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Zhang H, Wei P, Lu C, Wang Z, Fan X, Shan Y, Zhao G. Assessing structural integrity of the pyramidal tracts with diffusion spectrum imaging to predict postoperative motor function in pediatric epilepsy patients with hemispherectomy. ACTA EPILEPTOLOGICA 2023. [DOI: 10.1186/s42494-022-00115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Abstract
Background
Hemispherectomy is an effective treatment option for patients with drug-resistant epilepsy caused by hemispheric lesions. However, patients often have deterioration of their motor functions postoperatively. Diffusion spectrum imaging (DSI) was reliable in presenting the natural shape of the white matter fibers. At the same time, the natural sprawl pyramid tract (PT) might be more intuitive for predicting postoperative motor functions. Therefore, we assessed the motor functions by the natural shape revealed by DSI tractography.
Methods
Ten children with drug-resistant epilepsy who were candidates for hemispherectomy performed DSI PTs tractography and transcranial magnetic stimulation (TMS) for motor mapping. The motor function was evaluated with muscle strength and hand grasping capability. Pyramidal tract (PT) structural integrity and TMS mapping results were compared between patients who remained stable and those with deteriorated motor functions. Receiver operating characteristic (ROC) curves with PTs asymmetric ratio were analyzed to evaluate DSI tractography diagnostic value.
Results
All patients underwent DSI acquisition, while four patients successfully performed TMS. One patient had no response to TMS until the maximal machine output was reached. Four patients failed to perform TMS due to lacking cooperation. One patient was contraindicated to TMS. DSI successfully reconstructed the sharp angle fan-shaped PTs within the hemisphere. The accurate fiber distribution with fiber termination and thickness within the lesioned hemisphere was replicated with DSI tractography. No significance was found in patients’ age, sex, seizure frequency, or medication between patients with stable or deteriorated postoperative motor functions. DSI effectively predicted postoperative motor function as stable with damaged PTs, mild deterioration with atrophied PTs, and intact PTs with contralateral innervation confirmed by intracranial stimulation. The area under the curve (AUC) of DSI tractography was 0.84. According to ROC, the cut-off value of PTs asymmetric ratio was 11.5% with 100% sensitivity and 75% specificity. The sensitivity and specificity of TMS were 2/3 and 1/2, respectively.
Conclusions
The anatomic integrity of PTs with DSI tractography could effectively predict postoperative motor function after hemispherectomy. This enables neurosurgeons to inform patients and relatives about postoperative motor functions with direct morphological evidence of PTs to help them with their surgical decisions.
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Seedat ZA, Rier L, Gascoyne LE, Cook H, Woolrich MW, Quinn AJ, Roberts TPL, Furlong PL, Armstrong C, St. Pier K, Mullinger KJ, Marsh ED, Brookes MJ, Gaetz W. Mapping Interictal activity in epilepsy using a hidden Markov model: A magnetoencephalography study. Hum Brain Mapp 2022; 44:66-81. [PMID: 36259549 PMCID: PMC9783449 DOI: 10.1002/hbm.26118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
Epilepsy is a highly heterogeneous neurological disorder with variable etiology, manifestation, and response to treatment. It is imperative that new models of epileptiform brain activity account for this variability, to identify individual needs and allow clinicians to curate personalized care. Here, we use a hidden Markov model (HMM) to create a unique statistical model of interictal brain activity for 10 pediatric patients. We use magnetoencephalography (MEG) data acquired as part of standard clinical care for patients at the Children's Hospital of Philadelphia. These data are routinely analyzed using excess kurtosis mapping (EKM); however, as cases become more complex (extreme multifocal and/or polymorphic activity), they become harder to interpret with EKM. We assessed the performance of the HMM against EKM for three patient groups, with increasingly complicated presentation. The difference in localization of epileptogenic foci for the two methods was 7 ± 2 mm (mean ± SD over all 10 patients); and 94% ± 13% of EKM temporal markers were matched by an HMM state visit. The HMM localizes epileptogenic areas (in agreement with EKM) and provides additional information about the relationship between those areas. A key advantage over current methods is that the HMM is a data-driven model, so the output is tuned to each individual. Finally, the model output is intuitive, allowing a user (clinician) to review the result and manually select the HMM epileptiform state, offering multiple advantages over previous methods and allowing for broader implementation of MEG epileptiform analysis in surgical decision-making for patients with intractable epilepsy.
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Affiliation(s)
- Zelekha A. Seedat
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK,Young EpilepsySt Pier's LaneLingfieldRH7 6PWUK
| | - Lukas Rier
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Lauren E. Gascoyne
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Harry Cook
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Mark W. Woolrich
- Oxford Centre for Human Brain ActivityUniversity Department of Psychiatry, Warneford HospitalOxfordUK
| | - Andrew J. Quinn
- Oxford Centre for Human Brain ActivityUniversity Department of Psychiatry, Warneford HospitalOxfordUK
| | - Timothy P. L. Roberts
- Department of RadiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | | | - Caren Armstrong
- Department of RadiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA,Pediatric Epilepsy Program, Division of Child NeurologyCHOPPhiladelphiaPennsylvaniaUSA
| | | | - Karen J. Mullinger
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK,Centre for Human Brain Health, School of PsychologyUniversity of BirminghamBirminghamUK
| | - Eric D. Marsh
- Department of RadiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA,Pediatric Epilepsy Program, Division of Child NeurologyCHOPPhiladelphiaPennsylvaniaUSA,Departments of Neurology and PaediatricsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Matthew J. Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - William Gaetz
- Department of RadiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
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Fujiwara H, Olbrecht V, Tenney J. MEG Pharmacology: Sedation and Optimal MEG Acquisition. Clin Neurophysiol 2022; 138:143-147. [DOI: 10.1016/j.clinph.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/03/2022]
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Gofshteyn JS, Le T, Kessler S, Kamens R, Carr C, Gaetz W, Bloy L, Roberts TPL, Schwartz ES, Marsh ED. Synthetic aperture magnetometry and excess kurtosis mapping of Magnetoencephalography (MEG) is predictive of epilepsy surgical outcome in a large pediatric cohort. Epilepsy Res 2019; 155:106151. [PMID: 31247475 PMCID: PMC6699633 DOI: 10.1016/j.eplepsyres.2019.106151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/23/2019] [Accepted: 06/09/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Resective surgery is the most effective treatment option for patients with refractory epilepsy; however identification of patients who will benefit from epilepsy surgery remains challenging. Synthetic aperture magnetometry and excess kurtosis mapping (SAM(g2)) of magnetoencephalography (MEG) is a non-invasive tool that warrants further examination in the pediatric epilepsy population. Here, we examined the utility of MEG with SAM(g2) to determine if MEG epileptiform foci correlates with surgical outcome and to develop a predictive model incorporating MEG information to best assess likelihood of seizure improvement/freedom from resective surgery. METHODS 564 subjects who had MEG at the Children's Hospital of Philadelphia between 2010-2015 were screened. Clinical epilepsy history and prior electrographic records were extracted and reviewed and correlated with MEG findings. MEG assessments were made by both a neurologist and neuroradiologist. Predictive models were developed to assess the utility of MEG in determining Engel class at one year and five years after resective epilepsy surgery. RESULTS The number of MEG spike foci was highly associated with Engel class outcome at both one year and five years; however, using MEG data in isolation was not significantly predictive of 5 year surgical outcome. When combined with clinical factors; scalp EEG (single ictal onset zone), MRI (lesional or not), age and sex in a logistic regression model MEG foci was significant for Engel class outcome at both 1 year (p = 0.03) and 5 years (0.02). The percent correctly classified for Engel class at one year was 78.43% and the positive predictive value was 71.43. SIGNIFICANCE MEG using SAM(g2) analysis in an important non-invasive tool in the identification of those patients who will benefit most from surgery. Integrating MEG data analysis into pre-surgical evaluation can help to predict epilepsy outcome after resective surgery in the pediatric population if utilized with skilled interpretation.
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Affiliation(s)
- J S Gofshteyn
- Division of Pediatric Neurology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States; New-York Presbyterian Hospital, New York, NY, United States
| | - T Le
- Division of Pediatric Neurology, The Children's Hospital of Philadelphia, United States
| | - S Kessler
- Division of Pediatric Neurology, The Children's Hospital of Philadelphia, United States; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, United States
| | - R Kamens
- Division of Pediatric Neurology, The Children's Hospital of Philadelphia, United States
| | - C Carr
- Division of Pediatric Neurology, The Children's Hospital of Philadelphia, United States
| | - W Gaetz
- Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, United States; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, United States
| | - L Bloy
- Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, United States; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, United States
| | - T P L Roberts
- Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, United States; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, United States
| | - E S Schwartz
- Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, United States; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, United States
| | - E D Marsh
- Division of Pediatric Neurology, The Children's Hospital of Philadelphia, United States; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, United States.
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Rommer PS, Beisteiner R, Elwischger K, Auff E, Wiest G. Neuromagnetic cortical activation during initiation of optokinetic nystagmus: an MEG pilot study. Audiol Neurootol 2015; 20:189-94. [PMID: 25924627 DOI: 10.1159/000375114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/10/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate the spatiotemporal evolution of cortical activation during the initiation of optokinetic nystagmus using magnetoencephalography. BACKGROUND Previous imaging studies of optokinetic nystagmus in humans using positron emission tomography and functional magnetic resonance imaging discovered activation of a large set of cortical and subcortical structures during steady-state optokinetic stimulation, but did not provide information on the temporal dynamics of the initial response. Imaging studies have shown that cortical areas responsible for vision in occipital and temporo-occipital areas are involved, i.e. cortical areas control optokinetic stimulation in humans. Magnetoencephalography provides measures that reflect neural ensemble activity in the millisecond time scale, allowing the identification of early cortical components of visuomotor integration. DESIGN/METHODS We studied neuromagnetic cortical responses during the initiation of optokinetic nystagmus in 6 right-handed healthy subjects. Neuromagnetic activity was recorded with a whole-head magnetoencephalograph, consisting of 143 planar gradiometers. RESULTS The mean (±SD) latency between stimulus onset and initiation of optokinetic nystagmus was 177.7 ± 59 ms. Initiation of optokinetic nystagmus evoked an early component in the primary visual cortex starting at 40-90 ms prior to the onset of the slow phase of nystagmus. Almost simultaneously an overlapping second component occurred bilaterally in the temporo-occipital area (visual motion areas), pronounced in the right hemisphere, starting at 10-60 ms prior to the slow-phase onset. Both components showed long-duration activity lasting for up to 100 ms after slow-phase onset. CONCLUSIONS Our findings suggest that the initiation of optokinetic nystagmus induces early cortical activation in the occipital cortex and almost simultaneously bilaterally in the temporo-occipital cortex. These cortical regions might represent essential areas for the monitoring of retinal slip.
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Affiliation(s)
- Paulus S Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Magiorkinis E, Diamantis A, Sidiropoulou K, Panteliadis C. Highights in the history of epilepsy: the last 200 years. EPILEPSY RESEARCH AND TREATMENT 2014; 2014:582039. [PMID: 25210626 PMCID: PMC4158257 DOI: 10.1155/2014/582039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/19/2014] [Accepted: 08/04/2014] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to present the evolution of views on epilepsy as a disease and symptom during the 19th and the 20th century. A thorough study of texts, medical books, and reports along with a review of the available literature in PubMed was undertaken. The 19th century is marked by the works of the French medical school and of John Hughlings Jackson who set the research on epilepsy on a solid scientific basis. During the 20th century, the invention of EEG, the advance in neurosurgery, the discovery of antiepileptic drugs, and the delineation of underlying pathophysiological mechanisms, were the most significant advances in the field of research in epilepsy. Among the most prestigious physicians connected with epilepsy one can pinpoint the work of Henry Gastaut, Wilder Penfield, and Herbert Jasper. The most recent advances in the field of epilepsy include the development of advanced imaging techniques, the development of microsurgery, and the research on the connection between genetic factors and epileptic seizures.
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Affiliation(s)
- Emmanouil Magiorkinis
- Office for the Study of Hellenic Naval Medicine, Naval Hospital of Athens, Deinokratous 70, 11527 Athens, Greece
| | - Aristidis Diamantis
- Office for the Study of Hellenic Naval Medicine, Naval Hospital of Athens, Deinokratous 70, 11527 Athens, Greece
| | - Kalliopi Sidiropoulou
- Office for the Study of Hellenic Naval Medicine, Naval Hospital of Athens, Deinokratous 70, 11527 Athens, Greece
| | - Christos Panteliadis
- Division of Paediatric Neurology and Developmental Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Stilp Kiriakidi 1, 54634 Thessaloniki, Greece
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