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Chiu MY, Bolton J, Raskin JS, Curry DJ, Weiner HL, Pearl PL, Stone S. In Search of a Common Language: The Standardized Electrode Nomenclature for Stereoelectroencephalography Applications. J Clin Neurophysiol 2024; 41:405-409. [PMID: 38935653 DOI: 10.1097/wnp.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Stereoelectroencephalography (SEEG) is widely performed on individuals with medically refractory epilepsy for whom invasive seizure localization is desired. Despite increasing adoption in many centers across the world, no standardized electrode naming convention exists, generating confusion among both clinical and research teams. METHODS We have developed a novel nomenclature, named the Standardized Electrode Nomenclature for SEEG Applications system. Concise, unique, informative, and unambiguous labels provide information about entry point, deep targets, and relationships between electrodes. Inter-rater agreement was evaluated by comparing original electrode names from 10 randomly sampled cases (including 136 electrodes) with those prospectively assigned by four additional blinded raters. RESULTS The Standardized Electrode Nomenclature for SEEG Application system was prospectively implemented in 40 consecutive patients undergoing SEEG monitoring at our institution, creating unique electrode names in all cases, and facilitating implantation design, SEEG recording and mapping interpretation, and treatment planning among neurosurgeons, neurologists, and neurophysiologists. The inter-rater percent agreement for electrode names among two neurosurgeons, two epilepsy neurologists, and one neurosurgical fellow was 97.5%. CONCLUSIONS This standardized naming convention, Standardized Electrode Nomenclature for SEEG Application, provides a simple, concise, reproducible, and informative method for specifying the target(s) and relative position of each SEEG electrode in each patient, allowing for successful sharing of information in both the clinical and research settings. General adoption of this nomenclature could pave the way for improved communication and collaboration between institutions.
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Affiliation(s)
- Michelle Y Chiu
- Epilepsy Division, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeffrey Bolton
- Epilepsy Division, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeffrey S Raskin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, U.S.A
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, U.S.A.; and
| | - Howard L Weiner
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, U.S.A.; and
| | - Phillip L Pearl
- Epilepsy Division, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Scellig Stone
- Epilepsy Surgery Program, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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Barba C, Pelliccia V, Grisotto L, De Palma L, Nobile G, Gozzo F, Revay M, Carfi-Pavia G, Cossu M, Giordano F, Consales A, De Benedictis A, Cavallini E, Mion C, Accolla C, Specchio N, Nobili L, Guerrini R, Tassi L. Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: A multicenter study. Epilepsia Open 2024. [PMID: 38898721 DOI: 10.1002/epi4.12965] [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: 11/19/2023] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To assess seizure and developmental outcomes, their predictors, and complications in 160 children who, between 1998 and 2022, underwent surgery for lesional epilepsy with curative intent before the age of 3 years. To compare trends in epilepsy surgery in this age group before and after the year 2014. METHODS Retrospective multicenter study. Descriptive and univariate analyses, and multivariable models for all outcomes. RESULTS These 160 patients (76 F; 47.5%) underwent 169 surgeries (age at surgery 20.4 ± 9.4 months). At the last follow-up (77 ± 57.4 months), 121 patients (75.6%) were in Engel class I, 106 (66.2%) of whom were in Engel class Ia. Antiseizure medications were stopped in 84 patients (52.5%). Complications requiring reoperations were observed in 16 patients (10%; 9.5% of surgeries) and unexpected permanent deficits in 12 (7.5%; 7.1% of surgeries). Postoperative cognitive functions remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Multivariable analyses showed that the probability of achieving Engel class Ia was lower when the duration of epilepsy was longer, patients underwent preoperative video-EEG, and unexpected postoperative permanent deficits occurred. Cognitive improvement after surgery was associated with lower preoperative seizure frequency, better preoperative developmental level, and a longer postoperative follow-up. FCDII and tumors were the histopathologies carrying a higher probability of achieving seizure freedom, while polymicrogyria was associated with a lower probability of cognitive improvement. The number of patients operated on after 2014 was higher than before (61.3% vs. 38.7%), with stable outcomes. SIGNIFICANCE Epilepsy surgery is effective and safe in infants and toddlers, although the complication rate is higher than seen in older patients. Shorter duration of epilepsy, lower seizure frequency, no need for video-EEG, tumors, and some malformations of cortical development are robust predictors of seizure and cognitive outcome that may be exploited to increase earlier referral. PLAIN LANGUAGE SUMMARY This study analyzed the results of epilepsy surgery in 160 children who had been operated on before the age of 3 years at four Italian centers between 1998 and 2022. At the last follow-up (77 ± 57.4 months), 121 patients (75.6%) were free from disabling seizures, of which 106 (66.2%) were completely seizure-free since surgery. Major surgical complications occurred in 28 patients (17.5%), which is higher than observed with epilepsy surgery in general, but similar to hemispheric/multilobar surgery. Postoperative cognitive function remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Epilepsy surgery is effective and safe in infants and toddlers.
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Affiliation(s)
- Carmen Barba
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
| | | | - Laura Grisotto
- Department of Statistics, Computer Science, Application "G. Parenti" (DiSIA), University of Florence, Florence, Italy
| | - Luca De Palma
- Neurology, Epilepsy and Movement Disorders, EpiCARE, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Nobile
- Child Neuropsychiatry, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Gozzo
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Martina Revay
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giusy Carfi-Pavia
- Neurology, Epilepsy and Movement Disorders, EpiCARE, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
- Child Neurosurgery, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
| | - Flavio Giordano
- University of Florence, Florence, Italy
- Neurosurgery Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | | | | | | | | | - Nicola Specchio
- Neurology, Epilepsy and Movement Disorders, EpiCARE, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lino Nobili
- Child Neuropsychiatry, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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Bourdillon P, Ren L, Halgren M, Paulk AC, Salami P, Ulbert I, Fabó D, King JR, Sjoberg KM, Eskandar EN, Madsen JR, Halgren E, Cash SS. Differential cortical layer engagement during seizure initiation and spread in humans. Nat Commun 2024; 15:5153. [PMID: 38886376 PMCID: PMC11183216 DOI: 10.1038/s41467-024-48746-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/10/2024] [Indexed: 06/20/2024] Open
Abstract
Despite decades of research, we still do not understand how spontaneous human seizures start and spread - especially at the level of neuronal microcircuits. In this study, we used laminar arrays of micro-electrodes to simultaneously record the local field potentials and multi-unit neural activities across the six layers of the neocortex during focal seizures in humans. We found that, within the ictal onset zone, the discharges generated during a seizure consisted of current sinks and sources only within the infra-granular and granular layers. Outside of the seizure onset zone, ictal discharges reflected current flow in the supra-granular layers. Interestingly, these patterns of current flow evolved during the course of the seizure - especially outside the seizure onset zone where superficial sinks and sources extended into the deeper layers. Based on these observations, a framework describing cortical-cortical dynamics of seizures is proposed with implications for seizure localization, surgical targeting, and neuromodulation techniques to block the generation and propagation of seizures.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Neurosurgery, Hospital Foundation Adolphe de Rothschild, Paris, France.
- Integrative Neuroscience and Cognition Center, Paris Cité University, Paris, France.
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, National Center for Neurological Disorders, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Mila Halgren
- Brain and Cognitive Sciences Department and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Angelique C Paulk
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pariya Salami
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - István Ulbert
- HUN-REN, Research Center for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Budapest, Hungary
- Faculty of Information Technology and Bionics, Péter Pázmány Catholic University, Budapest, Hungary
- Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Dániel Fabó
- Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Jean-Rémi King
- Laboratoire des Systèmes Perceptifs, Département d'études cognitives, École normale supérieure, PSL University, CNRS, Paris, France
| | - Kane M Sjoberg
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Harvard College, Cambridge, MA, 02138, USA
| | - Emad N Eskandar
- Department of Neurological Surgery, Albert Einstein College of Medicine - Montefiore Medical Center, Bronx, NY, USA
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric Halgren
- Departments of Radiology and, Neurosciences, University of California, San Diego, San Diego, CA, USA
| | - Sydney S Cash
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Takahashi YK, Baba S, Kawashima T, Tachimori H, Iijima K, Kimura Y, Saito T, Nakagawa E, Komaki H, Iwasaki M. Treatment odyssey to epilepsy surgery in children with focal cortical dysplasia: Risk factors for delayed surgical intervention. Seizure 2024; 120:5-11. [PMID: 38880019 DOI: 10.1016/j.seizure.2024.06.007] [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: 04/06/2024] [Revised: 06/02/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVE To elucidate the patient's journey to epilepsy surgery and identify the risk factors contributing to surgical delay in pediatric patients with drug-resistant epilepsy (DRE) due to focal cortical dysplasia (FCD). METHODS A retrospective review was conducted of 93 pediatric patients who underwent curative epilepsy surgery for FCD between January 2012 and March 2023 at a tertiary epilepsy center. The Odyssey plot demonstrated the treatment process before epilepsy surgery, including key milestones of epilepsy onset, first hospital visit, epilepsy diagnosis, MRI diagnosis, DRE diagnosis, and surgery. The primary outcome was surgical delay; the duration from DRE to surgery. Multivariate linear regression models were used to examine the association between surgical delay and clinical, investigative, and treatment characteristics. RESULTS The median age at seizure onset was 1.3 years (interquartile range [IQR] 0.14-3.1), and at the time of surgery, it was 6 years (range 1-11). Notably, 46% experienced surgical delays exceeding two years. The Odyssey plot visually highlighted that surgical delay comprised a significant portion of the patient journey. Although most patients underwent MRI before referral, MRI abnormalities were identified before referral only in 39% of the prolonged group, compared to 70% of the non-prolonged group. Multivariate analyses showed that delayed notification of MRI abnormalities, longer duration from epilepsy onset to DRE, older age at onset, number of antiseizure medications tried, and moderate to severe intellectual disability were significantly associated with prolonged surgical delay. CONCLUSION Pediatric DRE patients with FCD experienced a long journey until surgery. Early and accurate identification of MRI abnormalities is important to minimize surgical delays.
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Affiliation(s)
- Yoko Kobayashi Takahashi
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Shimpei Baba
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takahiro Kawashima
- Department of Information Medicine, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Kodaira, Japan
| | - Hisateru Tachimori
- Department of Information Medicine, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Kodaira, Japan
| | - Keiya Iijima
- 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
| | - 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
| | - Hirofumi Komaki
- Department of Child Neurology, 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.
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Guo J, Wang Z, van 't Klooster MA, Van Der Salm SM, Leijten FS, Braun KP, Zijlmans M. Seizure Outcome After Intraoperative Electrocorticography-Tailored Epilepsy Surgery: A Systematic Review and Meta-Analysis. Neurology 2024; 102:e209430. [PMID: 38768406 PMCID: PMC11175635 DOI: 10.1212/wnl.0000000000209430] [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: 08/28/2023] [Accepted: 03/12/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Tailoring epilepsy surgery using intraoperative electrocorticography (ioECoG) has been debated, and modest number of epilepsy surgery centers apply this diagnostic method. We assessed the current evidence to use ioECoG-tailored epilepsy surgery for improving postsurgical outcome. METHODS PubMed and Embase were searched for original studies reporting on ≥10 cases who underwent ioECoG-tailored surgery for epilepsy, with a follow-up of at least 6 months. We used a random-effects model to calculate the overall rate of patients achieving favorable seizure outcome (FSO), defined as Engel class I, ILAE class 1, or seizure-free status. Meta-regression was used to investigate potential sources of heterogeneity. We calculated the odds ratio (OR) for estimating variables on FSO:ioECoG vs non-ioECoG-tailored surgery (if included studies contained patients with non-ioECoG-tailored surgery), ioECoG-tailored epilepsy surgery in children vs adults, temporal (TL) vs extratemporal lobe (eTL), MRI-positive vs MRI-negative, and complete vs incomplete resection of tissue that generated interictal epileptiform discharges (IEDs). A Bayesian network meta-analysis was conducted for underlying pathologies. We assessed the evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS Eighty-three studies (82 observational studies, 1 trial) comprising 3,631 patients with ioECoG-tailored surgery were included. The overall pooled rate of patients who attained FSO after ioECoG-tailored surgery was 74% (95% CI 71-77) with significant heterogeneity, which was predominantly attributed to pathologies and seizure outcome classifications. Twenty-two studies contained non-ioECoG-tailored surgeries. IoECoG-tailored surgeries reached a higher rate of FSO than non-ioECoG-tailored surgeries (OR 2.10 [95% CI 1.37-3.24]; p < 0.01; very low certainty). Complete resection of tissue that displayed IEDs in ioECoG predicted FSO better compared with incomplete resection (OR 3.04 [1.76-5.25]; p < 0.01; low certainty). We found insignificant difference in FSO after ioECoG-tailored surgery in children vs adults, TL vs eTL, or MRI-positive vs MRI-negative. The network meta-analysis showed that the odds of FSO was lower for malformations of cortical development than for tumors (OR 0.47 95% credible interval 0.25-0.87). DISCUSSION Although limited by low-quality evidence, our meta-analysis shows a relatively good surgical outcome (74% FSO) after epilepsy surgery with ioECoG, especially in tumors, with better outcome for ioECoG-tailored surgeries in studies describing both and better outcome after complete removal of IED areas.
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Affiliation(s)
- Jiaojiao Guo
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Ziyi Wang
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Maryse A van 't Klooster
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Sandra M Van Der Salm
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Frans S Leijten
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Kees P Braun
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Maeike Zijlmans
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
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Laguitton V, Boutin M, Brissart H, Breuillard D, Bilger M, Forthoffer N, Guinet V, Hennion S, Kleitz C, Mirabel H, Mosca C, Pradier S, Samson S, Voltzenlogel V, Planton M, Denos M, Bulteau C. Neuropsychological assessment in pediatric epilepsy surgery: A French procedure consensus. Rev Neurol (Paris) 2024; 180:494-506. [PMID: 37949750 DOI: 10.1016/j.neurol.2023.08.019] [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: 02/16/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 11/12/2023]
Abstract
Neuropsychological assessment is a mandatory part of the pre- and post-operative evaluation in pediatric epilepsy surgery. The neuropsychology task force of the ILAE - French Chapter aims to define a neuropsychological procedure consensus based on literature review and adapted for French practice. They performed a systematic review of the literature published between 1950 and 2023 on cognitive evaluation of individuals undergoing presurgical work-up and post-surgery follow-up and focused on the pediatric population aged 6-16. They classified publications listed in the PubMed database according to their level of scientific evidence. The systematic literature review revealed no study with high statistical power and only four studies using neuropsychological scales in their French version. Afterwards, the experts defined a neuropsychological consensus strategy in pediatric epilepsy surgery according to the psychometric determinants of cognitive tests, specificity of epilepsy, surgery context, French culture and literature reports. A common French neuropsychological procedure dedicated to pediatric epilepsy surgery is now available. This procedure could serve as a guide for the pre- and post-surgical work-up in French centers with pediatric epilepsy surgery programs. The main goal is to anticipate the functional risks of surgery, to support the postoperative outcome beyond the seizure-related one, while taking into consideration the plasticity and vulnerability of the immature brain and allowing the possibility of collaborative studies.
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Affiliation(s)
- V Laguitton
- Clinical Neurophysiology AP-HM, Timone Hospital, Marseille, France; Department of Pediatric Neurology, APHM, Timone Hospital, Marseille, France.
| | - M Boutin
- GHU-Paris Pôle Neuro-Sainte-Anne - Neurosurgery Unity, 1, rue Cabanis, Paris, France
| | - H Brissart
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurologie, 54000 Nancy, France
| | - D Breuillard
- Reference Center Rare Epilepsies, Hôpital Necker Enfants-Malades, Paris, France
| | - M Bilger
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - N Forthoffer
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
| | - V Guinet
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - S Hennion
- Reference Center Rare Epilepsies, Epilepsy Unit, University Lille, INSERM, CHU Lille, U1171 Degenerative and vascular cognitive disorders, Lille, France
| | - C Kleitz
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - H Mirabel
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France
| | - C Mosca
- Epilepsy Unit, CHU Grenoble-Alpes, Grenoble-Alpes, France
| | - S Pradier
- Functional Explorations of the Nervous System, Clinical Neurosciences Center, University Hospital Center Pellegrin, Bordeaux, France
| | - S Samson
- Neurology Department, Rehabilitation Unit, GH Pitié-Salpêtrière, APHP, Paris, France; Équipe Neuropsychologie: Audition, Cognition et Action (EA 4072), UFR de psychologie, Université Lille-Nord de France, Villeneuve d'Ascq, France
| | - V Voltzenlogel
- Centre d'études et de recherches en psychopathologie et psychologie de la santé, université de Toulouse, UT2J, Toulouse, France
| | - M Planton
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France; Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - M Denos
- Neurology Department, Rehabilitation Unit, GH Pitié-Salpêtrière, APHP, Paris, France
| | - C Bulteau
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, EpiCare Member, Paris, France; University of Paris Cité, MC(2)Lab, Institute of Psychology, 92000 Boulogne-Billancourt, France
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7
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Di Gennaro G, Lattanzi S, Mecarelli O, Saverio Mennini F, Vigevano F. Current challenges in focal epilepsy treatment: An Italian Delphi consensus. Epilepsy Behav 2024; 155:109796. [PMID: 38643659 DOI: 10.1016/j.yebeh.2024.109796] [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: 12/21/2023] [Revised: 03/18/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Epilepsy, a globally prevalent neurological condition, presents distinct challenges in management, particularly for focal-onset types. This study aimed at addressing the current challenges and perspectives in focal epilepsy management, with focus on the Italian reality. METHODS Using the Delphi methodology, this research collected and analyzed the level of consensus of a panel of Italian epilepsy experts on key aspects of focal epilepsy care. Areas of focus included patient flow, treatment pathways, controlled versus uncontrolled epilepsy, follow-up protocols, and the relevance of patient-reported outcomes (PROs). This method allowed for a comprehensive assessment of consensus and divergences in clinical opinions and practices. RESULTS The study achieved consensus on 23 out of 26 statements, with three items failing to reach a consensus. There was strong agreement on the importance of timely intervention, individualized treatment plans, regular follow-ups at Epilepsy Centers, and the role of PROs in clinical practice. In cases of uncontrolled focal epilepsy, there was a clear inclination to pursue alternative treatment options following the failure of two previous therapies. Divergent views were evident on the inclusion of epilepsy surgery in treatment for uncontrolled epilepsy and the routine necessity of EEG evaluations in follow-ups. Other key findings included concerns about the lack of pediatric-specific research limiting current therapeutic options in this patient population, insufficient attention to the transition from pediatric to adult care, and need for improved communication. The results highlighted the complexities in managing epilepsy, with broad consensus on patient care aspects, yet notable divergences in specific treatment and management approaches. CONCLUSION The study offered valuable insights into the current state and complexities of managing focal-onset epilepsy. It highlighted many deficiencies in the therapeutic pathway of focal-onset epilepsy in the Italian reality, while it also underscored the importance of patient-centric care, the necessity of early and appropriate intervention, and individualized treatment approaches. The findings also called for continued research, policy development, and healthcare system improvements to enhance epilepsy management, highlighting the ongoing need for tailored healthcare solutions in this evolving field.
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Affiliation(s)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome (Retired) and Past President of LICE, Italian League Against Epilepsy, Rome, Italy
| | - Francesco Saverio Mennini
- Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome "Tor Vergata", Rome, Italy; Institute for Leadership and Management in Health, Kingston University London, London, UK.
| | - Federico Vigevano
- Head of Paediatric Neurorehabilitation Department, IRCCS San Raffaele, Rome, Italy.
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Lagarde S, Modolo J, Yochum M, Carvallo A, Ballabeni A, Scavarda D, Carron R, Villeneuve N, Bartolomei F, Wendling F. Modification of brain conductivity in human focal epilepsy: A model-based estimation from stereoelectroencephalography. Epilepsia 2024; 65:1744-1755. [PMID: 38491955 DOI: 10.1111/epi.17957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE We have developed a novel method for estimating brain tissue electrical conductivity using low-intensity pulse stereoelectroencephalography (SEEG) stimulation coupled with biophysical modeling. We evaluated the hypothesis that brain conductivity is correlated with the degree of epileptogenicity in patients with drug-resistant focal epilepsy. METHODS We used bipolar low-intensity biphasic pulse stimulation (.2 mA) followed by a postprocessing pipeline for estimating brain conductivity. This processing is based on biophysical modeling of the electrical potential induced in brain tissue between the stimulated contacts in response to pulse stimulation. We estimated the degree of epileptogenicity using a semi-automatic method quantifying the dynamic of fast discharge at seizure onset: the epileptogenicity index (EI). We also investigated how the location of stimulation within specific anatomical brain regions or within lesional tissue impacts brain conductivity. RESULTS We performed 1034 stimulations of 511 bipolar channels in 16 patients. We found that brain conductivity was lower in the epileptogenic zone (EZ; unpaired median difference = .064, p < .001) and inversely correlated with the epileptogenic index value (p < .001, Spearman rho = -.32). Conductivity values were also influenced by anatomical site, location within lesion, and delay between SEEG electrode implantation and stimulation, and had significant interpatient variability. Mixed model multivariate analysis showed that conductivity is significantly associated with EI (F = 13.45, p < .001), anatomical regions (F = 5.586, p < .001), delay since implantation (F = 14.71, p = .003), and age at SEEG (F = 6.591, p = .027), but not with the type of lesion (F = .372, p = .773) or the delay since last seizure (F = 1.592, p = .235). SIGNIFICANCE We provide a novel model-based method for estimating brain conductivity from SEEG low-intensity pulse stimulations. The brain tissue conductivity is lower in EZ as compared to non-EZ. Conductivity also varies significantly across anatomical brain regions. Involved pathophysiological processes may include changes in the extracellular space (especially volume or tortuosity) in epileptic tissue.
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Affiliation(s)
- Stanislas Lagarde
- Epileptology and Cerebral Rhythmology Department (member of the ERN EpiCARE Network), APHM, Timone Hospital, Marseille, France
- INS, Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM, Marseille, France
- University Hospitals (HUG) and University of Geneva (UNIGE), Geneva, Switzerland
| | - Julien Modolo
- LTSI - U1099, University of Rennes, INSERM, Rennes, France
| | - Maxime Yochum
- LTSI - U1099, University of Rennes, INSERM, Rennes, France
| | | | - Alice Ballabeni
- Epileptology and Cerebral Rhythmology Department (member of the ERN EpiCARE Network), APHM, Timone Hospital, Marseille, France
- University of Modena and Reggio-Emilia, Modena, Italy
| | - Didier Scavarda
- INS, Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM, Marseille, France
- Pediatric Neurosurgery Department, APHM, Timone Hospital, Marseille, France
| | - Romain Carron
- INS, Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM, Marseille, France
- Stereotactic and Functional Neurosurgery Department, APHM, Timone Hospital, Marseille, France
| | | | - Fabrice Bartolomei
- Epileptology and Cerebral Rhythmology Department (member of the ERN EpiCARE Network), APHM, Timone Hospital, Marseille, France
- INS, Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM, Marseille, France
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Alturaifi A, Alshaikh H, Khojah O, Alqarni A, Albedaiwi T, Albluwi A, Alqurashi E, Kecheck H, Fallatah H, Almakati R, Gahtani R, Aljohani R, Alhubayshi M, Makkawi S. Drug-Resistant Epilepsy: Experience From a Tertiary Care Center in Saudi Arabia. Cureus 2024; 16:e61913. [PMID: 38975393 PMCID: PMC11227904 DOI: 10.7759/cureus.61913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/09/2024] Open
Abstract
Objectives This study aimed to describe the clinical characteristics, investigational results, and management strategies in patients with drug-resistant epilepsy (DRE). Methods This retrospective cohort study included all adult and adolescent patients (aged 14 years or older) diagnosed with DRE who visited the adult neurology clinic at King Abdulaziz Medical City, Jeddah, Saudi Arabia from January 2019 to December 2021. DRE was defined as failure to achieve seizure freedom despite undergoing adequate trials of two well-tolerated and appropriately selected antiseizure medications. Results This study included 299 patients with DRE. Most patients were in their second to fourth decade, with a mean age of 37 ± 17 years. Focal onset epilepsy was diagnosed in 52.5% of the patients, and an etiology for epilepsy was determined in 44.1% of the patients. Findings in brain magnetic resonance imaging were abnormal in 49% of the patients, whereas abnormal findings in electroencephalograms were found in 27.5%. The most common antiseizure medication was levetiracetam (67.6% of cases). Conclusion The findings of this study confirm the challenges in diagnosing and managing patients with DRE and emphasize the necessity for careful and comprehensive patient evaluation. Further research is needed to investigate the effectiveness, safety, and accessibility of diagnostic and therapeutic resources for patients with DRE.
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Affiliation(s)
- Adilah Alturaifi
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- Department of Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hatoon Alshaikh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Osama Khojah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Abdulaziz Alqarni
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Tarfah Albedaiwi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Amira Albluwi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Elaf Alqurashi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Husun Kecheck
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Halah Fallatah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Reuof Almakati
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Raghad Gahtani
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Rahaf Aljohani
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Madihah Alhubayshi
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
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Courtney MR, Antonic-Baker A, Chen Z, Sinclair B, Nicolo JP, Neal A, Marotta C, Bunyamin J, Law M, Kwan P, O'Brien TJ, Vivash L. Association of Localizing 18F-FDG-PET Hypometabolism and Outcome Following Epilepsy Surgery: Systematic Review and Meta-Analysis. Neurology 2024; 102:e209304. [PMID: 38626375 DOI: 10.1212/wnl.0000000000209304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although commonly used in the evaluation of patients for epilepsy surgery, the association between the detection of localizing 18fluorine fluorodeoxyglucose PET (18F-FDG-PET) hypometabolism and epilepsy surgery outcome is uncertain. We conducted a systematic review and meta-analysis to determine whether localizing 18F-FDG-PET hypometabolism is associated with favorable outcome after epilepsy surgery. METHODS A systematic literature search was undertaken. Eligible publications included evaluation with 18F-FDG-PET before epilepsy surgery, with ≥10 participants, and those that reported surgical outcome at ≥12 months. Random-effects meta-analysis was used to calculate the odds of achieving a favorable outcome, defined as Engel class I, International League Against Epilepsy class 1-2, or seizure-free, with localizing 18F-FDG-PET hypometabolism, defined as concordant with the epilepsy surgery resection zone. Meta-regression was used to characterize sources of heterogeneity. RESULTS The database search identified 8,916 studies, of which 98 were included (total patients n = 4,104). Localizing 18F-FDG-PET hypometabolism was associated with favorable outcome after epilepsy surgery for all patients with odds ratio (OR) 2.68 (95% CI 2.08-3.45). Subgroup analysis yielded similar findings for those with (OR 2.64, 95% CI 1.54-4.52) and without epileptogenic lesion detected on MRI (OR 2.49, 95% CI 1.80-3.44). Concordance with EEG (OR 2.34, 95% CI 1.43-3.83), MRI (OR 1.69, 95% CI 1.19-2.40), and triple concordance with both (OR 2.20, 95% CI 1.32-3.64) was associated with higher odds of favorable outcome. By contrast, diffuse 18F-FDG-PET hypometabolism was associated with worse outcomes compared with focal hypometabolism (OR 0.34, 95% CI 0.22-0.54). DISCUSSION Localizing 18F-FDG-PET hypometabolism is associated with favorable outcome after epilepsy surgery, irrespective of the presence of an epileptogenic lesion on MRI. The extent of 18F-FDG-PET hypometabolism provides additional information, with diffuse hypometabolism associated with worse surgical outcome than focal 18F-FDG-PET hypometabolism. These findings support the incorporation of 18F-FDG-PET into routine noninvasive investigations for patients being evaluated for epilepsy surgery to improve epileptogenic zone localization and to aid patient selection for surgery.
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Affiliation(s)
- Merran R Courtney
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Zhibin Chen
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Benjamin Sinclair
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - John-Paul Nicolo
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Andrew Neal
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Cassandra Marotta
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Jacob Bunyamin
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Meng Law
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Patrick Kwan
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Terence J O'Brien
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Lucy Vivash
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
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Ryvlin P, Barba C, Bartolomei F, Baumgartner C, Brazdil M, Fabo D, Fahoum F, Frauscher B, Ikeda A, Lhatoo S, Mani J, McGonigal A, Metsahonkala EL, Mindruta I, Nguyen DK, Rheims S, Rocamora R, Rydenhag B, Schuele S, Schulze-Bonhage A, Surges R, Vulliemoz S, Beniczky S. Grading system for assessing the confidence in the epileptogenic zone reported in published studies: A Delphi consensus study. Epilepsia 2024; 65:1346-1359. [PMID: 38420750 DOI: 10.1111/epi.17928] [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: 11/01/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE This study was undertaken to develop a standardized grading system based on expert consensus for evaluating the level of confidence in the localization of the epileptogenic zone (EZ) as reported in published studies, to harmonize and facilitate systematic reviews in the field of epilepsy surgery. METHODS We conducted a Delphi study involving 22 experts from 18 countries, who were asked to rate their level of confidence in the localization of the EZ for various theoretical clinical scenarios, using different scales. Information provided in these scenarios included one or several of the following data: magnetic resonance imaging (MRI) findings, invasive electroencephalography summary, and postoperative seizure outcome. RESULTS The first explorative phase showed an overall interrater agreement of .347, pointing to large heterogeneity among experts' assessments, with only 17% of the 42 proposed scenarios associated with a substantial level of agreement. A majority showed preferences for the simpler scale and single-item scenarios. The successive Delphi voting phases resulted in a majority consensus across experts, with more than two thirds of respondents agreeing on the rating of each of the tested single-item scenarios. High or very high levels of confidence were ascribed to patients with either an Engel class I or class IA postoperative seizure outcome, a well-delineated EZ according to all available invasive EEG (iEEG) data, or a well-delineated focal epileptogenic lesion on MRI. MRI signs of hippocampal sclerosis or atrophy were associated with a moderate level of confidence, whereas a low level was ascribed to other MRI findings, a poorly delineated EZ according to iEEG data, or an Engel class II-IV postoperative seizure outcome. SIGNIFICANCE The proposed grading system, based on an expert consensus, provides a simple framework to rate the level of confidence in the EZ reported in published studies in a structured and harmonized way, offering an opportunity to facilitate and increase the quality of systematic reviews and guidelines in the field of epilepsy surgery.
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Affiliation(s)
- Philippe Ryvlin
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
- Member of the ERN EpiCARE
| | - Fabrice Bartolomei
- Member of the ERN EpiCARE
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Christoph Baumgartner
- Member of the ERN EpiCARE
- Department for Epileptology and Clinical Neurophysiology, Medical Faculty, Sigmund Freud University, Vienna, Austria
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Milan Brazdil
- Member of the ERN EpiCARE
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniel Fabo
- Epilepsy Unit, Department of Neurology, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Birgit Frauscher
- Department of Neurology and Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Samden Lhatoo
- Department of Neurology, University of Texas Health Science Center, Houston, Texas, USA
| | - Jayanti Mani
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Center, Mumbai, India
| | - Aileen McGonigal
- Department of Neurosciences, Mater Misericordiae Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Eeva-Liisa Metsahonkala
- Member of the ERN EpiCARE
- Epilepsia Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Ioana Mindruta
- Member of the ERN EpiCARE
- Clinical Neuroscience Department, Carol Davila University of Medicine and Pharmacy, Epilepsy Monitoring, Bucharest, Romania
- Emergency University Hospital Bucharest, Bucharest, Romania
| | - Dang Khoa Nguyen
- Division of Neurology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Sylvain Rheims
- Member of the ERN EpiCARE
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France
| | - Rodrigo Rocamora
- Member of the ERN EpiCARE
- Epilepsy Monitoring Unit, Department of Neurology and Medical Research Institute, Hospital del Mar, Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bertil Rydenhag
- Member of the ERN EpiCARE
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Stephan Schuele
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Andreas Schulze-Bonhage
- Member of the ERN EpiCARE
- Epilepsy Center, Neurocenter, University Medical Center-University of Freiburg, Freiburg, Germany
| | - Rainer Surges
- Member of the ERN EpiCARE
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Sandor Beniczky
- Member of the ERN EpiCARE
- Department of Clinical Neurophysiology, Danish Epilepsy Center and Aarhus University Hospital, Dianalund, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Marchi A, Guex R, Denis M, El Youssef N, Pizzo F, Bénar CG, Bartolomei F. Neurofeedback and epilepsy: Renaissance of an old self-regulation method? Rev Neurol (Paris) 2024; 180:314-325. [PMID: 38485630 DOI: 10.1016/j.neurol.2024.02.386] [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: 10/03/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 04/28/2024]
Abstract
Neurofeedback is a brain-computer interface tool enabling the user to self-regulate their neuronal activity, and ultimately, induce long-term brain plasticity, making it an interesting instrument to cure brain disorders. Although this method has been used successfully in the past as an adjunctive therapy in drug-resistant epilepsy, this approach remains under-explored and deserves more rigorous scientific inquiry. In this review, we present early neurofeedback protocols employed in epilepsy and provide a critical overview of the main clinical studies. We also describe the potential neurophysiological mechanisms through which neurofeedback may produce its therapeutic effects. Finally, we discuss how to innovate and standardize future neurofeedback clinical trials in epilepsy based on evidence from recent research studies.
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Affiliation(s)
- A Marchi
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France.
| | - R Guex
- Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - M Denis
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France
| | - N El Youssef
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France
| | - F Pizzo
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France; Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - C-G Bénar
- Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - F Bartolomei
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France; Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
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13
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Sun T, Wu S, Liu X, Tao JX, Wang Q. Impact of intracranial subclinical seizures on seizure outcomes after SLAH in patients with mesial temporal lobe epilepsy. Clin Neurophysiol 2024; 160:121-129. [PMID: 38422970 DOI: 10.1016/j.clinph.2024.02.013] [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: 08/21/2023] [Revised: 12/31/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To investigate the association between subclinical seizures detected on intracranial electroencephalographic (i-SCSs)recordings and mesial temporal sclerosis (MTS), as well as their impact on surgical outcomes of stereotactic laser amygdalohippocampotomy (SLAH). METHODS A retrospective review was conducted on 27 patients with drug-resistant mesial temporal lobe epilepsy (MTLE) who underwent SLAH. The number of seizures detected on scalp EEG and iEEG was assessed. Patients were followed for a minimum of 3 years after SLAH. RESULTS Of the 1715 seizures recorded from mesial temporal regions, 1640 were identified as i-SCSs. Patients with MTS were associated with favorable short- and long-term surgical outcomes. Patients with MTS had a higher number of i-SCSs compared to patients without MTS. The numbers of i-SCSs were higher in patients with Engel I-II outcomes, but no significant statistical difference was found. However, it was observed that patients with MTS who achieved Engel I-II classification had higher numbers of i-SCSs than patients without MTS (P < 0.05). CONCLUSION Patients with MTS exhibited favorable short-term and long-term surgical outcome after SLAH. A higher number of i-SCSs was significantly associated with MTS in patients with MTLE. The number of i-SCSs tended to be higher in patients with Engel Ⅰ-Ⅱ surgical outcomes. SIGNIFICANCE The association between i-SCSs, MTS, and surgical outcomes in MTLE patients undergoing SLAH has significant implications for understanding the underlying mechanisms and identifying potential therapeutic targets to enhance surgical outcomes.
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Affiliation(s)
- Taixin Sun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; Department of Neurology, Beijing Electric Power Hospital, Capital Medical University, Beijing, PR China
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, IL 60637, USA
| | - Xi Liu
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei Province, PR China
| | - James X Tao
- Department of Neurology, The University of Chicago, Chicago, IL 60637, USA
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
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14
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Kronlage C, Heide EC, Hagberg GE, Bender B, Scheffler K, Martin P, Focke N. MP2RAGE vs. MPRAGE surface-based morphometry in focal epilepsy. PLoS One 2024; 19:e0296843. [PMID: 38330027 PMCID: PMC10852321 DOI: 10.1371/journal.pone.0296843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024] Open
Abstract
In drug-resistant focal epilepsy, detecting epileptogenic lesions using MRI poses a critical diagnostic challenge. Here, we assessed the utility of MP2RAGE-a T1-weighted sequence with self-bias correcting properties commonly utilized in ultra-high field MRI-for the detection of epileptogenic lesions using a surface-based morphometry pipeline based on FreeSurfer, and compared it to the common approach using T1w MPRAGE, both at 3T. We included data from 32 patients with focal epilepsy (5 MRI-positive, 27 MRI-negative with lobar seizure onset hypotheses) and 94 healthy controls from two epilepsy centres. Surface-based morphological measures and intensities were extracted and evaluated in univariate GLM analyses as well as multivariate unsupervised 'novelty detection' machine learning procedures. The resulting prediction maps were analyzed over a range of possible thresholds using alternative free-response receiver operating characteristic (AFROC) methodology with respect to the concordance with predefined lesion labels or hypotheses on epileptogenic zone location. We found that MP2RAGE performs at least comparable to MPRAGE and that especially analysis of MP2RAGE image intensities may provide additional diagnostic information. Secondly, we demonstrate that unsupervised novelty-detection machine learning approaches may be useful for the detection of epileptogenic lesions (maximum AFROC AUC 0.58) when there is only a limited lesional training set available. Third, we propose a statistical method of assessing lesion localization performance in MRI-negative patients with lobar hypotheses of the epileptogenic zone based on simulation of a random guessing process as null hypothesis. Based on our findings, it appears worthwhile to study similar surface-based morphometry approaches in ultra-high field MRI (≥ 7 T).
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Affiliation(s)
- Cornelius Kronlage
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Ev-Christin Heide
- Clinic of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Gisela E. Hagberg
- High-Field MR Centre, Max-Planck-Institute for Biological Cybernetics, Tuebingen, Germany
- Department for Biomedical Magnetic Resonances, University of Tuebingen, Tuebingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, University of Tuebingen, Tuebingen, Germany
| | - Klaus Scheffler
- High-Field MR Centre, Max-Planck-Institute for Biological Cybernetics, Tuebingen, Germany
- Department for Biomedical Magnetic Resonances, University of Tuebingen, Tuebingen, Germany
| | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Niels Focke
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Clinic of Neurology, University Medical Center Goettingen, Goettingen, Germany
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15
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Seth EA, Watterson J, Xie J, Arulsamy A, Md Yusof HH, Ngadimon IW, Khoo CS, Kadirvelu A, Shaikh MF. Feasibility of cardiac-based seizure detection and prediction: A systematic review of non-invasive wearable sensor-based studies. Epilepsia Open 2024; 9:41-59. [PMID: 37881157 PMCID: PMC10839362 DOI: 10.1002/epi4.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
A reliable seizure detection or prediction device can potentially reduce the morbidity and mortality associated with epileptic seizures. Previous findings indicating alterations in cardiac activity during seizures suggest the usefulness of cardiac parameters for seizure detection or prediction. This study aims to examine available studies on seizure detection and prediction based on cardiac parameters using non-invasive wearable devices. The Embase, PubMed, and Scopus databases were used to systematically search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Human studies that evaluated seizure detection or prediction based on cardiac parameters collected using wearable devices were included. The QUADAS-2 tool and proposed standards for validation for seizure detection devices were used for quality assessment. Twenty-four articles were identified and included in the analysis. Twenty studies evaluated seizure detection algorithms, and four studies focused on seizure prediction. Most studies used either a wrist-worn or chest-worn device for data acquisition. Among the seizure detection studies, cardiac parameters utilized for the algorithms mainly included heart rate (HR) (n = 11) or a combination of HR and heart rate variability (HRV) (n = 6). HR-based seizure detection studies collectively reported a sensitivity range of 56%-100% and a false alarm rate (FAR) of 0.02-8/h, with most studies performing retrospective validation of the algorithms. Three of the seizure prediction studies retrospectively validated multimodal algorithms, combining cardiac features with other physiological signals. Only one study prospectively validated their seizure prediction algorithm using HRV extracted from ECG data collected from a custom wearable device. These studies have demonstrated the feasibility of using cardiac parameters for seizure detection and prediction with wearable devices, with varying algorithmic performance. Many studies are in the proof-of-principle stage, and evidence for real-time detection or prediction is currently limited. Future studies should prioritize further refinement of the algorithm performance with prospective validation using large-scale longitudinal data. PLAIN LANGUAGE SUMMARY: This systematic review highlights the potential use of wearable devices, like wristbands, for detecting and predicting seizures via the measurement of heart activity. By reviewing 24 articles, it was found that most studies focused on using heart rate and changes in heart rate for seizure detection. There was a lack of studies looking at seizure prediction. The results were promising but most studies were not conducted in real-time. Therefore, more real-time studies are needed to verify the usage of heart activity-related wearable devices to detect seizures and even predict them, which will be beneficial to people with epilepsy.
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Affiliation(s)
- Eryse Amira Seth
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Jessica Watterson
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Department of Human‐Centred ComputingMonash UniversityMelbourneVictoriaAustralia
| | - Jue Xie
- Department of Human‐Centred ComputingMonash UniversityMelbourneVictoriaAustralia
| | - Alina Arulsamy
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Hadri Hadi Md Yusof
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Irma Wati Ngadimon
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Ching Soong Khoo
- Neurology Unit, Department of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Amudha Kadirvelu
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- School of Dentistry and Medical SciencesCharles Sturt UniversityOrangeNew South WalesAustralia
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16
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Bratu IF, Makhalova J, Garnier E, Villalon SM, Jegou A, Bonini F, Lagarde S, Pizzo F, Trébuchon A, Scavarda D, Carron R, Bénar C, Bartolomei F. Permutation entropy-derived parameters to estimate the epileptogenic zone network. Epilepsia 2024; 65:389-401. [PMID: 38041564 DOI: 10.1111/epi.17849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Quantification of the epileptogenic zone network (EZN) most frequently implies analysis of seizure onset. However, important information can also be obtained from the postictal period, characterized by prominent changes in the EZN. We used permutation entropy (PE), a measure of signal complexity, to analyze the peri-ictal stereoelectroencephalography (SEEG) signal changes with emphasis on the postictal state. We sought to determine the best PE-derived parameter (PEDP) for identifying the EZN. METHODS Several PEDPs were computed retrospectively on SEEG-recorded seizures of 86 patients operated on for drug-resistant epilepsy: mean baseline preictal entropy, minimum ictal entropy, maximum postictal entropy, the ratio between the maximum postictal and the minimum ictal entropy, and the ratio between the maximum postictal and the baseline preictal entropy. The performance of each biomarker was assessed by comparing the identified epileptogenic contacts or brain regions against the EZN defined by clinical analysis incorporating the Epileptogenicity Index and the connectivity epileptogenicity index methods (EZNc), using the receiver-operating characteristic and precision-recall. RESULTS The ratio between the maximum postictal and the minimum ictal entropy (defined as the Permutation Entropy Index [PEI]) proved to be the best-performing PEDP to identify the EZNC . It demonstrated the highest area under the curve (AUC) and F1 score at the contact level (AUC 0.72; F1 0.39) and at the region level (AUC 0.78; F1 0.47). PEI values gradually decreased between the EZN, the propagation network, and the non-involved regions. PEI showed higher performance in patients with slow seizure-onset patterns than in those with fast seizure-onset patterns. The percentage of resected epileptogenic regions defined by PEI was significantly correlated with surgical outcome. SIGNIFICANCE PEI is a promising tool to improve the delineation of the EZN. PEI combines ease and robustness in a routine clinical setting with high sensitivity for seizures without fast activity at seizure onset.
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Affiliation(s)
- Ionuț-Flavius Bratu
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Julia Makhalova
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- APHM, Timone Hospital, CEMEREM, Marseille, France
| | - Elodie Garnier
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Samuel Medina Villalon
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Aude Jegou
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Francesca Bonini
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Stanislas Lagarde
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Francesca Pizzo
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Agnès Trébuchon
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Didier Scavarda
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- APHM Paediatric Neurosurgery Department, Marseille, France
| | - Romain Carron
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- APHM Functional Neurosurgery Department, Marseille, France
| | - Christian Bénar
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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17
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Tang Y, Xiao L, Deng C, Zhu H, Gao X, Li J, Yang Z, Liu D, Feng L, Hu S. [ 18F]FDG PET metabolic patterns in mesial temporal lobe epilepsy with different pathological types. Eur Radiol 2024; 34:887-898. [PMID: 37581655 DOI: 10.1007/s00330-023-10089-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To investigate [18F]FDG PET patterns of mesial temporal lobe epilepsy (MTLE) patients with distinct pathologic types and provide possible guidance for predicting long-term prognoses of patients undergoing epilepsy surgery. METHODS This was a retrospective review of MTLE patients who underwent anterior temporal lobectomy between 2016 and 2021. Patients were classified as having chronic inflammation and gliosis (gliosis, n = 44), hippocampal sclerosis (HS, n = 43), or focal cortical dysplasia plus HS (FCD-HS, n = 13) based on the postoperative pathological diagnosis. Metabolic patterns and the severity of metabolic abnormalities were investigated among MTLE patients and healthy controls (HCs). The standardized uptake value (SUV), SUV ratio (SUVr), and asymmetry index (AI) of regions of interest were applied to evaluate the severity of metabolic abnormalities. Imaging processing was performed with statistical parametric mapping (SPM12). RESULTS With a mean follow-up of 2.8 years, the seizure freedom (Engel class IA) rates of gliosis, HS, and FCD-HS were 54.55%, 62.79%, and 69.23%, respectively. The patients in the gliosis group presented a metabolic pattern with a larger involvement of extratemporal areas, including the ipsilateral insula. SUV, SUVr, and AI in ROIs were decreased for patients in all three MTLE groups compared with those of HCs, but the differences among all three MTLE groups were not significant. CONCLUSIONS MTLE patients with isolated gliosis had the worst prognosis and hypometabolism in the insula, but the degree of metabolic decrease did not differ from the other two groups. Hypometabolic regions should be prioritized for [18F]FDG PET presurgical evaluation rather than [18F]FDG uptake values. CLINICAL RELEVANCE STATEMENT This study proposes guidance for optimizing the operation scheme in patients with refractory MTLE and emphasizes the potential of molecular neuroimaging with PET using selected tracers to predict the postsurgical histology of patients with refractory MTLE epilepsy. KEY POINTS • MTLE patients with gliosis had poor surgical outcomes and showed a distinct pattern of decreased metabolism in the ipsilateral insula. • In the preoperative assessment of MTLE, it is recommended to prioritize the evaluation of glucose hypometabolism areas over [18F]FDG uptake values. • The degree of glucose hypometabolism in the epileptogenic focus was not associated with the surgical outcomes of MTLE.
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Affiliation(s)
- Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Chijun Deng
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaomei Gao
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Department of Neurology, Xiangya Hospital, Central South University (Jiangxi Branch), Nanchang, Jiangxi, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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18
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Hangel G, Kasprian G, Chambers S, Haider L, Lazen P, Koren J, Diehm R, Moser K, Tomschik M, Wais J, Winter F, Zeiser V, Gruber S, Aull-Watschinger S, Traub-Weidinger T, Baumgartner C, Feucht M, Dorfer C, Bogner W, Trattnig S, Pataraia E, Roessler K. Implementation of a 7T Epilepsy Task Force consensus imaging protocol for routine presurgical epilepsy work-up: effect on diagnostic yield and lesion delineation. J Neurol 2024; 271:804-818. [PMID: 37805665 PMCID: PMC10827812 DOI: 10.1007/s00415-023-11988-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/05/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Recently, the 7 Tesla (7 T) Epilepsy Task Force published recommendations for 7 T magnetic resonance imaging (MRI) in patients with pharmaco-resistant focal epilepsy in pre-surgical evaluation. The objective of this study was to implement and evaluate this consensus protocol with respect to both its practicability and its diagnostic value/potential lesion delineation surplus effect over 3 T MRI in the pre-surgical work-up of patients with pharmaco-resistant focal onset epilepsy. METHODS The 7 T MRI protocol consisted of T1-weighted, T2-weighted, high-resolution-coronal T2-weighted, fluid-suppressed, fluid-and-white-matter-suppressed, and susceptibility-weighted imaging, with an overall duration of 50 min. Two neuroradiologists independently evaluated the ability of lesion identification, the detection confidence for these identified lesions, and the lesion border delineation at 7 T compared to 3 T MRI. RESULTS Of 41 recruited patients > 12 years of age, 38 were successfully measured and analyzed. Mean detection confidence scores were non-significantly higher at 7 T (1.95 ± 0.84 out of 3 versus 1.64 ± 1.19 out of 3 at 3 T, p = 0.050). In 50% of epilepsy patients measured at 7 T, additional findings compared to 3 T MRI were observed. Furthermore, we found improved border delineation at 7 T in 88% of patients with 3 T-visible lesions. In 19% of 3 T MR-negative cases a new potential epileptogenic lesion was detected at 7 T. CONCLUSIONS The diagnostic yield was beneficial, but with 19% new 7 T over 3 T findings, not major. Our evaluation revealed epilepsy outcomes worse than ILAE Class 1 in two out of the four operated cases with new 7 T findings.
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Affiliation(s)
- Gilbert Hangel
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria.
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria.
- Medical Imaging Cluster, Medical University of Vienna, Vienna, Austria.
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefanie Chambers
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
| | - Lukas Haider
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- NMR Research Unit, Faculty of Brain Science, Queens Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Philipp Lazen
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
| | - Johannes Koren
- Department of Neurology, Klinik Hietzing, Vienna, Austria
| | - Robert Diehm
- Center for Rare and Complex Childhood Onset Epilepsies, Member of ERN EpiCARE, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Moser
- Center for Rare and Complex Childhood Onset Epilepsies, Member of ERN EpiCARE, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Jonathan Wais
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Fabian Winter
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Vitalij Zeiser
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stephan Gruber
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria
| | | | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Martha Feucht
- Center for Rare and Complex Childhood Onset Epilepsies, Member of ERN EpiCARE, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Bogner
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria
| | | | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria
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19
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Ikemoto S, Pana R, von Ellenrieder N, Gotman J. Electroencephalography-functional magnetic resonance imaging for clinical evaluation in focal epilepsy. Epilepsia Open 2024; 9:84-95. [PMID: 37724422 PMCID: PMC10839335 DOI: 10.1002/epi4.12829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/27/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the contribution of simultaneous recording of electroencephalography-functional magnetic resonance imaging (EEG-fMRI) in the diagnosis of epilepsy syndrome, localization of the epileptogenic zone (EZ), and decision-making regarding surgical treatment. METHODS We performed a retrospective study to evaluate patients with focal epilepsy who underwent EEG-fMRI. Two evaluators assessed epilepsy syndrome, presumed focus, and surgical candidacy and defined confidence levels. They assessed these clinical characteristics first without EEG-fMRI and then including EEG-fMRI to assess how the results of EEG-fMRI changed the evaluations. We also determined how the clinical evaluation was affected by the concordance level between the blood oxygen level-dependent (BOLD) response and the presumed focus location, and by the confidence level of the BOLD response itself based on the t-value of the primary and secondary clusters. RESULTS Fifty-one scans from 48 patients were included. The BOLD map affected 66.7% of the evaluations by altering evaluation items (epilepsy syndrome, presumed focus, or surgical candidacy) or their confidence levels. EEG-fMRI results increased the confidence levels of epilepsy syndrome, presumed focus, or surgical candidacy in 47.1% of patients but reduced clinical confidence in these features in 11.8%. More specifically, the confidence levels increased for epilepsy syndrome in 28.5%, identification of presumed focus in 33.9%, and determination of surgical candidacy in 29.4%. The BOLD signal confidence level, whether high or low, did not influence these clinical factors. SIGNIFICANCE Previous studies have emphasized the utility of EEG-fMRI for the localization of the epileptogenic zone. This study demonstrated the potential of EEG-fMRI to influence clinical confidence when determining epilepsy syndrome, the presumed epileptic focus, and surgical candidacy.
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Affiliation(s)
- Satoru Ikemoto
- Montreal Neurological Institute and HospitalMontrealQuebecCanada
- Department of PediatricsThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Raluca Pana
- Montreal Neurological Institute and HospitalMontrealQuebecCanada
| | | | - Jean Gotman
- Montreal Neurological Institute and HospitalMontrealQuebecCanada
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Doss DJ, Johnson GW, Englot DJ. Imaging and Stereotactic Electroencephalography Functional Networks to Guide Epilepsy Surgery. Neurosurg Clin N Am 2024; 35:61-72. [PMID: 38000842 PMCID: PMC10676462 DOI: 10.1016/j.nec.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Epilepsy surgery is a potentially curative treatment of drug-resistant epilepsy that has remained underutilized both due to inadequate referrals and incomplete localization hypotheses. The complexity of patients evaluated for epilepsy surgery has increased, thus new approaches are necessary to treat these patients. The paradigm of epilepsy surgery has evolved to match this challenge, now considering the entire seizure network with the goal of disrupting it through resection, ablation, neuromodulation, or a combination. The network paradigm has the potential to aid in identification of the seizure network as well as treatment selection.
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Affiliation(s)
- Derek J Doss
- Department of Biomedical Engineering, Vanderbilt University, PMB 351631, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Vanderbilt University Institute of Imaging Science (VUIIS), 1161 21st Avenue South, Medical Center North AA-1105, Nashville, TN 37232, USA; Vanderbilt Institute for Surgery and Engineering (VISE), 1161 21st Avenue South, MCN S2323, Nashville, TN 37232, USA
| | - Graham W Johnson
- Department of Biomedical Engineering, Vanderbilt University, PMB 351631, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Vanderbilt University Institute of Imaging Science (VUIIS), 1161 21st Avenue South, Medical Center North AA-1105, Nashville, TN 37232, USA; Vanderbilt Institute for Surgery and Engineering (VISE), 1161 21st Avenue South, MCN S2323, Nashville, TN 37232, USA
| | - Dario J Englot
- Department of Biomedical Engineering, Vanderbilt University, PMB 351631, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Vanderbilt University Institute of Imaging Science (VUIIS), 1161 21st Avenue South, Medical Center North AA-1105, Nashville, TN 37232, USA; Vanderbilt Institute for Surgery and Engineering (VISE), 1161 21st Avenue South, MCN S2323, Nashville, TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, T4224 Medical Center North, Nashville, TN 37232, USA; Department of Electrical and Computer Engineering, Vanderbilt University, PMB 351824, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Department of Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA.
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21
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Nanda P, Richardson RM. Evolution of Stereo-Electroencephalography at Massachusetts General Hospital. Neurosurg Clin N Am 2024; 35:87-94. [PMID: 38000845 DOI: 10.1016/j.nec.2023.09.007] [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] [Indexed: 11/26/2023]
Abstract
The practice of invasive monitoring for presurgical epilepsy workup has evolved at Massachusetts General Hospital (MGH) in parallel to the evolution in the field's understanding of epilepsy as a network disorder. Implantations have shifted from an emphasis on singularly finding single foci for the purpose of resection to a network-hypothesis-driven approach aiming to delineate patients' seizure networks with the goal of developing surgical interventions that disrupt critical nodes of these networks. Here, the authors review all invasive monitoring cases at MGH from April 2016 through June 2023 to describe how this paradigm shift has taken form.
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Affiliation(s)
- Pranav Nanda
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA.
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
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van de Velden D, Heide EC, Bouter C, Bucerius J, Riedel CH, Focke NK. Effects of inverse methods and spike phases on interictal high-density EEG source reconstruction. Clin Neurophysiol 2023; 156:4-13. [PMID: 37832322 DOI: 10.1016/j.clinph.2023.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To determine the effect of inverse methods and timepoints of interictal epileptic discharges (IEDs) used for high-density electric source imaging (hd-ESI) in pharmacoresistant focal epilepsies. METHODS We retrospectively evaluated the hd-ESI and [18F]fluorodeoxyglucose positron emission tomography (18FDG-PET) of 21 operated patients with pharmacoresistant focal epilepsy (Engel I). Volumetric hd-ESI was performed with three different inverse methods such as the inverse solution linearly constrained minimum variance (LCMV, a beamformer method), standardized low resolution electromagnetic tomography (sLORETA) and weighted minimum-norm estimation (wMNE) and at different IED phases. Hd-ESI accuracy was determined by volumetric overlap and distance between hd-ESI source maximum, as well as 18FDG-PET hypometabolic region relative to the resection zone (RZ). RESULTS In our cohort, the shortest distances and greatest volumetric overlaps to the RZ were found in the half-rise and peak-phase for all inverse methods. The distance to the RZ was not different between the centroid of the clinical hypothesis-based cluster and the source maximum in peak-phase. However, the distance of the hypothesis-based cluster was significantly shorter compared to the cluster selected by the smallest p-value. CONCLUSIONS Hd-ESI provides the greatest accuracy in determining the RZ at the IED half-rise and peak-phase for all applied inverse methods, whereby sLORETA and LCMV were equally accurate. SIGNIFICANCE Our results offer guidance in selecting inverse methods and IED phases for hd-ESI, compare the performance of hd-ESI and 18FDG-PET and encourage future studies in investigating the relationship between interictal ESI and 18FDG-PET hypometabolism.
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Affiliation(s)
- Daniel van de Velden
- University Medical Center Göttingen, Clinic for Neurology, 37075 Göttingen, Germany.
| | - Ev-Christin Heide
- University Medical Center Göttingen, Clinic for Neurology, 37075 Göttingen, Germany
| | - Caroline Bouter
- University Medical Center Göttingen, Department of Nuclear Medicine, 37075 Göttingen, Germany
| | - Jan Bucerius
- University Medical Center Göttingen, Department of Nuclear Medicine, 37075 Göttingen, Germany
| | - Christian H Riedel
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Neuroradiology, 37075 Göttingen, Germany
| | - Niels K Focke
- University Medical Center Göttingen, Clinic for Neurology, 37075 Göttingen, Germany.
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23
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Rebsamen M, Jin BZ, Klail T, De Beukelaer S, Barth R, Rezny-Kasprzak B, Ahmadli U, Vulliemoz S, Seeck M, Schindler K, Wiest R, Radojewski P, Rummel C. Clinical Evaluation of a Quantitative Imaging Biomarker Supporting Radiological Assessment of Hippocampal Sclerosis. Clin Neuroradiol 2023; 33:1045-1053. [PMID: 37358608 PMCID: PMC10654177 DOI: 10.1007/s00062-023-01308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/09/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To evaluate the influence of quantitative reports (QReports) on the radiological assessment of hippocampal sclerosis (HS) from MRI of patients with epilepsy in a setting mimicking clinical reality. METHODS The study included 40 patients with epilepsy, among them 20 with structural abnormalities in the mesial temporal lobe (13 with HS). Six raters blinded to the diagnosis assessed the 3T MRI in two rounds, first using MRI only and later with both MRI and the QReport. Results were evaluated using inter-rater agreement (Fleiss' kappa [Formula: see text]) and comparison with a consensus of two radiological experts derived from clinical and imaging data, including 7T MRI. RESULTS For the primary outcome, diagnosis of HS, the mean accuracy of the raters improved from 77.5% with MRI only to 86.3% with the additional QReport (effect size [Formula: see text]). Inter-rater agreement increased from [Formula: see text] to [Formula: see text]. Five of the six raters reached higher accuracies, and all reported higher confidence when using the QReports. CONCLUSION In this pre-use clinical evaluation study, we demonstrated clinical feasibility and usefulness as well as the potential impact of a previously suggested imaging biomarker for radiological assessment of HS.
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Affiliation(s)
- Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Baudouin Zongxin Jin
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tomas Klail
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie De Beukelaer
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rike Barth
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beata Rezny-Kasprzak
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Uzeyir Ahmadli
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kaspar Schindler
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Swiss Institute for Translational and Entrepreneurial Medicine, sitem-insel, Bern, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
- Swiss Institute for Translational and Entrepreneurial Medicine, sitem-insel, Bern, Switzerland.
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
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Shin HJ, Kim SH, Kang HC, Lee JS, Kim HD. Surgical Treatment of Epilepsy with Bilateral MRI Abnormalities. World Neurosurg 2023; 180:e37-e45. [PMID: 37495100 DOI: 10.1016/j.wneu.2023.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To investigate the surgical outcomes of patients with drug-resistant epilepsy and bilateral brain magnetic resonance imaging (MRI) abnormalities who had undergone various epilepsy surgeries. METHODS Patients with drug-resistant epilepsy and bilateral brain abnormalities on MRI who underwent epilepsy surgery at the Severance Children's Hospital between October 2003 and December 2021 were included. The age of seizure onset was 18 years or younger. Engel's classification was used to assess seizure outcomes at 1, 2, and 5 years after surgery. RESULTS A total of 40 patients met the inclusion criteria. The median age at surgery was 10.9 years (interquartile range [IQR] 6.9-15.1); the median interval to surgery was 7.1 years (IQR 2.7-11.5). One year after surgery, a favorable outcome of Engel class I-II was observed in 53% (21/40) of patients. At the 2- and 5-year follow-ups, 56% (20/36) and 63% (17/27) of patients showed good postoperative outcomes, respectively. CONCLUSIONS Approximately, half of the patients with bilateral brain MRI abnormalities achieved seizure freedom after epilepsy surgery. The existence of bilateral brain MRI abnormalities should not hinder resective epilepsy surgery.
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Affiliation(s)
- Hui Jin Shin
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hee Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea; Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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25
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De Benedictis A, de Palma L, Rossi-Espagnet MC, Marras CE. Connectome-based approaches in pediatric epilepsy surgery: "State-of-the art" and future perspectives. Epilepsy Behav 2023; 149:109523. [PMID: 37944286 DOI: 10.1016/j.yebeh.2023.109523] [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: 06/25/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Modern epilepsy science has overcome the traditional interpretation of a strict region-specific origin of epilepsy, highlighting the involvement of wider patterns of altered neuronal circuits. In selected cases, surgery may constitute a valuable option to achieve both seizure freedom and neurocognitive improvement. Although epilepsy is now considered as a brain network disease, the most relevant literature concerning the "connectome-based" epilepsy surgery mainly refers to adults, with a limited number of studies dedicated to the pediatric population. In this review, the Authors summarized the main current available knowledge on the relevance of WM surgical anatomy in epilepsy surgery, the post-surgical modifications of brain structural connectivity and the related clinical impact of such modifications within the pediatric context. In the last part, possible implications and future perspectives of this approach have been discussed, especially concerning the optimization of surgical strategies and the predictive value of the epilepsy network analysis for planning tailored approaches, with the final aim of improving case selection, presurgical planning, intraoperative management, and postoperative results.
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Affiliation(s)
| | - Luca de Palma
- Epilepsy and Movement Disorders Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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26
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Straka B, Splitkova B, Vlckova M, Tesner P, Rezacova H, Krskova L, Koblizek M, Kyncl M, Maulisova A, Bukacova K, Uhrova-Meszarosova A, Musilova A, Kudr M, Ebel M, Belohlavkova A, Jahodova A, Liby P, Tichy M, Jezdik P, Zamecnik J, Aronica E, Krsek P. Genetic testing in children enrolled in epilepsy surgery program. A real-life study. Eur J Paediatr Neurol 2023; 47:80-87. [PMID: 37812946 DOI: 10.1016/j.ejpn.2023.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Although genetic causes of drug-resistant focal epilepsy and selected focal malformations of cortical development (MCD) have been described, a limited number of studies comprehensively analysed genetic diagnoses in patients undergoing pre-surgical evaluation, their outcomes and the effect of genetic diagnosis on surgical strategy. METHODS We analysed a prospective cohort of children enrolled in epilepsy surgery program over January 2018-July 2022. The majority of patients underwent germline and/or somatic genetic testing. We searched for predictors of surgical outcome and positive result of germline genetic testing. RESULTS Ninety-five patients were enrolled in epilepsy surgery program and 64 underwent resective epilepsy surgery. We ascertained germline genetic diagnosis in 13/74 patients having underwent germline gene testing (pathogenic or likely pathogenic variants in CHRNA4, NPRL3, DEPDC5, FGF12, GRIA2, SZT2, STXBP1) and identified three copy number variants. Thirty-five patients underwent somatic gene testing; we detected 10 pathogenic or likely pathogenic variants in genes SLC35A2, PTEN, MTOR, DEPDC5, NPRL3. Germline genetic diagnosis was significantly associated with the diagnosis of focal epilepsy with unknown seizure onset. SIGNIFICANCE Germline and somatic gene testing can ascertain a definite genetic diagnosis in a significant subgroup of patients in epilepsy surgery programs. Diagnosis of focal genetic epilepsy may tip the scales against the decision to proceed with invasive EEG study or surgical resection; however, selected patients with genetic focal epilepsies associated with MCD may benefit from resective epilepsy surgery and therefore, a genetic diagnosis does not disqualify patients from presurgical evaluation and epilepsy surgery.
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Affiliation(s)
- Barbora Straka
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Barbora Splitkova
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Marketa Vlckova
- Department of Biology and Medical Genetics, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Pavel Tesner
- Department of Biology and Medical Genetics, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Hana Rezacova
- Department of Biology and Medical Genetics, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Lenka Krskova
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Miroslav Koblizek
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Martin Kyncl
- Department of Radiology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Alice Maulisova
- Department of Clinical Psychology, Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Katerina Bukacova
- Department of Clinical Psychology, Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Anna Uhrova-Meszarosova
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Alena Musilova
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Martin Kudr
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Matyas Ebel
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Anezka Belohlavkova
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Alena Jahodova
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Petr Liby
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Michal Tichy
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Petr Jezdik
- Faculty of Electrical Engineering, Department of Circuit Theory, Czech Technical University in Prague, Technicka 2, Praha 6, 166 27, Czech Republic.
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Eleonora Aronica
- Amsterdam UMC Location University of Amsterdam, Department of Neuropathology, Amsterdam Neuroscience, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.
| | - Pavel Krsek
- Department of Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Full Member of the ERN EpiCARE, V Uvalu 84, 15006, Prague, Czech Republic.
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Makhalova J, Madec T, Medina Villalon S, Jegou A, Lagarde S, Carron R, Scavarda D, Garnier E, Bénar CG, Bartolomei F. The role of quantitative markers in surgical prognostication after stereoelectroencephalography. Ann Clin Transl Neurol 2023; 10:2114-2126. [PMID: 37735846 PMCID: PMC10646998 DOI: 10.1002/acn3.51900] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/26/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is the reference method in the presurgical exploration of drug-resistant focal epilepsy. However, prognosticating surgery on an individual level is difficult. A quantified estimation of the most epileptogenic regions by searching for relevant biomarkers can be proposed for this purpose. We investigated the performances of ictal (Epileptogenicity Index, EI; Connectivity EI, cEI), interictal (spikes, high-frequency oscillations, HFO [80-300 Hz]; Spikes × HFO), and combined (Spikes × EI; Spikes × cEI) biomarkers in predicting surgical outcome and searched for prognostic factors based on SEEG-signal quantification. METHODS Fifty-three patients operated on following SEEG were included. We compared, using precision-recall, the epileptogenic zone quantified using different biomarkers (EZq ) against the visual analysis (EZC ). Correlations between the EZ resection rates or the EZ extent and surgical prognosis were analyzed. RESULTS EI and Spikes × EI showed the best precision against EZc (0.74; 0.70), followed by Spikes × cEI and cEI, whereas interictal markers showed lower precision. The EZ resection rates were greater in seizure-free than in non-seizure-free patients for the EZ defined by ictal biomarkers and were correlated with the outcome for EI and Spikes × EI. No such correlation was found for interictal markers. The extent of the quantified EZ did not correlate with the prognosis. INTERPRETATION Ictal or combined ictal-interictal markers overperformed the interictal markers both for detecting the EZ and predicting seizure freedom. Combining ictal and interictal epileptogenicity markers improves detection accuracy. Resection rates of the quantified EZ using ictal markers were the only statistically significant determinants for surgical prognosis.
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Affiliation(s)
- Julia Makhalova
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
- Aix Marseille Univ, CNRS, CRMBMMarseilleFrance
| | - Tanguy Madec
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
| | - Samuel Medina Villalon
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | - Aude Jegou
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | - Stanislas Lagarde
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | - Romain Carron
- APHM, Timone Hospital, Functional, and Stereotactic NeurosurgeryMarseilleFrance
| | | | - Elodie Garnier
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | | | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
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Chang CW, Tseng WEJ, Lin WR, Ko PC, Liu CJ, Lim SN. Optimizing treatment persistence in epilepsy: a comparative analysis of combined antiseizure medications with different mechanisms of action. Ther Adv Neurol Disord 2023; 16:17562864231207161. [PMID: 37920860 PMCID: PMC10619360 DOI: 10.1177/17562864231207161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Background Combination therapy with antiseizure medications (ASMs) is a rational strategy if monotherapy cannot effectively control seizures, thereby aiming to improve tolerance and treatment persistence. Objectives To compare the efficacy of different ASM combinations among patients. Design Patients with epilepsy on monotherapy who had a second ASM added as concomitant two-drug therapy from January 2009 to May 2019 in the Chang Gung Research Database, Taiwan, were included in the analysis. Methods ASM combinations were compared based on their primary mechanism of action (MoA) which are as follows: gamma-aminobutyric acid receptor (G), sodium channel blocker (SC), synaptic vesicle protein 2A (SV2), calcium channel blocker (C), and multiple mechanisms (M). Treatment persistence was compared, and the predictors of persistence were analyzed. Results In total, 3033 patients were enrolled in this study. Combined ASMs with different MoAs had significantly longer treatment persistence than ASMs with similar MoAs, specifically SC and M combinations. Patients receiving combined ASMs with different MoAs were less likely to discontinue treatment [adjusted hazards ratio: 0.83 (95% CI: 0.75-0.93), p < 0.001]. Among all combinations, the SC + SV2 combination had the longest treatment persistence (mean ± SD: 912.7 ± 841.6 days). Meanwhile, patients receiving the G combination had a higher risk of treatment discontinuation than those receiving the SC + SV2 combination. Underlying malignancies were associated with an increased risk of treatment discontinuation across all MoA categories. Male patients receiving the SC, SV2, and M combinations were more likely to discontinue treatment than female patients. Moreover, patients with renal disease were more likely to discontinue treatment with the SV2 combinations. Conclusion ASM combinations with different MoAs had superior efficacy and tolerability to ASM combinations with similar MoAs, particularly SC and M combinations. In our cohort, factors associated with treatment discontinuation included underlying malignancy, male sex, and renal disease. These findings may provide valuable insights into the use of ASM combinations if monotherapy cannot adequately control seizures.
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Affiliation(s)
- Chun-Wei Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan City
| | - Wei-En Johnny Tseng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan City
- PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan City
| | - Wey-Ran Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan City
| | - Po-Chuan Ko
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan City
| | - Chun-Jing Liu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan City
| | - Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No. 5, Fuxing St., Guishan District, Taoyuan City, Taiwan
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Vivash L, Johns H, Churilov L, MacPhail S, Casillas-Espinosa P, Malpas C, Shultz SR, Tailby C, Wijayath M, Reutens D, Gillinder L, Perucca P, Carney P, Nicolo JP, Lawn N, Kwan P, Velakoulis D, Hovens CM, O'Brien TJ. Phase II randomised placebo-controlled trial of sodium selenate as a disease-modifying treatment in chronic drug-resistant temporal lobe epilepsy: the SeLECT study protocol. BMJ Open 2023; 13:e075888. [PMID: 37890967 PMCID: PMC10619053 DOI: 10.1136/bmjopen-2023-075888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Epilepsy is one of the most common neurological conditions worldwide. Despite many antiseizure medications (ASMs) being available, up to one-third of patients do not achieve seizure control. Preclinical studies have shown treatment with sodium selenate to have a disease-modifying effect in a rat model of chronic temporal lobe epilepsy (TLE). AIM This randomised placebo-controlled trial aims to evaluate the antiseizure and disease-modifying effects of sodium selenate in people with drug-resistant TLE. METHODS This will be a randomised placebo-controlled trial of sodium selenate. One hundred and twenty-four adults with drug-resistant TLE and ≥4 countable seizures/month will be recruited. Outcomes of interest will be measured at baseline, week 26 and week 52 and include an 8-week seizure diary, 24-hour electroencephalogram and cognitive, neuropsychiatric and quality of life measures. Participants will then be randomised to receive a sustained release formulation of sodium selenate (initially 10 mg three times a day, increasing to 15 mg three times a day at week 4 if tolerated) or a matching placebo for 26 weeks. OUTCOMES The primary outcome will be a consumer codesigned epilepsy-Desirability of Outcome Rank (DOOR), combining change in seizure frequency, adverse events, quality of life and ASM burden measures into a single outcome measure, compared between treatment arms over the whole 52-week period. Secondary outcomes will compare baseline measures to week 26 (antiseizure) and week 52 (disease modification). Exploratory measures will include biomarkers of treatment response. ETHICS AND DISSEMINATION The study has been approved by the lead site, Alfred Hospital Ethics Committee (594/20). Each participant will provide written informed consent prior to any trial procedures. The results of the study will be presented at national and international conferences, published in peer-reviewed journals and disseminated through consumer organisations. CONCLUSION This study will be the first disease-modification randomised controlled trial in patients with drug-resistant TLE. TRIAL REGISTRATION NUMBER ANZCTR; ACTRN12623000446662.
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Affiliation(s)
- Lucy Vivash
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Hannah Johns
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sara MacPhail
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Pablo Casillas-Espinosa
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Charles Malpas
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Sciences, Vancouver Island University, Vancouver, British Columbia, Australia
| | - Chris Tailby
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- Department of Clinical Neuropsychology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Manori Wijayath
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Reutens
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Gillinder
- Epilepsy Unit, Mater Hospital Brisbane, Brisbane, Queensland, Australia
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Piero Perucca
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Epilepsy Research Centre, Austin Hospital, Heidelberg, Victoria, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, texas, Australia
| | - Patrick Carney
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, texas, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - John-Paul Nicolo
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nicholas Lawn
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Patrick Kwan
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Christopher M Hovens
- Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Shrivastava M, Asranna A, Kenchiah R, Mundlamuri R, Viswanathan LG, Kulanthaivelu K, Bharath RD, Saini J, Sadashiva N, Arimappamagan A, Mahadevan A, Rajeswaran J, Malla BR, Sinha S. Yield of video electro encephalography for phase 1 pre-surgical evaluation of drug resistant epilepsy in 1200 adults: retrospective study from a tertiary center situated in a lower-middle-income country. Acta Neurol Belg 2023; 123:1773-1780. [PMID: 35908016 DOI: 10.1007/s13760-022-02031-x] [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: 02/17/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Video Electroencephalography (VEEG) is crucial for presurgical evaluation of Drug Refractory Epilepsy (DRE). The yield of VEEG in large volume centers, particularly those situated in Low-and Middle-Income countries (LMIC) is not well studied. METHODOLOGY We studied 1200 adults with drug resistant focal epilepsy whose seizures were recorded during VEEG in the epilepsy monitoring unit. VEEG review and analysis was done independently by trained epileptologists. Video EEG and MRI data were examined for concordance in order to generate a hypothesis for the presumed epileptogenic zone. RESULTS Analysis of seizure semiology provided information on the symptomatogenic zone in most cases except for 33 (2.75%) patients. A total of 1050 (87.5%) patients showed interictal epileptiform discharges (IEDs) with most (58.3%) showing unilateral IEDs. Most patients (n = 1162, 96.83%) showed ictal EEG discharges of which 951(81.8%) had unilateral ictal onset. Abnormal MRI was seen in 978 (81.5%) patients. Concordance of electroclinical data obtained by analysis of VEEG with MRI abnormality could be established in most patients (63%). Concordance was higher for patients with ictal onset from temporal regions (83.71%) as compared to posterior cortex (55.4%) and frontal regions (43.5%.) CONCLUSION: This study highlights the high yield of VEEG in phase 1 presurgical evaluation in DRE. Systematic evaluation of data from VEEG provided lateralizing and localizing information in most cases. Concordance between VEEG and MRI findings was noted in most patients. These findings support steps to increase referral for pre-surgical evaluation in DRE.
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Affiliation(s)
- Mayank Shrivastava
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Ajay Asranna
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Raghavendra Kenchiah
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Ravindranath Mundlamuri
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Karthik Kulanthaivelu
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Rose Dawn Bharath
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Jitender Saini
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Nishanth Sadashiva
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Anita Mahadevan
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Jamuna Rajeswaran
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Bhaskara Rao Malla
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Sanjib Sinha
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
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31
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Wang H, Wang H, Liu Y, Zhao J, Niu X, Zhu L, Ma X, Zong Y, Huang Y, Zhang W, Han Y. Efficacy and Safety of Five Broad-Spectrum Antiseizure Medications for Adjunctive Treatment of Refractory Epilepsy: A Systematic Review and Network Meta-analysis. CNS Drugs 2023; 37:883-913. [PMID: 37589821 DOI: 10.1007/s40263-023-01029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Overall, up to one-third of epilepsy patients have drug-resistant epilepsy. However, there was previously no meta-analysis to support the guidelines for broad-spectrum antiseizure medication selection for the adjunctive treatment of refractory epilepsy. In the present meta-analysis, we assessed the efficacy and safety of three second-generation broad-spectrum antiseizure medications, lamotrigine (LTG), levetiracetam (LEV), and topiramate (TPM), and two third-generation broad-spectrum antiseizure medications, perampanel (PER) and lacosamide (LCM), for the adjunctive treatment of refractory epilepsy. METHODS We systematically searched PubMed, Embase, and CENTRAL from inception to July 15, 2022. The studies included in the meta-analysis were required to meet the following criteria: (1) be randomized, double-blind clinical trials; (2) include patients aged >2 years with a clinical diagnosis of drug-resistant epilepsy; (3) have at least 8 weeks for the treatment period excluding the titration phase; and (4) report the outcomes of seizure response, seizure freedom and the withdrawal rate due to treatment-emergent adverse effects. Data were extracted, and the risk of bias for each study was assessed by two authors independently using RoB2 tools. We performed the network meta-analysis for each outcome through a group of programs in the mvmeta and network packages in Stata. Relative odds ratios with 95% confidence intervals were calculated as the result of the analyses. The surface under the cumulative ranking curve (SUCRA) and mean ranks were used to rank these treatments. RESULTS Forty-two randomized controlled trials (RCTs) (LTG-placebo: n = 6, LEV-placebo: n = 13, TPM-placebo: n = 9, PER-placebo: n = 6, LCM-placebo: n = 7, LEV-TPM: n = 1) with 10257 participants (LTG = 569, LEV = 1626, TPM = 701, PER = 1734, LCM = 1908, placebo = 3719) were included. Levetiracetam had subequal efficacy in 50 % seizure frequency reduction to TPM [odds ratio (OR) 1.00, 95% confidence interval (CI) 0.73-1.38], and LEV had a higher rate of ≥ 50% seizure frequency reduction than LCM (OR 1.49, 95% CI 1.11-2.01) and PER (OR 1.68, 95% CI 1.24-2.29). Levetiracetam was also related to a higher proportion of seizure freedom participants than TPM (OR 1.87, 95% CI 1.20-2.89), PER (OR 2.23, 95% CI 1.12-4.43), and LCM (OR 2.97, 95% CI 1.46-6.05). In addition, LEV was associated with a lower risk of experiencing at least one treatment-emergent adverse event (TEAE) than PER (OR 0.63, 95% CI 0.46-0.85) and TPM (OR 0.51, 95 % CI 0.36-0.72) and a lower proportion of patients experiencing TEAEs leading to discontinuation than PER (OR 0.51, 95% CI 0.27-0.97) and TPM (OR 0.50, 95 % CI 0.27-0.93). CONCLUSIONS Third-generation drugs (PER and LCM) had no advantages in terms of efficacy and safety for adjunctive treatment of refractory epilepsy compared with several second-generation drugs (LEV and LTG). Levetiracetam was the priority choice for adjunctive treatment of refractory epilepsy. Perampanel and LCM had no advantages in terms of efficacy and safety among the five drugs. REGISTRATION PROSPERO registration number, CRD42022344153; last edited on December 23, 2022.
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Affiliation(s)
- Hecheng Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Haoran Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Yi Liu
- Department of Neurology, Dalian Municipal Central Hospital, Central Hospital of Dalian University of Technology, Dalian, China
| | - Jing Zhao
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Xuewen Niu
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Lei Zhu
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Xiaomin Ma
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Yu Zong
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Yinglin Huang
- Department of Psychiatry, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Zhang
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, 453003, China.
| | - Yanshuo Han
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China.
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Nakatsuka K, Zanghi B, Hasegawa D. Efficacy evaluation of a commercially available MCT enriched therapeutic diet on dogs with idiopathic epilepsy treated with zonisamide: a prospective, randomized, double-blinded, placebo-controlled, crossover dietary preliminary study. BMC Vet Res 2023; 19:145. [PMID: 37674206 PMCID: PMC10481612 DOI: 10.1186/s12917-023-03710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Idiopathic epilepsy (IE) is a common, chronic brain dysfunction in dogs. Recently, the effect of feeding a diet enriched with medium-chain triglycerides (MCTs) on seizure frequency has been evaluated in several studies in dogs with IE. However, most dogs with IE in previous studies were treated with phenobarbital as the main antiseizure medication (ASM). In Japan, zonisamide (ZNS) is the most prescribed ASM for dogs with IE. The interaction between ZNS and various nutrients including MCTs and the potential effects on treatment efficacy resulting from combining these therapies have not been previously studied. A prospective, randomized, double-blinded, placebo-controlled, crossover dietary study was conducted. Dogs (n = 7) treated with ZNS were fed either a placebo diet (PL) or Purina ProPlan Veterinary Diet NeuroCare (NC) for 3 months, after which treatments were crossed over and continued for another 3 months. Seizure frequency (seizures/month; sz/m), blood tests including concentrations of ZNS and β-hydroxybutyric acid, and owner's visual analogue scale score were collected from all dogs for both treatment periods. RESULTS There was no significant difference in the seizure frequency between PL (2.95 ± 0.80 sz/m) and NC (1.90 ± 0.57 sz/m) during the 6 months of trial. Three of 7 dogs showed ≥ 50% seizure reduction, and 1 of those 3 dogs achieved seizure freedom in NC period. However, 2 of 7 dogs had no changes in epileptic seizure frequency, 2 of 7 dogs had a deterioration in seizure frequency in the NC period. Feeding the MCT diet concurrent with ZNS showed no apparent adverse effects and did not affect ZNS concentration. CONCLUSIONS This study indicated that the commercially available MCT-enriched diet (NC) can be safely used concurrently with ZNS for dogs with IE.
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Affiliation(s)
- Kazumasa Nakatsuka
- Department of Veterinary Pharmacology, Faculty of Agriculture, Tottori University, Tottori, Japan
- Academic, Nestlé Purina PetCare, Kobe, Japan
| | - Brian Zanghi
- Global Nutrition and Communications, Nestlé Purina PetCare, St. Louis, USA
| | - Daisuke Hasegawa
- Laboratory of Veterinary Radiology, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo, Japan.
- The Research Center for Animal Life Sciences, Nippon Veterinary and Life Science University, Tokyo, Japan.
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Matarrese MAG, Loppini A, Fabbri L, Tamilia E, Perry MS, Madsen JR, Bolton J, Stone SSD, Pearl PL, Filippi S, Papadelis C. Spike propagation mapping reveals effective connectivity and predicts surgical outcome in epilepsy. Brain 2023; 146:3898-3912. [PMID: 37018068 PMCID: PMC10473571 DOI: 10.1093/brain/awad118] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 04/06/2023] Open
Abstract
Neurosurgical intervention is the best available treatment for selected patients with drug resistant epilepsy. For these patients, surgical planning requires biomarkers that delineate the epileptogenic zone, the brain area that is indispensable for the generation of seizures. Interictal spikes recorded with electrophysiological techniques are considered key biomarkers of epilepsy. Yet, they lack specificity, mostly because they propagate across brain areas forming networks. Understanding the relationship between interictal spike propagation and functional connections among the involved brain areas may help develop novel biomarkers that can delineate the epileptogenic zone with high precision. Here, we reveal the relationship between spike propagation and effective connectivity among onset and areas of spread and assess the prognostic value of resecting these areas. We analysed intracranial EEG data from 43 children with drug resistant epilepsy who underwent invasive monitoring for neurosurgical planning. Using electric source imaging, we mapped spike propagation in the source domain and identified three zones: onset, early-spread and late-spread. For each zone, we calculated the overlap and distance from surgical resection. We then estimated a virtual sensor for each zone and the direction of information flow among them via Granger causality. Finally, we compared the prognostic value of resecting these zones, the clinically-defined seizure onset zone and the spike onset on intracranial EEG channels by estimating their overlap with resection. We observed a spike propagation in source space for 37 patients with a median duration of 95 ms (interquartile range: 34-206), a spatial displacement of 14 cm (7.5-22 cm) and a velocity of 0.5 m/s (0.3-0.8 m/s). In patients with good surgical outcome (25 patients, Engel I), the onset had higher overlap with resection [96% (40-100%)] than early-spread [86% (34-100%), P = 0.01] and late-spread [59% (12-100%), P = 0.002], and it was also closer to resection than late-spread [5 mm versus 9 mm, P = 0.007]. We found an information flow from onset to early-spread in 66% of patients with good outcomes, and from early-spread to onset in 50% of patients with poor outcome. Finally, resection of spike onset, but not area of spike spread or the seizure onset zone, predicted outcome with positive predictive value of 79% and negative predictive value of 56% (P = 0.04). Spatiotemporal mapping of spike propagation reveals information flow from onset to areas of spread in epilepsy brain. Surgical resection of the spike onset disrupts the epileptogenic network and may render patients with drug resistant epilepsy seizure-free without having to wait for a seizure to occur during intracranial monitoring.
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Affiliation(s)
- Margherita A G Matarrese
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX, USA
| | - Alessandro Loppini
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Lorenzo Fabbri
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX, USA
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Bolton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Scellig S D Stone
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Simonetta Filippi
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Christos Papadelis
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX, USA
- School of Medicine, Texas Christian University, Fort Worth, TX, USA
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Eriksson MH, Whitaker KJ, Booth J, Piper RJ, Chari A, Sanfilippo PM, Caballero AP, Menzies L, McTague A, Adler S, Wagstyl K, Tisdall MM, Cross JH, Baldeweg T. Pediatric epilepsy surgery from 2000 to 2018: Changes in referral and surgical volumes, patient characteristics, genetic testing, and postsurgical outcomes. Epilepsia 2023; 64:2260-2273. [PMID: 37264783 PMCID: PMC7615891 DOI: 10.1111/epi.17670] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Neurosurgery is a safe and effective form of treatment for select children with drug-resistant epilepsy. Still, there is concern that it remains underutilized, and that seizure freedom rates have not improved over time. We investigated referral and surgical practices, patient characteristics, and postoperative outcomes over the past two decades. METHODS We performed a retrospective cohort study of children referred for epilepsy surgery at a tertiary center between 2000 and 2018. We extracted information from medical records and analyzed temporal trends using regression analyses. RESULTS A total of 1443 children were evaluated for surgery. Of these, 859 (402 females) underwent surgical resection or disconnection at a median age of 8.5 years (interquartile range [IQR] = 4.6-13.4). Excluding palliative procedures, 67% of patients were seizure-free and 15% were on no antiseizure medication (ASM) at 1-year follow-up. There was an annual increase in the number of referrals (7%, 95% confidence interval [CI] = 5.3-8.6; p < .001) and surgeries (4% [95% CI = 2.9-5.6], p < .001) over time. Duration of epilepsy and total number of different ASMs trialed from epilepsy onset to surgery were, however, unchanged, and continued to exceed guidelines. Seizure freedom rates were also unchanged overall but showed improvement (odds ratio [OR] 1.09, 95% CI = 1.01-1.18; p = .027) after adjustment for an observed increase in complex cases. Children who underwent surgery more recently were more likely to be off ASMs postoperatively (OR 1.04, 95% CI = 1.01-1.08; p = .013). There was a 17% annual increase (95% CI = 8.4-28.4, p < .001) in children identified to have a genetic cause of epilepsy, which was associated with poor outcome. SIGNIFICANCE Children with drug-resistant epilepsy continue to be put forward for surgery late, despite national and international guidelines urging prompt referral. Seizure freedom rates have improved over the past decades, but only after adjustment for a concurrent increase in complex cases. Finally, genetic testing in epilepsy surgery patients has expanded considerably over time and shows promise in identifying patients in whom surgery is less likely to be successful.
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Affiliation(s)
- Maria H Eriksson
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neuropsychology, Great Ormond Street Hospital NHS Trust, London, UK
- The Alan Turing Institute, London, UK
- Department of Neurology, Great Ormond Street Hospital NHS Trust, London, UK
| | | | - John Booth
- Digital Research Environment, Great Ormond Street Hospital NHS Trust, London, UK
| | - Rory J Piper
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurosurgery, Great Ormond Street Hospital NHS Trust, London, UK
| | - Aswin Chari
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurosurgery, Great Ormond Street Hospital NHS Trust, London, UK
| | - Patricia Martin Sanfilippo
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neuropsychology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Ana Perez Caballero
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital NHS Trust, London, UK
| | - Lara Menzies
- Department of Clinical Genetics, Great Ormond Street Hospital NHS Trust, London, UK
| | - Amy McTague
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Sophie Adler
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Konrad Wagstyl
- Imaging Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Martin M Tisdall
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurosurgery, Great Ormond Street Hospital NHS Trust, London, UK
| | - J Helen Cross
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital NHS Trust, London, UK
- Young Epilepsy, Lingfield, UK
| | - Torsten Baldeweg
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neuropsychology, Great Ormond Street Hospital NHS Trust, London, UK
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Heide E, van de Velden D, Garnica Agudelo D, Hewitt M, Riedel C, Focke NK. Feasibility of high-density electric source imaging in the presurgical workflow: Effect of number of spikes and automated spike detection. Epilepsia Open 2023; 8:785-796. [PMID: 36938790 PMCID: PMC10472417 DOI: 10.1002/epi4.12732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/16/2023] [Indexed: 03/21/2023] Open
Abstract
OBJECTIVE Presurgical high-density electric source imaging (hdESI) of interictal epileptic discharges (IEDs) is only used by few epilepsy centers. One obstacle is the time-consuming workflow both for recording as well as for visual review. Therefore, we analyzed the effect of (a) an automated IED detection and (b) the number of IEDs on the accuracy of hdESI and time-effectiveness. METHODS In 22 patients with pharmacoresistant focal epilepsy receiving epilepsy surgery (Engel 1) we retrospectively detected IEDs both visually and semi-automatically using the EEG analysis software Persyst in 256-channel EEGs. The amount of IEDs, the Euclidean distance between hdESI maximum and resection zone, and the operator time were compared. Additionally, we evaluated the intra-individual effect of IED quantity on the distance between hdESI maximum of all IEDs and hdESI maximum when only a reduced amount of IEDs were included. RESULTS There was no significant difference in the number of IEDs between visually versus semi-automatically marked IEDs (74 ± 56 IEDs/patient vs 116 ± 115 IEDs/patient). The detection method of the IEDs had no significant effect on the mean distances between resection zone and hdESI maximum (visual: 26.07 ± 31.12 mm vs semi-automated: 33.6 ± 34.75 mm). However, the mean time needed to review the full datasets semi-automatically was shorter by 275 ± 46 min (305 ± 72 min vs 30 ± 26 min, P < 0.001). The distance between hdESI of the full versus reduced amount of IEDs of the same patient was smaller than 1 cm when at least a mean of 33 IEDs were analyzed. There was a significantly shorter intraindividual distance between resection zone and hdESI maximum when 30 IEDs were analyzed as compared to the analysis of only 10 IEDs (P < 0.001). SIGNIFICANCE Semi-automatized processing and limiting the amount of IEDs analyzed (~30-40 IEDs per cluster) appear to be time-saving clinical tools to increase the practicability of hdESI in the presurgical work-up.
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Affiliation(s)
- Ev‐Christin Heide
- Department of NeurologyUniversity Medical Center, Georg‐August UniversityGöttingenGermany
| | - Daniel van de Velden
- Department of NeurologyUniversity Medical Center, Georg‐August UniversityGöttingenGermany
| | - David Garnica Agudelo
- Department of NeurologyUniversity Medical Center, Georg‐August UniversityGöttingenGermany
| | - Manuel Hewitt
- Department of NeurologyUniversity Medical Center, Georg‐August UniversityGöttingenGermany
| | - Christian Riedel
- Institute for Diagnostic and Interventional NeuroradiologyUniversity Medical Center, Georg‐August UniversityGöttingenGermany
| | - Niels K. Focke
- Department of NeurologyUniversity Medical Center, Georg‐August UniversityGöttingenGermany
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Hoppe C, Beeres K, Witt J, Sassen R, Helmstaedter C. How are they doing as adults? Psychosocial and socioeconomic outcomes 11-30 years after pediatric epilepsy surgery. Epilepsia Open 2023; 8:797-810. [PMID: 37003960 PMCID: PMC10472367 DOI: 10.1002/epi4.12736] [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: 08/18/2022] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE Pediatric epilepsy surgery yields cure from epilepsy or complete seizure control with continued medication in many patients early in life. This study aimed to evaluate the long-term (>10 years) psychosocial and socioeconomic outcomes of pediatric epilepsy surgery and examine the role of comorbid disability, type of surgery, seizure freedom, and age at surgery. METHODS A novel ad hoc parent/patient questionnaire was used to assess educational and occupational attainment, marital/familial status, mobility, and other outcomes in patients who underwent unilobar or multilobar surgery for drug-refractory epilepsy during their childhood. The questionnaire also captured information on comorbid disability. RESULTS Of the 353 eligible patients, 203 could still be contacted and 101 of these (50%) returned appropriately filled-in questionnaires (follow-up intervals: 11-30 [mean: 19.6] years). The cure from epilepsy rate was 53%. Type of surgery was strongly confounded by comorbid disability. Patients with comorbid disabilities had significantly lower rates of regular school degrees, gainful employment, marriage, and driving license (N = 29; 12%, 4%, 0%, 3%) compared with non-disabled patients (N = 69; 89%, 80%, 43%, and 67%, respectively). Patients achieved lower school degrees than their siblings and parents. Non-disabled seizure-free patients had better employment and mobility outcomes compared with non-seizure-free patients. Age at surgery (<10 vs. ≥10 years of age) did not have any effect on any outcome in patients with preschool seizure onset. SIGNIFICANCE Pediatric epilepsy surgery can lead to permanent relief from epilepsy in many patients, but comorbid disability strongly impacts adult life achievement. In non-disabled patients, favorable outcomes in academic, occupational, marital, and mobility domains were achieved, approaching respective rates in the German population. Complete seizure freedom had additional positive effects on employment and mobility in this group. However, in case of chronic comorbid disability the overall life prospects may be limited despite favorable seizure outcomes.
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Affiliation(s)
- Christian Hoppe
- Department of EpileptologyUniversity Hospital BonnBonnGermany
| | | | | | - Robert Sassen
- Department of EpileptologyUniversity Hospital BonnBonnGermany
- Department of NeuropediatricsUniversity Hospital BonnBonnGermany
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Asadi-Pooya AA, Brigo F, Lattanzi S, Blumcke I. Adult epilepsy. Lancet 2023; 402:412-424. [PMID: 37459868 DOI: 10.1016/s0140-6736(23)01048-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 07/31/2023]
Abstract
Epilepsy is a common medical condition that affects people of all ages, races, social classes, and geographical regions. Diagnosis of epilepsy remains clinical, and ancillary investigations (electroencephalography, imaging, etc) are of aid to determine the type, cause, and prognosis. Antiseizure medications represent the mainstay of epilepsy treatment: they aim to suppress seizures without adverse events, but they do not affect the underlying predisposition to generate seizures. Currently available antiseizure medications are effective in around two-thirds of patients with epilepsy. Neurosurgical resection is an effective strategy to reach seizure control in selected individuals with drug-resistant focal epilepsy. Non-pharmacological treatments such as palliative surgery (eg, corpus callosotomy), neuromodulation techniques (eg, vagus nerve stimulation), and dietary interventions represent therapeutic options for patients with drug-resistant epilepsy who are not suitable for resective brain surgery.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany; Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Janca R, Jezdik P, Ebel M, Kalina A, Kudr M, Jahodova A, Krysl D, Mackova K, Straka B, Marusic P, Krsek P. Distinct patterns of interictal intracranial EEG in focal cortical dysplasia type I and II. Clin Neurophysiol 2023; 151:10-17. [PMID: 37121217 DOI: 10.1016/j.clinph.2023.03.360] [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: 12/28/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is the most common malformation causing refractory focal epilepsy. Surgical removal of the entire dysplastic cortex is crucial for achieving a seizure-free outcome. Precise presurgical distinctions between FCD types by neuroimaging are difficult, mainly in patients with normal magnetic resonance imaging findings. However, the FCD type is important for planning the extent of surgical approach and counselling. METHODS This study included patients with focal drug-resistant epilepsy and definite histopathological FCD type I or II diagnoses who underwent intracranial electroencephalography (iEEG). We detected interictal epileptiform discharges (IEDs) and their recruitment into repetitive discharges (RDs) to compare electrophysiological patterns characterizing FCD types. RESULTS Patients with FCD type II had a significantly higher IED rate (p < 0.005), a shorter inter-discharge interval within RD episodes (p < 0.003), sleep influence on decreased RD periodicity (p < 0.036), and longer RD episode duration (p < 0.003) than patients with type I. A Bayesian classifier stratified FCD types with 82% accuracy. CONCLUSION Temporal characteristics of IEDs and RDs reflect the histological findings of FCD subtypes and can differentiate FCD types I and II. SIGNIFICANCE Presurgical prediction of FCD type can help to plan a more tailored surgical approach in patients with normal magnetic resonance findings.
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Affiliation(s)
- Radek Janca
- Faculty of Electrical Engineering, Department of Circuit Theory, Czech Technical University in Prague, Technicka 2, 166 27 Prague, Czech Republic.
| | - Petr Jezdik
- Faculty of Electrical Engineering, Department of Circuit Theory, Czech Technical University in Prague, Technicka 2, 166 27 Prague, Czech Republic
| | - Matyas Ebel
- Department of Paediatric Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic(2)
| | - Adam Kalina
- Department of Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006 Prague, Czech Republic(2)
| | - Martin Kudr
- Department of Paediatric Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic(2)
| | - Alena Jahodova
- Department of Paediatric Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic(2)
| | - David Krysl
- Department of Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006 Prague, Czech Republic(2)
| | - Katerina Mackova
- Faculty of Electrical Engineering, Department of Circuit Theory, Czech Technical University in Prague, Technicka 2, 166 27 Prague, Czech Republic
| | - Barbora Straka
- Department of Paediatric Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic(2)
| | - Petr Marusic
- Department of Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006 Prague, Czech Republic(2)
| | - Pavel Krsek
- Department of Paediatric Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic(2)
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Janca R, Tomasek M, Kalina A, Marusic P, Krsek P, Lesko R. Automated Identification of Stereoelectroencephalography Contacts and Measurement of Factors Influencing Accuracy of Frame Stereotaxy. IEEE J Biomed Health Inform 2023; 27:3326-3336. [PMID: 37389996 DOI: 10.1109/jbhi.2023.3271857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is an established invasive diagnostic technique for use in patients with drug-resistant focal epilepsy evaluated before resective epilepsy surgery. The factors that influence the accuracy of electrode implantation are not fully understood. Adequate accuracy prevents the risk of major surgery complications. Precise knowledge of the anatomical positions of individual electrode contacts is crucial for the interpretation of SEEG recordings and subsequent surgery. METHODS We developed an image processing pipeline to localize implanted electrodes and detect individual contact positions using computed tomography (CT), as a substitute for time-consuming manual labeling. The algorithm automates measurement of parameters of the electrodes implanted in the skull (bone thickness, implantation angle and depth) for use in modeling of predictive factors that influence implantation accuracy. RESULTS Fifty-four patients evaluated by SEEG were analyzed. A total of 662 SEEG electrodes with 8,745 contacts were stereotactically inserted. The automated detector localized all contacts with better accuracy than manual labeling (p < 0.001). The retrospective implantation accuracy of the target point was 2.4 ± 1.1 mm. A multifactorial analysis determined that almost 58% of the total error was attributable to measurable factors. The remaining 42% was attributable to random error. CONCLUSION SEEG contacts can be reliably marked by our proposed method. The trajectory of electrodes can be parametrically analyzed to predict and validate implantation accuracy using a multifactorial model. SIGNIFICANCE This novel, automated image processing technique is a potentially clinically important, assistive tool for increasing the yield, efficiency, and safety of SEEG.
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Perucca E, Perucca P, White HS, Wirrell EC. Drug resistance in epilepsy. Lancet Neurol 2023:S1474-4422(23)00151-5. [PMID: 37352888 DOI: 10.1016/s1474-4422(23)00151-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 06/25/2023]
Abstract
Drug resistance is estimated to affect about a third of individuals with epilepsy, but its prevalence differs in relation to the epilepsy syndrome, the cause of epilepsy, and other factors such as age of seizure onset and presence of associated neurological deficits. Although drug-resistant epilepsy is not synonymous with unresponsiveness to any drug treatment, the probability of achieving seizure freedom on a newly tried medication decreases with increasing number of previously failed treatments. After two appropriately used antiseizure medications have failed to control seizures, individuals should be referred whenever possible to a comprehensive epilepsy centre for diagnostic re-evaluation and targeted management. The feasibility of epilepsy surgery and other treatments, including those targeting the cause of epilepsy, should be considered early after diagnosis. Substantial evidence indicates that a delay in identifying an effective treatment can adversely affect ultimate outcome and carry an increased risk of cognitive disability, other comorbidities, and premature mortality. Research on mechanisms of drug resistance and novel therapeutics is progressing rapidly, and potentially improved treatments, including those targeting disease modification, are on the horizon.
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Affiliation(s)
- Emilio Perucca
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Piero Perucca
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, VIC, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Gong M, Xu K, Shan Y, Wang Y, Zhang C, Wang X, Zhou J, Guan Y, Li T, Luan G. Protocol of a prospective multicenter randomized controlled trial of robot-assisted stereotactic lesioning in the treatment of focal drug-resistant epilepsy. Trials 2023; 24:387. [PMID: 37296479 DOI: 10.1186/s13063-023-07334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND This protocol describes the design of a multicenter randomized controlled trial of robot-assisted stereotactic lesioning versus epileptogenic foci resection. Typical causes of focal epilepsy include hippocampal sclerosis and focal cortical dysplasia. These patients usually present with drug resistance and require surgical treatment. Although epileptogenic foci resection is still the most commonly used treatment for such focal epilepsy, there is increasing evidence that epileptogenic focus resection may lead to neurological impairment. The treatment of epilepsy with a robot-assisted stereotactic lesioning mainly includes two new minimally invasive surgical methods: radiofrequency thermocoagulation (RF-TC) and laser interstitial thermal therapy (LITT). Seizure-free is less likely to be achieved by these two procedures, but neurologic preservation is better. In this study, we aimed to compare the safety and efficacy of RF-TC, LITT, and epileptogenic foci resection for focal drug-resistant epilepsy. METHODS This is a multicenter, three-arm, randomized controlled clinical trial. The study will include patients older than 3 years of age with epilepsy who have had medically refractory seizures for at least 2 years and are eligible for surgical treatment with an epileptogenic focus as determined by multidisciplinary evaluation prior to randomization. The primary outcome measure is seizure outcome (quantified by seizure remission rate) at 3-month, 6-month, and 1-year follow-up after treatment. Postoperative neurologic impairment, spectrum distribution change of video electroencephalogram, quality of life, and medical costs will also be assessed as secondary outcomes. TRIAL REGISTRATION Chinese Clinical Trials Registry ChiCTR2200060974. Registered on June 14, 2022. The status of the trial is recruiting, and the estimated study completion date is December 31, 2024.
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Affiliation(s)
- Mingkun Gong
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Ke Xu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yihe Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 10007, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Tianfu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China.
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Wu S, Wang Q, Zhai H, Zhang Y, Xu D, Yan G, Wu R. γ-Aminobutyric acid as a biomarker of the lateralizing and monitoring drug effect in patients with magnetic resonance imaging-negative temporal lobe epilepsy. Front Neurosci 2023; 17:1184440. [PMID: 37255748 PMCID: PMC10225511 DOI: 10.3389/fnins.2023.1184440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Despite verifying proton magnetic resonance spectroscopy (1H-MRS) for focal localization in magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE), it is necessary to illustrate metabolic changes and screen for effective biomarkers for monitoring therapeutic effect. We used 1H-MRS to investigate the role of metabolic levels in MRI-negative TLE. Materials and methods Thirty-seven patients (n = 37, 14 women) and 20 healthy controls (n = 20, 11 women) were investigated by 1H-MRS. We compared the metabolite level changes in the epileptic and contralateral sides on the mesial temporal and dorsolateral prefrontal cortices and analyzed their association with clinical symptoms. Results γ-Aminobutyric acid (GABA) levels were significantly lower on the epileptic side (2.292 ± 0.890) than in the contralateral side (2.662 ± 0.742, p = 0.029*) in patients on the mesial temporal lobe. N-acetylaspartate (NAA) levels were significantly lower on the epileptic side (7.284 ± 1.314) than on the contralateral side (7.655 ± 1.549, p = 0.034*). NAA + N-acetylaspartylglutamate levels were significantly lower on the epileptic side (7.668 ± 1.406) than on the contralateral side (8.086 ± 1.675, p = 0.032*). Glutamate levels were significantly lower on the epileptic side (7.773 ± 1.428) than on the contralateral side (8.245 ± 1.616, p = 0.040*). Moreover, a significant negative correlation was found between GABA levels in the epileptic mesial temporal lobe and tonic-clonic seizure frequency (r = -0.338, p = 0.046*). Conclusion γ-Aminobutyric acid (GABA) is a potential biomarker for lateralization and monitoring seizure frequency in MRI-negative TLE.
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Affiliation(s)
- Shuohua Wu
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
- Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Qianqi Wang
- Department of Basic Medical Sciences, School of Medicine, Xiamen University, Xiamen, China
| | - Huige Zhai
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
| | - Yiwen Zhang
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Dongyuan Xu
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
| | - Gen Yan
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Renhua Wu
- Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
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Jiang J, Qiu J, Yin J, Wang J, Jiang X, Yi Z, Chen Y, Zhou X, Sima X. Automated detection of hippocampal sclerosis using real-world clinical MRI images. Front Neurosci 2023; 17:1180679. [PMID: 37255750 PMCID: PMC10225575 DOI: 10.3389/fnins.2023.1180679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023] Open
Abstract
Background Hippocampal sclerosis (HS) is the most common pathological type of temporal lobe epilepsy (TLE) and one of the important surgical markers. Currently, HS is mainly diagnosed manually by radiologists based on visual inspection of MRI, which greatly relies on MRI quality and physician experience. In clinical practice, non-thin MRI scans are often used due to the time and efficiency needed for the acquisition. However, these scans can be difficult for junior physicians to interpret accurately. Thus, the rapid and accurate diagnosis of HS using real-world MRI images in clinical settings is a challenging task. Objective Our aim was to explore the feasibility of using computer vision methods to diagnose HS on real-world clinical MRI images and to provide a reference for future clinical applications of artificial intelligence methods to aid in detecting HS. Methods We proposed a deep learning algorithm called "HS-Net" to discriminate HS using real-world clinical MRI images. First, we delineated and segmented a region of interest (ROI) around the hippocampus. Then, we utilized the fractional differential (FD) method to enhance the textures of the ROIs. Finally, we used a small-sample image classification method based on transfer learning to fine-tune the feature extraction part of a pretrained model and added two fully connected layers and an output layer. In the study, 96 TLE patients with HS confirmed by postoperative pathology and 89 healthy controls were retrospectively enrolled. All subjects were cross-validated, and models were evaluated for performance, robustness, and clinical utility. Results The HS-Net model achieved an area under the curve (AUC) of 0.894, an accuracy of 82.88%, an F1-score of 84.08% in the test cohort based on real, routine, clinical T2-weighted fluid attenuated inversion recovery (FLAIR) sequence MRI images. Additionally, the AUC, accuracy and F1 scores of our model all increased by around 3 percentage points when the inputs were augmented with the ROIs of the textures enhanced using the FD method. Conclusions Our computational model has the potential to be used for the diagnosis of HS in real clinical MRI images, which could assist physicians, particularly junior physicians, in improving the accuracy of discrimination.
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Affiliation(s)
- Jingwen Jiang
- Department of Neurosurgery and West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jiajun Qiu
- Department of Neurosurgery and West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jin Yin
- Department of Neurosurgery and West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Junren Wang
- Department of Neurosurgery and West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Xinyue Jiang
- Department of Radiology, Chengdu Second People's Hospital, Chengdu, China
| | - Zuo Yi
- Department of Computer Science and Technology, College of Computer Science, Sichuan University, Chengdu, China
| | - Yang Chen
- Department of Neurosurgery and West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaobo Zhou
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Xiutian Sima
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
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Madireddy S, Madireddy S. Therapeutic Strategies to Ameliorate Neuronal Damage in Epilepsy by Regulating Oxidative Stress, Mitochondrial Dysfunction, and Neuroinflammation. Brain Sci 2023; 13:brainsci13050784. [PMID: 37239256 DOI: 10.3390/brainsci13050784] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Epilepsy is a central nervous system disorder involving spontaneous and recurring seizures that affects 50 million individuals globally. Because approximately one-third of patients with epilepsy do not respond to drug therapy, the development of new therapeutic strategies against epilepsy could be beneficial. Oxidative stress and mitochondrial dysfunction are frequently observed in epilepsy. Additionally, neuroinflammation is increasingly understood to contribute to the pathogenesis of epilepsy. Mitochondrial dysfunction is also recognized for its contributions to neuronal excitability and apoptosis, which can lead to neuronal loss in epilepsy. This review focuses on the roles of oxidative damage, mitochondrial dysfunction, NAPDH oxidase, the blood-brain barrier, excitotoxicity, and neuroinflammation in the development of epilepsy. We also review the therapies used to treat epilepsy and prevent seizures, including anti-seizure medications, anti-epileptic drugs, anti-inflammatory therapies, and antioxidant therapies. In addition, we review the use of neuromodulation and surgery in the treatment of epilepsy. Finally, we present the role of dietary and nutritional strategies in the management of epilepsy, including the ketogenic diet and the intake of vitamins, polyphenols, and flavonoids. By reviewing available interventions and research on the pathophysiology of epilepsy, this review points to areas of further development for therapies that can manage epilepsy.
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Affiliation(s)
- Sahithi Madireddy
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Makridis KL, Hoyer S, Elger CE, Kaindl AM. Is There a Cognitive Decline in Pediatric Patients Following Epilepsy Surgery? Pediatr Neurol 2023; 144:44-49. [PMID: 37146539 DOI: 10.1016/j.pediatrneurol.2023.03.020] [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: 05/15/2022] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Epilepsy surgery is currently the only way to cure drug-resistant epilepsy (DRE). The loss of epileptic activity or its propagation in the developing brain may not only result in seizure freedom but also be associated with further positive effects. Here, we analyzed the cognitive development of children and adolescents with DRE after epilepsy surgery. METHODS We evaluated retrospectively the cognitive development of children and adolescents before and after epilepsy surgery. RESULTS Fifty-three children and adolescents underwent epilepsy surgery at a median age of 7.62 years. Overall seizure freedom was 86.8% at a current median observation period of 20 months. Presurgically, 81.1% had the clinical diagnosis of cognitive impairment, which was confirmed by standardized tests in 43 of 53 patients (76.7%). Further 10 patients had severe cognitive impairment rendering a standardized test impossible. The median intelligence quotient (IQ)/development quotient value was 74. After surgery, caretakers reported developmental progress in all patients, whereas the median IQ decreased slightly (P = 0.404). In eight patients the IQ points decreased after surgery; however, their individual raw scores increased in line with their reported increase in cognitive abilities. CONCLUSIONS We did not detect any cognitive deterioration in children following epilepsy surgery. A loss of IQ points did not correspond to a real loss of cognitive abilities. These patients developed more slowly than age-matched peers with an average development speed but profited individually as seen in their raw scores. Therefore, an individual analysis of raw scores is relevant to assess the cognitive development after surgery.
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Affiliation(s)
- Konstantin L Makridis
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute of Cell- and Neurobiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Hoyer
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian E Elger
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Beta Neurologie - Kompetenzzentrum für Epilepsie, Beta Klinik GmbH, Bonn, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute of Cell- and Neurobiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Yogi A, Hirata Y, Linetsky M, Ellingson BM, Salamon N. Qualitative and quantitative evaluation for the heterogeneity of cortical tubers using structural imaging and diffusion-weighted imaging to predict the epileptogenicity in tuberous sclerosis complex patients. Neuroradiology 2023; 65:845-853. [PMID: 36456893 DOI: 10.1007/s00234-022-03094-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE We aimed to evaluate whether the heterogeneity of tuber imaging features, evaluated on the structural imaging and apparent diffusion coefficient (ADC) map, can facilitate detecting epileptogenic tubers before surgery in tuberous sclerosis complex (TSC) patients. METHODS Twenty-three consecutive patients, who underwent tuber resection at our institute, were retrospectively selected. A total of 125 tubers (39 epileptogenic, 86 non-epileptogenic) were used for the analysis. Tuber heterogeneity was evaluated, using a 5-point visual scale and standard deviation of ADC values (ADCsd). A 5-point visual scale reflected the degree of T1/T2 prolongation, presence of internal cystic degeneration, and their spatial distribution within the tuber. These results were statistically compared between epileptogenic and non-epileptogenic groups, and their performance in predicting the epileptogenicity was also evaluated by receiver operating characteristic (ROC) analysis. RESULTS A 5-point visual scale demonstrated that more heterogeneous tubers were significantly more epileptogenic (p < 0.001). Multiplicity of internal cystic degeneration moderately correlated with epileptogenicity (p < 0.03) based on the comparison between class 4 and class 5 tubers. ADCsd was significantly higher in epileptogenic tubers (p < 0.001). ROC curves revealed that a 5-point visual scale demonstrated higher area under the curve (AUC) value than ADCsd (0.75 and 0.72, respectively). CONCLUSION Tuber heterogeneity may help identify the epileptogenic tubers in presurgical TSC patients. Visual assessment and standard deviation of ADC value, which are easier to implement in clinical use, may be a useful tool predicting epileptogenic tubers, improving presurgical clinical management for TSC patients with intractable epilepsy.
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Affiliation(s)
- Akira Yogi
- Department of Radiology, University of the Ryukyus Hospital, 207 Uehara, Nishihara-Cho, Nakagami-Gun, Okinawa, 903-0215, Japan.
- Department of Radiological Science, David Geffen School of Medicine, University of California, 924 Westwood Blvd, Los AngelesLos Angeles, CA, 90024, USA.
| | - Yoko Hirata
- Department of Radiological Science, David Geffen School of Medicine, University of California, 924 Westwood Blvd, Los AngelesLos Angeles, CA, 90024, USA
- Department of Neurosurgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| | - Michael Linetsky
- Department of Radiological Science, David Geffen School of Medicine, University of California, 924 Westwood Blvd, Los AngelesLos Angeles, CA, 90024, USA
| | - Benjamin M Ellingson
- Department of Radiological Science, David Geffen School of Medicine, University of California, 924 Westwood Blvd, Los AngelesLos Angeles, CA, 90024, USA
| | - Noriko Salamon
- Department of Radiological Science, David Geffen School of Medicine, University of California, 924 Westwood Blvd, Los AngelesLos Angeles, CA, 90024, USA
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Baciu M, O'Sullivan L, Torlay L, Banjac S. New insights for predicting surgery outcome in patients with temporal lobe epilepsy. A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)00884-6. [PMID: 37003897 DOI: 10.1016/j.neurol.2023.02.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/16/2023] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
Resective surgery is the treatment of choice for one-third of adult patients with focal, drug-resistant epilepsy. This procedure is associated with substantial clinical and cognitive risks. In clinical practice, there is no validated model for epilepsy surgery outcome prediction (ESOP). Meta-analyses on ESOP studies assessing prognostic factors report discrepancies in terms of study design. Our review aims to systematically investigate methodological and analytical aspects of studies predicting clinical and cognitive outcomes after temporal lobe epilepsy surgery. A systematic review of ESOP studies published between 2000 and 2022 from three databases (MEDLINE, Web of Science, and PsycINFO) was completed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. It yielded 4867 articles. Among them, 21 corresponded to our inclusion criteria and were therefore retained in the final review. The risk of bias was assessed using A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies (PROBAST). Data extracted from the 21 studies were analyzed using narrative synthesis and descriptive statistics. Our findings show an increase in the use of multimodal datasets and machine learning analyses in recent ESOP studies, although regression remained the most frequently used approach. We also identified a more frequent use of network notions in recent ESOP studies. Nevertheless, several methodological issues were noted, such as small sample sizes, lack of information on the follow-up period, variability in seizure outcome, and the definition of neuropsychological postoperative change. Of 21 studies, only one provided a clinical tool to anticipate the cognitive outcome after epilepsy surgery. We conclude that methodological issues should be overcome before we move towards more complete models to better predict clinical and cognitive outcomes after epilepsy surgery. Recommendations for future studies to harness the possibilities of multimodal datasets and data fusion, are provided. A stronger bridge between fundamental and clinical research may result in developing accessible clinical tools.
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Affiliation(s)
- M Baciu
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L O'Sullivan
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L Torlay
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - S Banjac
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France.
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Brigo F, Broggi S, Lattanzi S. Withdrawal of antiseizure medications - for whom, when, and how? Expert Rev Neurother 2023; 23:311-319. [PMID: 36946546 DOI: 10.1080/14737175.2023.2195094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Epilepsy is a chronic disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. Most patients can achieve complete seizure control (seizure freedom) with antiseizure medications (ASMs). In some of them, the withdrawal of ASMs can be considered. Guidance is required to identify patients in whom drug discontinuation can be safely attempted and to inform when and how ASM withdrawal can be done. AREAS COVERED In this perspective, the authors discuss the evidence on ASM withdrawal in epilepsy patients who are seizure-free and provide some suggestions on how to do it effectively in clinical practice, minimizing the risk of seizure recurrence. EXPERT OPINION The decision of discontinuing ASMs in epilepsy patients should rely on an accurate estimate of seizure recurrence risk. Whenever possible, such a risk should be assessed on an individual basis. The decision should also consider the psychosocial and personal consequences of seizure relapse. No robust evidence is available on the safest tapering regimen.
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Affiliation(s)
- Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Serena Broggi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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Saito Y, Sugai K, Iwasaki M, Atobe M, Sato N, Kakita A, Saito Y, Ohtsuki T, Sasaki M. Periodic cycles of seizure clustering and suppression in children with epilepsy strongly suggest focal cortical dysplasia. Dev Med Child Neurol 2023; 65:431-436. [PMID: 35871498 DOI: 10.1111/dmcn.15365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022]
Abstract
AIM We investigated characteristic seizure patterns in epilepsy caused by focal cortical dysplasia (FCD), which differ from epilepsy by other aetiologies in surgical cases with lesions on magnetic resonance imaging (MRI), then examined if these features were applicable to patients with epilepsy without any lesions on MRI. METHOD We retrospectively studied clinicopathological features in 291 (143 females) children with epilepsy who had undergone resective surgery after comprehensive evaluation, including 277 cases with lesions on MRI (136 females, age at resection 0-17 years [mean 6 years 10 months, SD 5 years 7 months]) and 14 cases without any lesions on MRI (seven females, age 0-16 years [mean 7 years 8 months, SD 4 years 8 months]). RESULTS Among 277 patients with lesions on MRI, 87 cases exhibited recurrent periodic cycles of seizure clustering (≥5 seizures/day for ≥1 week) and suppression (no seizures for ≥1 week); of these, 80 cases (92%) were pathologically diagnosed with FCD. Other pathologies included glial scar, hippocampal sclerosis, hemimegalencephaly, and cortical tuber in three, two, one, and one case respectively. All 14 patients without any lesions on MRI had significant recurrent periodic seizure cycles and FCD histopathologically. INTERPRETATION Periodic seizure cycles characterized by clustering and suppression in patients with epilepsy strongly suggest the presence of FCD regardless of MRI findings, and comprehensive evaluations for epilepsy surgery should be proceeded.
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Affiliation(s)
- Yoshihiko Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenji Sugai
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mahito Atobe
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yuko Saito
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taisuke Ohtsuki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Epilepsy Hospital Bethel Japan, Miyagi, Japan
| | - Masayuki Sasaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
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Slingerland AL, Chua MMJ, Bolton J, Staffa SJ, Tsuboyama M, Prabhu SP, Pearl PL, Madsen JR, Stone SSD. Stereoelectroencephalography followed by combined electrode removal and MRI-guided laser interstitial thermal therapy or open resection: a single-center series in pediatric patients with medically refractory epilepsy. J Neurosurg Pediatr 2023; 31:206-211. [PMID: 36681974 DOI: 10.3171/2022.11.peds22262] [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: 06/23/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT) have emerged as safe, effective, and less invasive alternatives to subdural grid placement and open resection, respectively, for the localization and treatment of medically refractory epilepsy (MRE) in children. Reported pediatric experience combining these complementary techniques is limited, with traditional workflows separating electrode removal and ablation/resection. The authors describe the largest reported series of pediatric epilepsy patients who underwent MRgLITT following SEEG contrasted with a cohort that underwent craniotomy following SEEG, combining ablation/resection with electrode explantation as standard practice. METHODS The medical records of all patients with MRE who had undergone SEEG followed by MRgLITT or open resection/disconnection at Boston Children's Hospital between November 2015 and December 2020 were retrospectively reviewed. Primary outcome variables included surgical complication rates, length of hospital stay following treatment, and Engel classification at the last follow-up. RESULTS Of 74 SEEG patients, 27 (median age 12.1 years, 63% female) underwent MRgLITT and 47 (median age 12.1 years, 49% female) underwent craniotomy. Seventy patients (95%) underwent SEEG followed by combined electrode removal and treatment. Eight MRgLITT cases (30%) and no open cases targeted the insula (p < 0.001). Complication rates did not differ, although trends toward more subdural/epidural hematomas, infarcts, and permanent unanticipated neurological deficits were evident following craniotomy, whereas a trend toward more temporary unanticipated neurological deficits was seen following MRgLITT. The median duration of hospitalization after treatment was 3 and 5 days for MRgLITT and open cases, respectively (p = 0.078). Seizure outcomes were similar between the cohorts, with 74% of MRgLITT and craniotomy patients attaining Engel class I or II outcomes (p = 0.386) at the last follow-up (median 1.1 and 1.9 years, respectively). CONCLUSIONS MRgLITT and open resection following SEEG can both effectively treat MRE in pediatric patients and generally can be performed in a two-surgery workflow during a single hospitalization. In appropriately selected patients, MRgLITT tended to be associated with shorter hospitalizations and fewer complications following treatment and may be best suited for focal deep-seated targets associated with relatively challenging open surgical approaches.
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Affiliation(s)
| | | | | | - Steven J Staffa
- 3Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital
| | | | - Sanjay P Prabhu
- 4Department of Radiology, Division of Neuroradiology, Boston Children's Hospital, Boston, Massachusetts
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