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Wu P, Liu Q, Liu X, Sun Y, Zhang J, Wang R, Ji T, Wang S, Liu X, Jiang Y, Cai L, Wu Y. Clinical features of unilateral multilobar and hemispheric polymicrogyria (PMG)-related epilepsy and seizure outcome with different treatment options. Epilepsia Open 2024. [PMID: 38898786 DOI: 10.1002/epi4.12988] [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: 11/21/2023] [Revised: 05/12/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To provide evidence for choosing surgical or nonsurgical treatment for epilepsy in patients with unilateral multilobar and hemispheric polymicrogyria (PMG). METHODS We searched published studies until September 2022 related to unilateral multilobar and hemispheric PMG and included patients who were followed up at the Pediatric Epilepsy Centre of Peking University First Hospital in the past 10 years. We summarized the clinical characteristics and compared the long-term outcomes after surgical or nonsurgical (anti-seizure medications, ASMs) treatment. RESULTS A total of 70 patients (49 surgical, 21 non-surgical) with unilateral multilobar and hemispheric PMG were included. The median age at epilepsy onset was 2.5 years (1.0-4.1). The most common seizure types were focal and atypical absence seizures. In the whole cohort, 87.3% had hemiparesis and 67.1% had electrical status epilepticus during slow sleep (ESES). There were significant differences in age at epilepsy onset, extent of lesion, and EEG interictal discharges between the two groups. At the last follow-up (median 14.1 years), the rates of seizure-freedom (81.6% vs. 57.1%, p = 0.032) and ASM discontinuation (44.4% vs. 6.3%, p = 0.006) were higher in the surgical group than in the nonsurgical group. Patients in the surgical group had a higher rate of seizure-freedom with complete resection/disconnection than with subtotal resection (87.5% vs. 55.6%, p = 0.078), but with no statistically significant difference. In the nonsurgical group, more extensive lesions were associated with worse seizure outcomes. Cognition improved postoperatively in 90% of surgical patients. SIGNIFICANCE In patients with unilateral multilobar and hemispheric PMG, the age of seizure onset, the extent of the lesion and EEG features can help determine whether surgery should be performed early. Additionally, surgery could be more favorable for achieving seizure freedom and cognitive improvement sooner. PLAIN LANGUAGE SUMMARY We aim to summarize clinical characteristics and compare the long-term outcomes after surgical and nonsurgical (ASM) treatment to provide a basis for treatment decisions for patients with unilateral multilobar and hemispheric polymicrogyria (PMG)-related epilepsy. We found that patients with unilateral hemispheric and multilobar PMG had significantly higher rates of seizure freedom and ASM discontinuation with surgical treatment than with nonsurgical treatment. In the surgical group, seizure outcomes were better in patients treated with complete resection/disconnection than in those treated with subtotal resection, but the difference was not statistically significant.
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Affiliation(s)
- Pengxia Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Qingzhu Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Xianyu Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yu Sun
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Jie Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ruofan Wang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Taoyun Ji
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Shuang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Xiaoyan Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Lixin Cai
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
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Goel K, Ghadiyaram A, Krishnakumar A, Morden FTC, Higashihara TJ, Harris WB, Shlobin NA, Wang A, Karunungan K, Dubey A, Phillips HW, Weil AG, Fallah A. Hemimegalencephaly: A Systematic Comparison of Functional and Anatomic Hemispherectomy for Drug-Resistant Epilepsy. Neurosurgery 2024; 94:666-678. [PMID: 37975663 DOI: 10.1227/neu.0000000000002759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/19/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hemimegalencephaly (HME) is a rare diffuse malformation of cortical development characterized by unihemispheric hypertrophy, drug-resistant epilepsy (DRE), hemiparesis, and developmental delay. Definitive treatment for HME-related DRE is hemispheric surgery through either anatomic (AH) or functional hemispherectomy (FH). This individual patient data meta-analysis assessed seizure outcomes of AH and FH for HME with pharmacoresistant epilepsy, predictors of Engel I, and efficacy of different FH approaches. METHODS PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were searched from inception to Jan 13th, 2023, for primary literature reporting seizure outcomes in >3 patients with HME receiving AH or FH. Demographics, neurophysiology findings, and Engel outcome at the last follow-up were extracted. Postsurgical seizure outcomes were compared through 2-tailed t -test and Fisher exact test. Univariate and multivariate Cox regression analyses were performed to identify independent predictors of Engel I outcome. RESULTS Data from 145 patients were extracted from 26 studies, of which 89 underwent FH (22 vertical, 33 lateral), 47 underwent AH, and 9 received an unspecified hemispherectomy with a median last follow-up of 44.0 months (FH cohort) and 45.0 months (AH cohort). Cohorts were similar in preoperative characteristics and at the last follow-up; 77% (n = 66) of the FH cohort and 81% (n = 38) and of the AH cohort were Engel I. On multivariate analysis, only the presence of bilateral ictal electroencephalography abnormalities (hazard ratio = 11.5; P = .002) was significantly associated with faster time-to-seizure recurrence. A number-needed-to-treat analysis to prevent 1 additional case of posthemispherectomy hydrocephalus reveals that FH, compared with AH, was 3. There was no statistical significance for any differences in time-to-seizure recurrence between lateral and vertical FH approaches (hazard ratio = 2.59; P = .101). CONCLUSION We show that hemispheric surgery is a highly effective treatment for HME-related DRE. Unilateral ictal electroencephalography changes and using the FH approach as initial surgical management may result in better outcomes due to significantly lower posthemispherectomy hydrocephalus probability. However, larger HME registries are needed to further delineate the predictors of seizure outcomes.
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Affiliation(s)
- Keshav Goel
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
| | - Ashwin Ghadiyaram
- Virginia Commonwealth University School of Medicine, Richmond , Virginia , USA
| | - Asha Krishnakumar
- Virginia Commonwealth University School of Medicine, Richmond , Virginia , USA
| | - Frances T C Morden
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu , Hawaii , USA
| | - Tate J Higashihara
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu , Hawaii , USA
| | - William B Harris
- Department of Neurosurgery, University of Colorado, Boulder , Colorado , USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - Andrew Wang
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
| | - Krystal Karunungan
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
| | - Anwesha Dubey
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
| | - H Westley Phillips
- Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Alexander G Weil
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre, Montréal , Québec , Canada
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Centre (CHUM), Montréal , Québec , Canada
- Brain and Development Research Axis, Sainte-Justine Research Center, Montréal , Québec , Canada
- Department of Neuroscience, University of Montreal, Montréal , Québec , Canada
| | - Aria Fallah
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles , California , USA
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3
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Costa FV, Zabegalov KN, Kolesnikova TO, de Abreu MS, Kotova MM, Petersen EV, Kalueff AV. Experimental models of human cortical malformations: from mammals to 'acortical' zebrafish. Neurosci Biobehav Rev 2023; 155:105429. [PMID: 37863278 DOI: 10.1016/j.neubiorev.2023.105429] [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: 06/03/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
Human neocortex controls and integrates cognition, emotions, perception and complex behaviors. Aberrant cortical development can be triggered by multiple genetic and environmental factors, causing cortical malformations. Animal models, especially rodents, are a valuable tool to probe molecular and physiological mechanisms of cortical malformations. Complementing rodent studies, the zebrafish (Danio rerio) is an important model organism in biomedicine. Although the zebrafish (like other fishes) lacks neocortex, here we argue that this species can still be used to model various aspects and brain phenomena related to human cortical malformations. We also discuss novel perspectives in this field, covering both advantages and limitations of using mammalian and zebrafish models in cortical malformation research. Summarizing mounting evidence, we also highlight the importance of translationally-relevant insights into the pathogenesis of cortical malformations from animal models, and discuss future strategies of research in the field.
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Affiliation(s)
- Fabiano V Costa
- World-class Research Center "Center for Personalized Medicine", Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia
| | - Konstantin N Zabegalov
- Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia
| | - Tatiana O Kolesnikova
- World-class Research Center "Center for Personalized Medicine", Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia
| | | | - Maria M Kotova
- World-class Research Center "Center for Personalized Medicine", Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia
| | | | - Allan V Kalueff
- World-class Research Center "Center for Personalized Medicine", Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia; Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Laboratory of Preclinical Bioscreening, Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russian Federation, Pesochny, Russia; Ural Federal University, Yekaterinburg, Russia; Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia.
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Santos MV, Garcia CAB, Hamad APA, Costa UT, Sakamoto AC, Dos Santos AC, Machado HR. Clinical and Surgical Approach for Cerebral Cortical Dysplasia. Adv Tech Stand Neurosurg 2023; 48:327-354. [PMID: 37770690 DOI: 10.1007/978-3-031-36785-4_12] [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] [Indexed: 09/30/2023]
Abstract
The present article describes pathophysiological and clinical aspects of congenital malformations of the cerebral tissue (cortex and white matter) that cause epilepsy and very frequently require surgical treatment. A particular emphasis is given to focal cortical dysplasias, the most common pathology among these epilepsy-related malformations. Specific radiological and surgical features are also highlighted, so a thorough overview of cortical dysplasias is provided.
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Affiliation(s)
- Marcelo Volpon Santos
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil.
- Department of Surgery and Anantomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil.
| | - Camila Araujo Bernardino Garcia
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Paula Andrade Hamad
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Ursula Thome Costa
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Americo Ceiki Sakamoto
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Antonio Carlos Dos Santos
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Helio Rubens Machado
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
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5
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Cross JH, Reilly C, Gutierrez Delicado E, Smith ML, Malmgren K. Epilepsy surgery for children and adolescents: evidence-based but underused. THE LANCET CHILD & ADOLESCENT HEALTH 2022; 6:484-494. [DOI: 10.1016/s2352-4642(22)00098-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
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Licchetta L, Vignatelli L, Toni F, Teglia A, Beatrice Belotti LM, Ferri L, Menghi V, Mostacci B, Di Vito L, Bisulli F, Tinuper P. Long-term Outcome of Epilepsy and Cortical Malformations Due to Abnormal Migration and Postmigrational Development: A Cohort Study. Neurology 2022; 99:e23-e32. [PMID: 35410907 DOI: 10.1212/wnl.0000000000200352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the long-term outcome of patients with epilepsy and malformations of cortical development (MCD). METHODS We conducted a historical cohort study of patients with epilepsy and MCD due to impaired neuronal migration and postmigration organization, and with a follow-up period of ≥5 years. For each patient, MCD was classified after accurate neuroimaging reappraisal by an expert neuroradiologist. The primary outcome was remission, defined as a period of seizure freedom ≥5 years at any time from epilepsy onset. We used Kaplan-Meier estimates for survival analysis, and univariate and multivariate Cox regression analyses to evaluate baseline variables as possible factors associated with remission. RESULTS The cohort included 71 patients (M/F=31/40) with a 17-year median follow-up (1506 person-years). About half (49.3%) had heterotopia, 35.2% polymicrogyria, 7% lissencephaly and 8.5% had the combination of two MCD. The mean age at seizure onset was 12.4±7.2 years. Intellectual disability and neurological deficits were observed in 30.4% and 40.9%, respectively. More than 60% of patients had refractory epilepsy. In three patients who underwent epilepsy surgery, MCD diagnosis was confirmed by histology. At last visit, 44% of patients had been seizure-free during the previous year, however none of them had stopped anti-seizure medication. Thirty patients achieved remission (Remission group, 42.2%) at some point in their disease history, whereas 41 individuals (Non Remission group, 57.8%) had never been in remission for ≥5 years. The cumulative remission rate was 38% by 20 years from inclusion. In the Cox model, unilateral distribution of MCD (HR: 2.68, 95% CI: 1.04-6.92) and a low seizure frequency at onset (HR: 5.01, 95% CI: 1.12-22.5) were significantly associated with remission. CONCLUSIONS Patients with epilepsy and MCD showed a remission rate of 38% by 20 years from onset. Unilateral distribution of the MCD is associated with a three-fold probability of achieving remission. About 40% of patients showed a drug-sensitive condition with risk of relapse during their epilepsy course. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with epilepsy and MCD, unilateral MCD and low seizure frequency at onset are associated with achieving epilepsy remission.
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Affiliation(s)
- Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network EpiCARE, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network EpiCARE, Bologna, Italy
| | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neuroradiology Unit, Bologna, Italy
| | - Andrea Teglia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Laura Maria Beatrice Belotti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network EpiCARE, Bologna, Italy
| | - Lorenzo Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Veronica Menghi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network EpiCARE, Bologna, Italy
| | - Lidia Di Vito
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network EpiCARE, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network EpiCARE, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network EpiCARE, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Swanson LC, Ahmed R. Epilepsy Syndromes: Current Classifications and Future Directions. Neurosurg Clin N Am 2021; 33:113-134. [PMID: 34801136 DOI: 10.1016/j.nec.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This review describes the clinical presentations and treatment options for commonly recognized epilepsy syndromes in the pediatric age group, based on the 2017 International League Against Epilepsy classification. Structural epilepsies that are amenable to surgical intervention are discussed. Lastly, emerging technologies are reviewed that are expanding our knowledge of underlying epilepsy pathologies and will guide future syndromic classification systems including genetic testing and tissue repositories.
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Affiliation(s)
- Laura C Swanson
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. #18, Chicago, IL 60611, USA
| | - Raheel Ahmed
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, 1675 Highland Avenue #0002, Madison, WI 53705, USA.
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Adamczyk B, Węgrzyn K, Wilczyński T, Maciarz J, Morawiec N, Adamczyk-Sowa M. The Most Common Lesions Detected by Neuroimaging as Causes of Epilepsy. ACTA ACUST UNITED AC 2021; 57:medicina57030294. [PMID: 33809843 PMCID: PMC8004256 DOI: 10.3390/medicina57030294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
Epilepsy is a common neurological disorder characterized by chronic, unprovoked and recurrent seizures, which are the result of rapid and excessive bioelectric discharges in nerve cells. Neuroimaging is used to detect underlying structural abnormalities which may be associated with epilepsy. This paper reviews the most common abnormalities, such as hippocampal sclerosis, malformations of cortical development and vascular malformation, detected by neuroimaging in patients with epilepsy to help understand the correlation between these changes and the course, treatment and prognosis of epilepsy. Magnetic resonance imaging (MRI) reveals structural changes in the brain which are described in this review. Recent studies indicate the usefulness of additional imaging techniques. The use of fluorodeoxyglucose positron emission tomography (FDG-PET) improves surgical outcomes in MRI-negative cases of focal cortical dysplasia. Some techniques, such as quantitative image analysis, magnetic resonance spectroscopy (MRS), functional MRI (fMRI), diffusion tensor imaging (DTI) and fibre tract reconstruction, can detect small malformations—which means that some of the epilepsies can be treated surgically. Quantitative susceptibility mapping may become the method of choice in vascular malformations. Neuroimaging determines appropriate diagnosis and treatment and helps to predict prognosis.
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Excitatory/Inhibitory Synaptic Ratios in Polymicrogyria and Down Syndrome Help Explain Epileptogenesis in Malformations. Pediatr Neurol 2021; 116:41-54. [PMID: 33450624 DOI: 10.1016/j.pediatrneurol.2020.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The ratio between excitatory (glutamatergic) and inhibitory (GABAergic) inputs into maturing individual cortical neurons influences their epileptic potential. Structural factors during development that alter synaptic inputs can be demonstrated neuropathologically. Increased mitochondrial activity identifies neurons with excessive discharge rates. METHODS This study focuses on the neuropathological examinaion of surgical resections for epilepsy and at autopsy, in fetuses, infants, and children, using immunocytochemical markers, and electron microscopy in selected cases. Polymicrogyria and Down syndrome are highlighted. RESULTS Factors influencing afferent synaptic ratios include the following: (1) synaptic short-circuitry in fused molecular zones of adjacent gyri (polymicrogyria); (2) impaired development of dendritic spines decreasing excitation (Down syndrome); (3) extracellular keratan sulfate proteoglycan binding to somatic membranes but not dendritic spines may be focally diminished (cerebral atrophy, schizencephaly, lissencephaly, polymicrogyria) or augmented, ensheathing individual axons (holoprosencephaly), or acting as a barrier to axonal passage in the U-fiber layer. If keratan is diminished, glutamate receptors on the neuronal soma enable ectopic axosomatic excitatory synapses to form; (4) dysplastic, megalocytic neurons and balloon cells in mammalian target of rapamycin disorders; (5) satellitosis of glial cells displacing axosomatic synapses; (6) peri-neuronal inflammation (tuberous sclerosis) and heat-shock proteins. CONCLUSIONS Synaptic ratio of excitatory/inhibitory afferents is a major fundamental basis of epileptogenesis at the neuronal level. Neuropathology can demonstrate subcellular changes that help explain either epilepsy or lack of seizures in immature brains. Synaptic ratios in malformations influence postnatal epileptogenesis. Single neurons can be hypermetabolic and potentially epileptogenic.
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Scholl T, Gruber VE, Samueli S, Lehner R, Kasprian G, Czech T, Reinten RJ, Hoogendijk L, Hainfellner JA, Aronica E, Mühlebner A, Feucht M. Neurite Outgrowth Inhibitor (NogoA) Is Upregulated in White Matter Lesions of Complex Cortical Malformations. J Neuropathol Exp Neurol 2021; 80:274-282. [PMID: 33517425 DOI: 10.1093/jnen/nlaa159] [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: 11/14/2022] Open
Abstract
Complex cortical malformations (CCMs), such as hemimegalencephaly and polymicrogyria, are associated with drug-resistant epilepsy and developmental impairment. They share certain neuropathological characteristics including mammalian target of rapamycin (mTOR) activation and an atypical number of white matter neurons. To get a better understanding of the pathobiology of the lesion architecture, we investigated the role of neurite outgrowth inhibitor A (NogoA), a known regulator of neuronal migration. Epilepsy surgery specimens from 16 CCM patients were analyzed and compared with sections of focal cortical dysplasia IIB (FCD IIB, n = 22), tuberous sclerosis complex (TSC, n = 8) as well as healthy controls (n = 15). Immunohistochemistry was used to characterize NogoA, myelination, and mTOR signaling. Digital slides were evaluated automatically with ImageJ. NogoA staining showed a significantly higher expression within the white matter of CCM and FCD IIB, whereas cortical tubers presented levels similar to controls. Further analysis of possible associations of NogoA with other factors revealed a positive correlation with mTOR and seizure frequency. To identify the main expressing NogoA cell type, double staining revealed dysmorphic neuronal white matter cells. Increased NogoA expression is associated with profound inhibition of neuritic sprouting and therefore contributes to a decrease in neuronal network complexity in CCM patients.
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Affiliation(s)
- Theresa Scholl
- From the Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Victoria-Elisabeth Gruber
- From the Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sharon Samueli
- From the Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Reinhard Lehner
- Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Roy J Reinten
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisette Hoogendijk
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Eleonora Aronica
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands
| | - Angelika Mühlebner
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martha Feucht
- From the Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Sculier C, Taussig D, David O, Blustajn J, Ayoubian L, Bonheur J, Bulteau C, Chipaux M, Dorison N, Raffo E, Ferrand-Sorbets S, Dorfmüller G, Fohlen M. Focal polymicrogyria in children: Contribution of invasive explorations and epileptogenicity mapping in the surgical decision. Seizure 2021; 86:19-28. [PMID: 33517238 DOI: 10.1016/j.seizure.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Report of the contribution of invasive EEG (iEEG) and epileptogenicity mappings (EM) in a pediatric cohort of patients with epilepsy associated with focal polymicrogyria (PMG) and candidates for resective surgery. METHOD Retrospective pediatric case series of patients presenting focal PMG-related refractory epilepsy undergoing an invasive exploration (iEEG) at Fondation Rothschild Hospital. We reviewed clinical data, structural MRI, and visual analysis of iEEG recordings. Moreover, time-frequency analysis of SEEG signals with a neuroimaging approach (epileptogenicity maps) was used to support visual analysis. RESULTS Between 2012 and 2019, eight patients were selected. Five patients were explored with stereoelectroencephalography (SEEG) only, one patient with subdural exploration (SDE) only and two patients first underwent SEEG and then SDE. The mean age at seizure onset was 40.3 months (range 3-120), and the mean age for the iEEG 10.8 years (range 7-15). The epileptogenic zone (EZ) appeared concordant to the PMG lesion in only one case, was larger in three cases, smaller in two cases and different in one case. Four cases were selected for tailored resective surgery and one for total callosotomy. Two patients remained seizure-free at their last follow-up (mean 32.6 months, range 7-98). Epileptogenicity mapping (EM) refined the qualitative analysis, showing in four patients an EZ larger than visually defined. CONCLUSION This study is the first pediatric study to analyze the value of iEEG and EM as well as operability in focal PMG-related refractory epilepsy. The results illustrate the complexity of this pathology with variable concordance between the EZ and the lesion and mixed response to surgery.
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Affiliation(s)
- Claudine Sculier
- Département de Neurologie pédiatrique, Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Delphine Taussig
- Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France.
| | - Olivier David
- Univ. Grenoble Alpes, Inserm, GIN, Grenoble Institut des Neurosciences, 38000, Grenoble, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Jerry Blustajn
- Hôpital Fondation Rothschild, Imagerie médicale, Paris, France
| | - Leila Ayoubian
- Univ. Grenoble Alpes, Inserm, GIN, Grenoble Institut des Neurosciences, 38000, Grenoble, France
| | - Julie Bonheur
- Hôpital Fondation Rothschild, Neurochirurgie pédiatrique, Paris, France
| | - Christine Bulteau
- Hôpital Fondation Rothschild, Neurochirurgie pédiatrique, Paris, France; University of Paris, MC2Lab, Boulogne-Billancourt, France
| | - Mathilde Chipaux
- Hôpital Fondation Rothschild, Neurochirurgie pédiatrique, Paris, France
| | - Nathalie Dorison
- Hôpital Fondation Rothschild, Neurochirurgie pédiatrique, Paris, France
| | - Emmanuel Raffo
- Hôpital Fondation Rothschild, Neurochirurgie pédiatrique, Paris, France
| | | | - Georg Dorfmüller
- Hôpital Fondation Rothschild, Neurochirurgie pédiatrique, Paris, France
| | - Martine Fohlen
- Hôpital Fondation Rothschild, Neurochirurgie pédiatrique, Paris, France
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12
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Yang W, Williams A, Sun QQ. Circuit Mechanisms Underlying Epileptogenesis in a Mouse Model of Focal Cortical Malformation. Curr Biol 2020; 31:334-345.e4. [PMID: 33157021 DOI: 10.1016/j.cub.2020.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/23/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
Abstract
The way in which aberrant neural circuits contribute to epilepsy remains unclear. To elucidate this question, we dissected the circuit mechanisms underlying epileptogenesis using a mouse model of focal cortical malformation with spontaneous epileptiform discharges. We found that spontaneous spike-wave discharges and optogenetically induced hyperexcitable bursts in vivo were present in a cortical region distal to (>0.7 mm) freeze-lesion-induced microgyrus, instead of near the microgyrus. ChR2-assisted circuit mapping revealed ectopic inter-laminar excitatory input from infragranular layers to layers 2/3 pyramidal neurons as the key component of hyperexcitable circuitry. This hyperactivity disrupted the balance between excitation and inhibition and was more prominent in the cortical region distal to the microgyrus. Consistently, the inhibition from both parvalbumin-positive interneurons (PV) and somatostatin-positive interneurons (SOM) to pyramidal neurons were altered in a layer- and site-specific fashion. Finally, closed-loop optogenetic stimulation of SOM, but not PV, terminated spontaneous spike-wave discharges. Together, these results demonstrate the occurrence of highly site- and cell-type-specific synaptic reorganization underlying epileptic cortical circuits and provide new insights into potential treatment strategies.
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Affiliation(s)
- Weiguo Yang
- Department of Zoology and Physiology, University of Wyoming, Laramie, WY 82071, USA
| | - Anthony Williams
- Department of Zoology and Physiology, University of Wyoming, Laramie, WY 82071, USA
| | - Qian-Quan Sun
- Department of Zoology and Physiology, University of Wyoming, Laramie, WY 82071, USA; Wyoming Sensory Biology Center of Biomedical Research Excellence, University of Wyoming, Laramie, WY 82071, USA.
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13
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Zhang H, Li Y, Liu B, Shen L, Wang S, Yao H. Hypothalamic Hamartoma, Gray Matter Heterotopia, and Polymicrogyria in a Boy: Case Report and Literature Review. World Neurosurg 2020; 142:396-400. [PMID: 32711148 DOI: 10.1016/j.wneu.2020.07.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hypothalamic hamartomas (HHs) are rare, and it is even rarer when combined with gray matter heterotopia (GMH) and polymicrogyria (PMG). CASE DESCRIPTION A 5-year-old boy with HH, GMH, and PMG was retrospectively evaluated. The clinical data, including the symptoms, examinations, diagnosis, and treatment, were collected. The patient had a chief complaint of gelastic seizures and intellectual deficiency. Brain magnetic resonance imaging showed HH, paraventricular nodular heterotopia, and PMG. Video electroencephalographs were normal. The patient underwent resection of the HH via transcallosal transseptal interforniceal approach. Seizures disappeared immediately after complete resection of HH, and the intellectual development improved. CONCLUSIONS In this extremely rare case, resection of the HH eliminated the symptoms. Nonetheless, we still need to be cautious about the possible epilepsy that may be caused by GMH and PMG.
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Affiliation(s)
- Hongwu Zhang
- Department of Pediatric Surgery, Peking University First Hospital, Beijing, China
| | - Yu Li
- Department of Pediatric Surgery, Peking University First Hospital, Beijing, China
| | - Baofu Liu
- Department of Pediatric Surgery, Peking University First Hospital, Beijing, China
| | - Lixue Shen
- Department of Pediatric Surgery, Peking University First Hospital, Beijing, China
| | - Shulei Wang
- Department of Pediatric Surgery, Peking University First Hospital, Beijing, China
| | - Hongxin Yao
- Department of Pediatric Surgery, Peking University First Hospital, Beijing, China.
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14
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Taussig D, Chipaux M, Fohlen M, Dorison N, Bekaert O, Ferrand-Sorbets S, Dorfmüller G. Invasive evaluation in children (SEEG vs subdural grids). Seizure 2020; 77:43-51. [DOI: 10.1016/j.seizure.2018.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/09/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022] Open
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15
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Liu Y, Zhou W, Hong B, Zhao T, Xu C, Ruan J, Bai J, Wang S. Multiple Stereoelectroencephalography-Guided Radiofrequency Thermocoagulations for Polymicrogyria With Startle Seizures: A Case Report. Front Neurol 2019; 10:1095. [PMID: 31681156 PMCID: PMC6813566 DOI: 10.3389/fneur.2019.01095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/30/2019] [Indexed: 01/01/2023] Open
Abstract
The best results of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) were observed in epilepsies with more limited lesions, but this procedure is rarely used in a wide range of brain malformation. We report a rare case of polymicrogyria (PMG) combined with drug-resistant startle seizures. Presurgical monitoring was performed using SEEG owing to the large lesion and complexity of PMG. According to the intracranial electrode results, the seizure onset was extensive, with the onset starting earlier in the cingulate sulcus and insular pole than in other sites of the other electrodes. Multi-point and multi-step SEEG-guided RF-TC was used for diffuse lesion and functional protection. RF-TC was first applied to the cingulate sulcus and insular pole, and our patient was rendered free from startle seizures after 2 weeks. Two weeks of observation helped us to observe the efficacy of RF-TC and the changes of SEEG, so as to make the next TC scheme. The patient still had spontaneous seizures after the first treatment. RF-TC was then applied to other sites involved earlier. Finally, the patient reached Engel class IIa for a follow-up period of 1 year. There were no additional startle seizures, and important functional areas were protected.
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Affiliation(s)
- Yi'Ou Liu
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Wenjing Zhou
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Bo Hong
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Tong Zhao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chengwei Xu
- Inner Mongolia People's Hospital, Inner Mongolia Autonomous Region, Hohhot, China
| | - Jing Ruan
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Jianjun Bai
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Siyu Wang
- Tsinghua University Yuquan Hospital, Beijing, China
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16
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Parasagittal hemispherotomy in hemispheric polymicrogyria with electrical status epilepticus during slow sleep: Indications, results and follow-up. Seizure 2019; 71:190-200. [DOI: 10.1016/j.seizure.2019.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/04/2019] [Accepted: 07/20/2019] [Indexed: 11/17/2022] Open
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17
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Lenge M, Barba C, Montanaro D, Aghakhanyan G, Frijia F, Guerrini R. Relationships Between Morphologic and Functional Patterns in the Polymicrogyric Cortex. Cereb Cortex 2019; 28:1076-1086. [PMID: 28334078 DOI: 10.1093/cercor/bhx036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
Abstract
Polymicrogyria is a malformation of cortical folding and layering underlying different cognitive and neurological manifestations. The polymicrogyric cortex has heterogeneous morphofunctional patterns, qualitatively described at magnetic resonance imaging (MRI) by variable severity gradients and functional activations. We investigated the link between abnormal cortical folding and cortical function in order to improve surgical planning for patients with polymicrogyria and intractable epilepsy. We performed structural and functional MRI on 14 patients with perisylvian polymicrogyria and adopted surface-based methods to detect alterations of cortical thickness (CT) and local gyrification index (LGI) compared with normal cortex (30 age-matched subjects). We quantitatively assessed the grade of anatomic disruption of the polymicrogyric cortex and defined its relationship with decreased cortical function. We observed a good matching between visual analysis and morphometric measurements. CT maps revealed sparse clusters of thickening, while LGI maps disclosed circumscribed regions of maximal alteration with a uniformly decreasing centrifugal gradient. In polymicrogyric areas in which gyral and sulcal patterns were preserved, functional activation maintained the expected location, but was reduced in extent. Morphofunctional correlations, evaluated along cortico-cortical paths between maximum morphologic alterations and significant activations, identified an interindividual threshold for LGI (z-value = -1.09) beyond which functional activations were no longer identifiable.
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Affiliation(s)
- Matteo Lenge
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, 50139 Florence, Italy
| | - Carmen Barba
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, 50139 Florence, Italy
| | | | | | - Francesca Frijia
- Unit of Neuroradiology.,U.O.C. Bioingegneria e Ingegneria Clinica, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, 50139 Florence, Italy.,IRCCS Stella Maris Foundation, 56018 Calambrone, Pisa, Italy
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18
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Malformazioni dello sviluppo corticale. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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19
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Electrical cortical stimulation for refractory focal epilepsy: A long-term follow-up study. Epilepsy Res 2019; 151:24-30. [DOI: 10.1016/j.eplepsyres.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/25/2018] [Accepted: 01/06/2019] [Indexed: 11/24/2022]
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20
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Jalloh I, Cho N, Nga VD, Whitney R, Jain P, Al-Mehmadi S, Yau I, Okura H, Widjaja E, Otsubo H, Ochi A, Donner E, McCoy B, Drake J, Go C, Rutka JT. The role of surgery in refractory epilepsy secondary to polymicrogyria in the pediatric population. Epilepsia 2018; 59:1982-1996. [DOI: 10.1111/epi.14556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Ibrahim Jalloh
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
| | - Newton Cho
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
| | - Vincent D.W. Nga
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
- Division of Neurosurgery; National University Hospital; Singapore City Singapore
| | - Robyn Whitney
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Puneet Jain
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
- Division of Pediatric Neurology; Department of Pediatrics; BLK Super Speciality Hospital; New Delhi India
| | - Sameer Al-Mehmadi
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Ivanna Yau
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Hidehiro Okura
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
- Department of Neurosurgery; Juntendo University School of Medicine; Tokyo Japan
| | - Elysa Widjaja
- Division of Diagnostic Imaging; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Hiroshi Otsubo
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Ayako Ochi
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Elizabeth Donner
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Blathnaid McCoy
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - James Drake
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
| | - Cristina Go
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - James T. Rutka
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
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21
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Baba S, Okanishi T, Nishimura M, Kanai S, Itamura S, Suzuki T, Masuda Y, Enoki H, Fujimoto A. Effectiveness of total corpus callosotomy for diffuse bilateral polymicrogyria: Report of three pediatric cases. Brain Dev 2018; 40:719-723. [PMID: 29622280 DOI: 10.1016/j.braindev.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/08/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Polymicrogyria, a malformation of the cerebral cortex, frequently causes epilepsy. Diffuse bilateral polymicrogyria (DBP) is related to poor epilepsy prognosis, but most patients with DBP are not good candidates for resective epilepsy surgery and effectiveness of corpus callosotomy (CC), a palliative surgery, for patients without resective epileptogenic cortices, has not been established in DBP. Because CC might be effective against DBP-related epilepsy, we conducted total CC in three pediatric DBP cases. METHODS Case 1. A girl developed epilepsy at 3 months of age, with focal versive seizures and epileptic spasms. The electroencephalogram (EEG) showed a suppression-burst pattern. Total CC was performed at 6 months of age. Case 2. A female infant developed epilepsy on the day of birth, exhibiting epileptic spasms, generalized tonic-clonic seizures, and eye-deviating seizures. She had a history of clusters of tonic seizures. Total CC was performed at 1 year and 2 months of age. After CC, the epileptic focus of the tonic seizures was identified; a secondary resective surgery was conducted. Case 3. A girl developed multiple types of seizures at 3 years of age. Frequent atypical absence status was refractory to antiepileptic drugs. Total CC was conducted at 8 years of age. RESULTS Case 1: Frequencies of both seizure types decreased. The background EEG changed to continuous high-voltage slow waves. Case 2: Clusters of tonic seizures were well-controlled. Case 3: Atypical absence seizures completely disappeared. CONCLUSION CC could be effective for patients with DBP, whose habitual seizures include epileptic spasms and absence seizures.
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Affiliation(s)
- Shimpei Baba
- Department of Child Neurology, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tohru Okanishi
- Department of Child Neurology, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
| | - Mitsuyo Nishimura
- Laboratory of Neurophysiology, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Sotaro Kanai
- Department of Child Neurology, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Shinji Itamura
- Department of Child Neurology, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Takayuki Suzuki
- Division of Radiological Technology, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yosuke Masuda
- Comprehensive Epilepsy Center, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Hideo Enoki
- Department of Child Neurology, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei-Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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22
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Jayakar P, Jayakar A, Libenson M, Arzimanoglou A, Rydenhag B, Cross JH, Bhatia S, Tassi L, Lachhwani D, Gaillard WD. Epilepsy surgery near or in eloquent cortex in children-Practice patterns and recommendations for minimizing and reporting deficits. Epilepsia 2018; 59:1484-1491. [PMID: 30033517 DOI: 10.1111/epi.14510] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 06/13/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE We aimed to investigate the current practices guiding surgical resection strategies involving epileptogenic zones (EZs) near or in eloquent cortex (EC) at pediatric epilepsy surgery centers worldwide. METHODS A survey was conducted among 40 respondents from 33 pediatric epilepsy surgery centers worldwide on the weight assigned to diagnostic tests used to define the EZ and EC, how EC is viewed, and how surgeries are planned for foci near or in eloquent cortex. RESULTS A descriptive analysis was performed that revealed considerable variation in the use of diagnostic tests and resective strategies toward EZ and EC. SIGNIFICANCE The wide variation in strategies may contribute to undesirable outcomes characterized by poor seizure control with added deficits and underscores the need to establish best practices in pediatric epilepsy surgery. The survey data were used to formulate a set of recommendations to help minimize deficits and to report them consistently.
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Affiliation(s)
- Prasanna Jayakar
- Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
| | - Anuj Jayakar
- Department of Neurology and Epilepsy, Nicklaus Children's Hospital, Miami, Florida
| | - Mark Libenson
- Department of Neurology, Children's Hospital Boston, Boston, Massachusetts
| | - Alexis Arzimanoglou
- Clinical Epileptology, Sleep Disorders and Functional Neurology in Children, University Hospitals of Lyon, Lyon, France
| | - Bertil Rydenhag
- Epilepsy Research Group, Institute of Neuroscience and Physiology, Goteborg, Sweden
| | - J Helen Cross
- Department of Clinical & Experimental Epilepsy, Great Ormond Street Hospital, University College London, London, UK
| | - Sanjiv Bhatia
- Department of Neurosurgery, Miami Children's Hospital, Miami, Florida
| | - Laura Tassi
- Department of Neuroscience, Claudio Munari Epilepsy Surgery Centre, Milano, Italy
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23
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Maillard LG, Tassi L, Bartolomei F, Catenoix H, Dubeau F, Szurhaj W, Kahane P, Nica A, Marusic P, Mindruta I, Chassoux F, Ramantani G. Stereoelectroencephalography and surgical outcome in polymicrogyria-related epilepsy: A multicentric study. Ann Neurol 2017; 82:781-794. [PMID: 29059488 DOI: 10.1002/ana.25081] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to (1) assess the concordance between various polymicrogyria (PMG) types and the associated epileptogenic zone (EZ), as defined by stereoelectroencephalography (SEEG), and (2) determine the postsurgical seizure outcome in PMG-related drug-resistant epilepsy. METHODS We retrospectively analyzed 58 cases: 49 had SEEG and 39 corticectomy or hemispherotomy. RESULTS Mean age at SEEG or surgery was 28.3 years (range, 2-50). PMG was bilateral in 9 (16%) patients and unilateral in 49, including 17 (29%) unilobar, 12 (21%) multilobar, 15 (26%) perisylvian, and only 5 (9%) hemispheric. Twenty-eight (48%) patients additionally had schizencephaly, heterotopia, or focal cortical dysplasia. The SEEG-determined EZ was fully concordant with the PMG in only 8 (16%) cases, partially concordant in 74%, and discordant in 10%. The EZ included remote cortical areas in 21 (43%) cases and was primarily localized in those in 5 (10%), all related to the mesial temporal structures. All but 1 PMG patient with corticectomy or hemispherotomy had a unilateral PMG. At last follow-up (mean, 4.6 years; range, 1-16), 28 (72%) patients remained seizure free. Shorter epilepsy duration to surgery was an independent predictor of seizure freedom. INTERPRETATION PMG-related drug-resistant epilepsy warrants a comprehensive presurgical evaluation, including SEEG investigations in most cases, given that the EZ may only partially overlap with the PMG or include solely remote cortical areas. Seizure freedom is feasible in a large proportion of patients. PMG extent should not deter from exploring the possibility of epilepsy surgery. Our data support the early consideration of epilepsy surgery in this patient group. Ann Neurol 2017;82:781-794.
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Affiliation(s)
- Louis Georges Maillard
- Research Center for Automatic Control of Nancy (CRAN), University of Lorraine, CNRS, UMR 7039, Vandoeuvre, France.,Department of Neurology, Central University Hospital (CHU) Nancy, Nancy, France.,Medical Faculty, University of Lorraine, Nancy, France
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Fabrice Bartolomei
- Aix Marseille University, Institute of Systems Neuroscience, Marseille, France.,AP-HM, Hospital de la Timone, Department of Clinical Neurophysiology, Marseille, France
| | - Hélène Catenoix
- Functional Neurology and Epileptology Department, Pierre Wertheimer Neurological Hospital, Lyon, France
| | - François Dubeau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada
| | - William Szurhaj
- Epilepsy Unit, Lille University Medical Centre, Lille, France.,INSERM U1171, University of Lille, France
| | - Philippe Kahane
- Department of Neurology, Central University Hospital, Grenoble, France.,INSERM U1216, Grenoble Neuroscience Institute, Grenoble, France.,University Grenoble Alpes, Grenoble, France
| | - Anca Nica
- Neurology Department, CHU, Rennes, France.,INSERM, U1099, Rennes, France
| | - Petr Marusic
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Ioana Mindruta
- Department of Neurology, University Emergency Hospital, Bucharest, Romania.,Department of Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Georgia Ramantani
- Research Center for Automatic Control of Nancy (CRAN), University of Lorraine, CNRS, UMR 7039, Vandoeuvre, France.,Child Neurology, University Children's Hospital, Zurich, Switzerland.,Swiss Epilepsy Center, Zurich, Switzerland
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24
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Cossu M, Pelliccia V, Gozzo F, Casaceli G, Francione S, Nobili L, Mai R, Castana L, Sartori I, Cardinale F, Lo Russo G, Tassi L. Surgical treatment of polymicrogyria-related epilepsy. Epilepsia 2016; 57:2001-2010. [PMID: 27778326 DOI: 10.1111/epi.13589] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The role of resective surgery in the treatment of polymicrogyria (PMG)-related focal epilepsy is uncertain. Our aim was to retrospectively evaluate the seizure outcome in a consecutive series of patients with PMG-related epilepsy who received, or did not receive, surgical treatment, and to outline the clinical characteristics of patients who underwent surgery. METHODS We evaluated 64 patients with epilepsy associated with magnetic resonance imaging (MRI)-documented PMG. After presurgical evaluation, 32 patients were excluded from surgical treatment and 32 were offered surgery, which was declined by 8 patients. Seizure outcome was assessed in the 40 nonsurgical and 24 surgical patients. RESULTS Of 40 nonsurgical patients, 8 (20%) were seizure-free after a mean follow-up of 91.7 ± (standard deviation) 59.5 months. None of the eight patients who declined surgical treatment was seizure-free (mean follow-up: 74.3 ± 60.6 months). These seizure outcomes differ significantly (p = 0.000005 and p = 0.0003, respectively) from that of the 24 surgical patients, 18 of whom (66.7%) were Engel's class I postoperatively (mean follow-up: 66.5 ± 54.0 months). Of the eight patients excluded from surgery for seizure control at first visit, two had seizure recurrence at last contact. At last contact, antiepileptic drugs (AEDs) had been withdrawn in 6 of 24 surgical and in one of 40 nonsurgical cases (p = 0.0092). SIGNIFICANCE The present study indicates that, at least in a subset of adequately selected patients with PMG-related epilepsy, surgery may provide excellent seizure outcomes. Furthermore, it suggests that surgery is superior to AEDs for achieving seizure freedom in these cases.
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Affiliation(s)
- Massimo Cossu
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Veronica Pelliccia
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Francesca Gozzo
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Giuseppe Casaceli
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Stefano Francione
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Lino Nobili
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Roberto Mai
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Laura Castana
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Ivana Sartori
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Francesco Cardinale
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Giorgio Lo Russo
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Laura Tassi
- Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
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Jayakar P, Gotman J, Harvey AS, Palmini A, Tassi L, Schomer D, Dubeau F, Bartolomei F, Yu A, Kršek P, Velis D, Kahane P. Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques. Epilepsia 2016; 57:1735-1747. [PMID: 27677490 DOI: 10.1111/epi.13515] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 12/21/2022]
Abstract
Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography (IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary across epilepsy surgical centers; each modality has its advantages and limitations. IEEG can be performed in the same intraoperative setting, that is, intraoperative electrocorticography, or through an independent implantation procedure with chronic extraoperative recordings; the latter are not only resource intensive but also carry risk. A lack of understanding of IEEG limitations predisposes to data misinterpretation that can lead to denying surgery when indicated or, worse yet, incorrect resection with adverse outcomes. Given the lack of class 1 or 2 evidence on IEEG, a consensus-based expert recommendation on the diagnostic utility of IEEG is presented, with emphasis on the application of various modalities in specific substrates or locations, taking into account their relative efficacy, safety, ease, and incremental cost-benefit. These recommendations aim to curtail outlying indications that risk the over- or underutilization of IEEG, while retaining substantial flexibility in keeping with most standard practices at epilepsy centers and addressing some of the needs of resource-poor regions around the world.
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Affiliation(s)
- Prasanna Jayakar
- Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A
| | - Jean Gotman
- Montreal Neurological Hospital and Institute, McGill University, Montréal, Quebec, Canada
| | - A Simon Harvey
- The Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - André Palmini
- Services of Neurology and Neurosurgery, Hospital São Lucas, Porto Alegre, Brazil
| | - Laura Tassi
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Francois Dubeau
- Montreal Neurological Hospital and Institute, McGill University, Montréal, Quebec, Canada
| | - Fabrice Bartolomei
- Service of Neurophysiology Clinic, Public Hospital of Marseille, Marseille, France
| | - Alice Yu
- Neurology Department, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Pavel Kršek
- Department of Pediatric Neurology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Demetrios Velis
- Epilepsy Surgery Program, Free University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Philippe Kahane
- GIN INSERM U1216, Grenoble-Alpes Hospital and University, Grenoble, France
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