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Slegers R, Wagner L, van Kuijk S, Hilkman D, Hofman P, van Hoof R, Jansen J, van Kranen-Mastenbroek V, Rijkers K, Tousseyn S, Colon A, Schijns O. Stereo-electroencephalography-guided radiofrequency thermocoagulation restricted to periventricular nodular heterotopias in patients with drug-resistant epilepsy: A single center experience. Seizure 2024; 121:105-113. [PMID: 39146706 DOI: 10.1016/j.seizure.2024.07.016] [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: 06/05/2024] [Revised: 07/08/2024] [Accepted: 07/23/2024] [Indexed: 08/17/2024] Open
Abstract
INTRODUCTION Periventricular nodular heterotopias (PVNH) are developmental abnormalities with neurons abnormally clustered around the cerebral ventricles. Patients frequently present with focal drug-resistant epilepsy (DRE). However, the relationship between PVNH and the seizure onset zone (SOZ) is complex. Stereo-electroencephalography (SEEG) is an invasive diagnostic procedure for patients with DRE. In selected patients, the SEEG may be converted into a therapeutic procedure, lesioning the probable (SOZ) with pulsed radiofrequency thermocoagulation (RFTC). The aim of our study was to evaluate the efficacy and safety of SEEG-RFTC in a series of DRE patients with PVNH. METHODS Twenty-four patients with focal DRE related to PVNH and treated with SEEG-guided-RFTC restricted to nodules were prospectively collected between 2016 and 2023 and retrospectively analyzed after a follow-up of at least 12 months. RESULTS Seventeen patients (71 %) responded (ILAE class 1-4) after SEEG-guided RFTC of whom eleven (46 %) became seizure-free (class 1) at last follow up, nine (45 %) despite residual PVNH tissue on MRI. SEEG seizure onset was restricted to PVNH in eleven patients (class 1 in 45 %) and simultaneously in PVNH and other cortical areas in thirteen patients (class 1 in 46 %). Out of 31 SEEG-RFTC procedures in twenty-four patients, adverse events, related to RFTC, were recorded in eight (26 %), of which two patients (8 %) had predicted permanent visual complaints whilst the other five had transient complaints. SIGNIFICANCE This study demonstrates that a considerable percentage of patients, even with bilateral, multiple PVNH and involvement of adjacent cortical regions can be rendered seizure-free with SEEG-guided-RFTC restricted to the nodules. Furthermore, this study delivers evidence that the complete destruction of the entire nodule is not necessary to render a patient seizure free. This justifies the use of SEEG in patients with single, multiple or bilateral PVNHs to provide insight into the epileptogenic organization in and around these lesions.
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Affiliation(s)
- Rutger Slegers
- Department of Neurosurgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands
| | - Louis Wagner
- Department of Neurosurgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands.
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht (UMC+), the Netherlands
| | - Danny Hilkman
- Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands; Department of Clinical Neurophysiology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Paul Hofman
- Mental Health and Neuroscience (MHeNS) Research Institute, University Maastricht (UM), Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Raf van Hoof
- Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands
| | - Jacobus Jansen
- Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands; Mental Health and Neuroscience (MHeNS) Research Institute, University Maastricht (UM), Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre (MUMC+), the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Vivianne van Kranen-Mastenbroek
- Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands; Department of Clinical Neurophysiology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Kim Rijkers
- Department of Neurosurgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands; Mental Health and Neuroscience (MHeNS) Research Institute, University Maastricht (UM), Maastricht, the Netherlands
| | - Simon Tousseyn
- Department of Neurosurgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands; Mental Health and Neuroscience (MHeNS) Research Institute, University Maastricht (UM), Maastricht, the Netherlands
| | - Albert Colon
- Department of Neurosurgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands; Centre de les Etudes et traitement de l' epilepsie, CETE, centre hospitalier universitaire Martinique, Fort-de-France, France
| | - Olaf Schijns
- Department of Neurosurgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands; Mental Health and Neuroscience (MHeNS) Research Institute, University Maastricht (UM), Maastricht, the Netherlands
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Liu Q, Cai Y, Mao Z, Chen W, Chen B, Chen W, Zhang C, Lu Y, Xu J, He D. SEEG-RFTC in patients with refractory focal epilepsy: real-world outcomes from 121 cases. Ann Clin Transl Neurol 2024; 11:1999-2007. [PMID: 38968332 PMCID: PMC11330216 DOI: 10.1002/acn3.52117] [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: 03/04/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE Radiofrequency thermocoagulation (RFTC) has emerged as an effective and safe treatment method for patients with refractory focal epilepsy, when stereo-electroencephalography (SEEG) is implanted. Although real-world research results are still limited, a considerable number of patients have shown favorable outcomes with this less invasive method. This study aims to describe the outcomes and predictive factors of SEEG-RFTC in real-world research. METHODS A retrospective observational study was conducted on patients in the authors' epilepsy center. In total, 121 patients who underwent RFTC were included in the study. Post-RFTC outcomes were evaluated using the seizure-free rate and response rate (seizure frequency reduction more than 50%). Predictive factors influencing post-RFTC outcome were considered by comparing different variables. RESULTS The mean follow-up period was 18.3 months. Eighty-two patients (67.8%) were responders and 54 (44.6%) were seizure free. In 36 patients with malformation of cortical development, the seizure-free rate and the response rate were 69.44% and 83.33%, respectively. In 20 patients with hippocampal sclerosis, 19 patients were responders and 14 (70%) patients were seizure free at the last follow-up. The MRI feature and etiology of epilepsy are correlated with the outcome. MR-positive is a predictive factor for seizure freedom (p < 0.01) and responders (p < 0.01). Other factors have no predictive value for post-RFTC outcome. INTERPRETATION SEEG-RFTC is a safe procedure and yields favorable outcomes in numerous cases of focal DRE. The MRI feature and etiology of epilepsy are correlated with the seizure-free rate and response rate. And MRI positivity is the predictor for good RFTC outcome.
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Affiliation(s)
- Qiangqiang Liu
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiP. R. China
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Yanqing Cai
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Ziyu Mao
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Wenze Chen
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Bin Chen
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Wenzhen Chen
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiP. R. China
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Chencheng Zhang
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiP. R. China
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Yong Lu
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Jiwen Xu
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiP. R. China
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Dake He
- Department of Children NeurologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP. R. China
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Wu S, Issa NP, Rose SL, Haider HA, Nordli DR, Towle VL, Warnke PC, Tao JX. Depth versus surface: A critical review of subdural and depth electrodes in intracranial electroencephalographic studies. Epilepsia 2024; 65:1868-1878. [PMID: 38722693 DOI: 10.1111/epi.18002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/05/2024] [Accepted: 04/24/2024] [Indexed: 07/17/2024]
Abstract
Intracranial electroencephalographic (IEEG) recording, using subdural electrodes (SDEs) and stereoelectroencephalography (SEEG), plays a pivotal role in localizing the epileptogenic zone (EZ). SDEs, employed for superficial cortical seizure foci localization, provide information on two-dimensional seizure onset and propagation. In contrast, SEEG, with its three-dimensional sampling, allows exploration of deep brain structures, sulcal folds, and bihemispheric networks. SEEG offers the advantages of fewer complications, better tolerability, and coverage of sulci. Although both modalities allow electrical stimulation, SDE mapping can tessellate cortical gyri, providing the opportunity for a tailored resection. With SEEG, both superficial gyri and deep sulci can be stimulated, and there is a lower risk of afterdischarges and stimulation-induced seizures. Most systematic reviews and meta-analyses have addressed the comparative effectiveness of SDEs and SEEG in localizing the EZ and achieving seizure freedom, although discrepancies persist in the literature. The combination of SDEs and SEEG could potentially overcome the limitations inherent to each technique individually, better delineating seizure foci. This review describes the strengths and limitations of SDE and SEEG recordings, highlighting their unique indications in seizure localization, as evidenced by recent publications. Addressing controversies in the perceived usefulness of the two techniques offers insights that can aid in selecting the most suitable IEEG in clinical practice.
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Affiliation(s)
- Shasha Wu
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sandra L Rose
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Hiba A Haider
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Douglas R Nordli
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Vernon L Towle
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
| | - James X Tao
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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Du C, Jin W, Wang L, Yan J, Li G, Wu Y, Zhao G, Cui D, Yin S. Stereoelectroencephalography-guided radiofrequency thermocoagulation of the epileptogenic zone: a potential treatment and prognostic indicator for subsequent excision surgery. Acta Neurochir (Wien) 2024; 166:210. [PMID: 38735896 DOI: 10.1007/s00701-024-06106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) for drug-resistant focal epilepsy and investigate the relationship between post-RFTC remission duration and delayed excision surgery effectiveness. METHODS We conducted a retrospective analysis of 43 patients with drug-resistant focal epilepsy who underwent RFTC via SEEG electrodes. After excluding three, the remaining 40 were classified into subgroups based on procedures and outcomes. Twenty-four patients (60%) underwent a secondary excision surgery. We determined the predictive value of RFTC outcome upon subsequent surgical outcome by categorizing the delayed secondary surgery outcome as success (Engel I/II) versus failure (Engel III/IV). Demographic information, epilepsy characteristics, and the duration of seizure freedom after RFTC were assessed. RESULTS Among 40 patients, 20% achieved Engel class I with RFTC alone, while 24 underwent delayed secondary excision surgery. Overall, 41.7% attained Engel class I, with a 66.7% success rate combining RFTC with delayed surgery. Seizure freedom duration was significantly longer in the success group (mean 4.9 months, SD = 2.7) versus the failure group (mean 1.9 months, SD = 1.1; P = 0.007). A higher proportion of RFTC-only and delayed surgical success group patients had preoperative lesional findings (p = 0.01), correlating with a longer time to seizure recurrence (p < 0.05). Transient postoperative complications occurred in 10%, resolving within a year. CONCLUSION This study demonstrates that SEEG-guided RFTC is a safe and potential treatment option for patients with drug-resistant focal epilepsy. A prolonged duration of seizure freedom following RFTC may serve as a predictive marker for the success of subsequent excision surgery.
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Affiliation(s)
- Chuan Du
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Weipeng Jin
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Le Wang
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Jingtao Yan
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Guangfeng Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Yuzhang Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Guangrui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Deqiu Cui
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Shaoya Yin
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
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Tran A, Bunch M. Seizure freedom without seizure medication following stereoelectroencephalography implantation: a case report of drug-resistant post-traumatic epilepsy. Front Neurol 2024; 15:1391439. [PMID: 38725650 PMCID: PMC11079211 DOI: 10.3389/fneur.2024.1391439] [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: 02/25/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
Achieving seizure freedom following failure of several antiseizure medications (ASMs) is rare, with the likelihood of achieving further control decreasing with each successive ASM trial. When cases of drug-resistant epilepsy arise, a diagnostic procedure known as stereoelectroencephalography (sEEG) can be used to identify epileptogenic zones (EZ) within the brain. After localization of these zones, they can be targeted for future surgical intervention. Here, we describe a case of complete seizure freedom off medication after sEEG without resection or other therapeutic intervention. In 2017, a 36-year-old right-handed male presented with drug-resistant epilepsy stemming from prior traumatic brain injury. Due to ongoing seizures, in 2020 a robotic-assisted sEEG electrode placement procedure was employed to localize the seizure onset zone. During sEEG monitoring, a single event was captured where the patient had dysarthric speech, left arm dystonic flexion, and difficulty responding to questioning. Notably, this event had no sEEG correlate, suggesting seizure occurrence in a region not monitored by implanted electrodes, which prompted the placement of scalp electrodes following this event. However, no further clinical events consistent with seizure were provoked through the remainder of recording. Following the 13-day admission, the patient chose to self-discontinue all seizure medications and has remained seizure free as of October 2023, more than 3.5 years later. While sEEG is considered a relatively safe procedure for seizure localization in drug resistant epilepsy, the possibility of microlesions created by sEEG depth electrodes remains largely unexplored. Further evaluation should be performed into potential tissue injury produced by depth electrode insertion.
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Zanello M, Garnier E, Carron R, Jegou A, Lagarde S, Makhalova J, Medina S, Bénar CG, Bartolomei F, Pizzo F. Stereo-EEG-based ictal functional connectivity in patients with periventricular nodular heterotopia-related epilepsy. Epilepsia 2024; 65:e47-e54. [PMID: 38345420 DOI: 10.1111/epi.17891] [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: 10/17/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 04/16/2024]
Abstract
Nodular heterotopia (NH)-related drug-resistant epilepsy is challenging due to the deep location of the NH and the complexity of the underlying epileptogenic network. Using ictal stereo-electroencephalography (SEEG) and functional connectivity (FC) analyses in 14 patients with NH-related drug-resistant epilepsy, we aimed to determine the leading structure during seizures. For this purpose, we compared node IN and OUT strength between bipolar channels inside the heterotopia and inside gray matter, at the group level and at the individual level. At seizure onset, the channels within NH belonging to the epileptogenic and/or propagation network showed higher node OUT-strength than the channels within the gray matter (p = .03), with higher node OUT-strength than node IN-strength (p = .03). These results are in favor of a "leading" role of NH during seizure onset when involved in the epileptogenic- or propagation-zone network (50% of patients). However, when looking at the individual level, no significant difference between NH and gray matter was found, except for one patient (in two of three seizures). This result confirms the heterogeneity and the complexity of the epileptogenic network organization in NH and the need for SEEG exploration to characterize more precisely patient-specific epileptogenic network organization.
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Affiliation(s)
- Marc Zanello
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, Paris, France
| | - Elodie Garnier
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Romain Carron
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Stereotactic and Functional Neurosurgery, Marseille, France
| | - Aude Jegou
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Stanislas Lagarde
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Julia Makhalova
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- APHM La Timone, CEMEREM, Marseille, France
| | - Samuel Medina
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Christian-G Bénar
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Fabrice Bartolomei
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
| | - Francesca Pizzo
- INSERM, INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
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Huang Q, Xie P, Zhou J, Ding H, Liu Z, Li T, Guan Y, Wang M, Wang J, Teng P, Zhu M, Ma K, Wu H, Luan G, Zhai F. Predictors of seizure outcomes in stereo-electroencephalography-guided radio-frequency thermocoagulation for MRI-negative epilepsy. Ther Adv Chronic Dis 2024; 15:20406223241236258. [PMID: 38496233 PMCID: PMC10943718 DOI: 10.1177/20406223241236258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Background One-third of intractable epilepsy patients have no visually identifiable focus for neurosurgery based on imaging tests [magnetic resonance imaging (MRI)-negative cases]. Stereo-electroencephalography-guided radio-frequency thermocoagulation (SEEG-guided RF-TC) is utilized in the clinical treatment of epilepsy to lower the incidence of complications post-open surgery. Objective This study aimed to identify prognostic factors and long-term seizure outcomes in SEEG-guided RF-TC for patients with MRI-negative epilepsy. Design This was a single-center retrospective cohort study. Methods We included 30 patients who had undergone SEEG-guided RF-TC at Sanbo Brain Hospital, Capital Medical University, from April 2015 to December 2019. The probability of remaining seizure-free and the plotted survival curves were analyzed. Prognostic factors were analyzed using log-rank tests in univariate analysis and the Cox regression model in multivariate analysis. Results With a mean time of 31.07 ± 2.64 months (median 30.00, interquartile range: 18.00-40.00 months), 11 out of 30 patients (36.7%) were classified as International League Against Epilepsy class 1 in the last follow-up. The mean time of remaining seizure-free was 21.33 ± 4.55 months [95% confidence interval (CI) 12.41-30.25], and the median time was 3.00 ± 0.54 months (95% CI 1.94-4.06). Despite falling in the initial year, the probability of remaining seizure-free gradually stabilizes in the subsequent years. The patients were more likely to obtain seizure freedom when the epileptogenic zone was located in the insular lobe or with one focus on the limbic system (p = 0.034, hazard ratio 5.019, 95% CI 1.125-22.387). Conclusion Our findings may be applied to guide individualized surgical interventions and help clinicians make better decisions.
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Affiliation(s)
- Qi Huang
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Pandeng Xie
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Jian Zhou
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Haoran Ding
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Zhao Liu
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Tianfu Li
- Department of Brain Institute, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Yuguang Guan
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Jing Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Pengfei Teng
- Department of Magnetoencephalography, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Mingwang Zhu
- Department of Radiology, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Kaiqiang Ma
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Han Wu
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Guoming Luan
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Feng Zhai
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
- Department of Functional Neurosurgery, Neurological Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
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Vermoyal JC, Hardy D, Goirand-Lopez L, Vinck A, Silvagnoli L, Fortoul A, Francis F, Cappello S, Bureau I, Represa A, Cardoso C, Watrin F, Marissal T, Manent JB. Grey matter heterotopia subtypes show specific morpho-electric signatures and network dynamics. Brain 2024; 147:996-1010. [PMID: 37724593 DOI: 10.1093/brain/awad318] [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: 06/27/2023] [Revised: 08/04/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023] Open
Abstract
Grey matter heterotopia (GMH) are neurodevelopmental disorders associated with abnormal cortical function and epilepsy. Subcortical band heterotopia (SBH) and periventricular nodular heterotopia (PVNH) are two well-recognized GMH subtypes in which neurons are misplaced, either forming nodules lining the ventricles in PVNH, or forming bands in the white matter in SBH. Although both PVNH and SBH are commonly associated with epilepsy, it is unclear whether these two GMH subtypes differ in terms of pathological consequences or, on the contrary, share common altered mechanisms. Here, we studied two robust preclinical models of SBH and PVNH, and performed a systematic comparative assessment of the physiological and morphological diversity of heterotopia neurons, as well as the dynamics of epileptiform activity and input connectivity. We uncovered a complex set of altered properties, including both common and distinct physiological and morphological features across heterotopia subtypes, and associated with specific dynamics of epileptiform activity. Taken together, these results suggest that pro-epileptic circuits in GMH are, at least in part, composed of neurons with distinct, subtype-specific, physiological and morphological properties depending on the heterotopia subtype. Our work supports the notion that GMH represent a complex set of disorders, associating both shared and diverging pathological consequences, and contributing to forming epileptogenic networks with specific properties. A deeper understanding of these properties may help to refine current GMH classification schemes by identifying morpho-electric signatures of GMH subtypes, to potentially inform new treatment strategies.
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Affiliation(s)
- Jean-Christophe Vermoyal
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Delphine Hardy
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Lucas Goirand-Lopez
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Antonin Vinck
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Lucas Silvagnoli
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Aurélien Fortoul
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Fiona Francis
- INSERM, Sorbonne University, Institut du Fer à Moulin, Paris 75005, France
| | - Silvia Cappello
- Department of Physiological Genomics, Biomedical Center, LMU Munich, Planegg-Martinsried 82152, Germany
| | - Ingrid Bureau
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Alfonso Represa
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Carlos Cardoso
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Françoise Watrin
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Thomas Marissal
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
| | - Jean-Bernard Manent
- INMED, INSERM, Aix-Marseille University, Turing Centre for Living Systems, Marseille 13009, France
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9
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Frauscher B, Mansilla D, Abdallah C, Astner-Rohracher A, Beniczky S, Brazdil M, Gnatkovsky V, Jacobs J, Kalamangalam G, Perucca P, Ryvlin P, Schuele S, Tao J, Wang Y, Zijlmans M, McGonigal A. Learn how to interpret and use intracranial EEG findings. Epileptic Disord 2024; 26:1-59. [PMID: 38116690 DOI: 10.1002/epd2.20190] [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: 07/18/2023] [Revised: 10/21/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
Epilepsy surgery is the therapy of choice for many patients with drug-resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure-onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective "1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings" of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, and review available quantitative/signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology/epileptology by providing a basic understanding on the concepts of invasive intracranial EEG.
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Affiliation(s)
- B Frauscher
- Department of Neurology, Duke University Medical Center and Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - D Mansilla
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
- Neurophysiology Unit, Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - C Abdallah
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - A Astner-Rohracher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - S Beniczky
- Danish Epilepsy Centre, Dianalund, Denmark
- Aarhus University, Aarhus, Denmark
| | - M Brazdil
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Member of the ERN-EpiCARE, Brno, Czechia
- Behavioral and Social Neuroscience Research Group, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - V Gnatkovsky
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - J Jacobs
- Department of Paediatrics and Department of Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - G Kalamangalam
- Department of Neurology, University of Florida, Gainesville, Florida, USA
- Wilder Center for Epilepsy Research, University of Florida, Gainesville, Florida, USA
| | - P Perucca
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - P Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - S Schuele
- Department of Neurology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - J Tao
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Y Wang
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Wilder Center for Epilepsy Research, University of Florida, Gainesville, Florida, USA
| | - M Zijlmans
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - A McGonigal
- Department of Neurosciences, Mater Misericordiae Hospital, Brisbane, Queensland, Australia
- Mater Research Institute, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
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10
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Filipescu C, Landré E, Gavaret M, Zanello M, Pallud J. Bilateral periventricular nodular heterotopia: Can SEEG-guided radiofrequency thermocoagulations cure the epilepsy? Epileptic Disord 2024; 26:158-160. [PMID: 37877673 DOI: 10.1002/epd2.20171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Cristina Filipescu
- Neurophysiology and Epileptology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Elisabeth Landré
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Martine Gavaret
- Neurophysiology and Epileptology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Paris-Cité University, Paris, France
| | - Marc Zanello
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Paris-Cité University, Paris, France
| | - Johan Pallud
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Paris-Cité University, Paris, France
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11
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Li B, Zhang Y, Lin J, Xia L, Zhang Y, Jin Y, Fang J, Hu X, Han B, Peng R. Epileptogenicity of incomplete hippocampal inversion and hippocampal sclerosis in a case with periventricular nodular heterotopias. Epileptic Disord 2023; 25:779-782. [PMID: 37340546 DOI: 10.1002/epd2.20088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Bingqing Li
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, China
| | - Yong Zhang
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, China
| | - Jingzhi Lin
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, China
| | - Lihui Xia
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, China
| | - Yang Zhang
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, China
| | - Yang Jin
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, China
| | - Jin Fang
- Department of Imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, China
| | - Xiangshu Hu
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, China
| | - Biao Han
- School of Psychology, South China Normal University (Shipai), Guangzhou City, China
| | - Ruoyu Peng
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou City, China
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12
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Li H, Zhang M, Lin Z, Deng Z, Cao C, Zhan S, Liu W, Sun B. Utility of hybrid PET/MRI in stereoelectroencephalography guided radiofrequency thermocoagulation in MRI negative epilepsy patients. Front Neurosci 2023; 17:1163946. [PMID: 37378015 PMCID: PMC10291085 DOI: 10.3389/fnins.2023.1163946] [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: 02/11/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) is a novel advanced non-invasive presurgical examination tool for patients with drug-resistant epilepsy (DRE). This study aims to evaluate the utility of PET/MRI in patients with DRE who undergo stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RFTC). Methods This retrospective study included 27 patients with DRE who underwent hybrid PET/MRI and SEEG-guided RFTC. Surgery outcome was assessed using a modified Engel classification, 2 years after RFTC. Potential areas of the seizure onset zone (SOZ) were identified on PET/MRI and confirmed by SEEG. Results Fifteen patients (55%) became seizure-free after SEEG-guided RFTC. Engel class II, III, and IV were achieved in six, two, and four patients, respectively at the 2 years follow-up. MRI was negative in 23 patients and structural abnormalities were found in four patients. Hybrid PET/MRI contributed to the identification of new structural or metabolic lesions in 22 patients. Concordant results between PET/MRI and SEEG were found in 19 patients in the identification of SOZ. Among the patients with multifocal onset, seizure-free status was achieved in 50% (6/12). Conclusion SEEG-guided RFTC is an effective and safe treatment for drug-resistant epilepsy. Hybrid PET/MRI serves as a useful tool for detecting the potential SOZs in MRI-negative patients and guide the implantation of SEEG electrodes. Patients with multifocal epilepsy may also benefit from this palliative treatment.
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Affiliation(s)
- Hongyang Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Miao Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengdao Deng
- Research Group of Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium
| | - Chunyan Cao
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikun Zhan
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Liu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Paliotti K, Dassi C, Berrahmoune S, Bejaran ML, Davila CEV, Martinez AB, Estupiñà MCF, Mancardi MM, Riva A, Giacomini T, Severino M, Romaniello R, Dubeau F, Srour M, Myers KA. The phenotypic spectrum of epilepsy associated with periventricular nodular heterotopia. J Neurol 2023:10.1007/s00415-023-11724-z. [PMID: 37119372 DOI: 10.1007/s00415-023-11724-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Periventricular nodular heterotopia (PVNH) is a congenital brain malformation often associated with seizures. We aimed to clarify the spectrum of epilepsy phenotypes in PVNH and the significance of specific brain malformation patterns. METHODS In this retrospective cohort study, we recruited people with PVNH and a history of seizures, and collected data via medical record review and a standardized questionnaire. RESULTS One hundred individuals were included, aged 1 month to 61 years. Mean seizure onset age was 7.9 years. Ten patients had a self-limited epilepsy course and 35 more were pharmacoresponsive. Fifty-five had ongoing seizures, of whom 23 met criteria for drug resistance. Patients were subdivided as follows: isolated PVNH ("PVNH-Only") single nodule (18) or multiple nodules (21) and PVNH with additional brain malformations ("PVNH-Plus") single nodule (8) or multiple nodules (53). Of PVNH-Only single nodule, none had drug-resistant seizures. Amongst PVNH-Plus, 55% with multiple unilateral nodules were pharmacoresponsive, compared to only 21% with bilateral nodules. PVNH-Plus with bilateral nodules demonstrated the highest proportion of drug resistance (39%). A review of genetic testing results revealed eight patients with pathogenic or likely pathogenic single-gene variants, two of which were FLNA. Five had copy number variants, two of which were pathogenic. CONCLUSIONS The spectrum of epilepsy phenotypes in PVNH is broad, and seizure patterns are variable; however, epilepsy course may be predicted to an extent by the pattern of malformation. Overall, drug-resistant epilepsy occurs in approximately one quarter of affected individuals. When identified, genetic etiologies are very heterogeneous.
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Affiliation(s)
- Karina Paliotti
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Christelle Dassi
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Marlin Liz Bejaran
- Pediatric Neurology Department, Sant Joan de Déu Barcelona Children's Hospital, Sant Joan de Déu Research Institute, Member of the ERN EpiCARE, Barcelona, Spain
| | - Carlos Eduardo Valera Davila
- Pediatric Neurology Department, Sant Joan de Déu Barcelona Children's Hospital, Sant Joan de Déu Research Institute, Member of the ERN EpiCARE, Barcelona, Spain
| | - Ariadna Borràs Martinez
- Pediatric Neurology Department, Sant Joan de Déu Barcelona Children's Hospital, Sant Joan de Déu Research Institute, Member of the ERN EpiCARE, Barcelona, Spain
| | - Maria Carme Fons Estupiñà
- Pediatric Neurology Department, Sant Joan de Déu Barcelona Children's Hospital, Sant Joan de Déu Research Institute, Member of the ERN EpiCARE, Barcelona, Spain
| | - Maria Margherita Mancardi
- Epilepsy Center, Reference Center for Rare and Complex Epilepsies-EpiCARE, IRCCS Istituto Gaslini, Genoa, Italy
| | - Antonella Riva
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Gaslini, University of Genoa, Genoa, Italy
| | - Thea Giacomini
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Romina Romaniello
- Child Neuropsychiatry and Neurorehabilitation Department, Scientific Institute Eugenio Medea, La Nostra Famiglia, Lecco, Italy
| | - François Dubeau
- Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, QC, Canada
| | - Myriam Srour
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, MUHC Glen Site, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada
- Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, QC, Canada
| | - Kenneth A Myers
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, MUHC Glen Site, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada.
- Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, QC, Canada.
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14
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Durica SR, Caruso JP, Podkorytova I, Ding K, Hays R, Lega B, Perven G. Stereo-EEG Evaluation and Surgical Treatment in Patients With Drug-Resistant Focal Epilepsy Associated With Nodular Heterotopia. J Clin Neurophysiol 2023; 40:17-26. [PMID: 34009845 DOI: 10.1097/wnp.0000000000000850] [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: 01/10/2023] Open
Abstract
PURPOSE Nodular heterotopia (NH) is a common cause of drug-resistant epilepsy. Only limited studies detail the treatment of NH with laser interstitial thermal therapy and none analyze the relation between epileptogenicity and NH location. METHODS We retrospectively studied nine patients with drug-resistant epilepsy and NH who underwent stereoelectroencephalography and subsequent epilepsy surgery. Nodular heterotopia in the frontal lobes or along the bodies of the lateral ventricles was classified as anterior NH. Nodular heterotopia in the trigones, temporal or occipital horns, or temporal lobes was classified as posterior NH. Nodular heterotopia in both anterior and posterior locations was classified as diffuse NH. Interictal and ictal stereoelectroencephalography were analyzed, and patients were followed postoperatively to assess outcomes. RESULTS Of the six patients who underwent nine laser interstitial thermal therapy procedures either in isolation or in combination with other surgical therapies, four patients were Engel Ia, one was Engel IIb, and one was Engel IIIa, with an average follow-up of 22.8 months. All patients with posterior NH had interictal epileptiform abnormalities and seizures originating from the posterior NH. None of the patients with anterior NH had epileptiform activity recorded from their NH. CONCLUSION Laser interstitial thermal therapy alone or in combination with other surgical therapies is an effective treatment in those with drug-resistant epilepsy because of NH, even in those with extensive NH and broad seizure onset. We observed a trend suggesting that posterior NH are more likely to be epileptogenic compared with anterior NH and recommend that in patients with anterior NH, alternative epilepsy etiologies and stereoelectroencephalography implantation strategies be considered.
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Affiliation(s)
- Sarah R Durica
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, U.S.A.; and
| | - James P Caruso
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Irina Podkorytova
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Kan Ding
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Ryan Hays
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Bradley Lega
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, U.S.A
| | - Ghazala Perven
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, U.S.A
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15
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Frazzini V, Whitmarsh S, Lehongre K, Yger P, Lemarechal JD, Mathon B, Adam C, Hasboun D, Lambrecq V, Navarro V. Human periventricular nodular heterotopia shows several interictal epileptic patterns and hyperexcitability of neuronal firing. Front Neurol 2022; 13:1022768. [PMID: 36438938 PMCID: PMC9695411 DOI: 10.3389/fneur.2022.1022768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
Periventricular nodular heterotopia (PNH) is a malformation of cortical development that frequently causes drug-resistant epilepsy. The epileptogenicity of ectopic neurons in PNH as well as their role in generating interictal and ictal activity is still a matter of debate. We report the first in vivo microelectrode recording of heterotopic neurons in humans. Highly consistent interictal patterns (IPs) were identified within the nodules: (1) Periodic Discharges PLUS Fast activity (PD+F), (2) Sporadic discharges PLUS Fast activity (SD+F), and (3) epileptic spikes (ES). Neuronal firing rates were significantly modulated during all IPs, suggesting that multiple IPs were generated by the same local neuronal populations. Furthermore, firing rates closely followed IP morphologies. Among the different IPs, the SD+F pattern was found only in the three nodules that were actively involved in seizure generation but was never observed in the nodule that did not take part in ictal discharges. On the contrary, PD+F and ES were identified in all nodules. Units that were modulated during the IPs were also found to participate in seizures, increasing their firing rate at seizure onset and maintaining an elevated rate during the seizures. Together, nodules in PNH are highly epileptogenic and show several IPs that provide promising pathognomonic signatures of PNH. Furthermore, our results show that PNH nodules may well initiate seizures.
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Affiliation(s)
- Valerio Frazzini
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stephen Whitmarsh
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Katia Lehongre
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Pierre Yger
- Institut de la Vision, INSERM UMRS 968, UPMC UM 80, Paris, France
| | - Jean-Didier Lemarechal
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
- Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille, France
| | - Bertrand Mathon
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
- AP-HP, Pitié Salpêtrière Hospital, Department of Neurosurgery, Paris, France
| | - Claude Adam
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
| | - Dominique Hasboun
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
- AP-HP, Pitié Salpêtrière Hospital, Department de Neuroradiology, Paris, France
| | - Virginie Lambrecq
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Vincent Navarro
- AP-HP, Pitié Salpêtrière Hospital, Epilepsy Unit and Reference Center for Rare Epilepsies, Paris, France
- Sorbonne Université, Institut du Cerveau–Paris Brain Institute–ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
- *Correspondence: Vincent Navarro
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16
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Kerezoudis P, Tsayem IN, Lundstrom BN, Van Gompel JJ. Systematic review and patient-level meta-analysis of radiofrequency ablation for medically refractory epilepsy: Implications for clinical practice and research. Seizure 2022; 102:113-119. [PMID: 36219914 DOI: 10.1016/j.seizure.2022.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Radiofrequency thermocoagulation (RF-TC) is a minimally invasive procedure for the treatment of epileptic foci. The aim of this study is to review available evidence on the safety and efficacy of RF-TC for medically refractory epilepsy. METHODS A comprehensive literature search (Pubmed/Medline, EMBASE, Cochrane) was conducted for studies with patient-level data on RF-TC for medically refractory epilepsy. Seizure outcome (Engel classification) at last follow-up comprised the primary endpoint. New temporary or permanent post-procedural neurological deficits were the secondary endpoints. RESULTS A total of 20 studies (360 patients) were analyzed. Median age at the time of intervention was 29 years (interquartile range (IQR): 21-37) and 57% were males. A lesional MRI was noted in 59% of patients. Median duration of postoperative follow-up was 24 months (IQR: 11-48). The median number of RF-TC lesions per patient was 11 (IQR: 6-19), with bipolar ablation (i.e. between two contiguous contacts) being the most common method (n = 244, 68%). The most common RF-TC location was the mesial temporal structures, without (34%) or with (7%) the temporal neocortex, followed by the insula (13%) and the frontal lobe (12%). Multilobar targets were lesioned in 11% of patients. New neurological deficits developed in 10% of patients (2% remained permanently), with the most common being motor deficits. Among patients with at least 12 months of follow-up (n = 267, 74% of overall cohort), a favorable seizure outcome (Engel I/II class) was achieved in 62% of cases. Patients with a favorable seizure outcome were significantly more likely to have a lesional MRI (71% vs 43% 51%, p < 0.001), have a higher number of RF ablations (15 [IQR 8-31] vs 9 [IQR 4-14], p < 0.001), and undergo monopolar RF-TC (50% vs 30%, p = 0.002). CONCLUSION Current evidence supports the promising safety and efficacy profile of RF-TC for medically refractory epilepsy. Randomized controlled trial data are needed to further establish the role of this intervention in preoperative discussions with patients and their families.
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Affiliation(s)
- Panagiotis Kerezoudis
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | | | | | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Bartolini E, Cosottini M, Donatelli G, Tosetti M, Biagi L, Battini R, Guerrini R. Does 7T MRI reveal a neuronal bridge between periventricular heterotopia and overlying cortical malformations? Seizure 2022; 103:99-100. [DOI: 10.1016/j.seizure.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
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18
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Cometa A, Falasconi A, Biasizzo M, Carpaneto J, Horn A, Mazzoni A, Micera S. Clinical neuroscience and neurotechnology: An amazing symbiosis. iScience 2022; 25:105124. [PMID: 36193050 PMCID: PMC9526189 DOI: 10.1016/j.isci.2022.105124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the last decades, clinical neuroscience found a novel ally in neurotechnologies, devices able to record and stimulate electrical activity in the nervous system. These technologies improved the ability to diagnose and treat neural disorders. Neurotechnologies are concurrently enabling a deeper understanding of healthy and pathological dynamics of the nervous system through stimulation and recordings during brain implants. On the other hand, clinical neurosciences are not only driving neuroengineering toward the most relevant clinical issues, but are also shaping the neurotechnologies thanks to clinical advancements. For instance, understanding the etiology of a disease informs the location of a therapeutic stimulation, but also the way stimulation patterns should be designed to be more effective/naturalistic. Here, we describe cases of fruitful integration such as Deep Brain Stimulation and cortical interfaces to highlight how this symbiosis between clinical neuroscience and neurotechnology is closer to a novel integrated framework than to a simple interdisciplinary interaction.
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Affiliation(s)
- Andrea Cometa
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Antonio Falasconi
- Friedrich Miescher Institute for Biomedical Research, 4058 Basel, Switzerland
- Biozentrum, University of Basel, 4056 Basel, Switzerland
| | - Marco Biasizzo
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Jacopo Carpaneto
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Andreas Horn
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Neurology, 10117 Berlin, Germany
| | - Alberto Mazzoni
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Silvestro Micera
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- Translational Neural Engineering Lab, School of Engineering, École Polytechnique Fèdèrale de Lausanne, 1015 Lausanne, Switzerland
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19
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Alis C, Alis D, Uslu Besli L, Karaarslan E, Sonmezoglu K, Ozkara C, Yeni SN. The analysis of 18 F-FDG PET/MRI, electroencephalography, and semiology in patients with gray matter heterotopia: A pilot study. Acta Neurol Scand 2022; 146:662-670. [PMID: 36102058 DOI: 10.1111/ane.13705] [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: 05/14/2022] [Revised: 07/29/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe 18 F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18 F-FDG PET/MRI) along with semiology and electroencephalography (EEG) in patients with gray matter heterotopia (GMH); to evaluate the concordance between 18 F-FDG PET/MRI and clinical epileptogenic zone (EZ). MATERIALS & METHODS GMH (subcortical heterotopia [SCH] and periventricular nodular heterotopia [PNH]) patients with epilepsy who underwent 18 F-FDG PET/MRI were retrospectively enrolled. Two radiologists evaluated brain MRI, while two nuclear medicine specialists assessed the 18 F-FDG PET. The SUVmax values of visually hypometabolic cortical areas were compared to the contralateral cortex using a SUVmax threshold value of 10%; the SUVmax values of GMH lesions were compared with that of the right precentral gyrus. The cortex or GMH with hypometabolism on 18 F-FDG PET/MRI was considered representative of the EZ. The clinical EZ was identified using EEG and semiology. RESULTS Thirty patients (19 PNH; 11 SCH) with a mean age of 28.46 ± 9.52 years were enrolled. The heterotopic nodules were ametabolic in 3 patients (10%), hypometabolic in 16 (33.33%), isometabolic in 13 (26.66%), and hypermetabolic in 4 (10%). 18 F-FDG PET/MRI demonstrated hypometabolism in the cortex and GMH in 22/30 (73.33%) and 16/30 (53.33%). We could identify a clinical EZ in 18 patients, and 15 out of 18 (83.33%) had concordant 18 F-FDG PET/MRI findings. CONCLUSION Heterotopic nodules in GMH patients show different metabolic patterns on 18 F-FDG PET/MRI, with nearly three-quarters of the patients having cortical hypometabolism. 18 F-FDG PET/ MRI findings are mostly concordant with the clinical EZ.
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Affiliation(s)
- Ceren Alis
- Cerrahpasa School of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Lebriz Uslu Besli
- Cerrahpasa School of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ercan Karaarslan
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Cerrahpasa School of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cigdem Ozkara
- Cerrahpasa School of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seher Naz Yeni
- Cerrahpasa School of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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20
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Guo R, Jin L, Dou W, Liu L, Cui R. An Independent Seizure-Onset Zone in Medial Temporal Lobe Found by 18 F-FDG PET Imaging Besides Epileptogenic Periventricular Nodular Heterotopia. Clin Nucl Med 2022; 47:841-842. [PMID: 35619208 DOI: 10.1097/rlu.0000000000004283] [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: 11/26/2022]
Abstract
ABSTRACT A 23-year-old man with drug-resistant epilepsy was admitted for presurgical evaluation. The epileptogenic zone could not be derived from seizure semiology and scalp electroencephalographic monitoring definitely. MRI showed periventricular nodular heterotopia in occipital horn of left lateral ventricle with high FDG uptake on interictal 18 F-FDG PET scan, whereas the hypometabolic zone in the left medial temporal lobe was also found on PET with no abnormality on MRI. Stereoelectroencephalographic implantation was performed to identify the seizure-onset zone. Two independent epileptogenic foci located in periventricular nodular heterotopia and left hippocampus were validated by stereoelectroencephalographic monitoring and the outcome of subsequent thermocoagulation.
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Affiliation(s)
- Ruijie Guo
- From the Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine
| | | | | | - Linwen Liu
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruixue Cui
- From the Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine
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21
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Elliott RJS, Phan TN, Oluigbo CO. Technical case report: intractable focal seizures related to bifrontal transmantle heterotopia subserving peculiar homotopic motor distribution treated by responsive neurostimulation therapy. Acta Neurochir (Wien) 2022; 164:2153-2157. [PMID: 35415805 DOI: 10.1007/s00701-022-05193-y] [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: 12/29/2021] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
NeuroPace responsive neurostimulation (RNS®) therapy was used in a case of intractable focal epilepsy with bifrontal transmantle heterotopia subserving peculiar homotopic motor distribution in a 16-year-old, right-handed male with intractable seizures. Brain MRI demonstrated bifrontal transmantle heterotopia extending from the central sulcus to subjacent lateral ventricles along with polymicrogyria along the overlying cortex suspected to be the motor cortex. Functional MRI demonstrated homotopic distribution of finger and foot motor function (deeper) within the polymicrogyria. Invasive intracranial monitoring with depth electrodes and extraoperative brain mapping revealed eloquent cortical tissue which corresponded to the right leg and right shoulder motor function.
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Affiliation(s)
- Ross-Jordon S Elliott
- Department of Neurological Surgery, The George Washington University Hospital, 900 23rd Street NW, Washington, DC, 20037, USA
| | - Tiffany N Phan
- Division of Neurosurgery, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Chima O Oluigbo
- Division of Neurosurgery, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
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22
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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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23
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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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24
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Choi JY, Krishnan B, Hu S, Martinez D, Tang Y, Wang X, Sakaie K, Jones S, Murakami H, Blümcke I, Najm I, Ma D, Wang ZI. Using magnetic resonance fingerprinting to characterize periventricular nodular heterotopias in pharmacoresistant epilepsy. Epilepsia 2022; 63:1225-1237. [PMID: 35343593 PMCID: PMC9081261 DOI: 10.1111/epi.17191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to use a novel magnetic resonance fingerprinting (MRF) technique to examine in vivo tissue property characteristics of periventricular nodular heterotopia (PVNH). These characteristics were further correlated with stereotactic-electroencephalographic (SEEG) ictal onset findings. METHODS We included five patients with PVNH who had SEEG-guided surgery and at least 1 year of seizure freedom or substantial seizure reduction. High-resolution MRF scans were acquired at 3 T, generating three-dimensional quantitative T1 and T2 maps. We assessed the differences between T1 and T2 values from the voxels in the nodules located in the SEEG-defined seizure onset zone (SOZ) and non-SOZ, on -individual and group levels. Receiver operating characteristic analyses were performed to obtain the optimal classification performance. Quantification of SEEG ictal onset signals from the nodules was performed by calculating power spectrum density (PSD). The association between PSD and T1 /T2 values was further assessed at different frequency bands. RESULTS Individual-level analysis showed T1 was significantly higher in SOZ voxels than non-SOZ voxels (p < .05), with an average 73% classification accuracy. Group-level analysis also showed higher T1 was significantly associated with SOZ voxels (p < .001). At the optimal cutoff (normalized T1 of 1.1), a 76% accuracy for classifying SOZ nodules from non-SOZ nodules was achieved. T1 values were significantly associated with ictal onset PSD at the ultraslow, θ, β, γ, and ripple bands (p < .05). T2 values were significantly associated with PSD only at the ultraslow band (p < .05). SIGNIFICANCE Quantitative MRF measures, especially T1 , can provide additional noninvasive information to separate nodules in SOZ and non-SOZ. The T1 and T2 tissue property changes carry electrophysiological underpinnings relevant to the epilepsy, as shown by their significant positive associations with power changes during the SEEG seizure onset. The use of MRF as a supplementary noninvasive tool may improve presurgical evaluation for patients with PVNH and pharmacoresistant epilepsy.
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Affiliation(s)
- Joon Yul Choi
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Balu Krishnan
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Siyuan Hu
- Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - David Martinez
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Yinging Tang
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA.,Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaofeng Wang
- Quantitative Health Science, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ken Sakaie
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroatsu Murakami
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Ingmar Blümcke
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA.,Neuropathology, University of Erlangen, Erlangen, Germany
| | - Imad Najm
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Dan Ma
- Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Zhong Irene Wang
- Charles Shor Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
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25
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Shlobin NA, Campbell JM, Rosenow JM, Rolston JD. Ethical considerations in the surgical and neuromodulatory treatment of epilepsy. Epilepsy Behav 2022; 127:108524. [PMID: 34998267 PMCID: PMC10184316 DOI: 10.1016/j.yebeh.2021.108524] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 02/08/2023]
Abstract
Surgical resection and neuromodulation are well-established treatments for those with medically refractory epilepsy. These treatments entail important ethical considerations beyond those which extend to the treatment of epilepsy generally. In this paper, the authors explore these unique considerations through a framework that relates foundational principles of bioethics to features of resective epilepsy surgery and neuromodulation. The authors conducted a literature review to identify ethical considerations for a variety of epilepsy surgery procedures and to examine how foundational principles in bioethics may inform treatment decisions. Healthcare providers should be cognizant of how an increased prevalence of somatic and psychiatric comorbidities, the dynamic nature of symptom burden over time, the individual and systemic barriers to treatment, and variable sociocultural contexts constitute important ethical considerations regarding the use of surgery or neuromodulation for the treatment of epilepsy. Moreover, careful attention should be paid to how resective epilepsy surgery and neuromodulation relate to notions of patient autonomy, safety and privacy, and the shared responsibility for device management and maintenance. A three-tiered approach-(1) gathering information and assessing the risks and benefits of different treatment options, (2) clear communication with patient or proxy with awareness of patient values and barriers to treatment, and (3) long-term decision maintenance through continued identification of gaps in understanding and provision of information-allows for optimal treatment of the individual person with epilepsy while minimizing disparities in epilepsy care.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Justin M Campbell
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Neuroscience, University of Utah, Salt Lake City, UT, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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26
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Boulogne S, Pizzo F, Chatard B, Roehri N, Catenoix H, Ostrowsky‐Coste K, Giusiano B, Guenot M, Carron R, Bartolomei F, Rheims S. Functional connectivity and epileptogenicity of nodular heterotopias: A single‐pulse stimulation study. Epilepsia 2022; 63:961-973. [DOI: 10.1111/epi.17168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sébastien Boulogne
- Department of Functional Neurology and Epileptology Hospices Civils de Lyon and University of Lyon Lyon France
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
- Lyon 1 University Villeurbanne France
| | - Francesca Pizzo
- Inserm, INS Institut de Neurosciences des Systèmes Aix Marseille University Marseille France
- Epileptology and Cerebral Rythmology Department Assistance Publique – Hôpitaux de Marseille Marseille France
| | - Benoit Chatard
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
| | - Nicolas Roehri
- Inserm, INS Institut de Neurosciences des Systèmes Aix Marseille University Marseille France
| | - Hélène Catenoix
- Department of Functional Neurology and Epileptology Hospices Civils de Lyon and University of Lyon Lyon France
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
| | - Karine Ostrowsky‐Coste
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
- Epileptology, Sleep Disorders and Functional Pediatric Neurology Hospices Civils de Lyon and University of Lyon Lyon France
| | - Bernard Giusiano
- Inserm, INS Institut de Neurosciences des Systèmes Aix Marseille University Marseille France
- Epileptology and Cerebral Rythmology Department Assistance Publique – Hôpitaux de Marseille Marseille France
| | - Marc Guenot
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
- Department of Functional Neurosurgery Hospices Civils de Lyon and University of Lyon Lyon France
| | - Romain Carron
- Department of Functional Neurosurgery Assistance Publique –Hôpitaux de Marseille Marseille France
| | - Fabrice Bartolomei
- Inserm, INS Institut de Neurosciences des Systèmes Aix Marseille University Marseille France
- Epileptology and Cerebral Rythmology Department Assistance Publique – Hôpitaux de Marseille Marseille France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology Hospices Civils de Lyon and University of Lyon Lyon France
- Lyon's Neurosciences Research Center INSERM U1028 CNRS 5292 Lyon France
- Lyon 1 University Villeurbanne France
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27
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Luo T, Wang X, Wang J, Zhao R, Li H, Zhou Y, Wang Y. Optimization and high-density array of stereoelectroencephalography-guided radiofrequency thermocoagulation for the treatment of pediatric tuberous sclerosis complex with epilepsy. CNS Neurosci Ther 2022; 28:724-731. [PMID: 35032101 PMCID: PMC8981452 DOI: 10.1111/cns.13804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome involved in many organ systems. At the same time, epilepsy is the most common manifestation and more than 50% of TSC patients present with intractable epilepsy. This study investigated the efficacy and safety of optimized and high-density stereoelectroencephalography (SEEG) guided radiofrequency thermocoagulation (RF-TC) in treating TSC-related epilepsy. METHODS Nine TSC children with refractory epilepsy were treated with first-stage SEEG-Guided RF-TC, and four underwent second-stage-optimized high-density array of SEEG-Guided RF-TC. Patients' clinical data and postoperative outcomes were analyzed retrospectively. RESULTS The patients' median age at surgery was 4 years and 2 month (range from 3 years and 5 month to 16 years and 7 month). The mean age at surgery was 6.7 years old. Eight in 9 (88.9%) patients achieved complete remission after the final operation at half-year follow-up. Of seven patients with final postoperative time beyond 1 year, 6 (85.7%) reached completely seizure-free. No severe or long-term neurologic impairment existed in all nine patients. CONCLUSION Optimized high-density array of SEEG-guided RF-TC is a safe and highly effective approach and can be an alternative application applied for TSC patients with refractory epilepsy.
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Affiliation(s)
- Tian Luo
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xinhua Wang
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Ji Wang
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Rui Zhao
- Department of Neurosurgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Hao Li
- Department of Neurosurgery, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yuanfeng Zhou
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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28
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Xu X, Yu X, Kang G, Mao Z, Cui Z, Pan L, Zong R, Tang Y, Wan M, Ling Z. Role of High-Frequency Oscillation in Locating an Epileptogenic Zone for Radiofrequency Thermocoagulation. Front Hum Neurosci 2021; 15:699556. [PMID: 34630056 PMCID: PMC8497699 DOI: 10.3389/fnhum.2021.699556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Radiofrequency thermocoagulation (RFTC) has been proposed as a first-line surgical treatment option for patients with drug-resistant focal epilepsy (DRE) that is associated with gray matter nodular heterotopia (GMNH). Excellent results on seizures have been reported following unilateral RFTC performed on ictal high-frequency-discharge, fast-rhythm, and low-voltage initiation areas. Complex cases (GMNH plus other malformations of cortical development) do not have good outcomes with RFTC. Yet, there is little research studying the effect of high-frequency oscillation in locating epileptogenic zones for thermocoagulation on unilateral, DRE with bilateral GMNH. We present a case of DRE with bilateral GMNH, treated using RFTC on unilateral GMNH and the overlying cortex, guided by stereotactic electroencephalogram (SEGG), and followed up for 69 months. Twenty-four-hour EGG recordings, seizure frequency, post-RFTC MRI, and neuropsychological tests were performed once yearly. To date, this patient is seizure-free, the electroencephalogram is normal, neuropsychological problems have not been found, and the trace of RFTC has been clearly identified on MRI. His dosage of antiepileptic medication has, furthermore, been significantly reduced. It is concluded that RFTC on unilateral DRE with bilateral GMNH may achieve good long-term effects, lasting up to, and perhaps longer than, 69 months. Ictal high-frequency oscillation (fast ripple) inside the heterotopia and the overlying cortex may be the key to this successful effect.
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Affiliation(s)
- Xin Xu
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Xingguang Yu
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Guixia Kang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, Beijing University of Posts and Telecommunications, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Zhiqiang Cui
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Longsheng Pan
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Rui Zong
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Yuan Tang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, Beijing University of Posts and Telecommunications, Beijing, China
| | - Ming Wan
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Zhipei Ling
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
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Contento M, Pizzo F, López-Madrona VJ, Lagarde S, Makhalova J, Trébuchon A, Medina Villalon S, Giusiano B, Scavarda D, Carron R, Roehri N, Bénar CG, Bartolomei F. Changes in epileptogenicity biomarkers after stereotactic thermocoagulation. Epilepsia 2021; 62:2048-2059. [PMID: 34272883 DOI: 10.1111/epi.16989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Stereo-electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) aims at modifying epileptogenic networks to reduce seizure frequency. High-frequency oscillations (HFOs), spikes, and cross-rate are quantifiable epileptogenic biomarkers. In this study, we sought to evaluate, using SEEG signals recorded before and after thermocoagulation, whether a variation in these markers is related to the therapeutic effect of this procedure and to the outcome of surgery. METHODS Interictal segments of SEEG signals were analyzed in 38 patients during presurgical evaluation. We used an automatized method to quantify the rate of spikes, rate of HFOs, and cross-rate (a measure combining spikes and HFOs) before and after thermocoagulation. We analyzed the differences both at an individual level with a surrogate approach and at a group level with analysis of variance. We then evaluated the correlation between these variations and the clinical response to RF-TC and to subsequent resective surgery. RESULTS After thermocoagulation, 19 patients showed a clinical improvement. At the individual level, clinically improved patients more frequently had a reduction in spikes and cross-rate in the epileptogenic zone than patients without clinical improvement (p = .002, p = .02). At a group level, there was a greater decrease of HFOs in epileptogenic and thermocoagulated zones in patients with clinical improvement (p < .05) compared to those with no clinical benefit. Eventually, a significant decrease of all the markers after RF-TC was found in patients with a favorable outcome of resective surgery (spikes, p = .026; HFOs, p = .03; cross-rate, p = .03). SIGNIFICANCE Quantified changes in the rate of spikes, rate of HFOs, and cross-rate can be observed after thermocoagulation, and the reduction of these markers correlates with a favorable clinical outcome after RF-TC and with successful resective surgery. This may suggest that interictal biomarker modifications after RF-TC can be clinically used to predict the effectiveness of the thermocoagulation procedure and the outcome of resective surgery.
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Affiliation(s)
- Margherita Contento
- Department of Neurosciences, Drug Research, and Child's Health, University of Florence, Florence, Italy
| | - Francesca Pizzo
- Systems Neuroscience Institute, Aix-Marseille University, Marseille, France.,Epileptology and Cerebral Rhythmology, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
| | | | - Stanislas Lagarde
- Systems Neuroscience Institute, Aix-Marseille University, Marseille, France.,Epileptology and Cerebral Rhythmology, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
| | - Julia Makhalova
- Epileptology and Cerebral Rhythmology, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France.,Center for Magnetic Resonance in Biology and Medicine, Mixed Unit of Research 7339, Timone Hospital, Aix-Marseille University, Marseille, France
| | - Agnes Trébuchon
- Systems Neuroscience Institute, Aix-Marseille University, Marseille, France.,Epileptology and Cerebral Rhythmology, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
| | - Samuel Medina Villalon
- Systems Neuroscience Institute, Aix-Marseille University, Marseille, France.,Epileptology and Cerebral Rhythmology, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
| | - Bernard Giusiano
- Systems Neuroscience Institute, Aix-Marseille University, Marseille, France.,Epileptology and Cerebral Rhythmology, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
| | - Didier Scavarda
- Pediatric Neurosurgery Department, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
| | - Romain Carron
- Stereotactic and Functional Neurosurgery, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
| | - Nicolas Roehri
- Systems Neuroscience Institute, Aix-Marseille University, Marseille, France
| | | | - Fabrice Bartolomei
- Systems Neuroscience Institute, Aix-Marseille University, Marseille, France.,Epileptology and Cerebral Rhythmology, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
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30
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Shamim D, Cheng J, Pearson C, Landazuri P. Network radiofrequency ablation for drug resistant epilepsy. Epilepsy Behav Rep 2021; 16:100471. [PMID: 34381989 PMCID: PMC8335629 DOI: 10.1016/j.ebr.2021.100471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 10/31/2022] Open
Abstract
Radiofrequency ablation (RFA) is a minimally invasive procedure for drug-resistant focal epilepsy. Although well tolerated, seizure outcomes are less favorable than standard resection. RFA is commonly performed following stereoencephalography (sEEG) identification of the seizure onset zone (SOZ). We hypothesized RFA outcomes can improve by adding RFA of seizure spread regions to the SOZ as identified by sEEG, an approach we term network RFA. Four patients underwent network RFA at our institution from 8/2017 to 9/2019. There were two Engel IB outcomes and two Engel III outcomes. The median follow-up length was 25.5 months (range 17-35). No permanent neurological deficits occurred. Etiologies consisted of polymicrogyria (1), mixed malformation of cortical development (MCD) (2), and cryptogenic (1). This study provides descriptive results regarding the efficacy and safety of network RFA. Network RFA can be considered in patients with focal epilepsies with large MCDs that may not be amenable to standard resection.
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Affiliation(s)
- Daniah Shamim
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, United States
| | - Jennifer Cheng
- University of Kansas Medical Center, Department of Neurosurgery, Kansas City, KS, United States
| | - Caleb Pearson
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, United States
| | - Patrick Landazuri
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, United States
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31
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Bund C, Hirsch MPV, Ollivier I, Hirsch E, Namer IJ. Three Different FDG Patterns in Periventricular Nodular Heterotopia Correlated to Video Stereoelectroencephalography. Clin Nucl Med 2021; 46:586-588. [PMID: 33661202 DOI: 10.1097/rlu.0000000000003573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 40-year-old woman with a drug-resistant focal epilepsy underwent cerebral FDG PET in phase 1 presurgical epilepsy study. MRI essentially showed multiple periventricular nodular heterotopias. The stereoelectroencephalography coupled to MRI and FDG PET helped to define the anatomofunctional correlation of the epileptogenic zone network. This procedure brought to light 3 distinct patterns of FDG consumption, corresponding to different anatomoelectroclinical features. This pattern was already found in a previous FDG PET reflecting a "stable" permanent intralesional intercritical stereoelectroencephalography activity, an electrical "signature" of the lesion. Finally, functional imaging improved thermocoagulation in this patient and emphasized the use of FDG in drug-resistant epilepsy.
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Affiliation(s)
| | | | - Irène Ollivier
- Service de Neurochirurgie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Edouard Hirsch
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourgand
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32
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Remick M, McDowell MM, Gupta K, Felker J, Abel TJ. Emerging indications for stereotactic laser interstitial thermal therapy in pediatric neurosurgery. Int J Hyperthermia 2021; 37:84-93. [PMID: 32672117 DOI: 10.1080/02656736.2020.1769868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Surgical treatment of deep or difficult to access lesions represents a unique and significant challenge for pediatric neurosurgeons. The introduction of stereotactic magnetic resonance-guided laser interstitial thermal therapy (LITT) over the last decade has had a dramatic impact on the landscape of pediatric neurosurgery. LITT provides a safe and effective option for children with epilepsy from hypothalamic hamartoma that represents a ground-breaking new therapy for a condition which was historically very difficult to treat with previous neurosurgical techniques. LITT has also been used as an alternative surgical technique for mesial temporal sclerosis, focal cortical dysplasia, MR-negative epilepsy, cavernoma-related epilepsy, insular epilepsy, and corpus callosotomy among other epilepsy etiologies. In some cases, LITT has been associated with improved cognitive outcomes compared to standard techniques, as in mesial temporal lobe epilepsy. Initial experiences with LITT for neuro-oncologic processes are also promising. LITT is often attractive to patients and providers as a minimally invasive approach, but the differences in safety and clinical outcome between LITT and traditional approaches are still being studied. In this review, we examine the emerging indications and clinical evidence for LITT in pediatric neurosurgery.
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Affiliation(s)
- Madison Remick
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kanupriya Gupta
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James Felker
- Department of Pediatric Neuro-Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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33
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Intracranial Electroencephalography Reveals Selective Responses to Cognitive Stimuli in the Periventricular Heterotopias. J Neurosci 2021; 41:3870-3878. [PMID: 33727335 DOI: 10.1523/jneurosci.2785-20.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/27/2020] [Accepted: 03/06/2021] [Indexed: 11/21/2022] Open
Abstract
Our recent work suggests that non-lesional epileptic brain tissue is capable of generating normal neurophysiological responses during cognitive tasks, which are then seized by ongoing pathologic epileptic activity. Here, we aim to extend the scope of our work to epileptic periventricular heterotopias (PVH) and examine whether the PVH tissue also exhibits normal neurophysiological responses and network-level integration with other non-lesional cortical regions. As part of routine clinical assessment, three adult patients with PVH underwent implantation of intracranial electrodes and participated in experimental cognitive tasks. We obtained simultaneous recordings from PVH and remote cortical sites during rest as well as controlled experimental conditions. In all three subjects (two females), cognitive experimental conditions evoked significant electrophysiological responses in discrete locations within the PVH tissue that were correlated with responses seen in non-epileptic cortical sites. Moreover, the responsive PVH sites exhibited correlated electrophysiological activity with responsive, non-lesional cortical sites during rest conditions. Taken together, our work clearly demonstrates that the PVH tissue may be functionally organized and it may be functionally integrated within cognitively engaged cortical networks despite its anatomic displacement during neurodevelopment.SIGNIFICANCE STATEMENT Periventricular heterotopias (PVH) are developmentally abnormal brain tissues that frequently cause epileptic seizures. In a rare opportunity to obtain direct electrophysiological recordings from PVH, we were able to show that, contrary to common assumptions, PVH functional activity is similar to healthy cortical sites during a well-established cognitive task and exhibits clear resting state connectivity with the responsive cortical regions.
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34
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Consales A, Casciato S, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, de Palma L, Morano A, Vatti G, Villani F, Zamponi N, Tassi L, Di Gennaro G, Marras CE. The surgical treatment of epilepsy. Neurol Sci 2021; 42:2249-2260. [PMID: 33797619 DOI: 10.1007/s10072-021-05198-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/16/2021] [Indexed: 01/07/2023]
Abstract
In 2009, the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) conducted an overview about the techniques used for the pre-surgical evaluation and the surgical treatment of epilepsies. The recognition that, in selected cases, surgery can be considered the first-line approach, suggested that the experience gained by the main Italian referral centers should be pooled in order to provide a handy source of reference. In light of the progress made over these past years, some parts of that first report have accordingly been updated. The present revision aims to harmonize the general principles regulating the patient selection and the pre-surgical work-up, as well as to expand the use of epilepsy surgery, that still represents an underutilized resource, regrettably. The objective of this contribution is drawing up a methodological framework within which to integrate the experiences of each group in this complex and dynamic sector of the neurosciences.
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Affiliation(s)
- Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giancarlo Di Gennaro
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy.
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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35
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Karsonovich T, Alexander A, Graber S, O'Neill BR. Placement of leads for stereotactic electroencephalography without the use of anchor bolts: technical note. J Neurosurg Pediatr 2021; 27:253-258. [PMID: 33338995 DOI: 10.3171/2020.7.peds20403] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic electroencephalography (SEEG) is an increasingly common technique that neurosurgeons use to help identify the epileptogenic zone. The anchor bolt, which typically secures the electrode to the skull, can be problematic in very thin bone or in electrodes placed in the occiput. METHODS A technique is described to place electrodes without the use of an anchor bolt. Accuracy data for entry point, target point, and depth were collected and compared between electrodes placed with and those placed without an anchor bolt. RESULTS A total of 58 patients underwent placement of 793 electrodes, of which 25 were boltless. The mean entry and depth errors at target were equivalent, although there was a trend toward greater depth error with boltless electrodes (3.4 mm vs 2.01 mm and 2.59 mm in the bolted groups, respectively). The mean lateral target error was slightly but significantly smaller for boltless electrodes. The majority (60%) of boltless leads were placed into thin temporal squamous bone. The average skull thickness at the entry point for all boltless leads was 1.85 mm. CONCLUSIONS Boltless SEEG electrodes can be placed through thin bone, adjacent to a cranial defect, or in the occiput with equivalent accuracy to electrodes placed with anchor bolts.
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Affiliation(s)
- Torin Karsonovich
- 1Department of Neurosurgery
- 2Advocate Bromenn Medical Center, Normal, Illinois
| | - Allyson Alexander
- 1Department of Neurosurgery
- 3Children's Hospital of Colorado, Aurora; and
| | - Sarah Graber
- 3Children's Hospital of Colorado, Aurora; and
- 4Neuroscience Administration Research Team, Aurora, Colorado
| | - Brent R O'Neill
- 1Department of Neurosurgery
- 3Children's Hospital of Colorado, Aurora; and
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36
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Uribe-San-Martín R, Di Giacomo R, Mai R, Gozzo F, Pelliccia V, Mariani V, Cardinale F, Ciampi E, Onofrj M, Tassi L. In Reply: Forecasting Seizure Freedom After Epilepsy Surgery Assessing Concordance Between Noninvasive and StereoEEG Findings. Neurosurgery 2021; 88:E290-E291. [PMID: 33370839 DOI: 10.1093/neuros/nyaa503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Reinaldo Uribe-San-Martín
- Neurology Department Pontificia Universidad Católica de Chile Neurology Service Complejo Asistencial Hospital Sótero del Río Puente Alto, Chile
| | - Roberta Di Giacomo
- Clinical Epileptology and Experimental Neurophysiology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan, Italy
| | - Roberto Mai
- "Claudio Munari" Epilepsy Surgery Centre Niguarda Hospital Milan, Italy
| | - Francesca Gozzo
- "Claudio Munari" Epilepsy Surgery Centre Niguarda Hospital Milan, Italy
| | | | - Valeria Mariani
- "Claudio Munari" Epilepsy Surgery Centre Niguarda Hospital Milan, Italy
| | | | - Ethel Ciampi
- Neurology Department Pontificia Universidad Católica de Chile Neurology Service Complejo Asistencial Hospital Sótero del Río Puente Alto, Chile
| | - Marco Onofrj
- Department of Neuroscience Imaging and Clinical Sciences University G. D'Annunzio of Chieti-Pescara Chieti, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre Niguarda Hospital Milan, Italy
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37
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Arévalo-Astrada M, McLachlan RS, Suller-Marti A, Parrent AG, MacDougall KW, Mirsattari SM, Diosy D, Steven DA, Burneo JG. All that glitters: Contribution of stereo-EEG in patients with lesional epilepsy. Epilepsy Res 2021; 170:106546. [PMID: 33422972 DOI: 10.1016/j.eplepsyres.2020.106546] [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: 10/04/2020] [Revised: 12/05/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the contribution of stereo-EEG for localization purpose in patients with a visible lesion on MRI. BACKGROUND Intracranial EEG is often used to localize the epileptogenic focus in patients with non-lesional focal epilepsy. Its role in cases where a lesion is visible on MRI can be even more complex and the relationship between the lesion and the seizure onset has rarely been addressed. METHODS All consecutive patients between February 2013 and May 2018 who underwent stereo-EEG and had a lesion visible on MRI were included. We assessed the localization of the seizure onset and its relationship with the lesion. Clinical, radiological, and electrographic analyses were performed. RESULTS Stereo-EEG revealed a seizure onset with either partial or no overlap with the lesion seen on MRI in 42 (56 %) of the 75 lesions included. Mesial temporal sclerosis was the only lesion type associated with an exclusively lesional seizure onset (p = 0.003). CONCLUSION Epilepsy surgery in MRI-positive cases should rely not only the results of lesions seen on MRI, which might be potentially misleading; SEEG is a gold standard method in these cases to define resective borders.
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Affiliation(s)
- Miguel Arévalo-Astrada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Richard S McLachlan
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ana Suller-Marti
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew G Parrent
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Keith W MacDougall
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David Diosy
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Steven
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neuro-Epidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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38
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Khoo HM, Hall JA, Dubeau F, Tani N, Oshino S, Fujita Y, Gotman J, Kishima H. Technical Aspects of SEEG and Its Interpretation in the Delineation of the Epileptogenic Zone. Neurol Med Chir (Tokyo) 2020; 60:565-580. [PMID: 33162469 PMCID: PMC7803703 DOI: 10.2176/nmc.st.2020-0176] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Stereo-electroencephalography (SEEG) has gained global popularity in recent years. In Japan, a country in which invasive studies using subdural electrodes (SDEs) have been the mainstream, SEEG has been approved for insurance coverage in 2020 and is expected to gain in popularity. Some concepts supporting SEEG methodology are fundamentally different from that of SDE studies. Clinicians interested in utilizing SEEG in their practice should be aware of those aspects in which they differ. Success in utilizing the SEEG methodology relies heavily on the construction of an a priori hypothesis regarding the putative seizure onset zone (SOZ) and propagation. This article covers the technical and theoretical aspects of SEEG, including the surgical techniques and precautions, hypothesis construction, and the interpretation of the recording, all with the aim of providing an introductory guide to SEEG.
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Affiliation(s)
- Hui Ming Khoo
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Jeffery A Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University
| | - Francois Dubeau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University
| | - Naoki Tani
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Yuya Fujita
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Jean Gotman
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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39
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Radiofrequency Thermocoagulation in Refractory Focal Epilepsy: The Montreal Neurological Institute Experience. Can J Neurol Sci 2020; 48:626-639. [PMID: 33272353 DOI: 10.1017/cjn.2020.263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Radiofrequency thermocoagulation (RF-TC) is a minimally invasive ablative option for refractory focal epilepsy. METHODS A retrospective chart review was conducted of all patients who underwent stereoelectroencephalography (SEEG)-guided RF-TC at our institution. RESULTS Fourteen patients underwent robot-guided electrode implantation and subsequent RF-TC. After RF-TC, one of the three patients with PVNH was seizure free, one had 18 months of seizure freedom (Engel 2b), and one required temporal neocortical/PVNH resection (Engel 1a). One of the four patients with focal cortical dysplasia (FCD) was seizure free (Engel 1a), two attained seizure freedom after resection (Engel 1a and 1b), while one continues to have significant seizures (Engel 4b). One patient with cavernoma and low central area epileptogenic zone (EZ) did not benefit from RF-TC and is planned for resection. Two of the MRI-negative patients achieved seizure freedom for 3 months and 1 year, respectively, subsequently requiring resection (Engel 1a). One remains seizure free at 4 weeks. Three had seizure recurrence immediately (Engel 4b). With RF-TC alone, two patients (14%) achieved Engel 1a, two were seizure free at 1 year, one had 3 months of seizure freedom, while the rest had recurrence immediately or within a few weeks. 7/14 patients underwent secondary interventions after RF-TC. Overall, seven patients achieved Engel 1a or 1b, one each 2b and 3a, and five Engel 4b. CONCLUSION At our institution, RF-TC is a safe ablative procedure for refractory focal epilepsy. It can serve as a segue to secondary interventions and appears promising in PVNH cases. Its role in MRI-negative cases is less clear.
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Khoo HM, Gotman J, Hall JA, Dubeau F. Treatment of Epilepsy Associated with Periventricular Nodular Heterotopia. Curr Neurol Neurosci Rep 2020; 20:59. [PMID: 33123826 DOI: 10.1007/s11910-020-01082-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Epilepsy associated with periventricular nodular heterotopia (PNH), a developmental malformation, is frequently drug-resistant and requires focal therapeutic intervention. Invasive EEG study is usually necessary to delineate the epileptogenic zone, but constructing an accurate hypothesis to define an appropriate electrode implantation scheme and the treatment is challenging. This article reviews recent studies that help understanding the epileptogenicity and potential therapeutic options in PNH. RECENT FINDINGS New noninvasive diagnostic and intracerebral EEG analytic tools demonstrated that cortical hyperexcitability and aberrant connectivity (between nodules and cortices and among nodules) are likely mechanisms causing epilepsy in most patients. The deeply seated PNH, if epileptogenic, are ideal target for stereotactic ablative techniques, which offer concomitant ablation of multiple regions with relatively satisfactory seizure outcome. Advance in diagnostic and analytic tools have enhanced our understanding of the complex epileptogenicity in PNH. Development in stereotactic ablative techniques now offers promising therapeutic options for these patients.
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Affiliation(s)
- Hui Ming Khoo
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-shi, Osaka Prefecture, 565-0871, Japan.
| | - Jean Gotman
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - Jeffery A Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - François Dubeau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
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Youngerman BE, Save AV, McKhann GM. Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Epilepsy: Systematic Review of Technique, Indications, and Outcomes. Neurosurgery 2020; 86:E366-E382. [PMID: 31980831 DOI: 10.1093/neuros/nyz556] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For patients with focal drug-resistant epilepsy (DRE), surgical resection of the epileptogenic zone (EZ) may offer seizure freedom and benefits for quality of life. Yet, concerns remain regarding invasiveness, morbidity, and neurocognitive side effects. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a less invasive option for stereotactic ablation rather than resection of the EZ. OBJECTIVE To provide an introduction to MRgLITT for epilepsy, including historical development, surgical technique, and role in therapy. METHODS The development of MRgLITT is briefly recounted. A systematic review identified reported techniques and indication-specific outcomes of MRgLITT for DRE in human studies regardless of sample size or follow-up duration. Potential advantages and disadvantages compared to available alternatives for each indication are assessed in an unstructured review. RESULTS Techniques and outcomes are reported for mesial temporal lobe epilepsy, hypothalamic hamartoma, focal cortical dysplasia, nonlesional epilepsy, tuberous sclerosis, periventricular nodular heterotopia, cerebral cavernous malformations, poststroke epilepsy, temporal encephalocele, and corpus callosotomy. CONCLUSION MRgLITT offers access to foci virtually anywhere in the brain with minimal disruption of the overlying cortex and white matter, promising fewer neurological side effects and less surgical morbidity and pain. Compared to other ablative techniques, MRgLITT offers immediate, discrete lesions with real-time monitoring of temperature beyond the fiber tip for damage estimates and off-target injury prevention. Applications of MRgLITT for epilepsy are growing rapidly and, although more evidence of safety and efficacy is needed, there are potential advantages for some patients.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Akshay V Save
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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Wang Y, Xu J, Liu T, Chen F, Chen S, Xie Z, Fang T, Liang S. Magnetic resonance–guided laser interstitial thermal therapy versus stereoelectroencephalography-guided radiofrequency thermocoagulation for drug-resistant epilepsy: A systematic review and meta-analysis. Epilepsy Res 2020; 166:106397. [DOI: 10.1016/j.eplepsyres.2020.106397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
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Deleo F, Hong SJ, Fadaie F, Caldairou B, Krystal S, Bernasconi N, Bernasconi A. Whole-brain multimodal MRI phenotyping of periventricular nodular heterotopia. Neurology 2020; 95:e2418-e2426. [PMID: 32817185 DOI: 10.1212/wnl.0000000000010648] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To test the hypothesis that in periventricular nodular heterotopia (PVNH) structure and function of cortical areas overlying the heterotopic gray matter are preferentially affected. METHODS We studied a group of 40 patients with PVNH and normal-appearing cortex and compared their quantitative MRI markers of brain development, structure, and function to those of 43 age- and sex-matched healthy controls. Inspired by models of neocortical development suggesting that neuronal migration follows a curvilinear path to preserve topologic correspondence between the outer ventricular zone and the cortical surface, we computationally defined the overlying cortex using the Laplace equation and generated synthetic streamlines that link the ventricles, where nodules are located, and the neocortex. RESULTS We found multilobar cortical thickening encompassing prefrontal, latero-basal temporal, and temporoparietal cortices largely corresponding with the PVNH group-averaged map of the overlying cortex, the latter colocalized with areas of abnormal function, as defined by resting-state fMRI. Patients also presented hippocampal functional hyperconnectivity and malrotation, the latter positively correlating with neocortical maldevelopment indexed by increased folding complexity of the parahippocampus. In clusters of thickness and curvature findings, there were no significant differences between unilateral and bilateral PVNH; contrasting brain-wide metrics between cohorts was also unrevealing. There was no relationship between imaging markers and disease duration except for positive correlation with functional anomalies. CONCLUSION Our quantitative image analysis demonstrates widespread structural and functional alterations in PVNH with differential interaction with the overlying cortex and the hippocampus. Right hemispheric predominance may be explained by an early insult, likely genetically determined, on brain morphogenesis.
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Affiliation(s)
- Francesco Deleo
- From the Neuroimaging of Epilepsy Laboratory (F.D., S.-J.H., F.F., B.C., S.K., N.B., A.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and Epilepsy Unit (F.D.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Seok-Jun Hong
- From the Neuroimaging of Epilepsy Laboratory (F.D., S.-J.H., F.F., B.C., S.K., N.B., A.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and Epilepsy Unit (F.D.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fatemeh Fadaie
- From the Neuroimaging of Epilepsy Laboratory (F.D., S.-J.H., F.F., B.C., S.K., N.B., A.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and Epilepsy Unit (F.D.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Benoit Caldairou
- From the Neuroimaging of Epilepsy Laboratory (F.D., S.-J.H., F.F., B.C., S.K., N.B., A.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and Epilepsy Unit (F.D.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sidney Krystal
- From the Neuroimaging of Epilepsy Laboratory (F.D., S.-J.H., F.F., B.C., S.K., N.B., A.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and Epilepsy Unit (F.D.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Neda Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (F.D., S.-J.H., F.F., B.C., S.K., N.B., A.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and Epilepsy Unit (F.D.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (F.D., S.-J.H., F.F., B.C., S.K., N.B., A.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and Epilepsy Unit (F.D.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
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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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Bai J, Zhou W, Wang H, Zhang B, Lin J, Song X, Li J, Ruan J, Liu Y, Shi J, He J, Feng Q. Value of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation in treating drug-resistant focal epilepsy. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2019.9050015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Stereoelectroencephalography (SEEG) has been widely used in the presurgical evaluation of patients with medically intractable epilepsy. In the past, SEEG was commonly used as a method for mapping and localizing the epileptogenic zone (EZ). Since 2004, several studies have been conducted to examine the effectiveness of SEEG-guided radiofrequency thermocoagulation (RF-TC) in treating refractory epilepsy. However, the seizure-free and responder rates varied greatly across studies. We aimed to analyze the outcome of 56 patients who were treated with SEEG-guided RF-TC to evaluate the effectiveness of this treatment. SEEG-guided RF-TC can be considered as a treatment for refractory epilepsy. However, due to its limited efficacy, SEEG-guided RF-TC might be regarded as a temporary treatment performed under SEEG rather than a promising treatment for refractory epilepsy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Qian Feng
- Epilepsy Center, Yuquan Hospital, Tsinghua University, Beijing 100049, China
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Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC). Seizure 2020; 77:64-68. [DOI: 10.1016/j.seizure.2019.01.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 01/24/2023] Open
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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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Franco AC, Peralta AR, Morgado C, Gonçalves Ferreira A, Rainha Campos A, Bentes C. Stereo-EEG recording and minimally invasive treatment of a periventricular nodular heterotopy: Two-in-one strategy. Clin Neurophysiol 2020; 131:1099-1101. [PMID: 32200091 DOI: 10.1016/j.clinph.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/29/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Catarina Franco
- EEG/Sleep Lab and Neurophysiology Monitoring Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Department of Neurosciences and Mental Health, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência Para Epilepsias Refractárias from EpiCare Network (European Reference Network for Rare and Complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal.
| | - Ana Rita Peralta
- EEG/Sleep Lab and Neurophysiology Monitoring Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Department of Neurosciences and Mental Health, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência Para Epilepsias Refractárias from EpiCare Network (European Reference Network for Rare and Complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
| | - Carlos Morgado
- Department of Neuroradiology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Centro de Referência para Epilepsias Refractárias from EpiCare Network (European Reference Network for rare and complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
| | - António Gonçalves Ferreira
- Department of Neurosciences and Mental Health, Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência para Epilepsias Refractárias from EpiCare Network (European Reference Network for rare and complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
| | - Alexandre Rainha Campos
- Department of Neurosciences and Mental Health, Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência para Epilepsias Refractárias from EpiCare Network (European Reference Network for rare and complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
| | - Carla Bentes
- EEG/Sleep Lab and Neurophysiology Monitoring Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Department of Neurosciences and Mental Health, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência para Epilepsias Refractárias from EpiCare Network (European Reference Network for rare and complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
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Gao R, Yu T, Xu C, Zhang X, Yan X, Ni D, Zhang X, Ma K, Qiao L, Zhu J, Wang X, Ren Z, Zhang X, Zhang G, Li Y. The value of magnetoencephalography for stereo-EEG-guided radiofrequency thermocoagulation in MRI-negative epilepsy. Epilepsy Res 2020; 163:106322. [PMID: 32278277 DOI: 10.1016/j.eplepsyres.2020.106322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/24/2020] [Accepted: 03/19/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Magnetoencephalography (MEG) is valuable for guiding resective surgery in patients with epilepsy. However, its value for minimally invasive treatment is still unknown. This study aims to evaluate the value of MEG for stereo-electroencephalogram (EEG)-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in magnetic resonance imaging (MRI)-negative epilepsies. METHODS An observational cohort study was performed and 19 MRI-negative patients who underwent SEEG-guided RF-TC in our epilepsy center were included. In addition, 16 MRI-positive patients were included as a reference group. Semiology, electrophysiology, and imaging information were collected. To evaluate the value of locating the MEG cluster, the proportion of the RF-TC contacts located in the MEG cluster out of all contacts used to perform RF-TC in each patient was calculated. All patients underwent the standard SEEG-guided RF-TC procedure and were followed up after the treatment. RESULTS Nineteen MRI-negative patients were divided into two groups based on the existence of MEG clusters; 10 patients with MEG clusters were in group I and nine patients without any MEG cluster were in group II. No significant difference was observed in terms of age, sex, type of seizures, or number of SEEG electrodes implanted. The median of the proportion of contacts in the MEG cluster was 77.0 % (IQR 57.7-100.0 %). The follow-up results showed that the probability of being seizure-free at one year after RFTC in MRI-negative patients with an MEG cluster was 30.0 % (95 % CI 11.6-77.3 %), significantly (p = 0.014) higher than that in patients without an MEG cluster; there was no significant difference when compared with MRI-positive patients. CONCLUSION This is the first study to evaluate the value of MEG in SEEG-guided RF-TC in MRI-negative epilepsies. MEG is a useful supplement for patients with MRI-negative epilepsy. MEG can be applied in minimally invasive treatment. MEG clusters can help identify better candidates and provide a valuable target for SEEG-guided RF-TC, which leads to better outcomes.
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Affiliation(s)
- Runshi Gao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiating Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Duanyu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaohua Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kai Ma
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang Qiao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jin Zhu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Wang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhiwei Ren
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xi Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Li
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Wang D, Wei P, Shan Y, Ren L, Wang Y, Zhao G. Optimized stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of patients with focal epilepsy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:15. [PMID: 32055606 DOI: 10.21037/atm.2019.10.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epilepsy is a severe health disorder affecting people of all ages with high prevalence worldwide. The introduction of new antiepileptic drugs has yielded notable effects in recent decades, yet there are still approximately 30% of patients with seizures refractory to medical therapy. Open surgical resection is widely accepted as a highly effective approach for the treatment of drug-resistant focal epilepsy if the epileptogenic zone can be precisely delineated. However, concerns about the impact of open surgery on brain function have driven considerable interest in less invasive techniques. Clinically, stereoelectroencephalography (SEEG) offers a unique means of exploring the pathophysiologic process and accurately mapping the epileptogenic network in presurgical evaluations for patients with epilepsy because of insufficient information from other noninvasive investigations. Moreover, SEEG-guided radiofrequency thermocoagulation (SEEG-guided RF-TC), which ablates lesions directly through the recording electrodes according to electroclinical evidence, has emerged as a promising, minimally invasive modality with notable preservation of neurocognitive functions. This critical review summarizes the technical details of the parameters and the selection of patients for SEEG-guided RF-TC based on the literature as well as our experiences. With respect to the parameters, the power and duration of RF-TC are discussed. In particular, an optimized SEEG-guided RF-TC modality that integrates more contacts from multiple different electrodes to create a confluent lesioning field is proposed for a more curative effect in comparison to the current protocol of palliative treatment in which RF-TC selectively disrupts critical hubs in the epileptic network through contiguous contacts within the range of a single electrode. Currently, SEEG-guided RF-TC is indicated for a variety of small, deeply seeded and well-demarcated epileptogenic foci, such as deep heterotopic nodules and hypothalamic hamartoma. The efficacy of treating patients with focal cortical dysplasias in the eloquent cortex and with mesial temporal lobe epilepsy associated with hippocampal sclerosis needs to be further determined. Given the small number of patients reported, randomized controlled trials are necessary to compare the efficacy of SEEG-guided RF-TC with conventional methods in the future.
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Affiliation(s)
- Di Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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