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Jiang S, Zhu Y, Hu J. The Value of Stereo-electroencephalography in Temporal Lobe Epilepsy: Huashan Experience. Neurosurg Clin N Am 2024; 35:95-104. [PMID: 38000846 DOI: 10.1016/j.nec.2023.09.008] [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
Temporal lobe epilepsy (TLE) is one of the most common drug-refractory epilepsies. However, the diagnosis and treatment of TLE may be improved by better understanding its complex network. In this article, the authors summarize their experience with TLE and discuss their process for using stereo-electroencephalography (SEEG) as part of presurgical evaluation in the past 10 years. The authors demonstrate the value of SEEG in different types of TLE and discuss how their findings have impacted treatment options. Ultimately, the authors' experience will help other centers in addressing TLE cases.
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Affiliation(s)
- Shize Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanming Zhu
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jie Hu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
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2
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Kang W, Ju C, Joo J, Lee J, Shon YM, Park SM. Closed-loop direct control of seizure focus in a rodent model of temporal lobe epilepsy via localized electric fields applied sequentially. Nat Commun 2022; 13:7805. [PMID: 36528681 PMCID: PMC9759546 DOI: 10.1038/s41467-022-35540-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Direct electrical stimulation of the seizure focus can achieve the early termination of epileptic oscillations. However, direct intervention of the hippocampus, the most prevalent seizure focus in temporal lobe epilepsy is thought to be not practicable due to its large size and elongated shape. Here, in a rat model, we report a sequential narrow-field stimulation method for terminating seizures, while focusing stimulus energy at the spatially extensive hippocampal structure. The effects and regional specificity of this method were demonstrated via electrophysiological and biological responses. Our proposed modality demonstrates spatiotemporal preciseness and selectiveness for modulating the pathological target region which may have potential for further investigation as a therapeutic approach.
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Affiliation(s)
- Wonok Kang
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
- Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Chanyang Ju
- Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Jaesoon Joo
- Biomedical Engineering Research Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351, South Korea
| | - Jiho Lee
- Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Young-Min Shon
- Biomedical Engineering Research Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351, South Korea.
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351, Republic of Korea.
| | - Sung-Min Park
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Department of Electrical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Institute of Convergence Science, Yonsei University, Seoul, 03722, Republic of Korea.
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3
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Chiang S, Fan JM, Rao VR. Bilateral temporal lobe epilepsy: How many seizures are required in chronic ambulatory electrocorticography to estimate the laterality ratio? Epilepsia 2022; 63:199-208. [PMID: 34723396 PMCID: PMC9056258 DOI: 10.1111/epi.17113] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was undertaken to measure the duration of chronic electrocorticography (ECoG) needed to attain stable estimates of the seizure laterality ratio in patients with drug-resistant bilateral temporal lobe epilepsy (BTLE). METHODS We studied 13 patients with drug-resistant BTLE who were implanted for at least 1 year with a responsive neurostimulation device (RNS System) that provides chronic ambulatory ECoG. Bootstrap analysis and nonlinear regression were applied to model the relationship between chronic ECoG duration and the probability of capturing at least one seizure. Laterality of electrographic seizures in chronic ECoG was compared with the seizure laterality ratio from Phase 1 scalp video-electroencephalographic (vEEG) monitoring. The Kaplan-Meier estimator was used to evaluate time to seizure laterality ratio convergence. RESULTS Seizure laterality ratios from Phase 1 scalp vEEG monitoring correlated poorly with those from RNS chronic ECoG (r = .31, p = .30). Across the 13 patients, average electrographic seizure frequencies ranged from 1.4 seizures/month to 5.1 seizures/day. A 50% probability of recording at least one electrographic seizure required 9.1 days of chronic ECoG, and 90% probability required 44.3 days of chronic ECoG. A median recording duration of 150.9 days (5 months), corresponding to a median of 16 seizures, was needed before confidence intervals for the seizure laterality ratio reliably contained the long-term value. The median recording duration before the point estimate of the seizure laterality ratio converged to a stationary value was 236.8 days (7.9 months). SIGNIFICANCE RNS chronic ECoG overcomes temporal sampling limitations intrinsic to inpatient Phase 1 vEEG evaluations. In patients with drug-resistant BTLE, approximately 8 months of chronic RNS ECoG are needed to precisely estimate the seizure laterality ratio, with 75% of people with BTLE achieving convergence after 1 year of RNS recording. For individuals who are candidates for unilateral resection based on seizure laterality, optimized recording duration may help avert morbidity associated with delay to definitive treatment.
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Affiliation(s)
- Sharon Chiang
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Joline M Fan
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Vikram R Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
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4
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Földi T, Lőrincz ML, Berényi A. Temporally Targeted Interactions With Pathologic Oscillations as Therapeutical Targets in Epilepsy and Beyond. Front Neural Circuits 2021; 15:784085. [PMID: 34955760 PMCID: PMC8693222 DOI: 10.3389/fncir.2021.784085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Self-organized neuronal oscillations rely on precisely orchestrated ensemble activity in reverberating neuronal networks. Chronic, non-malignant disorders of the brain are often coupled to pathological neuronal activity patterns. In addition to the characteristic behavioral symptoms, these disturbances are giving rise to both transient and persistent changes of various brain rhythms. Increasing evidence support the causal role of these "oscillopathies" in the phenotypic emergence of the disease symptoms, identifying neuronal network oscillations as potential therapeutic targets. While the kinetics of pharmacological therapy is not suitable to compensate the disease related fine-scale disturbances of network oscillations, external biophysical modalities (e.g., electrical stimulation) can alter spike timing in a temporally precise manner. These perturbations can warp rhythmic oscillatory patterns via resonance or entrainment. Properly timed phasic stimuli can even switch between the stable states of networks acting as multistable oscillators, substantially changing the emergent oscillatory patterns. Novel transcranial electric stimulation (TES) approaches offer more reliable neuronal control by allowing higher intensities with tolerable side-effect profiles. This precise temporal steerability combined with the non- or minimally invasive nature of these novel TES interventions make them promising therapeutic candidates for functional disorders of the brain. Here we review the key experimental findings and theoretical background concerning various pathological aspects of neuronal network activity leading to the generation of epileptic seizures. The conceptual and practical state of the art of temporally targeted brain stimulation is discussed focusing on the prevention and early termination of epileptic seizures.
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Affiliation(s)
- Tamás Földi
- MTA-SZTE "Momentum" Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary.,HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged, Hungary.,Child and Adolescent Psychiatry, Department of the Child Health Center, University of Szeged, Szeged, Hungary
| | - Magor L Lőrincz
- MTA-SZTE "Momentum" Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary.,Department of Physiology, Anatomy and Neuroscience, Faculty of Sciences University of Szeged, Szeged, Hungary.,Neuroscience Division, Cardiff University, Cardiff, United Kingdom
| | - Antal Berényi
- MTA-SZTE "Momentum" Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary.,HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged, Hungary.,Neuroscience Institute, New York University, New York, NY, United States
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5
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Takeuchi Y, Harangozó M, Pedraza L, Földi T, Kozák G, Li Q, Berényi A. Closed-loop stimulation of the medial septum terminates epileptic seizures. Brain 2021; 144:885-908. [PMID: 33501929 DOI: 10.1093/brain/awaa450] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Temporal lobe epilepsy with distributed hippocampal seizure foci is often intractable and its secondary generalization might lead to sudden death. Early termination through spatially extensive hippocampal intervention is not feasible directly, because of the large size and irregular shape of the hippocampus. In contrast, the medial septum is a promising target to govern hippocampal oscillations through its divergent connections to both hippocampi. Combining this 'proxy intervention' concept and precisely timed stimulation, we report here that closed-loop medial septum electrical stimulation can quickly terminate intrahippocampal seizures and suppress secondary generalization in a rat kindling model. Precise stimulus timing governed by internal seizure rhythms was essential. Cell type-specific stimulation revealed that the precisely timed activation of medial septum GABAergic neurons underlaid the effects. Our concept of time-targeted proxy stimulation for intervening pathological oscillations can be extrapolated to other neurological and psychiatric disorders, and has potential for clinical translation.
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Affiliation(s)
- Yuichi Takeuchi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, 467-8603, Japan.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Márk Harangozó
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary
| | - Lizeth Pedraza
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Tamás Földi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Gábor Kozák
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary
| | - Qun Li
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Antal Berényi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary.,HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged 6720, Hungary.,Neuroscience Institute, New York University, New York, NY 10016, USA
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Tran DK, Tran DC, Mnatsakayan L, Lin J, Hsu F, Vadera S. Treatment of Multi-Focal Epilepsy With Resective Surgery Plus Responsive Neurostimulation (RNS): One Institution's Experience. Front Neurol 2020; 11:545074. [PMID: 33192973 PMCID: PMC7658333 DOI: 10.3389/fneur.2020.545074] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: Patients with medically refractory focal epilepsy can be difficult to treat surgically, especially if invasive monitoring reveals multiple ictal onset zones. Possible therapeutic options may include resection, neurostimulation, laser ablation, or a combination of these surgical modalities. To date, no study has examined outcomes associated with resection plus responsive neurostimulation (RNS, Neuropace, Inc., Mountain View, CA) implantation and we describe our initial experience in patients with multifocal epilepsy undergoing this combination therapy. Methods: A total of 43 responsive neurostimulation (RNS) devices were implanted at UCI from 2015 to 2019. We retrospectively reviewed charts of patients from the same time period who underwent both resection and RNS implantation. Patients were required to have independent or multifocal onset, undergo resection and RNS implantation, and have a minimum of six-months for follow-up to be included in the study. Demographics, location of ictal onset, location of surgery, complications, and seizure outcome were collected. Results: Ten patients met inclusion criteria for the study, and seven underwent both procedures in the same setting. The average age was 36. All patients had multifocal ictal onset on video electroencephalogram or invasive EEG with four patients undergoing subdural grid placement and four patients undergoing bilateral sEEG prior to the definitive surgery. Five patients underwent resection plus ipsilateral RNS placement and the remainder underwent resection with contralateral RNS placement. Two minor complications were encountered in this group. At six months follow up, there was an average of 81% ± 9 reduction in seizures, while four patients experienced complete seizure freedom at 1 year. Conclusion: Patients with multifocal epilepsy can be treated with partial resection plus RNS. The complication rates are low with potential for worthwhile seizure reduction.
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Affiliation(s)
- Diem Kieu Tran
- Department of Neurological Surgery, University of California, Irvine, Irvine, CA, United States
| | - Demi Chi Tran
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Lilit Mnatsakayan
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Jack Lin
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Frank Hsu
- Department of Neurological Surgery, University of California, Irvine, Irvine, CA, United States
| | - Sumeet Vadera
- Department of Neurological Surgery, University of California, Irvine, Irvine, CA, United States
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Müller M, Caporro M, Gast H, Pollo C, Wiest R, Schindler K, Rummel C. Linear and nonlinear interrelations show fundamentally distinct network structure in preictal intracranial EEG of epilepsy patients. Hum Brain Mapp 2019; 41:467-483. [PMID: 31625670 PMCID: PMC7268049 DOI: 10.1002/hbm.24816] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 12/24/2022] Open
Abstract
Resection of the seizure generating tissue can be highly beneficial in patients with drug-resistant epilepsy. However, only about half of all patients undergoing surgery get permanently and completely seizure free. Investigating the dependences between intracranial EEG signals adds a multivariate perspective largely unavailable to visual EEG analysis, which is the current clinical practice. We examined linear and nonlinear interrelations between intracranial EEG signals regarding their spatial distribution and network characteristics. The analyzed signals were recorded immediately before clinical seizure onset in epilepsy patients who received a standardized electrode implantation targeting the mesiotemporal structures. The linear interrelation networks were predominantly locally connected and highly reproducible between patients. In contrast, the nonlinear networks had a clearly centralized structure, which was specific for the individual pathology. The nonlinear interrelations were overrepresented in the focal hemisphere and in patients with no or only rare seizures after surgery specifically in the resected tissue. Connections to the outside were predominantly nonlinear. In all patients without worthwhile improvement after resective treatment, tissue producing strong nonlinear interrelations was left untouched by surgery. Our findings indicate that linear and nonlinear interrelations play fundamentally different roles in preictal intracranial EEG. Moreover, they suggest nonlinear signal interrelations to be a marker of epileptogenic tissue and not a characteristic of the mesiotemporal structures. Our results corroborate the network-based nature of epilepsy and suggest the application of network analysis to support the planning of resective epilepsy surgery.
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Affiliation(s)
- Michael Müller
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Matteo Caporro
- Department of Neurology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Heidemarie Gast
- Department of Neurology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
| | - Kaspar Schindler
- Department of Neurology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
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Multiphasic Side-Switching Seizures Are Easily Misdiagnosed as Unilateral Seizures During a Single EEG Monitoring Session: A Specific Subtype of Bitemporal Epilepsy. World Neurosurg 2018; 122:656-660. [PMID: 30481627 DOI: 10.1016/j.wneu.2018.11.138] [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: 10/16/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bitemporal epilepsy (BTLE) is a specific anatomoelectroclinical phenotype in the spectrum of temporal lobe epilepsy. The diagnosis of BTLE and the evaluation of the degree of seizure lateralization in BTLE patients are greatly influenced by the duration of EEG recording and the number of recorded habitual seizures. CASE DESCRIPTION A 25-year-old woman had a 5-year history of seizures. Her habitual seizures were described as sudden behavioral arrest, staring, unresponsiveness, and oral automatisms, with auras of fear and palpitation. Intermittent scalp electroencephalography (EEG) and intracranial EEG monitoring over 3 years showed multiphasic side-switching seizures. The seizures were limited to 1 temporal lobe within 1 phase and switched sides between phases. Despite antiepileptic drugs and vagus nerve stimulation, her seizures remained uncontrolled. The patient finally underwent unilateral anteromedial temporal lobectomy, mainly based on >60% of seizures recorded originating from the left side. The patient has been seizure free for more than 1 year at last follow-up. CONCLUSIONS This patient presented 1 specific subtype of BTLE that is prone to be misdiagnosed as unilateral temporal lobe epilepsy if the patient is recorded for a relatively short term, e.g., over a common EEG monitoring duration of 1 to 2 weeks.
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9
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Lin Y, Zhang Z, Zhang X, Yang Y, Huang Z, Zhu Y, Li L, Hu N, Zhang J, Wang Y. Lateralization Value of Low Frequency Band Beamformer Magnetoencephalography Source Imaging in Temporal Lobe Epilepsy. Front Neurol 2018; 9:829. [PMID: 30344505 PMCID: PMC6182046 DOI: 10.3389/fneur.2018.00829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 09/18/2018] [Indexed: 01/02/2023] Open
Abstract
Objective: In presurgical evaluation of temporal lobe epilepsy (TLE), selection of the resection side is challenging when bilateral temporal epileptiform discharges or structural abnormalities are present. We aim to evaluate the lateralization value of beamformer analysis of magnetoencephalography (MEG) in TLE. Methods: MEG data from 14 TLE patients were analyzed through beamformer analysis. We measured the hemispherical power distribution of beamformer sources and calculated the lateralization index (LI). We calculated the LI at multiple frequencies to explore the frequency dependency and at the delta frequency to define laterality. LI values ranging from -1 to -0.05 indicated right hemispheric dominance. LI values ranging from 0.05 to 1 indicated left hemispheric dominance. LI values ranging from -0.05 to 0.05 defined bilaterality. We measured the power of beamformer sources with a 9-s duration to explore time dependency. Results: The beamformer analysis showed that 10/14 patients had power dominance ipsilateral to resection. The delta frequency band had a higher lateralization value than other frequency bands. A time-dependent power fluctuation was found in the delta frequency band. Conclusions: MEG beamformer analysis, especially in the delta band, might efficiently provide additional information regarding lateralization in TLE.
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Affiliation(s)
- Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Zhiguo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xiating Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yingxue Yang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yu Zhu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Liping Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Ningning Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Junpeng Zhang
- Department of Medical Information Engineering, Sichuan University, Chengdu, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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10
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Schmeiser B, Zentner J, Steinhoff B, Brandt A, Schulze-Bonhage A, Kogias E, Hammen T. The role of presurgical EEG parameters and of reoperation for seizure outcome in temporal lobe epilepsy. Seizure 2017; 51:174-179. [DOI: 10.1016/j.seizure.2017.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/13/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022] Open
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11
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Uemori T, Toda K, Seki T. Seizure severity-dependent selective vulnerability of the granule cell layer and aberrant neurogenesis in the rat hippocampus. Hippocampus 2017; 27:1054-1068. [PMID: 28608989 DOI: 10.1002/hipo.22752] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 12/20/2022]
Abstract
The pilocarpine-induced status epilepticus rodent model has been commonly used to analyze the mechanisms of human temporal lobe epilepsy. Recent studies using this model have demonstrated that epileptic seizures lead to increased adult neurogenesis of the dentate granule cells, and cause abnormal cellular organization in dentate neuronal circuits. In this study, we examined these structural changes in rats with seizures of varying severity. In rats with frequent severe seizures, we found a clear loss of Prox1 and NeuN expression in the dentate granule cell layer (GCL), which was confined mainly to the suprapyramidal blade of the GCL at the septal and middle regions of the septotemporal axis of the hippocampus. In the damaged suprapyramidal region, the number of immature neurons in the subgranular zone was markedly reduced. In contrast, in rats with less frequent severe seizures, there was almost no loss of Prox1 and NeuN expression, and the number of immature neurons was increased. In rats with no or slight loss of Prox1 expression in the GCL, ectopic immature neurons were detected in the molecular layer of the suprapyramidal blade in addition to the hilus, and formed chainlike aggregated structures along the blood vessels up to the hippocampal fissure, suggesting that newly generated neurons migrate at least partially along blood vessels to the hippocampal fissure. These results suggest that seizures of different severity cause different effects on GCL damage, neurogenesis, and the migration of new neurons, and that these structural changes are selective to subdivisions of the GCL and the septotemporal axis of the hippocampus.
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Affiliation(s)
- Takeshi Uemori
- Department of Histology and Neuroanatomy, Tokyo Medical University, Tokyo, Japan
| | - Keiko Toda
- Department of Histology and Neuroanatomy, Tokyo Medical University, Tokyo, Japan
| | - Tatsunori Seki
- Department of Histology and Neuroanatomy, Tokyo Medical University, Tokyo, Japan
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12
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El Tahry R, Wang IZ. Failed epilepsy surgery: is this the end? Acta Neurol Belg 2017; 117:433-440. [PMID: 28303525 DOI: 10.1007/s13760-017-0769-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/07/2017] [Indexed: 12/14/2022]
Abstract
Resective epilepsy surgery can lead to sustained seizure control in 70-80% of patients evaluated for epilepsy surgery, indicating that up to 30% of patients still have recurrent seizures after surgery. Definitions of failed epilepsy surgery vary amongst studies. This review focuses on seizure outcome predictors after reoperation, possible mechanisms of failure and best management for this difficult patient population.
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Affiliation(s)
- Riëm El Tahry
- Department of Neurology, Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium.
- Department of Pneumology, Sleep Laboratory, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Av Hippocrate 10, 1200, Brussels, Belgium.
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13
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Outcome of temporal lobe epilepsy surgery evaluated with bitemporal intracranial electrode recordings. Epilepsy Res 2016; 127:324-330. [DOI: 10.1016/j.eplepsyres.2016.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 11/23/2022]
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Ding P, Zhang S, Zhang J, Hu X, Yu X, Liang S, Gao C, Liang S. Contralateral Hippocampal Stimulation for Failed Unilateral Anterior Temporal Lobectomy in Patients with Bilateral Temporal Lobe Epilepsy. Stereotact Funct Neurosurg 2016; 94:327-335. [PMID: 27723659 DOI: 10.1159/000449008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
Abstract
AIMS To prospectively study the surgical outcomes of unilateral anterior temporal lobectomy (ATL) in patients with intractable bilateral temporal lobe epilepsy (TLE) as well as two-staged contralateral hippocampal stimulation in patients after failed unilateral ATL. METHODS Eighteen carefully selected patients with bilateral TLE underwent unilateral ATL. Five cases with failed ATL underwent two-staged contralateral hippocampal stimulation. Seizure control and changes in intelligence quotient (IQ), memory quotient, and quality of life (QOL) were analyzed 2-5 years after treatment. RESULTS In the patients with unilateral ATL, the percentages seizure free were 55.6% (10/18), 50.0% (9/18), and 44.4% (4/9) at the 1-, 2-, and 5-year follow-up visits, respectively. There were significant difference in seizure control between the patients with unilateral ATL and the 12 cases in the medication group. Significant differences were also found in changes in the patients' QOL and full-scale IQ at the 2-year follow-up between the surgical and medication groups. Five patients who underwent contralateral hippocampal stimulation after failed unilateral ATL experienced 80-100% seizure reductions, and 80% were seizure free 1 year after hippocampal stimulation. CONCLUSION Unilateral ATL provides good seizure control and does not cause serious memory or IQ injury in carefully selected patients with true bilateral TLE. Contralateral hippocampal stimulation is a useful approach for patients who experience unilateral ATL failure.
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Affiliation(s)
- Ping Ding
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Stylianou P, Kimchi G, Hoffmann C, Blat I, Harnof S. Neuroimaging for patient selection for medial temporal lobe epilepsy surgery: Part 2 functional neuroimaging. J Clin Neurosci 2016; 23:23-33. [DOI: 10.1016/j.jocn.2015.04.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/11/2015] [Accepted: 04/18/2015] [Indexed: 11/17/2022]
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Nazem-Zadeh MR, Elisevich K, Air EL, Schwalb JM, Divine G, Kaur M, Wasade VS, Mahmoudi F, Shokri S, Bagher-Ebadian H, Soltanian-Zadeh H. DTI-based response-driven modeling of mTLE laterality. NEUROIMAGE-CLINICAL 2015; 11:694-706. [PMID: 27330966 PMCID: PMC4900487 DOI: 10.1016/j.nicl.2015.10.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 12/30/2022]
Abstract
Purpose To develop lateralization models for distinguishing between unilateral and bilateral mesial temporal lobe epilepsy (mTLE) and determining laterality in cases of unilateral mTLE. Background mTLE is the most common form of medically refractory focal epilepsy. Many mTLE patients fail to demonstrate an unambiguous unilateral ictal onset. Intracranial EEG (icEEG) monitoring can be performed to establish whether the ictal origin is unilateral or truly bilateral with independent bitemporal ictal origin. However, because of the expense and risk of intracranial electrode placement, much research has been done to determine if the need for icEEG can be obviated with noninvasive neuroimaging methods, such as diffusion tensor imaging (DTI). Methods Fractional anisotropy (FA) was used to quantify microstructural changes reflected in the diffusivity properties of the corpus callosum, cingulum, and fornix, in a retrospective cohort of 31 patients confirmed to have unilateral (n = 24) or bilateral (n = 7) mTLE. All unilateral mTLE patients underwent resection with an Engel class I outcome. Eleven were reported to have hippocampal sclerosis on pathological analysis; nine had undergone prior icEEG. The bilateral mTLE patients had undergone icEEG demonstrating independent epileptiform activity in both right and left hemispheres. Twenty-three nonepileptic subjects were included as controls. Results In cases of right mTLE, FA showed significant differences from control in all callosal subregions, in both left and right superior cingulate subregions, and in forniceal crura. Comparison of right and left mTLE cases showed significant differences in FA of callosal genu, rostral body, and splenium and the right posteroinferior and superior cingulate subregions. In cases of left mTLE, FA showed significant differences from control only in the callosal isthmus. Significant differences in FA were identified when cases of right mTLE were compared with bilateral mTLE cases in the rostral and midbody callosal subregions and isthmus. Based on 11 FA measurements in the cingulate, callosal and forniceal subregions, a response-driven lateralization model successfully differentiated all cases (n = 54) into groups of unilateral right (n = 12), unilateral left (n = 12), and bilateral mTLE (n = 7), and nonepileptic control (23). Conclusion The proposed response-driven DTI biomarker is intended to lessen diagnostic ambiguity of laterality in cases of mTLE and help optimize selection of surgical candidates. Application of this model shows promise in reducing the need for invasive icEEG in prospective cases. Develop response-driven lateralization model using diffusion tensor imaging Distinguish between unilateral and bilateral mesial temporal lobe epilepsy (mTLE) Determine or lessen diagnostic ambiguity of laterality in cases of unilateral mTLE Optimize selection of surgical candidates Reduction of the need for intracranial EEG
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Affiliation(s)
| | - Kost Elisevich
- Department of Clinical Neurosciences, Spectrum Health Medical Group, Division of Neurosurgery, Michigan State University, Grand Rapids, MI 49503, USA
| | - Ellen L Air
- Neurosurgery Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Jason M Schwalb
- Neurosurgery Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | - George Divine
- Public Health Sciences Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Manpreet Kaur
- Neurosurgery Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | | | - Fariborz Mahmoudi
- Radiology and Research Administration Department, Henry Ford Health System, Detroit, MI 48202, USA; Computer and IT engineering Faculty, Islamic Azad University, Qazvin Branch, Iran.
| | - Saeed Shokri
- Radiology and Research Administration Department, Henry Ford Health System, Detroit, MI 48202, USA; School of Computer Science, Wayne State University, Detroit, MI 48202, USA.
| | - Hassan Bagher-Ebadian
- Radiology and Research Administration Department, Henry Ford Health System, Detroit, MI 48202, USA; Neurology Department, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Hamid Soltanian-Zadeh
- Radiology and Research Administration Department, Henry Ford Health System, Detroit, MI 48202, USA; Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer, University of Tehran, Tehran, Iran.
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Waseem H, Osborn KE, Schoenberg MR, Kelley V, Bozorg AM, Benbadis SR, Vale FL. Predictors of surgical outcome in medically-resistant temporal lobe epilepsy with bilateral features on pre-operative evaluation. Clin Neurol Neurosurg 2015; 139:199-205. [PMID: 26513433 DOI: 10.1016/j.clineuro.2015.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 08/09/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study identifies potential prognostic factors for favorable anterior mesial temporal lobe (AMTL) resection outcomes in patients with medically refractory temporal lobe epilepsy (TLE) with bilateral features on pre-operative examination. METHODS Thirty-one patients demonstrated bilateral features defined as: bilateral independent temporal or bitemporal ictal onsets on surface or intracranial EEG, or bitemporal interictal epileptiform abnormalities on surface EEG with bilateral radiographic mesial temporal sclerosis. Surgical outcomes were classified according to reduction in seizure frequency: I (100% reduction), II (≥75% reduction), III (50-74% reduction), IV (<50% reduction). RESULTS Of 31 patients, 14 (45%) improved to class I and 9 (29%) had a class II outcome at an average of 4 years after surgery. Eight (26%) patients did not exhibit good surgical outcome (class III, class IV). We found that neuropsychological and Wada memory scores were significantly correlated (p<0.05) with surgical outcome, and logistic regression found neuropsychological evaluation significantly predicted better surgical outcome (p<0.05). CONCLUSIONS When bilateral features are present on pre-operative evaluation, neuropsychological and Wada test results can provide unique data to better identify those patients more likely to achieve substantial seizure reduction.
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Affiliation(s)
- Hena Waseem
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA.
| | - Katie E Osborn
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 East Fletcher Avenue, Tampa, FL 33613, USA.
| | - Mike R Schoenberg
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA; Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 East Fletcher Avenue, Tampa, FL 33613, USA; Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA.
| | - Valerie Kelley
- Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA.
| | - Ali M Bozorg
- Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA.
| | - Selim R Benbadis
- Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA.
| | - Fernando L Vale
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA.
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Stylianou P, Hoffmann C, Blat I, Harnof S. Neuroimaging for patient selection for medial temporal lobe epilepsy surgery: Part 1 Structural neuroimaging. J Clin Neurosci 2015; 23:14-22. [PMID: 26362835 DOI: 10.1016/j.jocn.2015.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/27/2015] [Accepted: 04/05/2015] [Indexed: 11/19/2022]
Abstract
The objective of part one of this review is to present the structural neuroimaging techniques that are currently used to evaluate patients with temporal lobe epilepsy (TLE), and to discuss their potential to define patient eligibility for medial temporal lobe surgery. A PubMed query, using Medline and Embase, and subsequent review, was performed for all English language studies published after 1990, reporting neuroimaging methods for the evaluation of patients with TLE. The extracted data included demographic variables, population and study design, imaging methods, gold standard methods, imaging findings, surgical outcomes and conclusions. Overall, 56 papers were reviewed, including a total of 1517 patients. This review highlights the following structural neuroimaging techniques: MRI, diffusion-weighted imaging, tractography, electroencephalography and magnetoencephalography. The developments in neuroimaging during the last decades have led to remarkable improvements in surgical precision, postsurgical outcome, prognosis, and the rate of seizure control in patients with TLE. The use of multiple imaging methods provides improved outcomes, and further improvements will be possible with future studies of larger patient cohorts.
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Affiliation(s)
- Petros Stylianou
- Department of Neurosurgery, The Chaim Sheba Medical Center, Nissim Aloni 16, Tel Aviv-Yafo 62919, Israel.
| | - Chen Hoffmann
- Department of Radiology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ilan Blat
- Department of Neurology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Sagi Harnof
- Department of Neurosurgery, The Chaim Sheba Medical Center, Nissim Aloni 16, Tel Aviv-Yafo 62919, Israel
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Didato G, Chiesa V, Villani F, Pelliccia V, Deleo F, Gozzo F, Canevini MP, Mai R, Spreafico R, Cossu M, Tassi L. Bitemporal epilepsy: A specific anatomo-electro-clinical phenotype in the temporal lobe epilepsy spectrum. Seizure 2015; 31:112-9. [DOI: 10.1016/j.seizure.2015.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022] Open
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Řehulka P, Doležalová I, Janoušová E, Tomášek M, Marusič P, Brázdil M, Kuba R. Ictal and postictal semiology in patients with bilateral temporal lobe epilepsy. Epilepsy Behav 2014; 41:40-6. [PMID: 25282104 DOI: 10.1016/j.yebeh.2014.09.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/07/2014] [Accepted: 09/10/2014] [Indexed: 11/28/2022]
Abstract
Bilateral temporal lobe epilepsy is characterized by evidence of seizure onset independently in both temporal lobes. The main aim of the present study was to determine whether patients with evidence of independent bilateral temporal lobe epilepsy (biTLE) can be identified noninvasively on the basis of seizure semiology analysis. Thirteen patients with biTLE, as defined by invasive EEG, were matched with 13 patients with unilateral temporal lobe epilepsy (uniTLE). In all 26 patients, the frequency of predefined clusters of ictal and periictal signs were evaluated: ictal motor signs (IMSs), periictal motor signs (PIMSs), periictal vegetative signs (PIVSs), the frequency of early oroalimentary automatisms (EOAs), and the duration of postictal unresponsiveness (PU). Some other noninvasive and clinical data were also evaluated. A lower frequency of IMSs was noted in the group with biTLE (patients = 46.2%, seizures = 20.7%) than in the group with uniTLE (patients = 92.3%, seizures = 61.0%) (p = 0.030; p < 0.001, respectively). The individual IMS average per seizure was significantly lower in the group with biTLE (0.14; range = 0-1.0) than in the group with uniTLE (0.80; range = 0-2.6) (p = 0.003). Postictal unresponsiveness was longer than 5 min in more patients (75.0%) and seizures (42.9%) in the group with biTLE than in the group with uniTLE (patients = 30.8%, seizures = 18.6%) (p = 0.047; p = 0.002). The frequency of EOAs, PIMSs, PIVSs, and other clinical data did not differ significantly. There is a lower frequency of ictal motor signs and longer duration of postictal unresponsiveness in patients with biTLE.
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Affiliation(s)
- Pavel Řehulka
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Behavioural and Social Neuroscience Research Group, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic.
| | - Irena Doležalová
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Behavioural and Social Neuroscience Research Group, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Eva Janoušová
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Martin Tomášek
- Department of Neurology, Charles University in Prague, Second Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Petr Marusič
- Department of Neurology, Charles University in Prague, Second Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Milan Brázdil
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Behavioural and Social Neuroscience Research Group, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Robert Kuba
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; Behavioural and Social Neuroscience Research Group, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
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Aghakhani Y, Liu X, Jette N, Wiebe S. Epilepsy surgery in patients with bilateral temporal lobe seizures: A systematic review. Epilepsia 2014; 55:1892-901. [DOI: 10.1111/epi.12856] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Yahya Aghakhani
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
| | - Xiaorong Liu
- Institute of Neuroscience and the Second Affiliated Hospital; Guangzhou Medical University; Guangzhou China
| | - Nathalie Jette
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences; Institute of Public Health and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences; Institute of Public Health and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
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Vogt VL, Witt JA, Malter MP, Schoene-Bake JC, Lehe MV, Elger CE, Helmstaedter C. Neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis. J Neurosurg 2014; 121:1247-56. [DOI: 10.3171/2014.7.jns132037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this study was to retrospectively assess the objective and subjective neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis (AHS).
Methods
Memory and executive functions were evaluated at baseline and at follow-up in 11 surgically treated patients and compared with 8 pharmacologically treated patients with temporal lobe epilepsy and bilateral AHS. The median follow-up duration was 16 months in the surgically treated patients and 80.5 months in the pharmacologically treated group. Subjective outcome was evaluated by questionnaires and included mood, quality of life, subjective memory, and activities of daily living.
Results
At the follow-up assessment, 82% of the surgically treated patients as opposed to 0% of the nonsurgery patients were seizure free. In the surgical group, nonverbal memory performance did not change significantly in any patient after surgery, but there was a floor effect in 55% of the surgical patients. Regarding verbal memory, 9% of the surgical patients improved while 73% declined, despite severe impairments already evident at baseline. In the nonsurgery control group, 13% of the patients declined in nonverbal memory (floor effect in 63%) and 25% declined in verbal memory (floor effect in 25%) at follow-up. None of the controls improved at follow-up. Executive functions remained unchanged on an impaired level in both groups. At follow-up, the patient groups did not differ significantly with respect to mood, quality of life, subjective memory, or activities of daily living. However, in most aspects, surgically treated patients reported a slightly better subjective outcome than pharmacologically treated patients and a significantly improved quality of life.
Conclusions
These results suggest that beyond benefits concerning seizure control, surgically treated patients with bilateral AHS, despite already poor baseline performance, are still at risk for severe postoperative decline in memory. In the light of predominantly minor benefits on a subjective level, the findings put the overall outcome of epilepsy surgery in bilateral AHS patients into perspective.
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Affiliation(s)
| | | | | | | | - Marec von Lehe
- 2Neurosurgery, University of Bonn, Medical Center, Bonn, Germany
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Tsiptsios DI, Howard RS, Koutroumanidis MA. Electroencephalographic assessment of patients with epileptic seizures. Expert Rev Neurother 2014; 10:1869-86. [DOI: 10.1586/ern.10.175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Malter MP, Tschampa HJ, Helmstaedter C, Urbach H, von Lehe M, Becker A, Clusmann H, Elger CE, Bien CG. Outcome after epilepsy surgery in patients with MRI features of bilateral ammon's horn sclerosis. Epilepsy Res 2013; 105:150-7. [DOI: 10.1016/j.eplepsyres.2013.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/17/2012] [Accepted: 02/11/2013] [Indexed: 11/25/2022]
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Chkhenkeli SA, ramka M, Rakviashvili TN, Lortkipanidze GS, Magalashvili GE, Bregvadze ES, Otarashvili A, Gagoshidze TS. Bitemporal Intractable Epilepsy: Could It Be Surgically Treatable? Stereotact Funct Neurosurg 2013; 91:104-12. [DOI: 10.1159/000343198] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 02/12/2011] [Indexed: 11/19/2022]
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Raghavendra S, Nooraine J, Mirsattari SM. Role of electroencephalography in presurgical evaluation of temporal lobe epilepsy. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:204693. [PMID: 23198144 PMCID: PMC3503287 DOI: 10.1155/2012/204693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/18/2012] [Accepted: 06/28/2012] [Indexed: 11/17/2022]
Abstract
Surgery remains a therapeutic option for patients with medically refractory epilepsy. Comprehensive presurgical evaluation includes electroencephalography (EEG) and video EEG in identifying patients who are likely to benefit from surgery. Here, we discuss in detail the utility of EEG in presurgical evaluation of patients with temporal lobe epilepsy along with illustrative cases.
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Affiliation(s)
| | - Javeria Nooraine
- Department of Neurology, Vikram Hospital, Bangalore 560052, India
| | - Seyed M. Mirsattari
- Departments of Clinical Neurological Sciences, Medical Imaging, Medical Biophysics, and Psychology, University of Western Ontario, London, ON, Canada N6A 5A5
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Wasade VS, Elisevich K, Schultz L, Jafari-Khouzani K, Smith BJ, Soltanian-Zadeh H, Constantinou J. Analysis of scalp EEG and quantitative MRI in cases of temporal lobe epilepsy requiring intracranial electrographic monitoring. Br J Neurosurg 2012; 27:221-7. [DOI: 10.3109/02688697.2012.724121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Temporal lobe epilepsy surgery failures: a review. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:201651. [PMID: 22934162 PMCID: PMC3420575 DOI: 10.1155/2012/201651] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 01/17/2012] [Accepted: 02/01/2012] [Indexed: 11/23/2022]
Abstract
Patients with temporal lobe epilepsy (TLE) are refractory to antiepileptic drugs in about 30% of cases. Surgical treatment has been shown to be beneficial for the selected patients but fails to provide a seizure-free outcome in 20–30% of TLE patients. Several reasons have been identified to explain these surgical failures. This paper will address the five most common causes of TLE surgery failure (a) insufficient resection of epileptogenic mesial temporal structures, (b) relapse on the contralateral mesial temporal lobe, (c) lateral temporal neocortical epilepsy, (d) coexistence of mesial temporal sclerosis and a neocortical lesion (dual pathology); and (e) extratemporal lobe epilepsy mimicking TLE or temporal plus epilepsy. Persistence of epileptogenic mesial structures in the posterior temporal region and failure to distinguish mesial and lateral temporal epilepsy are possible causes of seizure persistence after TLE surgery. In cases of dual pathology, failure to identify a subtle mesial temporal sclerosis or regions of cortical microdysgenesis is a likely explanation for some surgical failures. Extratemporal epilepsy syndromes masquerading as or coexistent with TLE result in incomplete resection of the epileptogenic zone and seizure relapse after surgery. In particular, the insula may be an important cause of surgical failure in patients with TLE.
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Jacobs J, Zijlmans M, Zelmann R, Chatillon CE, Hall J, Olivier A, Dubeau F, Gotman J. High-frequency electroencephalographic oscillations correlate with outcome of epilepsy surgery. Ann Neurol 2010; 67:209-20. [PMID: 20225281 DOI: 10.1002/ana.21847] [Citation(s) in RCA: 451] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE High-frequency oscillations (HFOs) in the intracerebral electroencephalogram (EEG) have been linked to the seizure onset zone (SOZ). We investigated whether HFOs can delineate epileptogenic areas even outside the SOZ by correlating the resection of HFO-generating areas with surgical outcome. METHODS Twenty patients who underwent a surgical resection for medically intractable epilepsy were studied. All had presurgical intracerebral EEG (500Hz filter and 2,000Hz sampling rate), at least 12-month postsurgical follow-up, and a postsurgical magnetic resonance imaging (MRI). HFOs (ripples, 80-250Hz; fast ripples, >250Hz) were identified visually during 5 to 10 minutes of slow-wave sleep. Rates and extent of HFOs and interictal spikes in resected versus nonresected areas, assessed on postsurgical MRIs, were compared with surgical outcome (Engel's classification). We also evaluated the predictive value of removing the SOZ in terms of surgical outcome. RESULTS The mean duration of follow-up was 22.7 months. Eight patients had good (Engel classes 1 and 2) and 12 poor (classes 3 and 4) surgical outcomes. Patients with a good outcome had a significantly larger proportion of HFO-generating areas removed than patients with a poor outcome. No such difference was seen for spike-generating regions or the SOZ. INTERPRETATION The correlation between removal of HFO-generating areas and good surgical outcome indicates that HFOs could be used as a marker of epileptogenicity and may be more accurate than spike-generating areas or the SOZ. In patients in whom the majority of HFO-generating tissue remained, a poor surgical outcome occurred.
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Affiliation(s)
- Julia Jacobs
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
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Jacobs J, Levan P, Châtillon CE, Olivier A, Dubeau F, Gotman J. High frequency oscillations in intracranial EEGs mark epileptogenicity rather than lesion type. ACTA ACUST UNITED AC 2009; 132:1022-37. [PMID: 19297507 DOI: 10.1093/brain/awn351] [Citation(s) in RCA: 251] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
High frequency oscillations (HFOs) called ripples (80-250 Hz) and fast ripples (FR, 250-500 Hz) can be recorded from intracerebral EEG macroelectrodes in patients with intractable epilepsy. HFOs occur predominantly in the seizure onset zone (SOZ) but their relationship to the underlying pathology is unknown. It was the aim of this study to investigate whether HFOs are specific to the SOZ or result from pathologically changed tissue, whether or not it is epileptogenic. Patients with different lesion types, namely mesial temporal atrophy (MTA), focal cortical dysplasia (FCD) and nodular heterotopias (NH) were investigated. Intracranial EEG was recorded from depth macroelectrodes with a sampling rate of 2000 Hz. Ripples (80-250 Hz) and Fast Ripples (250-500 Hz) were visually marked in 12 patients: five with MTA, four with FCD and three with NH. Rates of events were statistically compared in channels in four areas: lesional SOZ, non-lesional SOZ, lesional non-SOZ and non-lesional non-SOZ. HFO rates were clearly more linked to the SOZ than to the lesion. They were highest in areas in which lesion and SOZ overlap, but in patients with a SOZ outside the lesion, such as in NHs, HFO rates were clearly higher in the non-lesional SOZ than in the inactive lesions. No specific HFO pattern could be identified for the different lesion types. The findings suggest that HFOs represent a marker for SOZ areas independent of the underlying pathology and that pathologic tissue changes alone do not lead to high rates of HFOs.
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Affiliation(s)
- Julia Jacobs
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada.
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Chkhenkeli SA, Towle VL, Lortkipanidze GS, Spire JP, Bregvadze ES, Hunter JD, Kohrman M, Frim DM. Mutually suppressive interrelations of symmetric epileptic foci in bitemporal epilepsy and their inhibitory stimulation. Clin Neurol Neurosurg 2006; 109:7-22. [PMID: 16707211 DOI: 10.1016/j.clineuro.2006.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 03/27/2006] [Accepted: 03/31/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The goal of this study is to analyze the suppressive interaction of symmetric temporal lobe epileptic foci, assess some failures of epilepsy surgery, and evaluate the possibility of terminating focal seizures with stimulation of symmetric epileptic foci. MATERIALS AND METHODS One hundred and twenty-nine intractable epilepsy patients (age range 6-53 years) with bitemporal epileptiform abnormalities in multiple scalp EEGs were evaluated with chronically implanted depth and subdural electrodes. Interelectrode coherence and power spectra were studied using internally developed software. RESULTS Bitemporal epileptic foci were found in 85/129 (66%) patients with reciprocal relations between these foci in 57/85 (67%) patients. Temporal lobectomy was performed for 67/85 patients. 12/67 patients became free of seizures (Engel's Class I), 32/67 improved (Classes II and III), and 23/67 did not improve. 14/23 patients demonstrated post-surgical activation of the contralateral temporal lobe epileptic focus. For 8/14 of these patients, the stereotactic cryoamygdalatomy was performed in the temporal lobe contralateral to the first surgery. 5/8 patients became free of seizures. It was found that stimulation of temporal lobe deep epileptic focus may terminate focal seizures in the contralateral symmetric structures. CONCLUSION A mutually suppressive relationship is one of variants of the interaction of symmetric epileptic foci. Some epilepsy surgery failures may be a result of post-surgical activation of the intact focus. The increase of coherence between both temporal lobes before the seizure onset of the seizure suggests the establishment of functional interrelations between two epileptic foci at an early, "hidden" phase of seizures, and may predict the direction of seizure spread. Mutually suppressive interrelations of symmetric epileptic foci might be employed for chronic therapeutic stimulation.
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Jenssen S, Liporace J, Nei M, O'connor MJ, Sperling MR. Value of non-invasive testing when there are independent bitemporal seizures in the scalp EEG. Epilepsy Res 2006; 68:115-22. [PMID: 16386405 DOI: 10.1016/j.eplepsyres.2005.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 09/15/2005] [Accepted: 10/19/2005] [Indexed: 11/18/2022]
Abstract
We investigated the value of non-invasive data for predicting the outcome of intracranial EEG and anterior temporal lobectomy (ATL) (follow-up>1 year) in patients who have bitemporal independent seizures in the scalp EEG. No previous report has dealt with this patient group. Independent variables were duration of epilepsy, febrile seizures, interictal and ictal scalp EEG, ictal behavior, MRI, [18F]-fluorodeoxyglucose-PET (PET) and Wada test and dependent variables were surgical outcome (seizure free or not) and localized on intracranial EEG (finding all symptomatic seizures from one temporal lobe). Non-parametric statistics were used. Of 24 patients, 20 patients had IEEG, of which 12 were localized and 8 were not. Sixteen patients had ATL and, of these, 13 (81%) became seizure free and the remaining three improved. Lateralized findings on MRI and PET, a history of febrile convulsions and shorter duration of epilepsy were all associated with a focal onset on intracranial EEG, while there was a non-significant trend with ictal behavior. The non-invasive data did not predict surgical outcome. We conclude that some of these patients can do well with surgery. In most cases, intracranial EEG is necessary for localization of seizure focus, but if PET and MRI show focal abnormalities and there is a history of febrile convulsions no further evaluation could be needed. These findings need confirmation.
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Affiliation(s)
- Sigmund Jenssen
- Department of Neurology, Drexel Medical College, Hahnemann University Hospital, Mail Stop 423, Broad and Vine Streets, Philadelphia, PA 19129, USA.
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Escorsi-Rosset S, Bianchin MM, Walz R, Terra-Bustamante VC, Carlotti Jr. CG, Assirati Jr. JA, Santos AC, Sakamoto AC. Memory tests are not good predictors of surgical outcome in patients with mesial temporal Lobe epilepsy associated with hippocampal sclerosis. ACTA ACUST UNITED AC 2005. [DOI: 10.1590/s1676-26492005000300003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction: One of the objectives of pre-surgical evaluation in mesial temporal epilepsy associated to hippoocampal sclerosis is the identification of patients with bad surgical prognosis for seizure control. At least theoretically, neuropsychological tests could be used in this venue. Objective: To evaluate whether verbal and visual memory tests can be used as isolate predictors of the post-surgical seizure outcome in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis refractory to pharmacological treatment. Methods: In a retrospective cohort study using the control of epileptic seizures as end-point, we evaluated 187 patients and calculated the correlation of clinical variables, cognitive evaluation, neuroimaging data, demographic data and electrophysiological findings with the result of seizure control after lobectomy in these patients. Results: An unfavorable prognosis during the postoperative period was observed only in association with low visual reproduction scores (visual memory). However, after Bonferroni correction, which was necessary to reduce the chance of type I error, this result was found to be spurious. Conclusion: We conclude that neuropsychological tests of verbal and visual memory such as those used in the routine presurgical evaluation of our patients with temporal lobe epilepsy are not good isolated predictors of surgical outcome.
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Affiliation(s)
| | | | - Roger Walz
- Federal University of Santa Catarina, Brazil
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