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Bonda D, Kelly KA, Boop S, Feroze AH, Randle SC, Bindschadler M, Marashly A, Owens J, Lockrow J, Bozarth X, Novotny E, Friedman S, Goldstein HE, Grannan BL, Durfy S, Ojemann JG, Ko AL, Hauptman JS. Deep Brain Stimulation of Bilateral Centromedian Thalamic Nuclei in Pediatric Patients with Lennox-Gastaut Syndrome: An Institutional Experience. World Neurosurg 2024; 185:e631-e639. [PMID: 38403017 DOI: 10.1016/j.wneu.2024.02.099] [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: 08/03/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Surgical management of pediatric patients with nonlesional, drug-resistant epilepsy, including patients with Lennox-Gastaut syndrome (LGS), remains a challenge given the lack of resective targets in most patients and shows seizure freedom rates <50% at 5 years. The efficacy of deep brain stimulation (DBS) is less certain in children than in adults. This study examined clinical and seizure outcomes for pediatric patients with LGS undergoing DBS targeting of the centromedian thalamic nuclei (CMTN). METHODS An institutional review board-approved retrospective analysis was performed of patients aged ≤19 years with clinical diagnosis of LGS undergoing bilateral DBS placement to the CMTN from 2020 to 2021 by a single surgeon. RESULTS Four females and 2 males aged 6-19 years were identified. Before surgery, each child experienced at least 6 years of refractory seizures; 4 children had experienced seizures since infancy. All took antiseizure medications at the time of surgery. Five children had previous placement of a vagus nerve stimulator and 2 had a previous corpus callosotomy. The mean length of stay after DBS was 2 days. No children experienced adverse neurologic effects from implantation; the mean follow-up time was 16.3 months. Four patients had >60% reduction in seizure frequency after surgery, 1 patient experienced 10% reduction, and 1 patient showed no change. No children reported worsening seizure symptoms after surgery. CONCLUSIONS Our study contributes to the sparse literature describing CMTN DBS for children with drug-resistant epilepsy from LGS. Our results suggest that CMTN DBS is a safe and effective therapeutic modality that should be considered as an alternative or adjuvant therapy for this challenging patient population. Further studies with larger patient populations are warranted.
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Affiliation(s)
- David Bonda
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Katherine A Kelly
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Scott Boop
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Stephanie C Randle
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mike Bindschadler
- Center for Respiratory Therapy and Biologics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ahmad Marashly
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - James Owens
- Department of Pediatrics, Section of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Jason Lockrow
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Xiuhua Bozarth
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Edward Novotny
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Seth Friedman
- Center for Respiratory Therapy and Biologics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Hannah E Goldstein
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Benjamin L Grannan
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew L Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.
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Knoche T, Danyel LA, Varlet L, Haffner P, Alzureiqi MS, Kowski A, Gaus V. Clinical Course and Ophthalmologic Findings in Idiopathic Intracranial Hypertension and Pregnancy. Brain Sci 2023; 13:1616. [PMID: 38137064 PMCID: PMC10742287 DOI: 10.3390/brainsci13121616] [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: 10/29/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) has its highest prevalence among women of childbearing age and therefore frequently coincides with pregnancy. This retrospective cohort study aimed to explore the impact of pregnancy on the clinical course, ophthalmologic findings and on the therapeutic management of IIH patients. Individual patient records were reviewed for neuro-ophthalmologic findings, treatment strategy, adherence to therapy and pregnancy complications. Sixteen patients with 19 documented pregnancies were identified. The visual acuity, visual field defects and the grade of papilledema at baseline and after pregnancy were compared. The visual acuity and visual field mean deviation at baseline and at follow-up after pregnancy did not significantly differ. Papilledema at baseline was more pronounced in patients who had been diagnosed with IIH during pregnancy than in patients with established IIH. In this cohort, the visual acuity and the visual field were not lastingly impacted by pregnancy. The adherence to therapy was low, with 69% discontinuing treatment or medication.
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Affiliation(s)
- Theresia Knoche
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; (L.A.D.); (L.V.); (P.H.); (A.K.); (V.G.)
| | - Leon Alexander Danyel
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; (L.A.D.); (L.V.); (P.H.); (A.K.); (V.G.)
| | - Lisa Varlet
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; (L.A.D.); (L.V.); (P.H.); (A.K.); (V.G.)
| | - Paula Haffner
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; (L.A.D.); (L.V.); (P.H.); (A.K.); (V.G.)
| | | | - Alexander Kowski
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; (L.A.D.); (L.V.); (P.H.); (A.K.); (V.G.)
| | - Verena Gaus
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; (L.A.D.); (L.V.); (P.H.); (A.K.); (V.G.)
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Mulligan BP, Carniello TN. A procedure for predicting, illustrating, communicating, and optimizing patient-centered outcomes of epilepsy surgery using nomograms and Bayes' theorem. Epilepsy Behav 2023; 140:109088. [PMID: 36702057 DOI: 10.1016/j.yebeh.2023.109088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023]
Abstract
Clinicians have an ethical obligation to obtain and convey relevant information about possible treatment outcomes in a manner that can be comprehended by patients. This contributes to the processes of informed consent and shared prospective decision-making. In epilepsy neurosurgery, there has historically been an emphasis on studying clinician-centered (e.g., seizure- and cognition-related) outcomes and using these data to inform recommendations and, by extension, to frame pre-surgical counseling with respect to patients' decisions about elective neurosurgery. In contrast, there is a relative dearth of available data related to patient-centered outcomes of epilepsy neurosurgery, such as functional (e.g., employment) status, and there is also a lack of methods to communicate these data to patients. Here, illustrated using a hypothetical case scenario, we present a potential solution to the latter of these problems using principles of evidence-based neuropsychology; published data on patient employment status before and after epilepsy neurosurgery; and Bayes' theorem. First, we reviewed existing literature on employment outcomes following epilepsy neurosurgery to identify and extract data relevant to our hypothetical patient, clinical question, and setting. Then, we used the base rate (prior probability) of post-surgical unemployment, contingency tables (to derive likelihood ratios), and Bayes' theorem to compute the conditional (posterior) probability of post-surgical employment status for our hypothetical patient scenario. Finally, we translated this information to an intuitive visual format (Bayesian nomogram) that can support evidence-based pre-surgical counseling. We propose that the application of our patient-centered decision-support process and visual aid will improve clinician-patient communication about prospective risks and benefits of epilepsy neurosurgery and will empower clinicians and patients to make informed decisions about whether or not to pursue elective neurosurgery with a greater degree of confidence and with more realistic and concrete expectations about possible outcomes. We further propose that clinicians and patients would benefit from incorporating this evidence-based framework into a broader sequence of function-focused epilepsy treatment that includes pre-surgical assessments and interventions ("prehabilitation"), neurosurgery, and post-surgical cognitive/vocational rehabilitation.
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Affiliation(s)
- Bryce P Mulligan
- Epilepsy Program, The Ottawa Hospital, Ottawa, ON, Canada; Department of Psychology, The Ottawa Hospital, Ottawa, ON, Canada; School of Psychology, University of Ottawa, Ottawa, ON, Canada.
| | - Trevor N Carniello
- Behavioural Neuroscience Program, Laurentian University, Sudbury, ON, Canada; Department of Psychology, Laurentian University, Sudbury, ON, Canada
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Kunz M, Karschnia P, Borggraefe I, Noachtar S, Tonn JC, Vollmar C. Seizure-free outcome and safety of repeated epilepsy surgery for persistent or recurrent seizures. J Neurosurg 2023; 138:9-18. [PMID: 35901761 DOI: 10.3171/2022.4.jns212753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/25/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Reoperation may be an option for select patients with unsatisfactory seizure control after their first epilepsy surgery. The aim of this study was to describe the seizure-free outcome and safety of repeated epilepsy surgery in our tertiary referral center. METHODS Thirty-eight patients with focal refractory epilepsy, who underwent repeated epilepsy surgeries and had a minimum follow-up time of 12 months after reoperation, were included. Systematic reevaluation, including comprehensive neuroimaging and noninvasive (n = 38) and invasive (n = 25, 66%) video-electroencephalography monitoring, was performed. Multimodal 3D resection maps were created for individual patients to allow personalized reoperation. RESULTS The median time between the first operation and reoperation was 74 months (range 5-324 months). The median age at reoperation was 34 years (range 1-74 years), and the median follow-up was 38 months (range 13-142 months). Repeat MRI after the first epilepsy surgery showed an epileptogenic lesion in 24 patients (63%). The reoperation was temporal in 18 patients (47%), extratemporal in 9 (24%), and multilobar in 11 (29%). The reoperation was left hemispheric in 24 patients (63%), close to eloquent cortex in 19 (50%), and distant from the initial resection in 8 (21%). Following reoperation, 27 patients (71%) became seizure free (Engel class I), while 11 (29%) continued to have seizures. There were trends toward better outcome in temporal lobe epilepsy and for unilobar resections adjacent to the initial surgery, but there was no difference between MRI lesional and nonlesional patients. In all subgroups, Engel class I outcome was at least 50%. Perioperative complications occurred in 4 patients (11%), with no fatalities. CONCLUSIONS Reoperation for refractory focal epilepsy is an effective and safe option in patients with persistent or recurrent seizures after initial epilepsy surgery. A thorough presurgical reevaluation is essential for favorable outcome.
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Affiliation(s)
- Mathias Kunz
- 1Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University of Munich
| | - Philipp Karschnia
- 1Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University of Munich
| | - Ingo Borggraefe
- 2Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, University Hospital of the Ludwig-Maximilians-University of Munich; and
| | - Soheyl Noachtar
- 3Department of Neurology, Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Joerg-Christian Tonn
- 1Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University of Munich
| | - Christian Vollmar
- 3Department of Neurology, Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
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Wang S, Li Z, Ding X, Zhao Z, Zhang M, Xu H, Lu J, Dai L. Integrative Analyses Identify KCNJ15 as a Candidate Gene in Patients with Epilepsy. Neurol Ther 2022; 11:1767-1776. [PMID: 36168094 DOI: 10.1007/s40120-022-00407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Although there is accumulating evidence that genetic factors play a vital role in the pathogenesis of epilepsy, few epilepsy-associated genes have been identified. Additionally, the role of KCNJ15 in epilepsy has not been evaluated so far. METHODS Here, we performed differentially expressed gene analysis, expression quantitative trait loci analysis, gene co-expression analysis, and protein-protein interaction analysis to evaluate the role of KCNJ15 in epilepsy. RESULTS Analysis of gene expression and expression quantitative trait loci data revealed that KCNJ15 was significantly downregulated in patients with epilepsy (adjusted P = 0.0146 and log2 Fold change = - 1.0025), and an epilepsy-associated polymorphism (rs2833098) was linked to altered KCNJ15 expression level in human temporal lobe brain tissue (P = 0.0036). Gene co-expression analysis revealed that KCNJ15 was co-expressed with genes that have been reported to be associated with epilepsy in human brain tissue. Furthermore, protein-protein interaction analysis revealed strong supportive evidence for the role of KCNJ15 in epilepsy. CONCLUSION Our results show that KCNJ15 may be a candidate target for epilepsy. Functional analysis of KCNJ15 may provide novel insights for epilepsy treatment.
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Affiliation(s)
- Shitao Wang
- Department of Neurology, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China.
| | - Zongyou Li
- Department of Neurology, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Xiangqian Ding
- Department of Neurosurgery, Qilu Hospital of Shandong University, Shandong, China
| | - Zongyou Zhao
- Department of Neurology, Funan County People's Hospital, Funan, Anhui, China
| | - Mengen Zhang
- Department of Neurology, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Hui Xu
- Department of Neurology, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Jinghong Lu
- Department of Neurology, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Lili Dai
- Department of Geriatrics, Funan County People's Hospital, Funan, Anhui, China.
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Kang KW, Cho YW, Lee SK, Jung KY, Kim JH, Kim DW, Lee SA, Hong SB, Na IS, Lee SH, Baek WK, Choi SY, Kim MK. Multidimensional Early Prediction Score for Drug-Resistant Epilepsy. J Clin Neurol 2022; 18:553-561. [PMID: 36062773 PMCID: PMC9444554 DOI: 10.3988/jcn.2022.18.5.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Achieving favorable postoperative outcomes in patients with drug-resistant epilepsy (DRE) requires early referrals for preoperative examinations. The purpose of this study was to investigate the possibility of a user-friendly early DRE prediction model that is easy for nonexperts to utilize. Methods A two-step genotype analysis was performed, by applying 1) whole-exome sequencing (WES) to the initial test set (n=243) and 2) target sequencing to the validation set (n=311). Based on a multicenter case–control study design using the WES data set, 11 genetic and 2 clinical predictors were selected to develop the DRE risk prediction model. The early prediction scores for DRE (EPS-DRE) was calculated for each group of the selected genetic predictors (EPS-DREgen), clinical predictors (EPS-DREcln), and two types of predictor mix (EPS-DREmix) in both the initial test set and the validation set. Results The multidimensional EPS-DREmix of the predictor mix group provided a better match to the outcome data than did the unidimensional EPS-DREgen or EPS-DREcln. Unlike previous studies, the EPS-DREmix model was developed using only 11 genetic and 2 clinical predictors, but it exhibited good discrimination ability in distinguishing DRE from drug-responsive epilepsy. These results were verified using an unrelated validation set. Conclusions Our results suggest that EPS-DREmix has good performance in early DRE prediction and is a user-friendly tool that is easy to apply in real clinical trials, especially by nonexperts who do not have detailed knowledge or equipment for assessing DRE. Further studies are needed to improve the performance of the EPS-DREmix model.
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Affiliation(s)
- Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sang Kun Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Young Jung
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Bong Hong
- Department of Neurology, Samsung Medical Center, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute (SBRI), Seoul, Korea.,National Epilepsy Care Center, Seoul, Korea
| | - In-Seop Na
- National Program of Excellence in Software Centre, Chosun University, Gwangju, Korea
| | - So-Hyun Lee
- Department of Biomedical Science, Chonnam National University Medical School, Hwasun, Korea
| | - Won-Ki Baek
- Department of Microbiology, Keimyung University School of Medicine, Daegu, Korea
| | - Seok-Yong Choi
- Department of Biomedical Science, Chonnam National University Medical School, Hwasun, Korea.
| | - Myeong-Kyu Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
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Novais F, Andrea M, Andrade G, Loureiro S, Pimentel J, Câmara Pestana L. Intelligence quotient (IQ) as a predictor of epilepsy surgery outcome. Epilepsy Behav 2022; 132:108708. [PMID: 35640399 DOI: 10.1016/j.yebeh.2022.108708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/20/2022] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION About one-third of patients with epilepsy have a refractory form which is associated with important economic and psychosocial burden. Most of these patients also suffer from comorbidities. One of the most frequent is cognitive impairment. Resective surgery or neuromodulation techniques may improve seizure control. Several factors have been proposed as potential predictors of the success of surgery regarding seizure frequency. We aimed to study preoperative cognitive performance as a predictor of the epilepsy surgery outcome. METHODS In this ambispective study we studied total intelligence quotients (IQ) measured before surgery with the Wechsler Adult Intelligence Scale (WAIS) as a potential predictor of Engel Class at 1 year after surgery. Then we included IQ in a multivariate model and tested its performance. RESULTS Preoperative IQ was a significant and independent predictor of the Engel Class at 1 year after surgery (OR 0.94; CI 0.90-0.98; p = 0.007). The multivariate model including the age at epilepsy onset, education level, sex, and the type of surgery (resective versus palliative surgery) showed an area under the ROC curve of 0.85. CONCLUSIONS A low intelligence level may constitute a marker of worse prognosis after epilepsy surgery. However, other predictors should also be considered when evaluating surgical candidates.
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Affiliation(s)
- Filipa Novais
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal; Centro de Referência de Epilepsia Refratária, Hospital de Santa Maria, (CHULN), Lisboa, Portugal; EpiCARE Network, European Reference Network for Rare and Complex Epilepsies, Portugal.
| | - Mafalda Andrea
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Centro de Referência de Epilepsia Refratária, Hospital de Santa Maria, (CHULN), Lisboa, Portugal; EpiCARE Network, European Reference Network for Rare and Complex Epilepsies, Portugal
| | - Gabriela Andrade
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Susana Loureiro
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal; Centro de Referência de Epilepsia Refratária, Hospital de Santa Maria, (CHULN), Lisboa, Portugal; EpiCARE Network, European Reference Network for Rare and Complex Epilepsies, Portugal
| | - José Pimentel
- Faculdade de Medicina, Universidade de Lisboa, Portugal; Department of Neurosciences and Mental Health, Neurology Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Centro de Referência de Epilepsia Refratária, Hospital de Santa Maria, (CHULN), Lisboa, Portugal; EpiCARE Network, European Reference Network for Rare and Complex Epilepsies, Portugal
| | - Luís Câmara Pestana
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal; Centro de Referência de Epilepsia Refratária, Hospital de Santa Maria, (CHULN), Lisboa, Portugal; EpiCARE Network, European Reference Network for Rare and Complex Epilepsies, Portugal
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Milenković J, Vojvodić N. Aura in temporal lobe epilepsy: Correlation with postsurgical outcome. MEDICINSKI PODMLADAK 2022. [DOI: 10.5937/mp73-33394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Aura is a subjective feeling that represents warning of the incoming seizure and it is the very beginning of the epileptic seizure. Epilepsy is a chronical disease which manifests itself through spontaneous repetition of epileptic seizures. Aim: Determine the differences between characteristics of auras in patients with pharmacoresistant temporal epilepsy which were in remission after the surgically treatment and patients who had recurrent seizures after the procedure. Material and methods: Retrospective study includes patients with focal pharmacoresistance epilepsy treated in the Neurology Clinic, Epilepsy Department, Clinical Center of Serbia in the period between July 1, 2010 and June 30, 2019. After treatment by resective surgery the patients were postoperatively tracked for one year. The information that were collected were about the duration of epilepsy, the presence of febrile seizures, lateralization of the ictal and interictal EEG, and number and type of the auras that patients had. Chi-square and Fisher's test will be used in order to assess the difference in frequency between examined variables according to postsurgical outcome. Results will be considered as significant if p ≤ 0.05. Analysis done in IBM SPSS ver. 21. Results: Total number of the patients in this study is 132 - 57 male and 75 female. The most common type of the aura was mesial temporal aura and it was present in 77 (58.3%) patients, and after that by frequency comes nonspecific aura (12.1%). Up to 50% of the patients had only one aura, and 17 (12.9%) patients were without auras. A number of 110 patients had favorable outcome, and 22 patients had non-favorable outcome. There was no statistically significant difference found at frequency of examined variables according to postsurgical outcome (p > 0.05). The statistically significant difference in localization of the interictal EEG according to epileptic focus was discovered (p < 0.001). Conclusion: There is no statistically significant difference in frequency of listed variables according to outcome.
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Ka A, Taher A, D'Souza S, Barnes EH, Gupta S, Troedson C, Wade F, Teo O, Dale RC, Wong C, Bleasel AF, Dexter M, Kothur K, Gill D. Predictors of longitudinal seizure outcomes after epilepsy surgery in childhood. Epilepsy Behav Rep 2022; 19:100561. [PMID: 35899185 PMCID: PMC9309686 DOI: 10.1016/j.ebr.2022.100561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 10/31/2022] Open
Abstract
Long term seizure outcome in children following epilepsy surgery is favorable. Histopathology is an independent determinant of long-term seizure outcome. Long-term seizure outcome remains stable in children with tumours and FCD type 2b, whereas seizure freedom declines with time in children with other types of FCD and cortical malformations. Children with moderate to severe developmental disability and younger age of seizure onset have higher seizure recurrence reflecting broader epileptic networks.
There is a paucity of data on longitudinal seizure outcome of children undergoing epilepsy surgery. All children (n = 132) who underwent resective epilepsy surgery from January 1998 to December 2015 were identified. Relevant clinical, neurophysiological, imaging, surgical and seizure outcome data were extracted. Multivariable logistic regression analysis and Kaplan-Meier survival with Cox proportional hazard modelling were performed. The mean age at surgery was 7.8 years (range 0.2–17.9). 71% were seizure-free at a mean follow up of 5.3 ± 2.7 years. Of those who were seizure-free, 65 patients were able to completely wean off anti- seizure medications successfully. Using survival analysis, the probability of Engel Class I outcome at one year after surgery was 81% (95% confidence interval [CI] 87%–75%). This dropped to 73% at two years (95% CI 81%–65%), 58% at five years (95% CI 67.8%–48%), and 47% at ten years. Proportional hazard modelling showed that the presence of moderate to severe developmental disability (HR 6.5; p = 0.02) and lack of complete resection (HR 0.4; p = 0.02) maintain association as negative predictors of seizure-free outcome. Our study demonstrates favorable long-term seizure control following pediatric epilepsy surgery and highlights important predictors of seizure outcome guiding case selection and counseling of expectations prior to surgery.
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Epilepsy Surgery is a Viable Treatment for Lennox Gastaut Syndrome. Semin Pediatr Neurol 2021; 38:100894. [PMID: 34183143 DOI: 10.1016/j.spen.2021.100894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/21/2022]
Abstract
Lennox Gastaut Syndrome (LGS) is a severe developmental epileptic encephalopathy with onset in childhood characterized by multiple seizure types and characteristic electroencephalogram findings. The majority of patients develop drug resistant epilepsy, defined as failure of 2 appropriate anti-seizure medications used at adequate doses. Epilepsy surgery can reduce seizure burden, in some cases leading to seizure freedom, and improve neuro-developmental outcomes and quality of life. Epilepsy surgery should be considered for all patients with drug resistant LGS. Herein, we review current surgical treatment options for patients with LGS, both definitive and palliative, including: focal cortical resection, vagus nerve stimulation and corpus callosotomy. Newer neuromodulation techniques will be explored, as well as the concept of LGS as a secondary network disorder.
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Vega-García A, Orozco-Suárez S, Villa A, Rocha L, Feria-Romero I, Alonso Vanegas MA, Guevara-Guzmán R. Cortical expression of IL1-β, Bcl-2, Caspase-3 and 9, SEMA-3a, NT-3 and P-glycoprotein as biological markers of intrinsic severity in drug-resistant temporal lobe epilepsy. Brain Res 2021; 1758:147303. [PMID: 33516813 DOI: 10.1016/j.brainres.2021.147303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/24/2020] [Accepted: 01/15/2021] [Indexed: 12/22/2022]
Abstract
Mesial temporal lobe epilepsy (mTLE) is the most common epilepsy induced by previous cerebral injury, and one out of three mTLE patients develops drug resistance (DR). AIM To assess the expression of Bcl-2, Caspase-3, Caspase-9, IL1-β, SEMA-3a, NT-3 and P-glycoprotein in the temporal cortex and their relationship with the progression of mTLE-DR clinical features in patients with mTLE-DR. METHOD Tissue samples from 17 patients were evaluated for protein expression by Western blot and the relationships of the evaluated proteins with the clinical features of the mTLE were assessed through hierarchical cluster analysis. RESULTS The mTLE-DR group showed significantly higher P-glycoprotein, Bcl-2 and Caspase-9 levels ***p < 0.0001, ****p < 0.0001 and ***p < 0.0002, respectively, than the autopsy control group. Four patient clusters were identified: Clusters 1 and 3 showed relationships among the age of mTLE onset, duration of mTLE-DR, average number of epileptic seizures per week, number of previous antiepileptic drugs (AEDs) and increased expression of Caspase-3, Caspase-9, Neurotrophin-3 and Semaphorin-3a. Clusters 2 and 4 showed relationships among the mTLE onset age, current age, average number of epileptic seizures per week, number of previous AEDs and increased expression of IL1-β, Bcl-2, P-glycoprotein, Caspase-3 and NT-3. CONCLUSION The relationships among the clinical data the age of mTLE onset, DR duration, number of previous AEDs, and average number of seizures per week and the expression of proteins involved in neuronal death, neuroinflammation and aberrant connection formation, as which are biological markers in the cerebral temporal cortex, are important factors in the progression and severity of mTLE-DR and support the intrinsic severity hypothesis.
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Affiliation(s)
- A Vega-García
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
| | - S Orozco-Suárez
- Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades, "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, IMSS, Ciudad de México, Mexico.
| | - A Villa
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
| | - L Rocha
- Departamento de Farmacobiología, Centro de Investigación y Estudios Avanzados, Tlalpan, Ciudad de México, Mexico.
| | - I Feria-Romero
- Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades, "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, IMSS, Ciudad de México, Mexico.
| | - M A Alonso Vanegas
- Unidad de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", Ciudad de México, Mexico; Centro Internacional de Cirugía de Epilepsia, HMG Hospital Coyoacán, Ciudad de México, Mexico.
| | - R Guevara-Guzmán
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
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Quality of life in elderly patients after surgery for drug-resistant epilepsy - The impact of seizure outcome, neurological deficits and anxiety. Epilepsy Behav 2020; 112:107410. [PMID: 32956942 DOI: 10.1016/j.yebeh.2020.107410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Health related quality of life (HRQoL) has become a pivotal outcome parameter after surgery for drug-resistant epilepsy. The aim of the study was to investigate HRQoL and its relationship to seizure outcome, neurological deficits and anxiety after epilepsy surgery in a specific subpopulation of elderly patients. METHODS A total of 85 elderly patients (older than 50 years) answered a standardized HRQoL questionnaire one year after epilepsy surgery. The questionnaire addressed the present self-assessed HRQoL in four subdomains (physical function, cognitive function, mood, social interaction). The questionnaire was based on the "Epilepsy Surgery Inventory-55", adapted for use in German speaking patients and validated by the QOLIE -10 and Beck Depression Inventory. RESULTS A total of 51 patients (60%) were completely seizure free (ILAE1) at last available outcome (LAO). Permanent neurological deficits were observed in 8 patients (7%). Correlation analysis confirmed significant association between seizure outcome and overall HRQoL (r = -0.368, p < .001). New permanent neurological deficits showed impact on both HRQoL and the "cognitive function" subdomain. Anxiety and subjective assessment of postoperative status were strongly correlated with overall HRQoL (r = 0.692, p < .001 and r = 0.591, p < .001 respectively) and remained as independent prognostic factors in a multivariate regression analysis. CONCLUSION Surgery for drug-resistant epilepsy in elderly improves patients' HRQoL. Both seizure freedom and new neurological deficits influence overall HRQoL. Interestingly, anxiety and patients' subjective assessment of postoperative status showed the highest impact on HRQoL in this subpopulation of epilepsy patients.
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13
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Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data. Epilepsy Behav 2020; 111:107196. [PMID: 32554230 DOI: 10.1016/j.yebeh.2020.107196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study was to assess the long-term outcomes of epilepsy surgery between 1995 and 2015 in South Wales, UK, linking case note review, postal questionnaire, and routinely collected healthcare data. METHOD We identified patients from a departmental database and collected outcome data from patient case notes, a postal questionnaire, and the QOLIE-31-P and linked with Welsh routinely collected data in the Secure Anonymised Information Linkage (SAIL) databank. RESULTS Fifty-seven patients were included. Median age at surgery was 34 years (11-70), median: 24 years (2-56) after onset of habitual seizures. Median follow-up was 7 years (2-19). Twenty-eight (49%) patients were free from disabling seizures (Engel Class 1), 9 (16%) experienced rare disabling seizures (Class 2), 13 (23%) had worthwhile improvements (Class 3), and 7 (12%) had no improvement (Class 4). There was a 30% mean reduction in total antiepileptic drug (AED) load at five years postsurgery. Thirty-eight (66.7%) patients experienced tonic-clonic seizures presurgery verses 8 (14%) at last review. Seizure-free patients self-reported a greater overall quality of life (QOL; QOLIE-31-P) when compared with those not achieving seizure freedom. Seizure-free individuals scored a mean of 67.6/100 (100 is best), whereas those with continuing seizures scored 46.0/100 (p < 0.006). There was a significant decrease in the median rate of hospital admissions for any cause after epilepsy surgery (9.8 days per 1000 patient days before surgery compared with 3.9 after p < 0.005). SIGNIFICANCE Epilepsy surgery was associated with significant improvements in seizures, a reduced AED load, and an improved QOL that closely correlated with seizure outcomes and reduced hospital admission rates following surgery. Despite this, there was a long delay from onset of habitual seizures to surgery. The importance of long-term follow-up is emphasized in terms of evolving medical needs and health and social care outcomes.
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14
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González HFJ, Goodale SE, Jacobs ML, Haas KF, Landman BA, Morgan VL, Englot DJ. Brainstem Functional Connectivity Disturbances in Epilepsy may Recover After Successful Surgery. Neurosurgery 2020; 86:417-428. [PMID: 31093673 DOI: 10.1093/neuros/nyz128] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/20/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Focal seizures in temporal lobe epilepsy (TLE) are associated with widespread brain network perturbations and neurocognitive problems. OBJECTIVE To determine whether brainstem connectivity disturbances improve with successful epilepsy surgery, as recent work has demonstrated decreased brainstem connectivity in TLE that is related to disease severity and neurocognitive profile. METHODS We evaluated 15 adult TLE patients before and after (>1 yr; mean, 3.4 yr) surgery, and 15 matched control subjects using magnetic resonance imaging to measure functional and structural connectivity of ascending reticular activating system (ARAS) structures, including cuneiform/subcuneiform nuclei (CSC), pedunculopontine nucleus (PPN), and ventral tegmental area (VTA). RESULTS TLE patients who achieved long-term postoperative seizure freedom (10 of 15) demonstrated increases in functional connectivity between ARAS structures and fronto-parietal-insular neocortex compared to preoperative baseline (P = .01, Kruskal-Wallis), with postoperative connectivity patterns resembling controls' connectivity. No functional connectivity changes were detected in 5 patients with persistent seizures after surgery (P = .9, Kruskal-Wallis). Among seizure-free postoperative patients, larger increases in CSC, PPN, and VTA functional connectivity were observed in individuals with more frequent seizures before surgery (P < .05 for each, Spearman's rho). Larger postoperative increases in PPN functional connectivity were seen in patients with lower baseline verbal IQ (P = .03, Spearman's rho) or verbal memory (P = .04, Mann-Whitney U). No changes in ARAS structural connectivity were detected after successful surgery. CONCLUSION ARAS functional connectivity disturbances are present in TLE but may recover after successful epilepsy surgery. Larger increases in postoperative connectivity may be seen in individuals with more severe disease at baseline.
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Affiliation(s)
- Hernán F J González
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee
| | - Sarah E Goodale
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Monica L Jacobs
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin F Haas
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bennett A Landman
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee.,Department of Electrical Engineering, Vanderbilt University, Nashville, Tennessee.,Department of Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Victoria L Morgan
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Electrical Engineering, Vanderbilt University, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dario J Englot
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Leontariti M, Avgeris M, Katsarou M, Drakoulis N, Siatouni A, Verentzioti A, Alexoudi A, Fytraki A, Patrikelis P, Vassilacopoulou D, Gatzonis S, Sideris DC. Circulating miR‐146a and miR‐134 in predicting drug‐resistant epilepsy in patients with focal impaired awareness seizures. Epilepsia 2020; 61:959-970. [DOI: 10.1111/epi.16502] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Maria Leontariti
- Department of Biochemistry and Molecular Biology Faculty of Biology National and Kapodostrian University of Athens Athens Greece
| | - Margaritis Avgeris
- Department of Biochemistry and Molecular Biology Faculty of Biology National and Kapodostrian University of Athens Athens Greece
| | - Martha‐Spyridoula Katsarou
- Research Group of Clinical Pharmacology and Pharmacogenomics Faculty of Pharmacy School of Health Sciences National and Kapodistrian University of Athens Athens Greece
| | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics Faculty of Pharmacy School of Health Sciences National and Kapodistrian University of Athens Athens Greece
| | - Anna Siatouni
- First Department of Neurosurgery Evangelismos Hospital School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Anastasia Verentzioti
- First Department of Neurosurgery Evangelismos Hospital School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Athanasia Alexoudi
- First Department of Neurosurgery Evangelismos Hospital School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Aggeliki Fytraki
- First Department of Neurosurgery Evangelismos Hospital School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Panayiotis Patrikelis
- First Department of Neurosurgery Evangelismos Hospital School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Dido Vassilacopoulou
- Department of Biochemistry and Molecular Biology Faculty of Biology National and Kapodostrian University of Athens Athens Greece
| | - Stylianos Gatzonis
- First Department of Neurosurgery Evangelismos Hospital School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Diamantis C. Sideris
- Department of Biochemistry and Molecular Biology Faculty of Biology National and Kapodostrian University of Athens Athens Greece
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16
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Shu Y, Zhu C, Zeng M, Zhan Q, Hu Z, Wu X. The protective effect of carbenoxolone on gap junction damage in the hippocampal CA1 area of a temporal lobe epilepsy rat model. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:624. [PMID: 31930025 DOI: 10.21037/atm.2019.11.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Astrocytes are one of the most important types of neural cells in the central nervous system (CNS). Dysfunctional gap junction (GJ) communication could play an underlying role in epileptogenesis. Carbenoxolone (CBX) is a conventional chemical GJ blocker, and its target is connexin 43 (Cx43). Previous studies have shown that CBX can inhibit status epilepticus (SE) and spontaneous epileptic seizures (SESs). However, there is little information about the direct interaction between CBX and Cxs in temporal lobe epilepsy (TLE). Methods The behavior of epileptic rats was observed. Moreover, micromorphological changes in the hippocampal cornu ammonis 1 (CA1) area of epileptic rats following CBX injection were determined through transmission electron microscopy (TEM). To illustrate the possible mechanism of these changes, the Western blot method was used. Results After the injection of CBX, the seizure frequency, seizure duration, latency period to the first instance of SES, SESs behavioral score according to a scoring system developed by Velíšková and microstructures in the CA1 area were shown to be improved 60 days after SE by TEM. Furthermore, the dynamic expression patterns of Cx43 and Cx43 phosphorylated at Ser368 continuously declined after the injection of CBX until 60 days after SE. Conclusions CBX may contribute to the improvement of GJ dysfunction during epileptogenesis in the hippocampal CA1 area in a TLE rat model.
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Affiliation(s)
- Yi Shu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Can Zhu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Min Zeng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Qiong Zhan
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Zhiping Hu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xiaomei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
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17
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Prabhakar A, Khandelwal N, Vyas S, Gupta V, Kharbanda PS, Mohanty M. Functional MRI in epilepsy - Comparison of Lateralization index and language scoring. Indian J Radiol Imaging 2019; 29:168-176. [PMID: 31367088 PMCID: PMC6639858 DOI: 10.4103/ijri.ijri_281_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims: To evaluate the role of functional magnetic resonance imaging (fMRI) in epilepsy management and to ascertain whether laterality index (LI) derived from fMRI data, using routinely utilized paradigms, can serve as an adjunct to/or replace preoperative neuropsychological testing for evaluation of language lateralization and impairment. Materials and Methods: This was a prospective study which included 20 consecutive patients with a clinical diagnosis of temporal lobe epilepsy over a period of 1 year. Neuropsychological assessment included oral word association test and animal names test. The scores of both tests were compared with normographic data provided in the NIMHANS neuropsychology battery. Three fMRI paradigms were used, namely, picture naming, word generation, and sentence completion. Processing and statistical analysis were performed subsequently. Results and Conclusion: Right temporal lobe epilepsy (RTLE) was seen in 12 patients and left temporal lobe epilepsy (LTLE) in 8 patients. All patients were right handed. The activation pattern was predominantly left lateralized. Language lateralization varied with the type of paradigm. The overall percentage of patients showing left lateralization ranged from 44.00% for the picture naming task to 75% for the sentence completion. Reduced left lateralization was noted in both LTLE and RTLE patients. A negative correlation was observed in LTLE patients between performance in the verbal fluency and the lateralization index in the temporal and parietal regions of interest (ROI) in the word generation paradigm, suggesting that increased left lateralization was associated with a poorer score on neuropsychological tests. In RTLE patients, however, there was no significant correlation between performance in neuropsychological tests and LI. In conclusion, language lateralization using LI can serve as an adjunct during preoperative evaluation. However, it cannot replace neuropsychological testing.
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Affiliation(s)
- Anuj Prabhakar
- Department of Neuro Imaging and Interventional Neuroradiology, AIIMS, New Delhi, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Imaging and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Radiodiagnosis, Post Graduate Institute of Medical Imaging and Research, Chandigarh, India
| | - Vivek Gupta
- Department of Radiodiagnosis, Post Graduate Institute of Medical Imaging and Research, Chandigarh, India
| | - Parampreet S Kharbanda
- Department of Neurology, Post Graduate Institute of Medical Imaging and Research, Chandigarh, India
| | - Manju Mohanty
- Department of Neurosurgery, Post Graduate Institute of Medical Imaging and Research, Chandigarh, India
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18
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Ruiz AJ, Rahim AA. Bringing balance to the force-regulatable gene therapy for epilepsy. Gene Ther 2019; 26:347-349. [PMID: 31138935 DOI: 10.1038/s41434-019-0083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/28/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Arnaud J Ruiz
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Ahad A Rahim
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK.
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19
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Association Between Quantitative Electroencephalogram Frequency Composition and Post-Surgical Evolution in Pharmacoresistant Temporal Lobe Epilepsy Patients. Behav Sci (Basel) 2019; 9:bs9030023. [PMID: 30836608 PMCID: PMC6466595 DOI: 10.3390/bs9030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/05/2019] [Accepted: 02/27/2019] [Indexed: 11/17/2022] Open
Abstract
The purpose of this paper is to estimate the association between quantitative electroencephalogram frequency composition (QEEGC) and post-surgical evolution in patients with pharmacoresistant temporal lobe epilepsy (TLE) and to evaluate the predictive value of QEEGC before and after surgery. A prospective, longitudinal study was made at International Neurological Restoration Center, Havana, Cuba. Twenty-nine patients with TLE submitted to epilepsy surgery were evaluated before surgery, and six months and two years after. They were classified as unsatisfactory and satisfactory post-surgical clinical evolution using the Modified Engels Scale. Eighty-seven electroencephalograms with quantitative narrow- and broad-band measures were analyzed. A Mann Whitney test (p > 0.05) showed that QEEGC before surgery was similar between groups independently of two years post-surgical evolution. A Mann Whitney test (p ˂ 0.05) showed that subjects with two years satisfactory post-surgical evolution had greater alpha power compared to subjects with two years unsatisfactory post-surgical evolution that showed greater theta power. A Wilcoxon test (p ˂ 0.05) showed that alpha and theta power increased for two groups from pre-surgical state to post-surgical state. Logit regression (p ˂ 0.05) showed that six months after surgery, quantitative electroencephalogram frequency value with the greatest power at occipital regions shows predictive value for two years evolution. QEEGC can be a tool to predict the outcome of epilepsy surgery.
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20
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Mumford V, Rapport F, Shih P, Mitchell R, Bleasel A, Nikpour A, Herkes G, MacRae A, Bartley M, Vagholkar S, Braithwaite J. Promoting faster pathways to surgery: a clinical audit of patients with refractory epilepsy. BMC Neurol 2019; 19:29. [PMID: 30782132 PMCID: PMC6381714 DOI: 10.1186/s12883-019-1255-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Individuals with epilepsy who cannot be adequately controlled with anti-epileptic drugs, refractory epilepsy, may be suitable for surgical treatment following detailed assessment. This is a complex process and there are concerns over delays in referring refractory epilepsy patients for surgery and subsequent treatment. The aim of this study was to explore the different patient pathways, referral and surgical timeframes, and surgical and medical treatment options for refractory epilepsy patients referred to two Tertiary Epilepsy Clinics in New South Wales, Australia. Methods Clinical records were reviewed for 50 patients attending the two clinics, in two large teaching hospitals (25 in Clinic 1; 25 in Clinic 2. A purpose-designed audit tool collected detailed aspects of outpatient consultations and treatment. Patients with refractory epilepsy with their first appointment in 2014 were reviewed for up to six visits until the end of 2016. Data collection included: patient demographics, type of epilepsy, drug management, and assessment for surgery. Outcomes included: decisions regarding surgical and/or medical management, and seizure status following surgery. Patient-reported outcome measures to assess anxiety and depression were collected in Clinic 1 only. Results Patient mean age was 38.3 years (SD 13.4), the mean years since diagnosis was 17.3 years (SD 9.8), and 88.0% of patients had a main diagnosis of focal epilepsy. Patients were taking an average of 2.3 (SD 0.9) anti-epileptic drugs at the first clinic visit. A total of 17 (34.0%) patients were referred to the surgical team and 11 (22.0%) underwent a neuro-surgical procedure. The average waiting time between visit 1 to surgical referral was 38.8 weeks (SD 25.1), and between visit 1 and the first post-operative visit was 55.8 weeks (SD 25.0). Conclusion The findings confirm international data showing significant waiting times between diagnosis of epilepsy and referral to specialist clinics for surgical assessment and highlight different approaches in each clinic in terms of visit numbers and recorded activities. A standardised pathway and data collection, including patient-reported outcome measures, would provide better evidence for whether promoting earlier referral and assessment for surgery improves the lives of this disease group. Electronic supplementary material The online version of this article (10.1186/s12883-019-1255-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Virginia Mumford
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - Frances Rapport
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Patti Shih
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Andrew Bleasel
- University of Sydney, Sydney, Australia.,Westmead Hospital, Westmead, Australia
| | - Armin Nikpour
- University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Geoffrey Herkes
- University of Sydney, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia
| | - Amy MacRae
- Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Sanjyot Vagholkar
- Primary Care & Wellbeing, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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21
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Ali SO, Shahin NN, Safar MM, Rizk SM. Therapeutic potential of endothelial progenitor cells in a rat model of epilepsy: Role of autophagy. J Adv Res 2019; 18:101-112. [PMID: 30847250 PMCID: PMC6389652 DOI: 10.1016/j.jare.2019.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022] Open
Abstract
This is the first report showing EPCs therapeutic effects in PTZ-induced epilepsy. Intravenously administered EPCs homed into the epileptic rat hippocampus. EPCs amend the memory and locomotor activity deficits related to epilepsy. EPCs ameliorate epilepsy-associated alterations in neurotransmitters and autophagy. EPCs mitigate concomitant histological and vascular anomalies.
Epilepsy is one of the most well-known neurological conditions worldwide. One-third of adult epileptic patients do not respond to antiepileptic drugs or surgical treatment and therefore suffer from the resistant type of epilepsy. Stem cells have been given substantial consideration in the field of epilepsy therapeutics. The implication of pathologic vascular response in sustained seizures and the eminent role of endothelial progenitor cells (EPCs) in maintaining vascular integrity tempted us to investigate the potential therapeutic effects of EPCs in a pentylenetetrazole (PTZ)-induced rat model of epilepsy. Modulation of autophagy, a process that enables neurons to maintain an equilibrium of synthesis, degradation and subsequent reprocessing of cellular components, has been targeted. Intravenously administered EPCs homed into the hippocampus and amended the deficits in memory and locomotor activity. The cells mitigated neurological damage and the associated histopathological alterations and boosted the expression of brain-derived neurotrophic factor. EPCs corrected the perturbations in neurotransmitter activity and enhanced the expression of the downregulated autophagy proteins light chain protein-3 (LC-3), beclin-1, and autophagy-related gene-7 (ATG-7). Generally, these effects were comparable to those achieved by the reference antiepileptic drug, valproic acid. In conclusion, EPCs may confer therapeutic effects against epilepsy and its associated behavioural and biochemical abnormalities at least in part via the upregulation of autophagy. The study warrants further research in experimental and clinical settings to verify the prospect of using EPCs as a valid therapeutic strategy in patients with epilepsy.
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Affiliation(s)
- Shimaa O Ali
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo, Egypt
| | - Nancy N Shahin
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo, Egypt
| | - Marwa M Safar
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo, Egypt.,Pharmacology and Biochemistry Department, Faculty of Pharmacy, The British University in Egypt, El-Sherouk City, Cairo, Egypt
| | - Sherine M Rizk
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo, Egypt
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22
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Lebedeva AV, Avedisova AS, Kustov GV, Gersamiya AG, Kaymovskiy IL, Rider FK, Trifonov IS, Pashnin EV, Malkhasyan EA, Guekht AB, Krylov VV. [Prognosis for surgical treatment of pharmacoresistant epilepsy: the role of mental and cognitive disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:27-36. [PMID: 30698541 DOI: 10.17116/jnevro201811810227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This review focuses on the role of mental and cognitive disorders in the prognosis for surgical treatment of pharmacoresistant epilepsy. The authors analyze historical aspects of the surgical treatment of epilepsy and present current data on the prognosis of operative intervention with respect to seizure control, cognitive functioning, and psychiatric disorders. The psychiatrist's role in the structure of preoperative and postoperative management of patients is considered.
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Affiliation(s)
- A V Lebedeva
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - A S Avedisova
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Serbsky Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - G V Kustov
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - A G Gersamiya
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | | | - F K Rider
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - I S Trifonov
- Evdokimov Moscow State University of Medical Dentisitry, Moscow, Russia
| | - E V Pashnin
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - E A Malkhasyan
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - A B Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - V V Krylov
- Evdokimov Moscow State University of Medical Dentisitry, Moscow, Russia; Sklifosovsky Research Institute of Emergensy Medicine, Moscow, Russia
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Koh HY, Lee JH. Brain Somatic Mutations in Epileptic Disorders. Mol Cells 2018; 41:881-888. [PMID: 30352490 PMCID: PMC6199569 DOI: 10.14348/molcells.2018.0247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 12/20/2022] Open
Abstract
During the cortical development, cells in the brain acquire somatic mutations that can be implicated in various neurodevelopmental disorders. There is increasing evidence that brain somatic mutations lead to sporadic form of epileptic disorders with previously unknown etiology. In particular, malformation of cortical developments (MCD), ganglioglioma (GG) associated with intractable epilepsy and non-lesional focal epilepsy (NLFE) are known to be attributable to brain somatic mutations in mTOR pathway genes and others. In order to identify such somatic mutations presenting as low-level in epileptic brain tissues, the mutated cells should be enriched and sequenced with high-depth coverage. Nevertheless, there are a lot of technical limitations to accurately detect low-level of somatic mutations. Also, it is important to validate whether identified somatic mutations are truly causative for epileptic seizures or not. Furthermore, it will be necessary to understand the molecular mechanism of how brain somatic mutations disturb neuronal circuitry since epilepsy is a typical example of neural network disorder. In this review, we overview current genetic techniques and experimental tools in neuroscience that can address the existence and significance of brain somatic mutations in epileptic disorders as well as their effect on neuronal circuitry.
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Affiliation(s)
- Hyun Yong Koh
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141,
Korea
| | - Jeong Ho Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141,
Korea
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141,
Korea
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Kang JW, Eom S, Hong W, Kwon HE, Park S, Ko A, Kang HC, Lee JS, Lee YM, Kim DS, Kim HD. Long-term Outcome of Resective Epilepsy Surgery in Patients With Lennox-Gastaut Syndrome. Pediatrics 2018; 142:peds.2018-0449. [PMID: 30194277 DOI: 10.1542/peds.2018-0449] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the long-term outcome of resective epilepsy surgery in patients with Lennox-Gastaut syndrome (LGS). METHODS We reviewed the case reports of 90 patients with LGS who had undergone resective surgery between 2003 and 2014 at the Severance Children's Hospital and managed them for a minimum period of 2 years. RESULTS At the time of surgery, the patients were between 3.0 and 23.5 years old (mean ± SD: 9.3 ± 4.4). The time from seizure onset to surgery ranged from 0.7 to 20.1 years (7.2 ± 4.3). On postoperative follow-up for an average period of 6.1 ± 2.2 years (range: 2.1-11.4 years), 45 patients (50.0%) had no seizures, and 15 (16.7%) reported infrequent seizures. Seizure-free outcomes were achieved in 15 of the 21 (71.4%) hemispherectomies, 23 of the 51 (45.1%) multilobar resections, and 7 of the 18 (38.9%) single lobar resections. On high-resolution MRIs, 20 patients (22.2%) had negative findings, 8 of whom (40.0%) became seizure-free after resective surgery. Malformation of cortical development was the most common pathologic finding and was noted in 57 patients (63.3%). Seizure-free patients achieved better adaptive behavior and social competence than did patients with persistent seizures at the second (2-3 years after surgery) and third (4-6 years after surgery) follow-ups, as indicated by social quotients (P < .05). CONCLUSIONS Resective surgery is a viable option in some patients to treat seizures that are associated with LGS, with a high probability of seizure control and better adaptive function.
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Affiliation(s)
- Joon Won Kang
- Departments of Pediatrics and Medical Science, Chungnam National University Hospital and College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Soyong Eom
- Epilepsy Research Institute, College of Medicine
| | - William Hong
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Hye Eun Kwon
- Department of Pediatrics, International St Mary's Hospital and College of Medicine, Catholic Kwandong University, Incheon, Republic of Korea; and
| | - Soyoung Park
- Department of Pediatrics, Soon Chun Hyang University Hospital and College of Medicine, Soonchunhyang University, Bucheon, Republic of Korea
| | - Ara Ko
- Epilepsy Research Institute, College of Medicine.,Pediatric Epilepsy Clinics, Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital
| | - Hoon-Chul Kang
- Epilepsy Research Institute, College of Medicine.,Pediatric Epilepsy Clinics, Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital
| | - Joon Soo Lee
- Epilepsy Research Institute, College of Medicine.,Pediatric Epilepsy Clinics, Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, and
| | - Dong Seok Kim
- Division of Pediatric Neurosurgery, Severance Hospital, Yonsei University, Seoul, Republic of Korea
| | - Heung Dong Kim
- Epilepsy Research Institute, College of Medicine, .,Pediatric Epilepsy Clinics, Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital
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Liu JT, Liu B, Zhang H. Surgical versus medical treatment of drug-resistant epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2018; 82:179-188. [PMID: 29576434 DOI: 10.1016/j.yebeh.2017.11.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 11/02/2017] [Accepted: 11/12/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Surgery and drug therapy are the two main treatments for refractory epilepsy. However, to date, there has not been an adequate comparison of the outcomes of these two treatments. This systematic review compared the overall outcome of surgery and medical treatment in patients with drug-resistant epilepsy. METHODS Articles published in Embase, Medline, Pubmed, and the Cochrane library were searched from their inception until June 2016. RESULTS Twenty of the eighty-one (24.7%) full-text articles reviewed fulfilled the eligibility criteria and were included in the meta-analysis. Of 1800 patients with drug-resistant epilepsy, 526 of 923 patients (57.0%) in the surgery group were seizure-free compared with 134 of 877 patients (15.3%) in the medical treatment group (19 studies, risk ratio (RR)=3.72, 95% confidence interval (CI) [2.75-5.03]; P<0.00001, I2=53%). In addition, more patients were off antiepileptic drugs (AEDs) in the surgical group (3 studies, n=438, RR=4.76, 95% CI [2.21, 10.28], P<0.0001, I2=0%). Although different studies used different questionnaires to assess patient quality of life (QOL) in both treatment groups, the overall postintervention QOL scores were higher in the surgery than in the medical treatment group, by SMD (6 studies, n=459, SMD=0.61, 95% CI [0.23, 0.98], P=0.002, I2=66%). CONCLUSION As the complications of interventions, declines in memory, and word recall/naming were not assessed in the meta-analysis, the conclusions are limited to seizure-free, AED use, and QOL. The current evidence indicate that compared with medical treatment, surgery is more likely to achieve seizure-free, off AEDs, and better QOL.
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Affiliation(s)
- Jin-Tao Liu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province,China; Department of Surgery, the 413th Hospital of the Chinese People's Liberation Army, Zhoushan 316000, China
| | - Bei Liu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province,China
| | - Hua Zhang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province,China.
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Walther K, Dogan Onugoren M, Buchfelder M, Gollwitzer S, Graf W, Kasper BS, Kriwy P, Kurzbuch K, Lang J, Rössler K, Schwab S, Schwarz M, Stefan H, Hamer HM. Psychosocial outcome in epilepsy after extratemporal surgery. Epilepsy Behav 2018; 81:94-100. [PMID: 29454606 DOI: 10.1016/j.yebeh.2018.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Only limited data exist on psychosocial long-term outcome after epilepsy surgery in patients with extratemporal epilepsy. The aim of this study was to investigate psychosocial outcome after extratemporal epilepsy surgery and to assess factors predicting favorable outcome. METHOD Sixty-five out of 104 eligible patients who had undergone extratemporal epilepsy surgery at our epilepsy center between 1990 and 2015 (mean age: 42.2. years; 75% of the resections in the frontal lobe) completed a questionnaire asking about seizure status, employment status, marital and living situation, driving status, depressive symptoms, and quality of life (QOL). Follow-up was on average 9.2years after surgery (range: 1-26years). RESULTS Thirty-eight (58%) patients were free of disabling seizures (Engel class I), and 28 (43%) have not experienced any seizures after surgery (Engel class IA). Employment rate in the primary labor market remained at 45%, but more patients lost employment (14%) than gained employment (8%). Postoperative employment was predicted by preoperative employment (p=.007), seizure freedom (p=.025), older age at seizure onset (p=.018), younger age at follow-up (p=.035), and female gender (p=.048). Seizure-free patients were more likely to be driving; have a partner, particularly in males; and have lower depressive scores. Quality of life at follow-up was best predicted by employment (p=.012), partnership (p=.025), and seizure freedom (p=.025). In contrast, recurrence of seizures and early seizure onset were associated with poor psychosocial outcome, particularly in men. CONCLUSION The study provides support that extratemporal surgery can lead to improved QOL and favorable psychosocial outcome. Seizure freedom is important but not the only determinant of good psychosocial outcome.
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Affiliation(s)
- Katrin Walther
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Müjgan Dogan Onugoren
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stephanie Gollwitzer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Wolfgang Graf
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Burkhard S Kasper
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Peter Kriwy
- Institute of Sociology, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
| | - Katrin Kurzbuch
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Schwarz
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hermann Stefan
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
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Morales Chacón LM, Garcia Maeso I, Baez Martin MM, Bender Del Busto JE, García Navarro ME, Quintanal Cordero N, Estupiñan Díaz B, Lorigados Pedre L, Valdés Yerena R, Gonzalez J, Garbey Fernandez R, Sánchez Coroneux A. Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program. Behav Sci (Basel) 2018; 8:bs8020019. [PMID: 29389846 PMCID: PMC5836002 DOI: 10.3390/bs8020019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/10/2018] [Accepted: 01/20/2018] [Indexed: 12/05/2022] Open
Abstract
The purpose of this paper is to present a long- term electroclinical and employment follow up in temporal lobe epilepsy (TLE) patients in a comprehensive epilepsy surgery program. Forty adult patients with pharmacoresistant TLE underwent detailed presurgical evaluation. Electroencephalogram (EEG) and clinical follow up assessment for each patient were carried out. The occurrence of interictal epileptiform activity (IEA) and absolute spike frequency (ASF) were tabulated before and after 1, 6, 12, 24 and 72 months surgical treatment. Employment status pre- to post-surgery at the last evaluated period was also examined. Engel scores follow-up was described as follows: at 12 months 70% (28) class I, 10% (4) class II and 19% (8) class III-IV; at 24 months after surgery 55.2% (21) of the patients were class I, 28.9% (11) class II and 15.1% (6) class III-IV. After one- year follow up 23 (57.7%) patients were seizure and aura-free (Engel class IA). These figures changed to 47.3%, and 48.6% respectively two and five years following surgery whereas 50% maintained this condition in the last follow up period. A decline in the ASF was observed from the first year until the sixth year after surgery in relation to the preoperative EEG. The ASF one year after surgery allowed to distinguish “satisfactory” from “unsatisfactory” seizure relief outcome at the last follow up. An adequate social functioning in terms of education and employment in more than 50% of the patients was also found. Results revealed the feasibility of conducting a successful epilepsy surgery program with favorable long term electroclinical and psychosocial functioning outcomes in a developing country as well.
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Affiliation(s)
- Lilia Maria Morales Chacón
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Ivan Garcia Maeso
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Margarita M Baez Martin
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Juan E Bender Del Busto
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | | | - Nelson Quintanal Cordero
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Bárbara Estupiñan Díaz
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Lourdes Lorigados Pedre
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Ricardo Valdés Yerena
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Judith Gonzalez
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Randy Garbey Fernandez
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
| | - Abel Sánchez Coroneux
- Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
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Mehmood S, Dale C, Parry M, Snead C, Valiante TA. Predictive coding: A contemporary view on the burden of normality and forced normalization in individuals undergoing epilepsy surgery. Epilepsy Behav 2017; 75:110-113. [PMID: 28843211 DOI: 10.1016/j.yebeh.2017.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/22/2017] [Accepted: 06/11/2017] [Indexed: 12/21/2022]
Abstract
Following epilepsy surgery, a good psychosocial outcome is not necessarily contingent on a good seizure outcome. Increasingly, it is believed that "successful" surgery is a combination of both an acceptable and expected seizure status as well as the individual's perception of improvements in quality of life (QOL). The factors that create this optimal outcome remain an ongoing area of research in the epilepsy community. That being said, there have been some major breakthroughs in observing and understanding poor outcomes seen in a subset of postoperative patients with epilepsy. Characteristics of burden of normality and forced normalization are two phenomena that have been evident in cases of poor postoperative outcomes. In this review, we provide a summary of research and concepts used to explain these poor QOL outcomes for a seemingly successful surgery and suggest a contemporary view in understanding the mechanism of forced normalization through understanding the brain as a predictive organ. Using such a predictive coding model together with recommendations of other studies, we suggest the crucial need for a preoperative intervention addressing patient predictions and expectations to optimize on the benefits achievable through epilepsy surgery.
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Affiliation(s)
- Sumayya Mehmood
- Krembil Research Institute, Toronto Western Hospital (TWH), Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Carter Snead
- Division of Neurology, Departments of Medicine, Paediatrics and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Taufik A Valiante
- Krembil Research Institute, Toronto Western Hospital (TWH), Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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van der Loo LE, Schijns OEMG, Hoogland G, Colon AJ, Wagner GL, Dings JTA, Kubben PL. Methodology, outcome, safety and in vivo accuracy in traditional frame-based stereoelectroencephalography. Acta Neurochir (Wien) 2017; 159:1733-1746. [PMID: 28676892 PMCID: PMC5557874 DOI: 10.1007/s00701-017-3242-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
Background Stereoelectroencephalography (SEEG) is an established diagnostic technique for the localization of the epileptogenic zone in drug-resistant epilepsy. In vivo accuracy of SEEG electrode positioning is of paramount importance since higher accuracy may lead to more precise resective surgery, better seizure outcome and reduction of complications. Objective To describe experiences with the SEEG technique in our comprehensive epilepsy center, to illustrate surgical methodology, to evaluate in vivo application accuracy and to consider the diagnostic yield of SEEG implantations. Methods All patients who underwent SEEG implantations between September 2008 and April 2016 were analyzed. Planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative imaging. Quantitative analysis of deviation using Euclidean distance and directional errors was performed. Explanatory variables for electrode accuracy were analyzed using linear regression modeling. The surgical methodology, procedure-related complications and diagnostic yield were reported. Results Seventy-six implantations were performed in 71 patients, and a total of 902 electrodes were implanted. Median entry and target point deviations were 1.54 mm and 2.93 mm. Several factors that predicted entry and target point accuracy were identified. The rate of major complications was 2.6%. SEEG led to surgical therapy of various modalities in 53 patients (69.7%). Conclusions This study demonstrated that entry and target point localization errors can be predicted by linear regression models, which can aid in identification of high-risk electrode trajectories and further enhancement of accuracy. SEEG is a reliable technique, as demonstrated by the high accuracy of conventional frame-based implantation methodology and the good diagnostic yield.
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Long-Term Seizure, Quality of Life, Depression, and Verbal Memory Outcomes in a Controlled Mesial Temporal Lobe Epilepsy Surgical Series Using Portuguese-Validated Instruments. World Neurosurg 2017; 104:411-417. [DOI: 10.1016/j.wneu.2017.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 11/24/2022]
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Cerri C, Caleo M, Bozzi Y. Chemokines as new inflammatory players in the pathogenesis of epilepsy. Epilepsy Res 2017; 136:77-83. [PMID: 28780154 DOI: 10.1016/j.eplepsyres.2017.07.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/13/2017] [Accepted: 07/25/2017] [Indexed: 12/22/2022]
Abstract
A large series of clinical and experimental studies supports a link between inflammation and epilepsy, indicating that inflammatory processes within the brain are important contributors to seizure recurrence and precipitation. Systemic inflammation can precipitate seizures in children suffering from epileptic encephalopathies, and hallmarks of a chronic inflammatory state have been found in patients with temporal lobe epilepsy. Research performed on animal models of epilepsy further corroborates the idea that seizures upregulate inflammatory mediators, which in turn may enhance brain excitability and neuronal degeneration. Several inflammatory molecules and their signaling pathways have been implicated in epilepsy. Among these, the chemokine pathway has increasingly gained attention. Chemokines are small cytokines secreted by blood cells, which act as chemoattractants for leukocyte migration. Recent studies indicate that chemokines and their receptors are also produced by brain cells, and are involved in various neurological disorders including epilepsy. In this review, we will focus on a subset of pro-inflammatory chemokines (namely CCL2, CCL3, CCL5, CX3CL1) and their receptors, and their increasingly recognized role in seizure control.
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Affiliation(s)
- Chiara Cerri
- CNR Neuroscience Institute, via G. Moruzzi 1, 56124, Pisa, Italy; Fondazione Umberto Veronesi, Piazza Velasca 5, 20122 Milano, Italy.
| | - Matteo Caleo
- CNR Neuroscience Institute, via G. Moruzzi 1, 56124, Pisa, Italy.
| | - Yuri Bozzi
- CNR Neuroscience Institute, via G. Moruzzi 1, 56124, Pisa, Italy; Neurodevelopmental Disorders Research Group, Centre for Mind/Brain Sciences, University of Trento, via Sommarive 9, 38123 Povo, Trento, Italy.
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Eight Flurothyl-Induced Generalized Seizures Lead to the Rapid Evolution of Spontaneous Seizures in Mice: A Model of Epileptogenesis with Seizure Remission. J Neurosci 2017; 36:7485-96. [PMID: 27413158 DOI: 10.1523/jneurosci.3232-14.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 05/31/2016] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED The occurrence of recurrent, unprovoked seizures is the hallmark of human epilepsy. Currently, only two-thirds of this patient population has adequate seizure control. New epilepsy models provide the potential for not only understanding the development of spontaneous seizures, but also for testing new strategies to treat this disorder. Here, we characterize a primary generalized seizure model of epilepsy following repeated exposure to the GABAA receptor antagonist, flurothyl, in which mice develop spontaneous seizures that remit within 1 month. In this model, we expose C57BL/6J mice to flurothyl until they experience a generalized seizure. Each of these generalized seizures typically lasts <30 s. We induce one seizure per day for 8 d followed by 24 h video-electroencephalographic recordings. Within 1 d following the last of eight flurothyl-induced seizures, ∼50% of mice have spontaneous seizures. Ninety-five percent of mice tested have seizures within the first week of the recording period. Of the spontaneous seizures recorded, the majority are generalized clonic seizures, with the remaining 7-12% comprising generalized clonic seizures that transition into brainstem seizures. Over the course of an 8 week recording period, spontaneous seizure episodes remit after ∼4 weeks. Overall, the repeated flurothyl paradigm is a model of epileptogenesis with spontaneous seizures that remit. This model provides an additional tool in our armamentarium for understanding the mechanisms underlying epileptogenesis and may provide insights into why spontaneous seizures remit without anticonvulsant treatment. Elucidating these processes could lead to the development of new epilepsy therapeutics. SIGNIFICANCE STATEMENT Epilepsy is a chronic disorder characterized by the occurrence of recurrent, unprovoked seizures in which the individual seizure-ictal events are self-limiting. Remission of recurrent, unprovoked seizures can be achieved in two-thirds of cases by treatment with anticonvulsant medication, surgical resection, and/or nerve/brain electrode stimulation. However, there are examples in humans of epilepsy with recurrent, unprovoked seizures remitting without any intervention. While elucidating how recurrent, unprovoked seizures develop is critical for understanding epileptogenesis, an understanding of how and why recurrent, unprovoked seizures remit may further our understanding and treatment of epilepsy. Here, we describe a new model of recurrent, unprovoked spontaneous seizures in which the occurrence of spontaneous seizures naturally remits over time without any therapeutic intervention.
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Tang F, Hartz AMS, Bauer B. Drug-Resistant Epilepsy: Multiple Hypotheses, Few Answers. Front Neurol 2017; 8:301. [PMID: 28729850 PMCID: PMC5498483 DOI: 10.3389/fneur.2017.00301] [Citation(s) in RCA: 269] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/12/2017] [Indexed: 01/16/2023] Open
Abstract
Epilepsy is a common neurological disorder that affects over 70 million people worldwide. Despite the recent introduction of new antiseizure drugs (ASDs), about one-third of patients with epilepsy have seizures refractory to pharmacotherapy. Early identification of patients who will become refractory to ASDs could help direct such patients to appropriate non-pharmacological treatment, but the complexity in the temporal patterns of epilepsy could make such identification difficult. The target hypothesis and transporter hypothesis are the most cited theories trying to explain refractory epilepsy, but neither theory alone fully explains the neurobiological basis of pharmacoresistance. This review summarizes evidence for and against several major theories, including the pharmacokinetic hypothesis, neural network hypothesis, intrinsic severity hypothesis, gene variant hypothesis, target hypothesis, and transporter hypothesis. The discussion is mainly focused on the transporter hypothesis, where clinical and experimental data are discussed on multidrug transporter overexpression, substrate profiles of ASDs, mechanism of transporter upregulation, polymorphisms of transporters, and the use of transporter inhibitors. Finally, future perspectives are presented for the improvement of current hypotheses and the development of treatment strategies as guided by the current understanding of refractory epilepsy.
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Affiliation(s)
- Fei Tang
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States.,Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, United States
| | - Anika M S Hartz
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States.,Department of Pharmacology and Nutritional Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Björn Bauer
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, United States.,Epilepsy Center, University of Kentucky, Lexington, KY, United States
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Psychiatric symptoms after temporal epilepsy surgery. A one-year follow-up study. Epilepsy Behav 2017; 70:154-160. [PMID: 28427025 DOI: 10.1016/j.yebeh.2017.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/22/2022]
Abstract
Psychiatric symptoms must be considered in patients with refractory temporal lobe epilepsy after epilepsy surgery. The main objectives of our study were to describe clinical and socio-demographical characteristics of a cohort of patients with pharmacoresistant temporal lobe epilepsy who underwent temporal lobe epilepsy surgery, and moreover, to evaluate possible risk factors for developing psychiatric symptoms. In order to achieve those goals, we conducted a prospective evaluation of psychopathology throughout the first year after surgery in a clinical sample of 72 patients, by means of three clinical rated measures; the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), and the Brief Psychiatric Rating Scale (BPRS). The psychopathological evaluations were performed by an experienced psychiatrist. A presurgical evaluation was done by a multidisciplinary team (that includes neurologist, psychiatrist, neurosurgeon, neurophysiologist, radiologists, and nuclear medicine specialist) in all patients. The decision to proceed to surgery was taken after a surgical meeting of all members of the Multidisciplinary Epilepsy Unit team. The psychiatrist conducted two postoperative assessments at 6months and 12months after surgery. The main finding was that past history of mental illness (patients who were receiving psychiatric treatment prior to the baseline evaluation) was a risk factor for anxiety, depression, and psychosis after temporal lobe epilepsy surgery.
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Abstract
BACKGROUND Approximately 30% of patients with epilepsy have medically intractable seizures, and a proportion of them are candidates for surgical treatment. The efficacy and safety of epilepsy surgery have been supported by a large number of studies, yet only a small minority of such patients in Ontario receive surgery. METHODS Family physicians in Ontario were surveyed regarding demographics, referral practices and general knowledge about epilepsy surgery. Four hundred surveys were mailed to randomly selected family physicians using contact information from the College of Physicians and Surgeons of Ontario website. RESULTS The response rate was 50%. The majority of family physicians (81%) always refer patients with epilepsy, most often to neurologists. General knowledge of epilepsy was mixed, with 53.7% feeling that surgery should be considered in selected cases for the treatment of epilepsy, though 53.2% did not know what type of epilepsy could be surgically treated. CONCLUSIONS The results suggest a relatively low level of knowledge among family physicians in terms of when surgery ought to be considered, the types of epilepsy that are amenable to surgical treatment and the risks and benefits of epilepsy surgery. A lack of knowledge in these areas may partly underlie the low referral rates of epilepsy patients, though the results show that the majority of family physicians refer their patients with epilepsy to neurologists. Other factors must be considered, such as access to neurologists, epileptologists and surgical resources. Education campaigns directed at family physicians may improve knowledge and change referral practices. Future studies need to examine these possibilities.
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Falco-Walter J, Owen C, Sharma M, Reggi C, Yu M, Stoub TR, Stein MA. Magnetoencephalography and New Imaging Modalities in Epilepsy. Neurotherapeutics 2017; 14:4-10. [PMID: 28054328 PMCID: PMC5233639 DOI: 10.1007/s13311-016-0506-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The success of epilepsy surgery is highly dependent on correctly identifying the entire epileptogenic region. Current state-of-the-art for localizing the extent of surgically amenable areas involves combining high resolution three-dimensional magnetic resonance imaging (MRI) with electroencephalography (EEG) and magnetoencephalography (MEG) source modeling of interictal epileptiform activity. Coupling these techniques with newer quantitative structural MRI techniques, such as cortical thickness measurements, however, may improve the extent to which the abnormal epileptogenic region can be visualized. In this review we assess the utility of EEG, MEG and quantitative structural MRI methods for the evaluation of patients with epilepsy and introduce a novel method for the co-localization of a structural MRI measurement to MEG and EEG source modeling. When combined, these techniques may better identify the extent of abnormal structural and functional areas in patients with medically intractable epilepsy.
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Affiliation(s)
- Jessica Falco-Walter
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Christian Owen
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Christopher Reggi
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mandy Yu
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Travis R Stoub
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Michael A Stein
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
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Feng L, Shu Y, Wu Q, Liu T, Long H, Yang H, Li Y, Xiao B. EphA4 may contribute to microvessel remodeling in the hippocampal CA1 and CA3 areas in a mouse model of temporal lobe epilepsy. Mol Med Rep 2016; 15:37-46. [PMID: 27959424 PMCID: PMC5355650 DOI: 10.3892/mmr.2016.6017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 09/10/2016] [Indexed: 12/26/2022] Open
Abstract
Unclustered and pre-clustered ephrin-A5-Fc have identical anti-epileptic effects in the dentate gyrus of hippocampus in a mouse model of temporal lobe epilepsy (TLE), and act through alleviating ephrin receptor A4 (EphA4)-mediated neurogenesis and angiogenesis. However, the effects of ephrin-A5-Fcs on EphA4 and angiogenesis in Cornu Ammonis (CA)1 and CA3 areas remain unclear. In the present study, male C57BL/6 mice underwent pilocarpine-induced TLE. The expression of EphA4 and ephrin-A5 proteins was analyzed by immunohistochemistry, and the mean density and diameter of platelet endothelial cell adhesion molecule-1-labeled microvessels in CA1 and CA3 were calculated in the absence or presence of two types of ephrin-A5-Fc intrahippocampal infusion. Microvessels perpendicular to the pyramidal cell layer decreased; however, microvessels that traversed the layer increased, and became distorted and fragmented. The mean densities and diameters of microvessels gradually increased and remained greater than those in the control group at 56 days post-status epilepticus (SE). The upregulation of EphA4 and ephrin-A5 proteins began at 7 days and was maintained until 28 days, subsequently decreasing slightly at 56 days post-SE. Blockade of EphA4 by unclustered-ephrin-A5-Fc effected a reduction in the mean density and mean diameter of microvessels in the CA1 and CA3 areas; conversely, activation of EphA4 by clustered-ephrin-A5-Fc induced an increase in these values. Ephrin-A5 ligand binding to EphA4 receptor may contribute to angiogenesis during epileptogenesis in the hippocampal CA1 and CA3 areas.
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Affiliation(s)
- Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yi Shu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Qian Wu
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Tiantian Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Hongyu Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yi Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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Abstract
First-line treatment for epilepsy is antiepileptic drug and requires an interdisciplinary approach and enduring commitment and adherence from the patient and family for successful outcome. Despite adherence to antiepileptic drugs, refractory epilepsy occurs in approximately 30% of children with epilepsy, and surgical treatment is an important intervention to consider. Surgical management of pediatric epilepsy is highly effective in selected patients with refractory epilepsy; however, an evidence-based protocol, including best methods of presurgical imaging assessments, and neurodevelopmental and/or behavioral health assessments, is not currently available for clinicians. Surgical treatment of epilepsy can be critical to avoid negative outcomes in functional, cognitive, and behavioral health status. Furthermore, it is often the only method to achieve seizure freedom in refractory epilepsy. Although a large literature base can be found for adults with refractory epilepsy undergoing surgical treatment, less is known about how surgical management affects outcomes in children with epilepsy. The purpose of the review was fourfold: (1) to evaluate the available literature regarding presurgical assessment and postsurgical outcomes in children with medically refractory epilepsy, (2) to identify gaps in our knowledge of surgical treatment and its outcomes in children with epilepsy, (3) to pose questions for further research, and (4) to advocate for a more unified presurgical evaluation protocol including earlier referral for surgical candidacy of pediatric patients with refractory epilepsy. Despite its effectiveness, epilepsy surgery remains an underutilized but evidence-based approach that could lead to positive short- and long-term outcomes for children with refractory epilepsy.
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Malmgren K, Edelvik A. Long-term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment. Seizure 2016; 44:217-224. [PMID: 27839670 DOI: 10.1016/j.seizure.2016.10.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/06/2016] [Accepted: 10/16/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE There is Class I evidence for short-term efficacy of epilepsy surgery from two randomized controlled studies of temporal lobe resection. Long-term outcome studies are observational. The aim of this narrative review was to summarise long-term outcomes taking the study methodology into account. METHODS A PubMed search was conducted identifying articles on long-term outcomes of epilepsy surgery in adults with regard to seizures, antiepileptic drug treatment and employment. Definitions of seizure freedom were examined in order to identify the proportions of patients with sustained seizure freedom. The quality of the long-term studies was assessed. RESULTS In a number of high-quality studies 40-50% of patients had been continuously free from seizures with impairment of consciousness 10 years after resective surgery, with a higher proportion seizure-free at each annual follow-up. The proportion of seizure-free adults in whom AEDs have been withdrawn varied widely across studies, from 19-63% after around 5 years of seizure freedom. Few long-term vocational outcome studies were identified and results were inconsistent. Some investigators found no postoperative changes, others found decreased employment for patients with continuing seizures, but no change or increased employment for seizure-free patients. Having employment at baseline and postoperative seizure freedom were the strongest predictors of employment after surgery. CONCLUSIONS Long-term studies of outcomes after epilepsy surgery are by necessity observational. There is a need for more prospective longitudinal studies of both seizure and non-seizure outcomes, considering individual patient trajectories in order to obtain valid outcome data needed for counselling patients about epilepsy surgery.
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Affiliation(s)
- Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Anna Edelvik
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jennum P, Sabers A, Christensen J, Ibsen R, Kjellberg J. Socioeconomic outcome of epilepsy surgery: A controlled national study. Seizure 2016; 42:52-56. [PMID: 27770730 DOI: 10.1016/j.seizure.2016.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 09/25/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Epilepsy surgery has been a standard treatment for refractory epilepsies that cannot be controlled by standard medical treatment. We aimed to evaluate the health and social consequences of resective surgery relative to controls from a study of national data. METHODS Using the Danish National Patient Registry we identified all subjects with an epilepsy diagnosis between 1996 and 2009 and compared them with a group of patients with an epilepsy diagnosis who had had neither epilepsy surgery nor a vagus stimulation diagnosis by the index date, and who were matched by gender, index year for epilepsy diagnosis, and index year for epilepsy surgery. We considered all the health and social information available in the Danish health, medication and social registers. The duration of follow-up was three years. RESULTS 254 epilepsy patients and 989 controls were analyzed. Surgery patients were more severely affected by their disease as indicated by health care use and social impact before the surgical procedure. Patients who underwent epilepsy surgery had a significantly lower costs associated with the use of medication, outpatient services, inpatient admissions, and accident and emergency visits after surgery. The surgical intervention had no significant effects on social status in terms of occupation and educational level. CONCLUSION Although epilepsy surgery was followed by a reduction in inpatient and outpatient health care use, medication and use of accident and emergency facilities, suggesting a positive effect on the epileptic disease, there was no significant effect on social outcome measures.
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Arya R, Leach JL, Horn PS, Greiner HM, Gelfand M, Byars AW, Arthur TM, Tenney JR, Jain SV, Rozhkov L, Fujiwara H, Rose DF, Mangano FT, Holland KD. Clinical factors predict surgical outcomes in pediatric MRI-negative drug-resistant epilepsy. Seizure 2016; 41:56-61. [DOI: 10.1016/j.seizure.2016.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022] Open
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Jehi L, Jetté N. Not all that glitters is gold: A guide to surgical trials in epilepsy. Epilepsia Open 2016; 1:22-36. [PMID: 29588926 PMCID: PMC5867837 DOI: 10.1002/epi4.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 02/03/2023] Open
Abstract
Epilepsy surgery is often the only effective treatment in appropriately selected patients with drug‐resistant epilepsy, a disease affecting about 30% of those with epilepsy. We review the evidence supporting the use of epilepsy surgery, with a focus on randomized controlled trials (RCTs). Second, we identify gaps in knowledge about the benefits of epilepsy surgery for certain populations, the challenges of individualizing the choice of surgery, and our lack of understanding of the mechanisms of surgical outcomes. We conducted a search (MEDLINE, Embase, Cochrane, Clinicaltrials.gov) on March 2, 2016, to identify epilepsy surgery RCTs, systematic reviews, or health technology assessments (HTAs). Abstracts were screened to identify resective, palliative (e.g., corpus callosotomy, multiple subpial transection [MST]), ablative (e.g., Laser interstitial thermal therapy [LITT], gamma knife radiosurgery [RS]), and neuromodulation (e.g., cerebellar stimulation [CS], hippocampal stimulation [HS], repetitive transcranial magnetic stimulation [rTMS], responsive neurostimulation [RNS], thalamic stimulation [TS], trigeminal nerve stimulation [TNS], and vagal nerve stimulation [VNS]) RCTs. Study characteristics and outcomes were extracted. Knowledge gaps were identified. Of 1,205 abstracts, 20 RCTs were identified (resective surgery including corpus callosotomy [n = 7], MST [n = 0], RS [n = 1, 3 papers], LITT [n = 0], CS [n = 1], HS [n = 2], RNS [n = 1], rTMS [n = 1], TNS [n = 1], TS [n = 1], and VNS [n = 5]). Most studies targeted patients with temporal lobe epilepsy (TLE) and none examined the effectiveness of resective surgical therapies in patients with extra‐TLE (ETLE) or with specific lesions aside from mesial temporal lobe sclerosis. No pediatric surgical RCTs were identified except for VNS. Few RCTs address the effectiveness of surgery in epilepsy and most are of limited generalizability. Future studies are needed to compare the effectiveness of different surgical strategies, better understand the mechanisms of surgical outcomes, and define the ideal surgical approaches, particularly for patients with high or very low cognitive function, normal imaging, or ETLE.
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Affiliation(s)
- Lara Jehi
- Epilepsy Center Cleveland Clinic Neurological Institute Cleveland Ohio U.S.A
| | - Nathalie Jetté
- Department of Clinical Neurosciences and Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health Cumming School of Medicine University of Calgary Calgary Alberta Canada
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Kemp S, Garlovsky J, Reynders H, Caswell H, Baker G, Shah E. Predicting the psychosocial outcome of epilepsy surgery: A longitudinal perspective on the 'burden of normality'. Epilepsy Behav 2016; 60:149-152. [PMID: 27206234 DOI: 10.1016/j.yebeh.2016.04.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
Good seizure outcomes and good psychosocial outcomes following epilepsy surgery do not necessarily follow one from the other. This study explored the relationship between several presurgical psychosocial characteristics and postsurgical quality-of-life outcomes. The study aimed to develop the concept of 'the burden of normality' and identify risk factors for a poor psychosocial outcome that could be targeted with ameliorative presurgery cognitive behavioral techniques. Data were collected from 77 epilepsy surgery patients from three UK epilepsy centers and presurgery and postsurgery follow-up data were obtained from 30-34 patients, depending on the measure. Measures were self-report. Postsurgery intervals were determined by the epilepsy surgery care pathway at individual centers. Presurgery poor levels of mental health, poor social functioning, increased belief in illness chronicity, and associating epilepsy with social role limitations were all associated with poor postsurgical quality of life. Adopting an accepting coping strategy presurgery was associated with good postoperative quality of life. Regression analysis showed that a good postsurgical quality of life was positively predicted by a presurgical coping style of being able to make the best of a situation and see challenges in a positive light (i.e., positive reinterpretation and growth from the COPE scale) and negatively predicted by presurgical levels of anxiety. These data are presented as an important step in identifying psychological red flags for an adverse psychosocial outcome to epilepsy surgery, as exemplified by the concept of the 'burden of normality' and specifying targets for preoperative ameliorative psychological advice.
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Affiliation(s)
- Steven Kemp
- Department of Clinical and Health Psychology, St James' Hospital, Leeds, United Kingdom.
| | - Jack Garlovsky
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | | | | | - Gus Baker
- The Walton Centre, Liverpool, United Kingdom
| | - Emily Shah
- Department of Clinical and Health Psychology, St James' Hospital, Leeds, United Kingdom
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Edelvik A, Flink R, Malmgren K. Prospective and longitudinal long-term employment outcomes after resective epilepsy surgery. Neurology 2015; 85:1482-90. [PMID: 26408490 PMCID: PMC4631069 DOI: 10.1212/wnl.0000000000002069] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/29/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: To investigate long-term employment outcomes after resective epilepsy surgery in a national population-based cohort of adults. Methods: In the Swedish National Epilepsy Surgery Register, all adults who were operated with resective epilepsy surgery from 1995 to 2010 were identified. Two-year follow-up was available for 473/496, 5-year follow-up for 220/240, 10-year follow-up for 240/278, and 15-year follow-up for 85/109 patients. Results: There were no significant changes in employment outcome over time at group level, but for those with full-time employment at baseline, 79%, 79%, 57%, and 47% of seizure-free patients were in full-time work at 2-, 5-, 10-, and 15-year follow-up, compared to patients with benefits at baseline, where 16%, 27%, 31%, and 33% of seizure-free patients worked full time at these time points (p = 0.018 at 10 years). More patients with full-time work had ability to drive, a family of their own, and higher educational status than patients in part-time work or on benefits. Univariate predictors for employment at long term were having employment preoperatively, higher education, favorable seizure outcome, male sex, and younger age at surgery. Multivariate predictors were having employment preoperatively, favorable seizure outcome, and younger age. Conclusions: The best vocational outcomes occurred in seizure-free patients who were employed or students at baseline, which may reflect a higher general psychosocial level of function. Younger age also predicted better employment outcomes and it therefore seems plausible that early referral for surgery could contribute to better vocational outcomes.
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Affiliation(s)
- Anna Edelvik
- From the Department of Clinical Neuroscience and Rehabilitation (A.E., K.M.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Clinical Neurophysiology (R.F.), Uppsala University Hospital, Sweden.
| | - Roland Flink
- From the Department of Clinical Neuroscience and Rehabilitation (A.E., K.M.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Clinical Neurophysiology (R.F.), Uppsala University Hospital, Sweden
| | - Kristina Malmgren
- From the Department of Clinical Neuroscience and Rehabilitation (A.E., K.M.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Clinical Neurophysiology (R.F.), Uppsala University Hospital, Sweden
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Agadi S, Shetty AK. Concise Review: Prospects of Bone Marrow Mononuclear Cells and Mesenchymal Stem Cells for Treating Status Epilepticus and Chronic Epilepsy. Stem Cells 2015; 33:2093-103. [PMID: 25851047 DOI: 10.1002/stem.2029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/16/2015] [Indexed: 12/22/2022]
Abstract
Mononuclear cells (MNCs) and mesenchymal stem cells (MSCs) derived from the bone marrow and other sources have received significant attention as donor cells for treating various neurological disorders due to their robust neuroprotective and anti-inflammatory effects. Moreover, it is relatively easy to procure these cells from both autogenic and allogenic sources. Currently, there is considerable interest in examining the usefulness of these cells for conditions such as status epilepticus (SE) and chronic epilepsy. A prolonged seizure activity in SE triggers neurodegeneration in the limbic brain areas, which elicits epileptogenesis and evolves into a chronic epileptic state. Because of their potential for providing neuroprotection, diminishing inflammation and curbing epileptogenesis, early intervention with MNCs or MSCs appears attractive for treating SE as such effects may restrain the development of chronic epilepsy typified by spontaneous seizures and learning and memory impairments. Delayed administration of these cells after SE may also be useful for easing spontaneous seizures and cognitive dysfunction in chronic epilepsy. This concise review evaluates the current knowledge and outlook pertaining to MNC and MSC therapies for SE and chronic epilepsy. In the first section, the behavior of these cells in animal models of SE and their efficacy to restrain neurodegeneration, inflammation, and epileptogenesis are discussed. The competence of these cells for suppressing seizures and improving cognitive function in chronic epilepsy are conferred in the next section. The final segment ponders issues that need to be addressed to pave the way for clinical application of these cells for SE and chronic epilepsy.
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Affiliation(s)
- Satish Agadi
- Institute for Regenerative Medicine, Texas A&M Health Science Center College of Medicine at Scott & White, Temple, Texas, USA.,Department of Pediatrics, McLane's Children's Hospital, Baylor Scott & White Health, Temple, Texas, USA
| | - Ashok K Shetty
- Institute for Regenerative Medicine, Texas A&M Health Science Center College of Medicine at Scott & White, Temple, Texas, USA.,Research Service, Olin E. Teague Veterans Affairs Medical Center, Central Texas Veterans Health Care System, Temple, Texas, USA.,Department of Molecular and Cellular Medicine, Texas A&M Health Science Center College of Medicine, College Station, Texas, USA
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Schulze-Bonhage A, Zentner J. The preoperative evaluation and surgical treatment of epilepsy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:313-9. [PMID: 24861650 DOI: 10.3238/arztebl.2014.0313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND One-third of all patients with epilepsy have persistent seizures despite medical treatment. If the origin of the seizures can be localized to a particular site in the brain, epilepsy surgery is a treatment option that addresses the cause of the problem. METHOD The presurgical assessment and surgical treatment of epilepsy are discussed on the basis of a selective literature review and the authors' clinical experience. RESULTS Recent studies give further evidence that surgical treatment is superior to continued medical treatment for patients with seizures of focal origin that persist despite treatment with two antiepileptic drugs. Modern imaging and electrophysiological techniques enable the demonstration of subtle structural and functional changes of the cerebral cortex as a basis for individually tailored surgical resection. 60-80% of surgically treated patients become seizure-free. According to recent reviews, epilepsy surgery is associated with a permanent morbidity of 6% and with a mortality well under 1%; these figures are in the typical range for neurosurgical procedures. In the authors' series, 2% of patients had permanent complications, and the death rate was less than 0.1%. CONCLUSION Advances in presurgical assessment and the broad range of available surgical techniques have widened the applicability of surgical treatment for children and adults with medically refractory epilepsy. Patients should be referred early in the course of their disease to an epilepsy center for evaluation of the surgical options.
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Affiliation(s)
- Andreas Schulze-Bonhage
- Section for Epileptology, University Medical Center Freiburg, Department of Neurosurgery, University Medical Center Freiburg
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Cambiaghi M, Magri L, Cursi M. Importance of EEG in validating the chronic effects of drugs: suggestions from animal models of epilepsy treated with rapamycin. Seizure 2015; 27:30-9. [PMID: 25891924 DOI: 10.1016/j.seizure.2015.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/12/2015] [Accepted: 02/15/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The development of new drugs for the treatment of epilepsy is a major challenge for modern neurology and its first steps demand basic research. Preclinical studies on animal models of epilepsy are mainly based on the analysis of brain electrical activity to detect seizures, when they are not just limited to behavioral tests like the Racine scale. METHODS In the present review, we discuss the importance of using time-locked video and EEG recordings (Video-EEG) coupled with behavioral tests as tools to monitor and analyze the effects of anti-epileptic drugs in pre-clinical research. Particularly, we focus on the utility of a multimodal approach based on EEG/behavioral analysis to study the beneficial effects of chronic rapamycin treatment as a potential anti-epileptogenic therapy for a broad spectrum of epilepsy, including both genetic (as in tuberous sclerosis complex) and acquired diseases. RESULTS Changes and synchronization of neuronal activity of different areas have been correlated with specific behavior in both physiological and pathological conditions. In the epileptic brain, during a seizure there is an abnormal activation of many cells all at once, altering different networks. CONCLUSION A multimodal approach based on video, EEG analysis and behavioral tests would be the best option in preclinical studies of epilepsy.
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Affiliation(s)
- Marco Cambiaghi
- Università degli Studi di Torino, Department of Neuroscience, Turin, Italy.
| | - Laura Magri
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Marco Cursi
- Clinical Neurophysiology Unit, Department of Neurology, Scientific Institute San Raffaele, Milan, Italy
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Laxer KD, Trinka E, Hirsch LJ, Cendes F, Langfitt J, Delanty N, Resnick T, Benbadis SR. The consequences of refractory epilepsy and its treatment. Epilepsy Behav 2014; 37:59-70. [PMID: 24980390 DOI: 10.1016/j.yebeh.2014.05.031] [Citation(s) in RCA: 431] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 12/12/2022]
Abstract
Seizures in some 30% to 40% of patients with epilepsy fail to respond to antiepileptic drugs or other treatments. While much has been made of the risks of new drug therapies, not enough attention has been given to the risks of uncontrolled and progressive epilepsy. This critical review summarizes known risks associated with refractory epilepsy, provides practical clinical recommendations, and indicates areas for future research. Eight international epilepsy experts from Europe, the United States, and South America met on May 4, 2013, to present, review, and discuss relevant concepts, data, and literature on the consequences of refractory epilepsy. While patients with refractory epilepsy represent the minority of the population with epilepsy, they require the overwhelming majority of time, effort, and focus from treating physicians. They also represent the greatest economic and psychosocial burdens. Diagnostic procedures and medical/surgical treatments are not without risks. Overlooked, however, is that these risks are usually smaller than the risks of long-term, uncontrolled seizures. Refractory epilepsy may be progressive, carrying risks of structural damage to the brain and nervous system, comorbidities (osteoporosis, fractures), and increased mortality (from suicide, accidents, sudden unexpected death in epilepsy, pneumonia, vascular disease), as well as psychological (depression, anxiety), educational, social (stigma, driving), and vocational consequences. Adding to this burden is neuropsychiatric impairment caused by underlying epileptogenic processes ("essential comorbidities"), which appears to be independent of the effects of ongoing seizures themselves. Tolerating persistent seizures or chronic medicinal adverse effects has risks and consequences that often outweigh risks of seemingly "more aggressive" treatments. Future research should focus not only on controlling seizures but also on preventing these consequences.
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Affiliation(s)
- Kenneth D Laxer
- Sutter Pacific Epilepsy Program, California Pacific Medical Center, San Francisco, CA, USA.
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Lawrence J Hirsch
- Division of Epilepsy and EEG, Department of Neurology, Yale Comprehensive Epilepsy Center, New Haven, CT, USA
| | - Fernando Cendes
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - John Langfitt
- Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA; Department Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA; Strong Epilepsy Center, University of Rochester School of Medicine, Rochester, NY, USA
| | - Norman Delanty
- Epilepsy Service and National Epilepsy Surgery Programme, Beaumont Hospital, Dublin, Ireland
| | - Trevor Resnick
- Comprehensive Epilepsy Program, Miami Children's Hospital, Miami, FL, USA
| | - Selim R Benbadis
- Comprehensive Epilepsy Program, University of South Florida, Tampa, FL, USA
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