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Comparison of narcotic pain control between stereotactic electrocorticography and subdural grid implantation. Epilepsy Behav 2020; 103:106843. [PMID: 31882325 DOI: 10.1016/j.yebeh.2019.106843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The choice of subdural grid (SDG) or stereoelectroencephalography (sEEG) for patients with epilepsy can be complex and in some cases overlap. Comparing postoperative pain and narcotics consumption with SDG or sEEG can help develop an intracranial monitoring strategy. MATERIALS AND METHODS A retrospective study was performed for adult patients undergoing SDG or sEEG monitoring. Numeric Rating Scale (NRS) was used for pain assessment. Types and dosage of the opioids were calculated by converting into milligram morphine equivalents (MME). Narcotic consumption was analyzed at the following three time periods: I. the first 24 h of implantation; II. from the second postimplantation day to the day of explantation; and III. the days following electrode removal to discharge. RESULTS Forty-two patients who underwent SDG and 31 patients who underwent sEEG implantation were analyzed. After implantation, average NRS was 3.7 for SDG and 2.2 for sEEG (P < .001). After explantation, the NRS was 3.5 for SDG and 1.4 in sEEG (P < .001). Sixty percent of SDG patients and 13% of sEEG patients used more than one opioid in period III (P < .001). The SDG group had a significantly higher MME throughout the three periods compared with the sEEG group: period I: 448 (SDG) vs. 205 (sEEG) mg, P = .002; period II: 377 (SDG) vs. 102 (sEEG) mg, P < .001; and period III: 328 (SDG) vs. 75 (sEEG) mg; P = .002. Patients with the larger SDG implantation had the higher NRS (P = .03) and the higher MME at period I (P = .019). There was no correlation between the number of depth electrodes and pain control in patients with sEEG. CONCLUSIONS Patients undergoing sEEG had significantly less pain and required fewer opiates compared with patients with SDG. These differences in perioperative pain may be a consideration when choosing between these two invasive monitoring options.
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Tubbs RS, Loukas M, Barbaro NM, Shah KJ, Cohen-Gadol AA. External cortical landmarks for localization of the hippocampus: Application for temporal lobectomy and amygdalohippocampectomy. Surg Neurol Int 2018; 9:171. [PMID: 30210904 PMCID: PMC6122279 DOI: 10.4103/sni.sni_446_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/20/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Accessing the hippocampus for amygdalohippocampectomy and minimally invasive procedures, such as depth electrode placement, require an accurate knowledge regarding the location of the hippocampus. Methods: The authors removed 10 human cadaveric brains from the cranium and observed the relationships between the lateral temporal neocortex and the underlying hippocampus. They then measured the distance between the hippocampus and superficial landmarks. The authors also validated their study using magnetic resonance imaging (MRI) scans of 10 patients suffering from medial temporal lobe sclerosis where the distance from the hippocampal head to the anterior temporal tip was measured. Results: In general, the length of the hippocampus was along the inferior temporal sulcus and inferior aspect of the middle temporal gyrus. Although the hippocampus tended to be more superiorly located in female specimens and on the left side, this did not reach statistical significance. The length of the hippocampus tended to be shorter in females, but this too failed to reach statistical significance. The mean distance from the anterior temporal tip to the hippocampal head was identical in the cadavers and MRIs of patients with medial temporal lobe sclerosis. Conclusions: Additional landmarks for localizing the underlying hippocampus may be helpful in temporal lobe surgery. Based on this study, there are relatively constant anatomical landmarks between the hippocampus and overlying temporal cortex. Such landmarks may be used in localizing the hippocampus during amygdalohippocampectomy and depth electrode implantation in verifying the accuracy of image-guided methods and as adjuvant methodologies when these latter technologies are not used or are unavailable.
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Affiliation(s)
- R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Marios Loukas
- Department of Anatomic Sciences, St. George's University School of Medicine, St. George's, Grenada
| | - Nicholas M Barbaro
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kushal J Shah
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Sanz-Garcia A, Rings T, Lehnertz K. Impact of type of intracranial EEG sensors on link strengths of evolving functional brain networks. Physiol Meas 2018; 39:074003. [PMID: 29932428 DOI: 10.1088/1361-6579/aace94] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective and Approach: Investigating properties of evolving functional brain networks has become a valuable tool to characterize the complex dynamics of the epileptic brain. Such networks are usually derived from electroencephalograms (EEG) recorded with sensors implanted chronically into deeper structures of the brain and/or placed onto the cortex. It is still unclear, however, whether the use of different sensors for an identification of network nodes affects properties of functional brain networks. We address this question by investigating properties of links of such networks that we characterize by assessing interactions in multi-sensor, multi-day EEG data recorded from 49 epilepsy patients during presurgical evaluation. These data allow us to study the impact of different types of sensors together with the impact of various physiologic and pathophysiologic activities on the properties of links. MAIN RESULTS We observe that different types of sensors differently impact on spatial means and temporal fluctuations of link strengths. Moreover, the impact depends on the relative anatomical location of sensors with respect to location and extent of sources of the prevailing activities. SIGNIFICANCE Type and location of sensors should be considered when constructing networks.
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Affiliation(s)
- Ancor Sanz-Garcia
- Instituto de Investigacion Sanitaria, Hospital Universitario De La Princesa, C/Diego de Leon 62, 28006 Madrid, Spain
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Garcia-Lorenzo B, del Pino-Sedeño T, Rocamora R, López JE, Serrano-Aguilar P, Trujillo-Martín MM. Stereoelectroencephalography for Refractory Epileptic Patients Considered for Surgery: Systematic Review, Meta-Analysis, and Economic Evaluation. Neurosurgery 2018; 84:326-338. [DOI: 10.1093/neuros/nyy261] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 05/16/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Borja Garcia-Lorenzo
- Bordeaux Population Health, Team EMOS, Université de Bordeaux, Inserm U1219, Bordeaux, France
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Tasmania del Pino-Sedeño
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
- Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Rodrigo Rocamora
- Epilepsy Unit, Department of Neurology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Juan Erviti López
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Servicio de Prestaciones Farmacéuticas, Dirección Atención Primaria, Servicio Navarro de Salud, Pamplona, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Servicio de Evaluación y Planificación (SESCS), Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
| | - María M Trujillo-Martín
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
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Robotic-Guided Bihippocampal and Biparahippocampal Depth Placement for Responsive Neurostimulation in Bitemporal Lobe Epilepsy. World Neurosurg 2018; 111:181-189. [DOI: 10.1016/j.wneu.2017.10.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 11/16/2022]
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Helmstaedter C, Gielen GH, Witt JA. The immediate and short-term effects of bilateral intrahippocampal depth electrodes on verbal memory. Epilepsia 2018; 59:e78-e84. [PMID: 29417555 DOI: 10.1111/epi.14019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2018] [Indexed: 11/28/2022]
Abstract
In contrast to previous studies, Ljung et al. provide evidence of permanent cognitive consequences of bilateral intrahippocampal depth electrodes for verbal memory in patients who were not operated or operated in the right temporal lobe. Stimulated by this, we provide historical confirmatory and supplementary evidence of the detrimental effect of bilateral depth electrodes implanted along the longitudinal axis of the hippocampus on verbal learning and especially on delayed verbal memory and recognition performance. This is demonstrated in 31 patients with memory assessments before implantation, after explantation, and 3 months later after left/right temporal lobe surgery. After surgery, significant recovery from postimplantation impairment is found in right temporal patients. Left temporal resection patients stay on the level seen after implantation and do not recover. Surgery, however, has its own effects in addition to the implantation. Intracranial electrodes for electroencephalographic monitoring or electrical stimulation are commonly and increasingly used for diagnosis or treatment in pharmacoresistant epilepsies. Thus, the monitoring of invasive stereotactic approaches is recommended to find safe procedures for the patients. In response to the findings, we restricted indications and used different implantation schemes, different trajectories, and targets to minimize the risk of additional damage.
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Affiliation(s)
| | - Gerrit H Gielen
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
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van der Loo LE, Schijns OEMG, Hoogland G, Colon AJ, Wagner GL, Dings JTA, Kubben PL. Methodology, outcome, safety and in vivo accuracy in traditional frame-based stereoelectroencephalography. Acta Neurochir (Wien) 2017; 159:1733-1746. [PMID: 28676892 PMCID: PMC5557874 DOI: 10.1007/s00701-017-3242-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
Background Stereoelectroencephalography (SEEG) is an established diagnostic technique for the localization of the epileptogenic zone in drug-resistant epilepsy. In vivo accuracy of SEEG electrode positioning is of paramount importance since higher accuracy may lead to more precise resective surgery, better seizure outcome and reduction of complications. Objective To describe experiences with the SEEG technique in our comprehensive epilepsy center, to illustrate surgical methodology, to evaluate in vivo application accuracy and to consider the diagnostic yield of SEEG implantations. Methods All patients who underwent SEEG implantations between September 2008 and April 2016 were analyzed. Planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative imaging. Quantitative analysis of deviation using Euclidean distance and directional errors was performed. Explanatory variables for electrode accuracy were analyzed using linear regression modeling. The surgical methodology, procedure-related complications and diagnostic yield were reported. Results Seventy-six implantations were performed in 71 patients, and a total of 902 electrodes were implanted. Median entry and target point deviations were 1.54 mm and 2.93 mm. Several factors that predicted entry and target point accuracy were identified. The rate of major complications was 2.6%. SEEG led to surgical therapy of various modalities in 53 patients (69.7%). Conclusions This study demonstrated that entry and target point localization errors can be predicted by linear regression models, which can aid in identification of high-risk electrode trajectories and further enhancement of accuracy. SEEG is a reliable technique, as demonstrated by the high accuracy of conventional frame-based implantation methodology and the good diagnostic yield.
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Implantation of Responsive Neurostimulation for Epilepsy Using Intraoperative Computed Tomography: Technical Nuances and Accuracy Assessment. World Neurosurg 2017; 103:145-152. [DOI: 10.1016/j.wneu.2017.03.136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 01/09/2023]
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Chan AY, Lin JJ, Mnatsakanyan L, Sazgar M, Sen-Gupta I, Hsu FP, Vadera S. Robot-assisted placement of depth electrodes along the long Axis of the amygdalohippocampal complex. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2016. [DOI: 10.1016/j.inat.2016.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Delev D, Send K, Malter M, Ormond DR, Parpaley Y, von Lehe M, Schramm J, Grote A. Role of Subdural Interhemispheric Electrodes in Presurgical Evaluation of Epilepsy Patients. World Neurosurg 2015. [DOI: 10.1016/j.wneu.2015.07.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mikell CB, Sinha S, Sheth SA. Neurosurgery for schizophrenia: an update on pathophysiology and a novel therapeutic target. J Neurosurg 2015; 124:917-28. [PMID: 26517767 DOI: 10.3171/2015.4.jns15120] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The main objectives of this review were to provide an update on the progress made in understanding specific circuit abnormalities leading to psychotic symptoms in schizophrenia and to propose rational targets for therapeutic deep brain stimulation (DBS). Refractory schizophrenia remains a major unsolved clinical problem, with 10%-30% of patients not responding to standard treatment options. Progress made over the last decade was analyzed through reviewing structural and functional neuroimaging studies in humans, along with studies of animal models of schizophrenia. The authors reviewed theories implicating dysfunction in dopaminergic and glutamatergic signaling in the pathophysiology of the disorder, paying particular attention to neurosurgically relevant nodes in the circuit. In this context, the authors focused on an important pathological circuit involving the associative striatum, anterior hippocampus, and ventral striatum, and discuss the possibility of targeting these nodes for therapeutic neuromodulation with DBS. Finally, the authors examined ethical considerations in the treatment of these vulnerable patients. The functional anatomy of neural circuits relevant to schizophrenia remains of great interest to neurosurgeons and psychiatrists and lends itself to the development of specific targets for neuromodulation. Ongoing progress in the understanding of these structures will be critical to the development of potential neurosurgical treatments of schizophrenia.
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Affiliation(s)
- Charles B Mikell
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York; and
| | - Saurabh Sinha
- Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sameer A Sheth
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York; and
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Tubbs RS, Loukas M, Barbaro NM, Cohen-Gadol AA. Superficial cortical landmarks for localization of the hippocampus: Application for temporal lobectomy and amygdalohippocampectomy. Surg Neurol Int 2015; 6:16. [PMID: 25709853 PMCID: PMC4322378 DOI: 10.4103/2152-7806.150663] [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: 10/08/2014] [Accepted: 11/18/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Accessing the hippocampus for amygdalohippocampectomy and procedures such as depth electrode placement requires accurate knowledge regarding the location of the hippocampus. Methods: The authors removed 10 human cadaveric brains (20 sides) from their crania, noted relationships between the lateral temporal neocortex and underlying hippocampus, and measured the distance between the hippocampus and superficial landmarks. Results: Mean distances were as follows: 3.8 cm from the tip of the temporal lobe to the head of the hippocampus; 6.5 cm from the tip of the temporal lobe to the junction of the fornix and hippocampus; and 3.5 cm between the tail and head of the hippocampus. The head of the hippocampus ranged from 0 to 5 mm inferior to the inferior temporal sulcus. The tail of the hippocampus ranged from 2.2 to 7 mm superior to the inferior temporal sulcus. In two specimens, the tail was deep to the superior temporal sulcus. Generally the length of the hippocampus was along the inferior temporal sulcus and inferior aspect of the middle temporal gyrus. The hippocampus tended to be more superiorly located and shorter in females and left sides, but this was not statistically significant. Conclusions: Additional landmarks for localizing the underlying hippocampus may be helpful in temporal lobe surgery. Our study showed relatively constant anatomic landmarks between the hippocampus and overlying temporal cortex that may help localize the hippocampus during amygdalohippocampectomy and depth electrode implantation, verify the accuracy of image-guided methods, and used as adjuvant methodologies when these latter technologies are unavailable.
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Affiliation(s)
- R Shane Tubbs
- Pediatric Neurosurgery, Children's Hospital of Alabama, Birmingham, Alabama, USA ; Department of Anatomic Sciences, St. George's University School of Medicine, St. George's, Grenada, UK ; Centre of Anatomy and Human Identification, University of Dundee, Scotland, UK
| | - Marios Loukas
- Department of Anatomic Sciences, St. George's University School of Medicine, St. George's, Grenada, UK
| | - Nicholas M Barbaro
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Abstract
The Wada test was adapted from the procedure described by Wada in 1964. It still has a role in the prognostic evaluation of memory disorders after mesial temporal lobectomy. The test consists of injecting a short-acting anesthetic into one hemisphere, under continuous EEG monitoring and during carotid catheterization, to verify the function of contralateral structures. Intracranial EEG recordings deliver signals with few artifacts, and which are quite specific of the zone explored. Three types of electrodes are in common use: (a) foramen ovale (FO) electrodes: electrodes can be inserted directly, without any stereotactic procedure, to provide easy and comparative EEG recordings of the lower and middle portions of the temporal lobe close to the hippocampus. These allow validation of the temporal lobe origin of seizures using FO electrodes recording coupled with scalp EEG; (b): subdural strip or grip electrodes. This relatively aggressive technique carries infectious and hemorrhagic risks and does not allow the exploration of deep cortical structures. However, it permits precise functional cortical mapping via electrical stimulation because of dense and regular positioning of electrodes over the cortical convexity; (c) stereotactically implanted depth electrodes (stereo-electroencephalography [SEEG]). Electrodes are individually planned and inserted within the brain parenchyma through small burr holes. This technique is less aggressive than subdural grid exploration. However it offers relatively limited spatial sampling that may be less well adapted to precise functional evaluation. It allows recording from deep cortical structures and can be argued to be the gold standard of presurgical EEG exploration.
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Aghakhani Y, Liu X, Jette N, Wiebe S. Epilepsy surgery in patients with bilateral temporal lobe seizures: A systematic review. Epilepsia 2014; 55:1892-901. [DOI: 10.1111/epi.12856] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Yahya Aghakhani
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
| | - Xiaorong Liu
- Institute of Neuroscience and the Second Affiliated Hospital; Guangzhou Medical University; Guangzhou China
| | - Nathalie Jette
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences; Institute of Public Health and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences; Institute of Public Health and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
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[French guidelines on electroencephalogram]. Neurophysiol Clin 2014; 44:515-612. [PMID: 25435392 DOI: 10.1016/j.neucli.2014.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/07/2014] [Indexed: 12/11/2022] Open
Abstract
Electroencephalography allows the functional analysis of electrical brain cortical activity and is the gold standard for analyzing electrophysiological processes involved in epilepsy but also in several other dysfunctions of the central nervous system. Morphological imaging yields complementary data, yet it cannot replace the essential functional analysis tool that is EEG. Furthermore, EEG has the great advantage of being non-invasive, easy to perform and allows control tests when follow-up is necessary, even at the patient's bedside. Faced with the advances in knowledge, techniques and indications, the Société de Neurophysiologie Clinique de Langue Française (SNCLF) and the Ligue Française Contre l'Épilepsie (LFCE) found it necessary to provide an update on EEG recommendations. This article will review the methodology applied to this work, refine the various topics detailed in the following chapters. It will go over the summary of recommendations for each of these chapters and underline proposals for writing an EEG report. Some questions could not be answered by the review of the literature; in those cases, an expert advice was given by the working and reading groups in addition to the guidelines.
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Gonzalez-Martinez J, Mullin J, Vadera S, Bulacio J, Hughes G, Jones S, Enatsu R, Najm I. Stereotactic placement of depth electrodes in medically intractable epilepsy. J Neurosurg 2014; 120:639-44. [DOI: 10.3171/2013.11.jns13635] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Despite its long-reported successful record, with almost 60 years of clinical use, the technical complexity regarding the placement of stereoelectroencephalography (SEEG) depth electrodes may have contributed to the limited widespread application of the technique in centers outside Europe. The authors report on a simplified and novel SEEG surgical technique in the extraoperative mapping of refractory focal epilepsy.
Methods
The proposed technique was applied in patients with medically refractory focal epilepsy. Data regarding general demographic information, method of electrode implantation, time of implantation, number of implanted electrodes, seizure outcome after SEEG-guided resections, and complications were prospectively collected.
Results
From March 2009 to April 2012, 122 patients underwent SEEG depth electrode implantation at the Cleveland Clinic Epilepsy Center in which the authors' technique was used. There were 65 male and 57 female patients whose mean age was 33 years (range 5–68 years). The group included 21 pediatric patients (younger than 18 years). Planning and implantations were performed in a single stage. The time for planning was, on average, 33 minutes (range 20–47 minutes), and the time for implantation was, on average, 107 minutes (range 47–150 minutes). Complications related to the SEEG technique were observed in 3 patients. The calculated risk of complications per electrode was 0.18%. The seizure-free rate after SEEG-guided resections was 62% in a mean follow-up period of 12 months.
Conclusions
The authors report on a safe, simplified, and less time-consuming method of SEEG depth electrode implantation, using standard and widely available surgical tools, making the technique a reasonable option for extraoperative monitoring of patients with medically intractable epilepsy in centers lacking the Talairach stereotactic armamentarium.
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Affiliation(s)
| | | | | | | | | | - Stephen Jones
- 3Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rei Enatsu
- 1Epilepsy Center, Neurological Institute
- 2Department of Neurosurgery; and
| | - Imad Najm
- 1Epilepsy Center, Neurological Institute
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Van Gompel JJ, Bower MR, Worrell GA, Stead M, Chang SY, Goerss SJ, Kim I, Bennet KE, Meyer FB, Marsh WR, Blaha CD, Lee KH. Increased cortical extracellular adenosine correlates with seizure termination. Epilepsia 2014; 55:233-44. [PMID: 24483230 DOI: 10.1111/epi.12511] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Seizures are currently defined by their electrographic features. However, neuronal networks are intrinsically dependent on neurotransmitters of which little is known regarding their periictal dynamics. Evidence supports adenosine as having a prominent role in seizure termination, as its administration can terminate and reduce seizures in animal models. Furthermore, microdialysis studies in humans suggest that adenosine is elevated periictally, but the relationship to the seizure is obscured by its temporal measurement limitations. Because electrochemical techniques can provide vastly superior temporal resolution, we test the hypothesis that extracellular adenosine concentrations rise during seizure termination in an animal model and humans using electrochemistry. METHODS White farm swine (n = 45) were used in an acute cortical model of epilepsy, and 10 human epilepsy patients were studied during intraoperative electrocorticography (ECoG). Wireless Instantaneous Neurotransmitter Concentration Sensor (WINCS)-based fast scan cyclic voltammetry (FSCV) and fixed potential amperometry were obtained utilizing an adenosine-specific triangular waveform or biosensors, respectively. RESULTS Simultaneous ECoG and electrochemistry demonstrated an average adenosine increase of 260% compared to baseline, at 7.5 ± 16.9 s with amperometry (n = 75 events) and 2.6 ± 11.2 s with FSCV (n = 15 events) prior to electrographic seizure termination. In agreement with these animal data, adenosine elevation prior to seizure termination in a human patient utilizing FSCV was also seen. SIGNIFICANCE Simultaneous ECoG and electrochemical recording supports the hypothesis that adenosine rises prior to seizure termination, suggesting that adenosine itself may be responsible for seizure termination. Future work using intraoperative WINCS-based FSCV recording may help to elucidate the precise relationship between adenosine and seizure termination.
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Affiliation(s)
- Jamie J Van Gompel
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Van Gompel JJ, Ottman R, Worrell GA, Marsh R, Wetjen NM, Cascino GD, Meyer FB. Use of anterior temporal lobectomy for epilepsy in a community-based population. ACTA ACUST UNITED AC 2013; 69:1476-81. [PMID: 22911042 DOI: 10.1001/archneurol.2012.1200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the hypothesis that use of anterior temporal lobectomy (ATL) for temporal epilepsy has diminished over time. DESIGN Population-based cohort study. SETTING The Rochester Epidemiology Project based in Olmsted County, Minnesota. PARTICIPANTS Residents of Olmsted County. MAIN OUTCOME MEASURES Poisson regression was used to evaluate changes in ATL use over time by sex. RESULTS Over a 17-year period, from 1993 to 2009, 847ATLs were performed with the primary indication of epilepsy(average, 50 procedures/y). Of these, 26 occurred among Olmsted County residents. The use rates declinedsignificantly between 1993 and 2000 (8 years) and 2001 and 2009 (9 years) according to Poisson regression analysis, from 1.9 to 0.7 per 100 000 person-years(P=.01). The rate of ATL use among Olmsted County residents was 1.2 (95% CI, 0.9 to 2.4) per 100 000 person years of follow-up over this 17-year period. The sex specific rates were 1.6 (95% CI, 0.9 to 2.4) and 0.7 (95%CI, 0.2 to 1.3) per 100 000 person-years for females and males, respectively. CONCLUSIONS In this community-based cohort, the rate of ATL use was 1.2 per 100 000 person-years of followup.Use of this procedure has declined over time; the reasons for this are unknown but do not include referral pattern changes.
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Bekelis K, Desai A, Kotlyar A, Thadani V, Jobst BC, Bujarski K, Darcey TM, Roberts DW. Occipitotemporal hippocampal depth electrodes in intracranial epilepsy monitoring: safety and utility. J Neurosurg 2013; 118:345-52. [DOI: 10.3171/2012.9.jns112221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Intracranial monitoring for epilepsy has been proven to enhance diagnostic accuracy and provide localizing information for surgical treatment of intractable seizures. The authors investigated the usefulness of hippocampal depth electrodes in the era of more advanced imaging techniques.
Methods
Between 1988 and 2010, 100 patients underwent occipitotemporal hippocampal depth electrode (OHDE) implantation as part of invasive seizure monitoring, and their charts were retrospectively reviewed. The authors' technique involved the stereotactically guided (using the Leksell model G frame) implantation of a 12-contact depth electrode directed along the long axis of the hippocampus, through an occipital twist drill hole.
Results
Of the 100 patients (mean age 35.0 years [range 13–58 years], 51% male) who underwent intracranial investigation, 84 underwent resection of the seizure focus. Magnetic resonance imaging revealed mesial temporal sclerosis (MTS) in 27% of patients, showed abnormal findings without MTS in 55% of patients, and showed normal findings in 18% of patients. One patient developed a small asymptomatic occipital hemorrhage around the electrode tract. The use of OHDEs enabled epilepsy resection in 45.7% of patients who eventually underwent standard or selective temporal lobe resection. The hippocampal formation was spared during surgery because data obtained from the depth electrodes showed no or only secondary involvement in 14% of patients with preoperative temporal localization. The use of OHDEs prevented resections in 12% of patients with radiographic evidence of MTS. Eighty-three percent of patients who underwent resection had Engel Class I (68%) or II (15%) outcome at 2 years of follow-up.
Conclusions
The use of OHDEs for intracranial epilepsy monitoring has a favorable risk profile, and in the authors' experience it proved to be a valuable component of intracranial investigation. The use of OHDEs can provide the sole evidence for resection of some epileptogenic foci and can also result in hippocampal sparing or prevent likely unsuccessful resection in other patients.
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Affiliation(s)
| | | | - Alex Kotlyar
- 3Dartmouth Medical School, Hanover, New Hampshire
| | - Vijay Thadani
- 2Department of Neurology, Dartmouth-Hitchcock Medical Center; and
- 3Dartmouth Medical School, Hanover, New Hampshire
| | - Barbara C. Jobst
- 2Department of Neurology, Dartmouth-Hitchcock Medical Center; and
- 3Dartmouth Medical School, Hanover, New Hampshire
| | - Krzysztof Bujarski
- 2Department of Neurology, Dartmouth-Hitchcock Medical Center; and
- 3Dartmouth Medical School, Hanover, New Hampshire
| | - Terrance M. Darcey
- 1Section of Neurosurgery and
- 2Department of Neurology, Dartmouth-Hitchcock Medical Center; and
- 3Dartmouth Medical School, Hanover, New Hampshire
| | - David W. Roberts
- 1Section of Neurosurgery and
- 2Department of Neurology, Dartmouth-Hitchcock Medical Center; and
- 3Dartmouth Medical School, Hanover, New Hampshire
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Raghavendra S, Nooraine J, Mirsattari SM. Role of electroencephalography in presurgical evaluation of temporal lobe epilepsy. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:204693. [PMID: 23198144 PMCID: PMC3503287 DOI: 10.1155/2012/204693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/18/2012] [Accepted: 06/28/2012] [Indexed: 11/17/2022]
Abstract
Surgery remains a therapeutic option for patients with medically refractory epilepsy. Comprehensive presurgical evaluation includes electroencephalography (EEG) and video EEG in identifying patients who are likely to benefit from surgery. Here, we discuss in detail the utility of EEG in presurgical evaluation of patients with temporal lobe epilepsy along with illustrative cases.
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Affiliation(s)
| | - Javeria Nooraine
- Department of Neurology, Vikram Hospital, Bangalore 560052, India
| | - Seyed M. Mirsattari
- Departments of Clinical Neurological Sciences, Medical Imaging, Medical Biophysics, and Psychology, University of Western Ontario, London, ON, Canada N6A 5A5
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Wray CD, McDaniel SS, Saneto RP, Novotny EJ, Ojemann JG. Is postresective intraoperative electrocorticography predictive of seizure outcomes in children? J Neurosurg Pediatr 2012; 9:546-51. [PMID: 22546034 DOI: 10.3171/2012.1.peds11441] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intraoperative electrocorticography (ECoG) is commonly used to guide the extent of resection, especially in lesion-associated intractable epilepsy. Interictal epileptiform discharges on postresective ECoG (post-ECoG) have been predictive of seizure recurrence in some studies, particularly in adults undergoing medial temporal lobectomy, frontal lesionectomy, or low-grade glioma resection. The predictive value of postresective discharges in pediatric epilepsy surgery has not been extensively studied. METHODS The authors retrospectively examined the charts of all 52 pediatric patients who had undergone surgery with post-ECoG and had more than 1 year of follow-up between October 1, 2003, and October 1, 2009. RESULTS Of the 52 pediatric patients, 37 patients showed residual discharges at the end of their resection and 73% of these patients were seizure free, whereas 15 patients had no residual discharges and 60% of them were seizure-free, which was not significantly different (p = 0.36, chi-square). CONCLUSIONS Electrocorticography-guided surgery was associated with excellent postsurgical outcome. Although this sample size was too small to detect a subtle difference, absence of epileptiform discharges on post-ECoG does not appear to predict seizure freedom in all pediatric patients referred for epilepsy surgery. Future studies with larger study samples would be necessary to confirm this finding and determine whether post-ECoG may be useful in some subsets of pediatric epilepsy surgery candidates.
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Affiliation(s)
- Carter D Wray
- Department of Neurology, University of Washington, Seattle, WA, USA.
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Intracranial electrodes in the presurgical evaluation of epilepsy. Neurol Sci 2012; 33:723-9. [PMID: 22460695 DOI: 10.1007/s10072-012-1020-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
The resection of the epileptogenic area of brain is very important and useful for the treatment of uncontrolled epilepsy, especially for the patients with stereotyped partial seizures. The critical point for successful epilepsy surgery is the precise identification of epileptogenic zone. Actually, we cannot precisely localize the epileptogenic zone in about 25 % of patient with refractory seizures based on the noninvasive examination; thus for these patients, we mainly use the intracranial EEG to localize the epileptogenic zone which could be useful in 10-15 % of surgical candidates. The intracranial electrodes which are most used currently are depth electrodes, subdural strip electrodes, and subdural grid electrodes. The subject of this paper is to discuss and compare the indications, construction, insertion, interpretation, limitations, risks and accuracy of each of these methods.
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Morace R, Di Gennaro G, Picardi A, Quarato PP, Sparano A, Mascia A, Meldolesi GN, Grammaldo LG, De Risi M, Esposito V. Surgery after intracranial investigation with subdural electrodes in patients with drug-resistant focal epilepsy: outcome and complications. Neurosurg Rev 2012; 35:519-26; discussion 526. [DOI: 10.1007/s10143-012-0382-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 11/20/2011] [Indexed: 10/28/2022]
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Bower MR, Stead M, Meyer FB, Marsh WR, Worrell GA. Spatiotemporal neuronal correlates of seizure generation in focal epilepsy. Epilepsia 2012; 53:807-16. [PMID: 22352423 DOI: 10.1111/j.1528-1167.2012.03417.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Focal seizures are thought to reflect simultaneous activation of a large population of neurons within a discrete region of pathologic brain. Resective surgery targeting this focus is an effective treatment in carefully selected patients, but not all. Although in vivo recordings of single-neuron (i.e., "unit") activity in patients with epilepsy have a long history, no studies have examined long-term firing rates leading into seizures and the spatial relationship of unit activity with respect to the seizure-onset zone. METHODS Microelectrode arrays recorded action potentials from neurons in mesial temporal structures (often including contralateral mesial temporal structures) in seven patients with mesial temporal lobe epilepsy. KEY FINDINGS Only 7.6% of microelectrode recordings showed increased firing rates before seizure onset and only 32.4% of microelectrodes showed any seizure-related activity changes. Surprisingly, firing rates on the majority of microelectrodes (67.6%) did not change throughout the seizure, including some microelectrodes located within the seizure-onset zone. Furthermore, changes in firing rate before and at seizure onset were observed on microelectrodes located outside the seizure-onset zone and even in contralateral mesial temporal lobe. These early changes varied from seizure to seizure, demonstrating the heterogeneity of ensemble activity underlying the generation of focal seizures. Increased neuronal synchrony was primarily observed only following seizure onset. SIGNIFICANCE These results suggest that cellular correlates of seizure initiation and sustained ictal discharge in mesial temporal lobe epilepsy involve a small subset of the neurons within and outside the seizure-onset zone. These results further suggest that the "epileptic ensemble or network" responsible for seizure generation are more complex and heterogeneous than previously thought and that future studies may find mechanistic insights and therapeutic treatments outside the clinical seizure-onset zone.
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Affiliation(s)
- Mark R Bower
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, U.S.A.
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Lu Y, Yang L, Worrell GA, He B. Seizure source imaging by means of FINE spatio-temporal dipole localization and directed transfer function in partial epilepsy patients. Clin Neurophysiol 2011; 123:1275-83. [PMID: 22172768 DOI: 10.1016/j.clinph.2011.11.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 11/15/2011] [Accepted: 11/17/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the usage of a high-density EEG recording system and source imaging technique for localizing seizure activity in patients with medically intractable partial epilepsy. METHODS High-density, 76-channel scalp EEG signals were recorded in 10 patients with partial epilepsy. The patients underwent routine clinical pre-surgical evaluation and all had resective surgery with seizure free outcome. After applying a FINE (first principle vectors) spatio-temporal source localization and DTF (directed transfer function) connectivity analysis approach, ictal sources were imaged. Effects of number of scalp EEG electrodes on the seizure localization were also assessed using 76, 64, 48, 32, and 21 electrodes, respectively. RESULTS Surgical resections were used to assess the source imaging results. Results from the 76-channel EEG in the 10 patients showed high correlation with the surgically resected brain regions. The localization of seizure onset zone from 76-channel EEG showed improved source detection accuracy compared to other EEG configurations with fewer electrodes. CONCLUSIONS FINE together with DTF was able to localize seizure onset zones of partial epilepsy patients. High-density EEG recording can help achieve improved seizure source imaging. SIGNIFICANCE The present results suggest the promise of high-density EEG and electrical source imaging for noninvasively localizing seizure onset zones.
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Affiliation(s)
- Yunfeng Lu
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
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Bahuleyan B, Omodon M, Robinson S, Cohen AR. Frameless stereotactic endoscope-assisted transoccipital hippocampal depth electrode placement: cadaveric demonstration of a new approach. Childs Nerv Syst 2011; 27:1317-20. [PMID: 21607640 DOI: 10.1007/s00381-011-1489-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 05/09/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Hippocampal recording using depth electrodes is indicated in a small subgroup of patients with medically intractable seizures. There are several conventional techniques for implantation of hippocampal depth electrodes. We describe a new method for hippocampal depth electrode placement using an image-guided endoscopic transoccipital route. This technique is simple and effective, eliminating several drawbacks of conventional techniques. METHODS One silicone-injected cadaver head was used. A rigid endoscope sheath was inserted through a transoccipital corridor into the atrium of the lateral ventricle and then advanced to the temporal horn. Each of the hemispheres was cannulated. The hippocampus was identified visually, and a depth electrode was inserted into the substance of the hippocampus along its long axis under direct vision. RESULTS In both hemispheres we were able to successfully implant the depth electrode within the hippocampus. The advantages of our technique over conventional approaches are (1) there is no need for frame-based stereotaxy, thus reducing operating time and patient discomfort, (2) the electrodes are inserted into the hippocampus under direct endoscopic visualization, reducing the chance of injury to vascular structures, (3) there is no need to insert a larger cannula into the hippocampus before placement of the electrodes, reducing trauma to the hippocampus, and (4) the number of electrodes within the hippocampus can be assessed at the end of the procedure, reducing malposition. CONCLUSION We believe that image-guided endoscopic transoccipital hippocampal depth electrode placement can be performed with precision equal or superior to conventional techniques but without their major disadvantages.
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Affiliation(s)
- Biji Bahuleyan
- Division of Pediatric Neurosurgery Rainbow Babies and Children's Hospital The Neurological Institute, Case Western Reserve University School of Medicine, Rainbow B-501, Cleveland, OH, 44106, USA
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