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Lesser RP, Webber WRS, Miglioretti DL. Pan-cortical electrophysiologic changes underlying attention. Sci Rep 2024; 14:2680. [PMID: 38302535 PMCID: PMC10834435 DOI: 10.1038/s41598-024-52717-w] [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: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
We previously reported that pan-cortical effects occur when cognitive tasks end afterdischarges. For this report, we analyzed wavelet cross-coherence changes during cognitive tasks used to terminate afterdischarges studying multiple time segments and multiple groups of inter-electrode-con distances. We studied 12 patients with intractable epilepsy, with 970 implanted electrode contacts, and 39,871 electrode contact combinations. When cognitive tasks ended afterdischarges, coherence varied similarly across the cortex throughout the tasks, but there were gradations with time, distance, and frequency: (1) They tended to progressively decrease relative to baseline with time and then to increase toward baseline when afterdischarges ended. (2) During most time segments, decreases from baseline were largest for the closest inter-contact distances, moderate for intermediate inter-contact distances, and smallest for the greatest inter-contact distances. With respect to our patients' intractable epilepsy, the changes found suggest that future therapies might treat regions beyond those closest to regions of seizure onset and treat later in a seizure's evolution. Similar considerations might apply to other disorders. Our findings also suggest that cognitive tasks can result in pan-cortical coherence changes that participate in underlying attention, perhaps complementing the better-known regional mechanisms.
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Affiliation(s)
- Ronald P Lesser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - W R S Webber
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, Davis, School of Medicine, University of California, Davis, CA, 95616, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
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Horsley JJ, Thomas RH, Chowdhury FA, Diehl B, McEvoy AW, Miserocchi A, de Tisi J, Vos SB, Walker MC, Winston GP, Duncan JS, Wang Y, Taylor PN. Complementary structural and functional abnormalities to localise epileptogenic tissue. EBioMedicine 2023; 97:104848. [PMID: 37898096 PMCID: PMC10630610 DOI: 10.1016/j.ebiom.2023.104848] [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: 06/15/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND When investigating suitability for epilepsy surgery, people with drug-refractory focal epilepsy may have intracranial EEG (iEEG) electrodes implanted to localise seizure onset. Diffusion-weighted magnetic resonance imaging (dMRI) may be acquired to identify key white matter tracts for surgical avoidance. Here, we investigate whether structural connectivity abnormalities, inferred from dMRI, may be used in conjunction with functional iEEG abnormalities to aid localisation of the epileptogenic zone (EZ), improving surgical outcomes in epilepsy. METHODS We retrospectively investigated data from 43 patients (42% female) with epilepsy who had surgery following iEEG. Twenty-five patients (58%) were free from disabling seizures (ILAE 1 or 2) at one year. Interictal iEEG functional, and dMRI structural connectivity abnormalities were quantified by comparison to a normative map and healthy controls. We explored whether the resection of maximal abnormalities related to improved surgical outcomes, in both modalities individually and concurrently. Additionally, we suggest how connectivity abnormalities may inform the placement of iEEG electrodes pre-surgically using a patient case study. FINDINGS Seizure freedom was 15 times more likely in patients with resection of maximal connectivity and iEEG abnormalities (p = 0.008). Both modalities separately distinguished patient surgical outcome groups and when used simultaneously, a decision tree correctly separated 36 of 43 (84%) patients. INTERPRETATION Our results suggest that both connectivity and iEEG abnormalities may localise epileptogenic tissue, and that these two modalities may provide complementary information in pre-surgical evaluations. FUNDING This research was funded by UKRI, CDT in Cloud Computing for Big Data, NIH, MRC, Wellcome Trust and Epilepsy Research UK.
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Affiliation(s)
- Jonathan J Horsley
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fahmida A Chowdhury
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia; Centre for Medical Image Computing, Computer Science Department, University College London, London, United Kingdom
| | - Matthew C Walker
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Division of Neurology, Department of Medicine, Queen's University, Kingston, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yujiang Wang
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter N Taylor
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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Sinha N, Duncan JS, Diehl B, Chowdhury FA, de Tisi J, Miserocchi A, McEvoy AW, Davis KA, Vos SB, Winston GP, Wang Y, Taylor PN. Intracranial EEG Structure-Function Coupling and Seizure Outcomes After Epilepsy Surgery. Neurology 2023; 101:e1293-e1306. [PMID: 37652703 PMCID: PMC10558161 DOI: 10.1212/wnl.0000000000207661] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 06/02/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Surgery is an effective treatment for drug-resistant epilepsy, which modifies the brain's structure and networks to regulate seizure activity. Our objective was to examine the relationship between brain structure and function to determine the extent to which this relationship affects the success of the surgery in controlling seizures. We hypothesized that a stronger association between brain structure and function would lead to improved seizure control after surgery. METHODS We constructed functional and structural brain networks in patients with drug-resistant focal epilepsy by using presurgery functional data from intracranial EEG (iEEG) recordings, presurgery and postsurgery structural data from T1-weighted MRI, and presurgery diffusion-weighted MRI. We quantified the relationship (coupling) between structural and functional connectivity by using the Spearman rank correlation and analyzed this structure-function coupling at 2 spatial scales: (1) global iEEG network level and (2) individual iEEG electrode contacts using virtual surgeries. We retrospectively predicted postoperative seizure freedom by incorporating the structure-function connectivity coupling metrics and routine clinical variables into a cross-validated predictive model. RESULTS We conducted a retrospective analysis on data from 39 patients who met our inclusion criteria. Brain areas implanted with iEEG electrodes had stronger structure-function coupling in seizure-free patients compared with those with seizure recurrence (p = 0.002, d = 0.76, area under the receiver operating characteristic curve [AUC] = 0.78 [95% CI 0.62-0.93]). Virtual surgeries on brain areas that resulted in stronger structure-function coupling of the remaining network were associated with seizure-free outcomes (p = 0.007, d = 0.96, AUC = 0.73 [95% CI 0.58-0.89]). The combination of global and local structure-function coupling measures accurately predicted seizure outcomes with a cross-validated AUC of 0.81 (95% CI 0.67-0.94). These measures were complementary to other clinical variables and, when included for prediction, resulted in a cross-validated AUC of 0.91 (95% CI 0.82-1.0), accuracy of 92%, sensitivity of 93%, and specificity of 91%. DISCUSSION Our study showed that the strength of structure-function connectivity coupling may play a crucial role in determining the success of epilepsy surgery. By quantitatively incorporating structure-function coupling measures and standard-of-care clinical variables into presurgical evaluations, we may be able to better localize epileptogenic tissue and select patients for epilepsy surgery. CLASSIFICATION OF EVIDENCE This is a Class IV retrospective case series showing that structure-function mapping may help determine the outcome from surgical resection for treatment-resistant focal epilepsy.
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Affiliation(s)
- Nishant Sinha
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada.
| | - John S Duncan
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Beate Diehl
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Fahmida A Chowdhury
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Jane de Tisi
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Anna Miserocchi
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Andrew William McEvoy
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Kathryn A Davis
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Sjoerd B Vos
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Gavin P Winston
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Yujiang Wang
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
| | - Peter Neal Taylor
- From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada
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Mula M. Impact of psychiatric comorbidities on the treatment of epilepsies in adults. Expert Rev Neurother 2023; 23:895-904. [PMID: 37671683 DOI: 10.1080/14737175.2023.2250558] [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: 06/24/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Epilepsy is often accompanied by psychiatric comorbidities and the management of epilepsy in these patients presents unique challenges due to the interplay between the underlying neurological condition and the psychiatric symptoms and the combined use of multiple medications. AREAS COVERED This paper aims to explore the complexities associated with managing epilepsy in the presence of psychiatric comorbidities, focusing on the impact of psychiatric disorders on epilepsy treatment strategies and the challenges posed by the simultaneous administration of multiple medications. EXPERT OPINION Patients with epilepsy and psychiatric comorbidities seem to present with a more severe form of epilepsy that is resistant to drug treatments and burdened by an increased morbidity and mortality. Whether prompt treatment of psychiatric disorders can influence the long-term prognosis of the epilepsy is still unclear as well as the role of specific treatment strategies, such as neuromodulation, in this group of patients. Clinical practice recommendations and guidelines will prompt the development of new models of integrated care to be implemented.
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Affiliation(s)
- Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK of Great Britain and Northern Ireland
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Male R, Eriksson SH. The natural history of epilepsy and nonepileptic seizures in Sturge-Weber syndrome: A retrospective case-note review. Epilepsy Behav 2023; 145:109303. [PMID: 37348409 DOI: 10.1016/j.yebeh.2023.109303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Patients with Sturge-Weber Syndrome (SWS) experience varying degrees of neurological problems - including epilepsy, hemiparesis, learning disability (LD), and stroke-like episodes. While the range of clinical problems experienced by children with SWS is well recognized, the spectrum of clinical presentation and its treatment during adulthood has been relatively neglected in the literature to date. This study explored the natural history of epileptic and nonepileptic seizures into adulthood in patients with SWS, and their treatment, and investigated whether any clinical factors predict which symptoms a patient will experience during adulthood. METHODS A retrospective case-note review of a cohort of 26 adults with SWS at the National Hospital for Neurology and Neurosurgery (NHNN). Childhood data were also recorded, where available, to enable review of change/development of symptoms over time. RESULTS The course of epilepsy showed some improvement in adulthood - seventeen adults continued to have seizures, while six patients gained seizure freedom, and no one had adult-onset seizures. However, seizures did worsen for some patients. Although no factors reached statistical significance regarding predicting continued epilepsy in adulthood, being male, more severe LD, having required epilepsy surgery, and bilateral cortical involvement may be important. Nonepileptic seizures (NES) also began during adulthood for four patients. SIGNIFICANCE By adulthood, there is some degree of improvement in epilepsy overall; while NES may occur for the first time. While the majority of the results did not survive adjustments for multiple comparisons, some interesting trends appeared, which require further investigation in a multicenter national audit. Patients with more neurologically severe presentations during childhood may continue to experience seizures. Careful monitoring and screening are needed during adulthood, to detect changes and newly developing symptoms such as NES, and target treatment promptly.
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Affiliation(s)
- Rhian Male
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University; College London, London, UK.
| | - Sofia H Eriksson
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University; College London, London, UK.
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Duncan JS, Taylor PN. Optimising epilepsy surgery. Lancet Neurol 2023; 22:373-374. [PMID: 36972721 DOI: 10.1016/s1474-4422(23)00082-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/29/2023]
Affiliation(s)
- John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London WC1N 3NG, UK.
| | - Peter N Taylor
- Computational Neurology, Neuroscience & Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems group, School of Computing, Newcastle Helix, Newcastle University, Newcastle, UK
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Erkent I, Arslan GA, Saygi S, Irsel Tezer F. Subclinical seizures: The demographic data and scalp video-EEG findings, concordance with the epilepsy type and prognosis. Epilepsy Res 2023; 192:107142. [PMID: 37075526 DOI: 10.1016/j.eplepsyres.2023.107142] [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: 02/26/2023] [Revised: 04/01/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Subclinical seizures(SCSs) are overlooked in clinical practice. This study aims to investigate clinical, electrophysiological features of SCSs detected during video-electroencephalography(EEG) monitorization(VEM), concordance of the epilepsy type and SCSs, and predictors of the concordance. METHODS The data of drug-resistant epilepsy patients who had undergone video-EEG between 2010 and 2020 were investigated. Ictal activities showing temporospatial evolution lasted ≥ 10 s, without any behavioural changes were considered SCSs. Findings were re-evaluated for ictal localization, lateralization, ictal discharge type, vigilance status, and duration of SCSs to the accompaniment of clinical findings. Additionally, the concordance of epilepsy type and SCSs were analyzed. RESULTS Fifty-five SCSs were obtained in 24 of 804 patients (2,9 %) who were followed in the VEM unit; the epilepsy type of the patients was temporal in 26 and extratemporal lobe epilepsy in 29 SCSs. Among 55 SCSs recordings, 30 originated from the temporal lobe and 24 from the extratemporal lobe, and seizure localization could not be determined in one. The patients were younger, age at seizure onset was earlier, habitual seizures were more frequent, multiple anti-seizure drug use was higher, seizures more frequently occurred during sleep, cranial MR tended to be abnormal, patients were more likely to have a history of perinatal injury/head trauma, and the concordance of discharge patterns was lower in extratemporal SCSs.The concordance of epilepsy type with localization and lateralization of SCSs was not statistically significant. CONCLUSIONS SCSs originating from the temporal and extratemporal lobes might show similar characteristics with the epilepsy type, and SCSs might have clinical importance apart from epilepsy surgery.
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Affiliation(s)
- Irem Erkent
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Gokce Ayhan Arslan
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serap Saygi
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - F Irsel Tezer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Yossofzai O, Biswas A, Moineddin R, Ibrahim GM, Rutka J, Donner E, Snead C, Mitsakakis N, Widjaja E. Number of epilepsy surgeries has decreased despite an increase in pre-surgical evaluations at a tertiary pediatric epilepsy center in Ontario. Seizure 2023; 108:1-9. [PMID: 37059033 DOI: 10.1016/j.seizure.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE A recent U.S. study reported that the number of epilepsy surgeries has remained stable or declined in recent years despite an increase in pre-surgical evaluation. This study aimed to evaluate trends in pre-surgical evaluation and epilepsy surgery from 2001 to 2019 and to determine whether these trends have changed in the later period (2014-2019) compared to earlier period (2001-2013). METHODS This study evaluated trends in pre-surgical evaluation and epilepsy surgery at a tertiary pediatric epilepsy center. Children with drug resistant epilepsy who were evaluated for surgery were included. Clinical data, reasons for not undergoing surgery, and surgical characteristics of surgery patients were collected. Overall trends and trends in later period compared to earlier period for pre-surgical evaluation and epilepsy surgery were assessed. RESULTS There were 1151 children who were evaluated for epilepsy surgery and 546 underwent surgery. There was an upward trend in pre-surgical evaluation in the earlier period (rate ratio [RR]=1.04 (95%CI:1.02-1.07), p<0.001) and the trajectory of presurgical evaluation in the later period was not significantly different to the earlier period (RR=1.00 [95%CI:0.95-1.06], p = 0.88). Among the reasons for not undergoing surgery, failure to localize the seizures occurred more frequently in later period than earlier period (22.6% vs. 17.1% respectively, p = 0.024). For number of surgeries, there was an upward trend between 2001 and 2013 (RR=1.08 [95%CI:1.05-1.11], p<0.001), and a decreasing trend in the later period compared to earlier period (RR=0.91 [95%CI:0.84-0.99], p = 0.029). CONCLUSION Despite an increasing trend in pre-surgical evaluation, there was a decreasing trend in the number of epilepsy surgery in the later period as there was a larger proportion of patients in whom the seizures could not be localized. Trends in presurgical evaluation and epilepsy surgery will continue to evolve with introduction of technologies such as stereo-EEG and minimally invasive laser therapy.
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Affiliation(s)
- Omar Yossofzai
- Institute of Medical Science, University of Toronto, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, Canada
| | - Asthik Biswas
- Department of Diagnostic Imaging, The Hospital for Sick Children, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Canada
| | - George M Ibrahim
- Department of Neurosurgery, The Hospital for Sick Children, Canada
| | - James Rutka
- Department of Neurosurgery, The Hospital for Sick Children, Canada
| | | | - Carter Snead
- Division of Neurology, The Hospital for Sick Children, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario Research Institute, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, The Hospital for Sick Children, Canada; Division of Neurology, The Hospital for Sick Children, Canada; Department of Medical Imaging, Lurie Children's Hospital of Chicago, United States.
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9
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Li X, Chen Q, Wang Z, Wang X, Zhang W, Lu J, Zhang X, Wang Z, Zhang B. Altered spontaneous brain activity as a potential imaging biomarker for generalized and focal to bilateral tonic-clonic seizures: A resting-state fMRI study. Epilepsy Behav 2023; 140:109100. [PMID: 36791632 DOI: 10.1016/j.yebeh.2023.109100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/21/2022] [Accepted: 01/14/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE We aimed to determine whether alterations in spontaneous regional brain activity in those with generalized tonic-clonic seizures (GTCS) and focal to bilateral tonic-clonic seizures (FBTCS) and explore whether the alterations could be used as biomarkers to classify disease subtypes through support vector machine analysis (SVM). METHODS The fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) from resting-state functional magnetic resonance imaging (rs-fMRI) data were extracted from 57 patients with GTCS, 35 patients with FBTCS, and 50 age-matched and sex-matched normal controls (NCs) using the DPARSF 5.0 toolbox. Between-group comparisons were adjusted for covariates (age, sex, and equipment). Correlation analyses between imaging biomarkers and the frequency or duration of seizure activity were calculated using partial correlations. The differential imaging indicators, age, and sex were considered as the discriminative features in the SVM to evaluate classification performance. RESULTS The patients with GTCS showed lower fALFF values (voxel p < 0.001, cluster p < 0.05, Gaussian random field corrected, GRF corrected) in the right postcentral gyrus and precentral gyrus and lower ReHo values (GRF corrected) in the middle temporal gyrus than the NCs. The patients with FBTCS showed higher fALFF (GRF corrected) values in the right postcentral and precentral gyrus and higher ReHo (GRF corrected) values in the right postcentral gyrus. Both fALFF (GRF corrected) and ReHo (GRF corrected) values were lower in the right postcentral gyrus and precentral gyrus in the GTCS group than in the FBTCS group. In patients with FBTCS, fALFF values in the right postcentral and precentral gyrus were positively correlated with duration (r = 0.655, p = 0.008, Bonferroni corrected) in the low-duration group, and ReHo values in the right postcentral gyrus were positively correlated with frequency (r = 0.486, p = 0.022, uncorrected) in the low-frequency group. SVM results showed receiver operating characteristic curves of 0.89, 0.87, and 0.76 for the classification between GTCS and NC, between FBTCS and NC, and GTCS and FBTCS, respectively. SIGNIFICANCE This study detected alterations in fALFF and ReHo in the postcentral gyrus and precentral gyrus in patients with GTCS and FBTCS, which might contribute to understanding the pathogenesis, disease classification, and clinical targeted therapy.
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Affiliation(s)
- Xin Li
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qian Chen
- Department of Radiology, the Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Zhongyuan Wang
- Department of Neurology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xiaoyun Wang
- Department of Neurology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Wen Zhang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jiaming Lu
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xin Zhang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zhengge Wang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China.
| | - Bing Zhang
- Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China.
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Reinholdson J, Olsson I, Edelvik Tranberg A, Malmgren K. Low IQ predicts worse long-term seizure outcome after resective epilepsy surgery - A propensity score matched analysis. Epilepsy Res 2023; 191:107110. [PMID: 36821876 DOI: 10.1016/j.eplepsyres.2023.107110] [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: 01/09/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To describe long-term seizure outcomes in patients with IQ < 70 undergoing resective epilepsy surgery and to analyse whether baseline IQ predicts seizure outcome. METHODS Patients undergoing focal resective epilepsy surgery 1995-2017 at age ≥ 4 years were identified in the population-based Swedish National Epilepsy Surgery Register. Two-year, five-year and long-term (10-20-year follow-up) outcomes were analysed. Seizure outcomes of patients with IQ ≥ 70 and IQ < 70 at baseline were compared in the full cohort and between propensity score matched groups. RESULTS Follow-up data were available for 884 patients, 79 of whom had IQ < 70. Matched controls were found for 74 of the IQ < 70 patients. Preoperative MRI pathology was unifocal in 54 % and 79 % of IQ < 70 and IQ ≥ 70 patients before matching compared to 58 % and 62 % after matching, respectively. Patients with IQ < 70 achieved significantly worse seizure outcomes at all time points both when analysing the full cohort and the matched groups. After matching, the proportions of seizure-free patients in the IQ < 70 group were 28 %, 32 % and 32 % at the 2-year, 5-year and long-term follow-ups, respectively. Corresponding figures in the IQ ≥ 70 group were 54 %, 62 % and 60 % (p for difference between IQ groups 0.004, 0.002 and 0.049). In the IQ < 70 group, 36 %, 29 % and 45 % had a ≥ 75 % reduction in seizure frequency at the respective three follow-ups. CONCLUSION Low preoperative IQ predicts lower chances of seizure freedom after resective epilepsy surgery and few patients with IQ < 70 remain completely seizure-free in the long term. Nevertheless, a significant proportion had a reduction in seizure frequency of at least 75 % at long-term follow-up, indicating an important palliative potential of resective surgery for epilepsy patients with intellectual disability.
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Affiliation(s)
- Jesper Reinholdson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Ingrid Olsson
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Anna Edelvik Tranberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, SE-413 45 Gothenburg, Sweden..
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, SE-413 45 Gothenburg, Sweden..
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11
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Dasgupta D, Finn R, Chari A, Giampiccolo D, de Tisi J, O'Keeffe AG, Miserocchi A, McEvoy AW, Vos SB, Duncan JS. Hippocampal resection in temporal lobe epilepsy: Do we need to resect the tail? Epilepsy Res 2023; 190:107086. [PMID: 36709527 PMCID: PMC10626579 DOI: 10.1016/j.eplepsyres.2023.107086] [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: 08/22/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Anteromesial temporal lobe resection is the most common surgical technique used to treat drug-resistant mesial temporal lobe epilepsy, particularly when secondary to hippocampal sclerosis. Structural and functional imaging data suggest the importance of sparing the posterior hippocampus for minimising language and memory deficits. Recent work has challenged the view that maximal posterior hippocampal resection improves seizure outcome. This study was designed to assess whether resection of posterior hippocampal atrophy was associated with improved seizure outcome. METHODS Retrospective analysis of a prospective database of all anteromesial temporal lobe resections performed in individuals with hippocampal sclerosis at our epilepsy surgery centre, 2013-2021. Pre- and post-operative MRI were reviewed by 2 neurosurgical fellows to assess whether the atrophic segment, displayed by automated hippocampal morphometry, was resected, and ILAE seizure outcomes were collected at 1 year and last clinical follow-up. Data analysis used univariate and binary logistic regression. RESULTS Sixty consecutive eligible patients were identified of whom 70% were seizure free (ILAE Class 1 & 2) at one year. There was no statistically significant difference in seizure freedom outcomes in patients who had complete resection of atrophic posterior hippocampus or not (Fisher's Exact test statistic 0.69, not significant at p < .05) both at one year, and at last clinical follow-up. In the multivariate analysis only a history of status epilepticus (OR=0.2, 95%CI:0.042-0.955, p = .04) at one year, and pre-operative psychiatric disorder (OR=0.145, 95%CI:0.036-0.588, p = .007) at last clinical follow-up, were associated with a reduced chance of seizure freedom. SIGNIFICANCE Our data suggest that seizure freedom is not associated with whether or not posterior hippocampal atrophy is resected. This challenges the traditional surgical dogma of maximal posterior hippocampal resection in anteromesial temporal lobe resections and is a step further optimising this surgical procedure to maximise seizure freedom and minimise associated language and memory deficits.
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Affiliation(s)
- Debayan Dasgupta
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Roisin Finn
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK; Developmental Neuroscience, Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Davide Giampiccolo
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Institute of Neurosciences, Cleveland Clinic London, London, UK.
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Aidan G O'Keeffe
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK. aidan.o'
| | - Anna Miserocchi
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Andrew W McEvoy
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Sjoerd B Vos
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia.
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK.
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12
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Passaro EA. Neuroimaging in Adults and Children With Epilepsy. Continuum (Minneap Minn) 2023; 29:104-155. [PMID: 36795875 DOI: 10.1212/con.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This article discusses the fundamental importance of optimal epilepsy imaging using the International League Against Epilepsy-endorsed Harmonized Neuroimaging of Epilepsy Structural Sequences (HARNESS) protocol and the use of multimodality imaging in the evaluation of patients with drug-resistant epilepsy. It outlines a methodical approach to evaluating these images, particularly in the context of clinical information. LATEST DEVELOPMENTS Epilepsy imaging is rapidly evolving, and a high-resolution epilepsy protocol MRI is essential in evaluating newly diagnosed, chronic, and drug-resistant epilepsy. The article reviews the spectrum of relevant MRI findings in epilepsy and their clinical significance. Integrating multimodality imaging is a powerful tool in the presurgical evaluation of epilepsy, particularly in "MRI-negative" cases. For example, correlation of clinical phenomenology, video-EEG with positron emission tomography (PET), ictal subtraction single-photon emission computerized tomography (SPECT), magnetoencephalography (MEG), functional MRI, and advanced neuroimaging such as MRI texture analysis and voxel-based morphometry enhances the identification of subtle cortical lesions such as focal cortical dysplasias to optimize epilepsy localization and selection of optimal surgical candidates. ESSENTIAL POINTS The neurologist has a unique role in understanding the clinical history and seizure phenomenology, which are the cornerstones of neuroanatomic localization. When integrated with advanced neuroimaging, the clinical context has a profound impact on identifying subtle MRI lesions or finding the "epileptogenic" lesion when multiple lesions are present. Patients with an identified lesion on MRI have a 2.5-fold improved chance of achieving seizure freedom with epilepsy surgery compared with those without a lesion. This clinical-radiographic integration is essential to accurate classification, localization, determination of long-term prognosis for seizure control, and identification of candidates for epilepsy surgery to reduce seizure burden or attain seizure freedom.
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13
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Khoo A, de Tisi J, Foong J, Bindman D, O'Keeffe AG, Sander JW, Miserocchi A, McEvoy AW, Duncan JS. Long-term seizure, psychiatric and socioeconomic outcomes after frontal lobe epilepsy surgery. Epilepsy Res 2022; 186:106998. [PMID: 35985250 DOI: 10.1016/j.eplepsyres.2022.106998] [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: 01/26/2022] [Revised: 07/17/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Resective surgery for selected individuals with frontal lobe epilepsy can be effective, although multimodal outcomes are less established than in temporal lobe epilepsy. We describe long-term seizure remission and relapse patterns, psychiatric comorbidity, and socioeconomic outcomes following frontal lobe epilepsy surgery. METHODS We reviewed individual data on frontal lobe epilepsy procedures at our center between 1990 and 2020. This included the presurgical evaluation, operative details and annual postoperative seizure and psychiatric outcomes, prospectively recorded in an epilepsy surgery database. Outcome predictors were subjected to multivariable analysis, and rates of seizure freedom were analyzed using Kaplan-Meier methods. We used longitudinal assessment of the Index of Multiple Deprivation to assess change in socioeconomic status over time. RESULTS A total of 122 individuals with a median follow-up of seven years were included. Of these, 33 (27 %) had complete seizure freedom following surgery, with a further 13 (11 %) having only auras. Focal MRI abnormality, histopathology (focal cortical dysplasia, cavernoma or dysembryoplastic neuronal epithelial tumor) and fewer anti-seizure medications at the time of surgery were predictive of a favorable outcome; 67 % of those seizure-free for the first 12 months after surgery never experienced a seizure relapse. Thirty-one of 50 who had preoperative psychiatric pathology noticed improved psychiatric symptomatology by two years postoperatively. New psychiatric comorbidity was diagnosed in 15 (13 %). Persistent motor complications occurred in 5 % and dysphasia in 2 %. No significant change in socioeconomic deciles of deprivation was observed after surgery. SIGNIFICANCE Favorable long-term seizure, psychiatric and socioeconomic outcomes can be seen following frontal lobe epilepsy surgery. This is a safe and effective treatment that should be offered to suitable individuals early.
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Affiliation(s)
- Anthony Khoo
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
| | - Jane de Tisi
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Jacqueline Foong
- Department of Neuropsychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Dorothea Bindman
- Department of Neuropsychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Aidan G O'Keeffe
- School of Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, Heemstede 2103SW, Netherlands; Department of Neurology, West China Hospital, & Institute of Brain Science & Brain-inspired Technology, Sichuan University, Chengdu 610041, China
| | - Anna Miserocchi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Andrew W McEvoy
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - John S Duncan
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
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Sinha N, Johnson GW, Davis KA, Englot DJ. Integrating Network Neuroscience Into Epilepsy Care: Progress, Barriers, and Next Steps. Epilepsy Curr 2022; 22:272-278. [PMID: 36285209 PMCID: PMC9549227 DOI: 10.1177/15357597221101271] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Drug resistant epilepsy is a disorder involving widespread brain network
alterations. Recently, many groups have reported neuroimaging and
electrophysiology network analysis techniques to aid medical
management, support presurgical planning, and understand postsurgical
seizure persistence. While these approaches may supplement standard
tests to improve care, they are not yet used clinically or influencing
medical or surgical decisions. When will this change? Which approaches
have shown the most promise? What are the barriers to translating them
into clinical use? How do we facilitate this transition? In this
review, we will discuss progress, barriers, and next steps regarding
the integration of brain network analysis into the medical and
presurgical pipeline.
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Affiliation(s)
- Nishant Sinha
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia PA, USA
- Department of Neurology, Penn Epilepsy Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Graham W. Johnson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn A. Davis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia PA, USA
- Department of Neurology, Penn Epilepsy Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dario J. Englot
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Duncan JS. Multidisciplinary team meetings: the epilepsy experience. Pract Neurol 2022; 22:practneurol-2022-003350. [PMID: 35534196 DOI: 10.1136/practneurol-2022-003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/03/2022]
Abstract
Multidisciplinary team (MDT) meetings are essential for ensuring optimal and consistent management for patients with complex problems and a variety of treatment options. Epilepsy surgery MDTs are a good example of complex decision making and planning to the best possible outcomes. The meetings need to run to an agreed format, with participants from neurology, neurophysiology, neuroimaging, neuropsychology, neuropsychiatry and neurosurgery all contributing succinct opinions to enable an informed discussion. A key feature of a successful MDT is to have a clear record of complementary data and perspectives, and to document management options. It is crucial to have a debrief after the event if an outcome is less good than anticipated, with the case being gone through in as much detail as a preoperative case, and ensuring that the whole team shares the successes and the disappointments and learns from the experience.
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Affiliation(s)
- John S Duncan
- Department of Epilepsy, UCL Queen Square Institute of Neurology, London, UK
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Alim-Marvasti A, Vakharia VN, Duncan JS. Multimodal prognostic features of seizure freedom in epilepsy surgery. J Neurol Neurosurg Psychiatry 2022; 93:499-508. [PMID: 35246493 PMCID: PMC9016256 DOI: 10.1136/jnnp-2021-327119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Accurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models. METHODS We searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: 'clinical', 'imaging', 'neurophysiology', 'multimodal concordance', 'genetic', 'surgical technique' and 'pathology'. We propose a structural causal model based on these features. RESULTS We found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons. SIGNIFICANCE Seizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models. PROSPERO REGISTRATION NUMBER CRD42021185232.
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Affiliation(s)
- Ali Alim-Marvasti
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK .,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vejay Niranjan Vakharia
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK
| | - John Sidney Duncan
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK
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Taylor PN, Papasavvas CA, Owen TW, Schroeder GM, Hutchings FE, Chowdhury FA, Diehl B, Duncan JS, McEvoy AW, Miserocchi A, de Tisi J, Vos SB, Walker MC, Wang Y. Normative brain mapping of interictal intracranial EEG to localize epileptogenic tissue. Brain 2022; 145:939-949. [PMID: 35075485 PMCID: PMC9050535 DOI: 10.1093/brain/awab380] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/19/2021] [Accepted: 09/03/2021] [Indexed: 11/14/2022] Open
Abstract
The identification of abnormal electrographic activity is important in a wide range of neurological disorders, including epilepsy for localizing epileptogenic tissue. However, this identification may be challenging during non-seizure (interictal) periods, especially if abnormalities are subtle compared to the repertoire of possible healthy brain dynamics. Here, we investigate if such interictal abnormalities become more salient by quantitatively accounting for the range of healthy brain dynamics in a location-specific manner. To this end, we constructed a normative map of brain dynamics, in terms of relative band power, from interictal intracranial recordings from 234 participants (21 598 electrode contacts). We then compared interictal recordings from 62 patients with epilepsy to the normative map to identify abnormal regions. We proposed that if the most abnormal regions were spared by surgery, then patients would be more likely to experience continued seizures postoperatively. We first confirmed that the spatial variations of band power in the normative map across brain regions were consistent with healthy variations reported in the literature. Second, when accounting for the normative variations, regions that were spared by surgery were more abnormal than those resected only in patients with persistent postoperative seizures (t = -3.6, P = 0.0003), confirming our hypothesis. Third, we found that this effect discriminated patient outcomes (area under curve 0.75 P = 0.0003). Normative mapping is a well-established practice in neuroscientific research. Our study suggests that this approach is feasible to detect interictal abnormalities in intracranial EEG, and of potential clinical value to identify pathological tissue in epilepsy. Finally, we make our normative intracranial map publicly available to facilitate future investigations in epilepsy and beyond.
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Affiliation(s)
- Peter N Taylor
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Christoforos A Papasavvas
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
| | - Thomas W Owen
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
| | - Gabrielle M Schroeder
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
| | - Frances E Hutchings
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
| | - Fahmida A Chowdhury
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Beate Diehl
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - John S Duncan
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Andrew W McEvoy
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Anna Miserocchi
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Jane de Tisi
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Sjoerd B Vos
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Matthew C Walker
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Yujiang Wang
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
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18
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Mula M, Coleman H, Wilson SJ. Neuropsychiatric and Cognitive Comorbidities in Epilepsy. Continuum (Minneap Minn) 2022; 28:457-482. [PMID: 35393966 DOI: 10.1212/con.0000000000001123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses psychiatric and cognitive comorbidities of epilepsy over the lifespan and illustrates opportunities to improve the quality of care of children and adults with epilepsy. RECENT FINDINGS One in 3 people with epilepsy have a lifetime history of psychiatric disorders, and they represent an important prognostic marker of epilepsy. Contributors are diverse and display a complex relationship. Cognitive comorbidities are also common among those living with epilepsy and are increasingly recognized as a reflection of changes to underlying brain networks. Among the cognitive comorbidities, intellectual disability and dementia are common and can complicate the diagnostic process when cognitive and/or behavioral features resemble seizures. SUMMARY Comorbidities require consideration from the first point of contact with a patient because they can determine the presentation of symptoms, responsiveness to treatment, and the patient's day-to-day functioning and quality of life. In epilepsy, psychiatric and cognitive comorbidities may prove a greater source of disability for the patient and family than the seizures themselves, and in the case of essential comorbidities, they are regarded as core to the disorder in terms of etiology, diagnosis, and treatment.
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19
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Haemels M, Van Weehaeghe D, Cleeren E, Dupont P, van Loon J, Theys T, Van Laere K, Van Paesschen W, Goffin K. Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy. Acta Neurol Belg 2022; 122:325-335. [PMID: 33544336 DOI: 10.1007/s13760-020-01569-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/08/2020] [Indexed: 01/30/2023]
Abstract
The value of functional molecular changes outside the seizure onset zone as independent predictive factors of surgical outcome has been scarcely evaluated. The aim of this retrospective study was to evaluate relative metabolic and perfusion changes outside the seizure onset zone as predictors of postoperative outcome in patients with unifocal refractory focal epilepsy. Eighty-six unifocal epilepsy patients who underwent 18F-FDG PET prior to surgery were included. Ictal and interictal perfusion SPECT was available in 65 patients. Good postoperative outcome was defined as the International League against Epilepsy class 1. Using univariate statistical analysis, the predictive ability of volume-of-interest based relative metabolism/perfusion for outcome classification was quantified by AUC ROC-curve, using composite, unilateral cortical (frontal, orbitofrontal, temporal, parietal, occipital) and central volumes-of-interest. The results were cross-validated, and a false discovery rate (FDR) correction was applied. As a secondary objective, a subgroup analysis was performed on temporal lobe epilepsy patients (N = 64). Increased relative ictal perfusion in the contralateral central volume-of-interest was significantly associated with the good surgical outcome both in the total population (AUC 0.79, pFDR = 0.009) and the temporal lobe epilepsy subgroup (AUC 0.80, pFDR = 0.028). No other significant associations between functional molecular changes and postoperative outcome were found. Increased relative ictal perfusion in the contralateral central region significantly predicted outcome after epilepsy surgery in patients with refractory focal epilepsy. We postulate that these relative perfusion changes could be an expression of better preoperative neuronal network integration and centralization in the contralateral central structures, which is suggested to be associated with better postoperative outcome.
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20
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Klodowski DA, George BJ, Sperling MR. Seizure Latency and Epilepsy Localization as Predictors of Recurrence Following Epilepsy Surgery. Epilepsia 2022; 63:1074-1080. [PMID: 35286721 DOI: 10.1111/epi.17224] [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: 11/15/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary purpose is to determine if the time between epilepsy surgery and first seizure recurrence can estimate the timing of the next seizure event for temporal and extratemporal epilepsy. A secondary endpoint aimed to compare temporal and extratemporal epilepsy surgery and examine which subgroup has a higher hazard of subsequent seizure recurrence. METHODS Data was used from a retrospective database at Thomas Jefferson University Hospital. Records were stratified into temporal (N = 943) and extratemporal (N = 125) surgeries. Analyses were done using SAS and utilized Cox-Proportional hazards models while controlling for demographics and clinical factors. The primary predictor of time between surgery and first recurrence was treated as a nominal variable binned into six segments, while secondary endpoints used a categorical predictor of epilepsy location while controlling for seizure latency. RESULTS Generally, as seizure latency following surgery increased, the time between first seizure and second seizure increased. These results were statistical meaningful in the temporal set (Wald Chi Square: 40.4715, df = 5, p<0.0001). Outcomes could also be interpreted based on predictor group, for instance, if seizure one occurred between one to two months following surgery in the temporal set, the median number of days until the next seizure was 35.5 days (95% CIs: 21 - 89 days). Secondary analysis showed that temporal lobe epilepsy had a lower hazard of a second seizure than extratemporal lobe epilepsy (89.2% reduction in hazard; 95% CIs: 0.015 - 0.795). SIGNIFICANCE This analysis provides a framework to use initial seizure latency to predict the median number of days until the next seizure event, while stratifying based on epilepsy location and controlling for multiple variables. It also suggests that the hazard of seizure recurrence in temporal lobe epilepsy is lower than extratemporal lobe epilepsy.
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Affiliation(s)
- David A Klodowski
- Sidney Kimmel Medical College, Thomas Jefferson University.,Jefferson College of Population Health
| | - Brandon J George
- Jefferson College of Population Health.,Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University
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21
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Gomes-Duarte A, Venø MT, de Wit M, Senthilkumar K, Broekhoven MH, van den Herik J, Heeres FR, van Rossum D, Rybiczka-Tesulov M, Legnini I, van Rijen PC, van Eijsden P, Gosselaar PH, Rajewsky N, Kjems J, Vangoor VR, Pasterkamp RJ. Expression of Circ_Satb1 Is Decreased in Mesial Temporal Lobe Epilepsy and Regulates Dendritic Spine Morphology. Front Mol Neurosci 2022; 15:832133. [PMID: 35310884 PMCID: PMC8927295 DOI: 10.3389/fnmol.2022.832133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
Mesial temporal lobe epilepsy (mTLE) is a chronic disease characterized by recurrent seizures that originate in the temporal lobes of the brain. Anti-epileptic drugs (AEDs) are the standard treatment for managing seizures in mTLE patients, but are frequently ineffective. Resective surgery is an option for some patients, but does not guarantee a postoperative seizure-free period. Therefore, further insight is needed into the pathogenesis of mTLE to enable the design of new therapeutic strategies. Circular RNAs (circRNAs) have been identified as important regulators of neuronal function and have been implicated in epilepsy. However, the mechanisms through which circRNAs contribute to epileptogenesis remain unknown. Here, we determine the circRNA transcriptome of the hippocampus and cortex of mTLE patients by using RNA-seq. We report 333 differentially expressed (DE) circRNAs between healthy individuals and mTLE patients, of which 23 circRNAs displayed significant adjusted p-values following multiple testing correction. Interestingly, hippocampal expression of circ_Satb1, a circRNA derived from special AT-rich sequence binding protein 1 (SATB1), is decreased in both mTLE patients and in experimental epilepsy. Our work shows that circ_Satb1 displays dynamic patterns of neuronal expression in vitro and in vivo. Further, circ_Satb1-specific knockdown using CRISPR/CasRx approaches in hippocampal cultures leads to defects in dendritic spine morphology, a cellular hallmark of mTLE. Overall, our results identify a novel epilepsy-associated circRNA with disease-specific expression and previously unidentified cellular effects that are relevant for epileptogenesis.
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Affiliation(s)
- Andreia Gomes-Duarte
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Morten T. Venø
- Interdisciplinary Nanoscience Center, Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
- Omiics ApS, Aarhus, Denmark
| | - Marina de Wit
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ketharini Senthilkumar
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mark H. Broekhoven
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joëlle van den Herik
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Fleur R. Heeres
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Daniëlle van Rossum
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mateja Rybiczka-Tesulov
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ivano Legnini
- Systems Biology of Gene Regulatory Elements, Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Peter C. van Rijen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Pieter van Eijsden
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Peter H. Gosselaar
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Nikolaus Rajewsky
- Systems Biology of Gene Regulatory Elements, Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Jørgen Kjems
- Interdisciplinary Nanoscience Center, Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - Vamshidhar R. Vangoor
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - R. Jeroen Pasterkamp
- Affiliated Partner of the European Reference Network EpiCARE, Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- *Correspondence: R. Jeroen Pasterkamp,
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22
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18F-FDG PET/MR in focal epilepsy: A new step for improving the detection of epileptogenic lesions. Epilepsy Res 2021; 178:106819. [PMID: 34847426 DOI: 10.1016/j.eplepsyres.2021.106819] [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: 06/07/2021] [Revised: 10/19/2021] [Accepted: 11/15/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Hybrid PET/MR is a promising tool in focal drug-resistant epilepsy, however the additional value for the detection of epileptogenic lesions and surgical decision-making remains to be established. METHODS We retrospectively compared 18F-FDG PET/MR images with those obtained by a previous 18F-FDG PET co-registered with MRI (PET+MR) in 25 consecutive patients (16 females, 13-60 years) investigated for focal drug-resistant epilepsy. Visual analysis was performed by two readers blinded from imaging modalities, asked to assess the technical characteristics (co-registration, quality of images), the confidence in results, the location of PET abnormalities and the presence of a structural lesion on MRI. Clinical impact on surgical strategy and outcome was assessed independently. RESULTS The location of epileptic focus was temporal in 9 patients and extra-temporal in 16 others. MRI was initially considered negative in 21 patients. PET stand-alone demonstrated metabolic abnormalities in 19 cases (76%), and the co-registration with MRI allowed the detection of 4 additional structural lesions. Compared to PET+MR, the PET/MR sensitivity was increased by 13% and new structural lesions (mainly focal cortical dysplasias) were detected in 6 patients (24%). Change of surgical decision-making was substantial for 10 patients (40%), consisting in avoiding invasive monitoring in 6 patients and modifying the planning in 4 others. Seizure-free outcome (follow-up>1 year) was obtained in 12/14 patients who underwent a cortical resection. CONCLUSION Hybrid PET/MR may improve the detection of epileptogenic lesions, allowing to optimize the presurgical work-up and to increase the proportion of successful surgery even in the more complex cases.
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23
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Fox J, Wood MF, Phillips SE, Crudele A, Haas KF, Abou-Khalil BW, Sonmezturk HH. Enhanced rates of detection and treatment of depression and anxiety disorders among adult patients with epilepsy using automated EMR-based screening. Epilepsy Behav 2021; 123:108259. [PMID: 34418639 DOI: 10.1016/j.yebeh.2021.108259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Depression and anxiety disorders are common among patients with epilepsy (PWE). These comorbidities have been shown to influence prognosis and may have a greater impact on quality of life than seizure control. Despite guideline recommendations and expert consensus to regularly screen for and treat both conditions, there is evidence that they are underdiagnosed and undertreated. Our goal was to test a novel screening method to determine if it would increase the rate of detecting and treating depression and anxiety disorders among PWE. METHOD The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the Brief Epilepsy Anxiety Survey Instrument (brEASI) were selected as validated screening instruments for depression and anxiety disorders, respectively. They were sent via an electronic medical record-linked patient portal to all patients of four epileptologists 48 h prior to their clinic appointment. We evaluated whether this increased the rate of detecting and treating depression and anxiety disorders relative to a historical control group. RESULTS A total of 563 patients were included of whom 351 were sent the screening instruments. 62.7% of patients completed the screening instruments of whom 47.7% screened positive for either depression only (16.4%), anxiety disorders only (5.5%) or both (25.9%); a statistically significant increase relative to the control group. There was also a significantly increased proportion of patients for whom treatment was initiated for depression (p < 0.01), anxiety disorders (p < 0.01), or both (p < 0.01). CONCLUSIONS We identified an easily applicable and efficient means of enhancing detection and treatment rates for depression and anxiety disorders among PWE in a busy clinic setting.
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Affiliation(s)
- Jonah Fox
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Mitchell F Wood
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sharon E Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angela Crudele
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin F Haas
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bassel W Abou-Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hasan H Sonmezturk
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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24
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Samanta D, Beal JC, Grinspan ZM. Automated Identification of Surgical Candidates and Estimation of Postoperative Seizure Freedom in Children - A Focused Review. Semin Pediatr Neurol 2021; 39:100914. [PMID: 34620464 PMCID: PMC9082396 DOI: 10.1016/j.spen.2021.100914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022]
Abstract
Surgery is an effective but underused treatment for drug-resistant epilepsy in children. Algorithms to identify surgical candidates and estimate the likelihood of postoperative clinical improvement may be valuable to improve access to epilepsy surgery. We provide a focused review of these approaches. For adults with epilepsy, tools to identify surgical candidates and predict seizure and cognitive outcomes (Ie, Cases for Epilepsy (toolsforepilepsy.com) and Epilepsy Surgery Grading Scale) have been validated and are in use. Analogous tools for children need development. A promising approach is to apply statistical learning tools to clinical datasets, such as electroencephalogram tracings, imaging studies, and the text of clinician notes. Demonstration projects suggest these techniques have the potential to be highly accurate, and await further validation and clinical application.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jules C. Beal
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Zachary M. Grinspan
- Department of Pediatrics, Weill Cornell Medicine, New York, NY.,Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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25
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Fitzgerald Z, Morita-Sherman M, Hogue O, Joseph B, Alvim MKM, Yasuda CL, Vegh D, Nair D, Burgess R, Bingaman W, Najm I, Kattan MW, Blumcke I, Worrell G, Brinkmann BH, Cendes F, Jehi L. Improving the prediction of epilepsy surgery outcomes using basic scalp EEG findings. Epilepsia 2021; 62:2439-2450. [PMID: 34338324 PMCID: PMC8488002 DOI: 10.1111/epi.17024] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/15/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the role of scalp electroencephalography (EEG; ictal and interictal patterns) in predicting resective epilepsy surgery outcomes. We use the data to further develop a nomogram to predict seizure freedom. METHODS We retrospectively reviewed the scalp EEG findings and clinical data of patients who underwent surgical resection at three epilepsy centers. Using both EEG and clinical variables categorized into 13 isolated candidate predictors and 6 interaction terms, we built a multivariable Cox proportional hazards model to predict seizure freedom 2 years after surgery. Harrell's step-down procedure was used to sequentially eliminate the least-informative variables from the model until the change in the concordance index (c-index) with variable removal was less than 0.01. We created a separate model using only clinical variables. Discrimination of the two models was compared to evaluate the role of scalp EEG in seizure-freedom prediction. RESULTS Four hundred seventy patient records were analyzed. Following internal validation, the full Clinical + EEG model achieved an optimism-corrected c-index of 0.65, whereas the c-index of the model without EEG data was 0.59. The presence of focal to bilateral tonic-clonic seizures (FBTCS), high preoperative seizure frequency, absence of hippocampal sclerosis, and presence of nonlocalizable seizures predicted worse outcome. The presence of FBTCS had the largest impact for predicting outcome. The analysis of the models' interactions showed that in patients with unilateral interictal epileptiform discharges (IEDs), temporal lobe surgery cases had a better outcome. In cases with bilateral IEDs, abnormal magnetic resonance imaging (MRI) predicted worse outcomes, and in cases without IEDs, patients with extratemporal epilepsy and abnormal MRI had better outcomes. SIGNIFICANCE This study highlights the value of scalp EEG, particularly the significance of IEDs, in predicting surgical outcome. The nomogram delivers an individualized prediction of postoperative outcome, and provides a unique assessment of the relationship between the outcome and preoperative findings.
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Affiliation(s)
| | | | - Olivia Hogue
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Boney Joseph
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Deborah Vegh
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Richard Burgess
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Bingaman
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael W. Kattan
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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26
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Khoo A, de Tisi J, Mannan S, O'Keeffe AG, Sander JW, Duncan JS. Reasons for not having epilepsy surgery. Epilepsia 2021; 62:2909-2919. [PMID: 34558079 DOI: 10.1111/epi.17083] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study was undertaken to determine reasons for adults with drug-resistant focal epilepsy who undergo presurgical evaluation not proceeding with surgery, and to identify predictors of this course. METHODS We retrospectively analyzed data on 617 consecutive individuals evaluated for epilepsy surgery at a tertiary referral center between January 2015 and December 2019. We compared the characteristics of those in whom a decision not to proceed with surgical treatment was made with those who underwent definitive surgery in the same period. Multivariate logistic regression was performed to identify predictors of not proceeding with surgery. RESULTS A decision not to proceed with surgery was reached in 315 (51%) of 617 individuals evaluated. Common reasons for this were an inability to localize the epileptogenic zone (n = 104) and the presence of multifocal epilepsy (n = 74). An individual choice not to proceed with intracranial electroencephalography (icEEG; n = 50) or surgery (n = 39), risk of significant deficit (n = 33), declining noninvasive investigation (n = 12), and coexisting neurological comorbidity (n = 3) accounted for the remainder. Compared to 166 surgically treated patients, those who did not proceed to surgery were more likely to have a learning disability (odds ratio [OR] = 2.35, 95% confidence interval [CI] = 1.07-5.16), normal magnetic resonance imaging (OR = 4.48, 95% CI = 1.68-11.94), extratemporal epilepsy (OR = 2.93, 95% CI = 1.82-4.71), bilateral seizure onset zones (OR = 3.05, 95% CI = 1.41-6.61) and to live in more deprived socioeconomic areas (median deprivation decile = 40%-50% vs. 50%-60%, p < .05). SIGNIFICANCE Approximately half of those evaluated for surgical treatment of drug-resistant focal epilepsy do not proceed to surgery. Early consideration and discussion of the likelihood of surgical suitability or need for icEEG may help direct referral for presurgical evaluation.
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Affiliation(s)
- Anthony Khoo
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Shahidul Mannan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | | | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands.,Department of Neurology, West China Hospital, and Institute of Brain Science and Brain-Inspired Technology, Sichuan University, Chengdu, China
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK
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Petrik S, San Antonio-Arce V, Steinhoff BJ, Syrbe S, Bast T, Scheiwe C, Brandt A, Beck J, Schulze-Bonhage A. Epilepsy surgery: Late seizure recurrence after initial complete seizure freedom. Epilepsia 2021; 62:1092-1104. [PMID: 33778964 DOI: 10.1111/epi.16893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was undertaken to improve understanding of late relapse following epilepsy surgery in pharmacoresistant epilepsy. METHODS Retrospective comparison was made of 99 of 1278 patients undergoing surgery during 1999-2015 with seizure relapses after at least 2 years of complete seizure freedom with matched controls experiencing continued long-term seizure freedom. Univariate and multivariate analyses were performed. RESULTS With a mean follow-up of 9.7 years, mean time to seizure relapse was 56.6 months. In multivariate analysis, incomplete resection based on magnetic resonance imaging (MRI), bilateral lesions on preoperative MRI, and epilepsy onset in the first year of life carried a significantly higher risk of late relapse. In patients with late relapse, additional functional imaging with positron emission tomography had been performed significantly more often. Although the differences were not significant in multivariate analysis, doses of antiepileptic drugs were higher in the relapse group preoperatively and in the first 24 months and complete withdrawal was more frequent in the control group (68% vs. 51%). Regarding seizure frequency, most patients had mild seizure relapse (single relapse seizure or <1/month). SIGNIFICANCE In our predominantly lesional cohort, complete resection of the MRI lesion is the most important factor to maintain long-term seizure freedom. Two patterns of recurrence were identified: (1) incomplete resected lesions with seizure generation in proximity to the initial resection and (2) epileptogenic networks not detected preoperatively or evolving in the postoperative interval and manifesting with new clinical and diagnostic features.
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Affiliation(s)
- Stephan Petrik
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Victoria San Antonio-Arce
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Steffen Syrbe
- Division of Child Neurology and Inherited Metabolic Diseases, Center for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Bast
- Kork Epilepsy Center, Kehl-Kork, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Armin Brandt
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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28
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Witkowska-Wrobel A, Aristovich K, Crawford A, Perkins JD, Holder D. Imaging of focal seizures with Electrical Impedance Tomography and depth electrodes in real time. Neuroimage 2021; 234:117972. [PMID: 33757909 PMCID: PMC8204270 DOI: 10.1016/j.neuroimage.2021.117972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 01/31/2021] [Accepted: 03/12/2021] [Indexed: 11/26/2022] Open
Abstract
Intracranial EEG is the current gold standard technique for localizing seizures for surgery, but it can be insensitive to tangential dipole or distant sources. Electrical Impedance Tomography (EIT) offers a novel method to improve coverage and seizure onset localization. The feasibility of EIT has been previously assessed in a computer simulation, which revealed an improved accuracy of seizure detection with EIT compared to intracranial EEG. In this study, slow impedance changes, evoked by cell swelling occurring over seconds, were reconstructed in real time by frequency division multiplexing EIT using depth and subdural electrodes in a swine model of epilepsy. EIT allowed to generate repetitive images of ictal events at similar time course to fMRI but without its significant limitations. EIT was recorded with a system consisting of 32 parallel current sources and 64 voltage recorders. Seizures triggered with intracranial injection of benzylpenicillin (BPN) in five pigs caused a repetitive peak impedance increase of 3.4 ± 1.5 mV and 9.5 ± 3% (N =205 seizures); the impedance signal change was seen already after a single, first seizure. EIT enabled reconstruction of the seizure onset 9 ± 1.5 mm from the BPN cannula and 7.5 ± 1.1 mm from the closest SEEG contact (p<0.05, n =37 focal seizures in three pigs) and it could address problems with sampling error in intracranial EEG. The amplitude of the impedance change correlated with the spread of the seizure on the SEEG (p <<0.001, n =37). The results presented here suggest that combining a parallel EIT system with intracranial EEG monitoring has a potential to improve the diagnostic yield in epileptic patients and become a vital tool in improving our understanding of epilepsy.
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Affiliation(s)
| | - Kirill Aristovich
- Medical Physics and Biomedical Engineering, University College London, UK
| | - Abbe Crawford
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - Justin D Perkins
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - David Holder
- Medical Physics and Biomedical Engineering, University College London, UK
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Bjellvi J, Edelvik Tranberg A, Rydenhag B, Malmgren K. Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study. Neurosurgery 2021; 87:704-711. [PMID: 31792497 PMCID: PMC7490157 DOI: 10.1093/neuros/nyz488] [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] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/02/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Increased seizure frequency and new-onset tonic-clonic seizures (TCS) have been reported after epilepsy surgery. OBJECTIVE To analyze potential risk factors for these outcomes in a large cohort. METHODS We studied prospectively collected data in the Swedish National Epilepsy Surgery Register on increased seizure frequency and new-onset TCS after epilepsy surgery 1990-2015. RESULTS Two-year seizure outcome was available for 1407 procedures, and data on seizure types for 1372. Increased seizure frequency at follow-up compared to baseline occurred in 56 cases (4.0%) and new-onset TCS in 53 (3.9%; 6.6% of the patients without preoperative TCS). Increased frequency was more common in reoperations compared to first surgeries (7.9% vs 3.1%; P = .001) and so too for new-onset TCS (6.7% vs 3.2%; P = .017). For first surgeries, binary logistic regression was used to analyze predictors for each outcome. In univariable analysis, significant predictors for increased seizure frequency were lower age of onset, lower age at surgery, shorter epilepsy duration, preoperative neurological deficit, intellectual disability, high preoperative seizure frequency, and extratemporal procedures. For new-onset TCS, significant predictors were preoperative deficit, intellectual disability, and nonresective procedures. In multivariable analysis, independent predictors for increased seizure frequency were lower age at surgery (odds ratio (OR) 0.70 per increasing 10-yr interval, 95% CI 0.53-0.93), type of surgery (OR 0.42 for temporal lobe resections compared to other procedures, 95% CI 0.19-0.92), and for new-onset TCS preoperative neurological deficit (OR 2.57, 95% CI 1.32-5.01). CONCLUSION Seizure worsening is rare but should be discussed when counseling patients. The identified risk factors may assist informed decision-making before surgery.
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Affiliation(s)
- Johan Bjellvi
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Edelvik Tranberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil Rydenhag
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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30
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Sinha N, Peternell N, Schroeder GM, de Tisi J, Vos SB, Winston GP, Duncan JS, Wang Y, Taylor PN. Focal to bilateral tonic-clonic seizures are associated with widespread network abnormality in temporal lobe epilepsy. Epilepsia 2021; 62:729-741. [PMID: 33476430 PMCID: PMC8600951 DOI: 10.1111/epi.16819] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Our objective was to identify whether the whole-brain structural network alterations in patients with temporal lobe epilepsy (TLE) and focal to bilateral tonic-clonic seizures (FBTCS) differ from alterations in patients without FBTCS. METHODS We dichotomized a cohort of 83 drug-resistant patients with TLE into those with and without FBTCS and compared each group to 29 healthy controls. For each subject, we used diffusion-weighted magnetic resonance imaging to construct whole-brain structural networks. First, we measured the extent of alterations by performing FBTCS-negative (FBTCS-) versus control and FBTCS-positive (FBTCS+) versus control comparisons, thereby delineating altered subnetworks of the whole-brain structural network. Second, by standardizing each patient's networks using control networks, we measured the subject-specific abnormality at every brain region in the network, thereby quantifying the spatial localization and the amount of abnormality in every patient. RESULTS Both FBTCS+ and FBTCS- patient groups had altered subnetworks with reduced fractional anisotropy and increased mean diffusivity compared to controls. The altered subnetwork in FBTCS+ patients was more widespread than in FBTCS- patients (441 connections altered at t > 3, p < .001 in FBTCS+ compared to 21 connections altered at t > 3, p = .01 in FBTCS-). Significantly greater abnormalities-aggregated over the entire brain network as well as assessed at the resolution of individual brain areas-were present in FBTCS+ patients (p < .001, d = .82, 95% confidence interval = .32-1.3). In contrast, the fewer abnormalities present in FBTCS- patients were mainly localized to the temporal and frontal areas. SIGNIFICANCE The whole-brain structural network is altered to a greater and more widespread extent in patients with TLE and FBTCS. We suggest that these abnormal networks may serve as an underlying structural basis or consequence of the greater seizure spread observed in FBTCS.
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Affiliation(s)
- Nishant Sinha
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.,Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Natalie Peternell
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Gabrielle M Schroeder
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Jane de Tisi
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Sjoerd B Vos
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Centre for Medical Image Computing, University College London, London, UK.,Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Gavin P Winston
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - John S Duncan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Epilepsy Society MRI Unit, Chalfont St Peter, UK
| | - Yujiang Wang
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | - Peter N Taylor
- Computational Neuroscience, Neurology, and Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle Upon Tyne, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK
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31
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Sinha N, Wang Y, Moreira da Silva N, Miserocchi A, McEvoy AW, de Tisi J, Vos SB, Winston GP, Duncan JS, Taylor PN. Structural Brain Network Abnormalities and the Probability of Seizure Recurrence After Epilepsy Surgery. Neurology 2020; 96:e758-e771. [PMID: 33361262 PMCID: PMC7884990 DOI: 10.1212/wnl.0000000000011315] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 09/24/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed preoperative structural brain networks and clinical characteristics of patients with drug-resistant temporal lobe epilepsy (TLE) to identify correlates of postsurgical seizure recurrences. METHODS We examined data from 51 patients with TLE who underwent anterior temporal lobe resection (ATLR) and 29 healthy controls. For each patient, using the preoperative structural, diffusion, and postoperative structural MRI, we generated 2 networks: presurgery network and surgically spared network. Standardizing these networks with respect to controls, we determined the number of abnormal nodes before surgery and expected to be spared by surgery. We incorporated these 2 abnormality measures and 13 commonly acquired clinical data from each patient into a robust machine learning framework to estimate patient-specific chances of seizures persisting after surgery. RESULTS Patients with more abnormal nodes had a lower chance of complete seizure freedom at 1 year and, even if seizure-free at 1 year, were more likely to relapse within 5 years. The number of abnormal nodes was greater and their locations more widespread in the surgically spared networks of patients with poor outcome than in patients with good outcome. We achieved an area under the curve of 0.84 ± 0.06 and specificity of 0.89 ± 0.09 in predicting unsuccessful seizure outcomes (International League Against Epilepsy [ILAE] 3-5) as opposed to complete seizure freedom (ILAE 1) at 1 year. Moreover, the model-predicted likelihood of seizure relapse was significantly correlated with the grade of surgical outcome at year 1 and associated with relapses up to 5 years after surgery. CONCLUSION Node abnormality offers a personalized, noninvasive marker that can be combined with clinical data to better estimate the chances of seizure freedom at 1 year and subsequent relapse up to 5 years after ATLR. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that node abnormality predicts postsurgical seizure recurrence.
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Affiliation(s)
- Nishant Sinha
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada.
| | - Yujiang Wang
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Nádia Moreira da Silva
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Anna Miserocchi
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Andrew W McEvoy
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Jane de Tisi
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Sjoerd B Vos
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Gavin P Winston
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - John S Duncan
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Peter N Taylor
- From the Translational and Clinical Research Institute (N.S.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (N.S., Y.W., N.M.d.S., P.N.T.), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle Upon Tyne; NIHR University College London Hospitals Biomedical Research Centre (Y.W., A.M., A.W.M., J.d.T., S.B.V., G.P.W., J.S.D., P.N.T.), UCL Institute of Neurology, Queen Square; Centre for Medical Image Computing (S.B.V.), University College London; Epilepsy Society MRI Unit (S.B.V., G.P.W., J.S.D), Chalfont St Peter, UK; and Department of Medicine (G.P.W.,), Division of Neurology, Queen's University, Kingston, Ontario, Canada
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Lamberink HJ, Otte WM, Blümcke I, Braun KPJ. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. Lancet Neurol 2020; 19:748-757. [PMID: 32822635 DOI: 10.1016/s1474-4422(20)30220-9] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgery is a widely accepted treatment option for drug-resistant focal epilepsy. A detailed analysis of longitudinal postoperative seizure outcomes and use of antiepileptic drugs for different brain lesions causing epilepsy is not available. We aimed to analyse the association between histopathology and seizure outcome and drug freedom up to 5 years after epilepsy surgery, to improve presurgical decision making and counselling. METHODS In this retrospective, multicentre, longitudinal, cohort study, patients who had epilepsy surgery between Jan 1, 2000, and Dec 31, 2012, at 37 collaborating tertiary referral centres across 18 European countries of the European Epilepsy Brain Bank consortium were assessed. We included patients of all ages with histopathology available after epilepsy surgery. Histopathological diagnoses and a minimal dataset of clinical variables were collected from existing local databases and patient records. The primary outcomes were freedom from disabling seizures (Engel class 1) and drug freedom at 1, 2, and 5 years after surgery. Proportions of individuals who were Engel class 1 and drug-free were reported for the 11 main categories of histopathological diagnosis. We analysed the association between histopathology, duration of epilepsy, and age at surgery, and the primary outcomes using random effects multivariable logistic regression to control for confounding. FINDINGS 9147 patients were included, of whom seizure outcomes were available for 8191 (89·5%) participants at 2 years, and for 5577 (61·0%) at 5 years. The diagnoses of low-grade epilepsy associated neuroepithelial tumour (LEAT), vascular malformation, and hippocampal sclerosis had the best seizure outcome at 2 years after surgery, with 77·5% (1027 of 1325) of patients free from disabling seizures for LEAT, 74·0% (328 of 443) for vascular malformation, and 71·5% (2108 of 2948) for hippocampal sclerosis. The worst seizure outcomes at 2 years were seen for patients with focal cortical dysplasia type I or mild malformation of cortical development (50·0%, 213 of 426 free from disabling seizures), those with malformation of cortical development-other (52·3%, 212 of 405 free from disabling seizures), and for those with no histopathological lesion (53·5%, 396 of 740 free from disabling seizures). The proportion of patients being both Engel class 1 and drug-free was 0-14% at 1 year and increased to 14-51% at 5 years. Children were more often drug-free; temporal lobe surgeries had the best seizure outcomes; and a longer duration of epilepsy was associated with reduced chance of favourable seizure outcomes and drug freedom. This effect of duration was evident for all lesions, except for hippocampal sclerosis. INTERPRETATION Histopathological diagnosis, age at surgery, and duration of epilepsy are important prognostic factors for outcomes of epilepsy surgery. In every patient with refractory focal epilepsy presumed to be lesional, evaluation for surgery should be considered. FUNDING None.
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Affiliation(s)
- Herm J Lamberink
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Willem M Otte
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Ingmar Blümcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany.
| | - Kees P J Braun
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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Uribe San Martin R, Di Giacomo R, Mai R, Gozzo F, Pelliccia V, Mariani V, Cardinale F, Ciampi E, Onofrj M, Tassi L. Forecasting Seizure Freedom After Epilepsy Surgery Assessing Concordance Between Noninvasive and StereoEEG Findings. Neurosurgery 2020; 88:113-121. [DOI: 10.1093/neuros/nyaa322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 05/24/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Accurate localization of the probable Epileptogenic Zone (EZ) from presurgical studies is crucial for achieving good prognosis in epilepsy surgery.
OBJECTIVE
To evaluate the degree of concordance at a sublobar localization derived from noninvasive studies (video electroencephalography, EEG; magnetic resonance imaging, MRI; 18-fluorodeoxyglucose positron emission tomography FDG-PET, FDG-PET) and EZ estimated by stereoEEG, in forecasting seizure recurrence in a long-term cohort of patients with focal drug-resistant epilepsy.
METHODS
We selected patients with a full presurgical evaluation and with postsurgical outcome at least 1 yr after surgery. Multivariate Cox regression analysis for seizure freedom (Engel Ia) was performed.
RESULTS
A total of 74 patients were included, 62.2% were in Engel class Ia with a mean follow-up of 2.8 + 2.4 yr after surgery. In the multivariate analysis for Engel Ia vs >Ib, complete resection of the EZ found in stereoEEG (hazard ratio, HR: 0.24, 95%CI: 0.09-0.63, P = .004) and full concordance between FDG-PET and stereoEEG (HR: 0.11, 95%CI: 0.02-0.65, P = .015) portended a more favorable outcome. Most of our results were maintained when analyzing subgroups of patients.
CONCLUSION
The degree of concordance between noninvasive studies and stereoEEG may help to forecast the likelihood of cure before performing resective surgery, particularly using a sublobar classification and comparing the affected areas in the FDG-PET with EZ identified with stereoEEG.
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Affiliation(s)
- Reinaldo Uribe San Martin
- Neurology Department, Pontificia Universidad Católica de Chile, Neurology Service, Complejo Asistencial Hospital Sótero del Río, Santiago, Chile
| | - Roberta Di Giacomo
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Roberto Mai
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesca Gozzo
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Veronica Pelliccia
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Valeria Mariani
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesco Cardinale
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Ethel Ciampi
- Neurology Department, Pontificia Universidad Católica de Chile, Neurology Service, Complejo Asistencial Hospital Sótero del Río, Santiago, Chile
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. D’Annunzio of Chieti-Pescara, Italy
| | - Laura Tassi
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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Mula M, Kanner AM, Jetté N, Sander JW. Psychiatric Comorbidities in People With Epilepsy. Neurol Clin Pract 2020; 11:e112-e120. [PMID: 33842079 DOI: 10.1212/cpj.0000000000000874] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
Purpose of Review To review the latest evidence concerning the epidemiology, clinical implications, and management of psychiatric disorders in epilepsy. Recent Findings People with epilepsy have a 2-5 times increased risk of developing any psychiatric disorder, and 1 in 3 patients with epilepsy have a lifetime psychiatric diagnosis. Psychiatric comorbidities represent a poor prognostic marker as they have been associated with a poor response to treatment (drugs and surgery), increased morbidity, and mortality. Validated screening instruments are available for mood and anxiety disorders in adults as well as attention-deficit hyperactivity disorder in children with epilepsy. Summary All patients with epilepsy should be routinely screened for psychiatric disorder at the onset and at least once a year. Patients with epilepsy and their relatives should be informed of the risk of mental health problems and the implications.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
| | - Andres M Kanner
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
| | - Nathalie Jetté
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
| | - Josemir W Sander
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
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35
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Pennell PB. Unravelling the heterogeneity of epilepsy for optimal individualised treatment: advances in 2019. Lancet Neurol 2020; 19:8-10. [DOI: 10.1016/s1474-4422(19)30430-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/26/2022]
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36
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Mithani K, Boutet A, Germann J, Elias GJB, Weil AG, Shah A, Guillen M, Bernal B, Achua JK, Ragheb J, Donner E, Lozano AM, Widjaja E, Ibrahim GM. Lesion Network Localization of Seizure Freedom following MR-guided Laser Interstitial Thermal Ablation. Sci Rep 2019; 9:18598. [PMID: 31819108 PMCID: PMC6901556 DOI: 10.1038/s41598-019-55015-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/22/2019] [Indexed: 01/08/2023] Open
Abstract
Treatment-resistant epilepsy is a common and debilitating neurological condition, for which neurosurgical cure is possible. Despite undergoing nearly identical ablation procedures however, individuals with treatment-resistant epilepsy frequently exhibit heterogeneous outcomes. We hypothesized that treatment response may be related to the brain regions to which MR-guided laser ablation volumes are functionally connected. To test this, we mapped the resting-state functional connectivity of surgical ablations that either resulted in seizure freedom (N = 11) or did not result in seizure freedom (N = 16) in over 1,000 normative connectomes. There was no difference seizure outcome with respect to the anatomical location of the ablations, and very little overlap between ablation areas was identified using the Dice Index. Ablations that did not result in seizure-freedom were preferentially connected to a number of cortical and subcortical regions, as well as multiple canonical resting-state networks. In contrast, ablations that led to seizure-freedom were more functionally connected to prefrontal cortices. Here, we demonstrate that underlying normative neural circuitry may in part explain heterogenous outcomes following ablation procedures in different brain regions. These findings may ultimately inform target selection for ablative epilepsy surgery based on normative intrinsic connectivity of the targeted volume.
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Affiliation(s)
- Karim Mithani
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- University Health Network, Toronto, ON, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | | | | | - Alexander G Weil
- Division of Neurosurgery, CHU-Ste Justine, Université de Montréal, Montréal, Canada
| | - Ashish Shah
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, USA
| | - Magno Guillen
- Department of Radiology, Nicklaus Children's Hospital, Miami, USA
| | - Byron Bernal
- Department of Radiology, Nicklaus Children's Hospital, Miami, USA
| | - Justin K Achua
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, USA
| | - John Ragheb
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, USA
| | - Elizabeth Donner
- Division of Neurology, Hospital for Sick Children, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
| | - George M Ibrahim
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada. .,Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Canada.
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37
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Novais F, Pestana LC, Loureiro S, Andrea M, Figueira ML, Pimentel J. Psychiatric disorders as predictors of epilepsy surgery outcome. Epilepsy Behav 2019; 100:106513. [PMID: 31639645 DOI: 10.1016/j.yebeh.2019.106513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Our aim was to determine if a history of a mental disorder predicts a worst neurological outcome for patients undergoing epilepsy surgery. METHODS We conducted an ambispective observational study including people with refractory epilepsy who underwent resective surgery. Demographic, psychiatric, and neurological data were collected, before and one year after surgery. Presurgical interviews included a psychiatric evaluation and the determination of prevalent and lifetime psychiatric diagnosis. The one-year postsurgical outcome was classified according to the Engel Outcome Scale. Predictors of postsurgical Engel class were determined using an ordered logistic regression model. RESULTS A lifetime history of any mental disorder was a significant predictor of a higher Engel Class (p = 0.017). CONCLUSION This study shows that psychiatric lifetime diagnoses are associated with worse surgical outcome and highlighted the importance of the inclusion of these diagnoses in the evaluation of the potential success of the surgery.
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Affiliation(s)
- Filipa Novais
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - Luís Câmara Pestana
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Susana Loureiro
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Mafalda Andrea
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal
| | - Maria Luísa Figueira
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - José Pimentel
- Department of Neurosciences and Mental Health, Neurology Department, Hospital de Santa Maria (CHULN), Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal
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38
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Carboni M, Rubega M, Iannotti GR, De Stefano P, Toscano G, Tourbier S, Pittau F, Hagmann P, Momjian S, Schaller K, Seeck M, Michel CM, van Mierlo P, Vulliemoz S. The network integration of epileptic activity in relation to surgical outcome. Clin Neurophysiol 2019; 130:2193-2202. [PMID: 31669753 DOI: 10.1016/j.clinph.2019.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/21/2019] [Accepted: 09/12/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Epilepsy is a network disease with epileptic activity and cognitive impairment involving large-scale brain networks. A complex network is involved in the seizure and in the interictal epileptiform discharges (IEDs). Directed connectivity analysis, describing the information transfer between brain regions, and graph analysis are applied to high-density EEG to characterise networks. METHODS We analysed 19 patients with focal epilepsy who had high-density EEG containing IED and underwent surgery. We estimated cortical activity during IED using electric source analysis in 72 atlas-based cortical regions of the individual brain MRI. We applied directed connectivity analysis (information Partial Directed Coherence) and graph analysis on these sources and compared patients with good vs poor post-operative outcome at global, hemispheric and lobar level. RESULTS We found lower network integration reflected by global, hemispheric, lobar efficiency during the IED (p < 0.05) in patients with good post-surgical outcome, compared to patients with poor outcome. Prediction was better than using the IED field or the localisation obtained by electric source imaging. CONCLUSIONS Abnormal network patterns in epilepsy are related to seizure outcome after surgery. SIGNIFICANCE Our finding may help understand networks related to a more "isolated" epileptic activity, limiting the extent of the epileptic network in patients with subsequent good post-operative outcome.
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Affiliation(s)
- M Carboni
- EEG and Epilepsy, Neuroscience Department, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland; Functional Brain Mapping Lab, Department of Fundamental Neurosciences, University of Geneva, Geneva, Switzerland.
| | - M Rubega
- Functional Brain Mapping Lab, Department of Fundamental Neurosciences, University of Geneva, Geneva, Switzerland
| | - G R Iannotti
- EEG and Epilepsy, Neuroscience Department, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland; Functional Brain Mapping Lab, Department of Fundamental Neurosciences, University of Geneva, Geneva, Switzerland; Department of Neurosurgery, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - P De Stefano
- EEG and Epilepsy, Neuroscience Department, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - G Toscano
- EEG and Epilepsy, Neuroscience Department, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland; Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy
| | - S Tourbier
- Connectomics Lab, Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - F Pittau
- EEG and Epilepsy, Neuroscience Department, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - P Hagmann
- Connectomics Lab, Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - S Momjian
- Department of Neurosurgery, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - K Schaller
- Department of Neurosurgery, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - M Seeck
- EEG and Epilepsy, Neuroscience Department, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - C M Michel
- Functional Brain Mapping Lab, Department of Fundamental Neurosciences, University of Geneva, Geneva, Switzerland
| | - P van Mierlo
- EEG and Epilepsy, Neuroscience Department, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland; Medical Image and Signal Processing Group, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - S Vulliemoz
- EEG and Epilepsy, Neuroscience Department, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland.
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39
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Conte F, Van Paesschen W, Legros B, Depondt C. The Epilepsy Surgery Grading Scale: Validation in an independent population with drug-resistant focal epilepsy. Epilepsia 2019; 60:e78-e82. [PMID: 31247119 DOI: 10.1111/epi.16096] [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: 03/18/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
The Epilepsy Surgery Grading Scale (ESGS) is a simple tool that predicts a patient's likelihood of progressing to resective surgery and becoming seizure-free. The aim of our study was to validate the ESGS in an independent patient cohort. We retrospectively calculated the ESGS score for adult patients with drug-resistant focal epilepsy undergoing presurgical evaluation at two reference centers for drug-resistant epilepsy in Belgium. We classified patients into ESGS grade 1 (most favorable), grade 2 (intermediate), and grade 3 (least favorable). We assessed progression to surgery and postsurgical seizure freedom. A total of 238 patients underwent presurgical evaluation (presurgical cohort), of whom 140 progressed to surgery (surgical cohort). In the presurgical cohort, we observed significant differences in rates of surgery and in rates of seizure freedom between grades 1, 2, and 3. In the surgical cohort, we observed significant differences in rates of seizure freedom between grades 1 and 2 and between grades 1 and 3. We confirm the usefulness of the ESGS for the prognostic stratification of patients with drug-resistant focal epilepsy undergoing presurgical evaluation. Our results support the use of the ESGS in the decision process of presurgical evaluation in clinical practice.
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Affiliation(s)
| | - Wim Van Paesschen
- Department of Neurology, Gasthuisberg University Hospital, Leuven, Belgium
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40
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Conte F, Legros B, Van Paesschen W, Avbersek A, Muglia P, Depondt C. Long-term seizure outcomes in patients with drug resistant epilepsy. Seizure 2018; 62:74-78. [DOI: 10.1016/j.seizure.2018.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 01/26/2023] Open
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41
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Gummadavelli A, Zaveri HP, Spencer DD, Gerrard JL. Expanding Brain-Computer Interfaces for Controlling Epilepsy Networks: Novel Thalamic Responsive Neurostimulation in Refractory Epilepsy. Front Neurosci 2018; 12:474. [PMID: 30108472 PMCID: PMC6079216 DOI: 10.3389/fnins.2018.00474] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/22/2018] [Indexed: 01/01/2023] Open
Abstract
Seizures have traditionally been considered hypersynchronous excitatory events and epilepsy has been separated into focal and generalized epilepsy based largely on the spatial distribution of brain regions involved at seizure onset. Epilepsy, however, is increasingly recognized as a complex network disorder that may be distributed and dynamic. Responsive neurostimulation (RNS) is a recent technology that utilizes intracranial electroencephalography (EEG) to detect seizures and delivers stimulation to cortical and subcortical brain structures for seizure control. RNS has particular significance in the clinical treatment of medically refractory epilepsy and brain–computer interfaces in epilepsy. Closed loop RNS represents an important step forward to understand and target nodes in the seizure network. The thalamus is a central network node within several functional networks and regulates input to the cortex; clinically, several thalamic nuclei are safe and feasible targets. We highlight the network theory of epilepsy, potential targets for neuromodulation in epilepsy and the first reported use of RNS as a first generation brain–computer interface to detect and stimulate the centromedian intralaminar thalamic nucleus in a patient with bilateral cortical onset of seizures. We propose that advances in network analysis and neuromodulatory techniques using brain–computer interfaces will significantly improve outcomes in patients with epilepsy. There are numerous avenues of future direction in brain–computer interface devices including multi-modal sensors, flexible electrode arrays, multi-site targeting, and wireless communication.
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Affiliation(s)
- Abhijeet Gummadavelli
- Department of Neurosurgery, Yale University School of Medicine, Yale University, New Haven, CT, United States
| | - Hitten P Zaveri
- Department of Neurology, Yale University School of Medicine, Yale University, New Haven, CT, United States
| | - Dennis D Spencer
- Department of Neurosurgery, Yale University School of Medicine, Yale University, New Haven, CT, United States
| | - Jason L Gerrard
- Department of Neurosurgery, Yale University School of Medicine, Yale University, New Haven, CT, United States.,Department of Neuroscience, Yale University School of Medicine, Yale University, New Haven, CT, United States
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42
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Vakharia VN, Duncan JS, Witt JA, Elger CE, Staba R, Engel J. Getting the best outcomes from epilepsy surgery. Ann Neurol 2018. [PMID: 29534299 PMCID: PMC5947666 DOI: 10.1002/ana.25205] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug‐refractory focal epilepsies. Ann Neurol 2018;83:676–690
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Affiliation(s)
- Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom, and Chalfont Centre for Epilepsy
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom, and Chalfont Centre for Epilepsy
| | - Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Richard Staba
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jerome Engel
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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