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Bustros S, Kaur M, Ritchey E, Szaflarski JP, McGwin GJ, Riley KO, Bentley JN, Memon AA, Jaisani Z. Non-lesional epilepsy does not necessarily convey poor outcomes after invasive monitoring followed by resection or thermal ablation. Neurol Res 2024; 46:653-661. [PMID: 38602305 DOI: 10.1080/01616412.2024.2340879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE We aimed to compare outcomes including seizure-free status at the last follow-up in adult patients with medically refractory focal epilepsy identified as lesional vs. non-lesional based on their magnetic resonance imaging (MRI) findings who underwent invasive evaluation followed by subsequent resection or thermal ablation (LiTT). METHODS We identified 88 adult patients who underwent intracranial monitoring between 2014 and 2021. Of those, 40 received resection or LiTT, and they were dichotomized based on MRI findings, as lesional (N = 28) and non-lesional (N = 12). Patient demographics, seizure characteristics, non-invasive interventions, intracranial monitoring, and surgical variables were compared between the groups. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification, and postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Statistical analyses employed Fisher's exact test to compare categorical variables, while a t-test was used for continuous variables. RESULTS There were no differences in baseline characteristics between groups except for more often noted PET abnormality in the lesional group (p = 0.0003). 64% of the lesional group and 57% of the non-lesional group received surgical resection or LiTT (p = 0.78). At the last follow-up, 78.5% of the patients with lesional MRI findings achieved Engel I outcomes compared to 66.7% of non-lesional patients (p = 0.45). Kaplan-Meier curves did not show a significant difference in seizure-free duration between both groups after surgical intervention (p = 0.49). SIGNIFICANCE In our sample, the absence of lesion on brain MRI was not associated with worse seizure outcomes in adult patients who underwent invasive intracranial monitoring followed by resection or thermal ablation.
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Affiliation(s)
- Stephanie Bustros
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Manmeet Kaur
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Elizabeth Ritchey
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Gerald Jr McGwin
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - J Nicole Bentley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Adeel A Memon
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - Zeenat Jaisani
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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Jha R, Chua MMJ, Sarkis R, Tobochnik S, Rolston JD. Predictors of SOZ localization, subsequent surgical intervention, and seizure outcomes in iEEG. Ann Clin Transl Neurol 2024; 11:1787-1797. [PMID: 38831617 PMCID: PMC11251470 DOI: 10.1002/acn3.52084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE A third of the patients who undergo intracranial EEG (iEEG) for seizure-onset zone (SOZ) localization do not proceed to resective surgery for epilepsy, and over half of those who do continue to have seizures following treatment. To better identify candidates who are more likely to see benefits from undergoing iEEG, we investigated preoperative and iEEG peri-operative features associated with the localization of a putative SOZ, undergoing subsequent surgical treatment, and seizure outcomes. METHODS We conducted a retrospective cohort study of consecutive patients who underwent iEEG from 2001 to 2022 at two institutions. Outcomes included SOZ identification, proceeding to surgical treatment (resection vs. neuromodulation), and subsequent seizure freedom. RESULTS We identified 329 unique patients who were followed for a median of 3.9 (IQR:7) years, with a minimum of 2-year follow-up for seizure outcomes analyses. Multivariate analysis identified lateralized and lobar localization on scalp EEG (OR 3.8, p = 0.001) to be associated with SOZ localization. Patients with unilateral localization on scalp EEG (OR 3.0, p = 0.003), unilateral preimplantation hypothesis (OR 3.1, p = 0.001), and lesional preoperative MRI (OR 2.1, p = 0.033) were more likely to undergo resection than neuromodulation. Similarly, a unilateral pre-implantation hypothesis (OR 2.6, p < 0.001) favored seizure freedom, whereas prior neuromodulation (OR 0.3, p = 0.013) decreased the odds. Larger number of preoperative anti-seizure medications (ASMs) did not influence seizure freedom rates but did decrease favorable (Engel I, II) seizure outcomes (OR 0.7, p = 0.026). INTERPRETATION Non-invasive localization data prior to iEEG are associated with subsequent resection and seizure freedom, independent of iEEG localization. Factors predictive of SOZ localization are not necessarily predictive of post-operative seizure freedom.
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Affiliation(s)
- Rohan Jha
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Melissa M. J. Chua
- Department of NeurosurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Rani Sarkis
- Department of NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Steven Tobochnik
- Department of NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - John D. Rolston
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurosurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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van Dalen T, Kirkham JF, Chari A, D'Arco F, Moeller F, Eltze C, Cross JH, Tisdall MM, Thornton RC. Characterizing Frontal Lobe Seizure Semiology in Children. Ann Neurol 2024; 95:1138-1148. [PMID: 38624073 DOI: 10.1002/ana.26922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE The objective was to analyze seizure semiology in pediatric frontal lobe epilepsy patients, considering age, to localize the seizure onset zone for surgical resection in focal epilepsy. METHODS Fifty patients were identified retrospectively, who achieved seizure freedom after frontal lobe resective surgery at Great Ormond Street Hospital. Video-electroencephalography recordings of preoperative ictal seizure semiology were analyzed, stratifying the data based on resection region (mesial or lateral frontal lobe) and age at surgery (≤4 vs >4). RESULTS Pediatric frontal lobe epilepsy is characterized by frequent, short, complex seizures, similar to adult cohorts. Children with mesial onset had higher occurrence of head deviation (either direction: 55.6% vs 17.4%; p = 0.02) and contralateral head deviation (22.2% vs 0.0%; p = 0.03), ictal body-turning (55.6% vs 13.0%; p = 0.006; ipsilateral: 55.6% vs 4.3%; p = 0.0003), and complex motor signs (88.9% vs 56.5%; p = 0.037). Both age groups (≤4 and >4 years) showed hyperkinetic features (21.1% vs 32.1%), contrary to previous reports. The very young group showed more myoclonic (36.8% vs 3.6%; p = 0.005) and hypomotor features (31.6% vs 0.0%; p = 0.003), and fewer behavioral features (36.8% vs 71.4%; p = 0.03) and reduced responsiveness (31.6% vs 78.6%; p = 0.002). INTERPRETATION This study presents the most extensive semiological analysis of children with confirmed frontal lobe epilepsy. It identifies semiological features that aid in differentiating between mesial and lateral onset. Despite age-dependent differences, typical frontal lobe features, including hyperkinetic seizures, are observed even in very young children. A better understanding of pediatric seizure semiology may enhance the accuracy of onset identification, and enable earlier presurgical evaluation, improving postsurgical outcomes. ANN NEUROL 2024;95:1138-1148.
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Affiliation(s)
- Thijs van Dalen
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Jessica F Kirkham
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Aswin Chari
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Felice D'Arco
- Department of Pediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Friederike Moeller
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - Christin Eltze
- Department of Neurology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - J Helen Cross
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - Martin M Tisdall
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Rachel C Thornton
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Department of Neurophysiology, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
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Niu H, Li K, Liang X, Kong D, Li Z, Sun F, Liu X, Xu Z, Wei X, Lan S, Lu C. MR-guided laser interstitial thermal therapy for drug-resistant lesional epilepsy: a single-center experience. Chin Neurosurg J 2023; 9:26. [PMID: 37723550 PMCID: PMC10506236 DOI: 10.1186/s41016-023-00335-2] [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: 12/27/2022] [Accepted: 07/10/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND To describe and report the efficacy and safety of MR-guided laser interstitial thermal therapy (MRgLITT) in the treatment of drug-resistant epilepsy. METHODS A retrospective review of all MRgLITT procedures in our hospital was performed. All procedures were performed using a surgical laser ablation system. Demographic and outcome data were compiled and analyzed. RESULTS A total of 19 patients underwent MRgLITT procedures from June 2021 to November 2021. The average age at surgery was 18.1 years (3-61.4 years). The average length of hospitalization post-surgery was 4.95 days (4-7 days). Surgical substrates included 8 patients with hypothalamic hamartomas, 5 with medial temporal lobe epilepsy, 3 with deep focal cortical dysplasia, 1 with tuberous sclerosis, 1 with a cavernous malformation, and 1 with Lennox-Gastaut syndrome who underwent anterior corpus callosotomy. Complications occurred in three patients. After an average follow-up of 1 year, 6 patients were seizure-free (Engel I, 31.6%), 1 had significant seizure control (Engel II, 5.3%), 7 had seizure control (Engel III, 36.8%), and 5 had no improvement in their seizures (Engel IV, 26.3%). Fisher's exact tests did not reveal statistical significance for the association between Engel class outcome and epileptic disease. CONCLUSION This study confirmed that MRgLITT, as a method for treating drug-resistant epilepsy, is minimally invasive, safe, and efficient and that it can reduce the incidence of surgery-related complications.
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Affiliation(s)
- Hongchuan Niu
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Kai Li
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Xiaoning Liang
- Department of Neurosurgery, PKUCare Zibo Hospital, Shandong, China
| | - Desheng Kong
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Zongze Li
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Fengqiao Sun
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, Beijing, China
| | - Zongsheng Xu
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Xuejiao Wei
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Shuang Lan
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Changyu Lu
- Department of Neurosurgery, Peking University International Hospital, Beijing, China.
- Present Address: Department of Neurosurgery, Peking University International, No.1 Shengmingyuan Road, Zhongguancun Life Science Park, Changping District, Beijing, 102206, China.
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d'Orio P, Revay M, Bevacqua G, Battista F, Castana L, Squarza S, Chiarello D, Lo Russo G, Sartori I, Cardinale F. Stereo-electroencephalography (SEEG)-Guided Surgery in Epilepsy With Cingulate Gyrus Involvement: Electrode Implantation Strategies and Postoperative Seizure Outcome. J Clin Neurophysiol 2023; 40:516-528. [PMID: 36930225 DOI: 10.1097/wnp.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Surgical treatment of cingulate gyrus epilepsy is associated with good results on seizures despite its rarity and challenging aspects. Invasive EEG monitoring is often mandatory to assess the epileptogenic zone in these patients. To date, only small surgical series have been published, and a consensus about management of these complex cases did not emerge. The authors retrospectively analyzed a large surgical series of patients in whom at least part of the cingulate gyrus was confirmed as included in the epileptogenic zone by means of stereo-electroencephalography and was thus resected. One hundred twenty-seven patients were selected. Stereo-electroencephalography-guided implantation of intracerebral electrodes was performed in the right hemisphere in 62 patients (48.8%) and in the left hemisphere in 44 patients (34.7%), whereas 21 patients (16.5%) underwent bilateral implantations. The median number of implanted electrodes per patient was 13 (interquartile range 12-15). The median number of electrodes targeting the cingulate gyrus was 4 (interquartile range 3-5). The cingulate gyrus was explored bilaterally in 19 patients (15%). Complication rate was 0.8%. A favorable outcome (Engel class I) was obtained in 54.3% of patients, with a median follow-up of 60 months. The chance to obtain seizure freedom increased in cases in whom histologic diagnosis was type-IIb focal cortical dysplasia or tumor (mostly ganglioglioma or dysembryoplastic neuroepithelial tumor) and with male gender. Higher seizure frequency predicted better outcome with a trend toward significance. Our findings suggest that stereo-electroencephalography is a safe and effective methodology in achieving seizure freedom in complex cases of epilepsy with cingulate gyrus involvement.
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Affiliation(s)
- Piergiorgio d'Orio
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Martina Revay
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppina Bevacqua
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Neurosurgery Unit, Department of Translational Medicine, Ferrara University, Ferrara, Italy
| | - Francesca Battista
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology, and Child Health, Careggi University Hospital and University of Florence, Florence, Italy; and
| | - Laura Castana
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Squarza
- Neuroradiology Department, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniela Chiarello
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ivana Sartori
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Cardinale
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
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Kim JR, Jo H, Park B, Park YH, Chung YH, Shon YM, Seo DW, Hong SB, Hong SC, Seo SW, Joo EY. Identifying important factors for successful surgery in patients with lateral temporal lobe epilepsy. PLoS One 2023; 18:e0288054. [PMID: 37384651 PMCID: PMC10310033 DOI: 10.1371/journal.pone.0288054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/18/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE Lateral temporal lobe epilepsy (LTLE) has been diagnosed in only a small number of patients; therefore, its surgical outcome is not as well-known as that of mesial temporal lobe epilepsy. We aimed to evaluate the long-term (5 years) and short-term (2 years) surgical outcomes and identify possible prognostic factors in patients with LTLE. METHODS This retrospective cohort study was conducted between January 1995 and December 2018 among patients who underwent resective surgery in a university-affiliated hospital. Patients were classified as LTLE if ictal onset zone was in lateral temporal area. Surgical outcomes were evaluated at 2 and 5 years. We subdivided based on outcomes and compared clinical and neuroimaging data including cortical thickness between two groups. RESULTS Sixty-four patients were included in the study. The mean follow-up duration after the surgery was 8.4 years. Five years after surgery, 45 of the 63 (71.4%) patients achieved seizure freedom. Clinically and statistically significant prognostic factors for postsurgical outcomes were the duration of epilepsy before surgery and focal cortical dysplasia on postoperative histopathology at the 5-year follow-up. Optimal cut-off point for epilepsy duration was eight years after the seizure onset (odds ratio 4.375, p-value = 0.0214). Furthermore, we propose a model for predicting seizure outcomes 5 years after surgery using the receiver operating characteristic curve and nomogram (area under the curve = 0.733; 95% confidence interval, 0.588-0.879). Cortical thinning was observed in ipsilateral cingulate gyrus and contralateral parietal lobe in poor surgical group compared to good surgical group (p-value < 0.01, uncorrected). CONCLUSIONS The identified predictors of unfavorable surgical outcomes may help in selecting optimal candidates and identifying the optimal timing for surgery among patients with LTLE. Additionally, cortical thinning was more extensive in the poor surgical group.
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Affiliation(s)
- Jae Rim Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyunjin Jo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Boram Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Yu Hyun Park
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea
| | - Yeon Hak Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Min Shon
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Dae-Won Seo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Bong Hong
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Chyul Hong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Won Seo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Athreya A, Matthews RE, Drane DL, Bonilha L, Willie JT, Gross RE, Karakis I. Withdrawal of antiseizure medications after MRI-Guided laser interstitial thermal therapy in extra-temporal lobe epilepsy. Seizure 2023; 110:86-92. [PMID: 37331198 DOI: 10.1016/j.seizure.2023.06.012] [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: 10/28/2022] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE This study investigated the success rate of antiseizure medications (ASMs) withdrawal following MRI Guided Laser Interstitial Thermal Therapy (MRg-LITT) for extra-temporal lobe epilepsy (ETLE), and identified predictors of seizure recurrence. METHODS We retrospectively assessed 27 patients who underwent MRg-LITT for ETLE. Patients' demographics, disease characteristics, and post-surgical outcomes were evaluated for their potential to predict seizure recurrence associated with ASMs withdrawal. RESULTS The median period of observation post MRg-LITT was 3 years (range 18 - 96 months) and the median period to initial ASMs reduction was 0.5 years (range 1-36 months). ASMs reduction was attempted in 17 patients (63%), 5 (29%) of whom had seizure recurrence after initial reduction. Nearly all patient who relapsed regained seizure control after reinstitution of their ASMs regimen. Pre-operative seizure frequency (p = 0.002) and occurrence of acute post-operative seizures (p = 0.01) were associated with increased risk for seizure recurrence post ASMs reduction. At the end of the observation period, 11% of patients were seizure free without drugs, 52% were seizure free with drugs and 37% still experienced seizures despite ASMs. Compared with pre-operative status, the number of ASMs was reduced in 41% of patients, unchanged in 55% of them and increased in only 4% of them. CONCLUSIONS Successful MRg-LITT for ETLE allows for ASMs reduction in a significant portion of patients and complete ASMs withdrawal in a subset of them. Patients with higher pre-operative seizure frequency or occurrence of acute post operative seizures exhibit higher chances relapse post ASMs reduction.
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Affiliation(s)
- Arjun Athreya
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca E Matthews
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Leonardo Bonilha
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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Wee RWS, Nash A, Angus-Leppan H. Deep phenotyping of frontal lobe epilepsy compared to other epilepsy syndromes. J Neurol 2023; 270:3072-3081. [PMID: 36847847 DOI: 10.1007/s00415-023-11639-9] [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: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
AIMS Frontal lobe epilepsy (FLE) is understudied and often misdiagnosed. We sought to comprehensively phenotype FLE and to differentiate FLE from other focal and generalised epilepsy syndromes. METHODS This was a retrospective, observational cohort study of 1078 cases of confirmed epilepsy in a tertiary neurology centre in London. Data sources were electronic health records, investigation reports and clinical letters. RESULTS 166 patients had FLE based on clinical findings and investigations-97 with identifiable electroencephalography (EEG) foci in frontal areas (definite FLE), while 69 had no frontal EEG foci (probable FLE). Apart from EEG findings, probable and definite FLE did not differ in other features. FLE was distinct from generalized epilepsy, which tended to present with tonic-clonic seizures and be due to genetic causes. FLE and temporal lobe epilepsy (TLE) both featured focal unaware seizures and underlying structural or metabolic aetiology. FLE, TLE and generalized epilepsy differed in their EEG (P = 0.0003) and MRI (P = 0.002) findings, where FLE had a higher rate of normal EEG and abnormal MRI findings compared to TLE. CONCLUSIONS EEG is often normal for FLE, and abnormalities are commonly identified with MRI. There was no difference in the clinical features of definite and probable FLE, suggesting they represent the same clinical entity. The diagnosis of FLE can be made even when scalp EEG is normal. This large medical cohort provides hallmark features of FLE that differentiate it from TLE and other epilepsy syndromes.
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Affiliation(s)
- Ryan W S Wee
- Barnet Hospital, London, UK.,Epilepsy Initiative Group, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK
| | - Adina Nash
- Epilepsy Initiative Group, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK
| | - Heather Angus-Leppan
- Epilepsy Initiative Group, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK. .,UCL Queen Square Institute of Neurology, London, UK.
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Passaro EA. Neuroimaging in Adults and Children With Epilepsy. Continuum (Minneap Minn) 2023; 29:104-155. [PMID: 36795875 DOI: 10.1212/con.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This article discusses the fundamental importance of optimal epilepsy imaging using the International League Against Epilepsy-endorsed Harmonized Neuroimaging of Epilepsy Structural Sequences (HARNESS) protocol and the use of multimodality imaging in the evaluation of patients with drug-resistant epilepsy. It outlines a methodical approach to evaluating these images, particularly in the context of clinical information. LATEST DEVELOPMENTS Epilepsy imaging is rapidly evolving, and a high-resolution epilepsy protocol MRI is essential in evaluating newly diagnosed, chronic, and drug-resistant epilepsy. The article reviews the spectrum of relevant MRI findings in epilepsy and their clinical significance. Integrating multimodality imaging is a powerful tool in the presurgical evaluation of epilepsy, particularly in "MRI-negative" cases. For example, correlation of clinical phenomenology, video-EEG with positron emission tomography (PET), ictal subtraction single-photon emission computerized tomography (SPECT), magnetoencephalography (MEG), functional MRI, and advanced neuroimaging such as MRI texture analysis and voxel-based morphometry enhances the identification of subtle cortical lesions such as focal cortical dysplasias to optimize epilepsy localization and selection of optimal surgical candidates. ESSENTIAL POINTS The neurologist has a unique role in understanding the clinical history and seizure phenomenology, which are the cornerstones of neuroanatomic localization. When integrated with advanced neuroimaging, the clinical context has a profound impact on identifying subtle MRI lesions or finding the "epileptogenic" lesion when multiple lesions are present. Patients with an identified lesion on MRI have a 2.5-fold improved chance of achieving seizure freedom with epilepsy surgery compared with those without a lesion. This clinical-radiographic integration is essential to accurate classification, localization, determination of long-term prognosis for seizure control, and identification of candidates for epilepsy surgery to reduce seizure burden or attain seizure freedom.
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MAESAWA S, ISHIZAKI T, MUTOH M, ITO Y, TORII J, TANEI T, NAKATSUBO D, SAITO R. Clinical Impacts of Stereotactic Electroencephalography on Epilepsy Surgery and Associated Issues in the Current Situation in Japan. Neurol Med Chir (Tokyo) 2023; 63:179-190. [PMID: 37005247 DOI: 10.2176/jns-nmc.2022-0271] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Stereotactic electroencephalography (SEEG) is receiving increasing attention as a safe and effective technique in the invasive evaluation for epileptogenic zone (EZ) detection. The main clinical question is whether the use of SEEG truly improves outcomes. Herein, we compared outcomes in our patients after three types of intracranial EEG (iEEG): SEEG, the subdural electrode (SDE), and a combined method using depth and strip electrodes. We present here our preliminary results from two demonstrative cases. Several international reports from large epilepsy centers found the following clinical advantages of SEEG: 1) three-dimensional analysis of structures, including bilateral and multilobar structures; 2) low rate of complications; 3) less pneumoencephalopathy and less patient burden during postoperative course, which allows the initiation of video-EEG monitoring immediately after implantation and does not require resection to be performed in the same hospitalization; and 4) a higher rate of good seizure control after resection. In other words, SEEG more accurately identified the EZ than the SDE method. We obtained similar results in our preliminary experiences under limited conditions. In Japan, as of August 2022, dedicated electrodes and SEEG accessories have not been approved and the use of the robot arm is not widespread. The Japanese medical community is hopeful that these issues will soon be resolved and that the experience with SEEG in Japan will align with that of large epilepsy centers internationally.
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Affiliation(s)
- Satoshi MAESAWA
- Department of Neurosurgery, Nagoya University School of Medicine
| | | | - Manabu MUTOH
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Yoshiki ITO
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Jun TORII
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Takafumi TANEI
- Department of Neurosurgery, Nagoya University School of Medicine
| | | | - Ryuta SAITO
- Department of Neurosurgery, Nagoya University School of Medicine
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Morsi A, Sharma A, Golubovsky J, Bulacio J, McGovern R, Jehi L, Bingaman W. Does Stereoelectroencephalography Add Value in Patients with Lesional Epilepsy? World Neurosurg 2022; 167:e196-e203. [PMID: 35940500 DOI: 10.1016/j.wneu.2022.07.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) has gained popularity as an invasive monitoring modality for epileptogenic zone (EZ) localization. The need and indications for SEEG in patients with evident brain lesions or associated abnormalities on imaging is debated. We report our experience with SEEG as a presurgical evaluation tool for patients with lesional epilepsy. METHODS A retrospective cohort study was performed of 131 patients with lesional or magnetic resonance imaging abnormality-associated medically refractory focal epilepsy who underwent resections from 2010 to 2017. Seventy-one patients had SEEG followed by resection, and 60 had no invasive recordings. Volumetric analysis of resection cavities from 3T magnetic resonance imaging was performed. RESULTS Mean lesion and resection volumes for SEEG and non-SEEG were 16.2 (standard deviation [SD] = 29) versus 23.7 cm3 (SD = 38.4) and 28.1 (SD = 23.2) versus 43.6 cm3 (SD = 43.5), respectively (P = 0.009). Comparing patients with seizure recurrence and patients who remained seizure free, significantly associated variables with seizure recurrence included mean number of failed antiseizure medications (6.86 [SD = 0.32] vs. 5.75 [SD = 0.32]; P = 0.01) and in SEEG patients the mean number of electrodes implanted (8.1 [SD = 0.8] vs. 5.0 [SD = 0.8]; P = 0.005). After multivariate analysis, only failed numbers of medication remained significantly associated with seizure recurrence. CONCLUSIONS Seizure outcomes did not correlate with final resection volume after SEEG evaluation. SEEG evaluation presurgically can be used to maintain the efficacy of resection and decrease the volume and subsequent risk of extensive tissue removal. We believe that this technology allows resective surgery to proceed in a subpopulation of patients with lesional epilepsy who may otherwise not have been considered surgical candidates.
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Affiliation(s)
- Amr Morsi
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Akshay Sharma
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Joshua Golubovsky
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juan Bulacio
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Robert McGovern
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
| | - Lara Jehi
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Bingaman
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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12
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Zhao Z, Li H, Wang S, Chen C, He C, Hu L, Zheng Z, Zhu J, Ding M, Wang S, Ding Y. Patterns of hypometabolism in frontal lobe epilepsy originating in different frontal regions. Ann Clin Transl Neurol 2022; 9:1336-1344. [PMID: 35836348 PMCID: PMC9463953 DOI: 10.1002/acn3.51630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Analysis of FDG‐PET imaging commonly shows that hypometabolism extends into extra‐epileptogenic zones (extra‐EZ). This study investigates the distribution patterns of hypometabolism in frontal lobe epilepsy (FLE) originating in different frontal regions. Methods Sixty‐four patients with FLE were grouped by EZ localization according to Brodmann areas (BAs): Group 1 (the frontal motor and premotor area), BAs 4, 6, and 8; Group 2 (the inferior frontal gyrus and opercular area), BAs 44, 45, and 47; Group 3 (the dorsal prefrontal area), BAs 9, 10, 11, and 46; and Group 4 (the medial frontal and anterior cingulate gyrus), BAs 32 and 24. Regions of extra‐EZ hypometabolism were statistically analyzed between FLE groups and healthy controls. Correlation analysis was performed to identify relationships between the intensity of hypometabolism and clinical characteristics. Results Significant hypometabolism in the ipsilateral (Groups 1 and 4) or bilateral (Groups 2 and 3) anterior insulae was found. Groups 1 and 4 presented with limited distribution of extra‐EZ hypometabolism, whereas Groups 2 and 3 showed widely distributed extra‐EZ hypometabolism in the rectus gyrus, cingulate gyrus, and other regions. Additionally, the intensity of hypometabolism was correlated with epilepsy duration in Groups 2 and 3. Conclusions All FLE groups showed hypometabolism in the anterior insula. In addition, distinct patterns of extra‐EZ hypometabolism were identified for each FLE group. This quantitative FDG‐PET analysis expanded our understanding of the topography of epileptic networks and can guide EZ localization in the future.
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Affiliation(s)
- Zexian Zhao
- Department of Neurology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Hong Li
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shan Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cong Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenmin He
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lingli Hu
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhe Zheng
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Junming Zhu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Meiping Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yao Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Moloney PB, Dugan P, Widdess-Walsh P, Devinsky O, Delanty N. Genomics in the Presurgical Epilepsy Evaluation. Epilepsy Res 2022; 184:106951. [DOI: 10.1016/j.eplepsyres.2022.106951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/23/2022] [Accepted: 05/25/2022] [Indexed: 11/03/2022]
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14
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McGonigal A. Frontal lobe seizures: overview and update. J Neurol 2022; 269:3363-3371. [PMID: 35006387 DOI: 10.1007/s00415-021-10949-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/27/2022]
Abstract
Frontal lobe seizures (FLS) are debilitating for patients, highly diverse and often challenging for clinicians to evaluate. Frontal lobe epilepsy is the second most common localization for focal epilepsy, and if pharmacoresistant, can be amenable to resective surgery. Detailed study of frontal seizure semiology in conjunction with careful anatomical and electrophysiological correlation based on intracerebral recording with stereoelectroencephalography (SEEG) has allowed demonstration that ictal motor semiology reflects a hierarchical rostro-caudal axis of frontal lobe functional organization, thus helping with presurgical localization. Main semiological features allowing distinction between different frontal sublobar regions include motor signs and emotional signs. Frontal lobe seizure semiology also represents a valuable source of in vivo human behavioral data from a neuroscientific perspective. Advances in defining underlying etiologies of FLE are likely to be crucial for appropriate selection and exploration of potential surgical candidates, which could improve upon current surgical outcomes. Future research on investigating the genetic basis of epilepsies and relation to structural substrate (e.g. focal cortical dysplasia) and seizure organization and expression, could permit a "genotype-phenotype" approach that could be complementary to anatomical electroclinical correlations in better defining the spectrum of FLS. This could help with optimizing patient selection and prognostication with regards to therapeutic choices.
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Affiliation(s)
- Aileen McGonigal
- Clinical Neurophysiology, Timone Hospital, APHM, Marseille, France. .,Inserm, INS, Institut de Neurosciences Des Systèmes, Aix Marseille Univ, Marseille, France.
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15
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Bulacio JC, Bena J, Suwanpakdee P, Nair D, Gupta A, Alexopoulos A, Bingaman W, Najm I. Determinants of seizure outcome after resective surgery following stereoelectroencephalography. J Neurosurg 2021:1-9. [PMID: 34678771 DOI: 10.3171/2021.6.jns204413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate seizure outcomes after resective epilepsy surgery following stereoelectroencephalography (SEEG), including group characteristics, comparing surgical and nonsurgical groups and assess predictors of time to seizure recurrence. METHODS Clinical and EEG data of 536 consecutive patients who underwent SEEG at Cleveland Clinic Epilepsy Center between 2009 and 2017 were reviewed. The primary outcome was defined as complete seizure freedom since the resective surgery, discounting any auras or seizures that occurred within the 1st postoperative week. In addition, the rate of seizure freedom based on Engel classification was determined in patients with follow-up of ≥ 1 year. Presumably significant outcome variables were first identified using univariate analysis, and Cox proportional hazards modeling was used to identify outcome predictors. RESULTS Of 527 patients satisfying study criteria, 341 underwent resective surgery. Complete and continuous seizure freedom after surgery was achieved in 55.5% of patients at 1 year postoperatively, 44% of patients at 3 years, and 39% of patients at 5 years. As a secondary outcome point, 58% of patients achieved Engel class I seizure outcome for at least 1 year at last follow-up. Among surgical outcome predictors, in multivariate model analysis, the seizure recurrence rate by type of resection (p = 0.039) remained statistically significant, with the lowest risk of recurrence occurring after frontal and temporal lobe resections compared with multilobar and posterior quadrant surgeries. Patients with a history of previous resection (p = 0.006) and bilateral implantations (p = 0.023) were more likely to have seizure recurrence. The absence of an MRI abnormality prior to resective surgery did not significantly affect seizure outcome in this cohort. CONCLUSIONS This large, single-center series shows that resective surgery leads to continuous seizure freedom in a group of patients with complex and severe pharmacoresistant epilepsy after SEEG evaluation. In addition, up to 58% of patients achieved seizure freedom at last follow-up. The authors' results suggest that SEEG is equally effective in patients with frontal and temporal lobe epilepsy with or without MRI identified lesions.
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Affiliation(s)
- Juan C Bulacio
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - James Bena
- 2Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Dileep Nair
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Ajay Gupta
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | | | - William Bingaman
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Imad Najm
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland; and
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16
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Nitta N, Usui N, Kondo A, Tottori T, Terada K, Kasai Y, Takahashi Y, Nozaki K, Inoue Y. Neuropsychological outcomes after frontal lobectomy to treat intractable epilepsy. Epilepsy Behav 2021; 123:108240. [PMID: 34375803 DOI: 10.1016/j.yebeh.2021.108240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/14/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Frontal lobectomy is often used as a surgical treatment for frontal lobe epilepsy, especially when a large epileptogenic zone in the frontal lobe is inferred from preoperative evaluation. The frontal lobe is important for cognitive functions such as executive functions and verbal fluency, but the neuropsychological outcome after a frontal or prefrontal lobectomy that includes both the dorsolateral prefrontal cortex and ventral prefrontal cortex has not been studied thoroughly. In the present study, we evaluated neuropsychological outcomes after patients with frontal lobe epilepsy received a frontal or prefrontal lobectomy. METHODS We retrospectively reviewed the data of patients with frontal lobe epilepsy who underwent a frontal or prefrontal lobectomy that includes both the dorsolateral prefrontal cortex and ventral prefrontal cortex at 16 years or older from October 2004 to December 2014, with a minimum postoperative follow-up of 24 months. We analyzed and compared neuropsychological outcomes, including executive functions, verbal fluency, intelligence, and memory, before and after the operation. RESULTS Eighteen patients were 16 years or older and underwent pre- and postoperative (2 years after the operation) neuropsychological evaluations. Patients showed significant deterioration only on the Benton Visual Retention Test. Performance on tests of frontal lobe functions, such as executive function and verbal fluency, showed no significant deterioration. CONCLUSIONS Overall cognitive performance, including functions widely thought to depend on the frontal lobe, is stable after a frontal or prefrontal lobectomy to treat frontal lobe epilepsy.
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Affiliation(s)
- Naoki Nitta
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan; Department of Neurosurgery, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga 520-2192, Japan.
| | - Naotaka Usui
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Akihiko Kondo
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan
| | - Takayasu Tottori
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Kiyohito Terada
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Yoshinobu Kasai
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga 520-2192, Japan.
| | - Yushi Inoue
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka 420-8688, Japan.
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Electrically stimulated auras as a potential biomarker of the epileptogenic zone. Epilepsy Behav 2021; 122:108116. [PMID: 34139619 DOI: 10.1016/j.yebeh.2021.108116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
Electrocortical stimulation mapping (ESM) is often performed in patients undergoing stereoelectroencephalography (SEEG) prior to epilepsy surgery, with the goal of identifying functional cortex and preserving it postoperatively. ESM may also evoke a patient's typical seizure semiology. The purpose of this study was to determine whether the sites at which typical auras are evoked during ESM are associated with other known clinical and electrophysiologic biomarkers of the epileptogenic zone: the seizure onset zone (SOZ), the early spread zone (ES), and high-frequency oscillations (HFOs). We found that the sites at which auras were provoked were not consistently associated with known biomarkers (p = 0.09). We conclude that evoked auras during ESM may reflect electrical spread rather than true epileptogenicity, and that a larger study is needed to assess their potential value as independent epileptic biomarkers.
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Assessment of localization accuracy and postsurgical prediction of simultaneous 18F-FDG PET/MRI in refractory epilepsy patients. Eur Radiol 2021; 31:6974-6982. [PMID: 33638688 DOI: 10.1007/s00330-021-07738-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 12/16/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the accuracies of simultaneous 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([18F]-FDG PET/MRI) in preoperative localization and the postsurgical prediction. METHODS This retrospective study was performed on ninety-eight patients diagnosed with refractory epilepsy whose presurgical evaluation included [18F]-FDG PET/MRI, with 1-year post-surgery follow-up between August 2016 and December 2018. PET/MRI images were interpreted by two radiologists and a nuclear medicine physician to localize the EOZ using standard visual analysis and asymmetry index based on standard uptake value (SUV). The localization accuracy and predictive performance of simultaneous 18F-FDG PET/MRI based on the surgial pathology and postsurgical outcome were evaluated. RESULTS A total of 41.8% (41/98) patients were found to have a definitely structural abnormality on the MR portion of PET/MRI; 93.9% (92/98) were shown hypometabolism on the PET portion of the hybrid PET/MRI. PET/MRI identified 18 cases with subtle structural abnormalities on MRI re-read. Six percent (6/98) of patients PET/MRI were negative. A total of 65.3% (64/98) patients showed seizure-free at 1-year follow-up after epilepsy surgery. The sensitivity, specificity, and accuracy of [18F]-FDG PET/MRI was 95.3%, 8.8%, and 65.3% for seizure onset localization based on surgical pathology and postsurgical outcome, respectively. Multivariate regression analysis indicated that concordant of EOZ localization between PET/MRI and surgical resection range, which was a good positive predictor of seizure freedom (Engel I) (OR = 14.741, 95% CI 3.934-55.033, p < 0.001). CONCLUSIONS [18F]-FDG PET/MRI used as two combined modalities providing additional sensitivity when detecting possible epileptic foci and will probably improve the surgical outcome. KEY POINTS • Sensitivity, specificity, and accuracy of [18F]-FDG PET/MRI were 95.3%, 8.8%, and 65.3% for seizure onset localization based on surgical pathology and postsurgical outcome, respectively. • Concordance of EOZ localization between PET/MRI and surgical resection range was a good positive predictor of seizure freedom; presurgical [18F]-FDG PET/MRI will probably improve the surgical outcome.
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Prefrontal seizure classification based on stereo-EEG quantification and automatic clustering. Epilepsy Behav 2020; 112:107436. [PMID: 32906017 DOI: 10.1016/j.yebeh.2020.107436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Frontal seizures are organized according to anatomo-functional subdivisions of the frontal lobe. Prefrontal seizures have been the subject of few detailed studies to date. The objective of this study was to identify subcategories of prefrontal seizures based on seizure onset quantification and to look for semiological differences. METHODS Consecutive patients who underwent stereoelectroencephalography (SEEG) for drug-resistant prefrontal epilepsy between 2000 and 2018 were included. The different prefrontal regions investigated in our patients were dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), dorsomedial prefrontal cortex (DMPFC), ventromedial prefrontal cortex (VMPFC), and orbitofrontal cortex (OFC). The seizure onset zone (SOZ) was determined from one or two seizures in each patient, using the epileptogenicity index (EI) method. The presence or absence of 16 clinical ictal manifestations was analyzed. Classification of prefrontal networks was performed using the k-means automatic classification method. RESULTS A total of 51 seizures from 31 patients were analyzed. The optimal clustering was 4 subgroups of prefrontal seizures: a "pure DLPF" group, a "pure VMPF" group, a "pure OFC" group, and a "global prefrontal" group. The first 3 groups showed a mean EI considered epileptogenic (>0.4) only in one predominant structure, while the fourth group showed a high mean EI in almost all prefrontal structures. The median number of epileptogenic structures per seizure (prefrontal or extrafrontal) was 5 for the "global prefrontal" group and 2 for the other groups. We found that the most common signs were altered consciousness, automatisms/stereotypies, integrated gestural motor behavior, and hyperkinetic motor behavior. We found no significant difference in the distribution of ictal signs between the different groups. CONCLUSION Our study showed that although most prefrontal seizures manifest as a network of several anatomically distinct structures, we were able to determine a sublobar organization of prefrontal seizure onset with four groups.
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Trebuchon A, Racila R, Cardinale F, Lagarde S, McGonigal A, Lo Russo G, Scavarda D, Carron R, Mai R, Chauvel P, Bartolomei F, Francione S. Electrical stimulation for seizure induction during SEEG exploration: a useful predictor of postoperative seizure recurrence? J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2019-322469. [PMID: 33115935 DOI: 10.1136/jnnp-2019-322469] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/22/2020] [Accepted: 08/31/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Direct electrical stimulations of cerebral cortex are a traditional part of stereoelectroencephalography (SEEG) practice, but their value as a predictive factor for seizure outcome has never been carefully investigated. PATIENTS AND METHOD We retrospectively analysed a cohort of 346 patients operated on for drug-resistant focal epilepsy after SEEG exploration. As potential predictors we included: aetiology, MRI data, age of onset, duration of epilepsy, age at surgery, topography of surgery and whether a seizure was induced by either low frequency electrical stimulation (LFS) or high frequency electrical stimulation. RESULTS Of 346 patients, 63.6% had good outcome (no seizure recurrence, Engel I). Univariate analysis demonstrated significant correlation with favourable outcome (Engel I) for: aetiology, positive MRI and seizure induced by stimulation. At multivariate analysis, informative MRI, type II focal cortical dysplasia and tumour reduced the risk of seizure recurrence (SR) by 47%, 58% and 81%, respectively. Compared with the absence of induced seizures, the occurrence of ictal events after LFS significantly predicts a favourable outcome on seizures, with only 44% chance of disabling SR at last follow-up. CONCLUSION Among the already known predictors outcome, seizure induction by LFS therefore represents a positive predictive factor for seizure outcome after surgery.
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Affiliation(s)
- Agnes Trebuchon
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Epileptology and Clinical Neurophysiology, AP-HM, Timone Hospital, Marseille, France
| | - Renata Racila
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Francesco Cardinale
- Epilepsy and Parkinson Surgery Centre "C. Munari", Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Stanislas Lagarde
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Epileptology and Clinical Neurophysiology, AP-HM, Timone Hospital, Marseille, France
| | - Aileen McGonigal
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Epileptology and Clinical Neurophysiology, AP-HM, Timone Hospital, Marseille, France
| | - Giorgio Lo Russo
- Epilepsy and Parkinson Surgery Centre "C. Munari", Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Didier Scavarda
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Peadiatric Neurosurgery Unit, AP-HM, Timone Hospital, Marseille, France
| | - Romain Carron
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Functional Neurosurgery Unit, AP-HM, Timone Hospital, Marseille, France
| | - Roberto Mai
- Epilepsy and Parkinson Surgery Centre "C. Munari", Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Patrick Chauvel
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Fabrice Bartolomei
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Epileptology and Clinical Neurophysiology, AP-HM, Timone Hospital, Marseille, France
| | - Stefano Francione
- Epilepsy and Parkinson Surgery Centre "C. Munari", Ospedale Niguarda Ca' Granda, Milan, Italy
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Gupta K, Cabaniss B, Kheder A, Gedela S, Koch P, Hewitt KC, Alwaki A, Rich C, Ramesha S, Hu R, Drane DL, Gross RE, Willie JT. Stereotactic MRI-guided laser interstitial thermal therapy for extratemporal lobe epilepsy. Epilepsia 2020; 61:1723-1734. [PMID: 32777090 DOI: 10.1111/epi.16614] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRg-LITT) is an alternative to open epilepsy surgery. We assess safety and effectiveness of MRg-LITT for extratemporal lobe epilepsy (ETLE) in patients who are considered less favorable for open resection. METHODS We retrospectively reviewed sequential cases of patients with focal ETLE who underwent MRg-LITT between 2012 and 2019. Epileptogenic zones were determined from standard clinical and imaging data ± stereoelectroencephalography (SEEG). Standard stereotactic techniques, MRI thermometry, and a commercial laser thermal therapy system were used for ablations. Anatomic MRI was used to calculate ablation volumes. Clinical outcomes were determined longitudinally. RESULTS Thirty-five patients with mean epilepsy duration of 21.3 ± 12.2 years underwent MRg-LITT for focal ETLE at a mean age 36.4 ± 12.7 years. A mean 2.59 ± 1.45 trajectories per patient were used to obtain ablation volumes of 8.8 ± 7.5 cm3 . Mean follow-up was 27.3 ± 19.5 months. Of 32 patients with >12 months of follow-up, 17 (53%) achieved good outcomes (Engel class I + II) of whom 14 (44%) were Engel class I. Subgroup analysis revealed better outcomes for patients with lesional ETLE than for those who were nonlesional, multifocal, or who had failed prior interventions (P = .02). Of 13 patients showing favorable seizure-onset patterns (localized low voltage fast activity or rhythmic spiking on SEEG) prior to ablation, 9 (69%) achieved good outcomes, whereas only 3 of 11 (27%) who show other slower onset patterns achieved good outcomes. Minor adverse events included six patients with transient sensorimotor neurologic deficits and four patients with asymptomatic hemorrhages along the fiber tract. Major adverse events included one patient with a brain abscess that required stereotactic drainage and one patient with persistent hypothalamic obesity. Three deaths-two seizure-associated and one suicide-were unrelated to surgical procedures. SIGNIFICANCE MRI-guided laser interstitial thermal therapy (or MRg-LITT) was well-tolerated and yielded good outcomes in a heterogeneous group of ETLE patients. Lesional epilepsy and favorable seizure-onset patterns on SEEG predicted higher likelihoods of success.
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Affiliation(s)
- Kunal Gupta
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian Cabaniss
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul Koch
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abdulrahman Alwaki
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher Rich
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Supriya Ramesha
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ranliang Hu
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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22
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Hsieh HY, Chang CW, Cheng MY, Yan JL, Lim SN, Tseng WEJ, Chiang HI, Li HT, Chang BL, Lee CH, Lin CY, Wu T, Chang CN. Aggressive cytoreduction and multiple subpial cortical transections may obtain good surgical outcomes in refractory epilepsy with multiple epileptic foci. Biomed J 2020; 44:346-352. [PMID: 34183308 PMCID: PMC8358210 DOI: 10.1016/j.bj.2020.03.003] [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: 11/23/2018] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 11/25/2022] Open
Abstract
Backgrounds Epilepsy surgery is the most efficacious therapeutic modality for patients with medical refractory epilepsy, especially resective surgery. However, the variable etiologies and multiple epileptic foci are usually associated with the outcomes. The aim of this study was to demonstrate that combination of different intervention procedures might be an alternative option for patients of refractory epilepsy. Methods We retrospectively analyzed pre-operative and post-surgical outcomes in 30 patients who received epilepsy surgery between January 1, 2010 and December 31, 2014 at Chang Gung Memorial Hospital (CGMH), Linkou, according to Engel's classification. Results Twenty-six of the 30 patients (86.7%) had good outcomes, sum of class I and class II after epilepsy surgery. The good outcome rate of our complicated group was 80.0% (12/15), compared to 93.3% (14/15) in the simple group, but no significant differences between the two groups (p = 0.569). Four patients whose epileptic foci involved eloquent area and received multiple subpial cortical transection, and good outcome rate was 75% (3/4). At last, six patients had previously failed epilepsy surgery and received a reoperation, with a good outcome rate of 83.3% (5/6). Conclusion After complete pre-surgical evaluation and combined interventional procedures, the patients with refractory epilepsy had satisfactory outcomes and few neurological complications. Moreover, re-operation can improve the outcome in some patients who previously failed epilepsy surgery.
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Affiliation(s)
- Hsiang-Yao Hsieh
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Jiun-Lin Yan
- Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-En Johnny Tseng
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Program in Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Tao Li
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Bao-Luen Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih Yin Lin
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Neurology, Xiamen Chang Gung Hospital, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Neurosurgery, Xiamen Chang Gung Hospital, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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23
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Andrews JP, Chang EF. Epilepsy: Neocortical. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Cámpora NE, Mininni CJ, Kochen S, Lew SE. Seizure localization using pre ictal phase-amplitude coupling in intracranial electroencephalography. Sci Rep 2019; 9:20022. [PMID: 31882956 PMCID: PMC6934586 DOI: 10.1038/s41598-019-56548-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/27/2019] [Indexed: 11/09/2022] Open
Abstract
Understanding changes in brain rhythms provides useful information to predict the onset of a seizure and to localize its onset zone in epileptic patients. Brain rhythms dynamics in general, and phase-amplitude coupling in particular, are known to be drastically altered during epileptic seizures. However, the neural processes that take place before a seizure are not well understood. We analysed the phase-amplitude coupling dynamics of stereoelectroencephalography recordings (30 seizures, 5 patients) before and after seizure onset. Electrodes near the seizure onset zone showed higher phase-amplitude coupling. Immediately before the beginning of the seizure, phase-amplitude coupling dropped to values similar to the observed in electrodes far from the seizure onset zone. Thus, our results bring accurate information to detect epileptic events during pre-ictal periods and to delimit the zone of seizure onset in patients undergoing epilepsy surgery.
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Affiliation(s)
- Nuria E Cámpora
- Instituto de Ingeniería Biomédica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Camilo J Mininni
- Instituto de Biología y Medicina Experimental - CONICET, Buenos Aires, Argentina
| | - Silvia Kochen
- Centro de Epilepsia, Hospital Ramos Mejía. Estudio en Neurociencias y Sistemas Complejos (ENyS),CONICET. Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Sergio E Lew
- Instituto de Ingeniería Biomédica, Universidad de Buenos Aires, Buenos Aires, Argentina.
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25
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Di Giacomo R, Uribe-San-Martin R, Mai R, Francione S, Nobili L, Sartori I, Gozzo F, Pelliccia V, Onofrj M, Lo Russo G, de Curtis M, Tassi L. Stereo-EEG ictal/interictal patterns and underlying pathologies. Seizure 2019; 72:54-60. [DOI: 10.1016/j.seizure.2019.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022] Open
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26
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Samuel P J, Menon RN, Chandran A, Thomas SV, Vilanilam G, Abraham M, Radhakrishnan A. Seizure outcome and its predictors after frontal lobe epilepsy surgery. Acta Neurol Scand 2019; 140:259-267. [PMID: 31188464 DOI: 10.1111/ane.13139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/20/2019] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Frontal lobe epilepsy (FLE) surgery is the second most common focal resective surgery for drug-resistant epilepsy. Not many studies are available regarding the long-term surgical outcome of FLE. We studied the longitudinal outcome and predictors of seizure outcome following FLE surgery in a sizeable cohort of patients. MATERIALS & METHODS A total of 73 consecutive patients who underwent FLE surgery between January 1997 and May 2015 with a minimum follow-up of 1 year (range 1-16 years) were studied. Primary outcome was seizure freedom at last follow-up (Engel Class IA). "Seizure freedom" separately was defined as absence of seizures till last follow-up. Outcome predictors were subjected to multivariate analysis. Using Kaplan-Meier curve, we assessed the post-operative seizure freedom over time. RESULTS Twenty-five patients (34%) were seizure-free till last follow-up. The seizure freedom was 45%, 34%, 26%, 20% and 14% at the end of 1st, 2nd, 3rd, 4th and 5th post-operative year, respectively. Engel class I outcomes were 48%, 41%, 56%, 57% and 53% at end of 1st, 2nd, 3rd, 4th and 5th post-operative year, respectively. Predictors of seizure recurrence on multivariate analysis were older age at surgery (P = 0.032), longer duration of epilepsy (P = 0.031), presence of interictal epileptiform discharges in post-operative EEG on 7th day (P = 0.005), 3 months (P = 0.005) and 1 year (P = 0.0179). In subgroup analysis, duration of epilepsy of less than 2 years before surgery was a significant predictor for achieving seizure freedom (P = 0.029). CONCLUSIONS These results emphasize early surgery for better outcome in frontal lobe epilepsy. Post-operative EEG remained a good predictor for long-term outcome.
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Affiliation(s)
- Joseph Samuel P
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Ramshekhar N. Menon
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Anuvitha Chandran
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Sanjeev V. Thomas
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - George Vilanilam
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Mathew Abraham
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Ashalatha Radhakrishnan
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
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27
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Dührsen L, Sauvigny T, Ricklefs FL, Hamel W, Koeppen JA, Hebel JM, Lanz M, Martens T. Decision-making in temporal lobe epilepsy surgery based on invasive stereo-electroencephalography (sEEG). Neurosurg Rev 2019; 43:1403-1408. [PMID: 31502028 DOI: 10.1007/s10143-019-01175-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 11/27/2022]
Abstract
In medical refractory temporal lobe epilepsy (TLE), the epileptogenic zone can be difficult to identify and therefore difficult to treat, especially in the absence of clear MRI pathologies and specific results from presurgical evaluation. Invasive monitoring with stereo-electroencephalography (sEEG) is a tool for a better determination of the epileptogenic zone. Here, we investigate the impact of sEEG on decision-making in temporal lobe epilepsy surgery. We reviewed patients with TLE who underwent further investigation with sEEG in our epilepsy unit. We examined specifically how sEEG findings influenced our decision regarding indication for a surgical procedure and resection volume. From 2013 to 2017, we performed 152 temporal resections in epilepsy patients. Twenty-one of these patients were designated for further preoperative investigation with sEEG due to incongruent findings in presurgical evaluation. Six patients were implanted bitemporally. In five cases, the hypothesis for the epileptogenic zone and localization had to be changed due to sEEG findings and resulted in a different tailored resection than intended. In three cases, sEEG findings led to the cancelation of the originally intended temporal resection as the epileptogenic zone was not definable or bilateral. In another three cases, the prognosis for reduction of seizures postoperatively had to be reduced due to the sEEG findings. However, the resection was performed after interdisciplinary discussion and informed consent of the patient. The examination by sEEG led to a change of plan for further treatment in 13 patients (61.9%) suffering TLE in total. Invasive monitoring with sEEG electrodes had a strong impact on decision-making for further treatment in patients suffering from temporal lobe epilepsy with incongruent findings in presurgical examination designated for epilepsy surgery. This applies to resection volumes as well as to prediction of seizure outcome.
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Affiliation(s)
- Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Center for Molecular Neurobiology, Institute for Molecular and Cellular Cognition, Hamburg, Germany
| | - Franz L Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes A Koeppen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jonas M Hebel
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany
| | - Michael Lanz
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany
| | - Tobias Martens
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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28
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Morace R, Casciato S, Quarato PP, Mascia A, D'Aniello A, Grammaldo LG, De Risi M, Di Gennaro G, Esposito V. Long-term seizure outcome in frontal lobe epilepsy surgery. Epilepsy Behav 2019; 90:93-98. [PMID: 30522059 DOI: 10.1016/j.yebeh.2018.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to report long-term seizure outcome in patients who underwent frontal lobe epilepsy (FLE) surgery. METHOD This retrospective study included 44 consecutive subjects who underwent resective surgery for intractable FLE at IRCCS NEUROMED (period 2001-2014), followed up for at least 2 years (mean: 8.7 years). All patients underwent noninvasive presurgical evaluation and/or invasive electroencephalography (EEG) monitoring when nonconcordant data were obtained or epileptogenic zone was hypothesized to be close to the eloquent cortex. Electroclinical, neuroimaging, surgical data, and histology were compared to seizure outcome. RESULTS Mean epilepsy duration was 19 years; mean age at surgery was 31.6 years. Preoperative magnetic resonance imaging (MRI) showed a frontal lesion in 86.4 % of cases. Scalp video-electroencephalography (VEEG) monitoring detected a focal ictal onset in 90% of cases. Twenty-seven patients (61.4%) underwent invasive recordings. Resections involved dorsolateral (47.7%), medial (9%), orbital (13.6%), and rolandic (13.6%) region. Lobectomy within functional boundaries was performed in the remaining 7 cases (16%). Transient and permanent neurological deficits were observed in 2 and 3 cases, respectively. Histology revealed focal cortical dysplasia (45.5%), World Health Organization (WHO) I-II grade tumors (15.9%), gliosis (22.7%), vascular malformations (4.5%), Rasmussen encephalitis (6.8%), and normal tissue (4.5%). At last observation 68.1% of patients were in Engel's class I, 11.4% in class II, 9% in class III, and 11.4% in class IV. A favorable outcome was associated with focal ictal scalp EEG onset (p = 0.0357). CONCLUSION Surgery is a safe treatment option in drug-resistant FLE with a satisfying long-term outcome. These data highlight the importance of an appropriate selection of potential surgical candidates.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Vincenzo Esposito
- IRCCS "NEUROMED", Pozzilli, IS, Italy; Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
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29
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Steriade C, Martins W, Bulacio J, Morita-Sherman ME, Nair D, Gupta A, Bingaman W, Gonzalez-Martinez J, Najm I, Jehi L. Localization yield and seizure outcome in patients undergoing bilateral SEEG exploration. Epilepsia 2018; 60:107-120. [PMID: 30588603 DOI: 10.1111/epi.14624] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aimed to determine the rates and predictors of resection and seizure freedom after bilateral stereo-electroencephalography (SEEG) implantation. METHODS We reviewed 184 patients who underwent bilateral SEEG implantation (2009-2015). Noninvasive and invasive evaluation findings were collected. Outcomes of interest included subsequent resection and seizure freedom. Statistical analyses employed multivariable logistic regression and proportional hazard modeling. Preoperative and postoperative seizure frequency, severity, and quality of life scales were also compared. RESULTS Following bilateral SEEG implantation, 106 of 184 patients (58%) underwent resection. Single seizure type (P = 0.007), a family history of epilepsy (P = 0.003), 10 or more seizures per month (P = 0.004), lower number of electrodes (P = 0.02), or sentinel electrode placement (P = 0.04) was predictive of undergoing a resection, as were lack of nonlocalized (P < 0.0001) or bilateral (P < 0.0001) ictal-onset zones on SEEG. Twenty-six of 81 patients (32% with follow-up greater than 1 year) remained seizure-free. Predictors of seizure freedom were single seizure type (P = 0.01), short epilepsy duration (P = 0.008), use of 2 or fewer antiepileptic drugs (AEDs) at the time of surgery (P = 0.0006), primary localization hypothesis involving the frontal lobe (P = 0.002), sentinel electrode placement only (P = 0.02), and lack of overlap between ictal-onset zone and eloquent cortex (P = 0.04), along with epilepsy substrate histopathology (P = 0.007). Complete resection of a suspected focal cortical dysplasia showed a trend to increased likelihood of seizure freedom (P = 0.09). The 44 of 55 patients (80%) who underwent resection and experienced seizure recurrence had >50% seizure reduction, as opposed to 26 of 45 patients (58%) who continued medical therapy alone (P = 0.003). Seventy-two percent of patients had a clinically meaningful quality of life improvement (>10% decrease in the Quality of Life in Epilepsy [QOLIE-10] score) at 1 year. SIGNIFICANCE A strong preimplantation hypothesis of a suspected unifocal epilepsy increases the odds of resection and seizure freedom. We discuss a tailored approach, taking into account localization hypothesis and suspected epilepsy etiology in guiding implantation and subsequent surgical strategy.
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Affiliation(s)
- Claude Steriade
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - William Martins
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio.,Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas, Porto Alegre, Brazil
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajay Gupta
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
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30
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Marchi A, Giusiano B, King M, Lagarde S, Trébuchon-Dafonseca A, Bernard C, Rheims S, Bartolomei F, McGonigal A. Postictal electroencephalographic (EEG) suppression: A stereo-EEG study of 100 focal to bilateral tonic-clonic seizures. Epilepsia 2018; 60:63-73. [PMID: 30565663 DOI: 10.1111/epi.14601] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We aimed to describe intracerebral aspects of postictal generalized electroencephalography suppression (PGES) following focal to bilateral tonic-clonic ("secondarily generalized tonic-clonic") seizures (GTCS) recorded using stereoelectroencephalographic (SEEG), and to correlate these with electroclinical features. METHODS Three independent observers scored semiologic and SEEG features. Patient and epilepsy characteristics were collected. Descriptive statistics and multivariate analysis were performed. The operational definition of PGES on SEEG used strict criteria (absence of visible signal at 20 μV/mm amplitude, in all readable channels). Postictal regional suppression (RS) was identified if only a subset of implanted electrodes showed absence of signal. RESULTS We evaluated 100 seizures in 52 patients. Interobserver agreement was good (κ 0.72 for clinical features and 0.73 for EEG features). PGES was present in 27 of 100 and RS without PGES present in 42 of 100 seizures. Region of RS included epileptogenic zone in 43 of 51 (86%). No effect of sampling (multilobar or bilateral exploration) was seen. Oral tonicity (mouth opening and/or tonic vocalization during the tonic phase of GTCS) was associated with the presence of PGES (P = 0.029; negative predictive value [NPV] 0.91). Bilateral upper limb extension during the tonic phase correlated with PGES (P = 0.041; NPV 0.85). Association of both oral tonicity and bilateral upper limb extension had a high NPV of 0.96. SIGNIFICANCE SEEG recordings confirm true absence of signal during postictal EEG suppression. PGES is unlikely when both upper limb extension and oral tonicity are absent. We hypothesize that bilateral tonic seizure discharge at bulbar level brainstem regions is associated with the production of oral signs and may relate to mechanisms of PGES.
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Affiliation(s)
- Angela Marchi
- Clinical Neurophysiology Department, Sainte Anne Hospital, AP-HP, Paris, France
| | - Bernard Giusiano
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France
| | - Mark King
- Department of Neurosciences, Alfred Hospital, Melbourne, Victoria, Australia
| | - Stanislas Lagarde
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Agnès Trébuchon-Dafonseca
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Christophe Bernard
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France
| | - Sylvain Rheims
- Lyon University, Claude Bernard University, Lyon, France.,Department of Functional Neurology and Epileptology, Hospices Civils de Lyon (Lyon University Hospital), Lyon, France.,Lyon's Neuroscience Research Center (INSERM U1028, CNRS 5292), Lyon, France
| | - Fabrice Bartolomei
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Aileen McGonigal
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
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31
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Lagarde S, Buzori S, Trebuchon A, Carron R, Scavarda D, Milh M, McGonigal A, Bartolomei F. The repertoire of seizure onset patterns in human focal epilepsies: Determinants and prognostic values. Epilepsia 2018; 60:85-95. [DOI: 10.1111/epi.14604] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Stanislas Lagarde
- Epileptology Department; National Institute of Health and Medical Research; Institute of System Neuroscience; Timone Hospital; Public Assistance Hospitals of Marseille; Aix-Marseille University; Marseille France
| | - Sinziana Buzori
- Epileptology Department; National Institute of Health and Medical Research; Institute of System Neuroscience; Timone Hospital; Public Assistance Hospitals of Marseille; Aix-Marseille University; Marseille France
| | - Agnès Trebuchon
- Epileptology Department; National Institute of Health and Medical Research; Institute of System Neuroscience; Timone Hospital; Public Assistance Hospitals of Marseille; Aix-Marseille University; Marseille France
| | - Romain Carron
- Functional and Stereotactic Neurosurgery; National Institute of Health and Medical Research; Institute of System Neuroscience; Timone Hospital; Public Assistance Hospitals of Marseille; Aix-Marseille University; Marseille France
| | - Didier Scavarda
- Pediatric Neurosurgery; Timone Hospital; Public Assistance Hospitals of Marseille; Marseille France
| | - Mathieu Milh
- Pediatric Neurology; Timone Hospital; Public Assistance Hospitals of Marseille; Marseille France
| | - Aileen McGonigal
- Epileptology Department; National Institute of Health and Medical Research; Institute of System Neuroscience; Timone Hospital; Public Assistance Hospitals of Marseille; Aix-Marseille University; Marseille France
| | - Fabrice Bartolomei
- Epileptology Department; National Institute of Health and Medical Research; Institute of System Neuroscience; Timone Hospital; Public Assistance Hospitals of Marseille; Aix-Marseille University; Marseille France
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Kasper BS, Rössler K, Hamer HM, Dörfler A, Blümcke I, Coras R, Roesch J, Mennecke A, Wellmer J, Sommer B, Lorber B, Lang JD, Graf W, Stefan H, Schwab S, Buchfelder M, Rampp S. Coregistrating magnetic source and magnetic resonance imaging for epilepsy surgery in focal cortical dysplasia. Neuroimage Clin 2018; 19:487-496. [PMID: 29984157 PMCID: PMC6029564 DOI: 10.1016/j.nicl.2018.04.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/18/2018] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
Abstract
Background Epilepsy surgery for focal cortical dysplasia type II (FCD II) offers good chances for seizure freedom, but remains a challenge with respect to lesion detection, defining the epileptogenic zone and the optimal resection strategy. Integrating results from magnetic source imaging from magnetoencephalography (MEG) with magnetic resonance imaging (MRI) including MRI postprocessing may be useful for optimizing these goals. Methods We here present data from 21 adult FCD II patients, investigated during a 10 year period and evaluated including magnetic source imaging. 16 patients had epilepsy surgery, i.e. histopathologically verified FCD II, and a long follow up. We present our analysis of epileptogenic zones including MEG in relation to structural data according to MRI data and relate these results to surgical outcomes. Results FCD II in our cohort was characterized by high MEG yield and localization accuracy and MEG showed impact on surgical success-rates. MEG source localizations were detected in 95.2% of patients and were as close as 12.3 ± 8,1 mm to the MRI-lesion. After a mean follow up of >3 years, we saw >80% Engel I outcomes, with more favourable outcomes when the MEG source was completely resected (Fishers exact test 0,033). Conclusion We argue for a high value of conducting a combined MEG-MRI approach in the presurgical workup and the resection strategy in patients with FCD II related epilepsy.
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Affiliation(s)
- Burkhard S Kasper
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Karl Rössler
- Department of Neurosurgery, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Arnd Dörfler
- Department of Neuroradiology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Ingmar Blümcke
- Department of Neuropathology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Roland Coras
- Department of Neuropathology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Julie Roesch
- Department of Neuroradiology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Angelika Mennecke
- Department of Neuroradiology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Jörg Wellmer
- Ruhr-Epileptology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, Germany.
| | - Björn Sommer
- Department of Neurosurgery, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Bogdan Lorber
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia.
| | - Johannes D Lang
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Wolfgang Graf
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Hermann Stefan
- Epilepsy Center, Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Stefan Schwab
- Department of Neurology, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Stefan Rampp
- Department of Neurosurgery, Friedrich Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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Vakharia VN, Duncan JS, Witt JA, Elger CE, Staba R, Engel J. Getting the best outcomes from epilepsy surgery. Ann Neurol 2018. [PMID: 29534299 PMCID: PMC5947666 DOI: 10.1002/ana.25205] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug‐refractory focal epilepsies. Ann Neurol 2018;83:676–690
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Affiliation(s)
- Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom, and Chalfont Centre for Epilepsy
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom, and Chalfont Centre for Epilepsy
| | - Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Richard Staba
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jerome Engel
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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