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Chiarello D, Cognolato E, Francione S, Nobile G, Bosisio L, Barbagallo G, Pacetti M, Tortora D, Cantalupo G, Nobili L, Consales A. Negative MRI and a seizure onset zone close to eloquent areas in FCD type II: Application of MRg-LiTT after a SEEG re-evaluation in pediatric patients with a previous failed surgery. Epilepsy Behav 2024; 153:109694. [PMID: 38401416 DOI: 10.1016/j.yebeh.2024.109694] [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: 09/27/2023] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Negative MRI and an epileptogenic zone (EZ) adjacent to eloquent areas are two main issues that can be encountered during pre-surgical evaluation for epilepsy surgery. Focal Cortical Dysplasia type II (FCD type II) is the most common aetiology underlying a negative MRI. The objective of this study is to present three cases of pediatric patients exhibiting negative MRI and a seizure onset zone close to eloquent areas, who previously underwent traditional open surgery or SEEG-guided radiofrequency thermocoagulations (RF-TC). After seizure seizure recrudescence, pre-surgical SEEG was re-evaluated and Magnetic Resonance-guided laser interstitial thermal therapy (MRg-LiTT) was performed. We discuss the SEEG patterns, the planning of laser probes trajectories and the outcomes one year after the procedure. METHODS Pediatric patients who underwent SEEG followed by MRg-LiTT for drug-resistant epilepsy associated with FCD type II at our Centre were included. Pre-surgical videoEEG (vEEG), stereoEEG (sEEG), and MRI were reviewed. Post-procedure clinical outcome (measured by Engel score) and complications rates were evaluated. RESULTS Three patients underwent 3 MRg-LiTT procedures from January 2022 to June 2022. Epileptogenic zone was previously studied via SEEG in all the patients. All the three patients pre-surgical MRI was deemed negative. Mean age at seizure onset was 47 months (21-96 months), mean age at MRg-LiTT was 12 years (10 years 10 months - 12 years 9 months). Engel class Ia outcome was achieved in patients #2 and #3, Engel class Ib in patient #1. Mean follow-up length was of 17 months (13 months - 20 months). Complications occurred in one patient (patient #2, extradural hematoma). CONCLUSIONS The combined use of SEEG and MRg-LiTT in complex cases can lead to good outcomes both as a rescue therapy after failed surgery, but also as an alternative to open surgery after a successful SEEG-guided Radiofrequency Thermocoagulation (RF-TC). Specific SEEG patterns and a previous good outcome from RF-TC can be predictors of a favourable outcome.
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Affiliation(s)
- D Chiarello
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital, Milan, Italy; Neurology of Epilepsy and Movement Disorder Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Italy
| | - E Cognolato
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3).
| | - S Francione
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital, Milan, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - G Nobile
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - L Bosisio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - G Barbagallo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - M Pacetti
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - D Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - G Cantalupo
- Child Neuropsychiatry Unit, University Hospital of Verona (full member of the European Reference Network EpiCARE), Verona, Italy; Center for Research on Epilepsy in Pediatric age (CREP), University Hospital of Verona, Verona, Italy; Innovation Biomedicine section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - L Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3).
| | - A Consales
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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Castellano JF, Singla S, Barot N, Aronson JP. Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation: Diagnostic and Therapeutic Implications. Brain Sci 2024; 14:110. [PMID: 38391685 PMCID: PMC10887298 DOI: 10.3390/brainsci14020110] [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: 12/28/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Despite recent medical therapeutic advances, approximately one third of patients do not attain seizure freedom with medications. This drug-resistant epilepsy population suffers from heightened morbidity and mortality. In appropriate patients, resective epilepsy surgery is far superior to continued medical therapy. Despite this efficacy, there remain drawbacks to traditional epilepsy surgery, such as the morbidity of open neurosurgical procedures as well as neuropsychological adverse effects. SEEG-guided Radiofrequency Thermocoagulation (SgRFTC) is a minimally invasive, electrophysiology-guided intervention with both diagnostic and therapeutic implications for drug-resistant epilepsy that offers a convenient adjunct or alternative to ablative and resective approaches. We review the international experience with this procedure, including methodologies, diagnostic benefit, therapeutic benefit, and safety considerations. We propose a framework in which SgRFTC may be incorporated into intracranial EEG evaluations alongside passive recording. Lastly, we discuss the potential role of SgRFTC in both delineating and reorganizing epilepsy networks.
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Affiliation(s)
- James F Castellano
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Shobhit Singla
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Niravkumar Barot
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Joshua P Aronson
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Fawcett J, Davis S, Manford M. Further advances in epilepsy. J Neurol 2023; 270:5655-5670. [PMID: 37458794 DOI: 10.1007/s00415-023-11860-6] [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: 05/31/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 10/15/2023]
Abstract
In 2017, one of us reviewed advances in epilepsy (Manford in J Neurol 264:1811-1824, 2017). The current paper brings that review up to date and gives a slight change in emphasis. Once again, the story is of evolution rather than revolution. In recognition that most of our current medications act on neurotransmitters or ion channels, and not on the underlying changes in connectivity and pathways, they have been renamed as antiseizure (ASM) medications rather than antiepileptic drugs. Cenobamate is the one newly licensed medication for broader use in focal epilepsy but there have been a number of developments for specific disorders. We review new players and look forward to new developments in the light of evolving underlying science. We look at teratogenicity; old villains and new concerns in which clinicians play a vital role in explaining and balancing the risks. Medical treatment of status epilepticus, long without evidence, has benefitted from high-quality trials to inform practice; like buses, several arriving at once. Surgical treatment continues to be refined with improvements in the pre-surgical evaluation of patients, especially with new imaging techniques. Alternatives including stereotactic radiotherapy have received further focus and targets for palliative stimulation techniques have grown in number. Individuals' autonomy and quality of life continue to be the subject of research with refinement of what clinicians can do to help persons with epilepsy (PWE) achieve control. This includes seizure management but extends to broader considerations of human empowerment, needs and desires, which may be aided by emerging technologies such as seizure detection devices. The role of specialist nurses in improving that quality has been reinforced by specific endorsement from the International League against Epilepsy (ILAE).
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Affiliation(s)
- Joanna Fawcett
- Department of Neurology, Royal United Hospital, Bath, UK
| | - Sarah Davis
- Department of Neurology, Royal United Hospital, Bath, UK
| | - Mark Manford
- Department of Neurology, Royal United Hospital, Bath, UK.
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Chen JS, Lamoureux AA, Shlobin NA, Elkaim LM, Wang A, Ibrahim GM, Obaid S, Harroud A, Guadagno E, Dimentberg E, Bouthillier A, Bernhardt BC, Nguyen DK, Fallah A, Weil AG. Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy: A systematic review and individual participant data meta-analysis. Epilepsia 2023; 64:1957-1974. [PMID: 36824029 DOI: 10.1111/epi.17560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug-resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta-analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms "MR-guided ablation therapy" and "epilepsy". Multivariable mixed-effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow-up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure-free at last follow-up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p < .001) and mesial temporal sclerosis/atrophy (MTS/A; OR = 2.21, p = .011) were independently associated with greater odds of seizure freedom at last follow-up. Operative complications occurred in 28 (8.5%) of 330 patients and were independently associated with extratemporal ablations (OR = 5.40, p = .012) and nonlesional MRI studies (OR = 3.25, p = .017). Postoperative neurological deficits were observed in 53 (15.1%) of 352 patients and were independently predicted by hypothalamic hamartoma etiology (OR = 5.93, p = .006) and invasive electroencephalographic monitoring (OR = 4.83, p = .003). Overall, MRgLITT is particularly effective in treating patients with well-circumscribed lesional DRE, such as CCM and MTS/A, but less effective in nonlesional cases or lesional cases with a more diffuse epileptogenic network associated with generalized seizures. This study identifies independent predictors of seizure freedom and complications following MRgLITT that may help further guide patient selection.
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Affiliation(s)
- Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Audrey-Anne Lamoureux
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sami Obaid
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Adil Harroud
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Evan Dimentberg
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Dang K Nguyen
- Division of Neurology, University of Montreal Medical Center, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
- Brain and Child Development Axis, Sainte Justine Research Center, Montreal, Quebec, Canada
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Lu D, Wang T, Yang Y, Fan X, Chen S, Wei P, Shan Y, Zhao G. Advances in hypothalamic hamartoma research over the past 30 years (1992-2021): a bibliometric analysis. Front Neurol 2023; 14:1176459. [PMID: 37416311 PMCID: PMC10322195 DOI: 10.3389/fneur.2023.1176459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023] Open
Abstract
Background Hypothalamic hamartoma (HH) is a rare intracranial disease whose manifestations include gelastic seizures and precocious puberty. The diagnosis and treatment of HH have changed substantially over the past three decades as medical care has improved. Bibliometrics can reveal the evolution and development of a scientific field. Methods Documents on HH were retrieved from the Web of Science Core Collection (WoSCC) database on September 8, 2022. The search terms were as follows: "hypothalamic hamartoma" or "hamartoma of the hypothalamus" or "hypothalamic hamartomas." The types of documents were restricted to articles, case reports, and reviews. VOSviewer, CiteSpace, and the R package "bibliometrix" were used for a bibliometric analysis. Results A total of 667 independent documents on HH were obtained from the WoSCC database. The most common types of documents were articles (n = 498, 75%) and reviews (n = 103, 15%). The number of annual publications fluctuated but showed an upward trend overall, and the annual growth rate was 6.85%. The cumulative publication data indicated that the most influential journals in the HH field include Epilepsia, Epileptic Disorders, Child's Nervous System, Neurosurgery, and the Journal of Neurosurgery. Kerrigan JF, Ng YT, Rekate HL, Regis J, and Kameyama S were among the most prominent authors in the field of HH, with numerous publications and citations. American research institutions, especially the Barrow Neurological Institute, occupied a pivotal position in HH research. Other countries and institutions were catching up and producing considerable research results. Research on HH has steadily switched its emphasis from Pallister-Hall syndrome (PHS) and precocious puberty to epilepsy and new diagnostic and therapeutic techniques, including Gamma Knife, laser ablation, and interstitial thermal therapy. Conclusion HH remains a special neurological disease with significant research prospects. The development of novel technologies, including MRI-guided laser-induced thermal therapy (MRg-LiTT) and stereotactic radiofrequency thermocoagulation (RF-TC), has enabled the efficient treatment of gelastic seizures in HH while minimizing the risks associated with craniotomies. Through bibliometric analysis, this study points out the direction for future HH research.
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Affiliation(s)
- Di Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Tianren Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Yanfeng Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Sichang Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
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Michalak AJ, Greenblatt A, Wu S, Tobochnik S, Dave H, Raghupathi R, Esengul YT, Guerra A, Tao JX, Issa NP, Cosgrove GR, Lega B, Warnke P, Chen HI, Lucas T, Sheth SA, Banks GP, Kwon CS, Feldstein N, Youngerman B, McKhann G, Davis KA, Schevon C. Seizure onset patterns predict outcome after stereo-electroencephalography-guided laser amygdalohippocampotomy. Epilepsia 2023; 64:1568-1581. [PMID: 37013668 PMCID: PMC10247471 DOI: 10.1111/epi.17602] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (stereo-EEG) may miss seizure onset elsewhere. We hypothesized that stereo-EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the 2-year outcomes of patients who underwent single-fiber SLAH after stereo-EEG and evaluated whether stereo-EEG SOPs predict postoperative seizure freedom. METHODS This retrospective five-center study included patients with or without mesial temporal sclerosis (MTS) who underwent stereo-EEG followed by single-fiber SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. An SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was 2-year Engel I classification or recurrent seizures before then, stratified by SOP category. RESULTS Fifty-eight patients were included, with a mean follow-up duration of 39 ± 12 months after SLAH. Overall 1-, 2-, and 3-year Engel I seizure freedom probability was 54%, 36%, and 33%, respectively. Patients with SOPs, including low-voltage fast activity or low-frequency repetitive spiking, had a 46% 2-year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log-rank test, p = .00015). SIGNIFICANCE Patients who underwent SLAH after stereo-EEG had a low probability of seizure freedom at 2 years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between hippocampal seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.
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Affiliation(s)
- Andrew J. Michalak
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam Greenblatt
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Hina Dave
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramya Raghupathi
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Yasar T. Esengul
- Department of Neurology, University of Toledo College of Medicine, Toledo, OH, USA
| | - Antonio Guerra
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James X. Tao
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Naoum P. Issa
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Garth R. Cosgrove
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Bradley Lega
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Warnke
- Department of Neurosurgery, University of Chicago, Chicago, NY, USA
| | - H. Isaac Chen
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Timothy Lucas
- Department of Neurosurgery & Biomedical Engineering, Ohio State University; Neurotech Institute, Columbus, OH, USA
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Garrett P. Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Churl-Su Kwon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Gertrude H Sergievsky Center, New York, NY, USA
| | - Neil Feldstein
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Brett Youngerman
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Guy McKhann
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Kathryn A. Davis
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Catherine Schevon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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Nosova K, Quiceno E, Hussein A, Bozinov O, Nakaji P. History of Ablation Therapies in Neurosurgery. Neurosurg Clin N Am 2023; 34:193-198. [PMID: 36906326 DOI: 10.1016/j.nec.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
Laser interstitial thermal therapy (LITT) and high-intensity focused ultrasound thermal ablation are treatment options with great potential to treat glioblastoma, metastasis, epilepsy, essential tremor, and chronic pain. Results from recent studies show that LITT is a viable alternative to conventional surgical techniques in select patient populations. Although many of the bases for these treatments have existed since the 1930s, the most important advancement in these techniques has occurred in the last 15 years and the coming years hold much promise for these treatments.
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Affiliation(s)
- Kristin Nosova
- Department of Neurosurgery at Banner, University Medical Center, 755 East McDowell Road 2nd Floor, Phoenix, AZ 85006, USA
| | - Esteban Quiceno
- Department of Neurosurgery at Banner, University Medical Center, 755 East McDowell Road 2nd Floor, Phoenix, AZ 85006, USA
| | - Amna Hussein
- Department of Neurosurgery at Banner, University Medical Center, 755 East McDowell Road 2nd Floor, Phoenix, AZ 85006, USA
| | - Oliver Bozinov
- Department of Neurosurgery, Kantonsspital St. Gallen, St Gallen CH-9000, Switzerland
| | - Peter Nakaji
- Department of Neurosurgery at Banner, University Medical Center, 755 East McDowell Road 2nd Floor, Phoenix, AZ 85006, USA.
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Arredondo KH, Ahrens SM, Bagić AI, Bai S, Chapman KE, Ciliberto MA, Clarke DF, Eisner M, Fountain NB, Gavvala JR, Perry MS, Rossi KC, Wong-Kisiel LC, Herman ST, Ostendorf AP. Association Between Characteristics of National Association of Epilepsy Centers and Reported Utilization of Specific Surgical Techniques. Neurology 2023; 100:e719-e727. [PMID: 36323517 PMCID: PMC9969912 DOI: 10.1212/wnl.0000000000201526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Nearly one-third of persons with epilepsy will continue having seizures despite trialing multiple antiseizure medications. Epilepsy surgery may be beneficial in these cases, and evaluation at a comprehensive epilepsy center is recommended. Numerous palliative and potentially curative approaches exist, and types of surgery performed may be influenced by center characteristics. This article describes epilepsy center characteristics associated with epilepsy surgery access and volumes in the United States. METHODS We analyzed National Association of Epilepsy Centers 2019 annual report and supplemental survey data obtained with responses from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Surgical treatment volumes were compiled with center characteristics, including US Census region. We used multivariable modeling with zero-inflated Poisson regression models to present ORs and incidence rate ratios of receiving a given surgery type based on center characteristics. RESULTS The response rate was 100% with individual element missingness less than 4% across 352 observations undergoing univariate analysis. Multivariable models included 319 complete observations. Significant regional differences were present. The rates of laser interstitial thermal therapy (LITT) were lower at centers in the Midwest (incidence rate ratio [IRR] 0.74, 95% CI 0.59-0.92; p = 0.006) and Northeast (IRR 0.77, 95% CI 0.61-0.96; p = 0.022) compared with those in the South. Conversely, responsive neurostimulation implantation rates were higher in the Midwest (IRR 1.45, 95% CI 1.1-1.91; p = 0.008) and West (IRR 1.91, 95% CI 1.49-2.44; p < 0.001) compared with the South. Center accreditation level, institution type, demographics, and resources were also associated with variations in access and rates of potentially curative and palliative surgical interventions. DISCUSSION Epilepsy surgery procedure volumes are influenced by US epilepsy center region and other characteristics. These variations may affect access to specific surgical treatments for persons with drug resistant epilepsy across the United States.
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Affiliation(s)
- Kristen H Arredondo
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Stephanie M Ahrens
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Anto I Bagić
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Shasha Bai
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Kevin E Chapman
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Michael A Ciliberto
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Dave F Clarke
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Mariah Eisner
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Nathan B Fountain
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Jay R Gavvala
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - M Scott Perry
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Kyle C Rossi
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Lily C Wong-Kisiel
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Susan T Herman
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Adam P Ostendorf
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
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9
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Yossofzai O, Stone S, Madsen J, Moineddin R, Wang S, Ragheb J, Mohamed I, Bollo R, Clarke D, Perry MS, Weil AG, Raskin J, Pindrik J, Ahmed R, Lam S, Fallah A, Maniquis C, Andrade A, Ibrahim GM, Drake J, Rutka J, Tailor J, Mitsakakis N, Puka K, Widjaja E. Seizure outcome of pediatric magnetic resonance-guided laser interstitial thermal therapy versus open surgery: A matched noninferiority cohort study. Epilepsia 2023; 64:114-126. [PMID: 36318088 DOI: 10.1111/epi.17451] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been proposed as an alternative to open epilepsy surgery, to address concerns regarding the risk of open surgery. Our primary hypothesis was that seizure freedom at 1 year after MRgLITT is noninferior to open surgery in children with drug-resistant epilepsy (DRE). The secondary hypothesis was that MRgLITT has fewer complications and shorter hospitalization than surgery. The primary objective was to compare seizure outcome of MRgLITT to open surgery in children with DRE. The secondary objective was to compare complications and length of hospitalization of the two treatments. METHODS This retrospective multicenter cohort study included children with DRE treated with MRgLITT or open surgery with 1-year follow-up. Exclusion criteria were corpus callosotomy, neurostimulation, multilobar or hemispheric surgery, and lesion with maximal dimension > 60 mm. MRgLITT patients were propensity matched to open surgery patients. The primary outcome was seizure freedom at 1 year posttreatment. The difference in seizure freedom was compared using noninferiority test, with noninferiority margin of -10%. The secondary outcomes were complications and length of hospitalization. RESULTS One hundred eighty-five MRgLITT patients were matched to 185 open surgery patients. Seizure freedom at 1 year follow-up was observed in 89 of 185 (48.1%) MRgLITT and 114 of 185 (61.6%) open surgery patients (difference = -13.5%, one-sided 97.5% confidence interval = -23.8% to ∞, pNoninferiority = .79). The lower confidence interval boundary of -23.8% was below the prespecified noninferiority margin of -10%. Overall complications were lower in MRgLITT compared to open surgery (10.8% vs. 29.2%, respectively, p < .001). Hospitalization was shorter for MRgLITT than open surgery (3.1 ± 2.9 vs. 7.2 ± 6.1 days, p < .001). SIGNIFICANCE Seizure outcome of MRgLITT at 1 year posttreatment was inferior to open surgery. However, MRgLITT has the advantage of better safety profile and shorter hospitalization. The findings will help counsel children and parents on the benefits and risks of MRgLITT and contribute to informed decision-making on treatment options.
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Affiliation(s)
- Omar Yossofzai
- Department of Diagnostic Imaging, Hospital for Sick Children Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Scellig Stone
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joseph Madsen
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shelly Wang
- Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida, USA
| | - John Ragheb
- Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Ismail Mohamed
- Division of Pediatric Neurology, University of Alabama, Birmingham, Alabama, USA
| | - Robert Bollo
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Dave Clarke
- Department of Neurology, Dell Medical School, Austin, Texas, USA
| | - M Scott Perry
- Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Alexander G Weil
- Department of Neurosurgery, Saint Justine University Hospital Center, Montreal, Quebec, Canada
| | - Jeffrey Raskin
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA.,Division of Neurosurgery, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Jonathan Pindrik
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Raheel Ahmed
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Sandi Lam
- Division of Neurosurgery, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Aria Fallah
- Department of Neurosurgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Cassia Maniquis
- Department of Neurosurgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - George M Ibrahim
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Drake
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Rutka
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jignesh Tailor
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, Hospital for Sick Children Toronto, Toronto, Ontario, Canada.,Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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10
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Yao Y, Wang X, Hu W, Zhang C, Sang L, Zheng Z, Mo J, Liu C, Qiu J, Shao X, Zhang J, Zhang K. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Hypothalamic Hamartoma: Surgical Approach and Treatment Outcomes. J Clin Med 2022; 11:6579. [PMID: 36362807 PMCID: PMC9658093 DOI: 10.3390/jcm11216579] [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: 10/19/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 09/18/2023] Open
Abstract
Hypothalamic hamartoma (HH) is a rare lesion consisting of normal neurons and neuroglia arranged in an abnormal pattern which usually causes gelastic seizures (GS). Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been developed as a minimally invasive approach to treat HH and gradually become a first-line treatment. In total, this study enrolled 47 consecutive HH patients that underwent one round of ablation. Patients were followed for at least one year. Patients' medical records and surgical information were carefully reviewed, and univariate analyses were performed. Of the treated patients, 72.3% remained GS-free in this study, with an overall Engel class I rate of 68.1%. Long-term postoperative complications occurred in six patients. Factors associated with GS prognosis included Delalande classification (p = 0.033), HH volume (p = 0.01), and the ablation rate of the HH body (p = 0.035). The disconnection rate was 0.73 ± 0.14 in the Engel class Ia group as compared to 0.62 ± 0.13 in the Engel Ib-Engel IV group (p = 0.046). MRgLITT represents a safe and effective surgical procedure. Patients with larger or Delalande type IV HH may require multiple rounds of ablation. In addition to assessing the degree of disconnection, ablation volume should also be carefully considered for patients undergoing this procedure.
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Affiliation(s)
- Yuan Yao
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Wenhan Hu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Lin Sang
- Department of Neurosurgery, Beijing FengTai Hospital, Beijing 100070, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing FengTai Hospital, Beijing 100070, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Chang Liu
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Jiaji Qiu
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Xiaoqiu Shao
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing 100070, China
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11
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Rahman R, Ahmed N, Rahman S, Abdulla E, Al-Salihi MM, Rahman MM. Letter: The American Society for Stereotactic and Functional Neurosurgery Position Statement on Laser Interstitial Thermal Therapy for the Treatment of Drug-Resistant Epilepsy. Neurosurgery 2022; 90:e204-e205. [PMID: 35384935 DOI: 10.1227/neu.0000000000001977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Raphia Rahman
- Rowan School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Nazmin Ahmed
- Department of Neurosurgery, Ibrahim Cardiac Hospital and Research Institute (A Centre for Cardiovascular, Neuroscience and Organ Transplant Units), Dhaka, Bangladesh
| | - Sabrina Rahman
- Department of Public Health, Independent University-Bangladesh, Dhaka, Bangladesh
| | - Ebtesam Abdulla
- Department of Neurosurgery, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Md Moshiur Rahman
- Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
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