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Jaber K, Avigdor T, Mansilla D, Ho A, Thomas J, Abdallah C, Chabardes S, Hall J, Minotti L, Kahane P, Grova C, Gotman J, Frauscher B. A spatial perturbation framework to validate implantation of the epileptogenic zone. Nat Commun 2024; 15:5253. [PMID: 38897997 DOI: 10.1038/s41467-024-49470-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Stereo-electroencephalography (SEEG) is the gold standard to delineate surgical targets in focal drug-resistant epilepsy. SEEG uses electrodes placed directly into the brain to identify the seizure-onset zone (SOZ). However, its major constraint is limited brain coverage, potentially leading to misidentification of the 'true' SOZ. Here, we propose a framework to assess adequate SEEG sampling by coupling epileptic biomarkers with their spatial distribution and measuring the system's response to a perturbation of this coupling. We demonstrate that the system's response is strongest in well-sampled patients when virtually removing the measured SOZ. We then introduce the spatial perturbation map, a tool that enables qualitative assessment of the implantation coverage. Probability modelling reveals a higher likelihood of well-implanted SOZs in seizure-free patients or non-seizure free patients with incomplete SOZ resections, compared to non-seizure-free patients with complete resections. This highlights the framework's value in sparing patients from unsuccessful surgeries resulting from poor SEEG coverage.
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Affiliation(s)
- Kassem Jaber
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA
| | - Tamir Avigdor
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
| | - Daniel Mansilla
- Neurophysiology Unit, Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - Alyssa Ho
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - John Thomas
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA
| | - Chifaou Abdallah
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
| | - Stephan Chabardes
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Jeff Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
| | - Lorella Minotti
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Philippe Kahane
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Christophe Grova
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, School of Health, Department of Physics, Concordia University, Montréal, QC, Canada
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jean Gotman
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada.
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA.
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.
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Lee SK. Who are the Better Candidates for Epilepsy Surgery? J Epilepsy Res 2023; 13:37-41. [PMID: 38223357 PMCID: PMC10783962 DOI: 10.14581/jer.23006] [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: 11/09/2023] [Revised: 11/24/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024] Open
Abstract
The resective epilepsy surgery can be the effective procedure to get seizure-free outcome in these drug resistant epilepsy (DRE) patients. Class I evidence firmly establishes the superiority of epilepsy surgery over medical treatments in both seizure control and quality of life for DRE patients. For the effective identification of optimal surgical candidates, it's essential to understand the prognostic factors of epilepsy surgery based on the surgical methods employed. Established positive prognostic indicators for temporal resection include the presence of hippocampal sclerosis on magnetic resonance imaging (MRI), focal lesions on MRI, unilateral temporal spikes, concordant ictal electroencephalography (EEG), and a history of prolonged febrile convulsion. Potential negative predictors encompass preoperative secondary generalized tonic-clonic seizures, a normal MRI, postoperative EEG spikes, and age at the time of surgery. For neocortical epilepsy, the prognostic factors identified through multivariate analysis were the presence of a discrete lesion, localized hypometabolism on Fluorodeoxyglucose positron emission tomography (FDG-PET), and localized ictal EEG. A significant correlation was found between achieving a seizure-free outcome in no visible lesion on MRI (MR-negative) epilepsy patients and having concordance in two or more presurgical evaluations, specifically in interictal EEG, ictal EEG, FDG-PET, and ictal single-photon emission computed tomography. There was a marked improvement in the seizure-free outcome in MR-negative temporal lobe epilepsy (TLE) by the application of this strategy. The better surgical candidates for epilepsy surgery are the followings: patients displaying a discrete lesion on MRI with concordant video-EEG monitoring (VEM) results, patients diagnosed with unilateral hippocampal sclerosis who have concordant VEM results, patients with unilateral hippocampal sclerosis but discordant VEM results, patients with focal cortical dysplasia and concordant VEM results, and patients diagnosed with MR-negative TLE who exhibit two or more consistent results from presurgical evaluations.
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Affiliation(s)
- Sang Kun Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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3
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Alis C, Isler C, Alis D, Uzan M, Ozkara C. Outcome Predictors of Lesional Posterior Cortex Epilepsy Surgery. World Neurosurg 2023; 172:e483-e489. [PMID: 36690203 DOI: 10.1016/j.wneu.2023.01.055] [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: 10/19/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lesional posterior cortex epilepsy (PCE) is often drug resistant and may benefit from surgical intervention. In this study, we aimed to identify potential predictive factors associated with seizure recurrence after epilepsy surgery in lesional PCE. METHODS We retrospectively reviewed patients with PCE who underwent surgery between 1998 and 2021. They were divided into 2 groups according to seizure outcome; the seizure-free group (group 1) and the non-seizure-free group (group 2). The relationship among clinical factors, electroencephalography (EEG) or cranial magnetic resonance imaging findings, disease, and seizure outcome was investigated. RESULTS A total of 60 patients, with a mean age of 27.26 ± 12.35 years (range, 9-61 years), were included in the study. There were 31 patients (51.66%) in group 1 (Engel class I) and 29 patients (48.33%) in group 2 (13 [21.66%], 10 [16.66%], and 6 [10%] patients in Engel class II, III, and IV, respectively), with a mean follow-up of 8.95 ± 6.96 years (range, 1-24 years). No difference was observed regarding age, gender, age at seizure onset, operation type, treatment gap, and presence of bilateral lesions between the groups (P > 0.05). However, bilateral findings on interictal EEG and gliosis as the underlying disease were predictors of seizure recurrence (P < 0.05). CONCLUSIONS More than half of the patients (including 2 with bilateral magnetic resonance imaging lesions) were seizure free at long-term follow-up. However, patients with bilateral findings on interictal EEG and gliosis were more likely to have recurrent seizures after surgery. Because lesional PCE is almost always drug resistant and has a potential for favorable outcomes, epilepsy surgery should be considered early.
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Affiliation(s)
- Ceren Alis
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Mustafa Uzan
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
| | - Cigdem Ozkara
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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4
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Toledano R, Martínez-Alvarez R, Jiménez-Huete A, García-Morales I, Aledo-Serrano Á, Cabrera W, Rey G, Campo P, Gómez-Angulo JC, Blumcke I, Álvarez-Linera J, Del Pozo JM, Gil-Nagel A. Stereoelectroencephalography in the preoperative assessment of patients with refractory focal epilepsy: experience at an epilepsy centre. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:334-345. [PMID: 35672120 DOI: 10.1016/j.nrleng.2019.05.006] [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: 03/04/2019] [Accepted: 05/20/2019] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE. MATERIAL AND METHODS In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure. RESULTS The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages. CONCLUSION SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.
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Affiliation(s)
- R Toledano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain; Programa de Epilepsia, Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - R Martínez-Alvarez
- Servicio de Neurocirugía Funcional y Radiocirugía, Hospital Ruber Internacional, Madrid, Spain
| | - A Jiménez-Huete
- Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain
| | - I García-Morales
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain; Programa de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - Á Aledo-Serrano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain
| | - W Cabrera
- Departamento de Anatomía y Embriología, Universidad Complutense de Madrid, Spain
| | - G Rey
- Servicio de Física Médica y Protección Radiológica, Hospital Ruber Internacional, Madrid, Spain
| | - P Campo
- Departamento de Psicología Básica, Universidad Autónoma de Madrid, Spain
| | - J C Gómez-Angulo
- Servicio de Neurocirugía, Hospital Universitario de Getafe, Spain; Servicio de Neurocirugía, Hospital Ruber Internacional, Madrid, Spain
| | - I Blumcke
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Alemania
| | - J Álvarez-Linera
- Servicio de Neuroradiología, Hospital Ruber Internacional, Madrid, Spain
| | - J M Del Pozo
- Servicio de Neurocirugía, Hospital Ruber Internacional, Madrid, Spain
| | - A Gil-Nagel
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain
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5
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Toledano R, Martínez-Álvarez R, Jiménez-Huete A, García-Morales I, Aledo-Serrano Á, Cabrera W, Rey G, Campo P, Gómez-Angulo JC, Blumcke I, Álvarez-Linera J, Del Pozo JM, Gil-Nagel A. Stereoelectroencephalography in the preoperative assessment of patients with refractory focal epilepsy: Experience at an epilepsy centre. Neurologia 2022; 37:334-345. [PMID: 31337558 DOI: 10.1016/j.nrl.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE. MATERIAL AND METHODS In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure. RESULTS The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages. CONCLUSION SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.
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Affiliation(s)
- R Toledano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España; Programa de Epilepsia, Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - R Martínez-Álvarez
- Servicio de Neurocirugía Funcional y Radiocirugía, Hospital Ruber Internacional, Madrid, España
| | - A Jiménez-Huete
- Servicio de Neurología, Hospital Ruber Internacional, Madrid, España
| | - I García-Morales
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España; Programa de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - Á Aledo-Serrano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España
| | - W Cabrera
- Departamento de Anatomía y Embriología, Universidad Complutense de Madrid, España
| | - G Rey
- Servicio de Física Médica y Protección Radiológica, Hospital Ruber Internacional, Madrid, España
| | - P Campo
- Departamento de Psicología Básica, Universidad Autónoma de Madrid, España
| | - J C Gómez-Angulo
- Servicio de Neurocirugía, Hospital Universitario de Getafe, España; Servicio de Neurocirugía, Hospital Ruber Internacional, Madrid, España
| | - I Blumcke
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Alemania
| | - J Álvarez-Linera
- Servicio de Neurorradiología, Hospital Ruber Internacional, Madrid, España
| | - J M Del Pozo
- Servicio de Neurocirugía, Hospital Ruber Internacional, Madrid, España
| | - A Gil-Nagel
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España
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6
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Alim-Marvasti A, Vakharia VN, Duncan JS. Multimodal prognostic features of seizure freedom in epilepsy surgery. J Neurol Neurosurg Psychiatry 2022; 93:499-508. [PMID: 35246493 PMCID: PMC9016256 DOI: 10.1136/jnnp-2021-327119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Accurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models. METHODS We searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: 'clinical', 'imaging', 'neurophysiology', 'multimodal concordance', 'genetic', 'surgical technique' and 'pathology'. We propose a structural causal model based on these features. RESULTS We found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons. SIGNIFICANCE Seizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models. PROSPERO REGISTRATION NUMBER CRD42021185232.
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Affiliation(s)
- Ali Alim-Marvasti
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK .,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vejay Niranjan Vakharia
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK
| | - John Sidney Duncan
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-EEG monitoring: A clinical practice guideline of the international league against epilepsy and international federation of clinical neurophysiology. Clin Neurophysiol 2021; 134:111-128. [PMID: 34955428 DOI: 10.1016/j.clinph.2021.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events (see Table S1). For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, WV, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, France.
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich Switzerland.
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Danish Epilepsy Center, Dianalund, Denmark.
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Tatum WO, Mani J, Jin K, Halford JJ, Gloss D, Fahoum F, Maillard L, Mothersill I, Beniczky S. Minimum standards for inpatient long-term video-electroencephalographic monitoring: A clinical practice guideline of the International League Against Epilepsy and International Federation of Clinical Neurophysiology. Epilepsia 2021; 63:290-315. [PMID: 34897662 DOI: 10.1111/epi.16977] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023]
Abstract
The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events. For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and to establish its clinical utility.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Firas Fahoum
- Department of Neurology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Louis Maillard
- Department of Neurology, University of Nancy, UMR7039, University of Lorraine, Nancy, France
| | - Ian Mothersill
- Department of Clinical Neurophysiology, Swiss Epilepsy Center, Zurich,, Switzerland
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Danish Epilepsy Center, Dianalund, Denmark
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Lyu YE, Xu XF, Dai S, Feng M, Shen SP, Zhang GZ, Ju HY, Wang Y, Dong XB, Xu B. Resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy. World J Clin Cases 2021; 9:10518-10529. [PMID: 35004983 PMCID: PMC8686130 DOI: 10.12998/wjcc.v9.i34.10518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/09/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.
AIM To evaluate surgical resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy.
METHODS This retrospective case series included patients with drug-refractory bilateral occipital lobe epilepsy treated surgically between March 2006 and November 2015.
RESULTS Preoperative evaluation included scalp video-electroencephalography (EEG), magnetic resonance imaging, and PET-CT. During surgery (bilateral occipital craniotomy), epileptic foci and important functional areas were identified by EEG (intracranial cortical electrodes) and cortical functional mapping, respectively. Patients were followed up for at least 5 years to evaluate treatment outcome (Engel grade) and visual function. The 20 patients (12 males) were aged 4-30 years (median age, 12 years). Time since onset was 3-20 years (median, 8 years), and episode frequency was 4-270/mo (median, 15/mo). Common manifestations were elementary visual hallucinations (65.0%), flashing lights (30.0%), blurred vision (20.0%) and visual field defects (20.0%). Most patients were free of disabling seizures (Engel grade I) postoperatively (18/20, 90.0%) and at 1 year (18/20, 90.0%), 3 years (17/20, 85.0%) and ≥ 5 years (17/20, 85.0%). No patients were classified Engel grade IV (no worthwhile improvement). After surgery, there was no change in visual function in 13/20 (65.0%), development of a new visual field defect in 3/20 (15.0%), and worsening of a preexisting defect in 4/20 (20.0%).
CONCLUSION Resection of bilateral occipital lobe lesions during a single operation may be applicable in bilateral occipital lobe epilepsy.
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Affiliation(s)
- Yan-En Lyu
- Seventh Clinical School of Medicine, Beijing University of Chinese Medicine, Tongchuan 727031, Shaanxi Province, China
- Neurosurgery and Epilepsy Centre, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Xiao-Fei Xu
- Neurosurgery and Epilepsy Centre, General Hospital of Beijing Military Commanding Regain, Beijing 100700, China
| | - Shuang Dai
- Neurosurgery and Epilepsy Centre, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Min Feng
- Seventh Clinical School of Medicine, Beijing University of Chinese Medicine, Tongchuan 727031, Shaanxi Province, China
| | - Shao-Ping Shen
- Neurosurgery and Epilepsy Centre, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Guo-Zhen Zhang
- Neurosurgery and Epilepsy Centre, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Hong-Yan Ju
- Neurosurgery and Epilepsy Centre, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yao Wang
- Seventh Clinical School of Medicine, Beijing University of Chinese Medicine, Tongchuan 727031, Shaanxi Province, China
| | - Xiao-Bo Dong
- Neurosurgery and Epilepsy Centre, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Bin Xu
- Neurosurgery and Epilepsy Centre, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
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Castagno S, D'Arco F, Tahir MZ, Battey H, Eltze C, Moeller F, Tisdall M. Seizure outcomes of large volume temporo-parieto-occipital and frontal surgery in children with drug-resistant epilepsy. Epilepsy Res 2021; 177:106769. [PMID: 34560348 DOI: 10.1016/j.eplepsyres.2021.106769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In this study, we investigate the seizure outcomes of temporo-parieto-occipital (TPO) and frontal disconnections or resections in children with drug-resistant epilepsy (DRE) in order to determine factors which may predict surgical results. METHODS Children with DRE, who underwent either TPO or frontal disconnection or resection at Great Ormond Street Hospital for Children between 2000 and 2017, were identified from a prospectively collated operative database. Demographic data, age at surgery, type of surgery, scalp EEGs and operative histopathology were collected. Magnetic resonance imaging (MRI) was assessed to determine completeness of disconnection and presence of radiological lesion beyond the disconnection margins. Seizure outcome at 6, 12, and 24 months post-surgery was assessed using the Engel Scale (ES). Logistic regression was used to identify relationships between data variables and seizure outcome. RESULTS 46 children (males = 28, females = 18; age range 0.5-16.6 years) who underwent TPO (n = 32, including a re-do disconnection) or frontal disconnection or resection (n = 15) were identified. Patients in the TPO treatment group had more favourable seizure outcomes than those in the frontal treatment group (ES I-II in 56 %vs 47 % at 6 months, 52 % vs 46 % at 12 months). Presence of the lesion beyond disconnection boundaries and older age at the time of surgery were associated with poorer seizure outcome. Gender, surgery type, completeness of disconnection, scalp EEG findings and underlying pathology were not related to seizure outcome, but subgroup numbers were small. CONCLUSIONS Both TPO and frontal disconnection are effective treatments for selected children with posterior multi-lobar or diffuse frontal lobe epilepsy. Confinement of the MRI lesion within the disconnection margins and a younger age at surgery are associated with favourable seizure outcomes. Further studies are required to elucidate these findings.
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Affiliation(s)
| | - Felice D'Arco
- Great Ormond Street Hospital, Department of Radiology, London, WC1N 3JH, United Kingdom
| | - M Zubair Tahir
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
| | - Heather Battey
- Imperial College London, Department of Mathematics, London, SW7 2AZ, United Kingdom
| | - Christin Eltze
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Friederike Moeller
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Martin Tisdall
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
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11
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Mehvari Habibabadi J, Moein H, Jourahmad Z, Ahmadian M, Basiratnia R, Zare M, Hashemi Fesharaki SS, Badihian S, Barekatain M, Tabrizi N. Outcome of epilepsy surgery in lesional epilepsy: Experiences from a developing country. Epilepsy Behav 2021; 122:108221. [PMID: 34352668 DOI: 10.1016/j.yebeh.2021.108221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Our aim was to report the postoperative seizure outcome and associated factors in patients with lesional epilepsy, in a low-income setting. METHODS This longitudinal prospective study included patients who underwent epilepsy surgery at Kashani Comprehensive Epilepsy Center between 2014 and 2019. Post-surgical outcomes were reported according to the Engel score, and patients were classified into two groups of seizure free (SF) and not-seizure free (NSF). RESULTS A total of 148 adult patients, with a mean age of 30.45 ± 9.23 years were included. The SF outcome was reported in 86.5% of patients and antiepileptic drugs (AEDs) were reduced or discontinued in 45.9%. The mean follow-up duration was 26.7 ± 14.9 months. Temporal lobe lesions (76.3%) and mesial temporal sclerosis (MTS) (56.7%) were the most frequent etiologies. Temporal lesion (Incidence relative risk (IRR): 1.76, 95% CI [1.08-2.87], p = 0.023), prior history of CNS infection (IRR:1.18, 95% CI [1.03-1.35], p = 0.019), use of intra-operative ECoG (IRR:1.73, 95% CI [1.06-2.81], p = 0.028), and absence of IEDs in postoperative EEG (IRR: 1.41, 95% CI [1.18-1.70], p < 0.001) were positive predictors for a favorable outcome. CONCLUSION Many patients with drug-resistant lesional epilepsy showed a favorable response to surgery. We believe that resective epilepsy surgery in low-income settings is a major treatment option. The high frequency of patients with drug-resistant epilepsy in developing countries is associated with high rates of morbidity and mortality. Hence, strategies to increase access to epilepsy surgery in these settings are urgently needed.
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Affiliation(s)
| | - Houshang Moein
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Jourahmad
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran
| | - Mana Ahmadian
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran.
| | - Reza Basiratnia
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Zare
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran
| | | | - Shervin Badihian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Majid Barekatain
- Psychosomatic Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Tabrizi
- Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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12
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Yu S, Lam C, Shinde S, Kuczynski AM, Carlson HL, Dukelow SP, Brooks BL, Kirton A. Perilesional Gliosis Is Associated with Outcome after Perinatal Stroke. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1728687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractPerinatal ischemic stroke results in focal brain injury and life-long disability. Hemiplegic cerebral palsy and additional sequelae are common. With no prevention strategies, improving outcomes depends on understanding brain development. Reactive astrogliosis is a hallmark of brain injury that has been associated with outcomes but is unstudied in perinatal stroke. In this article, we hypothesized that gliosis was quantifiable and its extent would inversely correlate with clinical motor function. This was a population-based, retrospective, and cross-sectional study. Children with perinatal arterial ischemic stroke (AIS) or periventricular venous infarction (PVI) with magnetic resonance (MR) imaging were included. An image thresholding technique based on image intensity was utilized to quantify the degree of chronic gliosis on T2-weighted sequences. Gliosis scores were corrected for infarct volume and compared with the Assisting Hand and Melbourne Assessments (AHA and MA), neuropsychological profiles, and robotic measures. In total, 42 children were included: 25 with AIS and 17 with PVI (median = 14.0 years, range: 6.3–19 years, 63% males). Gliosis was quantifiable in all scans and scores were highly reliable. Gliosis scores as percentage of brain volume ranged from 0.3 to 3.2% and were comparable between stroke types. Higher gliosis scores were associated with better motor function for all three outcomes in the AIS group, but no association was observed for PVI. Gliosis can be objectively quantified in children with perinatal stroke. Associations with motor outcome in arterial but not venous strokes suggest differing glial responses may play a role in tissue remodeling and developmental plasticity following early focal brain injury.
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Affiliation(s)
- Sabrina Yu
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Charissa Lam
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Siddharth Shinde
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | | | - Helen L. Carlson
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Sean P. Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Brian L. Brooks
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
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13
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Cossu G, González-López P, Pralong E, Kalser J, Messerer M, Daniel RT. Unilateral prefrontal lobotomy for epilepsy: technique and surgical anatomy. Neurosurg Focus 2021; 48:E10. [PMID: 32234977 DOI: 10.3171/2020.1.focus19938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgery for frontal lobe epilepsy remains a challenge because of the variable seizure outcomes after surgery. Disconnective procedures are increasingly applied to isolate the epileptogenic focus and avoid complications related to extensive brain resection. Previously, the authors described the anterior quadrant disconnection procedure to treat large frontal lobe lesions extending up to but not involving the primary motor cortex. In this article, they describe a surgical technique for unilateral disconnection of the prefrontal cortex, while providing an accurate description of the surgical and functional anatomy of this disconnective procedure. METHODS The authors report the surgical treatment of a 5-month-old boy who presented with refractory epilepsy due to extensive cortical dysplasia of the left prefrontal lobe. In addition, with the aim of both describing the subcortical intrinsic anatomy and illustrating the different connections between the prefrontal lobe and the rest of the brain, the authors dissected six human cadaveric brain hemispheres. These dissections were performed from lateral to medial and from medial to lateral to reveal the various tracts sectioned during the three different steps in the surgery, namely the intrafrontal disconnection, anterior callosotomy, and frontobasal disconnection. RESULTS The first step of the dissection involves cutting the U-fibers. During the anterior intrafrontal disconnection, the superior longitudinal fasciculus in the depth of the middle frontal gyrus, the uncinate fasciculus, and the inferior frontooccipital fasciculus in the depth of the inferior frontal gyrus at the level of the anterior insular point are visualized and sectioned, followed by sectioning of the anterior limb of the internal capsule. Once the frontal horn is reached, the anterior callosotomy can be performed to disconnect the genu and the rostrum of the corpus callosum. The intrafrontal disconnection is deepened toward the falx, and at the medial surface, the cingulum is sectioned. The frontobasal disconnection involves cutting the anterior limb of the anterior commissure. CONCLUSIONS This technique allows selective isolation of the epileptogenic focus located in the prefrontal lobe to avoid secondary propagation. Understanding the surface and white matter fiber anatomy is essential to safely perform the procedure and obtain a favorable seizure outcome.
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Affiliation(s)
- Giulia Cossu
- 1Department of Neurosurgery, University Hospital of Lausanne
| | | | - Etienne Pralong
- 1Department of Neurosurgery, University Hospital of Lausanne
| | - Judith Kalser
- 3Department of Pediatrics, Section of Neuro-Pediatrics, University Hospital of Lausanne, Switzerland; and
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14
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van Lanen RHGJ, Colon AJ, Wiggins CJ, Hoeberigs MC, Hoogland G, Roebroeck A, Ivanov D, Poser BA, Rouhl RPW, Hofman PAM, Jansen JFA, Backes W, Rijkers K, Schijns OEMG. Ultra-high field magnetic resonance imaging in human epilepsy: A systematic review. NEUROIMAGE-CLINICAL 2021; 30:102602. [PMID: 33652376 PMCID: PMC7921009 DOI: 10.1016/j.nicl.2021.102602] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
RATIONALE Resective epilepsy surgery is an evidence-based curative treatment option for patients with drug-resistant focal epilepsy. The major preoperative predictor of a good surgical outcome is detection of an epileptogenic lesion by magnetic resonance imaging (MRI). Application of ultra-high field (UHF) MRI, i.e. field strengths ≥ 7 Tesla (T), may increase the sensitivity to detect such a lesion. METHODS A keyword search strategy was submitted to Pubmed, EMBASE, Cochrane Database and clinicaltrials.gov to select studies on UHF MRI in patients with epilepsy. Follow-up study selection and data extraction were performed following PRISMA guidelines. We focused on I) diagnostic gain of UHF- over conventional MRI, II) concordance of MRI-detected lesion, seizure onset zone and surgical decision-making, and III) postoperative histopathological diagnosis and seizure outcome. RESULTS Sixteen observational cohort studies, all using 7T MRI were included. Diagnostic gain of 7T over conventional MRI ranged from 8% to 67%, with a pooled gain of 31%. Novel techniques to visualize pathological processes in epilepsy and lesion detection are discussed. Seizure freedom was achieved in 73% of operated patients; no seizure outcome comparison was made between 7T MRI positive, 7T negative and 3T positive patients. 7T could influence surgical decision-making, with high concordance of lesion and seizure onset zone. Focal cortical dysplasia (54%), hippocampal sclerosis (12%) and gliosis (8.1%) were the most frequently diagnosed histopathological entities. SIGNIFICANCE UHF MRI increases, yet variably, the sensitivity to detect an epileptogenic lesion, showing potential for use in clinical practice. It remains to be established whether this results in improved seizure outcome after surgical treatment. Prospective studies with larger cohorts of epilepsy patients, uniform scan and sequence protocols, and innovative post-processing technology are equally important as further increasing field strengths. Besides technical ameliorations, improved correlation of imaging features with clinical semiology, histopathology and clinical outcome has to be established.
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Affiliation(s)
- R H G J van Lanen
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.
| | - A J Colon
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - C J Wiggins
- Scannexus, Ultra High Field MRI Research Center, Maastricht, The Netherlands
| | - M C Hoeberigs
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - A Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - D Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - B A Poser
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - R P W Rouhl
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P A M Hofman
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W Backes
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - K Rijkers
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - O E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
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15
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Kim DW, Lee SK, Jung KY, Chu K, Chung CK. Surgical treatment of nonlesional temporal lobe epilepsy. Seizure 2021; 86:129-134. [PMID: 33611174 DOI: 10.1016/j.seizure.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/17/2021] [Accepted: 02/09/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE One-third of the patients with drug-resistant temporal lobe epilepsy (TLE) have a normal MRI, but there are only a few studies regarding the surgical outcomes and the efficacy of anterior temporal lobectomy (ATL) in patients with nonlesional TLE. The objective of this study is to evaluate the surgical outcomes and efficacy of ATL in patients with nonlesional TLE. METHODS We included 77 consecutive patients without MRI-identifiable lesions who had undergone surgical resection for drug-resistant TLE. We performed univariate and multivariate logistic regression analyses to identify the predictors of surgical outcomes, and the efficacy of ATL in patients with nonlesional TLE. RESULTS More than two-thirds of patients (51/76, 67.3 %) had achieved seizure freedom at the last follow-up. Presence of oroalimentary automatism, localized hypometabolism in FDG-PET, and concordant results in presurgical evaluations were associated with better surgical outcomes. Only 15 out of 77 patients (19.2 %) with nonlesional TLE were treated with ATL, and the surgically resected areas were located within the resection margin of ATL in one-third of the patients (26/77, 33.8 %). Patients with auras suggesting neocortical ictal onset and lateralizing semiological features had a higher chance that their potentially epileptogenic areas were located beyond or outside the resection margin of ATL. CONCLUSION Our study showed that the potentially epileptogenic areas were located beyond or outside the margin of the ATL in nearly two-thirds of the patients. Several clinical factors may be useful in predicting the location of an epileptogenic area, which can help optimize a surgical strategy in these patients.
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Affiliation(s)
- Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Ki-Young Jung
- Department of Neurology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kon Chu
- Department of Neurology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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16
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Alim-Marvasti A, Pérez-García F, Dahele K, Romagnoli G, Diehl B, Sparks R, Ourselin S, Clarkson MJ, Duncan JS. Machine Learning for Localizing Epileptogenic-Zone in the Temporal Lobe: Quantifying the Value of Multimodal Clinical-Semiology and Imaging Concordance. Front Digit Health 2021; 3:559103. [PMID: 34713078 PMCID: PMC8521800 DOI: 10.3389/fdgth.2021.559103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 01/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Epilepsy affects 50 million people worldwide and a third are refractory to medication. If a discrete cerebral focus or network can be identified, neurosurgical resection can be curative. Most excisions are in the temporal-lobe, and are more likely to result in seizure-freedom than extra-temporal resections. However, less than half of patients undergoing surgery become entirely seizure-free. Localizing the epileptogenic-zone and individualized outcome predictions are difficult, requiring detailed evaluations at specialist centers. Methods: We used bespoke natural language processing to text-mine 3,800 electronic health records, from 309 epilepsy surgery patients, evaluated over a decade, of whom 126 remained entirely seizure-free. We investigated the diagnostic performances of machine learning models using set-of-semiology (SoS) with and without hippocampal sclerosis (HS) on MRI as features, using STARD criteria. Findings: Support Vector Classifiers (SVC) and Gradient Boosted (GB) decision trees were the best performing algorithms for temporal-lobe epileptogenic zone localization (cross-validated Matthews correlation coefficient (MCC) SVC 0.73 ± 0.25, balanced accuracy 0.81 ± 0.14, AUC 0.95 ± 0.05). Models that only used seizure semiology were not always better than internal benchmarks. The combination of multimodal features, however, enhanced performance metrics including MCC and normalized mutual information (NMI) compared to either alone (p < 0.0001). This combination of semiology and HS on MRI increased both cross-validated MCC and NMI by over 25% (NMI, SVC SoS: 0.35 ± 0.28 vs. SVC SoS+HS: 0.61 ± 0.27). Interpretation: Machine learning models using only the set of seizure semiology (SoS) cannot unequivocally perform better than benchmarks in temporal epileptogenic-zone localization. However, the combination of SoS with an imaging feature (HS) enhance epileptogenic lobe localization. We quantified this added NMI value to be 25% in absolute terms. Despite good performance in localization, no model was able to predict seizure-freedom better than benchmarks. The methods used are widely applicable, and the performance enhancements by combining other clinical, imaging and neurophysiological features could be similarly quantified. Multicenter studies are required to confirm generalizability. Funding: Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS) (203145Z/16/Z).
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Affiliation(s)
- Ali Alim-Marvasti
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Fernando Pérez-García
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, United Kingdom
| | - Karan Dahele
- University College London Medical School, London, United Kingdom
| | - Gloria Romagnoli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Rachel Sparks
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, United Kingdom
| | - Matthew J. Clarkson
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
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17
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Kämpfer C, Racz A, Quesada CM, Elger CE, Surges R. Predictive value of electrically induced seizures for postsurgical seizure outcome. Clin Neurophysiol 2020; 131:2289-2297. [PMID: 32674959 DOI: 10.1016/j.clinph.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether semiological similarity of electrically induced seizures (EIS) and spontaneously occurring habitual seizures (SHS) is associated with postsurgical seizure outcome in patients undergoing invasive video-EEG monitoring (VEM) before resective epilepsy surgery. METHODS Data of patients undergoing invasive VEM were retrospectively reviewed and included if at least one EIS and SHS during VEM occurred and the brain region in which EIS were elicited was resected. Seizure outcome was evaluated at three follow-up (FU) visits after surgery (1, 2 years and last available FU) according to the classification by Engel and the International League Against Epilepsy (ILAE). The level of semiological similarity of EIS and SHS was rated blinded to the surgical outcome. Statistics were done using Fisher's exact test and a mixed linear-logistic regression model. RESULTS 65 patients were included. Postsurgical seizure freedom was achieved in 51% (ILAE class 1) and 58% (Engel class I) at last FU (median 36 months). Patients with identical EIS and SHS displayed significantly better postsurgical seizure outcomes (ILAE class 1 at last FU: 76% vs. 31%, p < 0.001; Engel class I: 83% vs. 39%, p < 0.001). CONCLUSION EIS are useful to confirm the location of the epileptogenic zone. A high level of similarity between EIS and SHS is associated with a favorable postsurgical seizure outcome. SIGNIFICANCE EIS may be used as an additional predictor of postsurgical outcome when counselling patients to proceed to resective epilepsy surgery.
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Affiliation(s)
- Christopher Kämpfer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany; Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Attila Racz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Carlos M Quesada
- Department of Epileptology, University Hospital Bonn, Bonn, Germany; Department of Neurology, University Hospital Essen, Essen, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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18
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Traub-Weidinger T, Muzik O, Sundar LKS, Aull-Watschinger S, Beyer T, Hacker M, Hahn A, Kasprian G, Klebermass EM, Lanzenberger R, Mitterhauser M, Pilz M, Rausch I, Rischka L, Wadsak W, Pataraia E. Utility of Absolute Quantification in Non-lesional Extratemporal Lobe Epilepsy Using FDG PET/MR Imaging. Front Neurol 2020; 11:54. [PMID: 32082251 PMCID: PMC7005011 DOI: 10.3389/fneur.2020.00054] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 01/14/2020] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to establish a non-invasive clinical PET/MR protocol using [18F]-labeled deoxyglucose (FDG) that provides physicians with regional metabolic rate of glucose (MRGlc) values and to clarify the contribution of absolute quantification to clinical management of patients with non-lesional extratemporal lobe epilepsy (ETLE). The study included a group of 15 patients with non-lesional ETLE who underwent a dynamic FDG PET study using a fully-integrated PET/MRI system (Siemens Biograph). FDG tracer uptake images were converted to MRGlc (μmol/100 g/min) maps using an image derived input function that was extracted based on the combined analysis of PET and MRI data. In addition, the same protocol was applied to a group of healthy controls, yielding a normative database. Abnormality maps for ETLE patients were created with respect to the normative database, defining significant hypo- or hyper-metabolic regions that exceeded ±2 SD of normal regional mean MRGlc values. Abnormality maps derived from MRGlc images of ETLE patients contributed to the localization of hypo-metabolic areas against visual readings in 53% and increased the confidence in the original clinical readings in 33% of all cases. Moreover, quantification allowed identification of hyper-metabolic areas that are associated with frequently spiking cortex, rarely acknowledged in clinical readings. Overall, besides providing some confirmatory information to visual readings, quantitative PET imaging demonstrated only a moderate impact on clinical management of patients with complex pathology that leads to epileptic seizures, failing to provide new decisive information that would have changed classification of patients from being rejected to being considered for surgical intervention.
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Affiliation(s)
- Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Otto Muzik
- Department of Pediatrics, The Detroit Medical Center, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, United States
| | - Lalith Kumar Shiyam Sundar
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Eva-Maria Klebermass
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Ludwig-Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Magdalena Pilz
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Lucas Rischka
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine, Graz, Austria
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19
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Andrews JP, Chang EF. Epilepsy: Neocortical. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Couturier NH, Durand DM. Comparison of fiber tract low frequency stimulation to focal and ANT stimulation in an acute rat model of focal cortical seizures. Brain Stimul 2019; 13:499-506. [PMID: 31902689 DOI: 10.1016/j.brs.2019.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current implementations of direct brain stimulation for epilepsy in patients involve high-frequency (HFS) electrical current and targeting of grey matter. Studies have shown that low-frequency (LFS) fiber-tract stimulation may also prove effective. To compare the efficacy of high-frequency grey matter stimulation to the low-frequency fiber tract stimulation technique a well-controlled set of experiments using a single animal model of epilepsy is needed. OBJECTIVE The goal of this study was to determine the relative efficacy of different direct brain stimulation techniques for suppressing seizures using an acute rat model of focal cortical seizures. METHODS 4-AP was injected into the S1 region of cortex in rodents over 3 h. LFPs were recorded from the seizure focus and mirror focus to monitor seizure frequency during the experiments. CC-LFS, HFS-ANT, Focal-HFS, or a transection of the CC was applied. RESULTS Stimulation of the CC yielded a 65% ±14% (p = 0.0014) reduction of seizures in the focus and a 97% ±15% (p = 0.0026) reduction in the mirror focus (n = 7). By comparison transection of the CC produced a 65% ±18% reduction in the focus and a non-statistically significant reduction of 57% ±18% (p = 0.1381) in the mirror focus (n = 5). All other methods of stimulation failed to have a statistically significant effect on seizure suppression. CONCLUSIONS LFS of the CC is the only method of stimulation to significantly reduce seizure frequency in this model of focal cortical seizures. These results support the hypothesis that LFSof fiber tracts has significant potential for seizure control.
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Affiliation(s)
- Nicholas H Couturier
- Department of Biomedical Engineering, Neural Engineering Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Dominique M Durand
- Department of Biomedical Engineering, Neural Engineering Center, Case Western Reserve University, Cleveland, OH, USA.
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21
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Tanaka H, Gotman J, Khoo HM, Olivier A, Hall J, Dubeau F. Neurophysiological seizure-onset predictors of epilepsy surgery outcome: a multivariable analysis. J Neurosurg 2019; 133:1863-1872. [PMID: 31783358 DOI: 10.3171/2019.9.jns19527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to determine which neurophysiological seizure-onset features seen during scalp electroencephalography (EEG) and intracerebral EEG (iEEG) monitoring are predictors of postoperative outcome in a large series of patients with drug-resistant focal epilepsy who underwent resective surgery. METHODS The authors retrospectively analyzed the records of 75 consecutive patients with focal epilepsy, who first underwent scalp EEG and then iEEG (stereo-EEG) for presurgical assessment and who went on to undergo resective surgery between 2004 and 2015. To determine the independent prognostic factors from the neurophysiological scalp EEG and iEEG seizure-onset information, univariate and standard multivariable logistic regression analyses were used. Since scalp EEG and iEEG data were recorded at different times, the authors matched scalp seizures with intracerebral seizures for each patient using strict criteria. RESULTS A total of 3057 seizures were assessed. Forty-eight percent (36/75) of patients had a favorable outcome (Engel class I-II) after a minimum follow-up of at least 1 year. According to univariate analysis, a localized scalp EEG seizure onset (p < 0.001), a multilobar intracerebral seizure-onset zone (SOZ) (p < 0.001), and an extended SOZ (p = 0.001) were significantly associated with surgical outcome. According to multivariable analysis, the following two independent factors were found: 1) the ability of scalp EEG to localize the seizure onset was a predictor of a favorable postoperative outcome (OR 6.073, 95% CI 2.011-18.339, p = 0.001), and 2) a multilobar SOZ was a predictor of an unfavorable outcome (OR 0.076, 95% CI 0.009-0.663, p = 0.020). CONCLUSIONS The study findings show that localization at scalp seizure onset and a multilobar SOZ were strong predictors of surgical outcome. These predictors can help to select the better candidates for resective surgery.
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Affiliation(s)
- Hideaki Tanaka
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- 2Department of Neurosurgery, Fukuoka University Hospital
- 3Fukuoka Sanno Hospital, Epilepsy and Sleep Center, Fukuoka; and
| | - Jean Gotman
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Hui Ming Khoo
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- 4Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - André Olivier
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeffery Hall
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- 1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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22
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Samuel P J, Menon RN, Chandran A, Thomas SV, Vilanilam G, Abraham M, Radhakrishnan A. Seizure outcome and its predictors after frontal lobe epilepsy surgery. Acta Neurol Scand 2019; 140:259-267. [PMID: 31188464 DOI: 10.1111/ane.13139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/20/2019] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Frontal lobe epilepsy (FLE) surgery is the second most common focal resective surgery for drug-resistant epilepsy. Not many studies are available regarding the long-term surgical outcome of FLE. We studied the longitudinal outcome and predictors of seizure outcome following FLE surgery in a sizeable cohort of patients. MATERIALS & METHODS A total of 73 consecutive patients who underwent FLE surgery between January 1997 and May 2015 with a minimum follow-up of 1 year (range 1-16 years) were studied. Primary outcome was seizure freedom at last follow-up (Engel Class IA). "Seizure freedom" separately was defined as absence of seizures till last follow-up. Outcome predictors were subjected to multivariate analysis. Using Kaplan-Meier curve, we assessed the post-operative seizure freedom over time. RESULTS Twenty-five patients (34%) were seizure-free till last follow-up. The seizure freedom was 45%, 34%, 26%, 20% and 14% at the end of 1st, 2nd, 3rd, 4th and 5th post-operative year, respectively. Engel class I outcomes were 48%, 41%, 56%, 57% and 53% at end of 1st, 2nd, 3rd, 4th and 5th post-operative year, respectively. Predictors of seizure recurrence on multivariate analysis were older age at surgery (P = 0.032), longer duration of epilepsy (P = 0.031), presence of interictal epileptiform discharges in post-operative EEG on 7th day (P = 0.005), 3 months (P = 0.005) and 1 year (P = 0.0179). In subgroup analysis, duration of epilepsy of less than 2 years before surgery was a significant predictor for achieving seizure freedom (P = 0.029). CONCLUSIONS These results emphasize early surgery for better outcome in frontal lobe epilepsy. Post-operative EEG remained a good predictor for long-term outcome.
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Affiliation(s)
- Joseph Samuel P
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Ramshekhar N. Menon
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Anuvitha Chandran
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Sanjeev V. Thomas
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - George Vilanilam
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Mathew Abraham
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Ashalatha Radhakrishnan
- Department of Neurology, R.Madhavan Nayar Center for Comprehensive Epilepsy Care Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
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Bonini F, McGonigal A, Scavarda D, Carron R, Régis J, Dufour H, Péragut JC, Laguitton V, Villeneuve N, Chauvel P, Giusiano B, Trébuchon A, Bartolomei F. Predictive Factors of Surgical Outcome in Frontal Lobe Epilepsy Explored with Stereoelectroencephalography. Neurosurgery 2019; 83:217-225. [PMID: 28673029 DOI: 10.1093/neuros/nyx342] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/20/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Resective surgery established treatment for pharmacoresistant frontal lobe epilepsy (FLE), but seizure outcome and prognostic indicators are poorly characterized and vary between studies. OBJECTIVE To study long-term seizure outcome and identify prognostic factors. METHODS We retrospectively analyzed 42 FLE patients having undergone surgical resection, mostly preceded by invasive recordings with stereoelectroencephalography (SEEG). Postsurgical outcome up to 10-yr follow-up and prognostic indicators were analyzed using Kaplan-Meier analysis and multivariate and conditional inference procedures. RESULTS At the time of last follow-up, 57.1% of patients were seizure-free. The estimated chance of seizure freedom was 67% (95% confidence interval [CI]: 54-83) at 6 mo, 59% (95% CI: 46-76) at 1 yr, 53% (95% CI: 40-71) at 2 yr, and 46% (95% CI: 32-66) at 5 yr. Most relapses (83%) occurred within the first 12 mo. Multivariate analysis showed that completeness of resection of the epileptogenic zone (EZ) as defined by SEEG was the main predictor of seizure outcome. According to conditional inference trees, in patients with complete resection of the EZ, focal cortical dysplasia as etiology and focal EZ were positive prognostic indicators. No difference in outcome was found in patients with positive vs negative magnetic resonance imaging. CONCLUSION Surgical resection in drug-resistant FLE can be a successful therapeutic approach, even in the absence of neuroradiologically visible lesions. SEEG may be highly useful in both nonlesional and lesional FLE cases, because complete resection of the EZ as defined by SEEG is associated with better prognosis.
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Affiliation(s)
- Francesca Bonini
- APHM, Timone Hospital, Clinical Ne-urophysiology and Epileptology De-partment, Marseille, France.,Aix-Mar-seille Université, Institut de Neuroscience des Systèmes, INSERM UMR_S 1106, Marseille, France
| | - Aileen McGonigal
- APHM, Timone Hospital, Clinical Ne-urophysiology and Epileptology De-partment, Marseille, France.,Aix-Mar-seille Université, Institut de Neuroscience des Systèmes, INSERM UMR_S 1106, Marseille, France
| | - Didier Scavarda
- APHM, Timone Hospital, Paedia-tric Neurosurgery Department, Marse-ille, France
| | - Romain Carron
- APHM, Timone Hospital, Functional and Stereotactical Neuro-surgery Department, Marseille, France
| | - Jean Régis
- APHM, Timone Hospital, Functional and Stereotactical Neuro-surgery Department, Marseille, France
| | - Henry Dufour
- APHM, Timone Hospital, Neurosurgery Department, Marseille, France
| | - Jean-Claude Péragut
- APHM, Timone Hospital, Functional and Stereotactical Neuro-surgery Department, Marseille, France
| | | | - Nathalie Villeneuve
- Hôpital Henri Gastaut, Marseille, France.,Service de Neuropédiatrie, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Patrick Chauvel
- APHM, Timone Hospital, Clinical Ne-urophysiology and Epileptology De-partment, Marseille, France.,Aix-Mar-seille Université, Institut de Neuroscience des Systèmes, INSERM UMR_S 1106, Marseille, France
| | - Bernard Giusiano
- Aix-Mar-seille Université, Institut de Neuroscience des Systèmes, INSERM UMR_S 1106, Marseille, France
| | - Agnès Trébuchon
- APHM, Timone Hospital, Clinical Ne-urophysiology and Epileptology De-partment, Marseille, France.,Aix-Mar-seille Université, Institut de Neuroscience des Systèmes, INSERM UMR_S 1106, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Clinical Ne-urophysiology and Epileptology De-partment, Marseille, France.,Aix-Mar-seille Université, Institut de Neuroscience des Systèmes, INSERM UMR_S 1106, Marseille, France
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24
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Morace R, Casciato S, Quarato PP, Mascia A, D'Aniello A, Grammaldo LG, De Risi M, Di Gennaro G, Esposito V. Long-term seizure outcome in frontal lobe epilepsy surgery. Epilepsy Behav 2019; 90:93-98. [PMID: 30522059 DOI: 10.1016/j.yebeh.2018.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to report long-term seizure outcome in patients who underwent frontal lobe epilepsy (FLE) surgery. METHOD This retrospective study included 44 consecutive subjects who underwent resective surgery for intractable FLE at IRCCS NEUROMED (period 2001-2014), followed up for at least 2 years (mean: 8.7 years). All patients underwent noninvasive presurgical evaluation and/or invasive electroencephalography (EEG) monitoring when nonconcordant data were obtained or epileptogenic zone was hypothesized to be close to the eloquent cortex. Electroclinical, neuroimaging, surgical data, and histology were compared to seizure outcome. RESULTS Mean epilepsy duration was 19 years; mean age at surgery was 31.6 years. Preoperative magnetic resonance imaging (MRI) showed a frontal lesion in 86.4 % of cases. Scalp video-electroencephalography (VEEG) monitoring detected a focal ictal onset in 90% of cases. Twenty-seven patients (61.4%) underwent invasive recordings. Resections involved dorsolateral (47.7%), medial (9%), orbital (13.6%), and rolandic (13.6%) region. Lobectomy within functional boundaries was performed in the remaining 7 cases (16%). Transient and permanent neurological deficits were observed in 2 and 3 cases, respectively. Histology revealed focal cortical dysplasia (45.5%), World Health Organization (WHO) I-II grade tumors (15.9%), gliosis (22.7%), vascular malformations (4.5%), Rasmussen encephalitis (6.8%), and normal tissue (4.5%). At last observation 68.1% of patients were in Engel's class I, 11.4% in class II, 9% in class III, and 11.4% in class IV. A favorable outcome was associated with focal ictal scalp EEG onset (p = 0.0357). CONCLUSION Surgery is a safe treatment option in drug-resistant FLE with a satisfying long-term outcome. These data highlight the importance of an appropriate selection of potential surgical candidates.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Vincenzo Esposito
- IRCCS "NEUROMED", Pozzilli, IS, Italy; Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
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25
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Xu C, Yu T, Zhang G, Wang Y, Li Y. Prognostic Factors and Longitudinal Change in Long-Term Outcome of Frontal Lobe Epilepsy Surgery. World Neurosurg 2019; 121:e32-e38. [DOI: 10.1016/j.wneu.2018.08.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
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26
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Adkinson JA, Karumuri B, Hutson TN, Liu R, Alamoudi O, Vlachos I, Iasemidis L. Connectivity and Centrality Characteristics of the Epileptogenic Focus Using Directed Network Analysis. IEEE Trans Neural Syst Rehabil Eng 2018; 27:22-30. [PMID: 30561346 DOI: 10.1109/tnsre.2018.2886211] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Accurate epileptogenic focus localization is required prior to surgical resection of brain tissue for the treatment of patients with antiepileptic drug-resistant (intractable) epilepsy. This clinical need is only partially fulfilled through a subjective, and at times inconclusive, the evaluation of the recorded electroencephalogram (EEG) at seizures' onset (the so-called gold standard for focus localization in epilepsy). We herein present a novel method of multivariate analysis of the EEG that appears to be very promising for an objective and robust localization of the epileptogenic focus at seizures' onset. Using the measure of generalized partial directed coherence, combined with surrogate data analysis, we first estimated from multichannel intracranial EEG the statistically significant causal interactions between brain regions at the onset of 92 clinical seizures from nine patients with temporal lobe intractable epilepsy. From the networks that were formed based on the thus derived interactions, a set of centrality metrics was estimated per network node (brain site). Brain sites located anatomically within the epileptogenic focus were shown to be associated with greater inward centrality values than non-focal brain regions at high frequencies ( γ band), and particular inward centrality metrics accurately localized the focus in all nine patients. In addition to focus localization from seizure (ictal) onset, the developed novel framework for analysis of EEG could be employed to identify the changes of the focal network over time, peri-ictally and interictally, and thus shed light onto the dynamics of ictogenesis, which could then have a significant impact on automated prediction and closed-loop control of seizures by neuromodulation.
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27
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Polyanskaya MV, Demushkina AA, Vasiliev IG, Gazdieva HS, Kholin AA, Zavadenko NN, Alikhanov AA. Role of contrast-free MR-perfusion in the diagnosis of potential epileptogenic foci in children with focal epilepsia. ACTA ACUST UNITED AC 2018. [DOI: 10.17749/2077-8333.2018.10.2.006-018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ASL (Arterial Spin Labeling) – a novel modality of MR angiography – is based on radio-frequency labeling of aqueous protons in the arterial blood; the method is used to monitor blood supply to organs, including the brain. So far there has been little information on the use of ASL in children with focal epilepsy, especially in the pre-surgery period.Aim:to evaluate the perfusion patterns in seizure-free children with drug resistant focal epilepsy (FE) using the ASL mode of MRI.Materials and methods.We studied the ASL data of 54 (23-boys/31 girls) patients with FE treated in the Dpt. of Neurology at the Russian State Children Hospital from 2015 to 2018. The patients’ age varied from 4 months to 17 years. All images were produced with a 3T GE Discovery 750W system.Results. We found several brain perfusion patterns in children with FE; among other factors, those patterns depended on the clinical status of the patient, i. e. the interictal period or the early post- seizure period. The main pattern of the interictal period was characterized by a focal decrease in perfusion located around a structural focus identified on MRI scans. In the early post-seizure period, there was an increase in the arterial perfusion in the area of a structural epileptogenic lesion.Conclusion.ASL-MRI is an effective diagnostic method providing more information on children with FE during their pre-surgery phase. The ASL modality needs further research to rationalize its wider use as a preferred diagnostic tool or as a combination with the more complex PET and SPECT.
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28
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Colon A, Osch MV, Buijs M, Grond J, Hillebrand A, Schijns O, Wagner G, Ossenblok P, Hofman P, Buchem M, Boon P. MEG-guided analysis of 7T-MRI in patients with epilepsy. Seizure 2018; 60:29-38. [DOI: 10.1016/j.seizure.2018.05.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/26/2022] Open
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29
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Keren-Aviram G, Dachet F, Bagla S, Balan K, Loeb JA, Dratz EA. Proteomic analysis of human epileptic neocortex predicts vascular and glial changes in epileptic regions. PLoS One 2018; 13:e0195639. [PMID: 29634780 PMCID: PMC5892923 DOI: 10.1371/journal.pone.0195639] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/26/2018] [Indexed: 01/21/2023] Open
Abstract
Epilepsy is a common neurological disorder, which is not well understood at the molecular level. Exactly why some brain regions produce epileptic discharges and others do not is not known. Patients who fail to respond to antiseizure medication (refractory epilepsy) can benefit from surgical removal of brain regions to reduce seizure frequency. The tissue removed in these surgeries offers an invaluable resource to uncover the molecular and cellular basis of human epilepsy. Here, we report a proteomic study to determine whether there are common proteomic patterns in human brain regions that produce epileptic discharges. We analyzed human brain samples, as part of the Systems Biology of Epilepsy Project (SBEP). These brain pieces are in vivo electrophysiologically characterized human brain samples withdrawn from the neocortex of six patients with refractory epilepsy. This study is unique in that for each of these six patients the comparison of protein expression was made within the same patient: a more epileptic region was compared to a less epileptic brain region. The amount of epileptic activity was defined for each patient as the frequency of their interictal spikes (electric activity between seizures that is a parameter strongly linked to epilepsy). Proteins were resolved from three subcellular fractions, using a 2D differential gel electrophoresis (2D-DIGE), revealing 31 identified protein spots that changed significantly. Interestingly, glial fibrillary acidic protein (GFAP) was found to be consistently down regulated in high spiking brain tissue and showed a strong negative correlation with spike frequency. We also developed a two-step analysis method to select for protein species that changed frequently among the patients and identified these proteins. A total of 397 protein spots of interest (SOI) were clustered by protein expression patterns across all samples. These clusters were used as markers and this analysis predicted proteomic changes due to both histological differences and molecular pathways, revealed by examination of gene ontology clusters. Our experimental design and proteomic data analysis predicts novel glial changes, increased angiogenesis, and changes in cytoskeleton and neuronal projections between high and low interictal spiking regions. Quantitative histological staining of these same tissues for both the vascular and glial changes confirmed these findings, which provide new insights into the structural and functional basis of neocortical epilepsy.
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Affiliation(s)
- Gal Keren-Aviram
- Department of Chemistry & Biochemistry, Montana State University, Bozeman, Montana, United States of America
| | - Fabien Dachet
- The Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Shruti Bagla
- The Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Karina Balan
- The Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Jeffrey A. Loeb
- The Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Edward A. Dratz
- Department of Chemistry & Biochemistry, Montana State University, Bozeman, Montana, United States of America
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30
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Delev D, Quesada CM, Grote A, Boström JP, Elger C, Vatter H, Surges R. A multimodal concept for invasive diagnostics and surgery based on neuronavigated voxel-based morphometric MRI postprocessing data in previously nonlesional epilepsy. J Neurosurg 2018. [DOI: 10.3171/2016.12.jns161676] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDiagnosis and surgical treatment of refractory and apparent nonlesional focal epilepsy is challenging. Morphometric MRI voxel-based and other postprocessing methods can help to localize the epileptogenic zone and thereby support the planning of further invasive electroencephalography (EEG) diagnostics, and maybe resective epilepsy surgery.METHODSThe authors developed an algorithm to implement regions of interest (ROI), based on postprocessed MRI data, into a neuronavigation tool. This was followed by stereotactic ROI-guided implantation of depth electrodes and ROI-navigated resective surgery. Data on diagnostic yield, histology, and seizure outcome were collected and evaluated.RESULTSFourteen consecutive patients with apparently nonlesional epilepsy were included in this study. Reevaluation of the MR images with the help of MRI postprocessing analysis led to the identification of probable subtle lesions in 11 patients. Additional information obtained by SPECT imaging and MRI reevaluation suggested possible lesions in the remaining 3 patients. The ROI-guided invasive implantation of EEG yielded interictal and ictal activity in 13 patients who were consequently referred to resective surgery. Despite the apparently negative MRI findings, focal cortical dysplasia was found in 64% of the patients (n = 9). At the last available outcome, 8 patients (57%) were completely seizure free (International League Against Epilepsy Class 1).CONCLUSIONSThe results demonstrate the feasibility and usefulness of a robust and straightforward algorithm for implementation of MRI postprocessing-based targets into the neuronavigation system. This approach allowed the stereotactic implantation of a low number of depth electrodes only, which confirmed the seizure-onset hypothesis in 90% of the cases without causing any complications. Furthermore, the neuronavigated ROI-guided lesionectomy helped to perform resective surgery in this rather challenging subgroup of patients with apparent nonlesional epilepsy.
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Affiliation(s)
| | - Carlos M. Quesada
- 2Epileptology, University of Bonn, University Medical Center, Bonn, Germany
| | | | | | - Christian Elger
- 2Epileptology, University of Bonn, University Medical Center, Bonn, Germany
| | | | - Rainer Surges
- 2Epileptology, University of Bonn, University Medical Center, Bonn, Germany
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31
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Harward SC, Chen WC, Rolston JD, Haglund MM, Englot DJ. Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis. Neurosurgery 2018; 82:350-358. [PMID: 28419330 PMCID: PMC5640459 DOI: 10.1093/neuros/nyx158] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Occipital lobe epilepsy (OLE) is an uncommon but debilitating focal epilepsy syndrome with seizures often refractory to medical management. While surgical resection has proven a viable treatment, previous studies examining postoperative seizure freedom rates are limited by small sample size and patient heterogeneity, thus exhibiting significant variability in their results. OBJECTIVE To review the medical literature on OLE so as to investigate rates and predictors of both seizure freedom and visual outcomes following surgery. METHODS We reviewed manuscripts exploring surgical resection for drug-resistant OLE published between January 1990 and June 2015 on PubMed. Seizure freedom rates were analyzed and potential predictors were evaluated with separate meta-analyses. Postoperative visual outcomes were also examined. RESULTS We identified 27 case series comprising 584 patients with greater than 1 yr of follow-up. Postoperative seizure freedom (Engel class I outcome) was observed in 65% of patients, and was significantly predicted by age less than 18 yr (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-2.18), focal lesion on pathological analysis (OR 2.08, 95% CI 1.58-2.89), and abnormal preoperative magnetic resonance imaging (OR 3.24, 95% 2.03-6.55). Of these patients, 175 also had visual outcomes reported with 57% demonstrating some degree of visual decline following surgery. We did not find any relationship between postoperative visual and seizure outcomes. CONCLUSION Surgical resection for OLE is associated with favorable outcomes with nearly two-thirds of patients achieving postoperative seizure freedom. However, patients must be counseled regarding the risk of visual decline following surgery.
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Affiliation(s)
- Stephen C Harward
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - William C Chen
- Department of Neuro-logical Surgery, University of California San Francisco, San Francisco, California
| | - John D Rolston
- Department of Neuro-logical Surgery, University of California San Francisco, San Francisco, California
| | - Michael M Haglund
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Heo W, Kim JS, Chung CK, Lee SK. Relationship between cortical resection and visual function after occipital lobe epilepsy surgery. J Neurosurg 2017; 129:524-532. [PMID: 29076788 DOI: 10.3171/2017.5.jns162963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE In this study, the authors investigated long-term clinical and visual outcomes of patients after occipital lobe epilepsy (OLE) surgery and analyzed the relationship between visual cortical resection and visual function after OLE surgery. METHODS A total of 42 consecutive patients who were diagnosed with OLE and underwent occipital lobe resection between June 1995 and November 2013 were included. Clinical, radiological, and histopathological data were reviewed retrospectively. Seizure outcomes were categorized according to the Engel classification. Visual function after surgery was assessed using the National Eye Institute Visual Functioning Questionnaire 25. The relationship between the resected area of the visual cortex and visual function was demonstrated by multivariate linear regression models. RESULTS After a mean follow-up period of 102.2 months, 27 (64.3%) patients were seizure free, and 6 (14.3%) patients had an Engel Class II outcome. Nineteen (57.6%) of 33 patients had a normal visual field or quadrantanopia after surgery (normal and quadrantanopia groups). Patients in the normal and quadrantanopia groups had better vision-related quality of life than those in the hemianopsia group. The resection of lateral occipital areas 1 and 2 of the occipital lobe was significantly associated with difficulties in general vision, peripheral vision, and vision-specific roles. In addition, the resection of intraparietal sulcus 3 or 4 was significantly associated with decreased social functioning. CONCLUSIONS The authors found a favorable seizure control rate (Engel Class I or II) of 78.6%, and 57.6% of the subjects had good visual function (normal vision or quadrantanopia) after OLE surgery. Lateral occipital cortical resection had a significant effect on visual function despite preservation of the visual field.
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Affiliation(s)
- Won Heo
- Departments of1Neurosurgery and.,4Clinical Research Institute, Seoul National University Hospital
| | - June Sic Kim
- 5Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Chun Kee Chung
- Departments of1Neurosurgery and.,5Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Sang Kun Lee
- 3Neuroscience Research Institute, Seoul National University Medical Research Center; and.,4Clinical Research Institute, Seoul National University Hospital.,6Neurology, Seoul National University College of Medicine
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Pindrik J, Hoang N, Tubbs RS, Rocque BJ, Rozzelle CJ. Trans-falcine and contralateral sub-frontal electrode placement in pediatric epilepsy surgery: technical note. Childs Nerv Syst 2017; 33:1379-1388. [PMID: 28578510 DOI: 10.1007/s00381-017-3469-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/21/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Phase II monitoring with intracranial electroencephalography (ICEEG) occasionally requires bilateral placement of subdural (SD) strips, grids, and/or depth electrodes. While phase I monitoring often demonstrates a preponderance of unilateral findings, individual studies (video EEG, single photon emission computed tomography [SPECT], and positron emission tomography [PET]) can suggest or fail to exclude a contralateral epileptogenic onset zone. This study describes previously unreported techniques of trans-falcine and sub-frontal insertion of contralateral SD grids and depth electrodes for phase II monitoring in pediatric epilepsy surgery patients when concern about bilateral abnormalities has been elicited during phase I monitoring. METHODS Pediatric patients with medically refractory epilepsy undergoing stage I surgery for phase II monitoring involving sub-frontal and/or trans-falcine insertion of SD grids and/or depth electrodes at the senior author's institution were retrospectively reviewed. Intra-operative technical details of sub-frontal and trans-falcine approaches were studied, while intra-operative complications or events were noted. Operative techniques included gentle subfrontal retraction and elevation of the olfactory tracts (while preserving the relationship between the olfactory bulb and cribriform plate) to insert SD grids across the midline for coverage of the contralateral orbito-frontal regions. Trans-falcine approaches involved accessing the inter-hemispheric space, bipolar cauterization of the anterior falx cerebri below the superior sagittal sinus, and sharp dissection using a blunt elevator and small blade scalpel. The falcine window allowed contralateral SD strip, grid, and depth electrodes to be inserted for coverage of the contralateral frontal regions. RESULTS The study cohort included seven patients undergoing sub-frontal and/or trans-falcine insertion of contralateral SD strip, grid, and/or depth electrodes from February 2012 through June 2015. Five patients (71%) experienced no intra-operative events related to contralateral ICEEG electrode insertion. Intra-operative events of frontal territory venous engorgement (1/7, 14%) due to sacrifice of anterior bridging veins draining into the SSS and avulsion of a contralateral bridging vein (1/7, 14%), probably due to prior anterior corpus callosotomy, each occurred in one patient. There were no intra-operative or peri-operative complications in any of the patients studied. Two patients required additional surgery for supplemental SD strip and/or depth electrodes via burr hole craniectomy to enhance phase II monitoring. All patients proceeded to stage II surgery for resection of ipsilateral epileptogenic onset zones without adverse events. CONCLUSIONS Trans-falcine and sub-frontal insertion of contralateral SD strip, grid, and depth electrodes are previously unreported techniques for achieving bilateral frontal coverage in phase II monitoring in pediatric epilepsy surgery. This technique obviates the need for contralateral craniotomy and parenchymal exposure with limited, remediable risks. Larger case series using the method described herein are now necessary.
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Affiliation(s)
- Jonathan Pindrik
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Nguyen Hoang
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Brandon J Rocque
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Curtis J Rozzelle
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
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Zerouali Y, Ghaziri J, Nguyen DK. Multimodal investigation of epileptic networks: The case of insular cortex epilepsy. PROGRESS IN BRAIN RESEARCH 2017; 226:1-33. [PMID: 27323937 DOI: 10.1016/bs.pbr.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The insula is a deep cortical structure sharing extensive synaptic connections with a variety of brain regions, including several frontal, temporal, and parietal structures. The identification of the insular connectivity network is obviously valuable for understanding a number of cognitive processes, but also for understanding epilepsy since insular seizures involve a number of remote brain regions. Ultimately, knowledge of the structure and causal relationships within the epileptic networks associated with insular cortex epilepsy can offer deeper insights into this relatively neglected type of epilepsy enabling the refining of the clinical approach in managing patients affected by it. In the present chapter, we first review the multimodal noninvasive tests performed during the presurgical evaluation of epileptic patients with drug refractory focal epilepsy, with particular emphasis on their value for the detection of insular cortex epilepsy. Second, we review the emerging multimodal investigation techniques in the field of epilepsy, that aim to (1) enhance the detection of insular cortex epilepsy and (2) unveil the architecture and causal relationships within epileptic networks. We summarize the results of these approaches with emphasis on the specific case of insular cortex epilepsy.
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Affiliation(s)
- Y Zerouali
- Research Centre, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada; Ecole Polytechnique de Montréal, Montreal, QC, Canada
| | - J Ghaziri
- Research Centre, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - D K Nguyen
- Research Centre, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada; CHUM-Hôpital Notre-Dame, Montreal, QC, Canada.
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Kokkinos V, Kallifatidis A, Kapsalaki EZ, Papanikolaou N, Garganis K. Thin isotropic FLAIR MR images at 1.5T increase the yield of focal cortical dysplasia transmantle sign detection in frontal lobe epilepsy. Epilepsy Res 2017; 132:1-7. [DOI: 10.1016/j.eplepsyres.2017.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/20/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
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Jobst BC, Kapur R, Barkley GL, Bazil CW, Berg MJ, Bergey GK, Boggs JG, Cash SS, Cole AJ, Duchowny MS, Duckrow RB, Edwards JC, Eisenschenk S, Fessler AJ, Fountain NB, Geller EB, Goldman AM, Goodman RR, Gross RE, Gwinn RP, Heck C, Herekar AA, Hirsch LJ, King-Stephens D, Labar DR, Marsh WR, Meador KJ, Miller I, Mizrahi EM, Murro AM, Nair DR, Noe KH, Olejniczak PW, Park YD, Rutecki P, Salanova V, Sheth RD, Skidmore C, Smith MC, Spencer DC, Srinivasan S, Tatum W, Van Ness P, Vossler DG, Wharen RE, Worrell GA, Yoshor D, Zimmerman RS, Skarpaas TL, Morrell MJ. Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. Epilepsia 2017; 58:1005-1014. [DOI: 10.1111/epi.13739] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara C. Jobst
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire U.S.A
| | - Ritu Kapur
- NeuroPace, Inc.; Mountain View California U.S.A
| | | | - Carl W. Bazil
- Columbia University Medical Center; New York New York U.S.A
| | - Michel J. Berg
- University of Rochester Medical Center; Rochester New York U.S.A
| | | | - Jane G. Boggs
- Wake Forest University Health Sciences; Winston-Salem North Carolina U.S.A
| | - Sydney S. Cash
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | - Andrew J. Cole
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | - Michael S. Duchowny
- Miami Children's Hospital / Nicklaus Children's Hospital; Miami Florida U.S.A
| | | | | | | | - A. James Fessler
- University of Rochester Medical Center; Rochester New York U.S.A
| | - Nathan B. Fountain
- University of Virginia School of Medicine; Charlottesville Virginia U.S.A
| | - Eric B. Geller
- Institute of Neurology and Neurosurgery at Saint Barnabas; Livingston New Jersey U.S.A
| | | | | | | | - Ryder P. Gwinn
- Swedish Neuroscience Institute; Seattle Washington U.S.A
| | | | | | | | | | | | - W. R. Marsh
- Mayo Clinic Minnesota; Rochester Minnesota U.S.A
| | | | - Ian Miller
- Miami Children's Hospital / Nicklaus Children's Hospital; Miami Florida U.S.A
| | | | | | | | | | | | | | - Paul Rutecki
- University of Wisconsin Hospital and Clinics; Madison Wisconsin U.S.A
| | - Vicenta Salanova
- Indiana University School of Medicine; Indianapolis Indiana U.S.A
| | | | | | | | | | | | - William Tatum
- Mayo Clinic's Campus in Florida; Jacksonville Florida U.S.A
| | | | | | | | | | | | | | | | - Martha J. Morrell
- NeuroPace, Inc.; Mountain View California U.S.A
- Stanford University; Stanford California U.S.A
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Sun Y, Wang X, Che N, Qin H, Liu S, Wu X, Wei M, Cheng H, Yin J. Clinical characteristics and epilepsy outcomes following surgery caused by focal cortical dysplasia (type IIa) in 110 adult epileptic patients. Exp Ther Med 2017; 13:2225-2234. [PMID: 28565831 PMCID: PMC5443177 DOI: 10.3892/etm.2017.4315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/21/2016] [Indexed: 11/09/2022] Open
Abstract
The aim of the present study was to investigate the effects of surgical intervention of focal cortical dysplasia (FCD) IIa on the outcome of epilepsy, and to evaluate the prognostic factors of seizure freedom. Patient data from epilepsy surgeries were retrospectively reviewed at the Second Affiliated Hospital of Dalian Medical University between 2007 and 2015. A total of 110 patients with a definite pathological diagnosis of FCD IIa were included. Moreover, the clinical characteristics, seizure outcome and quality of life in adults with FCD IIa were evaluated. The Engel seizure outcome achievements were class I in 72, class II in 20, class III in 11 and class IV in 7 patients. In addition, the Engel seizure outcome was relevant with the resection range of the lesions (P=0.028). The assessments of electrocorticography (ECoG) patterns and magnetic resonance imaging (MRI) are relevant to determining the extent of the resection, which may influence the surgery outcome (P=0.001 and P=0.023). Using multivariate regression analyses, the extent of resection, seizure frequency, preoperative ECoG and location of resection were the most important risk factors for seizure recurrence. The results of quality of life in epilepsy-10 scoring revealed that the quality of life improved significantly following surgery (P<0.01). Moreover, surgical intervention, EcoG, MRI positioning and complete resection helped to have improved seizure control, relief of anxiety and quality of life. All these observations strongly recommend an early consideration of epilepsy surgery in FCD IIa patients.
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Affiliation(s)
- Yuqiang Sun
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China.,Department of Neurosurgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150036, P.R. China
| | - Xiaofeng Wang
- Department of Neurosurgery, Weinan Central Hospital, Weinan, Shaanxi 714000, P.R. China
| | - Ningwei Che
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Huamin Qin
- Department of Pathology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Shuping Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Xinling Wu
- Department of Psychology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Minghai Wei
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Huakun Cheng
- Department of Neurosurgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150036, P.R. China
| | - Jian Yin
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
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Dugan P, Carlson C, Jetté N, Wiebe S, Bunch M, Kuzniecky R, French J. Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug-resistant focal epilepsy. Epilepsia 2017; 58:792-800. [PMID: 28378422 DOI: 10.1111/epi.13730] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Presently, there is no simple method at initial presentation for identifying a patient's likelihood of progressing to surgery and a favorable outcome. The Epilepsy Surgery Grading Scale (ESGS) is a three-tier empirically derived mathematical scale with five categories: magnetic resonance imaging (MRI), electroencephalography (EEG), concordance (between MRI and EEG), semiology, and IQ designed to stratify patients with drug-resistant focal epilepsy based on their likelihood of proceeding to resective epilepsy surgery and achieving seizure freedom. METHODS In this cross-sectional study, we abstracted data from the charts of all patients admitted to the New York University Langone Medical Center (NYULMC) for presurgical evaluation or presented in surgical multidisciplinary conference (MDC) at the NYU Comprehensive Epilepsy Center (CEC) from 1/1/2007 to 7/31/2008 with focal epilepsy, who met minimal criteria for treatment resistance. We classified patients into ESGS Grade 1 (most favorable), Grade 2 (intermediate), and Grade 3 (least favorable candidates). Three cohorts were evaluated: all patients, patients presented in MDC, and patients who had resective surgery. The primary outcome measure was proceeding to surgery and seizure freedom. RESULTS Four hundred seven patients met eligibility criteria; 200 (49.1%) were presented in MDC and 113 (27.8%) underwent surgery. A significant difference was observed between Grades 1 and 3, Grades 1 and 2, and Grades 2 and 3 for all presurgical patients, and those presented in MDC, with Grade 1 patients having the highest likelihood of both having surgery and becoming seizure-free. There was no difference between Grades 1 and 2 among patients who had resective surgery. SIGNIFICANCE These results demonstrate that by systematically using basic information available during initial assessment, patients with drug-resistant epilepsy may be successfully stratified into clinically meaningful groups with varied prognosis. The ESGS may improve communication, facilitate decision making and early referral to a CEC, and allow patients and physicians to better manage expectations.
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Affiliation(s)
- Patricia Dugan
- Department of Neurology, New York University Langone Medical Center, New York, New York, U.S.A
| | - Chad Carlson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Nathalie Jetté
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Marjorie Bunch
- Department of Neurology, Albany Medical Center, Albany, New York, U.S.A
| | - Ruben Kuzniecky
- Department of Neurology, New York University Langone Medical Center, New York, New York, U.S.A
| | - Jacqueline French
- Department of Neurology, New York University Langone Medical Center, New York, New York, U.S.A
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Vlachos I, Krishnan B, Treiman DM, Tsakalis K, Kugiumtzis D, Iasemidis LD. The Concept of Effective Inflow: Application to Interictal Localization of the Epileptogenic Focus From iEEG. IEEE Trans Biomed Eng 2016; 64:2241-2252. [PMID: 28092511 DOI: 10.1109/tbme.2016.2633200] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
GOAL Accurate determination of the epileptogenic focus is of paramount diagnostic and therapeutic importance in epilepsy. The current gold standard for focus localization is from ictal (seizure) onset and thus requires the occurrence and recording of multiple typical seizures of a patient. Localization of the focus from seizure-free (interictal) periods remains a challenging problem, especially in the absence of interictal epileptiform activity. METHODS By exploring the concept of effective inflow, we developed a focus localization algorithm (FLA) based on directed connectivity between brain sites. Subsequently, using the measure of generalized partial directed coherence over a broad frequency band in FLA for the analysis of interictal periods from long-term (days) intracranial electroencephalographic signals, we identified the brain region that is the most frequent receiver of maximal effective inflow from other brain regions. RESULTS In six out of nine patients with temporal lobe epilepsy, the thus identified brain region was a statistically significant outlier (p < 0.01) and coincided with the clinically assessed epileptogenic focus. In the remaining three patients, the clinically assessed focus still exhibited the highest inflow, but it was not deemed an outlier (p > 0.01). CONCLUSIONS These findings suggest that the epileptogenic focus is a region of intense influence from other regions interictally, possibly as a mechanism to keep it under control in seizure-free periods. SIGNIFICANCE The developed framework is expected to assist with the accurate epileptogenic focus localization, reduce hospital stay and healthcare cost, and provide guidance to treatment of epilepsy via resective surgery or neuromodulation.
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Acute postoperative seizures as predictors of seizure outcomes after epilepsy surgery. Epilepsy Res 2016; 127:119-125. [DOI: 10.1016/j.eplepsyres.2016.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 08/14/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022]
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Kamson DO, Pilli VK, Asano E, Jeong JW, Sood S, Juhász C, Chugani HT. Cortical thickness asymmetries and surgical outcome in neocortical epilepsy. J Neurol Sci 2016; 368:97-103. [PMID: 27538609 DOI: 10.1016/j.jns.2016.06.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/08/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE We evaluated if cortical thickness measures were associated with surgical outcome in patients with non-lesional neocortical epilepsy. METHODS Twenty-one young patients (age: 2.4-19.7years) with epilepsy of neocortical origin and normal MRI underwent two-stage epilepsy surgery with subdural EEG monitoring. Cortical thickness was measured on presurgical volumetric MRI using the FreeSurfer software. The prognostic value of hemispheric and lobar/regional cortical thickness measures for 1-year and 2-year post-surgical seizure outcome has been analyzed. RESULTS At one-year follow-up, 14 patients (67%) were seizure-free. Hemispheric and frontal lobe cortical thickness showed no/minimal asymmetry in seizure-free patients but thinner cortex ipsilateral to the seizure focus in those with recurrent seizures (p=0.02). More robust differences were found in patients≥6years of age (p=0.006 for frontal asymmetries), whose cortical thickness asymmetries remained prognostic for 2-year post-surgical outcome (p=0.007). By using an optimal cutoff threshold based on a receiver operating characteristic analysis, mean hemispheric asymmetry predicted one-year seizure freedom with 93% sensitivity and 71% specificity in the whole group, and with 100% sensitivity and 92% specificity in patients≥6years of age. CONCLUSION In patients with neocortical epilepsy and normal MRI, neocortical thinning in the epileptic hemisphere, particularly in frontal cortex, is associated with poor surgical outcome. Although these results require validation in a larger cohort prospectively, these data suggest that presurgical evaluation of cortical thickness may assist in identification of patients at high risk for surgical failure.
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Affiliation(s)
- David O Kamson
- Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States
| | - Vinod K Pilli
- Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States
| | - Eishi Asano
- Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; Department of Neurology, Wayne State University, Harper University Hospital, 3990 John R. St, Detroit, MI 48201, United States
| | - Jeong-Won Jeong
- Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States
| | - Sandeep Sood
- Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; Department of Neurosurgery, Wayne State University, Harper University Hospital, 3990 John R. St, Detroit, MI 48201, United States
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States; Department of Neurology, Wayne State University, Harper University Hospital, 3990 John R. St, Detroit, MI 48201, United States.
| | - Harry T Chugani
- Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States; Department of Neurology, Wayne State University, Harper University Hospital, 3990 John R. St, Detroit, MI 48201, United States
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Nissen IA, Stam CJ, Citroen J, Reijneveld JC, Hillebrand A. Preoperative evaluation using magnetoencephalography: Experience in 382 epilepsy patients. Epilepsy Res 2016; 124:23-33. [PMID: 27232766 DOI: 10.1016/j.eplepsyres.2016.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/03/2015] [Accepted: 05/09/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Identifying epilepsy patients for whom clinical MEG is likely to be beneficial avoids or optimizes burdensome ancillary investigations. We determined whether it could be predicted upfront if MEG would be able to generate a hypothesis about the location of the epileptogenic zone (EZ), and in which patients MEG fails to do so. METHODS MEG recordings of 382 epilepsy patients with inconclusive findings regarding EZ localization prior to MEG were acquired for preoperative evaluation. MEG reports were categorized for several demographic, clinical and MEG variables. First, demographic and clinical variables were associated with MEG localization ability for upfront prediction. Second, all variables were compared between patients with and without MEG location in order to characterize patients without MEG location. RESULTS Our patient group had often complex etiology and did not contain the (by other means) straightforward and well-localized cases, such as those with concordant tumor and EEG location. For our highly-selected patient group, MEG localization ability cannot be predicted upfront, although the odds of a recording with MEG location were significantly higher in the absence of a tumor and in the presence of widespread MRI abnormalities. Compared to the patients with MEG location, patients without MEG location more often had a tumor, widespread EEG abnormalities, non-lateralizing MEG abnormalities, non-concordant MEG/EEG abnormalities and less often widespread MRI abnormalities or epileptiform MEG activity. In a subgroup of 48 patients with known surgery outcome, more patients with concordant MEG and resection area were seizure-free than patients with discordant results. CONCLUSIONS MEG potentially adds information about the location of the EZ even in patients with a complex etiology, and the clinical advice is to not withhold MEG in epilepsy surgery candidates. Providing a hypothesis about the location of the EZ using MEG is difficult in patients with inconclusive EEG and MRI findings, and in the absence of specific epileptiform activity. More refined methods are needed for patients where MEG currently does not contribute to the hypothesis about the location of the EZ.
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Affiliation(s)
- I A Nissen
- Department of Clinical Neurophysiology and MEG Center, Neuroscience Campus Amsterdam, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
| | - C J Stam
- Department of Clinical Neurophysiology and MEG Center, Neuroscience Campus Amsterdam, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
| | - J Citroen
- Department of Clinical Neurophysiology and MEG Center, Neuroscience Campus Amsterdam, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
| | - J C Reijneveld
- Brain Tumor Center Amsterdam & Department of Neurology, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
| | - A Hillebrand
- Department of Clinical Neurophysiology and MEG Center, Neuroscience Campus Amsterdam, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
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Unfavorable surgical outcomes in partial epilepsy with secondary bilateral synchrony: Intracranial electroencephalography study. Epilepsy Res 2016; 122:102-9. [DOI: 10.1016/j.eplepsyres.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/26/2016] [Accepted: 03/12/2016] [Indexed: 11/17/2022]
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Predictors of Postoperative Seizure Recurrence: A Longitudinal Study of Temporal and Extratemporal Resections. EPILEPSY RESEARCH AND TREATMENT 2016; 2016:7982494. [PMID: 27069682 PMCID: PMC4812270 DOI: 10.1155/2016/7982494] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/29/2022]
Abstract
Objective. We investigated the longitudinal outcome of resective epilepsy surgery to identify the predictors of seizure recurrence. Materials and Methods. We retrospectively analyzed patients who underwent resections for intractable epilepsy over a period of 7 years. Multiple variables were investigated as potential predictors of seizure recurrence. The time to first postoperative seizure was evaluated using survival analysis and univariate analysis at annual intervals. Results. Among 70 patients, 54 (77%) had temporal and 16 (23%) had extratemporal resections. At last follow-up (mean 48 months; range 24–87 months), the outcome was Engel class I in 84% (n = 59) of patients. Seizure recurrence followed two patterns: recurrence was “early” (within 2 years) in 82% of patients, of whom 83% continued to have seizures despite optimum medical therapy; recurrence was “late” (after 2 years) in 18%, of whom 25% continued to have seizures subsequently. Among the variables of interest, only resection site and ictal EEG remained as independent predictors of seizure recurrence over the long term (p < 0.05). Extratemporal resection and discordance between ictal EEG and resection area were associated with 4.2-fold and 5.6-fold higher risk of seizure recurrence, respectively. Conclusions. Extratemporal epilepsy and uncertainty in ictal EEG localization are independent predictors of unfavorable outcome. Seizure recurrence within two years of surgery indicates poor long-term outcome.
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Jalota A, Rossi MA, Pylypyuk V, Stein M, Stoub T, Balabanov A, Bergen D, Bermeo A, Park E, Smith M, Byrne R. Resecting critical nodes from an epileptogenic circuit in refractory focal-onset epilepsy patients using subtraction ictal SPECT coregistered to MRI. J Neurosurg 2016; 125:1565-1576. [PMID: 26991384 DOI: 10.3171/2015.6.jns141719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the positive predictive value of postresection outcomes obtained by presurgical subtracted ictal SPECT in patients with lesional (MRI positive) and nonlesional (MRI negative) refractory extratemporal lobe epilepsy (ETLE) and temporal lobe epilepsy (TLE). Specifically, outcomes were compared between partial versus complete resection of the regions of transient hyperperfusion identified using subtraction ictal SPECT coregistered to MRI (SISCOM) in relation to the ictal onset zone (IOZ) that was confirmed by electrocorticography (ECoG). That is, SISCOM was used to understand the long-term postsurgical outcomes following resection of the IOZ that overlapped with 1 or more regions of ictal onset-associated transient hyperperfusion. METHODS The study cohort included 44 consecutive patients with refractory ETLE or TLE who were treated between 2002 and 2013 and underwent presurgical evaluation using SISCOM. Concordance was determined between SISCOM localization and the IOZ on the basis of ECoG monitoring. In addition, the association between the extent of the resection site overlapping with the SISCOM signal and postresection outcomes were assessed. Postsurgical follow-up was longer than 24 months in 39 of 44 patients. RESULTS The dominant SISCOM signals were concordant with ECoG and overlapped the resection site in 32 of 44 (73%) patients (19 ETLE and 13 TLE patients), and 20 of 32 (63%) patients became seizure free. In all 19 ETLE patients with concordant SISCOM and ECoG results, the indicated location of ictal onset on ECoG was completely resected; 11 of 19 patients (58%) became seizure free (Engel Class I). In all 13 TLE patients with concordant SISCOM and ECoG results, the indicated ECoG focus was completely resected; 9 of 13 patients (69%) became seizure free (Engel Class I). Complete resection of the SISCOM signal was found in 7 of 34 patients (21%). Of these 7 patients, 5 patients (72%) were seizure free (Engel Class I). Partial resection of the SISCOM signal was found in 16 of 34 patients (47%), and 10 of these 16 patients (63%) were seizure free (Engel Class I) after more than 24 months of follow-up. CONCLUSIONS Concordance between 1 or more SISCOM regions of hyperperfusion with ECoG and at least partial resection of the dominant SISCOM signal in this refractory epilepsy cohort provided additional useful information for predicting long-term postresection outcomes. Such regions are likely critical nodes in more extensive, active, epileptogenic circuits. In addition, SPECT scanner technology may limit the sensitivity of meaningful SISCOM signals for identifying the maximal extent of the localizable epileptogenic network.
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Affiliation(s)
- Abhijay Jalota
- Rush Epilepsy Center, Department of Neurological Sciences
| | - Marvin A Rossi
- Rush Epilepsy Center, Department of Neurological Sciences.,Department of Diagnostic Radiology and Nuclear Medicine; and
| | | | - Michael Stein
- Rush Epilepsy Center, Department of Neurological Sciences
| | - Travis Stoub
- Rush Epilepsy Center, Department of Neurological Sciences
| | | | - Donna Bergen
- Rush Epilepsy Center, Department of Neurological Sciences
| | - Adriana Bermeo
- Rush Epilepsy Center, Department of Neurological Sciences
| | - Esmeralda Park
- Rush Epilepsy Center, Department of Neurological Sciences
| | - Michael Smith
- Rush Epilepsy Center, Department of Neurological Sciences
| | - Richard Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Abstract
AbstractThe role of fludeoxyglucose F 18 positron emission tomography (PET) in the presurgical evaluation of patients with medically intractable epilepsy continues to be refined. The purpose of this study was to systematically review the literature to assess the diagnostic accuracy and utility of PET in this setting. Thirty-nine studies were identified through MEDLINE and EMBASE databases that met the inclusion criteria. In adult patients, PET hypometabolism showed a 56 to 90% agreement with seizure onset localized by intracranial electroencephalogram (pediatric: 21 to 86%). In temporal lobe epilepsy patients with good surgical outcome, PET displayed moderate to high sensitivity in localizing the seizure focus (range: 71 to 89%). The sensitivity increased by 8 to 23% when PET results were combined with magnetic resonance imaging or electroencephalogram. PET has been shown to affect patient management by improving the guidance of intracranial electrodes placement, altering the decision to perform surgery, or excluding patients from further evaluation.
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Sierra-Marcos A, Carreño M, Setoain X, López-Rueda A, Aparicio J, Donaire A, Bargalló N. Accuracy of arterial spin labeling magnetic resonance imaging (MRI) perfusion in detecting the epileptogenic zone in patients with drug-resistant neocortical epilepsy: comparison with electrophysiological data, structural MRI, SISCOM and FDG-PET. Eur J Neurol 2015; 23:160-7. [DOI: 10.1111/ene.12826] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - M. Carreño
- Institute of Neurosciences; Hospital Clinic; Barcelona Spain
| | - X. Setoain
- Image Diagnosis Center; Hospital Clinic; Barcelona Spain
- Centro de Investigación Biomédica en Red en Bioingeniería; Biomateriales y Nanomedicina (CIBER-BBN); Barcelona Spain
| | - A. López-Rueda
- Image Diagnosis Center; Hospital Clinic; Barcelona Spain
| | - J. Aparicio
- Institute of Neurosciences; Hospital Clinic; Barcelona Spain
| | - A. Donaire
- Institute of Neurosciences; Hospital Clinic; Barcelona Spain
| | - N. Bargalló
- Image Diagnosis Center; Hospital Clinic; Barcelona Spain
- Medical Image Core Facility; August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Barcelona Spain
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Cho EB, Joo EY, Seo DW, Hong SC, Hong SB. Prognostic Role of Functional Neuroimaging after Multilobar Resection in Patients with Localization-Related Epilepsy. PLoS One 2015; 10:e0136565. [PMID: 26305092 PMCID: PMC4549147 DOI: 10.1371/journal.pone.0136565] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/04/2015] [Indexed: 11/19/2022] Open
Abstract
To investigate the usage of functional neuroimaging as a prognostic tool for seizure recurrence and long-term outcomes in patients with multilobar resection, we recruited 90 patients who received multilobar resections between 1995 and 2013 with at least 1-year follow-up (mean 8.0 years). All patients were monitored using intracranial electroencephalography (EEG) after pre-surgical evaluation. Clinical data (demographics, electrophysiology, and neuroimaging) were reviewed retrospectively. Surgical outcomes were evaluated at 1, 2, 5 years after surgery, and at the end of the study. After 1 year, 56 patients (62.2%) became Engel class I and at the last follow-up, 47 patients (52.2%) remained seizure-free. Furthermore, non-localized 18F-fluorodeoxyglucose positron emission tomography (PET), identifying hypometabolic areas not concordant with ictal onset zones, significantly correlated with seizure recurrence after 1 year. Non-lesional magnetic resonance imaging (MRI) and left-sided resection correlated with poor outcomes. In the last follow-up, non-localized PET and left-sided resection significantly correlated with seizure recurrence. Both localized PET and ictal-interictal SPECT subtraction co-registered to MR (SISCOM) predicted good surgical outcomes in the last follow-up (69.2%, Engel I). This study suggests that PET and SISCOM may predict postoperative outcomes for patients after multilobar epilepsy and shows comparable long-term surgical outcomes after multilobar resection.
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Affiliation(s)
- Eun Bin Cho
- Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience center, Samsung Medical Center, Seoul, South Korea
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience center, Samsung Medical Center, Seoul, South Korea
- * E-mail: (EYJ); (SBH)
| | - Dae-Won Seo
- Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience center, Samsung Medical Center, Seoul, South Korea
| | - Seung-Chyul Hong
- Department of Neurosurgery, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Bong Hong
- Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience center, Samsung Medical Center, Seoul, South Korea
- * E-mail: (EYJ); (SBH)
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Baud MO, Vulliemoz S, Seeck M. Recurrent secondary generalization in frontal lobe epilepsy: Predictors and a potential link to surgical outcome? Epilepsia 2015. [DOI: 10.1111/epi.13086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maxime O. Baud
- Department of Neurology; University of California San Francisco; San Francisco California U.S.A
| | - Serge Vulliemoz
- Epilepsy Center; Geneva University Hospital; Geneva Switzerland
| | - Margitta Seeck
- Epilepsy Center; Geneva University Hospital; Geneva Switzerland
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Yang PF, Jia YZ, Lin Q, Mei Z, Chen ZQ, Zheng ZY, Zhang HJ, Pei JS, Tian J, Zhong ZH. Intractable occipital lobe epilepsy: clinical characteristics, surgical treatment, and a systematic review of the literature. Acta Neurochir (Wien) 2015; 157:63-75. [PMID: 25278241 DOI: 10.1007/s00701-014-2217-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/01/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE We reported our experience in the surgical treatment of a relatively large cohort of patients with occipital lobe epilepsy (OLE). We also carried out a systematic review of the literature on OLE. METHODS Thirty-five consecutive patients who underwent occipital resection for epilepsy were included. Diagnoses were made following presurgical evaluations, including magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), scalp video-electroencephalogram (EEG) monitoring, and intracranial EEG monitoring. At last follow-up, seizure outcome was classified using the Engel classification scheme. RESULTS Twenty-five of 35 patients experienced/had experienced ≥1 type of aura before the seizure. Invasive recordings were used to define the epileptogenic area in 30 of 35 patients (85.7 %). All patients underwent occipital lesionectomies or topectomies. Histopathology revealed: cortical dysplasias, gliosis, dysembryoplastic neuroepithelial tumor, ganglioglioma, and tuberous sclerosis. After a mean follow-up of 44 months, 25 patients (71.4 %) were seizure free (Engel class I), 3 (8.6 %) rarely had seizures (Engel class II), 5 (14.3 %) improved more than 75 % (Engel class III), and 2 (5.7 %) had no significant improvement (Engel class IV). Preoperatively, 12 of 33 patients (36.4 %) had visual field deficits. Postoperatively, 25 patients (75.8 %) had new or aggravated visual field deficits. CONCLUSIONS The management of OLE has been aided greatly by the availability of high-resolution diagnosis. Postoperative visual field deficits occur in a significant proportion of patients. Comprehensive intracranial EEG coverage of all occipital surfaces helps to define the epileptogenic area and preserve visual function, especially in cases of focal cortical dysplasia undetectable by MRI.
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