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Tatum WO, Freund B, Middlebrooks EH, Lundstrom BN, Feyissa AM, Van Gompel JJ, Grewal SS. CM-Pf deep brain stimulation in polyneuromodulation for epilepsy. Epileptic Disord 2024. [PMID: 39078093 DOI: 10.1002/epd2.20255] [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: 01/31/2024] [Accepted: 06/09/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Neuromodulation is a viable option for patients with drug-resistant epilepsies. We reviewed the management of patients with two deep brain neurostimulators. In addition, patients implanted with a device targeting the centromedian-parafascicular (CM-Pf) nuclear complex supplements this report to provide an illustrative case to implantation and programming a patient with three active devices. METHODS A narrative review using PubMed and Embase identified patients with drug-resistant epilepsy implanted with more than one neurostimulator was performed. Combinations of vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS) were identified. We provide a background of a newly reported case of an adult with a triple implant eventually responding to CM-Pf DBS as the third implant following suboptimal benefit from VNS and RNS. RESULTS In review of the literature, dual-device therapy is increasing in reports of use with combinations of VNS, RNS, and DBS to treat patients with drug-resistant epilepsy. We review dual-device implants with thalamic DBS device combinations, functional neural networks, and programming patients with dual devices. CM-Pf is a new target for DBS and has shown a variable response in focal epilepsy. We report the unique case of 28-year-old male with drug-resistant focal epilepsy who experienced a 75% seizure reduction with CM-Pf DBS as his third device after suboptimal responses to VNS and RNS. After 9 months, he also experienced seizure freedom from recurrent focal to bilateral tonic-clonic seizures. No medical or surgical complications or safety issues were encountered. CONCLUSION We demonstrate safety and feasibility in an adult combining active VNS, RNS, and CM-Pf DBS. Patients with dual-device therapy who experience a suboptimal response to initial device use at optimized settings should not be considered a neuromodulation "failure." Strategies to combine devices require a working knowledge of brain networks.
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Affiliation(s)
- W O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - B Freund
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - E H Middlebrooks
- Department of Radiology, Division of Neuroradiology, Mayo Clinic, Jacksonville, Florida, USA
| | - B N Lundstrom
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - A M Feyissa
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - J J Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - S S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
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Middlebrooks EH, Gupta V, Agarwal AK, Freund BE, Messina SA, Tatum WO, Sabsevitz DS, Feyissa AM, Mirsattari SM, Galan FN, Quinones-Hinojosa A, Grewal SS, Murray JV. Radiologic Classification of Hippocampal Sclerosis in Epilepsy. AJNR Am J Neuroradiol 2024:ajnr.A8214. [PMID: 38383054 DOI: 10.3174/ajnr.a8214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
Temporal lobe epilepsy is a common form of epilepsy that is often associated with hippocampal sclerosis (HS). Although HS is commonly considered a binary assessment in radiologic evaluation, it is known that histopathologic changes occur in distinct clusters. Some subtypes of HS only affect certain subfields, resulting in minimal changes to the overall volume of the hippocampus. This is likely a major reason why whole hippocampal volumetrics have underperformed versus expert readers in the diagnosis of HS. With recent advancements in MRI technology, it is now possible to characterize the substructure of the hippocampus more accurately. However, this is not consistently addressed in radiographic evaluations. The histologic subtype of HS is critical for prognosis and treatment decision-making, necessitating improved radiologic classification of HS. The International League Against Epilepsy (ILAE) has issued a consensus classification scheme for subtyping HS histopathologic changes. This review aims to explore how the ILAE subtypes of HS correlate with radiographic findings, introduce a grading system that integrates radiologic and pathologic reporting in HS, and outline an approach to detecting HS subtypes by using MRI. This framework will not only benefit current clinical evaluations, but also enhance future studies involving high-resolution MRI in temporal lobe epilepsy.
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Affiliation(s)
- Erik H Middlebrooks
- From the Department of Radiology (E.H.M., V.G., A.K.A., J.V.M.), Mayo Clinic, Jacksonville, Florida
| | - Vivek Gupta
- From the Department of Radiology (E.H.M., V.G., A.K.A., J.V.M.), Mayo Clinic, Jacksonville, Florida
| | - Amit K Agarwal
- From the Department of Radiology (E.H.M., V.G., A.K.A., J.V.M.), Mayo Clinic, Jacksonville, Florida
| | - Brin E Freund
- Department of Neurology (B.E.F., W.O.T., A.M.F.), Mayo Clinic, Jacksonville, Florida
| | - Steven A Messina
- Department of Radiology (S.A.M.), Mayo Clinic, Rochester, Minnesota
| | - William O Tatum
- Department of Neurology (B.E.F., W.O.T., A.M.F.), Mayo Clinic, Jacksonville, Florida
| | - David S Sabsevitz
- Department of Psychiatry and Psychology (D.S.S.), Mayo Clinic, Jacksonville, Florida
| | - Anteneh M Feyissa
- Department of Neurology (B.E.F., W.O.T., A.M.F.), Mayo Clinic, Jacksonville, Florida
| | - Seyed M Mirsattari
- Departments of Clinical Neurological Sciences, Medical Imaging, Medical Biophysics, and Psychology (S.M.M.), University of Western Ontario, London, Ontario, Canada
| | - Fernando N Galan
- Department of Neurology (F.N.G.), Nemours Children's Health, Jacksonville, Florida
| | | | - Sanjeet S Grewal
- Department of Neurosurgery (A.Q.-H., S.S.G.), Mayo Clinic, Jacksonville, Florida
| | - John V Murray
- From the Department of Radiology (E.H.M., V.G., A.K.A., J.V.M.), Mayo Clinic, Jacksonville, Florida
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Wan X, Zeng Y, Wang J, Tian M, Yin X, Zhang J. Structural and functional abnormalities and cognitive profiles in older adults with early-onset and late-onset focal epilepsy. Cereb Cortex 2024; 34:bhae300. [PMID: 39052362 DOI: 10.1093/cercor/bhae300] [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: 03/10/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
This study aimed to determine the patterns of changes in structure, function, and cognitive ability in early-onset and late-onset older adults with focal epilepsy (OFE). This study first utilized the deformation-based morphometry analysis to identify structural abnormalities, which were used as the seed region to investigate the functional connectivity with the whole brain. Next, a correlation analysis was performed between the altered imaging findings and neuropsychiatry assessments. Finally, the potential role of structural-functional abnormalities in the diagnosis of epilepsy was further explored by using mediation analysis. Compared with healthy controls (n = 28), the area of reduced structural volume was concentrated in the bilateral cerebellum, right thalamus, and right middle cingulate cortex, with frontal, temporal, and occipital lobes also affected in early-onset focal epilepsy (n = 26), while late-onset patients (n = 31) displayed cerebellar, thalamic, and cingulate atrophy. Furthermore, correlation analyses suggest an association between structural abnormalities and cognitive assessments. Dysfunctional connectivity in the cerebellum, cingulate cortex, and frontal gyrus partially mediates the relationship between structural abnormalities and the diagnosis of early-onset focal epilepsy. This study identified structural and functional abnormalities in early-onset and late-onset focal epilepsy and explored characters in cognitive performance. Structural-functional coupling may play a potential role in the diagnosis of epilepsy.
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Affiliation(s)
- Xinyue Wan
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
- Human Phenome Institute, Fudan University, Shanghai 201203, China
| | - Yanwei Zeng
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
| | - Jianhong Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Mei Tian
- Human Phenome Institute, Fudan University, Shanghai 201203, China
| | - Xuyang Yin
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Fudan University, Shanghai 200040, China
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Doll A, Wegrzyn M, Woermann FG, Labudda K, Bien CG, Kissler J. MRI evidence for material-specific encoding deficits and mesial-temporal alterations in presurgical frontal lobe epilepsy patients. Epilepsia Open 2024; 9:355-367. [PMID: 38093701 PMCID: PMC10839294 DOI: 10.1002/epi4.12881] [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: 07/13/2023] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Neuroimaging studies reveal frontal lobe (FL) contributions to memory encoding. Accordingly, memory impairments are documented in frontal lobe epilepsy (FLE). Still, little is known about the structural or functional correlates of such impairments. Particularly, material specificity of functional changes in cerebral activity during memory encoding in FLE is unclear. METHODS We compared 24 FLE patients (15 right-sided) undergoing presurgical evaluation with 30 healthy controls on a memory fMRI-paradigm of learning scenes, faces, and words followed by an out-of-scanner recognition task as well as regarding their mesial temporal lobe (mTL) volumes. We also addressed effects of FLE lateralization and performance level (normal vs. low). RESULTS FLE patients had poorer memory performance and larger left hippocampal volumes than controls. Volume increase seemed, however, irrelevant or even dysfunctional for memory performance. Further, functional changes in FLE patients were right-sided for scenes and faces and bilateral for words. In detail, during face encoding, FLE patients had, regardless of their performance level, decreased mTL activation, while during scene and word encoding only low performing FLE patients had decreased mTL along with decreased FL activation. Intact verbal memory performance was associated with higher right frontal activation in FLE patients but not in controls. SIGNIFICANCE Pharmacoresistant FLE has a distinct functional and structural impact on the mTL. Effects vary with the encoded material and patients' performance levels. Thus, in addition to the direct effect of the FL, memory impairment in FLE is presumably to a large part due to functional mTL changes triggered by disrupted FL networks. PLAIN LANGUAGE SUMMARY Frontal lobe epilepsy (FLE) patients may suffer from memory impairment. Therefore, we asked patients to perform a memory task while their brain was scanned by MRI in order to investigate possible changes in brain activation during learning. FLE patients showed changes in brain activation during learning and also structural changes in the mesial temporal lobe, which is a brain region especially relevant for learning but not the origin of the seizures in FLE. We conclude that FLE leads to widespread changes that contribute to FLE patients' memory impairment.
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Affiliation(s)
- Anna Doll
- Department of Epileptology (Krankenhaus Mara)Medical School, Bielefeld UniversityBielefeldGermany
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Martin Wegrzyn
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Friedrich G. Woermann
- Department of Epileptology (Krankenhaus Mara)Medical School, Bielefeld UniversityBielefeldGermany
| | - Kirsten Labudda
- Department of Epileptology (Krankenhaus Mara)Medical School, Bielefeld UniversityBielefeldGermany
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Christian G. Bien
- Department of Epileptology (Krankenhaus Mara)Medical School, Bielefeld UniversityBielefeldGermany
| | - Johanna Kissler
- Department of PsychologyBielefeld UniversityBielefeldGermany
- Center for Cognitive Interaction Technology (CITEC)Bielefeld UniversityBielefeldGermany
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Liu Y, Li Q, Yi D, Duan J, Zhang Q, Huang Y, He H, Liao Y, Song Z, Deng L, Wang W, Liu D. Topological abnormality of structural covariance network in MRI-negative frontal lobe epilepsy. Front Neurosci 2023; 17:1136110. [PMID: 37214387 PMCID: PMC10196002 DOI: 10.3389/fnins.2023.1136110] [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: 01/02/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Background Frontal lobe epilepsy (FLE) is the second most common type of focal epilepsy, however, imaging studies of FLE have been far less than Temporal lobe epilepsy (TLE) and the structural findings were not consistent in previous literature. Object Investigate the changes in cortical thickness in patients with FLE and the alteration of the structural covariance networks (SCNs) of cortical thickness with graph-theory. Method Thirty patients with FLE (18 males/12 females; 28.33 ± 11.81 years) and 27 demographically matched controls (15 males/12 females; 29.22 ± 9.73 years) were included in this study with high-resolution structural brain MRI scans. The cortical thickness was calculated, and structural covariance network (SCN) of cortical thickness were reconstructed using 68 × 68 matrix and analyzed with graph-theory approach. Result Cortical thickness was not significantly different between two groups, but path length and node betweenness were significantly increased in patients with FLE, and the regional network alterations were significantly changed in right precentral gyrus and right temporal pole (FDR corrected, p < 0.05). Comparing to HC group, network hubs were decreased and shifted away from frontal lobe. Conclusion The topological properties of cortical thickness covariance network were significantly altered in patients with FLE, even without obvious surface-based morphological damage. Graph-theory based SCN analysis may provide sensitive neuroanatomical biomarkers for FLE.
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Affiliation(s)
- Yin Liu
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Quanji Li
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dali Yi
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Junhong Duan
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qingxia Zhang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yunchen Huang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Haibo He
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yunjie Liao
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Song
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lingling Deng
- Department of Radiology, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Wei Wang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ding Liu
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
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Zheng Y, Wan KR. Letter to the Editor. Precision deep brain stimulation. J Neurosurg 2023; 138:1165-1166. [PMID: 36334290 DOI: 10.3171/2022.9.jns222170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Potemkina EG, Salomatina TA, Andreev EV, Abramov KB, Bannikova VD, Dengina NO, Nezdorovina VG, Zabrodskaya YM, Samochernykh KA, Odintsova GV. [MR morphometry in epileptology: progress and perspectives]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:113-119. [PMID: 37325834 DOI: 10.17116/neiro202387031113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Morphometric MRI analysis improves neuroimaging of structural changes in epilepsy. OBJECTIVE To investigate diagnostic potential of MR brain morphometry in neurosurgical epileptology. MATERIAL AND METHODS An interdisciplinary working group reviewed the studies devoted to MR morphometry in epileptology as a part of state assignment No. 056-00119-22-00. Study subject was trials of MR-morphometry in epilepsy. Searching for literature data was conducted in international and national databases between 2017 and 2022 using certain keywords. Final analysis included 36 publications. RESULTS Currently, MR brain morphometry allows measurement of cortical volume and thickness, surface area and depth of furrows, as well as analysis of cortical tortuosity and fractal changes. In neurosurgical epileptology, MR-morphometry has the greatest diagnostic value in MR-negative epilepsy. This method simplifies preoperative diagnosis and reduces costs. CONCLUSION Morphometry in neurosurgical epileptology is an additional method for verifying the epileptogenic zone. Automated programs simplify application of this method.
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Affiliation(s)
- E G Potemkina
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
| | - T A Salomatina
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
| | - E V Andreev
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
| | - K B Abramov
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
| | - V D Bannikova
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
| | - N O Dengina
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
| | - V G Nezdorovina
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
| | - Yu M Zabrodskaya
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
| | - K A Samochernykh
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
| | - G V Odintsova
- Almazov National Medical Research Centre, Polenov Neurosurgery Research Institute, St. Petersburg, Russia
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