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De Knegt VE, Børresen ML, Knudsen M, Thomsen KM, Uldall PV, Jakobsen AV, Hoei-Hansen CE. Current state of hemispherectomy and callosotomy for pediatric refractory epilepsy in Denmark. Brain Dev 2024; 46:142-148. [PMID: 38044196 DOI: 10.1016/j.braindev.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To evaluate outcomes from hemispherectomy and callosotomy related to the need for anti-seizure medication (ASM), seizure frequency, and cognition. METHODS A review of the medical charts of all Danish pediatric patients who underwent hemispherectomy or callosotomy from January 1996 to December 2019 for preoperative and postoperative ASM use, seizure frequency, and cognitive data. RESULTS The median age of epilepsy onset was two years (interquartile range (IQR): 0.0-5.3) for the hemispherectomy patients (n = 16) and one year (IQR: 0.6-1.7) for callosotomy patients (n = 5). Median time from onset to final surgery was 3.4 years for hemispherectomy and 10.2 years for callosotomy, while the median follow-up time was 6.9 years and 9.0 years, respectively. Preoperatively, all patients had daily seizures and were treated with ≥ 2 ASM. Hemispherectomy resulted in a reduction in seizure frequency in 87.5 % of patients, with 78.6 % achieving seizure freedom. Furthermore, 81.3 % experienced a reduction in ASM use and 56.3 % stopped all ASM. Median IQ/developmental quotient (IQ/DQ) was low preoperatively (44.0 [IQR: 40.0-55.0]) and remained unchanged postoperatively (IQ change: 0.0 [IQR: -10.0-+4.0]). Callosotomy resulted in a seizure reduction of 86-99 % in four patients, and ASM could be reduced in three patients. Median IQ/DQ was 20.0 preoperatively (IQR: 20.0-30.0) and remained unchanged postoperatively (IQ change: 0.0 [IQR: 0.0]). CONCLUSION Hemispherectomy and callosotomy result in a substantial reduction in seizure frequency and ASM use without deterioration of IQ. Extensive epilepsy surgery should be considered early in children with drug-resistant epilepsy.
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Affiliation(s)
| | - Malene Landbo Børresen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marianne Knudsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Katrine Moe Thomsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Vilhelm Uldall
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Neuropaediatrics, The Danish Epilepsy Center Filadelfia, Dianalund, Denmark
| | - Anne Vagner Jakobsen
- Department of Neuropaediatrics, The Danish Epilepsy Center Filadelfia, Dianalund, Denmark
| | - Christina Engel Hoei-Hansen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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2
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [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: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
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Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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3
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Matarrese MAG, Loppini A, Fabbri L, Tamilia E, Perry MS, Madsen JR, Bolton J, Stone SSD, Pearl PL, Filippi S, Papadelis C. Spike propagation mapping reveals effective connectivity and predicts surgical outcome in epilepsy. Brain 2023; 146:3898-3912. [PMID: 37018068 PMCID: PMC10473571 DOI: 10.1093/brain/awad118] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 04/06/2023] Open
Abstract
Neurosurgical intervention is the best available treatment for selected patients with drug resistant epilepsy. For these patients, surgical planning requires biomarkers that delineate the epileptogenic zone, the brain area that is indispensable for the generation of seizures. Interictal spikes recorded with electrophysiological techniques are considered key biomarkers of epilepsy. Yet, they lack specificity, mostly because they propagate across brain areas forming networks. Understanding the relationship between interictal spike propagation and functional connections among the involved brain areas may help develop novel biomarkers that can delineate the epileptogenic zone with high precision. Here, we reveal the relationship between spike propagation and effective connectivity among onset and areas of spread and assess the prognostic value of resecting these areas. We analysed intracranial EEG data from 43 children with drug resistant epilepsy who underwent invasive monitoring for neurosurgical planning. Using electric source imaging, we mapped spike propagation in the source domain and identified three zones: onset, early-spread and late-spread. For each zone, we calculated the overlap and distance from surgical resection. We then estimated a virtual sensor for each zone and the direction of information flow among them via Granger causality. Finally, we compared the prognostic value of resecting these zones, the clinically-defined seizure onset zone and the spike onset on intracranial EEG channels by estimating their overlap with resection. We observed a spike propagation in source space for 37 patients with a median duration of 95 ms (interquartile range: 34-206), a spatial displacement of 14 cm (7.5-22 cm) and a velocity of 0.5 m/s (0.3-0.8 m/s). In patients with good surgical outcome (25 patients, Engel I), the onset had higher overlap with resection [96% (40-100%)] than early-spread [86% (34-100%), P = 0.01] and late-spread [59% (12-100%), P = 0.002], and it was also closer to resection than late-spread [5 mm versus 9 mm, P = 0.007]. We found an information flow from onset to early-spread in 66% of patients with good outcomes, and from early-spread to onset in 50% of patients with poor outcome. Finally, resection of spike onset, but not area of spike spread or the seizure onset zone, predicted outcome with positive predictive value of 79% and negative predictive value of 56% (P = 0.04). Spatiotemporal mapping of spike propagation reveals information flow from onset to areas of spread in epilepsy brain. Surgical resection of the spike onset disrupts the epileptogenic network and may render patients with drug resistant epilepsy seizure-free without having to wait for a seizure to occur during intracranial monitoring.
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Affiliation(s)
- Margherita A G Matarrese
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX, USA
| | - Alessandro Loppini
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Lorenzo Fabbri
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX, USA
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Bolton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Scellig S D Stone
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Simonetta Filippi
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Christos Papadelis
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX, USA
- School of Medicine, Texas Christian University, Fort Worth, TX, USA
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4
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Katlowitz KA, Athukuri P, Sharma H, Dang H, Soni A, Khan AB, Malbari F, Gadgil N, Weiner HL. Seizure outcomes after resection of primary brain tumors in pediatric patients: a systematic review and meta-analysis. J Neurooncol 2023; 164:525-533. [PMID: 37707753 DOI: 10.1007/s11060-023-04446-9] [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: 08/09/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Primary brain neoplasms are the most common solid tumors in pediatric patients and seizures are a common presenting symptom. Surgical intervention improves oncologic outcomes and seizure burden. A better understanding of factors that influence seizure outcomes in the surgical management of primary brain tumors of childhood can guide treatment approach thereby improving patient quality of life. METHODS We performed a systematic analysis using articles queried from PubMed, EMBASE, and Cochrane published from January 1990 to August 2022 to determine predictors of seizure outcomes in pediatric patients undergoing resection of primary brain tumors. RESULTS We identified 24 retrospective cohort studies, one prospective cohort study, and one mixed retrospective and prospective study for the systematic analysis. A total of 831 pediatric patients were available for analysis. 668 (80.4%) patients achieved seizure freedom after surgery. Complete tumor resection increased the likelihood of a seizure-free (Engel I) outcome compared to subtotal resection (OR 7.1, 95% CI 2.3-21.9). Rates of Engel I seizure outcomes did not significantly differ based on factors such as age at seizure onset, duration of epilepsy, gender, tumor laterality, or age at surgery, but trended towards significance for improved outcomes in temporal lobe tumors. CONCLUSION Primary brain tumors in the pediatric population are commonly associated with seizures. Resection of these lesions reduces seizure burden and is associated with high rates of seizure freedom. Complete resection, compared to subtotal resection, significantly increases the likelihood of seizure-free outcomes.
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Affiliation(s)
- Kalman A Katlowitz
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Prazwal Athukuri
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Huy Dang
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Astitva Soni
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - A Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Fatema Malbari
- Department of Pediatrics, Division of Child Neurology and Neurodevelopmental Disabilities, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Nisha Gadgil
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Koutsouras GW, Hall WA. Surgery for pediatric drug resistant epilepsy: a narrative review of its history, surgical implications, and treatment strategies. Transl Pediatr 2023; 12:245-259. [PMID: 36891373 PMCID: PMC9986775 DOI: 10.21037/tp-22-200] [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: 05/03/2022] [Accepted: 05/26/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Drug-resistant epilepsy (DRE), also known as medically refractory epilepsy, is a disorder of high prevalence and negatively impacts a patients quality of life, neurodevelopment, and life expectancy. Pediatric epilepsy surgery has been conducted since the late 1800s, and randomized controlled trials have demonstrated the marked effectiveness of surgery on seizure reduction and the potential for cure. Despite the strong evidence for pediatric epilepsy surgery, there is also strong evidence describing its underutilization. The objective of this narrative review is to describe the history, strength, and limitations in the evidence of surgery for pediatric drug resistant epilepsy. METHODS This narrative review was conducted utilizing standard search engines to include the relevant articles on the topic of surgery for drug resistant epilepsy in children, with main keywords including surgery in pediatric epilepsy and drug-refractory epilepsy. KEY CONTENT AND FINDINGS The first components describe the historical perspective of pediatric epilepsy surgery and the evidence that highlight the strengths and limitations of epilepsy surgery. We then highlight the importance of presurgical referral and evaluation, followed by a section detailing the surgical options for children with DRE. Lastly, we provide a perspective on the future of pediatric epilepsy surgery. CONCLUSIONS Evidence supports the role for surgery in pediatric medically refractory epilepsy in seizure frequency reduction, improved curative rates, and improvements in neurodevelopment and quality of life.
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Affiliation(s)
- George W Koutsouras
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Walter A Hall
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
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6
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Hartnett SM, Greiner HM, Arya R, Tenney JR, Aungaroon G, Holland K, Leach JL, Air EL, Skoch J, Mangano FT. Responsive neurostimulation device therapy in pediatric patients with complex medically refractory epilepsy. J Neurosurg Pediatr 2022; 30:499-506. [PMID: 36029267 DOI: 10.3171/2022.7.peds2281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pediatric epilepsy is characterized as drug resistant in 20%-30% of patients and defined as persistent seizures despite adequate treatment with two first-line antiepileptic medications. The American Academy of Neurology advocates surgical options earlier in the treatment of epilepsy to provide long-term seizure reduction. The new development of minimally invasive approaches has recently allowed for surgical options to patients not previously deemed surgical candidates. These may include patients with bilateral, deep, eloquent, or poorly localizing epileptogenic foci. To this end, responsive neurostimulation (RNS) is an FDA-approved closed-loop neuromodulation device for adjuvant treatment of adults with medically intractable epilepsy arising from one or multiple foci. METHODS In this study, the authors describe their initial institutional experience with the use of RNS in pediatric patients with drug-resistant epilepsy. An IRB-approved retrospective review was conducted of 8 pediatric patients who underwent RNS implantation at Cincinnati Children's Hospital Medical Center between 2019 and 2021. RESULTS Eight patients met the inclusion criteria for the study. The average age at the time of surgery was 14.7 years (range 8-18 years) with a mean follow-up of 16.5 months. All patients underwent invasive monitoring with stereo-EEG, subdural grid placement, or a combination of both. All patients had either bilateral or eloquent cortex targets. Trajectories were based on noninvasive (phase 1) and invasive (phase 2) seizure onset zone localization data. Four (50%) of the 8 patients underwent surgical intervention for epilepsy prior to RNS placement. RNS electrodes were placed with robot-assisted guidance in a hybrid operating room with intraoperative CT and electrocorticography. The authors demonstrated individualized RNS electrode trajectory and placement with targets in the amygdala/hippocampus, bilateral insula, bilateral parietal and occipital targets, and frontoparietal regions for a total of 14 implanted electrodes. One adverse event occurred, a wound infection requiring return to the operating room for removal of the RNS implant. All patients demonstrated a reduction in seizure frequency. All patients achieved > 50% reduction in seizure frequency at last follow-up. CONCLUSIONS RNS implantation in carefully selected pediatric patients appears safe and efficacious in reducing seizure burden with a low rate of operative complications.
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Affiliation(s)
- Sara M Hartnett
- 1Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hansel M Greiner
- 2Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- 3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ravindra Arya
- 2Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- 3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey R Tenney
- 2Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- 3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gewalin Aungaroon
- 2Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- 3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Katherine Holland
- 2Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- 3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James L Leach
- 2Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- 3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ellen L Air
- 4Department of Neurological Surgery, Henry Ford Medical Center, Detroit, Michigan; and
| | - Jesse Skoch
- 1Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- 5Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Francesco T Mangano
- 1Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- 3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- 5Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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7
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Hatoum R, Nathoo-Khedri N, Shlobin NA, Wang A, Weil AG, Fallah A. Barriers to Epilepsy Surgery in Pediatric Patients: A Scoping Review. Seizure 2022; 102:83-95. [DOI: 10.1016/j.seizure.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/05/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
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Papadelis C, Conrad SE, Song Y, Shandley S, Hansen D, Bosemani M, Malik S, Keator C, Perry MS. Case Report: Laser Ablation Guided by State of the Art Source Imaging Ends an Adolescent's 16-Year Quest for Seizure Freedom. Front Hum Neurosci 2022; 16:826139. [PMID: 35145387 PMCID: PMC8821813 DOI: 10.3389/fnhum.2022.826139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 01/14/2023] Open
Abstract
Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy (DRE). Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy (LITT), improved the safety and non-invasiveness of this method. Electric and magnetic source imaging (ESI/MSI) plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for 16 years and underwent surgery at Cook Children's Medical Center (CCMC). The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography (EEG), magnetoencephalography (MEG) with simultaneous conventional EEG (19 channels) and high-density EEG (256 channels) in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography (FDG-PET). Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free (Engel 1; 12 months after surgery). Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE.
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Affiliation(s)
- Christos Papadelis
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
- School of Medicine, Texas Christian University, University of North Texas Health Science Center, Fort Worth, TX, United States
- *Correspondence: Christos Papadelis orcid.org/0000-0001-6125-9217
| | - Shannon E. Conrad
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Yanlong Song
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
| | - Sabrina Shandley
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Daniel Hansen
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Madhan Bosemani
- Department of Radiology, Cook Children's Medical Center, Fort Worth, TX, United States
| | - Saleem Malik
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Cynthia Keator
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - M. Scott Perry
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
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Fernández-Concepción O, López Jiménez M, Valencia-Calderón C, Calderón-Valdivieso A, Recasén-Linares A, Reyes-Haro L, Vásquez-Ham C. Safety and effectiveness of surgery for epilepsy in children. Experience of a tertiary hospital in Ecuador. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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10
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Lee B, Bae MI, Eum D, Ntungi AM, Jun B, Min KT. Bleeding properties according to surgical sites during pediatric craniotomy: a retrospective study comparing the two stages of epilepsy surgery. Anesth Pain Med (Seoul) 2020; 15:283-290. [PMID: 33329826 PMCID: PMC7713839 DOI: 10.17085/apm.20010] [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] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background During pediatric epilepsy surgery, due to low circulating blood volume, intraoperative bleeding can result in significant hemodynamic instability, thereby requiring meticulous hemodynamic and transfusion strategies. Knowing the source of bleeding during the procedure would allow medical staff to better prepare the perioperative protocols for these patients. We compared intraoperative bleeding between the first (involving skin to meninges) and second (involving brain parenchyma) stages of epilepsy surgery to investigate the differences between various anatomical sites. Methods We reviewed the electronic medical records of 102 pediatric patients < 14 years old who underwent two-stage epilepsy surgeries during January 2012–December 2016. Invasive subdural grids were placed via craniotomy during Stage 1 and the epileptogenic zone was removed during Stage 2 of the surgery. We compared the volume of intraoperative bleeding between these two surgeries and identified variables associated with bleeding using multivariate regression analysis. Results Both surgeries resulted in similar intraoperative bleeding (24 vs. 26 ml/kg, P = 0.835), but Stage 2 required greater volumes of blood transfusion than Stage 1 (18.4 vs. 14.8 ml/kg, P = 0.011). Massive bleeding was associated with patients < 7 years of age in Stage 1 and weighing < 18 kg in Stage 2. Conclusions The volume of intraoperative bleeding was similar between the two stages of pediatric epilepsy surgery and was large enough to require blood transfusions. Thus, blood loss during pediatric epilepsy surgery occurred at both anatomic sites. This indicates the necessity of early preparation for blood transfusion in both stages of pediatric epilepsy surgery.
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Affiliation(s)
- Bora Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Il Bae
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Darhae Eum
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Abel Mussa Ntungi
- Department of Anesthesiology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, United Republic of Tanzania
| | - Byongnam Jun
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeong Tae Min
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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11
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Hoppe C, Helmstaedter C. Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery. Seizure 2020; 77:69-75. [DOI: 10.1016/j.seizure.2018.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 01/06/2023] Open
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Abstract
Magnetoencephalography (MEG) is a noninvasive neuroimaging technique that measures the electromagnetic fields generated by the human brain. This article highlights the benefits that pediatric MEG has to offer to clinical practice and pediatric research, particularly for infants and young children; reviews the existing literature on adult MEG systems for pediatric use; briefly describes the few pediatric MEG systems currently extant; and draws attention to future directions of research, with focus on the clinical use of MEG for patients with drug-resistant epilepsy.
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13
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Gadgil N, Muir M, Lopresti MA, Lam SK. An update on pediatric surgical epilepsy: Part II. Surg Neurol Int 2019; 10:258. [PMID: 31893159 PMCID: PMC6935971 DOI: 10.25259/sni_418_2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/22/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Recent advances may allow surgical options for pediatric patients with refractory epilepsy not previously deemed surgical candidates. This review outlines major technological developments in the field of pediatric surgical epilepsy. Methods: The literature was comprehensively reviewed and summarized pertaining to stereotactic electroencephalography (sEEG), laser ablation, focused ultrasound (FUS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) in pediatric epilepsy patients. Results: sEEG allows improved seizure localization in patients with widespread, bilateral, or deep-seated epileptic foci. Laser ablation may be used for destruction of deep-seated epileptic foci close to eloquent structures; FUS has a similar potential application. RNS is a palliative option for patients with eloquent, multiple, or broad epileptogenic foci. DBS is another palliative approach in children unsuitable for respective surgery. Conclusion: The landscape of pediatric epilepsy is changing due to improved diagnostic and treatment options for patients with refractory seizures. These interventions may improve seizure outcomes and decrease surgical morbidity, though further research is needed to define the appropriate role for each modality.
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Affiliation(s)
- Nisha Gadgil
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Matthew Muir
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Melissa A Lopresti
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Sandi K Lam
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Northwestern University Feinberg School of Medicine/Ann and Robert H Lurie Children's Hospital, Chicago, IL, USA
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Moletto A, Bagnasco I, Dassi P, Vigliano P. Long term neurocognitive improvement after "late" right hemispherectomy: case report and review of the literature. Childs Nerv Syst 2018; 34:1599-1603. [PMID: 29564536 DOI: 10.1007/s00381-018-3775-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/06/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the long-term neurocognitive changes of a right-handed girl with intractable epilepsy after late right hemispherectomy and compare them with data in the literature. METHOD The girl was affected by an epileptic encephalopathy associated with right fronto-temporo-parietal polymicrogyria; she was submitted to right hemispherectomy at the age of 5 and examined with cognitive and neuropsychological tests at the age of 17 years. The girl took advantage of neurocognitive rehabilitation for several years; she is currently seizure-free and off therapy. RESULTS At the end of the follow-up, the full-scale IQ is stable and within the normal range (p = 88). As the discrepancy between verbal IQ (pp = 120) and performance IQ (pp = 71) is significantly high, the girl was subjected to neurocognitive evaluation with the following results: verbal problem solving, verbal short- and long-term memory, and executive functions are within normal range. The most fragile functional areas are visual and spatial reasoning, verbal working memory, short-term visuospatial memory, visual attention, and processing speed, all > 2 SD. The spatial tests, such as coding, matrix reasoning, picture concepts, and arithmetic reasoning (which are favored by other functions such as associative memory and learning ability), are less severely impaired. CONCLUSIONS These findings show that good conceptual skills and verbal reasoning can compensate for some deficits in visual-perceptual and visuospatial functions.
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Affiliation(s)
- Alessandra Moletto
- Division of Child Neuropsychiatry, Martini Hospital, via Tofane 71, 10141, Torino, Italy
| | - Irene Bagnasco
- Division of Child Neuropsychiatry, Martini Hospital, via Tofane 71, 10141, Torino, Italy
| | - Patrizia Dassi
- Division of Child Neuropsychiatry, Martini Hospital, via Tofane 71, 10141, Torino, Italy
| | - Piernanda Vigliano
- Division of Child Neuropsychiatry, Martini Hospital, via Tofane 71, 10141, Torino, Italy.
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15
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Makler V, D'Agostino E, Bauer DF. Vagal Nerve Stimulator Lead Revision Using Needle-Tip Cautery: Case Series, Literature Review, and Technical Note. World Neurosurg 2018; 117:377-381. [PMID: 29966788 DOI: 10.1016/j.wneu.2018.06.176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Vagal nerve stimulators (VNs) have been in use in the United States since the 1990s as a palliative treatment option for drug-resistant epilepsy. Over time, the electrode coils wrapped around the vagus nerve become encapsulated by extensive scar tissue, making complete electrode removal challenging. We present a case series of lead revision surgeries with a unique way to remove the scar tissue around the vagus nerve, demonstrating a technique for complete electrode removal. METHODS This was a case series of 9 consecutive patients who underwent complete removal of an existing VNs electrode using needle tip monopolar electrocautery. RESULTS Complete removal of the entire VNs electrode array was achieved in all patients with no permanent complications seen at postoperative follow-up at 3 months. CONCLUSIONS Complete VNs electrode array removal can be safely achieved by using needle tip monopolar electrocautery.
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Affiliation(s)
- Vyacheslav Makler
- Section of Neurological Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon.
| | - Erin D'Agostino
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - David F Bauer
- Section of Neurological Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon
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Fernández-Concepción O, López Jiménez M, Valencia-Calderón C, Calderón-Valdivieso A, Recasén-Linares A, Reyes-Haro L, Vásquez-Ham C. Safety and effectiveness of surgery for epilepsy in children. Experience of a tertiary hospital in Ecuador. Neurologia 2018. [PMID: 29525400 DOI: 10.1016/j.nrl.2017.12.006] [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: 10/17/2022] Open
Abstract
INTRODUCTION There is sufficient evidence on the usefulness of surgery as a therapeutic alternative for patients with drug-resistant epilepsy; however this treatment is underutilized, especially in developing countries. METHODS We describe the outcomes of epilepsy surgery in 27 paediatric patients at Hospital Baca Ortiz in Quito, Ecuador. Our analysis considered the following variables: reduction in seizure frequency, surgery outcome according to the Engel classification, improvement in quality of life, and serious complications due to surgery. RESULTS 21 corpus callosotomies and 6 resective surgeries were performed. The mean seizure frequency decreased from 465 per month before surgery to 37.2 per month thereafter (p<.001); quality of life scale scores increased from 12.6 to 37.2 (p<.001), and quality of life improved in 72.7% of patients. Regarding resective surgery, 2 patients with temporal lobe epilepsy and one with posterior quadrant epilepsy achieved Engel class IA, and one patient undergoing hemispherotomy due to Rasmussen encephalitis achieved Engel class IIA. Two patients underwent surgery for hypothalamic hamartoma: one achieved Engel III and the other, Engel IA; however, the latter patient died in the medium term due to a postoperative complication. The other major complication was a case of hydrocephalus, which led to the death of a patient with refractory infantile spasms who underwent corpus callosotomy. CONCLUSIONS Favourable outcomes were observed in 92.5% of patients.
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Affiliation(s)
| | - M López Jiménez
- Servicio de Neurofisiología, Hospital Baca Ortiz, Quito, Ecuador
| | | | | | | | - L Reyes-Haro
- Servicio de Neurofisiología, Hospital Baca Ortiz, Quito, Ecuador
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