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Barba C, Pelliccia V, Grisotto L, De Palma L, Nobile G, Gozzo F, Revay M, Carfi‐Pavia G, Cossu M, Giordano F, Consales A, De Benedictis A, Cavallini E, Mion C, Accolla C, Specchio N, Nobili L, Guerrini R, Tassi L. Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: A multicenter study. Epilepsia Open 2024; 9:1382-1392. [PMID: 38898721 PMCID: PMC11296099 DOI: 10.1002/epi4.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To assess seizure and developmental outcomes, their predictors, and complications in 160 children who, between 1998 and 2022, underwent surgery for lesional epilepsy with curative intent before the age of 3 years. To compare trends in epilepsy surgery in this age group before and after the year 2014. METHODS Retrospective multicenter study. Descriptive and univariate analyses, and multivariable models for all outcomes. RESULTS These 160 patients (76 F; 47.5%) underwent 169 surgeries (age at surgery 20.4 ± 9.4 months). At the last follow-up (77 ± 57.4 months), 121 patients (75.6%) were in Engel class I, 106 (66.2%) of whom were in Engel class Ia. Antiseizure medications were stopped in 84 patients (52.5%). Complications requiring reoperations were observed in 16 patients (10%; 9.5% of surgeries) and unexpected permanent deficits in 12 (7.5%; 7.1% of surgeries). Postoperative cognitive functions remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Multivariable analyses showed that the probability of achieving Engel class Ia was lower when the duration of epilepsy was longer, patients underwent preoperative video-EEG, and unexpected postoperative permanent deficits occurred. Cognitive improvement after surgery was associated with lower preoperative seizure frequency, better preoperative developmental level, and a longer postoperative follow-up. FCDII and tumors were the histopathologies carrying a higher probability of achieving seizure freedom, while polymicrogyria was associated with a lower probability of cognitive improvement. The number of patients operated on after 2014 was higher than before (61.3% vs. 38.7%), with stable outcomes. SIGNIFICANCE Epilepsy surgery is effective and safe in infants and toddlers, although the complication rate is higher than seen in older patients. Shorter duration of epilepsy, lower seizure frequency, no need for video-EEG, tumors, and some malformations of cortical development are robust predictors of seizure and cognitive outcome that may be exploited to increase earlier referral. PLAIN LANGUAGE SUMMARY This study analyzed the results of epilepsy surgery in 160 children who had been operated on before the age of 3 years at four Italian centers between 1998 and 2022. At the last follow-up (77 ± 57.4 months), 121 patients (75.6%) were free from disabling seizures, of which 106 (66.2%) were completely seizure-free since surgery. Major surgical complications occurred in 28 patients (17.5%), which is higher than observed with epilepsy surgery in general, but similar to hemispheric/multilobar surgery. Postoperative cognitive function remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Epilepsy surgery is effective and safe in infants and toddlers.
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Affiliation(s)
- Carmen Barba
- Neuroscience DepartmentMeyer Children's Hospital IRCCSFlorenceItaly
- University of FlorenceFlorenceItaly
| | | | - Laura Grisotto
- Department of Statistics, Computer Science, Application “G. Parenti” (DiSIA)University of FlorenceFlorenceItaly
| | - Luca De Palma
- Neurology, Epilepsy and Movement Disorders, EpiCAREBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Giulia Nobile
- Child NeuropsychiatryIRCCS, Istituto Giannina GasliniGenoaItaly
| | - Francesca Gozzo
- “C. Munari” Epilepsy Surgery CenterNiguarda HospitalMilanItaly
| | - Martina Revay
- “C. Munari” Epilepsy Surgery CenterNiguarda HospitalMilanItaly
| | - Giusy Carfi‐Pavia
- Neurology, Epilepsy and Movement Disorders, EpiCAREBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Massimo Cossu
- “C. Munari” Epilepsy Surgery CenterNiguarda HospitalMilanItaly
- Child NeurosurgeryIRCCS, Istituto Giannina GasliniGenoaItaly
| | - Flavio Giordano
- University of FlorenceFlorenceItaly
- Neurosurgery DepartmentMeyer Children's Hospital IRCCSFlorenceItaly
| | | | | | | | | | | | - Nicola Specchio
- Neurology, Epilepsy and Movement Disorders, EpiCAREBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Lino Nobili
- Child NeuropsychiatryIRCCS, Istituto Giannina GasliniGenoaItaly
- DINOGMIUniversity of GenoaGenoaItaly
| | - Renzo Guerrini
- Neuroscience DepartmentMeyer Children's Hospital IRCCSFlorenceItaly
- University of FlorenceFlorenceItaly
| | - Laura Tassi
- “C. Munari” Epilepsy Surgery CenterNiguarda HospitalMilanItaly
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2
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Trinka E, Koepp M, Kalss G, Kobulashvili T. Evidence based noninvasive presurgical evaluation for patients with drug resistant epilepsies. Curr Opin Neurol 2024; 37:141-151. [PMID: 38334495 DOI: 10.1097/wco.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
PURPOSE OF REVIEW To review the current practices and evidence for the diagnostic accuracy and the benefits of presurgical evaluation. RECENT FINDINGS Preoperative evaluation of patients with drug-resistant focal epilepsies and subsequent epilepsy surgery leads to a significant proportion of seizure-free patients. Even those who are not completely seizure free postoperatively often experience improved quality of life with better social integration. Systematic reviews and meta-analysis on the diagnostic accuracy are available for Video-electroencephalographic (EEG) monitoring, magnetic resonance imaging (MRI), electric and magnetic source imaging, and functional MRI for lateralization of language and memory. There are currently no evidence-based international guidelines for presurgical evaluation and epilepsy surgery. SUMMARY Presurgical evaluation is a complex multidisciplinary and multiprofessional clinical pathway. We rely on limited consensus-based recommendations regarding the required staffing or methodological expertise in epilepsy centers.
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Affiliation(s)
- Eugen Trinka
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg
- Institute of Public Health, Medical Decision-Making and HTA, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg Austria
| | - Matthias Koepp
- UCL Queen Square Institute of Neurology
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Gudrun Kalss
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg
| | - Teia Kobulashvili
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg
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3
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Meng Q, Liu Y, Ren Y, Wu H, Zhang J, Li H, Dong S, Jing J, Liu X, Du C, Zhang H. Multivariate analysis of seizure outcomes after resective surgery for focal epilepsy: a single-center study on 833 patients. Neurosurg Rev 2023; 46:89. [PMID: 37071225 DOI: 10.1007/s10143-023-01988-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
The predictors of seizure outcomes after resective surgery for focal epilepsy, for an update on the features of good and poor outcomes, are investigated. A retrospective study of patients with focal epilepsy undergoing resective surgery from March 2011 to April 2019 was performed. There were 3 groups according to the seizure outcomes: seizure freedom, seizure improvement, and no improvement. Predictors of seizure outcomes were identified by multivariate logistic regression analysis. Of all 833 patients, 561 (67.3%) patients remained seizure-free at the last follow-up, 203 (24.4%) patients had seizure improvement, and 69 (8.3%) had no improvement. The mean follow-up duration was 5.2 years (range: 2.7 to 9.6). Predictors of better outcomes included epilepsy duration < 5 years, localized discharge, no. of antiepileptic drugs at surgery < 3, and temporal lobe resection. However, predictors of worse outcomes included intracranial hemorrhage in infancy, interictal abnormal discharge, intracranial electrode monitoring, and acute postoperative seizure. Our study suggests that resective surgery for focal epilepsy has satisfactory outcomes. Short epilepsy duration, localized discharge, and temporal lobe resection are positive predictors of seizure freedom. Patients with these predictors are intensively recommended for surgery.
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Affiliation(s)
- Qiang Meng
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Yong Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Yutao Ren
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hao Wu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiale Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Huanfa Li
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Shan Dong
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Jiangpeng Jing
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Xiaofang Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Changwang Du
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China
| | - Hua Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China.
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Ahrens SM, Arredondo KH, Bagić AI, Bai S, Chapman KE, Ciliberto MA, Clarke DF, Eisner M, Fountain NB, Gavvala JR, Perry MS, Rossi KC, Wong-Kisiel LC, Herman ST, Ostendorf AP. Epilepsy center characteristics and geographic region influence presurgical testing in the United States. Epilepsia 2023; 64:127-138. [PMID: 36317952 PMCID: PMC10099541 DOI: 10.1111/epi.17452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Persons with drug-resistant epilepsy may benefit from epilepsy surgery and should undergo presurgical testing to determine potential candidacy and appropriate intervention. Institutional expertise can influence use and availability of evaluations and epilepsy surgery candidacy. This census survey study aims to examine the influence of geographic region and other center characteristics on presurgical testing for medically intractable epilepsy. METHODS We analyzed annual report and supplemental survey data reported in 2020 from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Test utilization data were compiled with annual center volumes, available resources, and US Census regional data. We used Wilcoxon rank-sum, Kruskal-Wallis, and chi-squared tests for univariate analysis of procedure utilization. Multivariable modeling was also performed to assign odds ratios (ORs) of significant variables. RESULTS The response rate was 100% with individual element missingness < 11% across 342 observations undergoing univariate analysis. A total of 278 complete observations were included in the multivariable models, and significant regional differences were present. For instance, compared to centers in the South, those in the Midwest used neuropsychological testing (OR = 2.87, 95% confidence interval [CI] = 1.2-6.86; p = .018) and fluorodeoxyglucose-positron emission tomography (OR = 2.74, 95% CI = = 1.14-6.61; p = .025) more commonly. For centers in the Northeast (OR = .46, 95% CI = .23-.93; p = .031) and West (OR = .41, 95% CI = .19-.87; p = .022), odds of performing single-photon emission computerized tomography were lower by nearly 50% compared to those in the South. Center accreditation level, demographics, volume, and resources were also associated with varying individual testing rates. SIGNIFICANCE Presurgical testing for drug-resistant epilepsy is influenced by US geographic region and other center characteristics. These findings have potential implications for comparing outcomes between US epilepsy centers and may inject disparities in access to surgical treatment.
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Affiliation(s)
- Stephanie M Ahrens
- Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kristen H Arredondo
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Anto I Bagić
- Department of Neurology, University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, Pennsylvania, USA
| | - Shasha Bai
- Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kevin E Chapman
- Barrow Neurologic Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Michael A Ciliberto
- Department of Pediatrics, Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa, USA
| | - Dave F Clarke
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nathan B Fountain
- Department of Neurology, University of Virginia Health Sciences Center, Charlottesville, Virginia, USA
| | - Jay R Gavvala
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - M Scott Perry
- Jane and John Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Kyle C Rossi
- Department of Neurology, Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Adam P Ostendorf
- Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
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5
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Casciato S, Morano A, Ricci L, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, Consales A, de Palma L, Villani F, Zamponi N, Tassi L, Di Gennaro G, Beghi E, Marras CE. Knowledge and attitudes of neurologists toward epilepsy surgery: an Italian survey. Neurol Sci 2022; 43:4453-4461. [PMID: 35312881 PMCID: PMC8935880 DOI: 10.1007/s10072-022-06025-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
The current study, conceived with the contribution of the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) and the Epilepsy Study Group of the Italian Neurological Society (SIN), aimed to assess potential physician-related barriers to refer subjects for epilepsy surgery. All the members of SIN and LICE were invited by email to complete a 28-item online questionnaire. The survey items included: (1) individual and medical practice characteristics, (2) knowledge of current indications to select candidates for epilepsy surgery, (3) factors potentially affecting the attitude toward epilepsy surgery. Overall, 210 physicians completed the survey. More than half (63.3%) of the participants showed proper knowledge of the ILAE drug-resistance. Definition and almost two-thirds of them (71.9%) considered themselves adequately informed about indications, risks, and benefits of epilepsy surgery. Surgery was regarded as a valid option to be used as early as possible by 84.8% of the interviewees, and 71% of them estimated its complication rate to be low. However, more than half (63%) of the respondents reportedly referred patients for surgery only after the failure of 3–5 antiseizure medications. Overestimation of risks/complications of surgery and inadequate healthcare resources were identified as the main factor contrasting the patient referral for surgery by 43% and 40.5% of the participants, respectively. In conclusion, this survey confirms the existence of knowledge gap within both physicians and the healthcare system, as well as an educational need regarding epilepsy surgery. Further researches are warranted to define learning outcomes and optimize educational tools.
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Affiliation(s)
- Sara Casciato
- IRCCS NEUROMED, Via Atinense, 18, IS, 86170, Pozzilli, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Psychiatry and Neurology Unit, G. Salesi Hospital, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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Tassi L, Specchio N, Mecarelli O, Tinuper P, Vigevano F, Perucca E. The 50th anniversary of the Italian League Against Epilepsy (Lega Italiana Contro l’Epilessia). Epilepsy Behav Rep 2022; 19:100553. [PMID: 35664663 PMCID: PMC9157453 DOI: 10.1016/j.ebr.2022.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022] Open
Abstract
We describe the 50-year history of the Italian League Against Epilepsy (LICE). LICE promotes high-quality epilepsy care, education and research into epilepsy. LICE maintains close relations with ILAE and other professional societies.
This article was prepared to outline the article collection submitted on behalf of Lega Italiana Contro l’Epilepsia, or LICE, for the 50th anniversary of the founding of the ILAE Italian Chapter, and provides a brief summary of the history, with its landmark achievements and challenges. LICE is a multidisciplinary, inclusive, educational, informative and multifaceted organization. Initially in 1955 and then formally in 1972, LICE was born in Milano, with the mission to devote itself to people suffering with epilepsy and by promoting appropriate treatment and care, integration into society, to promote and pursue all kinds of activities designed to achieve those aims. The LICE is currently composed of more than 1000 members including neurologists, pediatric neurologists, neurosurgeons, neurophysiologists, and neuropsychologists who function throughout Italy dealing mainly or exclusively with the diagnosis and treatment of people with epilepsy.
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Malenica M, Kukuruzović M, Šeparović I, Čokolić Petrović D. POSTERIOR CORTEX SEIZURES
- PEDIATRIC CHALLENGES. Acta Clin Croat 2021; 60:25-30. [PMID: 36405000 PMCID: PMC9590239 DOI: 10.20471/acc.2021.60.s3.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Posterior cortex seizures have a complex semiologic presentation that is especially challenging in the pediatric population. Therefore, using clinical presentation in localizing ictal involvement is not sufficient in children, thus making this type of epilepsy quite under-recognized. As most of the ictal symptoms are subjective and could well be overshadowed by symptoms arising from adjacent cortices, primarily temporal and central ones, it is necessary not to overlook this large source of pharmacoresistant epilepsies. The parietal lobe as part of an extensive synaptic network is a great imitator, thus quite often producing inaccurate localization readings on scalp electroencephalography (EEG) due to very scattered interictal discharges and uninformative ictal recordings. Using direct cortical recordings in delineating the epileptogenic zone is helpful in some cases but even highly experienced epileptologists may erroneously interpret some features as arising from other localizations, especially the frontal lobe. Epilepsy surgery from the posterior quadrant is still quite rare and relatively unsuccessful, especially in non-lesional epilepsies due to elaborate mechanisms of connectivity, misleading semiology, and non-localizing EEG recordings, possibly due to insufficiency of parietal cortex synchronicity. Applying the aforementioned to the pediatric age makes it perhaps the most difficult challenge for a pediatric epileptologist.
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8
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Liu Y, Wu H, Li H, Dong S, Liu X, Li K, Du C, Meng Q, Zhang H. Severity Grading, Risk Factors, and Prediction Model of Complications After Epilepsy Surgery: A Large-Scale and Retrospective Study. Front Neurol 2021; 12:722478. [PMID: 34707556 PMCID: PMC8543040 DOI: 10.3389/fneur.2021.722478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To report complications after epilepsy surgery, grade the severity of complications, investigate risk factors, and develop a nomogram for risk prediction of complications. Methods: Patients with epilepsy surgery performed by a single surgeon at a single center between October 1, 2003 and April 30, 2019 were retrospectively analyzed. Study outcomes included severity grading of complications occurring during the 3-month period after surgery, risk factors, and a prediction model of these complications. Multivariable logistic regression analysis was used to calculate odds ratio and 95% confidence interval to identify risk factors. Results: In total, 2,026 surgical procedures were eligible. There were 380 patients with mild complications, 23 with moderate complications, and 82 with severe complications. Being male (odds ratio 1.29, 95% confidence interval 1.02–1.64), age at surgery (>40 years: 2.58, 1.55–4.31; ≤ 40: 2.25, 1.39–3.65; ≤ 30: 1.83, 1.18–2.84; ≤ 20: 1.71, 1.11–2.63), intracranial hemorrhage in infancy (2.28, 1.14–4.57), serial number of surgery ( ≤ 1,000: 1.41, 1.01–1.97; ≤ 1,500: 1.63, 1.18–2.25), type of surgical procedure (extratemporal resections: 2.04, 1.55–2.70; extratemporal plus temporal resections: 2.56, 1.80–3.65), surgery duration (>6 h: 1.94, 1.25–3.00; ≤ 6: 1.92, 1.39–2.65), and acute postoperative seizure (1.44, 1.06–1.97) were independent risk factors of complications. A nomogram including age at surgery, type of surgical procedure, and surgery duration was developed to predict the probability of complications. Conclusions: Although epilepsy surgery has a potential adverse effect on the patients, most complications are mild and severe complications are few. Risk factors should be considered during the perioperative period. Patients with the above risk factors should be closely monitored to identify and treat complications timely. The prediction model is very useful for surgeons to improve postoperative management.
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Affiliation(s)
- Yong Liu
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hao Wu
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Huanfa Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shan Dong
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaofang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kuo Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Changwang Du
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Meng
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hua Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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9
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Cossu M, d'Orio P, Barba C, Asioli S, Cardinale F, Casciato S, Caulo M, Colicchio G, Consales A, D'Aniello A, De Benedictis A, De Palma L, Didato G, Di Gennaro G, Di Giacomo R, Esposito V, Guerrini R, Nichelatti M, Revay M, Rizzi M, Vatti G, Villani F, Zamponi N, Tassi L, Marras CE. Focal Cortical Dysplasia IIIa in Hippocampal Sclerosis-Associated Epilepsy: Anatomo-Electro-Clinical Profile and Surgical Results From a Multicentric Retrospective Study. Neurosurgery 2021; 88:384-393. [PMID: 32860416 DOI: 10.1093/neuros/nyaa369] [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: 12/20/2019] [Accepted: 06/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hippocampal sclerosis (HS) may be associated with focal cortical dysplasia IIIa (FCD IIIa) in patients undergoing surgery for temporal lobe epilepsy (TLE). OBJECTIVE To investigate whether the anatomo-electro-clinical profile and surgical outcome in patients with HS-related TLE are affected by coexisting FCD IIIa. METHODS A total of 220 patients, operated in 5 centers, with at least 24 mo follow-up (FU), were retrospectively studied. Preliminary univariate and subsequent multivariate analyses were performed to investigate possible associations between several potential presurgical, surgical, and postsurgical predictors and different variables (Engel's class I and Engel's class Ia, co-occurrence of FCD IIIa). RESULTS At last available postoperative control (FU: range 24-95 mo, median 47 mo), 182 (82.7%) patients were classified as Engel's class I and 142 (64.5%) as Engel's class Ia. At multivariate analysis, extension of neocortical resection and postoperative electroencephalogram were significantly associated with Engel's class I, whereas length of FU had a significant impact on class Ia in the whole cohort and in isolated HS (iHS) patients, but not in the FCD IIIa group. No differences emerged in the anatomo-electro-clinical profile and surgical results between patients with FCD IIIa and with iHS. CONCLUSION Coexistence of FCD IIIa did not confer a distinct anatomo-electro-clinical profile to patients with HS-related epilepsy. Postoperative seizure outcome was similar in FCD IIIa and iHS cases. These findings indicate limited clinical relevance of FCD IIIa in HS-related epilepsy and might be useful for refining future FCD classifications. Further studies are needed to clarify the correlation of class Ia outcome with the duration of FU.
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Affiliation(s)
- Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Piergiorgio d'Orio
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.,Institute of Neuroscience, National Research Council, Parma, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | | | | | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | | | | | - Luca De Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Giuseppe Didato
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | | | - Roberta Di Giacomo
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Martina Revay
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Michele Rizzi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy.,Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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10
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Consales A, Casciato S, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, de Palma L, Morano A, Vatti G, Villani F, Zamponi N, Tassi L, Di Gennaro G, Marras CE. The surgical treatment of epilepsy. Neurol Sci 2021; 42:2249-2260. [PMID: 33797619 DOI: 10.1007/s10072-021-05198-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/16/2021] [Indexed: 01/07/2023]
Abstract
In 2009, the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) conducted an overview about the techniques used for the pre-surgical evaluation and the surgical treatment of epilepsies. The recognition that, in selected cases, surgery can be considered the first-line approach, suggested that the experience gained by the main Italian referral centers should be pooled in order to provide a handy source of reference. In light of the progress made over these past years, some parts of that first report have accordingly been updated. The present revision aims to harmonize the general principles regulating the patient selection and the pre-surgical work-up, as well as to expand the use of epilepsy surgery, that still represents an underutilized resource, regrettably. The objective of this contribution is drawing up a methodological framework within which to integrate the experiences of each group in this complex and dynamic sector of the neurosciences.
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Affiliation(s)
- Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giancarlo Di Gennaro
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy.
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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11
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Barba C, Cossu M, Guerrini R, Di Gennaro G, Villani F, De Palma L, Grisotto L, Consales A, Battaglia D, Zamponi N, d'Orio P, Revay M, Rizzi M, Casciato S, Esposito V, Quarato PP, Di Giacomo R, Didato G, Pastori C, Pavia GC, Pellacani S, Matta G, Pacetti M, Tamburrini G, Cesaroni E, Colicchio G, Vatti G, Asioli S, Caulo M, Marras CE, Tassi L. Temporal lobe epilepsy surgery in children and adults: A multicenter study. Epilepsia 2020; 62:128-142. [PMID: 33258120 DOI: 10.1111/epi.16772] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/11/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess seizure and cognitive outcomes and their predictors in children (<16 years at surgery) and adults undergoing temporal lobe epilepsy (TLE) surgery in eight Italian centers. METHODS This is a retrospective multicenter study. We performed a descriptive analysis and subsequently carried out multivariable mixed-effect models corrected for multiple comparisons. RESULTS We analyzed data from 511 patients (114 children) and observed significant differences in several clinical features between adults and children. The possibility of achieving Engel class IA outcome and discontinuing antiepileptic drugs (AEDs) at last follow-up (FU) was significantly higher in children (P = .006 and < .0001). However, percentages of children and adults in Engel class I at last FU (mean ± SD, 45.9 ± 17 months in children; 45.9 ± 20.6 months in adults) did not differ significantly. We identified different predictors of seizure outcome in children vs adults and at short- vs long-term FU. The only variables consistently associated with class I outcome over time were postoperative electroencephalography (EEG) in adults (abnormal, improved,odds ratio [OR] = 0.414, P = .023, Q = 0.046 vs normal, at 2-year FU and abnormal, improved, OR = 0.301, P = .001, Q = 0.002 vs normal, at last FU) and the completeness of resection of temporal magnetic resonance (MR) abnormalities other than hippocampal sclerosis in children (OR = 7.93, P = .001, Q = 0.003, at 2-year FU and OR = 45.03, P < .0001, Q < 0.0001, at last FU). Cognitive outcome was best predicted by preoperative performances in either age group. SIGNIFICANCE Clinical differences between adult and pediatric patients undergoing TLE surgery are reflected in differences in long-term outcomes and predictors of failures. Children are more likely to achieve sustained seizure freedom and withdraw AEDs after TLE surgery. Earlier referral should be encouraged as it can improve surgical outcome.
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Affiliation(s)
- Carmen Barba
- Member of the ERN EpiCARE, Neuroscience Department, Meyer Children's Hospital -University of Florence, Florence, Italy
| | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Renzo Guerrini
- Member of the ERN EpiCARE, Neuroscience Department, Meyer Children's Hospital -University of Florence, Florence, Italy.,IRCCS Stella Maris, Pisa, Italy
| | | | - Flavio Villani
- Member of the ERN EpiCARE, Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy.,Division of Neurophysiology and Epilepsy Centre, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca De Palma
- Member of the ERN EpiCARE, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Grisotto
- Department of Statistics, Computer Science, Application "G. Parenti", University of Florence, Florence, Italy
| | - Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Domenica Battaglia
- Child Psychiatry and Neurology Unit, Policlinic Agostino Gemelli Foundation, IRCCS, Roma, Italy
| | - Nelia Zamponi
- Child Psychiatry and Neurology Unit, G. Sales Hospital, Ancona, Italy
| | - Piergiorgio d'Orio
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.,Institute of Neuroscience, CNR, Parma, Italy
| | - Martina Revay
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Michele Rizzi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Roberta Di Giacomo
- Member of the ERN EpiCARE, Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Giuseppe Didato
- Member of the ERN EpiCARE, Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Chiara Pastori
- Member of the ERN EpiCARE, Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Giusy Carfi Pavia
- Member of the ERN EpiCARE, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Simona Pellacani
- Member of the ERN EpiCARE, Neuroscience Department, Meyer Children's Hospital -University of Florence, Florence, Italy
| | - Giulia Matta
- Member of the ERN EpiCARE, Neuroscience Department, Meyer Children's Hospital -University of Florence, Florence, Italy
| | - Mattia Pacetti
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Policlinic Agostino Gemelli Foundation, IRCCS, Rome, Italy
| | | | | | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Carlo Efisio Marras
- Member of the ERN EpiCARE, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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12
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Uribe San Martin R, Di Giacomo R, Mai R, Gozzo F, Pelliccia V, Mariani V, Cardinale F, Ciampi E, Onofrj M, Tassi L. Forecasting Seizure Freedom After Epilepsy Surgery Assessing Concordance Between Noninvasive and StereoEEG Findings. Neurosurgery 2020; 88:113-121. [DOI: 10.1093/neuros/nyaa322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 05/24/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Accurate localization of the probable Epileptogenic Zone (EZ) from presurgical studies is crucial for achieving good prognosis in epilepsy surgery.
OBJECTIVE
To evaluate the degree of concordance at a sublobar localization derived from noninvasive studies (video electroencephalography, EEG; magnetic resonance imaging, MRI; 18-fluorodeoxyglucose positron emission tomography FDG-PET, FDG-PET) and EZ estimated by stereoEEG, in forecasting seizure recurrence in a long-term cohort of patients with focal drug-resistant epilepsy.
METHODS
We selected patients with a full presurgical evaluation and with postsurgical outcome at least 1 yr after surgery. Multivariate Cox regression analysis for seizure freedom (Engel Ia) was performed.
RESULTS
A total of 74 patients were included, 62.2% were in Engel class Ia with a mean follow-up of 2.8 + 2.4 yr after surgery. In the multivariate analysis for Engel Ia vs >Ib, complete resection of the EZ found in stereoEEG (hazard ratio, HR: 0.24, 95%CI: 0.09-0.63, P = .004) and full concordance between FDG-PET and stereoEEG (HR: 0.11, 95%CI: 0.02-0.65, P = .015) portended a more favorable outcome. Most of our results were maintained when analyzing subgroups of patients.
CONCLUSION
The degree of concordance between noninvasive studies and stereoEEG may help to forecast the likelihood of cure before performing resective surgery, particularly using a sublobar classification and comparing the affected areas in the FDG-PET with EZ identified with stereoEEG.
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Affiliation(s)
- Reinaldo Uribe San Martin
- Neurology Department, Pontificia Universidad Católica de Chile, Neurology Service, Complejo Asistencial Hospital Sótero del Río, Santiago, Chile
| | - Roberta Di Giacomo
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Roberto Mai
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesca Gozzo
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Veronica Pelliccia
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Valeria Mariani
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesco Cardinale
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Ethel Ciampi
- Neurology Department, Pontificia Universidad Católica de Chile, Neurology Service, Complejo Asistencial Hospital Sótero del Río, Santiago, Chile
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. D’Annunzio of Chieti-Pescara, Italy
| | - Laura Tassi
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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13
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Rossi Sebastiano D, Tassi L, Duran D, Visani E, Gozzo F, Cardinale F, Nobili L, Del Sole A, Rubino A, Dotta S, Schiaffi E, Garbelli R, Franceschetti S, Spreafico R, Panzica F. Identifying the epileptogenic zone by four non-invasive imaging techniques versus stereo-EEG in MRI-negative pre-surgery epilepsy patients. Clin Neurophysiol 2020; 131:1815-1823. [PMID: 32544836 DOI: 10.1016/j.clinph.2020.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We evaluated four imaging techniques, i.e. Electroencephalography (EEG)-functional Magnetic Resonance Imaging (MRI) (EEG-fMRI), High-resolution EEG (HR-EEG), Magnetoencephalography (MEG) and 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (PET), for the identification of the epileptogenic zone (EZ) in 41 patients with negative MRI, candidate to neurosurgery. METHODS For each technique, results were compared to the Stereo-EEG. Diagnostic measures were calculated with respect to the post-surgical outcome, either for all the patients (39/41, two patients excluded) and for the subgroup of patients with the EZ involving more than one lobe (20/41). RESULTS When considered individually, each functional technique showed accuracy values ranging 54,6%-63,2%, having PET, MEG and HR-EEG higher sensitivity, and EEG-fMRI higher specificity. In patients with multilobar epileptogenic zone, functional techniques achieved the best accuracies (up to 80%) when three techniques, including EEG-fMRI, were considered together. CONCLUSIONS The study highlights the accuracy of a combination of functional imaging techniques in the identification of EZ in MRI negative focal epilepsy. The best diagnostic yield was obtained if the combination of PET, MEG (or HR-EEG as alternative), EEG-fMRI were considered together. SIGNIFICANCE The functional imaging techniques may improve the presurgical workup of MRI negative focal epilepsy, if epileptogenic zone involves more than one lobe.
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Affiliation(s)
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Dunja Duran
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Visani
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Gozzo
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | | | - Lino Nobili
- DINOGMI, University of Genoa, and Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Angelo Del Sole
- Department of Health Sciences, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy
| | - Annalisa Rubino
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Sara Dotta
- Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Schiaffi
- Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Roberto Spreafico
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ferruccio Panzica
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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14
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Rizzi M, Revay M, d'Orio P, Scarpa P, Mariani V, Pelliccia V, Della Costanza M, Zaniboni M, Castana L, Cardinale F, Lo Russo G, Cossu M. Tailored multilobar disconnective epilepsy surgery in the posterior quadrant. J Neurosurg 2020; 132:1345-1357. [PMID: 31026825 DOI: 10.3171/2019.1.jns183103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical treatment of drug-resistant epilepsy originating from the posterior quadrant (PQ) of the brain often requires large multilobar resections, and disconnective techniques have been advocated to limit the risks associated with extensive tissue removal. Few previous studies have described a tailored temporoparietooccipital (TPO) disconnective approach; only small series with short postoperative follow-ups have been reported. The aim of the present study was to present a tailored approach to multilobar PQ disconnections (MPQDs) for epilepsy and to provide details about selection of patients, presurgical investigations, surgical technique, treatment safety profile, and seizure and cognitive outcome in a large, single-center series of patients with a long-term follow-up. METHODS In this retrospective longitudinal study, the authors searched their prospectively collected database for patients who underwent MPQD for drug-resistant epilepsy in the period of 2005-2017. Tailored MPQDs were a posteriori grouped as follows: type I (classic full TPO disconnection), type II (partial TPO disconnection), type III (full temporooccipital [TO] disconnection), and type IV (partial TO disconnection), according to the disconnection plane in the occipitoparietal area. A bivariate statistical analysis was carried out to identify possible predictors of seizure outcome (Engel class I vs classes II-IV) among several presurgical, surgical, and postsurgical variables. Preoperative and postoperative cognitive profiles were also collected and evaluated. RESULTS Forty-two consecutive patients (29 males, 24 children) met the inclusion criteria. According to the presurgical evaluation (including stereo-electroencephalography in 13 cases), 12 (28.6%), 24 (57.1%), 2 (4.8%), and 4 (9.5%) patients received a type I, II, III, or IV MPQD, respectively. After a mean follow-up of 80.6 months, 76.2% patients were in Engel class I at last contact; at 6 months and 2 and 5 years postoperatively, Engel class I was recorded in 80.9%, 74.5%, and 73.5% of cases, respectively. Factors significantly associated with seizure freedom were the occipital pattern of seizure semiology and the absence of bilateral interictal epileptiform abnormalities at the EEG (p = 0.02). Severe complications occurred in 4.8% of the patients. The available neuropsychological data revealed postsurgical improvement in verbal domains, whereas nonunivocal outcomes were recorded in the other functions. CONCLUSIONS The presented data indicate that the use of careful anatomo-electro-clinical criteria in the presurgical evaluation allows for customizing the extent of surgical disconnections in PQ epilepsies, with excellent results on seizures and an acceptable safety profile.
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Affiliation(s)
- Michele Rizzi
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Martina Revay
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 3Section of Neurosurgery, Department of Neurosciences and of Sense Organs, University of Milan
| | - Piergiorgio d'Orio
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 2Institute of Neuroscience, CNR, Parma
| | - Pina Scarpa
- 4Cognitive Neuropsychology Centre, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Valeria Mariani
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Veronica Pelliccia
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 2Institute of Neuroscience, CNR, Parma
| | - Martina Della Costanza
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
- 5Clinic of Neurosurgery, Polytechnic University of Marche, Ancona; and
| | - Matteo Zaniboni
- 6Neurological Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Castana
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Francesco Cardinale
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Giorgio Lo Russo
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Massimo Cossu
- 1"C. Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan
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15
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Investigatory pathway and principles of patient selection for epilepsy surgery candidates: a systematic review. BMC Neurol 2020; 20:100. [PMID: 32183734 PMCID: PMC7079385 DOI: 10.1186/s12883-020-01680-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/10/2020] [Indexed: 01/20/2023] Open
Abstract
Background The predominant treatment for epilepsy is pharmacotherapy, yet 20–40% do not respond to anti-epileptic drugs. After becoming pharmacoresistant, some patients are worked-up to determine candidacy for epilepsy surgery. Despite the 2009 American Epilepsy Society guidelines, there is no broadly accepted criteria for the investigatory pathway and principles of patient selection for epilepsy surgery candidates. The objective of this systematic review is to elucidate what diagnostic pathways clinicians globally utilize. Methods Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Cochrane Handbook of Systemic Reviews of Interventions, we conducted a systematic review through MEDLINE, Embase, and CENTRAL. Results From 2092 screened articles, 14 met inclusion criteria for qualitative synthesis. Structural MRI was required in all investigatory pathways. All but two articles required neuropsychological assessment. Six required neuropsychiatric assessment. Two protocols mentioned assessing the patient’s support network. Three other protocols mentioned discussing expectations with patients. One also motioned conducing an occupational evaluation and making all surgery decisions in a multidisciplinary management conference. fMRI and the Wada test were required assessments in seven of the protocols. [18F]FDG-PET and SPECT were ancillary for all but three articles (where they were required). MEG and intracranial EEG were only mentioned as ancillary. Magnetic resonance (MR) spectroscopy was required at two institutes. With regards to the actual indication for selecting patients to begin the investigatory pathway, seven of the articles used a variation of the International League Against Epilepsy definition of refectory epilepsy, while one incorporated patient social history. Conclusions Despite attempts to standardize patient selection and investigatory pathways, no two protocols were identical. Scalp video/EEG telemetry, structural MRI, and neuropsychological assessment were the only assessments utilized in nearly all protocols. Socioeconomic restrictions appear to play a role in determining which tests are utilized in the investigatory pathway—not just for developing countries. However, cost-effective assessments, such as assessing patient support network and providing realistic expectation of outcomes, were only utilized in few protocols. In addition, no advanced imaging technologies (i.e., qMRI, 3D-MMI) were utilized. Overall, even amongst expert examiners there is significant variation throughout epilepsy centers globally, in selecting candidates and working up patients.
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18F-FDG in the presurgical evaluation of epilepsies: a pictorial essay. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Barba C, Specchio N, Guerrini R, Tassi L, De Masi S, Cardinale F, Pellacani S, De Palma L, Battaglia D, Tamburrini G, Didato G, Freri E, Consales A, Nozza P, Zamponi N, Cesaroni E, Di Gennaro G, Esposito V, Giulioni M, Tinuper P, Colicchio G, Rocchi R, Rubboli G, Giordano F, Lo Russo G, Marras CE, Cossu M. Increasing volume and complexity of pediatric epilepsy surgery with stable seizure outcome between 2008 and 2014: A nationwide multicenter study. Epilepsy Behav 2017; 75:151-157. [PMID: 28866334 DOI: 10.1016/j.yebeh.2017.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to assess common practice in pediatric epilepsy surgery in Italy between 2008 and 2014. METHODS A survey was conducted among nine Italian epilepsy surgery centers to collect information on presurgical and postsurgical evaluation protocols, volumes and types of surgical interventions, and etiologies and seizure outcomes in pediatric epilepsy surgery between 2008 and 2014. RESULTS Retrospective data on 527 surgical procedures were collected. The most frequent surgical approaches were temporal lobe resections and disconnections (133, 25.2%) and extratemporal lesionectomies (128, 24.3%); the most frequent etiologies were FCD II (107, 20.3%) and glioneuronal tumors (105, 19.9%). Volumes of surgeries increased over time independently from the age at surgery and the epilepsy surgery center. Engel class I was achieved in 73.6% of patients (range: 54.8 to 91.7%), with no significant changes between 2008 and 2014. Univariate analyses showed a decrease in the proportion of temporal resections and tumors and an increase in the proportion of FCDII, while multivariate analyses revealed an increase in the proportion of extratemporal surgeries over time. A higher proportion of temporal surgeries and tumors and a lower proportion of extratemporal and multilobar surgeries and of FCD were observed in low (<50surgeries/year) versus high-volume centers. There was a high variability across centers concerning pre- and postsurgical evaluation protocols, depending on local expertise and facilities. SIGNIFICANCE This survey reveals an increase in volume and complexity of pediatric epilepsy surgery in Italy between 2008 and 2014, associated with a stable seizure outcome.
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Affiliation(s)
- Carmen Barba
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy.
| | - Nicola Specchio
- Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy; IRCCS Stella Maris, Pisa, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Salvatore De Masi
- Clinical Trial Office, Children's Hospital Anna Meyer, Florence, Italy
| | | | - Simona Pellacani
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy
| | - Luca De Palma
- Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Giuseppe Didato
- Clinical and Experimental Epileptology, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | | | - Paolo Nozza
- Anatomical Pathology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Nelia Zamponi
- Child Neurology and Psychiatry Unit, Children's Hospital G. Salesi-University of Ancona, Ancona, Italy
| | - Elisabetta Cesaroni
- Child Neurology and Psychiatry Unit, Children's Hospital G. Salesi-University of Ancona, Ancona, Italy
| | | | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Neurology and Psychiatry, University of Rome "La Sapienza", Rome, Italy
| | - Marco Giulioni
- Division of Neurosurgery, IRCCS - Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Paolo Tinuper
- Division of Neurology, IRCCS - Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | | | - Raffaele Rocchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Guido Rubboli
- Danish Epilepsy Centre, Filadelfia/University of Copenhagen, Dianalund, Denmark; IRCCS Institute of Neurological Sciences, Neurology Unit, Bellaria Hospital, Bologna, Italy
| | - Flavio Giordano
- Neurosurgery Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Efisio Marras
- Pediatric Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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Rossini L, Garbelli R, Gnatkovsky V, Didato G, Villani F, Spreafico R, Deleo F, Lo Russo G, Tringali G, Gozzo F, Tassi L, de Curtis M. Seizure activity per se does not induce tissue damage markers in human neocortical focal epilepsy. Ann Neurol 2017; 82:331-341. [PMID: 28749594 DOI: 10.1002/ana.25005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/10/2017] [Accepted: 07/17/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The contribution of recurring seizures to the progression of epileptogenesis is debated. Seizure-induced brain damage is not conclusively demonstrated either in humans or in animal models of epilepsy. We evaluated the expression of brain injury biomarkers on postsurgical brain tissue obtained from 20 patients with frequent seizures and a long history of drug-resistant focal epilepsy. METHODS The expression patterns of specific glial, neuronal, and inflammatory molecules were evaluated by immunohistochemistry in the core of type II focal cortical dysplasias (FCD-II), at the FCD boundary (perilesion), and in the adjacent normal-appearing area included in the epileptogenic region. We also analyzed surgical specimens from cryptogenic patients not presenting structural alterations at imaging. RESULTS Astroglial and microglial activation, reduced neuronal density, perivascular CD3-positive T-lymphocyte clustering, and fibrinogen extravasation were demonstrated in the core of FCD-II lesions. No pathological immunoreactivity was observed outside the FCD-II or in cryptogenetic specimens, where the occurrence of interictal and ictal epileptiform activity was confirmed by either stereo-electroencephalography or intraoperative electrocorticography. INTERPRETATION Recurrent seizures do not induce the expression of brain damage markers in nonlesional epileptogenic cortex studied in postsurgical tissue from cryptogenic and FCD patients. This evidence argues against the hypothesis that epileptiform activity per se contributes to focal brain injury, at least in the neocortical epilepsies considered here. Ann Neurol 2017;82:331-341.
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Affiliation(s)
- Laura Rossini
- Epilepsy Unit, C. Besta Neurological Institute Foundation
| | - Rita Garbelli
- Epilepsy Unit, C. Besta Neurological Institute Foundation
| | | | | | - Flavio Villani
- Epilepsy Unit, C. Besta Neurological Institute Foundation
| | | | | | | | - Giovanni Tringali
- Neurosurgery Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | | | - Laura Tassi
- C. Munari Epilepsy Surgery Center, Niguarda Hospital
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Freri E, Matricardi S, Gozzo F, Cossu M, Granata T, Tassi L. Perisylvian, including insular, childhood epilepsy: Presurgical workup and surgical outcome. Epilepsia 2017. [DOI: 10.1111/epi.13816] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elena Freri
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute “C. Besta”; Milan Italy
| | - Sara Matricardi
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute “C. Besta”; Milan Italy
| | - Francesca Gozzo
- “C. Munari” Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - Massimo Cossu
- “C. Munari” Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute “C. Besta”; Milan Italy
| | - Laura Tassi
- “C. Munari” Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
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Jayakar P, Gotman J, Harvey AS, Palmini A, Tassi L, Schomer D, Dubeau F, Bartolomei F, Yu A, Kršek P, Velis D, Kahane P. Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques. Epilepsia 2016; 57:1735-1747. [PMID: 27677490 DOI: 10.1111/epi.13515] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 12/21/2022]
Abstract
Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography (IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary across epilepsy surgical centers; each modality has its advantages and limitations. IEEG can be performed in the same intraoperative setting, that is, intraoperative electrocorticography, or through an independent implantation procedure with chronic extraoperative recordings; the latter are not only resource intensive but also carry risk. A lack of understanding of IEEG limitations predisposes to data misinterpretation that can lead to denying surgery when indicated or, worse yet, incorrect resection with adverse outcomes. Given the lack of class 1 or 2 evidence on IEEG, a consensus-based expert recommendation on the diagnostic utility of IEEG is presented, with emphasis on the application of various modalities in specific substrates or locations, taking into account their relative efficacy, safety, ease, and incremental cost-benefit. These recommendations aim to curtail outlying indications that risk the over- or underutilization of IEEG, while retaining substantial flexibility in keeping with most standard practices at epilepsy centers and addressing some of the needs of resource-poor regions around the world.
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Affiliation(s)
- Prasanna Jayakar
- Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A
| | - Jean Gotman
- Montreal Neurological Hospital and Institute, McGill University, Montréal, Quebec, Canada
| | - A Simon Harvey
- The Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - André Palmini
- Services of Neurology and Neurosurgery, Hospital São Lucas, Porto Alegre, Brazil
| | - Laura Tassi
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Francois Dubeau
- Montreal Neurological Hospital and Institute, McGill University, Montréal, Quebec, Canada
| | - Fabrice Bartolomei
- Service of Neurophysiology Clinic, Public Hospital of Marseille, Marseille, France
| | - Alice Yu
- Neurology Department, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Pavel Kršek
- Department of Pediatric Neurology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Demetrios Velis
- Epilepsy Surgery Program, Free University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Philippe Kahane
- GIN INSERM U1216, Grenoble-Alpes Hospital and University, Grenoble, France
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Nagae LM, Lall N, Dahmoush H, Nyberg E, Mirsky D, Drees C, Honce JM. Diagnostic, treatment, and surgical imaging in epilepsy. Clin Imaging 2016; 40:624-36. [DOI: 10.1016/j.clinimag.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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Deleo F, Garbelli R, Milesi G, Gozzo F, Bramerio M, Villani F, Cardinale F, Tringali G, Spreafico R, Tassi L. Short- and long-term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology. Epilepsia 2015; 57:306-15. [DOI: 10.1111/epi.13277] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Francesco Deleo
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Rita Garbelli
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Gloria Milesi
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Francesca Gozzo
- Epilepsy Surgery Centre C. Munari; Niguarda Hospital; Milan Italy
| | | | - Flavio Villani
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | | | - Giovanni Tringali
- Neurosurgery Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Roberto Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Laura Tassi
- Epilepsy Surgery Centre C. Munari; Niguarda Hospital; Milan Italy
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Zucca I, Milesi G, Medici V, Tassi L, Didato G, Cardinale F, Tringali G, Colombo N, Bramerio M, D'Incerti L, Freri E, Morbin M, Fugnanesi V, Figini M, Spreafico R, Garbelli R. Type II focal cortical dysplasia: Ex vivo 7T magnetic resonance imaging abnormalities and histopathological comparisons. Ann Neurol 2015; 79:42-58. [PMID: 26448158 DOI: 10.1002/ana.24541] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/18/2015] [Accepted: 10/03/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the present report, the correlations between ex vivo high-resolution imaging and specific histological and ultrastructural patterns in type II focal cortical dysplasia (FCD) have been studied to explain the differences in the magnetic resonance imaging (MRI) detection of dysplasia and to contribute to the presurgical imaging evaluation of this pathology. METHODS Surgical specimens from 13 patients with FCD IIa/b were submitted to 7T MRI scanning, and then analyzed histologically and ultrastructurally to compare the results with the MRI findings. Region of interest (ROI)-based measures on T2-weighted images (T2wi) were quantitatively evaluated in the lesion and in adjacent perilesional gray and white matter. RESULTS Matched histological sections and 7T T2wi showed that the core of the lesion was characterized by patchy aggregates of abnormal cells and fiber disorganization related to inhomogeneity of intracortical signal intensity. The quantitative approach on T2wi can help to distinguish the lesions and perilesional areas even in a clinical MRI-negative case. The ultrastructural study showed that the strong signal hyperintensity in the white matter of FCD IIb was related to a dysmyelination process associated with severe fiber loss and abnormal cells. Less severe histopathological features were found in FCD IIa, thus reflecting their less evident MRI alterations. INTERPRETATION We suggest that white matter abnormalities in type IIb FCD are due to defects of the myelination processes and maturation, impaired by the presence of balloon cells. To reveal the presence and the border of type II cortical dysplasia on MRI, a quantitative ROI-based analysis (coefficient of variation) is also proposed.
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Affiliation(s)
- Ileana Zucca
- Scientific Department, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Gloria Milesi
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Valentina Medici
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Laura Tassi
- C. Munari Epilepsy Surgery Center, Niguarda Hospital, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Giuseppe Didato
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Francesco Cardinale
- C. Munari Epilepsy Surgery Center, Niguarda Hospital, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Giovanni Tringali
- Neurosurgery Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Nadia Colombo
- Department of Neuroradiology, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Manuela Bramerio
- Department of Pathology, Niguarda Hospital, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Ludovico D'Incerti
- Neuroradiology Unit, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Michela Morbin
- Neurology V and Neuropathology, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Valeria Fugnanesi
- Neurology V and Neuropathology, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Matteo Figini
- Scientific Department, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Roberto Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Rita Garbelli
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
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Roberts JI, Hrazdil C, Wiebe S, Sauro K, Vautour M, Wiebe N, Jetté N. Neurologists' knowledge of and attitudes toward epilepsy surgery: a national survey. Neurology 2014; 84:159-66. [PMID: 25503624 DOI: 10.1212/wnl.0000000000001127] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In the current study, we aim to assess potential neurologist-related barriers to epilepsy surgery among Canadian neurologists. METHODS A 29-item, pilot-tested questionnaire was mailed to all neurologists registered to practice in Canada. Survey items included the following: (1) type of medical practice, (2) perceptions of surgical risks and benefits, (3) knowledge of existing practice guidelines, and (4) barriers to surgery for patients with epilepsy. Neurologists who did not complete the questionnaire after the initial mailing were contacted a second time by e-mail, fax, or telephone. After this reminder, the survey was mailed a second time to any remaining nonresponders. RESULTS In total, 425 of 796 neurologists returned the questionnaire (response rate 53.5%). Respondents included 327 neurologists who followed patients with epilepsy in their practice. More than half (56.6%) of neurologists required patients to be drug-resistant and to have at least one seizure per year before considering surgery, and nearly half (48.6%) failed to correctly define drug-resistant epilepsy. More than 75% of neurologists identified inadequate health care resources as the greatest barrier to surgery for patients with epilepsy. CONCLUSIONS A substantial proportion of Canadian neurologists are unaware of recommended standards of practice for epilepsy surgery. Access also appears to be a significant barrier to epilepsy surgery and surgical evaluation. As a result, we are concerned that patients with epilepsy are receiving inadequate care. A greater emphasis must be placed on knowledge dissemination and ensuring that the infrastructure and personnel are in place to allow patients to have timely access to this evidence-based treatment.
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Affiliation(s)
- Jodie I Roberts
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Chantelle Hrazdil
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Samuel Wiebe
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Khara Sauro
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Michelle Vautour
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Natalie Wiebe
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Nathalie Jetté
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.I.R., C.H., S.W., K.S., M.V., N.W., N.J.), and Department of Community Health Sciences and O'Brien Institute for Public Health (J.I.R., S.W., K.S., N.J.), University of Calgary; and Department of Medicine (C.H.), Division of Neurology, University of British Columbia, Vancouver, Canada.
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Szilágyi T, Száva I, Metz EJ, Mihály I, Orbán-Kis K. Untangling the pathomechanisms of temporal lobe epilepsy—The promise of epileptic biomarkers and novel therapeutic approaches. Brain Res Bull 2014; 109:1-12. [DOI: 10.1016/j.brainresbull.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/11/2014] [Accepted: 08/14/2014] [Indexed: 12/30/2022]
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López González FJ, Rodríguez Osorio X, Gil-Nagel Rein A, Carreño Martínez M, Serratosa Fernández J, Villanueva Haba V, Donaire Pedraza AJ, Mercadé Cerdá JM. Drug-resistant epilepsy: definition and treatment alternatives. Neurologia 2014; 30:439-46. [PMID: 24975343 DOI: 10.1016/j.nrl.2014.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/23/2014] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Drug-resistant epilepsy affects 25% of all epileptic patients, and quality of life decreases in these patients due to their seizures. Early detection is crucial in order to establish potential treatment alternatives and determine if the patient is a surgical candidate. DEVELOPMENT PubMed search for articles, recommendations published by major medical societies, and clinical practice guidelines for drug-resistant epilepsy and its medical and surgical treatment options. Evidence and recommendations are classified according to the criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions. CONCLUSIONS Identifying patients with drug-resistant epilepsy is important for optimising drug therapy. Experts recommend rational polytherapy with antiepileptic drugs to find more effective combinations with fewer adverse effects. When adequate seizure control is not achieved, a presurgical evaluation in an epilepsy referral centre is recommended. These evaluations explore how to resect the epileptogenic zone without causing functional deficits in cases in which this is feasible. If resective surgery is not achievable, palliative surgery or neurostimulation systems (including vagus nerve, trigeminal nerve, or deep brain stimulation) may be an option. Other treatment alternatives such as ketogenic diet may also be considered in selected patients.
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Affiliation(s)
- F J López González
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España.
| | - X Rodríguez Osorio
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
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