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Wong GM, McCray A, Hom K, Teti S, Cohen NT, Gaillard WD, Oluigbo CO. Outcomes of stereoelectroencephalography following failed epilepsy surgery in children. Childs Nerv Syst 2024; 40:2471-2482. [PMID: 38652142 DOI: 10.1007/s00381-024-06420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Stereoelectroencephalography (SEEG) is valuable for delineating the seizure onset zone (SOZ) in pharmacoresistant epilepsy when non-invasive presurgical techniques are inconclusive. Secondary epilepsy surgery after initial failure is challenging and there is limited research on SEEG following failed epilepsy surgery in children. OBJECTIVE The objective of this manuscript is to present the outcomes of children who underwent SEEG after failed epilepsy surgery. METHODS In this single-institution retrospective study, demographics, previous surgery data, SEEG characteristics, management, and follow-up were analyzed for pediatric patients who underwent SEEG after unsuccessful epilepsy surgery between August 2016 and February 2023. RESULTS Fifty three patients underwent SEEG investigation during this period. Of this, 13 patients were identified who had unsuccessful initial epilepsy surgery (24%). Of these 13 patients, six patients (46%) experienced unsuccessful resective epilepsy surgery that targeted the temporal lobe, six patients (46%) underwent surgery involving the frontal lobe, and one patient (8%) had laser interstitial thermal therapy (LITT) of the right insula. SEEG in two thirds of patients (4/6) with initial failed temporal resections revealed expanded SOZ to include the insula. All 13 patients (100%) had a subsequent surgery after SEEG which was either LITT (54%) or surgical resection (46%). After the subsequent surgery, a favorable outcome (Engel class I/II) was achieved by eight patients (62%), while five patients experienced an unfavorable outcome (Engel class III/IV, 38%). Of the six patients with secondary surgical resection, four patients (67%) had favorable outcomes, while of the seven patients with LITT, two patients (29%) had favorable outcomes (Engel I/II). Average follow-up after the subsequent surgery was 37 months ±23 months. CONCLUSION SEEG following initial failed resective epilepsy surgery may help guide next steps at identifying residual epileptogenic cortex and is associated with favorable seizure control outcomes.
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Affiliation(s)
- Georgia M Wong
- Department of Neurological Surgery, Georgetown University School of Medicine, Washington, DC, USA.
| | - Ashley McCray
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Kara Hom
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
| | - Saige Teti
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Nathan T Cohen
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - William D Gaillard
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA.
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Mercer JP, Sobel RS, Wessell JE, Vandergrift WA, Edwards JC, Campbell ZM. Accounting for repeat intervention costs in the economic comparison of laser interstitial thermal therapy and anterior temporal lobectomy for treatment of refractory temporal lobe epilepsy. Epilepsy Behav 2024; 156:109810. [PMID: 38704985 DOI: 10.1016/j.yebeh.2024.109810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Laser interstitial thermal therapy (LITT) is an alternative to anterior temporal lobectomy (ATL) for the treatment of temporal lobe epilepsy that has been found by some to have a lower procedure cost but is generally regarded as less effective and sometimes results in a subsequent procedure. The goal of this study is to incorporate subsequent procedures into the cost and outcome comparison between ATL and LITT. METHODS This single-center, retrospective cohort study includes 85 patients undergoing ATL or LITT for temporal lobe epilepsy during the period September 2015 to December 2022. Of the 40 patients undergoing LITT, 35 % (N = 14) underwent a subsequent ATL. An economic cost model is derived, and difference in means tests are used to compare the costs, outcomes, and other hospitalization measures. RESULTS Our model predicts that whenever the percentage of LITT patients undergoing subsequent ATL (35% in our sample) exceeds the percentage by which the LITT procedure alone is less costly than ATL (7.2% using total patient charges), LITT will have higher average patient cost than ATL, and this is indeed the case in our sample. After accounting for subsequent surgeries, the average patient charge in the LITT sample ($103,700) was significantly higher than for the ATL sample ($88,548). A second statistical comparison derived from our model adjusts for the difference in effectiveness by calculating the cost per seizure-free patient outcome, which is $108,226 for ATL, $304,052 for LITT only, and $196,484 for LITT after accounting for the subsequent ATL surgeries. SIGNIFICANCE After accounting for the costs of subsequent procedures, we found in our cohort that LITT is not only less effective but also results in higher average costs per patient than ATL as a first course of treatment. While cost and effectiveness rates will vary across centers, we also provide a model for calculating cost effectiveness based on individual center data.
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Affiliation(s)
- J Preston Mercer
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29466, USA.
| | - Russell S Sobel
- Baker School of Business, The Citadel, 171 Moultrie Street, Charleston 29409, SC, USA
| | - Jeffrey E Wessell
- Department of Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29466, USA
| | - William A Vandergrift
- Department of Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29466, USA
| | - Jonathan C Edwards
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29466, USA
| | - Zeke M Campbell
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29466, USA
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3
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Zhang J, Liu J, Huang Y, Yan L, Xu S, Zhang G, Pei L, Yu H, Zhu X, Han X. Current role of magnetic resonance imaging on assessing and monitoring the efficacy of phototherapy. Magn Reson Imaging 2024; 110:149-160. [PMID: 38621553 DOI: 10.1016/j.mri.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
Phototherapy, also known as photobiological therapy, is a non-invasive and highly effective physical treatment method. Its broad use in clinics has led to significant therapeutic results. Phototherapy parameters, such as intensity, wavelength, and duration, can be adjusted to create specific therapeutic effects for various medical conditions. Meanwhile, Magnetic Resonance Imaging (MRI), with its diverse imaging sequences and excellent soft-tissue contrast, provides a valuable tool to understand the therapeutic effects and mechanisms of phototherapy. This review explores the clinical applications of commonly used phototherapy techniques, gives a brief overview of how phototherapy impacts different diseases, and examines MRI's role in various phototherapeutic scenarios. We argue that MRI is crucial for precise targeting, treatment monitoring, and prognosis assessment in phototherapy. Future research and applications will focus on personalized diagnosis and monitoring of phototherapy, expanding its applications in treatment and exploring multimodal imaging technology to enhance diagnostic and therapeutic precision and effectiveness.
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Affiliation(s)
- Jiangong Zhang
- Department of Nuclear Medicine, The First people's Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, PR China
| | - Jiahuan Liu
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Yang Huang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Linlin Yan
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Shufeng Xu
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Guozheng Zhang
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Lei Pei
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Huachen Yu
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Xisong Zhu
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Xiaowei Han
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China.
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Kheder A. Escaping the Procrustean Bed: A Perspective on Pediatric Stereoelectroencephalography. J Clin Neurophysiol 2024; 41:410-414. [PMID: 38935654 DOI: 10.1097/wnp.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
SUMMARY Stereoelectroencephalography is an established, hypothesis-driven method for investigating refractory epilepsy. There are special considerations and some limitations that apply to children who undergo stereoelectroencephalography. A key principle in stereoelectroencephalography is taking an individualized approach to investigating refractory epilepsy. A crucial factor for success in a personalized pediatric epilepsy surgery is understanding some of the fundamental and unique aspects of it, including, but not limited to, diverse etiology, epilepsy syndromes, maturation, and age-related characteristics as well as neural plasticity. Such features are reflected in the ontogeny of semiology and electrophysiology. In addition, special considerations are taken into account during cortical stimulation in children. Stereoelectroencephalography can guide a tailored surgical intervention where it is sufficient to render the patient seizure-free but it also lessens collateral damage with a minimum or no functional deficit. Epilepsy surgery outcomes remain stagnant despite advances in noninvasive testing modalities. A stereoelectroencephalography "way of thinking" and guided mentorship may influence outcomes positively.
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Affiliation(s)
- Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
- Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A.; and
- Emory and Children's Pediatric Institute, 2015 Uppergate Drive, Atlanta, Georgia, U.S.A
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Kaestner E, Stasenko A, Schadler A, Roth R, Hewitt K, Reyes A, Qiu D, Bonilha L, Voets N, Hu R, Willie J, Pedersen N, Shih J, Ben-Haim S, Gross R, Drane D, McDonald CR. Impact of white matter networks on risk for memory decline following resection versus ablation in temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2024; 95:663-670. [PMID: 38212059 PMCID: PMC11187680 DOI: 10.1136/jnnp-2023-332682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND With expanding neurosurgical options in epilepsy, it is important to characterise each options' risk for postoperative cognitive decline. Here, we characterise how patients' preoperative white matter (WM) networks relates to postoperative memory changes following different epilepsy surgeries. METHODS Eighty-nine patients with temporal lobe epilepsy with T1-weighted and diffusion-weighted imaging as well as preoperative and postoperative verbal memory scores (prose recall) underwent either anterior temporal lobectomy (ATL: n=38) or stereotactic laser amygdalohippocampotomy (SLAH; n=51). We computed laterality indices (ie, asymmetry) for volume of the hippocampus and fractional anisotropy (FA) of two deep WM tracts (uncinate fasciculus (UF) and inferior longitudinal fasciculus (ILF)). RESULTS Preoperatively, left-lateralised FA of the ILF was associated with higher prose recall (p<0.01). This pattern was not observed for the UF or hippocampus (ps>0.05). Postoperatively, right-lateralised FA of the UF was associated with less decline following left ATL (p<0.05) but not left SLAH (p>0.05), while right-lateralised hippocampal asymmetry was associated with less decline following both left ATL and SLAH (ps<0.05). After accounting for preoperative memory score, age of onset and hippocampal asymmetry, the association between UF and memory decline in left ATL remained significant (p<0.01). CONCLUSIONS Asymmetry of the hippocampus is an important predictor of risk for memory decline following both surgeries. However, asymmetry of UF integrity, which is only severed during ATL, is an important predictor of memory decline after ATL only. As surgical procedures and pre-surgical mapping evolve, understanding the role of frontal-temporal WM in memory networks could help to guide more targeted surgical approaches to mitigate cognitive decline.
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Affiliation(s)
- Erik Kaestner
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
| | - Alena Stasenko
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
| | - Adam Schadler
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
| | - Rebecca Roth
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kelsey Hewitt
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anny Reyes
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
| | - Deqiang Qiu
- Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Leonardo Bonilha
- Department of Neurology, University of South Carolina System, Columbia, South Carolina, USA
| | | | - Ranliang Hu
- Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Jon Willie
- Neurosurgery, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Jerry Shih
- Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Sharona Ben-Haim
- Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Robert Gross
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel Drane
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carrie R McDonald
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
- Psychiatry, University of California, San Diego, La Jolla, California, USA
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Hageboutros K, Hewitt KC, Lee GP, Bansal A, Block C, Pedersen NP, Willie JT, Loring DW, Schoenberg MR, Smith KA, Giller CA, Gross RE, Drane DL. Comparison of minimally invasive to standard temporal lobectomy approaches to epilepsy surgery: Seizure relief and visual confrontation naming outcomes. Epilepsy Behav 2024; 155:109669. [PMID: 38663142 DOI: 10.1016/j.yebeh.2024.109669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 05/28/2024]
Abstract
The purpose of this study was to systematically examine three different surgical approaches in treating left medial temporal lobe epilepsy (mTLE) (viz., subtemporal selective amygdalohippocampectomy [subSAH], stereotactic laser amygdalohippocampotomy [SLAH], and anterior temporal lobectomy [ATL]), to determine which procedures are most favorable in terms of visual confrontation naming and seizure relief outcome. This was a retrospective study of 33 adults with intractable mTLE who underwent left temporal lobe surgery at three different epilepsy surgery centers who also underwent pre-, and at least 6-month post-surgical neuropsychological testing. Measures included the Boston Naming Test (BNT) and the Engel Epilepsy Surgery Outcome Scale. Fisher's exact tests revealed a statistically significant decline in naming in ATLs compared to SLAHs, but no other significant group differences. 82% of ATL and 36% of subSAH patients showed a significant naming decline whereas no SLAH patient (0%) had a significant naming decline. Significant postoperative naming improvement was seen in 36% of SLAH patients in contrast to 9% improvement in subSAH patients and 0% improvement in ATLs. Finally, there were no statistically significant differences between surgical approaches with regard to seizure freedom outcome, although there was a trend towards better seizure relief outcome among the ATL patients. Results support a possible benefit of SLAH in preserving visual confrontation naming after left TLE surgery. While result interpretation is limited by the small sample size, findings suggest outcome is likely to differ by surgical approach, and that further research on cognitive and seizure freedom outcomes is needed to inform patients and providers of potential risks and benefits with each.
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Affiliation(s)
- Karine Hageboutros
- Neuropsychology Department, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Gregory P Lee
- Neuropsychology Department, Barrow Neurological Institute, Phoenix, AZ 85013, USA; Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Aastha Bansal
- Emory College of Arts and Sciences, Atlanta, GA 30322, USA
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nigel P Pedersen
- Department of Neurology, University of California Davis, Sacramento, CA 95816, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Mike R Schoenberg
- Department of Neurosurgery, University of South Florida, Tampa, FL 33606, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Cole A Giller
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Robert E Gross
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA 98195, USA.
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Mardones MD, Rostam KD, Nickerson MC, Gupta K. Canonical Wnt activator Chir99021 prevents epileptogenesis in the intrahippocampal kainate mouse model of temporal lobe epilepsy. Exp Neurol 2024; 376:114767. [PMID: 38522659 PMCID: PMC11058011 DOI: 10.1016/j.expneurol.2024.114767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
The Wnt signaling pathway mediates the development of dentate granule cell neurons in the hippocampus. These neurons are central to the development of temporal lobe epilepsy and undergo structural and physiological remodeling during epileptogenesis, which results in the formation of epileptic circuits. The pathways responsible for granule cell remodeling during epileptogenesis have yet to be well defined, and represent therapeutic targets for the prevention of epilepsy. The current study explores Wnt signaling during epileptogenesis and for the first time describes the effect of Wnt activation using Wnt activator Chir99021 as a novel anti-epileptogenic therapeutic approach. Focal mesial temporal lobe epilepsy was induced by intrahippocampal kainate (IHK) injection in wild-type and POMC-eGFP transgenic mice. Wnt activator Chir99021 was administered daily, beginning 3 h after seizure induction, and continued up to 21-days. Immature granule cell morphology was quantified in the ipsilateral epileptogenic zone and the contralateral peri-ictal zone 14 days after IHK, targeting the end of the latent period. Bilateral hippocampal electrocorticographic recordings were performed for 28-days, 7-days beyond treatment cessation. Hippocampal behavioral tests were performed after completion of Chir99021 treatment. Consistent with previous studies, IHK resulted in the development of epilepsy after a 14 day latent period in this well-described mouse model. Activation of the canonical Wnt pathway with Chir99021 significantly reduced bilateral hippocampal seizure number and duration. Critically, this effect was retained after treatment cessation, suggesting a durable antiepileptogenic change in epileptic circuitry. Morphological analyses demonstrated that Wnt activation prevented pathological remodeling of the primary dendrite in both the epileptogenic zone and peri-ictal zone, changes in which may serve as a biomarker of epileptogenesis and anti-epileptogenic treatment response in pre-clinical studies. These findings were associated with improved object location memory with Chir99021 treatment after IHK. This study provides novel evidence that canonical Wnt activation prevents epileptogenesis in the IHK mouse model of mesial temporal lobe epilepsy, preventing pathological remodeling of dentate granule cells. Wnt signaling may therefore play a key role in mesial temporal lobe epileptogenesis, and Wnt modulation may represent a novel therapeutic strategy in the prevention of epilepsy.
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Affiliation(s)
- Muriel D Mardones
- Indiana University, Stark Neurosciences Research Institute, W 15th St, Indianapolis, IN 46202, United States of America; Indiana University, Department of Neurosurgery, W 16th St, Indianapolis, IN 46202, United States of America.
| | - Kevin D Rostam
- Indiana University, Stark Neurosciences Research Institute, W 15th St, Indianapolis, IN 46202, United States of America.
| | - Margaret C Nickerson
- Indiana University, Stark Neurosciences Research Institute, W 15th St, Indianapolis, IN 46202, United States of America.
| | - Kunal Gupta
- Medical College of Wisconsin, Department of Neurosurgery, 8701 Watertown Plank Rd, Milwaukee, WI 53226, United States of America; Medical College of Wisconsin, Neuroscience Research Center, 8701 Watertown Plank Rd, Milwaukee, WI 53226, United States of America; Indiana University, Stark Neurosciences Research Institute, W 15th St, Indianapolis, IN 46202, United States of America; Indiana University, Department of Neurosurgery, W 16th St, Indianapolis, IN 46202, United States of America.
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Drane DL, Acerbo E, Rogers A, Pedersen NP, Williamson A, Stern MA, Dickey AS, Howard BM, Bearden DJ, Okada N, Staikova E, Gutekunst CA, Alwaki A, Gershon T, Jirsa V, Gross RE, Loring DW, Kheder A, Willie JT. Selective Posterior Cerebral Artery Wada Better Predicts Good Memory and Naming Outcomes Following Selective Stereotactic Thermal Ablation for Medial Temporal Lobe Epilepsy Than Internal Carotid Artery Wada. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.24.24304488. [PMID: 38585976 PMCID: PMC10996748 DOI: 10.1101/2024.03.24.24304488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The conventional intracarotid amobarbital (Wada) test has been used to assess memory function in patients being considered for temporal lobe epilepsy (TLE) surgery. Minimally invasive approaches that target the medial temporal lobe (MTL) and spare neocortex are increasingly used, but a knowledge gap remains in how to assess memory and language risk from these procedures. We retrospectively compared results of two versions of the Wada test, the intracarotid artery (ICA-Wada) and posterior cerebral artery (PCA-Wada) approaches, with respect to predicting subsequent memory and language outcomes, particularly after stereotactic laser amygdalohippocampotomy (SLAH). We included all patients being considered for SLAH who underwent both ICA-Wada and PCA-Wada at a single institution. Memory and confrontation naming assessments were conducted using standardized neuropsychological tests to assess pre- to post-surgical changes in cognitive performance. Of 13 patients who initially failed the ICA-Wada, only one patient subsequently failed the PCA-Wada (p=0.003, two-sided binomial test with p 0 =0.5) demonstrating that these tests assess different brain regions or networks. PCA-Wada had a high negative predictive value for the safety of SLAH, compared to ICA-Wada, as none of the patients who underwent SLAH after passing the PCA-Wada experienced catastrophic memory decline (0 of 9 subjects, p <.004, two-sided binomial test with p 0 =0.5), and all experienced a good cognitive outcome. In contrast, the single patient who received a left anterior temporal lobectomy after failed ICA- and passed PCA-Wada experienced a persistent, near catastrophic memory decline. On confrontation naming, few patients exhibited disturbance during the PCA-Wada. Following surgery, SLAH patients showed no naming decline, while open resection patients, whose surgeries all included ipsilateral temporal lobe neocortex, experienced significant naming difficulties (Fisher's exact test, p <.05). These findings demonstrate that (1) failing the ICA-Wada falsely predicts memory decline following SLAH, (2) PCA-Wada better predicts good memory outcomes of SLAH for MTLE, and (3) the MTL brain structures affected by both PCA-Wada and SLAH are not directly involved in language processing.
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9
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Volfart A, Rossion B, Brissart H, Busigny T, Colnat-Coulbois S, Maillard L, Jonas J. Stability of face recognition abilities after left or right anterior temporal lobectomy. J Neuropsychol 2024; 18 Suppl 1:115-133. [PMID: 37391874 DOI: 10.1111/jnp.12337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/08/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
Patients with anterior temporal lobe (ATL) resection due to mesial temporal lobe epilepsy (MTLE) have difficulties at identifying familiar faces and explicitly remembering newly learned faces but their ability to individuate unfamiliar faces remains largely unknown. Moreover, the extent to which their difficulties with familiar face identity recognition and learning is truly due to the ATL resection remains unknown. Here, we report a study of 24 MTLE patients and matched healthy controls tested with an extensive set of seven face and visual object recognition tasks (including three tasks evaluating unfamiliar face individuation) before and about 6 months after unilateral (nine left, 15 right) ATL resection. We found that ATL resection has little or no effect on the patients' preserved pre-surgical ability to perform unfamiliar face individuation, both at the group and individual levels. More surprisingly, ATL resection also has little effect on the patients' performance at recognizing and naming famous faces as well as at learning new faces. A substantial proportion of right MTLE patients (33%) even improved their response times on several tasks, which may indicate a functional release of visuo-spatial processing after resection in the right ATL. Altogether this study shows that face recognition abilities are mainly unaffected by ATL resection in MTLE, either because the critical regions for face recognition are spared or because performance at some tasks is already lower than normal preoperatively. Overall, these findings urge caution when interpreting the causal effect of brain lesions on face recognition ability in patients with ATL resection due to MTLE. They also illustrate the complexity of predicting cognitive outcomes after epilepsy surgery because of the influence of many different intertwined factors.
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Affiliation(s)
- Angélique Volfart
- CNRS, CRAN UMR 7039, Université de Lorraine, Nancy, France
- Institute of Research in Psychological Science, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bruno Rossion
- CNRS, CRAN UMR 7039, Université de Lorraine, Nancy, France
- Institute of Research in Psychological Science, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
- CHRU-Nancy, Service de Neurologie, Université de Lorraine, Nancy, France
| | - Hélène Brissart
- CNRS, CRAN UMR 7039, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service de Neurologie, Université de Lorraine, Nancy, France
| | - Thomas Busigny
- CNRS, CRAN UMR 7039, Université de Lorraine, Nancy, France
| | - Sophie Colnat-Coulbois
- CNRS, CRAN UMR 7039, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service de Neurochirurgie, Université de Lorraine, Nancy, France
| | - Louis Maillard
- CNRS, CRAN UMR 7039, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service de Neurologie, Université de Lorraine, Nancy, France
| | - Jacques Jonas
- CNRS, CRAN UMR 7039, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service de Neurologie, Université de Lorraine, Nancy, France
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10
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Castellano JF, Singla S, Barot N, Aronson JP. Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation: Diagnostic and Therapeutic Implications. Brain Sci 2024; 14:110. [PMID: 38391685 PMCID: PMC10887298 DOI: 10.3390/brainsci14020110] [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: 12/28/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Despite recent medical therapeutic advances, approximately one third of patients do not attain seizure freedom with medications. This drug-resistant epilepsy population suffers from heightened morbidity and mortality. In appropriate patients, resective epilepsy surgery is far superior to continued medical therapy. Despite this efficacy, there remain drawbacks to traditional epilepsy surgery, such as the morbidity of open neurosurgical procedures as well as neuropsychological adverse effects. SEEG-guided Radiofrequency Thermocoagulation (SgRFTC) is a minimally invasive, electrophysiology-guided intervention with both diagnostic and therapeutic implications for drug-resistant epilepsy that offers a convenient adjunct or alternative to ablative and resective approaches. We review the international experience with this procedure, including methodologies, diagnostic benefit, therapeutic benefit, and safety considerations. We propose a framework in which SgRFTC may be incorporated into intracranial EEG evaluations alongside passive recording. Lastly, we discuss the potential role of SgRFTC in both delineating and reorganizing epilepsy networks.
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Affiliation(s)
- James F Castellano
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Shobhit Singla
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Niravkumar Barot
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Joshua P Aronson
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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11
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Ghaith AK, El-Hajj VG, Sanchez-Garavito JE, Zamanian C, Ghanem M, Bon-Nieves A, Chen B, Drees CN, Miller D, Parker JJ, Almeida JP, Elmi-Terander A, Tatum W, Middlebrooks EH, Bydon M, Van-Gompel JJ, Lundstrom BN, Grewal SS. Trends in the Utilization of Surgical Modalities for the Treatment of Drug-Resistant Epilepsy: A Comprehensive 10-Year Analysis Using the National Inpatient Sample. Neurosurgery 2024:00006123-990000000-01011. [PMID: 38189460 DOI: 10.1227/neu.0000000000002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is considered one of the most prevalent and severe chronic neurological disorders worldwide. Our study aims to analyze the national trends in different treatment modalities for individuals with drug-resistant epilepsy and investigate the outcomes associated with these procedural trends in the United States. METHODS Using the National Inpatient Sample database from 2010 to 2020, patients with drug-resistant focal epilepsy who underwent laser interstitial thermal therapy (LITT), open surgical resection, vagus nerve stimulation (VNS), or responsive neurostimulation (RNS) were identified. Trend analysis was performed using piecewise joinpoint regression. Propensity score matching was used to compare outcomes between 10 years prepandemic before 2020 and the first peak of the COVID-19 pandemic. RESULTS This study analyzed a total of 33 969 patients with a diagnosis of drug-resistant epilepsy, with 3343 patients receiving surgical resection (78%), VNS (8.21%), RNS (8%), and LITT (6%). Between 2010 and 2020, there was an increase in the use of invasive electroencephalography monitoring for seizure zone localization (P = .003). There was an increase in the use of LITT and RNS (P < .001), while the use of surgical resection and VNS decreased over time (P < .001). Most of these patients (89%) were treated during the pre-COVID pandemic era (2010-2019), while a minority (11%) underwent treatment during the COVID pandemic (2020). After propensity score matching, the rate of pulmonary complications, postprocedural hematoma formation, and mortality were slightly higher during the pandemic compared with the prepandemic period (P = .045, P = .033, and P = .026, respectively). CONCLUSION This study indicates a relative decrease in the use of surgical resections, as a treatment for drug-resistant focal epilepsy. By contrast, newer, minimally invasive surgical approaches including LITT and RNS showed gradual increases in usage.
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Affiliation(s)
- Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor Gabriel El-Hajj
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Cameron Zamanian
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Marc Ghanem
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Antonio Bon-Nieves
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Baibing Chen
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - David Miller
- Department of Diagnostic Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jonathon J Parker
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Joao Paulo Almeida
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - William Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van-Gompel
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sanjeet S Grewal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
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12
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Issa NP, Warnke P. Interstitial laser ablation for epilepsy: beauty lies in the eye of the beholder. J Neurol Neurosurg Psychiatry 2023; 94:973-974. [PMID: 37852745 DOI: 10.1136/jnnp-2023-332702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Naoum P Issa
- Neurology, University of Chicago, Chicago, Illinois, USA
| | - Peter Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
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13
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Piazza MG, Smith KJ, Abel TJ. Influence of New Technologies on the Cost-Effectiveness of Invasive Monitoring in Epilepsy Surgery. World Neurosurg 2023; 180:231-232. [PMID: 37838164 DOI: 10.1016/j.wneu.2023.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Affiliation(s)
- Martin G Piazza
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth J Smith
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Youngerman BE, Banu MA, Khan F, McKhann GM, Schevon CA, Jagid JR, Cajigas I, Theodotou CB, Ko A, Buckley R, Ojemann JG, Miller JW, Laxton AW, Couture DE, Popli GS, Buch VP, Halpern CH, Le S, Sharan AD, Sperling MR, Mehta AD, Englot DJ, Neimat JS, Konrad PE, Sheth SA, Neal EG, Vale FL, Holloway KL, Air EL, Schwalb JM, D'Haese PF, Wu C. Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study. J Neurol Neurosurg Psychiatry 2023; 94:879-886. [PMID: 37336643 PMCID: PMC10776034 DOI: 10.1136/jnnp-2022-330979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown. METHODS This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed. RESULTS Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year. CONCLUSIONS MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Matei A Banu
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Farhan Khan
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | | | - Jonathan R Jagid
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Iahn Cajigas
- Department of Neurological Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian B Theodotou
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Andrew Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Robert Buckley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - John W Miller
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Adrian W Laxton
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Daniel E Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gautam S Popli
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vivek P Buch
- Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California, USA
| | - Casey H Halpern
- Department of Neurological Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scheherazade Le
- Department of Neurology, Stanford Comprehensive Epilepsy Center, Stanford, California, USA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashesh D Mehta
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University, Nashville, Nashville, Tennessee, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Peter E Konrad
- Department of Neurological Surgery, Vanderbilt University, Nashville, Nashville, Tennessee, USA
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Elliot G Neal
- Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida, USA
| | - Fernando L Vale
- Department of Neurological Surgery, Medical College of Georgia-Augusta University, Augusta, Georgia, USA
| | - Kathryn L Holloway
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ellen L Air
- Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Pierre-François D'Haese
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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15
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Cao Z, Guo M, Cao X, Liu T, Hu S, Xiao Y, Zhang M, Liu H. Progress in TLE treatment from 2003 to 2023: scientific measurement and visual analysis based on CiteSpace. Front Neurol 2023; 14:1223457. [PMID: 37854064 PMCID: PMC10580429 DOI: 10.3389/fneur.2023.1223457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/30/2023] [Indexed: 10/20/2023] Open
Abstract
Objective Temporal lobe epilepsy (TLE) is the most common cause of drug-resistant epilepsy and can be treated surgically to control seizures. In this study, we analyzed the relevant research literature in the field of temporal lobe epilepsy (TLE) treatment to understand the background, hotspots, and trends in TLE treatment research. Methods We discussed the trend, frontier, and hotspot of scientific output in TLE treatment research in the world in the last 20 years by searching the core collection of the Web of Science database. Excel and CiteSpace software were used to analyze the basic data of the literature. Result We identified a total of 2,051 publications on TLE treatment from 75 countries between 2003 and 2023. We found that the publication rate was generally increasing. The United States was the most publishing country; among the research institutions on TLE treatment, the University of California system published the most relevant literature and collaborated the most with other institutions. The co-citation of literature, keyword co-occurrence, and its clustering analysis showed that the early studies focused on open surgical treatment, mainly by lobectomy. In recent years, the attention given to stereotactic, microsurgery, and other surgical techniques has gradually increased, and the burst analysis indicated that new research hotspots may appear in the future in the areas of improved surgical procedures and mechanism research.
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Affiliation(s)
- Zhan Cao
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingjie Guo
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Xun Cao
- Medical College of Zhengzhou University, Zhengzhou, China
| | - Tiantian Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaowen Hu
- Department of Urinary Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Yafei Xiao
- Department of Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Min Zhang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hengfang Liu
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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16
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Alomar SA, Moshref RH, Moshref LH, Sabbagh AJ. Outcomes after laser interstitial thermal ablation for temporal lobe epilepsy: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:261. [PMID: 37779130 DOI: 10.1007/s10143-023-02164-4] [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: 09/18/2022] [Revised: 08/01/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Epilepsy is a common condition that affects approximately 1% of the world's population, with about one-third being refractory epilepsy. Temporal lobe epilepsy is the most common type of drug-resistant epilepsy, and laser interstitial thermal therapy (LITT) is an innovative treatment. In this systematic review and meta-analysis, we aimed to summarize the current evidence on outcomes after LITT, including seizure freedom rate, complication rate, and neurocognitive outcome. PubMed and OVID Medline search engines were systematically searched for all indexed publications in the English language up to July15, 2023. The search was limited to human studies. Proportions and 95% confidence interval (CI) values were calculated for seizure, neurocognitive outcome, and complication rate. A total of 836 patients were included. Overall seizure outcomes, regardless of the pathology, included Engel I outcome in 56% (95% CI, 52.4-59.5%), Engel II outcome in 19.2% (95% CI, 15.4-23.6%), Engel III outcome in 17.3% (95% CI, 13.5-21.8%), and Engel IV outcome in 10.5% (95% CI 6.3-17%) of the patients. The overall decline in verbal and visual memory regardless of laterality was 24.2 (95% CI 8.6-52%) and 25.2% (8.3-55.8%). For naming, the decline was 13.4% (6.6-25.4%). The results of the pooled analysis in comparison with available data in the literature showed that seizure outcomes after LITT were slightly inferior to published data after temporal lobectomy. Data on cognitive outcomes after LITT are scarce and heterogeneous.
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Affiliation(s)
- Soha A Alomar
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia.
| | - Rana H Moshref
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia
| | - Leena H Moshref
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia
| | - Abdulrahman J Sabbagh
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia
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17
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Chen JS, Lamoureux AA, Shlobin NA, Elkaim LM, Wang A, Ibrahim GM, Obaid S, Harroud A, Guadagno E, Dimentberg E, Bouthillier A, Bernhardt BC, Nguyen DK, Fallah A, Weil AG. Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy: A systematic review and individual participant data meta-analysis. Epilepsia 2023; 64:1957-1974. [PMID: 36824029 DOI: 10.1111/epi.17560] [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: 10/28/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug-resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta-analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms "MR-guided ablation therapy" and "epilepsy". Multivariable mixed-effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow-up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure-free at last follow-up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p < .001) and mesial temporal sclerosis/atrophy (MTS/A; OR = 2.21, p = .011) were independently associated with greater odds of seizure freedom at last follow-up. Operative complications occurred in 28 (8.5%) of 330 patients and were independently associated with extratemporal ablations (OR = 5.40, p = .012) and nonlesional MRI studies (OR = 3.25, p = .017). Postoperative neurological deficits were observed in 53 (15.1%) of 352 patients and were independently predicted by hypothalamic hamartoma etiology (OR = 5.93, p = .006) and invasive electroencephalographic monitoring (OR = 4.83, p = .003). Overall, MRgLITT is particularly effective in treating patients with well-circumscribed lesional DRE, such as CCM and MTS/A, but less effective in nonlesional cases or lesional cases with a more diffuse epileptogenic network associated with generalized seizures. This study identifies independent predictors of seizure freedom and complications following MRgLITT that may help further guide patient selection.
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Affiliation(s)
- Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Audrey-Anne Lamoureux
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sami Obaid
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Adil Harroud
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Evan Dimentberg
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Dang K Nguyen
- Division of Neurology, University of Montreal Medical Center, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
- Brain and Child Development Axis, Sainte Justine Research Center, Montreal, Quebec, Canada
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18
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Padda K, Matthews RE, Karakis I, Hewitt KC, Valentin E, Block C, Shade T, Dickey A, Millis S, Willie JT, Gross RE, Drane DL. Psychiatric changes after stereotactic laser amygdalohippocampotomy for medial temporal lobe epilepsy. Epilepsy Behav 2023; 145:109332. [PMID: 37422933 PMCID: PMC10523400 DOI: 10.1016/j.yebeh.2023.109332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive surgical treatment for drug-resistant temporal lobe epilepsy (TLE) that has comparable rates of seizure freedom to traditional open resective TLE surgery. The objective of this study was to determine psychiatric outcome (i.e., depression and anxiety changes, psychosis) after SLAH, to explore possible contributory factors to these changes, and to determine the prevalence of de novo psychopathology. METHODS We explored mood and anxiety in 37 adult patients with TLE undergoing SLAH using the Beck psychiatric symptoms scales (i.e., Beck Depression Inventory-II [BDI-II] and Beck Anxiety Inventory [BAI]) preoperatively and 6 months following surgery. Multivariable regression analysis was conducted to identify predictors of worse depression or anxiety symptoms following SLAH. The prevalence of de novo psychopathology following SLAH was also determined. RESULTS We found a significant decrease in BDI-II (mean decline from 16.3 to 10.9, p = 0.004) and BAI (mean decline from 13.3 to 9.0, p = 0.045) scores following SLAH at the group level. While the rate of resolution of depression (from 62% to 49%) did not achieve statistical significance (p = 0.13, McNemar's), the rate of resolution of anxiety (from 57% to 35%) was statistically significant (p = 0.03, McNemar's). The de novo rate of psychopathology (i.e., new onset depression or anxiety) following SLAH was 1 of 7 (14%). Using a metric of meaningful change rather than complete symptom resolution, 16 of 37 (43%) patients experienced improvement in depression and 6 of 37 (16%) experienced worsening. For anxiety, 14 of 37 (38%) experienced meaningful improvement and 8 of 37 (22%) experienced worsening. Baseline performance on the Beck Scales was the only factor contributing to outcome status. DISCUSSION In one of the first studies to evaluate psychiatric outcomes after SLAH, we found promising overall trends toward stability or significant improvement in symptom burden at the group level for both depression and anxiety. There was also a significant improvement in clinical anxiety, though the decrease in clinical depression was not significant, likely owing to the limitations of sample size. SLAH may improve overall psychiatric symptoms, similarly to traditional resective TLE surgery, but de novo psychopathology and postoperative psychiatric morbidity remain significant issues, and larger samples are necessary to determine causal contributory factors.
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Affiliation(s)
- Karanbir Padda
- Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Rebecca E Matthews
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Edward Valentin
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Taylor Shade
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adam Dickey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott Millis
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert E Gross
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA; Coulter Department of Biomedical Engineering, Emory University, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.
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19
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King-Stephens D. Old Diagnostic Meets Newer Therapy; ECoG During LiTT. Epilepsy Curr 2023; 23:233-234. [PMID: 37662453 PMCID: PMC10470095 DOI: 10.1177/15357597231171291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Intraoperative Electrocorticography During Laser-Interstitial Thermal Therapy Predicts Seizure Outcome in Mesial Temporal Lobe Epilepsy Chen, B, Grewal SS, Middlebrooks EH, Tatum WO, Ritaccio AL, Sirven JI, Freqund BE, Feyissa AM. Clin Neurophysiol. 2023;146:118-123. doi:10.1016/j.clinph.2022.12.003 Background and Objectives: Magnetic resonance-guided laser interstitial thermal therapy (MRLiTT) for treating temporal lobe epilepsy has recently gained popularity. We aimed to investigate the predictive value of pre-and post-MRLiTT epileptiform discharges (EDs) on intraoperative electrocorticography (iECoG) in seizure outcomes for patients with mesial temporal lobe epilepsy (mTLE). Methods: We conducted a pilot, prospective single-center cohort study on seven consecutive patients with mTLE that underwent MRLiTT. Pre- and post-MRLiTT iECoG was performed using a 1×8 contact depth electrode along the same trajectory used for the laser catheter. Findings: The responders had a robust reduction in ED frequency compared to pre-MRLiTT iECoG (86% vs 13%, p < 0.01). Clinical characteristics, including risk factors for epilepsy, duration of epilepsy, presence of mesial temporal lobe sclerosis, prior intracranial monitoring, the absolute frequency of pre- or post-MRLiTT EDs, and ablation volume were not significantly associated with responder status. Discussion: This is the first demonstration that intraoperative reduction in EDs during mesial temporal lobe MRLiTT may potentially predict seizure outcomes and may serve as an intraoperative biomarker for satisfactory ablation. However, larger prospective studies are needed to confirm our findings and evaluate the utility of iECoG during MRLiTT.
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Athreya A, Matthews RE, Drane DL, Bonilha L, Willie JT, Gross RE, Karakis I. Withdrawal of antiseizure medications after MRI-Guided laser interstitial thermal therapy in extra-temporal lobe epilepsy. Seizure 2023; 110:86-92. [PMID: 37331198 DOI: 10.1016/j.seizure.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE This study investigated the success rate of antiseizure medications (ASMs) withdrawal following MRI Guided Laser Interstitial Thermal Therapy (MRg-LITT) for extra-temporal lobe epilepsy (ETLE), and identified predictors of seizure recurrence. METHODS We retrospectively assessed 27 patients who underwent MRg-LITT for ETLE. Patients' demographics, disease characteristics, and post-surgical outcomes were evaluated for their potential to predict seizure recurrence associated with ASMs withdrawal. RESULTS The median period of observation post MRg-LITT was 3 years (range 18 - 96 months) and the median period to initial ASMs reduction was 0.5 years (range 1-36 months). ASMs reduction was attempted in 17 patients (63%), 5 (29%) of whom had seizure recurrence after initial reduction. Nearly all patient who relapsed regained seizure control after reinstitution of their ASMs regimen. Pre-operative seizure frequency (p = 0.002) and occurrence of acute post-operative seizures (p = 0.01) were associated with increased risk for seizure recurrence post ASMs reduction. At the end of the observation period, 11% of patients were seizure free without drugs, 52% were seizure free with drugs and 37% still experienced seizures despite ASMs. Compared with pre-operative status, the number of ASMs was reduced in 41% of patients, unchanged in 55% of them and increased in only 4% of them. CONCLUSIONS Successful MRg-LITT for ETLE allows for ASMs reduction in a significant portion of patients and complete ASMs withdrawal in a subset of them. Patients with higher pre-operative seizure frequency or occurrence of acute post operative seizures exhibit higher chances relapse post ASMs reduction.
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Affiliation(s)
- Arjun Athreya
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca E Matthews
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Leonardo Bonilha
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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Teye-Botchway L, Willie JT, van Rooij SJ. Unilateral amygdala ablation: a potential treatment option for severe chronic post-traumatic stress disorder (PTSD)? Expert Rev Neurother 2023; 23:483-486. [PMID: 37226517 PMCID: PMC10247517 DOI: 10.1080/14737175.2023.2218034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/22/2023] [Indexed: 05/26/2023]
Affiliation(s)
| | - Jon T. Willie
- Washington University School of Medicine in St. Louis, Departments of Neurosurgery, Psychiatry, Neurology, and Biomedical Engineering
| | - Sanne J.H. van Rooij
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
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22
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Arnold TC, Kini LG, Bernabei JM, Revell AY, Das SR, Stein JM, Lucas TH, Englot DJ, Morgan VL, Litt B, Davis KA. Remote effects of temporal lobe epilepsy surgery: Long-term morphological changes after surgical resection. Epilepsia Open 2023; 8:559-570. [PMID: 36944585 PMCID: PMC10235552 DOI: 10.1002/epi4.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE Epilepsy surgery is an effective treatment for drug-resistant patients. However, how different surgical approaches affect long-term brain structure remains poorly characterized. Here, we present a semiautomated method for quantifying structural changes after epilepsy surgery and compare the remote structural effects of two approaches, anterior temporal lobectomy (ATL), and selective amygdalohippocampectomy (SAH). METHODS We studied 36 temporal lobe epilepsy patients who underwent resective surgery (ATL = 22, SAH = 14). All patients received same-scanner MR imaging preoperatively and postoperatively (mean 2 years). To analyze postoperative structural changes, we segmented the resection zone and modified the Advanced Normalization Tools (ANTs) longitudinal cortical pipeline to account for resections. We compared global and regional annualized cortical thinning between surgical treatments. RESULTS Across procedures, there was significant cortical thinning in the ipsilateral insula, fusiform, pericalcarine, and several temporal lobe regions outside the resection zone as well as the contralateral hippocampus. Additionally, increased postoperative cortical thickness was seen in the supramarginal gyrus. Patients treated with ATL exhibited greater annualized cortical thinning compared with SAH cases (ATL: -0.08 ± 0.11 mm per year, SAH: -0.01 ± 0.02 mm per year, t = 2.99, P = 0.006). There were focal postoperative differences between the two treatment groups in the ipsilateral insula (P = 0.039, corrected). Annualized cortical thinning rates correlated with preoperative cortical thickness (r = 0.60, P < 0.001) and had weaker associations with age at surgery (r = -0.33, P = 0.051) and disease duration (r = -0.42, P = 0.058). SIGNIFICANCE Our evidence suggests that selective procedures are associated with less cortical thinning and that earlier surgical intervention may reduce long-term impacts on brain structure.
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Affiliation(s)
- T. Campbell Arnold
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Lohith G. Kini
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John M. Bernabei
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrew Y. Revell
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neuroscience, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sandhitsu R. Das
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Joel M. Stein
- Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Timothy H. Lucas
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurosurgery, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dario J. Englot
- Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
- Institute of Imaging ScienceVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Victoria L. Morgan
- Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
- Institute of Imaging ScienceVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Brian Litt
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kathryn A. Davis
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Laser Interstitial Thermal Therapy for Epilepsy. Neurosurg Clin N Am 2023; 34:247-257. [PMID: 36906331 DOI: 10.1016/j.nec.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Laser interstitial thermal therapy is an important new technique with a diverse use in epilepsy. This article gives an up-to-date evaluation of the current use of the technique within epilepsy, as well as provides some guidance to novice users appropriate clinical cases for its use.
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Medina-Pizarro M, Spencer DD, Damisah EC. Recent advances in epilepsy surgery. Curr Opin Neurol 2023; 36:95-101. [PMID: 36762633 DOI: 10.1097/wco.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW Technological innovations in the preoperative evaluation, surgical techniques and outcome prediction in epilepsy surgery have grown exponentially over the last decade. This review highlights and emphasizes relevant updates in techniques and diagnostic tools, discussing their context within standard practice at comprehensive epilepsy centres. RECENT FINDINGS High-resolution structural imaging has set an unprecedented opportunity to detect previously unrecognized subtle abnormalities. Machine learning and computer science are impacting the methodologies to analyse presurgical and surgical outcome data, building more accurate prediction models to tailor treatment strategies. Robotic-assisted placement of depth electrodes has increased the safety and ability to sample epileptogenic nodes within deep structures, improving our understanding of the seizure networks in drug-resistant epilepsy. The current available minimally invasive techniques are reasonable surgical alternatives to ablate or disrupt epileptogenic regions, although their sustained efficacy is still an active area of research. SUMMARY Epilepsy surgery is still underutilized worldwide. Every patient who continues with seizures despite adequate trials of two well selected and tolerated antiseizure medications should be evaluated for surgical candidacy. Collaboration between academic epilepsy centres is of paramount importance to answer long-standing questions in epilepsy surgery regarding the understanding of spatio-temporal dynamics in epileptogenic networks and its impact on surgical outcomes.
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Kim MJ, Hwang B, Mampre D, Negoita S, Tsehay Y, Sair H, Kang JY, Anderson WS. Ablation of apparent diffusion coefficient hyperintensity clusters in mesial temporal lobe epilepsy improves seizure outcomes after laser interstitial thermal therapy. Epilepsia 2023; 64:654-666. [PMID: 36196769 DOI: 10.1111/epi.17432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Laser interstitial thermal therapy (LiTT) is a minimally invasive surgical procedure for intractable mesial temporal epilepsy (mTLE). LiTT is safe and effective, but seizure outcomes are highly variable due to patient variability, suboptimal targeting, and incomplete ablation of the epileptogenic zone. Apparent diffusion coefficient (ADC) is a magnetic resonance imaging (MRI) sequence that can identify potential epileptogenic foci in the mesial temporal lobe to improve ablation and seizure outcomes. The objective of this study was to investigate whether ablation of tissue clusters with high ADC values in the mesial temporal structures is associated with seizure outcome in mTLE after LiTT. METHODS Twenty-seven patients with mTLE who underwent LiTT at our institution were analyzed. One-year seizure outcome was categorized as complete seizure freedom (International League Against Epilepsy [ILAE] Class I) and residual seizures (ILAE Class II-VI). Volumes of hippocampus and amygdala were segmented from the preoperative T1 MRI sequence. Spatially distinct hyperintensity clusters were identified in the preoperative ADC map. Proportion of cluster volume and number ablated were associated with seizure outcomes. RESULTS The mean age at surgery was 37.5 years and the mean follow-up duration was 1.9 years. Proportions of hippocampal cluster volume (p = .013) and number (p = .03) ablated were significantly higher in patients with seizure freedom. For amygdala clusters, the proportion of cluster number ablated was significantly associated with seizure outcome (p = .026). In the combined amygdalohippocampal complex, ablation of amygdalohippocampal clusters reliably predicted seizure outcome by their volume ablated (area under the curve [AUC] = 0.7670, p = .02). SIGNIFICANCE Seizure outcome after LiTT in patients with mTLE was associated significantly with the extent of cluster ablation in the amygdalohippocampal complex. The results suggest that preoperative ADC analysis may help identify high-yield pathological tissue clusters that represent epileptogenic foci. ADC-based cluster analysis can potentially assist ablation targeting and improve seizure outcome after LiTT in mTLE.
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Affiliation(s)
- Min Jae Kim
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Brian Hwang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - David Mampre
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Serban Negoita
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yohannes Tsehay
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Haris Sair
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Koutsouras GW, Hall WA. Surgery for pediatric drug resistant epilepsy: a narrative review of its history, surgical implications, and treatment strategies. Transl Pediatr 2023; 12:245-259. [PMID: 36891373 PMCID: PMC9986775 DOI: 10.21037/tp-22-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/26/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Drug-resistant epilepsy (DRE), also known as medically refractory epilepsy, is a disorder of high prevalence and negatively impacts a patients quality of life, neurodevelopment, and life expectancy. Pediatric epilepsy surgery has been conducted since the late 1800s, and randomized controlled trials have demonstrated the marked effectiveness of surgery on seizure reduction and the potential for cure. Despite the strong evidence for pediatric epilepsy surgery, there is also strong evidence describing its underutilization. The objective of this narrative review is to describe the history, strength, and limitations in the evidence of surgery for pediatric drug resistant epilepsy. METHODS This narrative review was conducted utilizing standard search engines to include the relevant articles on the topic of surgery for drug resistant epilepsy in children, with main keywords including surgery in pediatric epilepsy and drug-refractory epilepsy. KEY CONTENT AND FINDINGS The first components describe the historical perspective of pediatric epilepsy surgery and the evidence that highlight the strengths and limitations of epilepsy surgery. We then highlight the importance of presurgical referral and evaluation, followed by a section detailing the surgical options for children with DRE. Lastly, we provide a perspective on the future of pediatric epilepsy surgery. CONCLUSIONS Evidence supports the role for surgery in pediatric medically refractory epilepsy in seizure frequency reduction, improved curative rates, and improvements in neurodevelopment and quality of life.
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Affiliation(s)
- George W Koutsouras
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Walter A Hall
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
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Snyder KM, Forseth KJ, Donos C, Rollo PS, Fischer-Baum S, Breier J, Tandon N. Critical role of the ventral temporal lobe in naming. Epilepsia 2023; 64:1200-1213. [PMID: 36806185 DOI: 10.1111/epi.17555] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Lexical retrieval deficits are characteristic of a variety of different neurological disorders. However, the exact substrates responsible for this are not known. We studied a large cohort of patients undergoing surgery in the dominant temporal lobe for medically intractable epilepsy (n = 95) to localize brain regions that were associated with anomia. METHODS We performed a multivariate voxel-based lesion-symptom mapping analysis to correlate surgical lesions within the temporal lobe with changes in naming ability. Additionally, we used a surface-based mixed-effects multilevel analysis to estimate group-level broadband gamma activity during naming across a subset of patients with electrocorticographic recordings and integrated these results with lesion-deficit findings. RESULTS We observed that ventral temporal regions, centered around the middle fusiform gyrus, were significantly associated with a decline in naming. Furthermore, we found that the ventral aspect of temporal lobectomies was linearly correlated to a decline in naming, with a clinically significant decline occurring once the resection extended 6 cm from the anterior tip of the temporal lobe on the ventral surface. On electrocorticography, the majority of these cortical regions were functionally active following visual processing. These loci coincide with the sites of susceptibility artifacts during echoplanar imaging, which may explain why this region has been previously underappreciated as the locus responsible for postoperative naming deficits. SIGNIFICANCE Taken together, these data highlight the crucial contribution of the ventral temporal cortex in naming and its important role in the pathophysiology of anomia following temporal lobe resections. As such, surgical strategies should attempt to preserve this region to mitigate postoperative language deficits.
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Affiliation(s)
- Kathryn M Snyder
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA.,Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kiefer J Forseth
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA.,Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Cristian Donos
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA.,Faculty of Physics, University of Bucharest, Bucharest, Romania
| | - Patrick S Rollo
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA.,Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Simon Fischer-Baum
- Department of Psychological Sciences, Rice University, Houston, Texas, USA
| | - Joshua Breier
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA.,Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA.,Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, Texas, USA.,Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, USA
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28
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Chen B, Grewal SS, Middlebrooks EH, Tatum WO, Ritaccio AL, Sirven JI, Freund BE, Feyissa AM. Intraoperative electrocorticography during laser-interstitial thermal therapy predicts seizure outcome in mesial temporal lobe epilepsy. Clin Neurophysiol 2023; 146:118-123. [PMID: 36608529 DOI: 10.1016/j.clinph.2022.12.003] [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: 10/20/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Magnetic resonance-guided laser interstitial thermal therapy (MRLiTT) for treating temporal lobe epilepsy has recently gained popularity. We aimed to investigate the predictive value of pre-and post-MRLiTT epileptiform discharges (EDs) on intraoperative electrocorticography (iECoG) in seizure outcomes for patients with mesial temporal lobe epilepsy (mTLE). METHODS We conducted a pilot, prospective single-center cohort study on seven consecutive patients with mTLE that underwent MRLiTT. Pre- and post-MRLiTT iECoG was performed using a 1x8 contact depth electrode along the same trajectory used for the laser catheter. RESULTS The responders had a robust reduction in ED frequency compared to pre-MRLiTT iECoG (86% vs 13%, p < 0.01). Clinical characteristics, including risk factors for epilepsy, duration of epilepsy, presence of mesial temporal lobe sclerosis, prior intracranial monitoring, the absolute frequency of pre- or post-MRLiTT EDs, and ablation volume were not significantly associated with responder status. CONCLUSIONS This is the first demonstration that intraoperative reduction in EDs during mesial temporal lobe MRLiTT may potentially predict seizure outcomes and may serve as an intraoperative biomarker for satisfactory ablation. However, larger prospective studies are needed to confirm our findings and evaluate the utility of iECoG during MRLiTT. SIGNIFICANCE iECoG during mesial temporal lobe MRLiTT may help assess seizure outcomes.
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Affiliation(s)
- Baibing Chen
- Department of Neurology, Mayo Clinic Florida, FL, USA
| | | | | | | | | | | | - Brin E Freund
- Department of Neurology, Mayo Clinic Florida, FL, USA
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Treiber JM, Bayley JC, Curry D. Minimally Invasive Destructive, Ablative, and Disconnective Epilepsy Surgery. JOURNAL OF PEDIATRIC EPILEPSY 2023. [DOI: 10.1055/s-0042-1760106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractConventional epilepsy surgery performed by microsurgical dissection typically requires large cranial working windows created with high-speed drills and lengthy incisions. In the past few decades, minimally invasive techniques have been developed with smaller incisions, comparable efficacy, shorter hospitalizations, and better safety profiles. These minimally invasive alternatives utilize stereotactic, ultrasonic, radiotherapeutic, and endoscopic techniques. Although not able to completely replace conventional surgery for all etiologies of epilepsy, these minimally invasive techniques have revolutionized modern epilepsy surgery and have been an invaluable asset to the neurosurgeon's repertoire. The endoscope has allowed for surgeons to have adequate visualization during resective and disconnective epilepsy surgeries using keyhole or miniature craniotomies. Modern stereotactic techniques such as laser interstitial thermal therapy and radiofrequency ablation can be used as viable alternatives for mesial temporal lobe epilepsy and can destroy lesional tissue deep areas without the approach-related morbidity of microsurgery such as with hypothalamic hamartomas. These stereotactic techniques do not preclude future surgery in the settings of treatment failure and have been used successfully after failed conventional surgery. Multiple ablation corridors can be performed in a single procedure that can be used for lesioning of large targets or to simplify treating multifocal epilepsies. These stereotactic techniques have even been used successfully to perform disconnective procedures such as hemispherotomies and corpus callosotomies. In patients unable to tolerate surgery, stereotactic radiosurgery is a minimally invasive option that can result in improved seizure control with minimal procedural risks. Advances in minimally invasive neurosurgery provide viable treatment options for drug-resistant epilepsy with quicker recovery, less injury to functional brain, and for patients that may otherwise not choose conventional surgery.
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Affiliation(s)
- Jeffrey M. Treiber
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - James C. Bayley
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
| | - Daniel Curry
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, United States
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30
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Shamim D, Nwabueze O, Uysal U. Beyond Resection: Neuromodulation and Minimally Invasive Epilepsy Surgery. Noro Psikiyatr Ars 2022; 59:S81-S90. [PMID: 36578991 PMCID: PMC9767135 DOI: 10.29399/npa.28181] [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: 03/26/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Epilepsy is a common neurological disease impacting both patients and healthcare systems. Approximately one third of patients have drug-resistant epilepsy (DRE) and are candidates for surgical options. However, only a small percentage undergo surgical treatment due to factors such as patient misconception/fear of surgery, healthcare disparities in epilepsy care, complex presurgical evaluation, primary care knowledge gap, and lack of systemic structures to allow effective coordination between referring physician and surgical epilepsy centers. Resective surgical treatments are superior to medication management for DRE patients in terms of seizure outcomes but may be less palatable to patients. There have been major advancements in minimally invasive surgeries (MIS) and neuromodulation techniques that may allay these concerns. Both epilepsy MIS and neuromodulation have shown promising seizure outcomes while minimizing complications. Minimally invasive methods include Laser Interstitial Thermal Therapy (LITT), RadioFrequency Ablation (RFA), Stereotactic RadioSurgery (SRS). Neuromodulation methods, which are more palliative, include Vagus Nerve Stimulation (VNS), Deep Brain Stimulation (DBS), and Responsive Neurostimulation System (RNS). This review will discuss the role of these techniques in varied epilepsy subtypes, their effectiveness in improving seizure control, and adverse outcomes.
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Affiliation(s)
- Daniah Shamim
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, USA
| | - Obiefuna Nwabueze
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, USA
| | - Utku Uysal
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, USA,Correspondence Address: Utku Uysal, MS University of Kansas School of Medicine 4000 Cambridge Street Mailstop 1065 Kansas City, KS 66160, USA • E-mail:
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Miller KJ, Fine AL. Decision-making in stereotactic epilepsy surgery. Epilepsia 2022; 63:2782-2801. [PMID: 35908245 PMCID: PMC9669234 DOI: 10.1111/epi.17381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
Surgery can cure or significantly improve both the frequency and the intensity of seizures in patients with medication-refractory epilepsy. The set of diagnostic and therapeutic interventions involved in the path from initial consultation to definitive surgery is complex and includes a multidisciplinary team of neurologists, neurosurgeons, neuroradiologists, and neuropsychologists, supported by a very large epilepsy-dedicated clinical architecture. In recent years, new practices and technologies have emerged that dramatically expand the scope of interventions performed. Stereoelectroencephalography has become widely adopted for seizure localization; stereotactic laser ablation has enabled more focal, less invasive, and less destructive interventions; and new brain stimulation devices have unlocked treatment of eloquent foci and multifocal onset etiologies. This article articulates and illustrates the full framework for how epilepsy patients are considered for surgical intervention, with particular attention given to stereotactic approaches.
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Affiliation(s)
- Kai J. Miller
- Neurosurgery, Mayo Clinic, 200 First St., Rochester, MN, 55902
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Massot-Tarrús A, Mirsattari SM. Roles of fMRI and Wada tests in the presurgical evaluation of language functions in temporal lobe epilepsy. Front Neurol 2022; 13:884730. [PMID: 36247757 PMCID: PMC9562037 DOI: 10.3389/fneur.2022.884730] [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: 02/26/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
Surgical treatment of pharmacoresistant temporal lobe epilepsy (TLE) carries risks for language function that can significantly affect the quality of life. Predicting the risks of decline in language functions before surgery is, consequently, just as important as predicting the chances of becoming seizure-free. The intracarotid amobarbital test, generally known as the Wada test (WT), has been traditionally used to determine language lateralization and to estimate their potential decline after surgery. However, the test is invasive and it does not localize the language functions. Therefore, other noninvasive methods have been proposed, of which functional magnetic resonance (fMRI) has the greatest potential. Functional MRI allows localization of language areas. It has good concordance with the WT for language lateralization, and it is of predictive value for postsurgical naming outcomes. Consequently, fMRI has progressively replaced WT for presurgical language evaluation. The objective of this manuscript is to review the most relevant aspects of language functions in TLE and the current role of fMRI and WT in the presurgical evaluation of language. First, we will provide context by revising the language network distribution and the effects of TLE on them. Then, we will assess the functional outcomes following various forms of TLE surgery and measures to reduce postoperative language decline. Finally, we will discuss the current indications for WT and fMRI and the potential usefulness of the resting-state fMRI technique.
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Affiliation(s)
| | - Seyed M. Mirsattari
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
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Hwang BY, Eremiev A, Palla A, Mampre D, Negoita S, Tsehay YK, Kim MJ, Coogan C, Kang JY, Anderson WS. Association of intraoperative end-tidal carbon dioxide level with ablation volume during magnetic resonance-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy. J Neurosurg 2022; 137:427-433. [PMID: 34891139 DOI: 10.3171/2021.9.jns211554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Maximal safe ablation of target structures during magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) is critical to achieving good seizure outcome in patients with mesial temporal lobe epilepsy (mTLE). The authors sought to determine whether intraoperative physiological variables are associated with ablation volume during MRgLiTT. METHODS Patients with mTLE who underwent MRgLiTT at our institution from 2014 to 2019 were retrospectively analyzed. Ablation volume was determined with volumetric analysis of intraoperative postablation MR images. Physiological parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], end-tidal carbon dioxide [ETCO2]) measured 40 minutes prior to ablation were analyzed. Univariate and multivariate regression analyses were performed to determine independent predictors of ablation volume. RESULTS Forty-four patients met the inclusion criteria. The median (interquartile range) ablation volume was 4.27 (2.92-5.89) cm3, and median ablation energy was 7216 (6402-8784) J. The median MAP, SBP, DBP, and ETCO2 values measured during the 40-minute period leading up to ablation were 72.8 (66.2-81.5) mm Hg, 104.4 (96.4-114.4) mm Hg, 62.4 (54.1-69.8) mm Hg, and 34.1 (32.0-36.2) mm Hg, respectively. In univariate analysis, only total laser energy (r = 0.464, p = 0.003) and 40-minute average ETCO2 (r = -0.388, p = 0.012) were significantly associated with ablation volume. In multivariate analysis, only ETCO2 ≤ 33 mm Hg (p = 0.001) was significantly associated with ablation volume. CONCLUSIONS Total ablation energy and ETCO2, but not blood pressure, may significantly affect ablation volume in mTLE patients undergoing MRgLiTT. Mild hypocapnia was associated with increased extent of ablation. Intraoperative monitoring and modulation of ETCO2 may help improve extent of ablation, prediction of ablation volume, and potentially seizure outcome.
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Affiliation(s)
- Brian Y Hwang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Alexander Eremiev
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Adhith Palla
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - David Mampre
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Serban Negoita
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Yohannes K Tsehay
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Min Jae Kim
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
- 2Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher Coogan
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Joon Y Kang
- 2Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William S Anderson
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Wang Y, Anzivino MJ, Zhang Y, Bertram EH, Woznak J, Klibanov AL, Dumont E, Wintermark M, Lee KS. Noninvasive disconnection of targeted neuronal circuitry sparing axons of passage and nonneuronal cells. J Neurosurg 2022; 137:296-306. [PMID: 34798617 PMCID: PMC9117563 DOI: 10.3171/2021.7.jns21123] [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: 01/15/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgery can be highly effective for the treatment of medically intractable, neurological disorders, such as drug-resistant focal epilepsy. However, despite its benefits, surgery remains substantially underutilized due to both surgical concerns and nonsurgical impediments. In this work, the authors characterized a noninvasive, nonablative strategy to focally destroy neurons in the brain parenchyma with the goal of limiting collateral damage to nontarget structures, such as axons of passage. METHODS Low-intensity MR-guided focused ultrasound (MRgFUS), together with intravenous microbubbles, was used to open the blood-brain barrier (BBB) in a transient and focal manner in rats. The period of BBB opening was exploited to focally deliver to the brain parenchyma a systemically administered neurotoxin (quinolinic acid) that is well tolerated peripherally and otherwise impermeable to the BBB. RESULTS Focal neuronal loss was observed in targeted areas of BBB opening, including brain regions that are prime objectives for epilepsy surgery. Notably, other structures in the area of neuronal loss, including axons of passage, glial cells, vasculature, and the ventricular wall, were spared with this procedure. CONCLUSIONS These findings identify a noninvasive, nonablative approach capable of disconnecting neural circuitry while limiting the neuropathological consequences that attend other surgical procedures. Moreover, this strategy allows conformal targeting, which could enhance the precision and expand the treatment envelope for treating irregularly shaped surgical objectives located in difficult-to-reach sites. Finally, if this strategy translates to the clinic, the noninvasive nature and specificity of the procedure could positively influence both physician referrals for and patient confidence in surgery for medically intractable neurological disorders.
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Affiliation(s)
- Yi Wang
- Department of Neuroscience, University of Virginia, Charlottesville, Virginia
| | - Matthew J. Anzivino
- Department of Neuroscience, University of Virginia, Charlottesville, Virginia
| | - Yanrong Zhang
- Department of Radiology, Stanford University, Stanford, California
| | - Edward H. Bertram
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - James Woznak
- Department of Neuroscience, University of Virginia, Charlottesville, Virginia
- Focused Ultrasound Foundation, Global Internship Program, Charlottesville, Virginia
| | | | | | - Max Wintermark
- Department of Radiology, Stanford University, Stanford, California
| | - Kevin S. Lee
- Department of Neuroscience, University of Virginia, Charlottesville, Virginia
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia; and
- Center for Brain, Immunology, and Glia, University of Virginia, Charlottesville, Virginia
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Gross WL, Helfand AI, Swanson SJ, Conant LL, Humphries CJ, Raghavan M, Mueller WM, Busch RM, Allen L, Anderson CT, Carlson CE, Lowe MJ, Langfitt JT, Tivarus ME, Drane DL, Loring DW, Jacobs M, Morgan VL, Allendorfer JB, Szaflarski JP, Bonilha L, Bookheimer S, Grabowski T, Vannest J, Binder JR. Prediction of Naming Outcome With fMRI Language Lateralization in Left Temporal Epilepsy Surgery. Neurology 2022; 98:e2337-e2346. [PMID: 35410903 PMCID: PMC9202528 DOI: 10.1212/wnl.0000000000200552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Naming decline after left temporal lobe epilepsy (TLE) surgery is common and difficult to predict. Preoperative language fMRI may predict naming decline, but this application is still lacking evidence. We performed a large multicenter cohort study of the effectiveness of fMRI in predicting naming deficits after left TLE surgery. METHODS At 10 US epilepsy centers, 81 patients with left TLE were prospectively recruited and given the Boston Naming Test (BNT) before and ≈7 months after anterior temporal lobectomy. An fMRI language laterality index (LI) was measured with an auditory semantic decision-tone decision task contrast. Correlations and a multiple regression model were built with a priori chosen predictors. RESULTS Naming decline occurred in 56% of patients and correlated with fMRI LI (r = -0.41, p < 0.001), age at epilepsy onset (r = -0.30, p = 0.006), age at surgery (r = -0.23, p = 0.039), and years of education (r = 0.24, p = 0.032). Preoperative BNT score and duration of epilepsy were not correlated with naming decline. The regression model explained 31% of the variance, with fMRI contributing 14%, with a 96% sensitivity and 44% specificity for predicting meaningful naming decline. Cross-validation resulted in an average prediction error of 6 points. DISCUSSION An fMRI-based regression model predicted naming outcome after left TLE surgery in a large, prospective multicenter sample, with fMRI as the strongest predictor. These results provide evidence supporting the use of preoperative language fMRI to predict language outcome in patients undergoing left TLE surgery. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that fMRI language lateralization can help in predicting naming decline after left TLE surgery.
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Affiliation(s)
- William Louis Gross
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH.
| | - Alexander I Helfand
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Sara J Swanson
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Lisa L Conant
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Colin J Humphries
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Manoj Raghavan
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Wade M Mueller
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Robyn M Busch
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Linda Allen
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Christopher Todd Anderson
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Chad E Carlson
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Mark J Lowe
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - John T Langfitt
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Madalina E Tivarus
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Daniel L Drane
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - David W Loring
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Monica Jacobs
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Victoria L Morgan
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Jane B Allendorfer
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Jerzy P Szaflarski
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Leonardo Bonilha
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Susan Bookheimer
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Thomas Grabowski
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Jennifer Vannest
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Jeffrey R Binder
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
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Yousefi O, Sabahi M, Malcolm J, Adada B, Borghei-Razavi H. Laser Interstitial Thermal Therapy for Cavernous Malformations: A Systematic Review. Front Surg 2022; 9:887329. [PMID: 35647010 PMCID: PMC9136030 DOI: 10.3389/fsurg.2022.887329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Microsurgical resection of intracranial cavernous malformations (CM) is regarded as the standard treatment, but in recent years, there has been a trend toward minimally invasive procedures like ablation of such lesions by using laser interstitial thermal therapy (LITT). Methods A systematic search using keywords ‘laser interstitial thermal therapy’ OR ‘LITT’ AND ‘cavernoma’ OR ‘cavernous angiomas’ OR ‘cavernous malformations’ was conducted in MEDLINE (PubMed), Scopus, Embase, and Cochrane electronic bibliographic databases and studies reporting the outcome of LITT procedure on intracranial CM were included. The demographic data, symptoms of patients, location and size of the lesion, and surgical outcome were extracted from the articles. Result Six studies, reporting the outcome of 33 patients were included in this review. In 26 patients, CM was identified as the epileptogenic foci and in others, CM was the source of headache or focal neurological deficits. LITT led to a satisfactory outcome in all patients except for three who achieved improvement in symptoms after the open resection of the lesion. Most of the post-operative complications were transient and resolved at the time of the last follow up. Cyst formation at the previous ablated CM site was reported as the long-term complication of LITT in one case. Conclusion LITT can provide a comparable outcome to the open resection of CMs, by having less invasiveness, even in deep and eloquent area lesions, and complications that are often temporary and disappear gradually. However, technical issues, such as thermal monitoring during the procedure, are considered a challenge for this procedure in CMs. Further studies with a larger population are needed to report this method's long-term outcome and complications on CMs.
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Affiliation(s)
- Omid Yousefi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadmahdi Sabahi
- Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - James Malcolm
- Department of Neurosurgery, Emory University, Atlanta, GA, United States
| | - Badih Adada
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, United States
- Correspondence: Hamid Borghei-Razavi
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Stereotactic laser interstitial thermal therapy for the treatment of pediatric drug-resistant epilepsy: indications, techniques, and safety. Childs Nerv Syst 2022; 38:961-970. [PMID: 35274185 DOI: 10.1007/s00381-022-05491-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND MRI-guided laser interstitial thermal therapy (MRgLITT) is a promising alternative to open surgery for treatment of drug-resistant epilepsy, offering significant advantages over traditional approaches for candidate patients, including minimally invasive approach, shorter hospitalization, and decreased patient post-operative discomfort. LITT uses a stereotactically placed fiber optic laser probe to ablate tissue under real-time MR thermometry. METHODS Retrospective chart review of intraoperative and perioperative characteristics was performed for 28 cases of MRgLITT in 25 pediatric patients, ages 4-21 years old, at our institution between 2019 and 2021. MRgLITT ablation of the mesial temporal lobe was performed in 8 cases, extratemporal epileptogenic foci in 9 cases, and for corpus callosotomy in 11 cases. RESULTS At 1 year of follow-up, 53% of all patients experienced improvement in seizure frequency (Engel I or II) (class I: 38%, class II: 15%, class III: 17%, class IV: 31%), including 37% of MTL ablations and 80% extratemporal SOZ ablations. After MRgLITT corpus callosotomy, 71% of patients were free from atonic seizures at most recent follow-up. Median length of hospitalization was 2 days (1-3), including a median ICU stay of 1 day (1-2). CONCLUSION This series demonstrates the safety of MRgLITT as an approach for seizure control in drug-resistant epilepsy. We provide additional evidence that MRgLITT is an effective procedure that is well-tolerated by pediatric patients and is accompanied by an acceptable rate of complications and relatively short hospital stay.
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Hedaya AA, Hewitt KC, Hu R, Epstein CM, Gross RE, Drane DL, Willie JT. Open surgery or laser interstitial thermal therapy for low-grade epilepsy-associated tumors of the temporal lobe: A single-institution consecutive series. Epilepsy Behav 2022; 130:108659. [PMID: 35339067 PMCID: PMC9361400 DOI: 10.1016/j.yebeh.2022.108659] [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: 11/08/2021] [Revised: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Abstract
Outcomes of treating low-grade epilepsy-associated tumors (LEATs) in the temporal lobe with MRI-guided laser interstitial thermal therapy (MRgLITT) remain poorly characterized. This study aimed to compare the safety and effectiveness of treating temporal lobe LEATs with MRgLITT versus open resection in a consecutive single-institution series. We reviewed all adult patients with epilepsy that underwent surgery for temporal lobe LEATs at our institution between 2002 and 2019, during which time we switched from open surgery to MRgLITT. Surgical outcome was categorized by Engel classification at >12mo follow-up and Kaplan-Meir analysis of seizure freedom. We recorded hospital length of stay, adverse events, and available neuropsychological results. Of 14 total patients, 7 underwent 9 open resections, 6 patients underwent MRgLITT alone, and 1 patient underwent an open resection followed by MRgLITT. Baseline group demographics differed and were notable for preoperative duration of epilepsy of 9.0 years (range 1-36) for open resection versus 14.0 years (range 2-34) for MRgLITT. Median length of stay was one day shorter for MRgLITT compared to open resection (p=<.0001). There were no major adverse events in the series, but there were fewer minor adverse events following MRgLITT. At 12mo follow-up, 50% (5/10) of patients undergoing open resection and 57% (4/7) of patients undergoing MRgLITT were free of disabling seizures (Engel I). When comparing patients who underwent similar procedures in the dominant temporal lobe, patients undergoing MRgLITT had fewer and milder material-specific neuropsychological declines than patients undergoing open resections. In this small series, MRgLITT was comparably safe and effective relative to open resection of temporal lobe LEATs.
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Affiliation(s)
- Alexander A Hedaya
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ranliang Hu
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Charles M Epstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology, University of Washington, Seattle, WA, United States
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States.
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Abstract
PURPOSE OF REVIEW More than 20 new antiseizure medications have been approved by the US Food and Drug Administration (FDA) in the past 3 decades; however, outcomes in newly diagnosed epilepsy have not improved, and epilepsy remains drug resistant in up to 40% of patients. Evidence supports improved seizure outcomes and quality of life in those who have undergone epilepsy surgery, but epilepsy surgery remains underutilized. This article outlines indications for epilepsy surgery, describes the presurgical workup, and summarizes current available surgical approaches. RECENT FINDINGS Class I evidence has demonstrated the superiority of resective surgery compared to medical therapy for seizure control and quality of life in patients with drug-resistant epilepsy. The use of minimally invasive options, such as laser interstitial thermal therapy and stereotactic radiosurgery, are alternatives to resective surgery in well-selected patients. Neuromodulation techniques, such as responsive neurostimulation, deep brain stimulation, and vagus nerve stimulation, offer a suitable alternative, especially in those where resective surgery is contraindicated or where patients prefer nonresective surgery. Although neuromodulation approaches reduce seizure frequency, they are less likely to be associated with seizure freedom than resective surgery. SUMMARY Appropriate patients with drug-resistant epilepsy benefit from epilepsy surgery. If two well-chosen and tolerated medication trials do not achieve seizure control, referral to a comprehensive epilepsy center for a thorough presurgical workup and discussion of surgical options is appropriate. Mounting Class I evidence supports a significantly higher chance of stopping disabling seizures with surgery than with further medication trials.
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King-Stephens D. Is Node Disconnection the Key for Improving LITT Outcome? Epilepsy Curr 2022; 22:173-175. [DOI: 10.1177/15357597221086394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Stasenko A, Kaestner E, Reyes A, Lalani SJ, Paul B, Hegde M, Helm JL, Ben-Haim S, McDonald CR. Association Between Microstructural Asymmetry of Temporal Lobe White Matter and Memory Decline After Anterior Temporal Lobectomy. Neurology 2022; 98:e1151-e1162. [PMID: 35058338 PMCID: PMC8935440 DOI: 10.1212/wnl.0000000000200047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Risk for memory decline is a substantial concern in patients with temporal lobe epilepsy (TLE) undergoing anterior temporal lobectomy (ATL). Although prior studies have identified associations between memory and integrity of white matter (WM) networks within the medial temporal lobe (MTL) preoperatively, we contribute a study examining whether microstructural asymmetry of deep and superficial WM networks within the MTL predicts postoperative memory decline. METHODS Patients with drug-resistant TLE were recruited from 2 epilepsy centers in a prospective longitudinal study. All patients completed preoperative T1 and diffusion-weighted MRI (DWI) as well as preoperative and postoperative neuropsychological testing. Preoperative fractional anisotropy (FA) of the WM directly beneath the neocortex (i.e., superficial WM [SWM]) and of deep WM tracts associated with memory were calculated. Asymmetry was calculated for hippocampal volume and FA of each WM tract or region and examined in linear and logistic regressions with preoperative to postoperative memory change as the primary outcome. RESULTS Data were analyzed from 42 patients with TLE (19 left TLE [LTLE], 23 right TLE [RTLE]) who underwent ATL. Leftward FA asymmetry of the entorhinal SWM was associated with decline on prose and associative recall in LTLE, whereas leftward FA asymmetry of the uncinate fasciculus (UNC) was associated with decline on prose recall only. After controlling for preoperative memory score and hippocampal volume, leftward FA asymmetry of the entorhinal SWM uniquely contributed to decline in both prose and associative recall (β = -0.46; SE 0.14 and β = -0.68; SE 0.22, respectively) and leftward FA asymmetry of the UNC uniquely contributed to decline in prose recall (β = -0.31; SE 0.14). A model combining asymmetry of hippocampal volume and entorhinal FA correctly classified memory outcomes in 79% of patients with LTLE for prose (area under the curve [AUC] 0.89; sensitivity 82%; specificity 75%) and 81% of patients for associative (AUC 0.79; sensitivity 83%; specificity 80%) recall. Entorhinal SWM asymmetry was the strongest predictor in both models. DISCUSSION Preoperative asymmetry of deep WM and SWM integrity within the MTL is a strong predictor of postoperative memory decline in TLE, suggesting that surgical decision-making may benefit from considering each patient's WM network adequacy and reserve in addition to hippocampal integrity. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that preoperative asymmetry of deep WM and SWM integrity within the MTL is a predictor of postoperative memory decline.
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Affiliation(s)
- Alena Stasenko
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Erik Kaestner
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Anny Reyes
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Sanam J Lalani
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Brianna Paul
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Manu Hegde
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Jonathan L Helm
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Sharona Ben-Haim
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA
| | - Carrie R McDonald
- From the Center for Multimodal Imaging and Genetics (A.S., E.K., A.R., C.R.M.) and Departments of Psychiatry (A.S., E.K., A.R., S.J.L., C.R.M.) and Neurosurgery (S.B.-H.), University of California, San Diego; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (A.R., C.R.M.); Department of Neurology (B.P., M.H.), University of California, San Francisco; and Department of Psychology (J.L.H.), San Diego State University, CA.
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Wu C, Schwalb JM, Rosenow JM, McKhann GM, Neimat JS. The American Society for Stereotactic and Functional Neurosurgery Position Statement on Laser Interstitial Thermal Therapy for the Treatment of Drug-Resistant Epilepsy. Neurosurgery 2022; 90:155-160. [PMID: 34995216 DOI: 10.1227/neu.0000000000001799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
Magnetic resonance image-guided laser interstitial thermal therapy (MRgLITT) is a novel tool in the neurosurgical armamentarium for the management of drug-resistant epilepsy. Given the recent introduction of this technology, the American Society for Stereotactic and Functional Neurosurgery (ASSFN), which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides here the expert consensus opinion on evidence-based best practices for the use and implementation of this treatment modality. Indications for treatment are outlined, consisting of failure to respond to, or intolerance of, at least 2 appropriately chosen medications at appropriate doses for disabling, localization-related epilepsy in the setting of well-defined epileptogenic foci, or critical pathways of seizure propagation accessible by MRgLITT. Applications of MRgLITT in mesial temporal lobe epilepsy and hypothalamic hamartoma, along with its contraindications in the treatment of epilepsy, are discussed based on current evidence. To put this position statement in perspective, we detail the evidence and authority on which this ASSFN position statement is based.
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Affiliation(s)
- Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, New York, New York, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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Sinha SR, Yang JC, Wallace MJ, Grover K, Johnson FR, Reed SD. Patient preferences pertaining to treatment options for drug-resistant focal epilepsy. Epilepsy Behav 2022; 127:108529. [PMID: 35016055 DOI: 10.1016/j.yebeh.2021.108529] [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: 09/17/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine patient acceptability of benefit-risk trade-offs in selecting treatment options for drug-resistant mesial temporal lobe epilepsy, including open brain surgery, laser ablation (laser interstitial thermal therapy [LITT]), and continued medications. METHODS A discrete-choice experiment survey was developed, consisting of 20 versions that were randomly assigned to respondents. Each version had 8 sets of constructed treatment alternatives, representing open brain surgery, LITT, or continued medical management. For each set, respondents indicated the treatment alternative they would choose first. Treatment alternatives were characterized by varying levels of chance of seizure freedom for at least 2 years (20-70%), risk of 30-day mortality (0-10%), and risk of neurological deficits (0-40%). Respondents' choices were analyzed using random-parameters logit models to quantify acceptable benefit-risk trade-offs. Preference heterogeneity was evaluated using latent-class analysis. RESULTS The survey was administered to 2 cohorts of adult patients with drug-resistant epilepsy: a Duke cohort identified using diagnostic codes (n = 106) and a web-recruited panel with a self-reported physician diagnosis of drug-resistant epilepsy (n = 300). Based on mean preference weights, respondents who indicated a willingness to consider surgical intervention would accept a reduction in chance of seizure freedom from 70% to a minimum-acceptable benefit (MAB) of 23% if they could undergo LITT rather than open brain surgery. For a reduction in 30-day mortality from 1% to 0%, MAB was 52%. For a reduction in risk of long-term deficits from 10% to 0%, MAB was 39%. Latent-class analysis revealed additional choice patterns identifying respondent groups that more strongly favored continuing medications or undergoing surgery. CONCLUSION Patients who are receptive to surgery would accept significantly lower treatment effectiveness to undergo a minimally invasive procedure relative to open brain surgery. They also were willing to accept lower treatment benefit to reduce risks of mortality or neurological deficits.
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Affiliation(s)
- Saurabh R Sinha
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Jui-Chen Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Matthew J Wallace
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kiran Grover
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - F Reed Johnson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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Barot N, Batra K, Zhang J, Klem ML, Castellano J, Gonzalez-Martinez J, Bagic A. Surgical outcomes between temporal, extratemporal epilepsies and hypothalamic hamartoma: systematic review and meta-analysis of MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy. J Neurol Neurosurg Psychiatry 2022; 93:133-143. [PMID: 34321344 DOI: 10.1136/jnnp-2021-326185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Approximately 1/3 of patients with epilepsy have drug-resistant epilepsy (DRE) and require surgical interventions. This meta-analysis aimed to review the effectiveness of MRI-guided laser interstitial thermal therapy (MRgLITT) in DRE. METHODS The Population, Intervention, Comparator and Outcome approach and Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. PubMed, MEDLINE and EMBASE databases were systematically searched for English language publications from 2012 to Nov 2020. Data on the prevalence outcome using the Engel Epilepsy Surgery Outcome Scale (Class I-IV), and postoperative complications were analysed with 95% CIs. RESULTS Twenty-eight studies that included a total of 559 patients with DRE were identified. The overall prevalence of Engel class I outcome was 56% (95% CI 0.52% to 0.60%). Hypothalamic hamartomas (HH) patients had the highest seizure freedom rate of 67% (95% CI 0.57% to 0.76%) and outcome was overall comparable between mesial temporal lobe epilepsy (mTLE) (56%, 95% CI 0.50% to 0.61%) and extratemporal epilepsy (50% 95% CI 0.40% to 0.59%). The mTLE cases with mesial temporal sclerosis had better outcome vs non-lesional cases of mTLE. The prevalence of postoperative adverse events was 19% (95% CI 0.14% to 0.25%) and the most common adverse event was visual field deficits. The reoperation rate was 9% (95% CI 0.05% to 0.14%), which included repeat ablation and open resection. CONCLUSION MRgLITT is an effective and safe intervention for DRE with different disease aetiologies. The seizure freedom outcome is overall comparable in between extratemporal and temporal lobe epilepsy; and highest with HH. TRAIL REGISTRATION NUMBER The study protocol was registered with the National Institute for Health Research (CRD42019126365), which serves as a prospective register of systematic reviews. It is an international database of prospectively registered systematic reviews with a focus on health-related outcomes. Details about the protocol can be found at https://wwwcrdyorkacuk/PROSPERO/.
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Affiliation(s)
- Niravkumar Barot
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kavita Batra
- Office of Research, University of Nevada, Las vegas, Nevada, USA
| | - Jerry Zhang
- University of Pittsburgh, Biostatistical Consulting Laboratory, Pittsburgh, Pennsylvania, USA
| | - Mary Lou Klem
- Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Castellano
- Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Anto Bagic
- Neurology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
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Shurtleff HA, Poliakov A, Barry D, Wright JN, Warner MH, Novotny EJ, Marashly A, Buckley R, Goldstein HE, Hauptman JS, Ojemann JG, Shaw DWW. A clinically applicable functional MRI memory paradigm for use with pediatric patients. Epilepsy Behav 2022; 126:108461. [PMID: 34896785 DOI: 10.1016/j.yebeh.2021.108461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Clinically employable functional MRI (fMRI) memory paradigms are not yet established for pediatric patient epilepsy surgery workups. Seeking to establish such a paradigm, we evaluated the effectiveness of memory fMRI tasks we developed by quantifying individual activation in a clinical pediatric setting, analyzing patterns of activation relative to the side of temporal lobe (TL) pathology, and comparing fMRI and Wada test results. METHODS We retrospectively identified 72 patients aged 6.7-20.9 years with pathology (seizure focus and/or tumor) limited to the TL who had attempted memory and language fMRI tasks over a 9-year period as part of presurgical workups. Memory fMRI tasks required visualization of autobiographical memories in a block design alternating with covert counting. Language fMRI protocols involved verb and sentence generation. Scans were both qualitatively interpreted and quantitatively assessed for blood oxygenation level dependent (BOLD) signal change using region of interest (ROI) masks. We calculated the percentage of successfully scanned individual cases, compared 2 memory task activation masks in cases with left versus right TL pathology, and compared fMRI with Wada tests when available. Patients who had viable fMRI and Wada tests had generally concordant results. RESULTS Of the 72 cases, 60 (83%), aged 7.6-20.9 years, successfully performed the memory fMRI tasks and 12 (17%) failed. Eleven of 12 unsuccessful scans were due to motion and/or inability to perform the tasks, and the success of a twelfth was indeterminate due to orthodontic metal artifact. Seven of the successful 60 cases had distorted anatomy that precluded employing predetermined masks for quantitative analysis. Successful fMRI memory studies showed bilateral mesial temporal activation and quantitatively demonstrated: (1) left activation (L-ACT) less than right activation (R-ACT) in cases with left temporal lobe (L-TL) pathology, (2) nonsignificant R-ACT less than L-ACT in cases with right temporal lobe (R-TL) pathology, and (3) lower L-ACT plus R-ACT activation for cases with L-TL versus R-TL pathology. Patients who had viable fMRI and Wada tests had generally concordant results. SIGNIFICANCE This study demonstrates evidence of an fMRI memory task paradigm that elicits reliable activation at the individual level and can generally be accomplished in clinically involved pediatric patients. This autobiographical memory paradigm showed activation in mesial TL structures, and cases with left compared to right TL pathology showed differences in activation consistent with extant literature in TL epilepsy. Further studies will be required to assess outcome prediction.
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Affiliation(s)
- Hillary A Shurtleff
- Neurosciences Institute, Seattle Children's Hospital, United States; Center for Integrated Brain Research Seattle Children's, United States.
| | | | - Dwight Barry
- Clinical Analytics, Seattle Children's Hospital, United States
| | - Jason N Wright
- Radiology, Seattle Children's Hospital, United States; Department of Radiology, University of Washington School of Medicine, United States
| | - Molly H Warner
- Neurosciences Institute, Seattle Children's Hospital, United States; Center for Integrated Brain Research Seattle Children's, United States
| | - Edward J Novotny
- Neurosciences Institute, Seattle Children's Hospital, United States; Center for Integrated Brain Research Seattle Children's, United States; Neurology, Seattle Children's Hospital, United States; Department of Neurology, University of Washington School of Medicine, United States
| | - Ahmad Marashly
- Neurosciences Institute, Seattle Children's Hospital, United States; Center for Integrated Brain Research Seattle Children's, United States; Neurology, Seattle Children's Hospital, United States; Department of Neurology, University of Washington School of Medicine, United States
| | - Robert Buckley
- Department of Neurological Surgery, University of Washington School of Medicine, United States
| | - Hannah E Goldstein
- Neurosciences Institute, Seattle Children's Hospital, United States; Department of Neurological Surgery, University of Washington School of Medicine, United States; Neurological Surgery, Seattle Children's Hospital, United States
| | - Jason S Hauptman
- Neurosciences Institute, Seattle Children's Hospital, United States; Department of Neurological Surgery, University of Washington School of Medicine, United States; Neurological Surgery, Seattle Children's Hospital, United States
| | - Jeffrey G Ojemann
- Neurosciences Institute, Seattle Children's Hospital, United States; Center for Integrated Brain Research Seattle Children's, United States; Department of Neurological Surgery, University of Washington School of Medicine, United States; Neurological Surgery, Seattle Children's Hospital, United States
| | - Dennis W W Shaw
- Radiology, Seattle Children's Hospital, United States; Department of Radiology, University of Washington School of Medicine, United States
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Resection of dominant fusiform gyrus is associated with decline of naming function when temporal lobe epilepsy manifests after the age of five: A voxel-based lesion-symptom mapping study. NEUROIMAGE: CLINICAL 2022; 35:103129. [PMID: 36002957 PMCID: PMC9421498 DOI: 10.1016/j.nicl.2022.103129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
Resection in the dominant fusiform gyrus is associated with an increased risk of postoperative decline in picture naming. More temporo-posterior resections in this area results in a greater degree of naming decline. Risk of significant naming decline after left temporal surgery increased by 5% with every year of later seizure onset.
Objective To determine patients’ characteristics and regions in the temporal lobe where resections lead to a decline in picture naming. Methods 311 patients with left hemispheric dominance for language were included who underwent epilepsy surgery at the Epilepsy Center of Erlangen and whose picture naming scores (Boston Naming Test, BNT) were available preoperatively and 6-months postoperatively. Surgical lesions were mapped to an averaged template based on preoperative and postoperative MRI using voxel-based lesion-symptom mapping (VBLSM). Postoperative brain shifts were corrected. The relationship between lesioned brain areas and the presence of a postoperative naming decline was examined voxel-wise while controlling for effects of overall lesion size at first in the total cohort and then restricted to temporal lobe resections. Results In VBLSM in the total sample, a decline in BNT score was significantly related to left temporal surgery. When only considering patients with left temporal lobe resections (n = 121), 40 (33.1%) significantly worsened in BNT postoperatively. VBLSM including all patients with left temporal resections generated no significant results within the temporal lobe. However, naming decline of patients with epilepsy onset after 5 years of age was significantly associated with resections in the left inferior temporal (extent of BNT decline range: 10.8− 14.4%) and fusiform gyrus (decline range: 12.1−18.4%). Significance Resections in the posterior part of the dominant fusiform and inferior temporal gyrus was associated with a risk of deterioration in naming performance at six months after surgery in patients with epilepsy onset after 5 years of age but not with earlier epilepsy onset.
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Kaminski J, Bowren M, Manzel K, Tranel D. Neural correlates of recognition and naming of famous persons and landmarks: A special role for the left anterior temporal lobe. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:303-317. [PMID: 35964980 DOI: 10.1016/b978-0-12-823493-8.00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The anterior temporal lobes (ATLs) have been shown to be crucial for recognition and naming of unique entities such as persons and places. In this chapter, we review previous research that identified the neural underpinnings of these processes, and discuss the convergence zone theory of conceptual knowledge and proper name retrieval. Lesion-deficit and neuroimaging studies have found that the temporal poles are essential for recognition and naming of unique persons and places. Research has shown laterality, in that the right anterior temporal pole is specialized for recognition and the left for naming. Here, we analyzed recognition and naming of persons and landmarks in a large neurologic sample (N=244) using the Iowa Famous Faces and Famous Landmarks tests. For both categories, education had a significant effect on recognition and naming performances, but age and gender did not. Lesion-symptom maps revealed lower naming scores for both Faces and Landmarks associated with lesions to the anterior and mesial left temporal lobe. Lower recognition scores were also linked to left temporal lobe damage, possibly due to the method we used for measuring recognition (verbally based). Overall, the results demonstrate the importance of the temporal lobes for recognition and naming of unique persons and places.
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Affiliation(s)
- Jamie Kaminski
- Division of Neuropsychology and Cognitive Neuroscience, Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Mark Bowren
- Division of Neuropsychology and Cognitive Neuroscience, Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Kenneth Manzel
- Division of Neuropsychology and Cognitive Neuroscience, Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Daniel Tranel
- Division of Neuropsychology and Cognitive Neuroscience, Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States.
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Abstract
Temporal lobe epilepsy (TLE) is the most common cause of refractory epilepsy amenable for surgical treatment and seizure control. Surgery for TLE is a safe and effective strategy. The seizure-free rate after surgical resection in patients with mesial or neocortical TLE is about 70%. Resective surgery has an advantage over stereotactic radiosurgery in terms of seizure outcomes for mesial TLE patients. Both techniques have similar results for safety, cognitive outcomes, and associated costs. Stereotactic radiosurgery should therefore be seen as an alternative to open surgery for patients with contraindications for or with reluctance to undergo open surgery. Laser interstitial thermal therapy (LITT) has also shown promising results as a curative technique in mesial TLE but needs to be more deeply evaluated. Brain-responsive stimulation represents a palliative treatment option for patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior mesial temporal lobe resection. Overall, despite the expansion of innovative techniques in recent years, resective surgery remains the reference treatment for TLE and should be proposed as the first-line surgical modality. In the future, ultrasound therapies could become a credible therapeutic option for refractory TLE patients.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Paris, France; Paris Brain Institute, Paris, France
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France
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Marathe K, Alim-Marvasti A, Dahele K, Xiao F, Buck S, O'Keeffe AG, Duncan JS, Vakharia VN. Resective, Ablative and Radiosurgical Interventions for Drug Resistant Mesial Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Outcomes. Front Neurol 2021; 12:777845. [PMID: 34956057 PMCID: PMC8695716 DOI: 10.3389/fneur.2021.777845] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: One-third of individuals with focal epilepsy do not achieve seizure freedom despite best medical therapy. Mesial temporal lobe epilepsy (MTLE) is the most common form of drug resistant focal epilepsy. Surgery may lead to long-term seizure remission if the epileptogenic zone can be defined and safely removed or disconnected. We compare published outcomes following open surgical techniques, radiosurgery (SRS), laser interstitial thermal therapy (LITT) and radiofrequency ablation (RF-TC). Methods: PRISMA systematic review was performed through structured searches of PubMed, Embase and Cochrane databases. Inclusion criteria encompassed studies of MTLE reporting seizure-free outcomes in ≥10 patients with ≥12 months follow-up. Due to variability in open surgical approaches, only comparative studies were included to minimize the risk of bias. Random effects meta-analysis was performed to calculate effects sizes and a pooled estimate of the probability of seizure freedom per person-year. A mixed effects linear regression model was performed to compare effect sizes between interventions. Results: From 1,801 screened articles, 41 articles were included in the quantitative analysis. Open surgery included anterior temporal lobe resection as well as transcortical and trans-sylvian selective amygdalohippocampectomy. The pooled seizure-free rate per person-year was 0.72 (95% CI 0.66-0.79) with trans-sylvian selective amygdalohippocampectomy, 0.59 (95% CI 0.53-0.65) with LITT, 0.70 (95% CI 0.64-0.77) with anterior temporal lobe resection, 0.60 (95% CI 0.49-0.73) with transcortical selective amygdalohippocampectomy, 0.38 (95% CI 0.14-1.00) with RF-TC and 0.50 (95% CI 0.34-0.73) with SRS. Follow up duration and study sizes were limited with LITT and RF-TC. A mixed-effects linear regression model suggests significant differences between interventions, with LITT, ATLR and SAH demonstrating the largest effects estimates and RF-TC the lowest. Conclusions: Overall, novel "minimally invasive" approaches are still comparatively less efficacious than open surgery. LITT shows promising seizure effectiveness, however follow-up durations are shorter for minimally invasive approaches so the durability of the outcomes cannot yet be assessed. Secondary outcome measures such as Neurological complications, neuropsychological outcome and interventional morbidity are poorly reported but are important considerations when deciding on first-line treatments.
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Affiliation(s)
- Kajol Marathe
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Ali Alim-Marvasti
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Karan Dahele
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Sarah Buck
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Aidan G O'Keeffe
- Department of Statistical Science, University College London, London, United Kingdom
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom
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McDonald CR. Removing Basal Temporal Language Cortex in Epilepsy Surgery: Short-Term Disruption or Long-Lasting Problem? Epilepsy Curr 2021; 21:329-331. [PMID: 34924825 PMCID: PMC8655261 DOI: 10.1177/15357597211025134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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