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Hays MA, Daraie AH, Smith RJ, Sarma SV, Crone NE, Kang JY. Network excitability of stimulation-induced spectral responses helps localize the seizure onset zone. Clin Neurophysiol 2024; 166:43-55. [PMID: 39096821 PMCID: PMC11401764 DOI: 10.1016/j.clinph.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/11/2024] [Accepted: 07/19/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE While evoked potentials elicited by single pulse electrical stimulation (SPES) may assist seizure onset zone (SOZ) localization during intracranial EEG (iEEG) monitoring, induced high frequency activity has also shown promising utility. We aimed to predict SOZ sites using induced cortico-cortical spectral responses (CCSRs) as an index of excitability within epileptogenic networks. METHODS SPES was conducted in 27 epilepsy patients undergoing iEEG monitoring and CCSRs were quantified by significant early (10-200 ms) increases in power from 10 to 250 Hz. Using response power as CCSR network connection strengths, graph centrality measures (metrics quantifying each site's influence within the network) were used to predict whether sites were within the SOZ. RESULTS Across patients with successful surgical outcomes, greater CCSR centrality predicted SOZ sites and SOZ sites targeted for surgical treatment with median AUCs of 0.85 and 0.91, respectively. We found that the alignment between predicted and targeted SOZ sites predicted surgical outcome with an AUC of 0.79. CONCLUSIONS These findings indicate that network analysis of CCSRs can be used to identify increased excitability of SOZ sites and discriminate important surgical targets within the SOZ. SIGNIFICANCE CCSRs may supplement traditional passive iEEG monitoring in seizure localization, potentially reducing the need for recording numerous seizures.
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Affiliation(s)
- Mark A Hays
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
| | - Amir H Daraie
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel J Smith
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neuroengineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sridevi V Sarma
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA; Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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2
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Detchou D, Barrie U. Occipital lobe epilepsy surgery: treating seizures in the posterior cortex. Neurosurg Rev 2024; 47:514. [PMID: 39212792 DOI: 10.1007/s10143-024-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 08/14/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
Occipital lobe epilepsy (OLE) is an uncommon type of extratemporal epilepsy constituting roughly 2-13% of symptomatic partial epilepsies and epilepsy surgery cases. Over two-thirds of patients with OLE present with two characteristics: (1) ictal semiology compatible with an occipital seizure focus (e.g., ictal blindness, visual perceptual disturbance, eye blinking, nystagmus), and (2) lateralizing features referable to the posterior cortex (e.g., visual field defects, contralateral head deviation). The remaining one-third of patients present with ≥ 2 seizure types, indicative of spread to other lobes. A common representation of this cortical spread is the altered mental status and generalized tonic-clonic activity seen in patient with OLE. While the key clinical symptoms include visual hallucinations, it may be difficult to elicit on history, especially from children, and are not always present.
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Affiliation(s)
- Donald Detchou
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Umaru Barrie
- Department of Neurosurgery, New York University Grossman School of Medicine, New York City, NYC, USA
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3
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Kalss G, Pelliccia V, Zimmermann G, Trinka E, Tassi L. The Fingerprint of Scalp-EEG in Drug-Resistant Frontal Lobe Epilepsies. J Clin Neurophysiol 2024:00004691-990000000-00162. [PMID: 39042052 DOI: 10.1097/wnp.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Scalp-EEG incompletely covers the frontal lobe cortex. Underrepresentation of frontobasal or frontomesial structures, fast ictal spreading, and false lateralization impede scalp-EEG interpretation. Hence, we investigated the significance of scalp-EEG in the presurgical workup of frontal lobe epilepsy. METHODS Using descriptive statistical methods and Pearson chi-squared test for group comparisons, we retrospectively investigated postsurgical outcome, interictal epileptiform discharges (iiEDs), and electrographic seizure patterns on scalp-EEG in 81 consecutive patients undergoing resective epilepsy surgery within the margins of the frontal lobe. RESULTS Postoperatively, patients with frontopolar iiEDs (n = 7) or concordant frontopolar iiED focus and seizure-onset (n = 2) were seizure free (n = 7/7, Engel Ia). MRI-positive patients with frontopolar iiEDs or frontopolar seizure-onset (n = 1/8 Engel Id, n = 7/8 Engel Ia) underwent surgery without stereo-EEG. Thirteen of 16 patients with frontolateral (n = 8/10, Engel Ia), or left frontobasal (n = 5/6, Engel Ia) seizure-onset undergoing further stereo-EEG, were seizure-free postoperatively. Seizure-onset prevalent over one electrode (n = 37/44 Engel I, p = 0.02), fast activity (FA)/flattening at seizure-onset (n = 29/33 Engel I, p = 0.02), FA/flattening during the seizure (n = 38/46 Engel I, p = 0.05), or focal rhythmic sharp-/spike-/polyspike-and-slow waves during the seizure (n = 24/31, Engel Ia, p = 0.05) were favorable prognostic markers. Interictal polyspike waves (p = 0.006 for Engel Ia) and interictal paroxysmal FA (p = 0.02 for Engel I) were unfavorable prognostic markers. CONCLUSIONS Frontopolar scalp-EEG findings serve as biomarkers for predicting favorable surgical outcome in lesional frontal lobe epilepsy. Consequently, careful analysis of scalp-EEG assists in bypassing stereo-EEG in these patients.
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Affiliation(s)
- Gudrun Kalss
- Department of Neurology and Centre for Cognitive Neurosciences, Christian Doppler University Hospital, Paracelsus Medical University, Member of the European Reference Network EpiCARE, Salzburg, Austria
| | - Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Milan, Italy
| | - Georg Zimmermann
- Department of Neurology and Centre for Cognitive Neurosciences, Christian Doppler University Hospital, Paracelsus Medical University, Member of the European Reference Network EpiCARE, Salzburg, Austria
- Department of Mathematics, Paris-Lodron-University of Salzburg, Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria; and
| | - Eugen Trinka
- Department of Neurology and Centre for Cognitive Neurosciences, Christian Doppler University Hospital, Paracelsus Medical University, Member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Centre for Cognitive Neurosciences, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Milan, Italy
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4
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Battista F, Esposito A, Muscas G, Della Puppa A. Functional frontal lobectomy in the surgical treatment of pharmacoresistant frontal lobe epilepsy: how I do it. Acta Neurochir (Wien) 2024; 166:299. [PMID: 39020068 PMCID: PMC11254979 DOI: 10.1007/s00701-024-06176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/23/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Frontal lobe epilepsy is pharmacoresistant in 30% of cases, constituting 10-20% of epilepsy surgeries. For cases of no lesional epilepsy (negative MRI), frontal lobectomy is a crucial treatment, historically involving Frontal Anatomical Lobectomy (AFL) with a 33.3% complication risk and 55.7% seizure control. METHODS We describe Frontal Functional Lobectomy (FFL), in which the boundaries are defined on the patient's functional cortico-subcortical areas, recognized with advanced intraoperative technologies such as tractography and navigated transcranial magnetic stimulation (nTMS). CONCLUSIONS The FFL allows for a broader resection with a lower rate of postoperative complications than the AFL.
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Affiliation(s)
- Francesca Battista
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Florence, Italy
| | - Alice Esposito
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Florence, Italy
- University of Florence, School of Human Health Sciences, Firenze, Italia
| | - Giovanni Muscas
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Florence, Italy
| | - Alessandro Della Puppa
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Florence, Italy.
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Bustros S, Kaur M, Ritchey E, Szaflarski JP, McGwin GJ, Riley KO, Bentley JN, Memon AA, Jaisani Z. Non-lesional epilepsy does not necessarily convey poor outcomes after invasive monitoring followed by resection or thermal ablation. Neurol Res 2024; 46:653-661. [PMID: 38602305 DOI: 10.1080/01616412.2024.2340879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE We aimed to compare outcomes including seizure-free status at the last follow-up in adult patients with medically refractory focal epilepsy identified as lesional vs. non-lesional based on their magnetic resonance imaging (MRI) findings who underwent invasive evaluation followed by subsequent resection or thermal ablation (LiTT). METHODS We identified 88 adult patients who underwent intracranial monitoring between 2014 and 2021. Of those, 40 received resection or LiTT, and they were dichotomized based on MRI findings, as lesional (N = 28) and non-lesional (N = 12). Patient demographics, seizure characteristics, non-invasive interventions, intracranial monitoring, and surgical variables were compared between the groups. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification, and postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Statistical analyses employed Fisher's exact test to compare categorical variables, while a t-test was used for continuous variables. RESULTS There were no differences in baseline characteristics between groups except for more often noted PET abnormality in the lesional group (p = 0.0003). 64% of the lesional group and 57% of the non-lesional group received surgical resection or LiTT (p = 0.78). At the last follow-up, 78.5% of the patients with lesional MRI findings achieved Engel I outcomes compared to 66.7% of non-lesional patients (p = 0.45). Kaplan-Meier curves did not show a significant difference in seizure-free duration between both groups after surgical intervention (p = 0.49). SIGNIFICANCE In our sample, the absence of lesion on brain MRI was not associated with worse seizure outcomes in adult patients who underwent invasive intracranial monitoring followed by resection or thermal ablation.
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Affiliation(s)
- Stephanie Bustros
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Manmeet Kaur
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Elizabeth Ritchey
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Gerald Jr McGwin
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - J Nicole Bentley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Adeel A Memon
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - Zeenat Jaisani
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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Torres N, de Montalivet E, Borntrager Q, Benahmed S, Legrain A, Adesso E, Aubert N, Sauter-Starace F, Costecalde T, Martel F, Ratel D, Gaude C, Auboiroux V, Piallat B, Aksenova T, Molet J, Chabardes S. Focal cooling: An alternative treatment for drug-resistant epilepsy in a mesial temporal lobe epilepsy primate model-A preliminary study. Epilepsia 2024; 65:2069-2081. [PMID: 38794998 DOI: 10.1111/epi.18012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVE Focal cooling is emerging as a relevant therapy for drug-resistant epilepsy (DRE). However, we lack data on its effectiveness in controlling seizures that originate in deep-seated areas like the hippocampus. We present a thermoelectric solution for focal brain cooling that specifically targets these brain structures. METHODS A prototype implantable device was developed, including temperature sensors and a cannula for penicillin injection to create an epileptogenic zone (EZ) near the cooling tip in a non-human primate model of epilepsy. The mesial temporal lobe was targeted with repeated penicillin injections into the hippocampus. Signals were recorded from an sEEG (Stereoelectroencephalography) lead placed 2 mm from the EZ. Once the number of seizures had stabilized, focal cooling was applied, and temperature and electroclinical events were monitored using a customized detection algorithm. Tests were performed on two Macaca fascicularis monkeys at three temperatures. RESULTS Hippocampal seizures were observed 40-120 min post-injection, their duration and frequency stabilized at around 120 min. Compared to the control condition, a reduction in the number of hippocampal seizures was observed with cooling to 21°C (Control: 4.34 seizures, SD 1.704 per 20 min vs Cooling to 21°C: 1.38 seizures, SD 1.004 per 20 min). The effect was more pronounced with cooling to 17°C, resulting in an almost 80% reduction in seizure frequency. Seizure duration and number of interictal discharges were unchanged following focal cooling. After several months of repeated penicillin injections, hippocampal sclerosis was observed, similar to that recorded in humans. In addition, seizures were identified by detecting temperature variations of 0.3°C in the EZ correlated with the start of the seizures. SIGNIFICANCE In epilepsy therapy, the ultimate aim is total seizure control with minimal side effects. Focal cooling of the EZ could offer an alternative to surgery and to existing neuromodulation devices.
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Affiliation(s)
- Napoleon Torres
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | | | | | - Selimen Benahmed
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | - Antoine Legrain
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | - Eleonora Adesso
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | - Nicolas Aubert
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | | | | | - Felix Martel
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | - David Ratel
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | - Christophe Gaude
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | | | - Brigitte Piallat
- Inserm, U1216, Grenoble Institute of Neurosciences, Universite Grenoble Alpes, Grenoble, France
| | - Tetiana Aksenova
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | - Jenny Molet
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
| | - Stephan Chabardes
- CEA, LETI, Clinatec, Universite Grenoble Alpes, Grenoble, France
- Department of Neurosurgery, Inserm, U1216, Universite Grenoble Alpes, Grenoble, France
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7
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Electrocorticographic Patterns in Frontal Epilepsy and Long-Term Outcomes [RETRACTED]. J Clin Neurophysiol 2024:00004691-990000000-00145. [PMID: 38916879 DOI: 10.1097/wnp.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
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8
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Courtney MR, Antonic-Baker A, Chen Z, Sinclair B, Nicolo JP, Neal A, Marotta C, Bunyamin J, Law M, Kwan P, O'Brien TJ, Vivash L. Association of Localizing 18F-FDG-PET Hypometabolism and Outcome Following Epilepsy Surgery: Systematic Review and Meta-Analysis. Neurology 2024; 102:e209304. [PMID: 38626375 DOI: 10.1212/wnl.0000000000209304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although commonly used in the evaluation of patients for epilepsy surgery, the association between the detection of localizing 18fluorine fluorodeoxyglucose PET (18F-FDG-PET) hypometabolism and epilepsy surgery outcome is uncertain. We conducted a systematic review and meta-analysis to determine whether localizing 18F-FDG-PET hypometabolism is associated with favorable outcome after epilepsy surgery. METHODS A systematic literature search was undertaken. Eligible publications included evaluation with 18F-FDG-PET before epilepsy surgery, with ≥10 participants, and those that reported surgical outcome at ≥12 months. Random-effects meta-analysis was used to calculate the odds of achieving a favorable outcome, defined as Engel class I, International League Against Epilepsy class 1-2, or seizure-free, with localizing 18F-FDG-PET hypometabolism, defined as concordant with the epilepsy surgery resection zone. Meta-regression was used to characterize sources of heterogeneity. RESULTS The database search identified 8,916 studies, of which 98 were included (total patients n = 4,104). Localizing 18F-FDG-PET hypometabolism was associated with favorable outcome after epilepsy surgery for all patients with odds ratio (OR) 2.68 (95% CI 2.08-3.45). Subgroup analysis yielded similar findings for those with (OR 2.64, 95% CI 1.54-4.52) and without epileptogenic lesion detected on MRI (OR 2.49, 95% CI 1.80-3.44). Concordance with EEG (OR 2.34, 95% CI 1.43-3.83), MRI (OR 1.69, 95% CI 1.19-2.40), and triple concordance with both (OR 2.20, 95% CI 1.32-3.64) was associated with higher odds of favorable outcome. By contrast, diffuse 18F-FDG-PET hypometabolism was associated with worse outcomes compared with focal hypometabolism (OR 0.34, 95% CI 0.22-0.54). DISCUSSION Localizing 18F-FDG-PET hypometabolism is associated with favorable outcome after epilepsy surgery, irrespective of the presence of an epileptogenic lesion on MRI. The extent of 18F-FDG-PET hypometabolism provides additional information, with diffuse hypometabolism associated with worse surgical outcome than focal 18F-FDG-PET hypometabolism. These findings support the incorporation of 18F-FDG-PET into routine noninvasive investigations for patients being evaluated for epilepsy surgery to improve epileptogenic zone localization and to aid patient selection for surgery.
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Affiliation(s)
- Merran R Courtney
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Zhibin Chen
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Benjamin Sinclair
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - John-Paul Nicolo
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Andrew Neal
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Cassandra Marotta
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Jacob Bunyamin
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Meng Law
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Patrick Kwan
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Terence J O'Brien
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
| | - Lucy Vivash
- From the Department of Neuroscience (M.R.C., A.A.-B., Z.C., B.S., J.-P.N., A.N., C.M., J.B., M.L., P.K., T.J.O.B., L.V.), School of Translational Medicine, Monash University; Department of Neurology (M.R.C., B.S., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Alfred Health; Department of Neurology (M.R.C., J.-P.N., A.N., P.K., T.J.O.B., L.V.), Royal Melbourne Hospital; Department of Radiology (M.L.), Alfred Health; Department of Electrical and Computer Systems Engineering (M.L.), Monash University; and Department of Medicine (P.K., T.J.O.B., L.V.), The University of Melbourne, Victoria, Australia
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9
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Tojima M, Shimotake A, Neshige S, Okada T, Kobayashi K, Usami K, Matsuhashi M, Honda M, Takeyama H, Hitomi T, Yoshida T, Yokoyama A, Fushimi Y, Ueno T, Yamao Y, Kikuchi T, Namiki T, Arakawa Y, Takahashi R, Ikeda A. Specific consistency score for rational selection of epilepsy resection surgery candidates. Epilepsia 2024; 65:1322-1332. [PMID: 38470337 DOI: 10.1111/epi.17945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Degree of indication for epilepsy surgery is determined by taking multiple factors into account. This study aimed to investigate the usefulness of the Specific Consistency Score (SCS), a proposed score for focal epilepsy to rate the indication for epilepsy focal resection. METHODS This retrospective cohort study included patients considered for resective epilepsy surgery in Kyoto University Hospital from 2011 to 2022. Plausible epileptic focus was tentatively defined. Cardinal findings were scored based on specificity and consistency with the estimated laterality and lobe. The total points represented SCS. The association between SCS and the following clinical parameters was assessed by univariate and multivariate analysis: (1) probability of undergoing resective epilepsy surgery, (2) good postoperative seizure outcome (Engel I and II or Engel I only), and (3) lobar concordance between the noninvasively estimated focus and intracranial electroencephalographic (EEG) recordings. RESULTS A total of 131 patients were evaluated. Univariate analysis revealed higher SCS in the (1) epilepsy surgery group (8.4 [95% confidence interval (CI) = 7.8-8.9] vs. 4.9 [95% CI = 4.3-5.5] points; p < .001), (2) good postoperative seizure outcome group (Engel I and II; 8.7 [95% CI = 8.2-9.3] vs. 6.4 [95% CI = 4.5-8.3] points; p = .008), and (3) patients whose focus defined by intracranial EEG matched the noninvasively estimated focus (8.3 [95% CI = 7.3-9.2] vs. 5.4 [95% CI = 3.5-7.3] points; p = .004). Multivariate analysis revealed areas under the curve of .843, .825, and .881 for Parameters 1, 2, and 3, respectively. SIGNIFICANCE SCS provides a reliable index of good indication for resective epilepsy surgery and can be easily available in many institutions not necessarily specializing in epilepsy.
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Affiliation(s)
- Maya Tojima
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Shimotake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichiro Neshige
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tadashi Okada
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiyohide Usami
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Honda
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirofumi Takeyama
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takefumi Hitomi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Yoshida
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Atsushi Yokoyama
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tsukasa Ueno
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Namiki
- Department of Mathematics, Faculty of Science, Hokkaido University, Sapporo, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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10
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Fawcett J, Davis S, Manford M. Further advances in epilepsy. J Neurol 2023; 270:5655-5670. [PMID: 37458794 DOI: 10.1007/s00415-023-11860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 10/15/2023]
Abstract
In 2017, one of us reviewed advances in epilepsy (Manford in J Neurol 264:1811-1824, 2017). The current paper brings that review up to date and gives a slight change in emphasis. Once again, the story is of evolution rather than revolution. In recognition that most of our current medications act on neurotransmitters or ion channels, and not on the underlying changes in connectivity and pathways, they have been renamed as antiseizure (ASM) medications rather than antiepileptic drugs. Cenobamate is the one newly licensed medication for broader use in focal epilepsy but there have been a number of developments for specific disorders. We review new players and look forward to new developments in the light of evolving underlying science. We look at teratogenicity; old villains and new concerns in which clinicians play a vital role in explaining and balancing the risks. Medical treatment of status epilepticus, long without evidence, has benefitted from high-quality trials to inform practice; like buses, several arriving at once. Surgical treatment continues to be refined with improvements in the pre-surgical evaluation of patients, especially with new imaging techniques. Alternatives including stereotactic radiotherapy have received further focus and targets for palliative stimulation techniques have grown in number. Individuals' autonomy and quality of life continue to be the subject of research with refinement of what clinicians can do to help persons with epilepsy (PWE) achieve control. This includes seizure management but extends to broader considerations of human empowerment, needs and desires, which may be aided by emerging technologies such as seizure detection devices. The role of specialist nurses in improving that quality has been reinforced by specific endorsement from the International League against Epilepsy (ILAE).
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Affiliation(s)
- Joanna Fawcett
- Department of Neurology, Royal United Hospital, Bath, UK
| | - Sarah Davis
- Department of Neurology, Royal United Hospital, Bath, UK
| | - Mark Manford
- Department of Neurology, Royal United Hospital, Bath, UK.
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11
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Athreya A, Matthews RE, Drane DL, Bonilha L, Willie JT, Gross RE, Karakis I. Withdrawal of antiseizure medications after MRI-Guided laser interstitial thermal therapy in extra-temporal lobe epilepsy. Seizure 2023; 110:86-92. [PMID: 37331198 DOI: 10.1016/j.seizure.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE This study investigated the success rate of antiseizure medications (ASMs) withdrawal following MRI Guided Laser Interstitial Thermal Therapy (MRg-LITT) for extra-temporal lobe epilepsy (ETLE), and identified predictors of seizure recurrence. METHODS We retrospectively assessed 27 patients who underwent MRg-LITT for ETLE. Patients' demographics, disease characteristics, and post-surgical outcomes were evaluated for their potential to predict seizure recurrence associated with ASMs withdrawal. RESULTS The median period of observation post MRg-LITT was 3 years (range 18 - 96 months) and the median period to initial ASMs reduction was 0.5 years (range 1-36 months). ASMs reduction was attempted in 17 patients (63%), 5 (29%) of whom had seizure recurrence after initial reduction. Nearly all patient who relapsed regained seizure control after reinstitution of their ASMs regimen. Pre-operative seizure frequency (p = 0.002) and occurrence of acute post-operative seizures (p = 0.01) were associated with increased risk for seizure recurrence post ASMs reduction. At the end of the observation period, 11% of patients were seizure free without drugs, 52% were seizure free with drugs and 37% still experienced seizures despite ASMs. Compared with pre-operative status, the number of ASMs was reduced in 41% of patients, unchanged in 55% of them and increased in only 4% of them. CONCLUSIONS Successful MRg-LITT for ETLE allows for ASMs reduction in a significant portion of patients and complete ASMs withdrawal in a subset of them. Patients with higher pre-operative seizure frequency or occurrence of acute post operative seizures exhibit higher chances relapse post ASMs reduction.
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Affiliation(s)
- Arjun Athreya
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca E Matthews
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Leonardo Bonilha
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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12
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Inati SK, Zaghloul KA. Stop being so superficial: subcortical disconnection and long-term seizure outcomes. Brain 2023; 146:2203-2205. [PMID: 37132086 PMCID: PMC10232228 DOI: 10.1093/brain/awad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/04/2023] Open
Abstract
This scientific commentary refers to ‘Thalamostriatal disconnection underpins long-term seizure freedom in frontal lobe epilepsy surgery’ by Giampiccolo et al. (https://doi.org/10.1093/brain/awad085).
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Affiliation(s)
- Sara K Inati
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
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13
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Guo Z, Zhang C, Wang X, Liu C, Zhao B, Mo J, Zheng Z, Shao X, Zhang J, Zhang K, Hu W. Is intracranial electroencephalography mandatory for MRI-negative neocortical epilepsy surgery? J Neurosurg 2023; 138:1720-1730. [PMID: 36242573 DOI: 10.3171/2022.8.jns22995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE MRI-negative focal epilepsy is one of the most challenging cases in surgical epilepsy treatment. Many epilepsy centers recommend intracranial electroencephalography (EEG) for MRI-negative cases, especially neocortical epilepsy. This retrospective study aimed to explore whether intracranial monitoring is mandatory in MRI-negative neocortical epilepsy surgery and the factors that significantly influence the decision on whether to perform intracranial recording. METHODS In this study, consecutive surgical patients with focal MRI-negative neocortical epilepsy were recruited. All patients underwent routine preoperative evaluation according to the dedicated protocol of the authors' epilepsy center to determine the treatment strategy. Patients were divided into two groups according to the surgical strategy, i.e., a direct group and a stereo-EEG (SEEG)-guided group. History of epilepsy, seizure frequency, interictal and ictal EEG data, PET data, PET/MRI coregistration data, neuropathological findings, and surgical outcomes were compared between the two groups. Multivariate analysis was performed to identify factors influencing the decision to perform SEEG monitoring. RESULTS Sixty-four patients were included in this study, 19 and 45 of whom underwent direct and SEEG-guided cortical resection, respectively. At an average follow-up of 3.9 years postoperatively, 56 patients (87.5%) had Engel class I results without permanent neurological deficits. Surgical outcomes were not significantly different between the direct and SEEG-guided groups (94.7% vs 84.4%). PET hypometabolic abnormalities were detected in all patients. There were significant differences between the two groups in the extent of hypometabolism (focal vs nonfocal, p < 0.01) and pathological subtype (focal cortical dysplasia type II vs others, p = 0.03). Multivariate analysis revealed that the extent of hypometabolism (OR 0.01, 95% CI 0.00-0.15; p = 0.001) was the only independent factor affecting the treatment strategy. CONCLUSIONS Careful selection of patients with MRI-negative neocortical epilepsy may yield favorable outcomes after direct cortical resection without intracranial monitoring. PET/MRI coregistration plays an essential role in the preoperative evaluation and subsequent resection of these patients. Intracranial monitoring is not a mandatory requirement for surgery if the focal hypometabolic areas are consistent with the findings of semiology and scalp EEG.
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Affiliation(s)
| | | | - Xiu Wang
- 1Departments of Neurosurgery and
| | | | | | | | - Zhong Zheng
- 4Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Xiaoqiu Shao
- 5Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Jianguo Zhang
- 1Departments of Neurosurgery and
- 3Beijing Key Laboratory of Neurostimulation; and
| | - Kai Zhang
- 1Departments of Neurosurgery and
- 3Beijing Key Laboratory of Neurostimulation; and
| | - Wenhan Hu
- 1Departments of Neurosurgery and
- 3Beijing Key Laboratory of Neurostimulation; and
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14
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Ljunggren S, Winblad S, Samuelsson H, Malmgren K. Decision-making under ambiguity after frontal lobe resection for epilepsy. Epilepsy Behav 2023; 142:109215. [PMID: 37075512 DOI: 10.1016/j.yebeh.2023.109215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Decision-making is crucial to daily life and can impact our society as well as economic conditions. Although the frontal lobes have been identified as important for decision-making, this capacity has only been studied to a limited extent in frontal lobe epilepsy and not at all after frontal lobe resection (FLR) for epilepsy. This study aimed to explore decision-making under ambiguity after FLR for epilepsy. METHODS Fourteen patients having undergone FLR for epilepsy completed the Iowa Gambling Task (IGT) which is a widely used tool to measure decision-making under ambiguity. Iowa Gambling Task scores included in the analysis were: total net score, separate scores from five blocks across the test, and a change score (last block of IGT minus first block). A group of healthy controls (n = 30) was used as a comparison. Associations between IGT and standardized neuropsychological methods for assessment of executive functions, self-rating questionnaires of mental health, fatigue, and behavior linked to frontal lobe dysfunction were also investigated. RESULTS The patient group performed inferior to controls at the final block of the IGT (p =.001).A group difference in IGT change scores was found (p =.005), reflectingthe absence of a positive change in performance over time for the FLR group compared to the control group. Correlations with tests of executive functions as well as self-rating scales were mainly statistically nonsignificant. CONCLUSIONS This study shows that patients having undergone FLR for epilepsy have difficulties with decision-making under ambiguity. The performance illustrated a failure to learn throughout the task. Executive as well as emotional deficits may impact decision-making processes in this patient group and need to be considered in further studies. Prospective studies with larger cohorts are needed.
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Affiliation(s)
- Sofia Ljunggren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Stefan Winblad
- Department of Psychology, Gothenburg University, Box 500, SE-405 30 Gothenburg, Sweden.
| | - Hans Samuelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Gothenburg, Sweden; Department of Psychology, Gothenburg University, Box 500, SE-405 30 Gothenburg, Sweden.
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
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15
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Lee AT, Nichols NM, Speidel BA, Fan JM, Cajigas I, Knowlton RC, Chang EF. Modern intracranial electroencephalography for epilepsy localization with combined subdural grid and depth electrodes with low and improved hemorrhagic complication rates. J Neurosurg 2023; 138:821-827. [PMID: 35901681 DOI: 10.3171/2022.5.jns221118] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent trends have moved from subdural grid electrocorticography (ECoG) recordings toward stereo-electroencephalography (SEEG) depth electrodes for intracranial localization of seizures, in part because of perceived morbidity from subdural grid and strip electrodes. For invasive epilepsy monitoring, the authors describe the outcomes of a hybrid approach, whereby patients receive a combination of subdural grids, strips, and frameless stereotactic depth electrode implantations through a craniotomy. Evolution of surgical techniques was employed to reduce complications. In this study, the authors review the surgical hemorrhage and functional outcomes of this hybrid approach. METHODS A retrospective review was performed of consecutive patients who underwent hybrid implantation from July 2012 to May 2022 at an academic epilepsy center by a single surgeon. Outcomes included hemorrhagic and nonhemorrhagic complications, neurological deficits, length of monitoring, and number of electrodes. RESULTS A total of 137 consecutive procedures were performed; 113 procedures included both subdural and depth electrodes. The number of depth electrodes and electrode contacts did not increase the risk of hemorrhage. A mean of 1.9 ± 0.8 grid, 4.9 ± 2.1 strip, and 3.0 ± 1.9 depth electrodes were implanted, for a mean of 125.1 ± 32 electrode contacts per patient. The overall incidence of hematomas over the study period was 5.1% (7 patients) and decreased significantly with experience and the introduction of new surgical techniques. The incidence of hematomas in the last 4 years of the study period was 0% (55 patients). Symptomatic hematomas were all delayed and extra-axial. These patients required surgical evacuation, and there were no cases of hematoma recurrence. All neurological deficits related to hematomas were temporary and were resolved at hospital discharge. There were 2 nonhemorrhagic complications. The mean duration of monitoring was 7.3 ± 3.2 days. Seizures were localized in 95% of patients, with 77% of patients eventually undergoing resection and 17% undergoing responsive neurostimulation device implantation. CONCLUSIONS In the authors' institutional experience, craniotomy-based subdural and depth electrode implantation was associated with low hemorrhage rates and no permanent morbidity. The rate of hemorrhage can be nearly eliminated with surgical experience and specific techniques. The decision to use subdural electrodes or SEEG should be tailored to the patient's unique pathology and surgeon experience.
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Affiliation(s)
| | | | | | - Joline M Fan
- 2Neurology, University of California, San Francisco, California
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16
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Merenzon MA, Bhatia S, Levy A, Eatz T, Morell AA, Daggubati LC, Luther E, Shah AH, Komotar RJ, Ivan ME. Frontal lobe low-grade tumors seizure outcome: a pooled analysis of clinical predictors. Clin Neurol Neurosurg 2023; 226:107600. [PMID: 36709666 DOI: 10.1016/j.clineuro.2023.107600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Seizures present in 50-90 % of cases with low-grade brain tumors. Frontal lobe epilepsy is associated with dismal seizure outcomes compared to temporal lobe epilepsy. Our objective is to conduct a systematic review, report our case series, and perform a pooled analysis of clinical predictors of seizure outcomes in frontal lobe low-grade brain tumors. METHODS Searches of five electronic databases from January 1990 to June 2022 were reviewed following PRISMA guidelines. Individual patient data was extracted from 22 articles that fit the inclusion criteria. A single-surgeon case series from our institution was also retrospectively reviewed and analyzed through a pooled cohort of 127 surgically treated patients with frontal lobe low-grade brain tumors. RESULTS The mean age at surgery was 30.8 years, with 50.4 % of patients diagnosed as oligodendrogliomas. The majority of patients (81.1 %) were seizure-free after surgery (Engel I). On the multivariate analysis, gross total resection (GTR) (OR = 8.77, 95 % CI: 1.99-47.91, p = 0.006) and awake resection (OR = 9.94, 95 % CI: 1.93-87.81, p = 0.015) were associated with seizure-free outcome. A Kaplan-Meier curve showed that the probability of seizure freedom fell to 92.6 % at 3 months, and to 85.5 % at 27.3 months after surgery. CONCLUSION Epilepsy from tumor origin demands a balance between oncological management and epilepsy cure. Our pooled analysis suggests that GTR and awake resections are positive predictive factors for an Engel I at more than 6 months follow-up. To validate these findings, a longer-term follow-up and larger cohorts are needed.
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Affiliation(s)
- Martín A Merenzon
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Shovan Bhatia
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Adam Levy
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tiffany Eatz
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alexis A Morell
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lekhaj C Daggubati
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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17
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Obaid S, Chen JS, Ibrahim GM, Bouthillier A, Dimentberg E, Surbeck W, Guadagno E, Brunette-Clément T, Shlobin NA, Shulkin A, Hale AT, Tomycz LD, Von Lehe M, Perry MS, Chassoux F, Bouilleret V, Taussig D, Fohlen M, Dorfmuller G, Hagiwara K, Isnard J, Oluigbo CO, Ikegaya N, Nguyen DK, Fallah A, Weil AG. Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta-analysis. Epilepsia Open 2023; 8:12-31. [PMID: 36263454 PMCID: PMC9978079 DOI: 10.1002/epi4.12663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022] Open
Abstract
Insular epilepsy (IE) is an increasingly recognized cause of drug-resistant epilepsy amenable to surgery. However, concerns of suboptimal seizure control and permanent neurological morbidity hamper widespread adoption of surgery for IE. We performed a systematic review and individual participant data meta-analysis to determine the efficacy and safety profile of surgery for IE and identify predictors of outcomes. Of 2483 unique citations, 24 retrospective studies reporting on 312 participants were eligible for inclusion. The median follow-up duration was 2.58 years (range, 0-17 years), and 206 (66.7%) patients were seizure-free at last follow-up. Younger age at surgery (≤18 years; HR = 1.70, 95% CI = 1.09-2.66, P = .022) and invasive EEG monitoring (HR = 1.97, 95% CI = 1.04-3.74, P = .039) were significantly associated with shorter time to seizure recurrence. Performing MR-guided laser ablation or radiofrequency ablation instead of open resection (OR = 2.05, 95% CI = 1.08-3.89, P = .028) was independently associated with suboptimal or poor seizure outcome (Engel II-IV) at last follow-up. Postoperative neurological complications occurred in 42.5% of patients, most commonly motor deficits (29.9%). Permanent neurological complications occurred in 7.8% of surgeries, including 5% and 1.4% rate of permanent motor deficits and dysphasia, respectively. Resection of the frontal operculum was independently associated with greater odds of motor deficits (OR = 2.75, 95% CI = 1.46-5.15, P = .002). Dominant-hemisphere resections were independently associated with dysphasia (OR = 13.09, 95% CI = 2.22-77.14, P = .005) albeit none of the observed language deficits were permanent. Surgery for IE is associated with a good efficacy/safety profile. Most patients experience seizure freedom, and neurological deficits are predominantly transient. Pediatric patients and those requiring invasive monitoring or undergoing stereotactic ablation procedures experience lower rates of seizure freedom. Transgression of the frontal operculum should be avoided if it is not deemed part of the epileptogenic zone. Well-selected candidates undergoing dominant-hemisphere resection are more likely to exhibit transient language deficits; however, the risk of permanent deficit is very low.
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Affiliation(s)
- Sami Obaid
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada.,Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Jia-Shu Chen
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Evan Dimentberg
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada.,Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Werner Surbeck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tristan Brunette-Clément
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada.,Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Aidan Shulkin
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada
| | - Andrew T Hale
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Luke D Tomycz
- The Epilepsy Institute of New Jersey, Jersey City, New Jersey, USA
| | - Marec Von Lehe
- Department of Neurosurgery, Brandenburg Medical School, Neuruppin, Germany
| | - Michael Scott Perry
- Comprehensive Epilepsy Program, Jane and John Justin Neuroscience Center, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Francine Chassoux
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Université Paris-Descartes Paris, Paris, France
| | - Viviane Bouilleret
- Université Paris Saclay-APHP, Unité de Neurophysiologie Clinique et d'Épileptologie(UNCE), Le Kremlin Bicêtre, France
| | - Delphine Taussig
- Université Paris Saclay-APHP, Unité de Neurophysiologie Clinique et d'Épileptologie(UNCE), Le Kremlin Bicêtre, France.,Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | - Martine Fohlen
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | - Georg Dorfmuller
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | - Koichi Hagiwara
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Jean Isnard
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery, Lyon, France
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Naoki Ikegaya
- Departments of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Dang K Nguyen
- Division of Neurology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery and Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada.,Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada.,Department of Neuroscience, University of Montreal, Montreal, Quebec, Canada
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18
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Miyakawa N, Nagai Y, Hori Y, Mimura K, Orihara A, Oyama K, Matsuo T, Inoue KI, Suzuki T, Hirabayashi T, Suhara T, Takada M, Higuchi M, Kawasaki K, Minamimoto T. Chemogenetic attenuation of cortical seizures in nonhuman primates. Nat Commun 2023; 14:971. [PMID: 36854724 PMCID: PMC9975184 DOI: 10.1038/s41467-023-36642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
Epilepsy is a disorder in which abnormal neuronal hyperexcitation causes several types of seizures. Because pharmacological and surgical treatments occasionally interfere with normal brain function, a more focused and on-demand approach is desirable. Here we examined the efficacy of a chemogenetic tool-designer receptors exclusively activated by designer drugs (DREADDs)-for treating focal seizure in a nonhuman primate model. Acute infusion of the GABAA receptor antagonist bicuculline into the forelimb region of unilateral primary motor cortex caused paroxysmal discharges with twitching and stiffening of the contralateral arm, followed by recurrent cortical discharges with hemi- and whole-body clonic seizures in two male macaque monkeys. Expression of an inhibitory DREADD (hM4Di) throughout the seizure focus, and subsequent on-demand administration of a DREADD-selective agonist, rapidly suppressed the wide-spread seizures. These results demonstrate the efficacy of DREADDs for attenuating cortical seizure in a nonhuman primate model.
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Affiliation(s)
- Naohisa Miyakawa
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan.
| | - Yuji Nagai
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Yukiko Hori
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Koki Mimura
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Asumi Orihara
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kei Oyama
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | | | - Ken-Ichi Inoue
- Systems Neuroscience Section, Center for the Evolutionary Origins of Human Behavior, Kyoto University, Aichi, Japan
| | - Takafumi Suzuki
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita, Japan
| | - Toshiyuki Hirabayashi
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Tetsuya Suhara
- Institute for Quantum Life Science, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Masahiko Takada
- Systems Neuroscience Section, Center for the Evolutionary Origins of Human Behavior, Kyoto University, Aichi, Japan
| | - Makoto Higuchi
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Keisuke Kawasaki
- Department of Physiology, Niigata University School of Medicine, Niigata, Japan
| | - Takafumi Minamimoto
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan.
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19
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Yoganathan K, Malek N, Torzillo E, Paranathala M, Greene J. Neurological update: structural and functional imaging in epilepsy surgery. J Neurol 2023; 270:2798-2808. [PMID: 36792721 PMCID: PMC10130132 DOI: 10.1007/s00415-023-11619-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
Structural and functional imaging prior to surgery in drug-resistant focal epilepsy, has an important role to play alongside electroencephalography (EEG) techniques, in planning the surgical approach and predicting post-operative outcome. This paper reviews the role of structural and functional imaging of the brain, namely computed tomography (CT), magnetic resonance imaging (MRI), functional MRI (fMRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging in the preoperative work-up of people with medically refractory epilepsy. In MRI-negative patients, the precise localisation of the epileptogenic zone may be established by demonstrating hypometabolism on PET imaging or hyperperfusion on SPECT imaging in the area surrounding the seizure focus. These imaging modalities are far less invasive than intracranial EEG, which is the gold standard but requires surgical placement of electrodes or recording grids. Even when intracranial EEG is needed, PET or SPECT imaging can assist in the planning of EEG electrode placement, due to its' limited spatial sampling. Multimodal imaging techniques now allow the multidisciplinary epilepsy surgery team to identify and better characterise focal pathology, determine its' relationship to eloquent areas of the brain and the degree of interconnectedness within both physiological and pathological networks, as well as improve planning and surgical outcomes for patients. This paper will update the reader on this whole field and provide them with a practical guide, to aid them in the selection of appropriate investigations, interpretation of the findings and facilitating patient discussions in individuals with drug-resistant focal epilepsy.
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Affiliation(s)
- Katie Yoganathan
- University of Oxford and Oxford University Hospitals, Oxford, UK. .,Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Naveed Malek
- Department of Neurology, Queen's Hospital, Romford, UK
| | - Emma Torzillo
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - John Greene
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
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20
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Xu Y, Hu WH, Shao XQ, Ma YS, Lou L, Zhang K, Zhang JG. Long-term seizure outcome with the surgically remediable syndrome of frontal lobe epilepsy associated with superior frontal sulcus-related dysplasia. Front Neurol 2023; 14:1096712. [PMID: 37034087 PMCID: PMC10076633 DOI: 10.3389/fneur.2023.1096712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Objective To assess the long-term outcome of the surgically remediable syndrome of frontal lobe epilepsy (FLE) associated with superior frontal sulcus (SFS)-related dysplasia. Methods We retrospectively reviewed the medical charts and surgical features of 31 patients with drug-resistant frontal lobe epilepsy in our centers between 2016 and 2018. All patients underwent surgical resection. According to the epileptogenic zone (EZ), localization and resection extent were classified as (1) pure SFS group (PS group), (2) associated SFS group (AS group), and (3) no SFS group (NS group). The general characteristics, neuroradiological findings, morbidity, pathology, and long-term seizure outcome after surgery were analyzed to extract the potential value of the surgery for SFS-related dysplasia. Results Of 31 patients with FLE who underwent epilepsy surgery, 15 patients (nine men) were included PS group, five patients (five men) in the AS group, and 11 patients (eight men) in the NS group. Eleven patients detected abnormal focal signals in the presurgical MRI. Six patients in the PS group demonstrated the suspected focal cortical dysplasia (FCD) in the SFS detected with MRI. All patients demonstrated focal abnormal hypometabolism foci in the PET-MR co-registration. Twenty-five patients (80.6%) were seizure-free since surgery, including all 15 patients (100%) of the PS group, three in five patients (60%) of the AS group, and seven in 11 patients (63.6%) of the NS group. The difference in outcome between different groups was significant (p = 0.004, PS vs. AS group; p = 0.005, PS vs. NS group). As of the last follow-up (mean 66.2 ± 9.7months), 25 patients (80.6%) were seizure-free since surgery (Engel's class I). In addition, antiseizure medication was withdrawn in 19 patients (61.3%). Histologic examination of resected specimens revealed FCD in all 31 patients. The percentage of FCD II type was 100, 60, and 63.6% in the three different groups, respectively. Conclusion SFS-related dysplasia is a neuropathologic entity with a favorable postoperative outcome. FCD II is the most common type of SFS-related dysplasia. FDG-PET co-registered with MRI should be performed in patients with suspected SFS-related dysplasia, since it may depict areas of hypometabolism suggestive of dysplasia in the absence of MRI abnormalities.
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Affiliation(s)
- Yan Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional and Stereotactic Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Epilepsy Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
- *Correspondence: Yan Xu
| | - Wen-Han Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional and Stereotactic Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiao-Qiu Shao
- Department of Epilepsy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan-Shan Ma
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Lin Lou
- Department of Neurosurgery, Epilepsy Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional and Stereotactic Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional and Stereotactic Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Jian-Guo Zhang
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21
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Courtney MR, Antonic-Baker A, Sinclair B, Nicolo JP, Neal A, Law M, Kwan P, O'Brien TJ, Vivash L. 18F-FDG-PET hypometabolism as a predictor of favourable outcome in epilepsy surgery: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e065440. [PMID: 36202585 PMCID: PMC9540844 DOI: 10.1136/bmjopen-2022-065440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A substantial proportion of patients who undergo surgery for drug resistant focal epilepsy do not become seizure free. While some factors, such as the detection of hippocampal sclerosis or a resectable lesion on MRI and electroencephalogram-MRI concordance, can predict favourable outcomes in epilepsy surgery, the prognostic value of the detection of focal hypometabolism with 18F-fluorodeoxyglucose positive emission tomography (18F-FDG-PET) hypometabolism is uncertain. We propose a protocol for a systematic review and meta-analysis to examine whether localisation with 18F-FDG-PET hypometabolism predicts favourable outcomes in epilepsy surgery. METHODS AND ANALYSIS A systematic literature search of Medline, Embase and Web of Science will be undertaken. Publications which include evaluation with 18F-FDG-PET prior to surgery for drug resistant focal epilepsy, and which report ≥12 months of postoperative surgical outcome data will be included. Non-human, non-English language publications, publications with fewer than 10 participants and unpublished data will be excluded. Screening and full-text review of publications for inclusion will be undertaken by two independent investigators, with discrepancies resolved by consensus or a third investigator. Data will be extracted and pooled using random effects meta-analysis, with heterogeneity quantified using the I2 analysis. ETHICS AND DISSEMINATION Ethics approval is not required. Once complete, the systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022324823.
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Affiliation(s)
- Merran R Courtney
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Benjamin Sinclair
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - John-Paul Nicolo
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Neal
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Meng Law
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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22
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Le V, Thuy Le M, Nguyen DH, Tang LNP, Pham TA, Nguyen AM, Nguyen MK, Van Ngo T, Tran TT, Van Le T, Jallon P, Lim K. Epilepsy surgery program in a resource-limited setting in Vietnam: A multicentered collaborative model. Epilepsia Open 2022; 7:710-717. [PMID: 36136063 PMCID: PMC9712473 DOI: 10.1002/epi4.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Although epilepsy surgery is more effective than medical therapy for drug-resistant patients, it is underutilized in both high-income and low- and middle-income countries. In light of our efforts to establish an epilepsy surgery program in a resource-limited setting, this study aimed to determine the outcome of the epilepsy surgery program in Ho Chi Minh City (HCMC), Vietnam. METHODS In 2018, we developed the HCMC epilepsy core multidisciplinary team with members from various hospitals and centers. The team typically included neurologists, neurosurgeons, neuropsychologists, psychiatrists, and nursing specialists. Presurgical evaluations were performed for patients with drug-resistant epilepsy, fulfilling the ILAE criteria, with an epileptogenic lesion (mesial temporal sclerosis, low-grade gliomas, or focal cortical dysplasia). All epilepsy surgeries were performed in two epilepsy surgery centers in HCMC between 2018 and 2021. The patients were followed up for at least 12 months. RESULTS Fifty-two patients with drug-resistant epilepsy underwent presurgical evaluation, of which 35 underwent surgery. Among the 52 patients, 20 (38.5%) underwent surgery after showing concordance among the results of standard presurgical assessments such as semiology, scalp interictal or ictal electroencephalography, and brain imaging. Among the 26 people with epilepsy who required more advanced evaluations, 15 underwent surgery with intraoperative electrocorticography to delineate the optimal resection borders. The outcomes of Engel Class I and Class II were achieved in 29/35 (82.8%) and 6/35 (17.2%) patients, respectively. SIGNIFICANCE The epilepsy surgery program with a multicentered collaborative model in a resource-limited setting showed favorable outcomes in HCMC, Vietnam.
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Affiliation(s)
- Viet‐Thang Le
- Department of NeurosurgeryUniversity Medical Center at Ho Chi Minh CityHo Chi Minh CityVietnam,Department of NeurosurgeryUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Minh‐An Thuy Le
- Department of NeurologyUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam,Department of NeurologyNguyen Tri Phuong HospitalHo Chi Minh CityVietnam
| | - Duc Hue Nguyen
- Department of NeurosurgeryNguyen Tri Phuong HospitalHo Chi Minh CityVietnam
| | - Loc Ngoc Phuong Tang
- Department of NeurologyNguyen Tri Phuong HospitalHo Chi Minh CityVietnam,Department of NeurologyPham Ngoc Thach University of MedicineHo Chi Minh CityVietnam
| | - Tuan Anh Pham
- Department of NeurosurgeryUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam,Department of NeurosurgeryNguyen Tri Phuong HospitalHo Chi Minh CityVietnam
| | - Anh Minh Nguyen
- Department of NeurosurgeryUniversity Medical Center at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Minh Kien Nguyen
- Department of Infection DiseaseChildren Hospital 1Ho Chi Minh CityVietnam
| | - Tan Van Ngo
- Division of PET‐CT and Cyclotron, Nuclear Medicine DepartmentCho Ray hospitalHo Chi Minh CityVietnam
| | - Thanh Trung Tran
- Department of NeurologyNguyen Tri Phuong HospitalHo Chi Minh CityVietnam
| | - Tuan Van Le
- Department of NeurologyUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Pierre Jallon
- Department of NeurologyUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Kheng‐Seang Lim
- Division of Neurology, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
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23
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Jehi L, Jette N, Kwon CS, Josephson CB, Burneo JG, Cendes F, Sperling MR, Baxendale S, Busch RM, Triki CC, Cross JH, Ekstein D, Englot DJ, Luan G, Palmini A, Rios L, Wang X, Roessler K, Rydenhag B, Ramantani G, Schuele S, Wilmshurst JM, Wilson S, Wiebe S. Timing of referral to evaluate for epilepsy surgery: Expert Consensus Recommendations from the Surgical Therapies Commission of the International League Against Epilepsy. Epilepsia 2022; 63:2491-2506. [PMID: 35842919 PMCID: PMC9562030 DOI: 10.1111/epi.17350] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
Epilepsy surgery is the treatment of choice for patients with drug-resistant seizures. A timely evaluation for surgical candidacy can be life-saving for patients who are identified as appropriate surgical candidates, and may also enhance the care of nonsurgical candidates through improvement in diagnosis, optimization of therapy, and treatment of comorbidities. Yet, referral for surgical evaluations is often delayed while palliative options are pursued, with significant adverse consequences due to increased morbidity and mortality associated with intractable epilepsy. The Surgical Therapies Commission of the International League Against Epilepsy (ILAE) sought to address these clinical gaps and clarify when to initiate a surgical evaluation. We conducted a Delphi consensus process with 61 epileptologists, epilepsy neurosurgeons, neurologists, neuropsychiatrists, and neuropsychologists with a median of 22 years in practice, from 28 countries in all six ILAE world regions. After three rounds of Delphi surveys, evaluating 51 unique scenarios, we reached the following Expert Consensus Recommendations: (1) Referral for a surgical evaluation should be offered to every patient with drug-resistant epilepsy (up to 70 years of age), as soon as drug resistance is ascertained, regardless of epilepsy duration, sex, socioeconomic status, seizure type, epilepsy type (including epileptic encephalopathies), localization, and comorbidities (including severe psychiatric comorbidity like psychogenic nonepileptic seizures [PNES] or substance abuse) if patients are cooperative with management; (2) A surgical referral should be considered for older patients with drug-resistant epilepsy who have no surgical contraindication, and for patients (adults and children) who are seizure-free on 1-2 antiseizure medications (ASMs) but have a brain lesion in noneloquent cortex; and (3) referral for surgery should not be offered to patients with active substance abuse who are noncooperative with management. We present the Delphi consensus results leading up to these Expert Consensus Recommendations and discuss the data supporting our conclusions. High level evidence will be required to permit creation of clinical practice guidelines.
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Affiliation(s)
- Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nathalie Jette
- Department of Neurology and Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Churl-Su Kwon
- Department of Neurology, Epidemiology, Neurosurgery and the Gertrude H. Sergievsky Center, Columbia University, New York, USA
| | - Colin B Josephson
- Department of Clinical Neurosciences and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jorge G. Burneo
- Department of Clinical Neurological Sciences and NeuroEpidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | | | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Robyn M. Busch
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Chahnez Charfi Triki
- Department of Child Neurology, Hedi Chaker Hospital, LR19ES15 Sfax University, Sfax, Tunisia
| | - J Helen Cross
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dana Ekstein
- Department of Neurology, Agnes Ginges Center for Human Neurogenetics, Hadassah Medical Organization, Jerusalem, Israel
| | - Dario J Englot
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Guoming Luan
- Department of Neurosurgery, Comprehensive Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; Beijing Key Laboratory of Epilepsy; Epilepsy Institution, Beijing Institute for Brain Disorders, Beijing, China
| | - Andre Palmini
- Neurosciences and Surgical Departments, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Loreto Rios
- Clínica Integral de Epilepsia, Campus Clínico Facultad de Medicina Universidad Finis Terrae, Santiago, Chile
| | - Xiongfei Wang
- Department of Neurosurgery, Comprehensive Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; Beijing Key Laboratory of Epilepsy; Epilepsy Institution, Beijing Institute for Brain Disorders, Beijing, China
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Bertil Rydenhag
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Georgia Ramantani
- Department of Neuropediatrics, and University Children’s Hospital Zurich, Switzerland, University of Zurich, Switzerland
| | - Stephan Schuele
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Jo M Wilmshurst
- Department of Pediatric Neurology, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; Institute of Neurosciences, University of Cape Town, South Africa
| | - Sarah Wilson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Samuel Wiebe
- Department of Clinical Neurosciences and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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24
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Zheng B, Hsieh B, Rex N, Lauro PM, Collins SA, Blum AS, Roth JL, Ayub N, Asaad WF. A hierarchical anatomical framework and workflow for organizing stereotactic encephalography in epilepsy. Hum Brain Mapp 2022; 43:4852-4863. [PMID: 35851977 PMCID: PMC9582372 DOI: 10.1002/hbm.26017] [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: 05/31/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Stereotactic electroencephalography (SEEG) is an increasingly utilized method for invasive monitoring in patients with medically intractable epilepsy. Yet, the lack of standardization for labeling electrodes hinders communication among clinicians. A rational clustering of contacts based on anatomy rather than arbitrary physical leads may help clinical neurophysiologists interpret seizure networks. We identified SEEG electrodes on post‐implant CTs and registered them to preoperative MRIs segmented according to an anatomical atlas. Individual contacts were automatically assigned to anatomical areas independent of lead. These contacts were then organized using a hierarchical anatomical schema for display and interpretation. Bipolar‐referenced signal cross‐correlations were used to compare the similarity of grouped signals within a conventional montage versus this anatomical montage. As a result, we developed a hierarchical organization for SEEG contacts using well‐accepted, free software that is based solely on their post‐implant anatomical location. When applied to three example SEEG cases for epilepsy, clusters of contacts that were anatomically related collapsed into standardized groups. Qualitatively, seizure events organized using this framework were better visually clustered compared to conventional schemes. Quantitatively, signals grouped by anatomical region were more similar to each other than electrode‐based groups as measured by Pearson correlation. Further, we uploaded visualizations of SEEG reconstructions into the electronic medical record, rendering them durably useful given the interpretable electrode labels. In conclusion, we demonstrate a standardized, anatomically grounded approach to the organization of SEEG neuroimaging and electrophysiology data that may enable improved communication among and across surgical epilepsy teams and promote a clearer view of individual seizure networks.
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Affiliation(s)
- Bryan Zheng
- Department of Neurosurgery Warren Alpert Medical School, Brown University Providence Rhode Island USA
| | - Ben Hsieh
- Department of Diagnostic Imaging Warren Alpert Medical School, Brown University Providence Rhode Island USA
| | - Nathaniel Rex
- Department of Diagnostic Imaging Warren Alpert Medical School, Brown University Providence Rhode Island USA
| | - Peter M. Lauro
- Department of Neurosurgery Warren Alpert Medical School, Brown University Providence Rhode Island USA
| | - Scott A. Collins
- Department of Diagnostic Imaging Warren Alpert Medical School, Brown University Providence Rhode Island USA
| | - Andrew S. Blum
- Department of Neurology Warren Alpert Medical School, Brown University Providence Rhode Island USA
| | - Julie L. Roth
- Department of Neurology Warren Alpert Medical School, Brown University Providence Rhode Island USA
| | - Neishay Ayub
- Department of Neurology Warren Alpert Medical School, Brown University Providence Rhode Island USA
| | - Wael F. Asaad
- Department of Neurosurgery Warren Alpert Medical School, Brown University Providence Rhode Island USA
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Mirchi N, Warsi NM, Zhang F, Wong SM, Suresh H, Mithani K, Erdman L, Ibrahim GM. Decoding Intracranial EEG With Machine Learning: A Systematic Review. Front Hum Neurosci 2022; 16:913777. [PMID: 35832872 PMCID: PMC9271576 DOI: 10.3389/fnhum.2022.913777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Advances in intracranial electroencephalography (iEEG) and neurophysiology have enabled the study of previously inaccessible brain regions with high fidelity temporal and spatial resolution. Studies of iEEG have revealed a rich neural code subserving healthy brain function and which fails in disease states. Machine learning (ML), a form of artificial intelligence, is a modern tool that may be able to better decode complex neural signals and enhance interpretation of these data. To date, a number of publications have applied ML to iEEG, but clinician awareness of these techniques and their relevance to neurosurgery, has been limited. The present work presents a review of existing applications of ML techniques in iEEG data, discusses the relative merits and limitations of the various approaches, and examines potential avenues for clinical translation in neurosurgery. One-hundred-seven articles examining artificial intelligence applications to iEEG were identified from 3 databases. Clinical applications of ML from these articles were categorized into 4 domains: i) seizure analysis, ii) motor tasks, iii) cognitive assessment, and iv) sleep staging. The review revealed that supervised algorithms were most commonly used across studies and often leveraged publicly available timeseries datasets. We conclude with recommendations for future work and potential clinical applications.
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Affiliation(s)
- Nykan Mirchi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nebras M. Warsi
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Frederick Zhang
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Simeon M. Wong
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Hrishikesh Suresh
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Karim Mithani
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Lauren Erdman
- Vector Institute for Artificial Intelligence, MaRS Centre, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - George M. Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Alim-Marvasti A, Vakharia VN, Duncan JS. Multimodal prognostic features of seizure freedom in epilepsy surgery. J Neurol Neurosurg Psychiatry 2022; 93:499-508. [PMID: 35246493 PMCID: PMC9016256 DOI: 10.1136/jnnp-2021-327119] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Accurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models. METHODS We searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: 'clinical', 'imaging', 'neurophysiology', 'multimodal concordance', 'genetic', 'surgical technique' and 'pathology'. We propose a structural causal model based on these features. RESULTS We found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons. SIGNIFICANCE Seizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models. PROSPERO REGISTRATION NUMBER CRD42021185232.
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Affiliation(s)
- Ali Alim-Marvasti
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK .,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vejay Niranjan Vakharia
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK
| | - John Sidney Duncan
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK
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Gummadavelli A, Englot DJ, Schwalb JM, Wu C, Gonzalez-Martinez J, Niemat J, Gerrard JL. ASSFN Position Statement on Deep Brain Stimulation for Medication-Refractory Epilepsy. Neurosurgery 2022; 90:636-641. [PMID: 35271523 PMCID: PMC9514731 DOI: 10.1227/neu.0000000000001923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
Neuromodulation has taken a foothold in the landscape of surgical treatment for medically refractory epilepsies and offers additional surgical treatment options for patients who are not candidates for resective/ablative surgery. Approximately one third of patients with epilepsy suffer with medication-refractory epilepsy. A persistent underuse of epilepsy surgery exists. Neuromodulation treatments including deep brain stimulation (DBS) expand the surgical options for patients with epilepsy and provide options for patients who are not candidates for resective surgery. DBS of the bilateral anterior nucleus of the thalamus is an Food and Drug Administration-approved, safe, and efficacious treatment option for patients with refractory focal epilepsy. The purpose of this consensus position statement is to summarize evidence, provide recommendations, and identify indications and populations for future investigation in DBS for epilepsy. The recommendations of the American Society of Functional and Stereotactic Neurosurgeons are based on several randomized and blinded clinical trials with high-quality data to support the use of DBS to the anterior nucleus of the thalamus for the treatment of refractory focal-onset seizures.
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Affiliation(s)
- Abhijeet Gummadavelli
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA;
| | - Dario J. Englot
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA;
| | - Jason M. Schwalb
- Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan, USA;
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA;
| | - Jorge Gonzalez-Martinez
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;
| | - Joseph Niemat
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Jason L. Gerrard
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA;
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Hagemann A, Bien CG, Kalbhenn T, Hopf JL, Grewe P. Epilepsy Surgery in Extratemporal vs Temporal Lobe Epilepsy: Changes in Surgical Volumes and Seizure Outcome Between 1990 and 2017. Neurology 2022; 98:e1902-e1912. [DOI: 10.1212/wnl.0000000000200194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022] Open
Abstract
Objective:Seizure outcome after extratemporal lobe epilepsy (exTLE) surgery has often been poorer than after temporal lobe epilepsy (TLE) surgery, but recent improvements in diagnostics and surgery may have changed this. Our aim was to analyze the changes in presurgical and surgical volumes and seizure outcome two years after surgery for patients with exTLE compared to those with TLE.Methods:We performed a retrospective, single-center cohort study including patients from the Bethel presurgical-surgical-postsurgical database from 1990 to 2017. We used logistic regression to analyze factors influencing the odds for surgery and the odds for seizure freedom after surgery.Results:We included 3822 patients with presurgical evaluation, 2404 of whom had subsequently undergone surgery. The proportion of exTLE patients in presurgical evaluation increased from 41% between 1990-1993 to 64% in 2014-2017. The odds for surgery decreased over time (2003-2011: OR=0.50 [95%CI 0.36-0.70]; 2012-2017: OR=0.24 [CI 0.17-0.35]; reference: 1990-2002), and patients with exTLE had lower odds for surgery than TLE patients, but this difference diminished over time (exTLE vs. TLE 1990-2002: OR=0.14 [CI 0.09-0.20]; 2003-2011: OR=0.32 [CI 0.24-0.44]; 2012-2017: OR=0.46 [CI 0.34-0.63]). Etiology, the side of the epileptogenic lesion and invasive recordings additionally influenced the odds for surgery. The most frequent reasons for not undergoing surgery were the missing identification of a circumscribed epileptogenic zone or an unacceptable risk of postsurgical deficits in exTLE patients and the patient’s decision in TLE patients. Compared to TLE patients, the odds for seizure freedom after surgery started lower for patients with exTLE in earlier years, but increased (≤2 lobes 1990-2002: OR=0.47 [CI 0.33-0.68]; 2003-2011: OR=0.62 [CI 0.44-0.87]; 2012-2017: OR=0.78 [CI 0.53-1.15]; ≥3 lobes 1990-2002: OR=0.37 [CI 0.22-0.62]; 2003-2011: OR=0.73 [CI 0.43-1.23]; 2012-2017: OR=1.46 [CI 0.91-2.42]). Etiology, age at surgery and invasive recordings were further predictors for the odds for seizure freedom.Conclusion:Over the past 28 years, the success of resective surgery for patients with exTLE has improved. At the same time, the number of exTLE patients being evaluated for surgery increased as well as their odds for undergoing surgery.
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Abstract
PURPOSE OF REVIEW More than 20 new antiseizure medications have been approved by the US Food and Drug Administration (FDA) in the past 3 decades; however, outcomes in newly diagnosed epilepsy have not improved, and epilepsy remains drug resistant in up to 40% of patients. Evidence supports improved seizure outcomes and quality of life in those who have undergone epilepsy surgery, but epilepsy surgery remains underutilized. This article outlines indications for epilepsy surgery, describes the presurgical workup, and summarizes current available surgical approaches. RECENT FINDINGS Class I evidence has demonstrated the superiority of resective surgery compared to medical therapy for seizure control and quality of life in patients with drug-resistant epilepsy. The use of minimally invasive options, such as laser interstitial thermal therapy and stereotactic radiosurgery, are alternatives to resective surgery in well-selected patients. Neuromodulation techniques, such as responsive neurostimulation, deep brain stimulation, and vagus nerve stimulation, offer a suitable alternative, especially in those where resective surgery is contraindicated or where patients prefer nonresective surgery. Although neuromodulation approaches reduce seizure frequency, they are less likely to be associated with seizure freedom than resective surgery. SUMMARY Appropriate patients with drug-resistant epilepsy benefit from epilepsy surgery. If two well-chosen and tolerated medication trials do not achieve seizure control, referral to a comprehensive epilepsy center for a thorough presurgical workup and discussion of surgical options is appropriate. Mounting Class I evidence supports a significantly higher chance of stopping disabling seizures with surgery than with further medication trials.
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McGonigal A. Frontal lobe seizures: overview and update. J Neurol 2022; 269:3363-3371. [PMID: 35006387 DOI: 10.1007/s00415-021-10949-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/27/2022]
Abstract
Frontal lobe seizures (FLS) are debilitating for patients, highly diverse and often challenging for clinicians to evaluate. Frontal lobe epilepsy is the second most common localization for focal epilepsy, and if pharmacoresistant, can be amenable to resective surgery. Detailed study of frontal seizure semiology in conjunction with careful anatomical and electrophysiological correlation based on intracerebral recording with stereoelectroencephalography (SEEG) has allowed demonstration that ictal motor semiology reflects a hierarchical rostro-caudal axis of frontal lobe functional organization, thus helping with presurgical localization. Main semiological features allowing distinction between different frontal sublobar regions include motor signs and emotional signs. Frontal lobe seizure semiology also represents a valuable source of in vivo human behavioral data from a neuroscientific perspective. Advances in defining underlying etiologies of FLE are likely to be crucial for appropriate selection and exploration of potential surgical candidates, which could improve upon current surgical outcomes. Future research on investigating the genetic basis of epilepsies and relation to structural substrate (e.g. focal cortical dysplasia) and seizure organization and expression, could permit a "genotype-phenotype" approach that could be complementary to anatomical electroclinical correlations in better defining the spectrum of FLS. This could help with optimizing patient selection and prognostication with regards to therapeutic choices.
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Affiliation(s)
- Aileen McGonigal
- Clinical Neurophysiology, Timone Hospital, APHM, Marseille, France. .,Inserm, INS, Institut de Neurosciences Des Systèmes, Aix Marseille Univ, Marseille, France.
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Li H, Ji S, Dong B, Chen L. Seizure control after epilepsy surgery in early childhood: A systematic review and meta-analysis. Epilepsy Behav 2021; 125:108369. [PMID: 34731717 DOI: 10.1016/j.yebeh.2021.108369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/15/2021] [Accepted: 09/25/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This meta-analysis aimed to determine the main factors influencing surgical outcomes in children <3 years old with refractory epilepsy. METHODS The PubMed and Cochrane database were systematically searched for epilepsy surgery outcomes from December 1, 1991, to March 30, 2021, using the following search terms: "Epilepsy surgery OR Seizure operation" AND "under three years" OR "first three years" OR "early childhood" OR "infancy OR infants." Seizure onset, duration of epilepsy, magnetic resonance imaging findings, age at the time of surgery, surgical methods, resection extent, and pathological findings were considered potential moderators of differences in seizure outcomes. The fixed-effects models, combined effect sizes, and 95% confidence intervals (CI) were used to calculate the influence of potential factors on seizure outcomes. RESULTS Thirty two studies (559 cases) were included in the meta-analysis. The significant factors that correlated with a lower seizure control rate were frontal lobectomy (odds ratio [OR]: 0.33, 95% CI: 0.12-0.91; p = 0.03) and malformation of cortical development (MCD) (OR, 0.38; 95% CI: 0.24-0.62; p < 0.01). A higher seizure control rate was observed in children with tumors (92.86%) and Sturge-Weber syndrome (SWS, 91.43%). Frontal lobe epilepsy induced by MCD was related to the worst postoperative efficacy (OR, 0.26; 95% CI: 0.13-0.53; p < 0.01). SIGNIFICANCE The results of our meta-analyses revealed that pathology and surgical location play critical roles in the outcome of epilepsy surgery in children <3 years old. Clarification of the etiology of epilepsy before surgery is critical for better postoperative outcomes.
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Affiliation(s)
- Hua Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
| | - Shuming Ji
- Department of Clinical Research Management, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
| | - Bosi Dong
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China; Department of Clinical Research Management, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China.
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Fitzgerald Z, Morita-Sherman M, Hogue O, Joseph B, Alvim MKM, Yasuda CL, Vegh D, Nair D, Burgess R, Bingaman W, Najm I, Kattan MW, Blumcke I, Worrell G, Brinkmann BH, Cendes F, Jehi L. Improving the prediction of epilepsy surgery outcomes using basic scalp EEG findings. Epilepsia 2021; 62:2439-2450. [PMID: 34338324 PMCID: PMC8488002 DOI: 10.1111/epi.17024] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/15/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the role of scalp electroencephalography (EEG; ictal and interictal patterns) in predicting resective epilepsy surgery outcomes. We use the data to further develop a nomogram to predict seizure freedom. METHODS We retrospectively reviewed the scalp EEG findings and clinical data of patients who underwent surgical resection at three epilepsy centers. Using both EEG and clinical variables categorized into 13 isolated candidate predictors and 6 interaction terms, we built a multivariable Cox proportional hazards model to predict seizure freedom 2 years after surgery. Harrell's step-down procedure was used to sequentially eliminate the least-informative variables from the model until the change in the concordance index (c-index) with variable removal was less than 0.01. We created a separate model using only clinical variables. Discrimination of the two models was compared to evaluate the role of scalp EEG in seizure-freedom prediction. RESULTS Four hundred seventy patient records were analyzed. Following internal validation, the full Clinical + EEG model achieved an optimism-corrected c-index of 0.65, whereas the c-index of the model without EEG data was 0.59. The presence of focal to bilateral tonic-clonic seizures (FBTCS), high preoperative seizure frequency, absence of hippocampal sclerosis, and presence of nonlocalizable seizures predicted worse outcome. The presence of FBTCS had the largest impact for predicting outcome. The analysis of the models' interactions showed that in patients with unilateral interictal epileptiform discharges (IEDs), temporal lobe surgery cases had a better outcome. In cases with bilateral IEDs, abnormal magnetic resonance imaging (MRI) predicted worse outcomes, and in cases without IEDs, patients with extratemporal epilepsy and abnormal MRI had better outcomes. SIGNIFICANCE This study highlights the value of scalp EEG, particularly the significance of IEDs, in predicting surgical outcome. The nomogram delivers an individualized prediction of postoperative outcome, and provides a unique assessment of the relationship between the outcome and preoperative findings.
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Affiliation(s)
| | | | - Olivia Hogue
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Boney Joseph
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Deborah Vegh
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Richard Burgess
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Bingaman
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael W. Kattan
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Castagno S, D'Arco F, Tahir MZ, Battey H, Eltze C, Moeller F, Tisdall M. Seizure outcomes of large volume temporo-parieto-occipital and frontal surgery in children with drug-resistant epilepsy. Epilepsy Res 2021; 177:106769. [PMID: 34560348 DOI: 10.1016/j.eplepsyres.2021.106769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In this study, we investigate the seizure outcomes of temporo-parieto-occipital (TPO) and frontal disconnections or resections in children with drug-resistant epilepsy (DRE) in order to determine factors which may predict surgical results. METHODS Children with DRE, who underwent either TPO or frontal disconnection or resection at Great Ormond Street Hospital for Children between 2000 and 2017, were identified from a prospectively collated operative database. Demographic data, age at surgery, type of surgery, scalp EEGs and operative histopathology were collected. Magnetic resonance imaging (MRI) was assessed to determine completeness of disconnection and presence of radiological lesion beyond the disconnection margins. Seizure outcome at 6, 12, and 24 months post-surgery was assessed using the Engel Scale (ES). Logistic regression was used to identify relationships between data variables and seizure outcome. RESULTS 46 children (males = 28, females = 18; age range 0.5-16.6 years) who underwent TPO (n = 32, including a re-do disconnection) or frontal disconnection or resection (n = 15) were identified. Patients in the TPO treatment group had more favourable seizure outcomes than those in the frontal treatment group (ES I-II in 56 %vs 47 % at 6 months, 52 % vs 46 % at 12 months). Presence of the lesion beyond disconnection boundaries and older age at the time of surgery were associated with poorer seizure outcome. Gender, surgery type, completeness of disconnection, scalp EEG findings and underlying pathology were not related to seizure outcome, but subgroup numbers were small. CONCLUSIONS Both TPO and frontal disconnection are effective treatments for selected children with posterior multi-lobar or diffuse frontal lobe epilepsy. Confinement of the MRI lesion within the disconnection margins and a younger age at surgery are associated with favourable seizure outcomes. Further studies are required to elucidate these findings.
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Affiliation(s)
| | - Felice D'Arco
- Great Ormond Street Hospital, Department of Radiology, London, WC1N 3JH, United Kingdom
| | - M Zubair Tahir
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
| | - Heather Battey
- Imperial College London, Department of Mathematics, London, SW7 2AZ, United Kingdom
| | - Christin Eltze
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Friederike Moeller
- Great Ormond Street Hospital, Department of Neurology, London, WC1N 3JH, United Kingdom
| | - Martin Tisdall
- Great Ormond Street Hospital, Department of Neurosurgery, London, WC1N 3JH, United Kingdom
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Yan R, Zhang H, Wang J, Zheng Y, Luo Z, Zhang X, Xu Z. Application value of molecular imaging technology in epilepsy. IBRAIN 2021; 7:200-210. [PMID: 37786793 PMCID: PMC10528966 DOI: 10.1002/j.2769-2795.2021.tb00084.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 10/04/2023]
Abstract
Epilepsy is a common neurological disease with various seizure types, complicated etiologies, and unclear mechanisms. Its diagnosis mainly relies on clinical history, but an electroencephalogram is also a crucial auxiliary examination. Recently, brain imaging technology has gained increasing attention in the diagnosis of epilepsy, and conventional magnetic resonance imaging can detect epileptic foci in some patients with epilepsy. However, the results of brain magnetic resonance imaging are normal in some patients. New molecular imaging has gradually developed in recent years and has been applied in the diagnosis of epilepsy, leading to enhanced lesion detection rates. However, the application of these technologies in epilepsy patients with negative brain magnetic resonance must be clarified. Thus, we reviewed the relevant literature and summarized the information to improve the understanding of the molecular imaging application value of epilepsy.
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Affiliation(s)
- Rong Yan
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hai‐Qing Zhang
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Jing Wang
- Prevention and Health Care, The Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yong‐Su Zheng
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zhong Luo
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Xia Zhang
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zu‐Cai Xu
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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Mehvari Habibabadi J, Moein H, Jourahmad Z, Ahmadian M, Basiratnia R, Zare M, Hashemi Fesharaki SS, Badihian S, Barekatain M, Tabrizi N. Outcome of epilepsy surgery in lesional epilepsy: Experiences from a developing country. Epilepsy Behav 2021; 122:108221. [PMID: 34352668 DOI: 10.1016/j.yebeh.2021.108221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Our aim was to report the postoperative seizure outcome and associated factors in patients with lesional epilepsy, in a low-income setting. METHODS This longitudinal prospective study included patients who underwent epilepsy surgery at Kashani Comprehensive Epilepsy Center between 2014 and 2019. Post-surgical outcomes were reported according to the Engel score, and patients were classified into two groups of seizure free (SF) and not-seizure free (NSF). RESULTS A total of 148 adult patients, with a mean age of 30.45 ± 9.23 years were included. The SF outcome was reported in 86.5% of patients and antiepileptic drugs (AEDs) were reduced or discontinued in 45.9%. The mean follow-up duration was 26.7 ± 14.9 months. Temporal lobe lesions (76.3%) and mesial temporal sclerosis (MTS) (56.7%) were the most frequent etiologies. Temporal lesion (Incidence relative risk (IRR): 1.76, 95% CI [1.08-2.87], p = 0.023), prior history of CNS infection (IRR:1.18, 95% CI [1.03-1.35], p = 0.019), use of intra-operative ECoG (IRR:1.73, 95% CI [1.06-2.81], p = 0.028), and absence of IEDs in postoperative EEG (IRR: 1.41, 95% CI [1.18-1.70], p < 0.001) were positive predictors for a favorable outcome. CONCLUSION Many patients with drug-resistant lesional epilepsy showed a favorable response to surgery. We believe that resective epilepsy surgery in low-income settings is a major treatment option. The high frequency of patients with drug-resistant epilepsy in developing countries is associated with high rates of morbidity and mortality. Hence, strategies to increase access to epilepsy surgery in these settings are urgently needed.
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Affiliation(s)
| | - Houshang Moein
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Jourahmad
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran
| | - Mana Ahmadian
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran.
| | - Reza Basiratnia
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Zare
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran
| | | | - Shervin Badihian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Majid Barekatain
- Psychosomatic Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Tabrizi
- Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Jehi L, Braun K. Does etiology really matter for epilepsy surgery outcome? Brain Pathol 2021; 31:e12965. [PMID: 34196987 PMCID: PMC8412085 DOI: 10.1111/bpa.12965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/01/2021] [Indexed: 12/17/2022] Open
Abstract
Multiple factors influence the outcomes of epilepsy surgery. Prognostic indicators varying from clinical characteristics, imaging findings, ictal, and interictal electrophysiological activity have been linked to surgical outcomes. In this review, we focus on the relatively under‐studied role of the underlying epilepsy histopathology in driving post‐surgical outcomes, specifically focusing on the broad categories of seizure outcomes and cognitive outcomes. For each of these two outcomes of interest, we answer two questions: 1)‐ does etiology matter? and 2)‐ how could it matter? The goal is to review the existing literature on the relationship between etiology and surgical outcomes to provide the best possible judgment as to whether a causal relationship exists between histopathology and the ultimate surgical outcome as an initial step. Then, we delve into the possible mechanisms via which such relationships can be explained. We conclude with a call to action to the epilepsy surgery and histopathology research community to push the mechanistic understanding of the pathology‐outcome interaction and identify actionable knowledge and biomarkers that could inform patient care in a timely fashion. In this review, we focus on the relatively under‐studied role of the underlying epilepsy histopathology in driving post‐surgical outcomes, specifically focusing on the broad categories of seizure outcomes and cognitive outcomes. For each of these two outcomes of interest, we answer two questions: (1) does etiology matter? and (2) how could it matter? We then delve into the mechanisms of these answers.
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Affiliation(s)
- Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Kees Braun
- Dept. of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht University, the Netherlands
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Smith G, Stacey WC. The accuracy of quantitative EEG biomarker algorithms depends upon seizure onset dynamics. Epilepsy Res 2021; 176:106702. [PMID: 34229226 DOI: 10.1016/j.eplepsyres.2021.106702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/05/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the performance of different ictal quantitative biomarkers of the seizure onset zone (SOZ) across many seizures in a cohort of consecutive patients with a variety of seizure onset patterns. METHODS The Epileptogenicity Index (EI, a measure of fast activity) and Slow Polarizing Shift index (SPS, a measure of infraslow activity) were calculated for 212 seizures (22 patients). After stratification by onset pattern, median index values inside and outside the SOZ were compared in aggregate and for each of the onset patterns. Receiver Operating Characteristic (ROC) curves were constructed to compare the performance of each index. RESULTS Median values of EI (0.056 vs 0.0087), SPS (0.27 vs 0.19), and CI (0.21 vs 0.12) were significantly higher for contacts inside the SOZ, all p < 0.0001. Analysis of AUC showed variable performance of these indices across seizure types, although AUC for EI and SPS was generally greatest for seizures with fast activity at onset. CONCLUSIONS All indices were significantly higher for contacts inside the SOZ; however, the performance of these indices varied depending on the pattern of seizure onset. SIGNIFICANCE These findings suggest that future studies of quantitative biomarkers of the SOZ should account for seizure onset pattern.
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Affiliation(s)
- Garnett Smith
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, 1540 E Hospital Drive, Box 4279, Ann Arbor, MI, 48109-4279, USA.
| | - William C Stacey
- Department of Neurology, University of Michigan, 1500 E Medical Center Drive, SPC 5316, Ann Arbor, MI, 48109-5316, USA; Department of Biomedical Engineering, University of Michigan, 1500 E Medical Center Drive, SPC 5316, Ann Arbor, MI, 48109-5316, USA; Biointerfaces Institute, University of Michigan, 1500 E Medical Center Drive, SPC 5316, Ann Arbor, MI, 48109-5316, USA.
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Loring DW, Jarosiewicz B, Meador KJ, Kanner AM, Skarpaas TL, Morrell MJ. Mood and quality of life in patients treated with brain-responsive neurostimulation: The value of earlier intervention. Epilepsy Behav 2021; 117:107868. [PMID: 33684783 DOI: 10.1016/j.yebeh.2021.107868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish whether earlier treatment using direct brain-responsive neurostimulation for medically intractable focal-onset seizures is associated with better mood and Quality of Life (QoL) compared to later treatment intervention. METHODS Data were retrospectively analyzed from prospective clinical trials of a direct brain-responsive neurostimulator (RNS® System) for treatment of adults with medically intractable focal-onset epilepsy. Participants completed the Quality of Life in Epilepsy Inventory (QOLIE-31) yearly through 9 years of follow-up and the Beck Depression Inventory-II (BDI-II) through 2 years of follow-up. Changes in each assessment after treatment with responsive neurostimulation were calculated for patients who began treatment within 10 years of seizure onset (early) and those who began treatment 20 years or more after seizure onset (late). RESULTS The median duration of epilepsy was 18.3 years at enrollment. At 9 years, both the early (N = 51) and late (N = 109) treatment groups experienced similar and significant reductions in the frequency of disabling seizures (73.4% and 77.8%, respectively). The early treatment patients had significant improvements in QoL and mood. However, the late treatment patients not only failed to show these improvements but also declined in the emotional QoL subscale. CONCLUSIONS Patients treated with brain-responsive neurostimulation earlier in the course of their epilepsy show significant improvements in multiple domains of QoL and mood that are not observed in patients treated later in the course of their epilepsy despite similar efficacy in seizure reduction. Even with similar and substantial reductions in seizure frequency, the comorbidities of uncontrolled epilepsy may be less responsive to treatment when too many years have passed. The results of this study suggest that, as with resective and ablative surgery, treatment with brain-responsive neurostimulation should be delivered as early as possible in the course of medically resistant epilepsy to maximize the opportunity for improvements in mood and QoL.
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Affiliation(s)
- David W Loring
- Department of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA 30329, USA.
| | | | - Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA 94305, USA
| | - Andres M Kanner
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | | | - Martha J Morrell
- NeuroPace, Inc., Mountain View, CA, USA; Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA 94305, USA
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Whiting AC, Morita-Sherman M, Li M, Vegh D, Machado de Campos B, Cendes F, Wang X, Bingaman W, Jehi LE. Automated analysis of cortical volume loss predicts seizure outcomes after frontal lobectomy. Epilepsia 2021; 62:1074-1084. [PMID: 33756031 DOI: 10.1111/epi.16877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients undergoing frontal lobectomy demonstrate lower seizure-freedom rates than patients undergoing temporal lobectomy and several other resective interventions. We attempted to utilize automated preoperative quantitative analysis of focal and global cortical volume loss to develop predictive volumetric indicators of seizure outcome after frontal lobectomy. METHODS Ninety patients who underwent frontal lobectomy were stratified based on seizure freedom at a mean follow-up time of 3.5 (standard deviation [SD] 2.5) years. Automated quantitative analysis of cortical volume loss organized by distinct brain region and laterality was performed on preoperative T1-weighted magnetic resonance imaging (MRI) studies. Univariate statistical analysis was used to select potential predictors of seizure freedom. Backward variable selection and multivariate logistical regression were used to develop models to predict seizure freedom. RESULTS Forty-eight of 90 (53.3%) patients were seizure-free at the last follow-up. Several frontal and extrafrontal brain regions demonstrated statistically significant differences in both volumetric cortical volume loss and volumetric asymmetry between the left and right sides in the seizure-free and non-seizure-free cohorts. A final multivariate logistic model utilizing only preoperative quantitative MRI data to predict seizure outcome was developed with a c-statistic of 0.846. Using both preoperative quantitative MRI data and previously validated clinical predictors of seizure outcomes, we developed a model with a c-statistic of 0.897. SIGNIFICANCE This study demonstrates that preoperative cortical volume loss in both frontal and extrafrontal regions can be predictive of seizure outcome after frontal lobectomy, and models can be developed with excellent predictive capabilities using preoperative MRI data. Automated quantitative MRI analysis can be quickly and reliably performed in patients with frontal lobe epilepsy, and further studies may be developed for integration into preoperative risk stratification.
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Affiliation(s)
- Alexander C Whiting
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Manshi Li
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deborah Vegh
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas UNICAMP, Campinas, Brazil
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William Bingaman
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lara E Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
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Alsumaili M, Alkhateeb M, Khoja A, Alkhaja M, Alsulami A, Alqadi K, Baz S, Abalkhail T, Babtain F, Althubaiti I, Abu-Ata M, Alotaibi F. Seizure outcome after epilepsy surgery for patients with normal MRI: A Single center experience. Epilepsy Res 2021; 173:106620. [PMID: 33780709 DOI: 10.1016/j.eplepsyres.2021.106620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/12/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyze the surgical outcome in non-lesional intractable focal epilepsies in our center and to find possible predictors for better outcome. METHODS This is a retrospective study for 40 adult patients with intractable focal epilepsy following at KFSHRC-Riyadh, who underwent presurgical evaluation followed by resective surgery and continued follow up for a minimum of 2 years. The surgery outcome was evaluated based on the type of surgical procedure and histopathology results. RESULTS Out of all 40 patients studied, seizure freedom was achieved in 19 (47.5 %) and 17 (42.5 %) patients at the first and second year respectively in all non-lesional cases. Seizure freedom in non-lesional temporal lobe surgery was achieved in 10 (45 %) of patients at 2 years, 5 (38 %) in non-lesional frontal lobe patients at 2 years and 8 (44 %), 7 (38 %) for all extratemporal at 1 and 2 years respectively. Good prognosis was seen in patients with localized positron emission tomography (PET), had no aura and had a clear ictal onset either on scalp electroencephalogram (EEG) or subdural invasive electroencephalogram. SIGNIFICANCE The best surgical outcome is achievable in patients with non-lesional focal epilepsy. This study highlights the prognostic value of the PET scan and ictal scalp/subdural invasive EEG.
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Affiliation(s)
- Mohammad Alsumaili
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia; Pediatric Department, Armed Forces Hospital, Khamis Mushayt, Saudi Arabia.
| | - Mashael Alkhateeb
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Abeer Khoja
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia; Neurology Section, Medical Department, King Abdulaziz University, Building 10, Second Floor, Jeddah, Saudi Arabia.
| | - Mohammed Alkhaja
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia; Department of Internal Medicine, King Hamad University Hospital, House 2811, Road 445, Block 1204, Hamad Town, Busaiteen, Bahrain.
| | - Ashwaq Alsulami
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Khalid Alqadi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Salah Baz
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Tariq Abalkhail
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Fawzi Babtain
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Ibrahim Althubaiti
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Mahmoud Abu-Ata
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Faisal Alotaibi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia; Neurology Section, Medical Department, Aldara Hospital and Medical Center, Riyadh, Saudi Arabia.
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Thohar Arifin M, Hanaya R, Bakhtiar Y, Bintoro AC, Iida K, Kurisu K, Arita K, Bunyamin J, Askoro R, Brilliantika SP, Khairunnisa NI, Muttaqin Z. Initiating an epilepsy surgery program with limited resources in Indonesia. Sci Rep 2021; 11:5066. [PMID: 33658553 PMCID: PMC7930083 DOI: 10.1038/s41598-021-84404-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
To share the experiences of organizing the epilepsy surgery program in Indonesia. This study was divided into two periods based on the presurgical evaluation method: the first period (1999–2004), when interictal electroencephalogram (EEG) and magnetic resonance imaging (MRI) were used mainly for confirmation, and the second period (2005–2017), when long-term non-invasive and invasive video-EEG was involved in the evaluation. Long-term outcomes were recorded up to December 2019 based on the Engel scale. All 65 surgical recruits in the first period possessed temporal lobe epilepsy (TLE), while 524 patients were treated in the second period. In the first period, 76.8%, 16.1%, and 7.1% of patients with TLE achieved Classes I, II, and III, respectively, and in the second period, 89.4%, 5.5%, and 4.9% achieved Classes I, II, and III, respectively, alongside Class IV, at 0.3%. The overall median survival times for patients with focal impaired awareness seizures (FIAS), focal to bilateral tonic–clonic seizures and generalized tonic–clonic seizures were 9, 11 and 11 years (95% CI: 8.170–9.830, 10.170–11.830, and 7.265–14.735), respectively, with p = 0.04. The utilization of stringent and selective criteria to reserve surgeries is important for a successful epilepsy program with limited resources.
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Affiliation(s)
- Muhamad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia.
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Kagoshima Prefecture, Japan
| | - Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima City, Hiroshima Prefecture, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima City, Hiroshima Prefecture, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Kagoshima Prefecture, Japan
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Rofat Askoro
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Surya Pratama Brilliantika
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Novita Ikbar Khairunnisa
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
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Cossu G, González-López P, Pralong E, Kalser J, Messerer M, Daniel RT. Unilateral prefrontal lobotomy for epilepsy: technique and surgical anatomy. Neurosurg Focus 2021; 48:E10. [PMID: 32234977 DOI: 10.3171/2020.1.focus19938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgery for frontal lobe epilepsy remains a challenge because of the variable seizure outcomes after surgery. Disconnective procedures are increasingly applied to isolate the epileptogenic focus and avoid complications related to extensive brain resection. Previously, the authors described the anterior quadrant disconnection procedure to treat large frontal lobe lesions extending up to but not involving the primary motor cortex. In this article, they describe a surgical technique for unilateral disconnection of the prefrontal cortex, while providing an accurate description of the surgical and functional anatomy of this disconnective procedure. METHODS The authors report the surgical treatment of a 5-month-old boy who presented with refractory epilepsy due to extensive cortical dysplasia of the left prefrontal lobe. In addition, with the aim of both describing the subcortical intrinsic anatomy and illustrating the different connections between the prefrontal lobe and the rest of the brain, the authors dissected six human cadaveric brain hemispheres. These dissections were performed from lateral to medial and from medial to lateral to reveal the various tracts sectioned during the three different steps in the surgery, namely the intrafrontal disconnection, anterior callosotomy, and frontobasal disconnection. RESULTS The first step of the dissection involves cutting the U-fibers. During the anterior intrafrontal disconnection, the superior longitudinal fasciculus in the depth of the middle frontal gyrus, the uncinate fasciculus, and the inferior frontooccipital fasciculus in the depth of the inferior frontal gyrus at the level of the anterior insular point are visualized and sectioned, followed by sectioning of the anterior limb of the internal capsule. Once the frontal horn is reached, the anterior callosotomy can be performed to disconnect the genu and the rostrum of the corpus callosum. The intrafrontal disconnection is deepened toward the falx, and at the medial surface, the cingulum is sectioned. The frontobasal disconnection involves cutting the anterior limb of the anterior commissure. CONCLUSIONS This technique allows selective isolation of the epileptogenic focus located in the prefrontal lobe to avoid secondary propagation. Understanding the surface and white matter fiber anatomy is essential to safely perform the procedure and obtain a favorable seizure outcome.
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Affiliation(s)
- Giulia Cossu
- 1Department of Neurosurgery, University Hospital of Lausanne
| | | | - Etienne Pralong
- 1Department of Neurosurgery, University Hospital of Lausanne
| | - Judith Kalser
- 3Department of Pediatrics, Section of Neuro-Pediatrics, University Hospital of Lausanne, Switzerland; and
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Abstract
Nearly 30% of epilepsy patients are refractory to medical therapy. Surgical management of epilepsy is an increasingly viable option for these patients. Although surgery has historically been used as a palliative option, improvements in technology and outcomes show its potential in certain subsets of patients. This article reviews the two main categories of surgical epilepsy treatment-resective surgery and neuromodulation. Resective surgery includes temporal lobe resections, extratemporal resections, laser interstitial thermal therapy, and disconnection procedures. We discuss the three main types of neuromodulation-vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation for epilepsy. The history and indications are explored for each type of treatment. Given the myriad types of resection and neuromodulation techniques, patient selection is reviewed in detail, with a discussion on which patients are most likely to benefit from different treatment strategies. We also discuss outcomes with examples of the pertinent landmark trials and their results. Finally, complications and surgical technique are reviewed. As new indications emerge and patient selection is refined, surgical management will continue to evolve as an adjuvant therapy for epileptic patients.
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Affiliation(s)
- Shahjehan Ahmad
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Gupta K, Cabaniss B, Kheder A, Gedela S, Koch P, Hewitt KC, Alwaki A, Rich C, Ramesha S, Hu R, Drane DL, Gross RE, Willie JT. Stereotactic MRI-guided laser interstitial thermal therapy for extratemporal lobe epilepsy. Epilepsia 2020; 61:1723-1734. [PMID: 32777090 DOI: 10.1111/epi.16614] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRg-LITT) is an alternative to open epilepsy surgery. We assess safety and effectiveness of MRg-LITT for extratemporal lobe epilepsy (ETLE) in patients who are considered less favorable for open resection. METHODS We retrospectively reviewed sequential cases of patients with focal ETLE who underwent MRg-LITT between 2012 and 2019. Epileptogenic zones were determined from standard clinical and imaging data ± stereoelectroencephalography (SEEG). Standard stereotactic techniques, MRI thermometry, and a commercial laser thermal therapy system were used for ablations. Anatomic MRI was used to calculate ablation volumes. Clinical outcomes were determined longitudinally. RESULTS Thirty-five patients with mean epilepsy duration of 21.3 ± 12.2 years underwent MRg-LITT for focal ETLE at a mean age 36.4 ± 12.7 years. A mean 2.59 ± 1.45 trajectories per patient were used to obtain ablation volumes of 8.8 ± 7.5 cm3 . Mean follow-up was 27.3 ± 19.5 months. Of 32 patients with >12 months of follow-up, 17 (53%) achieved good outcomes (Engel class I + II) of whom 14 (44%) were Engel class I. Subgroup analysis revealed better outcomes for patients with lesional ETLE than for those who were nonlesional, multifocal, or who had failed prior interventions (P = .02). Of 13 patients showing favorable seizure-onset patterns (localized low voltage fast activity or rhythmic spiking on SEEG) prior to ablation, 9 (69%) achieved good outcomes, whereas only 3 of 11 (27%) who show other slower onset patterns achieved good outcomes. Minor adverse events included six patients with transient sensorimotor neurologic deficits and four patients with asymptomatic hemorrhages along the fiber tract. Major adverse events included one patient with a brain abscess that required stereotactic drainage and one patient with persistent hypothalamic obesity. Three deaths-two seizure-associated and one suicide-were unrelated to surgical procedures. SIGNIFICANCE MRI-guided laser interstitial thermal therapy (or MRg-LITT) was well-tolerated and yielded good outcomes in a heterogeneous group of ETLE patients. Lesional epilepsy and favorable seizure-onset patterns on SEEG predicted higher likelihoods of success.
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Affiliation(s)
- Kunal Gupta
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian Cabaniss
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul Koch
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abdulrahman Alwaki
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher Rich
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Supriya Ramesha
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ranliang Hu
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Kämpfer C, Racz A, Quesada CM, Elger CE, Surges R. Predictive value of electrically induced seizures for postsurgical seizure outcome. Clin Neurophysiol 2020; 131:2289-2297. [PMID: 32674959 DOI: 10.1016/j.clinph.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether semiological similarity of electrically induced seizures (EIS) and spontaneously occurring habitual seizures (SHS) is associated with postsurgical seizure outcome in patients undergoing invasive video-EEG monitoring (VEM) before resective epilepsy surgery. METHODS Data of patients undergoing invasive VEM were retrospectively reviewed and included if at least one EIS and SHS during VEM occurred and the brain region in which EIS were elicited was resected. Seizure outcome was evaluated at three follow-up (FU) visits after surgery (1, 2 years and last available FU) according to the classification by Engel and the International League Against Epilepsy (ILAE). The level of semiological similarity of EIS and SHS was rated blinded to the surgical outcome. Statistics were done using Fisher's exact test and a mixed linear-logistic regression model. RESULTS 65 patients were included. Postsurgical seizure freedom was achieved in 51% (ILAE class 1) and 58% (Engel class I) at last FU (median 36 months). Patients with identical EIS and SHS displayed significantly better postsurgical seizure outcomes (ILAE class 1 at last FU: 76% vs. 31%, p < 0.001; Engel class I: 83% vs. 39%, p < 0.001). CONCLUSION EIS are useful to confirm the location of the epileptogenic zone. A high level of similarity between EIS and SHS is associated with a favorable postsurgical seizure outcome. SIGNIFICANCE EIS may be used as an additional predictor of postsurgical outcome when counselling patients to proceed to resective epilepsy surgery.
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Affiliation(s)
- Christopher Kämpfer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany; Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Attila Racz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Carlos M Quesada
- Department of Epileptology, University Hospital Bonn, Bonn, Germany; Department of Neurology, University Hospital Essen, Essen, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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Abstract
Placebos impact epilepsy in a number of ways. Through randomized clinical trials, explicit clinical use, and also through implicit clinical use, placebos play a role in epilepsy. This chapter will discuss the reasons placebo is used, the determinants of placebo response in epilepsy, observations about placebo specific to epilepsy, and ways in which clinical trial design is impacted by placebo.
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Gonzalez-Lopez P, Cossu G, Pralong E, Baldoncini M, Messerer M, Daniel RT. Anterior peri-insular quadrantotomy: a cadaveric white matter dissection study. J Neurosurg Pediatr 2020; 25:331-339. [PMID: 31860823 DOI: 10.3171/2019.10.peds19472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior quadrant disconnection represents a safe surgical option in well-selected pediatric patients with a large frontal lobe lesion anterior to the motor cortex. The understanding of the anatomy of the white matter tracts connecting the frontal lobe with the rest of the cerebrum forms the basis of a safe and successful disconnective surgery. The authors explored and illustrated the relevant white matter tracts sectioned during each surgical step using fiber dissection techniques. METHODS Five human cadaveric hemispheres were dissected to illustrate the frontal connections in the 3 planes. The dissections were performed from lateral to medial, medial to lateral, and ventral to dorsal to describe the various tracts sectioned during the 4 steps of this surgery, namely the anterior suprainsular window, intrafrontal disconnection, anterior callosotomy, and frontobasal disconnection. RESULTS At the beginning of each surgical step, the U fibers were cut. During the anterior suprainsular window, the superior longitudinal fasciculus (SLF), the uncinate fasciculus, and the inferior fronto-occipital fasciculus (IFOF) were visualized and sectioned, followed by sectioning of the anterior limb of the internal capsule. During the intrafrontal disconnection, the SLF was cut, along with the corona radiata. At the medial surface the cingulum was sectioned. The anterior callosotomy disconnected the anterior third of the body of the callosum, the genu, and the rostrum. The frontobasal disconnection addressed the last remaining fibers connecting the frontal lobe with the rest of the hemisphere, namely the anterior limb of the anterior commissure. CONCLUSIONS The anterior peri-insular quadrantotomy aims at effectively treating children with large lesions of the frontal lobe anterior to the motor cortex. A precise understanding of the gyral anatomy of this lobe along with the several white matter connections is crucial to avoid motor complications and to ensure complete disconnection.
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Affiliation(s)
| | - Giulia Cossu
- 2Department of Neurosurgery, University Hospital of Lausanne, Switzerland
| | - Etienne Pralong
- 2Department of Neurosurgery, University Hospital of Lausanne, Switzerland
| | - Matias Baldoncini
- 3Department of Neurological Surgery, San Fernando Hospital, Buenos Aires, Argentina; and
| | - Mahmoud Messerer
- 2Department of Neurosurgery, University Hospital of Lausanne, Switzerland
- 4Faculty of Medicine and Biology, University of Lausanne, Switzerland
| | - Roy Thomas Daniel
- 2Department of Neurosurgery, University Hospital of Lausanne, Switzerland
- 4Faculty of Medicine and Biology, University of Lausanne, Switzerland
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Ius T, Pauletto G, Tomasino B, Maieron M, Budai R, Isola M, Cesselli D, Lettieri C, Skrap M. Predictors of Postoperative Seizure Outcome in Low Grade Glioma: From Volumetric Analysis to Molecular Stratification. Cancers (Basel) 2020; 12:cancers12020397. [PMID: 32046310 PMCID: PMC7072647 DOI: 10.3390/cancers12020397] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/21/2020] [Accepted: 02/06/2020] [Indexed: 12/16/2022] Open
Abstract
The importance of the extent of resection (EOR) has been widely demonstrated as the main predictor for survival, nevertheless its effect on tumor related epilepsy is less investigated. A total of 155 patients were enrolled after a first-line surgery for supratentorial Diffuse Low Grade Gliomas (DLGGs). Postoperative seizure outcome was analyzed stratifying the results by tumor volumetric data and molecular markers according to 2016 WHO classification. Receiver operating characteristic (ROC) curves were computed to asses EOR, residual tumor volume, and ΔT2T1 MRI index (expressing the tumor growing pattern) corresponding to optimal seizure outcome. A total of 70.97% of patients were seizure-free 18 months after surgery. Better seizure outcome was observed in IDH1/2 mutated and 1p/19q codeleted subgroup. At multivariate analysis, age (p = 0.014), EOR (p = 0.030), ΔT2T1 MRI index (p = 0.016) resulted as independent predictors of postoperative seizure control. Optimal parameters to improve postoperative seizure outcome were EOR ≥ 85%, ΔT2T1 MRI index ≤ 18 cm3, residual tumor volume ≤ 15 cm3. This study confirms the role of EOR and tumor growing pattern on postoperative seizure outcome independently from the molecular class. Higher ΔT2T1 MRI index, representing the infiltrative component of the tumor, is associated with worse seizure outcome and strengthens the evidence of common pathogenic mechanisms underlying tumor growth and postoperative seizure outcome.
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Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
- Correspondence: or ; Tel.: +39-347-0178730/+39-0432-554493
| | - Giada Pauletto
- Neurology Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (G.P.); (R.B.); (C.L.)
| | - Barbara Tomasino
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, 33078 Pordenone, Italy
| | - Marta Maieron
- Medical Physics, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Riccardo Budai
- Neurology Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (G.P.); (R.B.); (C.L.)
| | - Miriam Isola
- Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Daniela Cesselli
- Institute of Pathology, Santa Maria della Misericordia University Hospital, 33100 Udine Post, Italy;
| | - Christian Lettieri
- Neurology Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (G.P.); (R.B.); (C.L.)
| | - Miran Skrap
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
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Hirata S, Morino M, Nakae S, Matsumoto T. Surgical Technique and Outcome of Extensive Frontal Lobectomy for Treatment of Intracable Non-lesional Frontal Lobe Epilepsy. Neurol Med Chir (Tokyo) 2020; 60:17-25. [PMID: 31801933 PMCID: PMC6970070 DOI: 10.2176/nmc.oa.2018-0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although extensive frontal lobectomy (eFL) is a common surgical procedure for intractable frontal lobe epilepsy (FLE), there have been very few reports regarding surgical techniques for eFL. This article provides step-by-step descriptions of our surgical technique for non-lesional FLE. Sixteen patients undergoing eFL were included in this study. The goals were to maximize gray matter removal, including the orbital gyrus and subcallosal area, and to spare the primary motor and premotor cortexes and anterior perforated substance. The eFL consists of three steps: (1) positioning, craniotomy, and exposure; (2) lateral frontal lobe resection; and (3), resection of the rectus gyrus and orbital gyrus. Resection ahead of bregma allows preservation of motor and premotor area function. To remove the orbital gyrus preserving anterior perforated substance, it is essential to visualize the olfactory trigone beneath the pia. It is important to observe the surface of the contralateral medial frontal lobe for complete removal of the subcallosal area of the frontal lobe. Thirteen patients (81.25%) became seizure-free and three patients (18.75%) continued to have seizures. None of the patients showed any complications. The eFL is a good surgical technique for the treatment of intractable non-lesional FLE. For treatment of epilepsy by eFL, it is important to resect the non-eloquent area of the frontal lobe as much as possible with preservation of the eloquent cortex.
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Figueroa J, Morell A, Bowory V, Shah AH, Eichberg D, Buttrick SS, Richardson A, Sarkiss C, Ivan ME, Komotar RJ. Minimally invasive keyhole temporal lobectomy approach for supramaximal glioma resection: A safety and feasibility study. J Clin Neurosci 2020; 72:57-62. [PMID: 31948883 DOI: 10.1016/j.jocn.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
With a recent trend towards supra-maximal resection for gliomas and minimally invasive techniques, keyhole temporal lobectomies may serve an important role in neurosurgical oncology. Due to their location and proximity to eloquent brain, temporal lobe gliomas offer unique challenges that may limit the extent of resection. Here we describe a modified technique using mini-craniotomies through a keyhole approach for temporal lobectomies in glioma patients. We retrospectively reviewed data from consecutive patients who underwent temporal lobectomies for resection of gliomas from 2012 to 2018. Demographic data, extent of tumor resection, pre and post-op KPS, short term and long term complications, as well as other relevant data were collected. We identified 57 patients who underwent keyhole-mini craniotomy for temporal lobectomies for glioma. Surgical procedures were performed in 12 patients for low-grade glioma (LGG) and 45 patients for high-grade glioma (HGG). Awake craniotomies were performed in 15 of the cases, and 13 cases were for tumor recurrence. Supra-maximal resection (SMR) was achieved in 15 patients, while gross total resection (GTR) and near total resection (NTR) achieved in 32 patients and 10 patients, respectively. Average pre- and post-op KPS were equivalent, and post-operative complications requiring surgical intervention were experienced in 4 patients. Here we show that our modified keyhole craniotomy is both safe and effective in achieving SMR or GTR in glioma patients, with minimal morbidity. This minimally-invasive temporal lobectomy may be an instrumental tool for neurosurgical oncologists transitioning to less invasive techniques.
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Affiliation(s)
- Javier Figueroa
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States.
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Veronica Bowory
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Daniel Eichberg
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Simon S Buttrick
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Angela Richardson
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Christopher Sarkiss
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
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