park SY, Seo WK, Koh I, Koh SB, Seol HY. Microstructural white matter abnormality and frontal cognitive dysfunctions in juvenile myoclonic epilepsy. Epilepsia 2012; 53:1371-8. [PMID: 22708960 DOI: 10.1111/j.1528-1167.2012.03544.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Previous neuroimaging studies provide growing evidence that patients with juvenile myoclonic epilepsy (JME) have both structural and functional abnormalities of the thalamus and frontal lobe gray matter. However, limited data are available regarding the issue of white matter (WM) involvement, making the microstructural WM changes in JME largely unknown. In the present study we investigated changes of WM integrity in patients with JME, and their relationships with cognitive functions and epilepsy-specific clinical factors. METHODS We performed diffusion tensor imaging (DTI) and neuropsychological assessment in 25 patients with JME and 30 control subjects matched for age, gender, and education level. Between-group comparisons of fractional anisotropy (FA) and mean diffusivity (MD) were carried out in a whole-brain voxel-wise manner by using tract-based spatial statistics (TBSS). In addition, both FA and MD were correlated with cognitive performance and epilepsy-specific clinical variables to investigate the influence of these clinical and cognitive factors on WM integrity changes. KEY FINDINGS Neuropsychological evaluation revealed that patients with JME had poorer performance than control subjects on most of the frontal function tests. TBSS demonstrated that, compared to controls, patients with JME had significantly reduced FA and increased MD in bilateral anterior and superior corona radiata, genu and body of corpus callosum, and multiple frontal WM tracts. Disease severity, as assessed by the number of generalized tonic-clonic seizures in given years, was negatively correlated with FA and positively correlated with MD extracted from regions of significant differences between patients and controls in TBSS. SIGNIFICANCE Our findings of widespread disturbance of microstructural WM integrity in the frontal lobe and corpus callosum that interconnects frontal cortices could further support the pathophysiologic hypothesis of thalamofrontal network abnormality in JME. These WM abnormalities may implicate frontal cognitive dysfunctions and disease progression in JME.
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Affiliation(s)
- Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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Lin JH, Kwan SY. Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox–Gastaut syndrome. J Clin Neurosci 2012; 19:388-93. [DOI: 10.1016/j.jocn.2011.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 04/02/2011] [Indexed: 10/14/2022]
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Stepwise Synchronization Through the Corpus Callosum Is One Cause of Myoclonic Jerks. World Neurosurg 2012; 77:399.E5-8. [DOI: 10.1016/j.wneu.2011.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 06/30/2011] [Accepted: 07/07/2011] [Indexed: 11/22/2022]
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Jeong GU, Kim H, Lim BC, Chae JH, Kim KJ, Hwang YS, Hwang H. Predictive value of electroencephalography for seizure outcome following corpus callosotomy in children. J Epilepsy Res 2011; 1:65-70. [PMID: 24649448 PMCID: PMC3952332 DOI: 10.14581/jer.11012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 11/26/2011] [Indexed: 11/05/2022] Open
Abstract
Background and Purpose: This study aimed to determine whether preoperative or postoperative electroencephalography (EEG) can predict surgical outcome for corpus callosotomy. Methods: We retrospectively reviewed the medical records of 16 patients enrolled. We compared postoperative seizure outcome according to seizure type, preoperative interictal EEG, preoperative ictal EEG, and postoperative interictal EEG. Seizure outcome was classified according to postoperative seizure reduction, i.e., seizure free, >90%, 50–90%, <50%, and no change or worsened. A seizure reduction of 50% or more was judged as a “favorable outcome”. Results: Most patients showed a favorable outcome (12 patients, 75%) and two patients became seizure free (13%). Atonic seizure was most responsive to corpus callosotomy. Preoperative interictal epileptiform discharge had 3 patterns; bilateral independent, generalized, and combination of independent and generalized. None of the preoperative interictal epileptiform discharge (EDs) had significant correlation with seizure outcome. The preoperative ictal rhythm did not predict seizure outcome. However disappearance of generalized EDs on postoperative EEG was correlated with favorable seizure outcome. Conclusions: The presence of generalized EDs on postoperative interictal EEG predicted seizure outcome, whereas preoperative EEG did not.
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Affiliation(s)
- Go-Un Jeong
- Department of Pediatrics, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Yong Seung Hwang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
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Lee EH, Yum MS, Hong SH, Lee JK, You SJ, Ko TS. Staged Total Callosotomy for Lennox-Gastaut Syndrome: A Case Report. J Epilepsy Res 2011; 1:71-3. [PMID: 24649449 PMCID: PMC3952330 DOI: 10.14581/jer.11013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/21/2011] [Indexed: 11/25/2022] Open
Abstract
We report a case with Lennox-Gastaut syndrome (LGS) who underwent staged total callosotomy with a favorable outcome. A 6-year-old boy began having myoclonic seizures at the age of 8 months and was diagnosed with LGS when he was 27 months old. Various antiepileptic drugs and a ketogenic diet failed to control his multiple types of seizures. At the age of 36 months, he underwent corpus callosotomy and achieved an immediate, post-operative seizure free state. However, 3 months later, various seizures relapsed and were refractory to additional vagus nerve stimulation. Remaining callosal fibers in the splenium noted on post-operative diffusion tensor imaging made us to perform a second operation, total callosotomy. The patient finally achieved a seizure-free state with electroencephalography (EEG) normalization noted after the staged total callosotomy.
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Affiliation(s)
- Eun Hye Lee
- Department of Pediatrics, College of Medicine, Kyung Hee University
| | - Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center, Children’s Hospital, University of Ulsan College of Medicine
| | - Seok-Ho Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jeong-Kyo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Su Jeong You
- Department of Pediatrics, Epilepsy Center, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae-Sung Ko
- Department of Pediatrics, Asan Medical Center, Children’s Hospital, University of Ulsan College of Medicine
- Corresponding author: Tae-Sung Ko, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea, Tel. +82-2-473-3725, Fax. +82-2-3010-3388, E-mail;
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Yonekawa T, Nakagawa E, Takeshita E, Inoue Y, Inagaki M, Kaga M, Sugai K, Sasaki M, Kaido T, Takahashi A, Otsuki T. Effect of corpus callosotomy on attention deficit and behavioral problems in pediatric patients with intractable epilepsy. Epilepsy Behav 2011; 22:697-704. [PMID: 21978470 DOI: 10.1016/j.yebeh.2011.08.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
Abstract
To evaluate the effect of corpus callosotomy (CC) on attention deficit and behavioral problems in pediatric patients with intractable epilepsy, we retrospectively investigated sequential patients who had undergone CC to control seizures. Between August 2005 and April 2010, a total of 15 patients aged between 3.1 and 17.9 years underwent CC at our institute. All the patients experienced either drop attacks or head nodding, which were considered to be therapeutic targets of CC. A standardized instrument, the Child Behavior Checklist (CBCL), was used to assess behavioral and emotional problems before and after surgery. On postoperative EEGs, 8 (53%) showed improvement and 7 (47%) showed no change in epileptiform discharges. The Attention Problems scale and total score on the CBCL significantly improved in patients whose postoperative EEGs showed improvement. In addition to amelioration of target seizures, CC can improve attention impairments in association with improvement in the postoperative EEG.
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Affiliation(s)
- Takahiro Yonekawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
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Iwasaki M, Nakasato N, Kakisaka Y, Kanno A, Uematsu M, Haginoya K, Tominaga T. Lateralization of interictal spikes after corpus callosotomy. Clin Neurophysiol 2011; 122:2121-7. [DOI: 10.1016/j.clinph.2011.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 04/14/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
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Hur YJ, Kang HC, Kim DS, Choi SR, Kim HD, Lee JS. Uncovered primary seizure foci in Lennox-Gastaut syndrome after corpus callosotomy. Brain Dev 2011; 33:672-7. [PMID: 21146944 DOI: 10.1016/j.braindev.2010.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/08/2010] [Accepted: 11/10/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Corpus callosotomy (CC) is a palliative surgical procedure to control atonic, tonic, or generalized tonic-clonic seizure in Lennox-Gastaut syndrome (LGS). Here, we report patients with LGS who underwent resective surgery, following CC better delineating the presumed seizure foci localized in one hemisphere. METHODS We retrospectively reviewed seven patients with LGS who underwent CC and subsequent cortical resection. The median follow-up duration after lobectomy was 20 months (range, 15-54 months) and three patients had follow-up periods over 24 months. The findings of video electroencephalography (EEG) monitoring, structural and functional neuroimagings were compared between pre- and post-CC. RESULTS Four patients had Engel class I and one patient had Engel class II outcomes following cortical resection; post-CC, compared to pre-CC, showed better localized ictal/interictal epileptiform discharges in the unilateral frontal area in two patients, in the unilateral parieto-temporo-occipital areas in one patient and in the unilateral fronto-temporal areas in the remaining two patients. Two patients had Engel Class III outcome following cortical resection; post-CC EEG continued to show multifocal epileptiform discharges but predominantly arising from a unilateral frontal area. Following CC, positron emission tomography showed localized glucose hypometabolism of which location was concordant with post-CC EEG abnormalities in all patient. Similarly, ictal/interictal single photon emission computed tomography also showed localized abnormalities concordant with post-CC EEG abnormalities in five of the six patients. Pathological assessment revealed cortical dysplasia in six patients, whereas no pathological abnormality was found in the remaining patient, who obtained Engel Class I outcome following cortical resection. CONCLUSION CC could change EEG findings, glucose metabolisms and cerebral blood flows, and it is sometimes helpful in delineating the primary seizure focus in patients with LGS.
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Affiliation(s)
- Yun Jung Hur
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Republic of Korea
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Callosotomy and subsequent surgery for children with refractory epilepsy. Epilepsy Res 2011; 93:185-91. [DOI: 10.1016/j.eplepsyres.2010.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 12/15/2010] [Accepted: 12/21/2010] [Indexed: 11/29/2022]
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Peltola ME, Liukkonen E, Granström ML, Paetau R, Kantola-Sorsa E, Valanne L, Falck B, Blomstedt G, Gaily E. The effect of surgery in encephalopathy with electrical status epilepticus during sleep. Epilepsia 2010; 52:602-9. [PMID: 21087244 DOI: 10.1111/j.1528-1167.2010.02783.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE We analyzed clinical and electroencephalography (EEG) outcomes of 13 patients with pharmacoresistant encephalopathy with electrical status epilepticus during sleep (ESES) following epilepsy surgery. METHODS All patients had symptomatic etiology of ESES and preoperative neuropsychological deterioration. Ten patients had daily atypical absences. Clinical outcome was assessed at 6 months and at 2 years after surgery. Clinical and EEG data were reviewed retrospectively. The spike propagation pattern and area and source strength in source montage were analyzed from preoperative and postoperative EEG studies. KEY FINDINGS Preoperative sleep EEG showed electrical status epilepticus during sleep (SES) with one-way interhemispheric propagation in nine patients and with two-way interhemispheric propagation in four. The age of the patients at the time of surgery ranged from 3.6-9.9 years. Focal resection (two patients) or hemispherotomy (one patient with postoperative EEG) either terminated SES or restricted the discharge to one region. Either reduced SES propagation area or source strength was found in four of eight callosotomy patients with postoperative EEG. Of patients who had seizures preoperatively, Engel class I-II seizure outcome was observed in two of three children after focal resection or hemispherotomy and in two of eight children after callosotomy. None of these patients with Engel class I-II outcome had SES with two-way interhemispheric propagation on preoperative EEG. Cognitive deterioration was halted postoperatively in all except one patient. Cognitive catch-up of more than 10 IQ points was seen in three patients, all of whom had shown a first measured IQ of >75. SIGNIFICANCE Patients with pharmacoresistant ESES based on symptomatic etiology may benefit from resective surgery or corpus callosotomy regarding both seizure outcome and cognitive prognosis.
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Affiliation(s)
- Maria E Peltola
- Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland.
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Filho GMDA, Jackowski AP, Lin K, Silva I, S B Guaranha M, Guilhoto LMFF, Júnior HC, Yacubian EMT, Bressan RA. The integrity of corpus callosum and cluster B personality disorders: a quantitative MRI study in juvenile myoclonic epilepsy. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:516-21. [PMID: 20156513 DOI: 10.1016/j.pnpbp.2010.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 02/09/2010] [Accepted: 02/09/2010] [Indexed: 10/19/2022]
Abstract
Evidence suggests increased prevalence of cluster B personality disorders (PD) among patients with juvenile myoclonic epilepsy (JME), which has been associated with worse seizure control and more psychosocial dysfunctions. A preliminary voxel-based morphometry study demonstrated corpus callosum (CC) volume reduction in patients with JME and cluster B PD, particularly in the posterior midbody and isthmus. In this study we aimed to follow up these results with region of interest analysis. Sixteen JME patients with cluster B PD, 38 JME patients without any psychiatric disorder, and 30 demographically matched healthy controls submitted to a psychiatric evaluation and a magnetic resonance imaging scan. The total and regional callosal areas were obtained from the midsagittal slice using a semi-automated program. Psychiatric evaluation was performed through SCID-I and -II. Significant reductions in the posterior region of the CC were observed in the JME with PD group relative to the other groups. These data support previous findings of callosal reductions in cluster B PD, as well as a possible involvement of CC in patients with JME and such personality characteristics.
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Electrocorticogram changes during corpus callosotomy for uncontrolled symptomatic generalized epilepsy. J Clin Neurosci 2010; 17:132-4. [DOI: 10.1016/j.jocn.2009.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 01/21/2009] [Accepted: 02/03/2009] [Indexed: 11/19/2022]
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Battaglia D, Veggiotti P, Lettori D, Tamburrini G, Tartaglione T, Graziano A, Veredice C, Sacco A, Chieffo D, Pecoraro A, Colosimo C, Di Rocco C, Dravet C, Guzzetta F. Functional hemispherectomy in children with epilepsy and CSWS due to unilateral early brain injury including thalamus: Sudden recovery of CSWS. Epilepsy Res 2009; 87:290-8. [DOI: 10.1016/j.eplepsyres.2009.09.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 09/08/2009] [Accepted: 09/20/2009] [Indexed: 10/20/2022]
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Nakayama T, Otsuki T, Kaneko Y, Nakama H, Kaido T, Otsubo H, Nakagawa E, Sasaki M, Sugai K. Repeat magnetoencephalography and surgeries to eliminate atonic seizures of non-lesional frontal lobe epilepsy. Epilepsy Res 2009; 84:263-7. [DOI: 10.1016/j.eplepsyres.2009.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 12/23/2008] [Accepted: 02/01/2009] [Indexed: 12/01/2022]
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Hemispheric asymmetry of callosal neuronal participation in bilaterally synchronous epileptiform discharges. Seizure 2009; 18:7-13. [DOI: 10.1016/j.seizure.2008.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 05/09/2008] [Indexed: 11/20/2022] Open
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Pulsipher DT, Seidenberg M, Morton JJ, Geary E, Parrish J, Hermann B. MRI volume loss of subcortical structures in unilateral temporal lobe epilepsy. Epilepsy Behav 2007; 11:442-9. [PMID: 17996640 PMCID: PMC3680513 DOI: 10.1016/j.yebeh.2007.08.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 08/13/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Abstract
Few studies have examined the relative degree of brain volume loss in both the hippocampi and subcortical structures in unilateral temporal lobe epilepsy (TLE) and their association with clinical seizure correlates. In this study, quantitative MRI volumes were measured in the hippocampus, thalamus, caudate, putamen, and corpus callosum in 48 patients with unilateral TLE (26 right, and 22 left) and compared with the volumes of 29 healthy controls. The ipsilateral hippocampus, corpus callosum, and bilateral thalami exhibited the greatest volume loss, reflected by large to moderate effect size differences compared with controls. Bilaterally, the putamen showed the next highest volume reduction. The contralateral hippocampus and bilateral caudate nuclei showed the least volume reduction, characterized by small effect sizes. Furthermore, clinical seizure characteristics (e.g., duration of epilepsy) exhibited different patterns of association with the volume reductions observed across these structures. Findings suggest that distinct neurodevelopmental features may play a role in the volume abnormality observed in these regions.
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Affiliation(s)
- Dalin T. Pulsipher
- Rosalind Franklin University of Medicine and Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064,Corresponding Author: Dalin T. Pulsipher, Rosalind Franklin University of Medicine & Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064, Telephone: (847) 578-8736, Fax: (847) 578-8758,
| | - Michael Seidenberg
- Rosalind Franklin University of Medicine and Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064
| | - Jared J. Morton
- Rosalind Franklin University of Medicine and Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064
| | - Elizabeth Geary
- Rosalind Franklin University of Medicine and Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064
| | - Joy Parrish
- Rosalind Franklin University of Medicine and Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064
| | - Bruce Hermann
- University of Wisconsin Hospital, Department of Neurology, 600 Highland Avenue, Madison, WI 53792
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Salayev KA, Nakasato N, Ishitobi M, Shamoto H, Kanno A, Tominaga T, Iinuma K. Evaluation of Interhemispheric Time Difference by Magnetoencephalography Before and After Total Callosotomy-Two Case Reports-. Neurol Med Chir (Tokyo) 2006; 46:136-42. [PMID: 16565583 DOI: 10.2176/nmc.46.136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Interhemispheric time difference (ITD) measured by electroencephalography (EEG) and magnetoencephalography (MEG) was compared to seizure outcome after callosotomy. Two patients with frequent drop attacks underwent simultaneous EEG and MEG before and after total callosotomy. ITDs in 30 bilateral synchronized (BS) discharges were calculated independently by EEG and MEG. As minimum transcallosal conduction time was suggested to be approximately 20 msec, BS discharges were classified into five categories according to ITD and side: left- or right-leading long (300 to 80 msec), left- or right-leading moderate (80 to 20 msec), and negligible (<20 msec). In Case 1 before callosotomy, EEG detected 77% negligible and 23% right-leading moderate BS discharges, whereas MEG detected 30% and 63%, respectively. After callosotomy, drop attacks reduced remarkably and EEG and MEG detected no BS discharges. In Case 2 before callosotomy, EEG detected 77% negligible and 23% moderate BS discharges, whereas MEG detected 80% and 20%, respectively. After callosotomy, drop attacks recurred 2 months later and EEG and MEG detected left- and right-leading long BS discharges (63% by EEG and 56% by MEG). MEG detected a large number of BS discharges with moderate ITD before surgery in Case 1, suggesting that the transcallosal pathway was the main pathway for the synchronization, whereas the negligible ITD in Case 2 excludes transcallosal propagation. BS discharges with longer ITD after surgery in Case 2 suggest a persistent poly-synaptic non-transcallosal pathway. MEG with higher spatial resolution than EEG may provide surgical indications for callosotomy.
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Affiliation(s)
- Kamran Ali Salayev
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Miyagi
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Kwan SY, Lin JH, Wong TT, Chang KP, Yiu CH. Prognostic value of electrocorticography findings during callosotomy in children with Lennox–Gastaut syndrome. Seizure 2005; 14:470-5. [PMID: 16137897 DOI: 10.1016/j.seizure.2005.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2005] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To analyze findings and acute changes in electrocorticograms (ECoGs) obtained during corpus callosotomy in order to identify any relationships with the postoperative outcome of seizure activity. METHODS We retrospectively analyzed ECoGs obtained during anterior callosotomy (4-6 cm) in 48 patients with Lennox-Gastaut syndrome (32 boys and 16 girls, age 1-20 years, mean age 7.6 years) who underwent surgery between July 1993 and November 1996 to correlate recording findings with postoperative seizure activity. At the time of analysis, all patients had been followed postoperatively for more than 4 years. RESULTS Of 48 patients, 31 (64.6%) had significant improvement in seizure control after surgery. In pre-excisional ECoGs, 38 (79.2%) of 48 patients had bisynchronous epileptiform discharges. Patients (23 of 33 patients, 69.7%) with significant blockage of bisynchronous discharges recorded during callosotomy achieved the best postoperative seizure outcomes, but the difference did not reach statistical significance (P>0.05). CONCLUSIONS Based on our experience, changes in ECoG during callosotomy do not predict postoperative seizure outcome. Insignificant blockage of bisynchronous epileptiform discharges in ECoGs during callosotomy does not predict a worse prognosis than that associated with significant intraoperative blockage.
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Affiliation(s)
- Shang-Yeong Kwan
- Pediatric Epilepsy Surgery Group, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Synchrony Measures and Non-Homotopic: Do Synchrony Measures Between Non-Homotopic Areas Make Sense? ACTA ACUST UNITED AC 2005. [DOI: 10.1300/j184v09n02_09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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