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Ma K, Luan G, Wang X, Luo S, Qin L, Teng P, Guan Y, Zhao M, Wang J, Wang M, Gao JH. Magnetoencephalography STOUT Method Adapted to Radiofrequency Thermocoagulation for MR-Negative Insular Epilepsy: A Case Report. Front Neurol 2021; 12:683299. [PMID: 34721253 PMCID: PMC8548742 DOI: 10.3389/fneur.2021.683299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is one of the most challenging neurologic diseases confronted by human society. Approximately 30–40% of the worldwide epilepsy patients are diagnosed with drug-resistant epilepsy and require pre-surgery evaluation. Magnetoencephalography (MEG) is a unique technology that provides optimal spatial-temporal resolution and has become a powerful non-invasive imaging modality that can localize the interictal spikes and guide the implantation of intracranial electrodes. Currently, the most widely used MEG source estimation method for clinical applications is equivalent current dipoles (ECD). However, ECD has difficulties in precisely locating deep sources such as insular lobe. In contrast to ECD, another MEG source estimation method named spatio-temporal unifying tomography (STOUT) with spatial sparsity has particular advantages in locating deep sources. In this case study, we recruited a 5 year-old female patient with insular lobe epilepsy and her seizure recurred in 1 year after receiving the radiofrequency thermocoagulation (RF-TC) therapy. The STOUT method was adopted to locate deep sources for identifying the epileptic foci in epilepsy evaluation. MEG STOUT method strongly supported a stereo-electroencephalographic (SEEG)-guided RF-TC operation, and the patient reported a satisfactory therapeutic effect. This case raises the possibility that STOUT method can be used particularly for the localization of deep sources, and successfully conducted RF-TC under the guidance of MEG STOUT results.
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Affiliation(s)
- Kaiqiang Ma
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Epilepsy, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Epilepsy, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Shen Luo
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,Beijing City Key Laboratory for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Lang Qin
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Pengfei Teng
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Meng Zhao
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jia-Hong Gao
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,Beijing City Key Laboratory for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing, China.,McGovern Institute for Brain Research, Peking University, Beijing, China
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2
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Hou Z, Duan QT, Ke YY, An N, Yang H, Liu SY, Zhang CQ. Predictors of Seizure Freedom in Patients Undergoing Surgery for Central Nervous System Infection-Related Epilepsy: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:668439. [PMID: 34489847 PMCID: PMC8416488 DOI: 10.3389/fneur.2021.668439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Central nervous system infections (CNSIs), especially viral encephalitis and meningitis, are well-recognized causes of medically refractory epilepsy. Although surgery is an effective and durable intervention against these infections, the seizure control outcomes described in previous surgical series have been variable. Accordingly, it is not clear which variables are most valuable in predicting seizure control following surgery for CNSI. The aim of this meta-analysis was to identify the predictors of favorable surgical outcomes in CNSI-related epilepsy. Methods: The PubMed, EMBASE, Cochrane Library, WANGFANG, VIP, CBM, and CNKI databases were searched for studies according to the inclusion criteria. Prognostic factors, surgical outcomes, and patient characteristics were extracted. Heterogeneity was detected by the I2 and Q statistics. Results: Seventeen studies were included in our meta-analysis. Eight predictors of favorable outcomes (Engel Class I/II) were determined, including abnormal MRI findings, meningitis, temporal location only, regional ictal pattern, unilateral ictal pattern, older age at epilepsy, longer silent period, and longer time from infection, as follows: OR = 3.34 (95% CI 1.44–7.74), OR = 0.31 (95% CI 0.13–0.70), OR = 0.34 (95% CI 0.16–0.74), OR = 5.65 (95% CI 1.75–18.30), and OR = 9.53 (95% CI 2.36–38.48), respectively, and MD = 2.15 (95% CI 0.20–4.11), MD = 2.40 (95% CI 0.09–4.70), and MD = 8.49 (95% CI 1.50–15.48), respectively. A subgroup analysis found the following associations: regional and unilateral ictal patterns in viral encephalitis, a younger age at infection in parasitic encephalopathy, an older age at surgery, a longer time from onset, and a longer time from infection in unexplained meningitis. A sensitivity analysis restricted to studies that included each variable yielded robust results. Little evidence of publication bias was observed. Conclusions: This meta-analysis suggests that abnormal MRI findings, meningitis, temporal location only, regional and unilateral ictal patterns, older age at epilepsy, longer silent period, and longer time from infection are predictive factors in patients with favorable surgical outcomes in CNSI-related epilepsy. In addition, different infective agents influenced the results in regional and unilateral ictal patterns in ictal electroencephalography, as well as the relationship between age at infection and surgery and the time from epilepsy onset and infection.
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Affiliation(s)
- Zhi Hou
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qing-Tian Duan
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yan-Yan Ke
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ning An
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hui Yang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shi-Yong Liu
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chun-Qing Zhang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Noninvasive high-frequency oscillations riding spikes delineates epileptogenic sources. Proc Natl Acad Sci U S A 2021; 118:2011130118. [PMID: 33875582 PMCID: PMC8092606 DOI: 10.1073/pnas.2011130118] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Millions of people affected by epilepsy may undergo surgical resection of the epileptic tissues to stop seizures if such epileptic foci can be accurately delineated. High-frequency oscillations (HFOs), existing in electroencephalography, are highly correlated with epileptic brain, which is promising for guiding successful neurosurgery. However, it is unclear whether and how pathological HFOs can be differentiated to localize the epileptogenic tissues given the presence of various nonepileptic high-frequency activities. Here, we show morphological and source imaging evidence that pathological HFOs can be identified by the concurrence of epileptiform spikes. We describe a framework to delineate the underlying epileptogenicity using this biomarker. Our work may offer translational tools to improve treatments by noninvasively demarking pathological activities and hence epileptic foci. High-frequency oscillations (HFOs) are a promising biomarker for localizing epileptogenic brain and guiding successful neurosurgery. However, the utility and translation of noninvasive HFOs, although highly desirable, is impeded by the difficulty in differentiating pathological HFOs from nonepileptiform high-frequency activities and localizing the epileptic tissue using noninvasive scalp recordings, which are typically contaminated with high noise levels. Here, we show that the consistent concurrence of HFOs with epileptiform spikes (pHFOs) provides a tractable means to identify pathological HFOs automatically, and this in turn demarks an epileptiform spike subgroup with higher epileptic relevance than the other spikes in a cohort of 25 temporal epilepsy patients (including a total of 2,967 interictal spikes and 1,477 HFO events). We found significant morphological distinctions of HFOs and spikes in the presence/absence of this concurrent status. We also demonstrated that the proposed pHFO source imaging enhanced localization of epileptogenic tissue by 162% (∼5.36 mm) for concordance with surgical resection and by 186% (∼12.48 mm) with seizure-onset zone determined by invasive studies, compared to conventional spike imaging, and demonstrated superior congruence with the surgical outcomes. Strikingly, the performance of spike imaging was selectively boosted by the presence of spikes with pHFOs, especially in patients with multitype spikes. Our findings suggest that concurrent HFOs and spikes reciprocally discriminate pathological activities, providing a translational tool for noninvasive presurgical diagnosis and postsurgical evaluation in vulnerable patients.
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4
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Jiang H, Cai Z, Worrell GA, He B. Multiple Oscillatory Push-Pull Antagonisms Constrain Seizure Propagation. Ann Neurol 2019; 86:683-694. [PMID: 31566799 PMCID: PMC6856814 DOI: 10.1002/ana.25583] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/06/2019] [Accepted: 08/18/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Drug-resistant focal epilepsy is widely recognized as a network disease in which epileptic seizure propagation is likely coordinated by different neuronal oscillations such as low-frequency activity (LFA), high-frequency activity (HFA), or low-to-high cross-frequency coupling. However, the mechanism by which different oscillatory networks constrain the propagation of focal seizures remains unclear. METHODS We studied focal epilepsy patients with invasive electrocorticography (ECoG) recordings and compared multilayer directional network interactions between focal seizures either with or without secondary generalization. Within-frequency and cross-frequency directional connectivity were estimated by an adaptive directed transfer function and cross-frequency directionality, respectively. RESULTS In the within-frequency epileptic network, we found that the seizure onset zone (SOZ) always sent stronger information flow to the surrounding regions, and secondary generalization was accompanied by weaker information flow in the LFA from the surrounding regions to SOZ. In the cross-frequency epileptic network, secondary generalization was associated with either decreased information flow from surrounding regions' HFA to SOZ's LFA or increased information flow from SOZ's LFA to surrounding regions' HFA. INTERPRETATION Our results suggest that the secondary generalization of focal seizures is regulated by numerous within- and cross-frequency push-pull dynamics, potentially reflecting impaired excitation-inhibition interactions of the epileptic network. ANN NEUROL 2019;86:683-694.
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Affiliation(s)
- Haiteng Jiang
- Department of Biomedical EngineeringCarnegie Mellon UniversityPittsburghPA
| | - Zhengxiang Cai
- Department of Biomedical EngineeringCarnegie Mellon UniversityPittsburghPA
| | | | - Bin He
- Department of Biomedical EngineeringCarnegie Mellon UniversityPittsburghPA
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5
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Krishnaiah B, Ramaratnam S, Ranganathan LN. Subpial transection surgery for epilepsy. Cochrane Database Syst Rev 2018; 11:CD008153. [PMID: 30383287 PMCID: PMC6517173 DOI: 10.1002/14651858.cd008153.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nearly 30% of patients with epilepsy continue to have seizures despite using several antiepileptic drugs (AEDs). Such patients are regarded as having refractory, or uncontrolled, epilepsy. While there is no universally accepted definition of uncontrolled, or medically refractory, epilepsy, for the purposes of this review we will consider seizures as drug resistant if they have failed to respond to a minimum of two AEDs. Specialists consider that early surgical intervention may prevent seizures at a younger age, which in turn may improve the intellectual and social status of children. Many types of surgery are available for treating refractory epilepsy; one such procedure is known as subpial transection. OBJECTIVES To assess the effects of subpial transection for focal-onset seizures and generalised tonic-clonic seizures in children and adults. SEARCH METHODS For the latest update we searched the following databases on 7 August 2018: the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to August 06, 2018), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). We imposed no language restrictions. SELECTION CRITERIA We considered all randomised and quasi-randomised parallel-group studies, whether blinded or non-blinded. DATA COLLECTION AND ANALYSIS Two review authors (BK and SR) independently screened trials identified by the search. The same two review authors planned to independently assess the methodological quality of studies. Had we identified studies for inclusion, one review author would have extracted the data, and the other would have verified the data. MAIN RESULTS We found no relevant studies. AUTHORS' CONCLUSIONS We found no evidence to support or refute the use of subpial transection surgery for patients with medically refractory epilepsy. Well-designed randomised controlled trials are needed to guide clinical practice.
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Affiliation(s)
- Balaji Krishnaiah
- Penn State CenterDepartment of Neurology30 Hope DriveHersheyPhiladephiaUSAPA 17033
| | - Sridharan Ramaratnam
- The Nerve CentreDepartment of Neurology5/1 Rajachar StreetT NagarChennaiTamil NaduIndia600017
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Tomycz LD, Hale AT, Haider AS, Clarke DF, Lee MR. Invasive Insular Sampling in Pediatric Epilepsy: A Single-Institution Experience. Oper Neurosurg (Hagerstown) 2017; 15:310-317. [DOI: 10.1093/ons/opx253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
It has been increasingly recognized that the insular cortex plays an important role in frontotemporal-parietal epilepsy in children. The insula, however, cannot be properly interrogated with conventional subdural grids, and its anatomy makes it difficult to implicate the insula with semiology or noninvasive modalities. Frame-based, stereotactic placement of insular depth electrodes for direct extraoperative monitoring is a relatively low-risk maneuver that allows for conclusive interrogation of this region, and, in select cases, can easily be replaced with a laser applicator for minimally invasive treatment via thermoablation.
OBJECTIVE
To describe the largest reported series of pediatric patients with refractory epilepsy undergoing insular depth electrode placement.
METHODS
We used current procedural terminology billing records to identify cases of depth electrode insertion performed at our institution. Clinical information from patients undergoing invasive insular sampling was then retrospectively collected.
RESULTS
Seventy-four insular depth electrodes were placed in 49 patients for extraoperative, inpatient monitoring. The decision to place insular depth electrodes was determined by a multidisciplinary epilepsy team. In 65.3% of cases, direct invasive sampling implicated the insula in seizure onset and prompted either thermoablation or surgical resection of some portion of the insula. There were no serious adverse effects or complications associated with the placement of insular depth electrodes.
CONCLUSION
Given the low morbidity of insular depth electrode insertion and the high proportion of patients who exhibited insular involvement, it is worth considering whether insular depth electrodes should be part of the standard presurgical evaluation in children with treatment-refractory frontotemporal-parietal epilepsy.
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Affiliation(s)
- Luke D Tomycz
- Department of Neurological Surgery, Dell Children's Medical Center, Austin, Texas
| | - Andrew T Hale
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Dave F Clarke
- Department of Pediatric Neurology, Dell Children's Medical Center, Austin, Texas
| | - Mark R Lee
- Department of Neurological Surgery, Dell Children's Medical Center, Austin, Texas
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7
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Abstract
BACKGROUND Nearly 30% of patients with epilepsy continue to have seizures in spite of using several antiepileptic drug (AED) regimens. Such patients are regarded as having refractory, or uncontrolled, epilepsy. No definition of uncontrolled, or medically refractory, epilepsy has been universally accepted, but for the purposes of this review, we will consider seizures as drug resistant if they have failed to respond to a minimum of two AEDs. It is believed that early surgical intervention may prevent seizures at a younger age, which, in turn, may improve the intellectual and social status of children. Many types of surgery are available for treatment of refractory epilepsy; one such procedure is known as subpial transection. OBJECTIVES To determine the benefits and adverse effects of subpial transection for partial-onset seizures and generalised tonic-clonic seizures in children and adults. SEARCH METHODS We searched the Cochrane Epilepsy Group Specialised Register (29 June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; May 2015, Issue 5) and MEDLINE (1946 to 29 June 2015). We imposed no language restrictions. SELECTION CRITERIA We considered all randomised and quasi-randomised parallel-group studies, whether blinded or non-blinded. DATA COLLECTION AND ANALYSIS Two review authors (BK and SR) independently screened trials identified by the search. The same two review authors planned to independently assess the methodological quality of studies. When studies were identified for inclusion, one review author would have extracted the data, and the other would have verified the data. MAIN RESULTS We found no relevant studies. AUTHORS' CONCLUSIONS We found no evidence to support or refute use of subpial transection surgery for patients with medically refractory epilepsy. Well-designed randomised controlled trials are needed to guide clinical practice.
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Affiliation(s)
- Balaji Krishnaiah
- Department of Neurology, Penn State Center, 30 Hope Drive, Hershey, Philadephia, USA, PA 17033
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Kang M, Jung S, Zhang H, Kang T, Kang H, Yoo Y, Hong JP, Ahn JP, Kwak J, Jeon D, Kotov NA, Kim B. Subcellular neural probes from single-crystal gold nanowires. ACS NANO 2014; 8:8182-9. [PMID: 25112683 PMCID: PMC4535705 DOI: 10.1021/nn5024522] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/25/2014] [Indexed: 05/19/2023]
Abstract
Size reduction of neural electrodes is essential for improving the functionality of neuroprosthetic devices, developing potent therapies for neurological and neurodegenerative diseases, and long-term brain–computer interfaces. Typical neural electrodes are micromanufactured devices with dimensions ranging from tens to hundreds of micrometers. Their further miniaturization is necessary to reduce local tissue damage and chronic immunological reactions of the brain. Here we report the neural electrode with subcellular dimensions based on single-crystalline gold nanowires (NWs) with a diameter of ∼100 nm. Unique mechanical and electrical properties of defect-free gold NWs enabled their implantation and recording of single neuron-activities in a live mouse brain despite a ∼50× reduction of the size compared to the closest analogues. Reduction of electrode dimensions enabled recording of neural activity with improved spatial resolution and differentiation of brain activity in response to different social situations for mice. The successful localization of the epileptic seizure center was also achieved using a multielectrode probe as a demonstration of the diagnostics potential of NW electrodes. This study demonstrated the realism of single-neuron recording using subcellular-sized electrodes that may be considered a pivotal point for use in diverse studies of chronic brain diseases.
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Affiliation(s)
- Mijeong Kang
- Department of Chemistry and Department of Bio and Brain Engineering, KAIST, Daejeon 305-701, Korea
| | - Seungmoon Jung
- Department of Chemistry and Department of Bio and Brain Engineering, KAIST, Daejeon 305-701, Korea
| | - Huanan Zhang
- Department of Chemical Engineering, Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Taejoon Kang
- BioNanotechnology Research Center and BioNano Health Guard Research Center, KRIBB, Daejeon 305-806, Korea
| | - Hosuk Kang
- Department of Chemistry and Department of Bio and Brain Engineering, KAIST, Daejeon 305-701, Korea
| | - Youngdong Yoo
- Department of Chemistry and Department of Bio and Brain Engineering, KAIST, Daejeon 305-701, Korea
| | - Jin-Pyo Hong
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | | | - Juhyoun Kwak
- Department of Chemistry and Department of Bio and Brain Engineering, KAIST, Daejeon 305-701, Korea
| | - Daejong Jeon
- Department of Chemistry and Department of Bio and Brain Engineering, KAIST, Daejeon 305-701, Korea
- Address correspondence to (D. Jeon); (N. A. Kotov); (B. Kim)
| | - Nicholas A. Kotov
- Department of Chemical Engineering, Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan 48109, United States
- Address correspondence to (D. Jeon); (N. A. Kotov); (B. Kim)
| | - Bongsoo Kim
- Department of Chemistry and Department of Bio and Brain Engineering, KAIST, Daejeon 305-701, Korea
- Address correspondence to (D. Jeon); (N. A. Kotov); (B. Kim)
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House PM, Lanz M, Holst B, Martens T, Stodieck S, Huppertz HJ. Comparison of morphometric analysis based on T1- and T2-weighted MRI data for visualization of focal cortical dysplasia. Epilepsy Res 2013; 106:403-9. [DOI: 10.1016/j.eplepsyres.2013.06.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/22/2013] [Accepted: 06/28/2013] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Nearly 30% of patients with epilepsy continue to have seizures in spite of several antiepileptic drug (AED) regimens. In such cases they are regarded as having refractory, or uncontrolled epilepsy.There is no universally accepted definition for uncontrolled or medically refractory epilepsy, but for the purpose of this review, we will consider seizures to be drug resistant if they failed to respond to a minimum of two AEDs. It is believed that early surgical intervention may prevent seizures at a younger age and improve the intellectual and social status of children. There are many types of surgery for refractory epilepsy with subpial transection being one. OBJECTIVES Our main aim is to determine the benefits and adverse effects of subpial transection for partial-onset seizures and generalised tonic-clonic seizures in children and adults. SEARCH METHODS We searched the Cochrane Epilepsy Group Specialised Register (8 August 2013), The Cochrane Central Register of Controlled Trials (CENTRAL Issue 7 of 12, The Cochrane Library July 2013), and MEDLINE (1946 to 8 August 2013). We did not impose any language restrictions. SELECTION CRITERIA We considered all randomised and quasi-randomised parallel group studies either blinded or non-blinded. DATA COLLECTION AND ANALYSIS Two review authors (BK and SR) independently screened the trials identified by the search. The same two authors planned to independently assess the methodological quality of studies. If studies had been identified for inclusion, one author would have extracted the data and the other would have verified it. MAIN RESULTS No relevant studies were found. AUTHORS' CONCLUSIONS There is no evidence to support or refute the use of subpial transection surgery for medically refractory cases of epilepsy. Well designed randomised controlled trials are needed in future to guide clinical practice.
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Affiliation(s)
- Balaji Krishnaiah
- Department of Neurology, Penn State, 30 Hope Drive, Hershey, Pennsylvania, Philadelphia, USA, PA 17033
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Sellner J, Trinka E. Clinical characteristics, risk factors and pre‐surgical evaluation of post‐infectious epilepsy. Eur J Neurol 2012; 20:429-439. [DOI: 10.1111/j.1468-1331.2012.03842.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 07/04/2012] [Indexed: 12/22/2022]
Affiliation(s)
- J. Sellner
- 2. Neurologische Abteilung Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel Vienna Austria
- Department of Neurology Christian‐Doppler‐Klinik Paracelsus Medical University Salzburg Austria
- Department of Neurology Klinikum rechts der Isar Technische Universität München München Germany
| | - E. Trinka
- Department of Neurology Christian‐Doppler‐Klinik Paracelsus Medical University Salzburg Austria
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Ching S, Brown EN, Kramer MA. Distributed control in a mean-field cortical network model: implications for seizure suppression. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2012; 86:021920. [PMID: 23005798 DOI: 10.1103/physreve.86.021920] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 07/27/2012] [Indexed: 06/01/2023]
Abstract
Brain electrical stimulation (BES) has long been suggested as a means of controlling pathological brain activity. In epilepsy, control of a spatially localized source, the seizure focus, may normalize neuronal dynamics. Consequently, most BES research has been directed at controlling small, local, neuronal populations. At a higher level, pathological seizure activity can be viewed as a network event that may begin without a clear spatial focus or in multiple sites and spread rapidly through a distributed cortical network. In this paper, we begin to address the implications of local control in a network scenario. To do so, we explore the efficacy of local BES when deployed over a larger-scale neuronal network, for instance, using a grid of stimulating electrodes on the cortex. By introducing a mean-field model of neuronal interactions we are able to identify limitations in network controllability based on physiological constraints that suggest the need for more nuanced network control strategies.
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Affiliation(s)
- ShiNung Ching
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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13
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Romanelli P, Striano P, Barbarisi M, Coppola G, Anschel DJ. Non-resective surgery and radiosurgery for treatment of drug-resistant epilepsy. Epilepsy Res 2012; 99:193-201. [PMID: 22245137 DOI: 10.1016/j.eplepsyres.2011.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 12/13/2011] [Accepted: 12/26/2011] [Indexed: 10/14/2022]
Abstract
Epilepsy surgery is an effective treatment for properly selected patients with intractable seizures. However, many patients with medically intractable epilepsy are not excellent candidates for surgical resection of the epileptogenic zone. Due to recent advances in computer technology and bioengineering, several novel techniques are receiving increasing interest for their role in the care of people with epilepsy. Neuromodulation is an emerging surgical option to be used when conventional resective surgery is not indicated. We review the indications and expected outcomes of neuromodulatory treatments currently available for the treatment of refractory epilepsy, i.e., vagus nerve stimulation, deep brain stimulation, stereotactic radiosurgery, and multiple subpial transections.
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Affiliation(s)
- Pantaleo Romanelli
- Cyberknife Radiosurgery Center, Centro Diagnostico Italiano, Milan, Italy.
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14
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Brauer C, Kästner SBR, Rohn K, Schenk HC, Tünsmeyer J, Tipold A. Electroencephalographic recordings in dogs suffering from idiopathic and symptomatic epilepsy: diagnostic value of interictal short time EEG protocols supplemented by two activation techniques. Vet J 2011; 193:185-92. [PMID: 22099183 DOI: 10.1016/j.tvjl.2011.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 09/30/2011] [Accepted: 10/11/2011] [Indexed: 10/15/2022]
Abstract
The diagnostic value of interictal short time electroencephalographic (EEG) recordings in epileptic dogs under general anaesthesia with propofol and the muscle relaxant rocuronium bromide was investigated. Two activation techniques, namely photic stimulation and hyperventilation, were evaluated for their potential to enhance the diagnostic validity of these recordings. Sixty-one dogs suffering from idiopathic epilepsy and 28 dogs suffering from symptomatic epilepsy were included. Electroencephalograms were recorded using five subdermal EEG electrodes (F3, F4, Cz, O1 and O2). All 89 EEGs were analysed visually and 61 were also evaluated quantitatively with fast Fourier transformation. Interictal paroxysmal epileptiform activity was found in 25% of idiopathic and in 29% of symptomatic epileptic dogs. Quantitative analysis of the EEGs (qEEGs) detected significant differences of frequency analysis in single reading points without any continuous changes of frequency bands. A comparison between healthy and affected brain hemispheres in seven dogs with focal lesions of one hemisphere did not show any significant differences in qEEG analysis. qEEG was not more sensitive than visual evaluation. Despite the use of activation techniques, the results showed that short time EEG recordings in epileptic dogs can detect interictal epileptic activity in less than one third of all seizuring dogs and is not a useful screening method.
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Affiliation(s)
- Christina Brauer
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, D-30559 Hannover, Germany.
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15
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Yang L, Wilke C, Brinkmann B, Worrell GA, He B. Dynamic imaging of ictal oscillations using non-invasive high-resolution EEG. Neuroimage 2011; 56:1908-17. [PMID: 21453776 PMCID: PMC3359824 DOI: 10.1016/j.neuroimage.2011.03.043] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 02/23/2011] [Accepted: 03/16/2011] [Indexed: 12/01/2022] Open
Abstract
Scalp electroencephalography (EEG) has been established as a major component of the pre-surgical evaluation for epilepsy surgery. However, its ability to localize seizure onset zones (SOZ) has been significantly restricted by its low spatial resolution and indirect correlation with underlying brain activities. Here we report a novel non-invasive dynamic seizure imaging (DSI) approach based upon high-density EEG recordings. This novel approach was particularly designed to image the dynamic changes of ictal rhythmic discharges that evolve through time, space and frequency. This method was evaluated in a group of 8 epilepsy patients and results were rigorously validated using intracranial EEG (iEEG) (n=3) and surgical outcome (n=7). The DSI localized the ictal activity in concordance with surgically resected zones and ictal iEEG recordings in the cohort of patients. The present promising results support the ability to precisely and accurately image dynamic seizure activity from non-invasive measurements. The successful establishment of such a non-invasive seizure imaging modality for surgical evaluation will have a significant impact in the management of medically intractable epilepsy.
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Affiliation(s)
- Lin Yang
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
- Center for Neuroengineering, University of Minnesota, Minneapolis, MN, USA
| | - Christopher Wilke
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Brinkmann
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Mayo Systems Electrophysiology Lab, Rochester, MN, USA
| | - Gregory A. Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Mayo Systems Electrophysiology Lab, Rochester, MN, USA
| | - Bin He
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
- Center for Neuroengineering, University of Minnesota, Minneapolis, MN, USA
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16
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Maudsley AA, Domenig C, Ramsay RE, Bowen BC. Application of volumetric MR spectroscopic imaging for localization of neocortical epilepsy. Epilepsy Res 2009; 88:127-38. [PMID: 19926450 DOI: 10.1016/j.eplepsyres.2009.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 10/07/2009] [Accepted: 10/15/2009] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this study was to evaluate volumetric proton magnetic resonance spectroscopic imaging (MRSI) for localization of epileptogenic foci in neocortical epilepsy. METHODS Twenty-five subjects reporting seizures considered to be of neocortical origin were recruited to take part in a 3-T MR study that included high-resolution structural MRI and a whole-brain MRSI acquisition. Using a fully automated MRSI processing protocol, maps for signal intensity normalized N-acetylaspartate (NAA), creatine, and choline were created, together with the relative volume fraction of grey-matter, white-matter, and CSF within each MRSI voxel. Analyses were performed using visual observation of the metabolite and metabolite ratio maps; voxel-based calculation of differences in these metabolite maps relative to normal controls; comparison of average grey-matter and white-matter metabolite values over each lobar volume; and examination of relative left-right asymmetry factors by brain region. RESULTS Data from 14 subjects were suitable for inclusion in the analysis. Eight subjects had MRI-visible pathologies that were associated with decreases in NAA/creatine, which extended beyond the volume indicated by the MRI. Five subjects demonstrated no significant metabolic alterations using any of the analysis methods, and one subject had no findings on MRI or MRSI. CONCLUSIONS This proof of principle study supports previous evidence that alterations of MR-detected brain metabolites can be detected in tissue areas affected by neocortical seizure activity, while additionally demonstrating advantages of the volumetric MRSI approach.
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Affiliation(s)
- Andrew A Maudsley
- Department of Radiology, University of Miami School of Medicine, Miami, FL 33136, USA.
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17
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Forehead trauma outcomes: restoration of brain, soft tissues, and bone defects: a 3-step treatment. J Craniofac Surg 2009; 20:498-501. [PMID: 19276819 DOI: 10.1097/scs.0b013e31819b9e14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Head injuries are one of the most common causes of treatment in the emergency and accidents ward. The first causes of head traumatology are still car or motorcycle accidents, followed by personal aggressions. The authors here present a case of forehead trauma outcome after a severe injury in growing age. The interesting aspect is the triple challenge of cerebral, bone, and soft tissue restoration. The main goal was to restore functionality of the brain and to re-establish the integrity of cranial vault. Excision of pathologic cerebral cortex and well-known surgical techniques have been adopted to achieve this result. Moreover, the peculiar technique that led to the good result was to create a barrier between bone layer and soft tissues. The authors present their personal suggestions for the best functional and aesthetic outcome.
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American Clinical MEG Society (ACMEGS) Position Statement: The Value of Magnetoencephalography (MEG)/Magnetic Source Imaging (MSI) in Noninvasive Presurgical Evaluation of Patients With Medically Intractable Localization-related Epilepsy. J Clin Neurophysiol 2009; 26:290-3. [DOI: 10.1097/wnp.0b013e3181b49d50] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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