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Jolly S, Paliwal S, Gadepalli A, Chaudhary S, Bhagat H, Avitsian R. Designing Enhanced Recovery After Surgery Protocols in Neurosurgery: A Contemporary Narrative Review. J Neurosurg Anesthesiol 2024; 36:201-210. [PMID: 38011868 DOI: 10.1097/ana.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/16/2023] [Indexed: 11/29/2023]
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have revolutionized the approach to perioperative care in various surgical specialties. They reduce complications, improve patient outcomes, and shorten hospital lengths of stay. Implementation of ERAS protocols for neurosurgical procedures has been relatively underexplored and underutilized due to the unique challenges and complexities of neurosurgery. This narrative review explores the barriers to, and pioneering strategies of, standardized procedure-specific ERAS protocols, and the importance of multidisciplinary collaboration in neurosurgery and neuroanesthsia, patient-centered approaches, and continuous quality improvement initiatives, to achieve better patient outcomes. It also discusses initiatives to guide future clinical practice, research, and guideline creation, to foster the development of tailored ERAS protocols in neurosurgery.
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Affiliation(s)
- Sagar Jolly
- Department of General Anesthesiology, Cleveland Clinic, OH
| | | | - Aditya Gadepalli
- Department of Anaesthetics and Intensive Care, Royal Free London NHS Foundation Trust, London, UK
| | - Sheena Chaudhary
- Department of Neuroanesthesia and Critical Care, Fortis Memorial Research Institute, Gurugram, HR, India
| | - Hemant Bhagat
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rafi Avitsian
- Department of General Anesthesiology, Cleveland Clinic, OH
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Seghier ML. 7 T and beyond: toward a synergy between fMRI-based presurgical mapping at ultrahigh magnetic fields, AI, and robotic neurosurgery. Eur Radiol Exp 2024; 8:73. [PMID: 38945979 PMCID: PMC11214939 DOI: 10.1186/s41747-024-00472-y] [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: 03/30/2024] [Accepted: 04/22/2024] [Indexed: 07/02/2024] Open
Abstract
Presurgical evaluation with functional magnetic resonance imaging (fMRI) can reduce postsurgical morbidity. Here, we discuss presurgical fMRI mapping at ultra-high magnetic fields (UHF), i.e., ≥ 7 T, in the light of the current growing interest in artificial intelligence (AI) and robot-assisted neurosurgery. The potential of submillimetre fMRI mapping can help better appreciate uncertainty on resection margins, though geometric distortions at UHF might lessen the accuracy of fMRI maps. A useful trade-off for UHF fMRI is to collect data with 1-mm isotropic resolution to ensure high sensitivity and subsequently a low risk of false negatives. Scanning at UHF might yield a revival interest in slow event-related fMRI, thereby offering a richer depiction of the dynamics of fMRI responses. The potential applications of AI concern denoising and artefact removal, generation of super-resolution fMRI maps, and accurate fusion or coregistration between anatomical and fMRI maps. The latter can benefit from the use of T1-weighted echo-planar imaging for better visualization of brain activations. Such AI-augmented fMRI maps would provide high-quality input data to robotic surgery systems, thereby improving the accuracy and reliability of robot-assisted neurosurgery. Ultimately, the advancement in fMRI at UHF would promote clinically useful synergies between fMRI, AI, and robotic neurosurgery.Relevance statement This review highlights the potential synergies between fMRI at UHF, AI, and robotic neurosurgery in improving the accuracy and reliability of fMRI-based presurgical mapping.Key points• Presurgical fMRI mapping at UHF improves spatial resolution and sensitivity.• Slow event-related designs offer a richer depiction of fMRI responses dynamics.• AI can support denoising, artefact removal, and generation of super-resolution fMRI maps.• AI-augmented fMRI maps can provide high-quality input data to robotic surgery systems.
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Affiliation(s)
- Mohamed L Seghier
- Department of Biomedical Engineering and Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, UAE.
- Healtcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, UAE.
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Castro-Macías JI, San-Juan D, Anschel D, Cuellar-Figueroa VA. Electrocorticographic Patterns in Frontal Epilepsy and Long-Term Outcomes. J Clin Neurophysiol 2024:00004691-990000000-00145. [PMID: 38916879 DOI: 10.1097/wnp.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION The prognostic significance of tailored resection guided with intraoperative electrocorticography (iECoG) in frontal lobe epilepsy surgery has not been fully elucidated. OBJECTIVES To analyze influence of preresection and postresection iECoG patterns on long-term seizure control of adults with frontal lobe epilepsy undergoing epilepsy surgery. METHODS We retrospectively analyzed 27 patients undergoing epilepsy surgery from two centers with preresection and postresection iECoG and reported clinical variables, preresection and postresection iECoG patterns, and outcome using the Engel Outcome Scale. Descriptive statistics, Kaplan-Meier, the logistic regression model, and analysis of variance tests were used. RESULTS Fifteen males (55.6%), a mean and mode follow-up after surgery of 43 (range 2-117) and 19 months, respectively. At 6 months, seizure frequency outcome according to Engel Scale was I 74.1% (20/27), II 7.4% (2/27), III 3.7% (1/27), and IV 14.8% (4/27). We found that 51.9% (14/27) and 40.8% (11/27) of patients without residual epileptiform discharges in postresective iECoG become seizure-free at 6 and 12 months of follow-up, respectively, compared with other postresective iECoG patterns. CONCLUSIONS Disregarding the presence of lack of residual epileptiform discharges (interictal epileptiform discharges) after resection, Engel I outcome was seen between 74.1% and 63% at 6- and 12-month postresection follow-up, suggesting the outcome might be in relation with other factors.
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Affiliation(s)
| | - Daniel San-Juan
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, México
| | - David Anschel
- St. Charles Epilepsy/New York University Comprehensive Epilepsy Center, St. Charles Hospital, Port Jefferson, New York, U.S.A.; and
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Guo J, Wang Z, van 't Klooster MA, Van Der Salm SM, Leijten FS, Braun KP, Zijlmans M. Seizure Outcome After Intraoperative Electrocorticography-Tailored Epilepsy Surgery: A Systematic Review and Meta-Analysis. Neurology 2024; 102:e209430. [PMID: 38768406 PMCID: PMC11175635 DOI: 10.1212/wnl.0000000000209430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/12/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Tailoring epilepsy surgery using intraoperative electrocorticography (ioECoG) has been debated, and modest number of epilepsy surgery centers apply this diagnostic method. We assessed the current evidence to use ioECoG-tailored epilepsy surgery for improving postsurgical outcome. METHODS PubMed and Embase were searched for original studies reporting on ≥10 cases who underwent ioECoG-tailored surgery for epilepsy, with a follow-up of at least 6 months. We used a random-effects model to calculate the overall rate of patients achieving favorable seizure outcome (FSO), defined as Engel class I, ILAE class 1, or seizure-free status. Meta-regression was used to investigate potential sources of heterogeneity. We calculated the odds ratio (OR) for estimating variables on FSO:ioECoG vs non-ioECoG-tailored surgery (if included studies contained patients with non-ioECoG-tailored surgery), ioECoG-tailored epilepsy surgery in children vs adults, temporal (TL) vs extratemporal lobe (eTL), MRI-positive vs MRI-negative, and complete vs incomplete resection of tissue that generated interictal epileptiform discharges (IEDs). A Bayesian network meta-analysis was conducted for underlying pathologies. We assessed the evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS Eighty-three studies (82 observational studies, 1 trial) comprising 3,631 patients with ioECoG-tailored surgery were included. The overall pooled rate of patients who attained FSO after ioECoG-tailored surgery was 74% (95% CI 71-77) with significant heterogeneity, which was predominantly attributed to pathologies and seizure outcome classifications. Twenty-two studies contained non-ioECoG-tailored surgeries. IoECoG-tailored surgeries reached a higher rate of FSO than non-ioECoG-tailored surgeries (OR 2.10 [95% CI 1.37-3.24]; p < 0.01; very low certainty). Complete resection of tissue that displayed IEDs in ioECoG predicted FSO better compared with incomplete resection (OR 3.04 [1.76-5.25]; p < 0.01; low certainty). We found insignificant difference in FSO after ioECoG-tailored surgery in children vs adults, TL vs eTL, or MRI-positive vs MRI-negative. The network meta-analysis showed that the odds of FSO was lower for malformations of cortical development than for tumors (OR 0.47 95% credible interval 0.25-0.87). DISCUSSION Although limited by low-quality evidence, our meta-analysis shows a relatively good surgical outcome (74% FSO) after epilepsy surgery with ioECoG, especially in tumors, with better outcome for ioECoG-tailored surgeries in studies describing both and better outcome after complete removal of IED areas.
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Affiliation(s)
- Jiaojiao Guo
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Ziyi Wang
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Maryse A van 't Klooster
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Sandra M Van Der Salm
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Frans S Leijten
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Kees P Braun
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
| | - Maeike Zijlmans
- From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands
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de Font-Réaulx E, Solis-Santamaria A, Arch-Tirado E, González-Astiazarán A. Thermosensitive/thermochromic silicone and infrared thermography mapping in 60 consecutive cases of epilepsy surgery. Surg Neurol Int 2024; 15:63. [PMID: 38468653 PMCID: PMC10927215 DOI: 10.25259/sni_763_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Background Epilepsy surgery represents a therapeutic opportunity for those patients who do not respond to drug therapy. However, an important challenge is the precise identification of the epileptogenic area during surgery. Since it can be hard to delineate, it makes it necessary to use auxiliary tools as a guide during the surgical procedure. Electrocorticography (ECoG), despite having shown favorable results in terms of reducing post-surgical seizures, have certain limitations. Brain mapping using infrared thermography mapping and a new thermosensitive/thermochromic silicone (TTS) in epilepsy surgery has introduced a new resource of noninvasive and real-time devices that allow the localization of irritative zones. Methods Sixty consecutive patients with drug-resistant epilepsy with surgical indications who decided to participate voluntarily in the study were included in the study. We measured brain temperature using two quantitative methods and a qualitative method: the TTS sheet. In all cases, we used ECoG as the gold standard to identify irritative areas, and all brain tissue samples obtained were sent to pathology for diagnosis. Results In the subgroup in which the ECoG detected irritative areas (n = 51), adding the results in which there was a correlation with the different methods, the efficiency obtained to detect irritative areas is 94.11% (n = 48/51, P ≤ 0.0001) while the infrared thermography mapping method independently has an efficiency of 91.66% (P ≤ 0.0001). The TTS has a sensitivity of 95.71% and a specificity of 97.9% (P ≤ 0.0001) to detect hypothermic areas that correlate with the irritative zones detected by ECoG. No postoperative infections or wound dehiscence were documented, so the different methodologies used do not represent an additional risk for the surgical proceedings. Conclusion We consider that the infrared thermography mapping using high-resolution infrared thermography cameras and the TTS are both accurate and safe methods to identify irritative areas in epilepsy surgeries.
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Affiliation(s)
- Enrique de Font-Réaulx
- Head, Department of Epilepsy Surgery, Neurological Center, Centro Médico ABC, Mexico City, Mexico
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Biagioli N, Morandi S, Vaudano AE, Pugnaghi M, Moriconi E, Pavesi G, Tramontano V, Meletti S. Intraoperative ECoG in bottom-of-the-sulcus syndrome using a novel flexible strip electrode. Epileptic Disord 2024. [PMID: 38420724 DOI: 10.1002/epd2.20211] [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: 08/25/2023] [Revised: 01/09/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
The recording of epileptiform discharges from bottom-of-sulcus focal cortical dysplasia (BOSD) is often difficult during intraoperative electrocorticography (ECoG) due to the deep localization. We describe the use in this scenario of a new-generation electrode strip with high flexibility, easily adapted to cortical gyri and sulci. A right-handed 20-year-old male with drug-resistant focal epilepsy due to BOSD of the inferior frontal gyrus and daily focal aware seizures was evaluated for epilepsy surgery. Based on electroclinical and neuroimaging results, a focal cortectomy guided by ECoG was proposed. ECoG recordings were performed with new-generation cortical strips (Wise Cortical Strip; WCS®) and standard cortical strips. ECoG, performed on the convexity of the frontal cortical surface, recorded only sporadic spikes with both types of strips. Then, after microsurgical trans-sulcal dissection, WCS was molded along the sulcal surface of the suspected BOSD based on 3D-imaging reconstruction, showing continuous/subcontinuous 3-4-Hz rhythmic spike activity from the deepest electrode. Registration after resection of the BOSD did not show any epileptiform activity. Pathology showed dysmorphic neurons and gliosis. No surgical complications occurred. The patient is seizure-free after 12 months. This single case experience shows that highly flexible electrode strips with adaptability to cortical gyrations can identify IEDs originating from deep location and could therefore be useful in cases of bottom of the sulcus dysplasia.
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Affiliation(s)
- Niccolò Biagioli
- Department of Biomedical Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Sofia Morandi
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Matteo Pugnaghi
- Neurology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Elisa Moriconi
- Neurosurgery Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Giacomo Pavesi
- Neurosurgery Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Vincenzo Tramontano
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Stefano Meletti
- Department of Biomedical Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
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Lado FA, Ahrens SM, Riker E, Muh CR, Richardson RM, Gray J, Small B, Lewis SZ, Schofield TJ, Clarke DF, Hopp JL, Lee RR, Salpekar JA, Arnold ST. Guidelines for Specialized Epilepsy Centers: Executive Summary of the Report of the National Association of Epilepsy Centers Guideline Panel. Neurology 2024; 102:e208087. [PMID: 38306606 PMCID: PMC10962912 DOI: 10.1212/wnl.0000000000208087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 02/04/2024] Open
Abstract
The National Association of Epilepsy Centers first published the guidelines for epilepsy centers in 1990, which were last updated in 2010. Since that update, epilepsy care and the science of guideline development have advanced significantly, including the importance of incorporating a diversity of stakeholder perspectives such as those of patients and their caregivers. Currently, despite extensive published data examining the efficacy of treatments and diagnostic testing for epilepsy, there remain significant gaps in data identifying the essential services needed for a comprehensive epilepsy center and the optimal manner for their delivery. The trustworthy consensus-based statements (TCBS) process produces unbiased, scientifically valid guidelines through a transparent process that incorporates available evidence and expert opinion. A systematic literature search returned 5937 relevant studies from which 197 articles were retained for data extraction. A panel of 41 stakeholders with diverse expertise evaluated this evidence and drafted recommendations following the TCBS process. The panel reached consensus on 52 recommendations covering services provided by specialized epilepsy centers in both the inpatient and outpatient settings in major topic areas including epilepsy monitoring unit care, surgery, neuroimaging, neuropsychology, genetics, and outpatient care. Recommendations were informed by the evidence review and reflect the consensus of a broad panel of expert opinions.
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Affiliation(s)
- Fred A Lado
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Stephanie M Ahrens
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Ellen Riker
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Carrie R Muh
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - R Mark Richardson
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Johanna Gray
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Barbara Small
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Sandra Z Lewis
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Thomas J Schofield
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Dave F Clarke
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Jennifer L Hopp
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Roland R Lee
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Jay A Salpekar
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Susan T Arnold
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
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8
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Avila EK, Tobochnik S, Inati SK, Koekkoek JAF, McKhann GM, Riviello JJ, Rudà R, Schiff D, Tatum WO, Templer JW, Weller M, Wen PY. Brain tumor-related epilepsy management: A Society for Neuro-oncology (SNO) consensus review on current management. Neuro Oncol 2024; 26:7-24. [PMID: 37699031 PMCID: PMC10768995 DOI: 10.1093/neuonc/noad154] [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] [Indexed: 09/14/2023] Open
Abstract
Tumor-related epilepsy (TRE) is a frequent and major consequence of brain tumors. Management of TRE is required throughout the course of disease and a deep understanding of diagnosis and treatment is key to improving quality of life. Gross total resection is favored from both an oncologic and epilepsy perspective. Shared mechanisms of tumor growth and epilepsy exist, and emerging data will provide better targeted therapy options. Initial treatment with antiseizure medications (ASM) in conjunction with surgery and/or chemoradiotherapy is typical. The first choice of ASM is critical to optimize seizure control and tolerability considering the effects of the tumor itself. These agents carry a potential for drug-drug interactions and therefore knowledge of mechanisms of action and interactions is needed. A review of adverse effects is necessary to guide ASM adjustments and decision-making. This review highlights the essential aspects of diagnosis and treatment of TRE with ASMs, surgery, chemotherapy, and radiotherapy while indicating areas of uncertainty. Future studies should consider the use of a standardized method of seizure tracking and incorporating seizure outcomes as a primary endpoint of tumor treatment trials.
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Affiliation(s)
- Edward K Avila
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Neurology, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Sara K Inati
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Guy M McKhann
- Department of Neurosurgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - James J Riviello
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Italy
| | - David Schiff
- Department of Neurology, Division of Neuro-Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jessica W Templer
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Centre, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Center, and Division of Neuro-Oncology, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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9
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Freund BE, Feyissa AM, Khan A, Sirven JI, Grewal SS, Sabsevitz D, Moniz-Garcia D, Quinones-Hinojosa A, Tatum WO. Enhanced sensitivity of electrocorticography during awake craniotomy using a novel circular grid electrode. J Neurooncol 2023; 165:313-320. [PMID: 37932608 DOI: 10.1007/s11060-023-04495-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Awake craniotomy with intraoperative functional brain mapping (FBM) bedside neurological testing is an important technique used to optimize resective brain surgeries near eloquent cortex. Awake craniotomy performed with electrocorticography (ECoG) and direct electrical stimulation (DES) for FBM can delineate eloquent cortex from lesions and epileptogenic regions. However, current electrode technology demonstrates spatial limitations. Our group has developed a novel circular grid with the goal of improving spatial recording of ECoG to enhance detection of ictal and interictal activity. METHODS This retrospective study was approved by the institutional review board at Mayo Clinic Florida. We analyzed patients undergoing awake craniotomy with ECoG and DES and compared ECoG data obtained using the 22 contact circular grid to standard 6 contact strip electrode. RESULTS We included 144 cases of awake craniotomy with ECoG, 73 using circular grid and 71 with strip electrode. No significant differences were seen regarding preoperative clinical and demographic data, duration of ECoG recording (p = 0.676) and use of DES (p = 0.926). Circular grid was more sensitive in detecting periodic focal epileptiform discharges (PFEDs) (p = 0.004), PFEDs plus (p = 0.032), afterdischarges (ADs) per case (p = 0.022) at lower minimum (p = 0.012) and maximum (p < 0.0012) intensity stimulation, and seizures (p = 0.048). PFEDs (p < 0.001), PFEDs plus (p < 0.001), and HFOs (p < 0.001) but not ADs (p = 0.255) predicted electrographic seizures. CONCLUSION We demonstrate higher sensitivity in detecting ictal and interictal activity on ECoG during awake craniotomy with a novel circular grid compared to strip electrode, likely due to better spatial sampling during ECoG. We also found association between PFEDs and intraoperative seizures.
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Affiliation(s)
- Brin E Freund
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | | | - Aafreen Khan
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - David Sabsevitz
- Department of Psychiatry and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
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10
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Freund BE, Sherman WJ, Sabsevitz DS, Middlebrooks EH, Feyissa AM, Garcia DM, Grewal SS, Chaichana KL, Quinones-Hinojosa A, Tatum WO. Can we improve electrocorticography using a circular grid array in brain tumor surgery? Biomed Phys Eng Express 2023; 9:065027. [PMID: 37871586 DOI: 10.1088/2057-1976/ad05dd] [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: 05/21/2023] [Accepted: 10/23/2023] [Indexed: 10/25/2023]
Abstract
Intraoperative electrocorticography (iECoG) is used as an adjunct to localize the epileptogenic zone during surgical resection of brain tumors in patients with focal epilepsies. It also enables monitoring of after-discharges and seizures with EEG during functional brain mapping with electrical stimulation. When seizures or after-discharges are present, they complicate accurate interpretation of the mapping strategy to outline the brain's eloquent function and can affect the surgical procedure. Recurrent seizures during surgery requires urgent treatment and, when occurring during awake craniotomy, often leads to premature termination of brain mapping due to post-ictal confusion or sedation from acute rescue therapy. There are mixed results in studies on efficacy with iECoG in patients with epilepsy and brain tumors influencing survival and functional outcomes following surgery. Commercially available electrode arrays have inherent limitations. These could be improved with customization potentially leading to greater precision in safe and maximal resection of brain tumors. Few studies have assessed customized electrode grid designs as an alternative to commercially available products. Higher density electrode grids with intercontact distances less than 1 cm improve spatial delineation of electrophysiologic sources, including epileptiform activity, electrographic seizures, and afterdischarges on iECoG during functional brain mapping. In response to the shortcomings of current iECoG grid technologies, we designed and developed a novel higher-density hollow circular electrode grid array. The 360-degree iECoG monitoring capability allows continuous EEG recording during surgical intervention through the aperture with and without electrical stimulation mapping. Compared with linear strip electrodes that are commonly used for iECoG during surgery, the circular grid demonstrates significant benefits in brain tumor surgery. This includes quicker recovery of post-operative motor deficits (2.4 days versus 9 days, p = 0.05), more extensive tumor resection (92.0% versus 77.6%, p = 0.003), lesser reduction in Karnofsky Performance scale postoperatively (-2 versus -11.6, p = 0.007), and more sensitivity to recording afterdischarges. In this narrative review, we discuss the advantages and disadvantages of commercially available recording devices in the operating room and focus on the usefulness of the higher-density circular grid.
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Affiliation(s)
- Brin E Freund
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Wendy J Sherman
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - David S Sabsevitz
- Department of Psychiatry, Division of Neuropsychology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Erik H Middlebrooks
- Department of Radiology, Division of Neuroradiology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Anteneh M Feyissa
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Diogo Moniz Garcia
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Kaisorn L Chaichana
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Alfredo Quinones-Hinojosa
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - William O Tatum
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
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11
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Chen MI, Lee D, Wong BJ. Innovations in diagnostic and treatment options for pediatric epilepsy and their anesthetic implications. Curr Opin Anaesthesiol 2023; 36:485-490. [PMID: 37552014 DOI: 10.1097/aco.0000000000001303] [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: 08/09/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of anesthetic techniques for innovative diagnostic and therapeutic epilepsy procedures performed on pediatric patients. RECENT FINDINGS Recent studies have been published on the anesthetic consideration for functional MRI, robotic-assisted stereoelectroencephalography, high-intensity focused ultrasound, and magnetoencephalography. These articles describe the anesthesia management, risks, and outcome for these procedures. SUMMARY The number of diagnostic and treatment options being used for the management of pediatric epilepsy has increased significantly. In the past few years, a handful of articles have been published, which describe the anesthetic considerations for these procedures. These studies are helpful to anesthesiologists who are planning an upcoming anesthetic or who are developing a 'best practice' model for their institution. Because unlike other diagnostic studies, failure to understand what effects anesthetics have on the brain, may negate the utility of the study. Although these new findings can be used to provide some anesthesia practice recommendations for epilepsy procedures in which the best management is still unclear, additional high-quality studies are needed.
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Affiliation(s)
- Michael I Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford
| | - David Lee
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Becky J Wong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford
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12
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Chen JS, Lamoureux AA, Shlobin NA, Elkaim LM, Wang A, Ibrahim GM, Obaid S, Harroud A, Guadagno E, Dimentberg E, Bouthillier A, Bernhardt BC, Nguyen DK, Fallah A, Weil AG. Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy: A systematic review and individual participant data meta-analysis. Epilepsia 2023; 64:1957-1974. [PMID: 36824029 DOI: 10.1111/epi.17560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug-resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta-analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms "MR-guided ablation therapy" and "epilepsy". Multivariable mixed-effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow-up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure-free at last follow-up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p < .001) and mesial temporal sclerosis/atrophy (MTS/A; OR = 2.21, p = .011) were independently associated with greater odds of seizure freedom at last follow-up. Operative complications occurred in 28 (8.5%) of 330 patients and were independently associated with extratemporal ablations (OR = 5.40, p = .012) and nonlesional MRI studies (OR = 3.25, p = .017). Postoperative neurological deficits were observed in 53 (15.1%) of 352 patients and were independently predicted by hypothalamic hamartoma etiology (OR = 5.93, p = .006) and invasive electroencephalographic monitoring (OR = 4.83, p = .003). Overall, MRgLITT is particularly effective in treating patients with well-circumscribed lesional DRE, such as CCM and MTS/A, but less effective in nonlesional cases or lesional cases with a more diffuse epileptogenic network associated with generalized seizures. This study identifies independent predictors of seizure freedom and complications following MRgLITT that may help further guide patient selection.
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Affiliation(s)
- Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Audrey-Anne Lamoureux
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sami Obaid
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Adil Harroud
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Evan Dimentberg
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Dang K Nguyen
- Division of Neurology, University of Montreal Medical Center, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
- Brain and Child Development Axis, Sainte Justine Research Center, Montreal, Quebec, Canada
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13
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Frauscher B, Bénar CG, Engel JJ, Grova C, Jacobs J, Kahane P, Wiebe S, Zjilmans M, Dubeau F. Neurophysiology, Neuropsychology, and Epilepsy, in 2022: Hills We Have Climbed and Hills Ahead. Neurophysiology in epilepsy. Epilepsy Behav 2023; 143:109221. [PMID: 37119580 DOI: 10.1016/j.yebeh.2023.109221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
Since the discovery of the human electroencephalogram (EEG), neurophysiology techniques have become indispensable tools in our armamentarium to localize epileptic seizures. New signal analysis techniques and the prospects of artificial intelligence and big data will offer unprecedented opportunities to further advance the field in the near future, ultimately resulting in improved quality of life for many patients with drug-resistant epilepsy. This article summarizes selected presentations from Day 1 of the two-day symposium "Neurophysiology, Neuropsychology, Epilepsy, 2022: Hills We Have Climbed and the Hills Ahead". Day 1 was dedicated to highlighting and honoring the work of Dr. Jean Gotman, a pioneer in EEG, intracranial EEG, simultaneous EEG/ functional magnetic resonance imaging, and signal analysis of epilepsy. The program focused on two main research directions of Dr. Gotman, and was dedicated to "High-frequency oscillations, a new biomarker of epilepsy" and "Probing the epileptic focus from inside and outside". All talks were presented by colleagues and former trainees of Dr. Gotman. The extended summaries provide an overview of historical and current work in the neurophysiology of epilepsy with emphasis on novel EEG biomarkers of epilepsy and source imaging and concluded with an outlook on the future of epilepsy research, and what is needed to bring the field to the next level.
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Affiliation(s)
- B Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada.
| | - C G Bénar
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - J Jr Engel
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - C Grova
- Multimodal Functional Imaging Lab, PERFORM Centre, Department of Physics, Concordia University, Montreal, QC, Canada; Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, QC, Canada; Montreal Neurological Institute and Hospital, Neurology and Neurosurgery Department, McGill University, Montreal, QC, Canada
| | - J Jacobs
- Department of Pediatric and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - P Kahane
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institute Neurosciences, Department of Neurology, 38000 Grenoble, France
| | - S Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - M Zjilmans
- Stichting Epilepsie Instellingen Nederland, The Netherlands; Brain Center, University Medical Center Utrecht, The Netherlands
| | - F Dubeau
- Montreal Neurological Institute and Hospital, Neurology and Neurosurgery Department, McGill University, Montreal, QC, Canada
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