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Khan D, Sagar S, Jaleel J, Umar M, Tripathi M, Tripathi M, Sharma MC, Bal C. SISCOS in focal cortical dysplasia: localization and comparative analysis with MRI. Neuroradiology 2024:10.1007/s00234-024-03434-8. [PMID: 39060800 DOI: 10.1007/s00234-024-03434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE This study evaluates the efficacy of SISCOS (Subtraction ictal-interictal SPECT coregistered to SPECT) in localizing the epileptogenic zone (EZ) in focal cortical dysplasia (FCD), comparing its predictive performance with MRI and post-surgical outcomes based on ILAE classification. METHODS 84 patients with drug refractory epilepsy (DRE) who were operated and had histopathology consistent with FCD, were included in the study. All patients had undergone a complete work-up including SISCOS and MRI for EZ localization, followed by discussion in the multidisciplinary epilepsy surgery meeting prior to surgery. Ictal & interictal perfusion SPECT studies were performed with Tc-99 m Ethylene Cysteinate Dimer (Tc-99 m ECD) followed by SISCOS analysis using SPM2 and Bioimage Suite 2.6. Concordance for localization was determined by comparing with the surgical resection site and post-surgical outcomes were assessed using the ILAE classification. RESULTS The concordance for EZ localization demonstrated by SISCOS was 73.8% and MRI was 82.1%. 52 patients (61.9%) had good surgical outcome and 31(59%) of these were FCD type 2. In patients with discordant MRI findings, SISCOS was able to provide localisation in 86% (13/15), with 69.2% showing good surgical outcomes. Sensitivity of SISCOS and MRI was 73% (95% CI = 59-84.8%) and 78% (95% CI = 67.5-90.3%) respectively with no significant difference between the two. In FCD type I, both SISCOS and MRI revealed a similar a sensitivity of 76.4% (95%CI = 50.1-93.2%). Concordant cases exhibited higher seizure-free odds ratios for both modalities. CONCLUSION SISCOS is effective in localizing the EZ in FCD patients, comparable to MRI. Integrating SISCOS and MRI enhances lesion detection, especially in MRI discordant cases. A comprehensive diagnostic approach utilizing SISCOS and MRI can optimize the non-invasive pre-surgical assessment in DRE thereby guiding surgical decision-making in a resource-limited setting.
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Affiliation(s)
- Dikhra Khan
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sambit Sagar
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Jasim Jaleel
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mohammad Umar
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
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Yao Y, Wang X, Zhao B, Mo J, Guo Z, Yang B, Li Z, Fan X, Cai D, Sang L, Zheng Z, Shao X, Ai L, Hu W, Zhang C, Zhang K. Hypometabolic patterns are related to post-surgical seizure outcomes in focal cortical dysplasia: A semi-quantitative study. Epilepsia Open 2024; 9:653-664. [PMID: 38265725 PMCID: PMC10984320 DOI: 10.1002/epi4.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/25/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Fluorine-18-fluorodeoxyglucose-positron emission tomography (FDG-PET) is routinely used for presurgical evaluation in many epilepsy centers. Hypometabolic characteristics have been extensively examined in prior studies, but the metabolic patterns associated with specific pathological types of drug-resistant epilepsy remain to be fully defined. This study was developed to explore the relationship between metabolic patterns or characteristics and surgical outcomes in type I and II focal cortical dysplasia (FCD) patients based on results from a large cohort. METHODS Data from individuals who underwent epilepsy surgery from 2014 to 2019 with a follow-up duration of over 3 years and a pathological classification of type I or II FCD in our hospital were retrospectively analyzed. Hypometabolic patterns were quantitatively identified via statistical parametric mapping (SPM) and qualitatively analyzed via visual examination of PET-MRI co-registration images. Univariate analyses were used to explore the relationship between metabolic patterns and surgical outcomes. RESULTS In total, this study included data from 210 patients. Following SPM calculations, four hypometabolic patterns were defined including unilobar, multi-lobar, and remote patterns as well as cases where no pattern was evident. In type II FCD patients, the unilobar pattern was associated with the best surgical outcomes (p = 0.014). In visual analysis, single gyrus (p = 0.032) and Clear-cut hypometabolism edge (p = 0.040) patterns exhibited better surgery outcomes in the type II FCD group. CONCLUSIONS PET metabolic patterns are well-correlated with the prognosis of type II FCD patients. However, similar correlations were not observed in type I FCD, potentially owing to the complex distribution of the epileptogenic region. PLAIN LANGUAGE SUMMARY In this study, we demonstrated that FDG-PET was a crucial examination for patients with FCD, which was a common cause of epilepsy. We compared the surgical prognosis for patients with different hypometabolism distribution patterns and found that clear and focal abnormal region in PET was correlated with good surgical outcome in type II FCD patients.
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Affiliation(s)
- Yuan Yao
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Xiu Wang
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Baotian Zhao
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Jiajie Mo
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Zhihao Guo
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Bowen Yang
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Zilin Li
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Xiuliang Fan
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Du Cai
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Lin Sang
- Department of NeurosurgeryBeijing FengTai HospitalBeijingChina
| | - Zhong Zheng
- Department of NeurosurgeryBeijing FengTai HospitalBeijingChina
| | - Xiaoqiu Shao
- Department of NeurologyBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Lin Ai
- Department of Nuclear MedicineBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Wenhan Hu
- Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina
| | - Chao Zhang
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Kai Zhang
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
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Bajwa MH, Hashmi SA, Nisar A, Baqai MW, Bakhshi SK, Qadir MA, Shafiq F, Enam SA. Awake Surgery for Lesional Epilepsy in Resource-Limited Settings: Case Report and Review of Literature. Brain Tumor Res Treat 2023; 11:289-294. [PMID: 37953454 PMCID: PMC10641320 DOI: 10.14791/btrt.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Epilepsy surgery is a well-established treatment for drug-resistant epilepsy, with awake craniotomy being used in certain cases to remove epileptogenic foci while preserving crucial brain functions. We are presenting the first reported case from Pakistan of a 19-year-old woman who underwent awake epilepsy surgery to treat cortical dysplasia. She had a history of generalized tonic-clonic seizures since her childhood and was referred to our clinic due to an increase in seizure frequency. EEG and MRI identified the epileptogenic focus in the right parieto-temporal region. The patient underwent a neuro-navigation guided awake craniotomy and an excision of the epileptogenic focus in the right parieto-temporal region. The procedure was carried out using a scalp block and dexmedetomidine for conscious sedation, enabling the patient to remain awake throughout the surgery. Intraoperative mapping and electrocorticography were used for complex multidisciplinary care. Post-resection corticography showed no spikes along the resected margins. The patient was discharged without any complications and remained free of symptoms a year after the surgery. Awake epilepsy surgery is a viable option for removing epileptogenic foci while preserving vital cognitive functions. However, it is seldom used in low- and middle-income countries such as Pakistan. The successful outcome of this case underscores the need for greater awareness and availability of epilepsy surgery in resource-limited settings. Cost-effective measures, such as using small subdural strips for intraoperative localization, can be implemented.
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Affiliation(s)
- Mohammad Hamza Bajwa
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Karachi, Pakistan
| | - Syeda Amrah Hashmi
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Karachi, Pakistan
| | - Abdullah Nisar
- Department of Anesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Waqas Baqai
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Karachi, Pakistan
| | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Karachi, Pakistan
| | | | - Faraz Shafiq
- Department of Anesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Karachi, Pakistan.
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Chikara RK, Jahromi S, Tamilia E, Madsen JR, Stufflebeam SM, Pearl PL, Papadelis C. Electromagnetic source imaging predicts surgical outcome in children with focal cortical dysplasia. Clin Neurophysiol 2023; 153:88-101. [PMID: 37473485 PMCID: PMC10528204 DOI: 10.1016/j.clinph.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/25/2023] [Accepted: 06/15/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of electromagnetic source imaging (EMSI) in localizing spikes and predict surgical outcome in children with drug resistant epilepsy (DRE) due to focal cortical dysplasia (FCD). METHODS We retrospectively analyzed magnetoencephalography (MEG) and high-density (HD-EEG) data from 23 children with FCD-associated DRE who underwent intracranial EEG and surgery. We localized spikes using equivalent current dipole (ECD) fitting, dipole clustering, and dynamical statistical parametric mapping (dSPM) on EMSI, electric source imaging (ESI), and magnetic source imaging (MSI). We calculated the distance from the seizure onset zone (DSOZ) and resection (DRES). We estimated receiver operating characteristic (ROC) curves with Youden's index (J) to predict outcome. RESULTS EMSI presented shorter DSOZ (15.18 ± 9.06 mm) and DRES (8.56 ± 6.24 mm) compared to ESI (DSOZ: 25.04 ± 16.20 mm, p < 0.009; DRES: 18.88 ± 17.30 mm, p < 0.03) and MSI (DSOZ: 23.37 ± 8.98 mm, p < 0.03; DRES: 15.51 ± 10.11 mm, p < 0.02) for clustering in patients with good outcome. Clustering showed shorter DSOZ and DRES compared to ECD fitting and dSPM (p < 0.05). EMSI had higher performance as outcome predictor (J = 70.63%) compared to ESI (J = 41.27%) and MSI (J = 33.33%) for clustering. CONCLUSIONS EMSI provides superior localization and improved predictive performance than individual modalities. SIGNIFICANCE EMSI can help the surgical planning and facilitate the localization of epileptogenic foci.
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Affiliation(s)
- Rupesh Kumar Chikara
- Jane and John Justin Institute for Mind Health, Neuroscience Research, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Saeed Jahromi
- Jane and John Justin Institute for Mind Health, Neuroscience Research, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steve M Stufflebeam
- Athinoula Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Jane and John Justin Institute for Mind Health, Neuroscience Research, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA; School of Medicine, Texas Christian University, Fort Worth, TX, USA.
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Pedersen C, Aboian M, Messina SA, Daldrup-Link H, Franceschi AM. PET/MRI Applications in Pediatric Epilepsy. World J Nucl Med 2023; 22:78-86. [PMID: 37223623 PMCID: PMC10202574 DOI: 10.1055/s-0043-1764303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Epilepsy neuroimaging assessment requires exceptional anatomic detail, physiologic and metabolic information. Magnetic resonance (MR) protocols are often time-consuming necessitating sedation and positron emission tomography (PET)/computed tomography (CT) comes with a significant radiation dose. Hybrid PET/MRI protocols allow for exquisite assessment of brain anatomy and structural abnormalities, in addition to metabolic information in a single, convenient imaging session, which limits radiation dose, sedation time, and sedation events. Brain PET/MRI has proven especially useful for accurate localization of epileptogenic zones in pediatric seizure cases, providing critical additional information and guiding surgical decision making in medically refractory cases. Accurate localization of seizure focus is necessary to limit the extent of the surgical resection, preserve healthy brain tissue, and achieve seizure control. This review provides a systematic overview with illustrative examples demonstrating the applications and diagnostic utility of PET/MRI in pediatric epilepsy.
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Affiliation(s)
- Christian Pedersen
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Mariam Aboian
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Steven A. Messina
- Neuroradiology Division, Department of Radiology, Mayo Clinic Radiology, Rochester, Minnesota, United States
| | - Heike Daldrup-Link
- Department of Radiology and Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Ana M. Franceschi
- Neuroradiology Division, Department of Radiology, Northwell Health/Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
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Cross JH, Reilly C, Gutierrez Delicado E, Smith ML, Malmgren K. Epilepsy surgery for children and adolescents: evidence-based but underused. THE LANCET CHILD & ADOLESCENT HEALTH 2022; 6:484-494. [DOI: 10.1016/s2352-4642(22)00098-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
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7
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Padmanaban V, Baccon J, Acharya J, Sather M. Transmantle focal cortical dysplasia in a patient with drug-resistant epilepsy. BMJ Case Rep 2022; 15:e243983. [PMID: 35232729 PMCID: PMC8889153 DOI: 10.1136/bcr-2021-243983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Varun Padmanaban
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jennifer Baccon
- Department of Pathology and Laboratory Medicine, Akron Children's Hospital, Akron, Ohio, USA
- Department of Pathology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Jayant Acharya
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Michael Sather
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Wan HJ, Hu WH, Wang X, Zhang C, Wang SS, Zheng Z, Zhou F, Sang L, Zhang K, Zhang JG, Shao XQ. Interictal pattern on scalp electroencephalogram predicts excellent surgical outcome of epilepsy caused by focal cortical dysplasia. Epilepsia Open 2022; 7:350-360. [PMID: 35202517 PMCID: PMC9159252 DOI: 10.1002/epi4.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/25/2021] [Accepted: 02/18/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) represents an essential cause of drug-resistant epilepsy with surgery as an effective treatment option. This study aimed to identify the important predictors of favorable surgical outcomes and the impact of the interictal scalp electroencephalogram (EEG) patterns in predicting postsurgical seizure outcomes. METHODS We retrospectively evaluated 210 consecutive patients between 2015 and 2019. They were diagnosed with FCD by pathology, underwent resection, and had at least one year of postsurgical follow-up. Predictors of seizure freedom were analyzed. RESULTS Based on the information at the latest follow-up, seizure outcome was classified as Engel Class I (seizure-free) in 81.4% and Engel Class II-IV (non-seizure-free) in 18.6% of patients. There were 43, 105, and 62 cases of FCD type I, type II, and type III, respectively. The interictal EEG showed a repetitive discharge pattern (REDP) in 87 (41.4%) patients, polyspike discharge pattern (PDP) in 41 (19.5%), and the coexistence of REDP and PDP in the same location in 32 (15.2%) patients. The analyzed patterns in order of frequency were repetitive discharges lasting 5 seconds or more (32.4%); polyspikes (16.7%); RED type 1 (11.4%); continuous epileptiform discharges occupying >80% of the recording (11.4%); RED type 2 (6.2%); brushes (3.3%); focal, fast, continuous spikes (2.4%); focal fast rhythmic epileptiform discharges (1.43%); and frequent rhythmic bursting epileptiform activity (1.4%). The coexistence of REDP and PDP in the same location on scalp EEG and complete resection of the assumed epileptogenic zone (EZ) was independently associated with favorable postsurgical prognosis. SIGNIFICANCE Resective epilepsy surgery for intractable epilepsy caused by FCD has favorable outcomes. Interictal scalp EEG patterns were revealed to be predictive of excellent surgical outcomes and may help clinical decision-making and enable better presurgical evaluation.
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Affiliation(s)
- Hui-Juan Wan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Wen-Han Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Sheng-Song Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Feng Zhou
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
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Zhang L, Zhou H, Zhang W, Ling X, Zeng C, Tang Y, Gan J, Tan Q, Hu X, Li H, Cheng B, Xu H, Guo Q. Electroclinical and Multimodality Neuroimaging Characteristics and Predictors of Post-Surgical Outcome in Focal Cortical Dysplasia Type IIIa. Front Bioeng Biotechnol 2022; 9:810897. [PMID: 35083208 PMCID: PMC8784525 DOI: 10.3389/fbioe.2021.810897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Focal cortical dysplasia (FCD) type IIIa is an easily ignored cause of intractable temporal lobe epilepsy. This study aimed to analyze the clinical, electrophysiological, and imaging characteristics in FCD type IIIa and to search for predictors associated with postoperative outcome in order to identify potential candidates for epilepsy surgery. We performed a retrospective review including sixty-six patients with FCD type IIIa who underwent resection for drug-resistant epilepsy. We evaluated the clinical, electrophysiological, and neuroimaging features for potential association with seizure outcome. Univariate and multivariate analyses were conducted to explore their predictive role on the seizure outcome. We demonstrated that thirty-nine (59.1%) patients had seizure freedom outcomes (Engel class Ia) with a median postsurgical follow-up lasting 29.5 months. By univariate analysis, duration of epilepsy (less than 12 years) (p = 0.044), absence of contralateral insular lobe hypometabolism on PET/MRI (pLog-rank = 0.025), and complete resection of epileptogenic area (pLog-rank = 0.004) were associated with seizure outcome. The incomplete resection of the epileptogenic area (hazard ratio = 2.977, 95% CI 1.218–7.277, p = 0.017) was the only independent predictor for seizure recurrence after surgery by multivariate analysis. The results of past history, semiology, electrophysiological, and MRI were not associated with seizure outcomes. Carefully included patients with FCD type IIIa through a comprehensive evaluation of their clinical, electrophysiological, and neuroimaging characteristics can be good candidates for resection. Several preoperative factors appear to be predictive of the postoperative outcome and may help in optimizing the selection of ideal candidates to benefit from epilepsy surgery.
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Affiliation(s)
- Lingling Zhang
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Hailing Zhou
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wei Zhang
- Epilepsy Center, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Xueying Ling
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chunyuan Zeng
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yongjin Tang
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiefeng Gan
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qinghua Tan
- Epilepsy Center, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Xiangshu Hu
- Epilepsy Center, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Hainan Li
- Department of Pathology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Baijie Cheng
- Department of Pathology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Hao Xu
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qiang Guo
- Epilepsy Center, Guangdong 999 Brain Hospital, Guangzhou, China
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Pelliccia V, Deleo F, Gozzo F, Giovannelli G, Mai R, Cossu M, Tassi L. Early epilepsy surgery for non drug-resistant patients. Epilepsy Behav Rep 2022; 19:100542. [PMID: 35573058 PMCID: PMC9096667 DOI: 10.1016/j.ebr.2022.100542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Absence of drug-resistance is predictor of better post-surgical outcome. Post-surgical outcome in non drug-resistant patients is favourable irrespective of both the localization of surgery and the histological diagnosis. Non drug-resistant patients who underwent epilepsy surgery are more likely to successfully discontinue ASMs.
The aim of epilepsy treatment is to achieve seizure freedom. Surgery is often still considered a late option when pharmacological treatments have failed and epilepsy has become drug-resistant. We analyse the clinical features and surgical outcome in patients who underwent surgery without experiencing drug-resistance comparing with those observed in patients who became drug-resistant. Two-hundred and fifty patients with symptomatic focal epilepsy (12.1% of patients who underwent surgery at the “Claudio Munari” Epilepsy Surgery Center) were selected on the basis of initial period of seizure freedom and followed-up for at least 12 months. Patients were divided into two groups: those who underwent surgery during the initial period of seizure freedom (n = 74), and those who underwent surgery after an initial seizure-free period followed by drug-resistance (n = 176). Outcomes were significantly better in non-drug-resistant patients (p < 0.001), all of whom had Engel class Ia or Ic. In the drug-resistant group, 136 patients (77.3%) had class Ia or Ic. The median post-operative follow-up was respectively 75.0 and 84.0 months. Epilepsy surgery is a successful treatment, especially for non-drug-resistant patients with focal epilepsy with structural etiology. The timing of surgery affects the outcomes, and “early” surgery should be preferred to prevent likely drug-resistance and to improve prognosis.
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Affiliation(s)
- Veronica Pelliccia
- ”Claudio Munari” Epilepsy Surgery Center, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Francesco Deleo
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS, Istituto Neurologico “C. Besta”, Via Celoria 11, 20133 Milano, Italy
| | - Francesca Gozzo
- ”Claudio Munari” Epilepsy Surgery Center, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Ginevra Giovannelli
- ”Claudio Munari” Epilepsy Surgery Center, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
- Neurology and Stroke Unit, Careggi Hospital, Florence, Italy
| | - Roberto Mai
- ”Claudio Munari” Epilepsy Surgery Center, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Massimo Cossu
- ”Claudio Munari” Epilepsy Surgery Center, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Laura Tassi
- ”Claudio Munari” Epilepsy Surgery Center, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
- Corresponding author at: “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy.
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Radiofrequency thermocoagulation of the sulcus bottom in type II focal cortical dysplasia-related epilepsy with tapered implantation of electrodes: a case report. Acta Neurochir (Wien) 2021; 163:3045-3050. [PMID: 34499250 DOI: 10.1007/s00701-021-04998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
We report a 15-year-old male patient with recurrent epileptic seizures for 12 years. Oral multiple drugs do not work well to his condition. MRI FLAIR scans revealed focal cortical dysplasia type II in the right parietal lobe. The diagnosis of the patient was drug-refractory epilepsy, FCD-related secondary epilepsy. According to the shape of the FCD lesion, electrodes were implanted in a tapered pattern along the bottom of the sulcus to completely destroy the focus. Magnetic resonance imaging at 6 months after surgery revealed that the FCD at the sulcus bottom was completely destroyed. After 26 months of follow-up, the patient had undergone no epileptic seizures, reaching Engel class I. For FCD that are located deep in the brain and adjacent to functional areas, craniotomy has a high risk. And stereoelectroencephalography-guided radiofrequency thermocoagulation may be a preferred treatment.
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Castagno S, D'Arco F, Tahir MZ, Battey H, Eltze C, Moeller F, Tisdall M. Seizure outcomes of large volume temporo-parieto-occipital and frontal surgery in children with drug-resistant epilepsy. Epilepsy Res 2021; 177:106769. [PMID: 34560348 DOI: 10.1016/j.eplepsyres.2021.106769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In this study, we investigate the seizure outcomes of temporo-parieto-occipital (TPO) and frontal disconnections or resections in children with drug-resistant epilepsy (DRE) in order to determine factors which may predict surgical results. METHODS Children with DRE, who underwent either TPO or frontal disconnection or resection at Great Ormond Street Hospital for Children between 2000 and 2017, were identified from a prospectively collated operative database. Demographic data, age at surgery, type of surgery, scalp EEGs and operative histopathology were collected. Magnetic resonance imaging (MRI) was assessed to determine completeness of disconnection and presence of radiological lesion beyond the disconnection margins. Seizure outcome at 6, 12, and 24 months post-surgery was assessed using the Engel Scale (ES). Logistic regression was used to identify relationships between data variables and seizure outcome. RESULTS 46 children (males = 28, females = 18; age range 0.5-16.6 years) who underwent TPO (n = 32, including a re-do disconnection) or frontal disconnection or resection (n = 15) were identified. Patients in the TPO treatment group had more favourable seizure outcomes than those in the frontal treatment group (ES I-II in 56 %vs 47 % at 6 months, 52 % vs 46 % at 12 months). Presence of the lesion beyond disconnection boundaries and older age at the time of surgery were associated with poorer seizure outcome. Gender, surgery type, completeness of disconnection, scalp EEG findings and underlying pathology were not related to seizure outcome, but subgroup numbers were small. CONCLUSIONS Both TPO and frontal disconnection are effective treatments for selected children with posterior multi-lobar or diffuse frontal lobe epilepsy. Confinement of the MRI lesion within the disconnection margins and a younger age at surgery are associated with favourable seizure outcomes. Further studies are required to elucidate these findings.
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Affiliation(s)
| | - Felice D'Arco
- Great Ormond Street Hospital, Department of Radiology, London, WC1N 3JH, United Kingdom
| | - M Zubair Tahir
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
| | - Heather Battey
- Imperial College London, Department of Mathematics, London, SW7 2AZ, United Kingdom
| | - Christin Eltze
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Friederike Moeller
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Martin Tisdall
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
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13
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Niyas S, Chethana Vaisali S, Show I, Chandrika T, Vinayagamani S, Kesavadas C, Rajan J. Segmentation of focal cortical dysplasia lesions from magnetic resonance images using 3D convolutional neural networks. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Bdaiwi AS, Greiner HM, Leach J, Mangano FT, DiFrancesco MW. Categorizing cortical dysplasia lesions for surgical outcome using network functional connectivity. J Neurosurg Pediatr 2021; 28:600-608. [PMID: 34450591 DOI: 10.3171/2021.5.peds20990] [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: 12/23/2020] [Accepted: 05/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is often associated with drug-resistant epilepsy, leading to a recommendation to surgically remove the seizure focus. Predicting outcome for resection of FCD is challenging, requiring a new approach. Lesion-symptom mapping is a powerful and broadly applicable method for linking neurological symptoms or outcomes to damage to particular brain regions. In this work, the authors applied lesion network mapping, an expansion of the traditional approach, to search for the association of lesion network connectivity with surgical outcomes. They hypothesized that connectivity of lesion volumes, preoperatively identified by MRI, would associate with seizure outcomes after surgery in a pediatric cohort with FCD. METHODS This retrospective study included 21 patients spanning the ages of 3 months to 17.7 years with FCD lesions who underwent surgery for drug-resistant epilepsy. The mean brain-wide functional connectivity map of each lesion volume was assessed across a database of resting-state functional MRI data from healthy children (spanning approximately 2.9 to 18.9 years old) compiled at the authors' institution. Lesion connectivity maps were averaged across age and sex groupings from the database and matched to each patient. The authors sought to associate voxel-wise differences in these maps with subject-specific surgical outcome (seizure free vs persistent seizures). RESULTS Lesion volumes with persistent seizures after surgery tended to have stronger connectivity to attention and motor networks and weaker connectivity to the default mode network compared with lesion volumes with seizure-free surgical outcome. CONCLUSIONS Network connectivity-based lesion-outcome mapping may offer new insight for determining the impact of lesion volumes discerned according to both size and specific location. The results of this pilot study could be validated with a larger set of data, with the ultimate goal of allowing examination of lesions in patients with FCD and predicting their surgical outcomes.
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Affiliation(s)
- Abdullah S Bdaiwi
- 1Department of Physics, University of Cincinnati, Cincinnati.,5Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati; and
| | - Hansel M Greiner
- 2Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati
| | - James Leach
- 3Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Francesco T Mangano
- 4Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Mark W DiFrancesco
- 5Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati; and.,6Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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15
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Jayalakshmi S, Vooturi S, Vadapalli R, Madigubba S, Panigrahi M. Predictors of surgical outcome in focal cortical dysplasia and its subtypes. J Neurosurg 2021; 136:512-522. [PMID: 34330093 DOI: 10.3171/2020.12.jns203385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors analyzed predictors of surgical outcome in patients with focal cortical dysplasia (FCD) and its ILAE (International League Against Epilepsy) subtypes after noninvasive multimodal evaluation and calculated time to first seizure. METHODS Data of 355 patients with refractory epilepsy, confirmed FCD pathology, and 2-13 years of postsurgical follow-up were analyzed to determine the predictive roles of clinical, EEG, imaging, and surgical factors that influence seizure freedom. RESULTS The mean ± SD age at surgery was 20.26 ± 12.18 years. In total, 142 (40.0%) patients had daily seizures and 90 (25.3%) had multiple seizure types. MRI showed clear-cut FCD in 289 (81.4%) patients. Pathology suggested type I FCD in 27.3% of patients, type II in 28.4%, and type III in 42.8% of patients. At latest follow-up, 72.1% of patients were seizure free and 11.8% were seizure free and not receiving antiepileptic drugs. Among the subtypes, 88.8% of patients with type III, 69.3% with type II, and 50.5% with type I FCD were seizure free. Multiple seizure types, acute postoperative seizures (APOS), and type I FCD were predictors of persistent seizures, whereas type III FCD was the strongest predictor of seizure freedom. Type I FCD was associated with daily seizures, frontal and multilobar distribution, subtle findings on MRI, incomplete resection, and persistent seizures. Type II and III FCD were associated with clear-cut lesion on MRI, regional interictal and ictal EEG onset pattern, focal pattern on ictal SPECT, complete resection, and seizure freedom. Type III FCD was associated with temporal location, whereas type I and II FCD were associated with extratemporal location. Nearly 80% of patients with persistent seizures, mostly those with type I FCD, had their first seizure within 6 months postsurgery. CONCLUSIONS Long-term seizure freedom after surgery can be achieved in more than two-thirds of patients with FCD after noninvasive multimodal evaluation. Multiple seizure types, type I FCD, and APOS were predictors of persistent seizures. Seizures recurred in about 80% of patients within 6 months postsurgery.
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Affiliation(s)
| | | | | | | | - Manas Panigrahi
- 4Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, India
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16
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Abstract
INTRODUCTION Focal cortical dysplasias (FCDs) represent the most common etiology in pediatric drug-resistant focal epilepsies undergoing surgical treatment. The localization, extent and histopathological features of FCDs are considerably variable. Somatic mosaic mutations of genes that encode proteins in the PI3K-AKTmTOR pathway, which also includes the tuberous sclerosis associated genes TSC1 and TSC2, have been implicated in FCD type II in a substantial subset of patients. Surgery is the principal therapeutic option for FCD-related epilepsy. Advanced neurophysiological and neuroimaging techniques have improved surgical outcome and reduced the risk of postsurgical deficits. Pharmacological MTOR inhibitors are being tested in clinical trials and might represent an example of personalized treatment of epilepsy based on the known mechanisms of disease, used alone or in combination with surgery. AREAS COVERED This review will critically analyze the advances in the diagnosis and treatment of FCDs, with a special focus on the novel therapeutic options prompted by a better understanding of their pathophysiology. EXPERT OPINION Focal cortical dysplasia is a main cause of drug-resistant epilepsy, especially in children. Novel, personalized approaches are needed to more effectively treat FCD-related epilepsy and its cognitive consequences.
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Affiliation(s)
- Renzo Guerrini
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
| | - Carmen Barba
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
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17
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Mendes Coelho VC, Morita-Sherman M, Yasuda CL, Alvim MMK, Amorim BJ, Tedeschi H, Ghizoni E, Rogerio F, Cendes F. Magnetic resonance imaging findings and clinical characteristics in mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy in a predominantly adult cohort. Epilepsia 2021; 62:1429-1441. [PMID: 33884614 DOI: 10.1111/epi.16907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aimed to better characterize the magnetic resonance imaging (MRI) findings of mild malformation of cortical development with oligodendroglial hyperplasia (MOGHE), a rare clinicopathological entity associated with pharmacoresistance recently described in patients with frontal lobe epilepsy. METHODS We studied 12 patients who underwent epilepsy surgery and whose surgical specimens showed histopathological findings of MOGHE, characterized by preserved cortical lamination, blurred gray-white matter interface due to increased number of oligodendrocytes, and heterotopic neurons in the white matter. The age at MRI evaluation ranged from 11 to 58 years, except for one 4.5-year-old patient. RESULTS Following a detailed MRI analysis using an in-house protocol, we found abnormalities in all cases. The lesion was circumscribed in the frontal lobe in six (50%) and in the temporal lobe in three (25%) patients. In the remaining three patients (25%), the lesion was multilobar (frontotemporal and temporoparieto-occipital). Cortical thickening was mild in all patients, except in the 4.5-year-old patient, who had pronounced cortical thickening and white matter blurring. We also identified cortical/subcortical hyperintense T2/fluid-attenuated inversion recovery signal associated with gray/white matter blurring in all but one patient. When present, cleft cortical dimple, and deep sulci aided in localizing the lesion. Overall, the MRI findings were like those in focal cortical dysplasia (FCD) Type IIa. Surgical outcome was excellent in five patients (Engel Class I in 25% and II in 17%). The remaining seven patients (58%) had worthwhile seizure reduction (Engle Class III). Incomplete lesion resection was significantly associated with worse outcomes. SIGNIFICANCE MRI findings associated with MOGHE are similar to those described in FCD Type IIa. Although more frequent in the frontal lobe, MOGHE also occurred in the temporal lobe or involved multiple lobes. Multilobar or extensive MOGHE MRI lesions are associated with less favorable surgical outcomes. Because this is a rare condition, multicenter studies are necessary to characterize MOGHE further.
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Affiliation(s)
| | - Marcia Morita-Sherman
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil.,Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Clarissa L Yasuda
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Marina M K Alvim
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, University of Campinas, Campinas, São Paulo, Brazil
| | - Helder Tedeschi
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Enrico Ghizoni
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Fabio Rogerio
- Department of Pathology, University of Campinas, Campinas, São Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
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18
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Mathon B, Clemenceau S, Carpentier A. Intraoperative Ultrasound Shear-Wave Elastography in Focal Cortical Dysplasia Surgery. J Clin Med 2021; 10:jcm10051049. [PMID: 33802551 PMCID: PMC7961510 DOI: 10.3390/jcm10051049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/15/2021] [Accepted: 02/28/2021] [Indexed: 12/31/2022] Open
Abstract
Previous studies reported interest in intraoperative shear-wave elastography (SWE) guidance for brain-tumor and epilepsy surgeries. Focal cortical dysplasia (FCD) surgery is one of the most appropriate indications for using SWE guidance. The aim of this study was to evaluate the efficacy of ultrasound SWE techniques for the intraoperative detection of FCDs. We retrospectively analyzed data from 18 adult patients with drug-resistant epilepsy associated with FCD who had undergone SWE-guided surgery. Conventional B-mode images detected FCD in 2 patients (11.1%), while SWE detected FCD in 14 patients (77.8%). The stiffness ratios between MRI-positive and -negative cases were significantly different (3.6 ± 0.4 vs. 2.2 ± 0.6, respectively; p < 0.001). FCDs were significantly more frequently detected by interoperative SWE in women (OR 4.7, 95% CI (1.7–12.7); p = 0.004) and in patients in whom FCD was visible on magnetic resonance imaging (MRI; OR 2.3, 95% CI (1.3–4.3); p = 0.04). At 1 year after surgery and at last follow-up (mean = 21 months), seizure outcome was good (International League Against Epilepsy (ILAE) Class 1 or 2) in 72.2% and 55.6% of patients, respectively. Despite some limitations, our study highlighted the potential of SWE as an intraoperative tool to detect FCD. Future technical developments should allow for optimizing intraoperative surgical-cavity evaluation from the perspective of complete FCD resection. Interobserver reliability of SWE measurements should also be assessed by further studies.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (S.C.); (A.C.)
- Faculty of Medicine, Sorbonne University, 75005 Paris, France
- Paris Brain Institute (ICM, INSERM, UMRS 1127, CNRS, UMR 7225), 75013 Paris, France
- Correspondence: ; Tel.: +33-1-4216-3408
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (S.C.); (A.C.)
| | - Alexandre Carpentier
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (S.C.); (A.C.)
- Faculty of Medicine, Sorbonne University, 75005 Paris, France
- Paris Brain Institute (ICM, INSERM, UMRS 1127, CNRS, UMR 7225), 75013 Paris, France
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19
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David B, Kröll-Seger J, Schuch F, Wagner J, Wellmer J, Woermann F, Oehl B, Van Paesschen W, Breyer T, Becker A, Vatter H, Hattingen E, Urbach H, Weber B, Surges R, Elger CE, Huppertz HJ, Rüber T. External validation of automated focal cortical dysplasia detection using morphometric analysis. Epilepsia 2021; 62:1005-1021. [PMID: 33638457 DOI: 10.1111/epi.16853] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Focal cortical dysplasias (FCDs) are a common cause of drug-resistant focal epilepsy but frequently remain undetected by conventional magnetic resonance imaging (MRI) assessment. The visual detection can be facilitated by morphometric analysis of T1-weighted images, for example, using the Morphometric Analysis Program (v2018; MAP18), which was introduced in 2005, independently validated for its clinical benefits, and successfully integrated in standard presurgical workflows of numerous epilepsy centers worldwide. Here we aimed to develop an artificial neural network (ANN) classifier for robust automated detection of FCDs based on these morphometric maps and probe its generalization performance in a large, independent data set. METHODS In this retrospective study, we created a feed-forward ANN for FCD detection based on the morphometric output maps of MAP18. The ANN was trained and cross-validated on 113 patients (62 female, mean age ± SD =29.5 ± 13.6 years) with manually segmented FCDs and 362 healthy controls (161 female, mean age ± SD =30.2 ± 9.6 years) acquired on 13 different scanners. In addition, we validated the performance of the trained ANN on an independent, unseen data set of 60 FCD patients (28 female, mean age ± SD =30 ± 15.26 years) and 70 healthy controls (42 females, mean age ± SD = 40.0 ± 12.54 years). RESULTS In the cross-validation, the ANN achieved a sensitivity of 87.4% at a specificity of 85.4% on the training data set. On the independent validation data set, our method still reached a sensitivity of 81.0% at a comparably high specificity of 84.3%. SIGNIFICANCE Our method shows a robust automated detection of FCDs and performance generalizability, largely independent of scanning site or MR-sequence parameters. Taken together with the minimal input requirements of a standard T1 image, our approach constitutes a clinically viable and useful tool in the presurgical diagnostic routine for drug-resistant focal epilepsy.
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Affiliation(s)
- Bastian David
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Fabiane Schuch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.,Department of Neurology, St. Johannes Hospital Troisdorf, Germany
| | - Jan Wagner
- Department of Neurology, University Clinic Ulm, Ulm, Germany
| | - Jörg Wellmer
- Department of Neurology, Ruhr-Epileptology, University Hospital Knappschaftskrankenhaus, Ruhr-University, Bochum, Germany
| | - Friedrich Woermann
- Epilepsy Center Bethel, Mara Hospital & Society for Epilepsy Research, Bielefeld, Germany
| | | | - Wim Van Paesschen
- Laboratory for Epilepsy Research, Department of Neurology, University Hospitals and KU Leuven, Leuven, Belgium
| | - Tobias Breyer
- Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Horst Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | | | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.,Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Frankfurt am Main, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
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20
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Wang P, Du F, Li J, Yu H, Tang C, Jiang R. Functional magnetic resonance imaging based on Chinese tasks to protect language function in epileptics. Brain Behav 2021; 11:e01979. [PMID: 33377600 PMCID: PMC7882180 DOI: 10.1002/brb3.1979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of functional magnetic resonance imaging (fMRI) based on Chinese tasks to protect the language function in epileptics. MATERIALS AND METHODS A total of 34 native Chinese patients with epilepsy were enrolled and examined with BOLD-fMRI scan based on six Chinese tasks. The epileptics were randomly divided into the control group (n = 15) and the experimental group (n = 19). The control group underwent the hollowing and multiple subpial transection operation only based on intraoperative EEG, while the experimental group was under notification of task-state fMRI results in addition. Whereafter, the language ability of patients was evaluated by ABC assessment. RESULTS The brain regions related to Chinese function activated by different tasks were remarkably distinct and mainly concentrated in the temporal lobe and frontal lobe. In ontoanalysis, the activation signals of the fusiform gyrus, parahippocampal gyrus, hippocampus, and precentral gyrus were generally low or even could not be detected. Unlike ontoanalysis, group analysis showed that the main effect regions of AN and PN task were in right superior temporal gyrus. The main effect regions of FF and VFC task were in right middle temporal gyrus. The main effect region of SF task was in left superior temporal gyrus. The main effect region of VFL task was in right middle frontal gyrus. The ABC assessment score of the control group 6 months after surgery was significantly lower than that 1 week before surgery (p < .05), while there was no significant difference in the experimental group, and the score of the experimental group was higher than that of the control group. CONCLUSION In the surgical treatment of epilepsy, a personalized surgical plan, based on task-state fMRI and intraoperative EEG, can be developed according to the difference of activation areas to protect the language function and improve the quality of life in postoperative patients.
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Affiliation(s)
- Peng Wang
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Feizhou Du
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Jianhao Li
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Hongmei Yu
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Chencheng Tang
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Rui Jiang
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, China
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21
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Prada F, Gennari AG, Quaia E, D'Incerti L, de Curtis M, DiMeco F, Tringali G. Advanced intraoperative ultrasound (ioUS) techniques in focal cortical dysplasia (FCD) surgery: A preliminary experience on a case series. Clin Neurol Neurosurg 2020; 198:106188. [PMID: 32956988 DOI: 10.1016/j.clineuro.2020.106188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Focal Cortical Dysplasia (FCD) represents a broad spectrum of histopathological entities that cause drug-resistant epilepsy. Surgery has been shown to be the treatment of choice, but incomplete resection represents the leading cause of seizure persistence. Preliminary experiences with intraoperative ultrasound (ioUS) have proven its potential in defining and characterizing the lesion. In this study we analyzed the feasibility of advanced ultrasound techniques such as sono-elastography (SE) and contrast enhancement ultrasound (CEUS) in a small cohort of patients with FCD. MATERIAL AND METHODS We retrospectively reviewed all clinical records and images of patients with drug resistant epilepsy who underwent at least one advanced sonographic technique (SE and/or CEUS) during ioUS guided surgery between November 2014 and October 2017. We excluded from our analysis all patients with lesions other than FCD or those who had FCD associated with other pathological entities. RESULTS Four patients with type IIb FCD in the right frontal lobe were evaluated. All of them underwent SE, which highlighted heterogeneous stiffness in the dysplastic foci, also multiple areas of higher consistency were detected in all patients. Three patients evaluated with CEUS had visible enhancement in the FCD. Neither SE nor CEUS were better than ioUS in the identification of lesion boundaries. In the three patients who underwent both SE and CEUS we found no correspondence between stiffer areas and enhancement in the dysplastic areas. CONCLUSION Ourpreliminary report confirms the feasibility of SE and CEUS in FCD surgery and describes the imaging findings in this category of patients. Studies on larger cohorts of patients are warranted to better clarify the role of these advanced intraoperative ultrasound techniques in patients with FCD.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy; Department of Neurological Surgery, University of Virginia Virginia Health Science Center, Charlottesville, Virginia, USA.
| | - Antonio Giulio Gennari
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy; Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Emilio Quaia
- Department of Radiology, University of Padova, Via Giustiniani, Padova, Italy
| | - Ludovico D'Incerti
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
| | - Marco de Curtis
- Department of Neurology, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy; Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland, USA; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Tringali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
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22
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Kwon HE, Kim HD. Recent Aspects of Pediatric Epilepsy Surgery. J Epilepsy Res 2020; 9:87-92. [PMID: 32509543 PMCID: PMC7251342 DOI: 10.14581/jer.19010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 05/30/2019] [Accepted: 06/30/2019] [Indexed: 12/14/2022] Open
Abstract
Surgery has been and is now a well-established treatment indicated for adults and children with drug-resistant epilepsy (DRE). The surgical landscape for children with DRE appears to be expanding, and surgical cases of pediatric epilepsy have increased significantly in the past decade, contrary to adult epilepsy. Several fundamental changes have led to the widespread surgical treatment for DRE in children, based on a risk-benefit analysis of pediatric epilepsy surgery, and a change in our overall approach to evaluation. There are unique and age-related differences associated with pediatric epilepsy surgery, characterized by different types of etiologies, concerns for developmental progress, and safety issues. Indications for “pediatric epilepsy surgery” have been broadened to include a wide spectrum of etiologies without excluding children with “generalized” seizures, “generalized or multifocal eletroencephlography”, or patients with contra-lateral epileptiform activity or magnetic resonance imaging abnormalities. Furthermore, epilepsy surgery is increasingly considered in infancy and early childhood, which has similar surgical outcomes as the case of late childhood, in an effort to improve the eventual development outcome. Seizure freedom, or at least seizure reduction, is an excellent result with resolution of the associated epileptic encephalopathy, normalization of the EEG, and decrease in the total epileptic burden in the pediatric field.
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Affiliation(s)
- Hye Eun Kwon
- Department of Pediatrics, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Pediatric Epilepsy Clinic, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Farhat S, Darwish H, Nasreddine W, Salame J, Beydoun A. A Surgical Case of Complete Resection of the Focal Cortical and Subcortical Dysplasia in the Motor Cortex. World Neurosurg 2019; 132:93-98. [PMID: 31491580 DOI: 10.1016/j.wneu.2019.08.181] [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] [Received: 05/28/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Focal cortical dysplasias (FCDs) are highly epileptogenic and frequently associated with medically refractory focal epilepsy. FCDs are frequently located in the frontal lobe, making its complete resection highly challenging when in proximity to the motor cortex. CASE DESCRIPTION We report a case of a 25-year-old woman with medically refractory epilepsy secondary to a focal cortical dysplasia in the motor cortex and extending deeply into the subcortical white matter. A detailed presurgical evaluation and invasive electroencephalographic monitoring performed at our epilepsy monitoring unit, along with the use of motor mapping, functional magnetic resonance imaging, diffusion tensor imaging, and the Stealth navigation system resulted in the complete resection of the lesion without a permanent postoperative motor deficit. The patient remained seizure-free at a 63-month follow-up while being maintained on a single antiepileptic drug. CONCLUSION A detailed presurgical evaluation, accurate mapping of the functional and dysplastic cortex, and a well-planned tailored and complete surgical resection of the cortical dysplasia can result in a favorable outcome with relatively little risk of postoperative neurologic deficit.
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Affiliation(s)
- Sahar Farhat
- Comprehensive Epilepsy Program, Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Houssein Darwish
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Nasreddine
- Comprehensive Epilepsy Program, Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph Salame
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Beydoun
- Comprehensive Epilepsy Program, Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
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Blustajn J, Krystal S, Taussig D, Ferrand-Sorbets S, Dorfmüller G, Fohlen M. Optimizing the Detection of Subtle Insular Lesions on MRI When Insular Epilepsy Is Suspected. AJNR Am J Neuroradiol 2019; 40:1581-1585. [PMID: 31371357 DOI: 10.3174/ajnr.a6143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Abstract
Insular epilepsy is underdiagnosed and accounts for a number of failed operations. Identifying insular target lesions on MR imaging can help guide intracranial electroencephalography and improve the outcome of surgery. In this study, we present a novel method of exploring the insular region for subtle lesions on 3D MR imaging by MPR postprocessing of slices in oblique reference planes. Using this method, we retrospectively reviewed presurgical MRIs that were initially considered to have normal findings in 7 pediatric patients with intractable insular epilepsy. Insular epilepsy was confirmed in these patients on stereo-electroencephalography and histopathology. The MPR postprocessing method we describe helped detect subtle insular lesions in all 7 patients.
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Affiliation(s)
- J Blustajn
- From the Diagnostic Neuroradiology Department (J.B., S.K.)
| | - S Krystal
- From the Diagnostic Neuroradiology Department (J.B., S.K.)
| | - D Taussig
- Pediatric Neurosurgery Department (D.T., S.F.-S., G.D., M.F.), Rothschild Foundation Hospital, Paris, France
| | - S Ferrand-Sorbets
- Pediatric Neurosurgery Department (D.T., S.F.-S., G.D., M.F.), Rothschild Foundation Hospital, Paris, France
| | - G Dorfmüller
- Pediatric Neurosurgery Department (D.T., S.F.-S., G.D., M.F.), Rothschild Foundation Hospital, Paris, France
| | - M Fohlen
- Pediatric Neurosurgery Department (D.T., S.F.-S., G.D., M.F.), Rothschild Foundation Hospital, Paris, France.
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25
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Automatic detection and localization of Focal Cortical Dysplasia lesions in MRI using fully convolutional neural network. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2019.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Jayalakshmi S, Nanda SK, Vooturi S, Vadapalli R, Sudhakar P, Madigubba S, Panigrahi M. Focal Cortical Dysplasia and Refractory Epilepsy: Role of Multimodality Imaging and Outcome of Surgery. AJNR Am J Neuroradiol 2019; 40:892-898. [PMID: 31000525 DOI: 10.3174/ajnr.a6041] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Focal cortical dysplasia (FCD) is one of the most common causes of drug resistant epilepsy. Our aim was to evaluate the role of presurgical noninvasive multimodality imaging techniques in selecting patients with refractory epilepsy and focal cortical dysplasia for epilepsy surgery and the influence of the imaging modalities on long-term seizure freedom. MATERIALS AND METHODS We performed a retrospective analysis of data of 188 consecutive patients with FCD and refractory epilepsy with at least 2 years of postsurgery follow-up. Predictors of seizure freedom and the sensitivity of neuroimaging modalities were analyzed. RESULTS MR imaging showed clear-cut FCD in 136 (72.3%) patients. Interictal FDG-PET showed focal hypo-/hypermetabolism in 144 (76.6%); in 110 patients in whom ictal SPECT was performed, focal hyperperfusion was noted in 77 (70.3%). Focal resection was the most common surgery performed in 112 (59.6%). Histopathology revealed FCD type I in 102 (54.3%) patients. At last follow-up, 124 (66.0%) were seizure-free. Complete resection of FCD and type II FCD were predictors of seizure freedom. Localization of FCD on either MR imaging or PET or ictal SPECT had the highest sensitivity for seizure freedom at 97.5%. Among individual modalities, FDG-PET had the highest sensitivity (78.2%), followed by MR imaging (75.8%) and ictal SPECT (71.8%). The sensitivity of MR imaging to localize type I FCD (60.8%) was significantly lower than that for type II FCD (84.8%, P < .001). Among 37 patients with subtle MR imaging findings and a focal FDG-PET pattern, 30 patients had type I FCD. CONCLUSIONS During presurgical multimodality evaluation, localization of the extent of the epileptogenic zone in at least 2 imaging modalities helps achieve seizure freedom in about two-thirds of patients with refractory epilepsy due to FCD. FDG-PET is the most sensitive imaging modality for seizure freedom, especially in patients with type I FCD.
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Affiliation(s)
- S Jayalakshmi
- From the Departments of Neurology (S.J., S.K.N., S.V.)
| | - S K Nanda
- From the Departments of Neurology (S.J., S.K.N., S.V.)
| | - S Vooturi
- From the Departments of Neurology (S.J., S.K.N., S.V.)
| | | | | | | | - M Panigrahi
- Neurosurgery (M.P.), Krishna Institute of Medical Sciences, Secunderabad, India
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Kuroda N, Fujimoto A, Enoki H, Arai Y, Okanishi T. A case of focal cortical dysplasia type Ib atypically showing reversible intensity changes on magnetic resonance imaging which could be affected by epileptic discharge activity. Childs Nerv Syst 2019; 35:883-887. [PMID: 30810857 DOI: 10.1007/s00381-019-04093-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
Focal cortical dysplasia (FCD) was first described as a distinct neuropathological entity in 1971 by Taylor and colleagues. FCD is thought to be an embryological migration disorder and is thus considered a non-progressive, unchangeable disease throughout life. A 9-year-old right-handed boy was referred from a local hospital for medically intractable epileptic seizures. Serial magnetic resonance images (MRI) showed intensity changes that indicated exacerbation and remission. After presurgical evaluations including intracranial video-electroencephalogram monitoring, we performed a lesionectomy aided by MRI and epileptic focus resection. He has been free from seizures for more than 3 years. Neuropathological findings showed FCD type Ib. We surgically treated a patient with FCD, which showed MRI intensity changes indicating exacerbation and remission. Although FCD type Ib is generally invisible on MRI, in this patient, changes in intensity on MRI made FCD type Ib visible.
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Affiliation(s)
- Naoto Kuroda
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan.
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Yoshifumi Arai
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
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28
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Choi SA, Kim KJ. The Surgical and Cognitive Outcomes of Focal Cortical Dysplasia. J Korean Neurosurg Soc 2019; 62:321-327. [PMID: 31085958 PMCID: PMC6514316 DOI: 10.3340/jkns.2019.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/26/2019] [Indexed: 11/27/2022] Open
Abstract
Focal cortical dysplasia (FCD) is the major cause of intractable focal epilepsy in childhood leading to epilepsy surgery. The overall seizure freedom after surgery ranges between 50–75% at 2 years after surgery and the long-term seizure freedom remain relatively stable. Seizure outcome after surgery depends on a various factors such as pathologic etiologies, extent of lesion, and types of surgery. Therefore, seizure outcome after surgery for FCD should be analyzed carefully considering cohorts’ characteristics. Studies of pediatric epilepsy surgery emphasize the early surgical intervention for a better cognition. Early surgical intervention and cessation of seizure activity are important for children with intractable epilepsy. However, there are limited data on the cognitive outcome after surgery in pediatric FCD, requiring further investigation. This paper reviews the seizure and cognitive outcomes of epilepsy surgery for FCD in children. Several prognostic factors influencing seizure outcome after surgery will be discussed in detail.
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Affiliation(s)
- Sun Ah Choi
- Department of Pediatrics, Dankook University Hospital, Cheonan, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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29
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Prada F, Gennari AG, Del Bene M, Bono BC, Quaia E, D'Incerti L, Villani F, Didato G, Tringali G, DiMeco F. Intraoperative ultrasonography (ioUS) characteristics of focal cortical dysplasia (FCD) type II b. Seizure 2019; 69:80-86. [PMID: 30999253 DOI: 10.1016/j.seizure.2019.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Focal cortical dysplasia (FCD) is one of the major causes of drug-resistant epilepsy. Surgery has proved to be the treatment of choice, however up to a third of patients experience only partial resection. Ill-defined borders and lesions embedded in eloquent areas are two of the main drawbacks of FCD surgery. Preliminary experiences with intraoperative ultrasound (ioUS) have proved its feasibility and potential. We analyzed FCD' ioUS findings in our patients with FCD and compared them with magnetic resonance (MRI) ones. METHODS We retrospectively reviewed all records of patients with focal medically refractory epilepsy who underwent ioUS guided surgery between November 2014 and October 2017. Lesions other than FCD or FCD associated with other pathological entities were not considered. Patients' preoperative MRI and ioUS features were analyzed according to up-to-date literature and than compared. RESULTS A homogeneous population of five patients with type IIb FCD was evaluated. Focal cortical thickening and cortical ribbon hyper-intensity, blurring of the grey-white matter junction and hyper-intensity of the subcortical white matter on T2-weighted/FLAIR images were present in all patients. Cortical features had a complete concordance between ioUS and MRI. In particular ioUS thickening and hyper-echogenicity of cortical ribbon were identified in all cases (100%). Contrary, hyper-echoic subcortical white matter was detected in 60% of the patients. IoUS images resulted in clearer lesion borders than MRI images. CONCLUSION Our study confirms the potentials of ioUS as a valuable diagnostic tool to guide FCD surgeries.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurological Surgery, University of Virginia Virginia Health Science Center, Charlottesville, VA, USA.
| | - Antonio Giulio Gennari
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Beatrice Claudia Bono
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Medicine and Surgery, University of Milan, Via Festa del Perdono, Milan, Italy
| | - Emilio Quaia
- Department of Radiology, University of Padova, Via Giustiniani, Padova, Italy
| | - Ludovico D'Incerti
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Flavio Villani
- Division of Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Giuseppe Didato
- Division of Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Giovanni Tringali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, USA
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30
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Veersema TJ, Swampillai B, Ferrier CH, van Eijsden P, Gosselaar PH, van Rijen PC, Spliet WGM, Mühlebner A, Aronica E, Braun KPJ. Long-term seizure outcome after epilepsy surgery in patients with mild malformation of cortical development and focal cortical dysplasia. Epilepsia Open 2019; 4:170-175. [PMID: 30868127 PMCID: PMC6398095 DOI: 10.1002/epi4.12289] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 12/26/2022] Open
Abstract
Focal cortical dysplasia (FCD) and mild malformation of cortical development (mMCD) are frequent histopathologic diagnoses in patients who undergo surgery for refractory epilepsy. Literature concerning surgical outcome in patients with mMCD, as well as its contrast with FCD, has been scarce. We studied 88 patients with a histopathologic diagnosis of isolated FCD (n = 57) or mMCD (n = 31), revised according to the latest International League Against Epilepsy (ILAE) guidelines, who underwent resective or disconnective surgery. Our findings suggest differences between mMCD and FCD in clinical presentation and surgical outcome after surgery. Patients with mMCD developed seizures later in life, and their lesions had a predilection for location in the temporal lobe and remained undetected by magnetic resonance imaging (MRI) more frequently. A diagnosis of mMCD has a less favorable surgical outcome. Still, 32% of these patients reached continuous seizure freedom (Engel class 1A) at a latest median follow-up duration of 8 years, compared to 59% in FCD. A histopathologic diagnosis of mMCD, extratemporal surgery, and indication of an incomplete resection each were independent predictors of poor outcome.
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Affiliation(s)
- Tim J. Veersema
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Banu Swampillai
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Cyrille H. Ferrier
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Pieter van Eijsden
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Peter H. Gosselaar
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Peter C. van Rijen
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Wim G. M. Spliet
- Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Angelika Mühlebner
- Department of (Neuro) PathologyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Eleonora Aronica
- Department of (Neuro) PathologyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Kees P. J. Braun
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
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31
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Mouthaan BE, Rados M, Boon P, Carrette E, Diehl B, Jung J, Kimiskidis V, Kobulashvili T, Kuchukhidze G, Larsson PG, Leitinger M, Ryvlin P, Rugg-Gunn F, Seeck M, Vulliémoz S, Huiskamp G, Leijten FSS, Van Eijsden P, Trinka E, Braun KPJ. Diagnostic accuracy of interictal source imaging in presurgical epilepsy evaluation: A systematic review from the E-PILEPSY consortium. Clin Neurophysiol 2019; 130:845-855. [PMID: 30824202 DOI: 10.1016/j.clinph.2018.12.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/16/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Interictal high resolution (HR-) electric source imaging (ESI) and magnetic source imaging (MSI) are non-invasive tools to aid epileptogenic zone localization in epilepsy surgery candidates. We carried out a systematic review on the diagnostic accuracy and quality of evidence of these modalities. METHODS Embase, Pubmed and the Cochrane database were searched on 13 February 2017. Diagnostic accuracy studies taking post-surgical seizure outcome as reference standard were selected. Quality appraisal was based on the QUADAS-2 framework. RESULTS Eleven studies were included: eight MSI (n = 267), three HR-ESI (n = 127) studies. None was free from bias. This mostly involved: selection of operated patients only, interference of source imaging with surgical decision, and exclusion of indeterminate results. Summary sensitivity and specificity estimates were 82% (95% CI: 75-88%) and 53% (95% CI: 37-68%) for overall source imaging, with no statistical difference between MSI and HR-ESI. Specificity is higher when partially concordant results were included as non-concordant (p < 0.05). Inclusion of indeterminate test results as non-concordant lowered sensitivity (p < 0.05). CONCLUSIONS Source imaging has a relatively high sensitivity but low specificity for identification of the epileptogenic zone. SIGNIFICANCE We need higher quality studies allowing unbiased test evaluation to determine the added value and diagnostic accuracy of source imaging in the presurgical workup of refractory focal epilepsy.
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Affiliation(s)
- Brian E Mouthaan
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Matea Rados
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Paul Boon
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium
| | - Evelien Carrette
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium
| | - Beate Diehl
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Department of Clinical and Experimental Epilepsy, University College, London, UK
| | - Julien Jung
- Department of Functional Neurology and Epileptology, Institute of Epilepsies (IDEE), Hospices Civils de Lyon, Lyon, France
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Teia Kobulashvili
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Pål G Larsson
- Department of Neurosurgery, Clinic of Surgery and Neuroscience, Oslo University Hospital, Norway
| | - Markus Leitinger
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Fergus Rugg-Gunn
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Department of Clinical and Experimental Epilepsy, University College, London, UK
| | - Margitta Seeck
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Switzerland
| | - Serge Vulliémoz
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Switzerland
| | - Geertjan Huiskamp
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Frans S S Leijten
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Pieter Van Eijsden
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria; Institute of Public Health, Medical Decision Making and HTA, UMIT, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Kees P J Braun
- Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
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32
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Blauwblomme T, Dossi E, Pellegrino C, Goubert E, Iglesias BG, Sainte-Rose C, Rouach N, Nabbout R, Huberfeld G. Gamma-aminobutyric acidergic transmission underlies interictal epileptogenicity in pediatric focal cortical dysplasia. Ann Neurol 2019; 85:204-217. [PMID: 30597612 DOI: 10.1002/ana.25403] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Dysregulation of γ-aminobutyric acidergic (GABAergic) transmission has been reported in lesional acquired epilepsies (gliomas, hippocampal sclerosis). We investigated its involvement in a developmental disorder, human focal cortical dysplasia (FCD), focusing on chloride regulation driving GABAergic signals. METHODS In vitro recordings of 47 human cortical acute slices from 11 pediatric patients who received operations for FCD were performed on multielectrode arrays. GABAergic receptors and chloride regulators were pharmacologically modulated. Immunostaining for chloride cotransporter KCC2 and interneurons were performed on recorded slices to correlate electrophysiology and expression patterns. RESULTS FCD slices retain intrinsic epileptogenicity. Thirty-six of 47 slices displayed spontaneous interictal discharges, along with a pattern specific to the histological subtypes. Ictal discharges were induced in proepileptic conditions in 6 of 8 slices in the areas generating spontaneous interictal discharges, with a transition to seizure involving the emergence of preictal discharges. Interictal discharges were sustained by GABAergic signaling, as a GABAA receptor blocker stopped them in 2 of 3 slices. Blockade of NKCC1 Cl- cotransporters further controlled interictal discharges in 9 of 12 cases, revealing a Cl- dysregulation affecting actions of GABA. Immunohistochemistry highlighted decreased expression and changes in KCC2 subcellular localization and a decrease in the number of GAD67-positive interneurons in regions generating interictal discharges. INTERPRETATION Altered chloride cotransporter expression and changes in interneuron density in FCD may lead to paradoxical depolarization of pyramidal cells. Spontaneous interictal discharges are consequently mediated by GABAergic signals, and targeting chloride regulation in neurons may be considered for the development of new antiepileptic drugs. Ann Neurol 2019; 1-14 ANN NEUROL 2019;85:204-217.
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Affiliation(s)
- Thomas Blauwblomme
- APHP, Department of Pediatric Neurosurgery, Hospital Necker, Paris, France.,Université René Descartes. PRES Sorbonne Paris Cité, Paris, France.,INSERM U1129, Infantile Epilepsies and Brain Plasticity, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Elena Dossi
- Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, Paris, France
| | | | | | - Beatriz Gal Iglesias
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
| | - Christian Sainte-Rose
- APHP, Department of Pediatric Neurosurgery, Hospital Necker, Paris, France.,Université René Descartes. PRES Sorbonne Paris Cité, Paris, France
| | - Nathalie Rouach
- Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, Paris, France
| | - Rima Nabbout
- Université René Descartes. PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Neuropediatrics, Hospital Necker, Paris, France
| | - Gilles Huberfeld
- INSERM U1129, Infantile Epilepsies and Brain Plasticity, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.,Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, Paris, France.,Sorbonne University, AP-HP, Department of Neurophysiology, La Pitié-Salpêtrière Hospital, Paris, France
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33
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Hidalgo ET, Frankel HG, Rodriguez C, Orillac C, Phillips S, Patel N, Devinsky O, Friedman D, Weiner HL. Invasive monitoring after resection of epileptogenic neocortical lesions in multistaged epilepsy surgery in children. Epilepsy Res 2018; 148:48-54. [DOI: 10.1016/j.eplepsyres.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/31/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022]
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Martinez-Lizana E, Fauser S, Brandt A, Schuler E, Wiegand G, Doostkam S, San Antonio-Arce V, Jacobs J, Bast T, Shah M, Zentner J, Schulze-Bonhage A. Long-term seizure outcome in pediatric patients with focal cortical dysplasia undergoing tailored and standard surgical resections. Seizure 2018; 62:66-73. [PMID: 30296740 DOI: 10.1016/j.seizure.2018.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Focal cortical dysplasia (FCD) is the major cause of focal intractable epilepsy in childhood. Here we analyze the factors influencing the success of surgical treatment in a large cohort of children with histologically ascertained FCD. METHOD A retrospective study of the effects of FCD type, surgical intervention, and age at surgery in a pediatric cohort. RESULTS A total of 113 patients (71 male; mean age at surgery 10.3 years; range 0-18) were analyzed; 45 had undergone lesionectomy, 42 lobectomy, 18 multi-lobectomy, and eight hemispherotomy. Complete seizure control (Engel Ia) was achieved in 56% after two years, 52% at five years, and 50% at last follow-up (18-204 months). Resections were more extensive in younger patients (40% of the surgeries affecting more than one lobe in patients aged nine years or younger vs. 22% in patients older than nine years). While resections were more limited in older children, their long-term outcome tended to be superior (42% seizure freedom in patients aged nine years or younger vs. 56% in patients older than nine years). The outcome in FCD I was not significantly inferior to that in FCD II. CONCLUSIONS Our data confirm the long-term efficacy of surgery in children with FCD and epilepsy. An earlier age at surgery within this cohort did not predict a better long-term outcome, but it involved less-tailored surgical approaches. The data suggest that in patients with an unclear extent of the dysplastic area, later resections may offer advantages in terms of the precision of surgical-resection planning.
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Affiliation(s)
- Eva Martinez-Lizana
- Dept. of Epileptology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany.
| | | | - Armin Brandt
- Dept. of Epileptology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | | | - Gert Wiegand
- Dept. of Pediatric Neurology, University of Kiel, Kiel, Germany
| | - Soroush Doostkam
- Faculty of Medicine, University of Freiburg, Germany; Institute of Neuropathology, Medical Center - University of Freiburg, Germany
| | - Victoria San Antonio-Arce
- Dept. of Epileptology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; Dept. of Pediatric Neurology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Julia Jacobs
- Dept. of Epileptology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Thomas Bast
- Faculty of Medicine, University of Freiburg, Germany; Epilepsy Center Kork, Germany
| | - Mukesch Shah
- Faculty of Medicine, University of Freiburg, Germany; Dept. Neurosurgery, Medical Center - University of Freiburg, Germany
| | - Josef Zentner
- Faculty of Medicine, University of Freiburg, Germany; Dept. Neurosurgery, Medical Center - University of Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Dept. of Epileptology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
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35
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Gupta L, Hofman PAM, Besseling RMH, Jansen JFA, Backes WH. Abnormal Blood Oxygen Level-Dependent Fluctuations in Focal Cortical Dysplasia and the Perilesional Zone: Initial Findings. AJNR Am J Neuroradiol 2018; 39:1310-1315. [PMID: 29794237 DOI: 10.3174/ajnr.a5684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/01/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Focal cortical dysplasia is a common cause of intractable epilepsy for which neurosurgery is an option. Delineations of a focal cortical dysplasia lesion on structural brain images may not necessarily reflect the functional borders of normal tissue. Our objective was to determine whether abnormalities in spontaneous blood oxygen level-dependent fluctuations arise in focal cortical dysplasia lesions and proximal regions. MATERIALS AND METHODS Fourteen patients with focal cortical dysplasia-related epilepsy and 16 healthy controls underwent structural and resting-state functional MR imaging. Three known blood oxygen level-dependent measures were determined, including the fractional amplitude of low-frequency fluctuations, regional homogeneity, and wavelet entropy. These measures were evaluated in the lesion and perilesional zone and normalized to the contralateral cortex of patients with focal cortical dysplasia and healthy controls. RESULTS Patients showed significantly decreased fractional amplitude of low-frequency fluctuations and increased wavelet entropy in the focal cortical dysplasia lesion and the perilesional zone (≤2 cm) relative to the contralateral homotopic cortex and the same regions in healthy controls. Regional homogeneity was significantly increased in the focal cortical dysplasia lesion compared with the contralateral homotopic cortex and healthy controls. CONCLUSIONS Abnormalities in spontaneous blood oxygen level-dependent fluctuations were seen up to 2 cm distant from the radiologically visible boundary. It was demonstrated that functional boundaries go beyond structural boundaries of focal cortical dysplasia lesions. Validation is required to reveal whether this information is valuable for surgical planning and outcome evaluation of focal cortical dysplasia lesions and comparing current results with electrophysiologic analysis.
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Affiliation(s)
- L Gupta
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
| | - P A M Hofman
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- School for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R M H Besseling
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- Department of Electrical Engineering (R.M.H.B.), Eindhoven University of Technology, Eindhoven, the Netherlands
| | - J F A Jansen
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- School for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - W H Backes
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- School for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
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Singhal NS, Numis AL, Lee MB, Chang EF, Sullivan JE, Auguste KI, Rao VR. Responsive neurostimulation for treatment of pediatric drug-resistant epilepsy. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:21-24. [PMID: 30013930 PMCID: PMC6019859 DOI: 10.1016/j.ebcr.2018.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 01/26/2018] [Accepted: 02/07/2018] [Indexed: 11/25/2022]
Abstract
Responsive neurostimulation for epilepsy involves an implanted device that delivers direct electrical brain stimulation in response to detection of incipient seizures. Responsive neurostimulation is a safe and effective treatment for adults with drug-resistant epilepsy, but although novel treatments are critically needed for younger patients, responsive neurostimulation is currently not approved for children with drug-resistant epilepsy. Here, we report a 16-year-old patient with seizures arising from eloquent cortex, who was successfully treated with responsive neurostimulation. This case highlights the potential utility of this therapy for pediatric patients and underscores the need for larger studies.
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Affiliation(s)
- Nilika S Singhal
- Department of Neurology, University of California, San Francisco, USA
| | - Adam L Numis
- Department of Neurology, University of California, San Francisco, USA
| | - Morgan B Lee
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Edward F Chang
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Joseph E Sullivan
- Department of Neurology, University of California, San Francisco, USA
| | - Kurtis I Auguste
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Vikram R Rao
- Department of Neurology, University of California, San Francisco, USA
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Donkels C, Pfeifer D, Janz P, Huber S, Nakagawa J, Prinz M, Schulze-Bonhage A, Weyerbrock A, Zentner J, Haas CA. Whole Transcriptome Screening Reveals Myelination Deficits in Dysplastic Human Temporal Neocortex. Cereb Cortex 2018; 27:1558-1572. [PMID: 26796214 DOI: 10.1093/cercor/bhv346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Focal cortical dysplasias (FCDs) are local malformations of the human neocortex with strong epileptogenic potential. To investigate the underlying pathomechanisms, we performed a whole human transcriptome screening to compare the gene expression pattern of dysplastic versus nondysplastic temporal neocortex. Tissue obtained from FCD IIIa cases (mean age 20.5 years) who had undergone surgical treatment, due to intractable epilepsy, was compared with nondysplastic specimens (mean age 19.9 years) by means of Affymetrix arrays covering 28 869 genes. We found 211 differentially expressed genes (DEX) among which mainly genes important for oligodendrocyte differentiation and myelination were downregulated in FCD IIIa. These findings were confirmed as functionally important by Database for Annotation, Visualization, and Integrated Discovery (DAVID) analysis. The reduced expression of myelin-associated transcripts was confirmed for FCD Ia, IIa, and IIIa by real-time RT-qPCR. In addition, we found that the density of myelin basic protein mRNA-expressing oligodendrocytes and of 2',3'-cyclic nucleotide 3'-phosphodiesterase-positive myelin fibers was significantly reduced in dysplastic cortex. Moreover, high-resolution confocal imaging and 3D reconstruction revealed that the myelin fiber network was severely disorganized in dysplastic neocortex, indicating a disturbance of myelin sheath formation and maintenance in FCD.
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Affiliation(s)
- Catharina Donkels
- Experimental Epilepsy Research, Department of Neurosurgery.,Faculty of Biology
| | - Dietmar Pfeifer
- Department of Hematology, Oncology and Stem Cell Transplantation
| | - Philipp Janz
- Experimental Epilepsy Research, Department of Neurosurgery.,Faculty of Biology
| | - Susanne Huber
- Experimental Epilepsy Research, Department of Neurosurgery
| | - Julia Nakagawa
- Experimental Epilepsy Research, Department of Neurosurgery.,Department of Neurosurgery
| | - Marco Prinz
- Institute of Neuropathology.,Center for Biological Signalling Studies
| | - Andreas Schulze-Bonhage
- Epilepsy Center Freiburg, University Medical Center Freiburg, Freiburg, Germany.,BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany
| | | | | | - Carola A Haas
- Experimental Epilepsy Research, Department of Neurosurgery.,Bernstein Center Freiburg.,BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany
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mTOR-dependent alterations of Kv1.1 subunit expression in the neuronal subset-specific Pten knockout mouse model of cortical dysplasia with epilepsy. Sci Rep 2018; 8:3568. [PMID: 29476105 PMCID: PMC5824782 DOI: 10.1038/s41598-018-21656-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
Cortical dysplasia (CD) is a common cause for intractable epilepsy. Hyperactivation of the mechanistic target of rapamycin (mTOR) pathway has been implicated in CD; however, the mechanisms by which mTOR hyperactivation contribute to the epilepsy phenotype remain elusive. Here, we investigated whether constitutive mTOR hyperactivation in the hippocampus is associated with altered voltage-gated ion channel expression in the neuronal subset-specific Pten knockout (NS-Pten KO) mouse model of CD with epilepsy. We found that the protein levels of Kv1.1, but not Kv1.2, Kv1.4, or Kvβ2, potassium channel subunits were increased, along with altered Kv1.1 distribution, within the hippocampus of NS-Pten KO mice. The aberrant Kv1.1 protein levels were present in young adult (≥postnatal week 6) but not juvenile (≤postnatal week 4) NS-Pten KO mice. No changes in hippocampal Kv1.1 mRNA levels were found between NS-Pten KO and WT mice. Interestingly, mTOR inhibition with rapamycin treatment at early and late stages of the pathology normalized Kv1.1 protein levels in NS-Pten KO mice to WT levels. Together, these studies demonstrate altered Kv1.1 protein expression in association with mTOR hyperactivation in NS-Pten KO mice and suggest a role for mTOR signaling in the modulation of voltage-gated ion channel expression in this model.
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39
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Expression of pannexin 1 and 2 in cortical lesions from intractable epilepsy patients with focal cortical dysplasia. Oncotarget 2018; 8:6883-6895. [PMID: 28036289 PMCID: PMC5351677 DOI: 10.18632/oncotarget.14317] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 12/16/2016] [Indexed: 02/01/2023] Open
Abstract
Focal cortical dysplasia (FCD) is a major cause of intractable epilepsy in children however the mechanisms underlying the pathogenesis of FCD and FCD induced epilepsy remain unclear. Increasing evidence suggests that the large-pore ion channels, pannexin 1 (Panx1) and 2 (Panx2), are involved in epilepsy and brain development. In this study, we investigated the expression of Panx1 and Panx2 in surgical samples from patients with FCD type Ia (FCDIa), type IIa (FCDIIa), and type IIb (FCDIIb) and in age-matched autopsy control samples. We found Panx1 mRNA and protein levels were both increased in all these FCD samples. Immunohistochemical analyses revealed that Panx1 was mainly distributed in microcolumn neurons, dysmorphic neurons (DNs), balloon cells (BCs) and reactive astrocytes. Double-labeled staining showed that the Panx1-positive neurons were mostly glutamatergic DNs and occasionally GABAergic normal-appearing neurons. Importantly, the protein levels of Panx1 positively correlated with the frequency of seizures. Intriguingly, the Panx2 mRNA and protein levels were only upregulated in FCDIIb lesions and characteristically expressed on SOX2-positive multipotential BCs. Immunofluorescent experiments identified that Panx2-positive BCs mainly expressed the neuronal differentiation transcription factor MASH1 but not the immature glial marker vimentin. Taken together, our results established a potential role of the specific expression and cellular distribution patterns of Panx1 and Panx2 in FCD-associated epileptogenesis and pathogenesis.
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40
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Isler C, Kucukyuruk B, Ozkara C, Gunduz A, Is M, Tanriverdi T, Comunoglu N, Oz B, Uzan M. Comparison of clinical features and surgical outcome in focal cortical dysplasia type 1 and type 2. Epilepsy Res 2017; 136:130-136. [PMID: 28850830 DOI: 10.1016/j.eplepsyres.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/09/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Recent ILAE classification defined focal cortical dysplasia (FCD) patients with accompanying epileptic lesions as a separate group. We investigated data of patients with sole FCD lesions regarding long-term seizure outcome and different characteristics of FCD type 1 and type 2 patients. METHODS Eighty children and adult patients underwent surgery for FCD were included to the analysis of factors differentiating FCD type 1 and type 2 groups and their effect on long-term outcome. RESULTS FCD type 2 patients had earlier epilepsy onset (8.1 vs. 6.1 years. p=0.019) and underwent surgery younger than type 1 (18.2 vs. 23.7 years. p=0.034). FCD type 2 patients were more prominently MR positive (77.8% vs. 53.8%. p=0.029), which increased within FCD type 2 group as patients become younger (p=0.028). FCD Type 1 lesions showed mostly multilobar extension and FCD type 2 mostly located in frontal lobe. Seizure freedom was achieved in 65.4% of FCD type 1 patients and 70.4% of FCD type 2 patients. Seven patients had permanent de novo neurological deficits. Mean follow-up time was 5.5 years (Range: 1-11 years). CONCLUSION Surgical intervention in carefully selected patients may facilitate favorable seizure outcome leading to better quality of life. FCD type 1 and type 2 groups present with evident differences, which may promote medical and surgical management of these pathologies.
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Affiliation(s)
- Cihan Isler
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Kucukyuruk
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cigdem Ozkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysegul Gunduz
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Merih Is
- Department of Neurosurgery, Fatih Sultan Mehmet Research and Education Hospital, Health Sciences University, Istanbul, Turkey
| | - Taner Tanriverdi
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Uzan
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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41
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Abdallah C, Maillard LG, Rikir E, Jonas J, Thiriaux A, Gavaret M, Bartolomei F, Colnat-Coulbois S, Vignal JP, Koessler L. Localizing value of electrical source imaging: Frontal lobe, malformations of cortical development and negative MRI related epilepsies are the best candidates. NEUROIMAGE-CLINICAL 2017; 16:319-329. [PMID: 28856095 PMCID: PMC5565782 DOI: 10.1016/j.nicl.2017.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to prospectively assess the anatomical concordance of electric source localizations of interictal discharges with the epileptogenic zone (EZ) estimated by stereo-electroencephalography (SEEG) according to different subgroups: the type of epilepsy, the presence of a structural MRI lesion, the aetiology and the depth of the EZ. METHODS In a prospective multicentric observational study, we enrolled 85 consecutive patients undergoing pre-surgical SEEG investigation for focal drug-resistant epilepsy. Electric source imaging (ESI) was performed before SEEG. Source localizations were obtained from dipolar and distributed source methods. Anatomical concordance between ESI and EZ was defined according to 36 predefined sublobar regions. ESI was interpreted blinded to- and subsequently compared with SEEG estimated EZ. RESULTS 74 patients were finally analyzed. 38 patients had temporal and 36 extra-temporal lobe epilepsy. MRI was positive in 52. 41 patients had malformation of cortical development (MCD), 33 had another or an unknown aetiology. EZ was medial in 27, lateral in 13, and medio-lateral in 34. In the overall cohort, ESI completely or partly localized the EZ in 85%: full concordance in 13 cases and partial concordance in 50 cases. The rate of ESI full concordance with EZ was significantly higher in (i) frontal lobe epilepsy (46%; p = 0.05), (ii) cases of negative MRI (36%; p = 0.01) and (iii) MCD (27%; p = 0.03). The rate of ESI full concordance with EZ was not statistically different according to the depth of the EZ. SIGNIFICANCE We prospectively demonstrated that ESI more accurately estimated the EZ in subgroups of patients who are often the most difficult cases in epilepsy surgery: frontal lobe epilepsy, negative MRI and the presence of MCD.
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Affiliation(s)
- Chifaou Abdallah
- Neurology Department, University Hospital of Nancy, Nancy, France
| | - Louis G Maillard
- Neurology Department, University Hospital of Nancy, Nancy, France.,CRAN, UMR 7039, Lorraine University, Vandœuvre-les-Nancy Cedex, France.,CNRS, CRAN, UMR 7039, Vandœuvre-les-Nancy Cedex, France.,Medical Faculty, Lorraine University, Nancy, France
| | - Estelle Rikir
- Neurology Department, University Hospital of Sart-Tilman, Liege, Belgium.,Medical Faculty, Liege University, Liege, Belgium
| | - Jacques Jonas
- Neurology Department, University Hospital of Nancy, Nancy, France.,CRAN, UMR 7039, Lorraine University, Vandœuvre-les-Nancy Cedex, France.,CNRS, CRAN, UMR 7039, Vandœuvre-les-Nancy Cedex, France
| | - Anne Thiriaux
- Neurology department, University Hospital of Reims, Reims, France
| | - Martine Gavaret
- Clinical Neurophysiology Department, AP-HM, University Hospital la Timone, Marseille, France.,INSERM UMR 1106, Institut de Neurosciences des Systemes, Marseille, France.,Medical Faculty, Aix-Marseille University, Marseille, France
| | - Fabrice Bartolomei
- Clinical Neurophysiology Department, AP-HM, University Hospital la Timone, Marseille, France.,INSERM UMR 1106, Institut de Neurosciences des Systemes, Marseille, France.,Medical Faculty, Aix-Marseille University, Marseille, France
| | - Sophie Colnat-Coulbois
- Medical Faculty, Lorraine University, Nancy, France.,Neurosurgery Department, University Hospital of Nancy, Nancy, France
| | - Jean-Pierre Vignal
- Neurology Department, University Hospital of Nancy, Nancy, France.,CRAN, UMR 7039, Lorraine University, Vandœuvre-les-Nancy Cedex, France.,CNRS, CRAN, UMR 7039, Vandœuvre-les-Nancy Cedex, France
| | - Laurent Koessler
- Neurology Department, University Hospital of Nancy, Nancy, France.,CRAN, UMR 7039, Lorraine University, Vandœuvre-les-Nancy Cedex, France.,CNRS, CRAN, UMR 7039, Vandœuvre-les-Nancy Cedex, France
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42
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Huang C, Zhang H, Chi XS, Chen N, Gong J, Zhou Q, Blümcke I, Zhou D, Li JM. Putting the new ILAE classification of focal cortical dysplasia into practice in western China. Seizure 2017; 51:133-138. [PMID: 28843774 DOI: 10.1016/j.seizure.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To re-examine drug-resistant epilepsy cases using the revised 2011 ILAE classification of focal cortical dysplasia (FCD). METHODS Patients with drug-resistant epilepsy who have undergone epilepsy surgery in West China Hospital between July 2012 and Jun 2014 were included. Clinical histories, pathological diagnoses, and surgical outcomes were reviewed. A questionnaire was developed to investigate the clinical practice of the new classification. A short-term training program on FCD was carried out to improve pathological diagnosis accuracy. RESULTS 260 consecutive cases (177 male and 83 female) were included. Pathological diagnosis was changed in 70 cases (26.9%) after re-examination. The five most common pathological types were hippocampal sclerosis (19.2%, 50/260), brain tumors (17.7%, 46/260), vascular malformations (16.2%, 42/260), glial scars (11.2%, 29/260) and FCD (10.0%, 26/260). The most common subtype of isolated FCD was FCD IIb (53.8%, 14/26), followed by FCD IIa (42.3%, 11/26) and FCD Ib (3.8%, 1/26). In addition, forty-five cases were diagnosed as associated FCD type III (17.3%, 45/260). Half of patients with FCD achieved Engel class I at two-year follow-up. Questionnaire investigation suggested most participant pathologists lack sufficient knowledge on the new classification. The diagnostic sensitivity for different FCD subtypes was significantly improved by two to six folds after short-term training. CONCLUSIONS FCD is an important etiology of drug-resistant epilepsy in western China. It is essential to provide continuing trainings to improve diagnostic precision of FCD in developing countries.
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Affiliation(s)
- Cheng Huang
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China; Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Heng Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Sa Chi
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ni Chen
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041,Sichuan, People's Republic of China
| | - Jing Gong
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041,Sichuan, People's Republic of China
| | - Qiao Zhou
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041,Sichuan, People's Republic of China
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jin-Mei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Zhang G, Meng D, Liu Y, Yang K, Chen J, Su L, Zhang Z, Chen G. Epileptic Zone Resection for Magnetic Resonance Imaging–Negative Refractory Epilepsy Originating from the Primary Motor Cortex. World Neurosurg 2017; 102:434-441. [DOI: 10.1016/j.wneu.2017.02.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
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44
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Surgical outcomes in two different age groups with Focal Cortical Dysplasia type II: Any real difference? Epilepsy Behav 2017; 70:45-49. [PMID: 28410464 DOI: 10.1016/j.yebeh.2017.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Focal Cortical Dysplasias (FCDs) represent a common architectural cortical disorder underlying drug-resistant focal epilepsy. So far, studies aimed at evaluating whether age at surgery is a factor influencing surgical outcome are lacking, so that data on the comparison between patients harboring Type II FCD operated at younger age and those operated at adult age are still scarce. We compared presurgical clinical features and surgical outcomes of patients with histopathologically diagnosed Type II FCD undergoing surgery at an earlier age with those operated after 20 years of age. METHODS We retrospectively analyzed 1660 consecutive patients operated at the "Claudio Munari" Epilepsy Surgery Centre. There were 289 patients (17.4%) with a neuropathological diagnosis of Type II FCD. We included two different groups of patients, the first one including patients operated on at less than 6years, the second sharing the same seizure onset age but with delayed surgery, carried out after the age of 20. Seizure characteristics and, neuropsychological and postoperative seizure outcomes were evaluated by study group. RESULTS Forty patients underwent surgery before the age of 6 and 66 patients after the age of 20. Surgical outcome was favorable in the whole population (72.6% were classified in Engel's Class Ia+Ic), independently from age at surgery. In the children group, 32 patients were classified in Class I, including 30 (75%) children in classes Ia and Ic. In the adult group, 53 belonged to Class I of whom 47 (71%) were in classes Ia and Ic. The percentage of permanent complications, the surgical outcomes, and AED withdrawal did not significantly differ by study group. CONCLUSION Our results indicate that there is no difference between the groups, suggesting that outcome depends mainly on the histological findings and not on timing of surgery.
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Koc G, Bek S, Gokcil Z. Localization of ictal pouting in frontal lobe epilepsy: A case report. EPILEPSY & BEHAVIOR CASE REPORTS 2017; 8:27-30. [PMID: 29204345 PMCID: PMC5707212 DOI: 10.1016/j.ebcr.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/06/2017] [Accepted: 04/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Guray Koc
- Department of Neurology, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
- Corresponding author.
| | - Semai Bek
- Department of Neurology, Baskent University, Medical Faculty, Adana Training and Research Center, Adana, Turkey
| | - Zeki Gokcil
- Department of Neurology, Eastern Mediterranean University, Faculty Of Health Sciences, Physiotherapy And Rehabilitation, Cyprus
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Sun Y, Wang X, Che N, Qin H, Liu S, Wu X, Wei M, Cheng H, Yin J. Clinical characteristics and epilepsy outcomes following surgery caused by focal cortical dysplasia (type IIa) in 110 adult epileptic patients. Exp Ther Med 2017; 13:2225-2234. [PMID: 28565831 PMCID: PMC5443177 DOI: 10.3892/etm.2017.4315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/21/2016] [Indexed: 11/09/2022] Open
Abstract
The aim of the present study was to investigate the effects of surgical intervention of focal cortical dysplasia (FCD) IIa on the outcome of epilepsy, and to evaluate the prognostic factors of seizure freedom. Patient data from epilepsy surgeries were retrospectively reviewed at the Second Affiliated Hospital of Dalian Medical University between 2007 and 2015. A total of 110 patients with a definite pathological diagnosis of FCD IIa were included. Moreover, the clinical characteristics, seizure outcome and quality of life in adults with FCD IIa were evaluated. The Engel seizure outcome achievements were class I in 72, class II in 20, class III in 11 and class IV in 7 patients. In addition, the Engel seizure outcome was relevant with the resection range of the lesions (P=0.028). The assessments of electrocorticography (ECoG) patterns and magnetic resonance imaging (MRI) are relevant to determining the extent of the resection, which may influence the surgery outcome (P=0.001 and P=0.023). Using multivariate regression analyses, the extent of resection, seizure frequency, preoperative ECoG and location of resection were the most important risk factors for seizure recurrence. The results of quality of life in epilepsy-10 scoring revealed that the quality of life improved significantly following surgery (P<0.01). Moreover, surgical intervention, EcoG, MRI positioning and complete resection helped to have improved seizure control, relief of anxiety and quality of life. All these observations strongly recommend an early consideration of epilepsy surgery in FCD IIa patients.
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Affiliation(s)
- Yuqiang Sun
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China.,Department of Neurosurgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150036, P.R. China
| | - Xiaofeng Wang
- Department of Neurosurgery, Weinan Central Hospital, Weinan, Shaanxi 714000, P.R. China
| | - Ningwei Che
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Huamin Qin
- Department of Pathology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Shuping Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Xinling Wu
- Department of Psychology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Minghai Wei
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Huakun Cheng
- Department of Neurosurgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150036, P.R. China
| | - Jian Yin
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
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Qualmann KJ, Spaeth CG, Myers MF, Horn PS, Holland K, Mangano FT, Greiner HM. Pediatric Epilepsy Surgery: The Prognostic Value of Central Nervous System Comorbidities in Patients and their Families. J Child Neurol 2017; 32:467-474. [PMID: 28056629 PMCID: PMC5290252 DOI: 10.1177/0883073816685653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central nervous system comorbidities have been identified in patients with epilepsy. Several of these comorbidities have been correlated with poor surgery outcomes in patient cohorts. The authors sought to determine if prevalence of comorbidities in pediatric epilepsy surgery patients and their families correlate with long-term seizure outcome in a cross-sectional analysis. Three-generation pedigrees were elicited to compare family history of epilepsy, ADHD, anxiety, autism, bipolar disorder, cognitive disability, depression, migraine, and motor disability to surgery outcomes in 52 patients. Proportions of affected patients and relatives were compared to general population comorbidity rates and the patients' most recent seizure outcome classification. Patients and families had significantly higher rates of comorbidities than the general population. Poorer long-term seizure outcomes following resective surgery were associated with autism or cognitive disability in patients. Together these data support evidence for a common pathophysiological mechanism between epilepsy and central nervous system comorbidities.
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Affiliation(s)
- Krista J Qualmann
- 1 Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christine G Spaeth
- 1 Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Melanie F Myers
- 1 Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- 2 Division of Pediatric Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,3 Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine Holland
- 2 Division of Pediatric Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Francesco T Mangano
- 4 Division of Pediatric Neurosurgery, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- 2 Division of Pediatric Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Hidalgo ET, Weiner HL. Surgery for epileptogenic cerebral dysplasia in children. Dev Med Child Neurol 2017; 59:270-275. [PMID: 27730624 DOI: 10.1111/dmcn.13292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
Abstract
New developments in diagnostic methods, technical improvements in the surgical field, and a better understanding of the effects of epilepsy on the developing brain are contributing to the general observation that more children with epilepsy are being treated surgically. Malformations of cortical development are the most common cause of seizures in pediatric surgical candidates, and the best predictor of seizure freedom after surgery appears to be the complete removal of the epileptogenic lesion. To achieve this goal in challenging cases, such as magnetic resonance imaging-negative or multifocal lesions, a staged approach with pre- and/or post-resective invasive electroencephalography monitoring has increasingly been used at a number of centers. As the experience with this approach has grown, and the risks and benefits are better understood, a larger number of patients with epilepsy have been identified as potential surgical candidates. In this review, a number of the recent developments in pediatric epilepsy surgery are discussed.
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Affiliation(s)
- Eveline Teresa Hidalgo
- Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Howard L Weiner
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Rikir E, Koessler L, Ramantani G, Maillard LG. Added value and limitations of electrical source localization. Epilepsia 2017; 58:174-175. [DOI: 10.1111/epi.13643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Estelle Rikir
- Neurology Department; University Hospital of Nancy; Nancy France
- Neurology Department; University Hospital of Sart-Tilman; Liège Belgium
- Faculty of Medecine; University of Liège; Liège Belgium
| | - Laurent Koessler
- CRAN; UMR 7039; Lorraine University; Vandœuvre-lès-Nancy Cedex France
- CNRS; CRAN; UMR 7039; Vandœuvre-lès-Nancy Cedex France
| | - Georgia Ramantani
- CRAN; UMR 7039; Lorraine University; Vandœuvre-lès-Nancy Cedex France
- Division of Child Neurology; University Children's Hospital; Zürich Switzerland
- Swiss Epilepsy Center; Zürich Switzerland
| | - Louis G. Maillard
- Neurology Department; University Hospital of Nancy; Nancy France
- CRAN; UMR 7039; Lorraine University; Vandœuvre-lès-Nancy Cedex France
- CNRS; CRAN; UMR 7039; Vandœuvre-lès-Nancy Cedex France
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LaRiviere MJ, Gross RE. Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery. Front Surg 2016; 3:64. [PMID: 27995127 PMCID: PMC5136731 DOI: 10.3389/fsurg.2016.00064] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/21/2016] [Indexed: 12/02/2022] Open
Abstract
Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one-third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular, radiofrequency (RF) ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging. In the past 5 years, the most recent techniques have used MRI-guided laser interstitial thermotherapy (LITT), the development of which began in the 1980s, saw refinements in MRI thermal imaging through the 1990s, and was initially used primarily for the treatment of intracranial and extracranial tumors. The present review describes the original stereotactic ablation trials, followed by modern imaging-guided RF ablation series for mesial temporal lobe epilepsy. The developments of LITT and MRI thermometry are then discussed. Finally, the two currently available MRI-guided LITT systems are reviewed for their role in the treatment of mesial temporal lobe and other medically refractory epilepsies.
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Affiliation(s)
- Michael J. LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E. Gross
- Departments of Neurosurgery and Neurology, Emory University School of Medicine, Atlanta, GA, USA
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