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Akbarian B, Sainburg LE, Janson A, Johnson G, Doss DJ, Rogers BP, Englot DJ, Morgan VL. Association Between Postsurgical Functional Connectivity and Seizure Outcome in Patients With Temporal Lobe Epilepsy. Neurology 2024; 103:e209816. [PMID: 39226517 PMCID: PMC11373675 DOI: 10.1212/wnl.0000000000209816] [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: 09/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the success of presurgical network connectivity studies in predicting short-term (1-year) seizure outcomes, later seizure recurrence occurs in some patients with temporal lobe epilepsy (TLE). To uncover contributors to this recurrence, we investigated the relationship between functional connectivity and seizure outcomes at different time points after surgery in these patients. METHODS Patients included were clinically diagnosed with unilateral mesial TLE after a standard clinical evaluation and underwent selective amygdalohippocampectomy. Healthy controls had no history of seizures or head injury. Using resting-state fMRI, we assessed the postsurgical functional connectivity node strength, computed as the node's total strength to all other nodes, between seizure-free (Engel Ia-Ib) and nonseizure-free (Engel Ic-IV) acquisitions. The change over time after surgery in different outcome groups in these nodes was also characterized. RESULTS Patients with TLE (n = 32, mean age: 43.1 ± 11.9 years; 46.8% female) and 85 healthy controls (mean age: 37.7 ± 13.5 years; 48.2% female) were included. Resting fMRI was acquired before surgery and at least once after surgery in each patient (range 1-4 scans, 5-60 months). Differences between patients with (n = 30) and without (n = 18) seizure freedom were detected in the posterior insula ipsilateral to the resection (I-PIns: 95% CI -154.8 to -50.1, p = 2.8 × 10-4) and the bilateral central operculum (I-CO: 95% CI -163.2 to -65.1, p = 2.6 × 10-5, C-CO: 95% CI -172.7 to -55.8, p = 2.8 × 10-4). In these nodes, only those who were seizure-free had increased node strength after surgery that increased linearly over time (I-CO: 95% CI 1.0-5.2, p = 4.2 × 10-3, C-CO: 95% CI 1.0-5.2, p = 5.5 × 10-3, I-PIns: 95% CI 1.6-5.5, p = 0.9 × 10-3). Different outcome groups were not distinguished by node strength before surgery. DISCUSSION The findings suggest that network evolution in the first 5 years after selective amygdalohippocampectomy surgery is related to seizure outcomes in TLE. This highlights the need to identify presurgical and surgical conditions that lead to disparate postsurgical trajectories between seizure-free and nonseizure-free patients to identify potential contributors to long-term seizure outcomes. However, the lack of including other surgical approaches may affect the generalizability of the results.
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Affiliation(s)
- Behnaz Akbarian
- From the Department of Biomedical Engineering (B.A., L.E.S., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Vanderbilt University; and Vanderbilt University Institute of Imaging Science (B.A., L.E.S., A.J., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Department of Radiology and Radiological Sciences, and Department of Neurological Surgery (D.J.E., V.L.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Lucas E Sainburg
- From the Department of Biomedical Engineering (B.A., L.E.S., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Vanderbilt University; and Vanderbilt University Institute of Imaging Science (B.A., L.E.S., A.J., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Department of Radiology and Radiological Sciences, and Department of Neurological Surgery (D.J.E., V.L.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Andrew Janson
- From the Department of Biomedical Engineering (B.A., L.E.S., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Vanderbilt University; and Vanderbilt University Institute of Imaging Science (B.A., L.E.S., A.J., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Department of Radiology and Radiological Sciences, and Department of Neurological Surgery (D.J.E., V.L.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Graham Johnson
- From the Department of Biomedical Engineering (B.A., L.E.S., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Vanderbilt University; and Vanderbilt University Institute of Imaging Science (B.A., L.E.S., A.J., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Department of Radiology and Radiological Sciences, and Department of Neurological Surgery (D.J.E., V.L.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Derek J Doss
- From the Department of Biomedical Engineering (B.A., L.E.S., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Vanderbilt University; and Vanderbilt University Institute of Imaging Science (B.A., L.E.S., A.J., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Department of Radiology and Radiological Sciences, and Department of Neurological Surgery (D.J.E., V.L.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Baxter P Rogers
- From the Department of Biomedical Engineering (B.A., L.E.S., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Vanderbilt University; and Vanderbilt University Institute of Imaging Science (B.A., L.E.S., A.J., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Department of Radiology and Radiological Sciences, and Department of Neurological Surgery (D.J.E., V.L.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Dario J Englot
- From the Department of Biomedical Engineering (B.A., L.E.S., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Vanderbilt University; and Vanderbilt University Institute of Imaging Science (B.A., L.E.S., A.J., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Department of Radiology and Radiological Sciences, and Department of Neurological Surgery (D.J.E., V.L.M.), Vanderbilt University Medical Center, Nashville, TN
| | - Victoria L Morgan
- From the Department of Biomedical Engineering (B.A., L.E.S., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Vanderbilt University; and Vanderbilt University Institute of Imaging Science (B.A., L.E.S., A.J., G.J., D.J.D., B.P.R., D.J.E., V.L.M.), Department of Radiology and Radiological Sciences, and Department of Neurological Surgery (D.J.E., V.L.M.), Vanderbilt University Medical Center, Nashville, TN
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Doss DJ, Shless JS, Bick SK, Makhoul GS, Negi AS, Bibro CE, Rashingkar R, Gummadavelli A, Chang C, Gallagher MJ, Naftel RP, Reddy SB, Williams Roberson S, Morgan VL, Johnson GW, Englot DJ. The interictal suppression hypothesis is the dominant differentiator of seizure onset zones in focal epilepsy. Brain 2024; 147:3009-3017. [PMID: 38874456 PMCID: PMC11370787 DOI: 10.1093/brain/awae189] [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: 10/20/2023] [Revised: 04/19/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024] Open
Abstract
Successful surgical treatment of drug-resistant epilepsy traditionally relies on the identification of seizure onset zones (SOZs). Connectome-based analyses of electrographic data from stereo electroencephalography (SEEG) may empower improved detection of SOZs. Specifically, connectome-based analyses based on the interictal suppression hypothesis posit that when the patient is not having a seizure, SOZs are inhibited by non-SOZs through high inward connectivity and low outward connectivity. However, it is not clear whether there are other motifs that can better identify potential SOZs. Thus, we sought to use unsupervised machine learning to identify network motifs that elucidate SOZs and investigate if there is another motif that outperforms the ISH. Resting-state SEEG data from 81 patients with drug-resistant epilepsy undergoing a pre-surgical evaluation at Vanderbilt University Medical Center were collected. Directed connectivity matrices were computed using the alpha band (8-13 Hz). Principal component analysis (PCA) was performed on each patient's connectivity matrix. Each patient's components were analysed qualitatively to identify common patterns across patients. A quantitative definition was then used to identify the component that most closely matched the observed pattern in each patient. A motif characteristic of the interictal suppression hypothesis (high-inward and low-outward connectivity) was present in all individuals and found to be the most robust motif for identification of SOZs in 64/81 (79%) patients. This principal component demonstrated significant differences in SOZs compared to non-SOZs. While other motifs for identifying SOZs were present in other patients, they differed for each patient, suggesting that seizure networks are patient specific, but the ISH is present in nearly all networks. We discovered that a potentially suppressive motif based on the interictal suppression hypothesis was present in all patients, and it was the most robust motif for SOZs in 79% of patients. Each patient had additional motifs that further characterized SOZs, but these motifs were not common across all patients. This work has the potential to augment clinical identification of SOZs to improve epilepsy treatment.
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Affiliation(s)
- Derek J Doss
- Department of Biomedical Engineering, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN 37235, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Vanderbilt University Nashville, Nashville, TN 37235, USA
| | - Jared S Shless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Sarah K Bick
- Department of Biomedical Engineering, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Ghassan S Makhoul
- Department of Biomedical Engineering, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN 37235, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Vanderbilt University Nashville, Nashville, TN 37235, USA
| | - Aarushi S Negi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Camden E Bibro
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Rohan Rashingkar
- Department of Computer Science, Vanderbilt University Nashville, Nashville, TN 37235, USA
| | - Abhijeet Gummadavelli
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Catie Chang
- Department of Biomedical Engineering, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Department of Computer Science, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Martin J Gallagher
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Robert P Naftel
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Shilpa B Reddy
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Shawniqua Williams Roberson
- Department of Biomedical Engineering, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Victoria L Morgan
- Department of Biomedical Engineering, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN 37235, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Vanderbilt University Nashville, Nashville, TN 37235, USA
- Department of Computer Science, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Department of Radiology and Biomedical Imaging, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Graham W Johnson
- Department of Biomedical Engineering, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN 37235, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Vanderbilt University Nashville, Nashville, TN 37235, USA
| | - Dario J Englot
- Department of Biomedical Engineering, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN 37235, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Vanderbilt University Nashville, Nashville, TN 37235, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37235, USA
- Department of Computer Science, Vanderbilt University Nashville, Nashville, TN 37235, USA
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37235, USA
- Department of Radiology and Biomedical Imaging, Vanderbilt University Medical Center, Nashville, TN 37235, USA
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Langbein J, Boddeti U, Kreinbrink M, Khan Z, Rampalli I, Bachani M, Ksendzovsky A. Therapeutic approaches targeting seizure networks. FRONTIERS IN NETWORK PHYSIOLOGY 2024; 4:1441983. [PMID: 39171119 PMCID: PMC11335476 DOI: 10.3389/fnetp.2024.1441983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/16/2024] [Indexed: 08/23/2024]
Abstract
Epilepsy is one of the most common neurological disorders, affecting over 65 million people worldwide. Despite medical management with anti-seizure medications (ASMs), many patients fail to achieve seizure freedom, with over one-third of patients having drug-resistant epilepsy (DRE). Even with surgical management through resective surgery and/or neuromodulatory interventions, over 50 % of patients continue to experience refractory seizures within a year of surgery. Over the past 2 decades, studies have increasingly suggested that treatment failure is likely driven by untreated components of a pathological seizure network, a shift in the classical understanding of epilepsy as a focal disorder. However, this shift in thinking has yet to translate to improved treatments and seizure outcomes in patients. Here, we present a narrative review discussing the process of surgical epilepsy management. We explore current surgical interventions and hypothesized mechanisms behind treatment failure, highlighting evidence of pathologic seizure networks. Finally, we conclude by discussing how the network theory may inform surgical management, guiding the identification and targeting of more appropriate surgical regions. Ultimately, we believe that adapting current surgical practices and neuromodulatory interventions towards targeting seizure networks offers new therapeutic strategies that may improve seizure outcomes in patients suffering from DRE.
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Affiliation(s)
- Jenna Langbein
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ujwal Boddeti
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
- Surgical Neurology Branch, National Institute of Neurological Disorders, National Institutes of Health, Bethesda, MD, United States
| | - Matthew Kreinbrink
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ziam Khan
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ihika Rampalli
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Muzna Bachani
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Alexander Ksendzovsky
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
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Hajji EB, Traore B, Hassoune S, Alahiane Z, Chahid I, Bellakhdar S, Rafai MA, Lakhdar A. Drug-resistant epilepsy in Morocco: description, prevalence and predictive factors in Casablanca-Settat region. J Clin Neurosci 2024; 126:28-37. [PMID: 38824801 DOI: 10.1016/j.jocn.2024.05.037] [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: 03/19/2024] [Revised: 05/08/2024] [Accepted: 05/28/2024] [Indexed: 06/04/2024]
Abstract
Drug-resistant epilepsy (DRE) affects about one-third of people with epilepsy (PWE). Our study aims to estimate the DRE prevalence and its predictive factors in Morocco. A cross-sectional study was conducted over 18 months. PWE with clinical diagnosis of epilepsy, and with an antiseizure treatment duration >12 months were examined in the neurology, neurosurgery, psychiatry, and pediatrics departments, of different sampled clinical sectors for the Casablanca-Settat region. Sociodemographic and clinical data were collected using a questionnaire during consultations. Antiseizure multi-therapy, a seizure freedom duration <12 months, compliance, and adequate posology were the determining factors for classifying DRE. Data were analyzed using Statistical Package for Social Sciences (SPSS) software, version 21.0. Statistical significance was set at p < 0.05 and logistic regression was performed to determine the predictive factors. In our sample of 446 PWE, the median age is 25 years (IQR: 11.75-44.00). The DRE estimated prevalence was 29.4 %. Pseudo-resistant epilepsy (PRE) was 18.0 %. Multivariate logistic regression analysis reports that single marital status (ORa = 1.94; CI95%: 1.02-3.71), comorbidities and concomitant affections (ORa = 2.14; CI95%: 1.27-3.59), structural etiology (ORa = 1.96; CI95%: 1.16-3.30), pre-ictal aura (ORa = 1.90; CI95%: 1.09-3.29), inter-ictal EEG abnormalities (ORa = 2.45; CI95%: 1.24-4.84) and allopathic treatment use (ORa = 2.10; CI95%: 1.30-3.39) are the predictive factors for DRE. We report an alarming DRE prevalence. Associated factors found may contribute to the prognosis and early management. PWE awareness, facilitating healthcare access and the development of epilepsy surgery are the key points to limit DRE in Morocco and prevent its various complications, especially for the pediatric population.
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Affiliation(s)
- El Bachir Hajji
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Boubacar Traore
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco; Direction de la Pharmacie et du Médicament (DPM), Bamako, Mali
| | - Samira Hassoune
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco; Laboratory of Cellular and Molecular Pathology, Team "Epidemiology and Histology of Chronic and Cancerous Diseases", Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Zineb Alahiane
- Neuropediatrics Unit, Abderrahim El Harouchi University Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Imane Chahid
- Neuropediatrics Unit, Abderrahim El Harouchi University Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Salma Bellakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco; Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Mohammed Abdoh Rafai
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco; Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Abdelhakim Lakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco; Department of Neurosurgery, IBN ROCHD University Hospital, Casablanca, Morocco
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Khan D, Sagar S, Jaleel J, Umar M, Tripathi M, Tripathi M, Sharma MC, Bal C. SISCOS in focal cortical dysplasia: localization and comparative analysis with MRI. Neuroradiology 2024:10.1007/s00234-024-03434-8. [PMID: 39060800 DOI: 10.1007/s00234-024-03434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE This study evaluates the efficacy of SISCOS (Subtraction ictal-interictal SPECT coregistered to SPECT) in localizing the epileptogenic zone (EZ) in focal cortical dysplasia (FCD), comparing its predictive performance with MRI and post-surgical outcomes based on ILAE classification. METHODS 84 patients with drug refractory epilepsy (DRE) who were operated and had histopathology consistent with FCD, were included in the study. All patients had undergone a complete work-up including SISCOS and MRI for EZ localization, followed by discussion in the multidisciplinary epilepsy surgery meeting prior to surgery. Ictal & interictal perfusion SPECT studies were performed with Tc-99 m Ethylene Cysteinate Dimer (Tc-99 m ECD) followed by SISCOS analysis using SPM2 and Bioimage Suite 2.6. Concordance for localization was determined by comparing with the surgical resection site and post-surgical outcomes were assessed using the ILAE classification. RESULTS The concordance for EZ localization demonstrated by SISCOS was 73.8% and MRI was 82.1%. 52 patients (61.9%) had good surgical outcome and 31(59%) of these were FCD type 2. In patients with discordant MRI findings, SISCOS was able to provide localisation in 86% (13/15), with 69.2% showing good surgical outcomes. Sensitivity of SISCOS and MRI was 73% (95% CI = 59-84.8%) and 78% (95% CI = 67.5-90.3%) respectively with no significant difference between the two. In FCD type I, both SISCOS and MRI revealed a similar a sensitivity of 76.4% (95%CI = 50.1-93.2%). Concordant cases exhibited higher seizure-free odds ratios for both modalities. CONCLUSION SISCOS is effective in localizing the EZ in FCD patients, comparable to MRI. Integrating SISCOS and MRI enhances lesion detection, especially in MRI discordant cases. A comprehensive diagnostic approach utilizing SISCOS and MRI can optimize the non-invasive pre-surgical assessment in DRE thereby guiding surgical decision-making in a resource-limited setting.
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Affiliation(s)
- Dikhra Khan
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sambit Sagar
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Jasim Jaleel
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mohammad Umar
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, PET/CT, All India Institute of Medical Sciences, New Delhi, 110029, India
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Jaber K, Avigdor T, Mansilla D, Ho A, Thomas J, Abdallah C, Chabardes S, Hall J, Minotti L, Kahane P, Grova C, Gotman J, Frauscher B. A spatial perturbation framework to validate implantation of the epileptogenic zone. Nat Commun 2024; 15:5253. [PMID: 38897997 PMCID: PMC11187199 DOI: 10.1038/s41467-024-49470-z] [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: 11/17/2023] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Stereo-electroencephalography (SEEG) is the gold standard to delineate surgical targets in focal drug-resistant epilepsy. SEEG uses electrodes placed directly into the brain to identify the seizure-onset zone (SOZ). However, its major constraint is limited brain coverage, potentially leading to misidentification of the 'true' SOZ. Here, we propose a framework to assess adequate SEEG sampling by coupling epileptic biomarkers with their spatial distribution and measuring the system's response to a perturbation of this coupling. We demonstrate that the system's response is strongest in well-sampled patients when virtually removing the measured SOZ. We then introduce the spatial perturbation map, a tool that enables qualitative assessment of the implantation coverage. Probability modelling reveals a higher likelihood of well-implanted SOZs in seizure-free patients or non-seizure free patients with incomplete SOZ resections, compared to non-seizure-free patients with complete resections. This highlights the framework's value in sparing patients from unsuccessful surgeries resulting from poor SEEG coverage.
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Affiliation(s)
- Kassem Jaber
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA
| | - Tamir Avigdor
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
| | - Daniel Mansilla
- Neurophysiology Unit, Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - Alyssa Ho
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - John Thomas
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA
| | - Chifaou Abdallah
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
| | - Stephan Chabardes
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Jeff Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
| | - Lorella Minotti
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Philippe Kahane
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Christophe Grova
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, School of Health, Department of Physics, Concordia University, Montréal, QC, Canada
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jean Gotman
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada.
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA.
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.
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Danačíková Š, Straka B, Daněk J, Kořínek V, Otáhal J. In vitro human cell culture models in a bench-to-bedside approach to epilepsy. Epilepsia Open 2024; 9:865-890. [PMID: 38637998 PMCID: PMC11145627 DOI: 10.1002/epi4.12941] [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: 10/23/2023] [Revised: 03/05/2024] [Accepted: 03/31/2024] [Indexed: 04/20/2024] Open
Abstract
Epilepsy is the most common chronic neurological disease, affecting nearly 1%-2% of the world's population. Current pharmacological treatment and regimen adjustments are aimed at controlling seizures; however, they are ineffective in one-third of the patients. Although neuronal hyperexcitability was previously thought to be mainly due to ion channel alterations, current research has revealed other contributing molecular pathways, including processes involved in cellular signaling, energy metabolism, protein synthesis, axon guidance, inflammation, and others. Some forms of drug-resistant epilepsy are caused by genetic defects that constitute potential targets for precision therapy. Although such approaches are increasingly important, they are still in the early stages of development. This review aims to provide a summary of practical aspects of the employment of in vitro human cell culture models in epilepsy diagnosis, treatment, and research. First, we briefly summarize the genetic testing that may result in the detection of candidate pathogenic variants in genes involved in epilepsy pathogenesis. Consequently, we review existing in vitro cell models, including induced pluripotent stem cells and differentiated neuronal cells, providing their specific properties, validity, and employment in research pipelines. We cover two methodological approaches. The first approach involves the utilization of somatic cells directly obtained from individual patients, while the second approach entails the utilization of characterized cell lines. The models are evaluated in terms of their research and clinical benefits, relevance to the in vivo conditions, legal and ethical aspects, time and cost demands, and available published data. Despite the methodological, temporal, and financial demands of the reviewed models they possess high potential to be used as robust systems in routine testing of pathogenicity of detected variants in the near future and provide a solid experimental background for personalized therapy of genetic epilepsies. PLAIN LANGUAGE SUMMARY: Epilepsy affects millions worldwide, but current treatments fail for many patients. Beyond traditional ion channel alterations, various genetic factors contribute to the disorder's complexity. This review explores how in vitro human cell models, either from patients or from cell lines, can aid in understanding epilepsy's genetic roots and developing personalized therapies. While these models require further investigation, they offer hope for improved diagnosis and treatment of genetic forms of epilepsy.
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Affiliation(s)
- Šárka Danačíková
- Laboratory of Developmental EpileptologyInstitute of Physiology of the Czech Academy of SciencesPragueCzech Republic
- Department of Pathophysiology, Second Faculty of MedicineCharles UniversityPragueCzech Republic
- Laboratory of Cell and Developmental BiologyInstitute of Molecular Genetics of the Czech Academy of SciencesPragueCzech Republic
- Department of Physiology, Faculty of ScienceCharles UniversityPragueCzech Republic
| | - Barbora Straka
- Neurogenetics Laboratory of the Department of Paediatric Neurology, Second Faculty of MedicineCharles University and Motol University Hospital, Full Member of the ERN EpiCAREPragueCzech Republic
| | - Jan Daněk
- Laboratory of Developmental EpileptologyInstitute of Physiology of the Czech Academy of SciencesPragueCzech Republic
| | - Vladimír Kořínek
- Laboratory of Cell and Developmental BiologyInstitute of Molecular Genetics of the Czech Academy of SciencesPragueCzech Republic
| | - Jakub Otáhal
- Laboratory of Developmental EpileptologyInstitute of Physiology of the Czech Academy of SciencesPragueCzech Republic
- Department of Pathophysiology, Second Faculty of MedicineCharles UniversityPragueCzech Republic
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8
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Hangel G, Kasprian G, Chambers S, Haider L, Lazen P, Koren J, Diehm R, Moser K, Tomschik M, Wais J, Winter F, Zeiser V, Gruber S, Aull-Watschinger S, Traub-Weidinger T, Baumgartner C, Feucht M, Dorfer C, Bogner W, Trattnig S, Pataraia E, Roessler K. Implementation of a 7T Epilepsy Task Force consensus imaging protocol for routine presurgical epilepsy work-up: effect on diagnostic yield and lesion delineation. J Neurol 2024; 271:804-818. [PMID: 37805665 PMCID: PMC10827812 DOI: 10.1007/s00415-023-11988-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/05/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Recently, the 7 Tesla (7 T) Epilepsy Task Force published recommendations for 7 T magnetic resonance imaging (MRI) in patients with pharmaco-resistant focal epilepsy in pre-surgical evaluation. The objective of this study was to implement and evaluate this consensus protocol with respect to both its practicability and its diagnostic value/potential lesion delineation surplus effect over 3 T MRI in the pre-surgical work-up of patients with pharmaco-resistant focal onset epilepsy. METHODS The 7 T MRI protocol consisted of T1-weighted, T2-weighted, high-resolution-coronal T2-weighted, fluid-suppressed, fluid-and-white-matter-suppressed, and susceptibility-weighted imaging, with an overall duration of 50 min. Two neuroradiologists independently evaluated the ability of lesion identification, the detection confidence for these identified lesions, and the lesion border delineation at 7 T compared to 3 T MRI. RESULTS Of 41 recruited patients > 12 years of age, 38 were successfully measured and analyzed. Mean detection confidence scores were non-significantly higher at 7 T (1.95 ± 0.84 out of 3 versus 1.64 ± 1.19 out of 3 at 3 T, p = 0.050). In 50% of epilepsy patients measured at 7 T, additional findings compared to 3 T MRI were observed. Furthermore, we found improved border delineation at 7 T in 88% of patients with 3 T-visible lesions. In 19% of 3 T MR-negative cases a new potential epileptogenic lesion was detected at 7 T. CONCLUSIONS The diagnostic yield was beneficial, but with 19% new 7 T over 3 T findings, not major. Our evaluation revealed epilepsy outcomes worse than ILAE Class 1 in two out of the four operated cases with new 7 T findings.
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Affiliation(s)
- Gilbert Hangel
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria.
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria.
- Medical Imaging Cluster, Medical University of Vienna, Vienna, Austria.
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefanie Chambers
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
| | - Lukas Haider
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- NMR Research Unit, Faculty of Brain Science, Queens Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Philipp Lazen
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
| | - Johannes Koren
- Department of Neurology, Klinik Hietzing, Vienna, Austria
| | - Robert Diehm
- Center for Rare and Complex Childhood Onset Epilepsies, Member of ERN EpiCARE, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Moser
- Center for Rare and Complex Childhood Onset Epilepsies, Member of ERN EpiCARE, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Jonathan Wais
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Fabian Winter
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Vitalij Zeiser
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stephan Gruber
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria
| | | | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Martha Feucht
- Center for Rare and Complex Childhood Onset Epilepsies, Member of ERN EpiCARE, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Bogner
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria
| | | | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria
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9
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Doss DJ, Johnson GW, Englot DJ. Imaging and Stereotactic Electroencephalography Functional Networks to Guide Epilepsy Surgery. Neurosurg Clin N Am 2024; 35:61-72. [PMID: 38000842 PMCID: PMC10676462 DOI: 10.1016/j.nec.2023.09.001] [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] [Indexed: 11/26/2023]
Abstract
Epilepsy surgery is a potentially curative treatment of drug-resistant epilepsy that has remained underutilized both due to inadequate referrals and incomplete localization hypotheses. The complexity of patients evaluated for epilepsy surgery has increased, thus new approaches are necessary to treat these patients. The paradigm of epilepsy surgery has evolved to match this challenge, now considering the entire seizure network with the goal of disrupting it through resection, ablation, neuromodulation, or a combination. The network paradigm has the potential to aid in identification of the seizure network as well as treatment selection.
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Affiliation(s)
- Derek J Doss
- Department of Biomedical Engineering, Vanderbilt University, PMB 351631, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Vanderbilt University Institute of Imaging Science (VUIIS), 1161 21st Avenue South, Medical Center North AA-1105, Nashville, TN 37232, USA; Vanderbilt Institute for Surgery and Engineering (VISE), 1161 21st Avenue South, MCN S2323, Nashville, TN 37232, USA
| | - Graham W Johnson
- Department of Biomedical Engineering, Vanderbilt University, PMB 351631, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Vanderbilt University Institute of Imaging Science (VUIIS), 1161 21st Avenue South, Medical Center North AA-1105, Nashville, TN 37232, USA; Vanderbilt Institute for Surgery and Engineering (VISE), 1161 21st Avenue South, MCN S2323, Nashville, TN 37232, USA
| | - Dario J Englot
- Department of Biomedical Engineering, Vanderbilt University, PMB 351631, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Vanderbilt University Institute of Imaging Science (VUIIS), 1161 21st Avenue South, Medical Center North AA-1105, Nashville, TN 37232, USA; Vanderbilt Institute for Surgery and Engineering (VISE), 1161 21st Avenue South, MCN S2323, Nashville, TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, T4224 Medical Center North, Nashville, TN 37232, USA; Department of Electrical and Computer Engineering, Vanderbilt University, PMB 351824, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Department of Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA.
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10
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Horrillo-Maysonnial A, Avigdor T, Abdallah C, Mansilla D, Thomas J, von Ellenrieder N, Royer J, Bernhardt B, Grova C, Gotman J, Frauscher B. Targeted density electrode placement achieves high concordance with traditional high-density EEG for electrical source imaging in epilepsy. Clin Neurophysiol 2023; 156:262-271. [PMID: 37704552 DOI: 10.1016/j.clinph.2023.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE High-density (HD) electroencephalography (EEG) is increasingly used in presurgical epilepsy evaluation, but it is demanding in time and resources. To overcome these issues, we compared EEG source imaging (ESI) solutions with a targeted density and HD-EEG montage. METHODS HD-EEGs from patients undergoing presurgical evaluation were analyzed. A low-density recording was created by selecting the 25 electrodes of a standard montage from the 83 electrodes of the HD-EEG and adding 8-11 electrodes around the electrode with the highest amplitude interictal epileptiform discharges. The ESI solution from this "targeted" montage was compared to that from the HD-EEG using the distance between peak vertices, sublobar concordance and a qualitative similarity measure. RESULTS Fifty-eight foci of forty-three patients were included. The median distance between the peak vertices of the two montages was 13.2 mm, irrespective of focus' location. Tangential generators (n = 5/58) showed a higher distance than radial generators (p = 0.04). We found sublobar concordance in 54/58 of the foci (93%). Map similarity, assessed by an epileptologist, had a median score of 4/5. CONCLUSIONS ESI solutions obtained from a targeted density montage show high concordance with those calculated from HD-EEG. SIGNIFICANCE Requiring significantly fewer electrodes, targeted density EEG allows obtaining similar ESI solutions as traditional HD-EEG montage.
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Affiliation(s)
- A Horrillo-Maysonnial
- Clinical Neurophysiology Section, Clínica Universidad de Navarra, Pamplona, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain; Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - T Avigdor
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Canada.
| | - C Abdallah
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Canada.
| | - D Mansilla
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - J Thomas
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - N von Ellenrieder
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - J Royer
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - B Bernhardt
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - C Grova
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Canada; Multimodal Functional Imaging Lab, PERFORM Center, Department of Physics, Concordia University, Montreal, QC, Canada.
| | - J Gotman
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - B Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurology, Duke University Medical Center, Durham, NC, United States; Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, United States.
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11
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Schmitz B, Lattanzi S, Vonck K, Kälviäinen R, Nashef L, Ben‐Menachem E. Cenobamate in refractory epilepsy: Overview of treatment options and practical considerations. Epilepsia Open 2023; 8:1241-1255. [PMID: 37743544 PMCID: PMC10690671 DOI: 10.1002/epi4.12830] [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: 05/24/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023] Open
Abstract
Management of drug resistant epilepsy (DRE) represents a challenge to the treating clinician. This manuscript addresses DRE and provides an overview of treatment options, medical, surgical, and dietary. It addresses treatment strategies in polytherapy, then focuses on the role cenobamate (CNB) may play in reducing the burden of DRE while providing practical advice for its introduction. CNB is a recently approved, third generation, anti-seizure medication (ASM), a tetrazole-derived carbamate, thought to have a dual mechanism of action, through its effect on sodium channels as well as on GABAA receptors at a non-benzodiazepine site. CNB, having a long half-life, is an effective add-on ASM in refractory focal epilepsy with a higher response rate and a higher seizure-freedom rate than is usually seen in regulatory clinical trials. Experience post-licensing, though still limited, supports the findings of clinical trials and is encouraging. Its spectrum of action in relation to generalized epilepsies and seizures remains to be established, and there are no data on its efficacy in monotherapy. At the time of writing, CNB has been prescribed for some 50 000 individuals with DRE and focal epilepsy. A larger number is needed to fully establish its safety profile. It should at all times be introduced slowly to minimize the risk of serious allergic drug reactions. It has clinically meaningful interactions which must be anticipated and managed to maximize tolerability and likelihood of successful treatment. Despite the above, it may well prove to be of major benefit in the treatment of many patients with drug resistant epilepsy.
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Affiliation(s)
- Bettina Schmitz
- Center for Epilepsy, Department for NeurologyVivantes Humboldt‐KlinikumBerlinGermany
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical MedicineMarche Polytechnic UniversityAnconaItaly
| | - Kristl Vonck
- Department of Neurology, 4BrainGhent University HospitalGentBelgium
| | - Reetta Kälviäinen
- Kuopio Epilepsy Center, Kuopio University Hospital, Member of ERN EpiCARE, and Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
| | - Lina Nashef
- Neurology DepartmentKing's College HospitalLondonUK
| | - Elinor Ben‐Menachem
- Institution for Clinical Neuroscience, Sahlgrenska AcademyUniversity of GoteborgGoteborgSweden
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12
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Pérez Hinestroza J, Mazo C, Trujillo M, Herrera A. MRI and CT Fusion in Stereotactic Electroencephalography (SEEG). Diagnostics (Basel) 2023; 13:3420. [PMID: 37998556 PMCID: PMC10670384 DOI: 10.3390/diagnostics13223420] [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: 05/30/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 11/25/2023] Open
Abstract
Epilepsy is a neurological disorder characterized by spontaneous recurrent seizures. While 20% to 30% of epilepsy cases are untreatable with Anti-Epileptic Drugs, some of these cases can be addressed through surgical intervention. The success of such interventions greatly depends on accurately locating the epileptogenic tissue, a task achieved using diagnostic techniques like Stereotactic Electroencephalography (SEEG). SEEG utilizes multi-modal fusion to aid in electrode localization, using pre-surgical resonance and post-surgical computer tomography images as inputs. To ensure the absence of artifacts or misregistrations in the resultant images, a fusion method that accounts for electrode presence is required. We proposed an image fusion method in SEEG that incorporates electrode segmentation from computed tomography as a sampling mask during registration to address the fusion problem in SEEG. The method was validated using eight image pairs from the Retrospective Image Registration Evaluation Project (RIRE). After establishing a reference registration for the MRI and identifying eight points, we assessed the method's efficacy by comparing the Euclidean distances between these reference points and those derived using registration with a sampling mask. The results showed that the proposed method yielded a similar average error to the registration without a sampling mask, but reduced the dispersion of the error, with a standard deviation of 0.86 when a mask was used and 5.25 when no mask was used.
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Affiliation(s)
- Jaime Pérez Hinestroza
- Multimedia and Computer Vision Group, Universidad del Valle, Cali 760042, Colombia; (C.M.); (M.T.); (A.H.)
| | - Claudia Mazo
- Multimedia and Computer Vision Group, Universidad del Valle, Cali 760042, Colombia; (C.M.); (M.T.); (A.H.)
- School of Computing, Faculty of Engineering and Computing, Glasnevin Campus, Dublin City University, 9 Dublin, Ireland
| | - Maria Trujillo
- Multimedia and Computer Vision Group, Universidad del Valle, Cali 760042, Colombia; (C.M.); (M.T.); (A.H.)
| | - Alejandro Herrera
- Multimedia and Computer Vision Group, Universidad del Valle, Cali 760042, Colombia; (C.M.); (M.T.); (A.H.)
- Clinica Imbanaco Grupo Quironsalud, Cali 760042, Colombia
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13
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Nakamura T, Hatano K, Sato K, Enoki H, Fujimoto A. False lateralization of scalp EEG and semiology in cavernous malformation-associated temporal lobe epilepsy: A case report. Heliyon 2023; 9:e18237. [PMID: 37501958 PMCID: PMC10368837 DOI: 10.1016/j.heliyon.2023.e18237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
Background Several cases of temporal lobe epilepsy (TLE) showing false lateralization of ictal scalp electroencephalography (EEG) have been reported. However, TLE with cavernous malformation indicating false lateralization of both ictal scalp EEG and semiology as in the present case is rare. The aim of this report is to call attention to avoiding overestimation of ictal scalp EEG findings in epilepsy patients with cavernous malformation. Case report A 25-year-old man without any medical history suffered from seizures for a year despite appropriate anti-epileptic medication. Magnetic resonance imaging (MRI) revealed cavernous malformation in the left amygdala. The seizure type was brief impaired consciousness with left dystonic posturing, preceded by a sensation of blood rushing to the head. Long-term video EEG with scalp electrodes showed periodic sharp waves beginning from the right temporal area during seizures. Although both semiology and ictal scalp EEG indicated right TLE, intracranial EEG revealed the onset of low-voltage fast activity from the left hippocampus near the cavernous malformation. This patient therefore underwent removal of cavernous malformation and left amygdala, and achieved freedom from seizures postoperatively. Conclusion We reinforce the importance of performing intracranial EEG for cavernous malformation-associated epilepsy when discrepancies between scalp EEG and MRI are evident.
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Affiliation(s)
- Tomohiro Nakamura
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Keisuke Hatano
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
- Department of Pediatrics, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
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14
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Gelbard-Sagiv H, Pardo S, Getter N, Guendelman M, Benninger F, Kraus D, Shriki O, Ben-Sasson S. Optimizing Electrode Configurations for Wearable EEG Seizure Detection Using Machine Learning. SENSORS (BASEL, SWITZERLAND) 2023; 23:5805. [PMID: 37447653 DOI: 10.3390/s23135805] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
Epilepsy, a prevalent neurological disorder, profoundly affects patients' quality of life due to the unpredictable nature of seizures. The development of a reliable and user-friendly wearable EEG system capable of detecting and predicting seizures has the potential to revolutionize epilepsy care. However, optimizing electrode configurations for such systems, which is crucial for balancing accuracy and practicality, remains to be explored. This study addresses this gap by developing a systematic approach to optimize electrode configurations for a seizure detection machine-learning algorithm. Our approach was applied to an extensive database of prolonged annotated EEG recordings from 158 epilepsy patients. Multiple electrode configurations ranging from one to eighteen were assessed to determine the optimal number of electrodes. Results indicated that the performance was initially maintained as the number of electrodes decreased, but a drop in performance was found to have occurred at around eight electrodes. Subsequently, a comprehensive analysis of all eight-electrode configurations was conducted using a computationally intensive workflow to identify the optimal configurations. This approach can inform the mechanical design process of an EEG system that balances seizure detection accuracy with the ease of use and portability. Additionally, this framework holds potential for optimizing hardware in other machine learning applications. The study presents a significant step towards the development of an efficient wearable EEG system for seizure detection.
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Affiliation(s)
| | - Snir Pardo
- NeuroHelp Ltd., Ramat-Gan 5252181, Israel
| | - Nir Getter
- NeuroHelp Ltd., Ramat-Gan 5252181, Israel
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Miriam Guendelman
- NeuroHelp Ltd., Ramat-Gan 5252181, Israel
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Felix Benninger
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dror Kraus
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel
| | - Oren Shriki
- NeuroHelp Ltd., Ramat-Gan 5252181, Israel
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
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15
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Evans K, Stamas N, Li Q, Vincent T, Zhang L, Danielson V, Lam S, Lassagne R, Berger A. Patterns of utilization and cost of healthcare services and pharmacotherapy among patients with drug-resistant epilepsy during the two-year period before neurostimulation: A descriptive analysis of the journey to implantation based on analyses of a large United States healthcare claims database. Epilepsy Behav 2023; 145:109288. [PMID: 37348410 DOI: 10.1016/j.yebeh.2023.109288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To conduct a descriptive assessment of patterns of utilization and cost of healthcare services and pharmacotherapies among patients with drug-resistant epilepsy (DRE) before neurostimulator implantation. METHODS Using a large United States healthcare claims database, we identified all patients with DRE who were implanted with neurostimulators between January 1, 2012, and December 31, 2019. Patients without an epilepsy diagnosis on their implantation date were excluded, as were those without (1) anti-seizure medication (ASM) dispenses within 12 months of implantation date, and (2) continuous enrollment for the 24-month period before this date. Demographic and clinical characteristics were assessed over the two-year period before implantation, as were patterns of utilization and cost of healthcare services and pharmacotherapy. Care was assessed as all-cause or epilepsy-related, with the latter defined as all medical (inpatient and outpatient) care resulting in diagnoses of epilepsy and all ASM dispenses. RESULTS Eight hundred sixty patients met all selection criteria. Among these patients, comorbidities were common, including depression (27%), anxiety (30%), and learning disabilities (25%). Fifty-nine percent of patients had ≥1 all-cause hospitalizations; 57% had ≥1 epilepsy-related admissions. Patients averaged 8.6 epilepsy-related visits to physicians' offices, including 5.1 neurologist visits. Mean all-cause and epilepsy-related healthcare costs during the pre-implantation period were $123,500 and $91,995, respectively; corresponding median values were $74,567 and $53,029. Median monthly all-cause healthcare costs increased by 138% during the 24-month period (from $1,042 to $2,481 in the month prior to implantation); median epilepsy-related costs, by 290% (from $383 to $1,492). CONCLUSIONS The two-year period before neurostimulator implantation is a long and costly journey. Estimates likely minimize the burden experienced during this period, given that seizure frequency and severity-and corresponding impacts on quality of life-were unavailable in these data. Further research is needed to understand the clinical, economic, and psychological impact of the time between DRE onset and implantation among qualifying patients.
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Affiliation(s)
| | | | | | | | - Lu Zhang
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | | | - Sandi Lam
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Schulte F, Bitzer F, Gärtner FC, Bauer T, von Wrede R, Baumgartner T, Rácz A, Borger V, von Oertzen T, Vatter H, Essler M, Surges R, Rüber T. The diagnostic value of ictal SPECT-A retrospective, semiquantitative monocenter study. Epilepsia Open 2023; 8:183-192. [PMID: 36658093 PMCID: PMC9977750 DOI: 10.1002/epi4.12694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Ictal single photon emission computed tomography (SPECT) can be used as an advanced diagnostic modality to detect the seizure onset zone in the presurgical evaluation of people with epilepsy. In addition to visual assessment (VSA) of ictal and interictal SPECT images, postprocessing methods such as ictal-interictal SPECT analysis using SPM (ISAS) can visualize regional ictal blood flow differences. We aimed to evaluate and differentiate the diagnostic value of VSA and ISAS in the Bonn cohort. METHODS We included 161 people with epilepsy who underwent presurgical evaluation at the University Hospital Bonn between 2008 and 2020 and received ictal and interictal SPECT and ISAS. We retrospectively assigned SPECT findings to one of five categories according to their degree of concordance with the clinical focus hypothesis. RESULTS Seizure onset zones could be identified more likely on a sublobar concordance level by ISAS than by VSA (31% vs. 19% of cases; OR = 1.88; 95% Cl [1.04, 3.42]; P = 0.03). Both VSA and ISAS more often localized a temporal seizure onset zone than an extratemporal one. Neither VSA nor ISAS findings were predicted by the latency between seizure onset and tracer injection (P = 0.75). In people who underwent successful epilepsy surgery, VSA and ISAS indicated the correct resection site in 54% of individuals, while MRI and EEG showed the correct resection localization in 96% and 33% of individuals, respectively. It was more likely to become seizure-free after epilepsy surgery if ISAS or VSA had been successful. There was no MR-negative case with successful surgery, indicating that ictal SPECT is more useful for confirmation than for localization. SIGNIFICANCE The results of the most extensive clinical study of ictal SPECT to date allow an assessment of the diagnostic value of this elaborate examination and emphasize the importance of postprocessing routines.
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Affiliation(s)
- Freya Schulte
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Felix Bitzer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Tim von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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Reda AM, Elsharkawy A, Hasby SE. Usefulness of combined diffusion tensor imaging, arterial spin labelling and spectroscopic interictal analysis in refractory epilepsy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-00988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Abstract
Background
Epilepsy is a common neurological disorder especially in pediatric population. Patients with non-lesional epilepsy have normal conventional MRI findings. In the recent era of advances in neuroimaging studies, diffusion tensor imaging (DTI) and MR spectroscopy (MRS) can assess the tissue microstructure. Also, arterial spin labeling (ASL) is a noninvasive modality that evaluates cerebral blood flow. Multiple recent publications aimed at use of single or two new modalities in lateralization of epileptogenic focus in epilepsy, but the current study aimed to evaluate the added value of combined (DTI, ASL and MRS) in vivo localization of interactable epilepsy with negative conventional MRI findings.
Results
This prospective case control study was carried out in the period from January 1st, 2022 to October 1st, 2022 after approval of local ethical committee in our institution. Written informed consent was obtained from patients and healthy volunteers who were enrolled in this study. The current study included 46 patients with temporal lobe epilepsy and 20 age- and sex-matched healthy volunteers as a control group. The mean age in the patient group was 22.3 ± 12.2 years, and in the control group, it was 23.8 ± 15.1 years. The highest area under the curve (AUC) was for spectroscopy (0.913), the difference in NAA/Cr showed sensitivity of 94.1% and a specificity of 90%, while NAA/Cho + Cr showed a sensitivity of 91.8% and a specificity of 88%, the difference in rCBF showed an AUC of 0.89, with a cutoff value of 3.815 had a sensitivity of 80.4% and a specificity of 85%. As regards DTI, the changes in DTI parameters show sensitivity of 79.6% and a specificity of 80% in lateralization of the epileptic focus. The difference in FA only showed an AUC of 0.86, with a cutoff value of 0.01 had a sensitivity of 77% and a specificity of 75% and the difference in MD only showed an AUC of 0.771, with a cutoff value of 0.545 had a sensitivity of 67.4% and a specificity of 70%. The diagnostic performance of MRS in terms of the AUC was significantly higher than ASL parameters (difference in NAA/Cr, p = 0.033 and difference in NAA/Cho + Cr, p = 0.044), and MD (p = 0.02). No other statistically significant differences were shown between the studied parameters. When the three methods were combined, all patients’ epileptogenic foci were correctly localized and lateralized.
Conclusions
Combining ASL, DTI and H-MRS provided excellent diagnostic performance in localization and lateralization of the epileptogenic focus. If this combination is not applicable in clinical practice, ASL could provide a considerably accurate and feasible method in this context. The present study supported the value of the new noninvasive MRI techniques in the elaboration of hidden brain pathology.
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Evans K, Stamas N, Li Q, Vincent T, Halchenko Y, Zhang L, Danielson V, Murphy J, Barion F, Lam S, Lassagne R, Berger A. Impact of Vagus Nerve Stimulation for the Treatment of Drug-Resistant Epilepsy on Patterns of Use and Cost of Health Care Services and Pharmacotherapy: Comparisons of the 24-Month Periods Before and After Implantation. Clin Ther 2023; 45:136-150. [PMID: 36746736 DOI: 10.1016/j.clinthera.2023.01.007] [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: 11/16/2022] [Revised: 12/20/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE This study examines the impact of vagus nerve stimulation (VNS) as treatment for drug-resistant epilepsy (DRE) on the use and cost of health care services and pharmacotherapy. METHODS Using a large US health care claims database, we identified all patients with DRE who underwent VNS between January 1, 2012 and December 31, 2019. VNS implantation date was designated as the index date, and patients had to be continuously enrolled for the 24-month period before this date (preindex period). Outcomes included all-cause and epilepsy-related hospitalization, emergency department (ED) visits, and health care costs; health care claims resulting in an epilepsy diagnosis and all claims for antiseizure medications were deemed epilepsy related. Preindex data, except care related to preoperative medical clearance for VNS, were used to estimate multivariate regression models predicting outcomes during the 24-month postindex period (follow-up period). Predicted outcomes during follow-up were then compared with observed values. As a sensitivity analysis, we also replicated all analyses among subgroups defined by comorbid depression. FINDINGS A total of 659 patients underwent VNS for DRE and met the selection criteria. For the composite outcome of all-cause hospitalizations and ED visits, observed values were 42% lower than expected during the 24-month follow-up period; for the composite outcome of epilepsy-related hospitalizations and ED visits, observed values were 49% lower (P < 0.001 for both). Observed mean total all-cause costs, inclusive of costs of the procedure, were not significantly different than expected costs by month 19 of follow-up; mean total epilepsy-related costs were comparable by month 18. Findings were similar in subgroups with and without depression, although nominally greater differences (observed - expected) were seen in those with comorbid depression. IMPLICATIONS Our findings suggest that VNS is associated with decreased risk of hospitalization or ED visits (all cause and epilepsy related) during the 2-year period subsequent to implantation and may become cost-neutral within 2 years of implantation (vs continued medical management of DRE without VNS). Although expected outcomes were estimated based on the 24-month period before implantation, the degree to which they approximated what would have happened in the absence of VNS is unknowable. Further research is needed to better understand the extend and duration of the impact of VNS on seizure frequency and severity and health-related quality of life, including its performance among those with and without comorbid depression.
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Affiliation(s)
| | | | | | | | | | - Lu Zhang
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Sandi Lam
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Li J, Bai YC, Wu LH, Zhang P, Wei XC, Ma CH, Yan MN, Wang YT, Chen B. Synthetic relaxometry combined with MUSE DWI and 3D-pCASL improves detection of hippocampal sclerosis. Eur J Radiol 2022; 157:110571. [DOI: 10.1016/j.ejrad.2022.110571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/14/2022] [Accepted: 10/23/2022] [Indexed: 11/03/2022]
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Ghelichnia B, Balali P, Farahmand G, Shafiee Sabet M, Feizi S, Pourghaz B, Jameie M, Tafakhori A. Effects of Botulinum Toxin Injection on Reducing Myogenic Artifacts during Video-EEG Monitoring: A Longitudinal Study. Neurodiagn J 2022; 62:222-238. [PMID: 36585269 DOI: 10.1080/21646821.2022.2149996] [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: 01/01/2023]
Abstract
Medically refractory seizures affect one-third of patients with epilepsy (PwE), for whom epilepsy surgery is considered. Video electroencephalography (vEEG) monitoring is a fundamental tool for pre-operative seizure localization. Facial and cranial myogenic artifacts can obscure vEEG findings, thus interfering with seizure localization. Studies have shown the beneficial effects of botulinum toxin type A (BTX-A) injection into cranial muscles for reducing myogenic artifacts. This longitudinal study aimed to assess the effects of BTX-A injection on these artifacts. Twenty-two patients with medically refractory hypermotor seizures with daily seizure frequency and undetermined epilepsy localization were included in this study and underwent Dysport® injection (200 units) into the frontotemporal region. vEEG recordings were performed at baseline (one week before the injection), and at three days and six days post-injection. Before and after the injection, the amplitudes of myogenic artifacts were compared during various states (ictal, blinking, chewing, bruxism, head lateralization, scowling, talking, and yawning). BTX-A injection significantly reduced the amplitudes of EEG myogenic artifacts, except during blinking (day three) and talking (days three and six). On day six, significant reduction in EEG myogenic artifacts were noted during blinking, chewing, and bruxism for the greatest number of patients (95.5%, 90.9%, 81.8%), while significant reductions in EEG myogenic artifacts during talking, head lateralization, and ictal phase were associated with the least number of patients (22.7%, 36.3%, and 40.9%). Therefore, BTX-A injection could be a convenient method for filtering myogenic contamination, improving EEG interpretation, and facilitating seizure localization in patients with medically refractory seizures.
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Affiliation(s)
- Babak Ghelichnia
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pargol Balali
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Farahmand
- Neurology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Shafiee Sabet
- Ziaian Hospital, Department of Family Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Somaye Feizi
- Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Pourghaz
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Neuroscience Research Center Iran, University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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21
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Langenbruch L, Kellinghaus C. Epilepsy surgery in people with intellectual disability – English Version. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00527-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Cometa A, Falasconi A, Biasizzo M, Carpaneto J, Horn A, Mazzoni A, Micera S. Clinical neuroscience and neurotechnology: An amazing symbiosis. iScience 2022; 25:105124. [PMID: 36193050 PMCID: PMC9526189 DOI: 10.1016/j.isci.2022.105124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the last decades, clinical neuroscience found a novel ally in neurotechnologies, devices able to record and stimulate electrical activity in the nervous system. These technologies improved the ability to diagnose and treat neural disorders. Neurotechnologies are concurrently enabling a deeper understanding of healthy and pathological dynamics of the nervous system through stimulation and recordings during brain implants. On the other hand, clinical neurosciences are not only driving neuroengineering toward the most relevant clinical issues, but are also shaping the neurotechnologies thanks to clinical advancements. For instance, understanding the etiology of a disease informs the location of a therapeutic stimulation, but also the way stimulation patterns should be designed to be more effective/naturalistic. Here, we describe cases of fruitful integration such as Deep Brain Stimulation and cortical interfaces to highlight how this symbiosis between clinical neuroscience and neurotechnology is closer to a novel integrated framework than to a simple interdisciplinary interaction.
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Affiliation(s)
- Andrea Cometa
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Antonio Falasconi
- Friedrich Miescher Institute for Biomedical Research, 4058 Basel, Switzerland
- Biozentrum, University of Basel, 4056 Basel, Switzerland
| | - Marco Biasizzo
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Jacopo Carpaneto
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Andreas Horn
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Neurology, 10117 Berlin, Germany
| | - Alberto Mazzoni
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Silvestro Micera
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- Translational Neural Engineering Lab, School of Engineering, École Polytechnique Fèdèrale de Lausanne, 1015 Lausanne, Switzerland
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23
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Structural association between heterotopia and cortical lesions visualised with 7 T MRI in patients with focal epilepsy. Seizure 2022; 101:177-183. [DOI: 10.1016/j.seizure.2022.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/18/2022] [Accepted: 08/19/2022] [Indexed: 01/15/2023] Open
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Paulo DL, Ball TJ, Englot DJ. Emerging Technologies for Epilepsy Surgery. Neurol Clin 2022; 40:849-867. [DOI: 10.1016/j.ncl.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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25
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A simulation study to investigate the use of concentric tube robots for epilepsy surgery. Childs Nerv Syst 2022; 38:1349-1356. [PMID: 35084537 DOI: 10.1007/s00381-022-05449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Patients with pharmacoresistant refractory epilepsy may require epilepsy surgery to prevent future seizure occurrences. Conventional surgery consists of a large craniotomy with straight rigid tools with associated outcomes of morbidity, large tissue resections, and long post-operative recovery times. Concentric tube robots have recently been developed as a promising application to neurosurgery due to their nonlinear form and small diameter. The authors present a concept study to explore the feasibility of performing minimally invasive hemispherotomy with concentric tube robots. METHODS A model simulation was used to achieve the optimal design and surgical path planning parameters of the concentric tube robot for corpus callosotomy and temporal lobectomy. A single medial burr hole was chosen to access the lateral ventricles for both white matter disconnections. RESULTS The concentric tube robot was able to accurately reach the designated surgical paths on the corpus callosum and the temporal lobe. CONCLUSION In a model simulation, the authors demonstrated the feasibility of performing corpus callosotomy and temporal lobectomy using concentric tube robots. Further advancements in the technology may increase the applicability of this technique for epilepsy surgery to better patient outcomes.
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Multimodal Presurgical Evaluation of Medically Refractory Focal Epilepsy in Adults: An Update for Radiologists. AJR Am J Roentgenol 2022; 219:488-500. [PMID: 35441531 DOI: 10.2214/ajr.22.27588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surgery is a potentially curative treatment option for patients with medically refractory focal epilepsy. Advanced neuroimaging modalities often improve surgical outcomes by contributing key information during the highly individualized surgical planning process and intraoperative localization. Hence, neuroradiologists play an integral role as part of the multidisciplinary management team. In this review, we initially present the conceptual background and practical framework of the presurgical evaluation process, including a description of the surgical treatment approaches in medically refractory focal epilepsy in adults. This background is followed by an overview of the advanced modalities commonly used during the presurgical workup at level IV epilepsy centers including diffusion imaging techniques, blood oxygen level dependent (BOLD) functional MRI (fMRI), PET, SPECT, and subtraction ictal SPECT, as well as by introductions to 7-T MRI and electrophysiologic techniques including electroencephalography (EEG) and magnetoencephalography (MEG). We also provide illustrative case examples of multimodal neuroimaging including PET/MRI, PET/MRI-DTI, subtraction ictal SPECT, and image-guided stereotactic planning with fMRI-DTI.
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Wan HJ, Hu WH, Wang X, Zhang C, Wang SS, Zheng Z, Zhou F, Sang L, Zhang K, Zhang JG, Shao XQ. Interictal pattern on scalp electroencephalogram predicts excellent surgical outcome of epilepsy caused by focal cortical dysplasia. Epilepsia Open 2022; 7:350-360. [PMID: 35202517 PMCID: PMC9159252 DOI: 10.1002/epi4.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/25/2021] [Accepted: 02/18/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) represents an essential cause of drug-resistant epilepsy with surgery as an effective treatment option. This study aimed to identify the important predictors of favorable surgical outcomes and the impact of the interictal scalp electroencephalogram (EEG) patterns in predicting postsurgical seizure outcomes. METHODS We retrospectively evaluated 210 consecutive patients between 2015 and 2019. They were diagnosed with FCD by pathology, underwent resection, and had at least one year of postsurgical follow-up. Predictors of seizure freedom were analyzed. RESULTS Based on the information at the latest follow-up, seizure outcome was classified as Engel Class I (seizure-free) in 81.4% and Engel Class II-IV (non-seizure-free) in 18.6% of patients. There were 43, 105, and 62 cases of FCD type I, type II, and type III, respectively. The interictal EEG showed a repetitive discharge pattern (REDP) in 87 (41.4%) patients, polyspike discharge pattern (PDP) in 41 (19.5%), and the coexistence of REDP and PDP in the same location in 32 (15.2%) patients. The analyzed patterns in order of frequency were repetitive discharges lasting 5 seconds or more (32.4%); polyspikes (16.7%); RED type 1 (11.4%); continuous epileptiform discharges occupying >80% of the recording (11.4%); RED type 2 (6.2%); brushes (3.3%); focal, fast, continuous spikes (2.4%); focal fast rhythmic epileptiform discharges (1.43%); and frequent rhythmic bursting epileptiform activity (1.4%). The coexistence of REDP and PDP in the same location on scalp EEG and complete resection of the assumed epileptogenic zone (EZ) was independently associated with favorable postsurgical prognosis. SIGNIFICANCE Resective epilepsy surgery for intractable epilepsy caused by FCD has favorable outcomes. Interictal scalp EEG patterns were revealed to be predictive of excellent surgical outcomes and may help clinical decision-making and enable better presurgical evaluation.
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Affiliation(s)
- Hui-Juan Wan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Wen-Han Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Sheng-Song Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Feng Zhou
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
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van Lanen RHGJ, Wiggins CJ, Colon AJ, Backes WH, Jansen JFA, Uher D, Drenthen GS, Roebroeck A, Ivanov D, Poser BA, Hoeberigs MC, van Kuijk SMJ, Hoogland G, Rijkers K, Wagner GL, Beckervordersandforth J, Delev D, Clusmann H, Wolking S, Klinkenberg S, Rouhl RPW, Hofman PAM, Schijns OEMG. Value of ultra-high field MRI in patients with suspected focal epilepsy and negative 3 T MRI (EpiUltraStudy): protocol for a prospective, longitudinal therapeutic study. Neuroradiology 2022; 64:753-764. [PMID: 34984522 PMCID: PMC8907090 DOI: 10.1007/s00234-021-02884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/09/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE Resective epilepsy surgery is a well-established, evidence-based treatment option in patients with drug-resistant focal epilepsy. A major predictive factor of good surgical outcome is visualization and delineation of a potential epileptogenic lesion by MRI. However, frequently, these lesions are subtle and may escape detection by conventional MRI (≤ 3 T). METHODS We present the EpiUltraStudy protocol to address the hypothesis that application of ultra-high field (UHF) MRI increases the rate of detection of structural lesions and functional brain aberrances in patients with drug-resistant focal epilepsy who are candidates for resective epilepsy surgery. Additionally, therapeutic gain will be addressed, testing whether increased lesion detection and tailored resections result in higher rates of seizure freedom 1 year after epilepsy surgery. Sixty patients enroll the study according to the following inclusion criteria: aged ≥ 12 years, diagnosed with drug-resistant focal epilepsy with a suspected epileptogenic focus, negative conventional 3 T MRI during pre-surgical work-up. RESULTS All patients will be evaluated by 7 T MRI; ten patients will undergo an additional 9.4 T MRI exam. Images will be evaluated independently by two neuroradiologists and a neurologist or neurosurgeon. Clinical and UHF MRI will be discussed in the multidisciplinary epilepsy surgery conference. Demographic and epilepsy characteristics, along with postoperative seizure outcome and histopathological evaluation, will be recorded. CONCLUSION This protocol was reviewed and approved by the local Institutional Review Board and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER www.trialregister.nl : NTR7536.
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Affiliation(s)
- R H G J van Lanen
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands. .,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
| | - C J Wiggins
- Scannexus, Ultra-High Field MRI Research Center, Maastricht, the Netherlands
| | - A J Colon
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - W H Backes
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - D Uher
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - G S Drenthen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - D Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - B A Poser
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - M C Hoeberigs
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - G Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - K Rijkers
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - G L Wagner
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | | | - D Delev
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - H Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - S Wolking
- Department of Epileptology and Neurology, RWTH Aachen University Hospital, Aachen, Germany
| | - S Klinkenberg
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - R P W Rouhl
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P A M Hofman
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - O E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
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Polyanskaya M, Demushkina A, Kostylev F, Vasilyev I, Kholin A, Zavadenko N, Alikhanov A. The presurgical evaluation of patients with drug-resistant epilepsy. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:12-20. [DOI: 10.17116/jnevro202212208112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Zhang J, Zhang H, Li Y, Yuan M, Zhang J, Luo H, Yao Z, Gan J. Arterial spin labeling for presurgical localization of refractory frontal lobe epilepsy in children. Eur J Med Res 2021; 26:88. [PMID: 34362444 PMCID: PMC8349087 DOI: 10.1186/s40001-021-00564-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023] Open
Abstract
Background Epilepsy is one of the most common chronic neurological diseases. Despite the great variety and prevalence of antiepileptic drug treatments, one-third of epilepsies remain drug resistant. The frontal lobe is extensive, and frontal lobe seizures are difficult to locate, which increases the difficulty of the preoperative localization of the epileptogenic zone. Case presentation Two previously healthy girls with refractory frontal lobe epilepsy showed significant perfusion abnormalities in the right frontal lobe using the cerebral blood perfusion (CBF) quantitative analysis system. They became seizure-free after lesionectomy of the frontal lobe by ASL combined with electroencephalography (EEG) rapid localization. The histopathological diagnosis was focal cortical dysplasia (FCD) type IIa and IIb. Conclusions The positive outcome suggests that the combined use of ASL with EEG could be a beneficial option for the presurgical evaluation of pediatric epilepsy. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-021-00564-0.
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Affiliation(s)
- Jia Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Heng Zhang
- Department of neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yang Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Meng Yuan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jinxiu Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Huan Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | | | - Jing Gan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China. .,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China.
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Garcia-Cairasco N, Podolsky-Gondim G, Tejada J. Searching for a paradigm shift in the research on the epilepsies and associated neuropsychiatric comorbidities. From ancient historical knowledge to the challenge of contemporary systems complexity and emergent functions. Epilepsy Behav 2021; 121:107930. [PMID: 33836959 DOI: 10.1016/j.yebeh.2021.107930] [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: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
In this review, we will discuss in four scenarios our challenges to offer possible solutions for the puzzle associated with the epilepsies and neuropsychiatric comorbidities. We need to recognize that (1) since quite old times, human wisdom was linked to the plural (distinct global places/cultures) perception of the Universe we are in, with deep respect for earth and nature. Plural ancestral knowledge was added with the scientific methods; however, their joint efforts are the ideal scenario; (2) human behavior is not different than animal behavior, in essence the product of Darwinian natural selection; knowledge of animal and human behavior are complementary; (3) the expression of human behavior follows the same rules that complex systems with emergent properties, therefore, we can measure events in human, clinical, neurobiological situations with complexity systems' tools; (4) we can use the semiology of epilepsies and comorbidities, their neural substrates, and potential treatments (including experimental/computational modeling, neurosurgical interventions), as a source and collection of integrated big data to predict with them (e.g.: machine/deep learning) diagnosis/prognosis, individualized solutions (precision medicine), basic underlying mechanisms and molecular targets. Once the group of symptoms/signals (with a myriad of changing definitions and interpretations over time) and their specific sequences are determined, in epileptology research and clinical settings, the use of modern and contemporary techniques such as neuroanatomical maps, surface electroencephalogram and stereoelectroencephalography (SEEG) and imaging (MRI, BOLD, DTI, SPECT/PET), neuropsychological testing, among others, are auxiliary in the determination of the best electroclinical hypothesis, and help design a specific treatment, usually as the first attempt, with available pharmacological resources. On top of ancient knowledge, currently known and potentially new antiepileptic drugs, alternative treatments and mechanisms are usually produced as a consequence of the hard, multidisciplinary, and integrated studies of clinicians, surgeons, and basic scientists, all over the world. The existence of pharmacoresistant patients, calls for search of other solutions, being along the decades the surgeries the most common interventions, such as resective procedures (i.e., selective or standard lobectomy, lesionectomy), callosotomy, hemispherectomy and hemispherotomy, added by vagus nerve stimulation (VNS), deep brain stimulation (DBS), neuromodulation, and more recently focal minimal or noninvasive ablation. What is critical when we consider the pharmacoresistance aspect with the potential solution through surgery, is still the pursuit of localization-dependent regions (e.g.: epileptogenic zone (EZ)), in order to decide, no matter how sophisticated are the brain mapping tools (EEG and MRI), the size and location of the tissue to be removed. Mimicking the semiology and studying potential neural mechanisms and molecular targets - by means of experimental and computational modeling - are fundamental steps of the whole process. Concluding, with the conjunction of ancient knowledge, coupled to critical and creative contemporary, scientific (not dogmatic) clinical/surgical, and experimental/computational contributions, a better world and of improved quality of life can be offered to the people with epilepsy and neuropsychiatric comorbidities, who are still waiting (as well as the scientists) for a paradigm shift in epileptology, both in the Basic Science, Computational, Clinical, and Neurosurgical Arenas. This article is part of the Special Issue "NEWroscience 2018".
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Affiliation(s)
- Norberto Garcia-Cairasco
- Laboratório de Neurofisiologia e Neuroetologia Experimental, Departmento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. Brazil; Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Guilherme Podolsky-Gondim
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Julian Tejada
- Departamento de Psicologia, Universidade Federal de Sergipe, Brazil.
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32
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MRI and CT Fusion in Stereotactic Electroencephalography: A Literature Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11125524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epilepsy is a common neurological disease characterized by spontaneous recurrent seizures. Resection of the epileptogenic tissue may be needed in approximately 25% of all cases due to ineffective treatment with anti-epileptic drugs. The surgical intervention depends on the correct detection of epileptogenic zones. The detection relies on invasive diagnostic techniques such as Stereotactic Electroencephalography (SEEG), which uses multi-modal fusion to aid localizing electrodes, using pre-surgical magnetic resonance and intra-surgical computer tomography as the input images. Moreover, it is essential to know how to measure the performance of fusion methods in the presence of external objects, such as electrodes. In this paper, a literature review is presented, applying the methodology proposed by Kitchenham to determine the main techniques of multi-modal brain image fusion, the most relevant performance metrics, and the main fusion tools. The search was conducted using the databases and search engines of Scopus, IEEE, PubMed, Springer, and Google Scholar, resulting in 15 primary source articles. The literature review found that rigid registration was the most used technique when electrode localization in SEEG is required, which was the proposed method in nine of the found articles. However, there is a lack of standard validation metrics, which makes the performance measurement difficult when external objects are presented, caused primarily by the absence of a gold-standard dataset for comparison.
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33
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Rigney G, Lennon M, Holderrieth P. The use of computational models in the management and prognosis of refractory epilepsy: A critical evaluation. Seizure 2021; 91:132-140. [PMID: 34153898 DOI: 10.1016/j.seizure.2021.06.006] [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: 03/20/2021] [Revised: 05/05/2021] [Accepted: 06/06/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Drug resistant epilepsy (DRE) affects approximately 30 percent of individuals with epilepsy worldwide. Surgery remains the most effective treatment for individuals with DRE, but referral to surgery is low and only about 60 percent of individuals who undergo surgery experience seizure control postoperatively. The present paper evaluates the evidence for using computational models in the prediction of surgical resection sites and surgical outcomes for patients with DRE. METHODS We conducted a search in the Medline data base using the terms "refractory epilepsy", "drug-resistant epilepsy", "surgery", "computational model", and "artificial intelligence". Inclusion: original articles in English and case reports from 2000 to 2020. Reviews were excluded. RESULTS Clinical applications of computational models may lead to increased utilisation of surgical services through improving our ability to predict outcomes and by improving surgical outcomes outright. The identification and optimisation of nodes that are crucial for the genesis and propagation of epileptiform activity offers the most promising clinical applications of computational models discussed herein. CONCLUSION Advances in computational models may in the future significantly increase the application and efficacy of surgery for patients with DRE by optimising the site and amount of cortex to resect, but more research is needed before it achieves therapeutic utility.
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Affiliation(s)
- Grant Rigney
- The University of Oxford Department of Psychiatry, Warneford Hospital, Warneford Ln, Headington, Oxford OX3 7JX, United Kingdom.
| | - Matthew Lennon
- Department of Physiology, Anatomy and Genetics, Sherrington Building, University of Oxford, United Kingdom; Faculty of Medicine, University of New South Wales, NSW, Australia.
| | - Peter Holderrieth
- Department of Physiology, Anatomy and Genetics, Sherrington Building, University of Oxford, United Kingdom.
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Quintiliani M, Bianchi F, Fuggetta F, Chieffo DPR, Ramaglia A, Battaglia DI, Tamburrini G. Role of high-density EEG (hdEEG) in pre-surgical epilepsy evaluation in children: case report and review of the literature. Childs Nerv Syst 2021; 37:1429-1437. [PMID: 33604716 PMCID: PMC8084826 DOI: 10.1007/s00381-021-05069-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Electrical source imaging (ESI) and especially hdEEG represent a noninvasive, low cost and accurate method of localizing epileptic zone (EZ). Such capability can greatly increase seizure freedom rate in surgically treated drug resistant epilepsy cases. Furthermore, ESI might be important in intracranial record planning. CASE REPORT We report the case of a 15 years old boy suffering from drug resistant epilepsy with a previous history of DNET removal. The patient suffered from heterogeneous seizure semiology characterized by anesthesia and loss of tone in the left arm, twisting of the jaw to the left and dysarthria accompanied by daze; lightheadedness sometimes associated with headache and dizziness and at a relatively short time distance negative myoclonus involving the left hand. Clinical evidence poorly match scalp and video EEG monitoring thus requiring hdEEG recording followed by SEEG to define surgical target. Surgery was also guided by ECoG and obtained seizure freedom. DISCUSSION ESI offers an excellent estimate of EZ, being hdEEG and intracranial recordings especially important in defining it. We analyzed our results together with the data from the literature showing how in children hdEEG might be even more crucial than in adults due to the heterogeneity in seizures phenomenology. The complexity of each case and the technical difficulties in dealing with children, stress even more the importance of a noninvasive tool for diagnosis. In fact, hdEEG not only guided in the presented case SEEG planning but may also in the future offer the possibility to replace it.
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Affiliation(s)
- Michela Quintiliani
- Infantile Neuropsychiatry, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Federico Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.
| | - Filomena Fuggetta
- Infantile Neuropsychiatry, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | | | - Antonia Ramaglia
- Institute of Radiology, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Domenica Immacolata Battaglia
- Infantile Neuropsychiatry, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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De Vito A, Mankad K, Pujar S, Chari A, Ippolito D, D’Arco F. Narrative review of epilepsy: getting the most out of your neuroimaging. Transl Pediatr 2021; 10:1078-1099. [PMID: 34012857 PMCID: PMC8107872 DOI: 10.21037/tp-20-261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Neuroimaging represents an important step in the evaluation of pediatric epilepsy. The crucial role of brain imaging in the diagnosis, follow-up and presurgical assessment of patients with epilepsy is noted and has to be familiar to all neuroradiologists and trainees approaching pediatric brain imaging. Morphological qualitative imaging shows the majority of cerebral lesions/alterations underlying focal epilepsy and can highlight some features which are useful in the differential diagnosis of the different types of epilepsy. Recent advances in MRI acquisitions including diffusion-weighted imaging (DWI), post-acquisition image processing techniques, and quantification of imaging data are increasing the accuracy of lesion detection during the last decades. Functional MRI (fMRI) can be really useful and helps to identify cortical eloquent areas that are essential for language, motor function, and memory, and diffusion tensor imaging (DTI) can reveal white matter tracts that are vital for these functions, thus reducing the risk of epilepsy surgery causing new morbidities. Also positron emission tomography (PET), single photon emission computed tomography (SPECT), simultaneous electroencephalogram (EEG) and fMRI, and electrical and magnetic source imaging can be used to assess the exact localization of epileptic foci and help in the design of intracranial EEG recording strategies. The main role of these "hybrid" techniques is to obtain quantitative and qualitative informations, a necessary step to evaluate and demonstrate the complex relationship between abnormal structural and functional data and to manage a "patient-tailored" surgical approach in epileptic patients.
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Affiliation(s)
- Andrea De Vito
- Department of Neuroradiology, H. S. Gerardo Monza, Monza, Italy
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Suresh Pujar
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | | | - Felice D’Arco
- Department of Radiology, Great Ormond Street Hospital, London, UK
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Koren J, Hafner S, Feigl M, Baumgartner C. Systematic analysis and comparison of commercial seizure-detection software. Epilepsia 2021; 62:426-438. [PMID: 33464580 DOI: 10.1111/epi.16812] [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: 10/06/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine if three different commercially available seizure-detection software packages (Besa 2.0, Encevis 1.7, and Persyst 13) accurately detect seizures with high sensitivity, high specificity, and short detection delay in epilepsy patients undergoing long-term video-electroencephalography (EEG) monitoring (VEM). METHODS Comparison of sensitivity (detection rate), specificity (false alarm rate), and detection delay of three commercially available seizure-detection software packages in 81 randomly selected patients with epilepsy undergoing long-term VEM. RESULTS Detection rates on a per-patient basis were not significantly different between Besa (mean 67.6%, range 0-100%), Encevis (77.8%, 0-100%) and Persyst (81%, 0-100%; P = .059). False alarm rate (per hour) was significantly different between Besa (mean 0.7/h, range 0.01-6.2/h), Encevis (0.2/h, 0.01-0.5/h), and Persyst (0.9/h, 0.04-6.5/h; P < .001). Detection delay was significantly different between Besa (mean 30 s, range 0-431 s), Encevis (25 s, 2-163 s), and Persyst (20 s, 0-167 s; P = .007). Kappa statistics showed moderate to substantial agreement between the reference standard and each seizure-detection software (Besa: 0.47, 95% confidence interval [CI] 0.36-0.59; Encevis: 0.59, 95% CI 0.47-0.7; Persyst: 0.63, 95% CI 0.51-0.74). SIGNIFICANCE Three commercially available seizure-detection software packages showed similar, reasonable sensitivities on the same data set, but differed in false alarm rates and detection delay. Persyst 13 showed the highest detection rate and false alarm rate with the shortest detection delay, whereas Encevis 1.7 had a slightly lower sensitivity, the lowest false alarm rate, and longer detection delay.
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Affiliation(s)
- Johannes Koren
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Department of Neurology, Clinic Hietzing, Vienna, Austria
| | | | - Moritz Feigl
- Department of Medicine I, Institute of Cancer Research, Medical University of Vienna, Austria.,Institute for Hydrology and Water Management, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Christoph Baumgartner
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Department of Neurology, Clinic Hietzing, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
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Bernardo P, Santoro C, Rubino A, Mirone G, Cinalli G. Epilepsy surgery in neurofibromatosis type 1: an overlooked therapeutic approach. Childs Nerv Syst 2020; 36:2909-2910. [PMID: 32734402 DOI: 10.1007/s00381-020-04841-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Pia Bernardo
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy.
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
| | - Claudia Santoro
- Referral Centre of Neurofibromatosis, Department of Woman and Child, Specialistic and General Surgery and Clinic of Child and Adolescent Neuropsychiatry, "Luigi Vanvitelli" University of Campania, Via Luigi de Crecchio, 2, 80138, Naples, Italy
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, "Luigi Vanvitelli" University of Campania, Via Luigi de Crecchio, 2, 80138, Naples, Italy
| | - Alfonso Rubino
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy
| | - Giuseppe Mirone
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy
| | - Giuseppe Cinalli
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy
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Nicotinic Receptors in Sleep-Related Hypermotor Epilepsy: Pathophysiology and Pharmacology. Brain Sci 2020; 10:brainsci10120907. [PMID: 33255633 PMCID: PMC7761363 DOI: 10.3390/brainsci10120907] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/12/2022] Open
Abstract
Sleep-related hypermotor epilepsy (SHE) is characterized by hyperkinetic focal seizures, mainly arising in the neocortex during non-rapid eye movements (NREM) sleep. The familial form is autosomal dominant SHE (ADSHE), which can be caused by mutations in genes encoding subunits of the neuronal nicotinic acetylcholine receptor (nAChR), Na+-gated K+ channels, as well as non-channel signaling proteins, such as components of the gap activity toward rags 1 (GATOR1) macromolecular complex. The causative genes may have different roles in developing and mature brains. Under this respect, nicotinic receptors are paradigmatic, as different pathophysiological roles are exerted by distinct nAChR subunits in adult and developing brains. The widest evidence concerns α4 and β2 subunits. These participate in heteromeric nAChRs that are major modulators of excitability in mature neocortical circuits as well as regulate postnatal synaptogenesis. However, growing evidence implicates mutant α2 subunits in ADSHE, which poses interpretive difficulties as very little is known about the function of α2-containing (α2*) nAChRs in the human brain. Planning rational therapy must consider that pharmacological treatment could have different effects on synaptic maturation and adult excitability. We discuss recent attempts towards precision medicine in the mature brain and possible approaches to target developmental stages. These issues have general relevance in epilepsy treatment, as the pathogenesis of genetic epilepsies is increasingly recognized to involve developmental alterations.
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Cárdenas-Rodríguez N, Carmona-Aparicio L, Pérez-Lozano DL, Ortega-Cuellar D, Gómez-Manzo S, Ignacio-Mejía I. Genetic variations associated with pharmacoresistant epilepsy (Review). Mol Med Rep 2020; 21:1685-1701. [PMID: 32319641 PMCID: PMC7057824 DOI: 10.3892/mmr.2020.10999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
Epilepsy is a common, serious neurological disorder worldwide. Although this disease can be successfully treated in most cases, not all patients respond favorably to medical treatments, which can lead to pharmacoresistant epilepsy. Drug-resistant epilepsy can be caused by a number of mechanisms that may involve environmental and genetic factors, as well as disease- and drug-related factors. In recent years, numerous studies have demonstrated that genetic variation is involved in the drug resistance of epilepsy, especially genetic variations found in drug resistance-related genes, including the voltage-dependent sodium and potassium channels genes, and the metabolizer of endogenous and xenobiotic substances genes. The present review aimed to highlight the genetic variants that are involved in the regulation of drug resistance in epilepsy; a comprehensive understanding of the role of genetic variation in drug resistance will help us develop improved strategies to regulate drug resistance efficiently and determine the pathophysiological processes that underlie this common human neurological disease.
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Affiliation(s)
- Noemí Cárdenas-Rodríguez
- Laboratory of Neuroscience, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Liliana Carmona-Aparicio
- Laboratory of Neuroscience, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Diana L Pérez-Lozano
- Laboratory of Neuroscience, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Daniel Ortega-Cuellar
- Laboratory of Experimental Nutrition, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Saúl Gómez-Manzo
- Laboratory of Genetic Biochemistry, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Iván Ignacio-Mejía
- Laboratory of Translational Medicine, Military School of Health Graduates, Lomas de Sotelo, Militar, Mexico City 11200, Mexico
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