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Tan S, Goh R, Ng JS, Tang C, Ng C, Kovoor J, Stretton B, Gupta A, Ovenden C, Courtney MR, Neal A, Whitham E, Frasca J, Kiley M, Abou‐Hamden A, Bacchi S. Identifying epilepsy surgery referral candidates with natural language processing in an Australian context. Epilepsia Open 2024; 9:635-642. [PMID: 38261415 PMCID: PMC10984289 DOI: 10.1002/epi4.12901] [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: 07/27/2023] [Revised: 12/02/2023] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Epilepsy surgery is known to be underutilized. Machine learning-natural language processing (ML-NLP) may be able to assist with identifying patients suitable for referral for epilepsy surgery evaluation. METHODS Data were collected from two tertiary hospitals for patients seen in neurology outpatients for whom the diagnosis of "epilepsy" was mentioned. Individual case note review was undertaken to characterize the nature of the diagnoses discussed in these notes, and whether those with epilepsy fulfilled prespecified criteria for epilepsy surgery workup (namely focal drug refractory epilepsy without contraindications). ML-NLP algorithms were then developed using fivefold cross-validation on the first free-text clinic note for each patient to identify these criteria. RESULTS There were 457 notes included in the study, of which 250 patients had epilepsy. There were 37 (14.8%) individuals who fulfilled the prespecified criteria for epilepsy surgery referral without described contraindications, 32 (12.8%) of whom were not referred for epilepsy surgical evaluation in the given clinic visit. In the prediction of suitability for epilepsy surgery workup using the prespecified criteria, the tested models performed similarly. For example, the random forest model returned an area under the receiver operator characteristic curve of 0.97 (95% confidence interval 0.93-1.0) for this task, sensitivity of 1.0, and specificity of 0.93. SIGNIFICANCE This study has shown that there are patients in tertiary hospitals in South Australia who fulfill prespecified criteria for epilepsy surgery evaluation who may not have been referred for such evaluation. ML-NLP may assist with the identification of patients suitable for such referral. PLAIN LANGUAGE SUMMARY Epilepsy surgery is a beneficial treatment for selected individuals with drug-resistant epilepsy. However, it is vastly underutilized. One reason for this underutilization is a lack of prompt referral of possible epilepsy surgery candidates to comprehensive epilepsy centers. Natural language processing, coupled with machine learning, may be able to identify possible epilepsy surgery candidates through the analysis of unstructured clinic notes. This study, conducted in two tertiary hospitals in South Australia, demonstrated that there are individuals who fulfill criteria for epilepsy surgery evaluation referral but have not yet been referred. Machine learning-natural language processing demonstrates promising results in assisting with the identification of such suitable candidates in Australia.
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Affiliation(s)
- Sheryn Tan
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Rudy Goh
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Jeng Swen Ng
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Charis Tang
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Cleo Ng
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Joshua Kovoor
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Brandon Stretton
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Aashray Gupta
- University of AdelaideAdelaideSouth AustraliaAustralia
- Gold Coast University HospitalSouthportQueenslandAustralia
| | - Christopher Ovenden
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | | | | | - Emma Whitham
- Flinders University and Medical CentreBedford ParkSouth AustraliaAustralia
| | - Joseph Frasca
- Flinders University and Medical CentreBedford ParkSouth AustraliaAustralia
| | - Michelle Kiley
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Amal Abou‐Hamden
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Stephen Bacchi
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Flinders University and Medical CentreBedford ParkSouth AustraliaAustralia
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John TT, Ahmed OJ. Finding a Fragile Piece to End the Seizure War. Epilepsy Curr 2022; 22:178-180. [DOI: 10.1177/15357597221094937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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McGrath H, Mandel M, Sandhu MRS, Lamsam L, Adenu-Mensah N, Farooque P, Spencer DD, Damisah EC. Optimizing the surgical management of MRI-negative epilepsy in the neuromodulation era. Epilepsia Open 2022; 7:151-159. [PMID: 35038792 PMCID: PMC8886105 DOI: 10.1002/epi4.12578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 01/03/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To evaluate the role of intracranial electroencephalography monitoring in diagnosing and directing the appropriate therapy for MRI-negative epilepsy and to present the surgical outcomes of patients following treatment. METHODS Retrospective chart review between 2015 - 2021 at a single institution identified forty-eight patients with no lesion on MRI who received surgical intervention for their epilepsy. The outcomes assessed were the surgical treatment performed and the International League Against Epilepsy seizure outcomes at one year of follow up. RESULTS Eleven patients underwent surgery without invasive monitoring, including vagus nerve stimulation (10%), deep brain stimulation (8%), laser interstitial thermal therapy (2%) and callosotomy (2%). The remaining 37 patients received invasive monitoring followed by resection (35%), responsive neurostimulation (21%) and deep brain stimulation (15%) or no treatment (6%). At one year postoperatively, 39% were Class 1-2, 36% were Class 3-4 and 24% were Class 5. More patients with Class 1-2 or 3-4 outcomes underwent invasive monitoring (100% and 83% respectively) compared to those with poor outcomes (25%, p < 0.001). Patients with Class 1-2 outcomes more commonly underwent resection or responsive neurostimulation: 69% and 31%, respectively (p < 0.001). SIGNIFICANCE The optimal management of MRI-negative focal epilepsy may involve invasive monitoring followed by resection or responsive neurostimulation in most cases, as these treatments were associated with the best seizure outcomes in our cohort. Unless multifocal epileptogenesis is clear from the non-invasive evaluation, invasive monitoring is preferred before pursuing deep brain stimulation or vagal nerve stimulation directly.
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Affiliation(s)
- Hari McGrath
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Mauricio Mandel
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Mani R S Sandhu
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Layton Lamsam
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Nana Adenu-Mensah
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Pue Farooque
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, USA
| | - Dennis D Spencer
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Eyiyemisi C Damisah
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
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Guglielmi G, Eschbach KL, Alexander AL. Smaller Knife, Fewer Seizures? Recent Advances in Minimally Invasive Techniques in Pediatric Epilepsy Surgery. Semin Pediatr Neurol 2021; 39:100913. [PMID: 34620456 DOI: 10.1016/j.spen.2021.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
Abstract
Children with drug-resistant epilepsy are at high risk for developmental delay, increased mortality, psychiatric comorbidities, and requiring assistance with activities of daily living. Despite the advent of new and effective pharmacologic therapies, about one in 5 children will develop drug-resistant epilepsy, and most of these children continue to have seizures despite trials of other medication. Epilepsy surgery is often a safe and effective option which may offer seizure freedom or at least a significant reduction in seizure burden in many children. However, despite published evidence of safety and efficacy, epilepsy surgery remains underutilized in the pediatric population. Patient and family fears about the risks of surgery may contribute to this gap. Less invasive surgical techniques may be more palatable to children with epilepsy and their caregivers. In this review, we present recent advances in minimally invasive techniques for the surgical treatment of epilepsy as well as intriguing possibilities for the future. We describe the indications for, benefits of, and limits to minimally-invasive techniques including Stereo-encephalography, laser interstitial thermal ablation, deep brain stimulation, focused ultrasound, stereo-encephalography-guided radiofrequency ablation, endoscopic disconnections, and responsive neurostimulation.
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Affiliation(s)
- Gina Guglielmi
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Krista L Eschbach
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Allyson L Alexander
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO.
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Swarup O, Waxmann A, Chu J, Vogrin S, Lai A, Laing J, Barker J, Seiderer L, Ignatiadis S, Plummer C, Carne R, Seneviratne U, Cook M, Murphy M, D'Souza W. Long-term mood, quality of life, and seizure freedom in intracranial EEG epilepsy surgery. Epilepsy Behav 2021; 123:108241. [PMID: 34450387 DOI: 10.1016/j.yebeh.2021.108241] [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: 05/11/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the long-term outcomes in patients undergoing intracranial EEG (iEEG) evaluation for epilepsy surgery in terms of seizure freedom, mood, and quality of life at St. Vincent's Hospital, Melbourne. METHODS Patients who underwent iEEG between 1999 and 2016 were identified. Patients were retrospectively assessed between 2014 and 2017 by specialist clinic record review and telephone survey with standardized validated questionnaires for: 1) seizure freedom using the Engel classification; 2) Mood using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); 3) Quality-of-life outcomes using the QOLIE-10 questionnaire. Summary statistics and univariate analysis were performed to investigate variables for significance. RESULTS Seventy one patients underwent iEEG surgery: 49 Subdural, 14 Depths, 8 Combination with 62/68 (91.9%) of those still alive, available at last follow-up by telephone survey or medical record review (median of 8.2 years). The estimated epileptogenic zone was 62% temporal and 38% extra-temporal. At last follow-up, 69.4% (43/62) were Engel Class I and 30.6% (19/62) were Engel Class II-IV. Further, a depressive episode (NDDI-E > 15)was observed in 34% (16/47), while a 'better quality of life' (QOLIE-10 score < 25) was noted in 74% (31/42). Quality of life (p < 0.001) but not mood (p = 0.24) was associated with seizure freedom. SIGNIFICANCE Long-term seizure freedom can be observed in patients undergoing complex epilepsy surgery with iEEG evaluation and is associated with good quality of life.
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Affiliation(s)
- Oshi Swarup
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Medicine, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, Victoria 3050, Australia.
| | - Alexandra Waxmann
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Jocelyn Chu
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Simon Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Faculty of Health Arts and Design, Swinburne University of Technology, John St, Hawthorn, Victoria 3122, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Joshua Laing
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - James Barker
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Medicine, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, Victoria 3050, Australia
| | - Linda Seiderer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Sophia Ignatiadis
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Chris Plummer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Faculty of Health Arts and Design, Swinburne University of Technology, John St, Hawthorn, Victoria 3122, Australia
| | - Ross Carne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Neurosciences, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168, Australia
| | - Mark Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Michael Murphy
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
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Lopez K, Xu Y. Epilepsy at the intersection of disability, gender, and culture: A duoethnography. Epilepsy Behav 2021; 122:108121. [PMID: 34144459 DOI: 10.1016/j.yebeh.2021.108121] [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: 03/02/2021] [Revised: 05/15/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022]
Abstract
Epilepsy is a neurodevelopmental disorder that affects millions of adults and children. Several different types of seizures, ranging from generalized which affect both sides of the brain to focal seizures that are rooted in one location of the brain. In addition to the physical impact of epilepsy, there are many emotional and identity consequences of living with epilepsy. An area that is not yet explored is the impact of epilepsy on the lives of women of color. In this paper, we fill this gap by exploring the experiences of two women of color who have had epilepsy beginning in early childhood through motherhood. One of the women is Mexican-American and an early career faculty in social work. The other identifies as a Chinese immigrant doctoral student in disability studies. Together, these stories bring to the literature voices that have not been actively engaged by epilepsy research or academia. We use a duoethnographic approach in this work given that this method provides an opportunity to explore identity and intersectionality and juxtapose our narratives surrounding epilepsy. By applying disability critical race theory (DisCrit) to our narratives, we identified how fluctuating epileptic symptoms, gender, and culture, interact with the layers of our epileptic identities. Furthermore, we discuss how our experiences with epilepsy exposes the lack of accommodative efforts in both the healthcare and education systems for individuals with invisible neurodevelopmental disabilities. This duoethnography has important implications for engaging youth with epilepsy and other invisible disabilities. By showcasing our journey of "coming to terms" with epilepsy, our dialog provides insights into how to support youth in building a positive disability identity. Our experiences in academia set up a basis to discuss accommodations for students with epilepsy and other invisible disabilities.
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Affiliation(s)
- Kristina Lopez
- Arizona State University, School of Social Work, United States.
| | - Yue Xu
- University of Illinois at Chicago, Department of Disability and Human Development, United States
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Benevides ML, Costa Nunes J, Guarnieri R, Pauli C, Wolf P, Lunardi M, Kondageski C, Neves Linhares M, Lin K, Walz R. Quality of life long after temporal lobe epilepsy surgery. Acta Neurol Scand 2021; 143:629-636. [PMID: 33751549 DOI: 10.1111/ane.13406] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/29/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify variables independently associated with a meaningful improvement in QOL long after surgical treatment of drug-resistant MTLE-HS patients. MATERIAL & METHODS We prospectively evaluated 72 consecutive MTLE-HS surgically treated patients and analyzed pre and post-surgical variables independently associated with a meaningful improvement in QOL evaluated by the Quality of Life in Epilepsy-31 (QOLIE-31) overall score, and its domain scores determined at follow-up after 36 to 131 months (mean 93 months) after surgery. RESULTS The mean overall QOLIE-31 score and its subdomain scores improved significantly after surgery (p < 0.01), and 55 patients (76.4%) had a meaningful QOL improvement. Being seizure-free (Engel IA) after surgery showed a non-significant association (OR 2.63, CI 95% 0.53 to 13.05, p = 0.23) and lower depressive symptoms a significant association (OR 4.15, CI 95% 1.19 to 14.53, p = 0.03) with meaningful improvement of QOL. CONCLUSIONS Patients with MTLE-HS who underwent epilepsy surgery show a sustained, meaningful improvement in their QOL. Pre-surgical variables do not predict long-term QOL improvement after surgery. Lower levels of depressive symptoms at postoperative evaluation are associated with meaningful QOL improvement.
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Affiliation(s)
- Maria L. Benevides
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Graduate Program in Translational Neurosciences Federal University of Rio de Janeiro (UFRJ) Rio de Janeiro Brazil
| | - Jean Costa Nunes
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC) HU UFSC Florianópolis Brazil
- Division of Neuropathology UFSC Florianópolis Brazil
- Neurodiagnostic Brasil ‐ Diagnósticos em Neuropatologia Florianópolis Brazil
| | - Ricardo Guarnieri
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Psychiatry Division Internal Medicine Department HU UFSC Florianópolis Brazil
| | - Carla Pauli
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
| | - Peter Wolf
- Graduate Program in Medical Sciences HU UFSC Florianópolis Brazil
| | - Mariana Lunardi
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Graduate Program in Medical Sciences HU UFSC Florianópolis Brazil
| | - Charles Kondageski
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
| | - Marcelo Neves Linhares
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Neurosurgery Division HU UFSC Florianópolis Brazil
| | - Katia Lin
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC) HU UFSC Florianópolis Brazil
- Graduate Program in Medical Sciences HU UFSC Florianópolis Brazil
- Neurology Division Internal Medicine Department HU UFSC Florianópolis Brazil
| | - Roger Walz
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Graduate Program in Translational Neurosciences Federal University of Rio de Janeiro (UFRJ) Rio de Janeiro Brazil
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC) HU UFSC Florianópolis Brazil
- Neurology Division Internal Medicine Department HU UFSC Florianópolis Brazil
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Quality of life (QOL) narratives of growing up with epilepsy from youth and family perspectives. Epilepsy Behav 2021; 114:107613. [PMID: 33309235 DOI: 10.1016/j.yebeh.2020.107613] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Qualitative research studies deepen our understanding of growing up with epilepsy but are limited to the singular perspective of children or their parents at one point in childhood. A more complete view requires multiple perspectives and narrative accounts that represent development from early childhood to young adulthood. Thematic study of life narratives of 7 young people and at least one person within their families were interviewed separately (15 participants) for two interviews each (30 interviews). The objective was to obtain narratives of the life experiences, the attributions of those experiences, and crucial periods relating to quality of life (QOL) with no apriori assumptions that their lives were shaped by epilepsy. Themes were formed inductively from subthemes and codes were created based on the constant comparative method by two interviewers who iteratively co-coded the data. RESULTS Themes emerging from the data: "Story of My Health," "Growing by Doing," "To Adapt or Not to Adapt," "Supports and Challenges," "Parent World," and "Looking in and Out, Forward and Back", often included components of seizure and epilepsy experiences but also mirrored life challenges of growing up in general. The only exclusively epilepsy-specific theme: "To Adapt or Not to Adapt", was about the challenges and solutions for dealing with the uncertainty caused by seizures and potential isolation that results from others' reactions. CONCLUSIONS There were a range of experiences related to QOL described by participants growing up with epilepsy. The 'ingredients' of a good life (e.g., social and self-acceptance) were consistent with QOL research for general populations, although these were often expressed as more difficult to attain when growing up with epilepsy.
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Gibbs SN, Choi J, Khilfeh I, Ahmed KH, Yermilov I, Segal E. The Humanistic and Economic Burden of Pediatric Focal Seizures in the United States. J Child Neurol 2020; 35:543-555. [PMID: 32223583 DOI: 10.1177/0883073820911785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To better understand the humanistic and economic burden of focal seizures in children 2-12 years old. METHODS We conducted a targeted literature review by searching MEDLINE for English-language publications reporting on children 2-12 years old with focal seizures published in the United States since 2008. RESULTS Thirty-five publications were included. Incidence of focal seizures was 23.2 to 47.1 per 100,000 children per year; prevalence was 2.0 per 1,000 children, and ranged from 1.6 - 2.6 per 1,000 in patients of any age. Life expectancy was 47.3-61.8 years among children 3-12 years old. Patients took several antiepileptic drugs and experienced frequent seizures, sleep disorders, mood disorders, migraine, and seizure-related injuries (eg, bone fractures, sprains, open wounds). Children with focal seizures scored below average on cognitive assessments and up to 42%, 16%, and 19% had depression, anxiety, and attention-deficit disorder, respectively. Patients of any age had about 10 outpatient visits (2 epilepsy-related), 2 inpatient visits (less than 1 epilepsy-related), and 24 procedures (1 epilepsy-related) per year. Medication adherence was low: only half of pediatric patients maintained ≥90% adherence over 6 months. Annual total health care costs among patients of any age ranged from $18,369 - 38,549; first-year total health care costs for children were $19,883. CONCLUSIONS Incidence and prevalence of focal seizures is high and the humanistic and economic burdens are significant. Future studies focused exclusively on children with focal seizures are needed to more precisely describe the burden. We also suggest further research and implementation of methods to improve medication adherence as an approach to lessen burden on these young patients.
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Affiliation(s)
- Sarah N Gibbs
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | | | | | - K Hamzah Ahmed
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Irina Yermilov
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Eric Segal
- Northeast Regional Epilepsy Group, Hackensack, NJ Hackensack University Medical Center, Hackensack, NJ, USA.,Seton Hall School of Medicine, Nutley, NJ, USA
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Hashemi M, Vattikonda AN, Sip V, Guye M, Bartolomei F, Woodman MM, Jirsa VK. The Bayesian Virtual Epileptic Patient: A probabilistic framework designed to infer the spatial map of epileptogenicity in a personalized large-scale brain model of epilepsy spread. Neuroimage 2020; 217:116839. [PMID: 32387625 DOI: 10.1016/j.neuroimage.2020.116839] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022] Open
Abstract
Despite the importance and frequent use of Bayesian frameworks in brain network modeling for parameter inference and model prediction, the advanced sampling algorithms implemented in probabilistic programming languages to overcome the inference difficulties have received relatively little attention in this context. In this technical note, we propose a probabilistic framework, namely the Bayesian Virtual Epileptic Patient (BVEP), which relies on the fusion of structural data of individuals to infer the spatial map of epileptogenicity in a personalized large-scale brain model of epilepsy spread. To invert the individualized whole-brain model employed in this study, we use the recently developed algorithms known as No-U-Turn Sampler (NUTS) as well as Automatic Differentiation Variational Inference (ADVI). Our results indicate that NUTS and ADVI accurately estimate the degree of epileptogenicity of brain regions, therefore, the hypothetical brain areas responsible for the seizure initiation and propagation, while the convergence diagnostics and posterior behavior analysis validate the reliability of the estimations. Moreover, we illustrate the efficiency of the transformed non-centered parameters in comparison to centered form of parameterization. The Bayesian framework used in this work proposes an appropriate patient-specific strategy for estimating the epileptogenicity of the brain regions to improve outcome after epilepsy surgery.
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Affiliation(s)
- M Hashemi
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.
| | - A N Vattikonda
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - V Sip
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - M Guye
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - F Bartolomei
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; Epileptology Department, and Clinical Neurophysiology Department, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - M M Woodman
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - V K Jirsa
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.
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Liao CH, Chen SC, Yu HY, Lin CF, Chou CC, Lee CC, Lin CJ, Hsu SPC, Shih YH. Procedure-Related Temporal Infarct After Retractorless Transsylvian Selective Amygdalohippocampectomy and Impact on 2-Year Epilepsy Outcome. Oper Neurosurg (Hagerstown) 2020; 18:430-437. [PMID: 31369110 DOI: 10.1093/ons/opz192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Selective amygdalohippocampectomy (SAH) is designed to treat patients with mesial temporal lobe epilepsy (MTLE). OBJECTIVE To determine the volume and impact of temporal lobe infarction after retractorless transsylvian SAH (en bloc resection of the hippocampus) that have not been reported. METHODS A retrospective analysis of patients treated with retractorless transsylvian SAH. Infarctions were detected by magnetic resonance imaging (MRI) within the first week after the operation. Neuropsychological testing was performed preoperatively and 6 mo later. Seizure outcome was evaluated 2 yr after epilepsy surgery. RESULTS Between 2010 and 2014, a total of 30 patients were included in this study. Analysis of postoperative MRI showed the following: (1) mean removal volume of the hippocampus-parahippocampus was 5.72 cm3, and (2) mean volumes of temporal and insular infarctions were 1.71 and 0.25 cm3, respectively. Twenty-five patients (83.3%) were free of disabling seizures (Engel class I) at 2 yr of outcome. Neuropsychological testing revealed improvement in Perceptual Organization Index (P = .036) and verbal paired associates II (P = .014) after the operation. Neither infarction volume nor removal volume was related to epilepsy outcome in linear regression model. CONCLUSION Transsylvian SAH has comparable seizure outcomes but bears inherent risks of vasospasm/vascular injury. Immediate postoperative small infarction volume around resection cavity or along surgical corridor was noticed after retractorless transsylvian SAH, which did not cause neuropsychological deteriorations, in contrast to previous study with the use of self-sustaining rigid retraction system. Further study should be performed to compare procedure-related infarctions and their impacts on neuropsychological outcomes in different selective approaches.
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Affiliation(s)
- Chih-Hsiang Liao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shao-Ching Chen
- Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- School of Medicine, National Yang Ming University, Taipei, Taiwan.,Division of Epilepsy, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chien-Chen Chou
- School of Medicine, National Yang Ming University, Taipei, Taiwan.,Division of Epilepsy, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chung-Jung Lin
- School of Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sanford P C Hsu
- Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yang-Hsin Shih
- Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
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12
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D'Cruz J, Hefner M, Ledbetter C, Frilot C, Howard B, Zhu P, Riel-Romero R, Notarianni C, Toledo EG, Nanda A, Sun H. Focal epilepsy caused by single cerebral cavernous malformation (CCM) is associated with regional and global resting state functional connectivity (FC) disruption. NEUROIMAGE-CLINICAL 2019; 24:102072. [PMID: 31734529 PMCID: PMC6854067 DOI: 10.1016/j.nicl.2019.102072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
To our knowledge, this is the first study to report resting state functional connectivity (FC) abnormalities associated with focal epilepsy caused by a single cerebral cavernous malformation (CCM). We show, by comparing to the data acquired from the age and gender matched control group, that this type of focal epilepsy is associated with the disruption of the normal regional and global FC. The disruption includes a decrease in the coactivation between the region surrounding the CCM lesion, i.e., the lesional region, and its homotopic counterpart, a reduction in FC between the lesional region and the rest of the brain, and decreased FC among the default mode network (DMN). These changes may be alleviated or reversed after the surgical resection of the CCM and the epileptogenic zone has successfully stopped recurrent seizures. Finally, the severity of the FC disruption in the brain tissue adjacent to the CCM may be used to delineate the epileptogenic zone and to aid the surgical resection.
Epilepsy, including the type with focal onset, is increasingly viewed as a disorder of the brain network. Here we employed the functional connectivity (FC) metrics estimated from the resting state functional MRI (rsfMRI) to investigate the changes of brain network associated with focal epilepsy caused by single cerebral cavernous malformation (CCM). Eight CCM subjects and 21 age and gender matched controls were enrolled in the study. Seven of 8 CCM subjects underwent surgical resection of the CCM and became seizure free and 4 of the surgical subjects underwent a repeat rsfMRI study. We showed that there was both regional and global disruption of the FC values among the CCM subjects including decreased in homotopic FC (HFC) and global FC (GFC) in the regions of interest (ROIs) where the CCMs were located. There was also the disruption of the default mode network (DMN) especially the FC between the middle prefrontal cortex (MPFC) and the right lateral parietal cortex (LPR) among these individuals. We observed the trend of alleviation of these disruptions after the individual has become seizure free from the surgical resection of the CCM. Using a voxel-based approach, we found the disruption of the HFC and GFC in the brain tissue immediately adjacent to the CCM and the severity of the disruption appeared inversely proportional to the distance of the brain tissue to the lesion. Our findings confirm the disruption of normal brain networks from focal epilepsy, a process that may be reversible with successful surgical treatments rendering patients seizure free. Some voxel-based metrics may help identify the epileptogenic zone and guide the surgical resection.
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Affiliation(s)
- Jason D'Cruz
- Department of Neurosurgery, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States
| | - Matthew Hefner
- Department of Neurosurgery, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States
| | - Christina Ledbetter
- Department of Neurosurgery, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States
| | - Clifton Frilot
- School of Allied Health Professions, Department of Rehabilitation Sciences, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States
| | - Brady Howard
- Department of Neurosurgery, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States
| | - Peimin Zhu
- Department of Neurology, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States
| | - Rosario Riel-Romero
- Department of Neurology, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States
| | - Christina Notarianni
- Department of Neurosurgery, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States
| | - Eduardo Gonzalez Toledo
- Department of Radiology, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States
| | - Anil Nanda
- Department of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, United States
| | - Hai Sun
- Department of Neurosurgery, Louisiana State Unversity Health Science Center, Shreveport, LA 71103, United States.
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13
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Shah P, Ashourvan A, Mikhail F, Pines A, Kini L, Oechsel K, Das SR, Stein JM, Shinohara RT, Bassett DS, Litt B, Davis KA. Characterizing the role of the structural connectome in seizure dynamics. Brain 2019; 142:1955-1972. [PMID: 31099821 PMCID: PMC6598625 DOI: 10.1093/brain/awz125] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/11/2019] [Accepted: 03/07/2019] [Indexed: 12/23/2022] Open
Abstract
How does the human brain's structural scaffold give rise to its intricate functional dynamics? This is a central question in translational neuroscience that is particularly relevant to epilepsy, a disorder affecting over 50 million subjects worldwide. Treatment for medication-resistant focal epilepsy is often structural-through surgery or laser ablation-but structural targets, particularly in patients without clear lesions, are largely based on functional mapping via intracranial EEG. Unfortunately, the relationship between structural and functional connectivity in the seizing brain is poorly understood. In this study, we quantify structure-function coupling, specifically between white matter connections and intracranial EEG, across pre-ictal and ictal periods in 45 seizures from nine patients with unilateral drug-resistant focal epilepsy. We use high angular resolution diffusion imaging (HARDI) tractography to construct structural connectivity networks and correlate these networks with time-varying broadband and frequency-specific functional networks derived from coregistered intracranial EEG. Across all frequency bands, we find significant increases in structure-function coupling from pre-ictal to ictal periods. We demonstrate that short-range structural connections are primarily responsible for this increase in coupling. Finally, we find that spatiotemporal patterns of structure-function coupling are highly stereotyped for each patient. These results suggest that seizures harness the underlying structural connectome as they propagate. Mapping the relationship between structural and functional connectivity in epilepsy may inform new therapies to halt seizure spread, and pave the way for targeted patient-specific interventions.
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Affiliation(s)
- Preya Shah
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Arian Ashourvan
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Fadi Mikhail
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Pines
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lohith Kini
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Oechsel
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandhitsu R Das
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joel M Stein
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle S Bassett
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Electrical and Systems Engineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Department of Physics and Astronomy, College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Litt
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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14
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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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15
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Taskiran E, Matur Z, Gül G, Bebek N, Baykan B, Gökyigit A, Gürses C. The Impact of Affective State on Quality of Life in Focal Epilepsy in Turkey. J Neurosci Rural Pract 2019; 10:267-272. [PMID: 31001016 PMCID: PMC6454954 DOI: 10.4103/jnrp.jnrp_324_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Seizures and accompanying situations including social, medical, and psychiatric problems threaten the quality of life (QOL) in patients with epilepsy. The World Health Organization defines health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Aims: This study examines the prevalence of both depression and anxiety symptoms and also impact of the affective state on QOL in patients with focal epilepsy in Turkey. Settings and Design: One hundred and five patients with focal epilepsy over 18 years old were included in this study. The patients were classified into four groups according to the presence of AS and seizure control. Subjects and Methods: Patients’ affective symptoms (AS) and QOL were examined using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and QOL in Epilepsy Inventory-31 (QOLIE-31). Statistical Analysis Used: We used descriptive statistics, Chi-square test, independent samples t-test, one-way analysis of variance, Mann–Whitney U-test, Kruskal–Wallis H-test, and also Pearson's and Spearman's correlation test for correlations. Results: There were positive correlations between total QOLIE-31 score and epilepsy surgery, employment, and seizure freedom, whereas negative correlations were found with antiepileptic drug use, anxiety, and depression. Statistically significant differences were found in QOLIE-31 totals and subscores between Groups 3 and 4 (P < 0.05). Conclusions: The presence of AS has a negative impact on QOL in patients with focal epilepsy. Physicians should be aware that psychiatric comorbidities in epilepsy have a severe impact and epilepsy treatment requires comprehensive management.
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Affiliation(s)
- Emine Taskiran
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Zeliha Matur
- Department of Neurology, Istanbul Bilim University Faculty of Medicine, Istanbul, Turkey
| | - Günay Gül
- Department of Neurology, Neurology Clinic, Bakirkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Istanbul, Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayşen Gökyigit
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Candan Gürses
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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16
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Thuy Le MA, Fong SL, Lim KS, Gunadharma S, Sejahtera DP, Visudtibhan A, Chan D, Vorachit S, Chan S, Ohnmar, Chua AE, Cabral-Lim L, Yassin N, Le VT, Tan CT. Underutilization of epilepsy surgery in ASEAN countries. Seizure 2019; 69:51-56. [PMID: 30974407 DOI: 10.1016/j.seizure.2019.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This survey was performed to determine the availability of epilepsy surgery, and understand the limiting factors to epilepsy surgery in ASEAN countries with total of 640 million population. METHOD A cross-sectional survey was completed by national representatives in all ASEAN countries (Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam). RESULTS Overall facilities for initial epilepsy pre-surgical evaluation are available in most countries, but further non-invasive and invasive investigations are limited. Three countries (Brunei, Cambodia, and East Timor) have no epilepsy center, and 2 countries (Laos, Myanmar) have level 2 centers doing tumor surgery only. Level-3 epilepsy centers are available in 6 countries (Indonesia, Malaysia, Philippine, Singapore, Thailand, Vietnam); only 5 countries (Indonesia, Malaysia, Philippine, Singapore, Thailand) has at least one level-4 epilepsy care facility. Indonesia with 261 million population only has one level 3 and another level 4 center. The costs of presurgical evaluation and brain surgery vary within and among the countries. The main barriers towards epilepsy surgery in ASEAN include lack of expertise, funding and facilities. CONCLUSIONS Epilepsy surgery is underutilized in ASEAN with low number of level 3 centers, and limited availability of advanced presurgical evaluation. Lack of expertise, facilities and funding may be the key factors contributing to the underutilization.
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Affiliation(s)
- Minh-An Thuy Le
- Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy of Ho Chi Minh city, Ho Chi Minh City, Viet Nam
| | - Si-Lei Fong
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kheng-Seang Lim
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Suryani Gunadharma
- Faculty of Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Desin Pambudi Sejahtera
- Department of neurology, Sardjito general hospital, Yogyakarta, Indonesia; Epilepsy subdivision, department of neurology, faculty of medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Anannit Visudtibhan
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Derrick Chan
- Division of Neurology, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Somchit Vorachit
- Faculty of Medicine, University of Health Sciences, Vientiane, Laos
| | - Samleng Chan
- University of Health Sciences, Phnom Penh, Cambodia
| | - Ohnmar
- Department of Neurology, University of Medicine 1, Yangon, Myanmar
| | - Annabell E Chua
- Department of Neurosciences, College of Medicine-Philippine General Hospital, The Health Sciences Center, University of the Philippines Manila, Manila, Philippines
| | - Leonor Cabral-Lim
- Department of Neurosciences, College of Medicine-Philippine General Hospital, The Health Sciences Center, University of the Philippines Manila, Manila, Philippines
| | - Norazieda Yassin
- Neurology Unit, Department of Internal Medicine. Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei; Brunei Neurosciences, Stroke and Rehabilitation Centre (BNSRC), Brunei
| | - Viet-Thang Le
- Department of Neurosurgery, Faculty of Medicine, University of Medicine and Pharmacy of Ho Chi Minh city, Ho Chi Minh city, Viet Nam
| | - Chong-Tin Tan
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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17
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Walther K, Dogan Onugoren M, Buchfelder M, Gollwitzer S, Graf W, Kasper BS, Kriwy P, Kurzbuch K, Lang J, Rössler K, Schwab S, Schwarz M, Stefan H, Hamer HM. Psychosocial outcome in epilepsy after extratemporal surgery. Epilepsy Behav 2018; 81:94-100. [PMID: 29454606 DOI: 10.1016/j.yebeh.2018.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Only limited data exist on psychosocial long-term outcome after epilepsy surgery in patients with extratemporal epilepsy. The aim of this study was to investigate psychosocial outcome after extratemporal epilepsy surgery and to assess factors predicting favorable outcome. METHOD Sixty-five out of 104 eligible patients who had undergone extratemporal epilepsy surgery at our epilepsy center between 1990 and 2015 (mean age: 42.2. years; 75% of the resections in the frontal lobe) completed a questionnaire asking about seizure status, employment status, marital and living situation, driving status, depressive symptoms, and quality of life (QOL). Follow-up was on average 9.2years after surgery (range: 1-26years). RESULTS Thirty-eight (58%) patients were free of disabling seizures (Engel class I), and 28 (43%) have not experienced any seizures after surgery (Engel class IA). Employment rate in the primary labor market remained at 45%, but more patients lost employment (14%) than gained employment (8%). Postoperative employment was predicted by preoperative employment (p=.007), seizure freedom (p=.025), older age at seizure onset (p=.018), younger age at follow-up (p=.035), and female gender (p=.048). Seizure-free patients were more likely to be driving; have a partner, particularly in males; and have lower depressive scores. Quality of life at follow-up was best predicted by employment (p=.012), partnership (p=.025), and seizure freedom (p=.025). In contrast, recurrence of seizures and early seizure onset were associated with poor psychosocial outcome, particularly in men. CONCLUSION The study provides support that extratemporal surgery can lead to improved QOL and favorable psychosocial outcome. Seizure freedom is important but not the only determinant of good psychosocial outcome.
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Affiliation(s)
- Katrin Walther
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Müjgan Dogan Onugoren
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stephanie Gollwitzer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Wolfgang Graf
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Burkhard S Kasper
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Peter Kriwy
- Institute of Sociology, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
| | - Katrin Kurzbuch
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Schwarz
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hermann Stefan
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
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Davis KA, Devries SP, Krieger A, Mihaylova T, Minecan D, Litt B, Wagenaar JB, Stacey WC. The effect of increased intracranial EEG sampling rates in clinical practice. Clin Neurophysiol 2017; 129:360-367. [PMID: 29288992 DOI: 10.1016/j.clinph.2017.10.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/09/2017] [Accepted: 10/22/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Recent research suggests that high frequency intracranial EEG (iEEG) may improve localization of epileptic networks. This study aims to determine whether recording macroelectrode iEEG with higher sampling rates improves seizure localization in clinical practice. METHODS 14 iEEG seizures from 10 patients recorded with >2000 Hz sampling rate were downsampled to four sampling rates: 100, 200, 500, 1000 Hz. In the 56 seizures, seizure onset time and location was marked by 5 independent, blinded EEG experts. RESULTS When reading iEEG under clinical conditions, there was no consistent difference in time or localization of seizure onset or number of electrodes involved in the seizure onset zone with sampling rates varying from 100 to 1000 Hz. Stratification of patients by outcome did not improve with higher sampling rate. CONCLUSION When utilizing standard clinical protocols, there was no benefit to acquiring iEEGs with sampling rate >100 Hz. Significant variability was noted in EEG marking both within and between individual expert EEG readers. SIGNIFICANCE Although commercial equipment is capable of sampling much faster than 100 Hz, tools allowing visualization of subtle high frequency activity such as HFOs will be required to improve patient care. Quantitative methods may decrease reader variability, and potentially improve patient outcomes.
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Affiliation(s)
| | - Seth P Devries
- Dept of Pediatric Neurology, Helen DeVos Children's Hospital, USA
| | - Abba Krieger
- Dept of Statistics, The Wharton School of the University of Pennsylvania, USA
| | | | | | - Brian Litt
- Department of Neurology, University of Pennsylvania, USA
| | - Joost B Wagenaar
- Department of Neurology, University of Pennsylvania, USA; Blackfynn, Inc, USA
| | - William C Stacey
- Dept of Neurology, University of Michigan, USA; Dept of Biomedical Engineering, University of Michigan, USA
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19
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Long-Term Seizure, Quality of Life, Depression, and Verbal Memory Outcomes in a Controlled Mesial Temporal Lobe Epilepsy Surgical Series Using Portuguese-Validated Instruments. World Neurosurg 2017; 104:411-417. [DOI: 10.1016/j.wneu.2017.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 11/24/2022]
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20
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Hosoyama H, Matsuda K, Mihara T, Usui N, Baba K, Inoue Y, Tottori T, Otsubo T, Kashida Y, Iida K, Hirano H, Hanaya R, Arita K. Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey. J Neurosurg Pediatr 2017; 19:606-615. [PMID: 28291425 DOI: 10.3171/2016.12.peds16197] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier. METHODS Between 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe. RESULTS For 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome. CONCLUSIONS The seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of seizure control and social adaptation, resective surgery yielded longitudinal benefits in children with intractable epilepsy, especially those with a lesional pathology in a single lobe.
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Affiliation(s)
- Hiroshi Hosoyama
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.,Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Kazumi Matsuda
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Tadahiro Mihara
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Naotaka Usui
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Koichi Baba
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Yushi Inoue
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Takayasu Tottori
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Toshiaki Otsubo
- Department of Neurosurgery, Fujimoto General Hospital, Miyakonojo, Miyazaki; and
| | - Yumi Kashida
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.,Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Hirofumi Hirano
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
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21
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Berrigan P, Bardouille T, MacLellan M, Mohamed IS, Murthy M. Cost-utility analysis of magnetoencephalography used to inform intracranial electrode placement in patients with drug resistant epilepsy: a model based analysis. J Eval Clin Pract 2016; 22:938-945. [PMID: 27270644 DOI: 10.1111/jep.12567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We estimated the cost-effectiveness of adding magnetoencephalography to a standard assessment for epilepsy surgery consisting of neuropsychology, magnetic resonance imagining, scalp electroencephalography, video electroencephalography and intracranial electroencephalography, in the capacity of informing intracranial electroencephalography electrode placement. METHODS We used Microsoft Excel (2007) to construct a decision model. Discounted costs and quality adjusted life years are aggregated to calculate incremental cost-effectiveness ratios. Sensitivity analyses are conducted to assess robustness of findings. RESULTS Our base case analysis yielded a result of $14 300 per quality adjusted life year gained. A total of 82.7% of probabilistic sensitivity analysis iterations resulted in incremental cost-effectiveness ratios below $100 000 in 2014 Canadian dollars. CONCLUSIONS Our findings demonstrate that the inclusion of Magnetoencephalography in the assessment for epilepsy surgery in the capacity of informing intracranial electroencephalography electrode placement is likely not cost saving but does represent a reasonable allocation of resources from a value for money perspective.
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Affiliation(s)
- Patrick Berrigan
- Centre for Clinical Research, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Tim Bardouille
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, NS, Canada
| | - Matt MacLellan
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, NS, Canada
| | - Ismail S Mohamed
- Department of Paediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Manjari Murthy
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, NS, Canada
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22
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Kitwitee P, Unnwongse K, Srikijvilaikul T, Yadee T, Limwattananon C. Cost-Utility of Video-Electroencephalography Monitoring Followed by Surgery in Adults with Drug-Resistant Focal Epilepsy in Thailand. World Neurosurg 2016; 98:750-760.e3. [PMID: 27913266 DOI: 10.1016/j.wneu.2016.11.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study assessed whether video-electroencephalography (VEEG) monitoring followed by surgery was cost-effective in adult patients with drug-resistant focal epilepsy under Thai health care context, as compared with continued medical treatment without VEEG. METHODS The total cost (in Thai Baht, THB) and effectiveness (in quality-adjusted life years, QALYs) were estimated over a lifetime horizon, using a decision tree and a Markov model. Data on short-term surgical outcomes, direct health care costs, and utilities were collected from Thai patients in a specialized hospital. Long-term outcomes and relative effectiveness of the surgery over medical treatment were derived, using systematic reviews of published literature. RESULTS Seizure-free rates at years 1 and 2 after surgery were 79.4% and 77.8%, respectively. Costs of VEEG and surgery plus 1-year follow-up care were 216,782 THB, of which the VEEG and other necessary investigations were the main cost drivers (42.8%). On the basis of societal perspective, the total cost over a 40-year horizon accrued to 1,168,679 THB for the VEEG option, 64,939 THB higher than that for no VEEG. The VEEG option contributed to an additional 1.50 QALYs over no VEEG, resulting in an incremental cost-effectiveness ratio of 43,251 THB (USD 1236) per 1 QALY gained. Changes in key parameters had a minimal impact on the incremental cost-effectiveness ratio. Accounting for uncertainty, there was an 84% probability that the VEEG option was cost-effective on the basis of Thailand's cost-effective threshold of 160,000 THB/QALY. CONCLUSIONS For patients with drug-resistant epilepsy, VEEG monitoring followed by epilepsy surgery was cost-effective in Thailand. Therefore it should be recommended for health insurance coverage.
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Affiliation(s)
- Pimprapa Kitwitee
- Pharmacy and Health System Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen
| | | | | | - Tinonkorn Yadee
- Department of Neurology, Prasat Neurological Institute, Bangkok
| | - Chulaporn Limwattananon
- Department of linical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
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23
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Davis KA, Nanga RPR, Das S, Chen SH, Hadar PN, Pollard JR, Lucas TH, Shinohara RT, Litt B, Hariharan H, Elliott MA, Detre JA, Reddy R. Glutamate imaging (GluCEST) lateralizes epileptic foci in nonlesional temporal lobe epilepsy. Sci Transl Med 2016; 7:309ra161. [PMID: 26468323 DOI: 10.1126/scitranslmed.aaa7095] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
When neuroimaging reveals a brain lesion, drug-resistant epilepsy patients show better outcomes after resective surgery than do the one-third of drug-resistant epilepsy patients who have normal brain magnetic resonance imaging (MRI). We applied a glutamate imaging method, GluCEST (glutamate chemical exchange saturation transfer), to patients with nonlesional temporal lobe epilepsy based on conventional MRI. GluCEST correctly lateralized the temporal lobe seizure focus on visual and quantitative analyses in all patients. MR spectra, available for a subset of patients and controls, corroborated the GluCEST findings. Hippocampal volumes were not significantly different between hemispheres. GluCEST allowed high-resolution functional imaging of brain glutamate and has potential to identify the epileptic focus in patients previously deemed nonlesional. This method may lead to improved clinical outcomes for temporal lobe epilepsy as well as other localization-related epilepsies.
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Affiliation(s)
- Kathryn Adamiak Davis
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ravi Prakash Reddy Nanga
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sandhitsu Das
- Penn Image Computing & Science Lab, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Stephanie H Chen
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter N Hadar
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John R Pollard
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Timothy H Lucas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian Litt
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hari Hariharan
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mark A Elliott
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John A Detre
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ravinder Reddy
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Goodfellow M, Rummel C, Abela E, Richardson MP, Schindler K, Terry JR. Estimation of brain network ictogenicity predicts outcome from epilepsy surgery. Sci Rep 2016; 6:29215. [PMID: 27384316 PMCID: PMC4935897 DOI: 10.1038/srep29215] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/13/2016] [Indexed: 02/01/2023] Open
Abstract
Surgery is a valuable option for pharmacologically intractable epilepsy. However, significant post-operative improvements are not always attained. This is due in part to our incomplete understanding of the seizure generating (ictogenic) capabilities of brain networks. Here we introduce an in silico, model-based framework to study the effects of surgery within ictogenic brain networks. We find that factors conventionally determining the region of tissue to resect, such as the location of focal brain lesions or the presence of epileptiform rhythms, do not necessarily predict the best resection strategy. We validate our framework by analysing electrocorticogram (ECoG) recordings from patients who have undergone epilepsy surgery. We find that when post-operative outcome is good, model predictions for optimal strategies align better with the actual surgery undertaken than when post-operative outcome is poor. Crucially, this allows the prediction of optimal surgical strategies and the provision of quantitative prognoses for patients undergoing epilepsy surgery.
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Affiliation(s)
- M Goodfellow
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK.,Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, UK.,EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, UK
| | - C Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, University of Bern, Switzerland
| | - E Abela
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, University of Bern, Switzerland
| | - M P Richardson
- EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K Schindler
- Department of Neurology, University of Bern, Switzerland
| | - J R Terry
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK.,Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, UK.,EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, UK
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Abstract
Psychosis of epilepsy (POE) is a term applied to a group of psychotic disorders with a distinct phenomenology in which potential etiopathogenic mechanisms are believed to be closely related to a seizure disorder. POE can present as interictal psychotic episodes, which may often differ semiologically from primary schizophrenic disorder. They may present as ictal or postictal psychotic episodes and may be the expression of an iatrogenic process to pharmacologic and/or surgical interventions.Epilepsy and POE have a complex and bidirectional relation, as not only are patients with epilepsy at greater risk of developing a psychotic disorder, but patients with a primary psychotic disorder are also at greater risk of developing epilepsy. The prevalence of POE is more than 7 times higher than the frequency of primary schizophreniform disorders in the general population. While POE has been associated with focal epilepsy of temporal and frontal lobe origin, its etiology and pathophysiology of POE have yet to be established.The treatment of all forms of POE, with the exception of ictal psychotic episodes, requires the use of antipsychotic drugs, preferably the atypical antipsychotic agents with a very low or negligible potential to lower the seizure threshold (eg, risperidone, apiprazole), starting at a low dose with stepwise increments.
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26
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Strzelczyk A, Hamer HM. [Impact of early benefit assessment on patients with epilepsy in Germany: Current healthcare provision and therapeutic needs]. DER NERVENARZT 2016; 87:386-93. [PMID: 26927680 DOI: 10.1007/s00115-016-0087-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Epilepsy is one of the most common chronic neurological diseases and represents a significant burden for patients, their families and society. In more than 75 % of patients anticonvulsant therapy consists of valproate, carbamazepine, lamotrigine or levetiracetam. There is a need for polytherapy in drug-refractory patients and they suffer from negative effects on quality of life and employment that is associated with high indirect costs. To allow a comprehensive treatment in this patient group, access to new anticonvulsants with novel modes of action is needed; however, all applications for new antiepileptic drugs failed to prove added benefits during the Pharmaceutical Market Restructuring Act (AMNOG) in Germany. One of the main reasons is the mandatory definition of a standard comparative therapy. It remains unclear whether there will be studies in the future which will fulfill the requirements of the current version of AMNOG. Observational studies after approval and marketing of new antiepileptic drugs could be better alternatives to prove added benefits for individual patients in the current German healthcare system.
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Affiliation(s)
- A Strzelczyk
- Epilepsiezentrum Frankfurt Rhein-Main, Klinik für Neurologie, J.W. Goethe Universität, Schleusenweg 2-16, Haus 95, 60528, Frankfurt am Main, Deutschland. .,Epilepsiezentrum Hessen, Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland.
| | - H M Hamer
- Epilepsiezentrum Erlangen, Klinik für Neurologie, Friedrich-Alexander Universität, Erlangen, Deutschland
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27
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Wei W, Zhang Z, Xu Q, Yang F, Sun K, Lu G. More Severe Extratemporal Damages in Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis Than That With Other Lesions: A Multimodality MRI Study. Medicine (Baltimore) 2016; 95:e3020. [PMID: 26962820 PMCID: PMC4998901 DOI: 10.1097/md.0000000000003020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) presents different clinical presentations from that with other lesions (OL). It is significant to investigate the neural mechanism underlying the different clinical presentations using neuroimaging study.Thirty mTLE patients with mTLE-HS, 30 mTLE patients with other lesions (mTLE-OL), and 30 age- and sex-matched healthy controls were involved. Amplitude of low-frequency fluctuation (ALFF) analysis-based resting-state functional magnetic resonance imaging (fMRI) and voxel-based morphometry (VBM) based morphometric MRI were employed to describing functional and structural imaging alterations in mTLE. Imaging parameters of ALFF and gray matter volume (GMV) were compared among groups and correlated with clinical variables and cognitive scores.For parameter of ALFF, both patient groups of mTLE-HS and mTLE-OL showed decrease in the frontal cortices relative to the healthy controls; mTLE-HS showed more decrease in the prefrontal and brain default regions relative to mTLE-OL. For GMV, both patient groups showed decrease in the frontal cortex, thalamus, and cerebellum; mTLE-HS showed more GMV decrease relative to the mTLE-OL, also mainly in the prefrontal and brain default regions. In both patient groups, the prefrontal regions showed negative correlation between GMV and epilepsy duration.This work revealed distinct alteration patterns of functional and structural brain organizations in mTLEs with different forms. MTLE-HS, despite with smaller lesion size of the pathological focus, presented more severe functional and structural damages in the extratemporal regions than mTLE-OL. The findings provided imaging evidence to support the proposal that mTLE-HS is a special epilepsy syndrome.
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Affiliation(s)
- Wei Wei
- From the Department of Medical Imaging (WW, ZZ, QX, GL), Department of Neurology (QX), Department of Neurosurgery (FY), Jinling Hospital, Nanjing University School of Medicine, and State Key Laboratory of Analytical Chemistry for Life Science (ZZ, GL), Nanjing University, Nanjing, China
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Fallah A, Weil AG, Sur S, Miller I, Jayakar P, Morrison G, Bhatia S, Ragheb J. Epilepsy surgery related to pediatric brain tumors: Miami Children's Hospital experience. J Neurosurg Pediatr 2015; 16:675-80. [PMID: 26339959 DOI: 10.3171/2015.4.peds14476] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Pediatric brain tumors may be associated with medically intractable epilepsy for which surgery is indicated. The authors sought to evaluate the efficacy of epilepsy surgery for seizure control in pediatric patients with brain tumors. METHODS The authors performed a retrospective review of consecutive patients undergoing resective epilepsy surgery related to pediatric brain tumors at Miami Children's Hospital between June 1986 and June 2014. Time-to-event analysis for seizure recurrence was performed; an "event" was defined as any seizures that occurred following resective epilepsy surgery, not including seizures and auras in the 1st postoperative week. The authors analyzed several preoperative variables to determine their suitability to predict seizure recurrence following surgery. RESULTS Eighty-four patients (47 males) with a mean age (± standard deviation) of 8.7 ± 5.5 years (range 0.5-21.6 years) were included. The study included 39 (46%) patients with gliomas, 20 (24%) with dysembryoplastic neuroepithelial tumors (DNETs), 14 (17%) with gangliogliomas, and 11 (13%) with other etiologies. Among the patients with gliomas, 18 were classified with low-grade glioma, 5 had oligodendroglioma, 6 had uncategorized astrocytoma, 3 had pilocytic astrocytoma, 3 had pleomorphic xanthoastrocytoma, 3 had glioblastoma, and 1 had gliomatosis cerebri. Seventy-nine (94.0%) resections were guided by intraoperative electrocorticography (ECoG). The mean time (± standard deviation) to seizure recurrence was 81.8 ± 6.3 months. Engel Class I outcome was achieved in 66 (78%) and 63 (75%) patients at 1 and 2 years' follow-up, respectively. Patients with ganglioglioma demonstrated the highest probability of long-term seizure freedom, followed by patients with DNETs and gliomas. In univariate analyses, temporal location (HR 1.75, 95% CI 0.26-1.27, p = 0.171) and completeness of resection (HR 1.69, 95% CI 0.77-3.74, p = 0.191) demonstrated a trend toward a longer duration of seizure freedom. CONCLUSIONS ECoG-guided epilepsy surgery for pediatric patients with brain tumors is highly effective. Tumors located in the temporal lobe and those in which a complete ECoG-guided resection is performed may result in a greater likelihood of long-term seizure freedom.
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Affiliation(s)
- Aria Fallah
- Departments of 1 Neurosurgery and.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Ian Miller
- Neurology, Miami Children's Hospital, Miami, Florida; and
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30
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Chugani HT, Ilyas M, Kumar A, Juhász C, Kupsky WJ, Sood S, Asano E. Surgical treatment for refractory epileptic spasms: The Detroit series. Epilepsia 2015; 56:1941-9. [PMID: 26522016 DOI: 10.1111/epi.13221] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We reviewed our experience of surgery for epileptic spasms (ES) with or without history of infantile spasms. METHODS Data were reviewed from 65 (33 male) patients with ES who underwent surgery between 1993 and 2014; palliative cases were excluded. RESULTS Mean age at surgery was 5.1 (range 0.2-19) years, with mean postsurgical follow-up of 45.3 (6-120) months. Mean number of anticonvulsants used preoperatively was 4.2 (2-8), which decreased to 1.2 (0-4) postoperatively (p < 0.0001). Total hemispherectomy was the most commonly performed surgery (n = 20), followed by subtotal hemispherectomy (n = 17), multilobar resection (n = 13), lobectomy (n = 7), tuberectomy (n = 6), and lobectomy + tuberectomy (n = 2), with International League Against Epilepsy (ILAE) class I outcome in 20, 10, 7, 6, 3, and 0 patients, respectively (total 46/65 (71%); 22 off medication). Shorter duration of epilepsy (p = 0.022) and presence of magnetic resonance imaging (MRI) lesion (p = 0.026) were independently associated with class I outcome. Of 34 patients operated <3 years after seizure onset, 30 (88%) achieved class I outcome. Thirty-seven (79%) of 47 patients with lesional MRI had class-I outcome, whereas 9 (50%) of 18 with normal MRI had class I outcome. Positron emission tomography (PET) scan was abnormal in almost all patients [61 (97%) of 63 with lateralizing/localizing findings in 56 (92%) of 61 patients, thus helping in surgical decision making and guiding subdural grid placements, particularly in patients with nonlesional MRI. Fifteen patients had postoperative complications, mostly minor. SIGNIFICANCE Curative epilepsy surgery in ES patients, with or without history of infantile spasms, is best accomplished at an early age and in those patients with lesional abnormalities on MRI with electroencephalography (EEG) concordance. Good outcomes can be achieved even when there is no MRI lesion but positive PET localization.
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Affiliation(s)
- Harry T Chugani
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.,Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A
| | - Mohammed Ilyas
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.,Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A
| | - Ajay Kumar
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.,Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.,Department of Radiology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.,Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A
| | - William J Kupsky
- Department of Pathology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A
| | - Sandeep Sood
- Department of Neurosurgery, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A
| | - Eishi Asano
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.,Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A
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Assessment of driving outcomes after epilepsy surgery. Epilepsy Behav 2015; 52:25-30. [PMID: 26406448 DOI: 10.1016/j.yebeh.2015.08.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/14/2015] [Accepted: 08/30/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Driving is an important factor contributing to good quality of life in patients with epilepsy. Little work has been undertaken to explore the details of driving experience alone in this patient population. We assessed the driving status of our patients prior to and following surgery for epilepsy. We also sought to determine what associations exist between patient characteristics and postoperative driving status. METHODS The participants were selected from those adult patients with epilepsy who have required surgical treatment at our home institution between 2006 and 2010. Each participant received a questionnaire asking about driving and seizure status before and after surgery. The surveys were distributed using a modified Dillman approach. Perioperative patient data were obtained from the electronic medical record system in addition to a previously assembled epilepsy database from the Neurology Department at our institution. Independent variables were analyzed to look for significant associations with driving outcomes. RESULTS One hundred forty eligible patients were included in the survey population; 78 patients returned a questionnaire for a response rate of 55.7%. Eighty percent of patients experienced driving as a regular part of life at some point prior to surgery. At the time of the questionnaire distribution, 68% of patients had returned to regular driving. Demographic characteristics did not play a significant role in whether or not the patient had a favorable driving outcome after surgery. However, patients who had a history of driving on a regular basis prior to surgery and those who had an Engel Class I outcome after surgery had significantly higher rates of good driving outcomes. Also, patients with an unfavorable preoperative driving status were more likely to have a favorable driving outcome after surgery if they had an Engel Class I outcome. Patients in whom intracranial electroencephalography (EEG) was utilized prior to resection had worse driving outcomes. CONCLUSIONS A surprisingly high percentage of patients with epilepsy have experienced driving on a regular basis prior to surgery. We can assume that most patients were not driving immediately prior to surgery, given the fact that they had progressed to requiring surgery for treatment of their epilepsy. Thus, a driving rate of 68% after surgery can be considered good. We found that a patient's preoperative driving history, the use of intracranial EEG before surgical resection, and Engel classification were significant predictors of postoperative driving outcomes. These data provide patients with assistance in preoperative counseling. More investigation needs to be completed in other patient variables - such as seizure types, magnetic resonance imaging (MRI) findings, and patient motivators for driving - as possible predictors of driving outcomes.
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Gross RE, Willie JT, Drane DL. The Role of Stereotactic Laser Amygdalohippocampotomy in Mesial Temporal Lobe Epilepsy. Neurosurg Clin N Am 2015; 27:37-50. [PMID: 26615106 DOI: 10.1016/j.nec.2015.08.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Stereotactic laser amygdalohippocampotomy (SLAH) uses laser interstitial thermal therapy guided by magnetic resonance thermography. This novel intervention can achieve seizure freedom while minimizing collateral damage compared to traditional open surgery, in patients with mesial temporal lobe epilepsy. An algorithm is presented to guide treatment decisions for initial and repeat procedures in patients with and without mesial temporal sclerosis. SLAH may improve access by medication-refractory patients to effective surgical treatments and thereby decrease medical complications, increase productivity, and minimize socioeconomic consequences in patients with chronic epilepsy.
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Affiliation(s)
- Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road N.E., Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Suite 6111, Atlanta, GA 30322, USA; Interventional MRI Program, Emory University Hospital, 1364 Clifton Road, N.E., Atlanta, GA 30322, USA; Coulter Department of Biomedical Engineering, Emory University, 1760 Haygood Dr, Ste W 200, Atlanta, GA 30322, USA.
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road N.E., Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Suite 6111, Atlanta, GA 30322, USA; Interventional MRI Program, Emory University Hospital, 1364 Clifton Road, N.E., Atlanta, GA 30322, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Suite 6111, Atlanta, GA 30322, USA; Department of Neurology, University of Washington School of Medicine, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, USA
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Shurtleff HA, Barry D, Firman T, Warner MH, Aguilar-Estrada RL, Saneto RP, Kuratani JD, Ellenbogen RG, Novotny EJ, Ojemann JG. Impact of epilepsy surgery on development of preschool children: identification of a cohort likely to benefit from early intervention. J Neurosurg Pediatr 2015; 16:383-92. [PMID: 26140458 DOI: 10.3171/2015.3.peds14359] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Outcomes of focal resection in young children with early-onset epilepsy are varied in the literature due to study differences. In this paper, the authors sought to define the effect of focal resection in a small homogeneous sample of children who were otherwise cognitively intact, but who required early surgical treatment. Preservation of and age-appropriate development of intelligence following focal resection was hypothesized. METHODS Cognitive outcome after focal resection was retrospectively reviewed for 15 cognitively intact children who were operated on at the ages of 2-6 years for lesion-related, early-onset epilepsy. Intelligence was tested prior to and after surgery. Effect sizes and confidence intervals for means and standard deviations were used to infer changes and differences in intelligence between 1) groups (pre vs post), 2) left versus right hemisphere resections, and 3) short versus long duration of seizures prior to resection. RESULTS No group changes from baseline occurred in Full Scale, verbal, or nonverbal IQ. No change from baseline intelligence occurred in children who underwent left or right hemisphere surgery, including no group effect on verbal scores following surgery in the dominant hemisphere. Patients with seizure durations of less than 6 months prior to resection showed improvement from their presurgical baseline in contrast to those with seizure duration of greater than 6 months prior to surgery, particularly in Wechsler Full Scale IQ and nonverbal intelligence. CONCLUSIONS This study suggests that surgical treatment of focal seizures in cognitively intact preschool children is likely to result in seizure remediation, antiepileptic drug discontinuation, and no significant decrement in intelligence. The latter finding is particularly significant in light of the longstanding concern associated with performing resections in the language-dominant hemisphere. Importantly, shorter seizure duration prior to resection can result in improved cognitive outcome, suggesting that surgery for this population should occur sooner to help improve intelligence outcomes.
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Affiliation(s)
| | - Dwight Barry
- Health Informatics, Group Health, Seattle, Washington; and
| | | | - Molly H Warner
- Departments of 1 Neurology.,Psychiatry, Seattle Children's Hospital
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Anterior temporal lobectomy compared with laser thermal hippocampectomy for mesial temporal epilepsy: A threshold analysis study. Epilepsy Res 2015. [DOI: 10.1016/j.eplepsyres.2015.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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Hardouin JB, Blanchin M, Feddag ML, Néel TL, Perrot B, Sébille V. Power and sample size determination for group comparison of patient-reported outcomes using polytomous Rasch models. Stat Med 2015; 34:2444-55. [DOI: 10.1002/sim.6478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Benoit Hardouin
- EA4275 - SPHERE “Biostatistics, Pharmacoepidemiology and Human Sciences Research”, Faculties of Medicine and Pharmaceutical Sciences; University of Nantes - PRES UNAM; 1 rue Gaston Veil 44035 Nantes France
- Team of Methodology and Biostatistics; University Hospital of Nantes - Clinical Research; Unit 1 place Alexis-Ricordeau 44093 Nantes France
| | - Myriam Blanchin
- EA4275 - SPHERE “Biostatistics, Pharmacoepidemiology and Human Sciences Research”, Faculties of Medicine and Pharmaceutical Sciences; University of Nantes - PRES UNAM; 1 rue Gaston Veil 44035 Nantes France
| | - Mohand-Larbi Feddag
- EA4275 - SPHERE “Biostatistics, Pharmacoepidemiology and Human Sciences Research”, Faculties of Medicine and Pharmaceutical Sciences; University of Nantes - PRES UNAM; 1 rue Gaston Veil 44035 Nantes France
| | - Tanguy Le Néel
- EA4275 - SPHERE “Biostatistics, Pharmacoepidemiology and Human Sciences Research”, Faculties of Medicine and Pharmaceutical Sciences; University of Nantes - PRES UNAM; 1 rue Gaston Veil 44035 Nantes France
| | - Bastien Perrot
- EA4275 - SPHERE “Biostatistics, Pharmacoepidemiology and Human Sciences Research”, Faculties of Medicine and Pharmaceutical Sciences; University of Nantes - PRES UNAM; 1 rue Gaston Veil 44035 Nantes France
- Team of Methodology and Biostatistics; University Hospital of Nantes - Clinical Research; Unit 1 place Alexis-Ricordeau 44093 Nantes France
| | - Véronique Sébille
- EA4275 - SPHERE “Biostatistics, Pharmacoepidemiology and Human Sciences Research”, Faculties of Medicine and Pharmaceutical Sciences; University of Nantes - PRES UNAM; 1 rue Gaston Veil 44035 Nantes France
- Team of Methodology and Biostatistics; University Hospital of Nantes - Clinical Research; Unit 1 place Alexis-Ricordeau 44093 Nantes France
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Wasade VS, Elisevich K, Tahir R, Smith B, Schultz L, Schwalb J, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes after resective surgery for intractable epilepsy. Epilepsy Behav 2015; 43:122-7. [PMID: 25614128 DOI: 10.1016/j.yebeh.2014.11.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/06/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
Abstract
Resective surgery is considered an effective treatment for refractory localization-related epilepsy. Most studies have reported seizure and psychosocial outcomes of 2-5 years postsurgery and a few up to 10 years. Our study aimed to assess long-term (up to 15 years) postsurgical seizure and psychosocial outcomes at our epilepsy center. The Henry Ford Health System Corporate Data Store was accessed to identify patients who had undergone surgical resection for localization-related epilepsy from 1993 to 2011. Demographics including age at epilepsy onset and surgery, seizure frequency before surgery, and pathology were gathered from electronic medical records. Phone surveys were conducted from May 2012 to January 2013 to determine patients' current seizure frequency and psychosocial metrics including driving and employment status and use of antidepressants. Surgical outcomes were based on Engel's classification (classes I and II=favorable outcomes). McNemar's tests, chi-square tests, two sample t-tests, and Wilcoxon two sample tests were used to analyze the relationships of psychosocial and surgical outcomes with demographic and surgical characteristics. A total of 470 patients had resective epilepsy surgery, and of those, 50 (11%) had died since surgery. Of the remaining, 253 (60%) were contacted with mean follow-up of 10.6±5.0years (27% of patients had follow-up of 15 years or longer). Of the patients surveyed, 32% were seizure-free and 75% had a favorable outcome (classes I and II). Favorable outcomes had significant associations with temporal resection (78% temporal vs 58% extratemporal, p=0.01) and when surgery was performed after scalp EEG only (85% vs 65%, p<0.001). Most importantly, favorable and seizure-free outcome rates remained stable after surgery over long-term follow-up [i.e., <5 years (77%, 41%), 5-10 years (67%, 29%), 10-15 years (78%, 38%), and >15 years (78%, 26%)]. Compared to before surgery, patients at the time of the survey were more likely to be driving (51% vs 35%, p<0.001) and using antidepressants (30% vs 22%, p=0.013) but less likely to be working full-time (23% vs 42%, p<0.001). A large majority of patients (92%) considered epilepsy surgery worthwhile regardless of the resection site, and this was associated with favorable outcomes (favorable=98% vs unfavorable=74%, p<0.001). The findings suggest that resective epilepsy surgery yields favorable long-term postoperative seizure and psychosocial outcomes.
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Affiliation(s)
- Vibhangini S Wasade
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA.
| | - Kost Elisevich
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Rizwan Tahir
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Brien Smith
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Lonni Schultz
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Jason Schwalb
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Marianna Spanaki-Varelas
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
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Hawasli AH, Bandt SK, Hogan RE, Werner N, Leuthardt EC. Laser ablation as treatment strategy for medically refractory dominant insular epilepsy: therapeutic and functional considerations. Stereotact Funct Neurosurg 2014; 92:397-404. [PMID: 25359500 DOI: 10.1159/000366001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 07/14/2014] [Indexed: 11/19/2022]
Abstract
Since its introduction to neurosurgery in 2008, laser ablative techniques have been largely confined to the management of unresectable tumors. Application of this technology for the management of focal epilepsy in the adult population has not been fully explored. Given that nearly 1,000,000 Americans live with medically refractory epilepsy and current surgical techniques only address a fraction of epileptic pathologies, additional therapeutic options are needed. We report the successful treatment of dominant insular epilepsy in a 53-year-old male with minimally invasive laser ablation complicated by mild verbal and memory deficits. We also report neuropsychological test data on this patient before surgery and at 8 months after the ablation procedure. This account represents the first reported successful patient outcome of laser ablation as an effective treatment option for medically refractory post-stroke epilepsy in an adult.
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Affiliation(s)
- Ammar H Hawasli
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Mo., USA
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Na M, Ge H, Shi C, Shen H, Wang Y, Pu S, Liu L, Wang H, Xie C, Zhu M, Wang J, Shi C, Lin Z. Long-term seizure outcome for international consensus classification of hippocampal sclerosis: a survival analysis. Seizure 2014; 25:141-6. [PMID: 25455728 DOI: 10.1016/j.seizure.2014.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/05/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Surgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy (MTLE) as a result of hippocampal sclerosis (HS). However, approximately one-third of patients with intractable epilepsy did not become seizure-free after tailored resection strategies. It would be compelling to identify predictive factors of postoperative seizure outcomes. Our aim was to assess the correlation between HS classification and long-term postoperative seizure outcome in patients with MTLE due to HS. METHODS To investigate HS classification, semi-quantitative analysis and immunohistochemical staining of neuronal nuclei (NeuN) were performed on 100 postoperative hippocampal specimens. All patients had a 1-7 year postoperative follow-up. The postoperative seizure outcome was evaluated using International League Against Epilepsy (ILAE) outcome classification. RESULTS Three types of HS were recognized. The highest incidence of initial precipitating injury (IPI) was noted in the HS ILAE type 1 group (53.1%). The most favorable long-term seizure outcome was also noted in the HS ILAE type 1 group. The shortest epilepsy duration was recorded in the HS ILAE type 2 group (mean epilepsy duration=6.64 ± 5.83 years). The completely seizure free rate of patients in all groups declined with an increase in time. CONCLUSIONS Our study for the first time demonstrated a significant correlation between HS ILAE types and long-term postoperative seizure outcome in patients with MTLE due to HS. Therefore, HS ILAE types have predictive value in long-term seizure outcome following epilepsy surgery.
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Affiliation(s)
- Meng Na
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Haitao Ge
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chen Shi
- Department of Neurosurgery, New York University Langone Medical Center and School of Medicine, New York, NY, USA
| | - Hong Shen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yu Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Song Pu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Li Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Haiyang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chuncheng Xie
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Minwei Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jiabin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Changbin Shi
- Section of Neurosurgery/Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Zhiguo Lin
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
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Kovanda TJ, Tubbs RS, Cohen-Gadol AA. Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications. Surg Neurol Int 2014; 5:133. [PMID: 25298915 PMCID: PMC4174670 DOI: 10.4103/2152-7806.140651] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/03/2014] [Indexed: 11/08/2022] Open
Abstract
Background: A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Of these, transsylvian selective amygdalohippocampectomy (SA), which was originally developed to maximize temporal lobe preservation, is arguably the most technically demanding to perform. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex. Methods: In this article, the authors describe technical nuances to improve the safety of SA. Results: Wide sylvian fissure opening and use of neuronavigation allows an adequate exposure of the amygdala and hippocampus through a corticotomy within the inferior insular sulcus. Avoidance of rigid retractors and careful manipulation and mobilization of middle cerebral vessels will minimize ischemic complications. Identification of important landmarks during amygdalohippocampectomy, such as the medial edge of the tentorium and the third nerve within the intact arachnoid membranes covering the brainstem, further avoids operator disorientation. Conclusion: SA is a safe technique for resection of medial temporal lobe epileptogenic foci leading to drug-resistant medial temporal lobe epilepsy.
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Affiliation(s)
- Timothy J Kovanda
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - R Shane Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Ilyas M, Sivaswamy L, Asano E, Sood S, Zidan M, Chugani H. Seizure control following palliative resective surgery for intractable epilepsy-a pilot study. Pediatr Neurol 2014; 51:330-5. [PMID: 25160538 DOI: 10.1016/j.pediatrneurol.2014.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/19/2014] [Accepted: 05/04/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with intractable epilepsy who have bilateral epileptic foci may not qualify for curative epilepsy surgery. In some cases palliative resection may be undertaken with a goal to decrease seizure frequency and improve quality of life. Here we present data on the outcome of palliative epilepsy surgery in children. METHODS We reviewed medical charts of children who underwent palliative resection for intractable epilepsy during the years 1999-2013 at Children's Hospital of Michigan. The palliative intent of resection was declared preoperatively. Outcome was assessed in terms of seizure reduction. RESULTS There were 18 patients (11 males, median age of surgery was 3.5 years [range 0.5-16 years]). The median duration of follow-up after surgery was 12.5 months (range 6-60 months). Hemispherectomy was the most commonly performed palliative resection (nine patients), followed by lobectomy (six patients), multilobar resection (one patient), and tuberectomy (two patients). Reduction in seizure frequency was observed in 11 patients, with eight patients achieving seizure freedom on antiepileptic drugs and three with >50% reduction in seizure frequency. Transient improvement in seizure frequency occurred in two patients, whereas there was no benefit in five patients. CONCLUSIONS Beneficial effects of epilepsy surgery may be realized in carefully selected situations wherein the most epileptogenic focus is resected to reduce seizure burden and improve quality of life.
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Affiliation(s)
- Mohammed Ilyas
- Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan.
| | - Lalitha Sivaswamy
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Eishi Asano
- Children's Hospital of Michigan, Detroit, Michigan
| | - Sandeep Sood
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Marwan Zidan
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Research Center of Michigan, Detroit, Michigan
| | - Harry Chugani
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
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Management of antiepileptic drugs following epilepsy surgery: A meta-analysis. Epilepsy Res 2014; 108:765-74. [DOI: 10.1016/j.eplepsyres.2014.01.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 01/26/2014] [Indexed: 11/18/2022]
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Kanchanatawan B, Limothai C, Srikijvilaikul T, Maes M. Clinical predictors of 2-year outcome of resective epilepsy surgery in adults with refractory epilepsy: a cohort study. BMJ Open 2014; 4:e004852. [PMID: 24755212 PMCID: PMC4010813 DOI: 10.1136/bmjopen-2014-004852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Resective epilepsy surgery is currently a standard treatment for intractable epilepsy. Seizure freedom and discontinuation of antiepileptic drugs are the ultimate goals of epilepsy treatment. This study was carried out to delineate (1) possible differences in the success rate of epilepsy surgery 6 and 24 months after surgery; and (2) the clinical predictors of a good response to surgery. SETTING This is a cohort study performed at a tertiary care unit of a university hospital. PARTICIPANTS In this cohort study, 189 adults with intractable epilepsy who underwent epilepsy surgery were included. We collected clinical data at three time points, that is, preoperative and 6 and 24 months after surgery. PRIMARY AND SECONDARY OUTCOME MEASURES Engel class I-IV classification was the primary outcome measure of epilepsy surgery. The authors statistically adjusted Engel class I-IV classification for postoperative changes in antiepileptic drugs and used this new classification as a secondary outcome variable. RESULTS The success rate was 78.8% 6 months after surgery and increased to 88.3% 24 months after surgery. This success rate was reflected not only by the reduced number of seizures postsurgery, but also by a reduced dosage and use of antiepileptic drugs. Logistic regression analysis showed that a successful outcome of surgery is predicted by having temporal rather than extratemporal lobe epilepsy and less than nine presurgery seizures per month, while a positive familial history of epilepsy, younger age and dysphoric symptoms, the first 3 months after surgery, significantly worsened the outcome of surgery. Duration of illness, age at onset, epilepsy location, type of lesions and the presence of psychosis were not significant in predicting treatment outcome. CONCLUSIONS These findings have clinical relevance in that a better selection of patients based on the significant clinical predictors will increase the success rate of epilepsy surgery and treatment.
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Affiliation(s)
- B Kanchanatawan
- Faculty of Medicine, Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - C Limothai
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - T Srikijvilaikul
- Department of Surgery, Prasat Neurological Institute, Bangkok, Thailand
| | - M Maes
- Faculty of Medicine, Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Deakin University, Geelong, Australia
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Kasasbeh AS, Gurnett CA, Smyth MD. Palliative epilepsy surgery in Aicardi syndrome: a case series and review of literature. Childs Nerv Syst 2014; 30:497-503. [PMID: 23948796 DOI: 10.1007/s00381-013-2259-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 08/01/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Aicardi syndrome (AS) is a severe neurodevelopmental disorder characterized by the triad of seizures, agenesis of corpus callosum, and chorioretinal lacunae. Seizures in AS are typically frequent, of various types, and refractory to medical therapy. Optimal treatment of seizures in AS remains undetermined. METHODS We report a series of four patients with Aicardi syndrome who underwent surgical management of their epilepsy including two with corpus callosotomy (CC) of a partial corpus callosum and three with vagus nerve stimulator implantation. RESULTS Seizure outcome was variable and ranged from near complete resolution of seizures to worsening of seizure profile. The most favorable seizure outcome was seen in a patient with partial agenesis of the corpus callosum treated with CC. CONCLUSIONS Seizure outcome following CC or vagus nerve stimulation in patients with Aicardi syndrome is variable. Although palliative epilepsy surgery may result in improvement in the seizure profile in some patients, studies on larger patient cohorts are needed to identify the precise role that surgery may play in the multidisciplinary approach to controlling seizures in Aicardi syndrome.
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Affiliation(s)
- Aimen S Kasasbeh
- Neural Engineering Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA,
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Abstract
PURPOSE OF REVIEW This article outlines indications for neurosurgical treatment of epilepsy, describes the presurgical workup, summarizes surgical approaches, and details expected risks and benefits. RECENT FINDINGS There is class I evidence for the efficacy of temporal lobectomy in treating intractable seizures, and accumulating documentation that successful surgical treatment reverses much of the disability, morbidity, and excess mortality of chronic epilepsy. SUMMARY Chronic, uncontrolled focal epilepsy causes progressive disability and increased mortality, but these can be reversed with seizure control. Vigorous efforts to stop seizures are warranted. If two well-chosen and tolerated medication trials do not achieve seizure control, an early workup for epilepsy surgery should be arranged. If this workup definitively identifies the brain region from which the seizures arise, and this region can be removed with a low risk of disabling neurologic deficits, neurosurgery will have a much better chance of stopping seizures than further medication trials.
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Affiliation(s)
- John W Miller
- Miller, Harborview Medical Center, Box 359745, 325 Ninth Avenue, Seattle, WA 98104, USA.
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Jefferys JGR. Are Changes in Synaptic Function That Underlie Hyperexcitability Responsible for Seizure Activity? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 813:185-94. [DOI: 10.1007/978-94-017-8914-1_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Wellmer J, Quesada CM, Rothe L, Elger CE, Bien CG, Urbach H. Proposal for a magnetic resonance imaging protocol for the detection of epileptogenic lesions at early outpatient stages. Epilepsia 2013; 54:1977-87. [DOI: 10.1111/epi.12375] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2013] [Indexed: 01/04/2023]
Affiliation(s)
- Jörg Wellmer
- Ruhr-Epileptology; Department of Neurology; University Hospital Knappschaftskrankenhaus; Bochum Germany
| | - Carlos M. Quesada
- Department of Epileptology & Life and Brain Institute; University Hospital Bonn; Bonn Germany
| | - Lars Rothe
- Ruhr-Epileptology; Department of Neurology; University Hospital Knappschaftskrankenhaus; Bochum Germany
| | - Christian E. Elger
- Department of Epileptology & Life and Brain Institute; University Hospital Bonn; Bonn Germany
| | | | - Horst Urbach
- Department of Neuroradiology; University Hospital Freiburg; Freiburg Germany
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Kasasbeh AS, Smyth MD, Steger-May K, Jalilian L, Bertrand M, Limbrick DD. Outcomes After Anterior or Complete Corpus Callosotomy in Children. Neurosurgery 2013; 74:17-28; discussion 28. [DOI: 10.1227/neu.0000000000000197] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Corpus callosotomy (CC) is a valuable palliative surgical option for children with medically refractory epilepsy due to generalized or multifocal cortical seizure onset.
OBJECTIVE:
To investigate the extent of CC resulting in optimal seizure control in a pediatric patient population and to evaluate the modification of seizure profile after various CC approaches.
METHODS:
The records of 58 children (3–22 years of age at the time of surgery) with medically refractory epilepsy who underwent CC between 1995 and 2011 were retrospectively reviewed.
RESULTS:
Anterior two thirds callosotomy resulted in resolution of absence (P = .03) and astatic (P = .03) seizures, whereas anterior two thirds callosotomy followed by second-stage completion resulted in resolution of generalized tonic-clonic (GTC) (P = .03), astatic (P = .005), and myoclonic (P = .03) seizures in addition to a trend toward resolution of absence seizures (P = .08). Single-stage upfront complete callosotomy resulted in resolution of absence (P = .002), astatic (P < .0001), myoclonic (P = .007), and complex partial (P = .008) seizures in addition to a trend toward resolution of GTC (P = .06). In comparing a composite of subjects who underwent anterior two thirds callosotomy alone or 2-stage complete callosotomy before the second stage to complete the callosotomy with subjects who underwent upfront complete CC, a more favorable outcome was found in those with the upfront complete CC (P = .02).
CONCLUSION:
Single-stage upfront complete callosotomy is effective in relieving a broader spectrum of seizure types than anterior two thirds callosotomy or 2-stage complete callosotomy in children. The advantages of single-stage complete callosotomy must be weighed against the potentially higher risk of neurological and operative complications.
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Affiliation(s)
| | | | - Karen Steger-May
- Department of Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Laleh Jalilian
- Department of Neurology, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, Missouri
| | - Mary Bertrand
- Department of Neurology, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, Missouri
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Karakis I, Montouris GD, Piperidou C, Luciano MS, Meador KJ, Cole AJ. The effect of epilepsy surgery on caregiver quality of life. Epilepsy Res 2013; 107:181-9. [PMID: 24054427 DOI: 10.1016/j.eplepsyres.2013.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 07/28/2013] [Accepted: 08/14/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE Epilepsy surgery has been shown to improve patient quality of life (QOL). Little is known about its effect on caregiver QOL. METHODS The study population comprised of 26 persons with epilepsy (PWE) who underwent long term video EEG monitoring at Massachusetts General Hospital for presurgical evaluation along with 16 caregivers. The PWE completed epilepsy directed QOL (QOLIE-31) and psychological (Beck depression-BDI and anxiety inventory-BAI) questionnaires before and after surgery. Their participating caregivers completed generic health related QOL (SF36v2) and disease burden (Zarit caregiver burden inventory-ZCBI) questionnaires before and after surgery. Demographic data for all participants and disease/surgery related data for the PWE were collected. Statistical analysis was performed to compare PWE and caregiver QOL before and after surgery. RESULTS Mean patient age was 37 years. Most (77%) suffered from symptomatic partial epilepsy for approximately 18 years prior to surgery, averaging 4 seizures per month and 2.2 antiepileptic drugs (AEDs). 78% of them underwent an anterior temporal lobectomy and the rest extra-temporal resections. On follow up at approximately 9 months, 69% had a surgical outcome of Engel class I, 23% of class II and 8% class IV. Postoperatively, the PWE remained on average on 1.9 AEDs. There was a statistically significant improvement for both the aggregate QOLIE-31 score and all its subscales (except for medication effects) as well as the BAI scores. 96% of the PWE felt that the decision to go through surgery was worthwhile. Mean caregivers age was 47 years. Half of them were spouses to the PWE and the majority of the rest their parents. 50% of them stated that their overall time devoted to patient's care decreased after surgery and 50% that it remained unchanged. The mental component scale (SF36v2, MCS) of caregiver QOL showed statistically significant improvement. ZCBI score and the physical component scale of their QOL (SF36v2, PCS) did not significantly vary before and after surgery. 75% of caregivers deemed their QOL better post surgery vs 19% similar. 94% of the caregivers felt that the decision to go through surgery was worthwhile. CONCLUSIONS Successful epilepsy surgery has a positive impact not only to patient QOL but also to their caregiver. To the best of our knowledge, this is the first pilot study to systematically address the impact of epilepsy surgery on caregivers providing additional support to epilepsy surgery as the optimal treatment modality in carefully selected patients. These findings call for further investigation on the caregiver quality of life in epilepsy and for its inclusion in the treatment plan and quality indicators for epilepsy surgery.
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Affiliation(s)
- Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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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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