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Hu WH, Mo JJ, Yang BW, Liu HG, Zhang C, Wang X, Qiu JJ, Zhao BT, Shao XQ, Zhang JG, Zhang K. Voxel-Based Morphometric MRI Postprocessing-Assisted Laser Interstitial Thermal Therapy for Focal Cortical Dysplasia-Suspected Lesions: Technique and Outcomes. Oper Neurosurg (Hagerstown) 2022; 23:334-341. [PMID: 36001745 DOI: 10.1227/ons.0000000000000328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND MRI-guided laser interstitial thermal therapy (MRgLITT) is a novel treatment modality for focal cortical dysplasia (FCD). However, identifying the location and extent of subtle FCD by visual analysis during MRgLITT remains challenging. OBJECTIVE To introduce voxel-based morphometric MRI postprocessing into the procedure of MRgLITT for FCD-suspected lesions and assess the complementary value of the MRI postprocessing technique for the trajectory design and thermal parameter setting of MRgLITT. METHODS Junction and normalized fluid-attenuated inversion recovery signal intensity images were used to detect the gray-white matter junction blurring and cortical fluid-attenuated inversion recovery hyperintensity, respectively. According to the 2 postprocessing images, the region of interest (ROI) for ablation was drawn. The main principle of presurgical planning is that the trajectory of the laser fiber was designed as far as possible along the long axis of the ROI while the extent of planned ablation covered the entire ROI. The subsequent intraoperative procedure was performed under the guidance of the presurgical plan. RESULTS Nine patients with epilepsy with FCD-suspected lesions underwent MRgLITT with the assistance of MRI postprocessing images. Among them, 4 patients were junction positive, 2 patients were normalized fluid-attenuated inversion recovery signal intensity positive, and the remaining 3 patients were positive for both. Postsurgical MRI demonstrated that the ROIs were ablated entirely in 7 patients. Engel Ia, Ib, and IV scores were obtained at 1-year follow-up for 6, 1, and 2 patients, respectively. CONCLUSION MRI postprocessing provides complementary information for designing the laser fiber trajectory and subsequent ablation for FCDs.
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Affiliation(s)
- Wen-Han Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jia-Jie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo-Wen Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huan-Guang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia-Ji Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bao-Tian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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High density electric source imaging in childhood-onset epilepsy due to focal cortical dysplasia. Clin Neurophysiol Pract 2022; 7:245-251. [PMID: 36062078 PMCID: PMC9428727 DOI: 10.1016/j.cnp.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 11/22/2022] Open
Abstract
ESI with 64 electrodes allows accurate localization of the epileptogenic area in patients with FCD. Concordant results with other imaging techniques is associated with excellent outcome. ESI should become a standard imaging tool in pediatric surgical candidates with FCD.
Objective The goal of this study was to investigate the diagnostic utility of electric source imaging (ESI) in the presurgical evaluation of children with focal cortical dysplasia (FCD) and to compare it with other imaging techniques. Methods Twenty patients with epilepsy onset before 18 years, surgically treated focal epilepsy with a minimal follow-up of 2 years, and histologically proven FCD were retrospectively selected. All patients underwent MRI, positron emission tomography (PET), and 16 patients also had ictal single-photon emission computed tomography (iSPECT). ESI, using EEG with 64 electrodes or more (HD-ESI), was performed in all 20 patients. We determined sensitivity, specificity and accuracy of ESI, and compared its yield to that of other imaging techniques. Results Twelve patients were seizure-free post-operatively (60%). Among all patients, highest localization accuracy (80%) was obtained with ESI, followed by PET and iSPECT (75%). When results from ESI and SPECT were concordant 100% of patients achieved Engel I outcome. If ESI and PET showed concordant localization, 90% of patients achieved postoperative seizure freedom. Conclusions Our findings demonstrate that HD-ESI allows accurate localization of the epileptogenic zone in patients with FCD. Significance In combination with other imaging modalities, ESI helps with planning a more accurate surgery and therefore, the chances of postoperative seizure control are higher. Since it is based on EEG recordings, it does not require sedation, which is particularly interesting in pediatric patients. ESI represents an important imaging tool in focal epilepsies due to cortical dysplasia, which might be difficult to detect on standard imaging.
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Ka A, Taher A, D'Souza S, Barnes EH, Gupta S, Troedson C, Wade F, Teo O, Dale RC, Wong C, Bleasel AF, Dexter M, Kothur K, Gill D. Predictors of longitudinal seizure outcomes after epilepsy surgery in childhood. Epilepsy Behav Rep 2022; 19:100561. [PMID: 35899185 PMCID: PMC9309686 DOI: 10.1016/j.ebr.2022.100561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 10/31/2022] Open
Abstract
Long term seizure outcome in children following epilepsy surgery is favorable. Histopathology is an independent determinant of long-term seizure outcome. Long-term seizure outcome remains stable in children with tumours and FCD type 2b, whereas seizure freedom declines with time in children with other types of FCD and cortical malformations. Children with moderate to severe developmental disability and younger age of seizure onset have higher seizure recurrence reflecting broader epileptic networks.
There is a paucity of data on longitudinal seizure outcome of children undergoing epilepsy surgery. All children (n = 132) who underwent resective epilepsy surgery from January 1998 to December 2015 were identified. Relevant clinical, neurophysiological, imaging, surgical and seizure outcome data were extracted. Multivariable logistic regression analysis and Kaplan-Meier survival with Cox proportional hazard modelling were performed. The mean age at surgery was 7.8 years (range 0.2–17.9). 71% were seizure-free at a mean follow up of 5.3 ± 2.7 years. Of those who were seizure-free, 65 patients were able to completely wean off anti- seizure medications successfully. Using survival analysis, the probability of Engel Class I outcome at one year after surgery was 81% (95% confidence interval [CI] 87%–75%). This dropped to 73% at two years (95% CI 81%–65%), 58% at five years (95% CI 67.8%–48%), and 47% at ten years. Proportional hazard modelling showed that the presence of moderate to severe developmental disability (HR 6.5; p = 0.02) and lack of complete resection (HR 0.4; p = 0.02) maintain association as negative predictors of seizure-free outcome. Our study demonstrates favorable long-term seizure control following pediatric epilepsy surgery and highlights important predictors of seizure outcome guiding case selection and counseling of expectations prior to surgery.
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Kankirawatana P, Mohamed IS, Lauer J, Aban I, Kim H, Li R, Harrison A, Goyal M, Rozzelle CJ, Knowlton R, Blount JP. Relative contribution of individual versus combined functional imaging studies in predicting seizure freedom in pediatric epilepsy surgery: an area under the curve analysis. Neurosurg Focus 2021; 48:E13. [PMID: 32234993 DOI: 10.3171/2020.1.focus19974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the predictive value and relative contribution of noninvasive presurgical functional imaging modalities based on the authors' institutional experience in pursuing seizure-free surgical outcomes in children with medically refractory epilepsy. METHODS This was a retrospective, single-institution, observational cohort study of pediatric patients who underwent evaluation and surgical treatment for medically refractory partial epilepsy between December 2003 and June 2016. During this interval, 108 children with medically refractory partial epilepsy underwent evaluation for localization and resective epilepsy surgery. Different noninvasive functional imaging modalities, including ictal SPECT, FDG-PET, and magnetoencephalography-magnetic source imaging, were utilized to augment a standardized paradigm (electroencephalography/semiology, MRI, and neuropsychology findings) for localization. Outcomes were evaluated at a minimum of 2 years (mean 7.5 years) utilizing area under the receiver operating characteristic curve analysis. Localizing modalities and other clinical covariates were examined in relation to long-term surgical outcomes. RESULTS There was variation in the contribution of each test, and no single presurgical workup modality could singularly and reliably predict a seizure-free outcome. However, concordance of presurgical modalities yielded a high predictive value. No difference in long-term outcomes between inconclusive (normal or diffusely abnormal) and abnormal focal MRI results were found. Long-term survival analyses revealed a statistically significant association between seizure freedom and patients with focal ictal EEG, early surgical intervention, and no history of generalized convulsions. CONCLUSIONS Comprehensive preoperative evaluation utilizing multiple noninvasive functional imaging modalities is not redundant and can improve pediatric epilepsy surgical outcomes.
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Affiliation(s)
- Pongkiat Kankirawatana
- 1Division of Pediatric Neurology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Ismail S Mohamed
- 1Division of Pediatric Neurology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Jason Lauer
- 2Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Inmaculada Aban
- 3Division of Biostatistics, UAB School of Public Health, The University of Alabama at Birmingham, Alabama
| | - Hyunmi Kim
- 4Division of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Rong Li
- 5Department of Pathology, The University of Alabama at Birmingham, Alabama
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- 1Division of Pediatric Neurology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Monisha Goyal
- 1Division of Pediatric Neurology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Curtis J Rozzelle
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; and
| | - Robert Knowlton
- 7Department of Neurology, University of California, San Francisco, California
| | - Jeffrey P Blount
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; and
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van Lanen RHGJ, Colon AJ, Wiggins CJ, Hoeberigs MC, Hoogland G, Roebroeck A, Ivanov D, Poser BA, Rouhl RPW, Hofman PAM, Jansen JFA, Backes W, Rijkers K, Schijns OEMG. Ultra-high field magnetic resonance imaging in human epilepsy: A systematic review. Neuroimage Clin 2021; 30:102602. [PMID: 33652376 PMCID: PMC7921009 DOI: 10.1016/j.nicl.2021.102602] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
RATIONALE Resective epilepsy surgery is an evidence-based curative treatment option for patients with drug-resistant focal epilepsy. The major preoperative predictor of a good surgical outcome is detection of an epileptogenic lesion by magnetic resonance imaging (MRI). Application of ultra-high field (UHF) MRI, i.e. field strengths ≥ 7 Tesla (T), may increase the sensitivity to detect such a lesion. METHODS A keyword search strategy was submitted to Pubmed, EMBASE, Cochrane Database and clinicaltrials.gov to select studies on UHF MRI in patients with epilepsy. Follow-up study selection and data extraction were performed following PRISMA guidelines. We focused on I) diagnostic gain of UHF- over conventional MRI, II) concordance of MRI-detected lesion, seizure onset zone and surgical decision-making, and III) postoperative histopathological diagnosis and seizure outcome. RESULTS Sixteen observational cohort studies, all using 7T MRI were included. Diagnostic gain of 7T over conventional MRI ranged from 8% to 67%, with a pooled gain of 31%. Novel techniques to visualize pathological processes in epilepsy and lesion detection are discussed. Seizure freedom was achieved in 73% of operated patients; no seizure outcome comparison was made between 7T MRI positive, 7T negative and 3T positive patients. 7T could influence surgical decision-making, with high concordance of lesion and seizure onset zone. Focal cortical dysplasia (54%), hippocampal sclerosis (12%) and gliosis (8.1%) were the most frequently diagnosed histopathological entities. SIGNIFICANCE UHF MRI increases, yet variably, the sensitivity to detect an epileptogenic lesion, showing potential for use in clinical practice. It remains to be established whether this results in improved seizure outcome after surgical treatment. Prospective studies with larger cohorts of epilepsy patients, uniform scan and sequence protocols, and innovative post-processing technology are equally important as further increasing field strengths. Besides technical ameliorations, improved correlation of imaging features with clinical semiology, histopathology and clinical outcome has to be established.
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Affiliation(s)
- R H G J van Lanen
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.
| | - A J Colon
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - C J Wiggins
- Scannexus, Ultra High Field MRI Research Center, Maastricht, The Netherlands
| | - M C Hoeberigs
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - A Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - D Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - B A Poser
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - R P W Rouhl
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P A M Hofman
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W Backes
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - K Rijkers
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - O E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
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Focal cortical dysplasia: etiology, epileptogenesis, classification, clinical presentation, imaging, and management. Childs Nerv Syst 2020; 36:2939-2947. [PMID: 32766946 DOI: 10.1007/s00381-020-04851-9] [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: 04/05/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Focal cortical dysplasia (FCD) is the most prevalent cause of intractable epilepsy in children. It was first described by Taylor et al. in 1971. In 2011, the International League against Epilepsy described an international consensus of classification for FCD. However, the exact mechanism causing this pathology remains unclear. The diagnosis and recognition of FCD increase with the advances in neuroradiology and electrophysiology. FOCUS OF REVIEW In this paper, we discuss the literature regarding management of FCD with a focus on etiology, pathophysiology, classification, clinical presentation, and imaging modalities. We will also discuss certain variables affecting surgical outcome of patients with FCD. CONCLUSION Based on our review findings, it is concluded that surgical management with complete resection of the lesion following preoperative localization of the epileptogenic zone in patients with FCD subtypes can provide a seizure-free outcome.
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Novel tonometer device distinguishes brain stiffness in epilepsy surgery. Sci Rep 2020; 10:20978. [PMID: 33262385 PMCID: PMC7708453 DOI: 10.1038/s41598-020-77888-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
Complete surgical resection of abnormal brain tissue is the most important predictor of seizure freedom following surgery for cortical dysplasia. While lesional tissue is often visually indiscernible from normal brain, anecdotally, it is subjectively stiffer. We report the first experience of the use of a digital tonometer to understand the biomechanical properties of epilepsy tissue and to guide the conduct of epilepsy surgery. Consecutive epilepsy surgery patients (n = 24) from UCLA Mattel Children’s Hospital were recruited to undergo intraoperative brain tonometry at the time of open craniotomy for epilepsy surgery. Brain stiffness measurements were corrected with abnormalities on neuroimaging and histopathology using mixed-effects multivariable linear regression. We collected 249 measurements across 30 operations involving 24 patients through the pediatric epilepsy surgery program at UCLA Mattel Children’s Hospital. On multivariable mixed-effects regression, brain stiffness was significantly associated with the presence of MRI lesion (β = 32.3, 95%CI 16.3–48.2; p < 0.001), severity of cortical disorganization (β = 19.8, 95%CI 9.4–30.2; p = 0.001), and recent subdural grid implantation (β = 42.8, 95%CI 11.8–73.8; p = 0.009). Brain tonometry offers the potential of real-time intraoperative feedback to identify abnormal brain tissue with millimeter spatial resolution. We present the first experience with this novel intraoperative tool for the conduct of epilepsy surgery. A carefully designed prospective study is required to elucidate whether the clinical application of brain tonometry during resective procedures could guide the area of resection and improve seizure outcomes.
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Jackson HN, Gadgil N, Pan IW, Clarke DF, Wagner KM, Cronkite CA, Lam S. Sociodemographic Factors in Pediatric Epilepsy Surgery. Pediatr Neurol 2020; 107:71-76. [PMID: 32284204 DOI: 10.1016/j.pediatrneurol.2019.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite documented efficacy of surgical treatment in carefully selected patients, surgery is delayed and/or underutilized in both adult and children with focal onset epilepsy. The reasons for surgical delay are often assumed or theorized, and studies have predominantly targeted the adult population. To focus on a more targeted pediatric population and to determine identifiable reasons for intervention, this study aimed to investigate time to epilepsy surgery among pediatric patients with medically intractable epilepsy associated with focal cortical dysplasia and to identify sociodemographic and clinical associations in time to epilepsy surgery. METHODS We reviewed 96 consecutive pediatric patients who underwent surgery for medically intractable epilepsy with a diagnosis of focal cortical dysplasia. Descriptive statistics, univariate and multivariate analyses were conducted to study the association of sociodemographic variables of patients with focal cortical dysplasia and time to epilepsy surgery and postoperative seizure control. RESULTS We identified that non-white patients on average had a longer duration of epilepsy before surgery and traveled shorter distances for care. Non-white patients were more likely to have government-funded insurance. Patients who traveled the shortest distance to the surgical center underwent epilepsy surgery at an older age. CONCLUSIONS Sociodemographic factors of travel distance, insurance, and race influenced time to epilepsy surgery for children with focal cortical dysplasia. Further research is warranted to target barriers in access to subspecialty care and develop ways to identify earlier the patients who may benefit from evaluation and deployment of surgical intervention.
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Affiliation(s)
- Hudin N Jackson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Nisha Gadgil
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - I-Wen Pan
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas
| | - Dave F Clarke
- Division of Pediatric Neurology, Department of Neurology, Dell Medical School University of Texas at Austin, Austin, Texas
| | - Kathryn M Wagner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Sandi Lam
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Bartolini E, Cosottini M, Costagli M, Barba C, Tassi L, Spreafico R, Garbelli R, Biagi L, Buccoliero A, Giordano F, Guerrini R. Ultra-High-Field Targeted Imaging of Focal Cortical Dysplasia: The Intracortical Black Line Sign in Type IIb. AJNR Am J Neuroradiol 2019; 40:2137-2142. [PMID: 31727747 DOI: 10.3174/ajnr.a6298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging has limitations in detecting focal cortical dysplasia. We assessed the added value of 7T in patients with histologically proved focal cortical dysplasia to highlight correlations between neuropathology and ultra-high-field imaging. MATERIALS AND METHODS Between 2013 and 2019, we performed a standardized 7T MR imaging protocol in patients with drug-resistant focal epilepsy. We focused on 12 patients in whom postsurgical histopathology revealed focal cortical dysplasia and explored the diagnostic yield of preoperative 7T versus 1.5/3T MR imaging and the correlations of imaging findings with histopathology. We also assessed the relationship between epilepsy surgery outcome and the completeness of surgical removal of the MR imaging-visible structural abnormality. RESULTS We observed clear abnormalities in 10/12 patients using 7T versus 9/12 revealed by 1.5/3T MR imaging. In patients with focal cortical dysplasia I, 7T MR imaging did not disclose morphologic abnormalities (n = 0/2). In patients with focal cortical dysplasia II, 7T uncovered morphologic signs that were not visible on clinical imaging in 1 patient with focal cortical dysplasia IIa (n = 1/4) and in all those with focal cortical dysplasia IIb (n = 6/6). T2*WI provided the highest added value, disclosing a peculiar intracortical hypointense band (black line) in 5/6 patients with focal cortical dysplasia IIb. The complete removal of the black line was associated with good postsurgical outcome (n = 4/5), while its incomplete removal yielded unsatisfactory results (n = 1/5). CONCLUSIONS The high sensitivity of 7T T2*-weighted images provides an additional tool in defining potential morphologic markers of high epileptogenicity within the dysplastic tissue of focal cortical dysplasia IIb and will likely help to more precisely plan epilepsy surgery and explain surgical failures.
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Affiliation(s)
- E Bartolini
- From the Department of Pediatric Neurology (E.B., C.B., A.B., R. Guerrini).,Neurology Unit (E.B.), USL Centro Toscana, Nuovo Ospedale Santo Stefano, Prato, Italy
| | - M Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery (M. Cosottini), University of Pisa, Pisa, Italy
| | - M Costagli
- IMAGO7 Research Foundation (M. Costagli), Pisa, Italy
| | - C Barba
- From the Department of Pediatric Neurology (E.B., C.B., A.B., R. Guerrini)
| | - L Tassi
- Epilepsy Surgery Centre C. Munari (L.T.), Ospedale Niguarda, Milano, Italy
| | - R Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit (R.S., R. Garbelli), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico C. Besta, Milano, Italy
| | - R Garbelli
- Clinical Epileptology and Experimental Neurophysiology Unit (R.S., R. Garbelli), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico C. Besta, Milano, Italy
| | - L Biagi
- Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris (L.B., R. Guerrini), Pisa, Italy
| | - A Buccoliero
- From the Department of Pediatric Neurology (E.B., C.B., A.B., R. Guerrini)
| | - F Giordano
- Neurogenetics and Neurobiology Unit and Laboratories, and Pediatric Neurosurgery Unit (F.G.), Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - R Guerrini
- From the Department of Pediatric Neurology (E.B., C.B., A.B., R. Guerrini) .,Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris (L.B., R. Guerrini), Pisa, Italy
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Chen J, Huang Z, Li L, Ren L, Wang Y. Histological type of focal cortical dysplasia is associated with the risk of postsurgical seizure in children and adolescents. Ther Clin Risk Manag 2019; 15:877-884. [PMID: 31371975 PMCID: PMC6628944 DOI: 10.2147/tcrm.s203039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/14/2019] [Indexed: 01/23/2023] Open
Abstract
Aim Focal cortical dysplasia (FCD) is a common cause of refractory epilepsy in children and adolescents. Epilepsy surgery is a treatment option for FCD. This study aimed to investigate the relationship between postsurgical outcomes and FCD types according to the International League Against Epilepsy (ILAE) classification and assess prognostic factors in pediatric and adolescent epilepsy surgery. Methods We retrospectively analyzed 92 children and adolescents with a proven pathological diagnosis of FCD who underwent resective surgery at our epilepsy center between August 2012 and September 2015. The patients were followed up for at least 1 year to evaluate the surgical outcomes, and a multivariable regression analysis was performed to identify risk factors of seizure relapse. Results After surgery, 53.3% of the patients were completely seizure-free during the entire follow-up period. The FCD types, incomplete resection of the epileptic cortex, and use of intracranial electrode were independent risk factors of seizure recurrence. The patients with FCD type II had relatively favorable surgical outcomes compared to the patients with FCD type I. The difference in the postoperative outcome between patients with FCD types III and I was not significant. Conclusion There is a significant association between FCD types and surgical outcomes in children and adolescents with epilepsy. These findings provide guidance for the optimization of surgical strategies.
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Affiliation(s)
- Jia Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation , Beijing 100053, People's Republic of China
| | - Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation , Beijing 100053, People's Republic of China
| | - Liping Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation , Beijing 100053, People's Republic of China
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation , Beijing 100053, People's Republic of China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation , Beijing 100053, People's Republic of China
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Abstract
BACKGROUND This is an updated version of the original Cochrane review, published in 2015.Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary between at least 20% and up to 70%. If the epileptogenic zone can be located, surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.Secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence, and to identify the factors that correlate with remission of seizures postoperatively. SEARCH METHODS For the latest update, we searched the following databases on 11 March 2019: Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to March 08, 2019), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) that included at least 30 participants in a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), with an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome related to postoperative seizure control. Cohort studies or case series were included in the previous version of this review. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportions of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RRs) and 95% confidence intervals (95% CIs). MAIN RESULTS We identified 182 studies with a total of 16,855 included participants investigating outcomes of surgery for epilepsy. Nine studies were RCTs (including two that randomised participants to surgery or medical treatment (99 participants included in the two trials received medical treatment)). Risk of bias in these RCTs was unclear or high. Most of the remaining 173 non-randomised studies followed a retrospective design. We assessed study quality using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses, we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across domains.In terms of freedom from seizures, two RCTs found surgery (n = 97) to be superior to medical treatment (n = 99); four found no statistically significant differences between anterior temporal lobectomy (ATL) with or without corpus callosotomy (n = 60), between subtemporal or transsylvian approach to selective amygdalohippocampectomy (SAH) (n = 47); between ATL, SAH and parahippocampectomy (n = 43) or between 2.5 cm and 3.5 cm ATL resection (n = 207). One RCT found total hippocampectomy to be superior to partial hippocampectomy (n = 70) and one found ATL to be superior to stereotactic radiosurgery (n = 58); and another provided data to show that for Lennox-Gastaut syndrome, no significant differences in seizure outcomes were evident between those treated with resection of the epileptogenic zone and those treated with resection of the epileptogenic zone plus corpus callosotomy (n = 43). We judged evidence from the nine RCTs to be of moderate to very low quality due to lack of information reported about the randomised trial design and the restricted study populations.Of the 16,756 participants included in this review who underwent a surgical procedure, 10,696 (64%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to recording of adverse events to be very poor.In total, 120 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography, history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection, and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation, and presence of postoperative discharges were prognostic factors of outcome.Twenty-nine studies reported multi-variable models of prognostic factors, and showed that the direction of association of factors with outcomes was generally the same as that found in univariate analyses.We observed variability in many of our analyses, likely due to small study sizes with unbalanced group sizes and variation in the definition of seizure outcome, the definition of prognostic factors, and the influence of the site of surgery AUTHORS' CONCLUSIONS: Study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcomes. Future research should be of high quality, follow a prospective design, be appropriately powered, and focus on specific issues related to diagnostic tools, the site-specific surgical approach, and other issues such as extent of resection. Researchers should investigate prognostic factors related to the outcome of surgery via multi-variable statistical regression modelling, where variables are selected for modelling according to clinical relevance, and all numerical results of the prognostic models are fully reported. Journal editors should not accept papers for which study authors did not record adverse events from a medical intervention. Researchers have achieved improvements in cancer care over the past three to four decades by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Sarah J Nevitt
- University of LiverpoolDepartment of BiostatisticsBlock F, Waterhouse Building1‐5 Brownlow HillLiverpoolUKL69 3GL
| | - Jennifer Cotton
- The Clatterbridge Cancer Centre NHS Foundation TrustWirralUK
| | - Sacha Gandhi
- NHS Ayrshire and ArranDepartment of General SurgeryAyrUKKA6 6DX
| | - Jennifer Weston
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolMerseysideUKL9 7LJ
| | - Ajay Sudan
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Roberto Ramirez
- Royal Manchester Children's HospitalHospital RoadPendleburyManchesterUKM27 4HA
| | - Richard Newton
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
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Choi SA, Kim KJ. The Surgical and Cognitive Outcomes of Focal Cortical Dysplasia. J Korean Neurosurg Soc 2019; 62:321-327. [PMID: 31085958 PMCID: PMC6514316 DOI: 10.3340/jkns.2019.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/26/2019] [Indexed: 11/27/2022] Open
Abstract
Focal cortical dysplasia (FCD) is the major cause of intractable focal epilepsy in childhood leading to epilepsy surgery. The overall seizure freedom after surgery ranges between 50–75% at 2 years after surgery and the long-term seizure freedom remain relatively stable. Seizure outcome after surgery depends on a various factors such as pathologic etiologies, extent of lesion, and types of surgery. Therefore, seizure outcome after surgery for FCD should be analyzed carefully considering cohorts’ characteristics. Studies of pediatric epilepsy surgery emphasize the early surgical intervention for a better cognition. Early surgical intervention and cessation of seizure activity are important for children with intractable epilepsy. However, there are limited data on the cognitive outcome after surgery in pediatric FCD, requiring further investigation. This paper reviews the seizure and cognitive outcomes of epilepsy surgery for FCD in children. Several prognostic factors influencing seizure outcome after surgery will be discussed in detail.
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Affiliation(s)
- Sun Ah Choi
- Department of Pediatrics, Dankook University Hospital, Cheonan, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Wang W, Lin Y, Wang S, Jones S, Prayson R, Moosa ANV, McBride A, Gonzalez-Martinez J, Bingaman W, Najm I, Alexopoulos A, Wang ZI. Voxel-based morphometric magnetic resonance imaging postprocessing in non-lesional pediatric epilepsy patients using pediatric normal databases. Eur J Neurol 2019; 26:969-e71. [PMID: 30685877 DOI: 10.1111/ene.13916] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Pre-surgical evaluation of pediatric patients with drug-resistant focal epilepsy and negative (non-lesional) magnetic resonance imaging (MRI) is particularly challenging. Focal cortical dysplasia (FCD), a frequent pathological substrate in such setting, may be subtle on MRI and evade detection. The aim of this study was to use voxel-based MRI postprocessing to improve the detection of subtle FCD in pediatric surgical candidates. METHODS A consecutive cohort of pediatric patients undergoing pre-surgical evaluation with a negative MRI by visual analysis was included. MRI postprocessing was performed using a voxel-based morphometric analysis program (MAP) on T1-weighted volumetric MRI, with comparison to an age-specific normal pediatric database. The pertinence of MAP-positive areas was confirmed by surgical outcome and pathology. RESULTS A total of 78 patients were included. Forty-four patients (56%) had positive MAP regions. Complete resection of the MAP-positive regions was positively associated with seizure-free outcome compared with the no/partial resection group (P < 0.001). Patients with no/partial resection of the MAP-positive regions had worse seizure outcomes than the MAP-negative group (P = 0.002). The MAP-positive rate was 100%, 77%, 63% and 40% in the 3-5, 5-10, 10-15 and 15-21 year age groups, respectively. MAP-positive rates were 45% in patients with temporal resection and 63% in patients with extratemporal resection. Complete resection of the MAP-positive regions was positively associated with seizure-free outcome in the extratemporal group (P = 0.001) but not in the temporal group (P = 0.070). CONCLUSION Our data suggest the importance of using MRI postprocessing in the pre-surgical evaluation process of pediatric epilepsy patients with apparently normal MRI.
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Affiliation(s)
- W Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Epilepsy Center, Cleveland Clinic Foundation (CCF), Cleveland, OH, USA
| | - Y Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Epilepsy Center, Cleveland Clinic Foundation (CCF), Cleveland, OH, USA
| | - S Wang
- Epilepsy Center, Cleveland Clinic Foundation (CCF), Cleveland, OH, USA.,Epilepsy Center, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - S Jones
- Imaging Institute, CCF, Cleveland, OH, USA
| | - R Prayson
- Department of Anatomic Pathology, CCF, Cleveland, OH, USA
| | - A N V Moosa
- Epilepsy Center, Cleveland Clinic Foundation (CCF), Cleveland, OH, USA
| | - A McBride
- Cleveland Clinic Lerner College of Medicine, CCF, Cleveland, OH, USA
| | | | - W Bingaman
- Department of Neurosurgery, CCF, Cleveland, OH, USA
| | - I Najm
- Epilepsy Center, Cleveland Clinic Foundation (CCF), Cleveland, OH, USA
| | - A Alexopoulos
- Epilepsy Center, Cleveland Clinic Foundation (CCF), Cleveland, OH, USA
| | | | - Z I Wang
- Epilepsy Center, Cleveland Clinic Foundation (CCF), Cleveland, OH, USA
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15
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Gupta L, Hofman PAM, Besseling RMH, Jansen JFA, Backes WH. Abnormal Blood Oxygen Level-Dependent Fluctuations in Focal Cortical Dysplasia and the Perilesional Zone: Initial Findings. AJNR Am J Neuroradiol 2018; 39:1310-1315. [PMID: 29794237 DOI: 10.3174/ajnr.a5684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/01/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Focal cortical dysplasia is a common cause of intractable epilepsy for which neurosurgery is an option. Delineations of a focal cortical dysplasia lesion on structural brain images may not necessarily reflect the functional borders of normal tissue. Our objective was to determine whether abnormalities in spontaneous blood oxygen level-dependent fluctuations arise in focal cortical dysplasia lesions and proximal regions. MATERIALS AND METHODS Fourteen patients with focal cortical dysplasia-related epilepsy and 16 healthy controls underwent structural and resting-state functional MR imaging. Three known blood oxygen level-dependent measures were determined, including the fractional amplitude of low-frequency fluctuations, regional homogeneity, and wavelet entropy. These measures were evaluated in the lesion and perilesional zone and normalized to the contralateral cortex of patients with focal cortical dysplasia and healthy controls. RESULTS Patients showed significantly decreased fractional amplitude of low-frequency fluctuations and increased wavelet entropy in the focal cortical dysplasia lesion and the perilesional zone (≤2 cm) relative to the contralateral homotopic cortex and the same regions in healthy controls. Regional homogeneity was significantly increased in the focal cortical dysplasia lesion compared with the contralateral homotopic cortex and healthy controls. CONCLUSIONS Abnormalities in spontaneous blood oxygen level-dependent fluctuations were seen up to 2 cm distant from the radiologically visible boundary. It was demonstrated that functional boundaries go beyond structural boundaries of focal cortical dysplasia lesions. Validation is required to reveal whether this information is valuable for surgical planning and outcome evaluation of focal cortical dysplasia lesions and comparing current results with electrophysiologic analysis.
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Affiliation(s)
- L Gupta
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
| | - P A M Hofman
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- School for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R M H Besseling
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- Department of Electrical Engineering (R.M.H.B.), Eindhoven University of Technology, Eindhoven, the Netherlands
| | - J F A Jansen
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- School for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - W H Backes
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- School for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
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Choi SA, Kim SY, Kim H, Kim WJ, Kim H, Hwang H, Choi JE, Lim BC, Chae JH, Chong S, Lee JY, Phi JH, Kim SK, Wang KC, Kim KJ. Surgical outcome and predictive factors of epilepsy surgery in pediatric isolated focal cortical dysplasia. Epilepsy Res 2017; 139:54-59. [PMID: 29197666 DOI: 10.1016/j.eplepsyres.2017.11.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/26/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is a common cause of medically intractable epilepsy in children. Epilepsy surgery has been a valuable treatment option to achieve seizure freedom in these intractable epilepsy patients. We aimed to present long-term surgical outcome, in relation to pathological severity, and to assess predictive factors of epilepsy surgery in pediatric isolated FCD. METHODS We retrospectively analyzed the data of 58 children and adolescents, with FCD International League Against Epilepsy (ILAE) task force classification types I and II, who underwent resective epilepsy surgery and were followed for at least 2 years after surgery. RESULTS The mean age at epilepsy onset was 4.3 years (0-14.2 years), and mean age at epilepsy surgery was 9.4 years (0.4-17.5 years). The mean duration of postoperative follow-up was 5.1±2.6 years (2-12.4 years). Of 58 patients, 62% of patients achieved Engel class I at 2 years postoperatively, 58% at 5 years postoperatively, and 53% at the last follow up. Forty eight percent of our cohort successfully discontinued antiepileptic medication. Of 30 patients with seizure recurrence, 83% of seizures recurred within 2 years after surgery. We observed that FCD type IIb was significantly associated with a better surgical outcome. At fifth postoperative year, 88% of FCD IIb patients were seizure free compared with 21% of type I and 57% of type IIa patients (P=0.043). By multivariate analysis, lesion on MRI (P=0.02) and complete resection (P<0.01) were the most important predictive factors for a seizure-free outcome. SIGNIFICANCE Epilepsy surgery is highly effective; more than half of medically intractable epilepsy patients achieved seizure freedom after surgery. In addition, we found significant difference in surgical outcomes according to the ILAE task force classification. Lesion on MRI and complete resection were the most important predictive factors for favorable seizure outcome in isolated FCD patients.
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Affiliation(s)
- Sun Ah Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyuna Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ji Eun Choi
- Department of Pediatrics, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Byung Chan Lim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sangjoon Chong
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Ki Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Dwivedi R, Ramanujam B, Chandra PS, Sapra S, Gulati S, Kalaivani M, Garg A, Bal CS, Tripathi M, Dwivedi SN, Sagar R, Sarkar C, Tripathi M. Surgery for Drug-Resistant Epilepsy in Children. N Engl J Med 2017; 377:1639-1647. [PMID: 29069568 DOI: 10.1056/nejmoa1615335] [Citation(s) in RCA: 344] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neurosurgical treatment may improve seizures in children and adolescents with drug-resistant epilepsy, but additional data are needed from randomized trials. METHODS In this single-center trial, we randomly assigned 116 patients who were 18 years of age or younger with drug-resistant epilepsy to undergo brain surgery appropriate to the underlying cause of epilepsy along with appropriate medical therapy (surgery group, 57 patients) or to receive medical therapy alone (medical-therapy group, 59 patients). The patients in the medical-therapy group were assigned to a waiting list for surgery. The primary outcome was freedom from seizures at 12 months. Secondary outcomes were the score on the Hague Seizure Severity scale, the Binet-Kamat intelligence quotient, the social quotient on the Vineland Social Maturity Scale, and scores on the Child Behavior Checklist and the Pediatric Quality of Life Inventory. RESULTS At 12 months, freedom from seizures occurred in 44 patients (77%) in the surgery group and in 4 (7%) in the medical-therapy group (P<0.001). Between-group differences in the change from baseline to 12 months significantly favored surgery with respect to the score on the Hague Seizure Severity scale (difference, 19.4; 95% confidence interval [CI], 15.8 to 23.1; P<0.001), on the Child Behavior Checklist (difference, 13.1; 95% CI, 10.7 to 15.6; P<0.001), on the Pediatric Quality of Life Inventory (difference, 21.9; 95% CI, 16.4 to 27.6; P<0.001), and on the Vineland Social Maturity Scale (difference, 4.7; 95% CI, 0.4 to 9.1; P=0.03), but not on the Binet-Kamat intelligence quotient (difference, 2.5; 95% CI, -0.1 to 5.1; P=0.06). Serious adverse events occurred in 19 patients (33%) in the surgery group, including hemiparesis in 15 (26%). CONCLUSIONS In this single-center trial, children and adolescents with drug-resistant epilepsy who had undergone epilepsy surgery had a significantly higher rate of freedom from seizures and better scores with respect to behavior and quality of life than did those who continued medical therapy alone at 12 months. Surgery resulted in anticipated neurologic deficits related to the region of brain resection. (Funded by the Indian Council of Medical Research and others; Clinical Trial Registry-India number, CTRI/2010/091/000525 .).
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Affiliation(s)
- Rekha Dwivedi
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Savita Sapra
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Chandra S Bal
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Sada N Dwivedi
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
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Comparison of the diagnostic accuracy of PET/MRI to PET/CT-acquired FDG brain exams for seizure focus detection: a prospective study. Pediatr Radiol 2017; 47:1500-1507. [PMID: 28512714 DOI: 10.1007/s00247-017-3888-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/23/2017] [Accepted: 05/02/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is great interest in positron emission tomography (PET)/magnetic resonance (MR) as a clinical tool due to its capacity to provide diverse diagnostic information in a single exam. OBJECTIVE The goal of this exam is to compare the diagnostic accuracy of PET/MR-acquired [F-18]2-fluoro-2-deoxyglucose (FDG) brain exams to that of PET/CT with respect to identifying seizure foci in children with localization-related epilepsy. MATERIALS AND METHODS Institutional Review Board approval and informed consent were obtained for this Health Insurance Portability and Accountability Act-compliant, prospective study. All patients referred for clinical FDG-PET/CT exams of the brain at our institution for a diagnosis of localization-related epilepsy were prospectively recruited to undergo an additional FDG-PET acquisition on a tandem PET/MR system. Attenuation-corrected FDG images acquired at PET/MR and PET/CT were interpreted independently by five expert readers. Readers were blinded to the scanner used for acquisition and attenuation correction as well as all other clinical and imaging data. A Likert scale scoring system (1-5) was used to assess image quality. The locale of seizure origin determined at multidisciplinary epilepsy surgery work rounds was considered the reference standard. Non-inferiority testing for paired data was used to compare the diagnostic accuracy of PET/MR to that of PET/CT. RESULTS The final study population comprised 35 patients referred for a diagnosis of localization-related epilepsy (age range: 2-19 years; median: 11 years; 21 males, 14 females). Image quality did not differ significantly between the two modalities. The accuracy of PET/MR was not inferior to that of PET/CT for localization of a seizure focus (P=0.017). CONCLUSION The diagnostic accuracy of FDG-PET images acquired on a PET/MR scanner and generated using MR-based attenuation correction was not inferior to that of PET images processed by traditional CT-based correction.
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Isler C, Kucukyuruk B, Ozkara C, Gunduz A, Is M, Tanriverdi T, Comunoglu N, Oz B, Uzan M. Comparison of clinical features and surgical outcome in focal cortical dysplasia type 1 and type 2. Epilepsy Res 2017; 136:130-136. [PMID: 28850830 DOI: 10.1016/j.eplepsyres.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/09/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Recent ILAE classification defined focal cortical dysplasia (FCD) patients with accompanying epileptic lesions as a separate group. We investigated data of patients with sole FCD lesions regarding long-term seizure outcome and different characteristics of FCD type 1 and type 2 patients. METHODS Eighty children and adult patients underwent surgery for FCD were included to the analysis of factors differentiating FCD type 1 and type 2 groups and their effect on long-term outcome. RESULTS FCD type 2 patients had earlier epilepsy onset (8.1 vs. 6.1 years. p=0.019) and underwent surgery younger than type 1 (18.2 vs. 23.7 years. p=0.034). FCD type 2 patients were more prominently MR positive (77.8% vs. 53.8%. p=0.029), which increased within FCD type 2 group as patients become younger (p=0.028). FCD Type 1 lesions showed mostly multilobar extension and FCD type 2 mostly located in frontal lobe. Seizure freedom was achieved in 65.4% of FCD type 1 patients and 70.4% of FCD type 2 patients. Seven patients had permanent de novo neurological deficits. Mean follow-up time was 5.5 years (Range: 1-11 years). CONCLUSION Surgical intervention in carefully selected patients may facilitate favorable seizure outcome leading to better quality of life. FCD type 1 and type 2 groups present with evident differences, which may promote medical and surgical management of these pathologies.
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Affiliation(s)
- Cihan Isler
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Kucukyuruk
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cigdem Ozkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysegul Gunduz
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Merih Is
- Department of Neurosurgery, Fatih Sultan Mehmet Research and Education Hospital, Health Sciences University, Istanbul, Turkey
| | - Taner Tanriverdi
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Uzan
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Paldino MJ, Chu ZD, Chapieski ML, Golriz F, Zhang W. Repeatability of graph theoretical metrics derived from resting-state functional networks in paediatric epilepsy patients. Br J Radiol 2017; 90:20160656. [PMID: 28406312 PMCID: PMC5602170 DOI: 10.1259/bjr.20160656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 03/29/2017] [Accepted: 04/12/2017] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To measure the repeatability of metrics that quantify brain network architecture derived from resting-state functional MRI in a cohort of paediatric patients with epilepsy. METHODS We identified patients with: (1) epilepsy; (2) brain MRI at 3 T; (3) two identical resting-state functional MRI acquisitions performed on the same day. Undirected, weighted networks were constructed based on the resting-state time series using a range of processing parameters including parcellation size and graph threshold. The following topological properties were calculated: degree, strength, characteristic path length, global efficiency, clustering coefficient, modularity and small worldness. Based on repeated measures, we then calculated: (1) Pearson correlation coefficient; (2) intraclass correlation coefficient; (3) root-mean-square coefficient of variation; (4) repeatability coefficient; and (5) 95% confidence limits for change. RESULTS 26 patients were included (age range: 4-21 years). Correlation coefficients demonstrated a highly consistent relationship between repeated observations for all metrics, and the intraclass correlation coefficients were generally in the excellent range. Repeatability in the data set was not significantly influenced by parcellation size. However, trends towards decreased repeatability were observed at higher graph thresholds. CONCLUSION These findings demonstrate the reliability of network metrics in a cohort of paediatric patients with epilepsy. Advances in knowledge: Our results point to the potential for graph theoretical analyses of resting-state data to provide reliable markers of network architecture in children with epilepsy. At the level of an individual patient, change over time greater than the repeatability coefficient or 95% confidence limits for change is unlikely to be related to intrinsic variability of the method.
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Affiliation(s)
- Michael J Paldino
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Zili D Chu
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Mary L Chapieski
- Department of Pediatric Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Farahnaz Golriz
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Wei Zhang
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA
- Outcomes and Impact Service, Texas Children's Hospital, Houston, TX, USA
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Sun Y, Wang X, Che N, Qin H, Liu S, Wu X, Wei M, Cheng H, Yin J. Clinical characteristics and epilepsy outcomes following surgery caused by focal cortical dysplasia (type IIa) in 110 adult epileptic patients. Exp Ther Med 2017; 13:2225-2234. [PMID: 28565831 PMCID: PMC5443177 DOI: 10.3892/etm.2017.4315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/21/2016] [Indexed: 11/09/2022] Open
Abstract
The aim of the present study was to investigate the effects of surgical intervention of focal cortical dysplasia (FCD) IIa on the outcome of epilepsy, and to evaluate the prognostic factors of seizure freedom. Patient data from epilepsy surgeries were retrospectively reviewed at the Second Affiliated Hospital of Dalian Medical University between 2007 and 2015. A total of 110 patients with a definite pathological diagnosis of FCD IIa were included. Moreover, the clinical characteristics, seizure outcome and quality of life in adults with FCD IIa were evaluated. The Engel seizure outcome achievements were class I in 72, class II in 20, class III in 11 and class IV in 7 patients. In addition, the Engel seizure outcome was relevant with the resection range of the lesions (P=0.028). The assessments of electrocorticography (ECoG) patterns and magnetic resonance imaging (MRI) are relevant to determining the extent of the resection, which may influence the surgery outcome (P=0.001 and P=0.023). Using multivariate regression analyses, the extent of resection, seizure frequency, preoperative ECoG and location of resection were the most important risk factors for seizure recurrence. The results of quality of life in epilepsy-10 scoring revealed that the quality of life improved significantly following surgery (P<0.01). Moreover, surgical intervention, EcoG, MRI positioning and complete resection helped to have improved seizure control, relief of anxiety and quality of life. All these observations strongly recommend an early consideration of epilepsy surgery in FCD IIa patients.
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Affiliation(s)
- Yuqiang Sun
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China.,Department of Neurosurgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150036, P.R. China
| | - Xiaofeng Wang
- Department of Neurosurgery, Weinan Central Hospital, Weinan, Shaanxi 714000, P.R. China
| | - Ningwei Che
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Huamin Qin
- Department of Pathology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Shuping Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Xinling Wu
- Department of Psychology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Minghai Wei
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Huakun Cheng
- Department of Neurosurgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150036, P.R. China
| | - Jian Yin
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
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Veersema TJ, Ferrier CH, van Eijsden P, Gosselaar PH, Aronica E, Visser F, Zwanenburg JM, de Kort GAP, Hendrikse J, Luijten PR, Braun KPJ. Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy. Epilepsia Open 2017; 2:162-171. [PMID: 29588945 PMCID: PMC5719847 DOI: 10.1002/epi4.12041] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study is to determine whether the use of 7 tesla (T) MRI in clinical practice leads to higher detection rates of focal cortical dysplasias in possible candidates for epilepsy surgery. Methods In our center patients are referred for 7 T MRI if lesional focal epilepsy is suspected, but no abnormalities are detected at one or more previous, sufficient‐quality lower‐field MRI scans, acquired with a dedicated epilepsy protocol, or when concealed pathology is suspected in combination with MR‐visible mesiotemporal sclerosis—dual pathology. We assessed 40 epilepsy patients who underwent 7 T MRI for presurgical evaluation and whose scans (both 7 T and lower field) were discussed during multidisciplinary epilepsy surgery meetings that included a dedicated epilepsy neuroradiologist. We compared the conclusions of the multidisciplinary visual assessments of 7 T and lower‐field MRI scans. Results In our series of 40 patients, multidisciplinary evaluation of 7 T MRI identified additional lesions not seen on lower‐field MRI in 9 patients (23%). These findings were guiding in surgical planning. So far, 6 patients underwent surgery, with histological confirmation of focal cortical dysplasia or mild malformation of cortical development. Significance Seven T MRI improves detection of subtle focal cortical dysplasia and mild malformations of cortical development in patients with intractable epilepsy and may therefore contribute to identification of surgical candidates and complete resection of the epileptogenic lesion, and thus to postoperative seizure freedom.
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Affiliation(s)
- Tim J. Veersema
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Cyrille H. Ferrier
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Pieter van Eijsden
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Peter H. Gosselaar
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Eleonora Aronica
- Department of (Neuro)PathologyAcademic Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
- Center for NeuroscienceSwammerdam Institute for Life SciencesUniversity of AmsterdamAmsterdamthe Netherlands
- SEIN—Stichting Epilepsie Instellingen NederlandHeemstedethe Netherlands
| | | | - Jaco M. Zwanenburg
- Department of RadiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - Jeroen Hendrikse
- Department of RadiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Peter R. Luijten
- Department of RadiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Kees P. J. Braun
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
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Paldino MJ, Golriz F, Chapieski ML, Zhang W, Chu ZD. Brain Network Architecture and Global Intelligence in Children with Focal Epilepsy. AJNR Am J Neuroradiol 2017; 38:349-356. [PMID: 27737853 PMCID: PMC7963842 DOI: 10.3174/ajnr.a4975] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 08/29/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE The biologic basis for intelligence rests to a large degree on the capacity for efficient integration of information across the cerebral network. We aimed to measure the relationship between network architecture and intelligence in the pediatric, epileptic brain. MATERIALS AND METHODS Patients were retrospectively identified with the following: 1) focal epilepsy; 2) brain MR imaging at 3T, including resting-state functional MR imaging; and 3) full-scale intelligence quotient measured by a pediatric neuropsychologist. The cerebral cortex was parcellated into approximately 700 gray matter network "nodes." The strength of a connection between 2 nodes was defined by the correlation between their blood oxygen level-dependent time-series. We calculated the following topologic properties: clustering coefficient, transitivity, modularity, path length, and global efficiency. A machine learning algorithm was used to measure the independent contribution of each metric to the intelligence quotient after adjusting for all other metrics. RESULTS Thirty patients met the criteria (4-18 years of age); 20 patients required anesthesia during MR imaging. After we accounted for age and sex, clustering coefficient and path length were independently associated with full-scale intelligence quotient. Neither motion parameters nor general anesthesia was an important variable with regard to accurate intelligence quotient prediction by the machine learning algorithm. A longer history of epilepsy was associated with shorter path lengths (P = .008), consistent with reorganization of the network on the basis of seizures. Considering only patients receiving anesthesia during machine learning did not alter the patterns of network architecture contributing to global intelligence. CONCLUSIONS These findings support the physiologic relevance of imaging-based metrics of network architecture in the pathologic, developing brain.
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Affiliation(s)
- M J Paldino
- From the Departments of Radiology (M.J.P., F.G., Z.D.C.)
| | - F Golriz
- From the Departments of Radiology (M.J.P., F.G., Z.D.C.)
| | | | - W Zhang
- Outcomes and Impact Service (W.Z.), Texas Children's Hospital, Houston, Texas
| | - Z D Chu
- From the Departments of Radiology (M.J.P., F.G., Z.D.C.)
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To Wean or Not to Wean, That Is the Question; the Downside of Maintaining Antiepileptic Drugs After Pediatric Epilepsy Surgery. Epilepsy Curr 2016; 16:96-7. [PMID: 27073340 DOI: 10.5698/1535-7511-16.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Rubinger L, Chan C, D'Arco F, Moineddin R, Muthaffar O, Rutka JT, Snead OC, Smith ML, Widjaja E. Change in presurgical diagnostic imaging evaluation affects subsequent pediatric epilepsy surgery outcome. Epilepsia 2015; 57:32-40. [PMID: 26715387 DOI: 10.1111/epi.13229] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Since 2008, we have changed our presurgical diagnostic imaging evaluation for medically refractory focal epilepsy to include high-resolution epilepsy protocol on 3 T magnetic resonance imaging (MRI), and combined magnetoencephalography and 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) in selected patients with normal or subtle changes on MRI or discordant diagnostic tests. The aim of this study was to evaluate the effectiveness of the change in imaging practice on epilepsy surgery outcome in a tertiary pediatric epilepsy surgery center. METHODS The change in practice occurred in early 2008, and patients were classified based on old or new practice. The patient characteristics, surgical variables, and seizure-free surgical outcome were compared, and the trend in seizure-free outcome over time was assessed. RESULTS There was a trend for increased abnormal MRI (92% vs. 86%, respectively, p = 0.062), and increased utilization of FDG-PET (34% vs. 3% respectively, p < 0.001) with new relative to old practice. There were no statistically significant differences in invasive monitoring, location, and type of surgery and histology between the two periods (all p > 0.05). During the old practice, there was no statistically significant change in yearly trend of seizure-free outcome (odds ratio [OR] 0.960, 95% confidence interval [CI] 0.875-1.053, p = 0.386). The change in practice in 2008 was associated with a significant improvement in seizure-free outcome (OR 1.535, 95% CI 1.100-2.142, p = 0.012). During the new practice, there was a significant positive trend in yearly seizure-free outcome (OR 1.219, 95% CI 1.053-1.411, p = 0.008), after adjusting for age at seizure onset, invasive monitoring, location and type of surgery, histology, MRI, magnetoencephalography, and FDG-PET. SIGNIFICANCE We have found an improvement in seizure-free surgical outcome following the change in imaging practice. This study highlights the importance of optimizing and improving presurgical diagnostic imaging evaluation to improve surgical outcome.
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Affiliation(s)
- Luc Rubinger
- Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carol Chan
- Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Felice D'Arco
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Osama Muthaffar
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - James T Rutka
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - O Carter Snead
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
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Paldino MJ, Hedges K, Golriz F. The Arcuate Fasciculus and Language Development in a Cohort of Pediatric Patients with Malformations of Cortical Development. AJNR Am J Neuroradiol 2015; 37:169-75. [PMID: 26381551 DOI: 10.3174/ajnr.a4461] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/12/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with epilepsy and malformations of cortical development have a high prevalence of language deficits. The purpose of this study was to investigate whether the status of the arcuate fasciculus at diffusion tractography could provide a clinically meaningful marker of language function in patients with cortical malformations. MATERIALS AND METHODS Thirty-seven patients 3-18 years of age who had DTI performed at 3T and language evaluation by a pediatric neurologist were retrospectively identified. Twenty-two age-matched children without any neurologic, language, or MR imaging abnormalities who had identical DTI performed for an indication of headache were selected as a control cohort. The arcuate fasciculi were constructed and segmented by deterministic tractography for all subjects. RESULTS Twenty-one patients had intact language; 11 had mild-to-moderate and 5, profound language impairment. All patients with normal language and all control subjects had an identifiable left arcuate. The left arcuate was absent in 11 patients; all 11 were language-impaired. Failure to identify the left arcuate was strongly associated with some degree of language impairment (P < .001). Sensitivity, specificity, and positive predictive value for language dysfunction were 65%, 100%, and 100%, respectively. The absence of the arcuate bilaterally was associated with complete failure to develop oral language (P < .015). CONCLUSIONS Failure to identify the left arcuate fasciculus at diffusion tractography was a highly specific marker of language dysfunction in a cohort of pediatric patients with malformations of cortical development. Failure to identify the arcuate fasciculus on either side was associated with failure to develop oral language.
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Affiliation(s)
- M J Paldino
- From the Department of Radiology (M.J.P., K.H.), Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - K Hedges
- From the Department of Radiology (M.J.P., K.H.), Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - F Golriz
- Department of Radiology (F.G.), Texas Children's Hospital, Houston, Texas.
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Fray S, Ben Ali N, Kchaou M, Chebbi S, Belal S. [Predictors factors of refractory epilepsy in childhood]. Rev Neurol (Paris) 2015; 171:730-5. [PMID: 26318897 DOI: 10.1016/j.neurol.2015.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 05/10/2015] [Accepted: 06/02/2015] [Indexed: 12/13/2022]
Abstract
The aim of this study is to identify early predictors of refractory epilepsy. From 600 epileptic children followed for at least 2 years in the department of neurology of Charles Nicolle hospital of Tunis, were identified children with refractory epilepsy. Controls were children who responded well to antiepileptic drugs and who were seizure free for at least 2years. We collected anamnestic, clinical, neuropsychological and radiological data for all children. We identified 67 children with refractory epilepsy, representing 11.6% of the initial population. At diagnosis, the average age was 9.16 years. Some factors have been identified as predictors of drug resistance epilepsy: age of onset less than one year, partial and atonic seizure, combination of several types of attacks, presence of mental retardation and pyramidal syndrome, abnormal electroencephalogram especially focal abnormalities, spike, amplitude abnormalities, interhemispheric asymmetry; and resistance to first antiepileptic drug. Symptomatic epilepsy, especially if associated with radiological lesions such as hippocampal sclerosis and structural brain malformations, was highly correlated with drug resistance. Our study suggests that the initial presentation of epilepsy could predict long-term outcome to drug resistance epilepsy if a detailed analysis of anamnestic, clinical and complementary data is established.
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Affiliation(s)
- S Fray
- Service de neurologie, hôpital Charles-Nicolle, boulevard du 9-Avril, Tunis, Tunisie.
| | - N Ben Ali
- Service de neurologie, hôpital Charles-Nicolle, boulevard du 9-Avril, Tunis, Tunisie
| | - M Kchaou
- Service de neurologie, hôpital Charles-Nicolle, boulevard du 9-Avril, Tunis, Tunisie
| | - S Chebbi
- Service de neurologie, hôpital Charles-Nicolle, boulevard du 9-Avril, Tunis, Tunisie
| | - S Belal
- Service de neurologie, hôpital Charles-Nicolle, boulevard du 9-Avril, Tunis, Tunisie
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Abstract
BACKGROUND AND PURPOSE Epilepsy surgery for medically refractory epilepsy secondary to cortical dysplasia in children poses special challenges. We aim to review the current available literature on the outcome after epilepsy surgery for cortical dysplasia in children and critically evaluate the prognostic predictors of outcome. METHODS A comprehensive review of the literature was performed focusing on the outcome after epilepsy surgery for cortical dysplasia in children. Two large recent meta-analyses that included children and adults and several pediatric series of cortical dysplasia in children were reviewed. RESULTS AND CONCLUSIONS The overall seizure freedom rates range from 40 to 73 %, at about 2 years after surgery; most studies report 50-55% success rate. Complete resection of the epileptogenic lesion/zone remains the most important variable predictive of postoperative seizure freedom. Features unique to cortical dysplasia that limits our ability to ensure complete resection of the epileptogenic zone are reviewed.
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Affiliation(s)
- Ahsan N V Moosa
- Section of Pediatric Epilepsy, Epilepsy Center, Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk S-51, Cleveland, OH, 44195, USA,
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29
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Chen HH, Chen C, Hung SC, Liang SY, Lin SC, Hsu TR, Yeh TC, Yu HY, Lin CF, Hsu SPC, Liang ML, Yang TF, Chu LS, Lin YY, Chang KP, Kwan SY, Ho DM, Wong TT, Shih YH. Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children: early intervention maybe better. Childs Nerv Syst 2014; 30:1885-95. [PMID: 25296550 DOI: 10.1007/s00381-014-2463-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/04/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Focal cortical dysplasia (FCD) is a specific malformation of cortical development harboring intrinsic epileptogenicity, and most of the patients develop drug-resistant epilepsy in early childhood. The detrimental effects of early and frequent seizures on cognitive function in children are significant clinical issues. In this study, we evaluate the effects of early surgical intervention of FCD on epilepsy outcome and cognitive development. METHODS From 2006 to 2013, 30 children younger than 18 years old underwent resective surgery for FCDs at Taipei Veterans General Hospital. The mean age at surgery was 10.0 years (range 1.7 to 17.6 years). There were 21 boys and 9 girls. In this retrospective clinical study, seizure outcome, cognitive function, and quality of life were evaluated. To evaluate the effects to outcomes on early interventions, the patients were categorized into four groups according to age of seizure onset, duration of seizure before surgery, and severity of cognitive deficits. RESULTS Eleven of 22 (50 %) patients demonstrated developmental delay preoperatively. The Engel seizure outcome achievements were class I in 21 (70 %), class II in 2 (7 %), class III in 6 (20 %), and class IV in 1 (3 %) patients. The locations of FCDs resected were in the frontal lobe in 18 cases, temporal lobe in 7, parietal lobe in 2, and in bilobes including frontoparietal lobe in 2 and parieto-occipital lobes in 1. Eight cases that had FCDs involved in the rolandic cortex presented hemiparesis before surgical resection. Motor function in four of them improved after operation. The histopathological types of FCDs were type Ia in 1, type Ib in 7, type IIa in 7, type IIb in 12, and type III in 3 patients. FCDs were completely resected in 20 patients. Eighteen (90 %) of them were seizure free (p < 0.001) with three patients that received more than one surgery to accomplish complete resection. The patients who had early seizure onset, no significant cognitive function deficit, and early surgical intervention with complete resection in less than 2 years of seizure duration showed best outcomes on seizure control, cognitive function, and quality of life. CONCLUSION Delay in cognitive development and poor quality of life is common in children treated for FCDs. Early surgical intervention and complete resection of the lesion help for a better seizure control, cognitive function development, and quality of life. FCDs involved eloquent cortex may not prohibit complete resection for better outcomes.
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Affiliation(s)
- Hsin-Hung Chen
- Department of Neurosurgery, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,
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Englot DJ, Han SJ, Rolston JD, Ivan ME, Kuperman RA, Chang EF, Gupta N, Sullivan JE, Auguste KI. Epilepsy surgery failure in children: a quantitative and qualitative analysis. J Neurosurg Pediatr 2014; 14:386-95. [PMID: 25127098 PMCID: PMC4393949 DOI: 10.3171/2014.7.peds13658] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Resection is a safe and effective treatment option for children with pharmacoresistant focal epilepsy, but some patients continue experience seizures after surgery. While most studies of pediatric epilepsy surgery focus on predictors of postoperative seizure outcome, these factors are often not modifiable, and the reasons for surgical failure may remain unclear. METHODS The authors performed a retrospective cohort study of children and adolescents who received focal resective surgery for pharmacoresistant epilepsy. Both quantitative and qualitative analyses of factors associated with persistent postoperative seizures were conducted. RESULTS Records were reviewed from 110 patients, ranging in age from 6 months to 19 years at the time of surgery, who underwent a total of 115 resections. At a mean 3.1-year follow-up, 76% of patients were free of disabling seizures (Engel Class I outcome). Seizure freedom was predicted by temporal lobe surgery compared with extratemporal resection, tumor or mesial temporal sclerosis compared with cortical dysplasia or other pathologies, and by a lower preoperative seizure frequency. Factors associated with persistent seizures (Engel Class II-IV outcome) included residual epileptogenic tissue adjacent to the resection cavity (40%), an additional epileptogenic zone distant from the resection cavity (32%), and the presence of a hemispheric epilepsy syndrome (28%). CONCLUSIONS While seizure outcomes in pediatric epilepsy surgery may be improved by the use of high-resolution neuroimaging and invasive electrographic studies, a more aggressive resection should be considered in certain patients, including hemispherectomy if a hemispheric epilepsy syndrome is suspected. Family counseling regarding treatment expectations is critical, and reoperation may be warranted in select cases.
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Affiliation(s)
- Dario J. Englot
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco,Department of Neurological Surgery, University of California, San Francisco
| | - Seunggu J. Han
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco,Department of Neurological Surgery, University of California, San Francisco
| | - John D. Rolston
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco,Department of Neurological Surgery, University of California, San Francisco
| | - Michael E. Ivan
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco,Department of Neurological Surgery, University of California, San Francisco
| | - Rachel A. Kuperman
- Pediatric Epilepsy Program, Children’s Hospital and Research Center Oakland, California
| | - Edward F. Chang
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco,Department of Neurological Surgery, University of California, San Francisco
| | - Nalin Gupta
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco,Department of Neurological Surgery, University of California, San Francisco,Department of Pediatrics, University of California, San Francisco
| | - Joseph E. Sullivan
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco,Department of Neurology, University of California, San Francisco,Department of Pediatrics, University of California, San Francisco
| | - Kurtis I. Auguste
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco,Department of Neurological Surgery, University of California, San Francisco,Department of Pediatrics, University of California, San Francisco,Pediatric Epilepsy Program, Children’s Hospital and Research Center Oakland, California
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31
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Paldino MJ, Hedges K, Rodrigues KM, Barboriak DP. Repeatability of quantitative metrics derived from MR diffusion tractography in paediatric patients with epilepsy. Br J Radiol 2014; 87:20140095. [PMID: 24720623 DOI: 10.1259/bjr.20140095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To quantify the test-retest repeatability of mean diffusivity (MD) and fractional anisotropy (FA) derived from diffusion tensor imaging (DTI) tractography in a cohort of paediatric patients with localization-related epilepsy. METHODS 30 patients underwent 2 DTI acquisitions [repetition time/echo time (ms), 7000/90; flip, 90°; b-value, 1000 s mm(-2); voxel (mm), 2 × 2 × 2]. Two observers used Diffusion Toolkit and TrackVis ( www.trackvis.org ) to segment and analyse the following tracts: corpus callosum, corticospinal tracts, arcuate fasciculi, inferior longitudinal fasciculi and inferior fronto-occipital fasciculi. Mean MD and mean FA were calculated for each tract. Each observer independently analysed one of the DTI data sets for every patient. RESULTS Segmentation identified all tracts in all subjects, except the arcuate fasciculus. There was a highly consistent relationship between repeated observations of MD (r = 0.993; p < 0.0001) and FA (r = 0.990; p < 0.0001). For each tract, coefficients of variation ranged from 0.9% to 2.1% for MD and from 1.5% to 2.8% for FA. The 95% confidence limits (CLs) for change ranged from 2.8% to 6% for MD and from 4.3% to 8.6% for FA. For the arcuate fasciculus, Cohen's κ for agreement between the observers (identifiable vs not identifiable) was 1.0. CONCLUSION We quantified the repeatability of two commonly utilized scalar metrics derived from DTI tractography. For an individual patient, changes greater than the repeatability coefficient or 95% CLs for change are unlikely to be related to variability in their measurement. ADVANCES IN KNOWLEDGE Reproducibility of these metrics will aid in the design of future studies and might one day be used to guide management in patients with epilepsy.
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Affiliation(s)
- M J Paldino
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA
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Bhalla D, Godet B, Druet-Cabanac M, Preux PM. Etiologies of epilepsy: a comprehensive review. Expert Rev Neurother 2014; 11:861-76. [DOI: 10.1586/ern.11.51] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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33
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Wilenius J, Medvedovsky M, Gaily E, Metsähonkala L, Mäkelä JP, Paetau A, Valanne L, Paetau R. Interictal MEG reveals focal cortical dysplasias: Special focus on patients with no visible MRI lesions. Epilepsy Res 2013; 105:337-48. [DOI: 10.1016/j.eplepsyres.2013.02.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 01/03/2013] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
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Jin SH, Jeong W, Chung CK. Information source in multiple MEG spike clusters can be identified by effective connectivity in focal cortical dysplasia. Epilepsy Res 2013; 105:118-24. [DOI: 10.1016/j.eplepsyres.2013.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 12/07/2012] [Accepted: 01/22/2013] [Indexed: 11/28/2022]
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Yin ZR, Kang HC, Wu W, Wang M, Zhu SQ. Do neuroimaging results impact prognosis of epilepsy surgery? A meta-analysis. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2013; 33:159-165. [PMID: 23592123 DOI: 10.1007/s11596-013-1090-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Indexed: 06/02/2023]
Abstract
The neuroimaging results of drug-resistant epilepsy patients play an important role in the surgery decision and prognosis. The aim of this study was to evaluate the impact of these results on the efficacy of epilepay surgery, and then to explore surgical benefit for epilepsy patients with negative magnetic resonance (MR) images. Twenty-four subgroups describing the outcomes of 1475 epilepsy patients with positive-neuroimaging results and 696 patients with negative-neuroimaging results were involved in the meta-analysis. Overall, the odds of postoperational seizure-free rate were 2.03 times higher in magnetic resonance imaging-positive (MRI-positive) patients than in MRI-negative patients [odds ratio (OR)=2.03, 95% CI (1.67, 2.47), P<0.00001]. For patients with temporal lobe epilepsy (TLE), the odds were 1.76 times higher in those with MRI-positive results than in those with MRI-negative results [OR=1.76, 95% CI (1.34, 2.32), P<0.0001]. For patients with extra-temporal lobe epilepsy (extra-TLE), the odds were 2.88 times higher in MRI-positive patients than in MRI-negative patients [OR=2.88, 95% CI (1.53, 5.43), P=0.001]. It was concluded that the seizure-free rate of MRI-positive patients after surgery was higher than that of MRI-negative patients. For patients with negative results, an appropriate surgery should be concerned for TLE.
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Affiliation(s)
- Zhuo-Ran Yin
- Department of Neurology, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hui-Cong Kang
- Department of Neurology, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Min Wang
- Department of Neurology, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Sui-Qiang Zhu
- Department of Neurology, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Ibrahim GM, Fallah A, Snead OC, Drake JM, Rutka JT, Bernstein M. The use of high frequency oscillations to guide neocortical resections in children with medically-intractable epilepsy: How do we ethically apply surgical innovations to patient care? Seizure 2012; 21:743-7. [DOI: 10.1016/j.seizure.2012.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 11/17/2022] Open
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Hauptman JS, Mathern GW. Surgical treatment of epilepsy associated with cortical dysplasia: 2012 update. Epilepsia 2012; 53 Suppl 4:98-104. [PMID: 22946727 DOI: 10.1111/j.1528-1167.2012.03619.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cortical dysplasia is the most common etiology in children and the third most frequent finding in adults undergoing epilepsy neurosurgery. The new International League Against Epilepsy (ILAE) classification grades isolated cortical dysplasia into mild type I (cortical dyslamination), severe type II (dyslamination plus dysmorphic neurons and balloon cells), and dysplasia associated with other epileptogenic lesions (type III). Multilobar type II lesions present at an earlier age and with more severe epilepsy compared with focal type I abnormalities, often in the temporal lobe, and these findings are reflected in types and age of operations for cortical dysplasia. Presurgical evaluation of patients with epilepsy from cortical dysplasia can be challenging. Interictal and ictal scalp electroencephalography (EEG) accurately localizes cortical dysplasia with 50-66% accuracy. Structural magnetic resonance imaging (MRI) is negative in roughly 30% of cases, most often linked with mild type I cases. FDG-PET can be 80-90% accurate, but is not 100% sensitive. Chronic intracranial electrodes are used in about 50% of cases with cortical dysplasia, but often do not capture restricted ictal-onset zones. About 60% of patients with cortical dysplasia are seizure free after epilepsy neurosurgery, with much higher rates of becoming seizure free with complete (80%) compared with incomplete (20%) resections. The most common reason for incomplete resection is the risk of an unacceptable neurologic deficit. Future challenges include better tools in identifying subtle forms of type I cortical dysplasia, and development of adjunctive treatments from basic research for those undergoing incomplete resections.
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Affiliation(s)
- Jason S Hauptman
- Department of Neurosurgery, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Moseley BD, Nickels K, Wirrell EC. Surgical outcomes for intractable epilepsy in children with epileptic spasms. J Child Neurol 2012; 27:713-20. [PMID: 22123426 DOI: 10.1177/0883073811424463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epileptic spasms, or seizures marked by flexor, extensor, or flexor-extensor spasms, are not always responsive to medical management. The purpose of our study was to evaluate the outcome of epilepsy surgery in children with medically intractable epileptic spasms. We identified 11 children with epileptic spasms who underwent lesionectomy (36%), lobectomy (27%), multi-lobectomy (9%), hemispherectomy (18%), or corpus callosotomy (9%). At the time of surgery, 6 children had developed other concurrent seizure type(s), including simple partial (9%), complex partial (27%), partial undifferentiated (9%), primary generalized tonic clonic (9%), tonic (9%), atonic (27%), and myoclonic (9%) seizures. Six children (55%) were seizure free at last follow-up from initial surgery. Predictors of favorable outcome included lack of focal slowing and the presence of less than 2 interictal epileptiform abnormalities on postoperative electroencephalogram (P = .035 and .035, respectively). Favorable outcome was significantly associated with parent/caregiver report of improved postoperative developmental outcomes (P = .026).
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Rowland NC, Englot DJ, Cage TA, Sughrue ME, Barbaro NM, Chang EF. A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia. J Neurosurg 2012; 116:1035-41. [DOI: 10.3171/2012.1.jns111105] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Focal cortical dysplasia (FCD) is one of the most common causes of medically refractory epilepsy leading to surgery. However, seizure control outcomes reported in isolated surgical series are highly variable. As a result, it is not clear which variables are most crucial in predicting seizure freedom following surgery for FCD. The authors' aim was to determine the prognostic factors for seizure control in FCD by performing a meta-analysis of the published literature.
Methods
A MEDLINE search of the published literature yielded 37 studies that met inclusion and exclusion criteria. Seven potential prognostic variables were determined from these studies and were dichotomized for analysis. For each variable, individual studies were weighted by inverse variance and combined to generate an odds ratio favoring seizure freedom. The methods complied with a standardized meta-analysis reporting protocol.
Results
Two thousand fourteen patients were included in the analysis. The overall rate of seizure freedom (Engel Class I) among patients undergoing surgery for FCD in the cohort of studies was 55.8% ± 16.2%. Partial seizures, a temporal location, detection with MRI, and a Type II Palmini histological classification were associated with higher rates of postoperative seizure control. As a treatment-related factor, complete resection of the anatomical or electrographic abnormality was the most important predictor overall of seizure freedom. Neither age nor electroencephalographic localization of the ictal onset significantly affected seizure freedom after surgery.
Conclusions
Using a large population cohort pooled from the published literature, an analysis identified important factors that are prognostic in patients with epilepsy due to FCD. The most important of these factors—diagnostic imaging and resection—provide modalities through which improvements in the impact of FCD can be effected.
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Fellah S, Callot V, Viout P, Confort-Gouny S, Scavarda D, Dory-Lautrec P, Figarella-Branger D, Cozzone PJ, Girard N. Epileptogenic brain lesions in children: the added-value of combined diffusion imaging and proton MR spectroscopy to the presurgical differential diagnosis. Childs Nerv Syst 2012; 28:273-82. [PMID: 22038149 DOI: 10.1007/s00381-011-1604-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 09/28/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE Focal cortical dysplasia (FCD), dysembryoplastic neuroepithelial tumors (DNTs), and gangliogliomas (GGs) share many clinical features, and the presurgical differential diagnosis of these lesions using conventional magnetic resonance imaging (MRI) is challenging in some cases. The purpose of this work was thus to evaluate the capacity of diffusion-weighted imaging (DWI) and proton magnetic resonance spectroscopy (MRS) to distinguish each lesion from the others. METHODS Seventeen children (mean age 9.0 ± 4.7 years), who had been referred for epilepsy associated with a brain tumor and operated, were selected. Preoperative MRI examinations were performed on a 1.5 T system and included anatomical images [T2-weighted, fluid-attenuated inversion recovery (FLAIR) and T1 pre- and post-injection images] as well as DWI and MRS [echo time (TE) = 30 and 135 ms]. Apparent diffusion coefficient (ADC) values were calculated in the lesion and healthy control. MRS relative quantification consisted in normalizing each metabolite by the sum (S) of all metabolites (S(TE=135 ms) = NAA+Cr+Cho; S(TE=30 ms) = NAA+Cr+Cho+Glx+mI). Univariate and multivariate analyses were performed in order to determine which criteria could differentiate the different epileptogenic brain lesions. RESULTS When taken alone, none of the MRI parameters was able to distinguish each disease from the others. Conventional MRI failed classifying two patients. When adding ADC to the linear discriminant analysis (LDA), one patient was still misclassified. Complete separation of the three groups was possible when combining conventional MRI, diffusion, and MRS either at long or short TE. CONCLUSION This study shows the added-value of multimodal MRI and MRS in the presurgical diagnosis of epileptogenic brain lesions in children.
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Affiliation(s)
- Slim Fellah
- Centre de Résonance Magnétique Biologique et Médicale, Aix-Marseille University/CNRS, Marseille, France.
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Dhamija R, Moseley BD, Cascino GD, Wirrell EC. A population-based study of long-term outcome of epilepsy in childhood with a focal or hemispheric lesion on neuroimaging. Epilepsia 2011; 52:1522-6. [PMID: 21762438 PMCID: PMC3244832 DOI: 10.1111/j.1528-1167.2011.03192.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate long-term seizure outcome in children with epilepsy and a focal or hemispheric neuroimaging abnormality. METHODS All children (<18 years and residing in Olmsted County, Minnesota) with new-onset epilepsy diagnosed between 1980 and 2004 and a single focal lesion on neuroimaging were identified by review of the Rochester Epidemiologic Project database. Outcomes were divided into three categories: (1) seizure freedom for 1 or more years at last follow-up, (2) ongoing seizures but not medically intractable epilepsy, and (3) medically intractable epilepsy or undergoing epilepsy surgery. We also evaluated the proportion who achieved seizure control without surgical intervention and whether lesion type predicted intractability. KEY FINDINGS Of the 359 children with newly diagnosed epilepsy, 37 (10%) had a focal or hemispheric lesion on neuroimaging. Median age of diagnosis was 89 months (25th percentile 26 months, 75th percentile 142 months) and at follow-up was 137 months (25th percentile 95 months, 75th percentile 211 months). Eighty-three percent of children with malformations of cortical development, 67% with mesial temporal sclerosis, 33% with encephalomalacia, and 50% with vascular malformations had intractable epilepsy at follow-up or underwent resective surgery for medically intractable epilepsy. Among the different etiologies, presence of encephalomalacia predicted the lowest likelihood of medical intractability or undergoing surgery (p < 0.01). At final follow-up, 24 (65%) of our entire cohort was seizure free. Following surgery, seizure freedom was achieved in 80% with mesial temporal sclerosis, 67% with encephalomalacia, 67% with vascular malformation, and 50% with malformations of cortical development. There was no statistically significant difference between the different etiologies on neuroimaging and seizure freedom after surgery. Twelve children (32%) achieved seizure freedom with medical management alone. SIGNIFICANCE Focal lesions on neuroimaging confer a high risk of medical intractability among children with new-onset epilepsy. However, 32% of this cohort achieved seizure remission with medical management alone, including 58% with encephalomalacia and 33% with mesial temporal sclerosis.
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Elliott RE, Morsi A, Geller EB, Carlson CC, Devinsky O, Doyle WK. Impact of Failed Intracranial Epilepsy Surgery on the Effectiveness of Subsequent Vagus Nerve Stimulation. Neurosurgery 2011; 69:1210-7. [DOI: 10.1227/neu.0b013e3182230ae3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Using the Cyberonics registry, Amar and colleagues reported poorer efficacy of vagus nerve stimulation (VNS) in patients who failed intracranial epilepsy surgery (IES).
OBJECTIVE
To study the impact of failed IES and other surrogate marker of severe epilepsy on VNS effectiveness in a large cohort with treatment-resistant epilepsy (TRE).
METHODS
We retrospectively reviewed 376 patients (188 female patients; 265 adults; mean age, 29.4 years at implantation) with TRE who underwent VNS implantation between 1997 and 2008 and had at least 1 year of follow-up. One hundred ten patients (29.3%) had failed ≥1 prior craniotomies for TRE, and 266 (70.7%) had no history of IES.
RESULTS
The mean duration of VNS therapy was 5.1 years. Patients with prior IES were more commonly male and adult, had a greater number of seizure types, and more commonly had focal or multifocal vs generalized seizures (P > .05). There was no significant difference in the mean percentage seizure reduction between patients with and without a history of IES (59.1% vs 56.5%; P = .42). There was no correlation between type of failed IES (callosotomy vs resection) and seizure reduction with VNS therapy.
CONCLUSION
Failed IES did not affect the response to VNS therapy. Unlike prior reports, patients with callosotomy did not respond better than those who had resective surgery. Nearly 50% of patients experienced at least 50% reduction in seizure frequency. For patients with TRE, including patients who failed cranial epilepsy surgeries, VNS should be considered a palliative treatment option.
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Affiliation(s)
- Robert E. Elliott
- Department of Neurosurgery, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Amr Morsi
- Department of Neurosurgery, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Eric B. Geller
- Department of Neurology, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Chad C. Carlson
- Department of Neurology, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Orrin Devinsky
- Department of Neurology, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Werner K. Doyle
- Department of Neurosurgery, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
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