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Winter F, Krueger MT, Delev D, Theys T, Van Roost DMP, Fountas K, Schijns OE, Roessler K. Current state of the art of traditional and minimal invasive epilepsy surgery approaches. BRAIN & SPINE 2024; 4:102755. [PMID: 38510599 PMCID: PMC10951767 DOI: 10.1016/j.bas.2024.102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
Introduction Open resective surgery remains the main treatment modality for refractory epilepsy, but is often considered a last resort option due to its invasiveness. Research question This manuscript aims to provide an overview on traditional as well as minimally invasive surgical approaches in modern state of the art epilepsy surgery. Materials and methods This narrative review addresses both historical and contemporary as well as minimal invasive surgical approaches in epilepsy surgery. Peer-reviewed published articles were retrieved from PubMed and Scopus. Only articles written in English were considered for this work. A range of traditional and minimally invasive surgical approaches in epilepsy surgery were examined, and their respective advantages and disadvantages have been summarized. Results The following approaches and techniques are discussed: minimally invasive diagnostics in epilepsy surgery, anterior temporal lobectomy, functional temporal lobectomy, selective amygdalohippocampectomy through a transsylvian, transcortical, or subtemporal approach, insulo-opercular corticectomies compared to laser interstitial thermal therapy, radiofrequency thermocoagulation, stereotactic radiosurgery, neuromodulation, high intensity focused ultrasound, and disconnection surgery including callosotomy, hemispherotomy, and subpial transections. Discussion and conclusion Understanding the benefits and disadvantages of different surgical approaches and strategies in traditional and minimal invasive epilepsy surgery might improve the surgical decision tree, as not all procedures are appropriate for all patients.
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Affiliation(s)
- Fabian Winter
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Marie T. Krueger
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
- Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany
| | - Daniel Delev
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Center for Integrated Oncology, Universities Aachen, Bonn, Cologne, Düsseldorf (CIO ABCD), Germany
| | - Tom Theys
- Department of Neurosurgery, Universitair Ziekenhuis Leuven, UZ Leuven, Belgium
| | | | - Kostas Fountas
- Department of Neurosurgery, University of Thessaly, Greece
| | - Olaf E.M.G. Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience (MHeNS), University Maastricht, Maastricht, the Netherlands
- Academic Center for Epileptology, Maastricht University Medical Center & Kempenhaeghe, Maastricht, Heeze, the Netherlands
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Austria
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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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Gong M, Xu K, Shan Y, Wang Y, Zhang C, Wang X, Zhou J, Guan Y, Li T, Luan G. Protocol of a prospective multicenter randomized controlled trial of robot-assisted stereotactic lesioning in the treatment of focal drug-resistant epilepsy. Trials 2023; 24:387. [PMID: 37296479 DOI: 10.1186/s13063-023-07334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND This protocol describes the design of a multicenter randomized controlled trial of robot-assisted stereotactic lesioning versus epileptogenic foci resection. Typical causes of focal epilepsy include hippocampal sclerosis and focal cortical dysplasia. These patients usually present with drug resistance and require surgical treatment. Although epileptogenic foci resection is still the most commonly used treatment for such focal epilepsy, there is increasing evidence that epileptogenic focus resection may lead to neurological impairment. The treatment of epilepsy with a robot-assisted stereotactic lesioning mainly includes two new minimally invasive surgical methods: radiofrequency thermocoagulation (RF-TC) and laser interstitial thermal therapy (LITT). Seizure-free is less likely to be achieved by these two procedures, but neurologic preservation is better. In this study, we aimed to compare the safety and efficacy of RF-TC, LITT, and epileptogenic foci resection for focal drug-resistant epilepsy. METHODS This is a multicenter, three-arm, randomized controlled clinical trial. The study will include patients older than 3 years of age with epilepsy who have had medically refractory seizures for at least 2 years and are eligible for surgical treatment with an epileptogenic focus as determined by multidisciplinary evaluation prior to randomization. The primary outcome measure is seizure outcome (quantified by seizure remission rate) at 3-month, 6-month, and 1-year follow-up after treatment. Postoperative neurologic impairment, spectrum distribution change of video electroencephalogram, quality of life, and medical costs will also be assessed as secondary outcomes. TRIAL REGISTRATION Chinese Clinical Trials Registry ChiCTR2200060974. Registered on June 14, 2022. The status of the trial is recruiting, and the estimated study completion date is December 31, 2024.
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Affiliation(s)
- Mingkun Gong
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Ke Xu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yihe Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 10007, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Tianfu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Haidian District, No. 50, Yikesong Road, Beijing, 100093, China.
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Fu KH, Wang YC, Lim SN, Cheng MY, Wu T, Chang CW, Chang BL, Lee CY, Lee CH, Tseng WEJ, Chiang HI, Liao TW, Tu PH. Long-term Outcome of Seizure Control and Neurologic Performance After Limited Hippocampal Radiofrequency Thermocoagulation for Mesial Temporal Lobe Epilepsy. World Neurosurg 2023; 173:e18-e26. [PMID: 36693618 DOI: 10.1016/j.wneu.2023.01.061] [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: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Limited hippocampal radiofrequency thermocoagulation (RFTC) for patients with mesial temporal lobe epilepsy was associated with good short-term seizure control and few complications. We aimed to demonstrate the neuropsychologic outcomes and assess the prognostic factors of long-term seizure control in these patients. METHODS We included all patients with mesial temporal lobe epilepsy who underwent limited hippocampal RFTC from January 2016 to December 2020. Clinical data of age, sex, seizure control before and after operation were all corrected. Pre- and postoperative neuropsychologic function including full-scale intelligence quotient (FSIQ), memory quotient, and the Mini-Mental State Examination was used. RESULTS Thirty-one patients (17 female and 14 male) with a mean epilepsy duration of 22.3 years and seizure frequency of 5.7 times per month were included. The intraoperative seizure rate was 19.3%, and a higher preoperative seizure frequency (P = 0.001) and longer duration of epilepsy (P = 0.042) were associated with the occurrence of intraoperative seizures. The postoperative FSIQ scores were significantly better than preoperative scores (mean 92.1 vs. 89.7, P = 0.014). Nine patients (29%) who underwent limited hippocampal RFTC were seizure-free at 1 year of follow-up. Responders represented 58% (n = 18) of patients at 1 year. The mean follow-up period was 34.7 ± 13.3 months. Five patients remained seizure free and 13 patients are still responders at the last follow-up visits. Long-term seizure frequency was 2.32 ± 2.86 times per month. CONCLUSIONS Limited hippocampal RFTC is a safe stereotactic minimal invasive procedure with good neuropsychologic outcome and acceptable efficacy of seizure reduction in appropriately selected patients.
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Affiliation(s)
- Kuan-Hao Fu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tony Wu
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Bao-Luen Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wei-En Johnny Tseng
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan City, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ting-Wei Liao
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
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Laser Interstitial Thermal Therapy for Epilepsy. Neurosurg Clin N Am 2023; 34:247-257. [PMID: 36906331 DOI: 10.1016/j.nec.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Laser interstitial thermal therapy is an important new technique with a diverse use in epilepsy. This article gives an up-to-date evaluation of the current use of the technique within epilepsy, as well as provides some guidance to novice users appropriate clinical cases for its use.
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Oliveira LPD, Pérez-Enríquez C, Barguilla A, Langohr K, Conesa G, Infante N, Principe A, Rocamora R. Stereo-electroencephalography-guided radiofrequency thermocoagulation in patients with MRI-negative focal epilepsy. J Neurosurg 2023; 138:837-846. [PMID: 35962969 DOI: 10.3171/2022.6.jns22733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/13/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Coupled with stereo-electroencephalography (SEEG), radiofrequency thermocoagulation (RFTC) has emerged as a therapeutic alternative for patients with refractory focal epilepsy, with proven safe but highly variable results across studies. The authors aimed to describe the outcomes and safety of SEEG-RFTC, focusing on patients with MRI-negative epilepsy. METHODS A retrospective observational study was conducted on patients evaluated by SEEG in the authors' center. Of 84 total cases, 55 underwent RFTC, with 31 MRI-negative epilepsies that were ultimately included in the study. The primary outcome was freedom from disabling seizures at last follow-up. Secondary outcomes were reduction in seizure frequency (RFTC response = seizure frequency reduction > 50%), peri-interventional complications, and neuropsychological outcomes. Potential factors influencing post-RFTC outcome were considered by comparing different variables between responders and nonresponders. RESULTS The mean follow-up period was 30.9 months (range 7.1-69.8 months). Three patients underwent subsequent resection/laser interstitial thermal therapy within the 1st year after RFTC failure. All other patients completed a minimum follow-up period of 1 year. Fourteen patients (45.2%) showed at least a 50% reduction in seizure frequency (responders), and 8 were seizure free (25.8% of the whole cohort). One case showed a permanent complication not directly related to thermolesions. Most patients (76%) showed no significant cognitive decline. Electrically elicited seizures (EESs) were observed in all seizure-free patients and were more frequent in responders (p = 0.038). All patients who were seizure free at the 6-month visit maintained their status during long-term follow-up. CONCLUSIONS SEEG-RFTC is a safe procedure and leads to a good response in many cases of MRI-negative focal epilepsies. One-quarter of the patients were seizure free and almost one-half were responders at the last follow-up. Although these results are still far from those achieved through conventional resection, a nonnegligible proportion of patients may benefit from this one-stage and much less invasive approach. Factors associated with seizure outcome remain to be elucidated; however, responders were significantly more frequent among patients with EESs, and achieving 6 months of seizure freedom appears to predict a good long-term response. In addition, the positive predictive value of RFTC response may be a valuable factor in the decision to proceed to subsequent surgery.
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Affiliation(s)
- Luísa Panadés-de Oliveira
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar.,2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM)
| | - Carmen Pérez-Enríquez
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar.,2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM)
| | - Ainara Barguilla
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar
| | - Klaus Langohr
- 3Department of Statistics and Operations Research, Universitat Politècnica de Catalunya BarcelonaTech.,4Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, IMIM
| | - Gerardo Conesa
- 2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM).,5Department of Neurosurgery, Hospital del Mar; and
| | | | - Alessandro Principe
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar.,2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM).,6Biomedical Engineering, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Rodrigo Rocamora
- 1Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar.,2Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM).,6Biomedical Engineering, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Treiber JM, Bayley JC, Curry D. Minimally Invasive Destructive, Ablative, and Disconnective Epilepsy Surgery. JOURNAL OF PEDIATRIC EPILEPSY 2023. [DOI: 10.1055/s-0042-1760106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractConventional epilepsy surgery performed by microsurgical dissection typically requires large cranial working windows created with high-speed drills and lengthy incisions. In the past few decades, minimally invasive techniques have been developed with smaller incisions, comparable efficacy, shorter hospitalizations, and better safety profiles. These minimally invasive alternatives utilize stereotactic, ultrasonic, radiotherapeutic, and endoscopic techniques. Although not able to completely replace conventional surgery for all etiologies of epilepsy, these minimally invasive techniques have revolutionized modern epilepsy surgery and have been an invaluable asset to the neurosurgeon's repertoire. The endoscope has allowed for surgeons to have adequate visualization during resective and disconnective epilepsy surgeries using keyhole or miniature craniotomies. Modern stereotactic techniques such as laser interstitial thermal therapy and radiofrequency ablation can be used as viable alternatives for mesial temporal lobe epilepsy and can destroy lesional tissue deep areas without the approach-related morbidity of microsurgery such as with hypothalamic hamartomas. These stereotactic techniques do not preclude future surgery in the settings of treatment failure and have been used successfully after failed conventional surgery. Multiple ablation corridors can be performed in a single procedure that can be used for lesioning of large targets or to simplify treating multifocal epilepsies. These stereotactic techniques have even been used successfully to perform disconnective procedures such as hemispherotomies and corpus callosotomies. In patients unable to tolerate surgery, stereotactic radiosurgery is a minimally invasive option that can result in improved seizure control with minimal procedural risks. Advances in minimally invasive neurosurgery provide viable treatment options for drug-resistant epilepsy with quicker recovery, less injury to functional brain, and for patients that may otherwise not choose conventional surgery.
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Affiliation(s)
- Jeffrey M. Treiber
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - James C. Bayley
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Daniel Curry
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
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Mo J, Zhang J, Hu W, Sang L, Zheng Z, Zhou W, Wang H, Zhu J, Zhang C, Wang X, Zhang K. Automated Detection and Surgical Planning for Focal Cortical Dysplasia with Multicenter Validation. Neurosurgery 2022; 91:799-807. [PMID: 36135782 DOI: 10.1227/neu.0000000000002113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with surgically amenable focal cortical dysplasia (FCD), subtle neuroimaging representation and the risk of open surgery lead to gaps in surgical treatment and delays in surgery. OBJECTIVE To construct an integrated platform that can accurately detect FCD and automatically establish trajectory planning for magnetic resonance-guided laser interstitial thermal therapy. METHODS This multicenter study included retrospective patients to train the automated detection model, prospective patients for model evaluation, and an additional cohort for construction of the automated trajectory planning algorithm. For automated detection, we evaluated the performance and generalization of the conventional neural network in different multicenter cohorts. For automated trajectory planning, feasibility/noninferiority and safety score were calculated to evaluate the clinical value. RESULTS Of the 260 patients screened for eligibility, 202 were finally included. Eighty-eight patients were selected for conventional neural network training, 88 for generalizability testing, and 26 for the establishment of an automated trajectory planning algorithm. The model trained using preprocessed and multimodal neuroimaging displayed the best performance in diagnosing FCD (figure of merit = 0.827 and accuracy range = 75.0%-91.7% across centers). None of the clinical variables had a significant effect on prediction performance. Moreover, the automated trajectory was feasible and noninferior to the manual trajectory (χ2 = 3.540, P = .060) and significantly safer (overall: test statistic = 30.423, P < .001). CONCLUSION The integrated platform validated based on multicenter, prospective cohorts exhibited advantages of easy implementation, high performance, and generalizability, thereby indicating its potential in the diagnosis and minimally invasive treatment of FCD.
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Affiliation(s)
- Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Wenjing Zhou
- Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing, China
| | - Haixiang Wang
- Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing, China
| | - Junming Zhu
- Epilepsy Center, Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Abramov I, Jubran JH, Houlihan LM, Park MT, Howshar JT, Farhadi DS, Loymak T, Cole TS, Pitskhelauri D, Preul MC. Multiple hippocampal transection for mesial temporal lobe epilepsy: A systematic review. Seizure 2022; 101:162-176. [PMID: 36041364 DOI: 10.1016/j.seizure.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/02/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Multiple hippocampal transection (MHT) is a surgical technique that offers adequate seizure control with minimal perioperative morbidity. However, there is little evidence available to guide neurosurgeons in selecting this technique for use in appropriate patients. This systematic review analyzes patient-level data associated with MHT for intractable epilepsy, focusing on postoperative seizure control and memory outcomes. METHODS The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 databases (PubMed, Medline, Embase) up to August 1, 2021. Inclusion criteria were that the majority of patients had received a diagnosis of intractable epilepsy, the article was written in English, MHT was the primary procedure, and patient-level metadata were included. RESULTS Fifty-nine unique patients who underwent MHT were identified across 11 studies. Ten (17%) of 59 patients underwent MHT alone. Forty-three (75%) of 57 patients who had a follow-up 12 months or longer were seizure free at last follow-up. With respect to postoperative verbal memory retention, 9 of 38 (24%) patient test scores did not change, 14 (37%) decreased, and 16 (42%) increased. With respect to postoperative nonverbal memory retention, 12 of 38 (34%) patient test scores did not change, 13 (34%) decreased, and 13 (33%) increased. CONCLUSION There are few reported patients analyzed after MHT. Although the neurocognitive benefits of MHT are unproven, this relatively novel technique has shown promise in the management of seizures in patients with intractable epilepsy. However, structured trials assessing MHT in isolation are warranted.
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Affiliation(s)
- Irakliy Abramov
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Jubran H Jubran
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Lena Mary Houlihan
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Marian T Park
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Jacob T Howshar
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Dara S Farhadi
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Thanapong Loymak
- Department of Neurosurgery, Srisawan Hospital, Nakhonsawan, Thailand
| | - Tyler S Cole
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - David Pitskhelauri
- Department of Neuro-Oncology, Burdenko Neurosurgical Center, Moscow, Russia
| | - Mark C Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Kaestner E, Pedersen NP, Hu R, Vosoughi A, Alwaki A, Ruiz AR, Staikova E, Hewitt KC, Epstein C, McDonald CR, Gross RE, Drane DL. Electrical Wada for pre-surgical memory testing: a case report. Epileptic Disord 2022; 24:411-416. [PMID: 34874269 PMCID: PMC9133096 DOI: 10.1684/epd.2021.1390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
We report a case study of a surgical candidate, a 51-year-old woman with left temporal lobe epilepsy, who failed a left injection intracarotid amobarbital procedure (e.g., Wada test), scoring 0 of 8 items. This raised concerns for postoperative memory decline. However, the patient was uninterested in a neuromodulatory approach and wished to be reconsidered for surgery. A stereotactic laser amygdalohippocampotomy (SLAH) was considered, encouraging the need for an alternative test to evaluate risk of memory decline. We developed a novel approach to testing memory during stimulation of a depth electrode implanted in the hippocampus, i.e., an electric Wada. During multiple stimulation trials across a range of amplitudes, the patient scored up to 8 of 8 items, which suggested strong contralateral memory support. The surgical team proceeded with a radiofrequency ablation and a subsequent SLAH. The patient remains seizure-free at 12 months post SLAH with no evidence of verbal or visuospatial memory decline based on a post-surgical neuropsychological battery. We believe that this case study provides a proof of concept for the feasibility and possible utility of an electric version of the Wada procedure. Future studies are needed to develop an optimal paradigm and to validate this approach.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Nigel P Pedersen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA, Department of Biomedical Engineering, Georgia Tech, Atlanta, GA, USA
| | - Ranling Hu
- Department of Radiology, Emory University, GA, USA
| | - Armin Vosoughi
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Abdulrahman Alwaki
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ekaterina Staikova
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles Epstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA, Department of Psychiatry, University of California, San Diego, CA, USA, San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Robert E Gross
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA, Department of Neurosurgery, Emory University, 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
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11
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Kaestner E, Stasenko A, Ben-Haim S, Shih J, Paul BM, McDonald CR. The importance of basal-temporal white matter to pre- and post-surgical naming ability in temporal lobe epilepsy. Neuroimage Clin 2022; 34:102963. [PMID: 35220106 PMCID: PMC8888987 DOI: 10.1016/j.nicl.2022.102963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/15/2021] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Emerging research highlights the importance of basal-temporal cortex, centered on the fusiform gyrus, to both pre-surgical naming ability and post-surgical naming outcomes in temporal lobe epilepsy (TLE). In this study, we investigate whether integrity of the white matter network that interconnects this basal region to the distributed language network affects naming ability and risk for post-surgical naming decline. METHODS Patients with drug-resistant TLE were recruited from two epilepsy centers in a prospective longitudinal study. The pre-surgical dataset included 50 healthy controls, 47 left TLE (L-TLE), and 41 right TLE (R-TLE) patients. All participants completed pre-surgical T1- and diffusion-weighted MRI (dMRI), as well as neuropsychological tests of auditory and visual naming. Nineteen L-TLE and 18 R-TLE patients underwent anterior temporal lobectomy (ATL) and also completed post-surgical neuropsychological testing. Pre-surgical fractional anisotropy (FA) of the white matter directly beneath the fusiform neocortex (i.e., superficial white matter; SWM) and of deep white matter tracts with connections to the basal-temporal cortex [inferior longitudinal fasciculus (ILF) and inferior frontal occipital fasciculus (IFOF)] was calculated. Clinical variables, hippocampal volume, and FA of each white matter tract or region were examined in linear regressions with naming scores, or change in naming scores, as the primary outcomes. RESULTS Pre-surgically, higher FA in the bilateral ILF, bilateral IFOF, and left fusiform SWM was associated with better visual and auditory naming scores (all ps < 0.05 with FDR correction). In L-TLE, higher pre-surgical FA was also associated with less naming decline post-surgically, but results varied across tracts. When including only patients with typical language dominance, only integrity of the right fusiform SWM was associated with less visual naming decline (p = .0018). DISCUSSION Although a broad network of white matter network matter may contribute to naming ability pre-surgically, the reserve capacity of the contralateral (right) fusiform SWM may be important for mitigating visual naming decline following ATL in L-TLE. This shows that the study of the structural network interconnecting the basal-temporal region to the wider language network has implications for understanding both pre- and post-surgical naming in TLE.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Alena Stasenko
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California, San Diego, CA, USA
| | - Jerry Shih
- Department of Neurosurgery, University of California, San Diego, CA, USA
| | - Brianna M Paul
- Department of Neurology, University of California -San Francisco, San Francisco, CA, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
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12
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Acerbo E, Safieddine S, Weber P, Botzanowski B, Missey F, Carrère M, Gross RE, Bartolomei F, Carron R, Jirsa V, Vanzetta I, Trébuchon A, Williamson A. Non-thermal Electroporation Ablation of Epileptogenic Zones Stops Seizures in Mice While Providing Reduced Vascular Damage and Accelerated Tissue Recovery. Front Behav Neurosci 2022; 15:774999. [PMID: 35002646 PMCID: PMC8740210 DOI: 10.3389/fnbeh.2021.774999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
In epilepsy, the most frequent surgical procedure is the resection of brain tissue in the temporal lobe, with seizure-free outcomes in approximately two-thirds of cases. However, consequences of surgery can vary strongly depending on the brain region targeted for removal, as surgical morbidity and collateral damage can lead to significant complications, particularly when bleeding and swelling are located near delicate functional cortical regions. Although focal thermal ablations are well-explored in epilepsy as a minimally invasive approach, hemorrhage and edema can be a consequence as the blood-brain barrier is still disrupted. Non-thermal irreversible electroporation (NTIRE), common in many other medical tissue ablations outside the brain, is a relatively unexplored method for the ablation of neural tissue, and has never been reported as a means for ablation of brain tissue in the context of epilepsy. Here, we present a detailed visualization of non-thermal ablation of neural tissue in mice and report that NTIRE successfully ablates epileptic foci in mice, resulting in seizure-freedom, while causing significantly less hemorrhage and edema compared to conventional thermal ablation. The NTIRE approach to ablation preserves the blood-brain barrier while pathological circuits in the same region are destroyed. Additionally, we see the reinnervation of fibers into ablated brain regions from neighboring areas as early as day 3 after ablation. Our evidence demonstrates that NTIRE could be utilized as a precise tool for the ablation of surgically challenging epileptogenic zones in patients where the risk of complications and hemorrhage is high, allowing not only reduced tissue damage but potentially accelerated recovery as vessels and extracellular matrix remain intact at the point of ablation.
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Affiliation(s)
- Emma Acerbo
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France
| | - Sawssan Safieddine
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France
| | - Pascal Weber
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France
| | - Boris Botzanowski
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France
| | - Florian Missey
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France
| | - Marcel Carrère
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France
| | - Romain Carron
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France.,Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Aix-Marseille Université, Marseille, France
| | - Viktor Jirsa
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France
| | - Ivo Vanzetta
- Institut de Neurosciences de la Timone, CNRS, Aix-Marseille Université, Marseille, France
| | - Agnès Trébuchon
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France
| | - Adam Williamson
- Institut de Neurosciences des Systèmes, UMR 1106, Aix-Marseille Université, Marseille, France.,Center for Bioelectronic Medicine, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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13
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Athreya A, Fasano RE, Drane DL, Millis SR, Willie JT, Gross RE, Karakis I. Withdrawal of antiepileptic drugs after stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Epilepsy Res 2021; 176:106721. [PMID: 34273722 DOI: 10.1016/j.eplepsyres.2021.106721] [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: 04/12/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This retrospective study investigated the success rate of withdrawal of antiepileptic drugs (AEDs) following stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE), and identified predictors of seizure recurrence. MATERIALS AND METHODS We retrospectively assessed 65 patients who underwent SLAH for MTLE (59 lesional). Patients' demographics, disease characteristics and post-surgical outcomes were evaluated for their potential to predict seizure recurrence associated with withdrawal of AEDs. RESULTS The mean period of observation post SLAH was 51 months (range 12-96 months) and the mean period to initial reduction of AEDs was 21 months (range 12-60 months). Reduction of AEDs was attempted in 37 patients (57 %) who were seizure free post SLAH and it was successful in approximately 2/3 of them. From the remainder 1/3 who relapsed, nearly all regained seizure control after reinstitution of their AEDs. The likelihood of relapse after reduction of AEDs was predicted only by pre-operative seizure frequency. At the end of the observation period, approximately 14 % of all SLAH patients were seizure free without AEDs and approximately 54 % remained seizure free on AEDs. Compared with preoperative status, the number of AEDs were reduced in 37 % of patients, unchanged in 51 % of them and increased in 12 % of them. CONCLUSIONS Successful SLAH for MTLE allows for reduction of AEDs in a significant portion of patients and complete withdrawal of AEDs in a subset of them. Patients with higher pre-operative seizure frequency exhibit a greater chance of relapse post reduction of AEDs.
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Affiliation(s)
- Arjun Athreya
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca E Fasano
- 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
| | - Scott R Millis
- Department of Neurology, Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, 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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14
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Wang R, Beg U, Padmanaban V, Abel TJ, Lipsman N, Ibrahim GM, Mansouri A. A Systematic Review of Minimally Invasive Procedures for Mesial Temporal Lobe Epilepsy: Too Minimal, Too Fast? Neurosurgery 2021; 89:164-176. [PMID: 33862622 DOI: 10.1093/neuros/nyab125] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cortico-amygdalohippocampectomy (CAH) is effective for mesial temporal lobe epilepsy (mTLE). Concerns regarding surgical morbidity have generated enthusiasm for more minimally invasive interventions. A careful analysis of current data is warranted before widespread adoption of these techniques. OBJECTIVE To systematically review the use of laser interstitial thermal therapy (LITT), stereotactic radiosurgery (SRS), radiofrequency thermocoagulation (RF-TC), and focused ultrasound for mTLE. METHODS Major online databases were searched for prospective observational studies, randomized clinical trials, and retrospective studies (>50 patients), including mTLE patients. Outcomes of interest were seizure freedom (Engel I), complications and re-operation rates, and neuropsychological and quality-of-life (QoL) data. RESULTS Nineteen publications were identified. At ≥6 mo postoperatively, LITT (9/19) Engel I outcomes ranged from 52% to 80%. SRS (3/19) has a latency period (52%-67%, 24-36 mo postoperatively) and the radiosurgery vs. open surgery for epilepsy (ROSE) trial reported inferiority of SRS compared to CAH. RF-TC (7/19) demonstrated variable seizure freedom rates (0%-79%) and high re-operation rates (0%-90%). Twelve studies reported neuropsychological outcomes but QoL (4/19) was not widely reported, and few studies (3/19) assessed both. Study quality ranged from fair to good. CONCLUSION Based on nonrandomized data, LITT has compelling evidence of efficacy; however, comparisons to surgical resection are lacking. SRS has a latency period and is inferior to CAH (ROSE trial). RF-TC is a less resource-intensive alternative to LITT; however, comparisons of efficacy are limited. Additional studies are needed before minimally invasive procedures can supplant standard surgery.
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Affiliation(s)
- Ryan Wang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Usman Beg
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona, USA
| | - Varun Padmanaban
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pennsylvania, USA
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Hurvitz Brain Sciences Program, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.,Penn State Cancer Institute, Hershey, Pennsylvania, USA
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15
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Kohlhase K, Zöllner JP, Tandon N, Strzelczyk A, Rosenow F. Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta-analysis of outcomes. Epilepsia 2021; 62:831-845. [PMID: 33656182 DOI: 10.1111/epi.16846] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023]
Abstract
Magnetic resonance-guided laser interstitial laser therapy (MRgLITT) and radiofrequency ablation (RFA) represent two minimally invasive methods for the treatment of drug-refractory mesial temporal lobe epilepsy (mTLE). We performed a systematic review and a meta-analysis to compare outcomes and complications between MRgLITT, RFA, and conventional surgical approaches to the temporal lobe (i.e., anterior temporal lobe resection [ATL] or selective amygdalohippocampectomy [sAHE]). Forty-three studies (13 MRgLITT, 6 RFA, and 24 surgery studies) involved 554, 123, 1504, and 1326 patients treated by MRgLITT, RFA, ATL, or sAHE, respectively. Engel Class I (Engel-I) outcomes were achieved after MRgLITT in 57% (315/554, range = 33.3%-67.4%), RFA in 44% (54/123, range = 0%-67.2%), ATL in 69% (1032/1504, range = 40%-92.9%), and sAHE in 66% (887/1326, range = 21.4%-93.3%). Meta-analysis revealed no significant difference in seizure outcome between MRgLITT and RFA (Q = 2.74, p = .098), whereas ATL and sAHE were both superior to MRgLITT (ATL: Q = 8.92, p = .002; sAHE: Q = 4.33, p = .037) and RFA (ATL: Q = 6.42, p = .0113; sAHE: Q = 5.04, p = .0247), with better outcome in patients at follow-up of 60 months or more. Mesial hippocampal sclerosis (mTLE + hippocampal sclerosis) was associated with significantly better outcome after MRgLITT (Engel-I outcome in 64%; Q = 8.55, p = .0035). The rate of major complications was 3.8% for MRgLITT, 3.7% for RFA, 10.9% for ATL, and 7.4% for sAHE; the differences did not show statistical significance. Neuropsychological deficits occurred after all procedures, with left-sided surgeries having a higher rate of verbal memory impairment. Lateral functions such as naming or object recognition may be more preserved in MRgLITT. Thermal therapies are effective techniques but show a significantly lower rate of Engel-I outcome in comparison to ATL and sAHE. Between MRgLITT and RFA there were no significant differences in Engel-I outcome, whereby the success of treatment seems to depend on the approach used (e.g., occipital approach). MRgLITT shows a similar rate of complications compared to RFA, whereas patients undergoing MRgLITT may experience fewer major complications compared to ATL or sAHE and might have a more beneficial neuropsychological outcome.
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Affiliation(s)
- Konstantin Kohlhase
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
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16
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Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC). Seizure 2020; 77:64-68. [DOI: 10.1016/j.seizure.2019.01.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 01/24/2023] Open
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17
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Hoppe C, Helmstaedter C. Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery. Seizure 2020; 77:69-75. [DOI: 10.1016/j.seizure.2018.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 01/06/2023] Open
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18
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Wang D, Wei P, Shan Y, Ren L, Wang Y, Zhao G. Optimized stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of patients with focal epilepsy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:15. [PMID: 32055606 DOI: 10.21037/atm.2019.10.112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epilepsy is a severe health disorder affecting people of all ages with high prevalence worldwide. The introduction of new antiepileptic drugs has yielded notable effects in recent decades, yet there are still approximately 30% of patients with seizures refractory to medical therapy. Open surgical resection is widely accepted as a highly effective approach for the treatment of drug-resistant focal epilepsy if the epileptogenic zone can be precisely delineated. However, concerns about the impact of open surgery on brain function have driven considerable interest in less invasive techniques. Clinically, stereoelectroencephalography (SEEG) offers a unique means of exploring the pathophysiologic process and accurately mapping the epileptogenic network in presurgical evaluations for patients with epilepsy because of insufficient information from other noninvasive investigations. Moreover, SEEG-guided radiofrequency thermocoagulation (SEEG-guided RF-TC), which ablates lesions directly through the recording electrodes according to electroclinical evidence, has emerged as a promising, minimally invasive modality with notable preservation of neurocognitive functions. This critical review summarizes the technical details of the parameters and the selection of patients for SEEG-guided RF-TC based on the literature as well as our experiences. With respect to the parameters, the power and duration of RF-TC are discussed. In particular, an optimized SEEG-guided RF-TC modality that integrates more contacts from multiple different electrodes to create a confluent lesioning field is proposed for a more curative effect in comparison to the current protocol of palliative treatment in which RF-TC selectively disrupts critical hubs in the epileptic network through contiguous contacts within the range of a single electrode. Currently, SEEG-guided RF-TC is indicated for a variety of small, deeply seeded and well-demarcated epileptogenic foci, such as deep heterotopic nodules and hypothalamic hamartoma. The efficacy of treating patients with focal cortical dysplasias in the eloquent cortex and with mesial temporal lobe epilepsy associated with hippocampal sclerosis needs to be further determined. Given the small number of patients reported, randomized controlled trials are necessary to compare the efficacy of SEEG-guided RF-TC with conventional methods in the future.
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Affiliation(s)
- Di Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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19
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Ginalis EE, Patel NV, Danish SF. Commentary: Anatomic and Thermometric Analysis of Cranial Nerve Palsy After Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy. Oper Neurosurg (Hagerstown) 2019; 18:E219-E220. [DOI: 10.1093/ons/opz352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elizabeth E Ginalis
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nitesh V Patel
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shabbar F Danish
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
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20
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Ross L, Naduvil AM, Bulacio JC, Najm IM, Gonzalez-Martinez JA. Stereoelectroencephalography-Guided Laser Ablations in Patients With Neocortical Pharmacoresistant Focal Epilepsy: Concept and Operative Technique. Oper Neurosurg (Hagerstown) 2019; 15:656-663. [PMID: 29554343 DOI: 10.1093/ons/opy022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 01/23/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Laser ablation surgery has had encouraging results in the treatment of multiple intracranial diseases including primary and metastatic brain tumors, radiation necrosis, and epilepsy. The use of the stereoelectroencephalography (SEEG) method in combination with laser thermocoagulation therapy with the goal of modulating epileptic networks in patients with neocortical nonlesional phamacoresistant epilepsy has not been previously described. OBJECTIVE To describe the novel methodological and conceptual aspects related to SEEG-guided laser ablations in patients with magnetic resonance imaging (MRI)-negative pharmacoresistant neocortical focal epilepsy. METHODS Guided by previous SEEG intracranial data, a laser ablation probe was inserted by using a robotic guidance device in a 17-yr-old medically refractory epilepsy patient with difficult to localize seizures and nonlesional MRI. The laser applicator position was confirmed by MRI, targeting the left mesial rostral superior frontal gyrus. The ablation was performed under multiplanar digital imaging views and real-time thermal imaging and treatment estimates in each plane. A postablation MRI (contrasted T1 sequence) confirmed the ablation's location and size. RESULTS The entire procedure was achieved in approximately 100 min. The actual ablation was performed in less than 3 min. Approximately, additional 30 min preoperatively were used for positioning and robot registration. Precise placement of laser application (in comparison with preplanned trajectories) was achieved using the robotic guidance and confirmed by the intraoperative magnetic resonance images. No complications were reported. The patient has been seizure-free since surgery. The follow-up period is 20 mo. Two additional patients, treated with similar methodology, are also described. CONCLUSION The preliminary experience with the described method shows the feasibility of a unique combination of the SEEG methodology with laser thermocoagulation in patients with neocortical MRI-negative pharmacoresistant focal epilepsy.
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Affiliation(s)
- Louis Ross
- Department of Neurosurgery, Cleveland Clinic, Ohio
| | | | | | - Imad M Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | - Jorge A Gonzalez-Martinez
- Department of Neurosurgery, Cleveland Clinic, Ohio.,Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
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Holanda VM, Gungor A, Baydin S, Middlebrooks EH, Danish SF. Anatomic Investigation of the Trajectory for Stereotactic Laser Amygdalohippocampectomy. Oper Neurosurg (Hagerstown) 2019; 15:194-206. [PMID: 29140463 DOI: 10.1093/ons/opx218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 09/16/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) has emerged as a promising treatment for mesial temporal lobe epilepsy. Surgeons must understand the relevant anatomy that is traversed by the catheter and affected by ablation. OBJECTIVE To study the anatomic structures crossed by the LITT catheter until it reaches the amygdala. METHODS Three human cadaveric heads were implanted with catheters using a frameless stereotactic technique. The Visualase® system (Medtronic, Dublin, Ireland) was utilized to ablate along the trajectory. Coronal and oblique axial slices were created. Fiber tract dissections were performed in a lateral-medial and inferior-superior scheme. Magnetic resonance tractography was acquired to illustrate the tracts dissected. RESULTS Entry points occurred within 4 cm of the transverse and sagittal sinus, inferior to the lambdoid suture. The cortex of the inferior occipital gyrus was crossed in the region of the transverse occipital sulcus. The vertical occipital fasciculus was crossed en route to passing through the optic radiations. The catheter crossed through or inferior to the optic radiations before piercing the parahippocampal gyrus at about 4 cm from the skull. The catheter entered the hippocampus as it pierced the superior margin of the parahippocampus at 6 cm. The catheter entered the head of the hippocampus to lie inferolateral to the amygdala in the last centimeter of the trajectory. CONCLUSION Understanding the anatomic principles of LITT catheter trajectories will improve the ability to perform this procedure. The current study is the first to examine the anatomy of this trajectory and will serve as the basis for future studies.
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Affiliation(s)
- Vanessa M Holanda
- Center of Neurology and Neurosurgery Associates (NeuroCENNA), Beneficência Portuguesa of São Paulo Hospital, São Paulo-SP, Brazil
| | - Abuzer Gungor
- Department of Neurosurgery, Bakirkoy Research and Training Hospital for Neurology, Neurosurgery, and Psychiatry, Istanbul, Turkey
| | - Serhat Baydin
- Department of Neurosurgery, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Erik H Middlebrooks
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shabbar F Danish
- Division of Neurosurgery, Rutgers-RWJ Medical School, New Brunswick, New Jersey
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Lee CY, Li HT, Wu T, Cheng MY, Lim SN, Lee ST. Efficacy of limited hippocampal radiofrequency thermocoagulation for mesial temporal lobe epilepsy. J Neurosurg 2019; 131:781-789. [PMID: 30497199 DOI: 10.3171/2018.4.jns184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Radiofrequency thermocoagulation (RFTC), which has been developed for drug-resistant epilepsy patients, involves less brain tissue loss due to surgery, fewer surgical adverse effects, and generally good seizure control. This study demonstrates the effectiveness of RFTC performed at limited hippocampal locations. METHODS Daily seizure diaries were prospectively maintained for at least 6 months by 9 patients (ages 30-59 years) with drug-resistant mesial temporal lobe epilepsy (MTLE) before treatment with RFTC. The limited target for stereotactic RFTC was chosen based on intraoperative electroencephalography (EEG) recording and was initially tested with a Radionics electrode at a low temperature, 45°C, for 60 seconds. The therapeutic RFTC heating parameters were 78°C-80°C for 90 seconds. All patients who received the RFTC treatment underwent both MRI and EEG recording immediately postoperatively and at the 3-month follow-up. Monthly outpatient clinic visits were arranged over 6 months to document seizure frequency and severity to clarify the changes noted in imaging studies and EEG patterns. RESULTS Two patients were excluded from our analysis because one had undergone multiple seizure surgeries and the other had a poor recording of seizure frequency, before the RFTC surgery. Five and two patients underwent left-sided and right-sided RFTC, respectively. None of the patients had generalized tonic-clonic attacks postoperatively, and no adverse effects or complications occurred. According to MRI data, the effect of coagulation was limited to less than 1.0 cm in diameter and perifocal edema was also in limited range. The seizure frequency within 6 months decreased postoperatively with a mean reduction in seizures of 78% (range 36%-100%). Only two patients had a temporary increase in seizure frequency within 2 weeks of the surgery, and over 50% of all patients showed a decrease in average seizure frequency. CONCLUSIONS The study results confirm that limited RFTC provides a more effective surgery with similar seizure control but fewer complications than resective surgery for drug-resistant MTLE patients.
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Affiliation(s)
| | - Han-Tao Li
- 2Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- 2Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- 2Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Siew-Na Lim
- 2Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Predictors of meaningful improvement in quality of life after selective amygdalohippocampectomy in Chinese patients with refractory temporal lobe epilepsy: A prospective study. Epilepsy Behav 2019; 97:1-7. [PMID: 31181423 DOI: 10.1016/j.yebeh.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Our aim was to determine the independent predictors of minimum clinically important difference (MCID) in quality of life (QOL) after selective amygdalohippocampectomy (SAH) among Chinese patients with refractory mesial temporal lobe epilepsy (MTLE). METHODS We conducted a prospective study and enrolled 50 consecutive patients with refractory MTLE who underwent SAH after their presurgical evaluations. The variables independently associated with MCID in the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) overall score 1 year after SAH were analyzed by multiple binary logistic regression analysis. RESULTS Significant improvements in the QOLIE-31 overall score and all subscale scores were observed after SAH (p < 0.001). Among 50 patients with refractory MTLE, 78% reached the criteria for MCID of QOL overall score after SAH. In the multiple binary logistic regression model, the presurgical independent predictors of significant improvement by MCID in QOL were absence of depression diagnosis (adjusted odds ratio [OR] = 8.391, 95% confidence interval [CI] = 1.240-56.776, p = 0.029) and good cognitive function (adjusted OR = 8.427, 95% CI = 1.115-63.670, p = 0.039); the postoperative independent predictor was seizure freedom (adjusted OR = 8.477, 95% CI = 1.195-60.122, p = 0.032). The sensitivity and specificity for significant improvement in the QOL were 97.4% and 45.5% respectively, with an overall model accuracy of 86.0%. CONCLUSIONS Presurgical depression, cognitive function, and postsurgical seizure freedom are independent predictors for meaningful improvement in QOL after SAH among the Chinese patients with refractory MTLE. Preoperative evaluation of patients with refractory MTLE should consider the cognitive dysfunction and psychological disorders.
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Drane DL, Pedersen NP. Knowledge of language function and underlying neural networks gained from focal seizures and epilepsy surgery. BRAIN AND LANGUAGE 2019; 189:20-33. [PMID: 30615986 PMCID: PMC7183240 DOI: 10.1016/j.bandl.2018.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/05/2018] [Accepted: 12/19/2018] [Indexed: 05/09/2023]
Abstract
The effects of epilepsy and its treatments have contributed significantly to language models. The setting of epilepsy surgery, which allows for careful pre- and postsurgical evaluation of patients with cognitive testing and neuroimaging, has produced a wealth of language findings. Moreover, a new wave of surgical interventions, including stereotactic laser ablation and radio frequency ablation, have contributed new insights and corrections to language models as they can make extremely precise, focal lesions. This review covers the common language deficits observed in focal dyscognitive seizure syndromes. It also addresses the effects of surgical interventions on language, and highlights insights gained from unique epilepsy assessment methods (e.g., cortical stimulation mapping, Wada evaluation). Emergent findings are covered including a lack of involvement of the hippocampus in confrontation word retrieval, possible roles for key white matter tracts in language, and the often-overlooked basal temporal language area. The relationship between language and semantic memory networks is also explored, with brief consideration given to the prevailing models of semantic processing, including the amodal Hub and distributed, multi-modal processing models.
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Affiliation(s)
- 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 School of Medicine, Seattle, WA, USA.
| | - Nigel P Pedersen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Yan H, Snead C, Ibrahim GM. Epilepsy surgery for children with severe developmental delay: An ethical double jeopardy. Epilepsy Behav 2019; 90:287-290. [PMID: 30477990 DOI: 10.1016/j.yebeh.2018.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Han Yan
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Carter Snead
- Department of Neurology, Hospital for Sick Children, Toronto, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Division of Neurosurgery, Hospital for Sick Children, Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Canada.
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Busby N, Halai AD, Parker GJM, Coope DJ, Lambon Ralph MA. Mapping whole brain connectivity changes: The potential impact of different surgical resection approaches for temporal lobe epilepsy. Cortex 2018; 113:1-14. [PMID: 30557759 DOI: 10.1016/j.cortex.2018.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
Abstract
In neurosurgery there are several situations that require transgression of the temporal cortex. For example, a subset of patients with temporal lobe epilepsy require surgical resection (most typically, en-bloc anterior temporal lobectomy). This procedure is the gold standard to alleviate seizures but is associated with chronic cognitive deficits. In recent years there have been multiple attempts to find the optimum balance between minimising the size of resection in order to preserve cognitive function, while still ensuring seizure freedom. Some attempts involve reducing the distance that the resection stretches back from the temporal pole, whilst others try to preserve one or more of the temporal gyri. More recent advanced surgical techniques (selective amygdalo-hippocamptectomies) try to remove the least amount of tissue by going under (sub-temporal), over (trans-Sylvian) or through the temporal lobe (middle-temporal), which have been related to better cognitive outcomes. Previous comparisons of these surgical techniques focus on comparing seizure freedom or behaviour post-surgery, however there have been no systematic studies showing the effect of surgery on white matter connectivity. The main aim of this study, therefore, was to perform systematic 'pseudo-neurosurgery' based on existing resection methods on healthy neuroimaging data and measuring the effect on long-range connectivity. We use anatomical connectivity maps (ACM) to determine long-range disconnection, which is complementary to existing measures of local integrity such as fractional anisotropy or mean diffusivity. ACMs were generated for each diffusion scan in order to compare whole-brain connectivity with an 'ideal resection', nine anterior temporal lobectomy and three selective approaches. For en-bloc resections, as distance from the temporal pole increased, reduction in connectivity was evident within the arcuate fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and the uncinate fasciculus. Increasing the height of resections dorsally reduced connectivity within the uncinate fasciculus. Sub-temporal amygdalohippocampectomy resections were associated with connectivity patterns most similar to the 'ideal' baseline resection, compared to trans-Sylvian and middle-temporal approaches. In conclusion, we showed the utility of ACM in assessing long-range disconnections/disruptions during temporal lobe resections, where we identified the sub-temporal resection as the least disruptive to long-range connectivity which may explain its better cognitive outcome. These results have a direct impact on understanding the amount and/or type of cognitive deficit post-surgery, which may not be obtainable using local measures of white matter integrity.
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Affiliation(s)
- Natalie Busby
- Neuroscience and Aphasia Research Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK.
| | - Ajay D Halai
- Neuroscience and Aphasia Research Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Geoff J M Parker
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK; Bioxydyn Ltd., Manchester, UK
| | - David J Coope
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK; Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK
| | - Matthew A Lambon Ralph
- Neuroscience and Aphasia Research Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, UK.
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27
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Laser interstitial thermal therapy (LITT): Seizure outcomes for refractory mesial temporal lobe epilepsy. Epilepsy Behav 2018; 89:37-41. [PMID: 30384097 DOI: 10.1016/j.yebeh.2018.09.040] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is a minimally invasive alternative with less cognitive risks compared with traditional surgery for focal drug-resistant epilepsy. OBJECTIVE We describe seizure outcomes and complications after LITT in our cohort with intractable mesial temporal lobe epilepsy (MTLE). MATERIAL AND METHODS We prospectively tracked Stanford's MTLE cases treated with LITT from October 2014 to October 2017. Primary endpoints were seizure outcomes by (1) Engel classification and (2) reduction in baseline seizure frequency. Secondary outcomes were postablation complications. RESULTS A total of 30 patients underwent selective amygdalohippocampotomy via LITT. Mesial temporal sclerosis (MTS) was present in 23/30 (77%) patients. Median follow-up was 18 ± 12 months (range: 6-44 months). Almost all 28/29 (97%) patients had >50% reduction, and 22/29 (76%) patients had >90% reduction in seizure frequency. Engel Class I outcome was achieved in 18/29 (62%) patients; with complete seizure freedom in 9/29 (31%) patients (Engel Class IA). Three (10%) patients have had only focal aware seizures (Engel Class 1B). Seizures only occurred with medication withdrawal in 6/29 (21%) patients (Engel Class ID). Class II was achieved by 6/29 (21%) and Class III by 5/29 (17%) patients. Complications included perioperative seizures in 10/29 (34%) and nonseizure complaints in 6/29 (21%) patients. Three (10%) patients had neurological deficits including one permanent superior quadrantanopsia, one transient trochlear, and one transient oculomotor nerve palsy. CONCLUSIONS Overall, Engel Class I outcome was achieved in 62% of patients with MTLE, and 97% of patients achieved >50% seizure frequency reduction. Complications were largely temporary, though there was one persistent visual field deficit. Laser ablation is well-tolerated and offers marked seizure reduction for the majority of patients.
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Marashly A, Loman MM, Lew SM. Stereotactic laser ablation for nonlesional cingulate epilepsy: case report. J Neurosurg Pediatr 2018; 22:481-488. [PMID: 30074447 DOI: 10.3171/2018.5.peds18120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/22/2018] [Indexed: 11/06/2022]
Abstract
Stereotactic laser ablation (SLA) is being increasingly used to treat refractory focal epilepsy, especially mesial temporal lobe epilepsy. However, emerging evidence suggests it can be used for extratemporal lobe epilepsy as well.The authors report the case of a 17-year-old male who presented with refractory nocturnal seizures characterized by bilateral arms stiffening or rhythmic jerking lasting several seconds. Semiology suggested an epileptogenic zone close to one of the supplementary sensory motor areas. Electroencephalography showed seizures arising from the central region without consistent lateralization. Brain imaging showed no abnormality. An invasive evaluation using bilateral stereoelectroencephalography (SEEG) was utilized in 2 steps, first to establish the laterality of seizures, and second to further cover the mesial cingulate region of the right hemisphere. Seizures arose from the middle portion of the right cingulate gyrus. Extraoperative electrical mapping revealed that the seizure onset zone was adjacent to eloquent motor areas. SLA targeting the right midcingulate gyrus was performed. The patient has remained seizure free since immediately after the procedure with no postoperative deficits (follow-up of 17 months).This case highlights the utility of SEEG in evaluating difficult-to-localize, focal epilepsy. It also demonstrates that the use of SLA can be extended to nonlesional, extratemporal epilepsies.
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Schmid E, Thomschewski A, Taylor A, Zimmermann G, Kirschner M, Kobulashvili T, Brigo F, Rados M, Helmstaedter C, Braun K, Trinka E. Diagnostic accuracy of functional magnetic resonance imaging, Wada test, magnetoencephalography, and functional transcranial Doppler sonography for memory and language outcome after epilepsy surgery: A systematic review. Epilepsia 2018; 59:2305-2317. [PMID: 30374948 DOI: 10.1111/epi.14588] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The European Union-funded E-PILEPSY project was launched to develop guidelines and recommendations for epilepsy surgery. In this systematic review, we aimed to assess the diagnostic accuracy of functional magnetic resonance imaging (fMRI), Wada test, magnetoencephalography (MEG), and functional transcranial Doppler sonography (fTCD) for memory and language decline after surgery. METHODS The literature search was conducted using PubMed, Embase, and CENTRAL. The diagnostic accuracy was expressed in terms of sensitivity and specificity for postoperative language or memory decline, as determined by pre- and postoperative neuropsychological assessments. If two or more estimates of sensitivity or specificity were extracted from a study, two meta-analyses were conducted, using the maximum ("best case") and the minimum ("worst case") of the extracted estimates, respectively. RESULTS Twenty-eight papers were eligible for data extraction and further analysis. All tests for heterogeneity were highly significant, indicating large between-study variability (P < 0.001). For memory outcomes, meta-analyses were conducted for Wada tests (n = 17) using both memory and language laterality quotients. In the best case, meta-analyses yielded a sensitivity estimate of 0.79 (95% confidence interval [CI] = 0.67-0.92) and a specificity estimate of 0.65 (95% CI = 0.47-0.83). For the worst case, meta-analyses yielded a sensitivity estimate of 0.65 (95% CI = 0.48-0.82) and a specificity estimate of 0.46 (95% CI = 0.28-0.65). The overall quality of evidence, which was assessed using Grading of Recommendations Assessment, Development, and Evaluation methodology, was rated as very low. Meta-analyses concerning diagnostic accuracy of fMRI, fTCD, and MEG were not feasible due to small numbers of studies (fMRI, n = 4; fTCD, n = 1; MEG, n = 0). This also applied to studies concerning language outcomes (Wada test, n = 6; fMRI, n = 2; fTCD, n = 1; MEG, n = 0). SIGNIFICANCE Meta-analyses could only be conducted in a few subgroups for the Wada test with low-quality evidence. Thus, more evidence from high-quality studies and improved data reporting are required. Moreover, the large between-study heterogeneity underlines the necessity for more homogeneous and thus comparable studies in future research.
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Affiliation(s)
- Elisabeth Schmid
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
| | - Alexandra Taylor
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Matea Rados
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | | | - Kees Braun
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
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Moles A, Guénot M, Rheims S, Berthiller J, Catenoix H, Montavont A, Ostrowsky-Coste K, Boulogne S, Isnard J, Bourdillon P. SEEG-guided radiofrequency coagulation (SEEG-guided RF-TC) versus anterior temporal lobectomy (ATL) in temporal lobe epilepsy. J Neurol 2018; 265:1998-2004. [DOI: 10.1007/s00415-018-8958-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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Tao JX, Wu S, Lacy M, Rose S, Issa NP, Yang CW, Dorociak KE, Bruzzone M, Kim J, Daif A, Choi J, Towle VL, Warnke PC. Stereotactic EEG-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2018; 89:542-548. [PMID: 29183959 DOI: 10.1136/jnnp-2017-316833] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/28/2017] [Accepted: 11/08/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the outcomes of combined stereo-electroencephalography-guided and MRI-guided stereotactic laser interstitial thermal therapy (LITT) in the treatment of patients with drug-resistant mesial temporal lobe epilepsy (mTLE). METHODS We prospectively assessed the surgical and neuropsychological outcomes in 21 patients with medically refractory mTLE who underwent LITT at the University of Chicago Medical Center. We further compared the surgical outcomes in patients with and without mesial temporal sclerosis (MTS). RESULTS Of the 21 patients, 19 (90%) underwent Invasive EEG study and 11 (52%) achieved freedom from disabling seizures with a mean duration of postoperative follow-up of 24±11 months after LITT. Eight (73%) of 11 patients with MTS achieved freedom from disabling seizures, whereas 3 (30 %) of 10 patients without MTS achieved freedom from disabling seizures. Patients with MTS were significantly more likely to become seizure-free, as compared with those without MTS (P=0.002). There was no significant difference in total ablation volume and the percentage of the ablated amygdalohippocampal complex between seizure-free and non-seizure-free patients. Presurgical and postsurgical neuropsychological assessments were obtained in 10 of 21 patients. While there was no group decline in any neuropsychological assessment, a significant postoperative decline in verbal memory and confrontational naming was observed in individual patients. CONCLUSIONS MRI-guided LITT is a safe and effective alternative to selective amygdalohippocampectomy and anterior temporal lobectomy for mTLE with MTS. Nevertheless, its efficacy in those without MTS seems modest. Large multicentre and prospective studies are warranted to further determine the efficacy and safety of LITT.
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Affiliation(s)
- James X Tao
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Maureen Lacy
- Department of Psychiatry, The University of Chicago, Chicago, Illinois, USA
| | - Sandra Rose
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Naoum P Issa
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Carina W Yang
- Department of Radiology, The University of Chicago, Chicago, Illinois, USA
| | | | - Maria Bruzzone
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Jisoon Kim
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Ahmad Daif
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Jason Choi
- Department of Neurosurgery, The University of Chicago, Chicago, Illinois, USA
| | - Vernon L Towle
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- Department of Neurosurgery, The University of Chicago, Chicago, Illinois, USA
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Petito GT, Wharen RE, Feyissa AM, Grewal SS, Lucas JA, Tatum WO. The impact of stereotactic laser ablation at a typical epilepsy center. Epilepsy Behav 2018; 78:37-44. [PMID: 29172137 DOI: 10.1016/j.yebeh.2017.10.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/29/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Stereotactic laser ablation (SLA) is a novel form of epilepsy surgery for patients with drug-resistant focal epilepsy. We evaluated one hundred consecutive surgeries performed for patients with epilepsy to address the impact of SLA on our therapeutic approach, as well as patient outcomes. METHODS A retrospective, single center analysis of the last one hundred neurosurgeries for epilepsy was performed from 2013 to 2015. Demographics, surgical procedures, and postoperative measures were assessed up to 5years to compare the effect of SLA on outcome. Confidence intervals (CI) and comparative tests of proportions compared outcomes for SLA and resective surgery. Procedural categorical comparison used Chi-square and Kaplan-Meier curves. Student t-test was utilized for single variables such as age at procedure and seizure onset. RESULTS One hundred surgeries for epilepsy yielded thirty-three SLAs and twenty-one resections with a mean of 21.7-month and 21.3-month follow-up, respectively. The temporal lobe was the most common target for SLA (92.6%) and resection (75%). A discrete lesion was present on brain magnetic resonance imaging (MRI) in 27/32 (84.4%) of SLA patients compared with 7/20 (35%) of resection patients with a normal MRI. Overall, 55-60% of patients became seizure-free (SF). Four of five patients with initial failure to SLA became SF with subsequent resection surgery. Complications were more frequent with resection although SF outcomes did not differ (Chi square; p=0.79). Stereotactic laser ablation patients were older than those with resections (47.0years vs. 35.4years, p=0.001). The mean length of hospitalization prior to discharge was shorter for SLA (1.18days) compared with open resection (3.43days; SD: 3.16 days) (p=0.0002). CONCLUSION We now use SLA as a first line therapy at our center in patients with lesional temporal lobe epilepsy (TLE) before resection. Seizure-free outcome with SLA and resection was similar but with a shorter length of stay. Long-term follow-up is recommended to determine sustained SF status from SLA.
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Affiliation(s)
- Gabrielle T Petito
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Robert E Wharen
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Sanjeet S Grewal
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - John A Lucas
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - William O Tatum
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Hong SJ, Bernhardt B, Gill R, Bernasconi N, Bernasconi A. Connectome-Based Pattern Learning Predicts Histology and Surgical Outcome of Epileptogenic Malformations of Cortical Development. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/978-3-319-66182-7_45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Vuong J, Devergnas A. The role of the basal ganglia in the control of seizure. J Neural Transm (Vienna) 2017; 125:531-545. [PMID: 28766041 DOI: 10.1007/s00702-017-1768-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/23/2017] [Indexed: 12/19/2022]
Abstract
Epilepsy is a network disorder and each type of seizure involves distinct cortical and subcortical network, differently implicated in the control and propagation of the ictal activity. The role of the basal ganglia has been revealed in several cases of focal and generalized seizures. Here, we review the data that show the implication of the basal ganglia in absence, temporal lobe, and neocortical seizures in animal models (rodent, cat, and non-human primate) and in human. Based on these results and the advancement of deep brain stimulation for Parkinson's disease, basal ganglia neuromodulation has been tested with some success that can be equally seen as promising or disappointing. The effect of deep brain stimulation can be considered promising with a 76% in seizure reduction in temporal lobe epilepsy patients, but also disappointing, since only few patients have become seizure free and the antiepileptic effects have been highly variable among patients. This variability could probably be explained by the heterogeneity among the patients included in these clinical studies. To illustrate the importance of specific network identification, electrophysiological activity of the putamen and caudate nucleus has been recorded during penicillin-induced pre-frontal and motor seizures in one monkey. While an increase of the firing rate was found in putamen and caudate nucleus during pre-frontal seizures, only the activity of the putamen cells was increased during motor seizures. These preliminary results demonstrate the implication of the basal ganglia in two types of neocortical seizures and the necessity of studying the network to identify the important nodes implicated in the propagation and control of each type of seizure.
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Affiliation(s)
- J Vuong
- Yerkes National Primate Research Center, Emory University, 954 Gatewood Road NE, Atlanta, GA, 30329, USA
| | - Annaelle Devergnas
- Yerkes National Primate Research Center, Emory University, 954 Gatewood Road NE, Atlanta, GA, 30329, USA. .,Department of Neurology, Emory University, Atlanta, GA, 30322, USA.
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Kang JY, Sperling MR. Epileptologist's view: Laser interstitial thermal ablation for treatment of temporal lobe epilepsy. Epilepsy Res 2017; 142:149-152. [PMID: 28774708 DOI: 10.1016/j.eplepsyres.2017.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/23/2017] [Accepted: 07/11/2017] [Indexed: 11/29/2022]
Abstract
A procedure called laser interstitial thermal ablation has been utilized to treat drug resistant epilepsy. With this technique, a probe is stereotactically inserted into a target structure responsible for seizures, such as mesial temporal lobe, hypothalamic hamartoma, or a small malformation of cortical development, and the tip is then heated by application of laser energy to ablate structures adjacent to the probe tip. This procedure has the advantage of selectively targeting small lesions responsible for seizures, and is far less invasive than open surgery with shorter hospitalization, less pain, and rapid return to normal activities. Initial results in mesial temporal lobe epilepsy are promising, with perhaps half of patients becoming free of seizures after the procedure. Neuropsychological deficits appear to be reduced because of the smaller volume of ablated cortex in contrast to large resections. More research must be done to establish optimal targeting of structures for ablation and selection of candidates for surgery, and more patients must be studied to better establish efficacy and adverse effect rates.
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Affiliation(s)
- Joon Y Kang
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
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36
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Krámská L, Vojtěch Z, Lukavský J, Stará M, Malíková H. Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study. Stereotact Funct Neurosurg 2017; 95:149-157. [DOI: 10.1159/000468527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/02/2017] [Indexed: 11/19/2022]
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Morris SA, Rollo M, Rollo P, Johnson J, Grant GA, Friedman E, Kalamangalam G, Tandon N. Prolonged Blood-Brain Barrier Disruption Following Laser Interstitial Ablation in Epilepsy: A Case Series with a Case Report of Postablation Optic Neuritis. World Neurosurg 2017; 104:467-475. [PMID: 28502693 DOI: 10.1016/j.wneu.2017.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Laser interstitial thermal therapy has become increasingly popular for targeting epileptic foci in a minimally invasive fashion. Despite its use in >1000 patients, the long-term effects of photothermal injury on brain physiology remain poorly understood. METHODS We prospectively followed clinical and radiographic courses of 13 patients undergoing laser ablation for focal epilepsy by the senior author (N.T.). Only patients with nonenhancing lesions and patients who had a delayed postoperative magnetic resonance imaging (MRI) scan with gadolinium administration approximately 6 months after ablation were considered. Volumetric estimates of the amount of enhancement immediately after ablation and on the delayed MRI scan were made. RESULTS Median interval between surgery and delayed postoperative MRI scan was 6 months (range, 5-8 months). In 12 of 13 cases, persistent enhancement was seen, consistent with prolonged blood-brain barrier dysfunction. Enhancement, when present, was 9%-67% (mean 30%). There was no correlation between the time from surgery and the relative percentage of postoperative enhancement on MRI. The blood-brain barrier remained compromised to gadolinium contrast for up to 8 months after thermal therapy. There were no adverse events from surgical intervention; however, 1 patient developed delayed optic neuritis. CONCLUSIONS Prolonged incompetence of the blood-brain barrier produced by thermal ablation may provide a path for delivery of macromolecules into perilesional tissue, which could be exploited for therapeutic benefit, but rarely it may result in autoimmune central nervous system inflammatory conditions.
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Affiliation(s)
- Saint-Aaron Morris
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Matthew Rollo
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Patrick Rollo
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Jessica Johnson
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Elliott Friedman
- Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Giridhar Kalamangalam
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA.
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Laser interstitial thermotherapy (LiTT) in epilepsy surgery. Seizure 2017; 48:45-52. [DOI: 10.1016/j.seizure.2017.04.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/02/2017] [Accepted: 04/04/2017] [Indexed: 01/15/2023] Open
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Geller EB, Skarpaas TL, Gross RE, Goodman RR, Barkley GL, Bazil CW, Berg MJ, Bergey GK, Cash SS, Cole AJ, Duckrow RB, Edwards JC, Eisenschenk S, Fessler J, Fountain NB, Goldman AM, Gwinn RP, Heck C, Herekar A, Hirsch LJ, Jobst BC, King-Stephens D, Labar DR, Leiphart JW, Marsh WR, Meador KJ, Mizrahi EM, Murro AM, Nair DR, Noe KH, Park YD, Rutecki PA, Salanova V, Sheth RD, Shields DC, Skidmore C, Smith MC, Spencer DC, Srinivasan S, Tatum W, Van Ness PC, Vossler DG, Wharen RE, Worrell GA, Yoshor D, Zimmerman RS, Cicora K, Sun FT, Morrell MJ. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy. Epilepsia 2017; 58:994-1004. [DOI: 10.1111/epi.13740] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Carl W. Bazil
- Columbia University Medical Center; New York City New York U.S.A
| | - Michael J. Berg
- University of Rochester Medical Center; Rochester New York U.S.A
| | | | - Sydney S. Cash
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | - Andrew J. Cole
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | | | | | | | - James Fessler
- University of Rochester Medical Center; Rochester New York U.S.A
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Donald C. Shields
- George Washington University School of Medicine & Health Sciences; Washington Washington DC U.S.A
| | | | | | | | | | - William Tatum
- Mayo Clinic College of Medicine; Jacksonville Florida U.S.A
| | | | | | | | | | | | | | | | | | - Martha J. Morrell
- NeuroPace, Inc.; Mountain View California U.S.A
- Stanford University School of Medicine; Stanford California U.S.A
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40
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Nagae LM, Honce JM, Nyberg E, Ojemann S, Abosch A, Drees CN. Imaging of Laser Therapy in Epilepsy. J Neuroimaging 2017; 27:292-299. [PMID: 28370739 DOI: 10.1111/jon.12438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE MR-guided laser interstitial thermal therapy (MRgLITT) is an increasingly popular neuroablative method for the surgical treatment of epilepsy patients. This article intends to demonstrate the utility and pitfalls of imaging in the context of patient care with MRgLITT. MATERIAL AND METHODS A retrospective review of the medical records and imaging database with six illustrative cases selected to demonstrate the use of imaging throughout patient management with MRgLITT in diverse clinical situations and pathologies. A review of the knowledge in the literature was applied to the relevant points discussed. RESULTS Imaging findings were described in the setting of laser therapy in nonlesional epilepsy, mesial temporal sclerosis, dual pathology, periventricular nodular heterotopia, and schizencephaly. Discussion of imaging principles, potential pitfalls, as well as its use in the patient work-up and follow-up, is shown. CONCLUSIONS MRgLITT is an alternative minimally invasive therapy for refractory epilepsy, which is becoming widely sought for. Imaging plays a crucial role prior to, during, and after the procedure.
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Affiliation(s)
- Lidia M Nagae
- Department of Radiology, Neuroradiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Justin M Honce
- Department of Radiology, Neuroradiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Eric Nyberg
- Department of Radiology, Neuroradiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Denver School of Medicine, Aurora, CO
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado Denver School of Medicine, Aurora, CO
| | - Cornelia N Drees
- Department of Neurology, Epilepsy Section, University of Colorado Denver School of Medicine, Aurora, CO
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Abstract
In common with other stereotactic procedures, stereotactic laser thermocoagulation (SLT) promises gentle destruction of pathological tissue, which might become especially relevant for epilepsy surgery in the future. Compared to standard resection, no large craniotomy is necessary, cortical damage during access to deep-seated lesions can be avoided and interventions close to eloquent brain areas become possible. We describe the history and rationale of laser neurosurgery as well as the two available SLT systems (Visualase® and NeuroBlate®; CE marks pending). Both systems are coupled with magnetic resonance imaging (MRI) and MR thermometry, thereby increasing patient safety. We report the published clinical experiences with SLT in epilepsy surgery (altogether approximately 200 cases) with respect to complications, brain structural alterations, seizure outcome, neuropsychological findings and treatment costs. The rate of seizure-free patients seems to be slightly lower than for resection surgery. Due to the inadequate quality of studies, the neuropsychological superiority of SLT has not yet been unambiguously demonstrated.
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42
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Hong SJ, Bernhardt BC, Caldairou B, Hall JA, Guiot MC, Schrader D, Bernasconi N, Bernasconi A. Multimodal MRI profiling of focal cortical dysplasia type II. Neurology 2017; 88:734-742. [PMID: 28130467 DOI: 10.1212/wnl.0000000000003632] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 11/30/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize in vivo MRI signatures of focal cortical dysplasia (FCD) type IIA and type IIB through combined analysis of morphology, intensity, microstructure, and function. METHODS We carried out a multimodal 3T MRI profiling of 33 histologically proven FCD type IIA (9) and IIB (24) lesions. A multisurface approach operating on manual consensus labels systematically sampled intracortical and subcortical lesional features. Geodesic distance mapping quantified the same features in the lesion perimeter. Logistic regression assessed the relationship between MRI and histology, while supervised pattern learning was used for individualized subtype prediction. RESULTS FCD type IIB was characterized by abnormal morphology, intensity, diffusivity, and function across all surfaces, while type IIA lesions presented only with increased fluid-attenuated inversion recovery signal and reduced diffusion anisotropy close to the gray-white matter interface. Similar to lesional patterns, perilesional anomalies were more marked in type IIB extending up to 16 mm. Structural MRI markers correlated with categorical histologic characteristics. A profile-based classifier predicted FCD subtypes with equal sensitivity of 85%, while maintaining a high specificity of 94% against healthy and disease controls. CONCLUSIONS Image processing applied to widely available MRI contrasts has the ability to dissociate FCD subtypes at a mesoscopic level. Integrating in vivo staging of pathologic traits with automated lesion detection is likely to provide an objective definition of lesional boundary and assist emerging approaches, such as minimally invasive thermal ablation, which do not supply tissue specimen.
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Affiliation(s)
- Seok-Jun Hong
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Boris C Bernhardt
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Benoit Caldairou
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Jeffery A Hall
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Marie C Guiot
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Dewi Schrader
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Neda Bernasconi
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Andrea Bernasconi
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada.
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Vogt VL, Äikiä M, Del Barrio A, Boon P, Borbély C, Bran E, Braun K, Carette E, Clark M, Cross JH, Dimova P, Fabo D, Foroglou N, Francione S, Gersamia A, Gil-Nagel A, Guekht A, Harrison S, Hecimovic H, Heminghyt E, Hirsch E, Javurkova A, Kälviäinen R, Kavan N, Kelemen A, Kimiskidis VK, Kirschner M, Kleitz C, Kobulashvili T, Kosmidis MH, Kurtish SY, Lesourd M, Ljunggren S, Lossius MI, Malmgren K, Mameniskiené R, Martin-Sanfilippo P, Marusic P, Miatton M, Özkara Ç, Pelle F, Rubboli G, Rudebeck S, Ryvlin P, van Schooneveld M, Schmid E, Schmidt PM, Seeck M, Steinhoff BJ, Shavel-Jessop S, Tarta-Arsene O, Trinka E, Viggedal G, Wendling AS, Witt JA, Helmstaedter C. Current standards of neuropsychological assessment in epilepsy surgery centers across Europe. Epilepsia 2017; 58:343-355. [PMID: 28067423 DOI: 10.1111/epi.13646] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 11/29/2022]
Abstract
We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe.
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Affiliation(s)
- Viola Lara Vogt
- Department of Epileptology, Medical Center, University of Bonn, Bonn, Germany
| | - Marja Äikiä
- Epilepsy Center/Neurocenter, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antonio Del Barrio
- Department of Neurology, Epilepsy Program, Hospital Ruber International, Madrid, Spain
| | - Paul Boon
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Csaba Borbély
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Ema Bran
- Department of Clinical Neurosciences, Pediatric Neurology Clinic, Carol Davila University of Medicine, Bucharest, Romania.,Alexandu Obregia Clinical Psychiatric Hospital, Pediatric Neurology Clinic, Bucharest, Romania
| | - Kees Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evelien Carette
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Maria Clark
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Judith Helen Cross
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Petia Dimova
- Clinic of Child Neurology, St Naum University Hospital of Neurology and Psychiatry, Sofia, Bulgaria
| | - Daniel Fabo
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Stefano Francione
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Anna Gersamia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Department of Neurology and Neurosurgery of the Russian National Research Medical University, Moscow, Russia
| | - Antonio Gil-Nagel
- Department of Neurology, Epilepsy Program, Hospital Ruber International, Madrid, Spain
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Department of Neurology and Neurosurgery of the Russian National Research Medical University, Moscow, Russia
| | - Sue Harrison
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Hrvoje Hecimovic
- Department of Neurology, Zagreb Epilepsy Center, University Hospital, Zagreb, Croatia
| | - Einar Heminghyt
- National Center for Epilepsy (SSE), Oslo University Hospital, Oslo, Norway
| | | | - Alena Javurkova
- 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | | | - Nicole Kavan
- EEG & Epilepsy Unit, Hospital of Geneva & Functional Neurology and Neurosurgery Program, University Hospitals of Geneva and Lausanne, Geneva, Switzerland
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Margarita Kirschner
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Selin Yagci Kurtish
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mathieu Lesourd
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Sofia Ljunggren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Kristina Malmgren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ruta Mameniskiené
- Faculty of Medicine, Clinic of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania.,Department of Neurology, Vilnius University Hospital Santariškių klinikos, Vilnius, Lithuania
| | - Patricia Martin-Sanfilippo
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Petr Marusic
- 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Marijke Miatton
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Çiğdem Özkara
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Federica Pelle
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Guido Rubboli
- Danish Epilepsy Center, Filadelfia/University of Copenhagen, EEMA (European Epilepsy Monitoring Unit Association), Dianalund, Denmark.,Epilepsy Institute, IDEE, Lyon, France
| | - Sarah Rudebeck
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,Epilepsy Institute, IDEE, Lyon, France
| | - Monique van Schooneveld
- Department of Pediatric Psychology, Sector of Neuropsychology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth Schmid
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Margitta Seeck
- EEG & Epilepsy Unit, Hospital of Geneva & Functional Neurology and Neurosurgery Program, University Hospitals of Geneva and Lausanne, Geneva, Switzerland
| | | | - Sara Shavel-Jessop
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Oana Tarta-Arsene
- Department of Clinical Neurosciences, Pediatric Neurology Clinic, Carol Davila University of Medicine, Bucharest, Romania.,Alexandu Obregia Clinical Psychiatric Hospital, Pediatric Neurology Clinic, Bucharest, Romania
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gerd Viggedal
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Juri-Alexander Witt
- Department of Epileptology, Medical Center, University of Bonn, Bonn, Germany
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Tao JX, Issa N, Collins JW, Wu S, Rose S, Warnke P. Homonymous hemianopsia after MR-guided stereotactic laser amygdalohippocampectomy. Epilepsy Behav 2017; 66:140-141. [PMID: 27993511 DOI: 10.1016/j.yebeh.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Affiliation(s)
- James X Tao
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States.
| | - Naoum Issa
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States
| | - John W Collins
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States
| | - Sandra Rose
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States
| | - Peter Warnke
- Department of Neurosurgery, The University of Chicago, Chicago, IL 60637, United States
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Kang JY, Sperling MR. Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy. Neurotherapeutics 2017; 14:176-181. [PMID: 27905093 PMCID: PMC5233636 DOI: 10.1007/s13311-016-0498-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Surgery is the most effective treatment for drug-resistant epilepsy. Long-term studies demonstrate that about 60% to 80% of patients become seizure-free after anterior temporal lobectomy and a majority of patients (about 95%) report significant seizure reduction after surgery. In the last few years, there has been significant advances in minimally invasive surgical techniques to treat drug-resistant epilepsy. These minimally invasive procedures have significant advantages over open surgery in that they produce less immediate discomfort and disability, while allowing for greater preservation of functional tissue. Laser interstitial thermal therapy (LiTT) is an example of such a procedure. Recent advances in imaging, surgical navigation, and real-time thermal monitoring have made LiTT safer and easier to implement, offering an effective and powerful neurosurgical tool for drug-resistant epilepsy. This article will review the technical considerations, uses, and potential future directions for LiTT in drug-resistant epilepsy.
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Affiliation(s)
- Joon Y Kang
- Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, MD, 21287, USA.
| | - Michael R Sperling
- Thomas Jefferson University Hospital, 900 Walnut Street Suite 200, Philadelphia, PA, 19107, USA
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Wicks RT, Jermakowicz WJ, Jagid JR, Couture DE, Willie JT, Laxton AW, Gross RE. Laser Interstitial Thermal Therapy for Mesial Temporal Lobe Epilepsy. Neurosurgery 2016; 79 Suppl 1:S83-S91. [DOI: 10.1227/neu.0000000000001439] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Approximately one-third of patients with epilepsy do not achieve adequate seizure control through medical management alone. Mesial temporal lobe epilepsy (MTLE) is one of the most common forms of medically refractory epilepsy referred for surgical management. Stereotactic laser amygdalohippocampotomy using magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is an important emerging therapy for MTLE. Initial published reports support MRg-LITT as a less invasive surgical option with a shorter hospital stay and fewer neurocognitive side effects compared with craniotomy for anterior temporal lobectomy with amygdalohippocampectomy and selective amygdalohippocampectomy. We provide a historical overview of laser interstitial thermal therapy development and the technological advancements that led to the currently available commercial systems. Current applications of MRg-LITT for MTLE, reported outcomes, and technical issues of the surgical procedure are reviewed. Although initial reports indicate that stereotactic laser amygdalohippocampotomy may be a safe and effective therapy for medically refractory MTLE, further research is required to establish its long-term effectiveness and its cost/benefit profile.
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Affiliation(s)
- Robert T. Wicks
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | - Daniel E. Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jon T. Willie
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Adrian W. Laxton
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Robert E. Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia
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48
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Sinha S, Danish SF. History and Technical Approaches and Considerations for Ablative Surgery for Epilepsy. Neurosurg Clin N Am 2016; 27:27-36. [PMID: 26615105 DOI: 10.1016/j.nec.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The history of epilepsy surgery is generally noted to have begun in 1886 with Victor Horsley's first report of craniotomies for posttraumatic epilepsy. With increased understanding of brain function and development of electroencephalographic methods, nonlesional epilepsy began to be treated with resection in the 1950s. Methodological improvements and increased understanding of pathophysiology followed, and the advent of stereotaxy and ablative technology in the 1960s and 1970s heralded a new era of minimally invasive, targeted procedures for lesional and nonlesional epilepsy. Current techniques combine stereotactic methods, improved ablative technologies, and electroencephalographic methods for a multidisciplinary approach to the neurosurgical treatment of epilepsy.
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Affiliation(s)
- Saurabh Sinha
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - Shabbar F Danish
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA.
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49
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Staged laser interstitial thermal therapy and topectomy for complete obliteration of complex focal cortical dysplasias. J Clin Neurosci 2016; 31:224-8. [DOI: 10.1016/j.jocn.2016.02.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/28/2016] [Indexed: 11/21/2022]
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