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Liu Y, Zhang J, Ren Y, Wu H, Li H, Dong S, Liu X, Du C, Meng Q, Zhang H. The clinical features of patients with seizure freedom and failure after total corpus callosotomy for childhood-onset refractory epilepsy. Br J Neurosurg 2023:1-8. [PMID: 37927066 DOI: 10.1080/02688697.2023.2273840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Corpus callosotomy is a palliative surgery for medically refractory epilepsy. We aim to analyze the clinical features of patients with seizure freedom and failure after total corpus callosotomy for childhood-onset refractory epilepsy. METHODS We retrospectively reviewed the clinical courses of patients with childhood-onset refractory epilepsy undergoing total corpus callosotomy between May 2009 and March 2019. Seizure outcome at the last follow-up was the primary outcome. The clinical features of patients with seizure freedom and failure after callosotomy were compared. RESULTS Eighty patients with childhood-onset refractory epilepsy underwent total corpus callosotomy; 15 (18.8%) obtained freedom from all seizures and 19 (23.8%) had unworthwhile improvement and failure. The mean ages at seizure onset in patients with seizure freedom and failure after callosotomy were 5.7 and 5.9 years; and mean seizure durations were 9.4 and 11.5 years, respectively. Univariate analysis found epilepsy syndrome (p = 0.047), mental retardation (p = 0.007), previous medical history (p = 0.004), ≥10 seizures per day (p = 0.024), theta waves in the background electroencephalogram (p = 0.024), and acute postoperative seizure (p = 0.000) were associated with failure after callosotomy. Seizure freedom after callosotomy was more common among patients with less than 10 seizures per day. CONCLUSIONS Total corpus callosotomy is an effective palliative procedure for childhood-onset refractory epilepsy, particularly for patients with specific clinical characteristics. Callosotomy has a high seizure-free rate in well-selected patients.
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Affiliation(s)
- Yong Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Jiale Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Yutao Ren
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Hao Wu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Huanfa Li
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Shan Dong
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Xiaofang Liu
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Changwang Du
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Qiang Meng
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Hua Zhang
- Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, China
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Kosugi K, Iijima K, Yokosako S, Takayama Y, Kimura Y, Kaneko Y, Sumitomo N, Saito T, Nakagawa E, Sato N, Iwasaki M. Low EEG Gamma Entropy and Glucose Hypometabolism After Corpus Callosotomy Predicts Seizure Outcome After Subsequent Surgery. Front Neurol 2022; 13:831126. [PMID: 35401399 PMCID: PMC8989433 DOI: 10.3389/fneur.2022.831126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with generalized epilepsy who had lateralized EEG abnormalities after corpus callosotomy (CC) occasionally undergo subsequent surgeries to control intractable epilepsy.ObjectivesThis study evaluated retrospectively the combination of EEG multiscale entropy (MSE) and FDG-PET for identifying lateralization of the epileptogenic zone after CC.MethodsThis study included 14 patients with pharmacoresistant epilepsy who underwent curative epilepsy surgery after CC. Interictal scalp EEG and FDG-PET obtained after CC were investigated to determine (1) whether the MSE calculated from the EEG and FDG-PET findings was lateralized to the surgical side, and (2) whether the lateralization was associated with seizure outcomes.ResultsSeizure reduction rate was higher in patients with lateralized findings to the surgical side than those without (MSE: p < 0.05, FDG-PET: p < 0.05, both: p < 0.01). Seizure free rate was higher in patients with lateralized findings in both MSE and FDG-PET than in those without (p < 0.05).ConclusionsThis study demonstrated that patients with lateralization of MSE and FDG-PET to the surgical side had better seizure outcomes. The combination of MSE and conventional FDG-PET may help to select surgical candidates for additional surgery after CC with good postoperative seizure outcomes.
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Affiliation(s)
- Kenzo Kosugi
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Suguru Yokosako
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuiko Kimura
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuu Kaneko
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
- *Correspondence: Masaki Iwasaki
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Höller Y, Nardone R. Quantitative EEG biomarkers for epilepsy and their relation to chemical biomarkers. Adv Clin Chem 2020; 102:271-336. [PMID: 34044912 DOI: 10.1016/bs.acc.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The electroencephalogram (EEG) is the most important method to diagnose epilepsy. In clinical settings, it is evaluated by experts who identify patterns visually. Quantitative EEG is the application of digital signal processing to clinical recordings in order to automatize diagnostic procedures, and to make patterns visible that are hidden to the human eye. The EEG is related to chemical biomarkers, as electrical activity is based on chemical signals. The most well-known chemical biomarkers are blood laboratory tests to identify seizures after they have happened. However, research on chemical biomarkers is much less extensive than research on quantitative EEG, and combined studies are rarely published, but highly warranted. Quantitative EEG is as old as the EEG itself, but still, the methods are not yet standard in clinical practice. The most evident application is an automation of manual work, but also a quantitative description and localization of interictal epileptiform events as well as seizures can reveal important hints for diagnosis and contribute to presurgical evaluation. In addition, the assessment of network characteristics and entropy measures were found to reveal important insights into epileptic brain activity. Application scenarios of quantitative EEG in epilepsy include seizure prediction, pharmaco-EEG, treatment monitoring, evaluation of cognition, and neurofeedback. The main challenges to quantitative EEG are poor reliability and poor generalizability of measures, as well as the need for individualization of procedures. A main hindrance for quantitative EEG to enter clinical routine is also that training is not yet part of standard curricula for clinical neurophysiologists.
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Affiliation(s)
- Yvonne Höller
- Faculty of Psychology, University of Akureyri, Akureyri, Iceland.
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
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4
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Symmetry of ictal slow waves may predict the outcomes of corpus callosotomy for epileptic spasms. Sci Rep 2019; 9:19733. [PMID: 31875025 PMCID: PMC6930281 DOI: 10.1038/s41598-019-56303-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/05/2019] [Indexed: 12/05/2022] Open
Abstract
We aimed to analyse the ictal electrographic changes on scalp electroencephalography (EEG), focusing on high-voltage slow waves (HVSs) in children with epileptic spasms (ES) and tonic spasms (TS) and then identified factors associated with corpus callosotomy (CC) outcomes. We enrolled 17 patients with ES/TS who underwent CC before 20 years of age. Post-CC Engel’s classification was as follows: I in 7 patients, II in 2, III in 4, and IV in 4. Welch’s t-test was used to analyse the correlation between ictal HVSs and CC outcomes based on the following three symmetrical indices: (1) negative peak delay: interhemispheric delay between negative peaks; (2) amplitude ratio: interhemispheric ratio of amplitude values for the highest positive peaks; and (3) duration ratio: interhemispheric ratio of slow wave duration. Ages at CC ranged from 17–237 months. Four to 15 ictal EEGs were analysed for each patient. The negative peak delay, amplitude ratio and duration ratio ranged from 0–530 ms, 1.00–7.40 and 1.00–2.74, respectively. The negative peak delay, amplitude ratio and duration ratio were significantly higher in the seizure residual group (p = 0.017, <0.001, <0.001, respectively). Symmetry of ictal HVSs may predict favourable outcomes following CC for ES/TS.
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Lehner KR, Yeagle EM, Argyelan M, Klimaj Z, Du V, Megevand P, Hwang ST, Mehta AD. Validation of corpus callosotomy after laser interstitial thermal therapy: a multimodal approach. J Neurosurg 2019; 131:1095-1105. [PMID: 30497188 DOI: 10.3171/2018.4.jns172588] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
Objective Disconnection of the cerebral hemispheres by corpus callosotomy (CC) is an established means to palliate refractory generalized epilepsy. Laser interstitial thermal therapy (LITT) is gaining acceptance as a minimally invasive approach to treating epilepsy, but this method has not been evaluated in clinical series using established methodologies to assess connectivity. The goal in this study was to demonstrate the safety and feasibility of MRI-guided LITT for CC and to assess disconnection by using electrophysiology- and imaging-based methods. Methods Retrospective chart and imaging review was performed in 5 patients undergoing LITT callosotomy at a single center. Diffusion tensor imaging and resting functional MRI were performed in all patients to assess anatomical and functional connectivity. In 3 patients undergoing simultaneous intracranial electroencephalography monitoring, corticocortical evoked potentials and resting electrocorticography were used to assess electrophysiological correlates. Results All patients had generalized or multifocal seizure onsets. Three patients with preoperative evidence for possible lateralization underwent stereoelectroencephalography depth electrode implantation during the perioperative period. LITT ablation of the anterior corpus callosum was completed in a single procedure in 4 patients. One complication involving misplaced devices required a second procedure. Adequacy of the anterior callosotomy was confirmed using contrast-enhanced MRI and diffusion tensor imaging. Resting functional MRI, corticocortical evoked potentials, and resting electrocorticography demonstrated functional disconnection of the hemispheres. Postcallosotomy monitoring revealed lateralization of the seizures in all 3 patients with preoperatively suspected occult lateralization. Four of 5 patients experienced > 80% reduction in generalized seizure frequency. Two patients undergoing subsequent focal resection are free of clinical seizures at 2 years. One patient developed a 9-mm intraparenchymal hematoma at the site of entry and continued to have seizures after the procedure. Conclusions MRI-guided LITT provides an effective minimally invasive alternative method for CC in the treatment of seizures associated with drop attacks, bilaterally synchronous onset, and rapid secondary generalization. The disconnection is confirmed using anatomical and functional neuroimaging and electrophysiological measures.
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Affiliation(s)
- Kurt R Lehner
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
| | - Erin M Yeagle
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
- 2The Feinstein Institute for Medical Research; and
| | | | | | - Victor Du
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
| | | | - Sean T Hwang
- 3Department of Neurology, North Shore University Hospital, Manhasset, New York
| | - Ashesh D Mehta
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
- 2The Feinstein Institute for Medical Research; and
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Kagawa K, Iida K, Hashizume A, Katagiri M, Baba S, Kurisu K, Otsubo H. Magnetoencephalography using gradient magnetic field topography (GMFT) can predict successful anterior corpus callosotomy in patients with drop attacks. Clin Neurophysiol 2016; 127:221-229. [DOI: 10.1016/j.clinph.2015.04.292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/21/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
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Dimitriadis SI. Predictive value of MEG using gradient magnetic field topography (GMFT) for seizure outcome following anterior corpus callosotomy (ACC) in patients with drop attacks. Clin Neurophysiol 2015; 127:12-14. [PMID: 26168716 DOI: 10.1016/j.clinph.2015.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Stavros I Dimitriadis
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK; Cardiff University Brain Research Imaging Center (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK; Artificial Intelligence and Information Analysis Laboratory, Department of Informatics, Aristotle University, 54124 Thessaloniki, Greece; NeuroInformatics Group, AUTH, Thessaloniki, Greece.
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8
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Yang PF, Lin Q, Mei Z, Chen ZQ, Zhang HJ, Pei JS, Tian J, Jia YZ, Zhong ZH. Outcome after anterior callosal section that spares the splenium in pediatric patients with drop attacks. Epilepsy Behav 2014; 36:47-52. [PMID: 24857808 DOI: 10.1016/j.yebeh.2014.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
We report on the efficacy and safety of extended, one-stage anterior callosal section that spares the splenium, which is performed in a large series of pediatric patients with drop attacks. Twenty-nine pediatric patients with drop attacks were studied (19 males and 10 females; mean age: 9.9 years). As presurgical factors, the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, electroencephalograph abnormalities, magnetic resonance imaging abnormalities, and (18)fluorodeoxyglucose positron emission tomography abnormalities were analyzed. All patients had multiple seizure types, including drop attacks, atypical absence seizures, complex partial seizures, tonic seizures, and generalized tonic-clonic seizures. All patients were developmentally impaired and had electroencephalograph results showing marked secondary bilateral synchrony. All patients received an extended, one-stage callosal section, leaving only the splenium intact. The mean follow-up time was 5.2 years. Seizure outcome (cessation of seizures or ≥ 90% seizure reduction) was achieved in 79.3% of patients with drop attacks. The families assessed the overall daily function as improved in 62.1% of the patients, unchanged in 24.1%, and worse in 13.8%. Family satisfaction with callosotomy was achieved in 82.8% of the patients. The majority of the patients had some degree of a transient acute postoperative disconnection syndrome that disappeared within 3 weeks. Postoperatively, patients showed a consistent increase in attention levels. We conclude that extended callosal sectioning that leaves the splenium intact should be considered a good palliative surgical option for pediatric patients with drop attacks and that diminishment of epileptic discharge synchrony is a good prognostic sign following callosotomy. We also found that the postoperative increase in attention levels was as useful as seizure control in improving the quality of life of these patients.
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Affiliation(s)
- Peng-Fan Yang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China.
| | - Qiao Lin
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhen Mei
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zi-Qian Chen
- Department of Medical Imaging, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Hui-Jian Zhang
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jia-Sheng Pei
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Jun Tian
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Yan-Zeng Jia
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
| | - Zhong-Hui Zhong
- Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China
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Okumura E, Iwasaki M, Sakuraba R, Itabashi I, Osawa SI, Jin K, Itabashi H, Kato K, Kanno A, Tominaga T, Nakasato N. Time-varying inter-hemispheric coherence during corpus callosotomy. Clin Neurophysiol 2013; 124:2091-100. [DOI: 10.1016/j.clinph.2013.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/28/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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Jeong GU, Kim H, Lim BC, Chae JH, Kim KJ, Hwang YS, Hwang H. Predictive value of electroencephalography for seizure outcome following corpus callosotomy in children. J Epilepsy Res 2011; 1:65-70. [PMID: 24649448 PMCID: PMC3952332 DOI: 10.14581/jer.11012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 11/26/2011] [Indexed: 11/05/2022] Open
Abstract
Background and Purpose: This study aimed to determine whether preoperative or postoperative electroencephalography (EEG) can predict surgical outcome for corpus callosotomy. Methods: We retrospectively reviewed the medical records of 16 patients enrolled. We compared postoperative seizure outcome according to seizure type, preoperative interictal EEG, preoperative ictal EEG, and postoperative interictal EEG. Seizure outcome was classified according to postoperative seizure reduction, i.e., seizure free, >90%, 50–90%, <50%, and no change or worsened. A seizure reduction of 50% or more was judged as a “favorable outcome”. Results: Most patients showed a favorable outcome (12 patients, 75%) and two patients became seizure free (13%). Atonic seizure was most responsive to corpus callosotomy. Preoperative interictal epileptiform discharge had 3 patterns; bilateral independent, generalized, and combination of independent and generalized. None of the preoperative interictal epileptiform discharge (EDs) had significant correlation with seizure outcome. The preoperative ictal rhythm did not predict seizure outcome. However disappearance of generalized EDs on postoperative EEG was correlated with favorable seizure outcome. Conclusions: The presence of generalized EDs on postoperative interictal EEG predicted seizure outcome, whereas preoperative EEG did not.
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Affiliation(s)
- Go-Un Jeong
- Department of Pediatrics, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Yong Seung Hwang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
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Iwasaki M, Nakasato N, Kakisaka Y, Kanno A, Uematsu M, Haginoya K, Tominaga T. Lateralization of interictal spikes after corpus callosotomy. Clin Neurophysiol 2011; 122:2121-7. [DOI: 10.1016/j.clinph.2011.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 04/14/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
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Hur YJ, Kang HC, Kim DS, Choi SR, Kim HD, Lee JS. Uncovered primary seizure foci in Lennox-Gastaut syndrome after corpus callosotomy. Brain Dev 2011; 33:672-7. [PMID: 21146944 DOI: 10.1016/j.braindev.2010.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/08/2010] [Accepted: 11/10/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Corpus callosotomy (CC) is a palliative surgical procedure to control atonic, tonic, or generalized tonic-clonic seizure in Lennox-Gastaut syndrome (LGS). Here, we report patients with LGS who underwent resective surgery, following CC better delineating the presumed seizure foci localized in one hemisphere. METHODS We retrospectively reviewed seven patients with LGS who underwent CC and subsequent cortical resection. The median follow-up duration after lobectomy was 20 months (range, 15-54 months) and three patients had follow-up periods over 24 months. The findings of video electroencephalography (EEG) monitoring, structural and functional neuroimagings were compared between pre- and post-CC. RESULTS Four patients had Engel class I and one patient had Engel class II outcomes following cortical resection; post-CC, compared to pre-CC, showed better localized ictal/interictal epileptiform discharges in the unilateral frontal area in two patients, in the unilateral parieto-temporo-occipital areas in one patient and in the unilateral fronto-temporal areas in the remaining two patients. Two patients had Engel Class III outcome following cortical resection; post-CC EEG continued to show multifocal epileptiform discharges but predominantly arising from a unilateral frontal area. Following CC, positron emission tomography showed localized glucose hypometabolism of which location was concordant with post-CC EEG abnormalities in all patient. Similarly, ictal/interictal single photon emission computed tomography also showed localized abnormalities concordant with post-CC EEG abnormalities in five of the six patients. Pathological assessment revealed cortical dysplasia in six patients, whereas no pathological abnormality was found in the remaining patient, who obtained Engel Class I outcome following cortical resection. CONCLUSION CC could change EEG findings, glucose metabolisms and cerebral blood flows, and it is sometimes helpful in delineating the primary seizure focus in patients with LGS.
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Affiliation(s)
- Yun Jung Hur
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Republic of Korea
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13
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The role of the interictal EEG in selecting candidates for resective epilepsy surgery. Epilepsy Behav 2011; 20:167-71. [PMID: 20889385 DOI: 10.1016/j.yebeh.2010.08.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 08/23/2010] [Indexed: 11/21/2022]
Abstract
The interictal EEG is a noninvasive and useful test for selecting candidates for resective epilepsy surgery, although it has many pitfalls. It is an essential test for the most common drug-resistant epilepsy, mesial temporal sclerosis, and predicts good outcome when interictal epileptiform discharges are concordant with unilateral hippocampal atrophy or sclerosis, and predicts poor outcome when interictal epileptic discharges are discordant with the lesion. Its role in other types of epilepsy surgery, including nonlesional cases and corpus callosotomy, is less clear. Future research gathering large multicenter prospective data is needed to maximize the role of this classic neurophysiological test in the evaluation of candidates for epilepsy surgery.
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14
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Callosotomy and subsequent surgery for children with refractory epilepsy. Epilepsy Res 2011; 93:185-91. [DOI: 10.1016/j.eplepsyres.2010.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 12/15/2010] [Accepted: 12/21/2010] [Indexed: 11/29/2022]
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15
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Silverberg A, Parker-Menzer K, Devinsky O, Doyle W, Carlson C. Bilateral intracranial electroencephalographic monitoring immediately following corpus callosotomy. Epilepsia 2010; 51:2203-6. [DOI: 10.1111/j.1528-1167.2010.02568.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tanriverdi T, Olivier A, Poulin N, Andermann F, Dubeau F. Long-term seizure outcome after corpus callosotomy: a retrospective analysis of 95 patients. J Neurosurg 2009; 110:332-42. [DOI: 10.3171/2008.3.17570] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors report long-term follow-up seizure outcome in patients who underwent corpus callosotomy during the period 1981–2001 at the Montreal Neurological Institute.
Methods
The records of 95 patients with a minimum follow-up of 5 years (mean 17.2 years) were retrospectively evaluated with respect to seizure, medication outcomes, and prognostic factors on seizure outcome.
Results
All patients had more than one type of seizure, most frequently drop attacks and generalized tonicclonic seizures. The most disabling seizure type was drop attacks, followed by generalized tonic-clonic seizures. Improvement was noted in several seizure types and was most likely for generalized tonic-clonic seizures (77.3%) and drop attacks (77.2%). Simple partial, generalized tonic, and myoclonic seizures also benefited from anterior callosotomy. The extent of the callosal section was correlated with favorable seizure outcome. The complications were mild and transient and no death was seen.
Conclusions
This study confirms that anterior callosotomy is an effective treatment in intractable generalized seizures that are not amenable to focal resection. When considering this procedure, the treating physician must thoroughly assess the expected benefits, limitations, likelihood of residual seizures, and the risks, and explain them to the patient, his or her family, and other caregivers.
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Affiliation(s)
| | | | | | - Frederick Andermann
- 2Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- 2Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Hemispheric asymmetry of callosal neuronal participation in bilaterally synchronous epileptiform discharges. Seizure 2009; 18:7-13. [DOI: 10.1016/j.seizure.2008.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 05/09/2008] [Indexed: 11/20/2022] Open
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Abstract
Corpus callosotomy is a palliative surgical procedure that is suitable for some patients with intractable seizures who are not candidates for focal resective surgery. The rationale for this procedure is based on the hypothesis that the corpus callosum is a critical pathway for interhemispheric spread of epileptic activity. Efficacy and relatively low permanent morbidity in corpus callosotomy for medically intractable epilepsy have been demonstrated by more than six decades of experience. Callosotomy best ameliorates drop attacks (tonic and atonic seizures), though tonic-clonic, absence, and frontal lobe complex partial seizures often respond as well. In addition to seizure reduction, behavior and quality of life may improve. Hence, callosotomy is justified as a therapy for appropriate patients with intractable epilepsy.
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Rathore C, Abraham M, Rao RM, George A, Sankara Sarma P, Radhakrishnan K. Outcome after corpus callosotomy in children with injurious drop attacks and severe mental retardation. Brain Dev 2007; 29:577-85. [PMID: 17507193 DOI: 10.1016/j.braindev.2007.03.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 01/21/2007] [Accepted: 03/20/2007] [Indexed: 11/23/2022]
Abstract
Wide variability in patient selection, extent of callosal section and definition of successful outcome between studies make impact of corpus callosotomy on patients with medically refractory epilepsies difficult to interpret. Severe mental retardation is considered to be predictive of unfavorable seizure outcome after callosotomy. Very little attention has been paid on the influence of callosotomy on the psychosocial burden on the patients' families. We evaluated the seizure outcome, and parental perception about change in cognition and behavior of 17 children (median age 9.5 years, range 3.5-18 years) with severe mental retardation (IQ<30 in all, except one) and injurious drop attacks, who have completed >or=1-year postoperative follow-up after callosotomy. Nearly two-thirds of our patients had >or=90% reduction in drop attacks and generalized tonic-clonic seizures. In the one-stage total callosotomy group, 9 of 11 (82%) patients had favorable outcome, compared to 2 of the 6 (33%) in the partial callosotomy group. Absence of generalized epileptiform discharges on the 1-year postoperative EEG was significantly associated with a favorable seizure outcome. The mean duration of epilepsy prior to callosotomy tended to be shorter among patients with favorable seizure outcome. Postoperative complications were trivial and transient. Nearly three-fourths of the parents appreciated improvements in behavior and attentiveness of their children and were satisfied with the outcome. We conclude that, in children with severe mental retardation and injurious drop attacks, total callosotomy can be undertaken as a one-stage procedure with insignificant morbidity and results in highly favorable seizure outcome.
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Affiliation(s)
- Chaturbhuj Rathore
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Kamida T, Fujiki M, Baba H, Ono T, Abe T, Kobayashi H. The relationship between paired pulse magnetic MEP and surgical prognosis in patients with intractable epilepsy. Seizure 2006; 16:113-9. [PMID: 17188003 DOI: 10.1016/j.seizure.2006.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 04/24/2006] [Accepted: 10/31/2006] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To assess whether paired pulse magnetic motor evoked potential (MEP) can predict surgical prognosis in patients with intractable epilepsy. METHODS MEP of the unilateral hand muscles were recorded following paired pulse transcranial magnetic stimulation (TMS) of the motor cortex. The interstimulus intervals of paired stimulation were 1-16 ms with a conditioning stimulus that was 90% active motor threshold. Subjects were six patients with temporal lobe epilepsy (TLE) scheduled for anterior temporal lobectomy and three patients with myoclonic or head-drop seizures scheduled for anterior corpus callosotomy, resulting in the unilateralization of epileptic discharges. The hemisphere showing unilateral discharges was defined as the affected hemisphere. The intracortical inhibition and facilitation curve was drawn based on MEP before and after surgery and the relationship between MEP and surgical prognosis was investigated. RESULTS In five patients with TLE showing class I surgical results (Engel's classification), the affected hemisphere showing cortical hyperexcitability preoperatively was almost normalized after surgery. However, in a patient with class III, the unaffected hemisphere showed cortical hyperexcitability before and after surgery. In the callosotomy group, two patients with excellent outcomes showed the same results as TLE group with class I. CONCLUSIONS Paired pulse magnetic MEP may provide predictive value in terms of surgical outcome in those patients with intractable epilepsy.
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Affiliation(s)
- T Kamida
- Department of Neurosurgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan.
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Le Bé JV, Silberberg G, Wang Y, Markram H. Morphological, electrophysiological, and synaptic properties of corticocallosal pyramidal cells in the neonatal rat neocortex. Cereb Cortex 2006; 17:2204-13. [PMID: 17124287 DOI: 10.1093/cercor/bhl127] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neocortical pyramidal cells (PCs) project to various cortical and subcortical targets. In layer V, the population of thick tufted PCs (TTCs) projects to subcortical targets such as the tectum, brainstem, and spinal cord. Another population of layer V PCs projects via the corpus callosum to the contralateral neocortical hemisphere mediating information transfer between the hemispheres. This subpopulation (corticocallosally projecting cells [CCPs]) has been previously described in terms of their morphological properties, but less is known about their electrophysiological properties, and their synaptic connectivity is unknown. We studied the morphological, electrophysiological, and synaptic properties of CCPs by retrograde labeling with fluorescent microbeads in P13-P16 Wistar rats. CCPs were characterized by shorter, untufted apical dendrites, which reached only up to layers II/III, confirming previous reports. Synaptic connections between CCPs were different from those observed between TTCs, both in probability of occurrence and dynamic properties. We found that the CCP network is about 4 times less interconnected than the TTC network and the probability of release is 24% smaller, resulting in a more linear synaptic transmission. The study shows that layer V pyramidal neurons projecting to different targets form subnetworks with specialized connectivity profiles, in addition to the specialized morphological and electrophysiological intrinsic properties.
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Affiliation(s)
- Jean-Vincent Le Bé
- Laboratory of Neural Microcircuitry, Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
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Nei M, O'Connor M, Liporace J, Sperling MR. Refractory generalized seizures: response to corpus callosotomy and vagal nerve stimulation. Epilepsia 2006; 47:115-22. [PMID: 16417539 DOI: 10.1111/j.1528-1167.2006.00377.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The vagal nerve stimulator (VNS) and corpus callosotomy can reduce seizure frequency when seizures are refractory to medications. However, the efficacy and safety of these two procedures have not been compared. This study evaluates the two procedures for generalized seizures. METHODS All patients with refractory generalized seizures (generalized tonic-clonic, tonic, or atonic) who underwent a corpus callosotomy (anterior or complete) (n = 53) without other forms of epilepsy surgery and those who underwent VNS placement (n = 25) were evaluated for this study. Seizure response and procedure complications were evaluated. RESULTS For those with a corpus callosotomy and generalized tonic-clonic seizures (n = 50), 79.5% had >or=50% decrease in the frequency of generalized tonic-clonic seizures, and 60% had >or=80% seizure reduction. For those with a VNS and generalized tonic-clonic seizures (n = 21), 50% had >or=50% seizure reduction, and 33% had >or=80% seizure reduction. Tonic and atonic seizures decreased after either VNS or a corpus callosotomy. The complication rate for corpus callosotomy was higher (21% all complications, 3.8% permanent) than that for VNS (8%; none permanent), but complications for both corpus callosotomy and VNS were rarely permanent. CONCLUSIONS Both corpus callosotomy and VNS are effective in reducing generalized seizures. Corpus callosotomy is associated with greater efficacy but higher risk for complications, although these were generally transient.
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Affiliation(s)
- Maromi Nei
- Department of Neurology, Jefferson Medical College, Philadelphia, PA, USA.
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Salayev KA, Nakasato N, Ishitobi M, Shamoto H, Kanno A, Tominaga T, Iinuma K. Evaluation of Interhemispheric Time Difference by Magnetoencephalography Before and After Total Callosotomy-Two Case Reports-. Neurol Med Chir (Tokyo) 2006; 46:136-42. [PMID: 16565583 DOI: 10.2176/nmc.46.136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Interhemispheric time difference (ITD) measured by electroencephalography (EEG) and magnetoencephalography (MEG) was compared to seizure outcome after callosotomy. Two patients with frequent drop attacks underwent simultaneous EEG and MEG before and after total callosotomy. ITDs in 30 bilateral synchronized (BS) discharges were calculated independently by EEG and MEG. As minimum transcallosal conduction time was suggested to be approximately 20 msec, BS discharges were classified into five categories according to ITD and side: left- or right-leading long (300 to 80 msec), left- or right-leading moderate (80 to 20 msec), and negligible (<20 msec). In Case 1 before callosotomy, EEG detected 77% negligible and 23% right-leading moderate BS discharges, whereas MEG detected 30% and 63%, respectively. After callosotomy, drop attacks reduced remarkably and EEG and MEG detected no BS discharges. In Case 2 before callosotomy, EEG detected 77% negligible and 23% moderate BS discharges, whereas MEG detected 80% and 20%, respectively. After callosotomy, drop attacks recurred 2 months later and EEG and MEG detected left- and right-leading long BS discharges (63% by EEG and 56% by MEG). MEG detected a large number of BS discharges with moderate ITD before surgery in Case 1, suggesting that the transcallosal pathway was the main pathway for the synchronization, whereas the negligible ITD in Case 2 excludes transcallosal propagation. BS discharges with longer ITD after surgery in Case 2 suggest a persistent poly-synaptic non-transcallosal pathway. MEG with higher spatial resolution than EEG may provide surgical indications for callosotomy.
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Affiliation(s)
- Kamran Ali Salayev
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Miyagi
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