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Alashjaie R, Kerr EN, AlShoumer A, Hawkins C, Yau I, Weiss S, Ochi A, Otsubo H, Krishnan P, Widjaja E, Ibrahim GM, Donner EJ, Jain P. Surgical outcomes in children with drug-resistant epilepsy and hippocampal sclerosis. Epilepsy Res 2024; 203:107367. [PMID: 38703703 DOI: 10.1016/j.eplepsyres.2024.107367] [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: 02/19/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Hippocampal sclerosis (HS) is a common surgical substrate in adult epilepsy surgery cohorts but variably reported in various pediatric cohorts. OBJECTIVE We aimed to study the epilepsy phenotype, radiological and pathological variability, seizure and neurocognitive outcomes in children with drug-resistant epilepsy and hippocampal sclerosis (HS) with or without additional subtle signal changes in anterior temporal lobe who underwent surgery. METHODS This retrospective study enrolled children with drug-resistant focal epilepsy and hippocampal sclerosis with or without additional subtle T2-Fluid Attenuated Inversion Recovery (FLAR)/Proton Density (PD) signal changes in anterior temporal lobe who underwent anterior temporal lobectomy with amygdalohippocampectomy. Their clinical, EEG, neuropsychological, radiological and pathological data were reviewed and summarized. RESULTS Thirty-six eligible patients were identified. The mean age at seizure onset was 3.7 years; 25% had daily seizures at time of surgery. Isolated HS was noted in 22 (61.1%) cases and additional subtle signal changes in ipsilateral temporal lobe in 14 (38.9%) cases. Compared to the normative population, the group mean performance in intellectual functioning and most auditory and visual memory tasks were significantly lower than the normative sample. The mean age at surgery was 12.3 years; 22 patients (61.1%) had left hemispheric surgeries. ILAE class 1 outcomes was seen in 28 (77.8%) patients after a mean follow up duration of 2.3 years. Hippocampal sclerosis was noted pathologically in 32 (88.9%) cases; type 2 (54.5%) was predominant subtype where further classification was possible. Additional pathological abnormalities were seen in 11 cases (30.6%); these had had similar rates of seizure freedom as compared to children with isolated hippocampal sclerosis/gliosis (63.6% vs 84%, p=0.21). Significant reliable changes were observed across auditory and visual memory tasks at an individual level post surgery. CONCLUSIONS Favourable seizure outcomes were seen in most children with isolated radiological hippocampal sclerosis. Patients with additional pathological abnormalities had similar rates of seizure freedom as compared to children with isolated hippocampal sclerosis/gliosis.
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Affiliation(s)
- Ream Alashjaie
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth N Kerr
- Department of Psychology, Hospital for Sick Children, Toronto, University of Toronto, Ontario, Canada
| | - Azhar AlShoumer
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia Hawkins
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ivanna Yau
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shelly Weiss
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ayako Ochi
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Department of Medical Imaging, Lurie Children's Hospital of Chicago, Chicago, United States of America
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth J Donner
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Manokaran RK, Yau I, Whitney R, Ochi A, Otsubo H, Widjaja E, Ibrahim GM, Donner EJ, Jain P. Contralateral hippocampal sclerosis following functional hemispherectomy in children: A report of three cases. Seizure 2023; 111:147-150. [PMID: 37634352 DOI: 10.1016/j.seizure.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023] Open
Abstract
PURPOSE Hippocampal Sclerosis (HS) may co-exist with temporal or extratemporal lesions (dual pathology) in children and is usually ipsilateral to the radiological lesion. Here were report three cases with extensive hemispheric cortical malformation and drug resistant epilepsy who had persistent seizures after functional hemispherectomy (FH) and developed contralateral HS after the surgery. METHODS This retrospective study enrolled children who underwent FH and developed contralateral HS after surgery. Their clinical, EEG, radiological and pathological data were reviewed and summarized. RESULTS Ninety-five children underwent FH during the study period; Three cases (3.2%) were eligible. They all had unilateral extensive hemispheric cortical malformation who underwent FH between 3 and 5 months of age with no clinical, EEG or radiological suggestion for involvement of contralateral hemisphere prior to FH. All three patients had persisting seizures after FH. Contralateral HS was detected between 2.2 to 3.7 years after FH in all three cases. Two of the patients showed pathogenic variants in GATOR1 pathway genes. CONCLUSIONS The genesis of contralateral HS in the reported patients remains unexplained. The presence and distribution of "second-hit" somatic mutations may play an important role in governing the seizure outcomes of epilepsy surgery in patients with apparently unilateral malformations of cortical development.
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Affiliation(s)
- Ranjith Kumar Manokaran
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Ivanna Yau
- Epilepsy Program, Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Robyn Whitney
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada.
| | - Ayako Ochi
- Epilepsy Program, Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Hiroshi Otsubo
- Epilepsy Program, Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Elysa Widjaja
- Department of Medical Imaging, Lurie Children's Hospital of Chicago, Chicago, United States of America.
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada.
| | - Elizabeth J Donner
- Epilepsy Program, Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Santos MV, Garcia CAB, Hamad APA, Costa UT, Sakamoto AC, Dos Santos AC, Machado HR. Clinical and Surgical Approach for Cerebral Cortical Dysplasia. Adv Tech Stand Neurosurg 2023; 48:327-354. [PMID: 37770690 DOI: 10.1007/978-3-031-36785-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The present article describes pathophysiological and clinical aspects of congenital malformations of the cerebral tissue (cortex and white matter) that cause epilepsy and very frequently require surgical treatment. A particular emphasis is given to focal cortical dysplasias, the most common pathology among these epilepsy-related malformations. Specific radiological and surgical features are also highlighted, so a thorough overview of cortical dysplasias is provided.
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Affiliation(s)
- Marcelo Volpon Santos
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil.
- Department of Surgery and Anantomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil.
| | - Camila Araujo Bernardino Garcia
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Paula Andrade Hamad
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Ursula Thome Costa
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Americo Ceiki Sakamoto
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Antonio Carlos Dos Santos
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Helio Rubens Machado
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
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Kim D, Lee J, Moon J, Moon T. Interpretable deep learning-based hippocampal sclerosis classification. Epilepsia Open 2022; 7:747-757. [PMID: 36177546 PMCID: PMC9712484 DOI: 10.1002/epi4.12655] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/26/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the performance of a deep learning model for hippocampal sclerosis classification on the clinical dataset and suggest plausible visual interpretation for the model prediction. METHODS T2-weighted oblique coronal images of the brain MRI epilepsy protocol performed on patients were used. The training set included 320 participants with 160 no, 100 left and 60 right hippocampal sclerosis, and cross-validation was implemented. The test set consisted of 302 participants with 252 no, 25 left and 25 right hippocampal sclerosis. As the test set was imbalanced, we took an average of the accuracy achieved within each group to measure a balanced accuracy for multiclass and binary classifications. The dataset was composed to include not only healthy participants but also participants with abnormalities besides hippocampal sclerosis in the control group. We visualized the reasons for the model prediction using the layer-wise relevance propagation method. RESULTS When evaluated on the validation of the training set, we achieved multiclass and binary classification accuracy of 87.5% and 88.8% from the voting ensemble of six models. Evaluated on the test sets, we achieved multiclass and binary classification accuracy of 91.5% and 89.76%. The distinctly sparse visual interpretations were provided for each individual participant and group to suggest the contribution of each input voxel to the prediction on the MRI. SIGNIFICANCE The current interpretable deep learning-based model is promising for adapting effectively to clinical settings by utilizing commonly used data, such as MRI, with realistic abnormalities faced by neurologists to support the diagnosis of hippocampal sclerosis with plausible visual interpretation.
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Affiliation(s)
- Dohyun Kim
- Department of Artificial IntelligenceSungkyunkwan UniversitySuwonSouth Korea
| | - Jungtae Lee
- Application Engineering Team, Memory BusinessSamsung Electronics Co., Ltd.SuwonSouth Korea
| | - Jangsup Moon
- Department of NeurologySeoul National University HospitalSeoulSouth Korea,Department of Genomic MedicineSeoul National University HospitalSeoulSouth Korea
| | - Taesup Moon
- Department of Electrical and Computer EngineeringSeoul National UniversitySeoulSouth Korea,ASRI/INMC/IPAI/AIISSeoul National UniversitySeoulSouth Korea
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Schur S, Moreau JT, Khoo HM, Koupparis A, Simard Tremblay E, Myers KA, Osterman B, Rosenblatt B, Farmer JP, Saint-Martin C, Turpin S, Hall J, Olivier A, Bernasconi A, Bernasconi N, Baillet S, Dubeau F, Gotman J, Dudley RWR. New interinstitutional, multimodal presurgical evaluation protocol associated with improved seizure freedom for poorly defined cases of focal epilepsy in children. J Neurosurg Pediatr 2022; 29:74-82. [PMID: 34624842 DOI: 10.3171/2021.6.peds218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In an attempt to improve postsurgical seizure outcomes for poorly defined cases (PDCs) of pediatric focal epilepsy (i.e., those that are not visible or well defined on 3T MRI), the authors modified their presurgical evaluation strategy. Instead of relying on concordance between video-electroencephalography and 3T MRI and using functional imaging and intracranial recording in select cases, the authors systematically used a multimodal, 3-tiered investigation protocol that also involved new collaborations between their hospital, the Montreal Children's Hospital, and the Montreal Neurological Institute. In this study, the authors examined how their new strategy has impacted postsurgical outcomes. They hypothesized that it would improve postsurgical seizure outcomes, with the added benefit of identifying a subset of tests contributing the most. METHODS Chart review was performed for children with PDCs who underwent resection following the new strategy (i.e., new protocol [NP]), and for the same number who underwent treatment previously (i.e., preprotocol [PP]); ≥ 1-year follow-up was required for inclusion. Well-defined, multifocal, and diffuse hemispheric cases were excluded. Preoperative demographics and clinical characteristics, resection volumes, and pathology, as well as seizure outcomes (Engel class Ia vs > Ia) at 1 year postsurgery and last follow-up were reviewed. RESULTS Twenty-two consecutive NP patients were compared with 22 PP patients. There was no difference between the two groups for resection volumes, pathology, or preoperative characteristics, except that the NP group underwent more presurgical evaluation tests (p < 0.001). At 1 year postsurgery, 20 of 22 NP patients and 10 of 22 PP patients were seizure free (OR 11.81, 95% CI 2.00-69.68; p = 0.006). Magnetoencephalography and PET/MRI were associated with improved postsurgical seizure outcomes, but both were highly correlated with the protocol group (i.e., independent test effects could not be demonstrated). CONCLUSIONS A new presurgical evaluation strategy for children with PDCs of focal epilepsy led to improved postsurgical seizure freedom. No individual presurgical evaluation test was independently associated with improved outcome, suggesting that it may be the combined systematic protocol and new interinstitutional collaborations that makes the difference rather than any individual test.
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Affiliation(s)
- Solon Schur
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University
| | - Jeremy T Moreau
- 2McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University.,3Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Hui Ming Khoo
- 4Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | | | | | - Kenneth A Myers
- 6Division of Neurology and Department of Clinical Neurophysiology, Montreal Children's Hospital
| | - Bradley Osterman
- 6Division of Neurology and Department of Clinical Neurophysiology, Montreal Children's Hospital
| | - Bernard Rosenblatt
- 6Division of Neurology and Department of Clinical Neurophysiology, Montreal Children's Hospital
| | - Jean-Pierre Farmer
- 3Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | | | - Sophie Turpin
- 8Division of Nuclear Medicine, Medical Imaging, CHU Ste-Justine and Montreal Children's Hospital; and
| | - Jeff Hall
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University
| | - Andre Olivier
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University
| | - Andrea Bernasconi
- 9Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- 9Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | | | - Francois Dubeau
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University
| | - Jean Gotman
- 5Montreal Neurological Institute, McGill University
| | - Roy W R Dudley
- 1Montreal Neurological Institute and Hospital, McGill University Health Center, Department of Neurology and Neurosurgery, McGill University.,3Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children's Hospital, Montreal, Quebec, Canada
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Garcia-Cairasco N, Podolsky-Gondim G, Tejada J. Searching for a paradigm shift in the research on the epilepsies and associated neuropsychiatric comorbidities. From ancient historical knowledge to the challenge of contemporary systems complexity and emergent functions. Epilepsy Behav 2021; 121:107930. [PMID: 33836959 DOI: 10.1016/j.yebeh.2021.107930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
In this review, we will discuss in four scenarios our challenges to offer possible solutions for the puzzle associated with the epilepsies and neuropsychiatric comorbidities. We need to recognize that (1) since quite old times, human wisdom was linked to the plural (distinct global places/cultures) perception of the Universe we are in, with deep respect for earth and nature. Plural ancestral knowledge was added with the scientific methods; however, their joint efforts are the ideal scenario; (2) human behavior is not different than animal behavior, in essence the product of Darwinian natural selection; knowledge of animal and human behavior are complementary; (3) the expression of human behavior follows the same rules that complex systems with emergent properties, therefore, we can measure events in human, clinical, neurobiological situations with complexity systems' tools; (4) we can use the semiology of epilepsies and comorbidities, their neural substrates, and potential treatments (including experimental/computational modeling, neurosurgical interventions), as a source and collection of integrated big data to predict with them (e.g.: machine/deep learning) diagnosis/prognosis, individualized solutions (precision medicine), basic underlying mechanisms and molecular targets. Once the group of symptoms/signals (with a myriad of changing definitions and interpretations over time) and their specific sequences are determined, in epileptology research and clinical settings, the use of modern and contemporary techniques such as neuroanatomical maps, surface electroencephalogram and stereoelectroencephalography (SEEG) and imaging (MRI, BOLD, DTI, SPECT/PET), neuropsychological testing, among others, are auxiliary in the determination of the best electroclinical hypothesis, and help design a specific treatment, usually as the first attempt, with available pharmacological resources. On top of ancient knowledge, currently known and potentially new antiepileptic drugs, alternative treatments and mechanisms are usually produced as a consequence of the hard, multidisciplinary, and integrated studies of clinicians, surgeons, and basic scientists, all over the world. The existence of pharmacoresistant patients, calls for search of other solutions, being along the decades the surgeries the most common interventions, such as resective procedures (i.e., selective or standard lobectomy, lesionectomy), callosotomy, hemispherectomy and hemispherotomy, added by vagus nerve stimulation (VNS), deep brain stimulation (DBS), neuromodulation, and more recently focal minimal or noninvasive ablation. What is critical when we consider the pharmacoresistance aspect with the potential solution through surgery, is still the pursuit of localization-dependent regions (e.g.: epileptogenic zone (EZ)), in order to decide, no matter how sophisticated are the brain mapping tools (EEG and MRI), the size and location of the tissue to be removed. Mimicking the semiology and studying potential neural mechanisms and molecular targets - by means of experimental and computational modeling - are fundamental steps of the whole process. Concluding, with the conjunction of ancient knowledge, coupled to critical and creative contemporary, scientific (not dogmatic) clinical/surgical, and experimental/computational contributions, a better world and of improved quality of life can be offered to the people with epilepsy and neuropsychiatric comorbidities, who are still waiting (as well as the scientists) for a paradigm shift in epileptology, both in the Basic Science, Computational, Clinical, and Neurosurgical Arenas. This article is part of the Special Issue "NEWroscience 2018".
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Affiliation(s)
- Norberto Garcia-Cairasco
- Laboratório de Neurofisiologia e Neuroetologia Experimental, Departmento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. Brazil; Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Guilherme Podolsky-Gondim
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Julian Tejada
- Departamento de Psicologia, Universidade Federal de Sergipe, Brazil.
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Kassiri J, Elliott C, Liu N, Mailo J, Rajapakse T, Schmitt L, Wheatley M, Sinclair DB. Neuroimaging in pediatric temporal lobe epilepsy: Does neuroimaging accurately predict pathology and surgical outcome? Epilepsy Res 2021; 175:106680. [PMID: 34102391 DOI: 10.1016/j.eplepsyres.2021.106680] [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: 02/06/2021] [Revised: 05/17/2021] [Accepted: 05/31/2021] [Indexed: 11/15/2022]
Abstract
Temporal lobe epilepsy (TLE) in children is considered different from that in adults. As such, characterizing the structural lesions present in pediatric patients with TLE and their association with long-term seizure control is important. Here, we aimed to assess the concordance between preoperative imaging and postoperative histopathological diagnoses and their associations with seizure outcomes in pediatric patients with TLE undergoing temporal lobe surgery. We retrospectively reviewed the charts of pediatric patients with TLE who underwent surgical treatment between 1988 and 2020 as a part of the Comprehensive Epilepsy Program at the University of Alberta. Demographic, age at seizure onset, age at surgery, preoperative electroencephalography (EEG), long-term video EEG, imaging (magnetic resonance imaging [MRI] and computed tomography), neuropathology, and long-term seizure outcome data were acquired and analyzed. One hundred and seventeen patients underwent surgery for refractory TLE; the preoperative MRI diagnosis was concordant with the histopathological diagnosis in 76 % of cases. Tumors were identified with high accuracy (91 %). Mesial temporal sclerosis (MTS) was strongly associated with an excellent outcome after surgery (94 %). Patients with normal imaging results or non-specific pathologies were more likely to experience poor seizure outcomes after surgery (50 %). The radiological identification of lesions was associated with good long-term seizure outcomes, whereas normal MRI results were associated with significantly poorer long-term seizure outcomes. An accurate preoperative MRI is essential to epilepsy surgery since it impacts all stages of management; these results will thereafter help inform practitioners' efforts to predict seizure outcome.
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Affiliation(s)
- Janani Kassiri
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada.
| | - Cameron Elliott
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - Natarie Liu
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - Janette Mailo
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Thilinie Rajapakse
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Schmitt
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Wheatley
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - D Barry Sinclair
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
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Abstract
BACKGROUND This is an updated version of the original Cochrane review, published in 2015.Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary between at least 20% and up to 70%. If the epileptogenic zone can be located, surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.Secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence, and to identify the factors that correlate with remission of seizures postoperatively. SEARCH METHODS For the latest update, we searched the following databases on 11 March 2019: Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to March 08, 2019), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) that included at least 30 participants in a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), with an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome related to postoperative seizure control. Cohort studies or case series were included in the previous version of this review. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportions of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RRs) and 95% confidence intervals (95% CIs). MAIN RESULTS We identified 182 studies with a total of 16,855 included participants investigating outcomes of surgery for epilepsy. Nine studies were RCTs (including two that randomised participants to surgery or medical treatment (99 participants included in the two trials received medical treatment)). Risk of bias in these RCTs was unclear or high. Most of the remaining 173 non-randomised studies followed a retrospective design. We assessed study quality using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses, we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across domains.In terms of freedom from seizures, two RCTs found surgery (n = 97) to be superior to medical treatment (n = 99); four found no statistically significant differences between anterior temporal lobectomy (ATL) with or without corpus callosotomy (n = 60), between subtemporal or transsylvian approach to selective amygdalohippocampectomy (SAH) (n = 47); between ATL, SAH and parahippocampectomy (n = 43) or between 2.5 cm and 3.5 cm ATL resection (n = 207). One RCT found total hippocampectomy to be superior to partial hippocampectomy (n = 70) and one found ATL to be superior to stereotactic radiosurgery (n = 58); and another provided data to show that for Lennox-Gastaut syndrome, no significant differences in seizure outcomes were evident between those treated with resection of the epileptogenic zone and those treated with resection of the epileptogenic zone plus corpus callosotomy (n = 43). We judged evidence from the nine RCTs to be of moderate to very low quality due to lack of information reported about the randomised trial design and the restricted study populations.Of the 16,756 participants included in this review who underwent a surgical procedure, 10,696 (64%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to recording of adverse events to be very poor.In total, 120 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography, history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection, and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation, and presence of postoperative discharges were prognostic factors of outcome.Twenty-nine studies reported multi-variable models of prognostic factors, and showed that the direction of association of factors with outcomes was generally the same as that found in univariate analyses.We observed variability in many of our analyses, likely due to small study sizes with unbalanced group sizes and variation in the definition of seizure outcome, the definition of prognostic factors, and the influence of the site of surgery AUTHORS' CONCLUSIONS: Study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcomes. Future research should be of high quality, follow a prospective design, be appropriately powered, and focus on specific issues related to diagnostic tools, the site-specific surgical approach, and other issues such as extent of resection. Researchers should investigate prognostic factors related to the outcome of surgery via multi-variable statistical regression modelling, where variables are selected for modelling according to clinical relevance, and all numerical results of the prognostic models are fully reported. Journal editors should not accept papers for which study authors did not record adverse events from a medical intervention. Researchers have achieved improvements in cancer care over the past three to four decades by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Sarah J Nevitt
- University of LiverpoolDepartment of BiostatisticsBlock F, Waterhouse Building1‐5 Brownlow HillLiverpoolUKL69 3GL
| | - Jennifer Cotton
- The Clatterbridge Cancer Centre NHS Foundation TrustWirralUK
| | - Sacha Gandhi
- NHS Ayrshire and ArranDepartment of General SurgeryAyrUKKA6 6DX
| | - Jennifer Weston
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolMerseysideUKL9 7LJ
| | - Ajay Sudan
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Roberto Ramirez
- Royal Manchester Children's HospitalHospital RoadPendleburyManchesterUKM27 4HA
| | - Richard Newton
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
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9
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Zhang C, Kwan P. The Concept of Drug-Resistant Epileptogenic Zone. Front Neurol 2019; 10:558. [PMID: 31214106 PMCID: PMC6555267 DOI: 10.3389/fneur.2019.00558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/09/2019] [Indexed: 12/01/2022] Open
Abstract
Resective surgery is the most effective way to treat drug-resistant epilepsy. Despite extensive pre-surgical evaluation, only 30–70% patients would become seizure-free after surgery. New approaches and strategies are needed to improve the outcome of epilepsy surgery. It is commonly observed in clinical practice that antiepileptic drugs (AEDs) could maintain seizure freedom in a large proportion of patients after surgery, who were uncontrolled before the operation. In some patients cessation of AEDs leads to seizure recurrence which, in most cases, can be controlled by resuming AEDs. These observations suggest that the surgery has converted the epilepsy from drug-resistant to drug-responsive, implying that the operation has removed the brain tissue accounting for pharmacoresistance, rather than the pathological substrate of epilepsy (at least not completely). Based on these observations, it is hypothesized that there is a drug-resistant epileptogenic zone (DREZ) which overlaps with the epileptogenic zone (EZ), and has both epileptogenic and drug-resistant properties. DREZ is necessary and sufficient to cause drug-resistant epilepsy, and its remove would render the epilepsy drug-responsive. Testing the hypothesis requires the development of new methods to define the DREZ, which may be used to guide surgical planning when the epileptogenic zone cannot be completely excised. This concept can also help understand the mechanisms of drug-resistant epilepsy, leading to new therapeutic strategies.
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Affiliation(s)
- Chunbo Zhang
- School of Pharmacy, Nanchang University, Nanchang, China
| | - Patrick Kwan
- Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, VIC, Australia.,Departments of Medicine and Neurology, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
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10
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Mehvari Habibabadi J, Badihian S, Tabrizi N, Manouchehri N, Zare M, Basiratnia R, Barekatain M, Moein H, Mehvari Habibabadi A, Moein P, Gookizadeh P. Evaluation of dual pathology among drug-resistant epileptic patients with hippocampal sclerosis. Neurol Sci 2018; 40:495-502. [PMID: 30539344 DOI: 10.1007/s10072-018-3677-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/04/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE Dual pathology (DP) is defined as simultaneous presence of hippocampal sclerosis (HS) and any other pathology in the brain. Since this is a less probed concept, we aimed to evaluate the frequency and characteristics of DP among drug-resistant epileptic patients with HS. METHODS This is a cross-sectional study conducted during 2007-2016 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with diagnosis of drug-resistant epilepsy and HS were enrolled in the study, and demographic data, seizure semiology, EEG findings, and MRI findings were collected. We compared these variables between three groups of DP, unilateral HS, and bilateral HS. RESULTS Of the 200 enrolled cases, 29 patients (14.5%) had DP and 21 patients (10.5%) had bilateral HS; the remaining patients had unilateral HS. The average age of patients with DP was 30.03, and 65.5% of them were male. Patients with DP had more EEG discharges from regional and multi-focal sites compared to unilateral HS (P value < 0.001). Also, complex partial seizure (CPS) was more commonly presented in patients with unilateral HS (96.8%). Comparison of disease characteristics between DP and bilateral HS showed no difference in most categories (P > 0.05). CONCLUSIONS We found DP among 14.5% of our drug-resistant epileptic patients with HS. DP patients mostly presented with CPS and had high proportion of ictal and interictal EEG discharges from regional and multi-focal areas. Gliosis and focal cortical dysplasia were the most common pathologies among DP patients. Patients with DP showed a similar behavior to bilateral HS in many features.
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Affiliation(s)
| | - Shervin Badihian
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Students' Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Tabrizi
- Neurology Department, Medical School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Navid Manouchehri
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Students' Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Zare
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Basiratnia
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Barekatain
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Houshang Moein
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Payam Moein
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Peyman Gookizadeh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. .,Students' Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. .,, Isfahan, Iran.
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11
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Effect of Temporal Neocortical Pathology on Seizure Freeness in Adult Patients with Temporal Lobe Epilepsy. World Neurosurg 2018; 116:e801-e805. [DOI: 10.1016/j.wneu.2018.05.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 11/23/2022]
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12
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Holm E, Foged MT, Beniczky S, Jespersen B, Brennum J, Pinborg LH. Efficacy of the Danish epilepsy surgery programme. Acta Neurol Scand 2018; 137:245-251. [PMID: 28994451 DOI: 10.1111/ane.12857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Despite optimal medical treatment, approximately one-third of patients with epilepsy continue to have seizures. Epilepsy surgery is widely accepted as a therapeutic option in the selected subset of patients with drug-resistant focal epilepsy. Here, we report the results of the Danish epilepsy surgery programme from 2009 to 2014. MATERIAL AND METHODS A total of 169 consecutive patients, operated at Rigshospitalet, were included. Information was gathered from digital patient records. Before 1-year follow-up, two patients were lost to follow-up and three were referred to new surgery. RESULTS The median years of drug resistance before operation were 11 years. At 1-year follow-up (n = 164), seizure outcomes were as follows: 65% Engel I (free from disabling seizures), 51% Engel IA (completely seizure free) and 9% Engel IV (no worthwhile improvement), and for patients operated in the medial temporal lobe (n = 114): 70% Engel I, 56% Engel IA, 5% Engel IV. The outcomes of the 53 patients needing intracranial EEG recording (ICR) were not significantly different from the patients only evaluated with surface EEG. None of the eight MRI-negative patients operated outside the medial temporal lobe after ICR were free of disabling seizures. 12% of MTLE patients developed de novo depression after epilepsy surgery despite good surgical outcome. Three patients required rehabilitation due to post-operative hemiplegia. CONCLUSION The outcomes of the Danish epilepsy surgery programme align with international results found in recent meta-analyses. Serious complications to epilepsy surgery are seldom. In accordance with international recommendations, Danish drug-resistant patients should be referred to epilepsy surgery evaluation at an earlier stage of the disease.
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Affiliation(s)
- E. Holm
- Neurobiology Research Unit Department of Neurology Copenhagen University Hospital Rigshospitalet Denmark
| | - M. T. Foged
- Neurobiology Research Unit Department of Neurology Copenhagen University Hospital Rigshospitalet Denmark
| | | | - B. Jespersen
- Department of Neurosurgery Copenhagen University Hospital Rigshospitalet Denmark
| | - J. Brennum
- Department of Neurosurgery Copenhagen University Hospital Rigshospitalet Denmark
| | - L. H. Pinborg
- Neurobiology Research Unit Department of Neurology Copenhagen University Hospital Rigshospitalet Denmark
- Epilepsy Clinic Department of Neurology Copenhagen University Hospital Rigshospitalet Denmark
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13
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Kubota Y, Ochiai T, Hori T, Kawamata T. Usefulness of StereoEEG-based tailored surgery for medial temporal lobe epilepsy. Preliminary results in 11 patients. Clin Neurol Neurosurg 2017; 158:67-71. [PMID: 28482271 DOI: 10.1016/j.clineuro.2017.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/22/2017] [Accepted: 04/30/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Surgical options for medial temporal lobe epilepsy (MTLE) include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH). Optimal criteria for choosing the appropriate surgical approach remain uncertain. This article reports 11 consecutive cases in which electrophysiological findings of stereoelectroencephalography (SEEG) were used to determine the optimal surgical approach. PATIENTS AND METHODS Eleven consecutive patients with MTLE underwent SEEG evaluation and were placed in either the medial or the medial+lateral group based on the findings. Patients in the medial group underwent SAH using the subtemporal approach, and patients in the medial+lateral group underwent SEEG-guided anterior temporal lobectomy. SEEG findings were also compared with other examinations including flumazenil (FMZ)-positron emission tomography (PET), fluorine-18 labeled fluorodeoxyglucose (FDG)-PET, and magnetoencephalography (MEG). Results were evaluated to determine which examinations most consistently identified the epileptogenic zone. RESULTS Of the 11 cases, 4 patients were placed in the medial group, and 7 patients in the medial+lateral group. Of patients, 90.9% were classified in class I of the Engel Epilepsy Surgery Outcome Scale, while 72.7% were classified in class I by the International League Against Epilepsy (ILAE) system. Analyzed by group, 100% of the medial group experienced an Engel class I outcome in the medial group, compared to 85.7% in the medial+lateral group. SEEG findings were comparable with FDG-PET results (10 of 11, 91%). CONCLUSION Tailored surgery guided by SEEG is an electrophysiologically feasible treatment for MTLE that can result in favorable outcomes. Although seizures are thought to originate in the medial temporal lobe in MTLE, it is important for involvement of the lateral temporal cortex to be also considered in some cases.
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Affiliation(s)
- Yuichi Kubota
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan.
| | - Taku Ochiai
- Ochiai Brain Clinic, Saitama, Saitama, Japan
| | | | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
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Gales JM, Jehi L, Nowacki A, Prayson RA. The role of histopathologic subtype in the setting of hippocampal sclerosis–associated mesial temporal lobe epilepsy. Hum Pathol 2017; 63:79-88. [DOI: 10.1016/j.humpath.2017.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/02/2017] [Accepted: 02/23/2017] [Indexed: 11/17/2022]
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IWASAKI M, JIN K, NAKASATO N, TOMINAGA T. Non-invasive Evaluation for Epilepsy Surgery. Neurol Med Chir (Tokyo) 2016; 56:632-640. [PMID: 27627857 PMCID: PMC5066084 DOI: 10.2176/nmc.ra.2016-0186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/29/2016] [Indexed: 12/02/2022] Open
Abstract
Epilepsy surgery is aimed to remove the brain tissues that are indispensable for generating patient's epileptic seizures. There are two purposes in the pre-operative evaluation: localization of the epileptogenic zone and localization of function. Surgery is planned to remove possible epileptogenic zone while preserving functional area. Since no single diagnostic modality is superior to others in identifying and localizing the epileptogenic zone, multiple non-invasive evaluations are performed to estimate the location of the epileptogenic zone after concordance between evaluations. Essential components of non-invasive pre-surgical evaluation of epilepsy include detailed clinical history, long-term video-electroencephalography monitoring, epilepsy-protocol magnetic resonance imaging (MRI), and neuropsychological testing. However, a significant portion of drug-resistant epilepsy is associated with no or subtle MRI lesions or with ambiguous electro-clinical signs. Additional evaluations including fluoro-deoxy glucose positron emission tomography (FDG-PET), magnetoencephalography and ictal single photon emission computed tomography can play critical roles in planning surgery. FDG-PET should be registered on three-dimensional MRI for better detection of focal cortical dysplasia. All diagnostic tools are complementary to each other in defining the epileptogenic zone, so that it is always important to reassess the data based on other results to pick up or confirm subtle abnormalities.
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Affiliation(s)
- Masaki IWASAKI
- Department of Neurosurgery, National Center Hospital of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka JIN
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu NAKASATO
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Nagae LM, Lall N, Dahmoush H, Nyberg E, Mirsky D, Drees C, Honce JM. Diagnostic, treatment, and surgical imaging in epilepsy. Clin Imaging 2016; 40:624-36. [DOI: 10.1016/j.clinimag.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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Nonoda Y, Miyakoshi M, Ojeda A, Makeig S, Juhász C, Sood S, Asano E. Interictal high-frequency oscillations generated by seizure onset and eloquent areas may be differentially coupled with different slow waves. Clin Neurophysiol 2016; 127:2489-99. [PMID: 27178869 DOI: 10.1016/j.clinph.2016.03.022] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE High-frequency oscillations (HFOs) can be spontaneously generated by seizure-onset and functionally-important areas. We determined if consideration of the spectral frequency bands of coupled slow-waves could distinguish between epileptogenic and physiological HFOs. METHODS We studied a consecutive series of 13 children with focal epilepsy who underwent extraoperative electrocorticography. We measured the occurrence rate of HFOs during slow-wave sleep at each electrode site. We subsequently determined the performance of HFO rate for localization of seizure-onset sites and undesirable detection of nonepileptic sensorimotor-visual sites defined by neurostimulation. We likewise determined the predictive performance of modulation index: MI(XHz)&(YHz), reflecting the strength of coupling between amplitude of HFOsXHz and phase of slow-waveYHz. The predictive accuracy was quantified using the area under the curve (AUC) on receiver-operating characteristics analysis. RESULTS Increase in HFO rate localized seizure-onset sites (AUC⩾0.72; p<0.001), but also undesirably detected nonepileptic sensorimotor-visual sites (AUC⩾0.58; p<0.001). Increase in MI(HFOs)&(3-4Hz) also detected both seizure-onset (AUC⩾0.74; p<0.001) and nonepileptic sensorimotor-visual sites (AUC⩾0.59; p<0.001). Increase in subtraction-MIHFOs [defined as subtraction of MI(HFOs)&(0.5-1Hz) from MI(HFOs)&(3-4Hz)] localized seizure-onset sites (AUC⩾0.71; p<0.001), but rather avoided detection of nonepileptic sensorimotor-visual sites (AUC⩽0.42; p<0.001). CONCLUSION Our data suggest that epileptogenic HFOs may be coupled with slow-wave3-4Hz more preferentially than slow-wave0.5-1Hz, whereas physiologic HFOs with slow-wave0.5-1Hz more preferentially than slow-wave3-4Hz during slow-wave sleep. SIGNIFICANCE Further studies in larger samples are warranted to determine if consideration of the spectral frequency bands of slow-waves coupled with HFOs can positively contribute to presurgical evaluation of patients with focal epilepsy.
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Affiliation(s)
- Yutaka Nonoda
- Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Makoto Miyakoshi
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - Alejandro Ojeda
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - Scott Makeig
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - Csaba Juhász
- Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Sandeep Sood
- Neurosurgery, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Eishi Asano
- Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA.
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Gales JM, Prayson RA. Remote infarct of the temporal lobe with coexistent hippocampal sclerosis in mesial temporal lobe epilepsy. Hum Pathol 2016; 48:111-6. [DOI: 10.1016/j.humpath.2015.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/02/2015] [Accepted: 09/16/2015] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary according to the age of the participants and which focal epilepsies are included, but have been reported as at least 20% and in some studies up to 70%. If the epileptogenic zone can be located surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.The secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence and to identify the factors that correlate to remission of seizures postoperatively. SEARCH METHODS We searched the Cochrane Epilepsy Group Specialised Register (June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 6), MEDLINE (Ovid) (2001 to 4 July 2013), ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for relevant trials up to 4 July 2013. SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs), cohort studies or case series, with either a prospective and/or retrospective design, including at least 30 participants, a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome relating to postoperative seizure control. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportion of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RR) and 95% confidence intervals. MAIN RESULTS We identified 177 studies (16,253 participants) investigating the outcome of surgery for epilepsy. Four studies were RCTs (including one that randomised participants to surgery or medical treatment). The risk of bias in the RCTs was unclear or high, limiting our confidence in the evidence that addressed the primary review objective. Most of the remaining 173 non-randomised studies had a retrospective design; they were of variable size, were conducted in a range of countries, recruited a wide demographic range of participants, used a wide range of surgical techniques and used different scales used to measure outcomes. We performed quality assessment using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across the domains.In terms of freedom from seizures, one RCT found surgery to be superior to medical treatment, two RCTs found no statistically significant difference between anterior temporal lobectomy (ATL) with or without corpus callosotomy or between 2.5 cm or 3.5 cm ATL resection, and one RCT found total hippocampectomy to be superior to partial hippocampectomy. We judged the evidence from the four RCTs to be of moderate to very low quality due to the lack of information reported about the randomised trial design and the restricted study populations.Of the 16,253 participants included in this review, 10,518 (65%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to the recording of adverse events to be very poor.In total, 118 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: an abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography (EEG), history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation or presence of postoperative discharges were prognostic factors of outcome. We observed variability between studies for many of our analyses, likely due to the small study sizes with unbalanced group sizes, variation in the definition of seizure outcome, definition of the prognostic factor and the influence of the site of surgery, all of which we observed to be related to postoperative seizure outcome. Twenty-nine studies reported multivariable models of prognostic factors and the direction of association of factors with outcome was generally the same as found in the univariate analyses. However, due to the different multivariable analysis approaches and selective reporting of results, meaningful comparison of multivariate analysis with univariate meta-analysis is difficult. AUTHORS' CONCLUSIONS The study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcome. Future research should be of high quality, have a prospective design, be appropriately powered and focus on specific issues related to diagnostic tools, the site-specific surgical approach and other issues such as the extent of resection. Prognostic factors related to the outcome of surgery should be investigated via multivariable statistical regression modelling, where variables are selected for modelling according to clinical relevance and all numerical results of the prognostic models are fully reported. Protocols should include pre- and postoperative measures of speech and language function, cognition and social functioning along with a mental state assessment. Journal editors should not accept papers where adverse events from a medical intervention are not recorded. Improvements in the development of cancer care over the past three to four decades have been achieved by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Department of Paediatric Neurology, Royal Manchester Children's Hospital, Hathersage Road, Manchester, UK, M13 0JH
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Hamelin S, Depaulis A. Revisiting hippocampal sclerosis in mesial temporal lobe epilepsy according to the "two-hit" hypothesis. Rev Neurol (Paris) 2015; 171:227-35. [PMID: 25748332 DOI: 10.1016/j.neurol.2015.01.560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/20/2015] [Indexed: 12/28/2022]
Abstract
Hippocampal sclerosis (HS) is the most common neuropathological pattern observed in pharmacoresistant epilepsy and represents a critical feature in mesial temporal lobe epilepsy syndrome. However, its pathophysiological mechanisms and neuropathological consequences on seizures remain mostly unresolved. The new international classification of hippocampal sclerosis aims at standardizing its description to allow comparisons between different clinical studies. However, several aspects are not considered in this classification (granule cell dispersion, sprouting, glial modifications…). In this chapter, we discuss these different features associated with hippocampal sclerosis in perspective with the "two-hit" hypothesis and propose mechanisms that could be involved in the modulation of some specific neuropathological aspects like early life stress, hyperthermic seizures, brain lesions or hormonal modifications.
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Affiliation(s)
- S Hamelin
- Inserm, U836, université Joseph-Fourier, dite Santé, bâtiment Edmond-J.-Safra, chemin Fortuné-Ferrini, 38706 La Tronche cedex, France; University Grenoble-Alpes, Grenoble institut des neurosciences, chemin Fortuné-Ferrini, 38700 La Tronche, France; Hôpital Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38302 Bourgoin-Jallieu cedex, France.
| | - A Depaulis
- Inserm, U836, université Joseph-Fourier, dite Santé, bâtiment Edmond-J.-Safra, chemin Fortuné-Ferrini, 38706 La Tronche cedex, France; University Grenoble-Alpes, Grenoble institut des neurosciences, chemin Fortuné-Ferrini, 38700 La Tronche, France; CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
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Abstract
BACKGROUND AND PURPOSE Epilepsy surgery for medically refractory epilepsy secondary to cortical dysplasia in children poses special challenges. We aim to review the current available literature on the outcome after epilepsy surgery for cortical dysplasia in children and critically evaluate the prognostic predictors of outcome. METHODS A comprehensive review of the literature was performed focusing on the outcome after epilepsy surgery for cortical dysplasia in children. Two large recent meta-analyses that included children and adults and several pediatric series of cortical dysplasia in children were reviewed. RESULTS AND CONCLUSIONS The overall seizure freedom rates range from 40 to 73 %, at about 2 years after surgery; most studies report 50-55% success rate. Complete resection of the epileptogenic lesion/zone remains the most important variable predictive of postoperative seizure freedom. Features unique to cortical dysplasia that limits our ability to ensure complete resection of the epileptogenic zone are reviewed.
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Affiliation(s)
- Ahsan N V Moosa
- Section of Pediatric Epilepsy, Epilepsy Center, Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk S-51, Cleveland, OH, 44195, USA,
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Johnson AM, Sugo E, Barreto D, Cunningham AM, Hiew CC, Lawson JA, Somerville ER, Connolly AM, Bye AM. Clinicopathological associations in temporal lobe epilepsy patients utilising the current ILAE focal cortical dysplasia classification. Epilepsy Res 2014; 108:1345-51. [DOI: 10.1016/j.eplepsyres.2014.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/09/2014] [Accepted: 06/13/2014] [Indexed: 11/16/2022]
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Liu JYW, Ellis M, Brooke-Ball H, de Tisi J, Eriksson SH, Brandner S, Sisodiya SM, Thom M. High-throughput, automated quantification of white matter neurons in mild malformation of cortical development in epilepsy. Acta Neuropathol Commun 2014; 2:72. [PMID: 24927775 PMCID: PMC4229809 DOI: 10.1186/2051-5960-2-72] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/09/2014] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION In epilepsy, the diagnosis of mild Malformation of Cortical Development type II (mMCD II) predominantly relies on the histopathological assessment of heterotopic neurons in the white matter. The exact diagnostic criteria for mMCD II are still ill-defined, mainly because findings from previous studies were contradictory due to small sample size, and the use of different stains and quantitative systems. Advance in technology leading to the development of whole slide imaging with high-throughput, automated quantitative analysis (WSA) may overcome these differences, and may provide objective, rapid, and reliable quantitation of white matter neurons in epilepsy. This study quantified the density of NeuN immunopositive neurons in the white matter of up to 142 epilepsy and control cases using WSA. Quantitative data from WSA was compared to two other systems, semi-automated quantitation, and the widely accepted method of stereology, to assess the reliability and quality of results from WSA. RESULTS All quantitative systems showed a higher density of white matter neurons in epilepsy cases compared to controls (P = 0.002). We found that, in particular, WSA with user-defined region of interest (manual) was superior in terms of larger sampled size, ease of use, time consumption, and accuracy in region selection and cell recognition compared to other methods. Using results from WSA manual, we proposed a threshold value for the classification of mMCD II, where 78% of patients now classified with mMCD II were seizure-free at the second post-operatively follow up. CONCLUSION This study confirms the potential role of WSA in future quantitative diagnostic histology, especially for the histopathological diagnosis of mMCD.
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Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis. J Neurol Sci 2014; 340:183-90. [DOI: 10.1016/j.jns.2014.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 11/20/2022]
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Palmini A, Paglioli E, Silva VD. Developmental tumors and adjacent cortical dysplasia: single or dual pathology? Epilepsia 2014; 54 Suppl 9:18-24. [PMID: 24328867 DOI: 10.1111/epi.12438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Developmental tumors often lead to refractory partial seizures and constitute a well-defined, surgically remediable epilepsy syndrome. Dysplastic features are often associated with these tumors, and their significance carries both practical and conceptual relevance. If associated focal cortical dysplasia (FCD) relates to the extent of the epileptogenic tissue, then presurgical evaluation and surgical strategies should target both the tumor and the surrounding dyslaminated cortex. Furthermore, the association has been included in the recently revised classification of FCD and the epileptogenicity of this associated dysplastic tissue is crucial to validate such revision. In addition to the possibility of representing dual pathology, the association of developmental tumors and adjacent dysplasia may instead represent a single developmental lesion with distinct parts distributed along a histopathologic continuum. Moreover, the possibility that this adjacent dyslamination is of minor epileptogenic relevance should also be entertained. Surgical data show that complete resection of the solid tumors and immediately adjacent tissue harboring satellites may disrupt epileptogenic networks and lead to high rates of seizure freedom, challenging the epileptogenic relevance of more extensive adjacent dyslaminated cortex. Whether the latter is a primary or secondary abnormality and whether dyslaminated cortex in the context of a second lesion may produce seizures after complete resection of the main lesion is still to be proven.
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Affiliation(s)
- André Palmini
- Porto Alegre Epilepsy Surgery Program, Services of Neurology and Neurosurgery, Hospital São Lucas, Porto Alegre, Brazil; Department ofInternal Medicine, Faculty of Medicine, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Goellner E, Bianchin MM, Burneo JG, Parrent AG, Steven DA. Timing of early and late seizure recurrence after temporal lobe epilepsy surgery. Epilepsia 2013; 54:1933-41. [DOI: 10.1111/epi.12389] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Eduardo Goellner
- Epilepsy Program; Department of Clinical Neurological Sciences; Western University; London Health Sciences Centre; London Ontario Canada
- Hospital Mãe de Deus; Porto Alegre Rio Grande do Sul Brazil
- Postgraduate Program in Medical Sciences; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Marino M. Bianchin
- Postgraduate Program in Medical Sciences; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Jorge G. Burneo
- Epilepsy Program; Department of Clinical Neurological Sciences; Western University; London Health Sciences Centre; London Ontario Canada
| | - Andrew G. Parrent
- Epilepsy Program; Department of Clinical Neurological Sciences; Western University; London Health Sciences Centre; London Ontario Canada
| | - David A. Steven
- Epilepsy Program; Department of Clinical Neurological Sciences; Western University; London Health Sciences Centre; London Ontario Canada
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Hemb M, Palmini A, Paglioli E, Paglioli EB, Costa da Costa J, Azambuja N, Portuguez M, Viuniski V, Booij L, Nunes ML. An 18-year follow-up of seizure outcome after surgery for temporal lobe epilepsy and hippocampal sclerosis. J Neurol Neurosurg Psychiatry 2013; 84:800-5. [PMID: 23408065 DOI: 10.1136/jnnp-2012-304038] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the very long-term clinical outcome of surgery for mesial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE/HS) without atypical features. The impact of surgical technique and postoperative reduction of medication on this outcome was investigated. DESIGN Prospective longitudinal cohort follow-up study for up to18 years. SETTING Epilepsy surgery centre in a university hospital. PATIENTS 108 patients who underwent unilateral MTLE/HS. INTERVENTION Surgery for MTLE/HS. MAIN OUTCOME MEASURE Engel classification (I). Clinical evaluations were based on systematic interviews in person or by phone. Kaplan-Maier survival curves estimated the probability of remaining seizure free. The impact of medication management in the postoperative outcome was analysed using Cox regression. RESULTS The probability of remaining completely seizure-free at 12 and 18 years after MTLE/HS surgery was 65% and 62%, respectively. The risk of having any recurrence was 22% during the first 24 months and increased 1.4% per year afterwards. Type of surgical technique (selective amygdalohippocampectomy vs anterior temporal lobectomy) did not impact on outcome. Remaining on antiepileptic drugs and history of generalised clonic seizure diminished the probability of remaining seizure free. CONCLUSIONS MTLE/HS surgery is able to keep patients seizure free for almost up to two decades. Removal of the neocortex besides the mesial portion of the temporal lobe does not lead to better chances of seizure control. These findings are applicable to the typical unilateral MTLE/HS syndrome and cannot be generalised for all types of TLE. Future longitudinal randomised controlled studies are needed to replicate these findings.
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Affiliation(s)
- Marta Hemb
- Serviço de Neurologia, Hospital São Lucas da PUCRS. Av. Ipiranga, 6690 #220 90610-000, Porto Alegre, RS, Brazil;
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Display of consistent ictal networks in refractory mesial temporal lobe epilepsy. Clin Neurophysiol 2013; 124:1729-36. [PMID: 23639378 DOI: 10.1016/j.clinph.2013.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 02/19/2013] [Accepted: 03/24/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Exploration of emergent ictal networks was performed in homogeneous subjects with refractory medial temporal lobe epilepsy. METHODS Maximal Synchrony Index (SI) values were calculated for all electrode pairs for each second during 25 seizures and displayed as connectivity animations. Consistent temporal patterns of SI value and spatial connectivity were observed across seizures and subjects, and used to define a sequence of network stages. RESULTS Highest SI values were found in electrodes within the area of surgical resection. Analysis of these electrodes by network stage demonstrated lateral temporal cortex dominance at seizure initiation, giving way to hippocampal synchrony during the major portion of the seizure, with lateral temporal regions re-emerging as the seizure terminated. SI values also corresponded to behavioral severity of seizures, and lower SI values were associated with post-surgical seizure freedom. CONCLUSION SI based methods of network characterization consistently display the intrinsic MTLE ictal network and may be sensitive to clinical features. SIGNIFICANCE Consistency of EEG-derived network patterns is an important step as network features are applied towards improvement of clinical management. These data confirm consistency of network patterns within and across subjects and support the potential for these methods to distinguish relevant clinical variables.
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Comparison of MRI features and surgical outcome among the subtypes of focal cortical dysplasia. Seizure 2012; 21:789-94. [DOI: 10.1016/j.seizure.2012.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/07/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022] Open
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Murakami N, Morioka T, Suzuki SO, Hashiguchi K, Amano T, Sakata A, Iwaki T, Sasaki T. Focal cortical dysplasia type IIa underlying epileptogenesis in patients with epilepsy associated with Sturge-Weber syndrome. Epilepsia 2012; 53:e184-8. [PMID: 22905723 DOI: 10.1111/j.1528-1167.2012.03628.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In patients with epilepsy associated with Sturge-Weber syndrome (SWS), epileptogenesis has been suggested to be caused by chronic ischemia in cortical areas affected by leptomeningeal angiomatosis or by ischemia-related cortical malformations. However, this has not been fully verified electrophysiologically. We herein present two cases of SWS with medically intractable epilepsy in which the epileptogenic area involved focal cortical dysplasia (FCD) type IIa near the region of leptomeningeal angiomatosis. In both cases, the ictal-onset zones were identified by chronic subdural electrodes, and the presence of FCD type IIa was shown histopathologically. In SWS, especially in association with focal leptomeningeal angiomatosis, FCD may thus play a major role in epileptogenesis. FCD should therefore be demonstrated by the collective findings of perioperative neurophysiologic examination, anatomic and functional neuroimaging, and histopathologic examination.
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Affiliation(s)
- Nobuya Murakami
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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[Structural magnetic resonance imaging in epilepsy]. RADIOLOGIA 2012; 54:9-20. [PMID: 22245703 DOI: 10.1016/j.rx.2011.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 07/07/2011] [Accepted: 07/09/2011] [Indexed: 11/22/2022]
Abstract
Magnetic resonance imaging is the main structural imaging in epilepsy. In patients with focal seizures, detection (and characterization) of a structural lesion consistent with electroclinical data allows therapeutic decisions without having to resort to other more expensive or invasive diagnostic procedures. The identification of some lesions may provide prognostic value, as in the case of Mesial Temporal Sclerosis (MTS) or may contribute to genetic counseling, as in the case of some Malformations of Cortical Development (MCD). The aim of this paper is to review the current state of structural MRI techniques, propose a basic protocol of epilepsy and mention the indications for structural MRI. Also, review the semiology of the main causes of epilepsy, with emphasis on MTS and MCD, by its highest frequency and by the special impact that MRI has shown in dealing with these entities.
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Ritaccio A, Boatman-Reich D, Brunner P, Cervenka MC, Cole AJ, Crone N, Duckrow R, Korzeniewska A, Litt B, Miller KJ, Moran DW, Parvizi J, Viventi J, Williams J, Schalk G. Proceedings of the Second International Workshop on Advances in Electrocorticography. Epilepsy Behav 2011; 22:641-50. [PMID: 22036287 PMCID: PMC3847909 DOI: 10.1016/j.yebeh.2011.09.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 09/24/2011] [Indexed: 11/15/2022]
Abstract
The Second International Workshop on Advances in Electrocorticography (ECoG) was convened in San Diego, CA, USA, on November 11-12, 2010. Between this meeting and the inaugural 2009 event, a much clearer picture has been emerging of cortical ECoG physiology and its relationship to local field potentials and single-cell recordings. Innovations in material engineering are advancing the goal of a stable long-term recording interface. Continued evolution of ECoG-driven brain-computer interface technology is determining innovation in neuroprosthetics. Improvements in instrumentation and statistical methodologies continue to elucidate ECoG correlates of normal human function as well as the ictal state. This proceedings document summarizes the current status of this rapidly evolving field.
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